|
SUTURE OF INFRAPATELLAR TENDON; PRIMARY
|
Facility
|
OP
|
$8,661.10
|
|
|
Service Code
|
CPT 27380
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,186.50 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,661.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,351.78
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
|
|
SUTURE OF INFRAPATELLAR TENDON; SECONDARY RECONSTRUCTION, INCLUDING FASCIAL OR TENDON GRAFT
|
Facility
|
OP
|
$8,661.10
|
|
|
Service Code
|
CPT 27381
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,186.50 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,661.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,351.78
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
|
|
SUTURE OF LARGE INTESTINE (COL
|
Facility
|
OP
|
$2,150.00
|
|
|
Service Code
|
HCPCS 44604
|
| Hospital Charge Code |
76101856
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$279.50 |
| Max. Negotiated Rate |
$2,064.00 |
| Rate for Payer: Aetna Commercial |
$1,655.50
|
| Rate for Payer: Anthem Medicaid |
$739.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,677.00
|
| Rate for Payer: Cash Price |
$1,075.00
|
| Rate for Payer: Cigna Commercial |
$1,784.50
|
| Rate for Payer: First Health Commercial |
$2,042.50
|
| Rate for Payer: Humana Commercial |
$1,827.50
|
| Rate for Payer: Humana KY Medicaid |
$739.38
|
| Rate for Payer: Kentucky WC Medicaid |
$746.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,763.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,586.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$645.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$754.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,892.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,612.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$430.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$279.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$666.50
|
| Rate for Payer: PHCS Commercial |
$2,064.00
|
| Rate for Payer: United Healthcare All Payer |
$1,892.00
|
|
|
SUTURE OF LARGE INTESTINE (COL
|
Professional
|
Both
|
$2,150.00
|
|
|
Service Code
|
HCPCS 44604
|
| Hospital Charge Code |
76101856
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$631.37 |
| Max. Negotiated Rate |
$2,150.00 |
| Rate for Payer: Aetna Commercial |
$1,535.51
|
| Rate for Payer: Anthem Medicaid |
$631.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,150.00
|
| Rate for Payer: Cash Price |
$1,075.00
|
| Rate for Payer: Cash Price |
$1,075.00
|
| Rate for Payer: Cigna Commercial |
$1,430.22
|
| Rate for Payer: Healthspan PPO |
$1,294.92
|
| Rate for Payer: Humana Medicaid |
$631.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,352.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$644.00
|
| Rate for Payer: Molina Healthcare Passport |
$631.37
|
| Rate for Payer: Multiplan PHCS |
$1,290.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,505.00
|
| Rate for Payer: UHCCP Medicaid |
$752.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$637.68
|
|
|
SUTURE OF LARGE INTESTINE (COL
|
Facility
|
IP
|
$2,150.00
|
|
|
Service Code
|
HCPCS 44604
|
| Hospital Charge Code |
76101856
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$279.50 |
| Max. Negotiated Rate |
$2,064.00 |
| Rate for Payer: Aetna Commercial |
$1,655.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,677.00
|
| Rate for Payer: Cash Price |
$1,075.00
|
| Rate for Payer: Cigna Commercial |
$1,784.50
|
| Rate for Payer: First Health Commercial |
$2,042.50
|
| Rate for Payer: Humana Commercial |
$1,827.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,763.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,586.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$645.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,892.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,612.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$430.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$279.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$666.50
|
| Rate for Payer: PHCS Commercial |
$2,064.00
|
| Rate for Payer: United Healthcare All Payer |
$1,892.00
|
|
|
SUTURE OF LARGE INTESTINE (COL
|
Professional
|
Both
|
$2,150.00
|
|
|
Service Code
|
HCPCS 44604
|
| Hospital Charge Code |
761P1856
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$631.37 |
| Max. Negotiated Rate |
$2,150.00 |
| Rate for Payer: Aetna Commercial |
$1,535.51
|
| Rate for Payer: Anthem Medicaid |
$631.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,150.00
|
| Rate for Payer: Cash Price |
$1,075.00
|
| Rate for Payer: Cash Price |
$1,075.00
|
| Rate for Payer: Cigna Commercial |
$1,430.22
|
| Rate for Payer: Healthspan PPO |
$1,294.92
|
| Rate for Payer: Humana Medicaid |
$631.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,352.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$644.00
|
| Rate for Payer: Molina Healthcare Passport |
$631.37
|
| Rate for Payer: Multiplan PHCS |
$1,290.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,505.00
|
| Rate for Payer: UHCCP Medicaid |
$752.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$637.68
|
|
|
SUTURE OF QUADRICEPS OR HAMSTRING MUSCLE RUPTURE; PRIMARY
|
Facility
|
OP
|
$8,661.10
|
|
|
Service Code
|
CPT 27385
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,186.50 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,661.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,351.78
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
|
|
SUTURE OF RECENT WOUND - EYEL
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 67930
|
| Hospital Charge Code |
76102397
