|
TENDON SHORTENING(P
|
Professional
|
Both
|
$985.00
|
|
|
Service Code
|
HCPCS 26477
|
| Hospital Charge Code |
761P0706
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$270.60 |
| Max. Negotiated Rate |
$998.85 |
| Rate for Payer: Aetna Commercial |
$806.92
|
| Rate for Payer: Anthem Medicaid |
$270.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$985.00
|
| Rate for Payer: Cash Price |
$492.50
|
| Rate for Payer: Cash Price |
$492.50
|
| Rate for Payer: Cigna Commercial |
$998.85
|
| Rate for Payer: Healthspan PPO |
$730.90
|
| Rate for Payer: Humana Medicaid |
$270.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$700.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$276.01
|
| Rate for Payer: Molina Healthcare Passport |
$270.60
|
| Rate for Payer: Multiplan PHCS |
$591.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$689.50
|
| Rate for Payer: UHCCP Medicaid |
$344.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$273.31
|
|
|
TENDON TRANSPLANTATION OR TRANSFER, FLEXOR OR EXTENSOR, FOREARM AND/OR WRIST, SINGLE; EACH TENDON
|
Facility
|
OP
|
$3,918.70
|
|
|
Service Code
|
CPT 25310
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,799.07 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
|
|
TENDRIL SDX A-LEAD 46CM
|
Facility
|
IP
|
$3,950.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$513.50 |
| Max. Negotiated Rate |
$3,792.00 |
| Rate for Payer: Aetna Commercial |
$3,041.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,081.00
|
| Rate for Payer: Cash Price |
$1,975.00
|
| Rate for Payer: Cigna Commercial |
$3,278.50
|
| Rate for Payer: First Health Commercial |
$3,752.50
|
| Rate for Payer: Humana Commercial |
$3,357.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,239.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,915.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,185.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,476.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,962.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$790.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$513.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.50
|
| Rate for Payer: PHCS Commercial |
$3,792.00
|
| Rate for Payer: United Healthcare All Payer |
$3,476.00
|
|
|
TENDRIL SDX A-LEAD 46CM
|
Facility
|
OP
|
$3,950.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$513.50 |
| Max. Negotiated Rate |
$3,792.00 |
| Rate for Payer: Aetna Commercial |
$3,041.50
|
| Rate for Payer: Anthem Medicaid |
$1,358.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,081.00
|
| Rate for Payer: Cash Price |
$1,975.00
|
| Rate for Payer: Cigna Commercial |
$3,278.50
|
| Rate for Payer: First Health Commercial |
$3,752.50
|
| Rate for Payer: Humana Commercial |
$3,357.50
|
| Rate for Payer: Humana KY Medicaid |
$1,358.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,372.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,239.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,915.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,185.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,385.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,476.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,962.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$790.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$513.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.50
|
| Rate for Payer: PHCS Commercial |
$3,792.00
|
| Rate for Payer: United Healthcare All Payer |
$3,476.00
|
|
|
TENECTEPLASE 1mg (50mg SDV)
|
Facility
|
OP
|
$42,660.42
|
|
|
Service Code
|
HCPCS J3101
|
| Hospital Charge Code |
25004340
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$153.11 |
| Max. Negotiated Rate |
$40,954.00 |
| Rate for Payer: Aetna Commercial |
$32,848.52
|
| Rate for Payer: Anthem Medicaid |
$14,670.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$153.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$33,275.13
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$214.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$206.70
|
| Rate for Payer: Cash Price |
$21,330.21
|
| Rate for Payer: Cash Price |
$21,330.21
|
| Rate for Payer: Cigna Commercial |
$35,408.15
|
| Rate for Payer: First Health Commercial |
$40,527.40
|
| Rate for Payer: Humana Commercial |
$36,261.36
|
| Rate for Payer: Humana KY Medicaid |
$14,670.92
|
| Rate for Payer: Humana Medicare Advantage |
$153.11
|
| Rate for Payer: Kentucky WC Medicaid |
$14,820.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34,981.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$31,483.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$183.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,965.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$37,541.17
|
| Rate for Payer: Ohio Health Group HMO |
$31,995.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,532.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,545.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,224.73
|
| Rate for Payer: PHCS Commercial |
$40,954.00
|
| Rate for Payer: United Healthcare All Payer |
$37,541.17
|
|
|
TENECTEPLASE 1mg (50mg SDV)
|
Facility
|
IP
|
$42,660.42
|
|
|
Service Code
|
HCPCS J3101
|
| Hospital Charge Code |
25004340
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,545.85 |
| Max. Negotiated Rate |
$40,954.00 |
| Rate for Payer: Aetna Commercial |
$32,848.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$33,275.13
|
| Rate for Payer: Cash Price |
$21,330.21
|
| Rate for Payer: Cigna Commercial |
$35,408.15
|
| Rate for Payer: First Health Commercial |
$40,527.40
|
| Rate for Payer: Humana Commercial |
$36,261.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34,981.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$31,483.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,798.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$37,541.17
|
| Rate for Payer: Ohio Health Group HMO |
$31,995.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,532.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,545.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,224.73
|
| Rate for Payer: PHCS Commercial |
$40,954.00
|
| Rate for Payer: United Healthcare All Payer |
$37,541.17
|
|
|
TENEX (GUANFACINE) 1 1MG/1TAB
|
Facility
|
IP
|
$4.76
|
|
|
Service Code
|
NDC 29300045801
|
| Hospital Charge Code |
25001506
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$4.57 |
| Rate for Payer: Aetna Commercial |
$3.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.71
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cigna Commercial |
$3.95
|
| Rate for Payer: First Health Commercial |
$4.52
|
| Rate for Payer: Humana Commercial |
$4.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.19
|
| Rate for Payer: Ohio Health Group HMO |
$3.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.48
|
| Rate for Payer: PHCS Commercial |
$4.57
|
| Rate for Payer: United Healthcare All Payer |
$4.19
|
|
|
TENEX (GUANFACINE) 1 1MG/1TAB
|
Facility
|
OP
|
$4.76
|
|
|
Service Code
|
NDC 29300045801
|
| Hospital Charge Code |
25001506
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$4.57 |
| Rate for Payer: Aetna Commercial |
$3.67
|
| Rate for Payer: Anthem Medicaid |
$1.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.71
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cigna Commercial |
$3.95
|
| Rate for Payer: First Health Commercial |
$4.52
|
| Rate for Payer: Humana Commercial |
$4.05
|
| Rate for Payer: Humana KY Medicaid |
$1.64
|
| Rate for Payer: Kentucky WC Medicaid |
$1.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.19
|
| Rate for Payer: Ohio Health Group HMO |
$3.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.48
|
| Rate for Payer: PHCS Commercial |
$4.57
|
| Rate for Payer: United Healthcare All Payer |
$4.19
|
|
|
TENFUSE 2.7*16MM STRAIGHT
|
Facility
|
OP
|
$5,682.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$738.72 |
| Max. Negotiated Rate |
$5,455.20 |
| Rate for Payer: Aetna Commercial |
$4,375.52
|
| Rate for Payer: Anthem Medicaid |
$1,954.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,432.35
|
| Rate for Payer: Cash Price |
$2,841.25
|
| Rate for Payer: Cigna Commercial |
$4,716.48
|
| Rate for Payer: First Health Commercial |
$5,398.38
|
| Rate for Payer: Humana Commercial |
$4,830.12
|
| Rate for Payer: Humana KY Medicaid |
$1,954.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,974.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,659.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,193.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,704.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,993.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,000.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,261.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,136.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$738.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,761.58
|
| Rate for Payer: PHCS Commercial |
$5,455.20
|
| Rate for Payer: United Healthcare All Payer |
$5,000.60
|
|
|
TENFUSE 2.7*16MM STRAIGHT
|
Facility
|
IP
|
$5,682.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$738.72 |
| Max. Negotiated Rate |
$5,455.20 |
| Rate for Payer: Aetna Commercial |
$4,375.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,432.35
|
| Rate for Payer: Cash Price |
$2,841.25
|
| Rate for Payer: Cigna Commercial |
$4,716.48
|
| Rate for Payer: First Health Commercial |
$5,398.38
|
| Rate for Payer: Humana Commercial |
$4,830.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,659.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,193.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,704.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,000.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,261.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,136.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$738.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,761.58
|
| Rate for Payer: PHCS Commercial |
$5,455.20
|
| Rate for Payer: United Healthcare All Payer |
$5,000.60
|
|
|
TENODESIS DISTAL JOINT EACH
|
Professional
|
Both
|
$1,520.00
|
|
|
Service Code
|
HCPCS 26474
|
| Hospital Charge Code |
76100705
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$292.70 |
| Max. Negotiated Rate |
$1,520.00 |
| Rate for Payer: Aetna Commercial |
$819.62
|
| Rate for Payer: Anthem Medicaid |
$292.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,520.00
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cigna Commercial |
$1,021.25
|
| Rate for Payer: Healthspan PPO |
$742.39
|
| Rate for Payer: Humana Medicaid |
$292.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$721.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$298.55
|
| Rate for Payer: Molina Healthcare Passport |
$292.70
|
| Rate for Payer: Multiplan PHCS |
$912.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,064.00
|
| Rate for Payer: UHCCP Medicaid |
$532.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$295.63