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
SUTURE OF RECENT WOUND - EYEL
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 67930
|
| Hospital Charge Code |
76102397
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$2,829.05 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem Medicaid |
$343.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,020.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,829.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,728.01
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Humana KY Medicaid |
$343.90
|
| Rate for Payer: Humana Medicare Advantage |
$2,020.75
|
| Rate for Payer: Kentucky WC Medicaid |
$347.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,424.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$350.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
SUTURE OF RECENT WOUND - EYEL
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 67930
|
| Hospital Charge Code |
76102397
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$118.18 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$328.49
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$118.18
|
| Rate for Payer: Anthem Medicaid |
$123.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,000.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$319.03
|
| Rate for Payer: Healthspan PPO |
$424.32
|
| Rate for Payer: Humana Medicaid |
$123.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$312.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$125.91
|
| Rate for Payer: Molina Healthcare Passport |
$123.44
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$124.09
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$124.67
|
|
|
SUTURE OF RECENT WOUND - EYE(P
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 67930
|
| Hospital Charge Code |
761P2397
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$118.18 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$328.49
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$118.18
|
| Rate for Payer: Anthem Medicaid |
$123.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,000.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$319.03
|
| Rate for Payer: Healthspan PPO |
$424.32
|
| Rate for Payer: Humana Medicaid |
$123.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$312.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$125.91
|
| Rate for Payer: Molina Healthcare Passport |
$123.44
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$124.09
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$124.67
|
|
|
SUTURE OF SMALL INTESTINE (ENT
|
Facility
|
OP
|
$1,850.00
|
|
|
Service Code
|
HCPCS 44602
|
| Hospital Charge Code |
76101854
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$240.50 |
| Max. Negotiated Rate |
$1,776.00 |
| Rate for Payer: Aetna Commercial |
$1,424.50
|
| Rate for Payer: Anthem Medicaid |
$636.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,443.00
|
| Rate for Payer: Cash Price |
$925.00
|
| Rate for Payer: Cigna Commercial |
$1,535.50
|
| Rate for Payer: First Health Commercial |
$1,757.50
|
| Rate for Payer: Humana Commercial |
$1,572.50
|
| Rate for Payer: Humana KY Medicaid |
$636.22
|
| Rate for Payer: Kentucky WC Medicaid |
$642.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,517.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,365.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$555.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$648.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,628.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,387.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$370.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$573.50
|
| Rate for Payer: PHCS Commercial |
$1,776.00
|
| Rate for Payer: United Healthcare All Payer |
$1,628.00
|
|
|
SUTURE OF SMALL INTESTINE (ENT
|
Facility
|
IP
|
$1,850.00
|
|
|
Service Code
|
HCPCS 44602
|
| Hospital Charge Code |
76101854
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$240.50 |
| Max. Negotiated Rate |
$1,776.00 |
| Rate for Payer: Aetna Commercial |
$1,424.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,443.00
|
| Rate for Payer: Cash Price |
$925.00
|
| Rate for Payer: Cigna Commercial |
$1,535.50
|
| Rate for Payer: First Health Commercial |
$1,757.50
|
| Rate for Payer: Humana Commercial |
$1,572.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,517.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,365.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$555.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,628.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,387.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$370.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$573.50
|
| Rate for Payer: PHCS Commercial |
$1,776.00
|
| Rate for Payer: United Healthcare All Payer |
$1,628.00
|
|
|
SUTURE OF SMALL INTESTINE (ENT
|
Professional
|
Both
|
$1,850.00
|
|
|
Service Code
|
HCPCS 44602
|
| Hospital Charge Code |
76101854
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$529.77 |
| Max. Negotiated Rate |
$1,978.04 |
| Rate for Payer: Aetna Commercial |
$1,978.04
|
| Rate for Payer: Anthem Medicaid |
$529.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,850.00
|
| Rate for Payer: Cash Price |
$925.00
|
| Rate for Payer: Cash Price |
$925.00
|
| Rate for Payer: Cigna Commercial |
$1,799.02
|
| Rate for Payer: Healthspan PPO |
$1,668.11
|
| Rate for Payer: Humana Medicaid |
$529.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,796.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$540.37
|
| Rate for Payer: Molina Healthcare Passport |
$529.77
|
| Rate for Payer: Multiplan PHCS |