|
|
|
TENODESIS DISTAL JOINT EACH
|
Facility
|
OP
|
$1,520.00
|
|
|
Service Code
|
HCPCS 26474
|
| Hospital Charge Code |
76100705
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$197.60 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Aetna Commercial |
$1,170.40
|
| Rate for Payer: Anthem Medicaid |
$522.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,185.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cigna Commercial |
$1,261.60
|
| Rate for Payer: First Health Commercial |
$1,444.00
|
| Rate for Payer: Humana Commercial |
$1,292.00
|
| Rate for Payer: Humana KY Medicaid |
$522.73
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$528.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,246.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,121.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$533.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,337.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,140.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$304.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$197.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$471.20
|
| Rate for Payer: PHCS Commercial |
$1,459.20
|
| Rate for Payer: United Healthcare All Payer |
$1,337.60
|
|
|
TENODESIS DISTAL JOINT EACH
|
Facility
|
IP
|
$1,520.00
|
|
|
Service Code
|
HCPCS 26474
|
| Hospital Charge Code |
76100705
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$197.60 |
| Max. Negotiated Rate |
$1,459.20 |
| Rate for Payer: Aetna Commercial |
$1,170.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,185.60
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cigna Commercial |
$1,261.60
|
| Rate for Payer: First Health Commercial |
$1,444.00
|
| Rate for Payer: Humana Commercial |
$1,292.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,246.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,121.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$456.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,337.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,140.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$304.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$197.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$471.20
|
| Rate for Payer: PHCS Commercial |
$1,459.20
|
| Rate for Payer: United Healthcare All Payer |
$1,337.60
|
|
|
TENODESIS DISTAL JOINT EACH(P
|
Professional
|
Both
|
$1,520.00
|
|
|
Service Code
|
HCPCS 26474
|
| Hospital Charge Code |
761P0705
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$292.70 |
| Max. Negotiated Rate |
$1,520.00 |
| Rate for Payer: Aetna Commercial |
$819.62
|
| Rate for Payer: Anthem Medicaid |
$292.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,520.00
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cigna Commercial |
$1,021.25
|
| Rate for Payer: Healthspan PPO |
$742.39
|
| Rate for Payer: Humana Medicaid |
$292.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$721.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$298.55
|
| Rate for Payer: Molina Healthcare Passport |
$292.70
|
| Rate for Payer: Multiplan PHCS |
$912.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,064.00
|
| Rate for Payer: UHCCP Medicaid |
$532.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$295.63
|
|
|
TENODESIS LONG TENDON BICEPS
|
Professional
|
Both
|
$1,650.00
|
|
|
Service Code
|
HCPCS 23430
|
| Hospital Charge Code |
76100460
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$506.31 |
| Max. Negotiated Rate |
$1,650.00 |
| Rate for Payer: Aetna Commercial |
$1,093.12
|
| Rate for Payer: Anthem Medicaid |
$506.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,650.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cigna Commercial |
$1,199.77
|
| Rate for Payer: Healthspan PPO |
$990.13
|
| Rate for Payer: Humana Medicaid |
$506.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$919.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$516.44
|
| Rate for Payer: Molina Healthcare Passport |
$506.31
|
| Rate for Payer: Multiplan PHCS |
$990.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,155.00
|
| Rate for Payer: UHCCP Medicaid |
$577.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$511.37
|
|
|
TENODESIS LONG TENDON BICEPS
|
Facility
|
IP
|
$1,650.00
|
|
|
Service Code
|
HCPCS 23430
|
| Hospital Charge Code |
76100460
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$214.50 |
| Max. Negotiated Rate |
$1,584.00 |
| Rate for Payer: Aetna Commercial |
$1,270.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,287.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cigna Commercial |
$1,369.50
|
| Rate for Payer: First Health Commercial |
$1,567.50
|
| Rate for Payer: Humana Commercial |
$1,402.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,353.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,217.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$495.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,452.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,237.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$330.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$214.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$511.50
|
| Rate for Payer: PHCS Commercial |
$1,584.00
|
| Rate for Payer: United Healthcare All Payer |
$1,452.00
|
|
|
TENODESIS LONG TENDON BICEPS
|
Facility
|
OP
|
$1,650.00
|
|
|
Service Code
|
HCPCS 23430
|
| Hospital Charge Code |
76100460
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$214.50 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$1,270.50