$1,110.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,295.00
|
| Rate for Payer: UHCCP Medicaid |
$647.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$535.07
|
|
|
SUTURE OF SMALL INTESTINE (ENT
|
Professional
|
Both
|
$1,850.00
|
|
|
Service Code
|
HCPCS 44602
|
| Hospital Charge Code |
761P1854
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$529.77 |
| Max. Negotiated Rate |
$1,978.04 |
| Rate for Payer: Aetna Commercial |
$1,978.04
|
| Rate for Payer: Anthem Medicaid |
$529.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,850.00
|
| Rate for Payer: Cash Price |
$925.00
|
| Rate for Payer: Cash Price |
$925.00
|
| Rate for Payer: Cigna Commercial |
$1,799.02
|
| Rate for Payer: Healthspan PPO |
$1,668.11
|
| Rate for Payer: Humana Medicaid |
$529.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,796.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$540.37
|
| Rate for Payer: Molina Healthcare Passport |
$529.77
|
| Rate for Payer: Multiplan PHCS |
$1,110.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,295.00
|
| Rate for Payer: UHCCP Medicaid |
$647.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$535.07
|
|
|
SUTURE PASSING WIRE
|
Facility
|
OP
|
$1,512.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$196.62 |
| Max. Negotiated Rate |
$1,452.00 |
| Rate for Payer: Aetna Commercial |
$1,164.62
|
| Rate for Payer: Anthem Medicaid |
$520.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,179.75
|
| Rate for Payer: Cash Price |
$756.25
|
| Rate for Payer: Cigna Commercial |
$1,255.38
|
| Rate for Payer: First Health Commercial |
$1,436.88
|
| Rate for Payer: Humana Commercial |
$1,285.62
|
| Rate for Payer: Humana KY Medicaid |
$520.15
|
| Rate for Payer: Kentucky WC Medicaid |
$525.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,240.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,116.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$453.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$530.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,331.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,134.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$302.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$196.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$468.88
|
| Rate for Payer: PHCS Commercial |
$1,452.00
|
| Rate for Payer: United Healthcare All Payer |
$1,331.00
|
|
|
SUTURE PASSING WIRE
|
Facility
|
IP
|
$1,512.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$196.62 |
| Max. Negotiated Rate |
$1,452.00 |
| Rate for Payer: Aetna Commercial |
$1,164.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,179.75
|
| Rate for Payer: Cash Price |
$756.25
|
| Rate for Payer: Cigna Commercial |
$1,255.38
|
| Rate for Payer: First Health Commercial |
$1,436.88
|
| Rate for Payer: Humana Commercial |
$1,285.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,240.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,116.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$453.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,331.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,134.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$302.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$196.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$468.88
|
| Rate for Payer: PHCS Commercial |
$1,452.00
|
| Rate for Payer: United Healthcare All Payer |
$1,331.00
|
|
|
SUTURE REPAIR AORTA
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 33320
|
| Hospital Charge Code |
76101284
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$560.00 |
| Max. Negotiated Rate |
$1,785.60 |
| Rate for Payer: Aetna Commercial |
$1,785.60
|
| Rate for Payer: Anthem Medicaid |
$891.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,600.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,693.30
|
| Rate for Payer: Healthspan PPO |
$1,755.59
|
| Rate for Payer: Humana Medicaid |
$891.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,488.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$909.69
|
| Rate for Payer: Molina Healthcare Passport |
$891.85
|
| Rate for Payer: Multiplan PHCS |
$960.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,120.00
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$900.77
|
|
|
SUTURE REPAIR AORTA
|
Facility
|
IP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 33320
|
| Hospital Charge Code |
76101284
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$1,536.00 |
| Rate for Payer: Aetna Commercial |
$1,232.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,248.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,328.00
|
| Rate for Payer: First Health Commercial |
$1,520.00
|
| Rate for Payer: Humana Commercial |
$1,360.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,312.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,180.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$480.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,408.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$208.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$496.00
|
| Rate for Payer: PHCS Commercial |
$1,536.00
|
| Rate for Payer: United Healthcare All Payer |
$1,408.00
|
|
|
SUTURE REPAIR AORTA
|
Facility
|
OP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 33320
|
| Hospital Charge Code |
76101284
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$1,536.00 |
| Rate for Payer: Aetna Commercial |
$1,232.00
|
| Rate for Payer: Anthem Medicaid |
$550.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,248.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,328.00
|
| Rate for Payer: First Health Commercial |
$1,520.00
|
| Rate for Payer: Humana Commercial |
$1,360.00
|
| Rate for Payer: Humana KY Medicaid |
$550.24
|
| Rate for Payer: Kentucky WC Medicaid |
$555.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,312.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,180.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$480.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$561.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,408.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$208.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$496.00
|
| Rate for Payer: PHCS Commercial |
$1,536.00
|
| Rate for Payer: United Healthcare All Payer |
$1,408.00
|
|
|
SUTURE REPAIR AORTA(P
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 33320
|
| Hospital Charge Code |
761P1284
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$560.00 |
| Max. Negotiated Rate |
$1,785.60 |
| Rate for Payer: Aetna Commercial |
$1,785.60
|
| Rate for Payer: Anthem Medicaid |
$891.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,600.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,693.30
|
| Rate for Payer: Healthspan PPO |
$1,755.59
|
| Rate for Payer: Humana Medicaid |
$891.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,488.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$909.69
|
| Rate for Payer: Molina Healthcare Passport |
$891.85
|
| Rate for Payer: Multiplan PHCS |
$960.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,120.00
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$900.77
|
|
|
SUTURE REPAIR INTERMED >30CM
|
Facility
|
IP
|
$209.00
|
|
| Hospital Charge Code |
76102550
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$27.17 |
| Max. Negotiated Rate |
$200.64 |
| Rate for Payer: Aetna Commercial |
$160.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$163.02
|
| Rate for Payer: Cash Price |
$104.50
|
| Rate for Payer: Cigna Commercial |
$173.47
|
| Rate for Payer: First Health Commercial |
$198.55
|
| Rate for Payer: Humana Commercial |
$177.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$171.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$154.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$62.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$183.92
|
| Rate for Payer: Ohio Health Group HMO |
$156.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$41.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$64.79
|
| Rate for Payer: PHCS Commercial |
$200.64
|
| Rate for Payer: United Healthcare All Payer |
$183.92
|
|
|
SUTURE REPAIR INTERMED >30CM
|
Facility
|
IP
|
$218.00
|
|
| Hospital Charge Code |
45000330
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$28.34 |
| Max. Negotiated Rate |
$209.28 |
| Rate for Payer: Aetna Commercial |
$167.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$170.04
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cigna Commercial |
$180.94
|
| Rate for Payer: First Health Commercial |
$207.10
|
| Rate for Payer: Humana Commercial |
$185.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$178.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$160.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$191.84
|
| Rate for Payer: Ohio Health Group HMO |
$163.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$43.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$67.58
|
| Rate for Payer: PHCS Commercial |
$209.28
|
| Rate for Payer: United Healthcare All Payer |
$191.84
|
|
|
SUTURE REPAIR INTERMED >30CM
|
Facility
|
OP
|
$209.00
|
|
| Hospital Charge Code |
76102550
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$27.17 |
| Max. Negotiated Rate |
$200.64 |
| Rate for Payer: Aetna Commercial |
$160.93
|
| Rate for Payer: Anthem Medicaid |
$71.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$163.02
|
| Rate for Payer: Cash Price |
$104.50
|
| Rate for Payer: Cigna Commercial |
$173.47
|
| Rate for Payer: First Health Commercial |
$198.55
|
| Rate for Payer: Humana Commercial |
$177.65
|
| Rate for Payer: Humana KY Medicaid |
$71.88
|
| Rate for Payer: Kentucky WC Medicaid |
$72.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$171.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$154.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$62.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$73.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$183.92
|
| Rate for Payer: Ohio Health Group HMO |
$156.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$41.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$64.79
|
| Rate for Payer: PHCS Commercial |
$200.64
|
| Rate for Payer: United Healthcare All Payer |
$183.92
|
|
|
SUTURE REPAIR INTERMED >30CM
|
Facility
|
IP
|
$209.00
|
|
| Hospital Charge Code |
76102558
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$27.17 |
| Max. Negotiated Rate |
$200.64 |
| Rate for Payer: Aetna Commercial |
$160.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$163.02
|
| Rate for Payer: Cash Price |
$104.50
|
| Rate for Payer: Cigna Commercial |
$173.47
|
| Rate for Payer: First Health Commercial |
$198.55
|
| Rate for Payer: Humana Commercial |
$177.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$171.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$154.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$62.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$183.92
|
| Rate for Payer: Ohio Health Group HMO |
$156.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$41.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$64.79
|
| Rate for Payer: PHCS Commercial |
$200.64
|
| Rate for Payer: United Healthcare All Payer |
$183.92
|
|