|
| Rate for Payer: Anthem Medicaid |
$567.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,287.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,661.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,351.78
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cigna Commercial |
$1,369.50
|
| Rate for Payer: First Health Commercial |
$1,567.50
|
| Rate for Payer: Humana Commercial |
$1,402.50
|
| Rate for Payer: Humana KY Medicaid |
$567.44
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$573.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,353.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,217.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$578.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,452.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,237.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$330.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$214.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$511.50
|
| Rate for Payer: PHCS Commercial |
$1,584.00
|
| Rate for Payer: United Healthcare All Payer |
$1,452.00
|
|
|
TENODESIS LONG TENDON BICEPS(P
|
Professional
|
Both
|
$1,650.00
|
|
|
Service Code
|
HCPCS 23430
|
| Hospital Charge Code |
761P0460
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$506.31 |
| Max. Negotiated Rate |
$1,650.00 |
| Rate for Payer: Aetna Commercial |
$1,093.12
|
| Rate for Payer: Anthem Medicaid |
$506.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,650.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cigna Commercial |
$1,199.77
|
| Rate for Payer: Healthspan PPO |
$990.13
|
| Rate for Payer: Humana Medicaid |
$506.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$919.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$516.44
|
| Rate for Payer: Molina Healthcare Passport |
$506.31
|
| Rate for Payer: Multiplan PHCS |
$990.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,155.00
|
| Rate for Payer: UHCCP Medicaid |
$577.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$511.37
|
|
|
TENODESIS OF LONG TENDON OF BICEPS
|
Facility
|
OP
|
$8,661.10
|
|
|
Service Code
|
CPT 23430
|
|
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
|
|
|
TENODESIS SCREW 5.5MMX10
|
Facility
|
IP
|
$3,197.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$415.68 |
| Max. Negotiated Rate |
$3,069.60 |
| Rate for Payer: Aetna Commercial |
$2,462.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,494.05
|
| Rate for Payer: Cash Price |
$1,598.75
|
| Rate for Payer: Cigna Commercial |
$2,653.92
|
| Rate for Payer: First Health Commercial |
$3,037.62
|
| Rate for Payer: Humana Commercial |
$2,717.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,621.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,359.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$959.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,813.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,398.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$639.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$415.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$991.22
|
| Rate for Payer: PHCS Commercial |
$3,069.60
|
| Rate for Payer: United Healthcare All Payer |
$2,813.80
|
|
|
TENODESIS SCREW 5.5MMX10
|
Facility
|
OP
|
$3,197.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$415.68 |
| Max. Negotiated Rate |
$3,069.60 |
| Rate for Payer: Aetna Commercial |
$2,462.08
|
| Rate for Payer: Anthem Medicaid |
$1,099.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,494.05
|
| Rate for Payer: Cash Price |
$1,598.75
|
| Rate for Payer: Cigna Commercial |
$2,653.92
|
| Rate for Payer: First Health Commercial |
$3,037.62
|
| Rate for Payer: Humana Commercial |
$2,717.88
|
| Rate for Payer: Humana KY Medicaid |
$1,099.62
|
| Rate for Payer: Kentucky WC Medicaid |
$1,110.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,621.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,359.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$959.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,121.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,813.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,398.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$639.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$415.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$991.22
|
| Rate for Payer: PHCS Commercial |
$3,069.60
|
| Rate for Payer: United Healthcare All Payer |
$2,813.80
|
|
|
TENOGLIDE TENDON PROT SHT 4*5
|
Facility
|
IP
|
$11,309.92
|
|
|
Service Code
|
HCPCS C9356
|
| Hospital Charge Code |
27000132
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,470.29 |
| Max. Negotiated Rate |
$10,857.52 |
| Rate for Payer: Aetna Commercial |
$8,708.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,821.74
|
| Rate for Payer: Cash Price |
$5,654.96
|
| Rate for Payer: Cigna Commercial |
$9,387.23
|
| Rate for Payer: First Health Commercial |
$10,744.42
|
| Rate for Payer: Humana Commercial |
$9,613.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,274.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,346.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,392.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,952.73
|
| Rate for Payer: Ohio Health Group HMO |
$8,482.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,261.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,470.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,506.08
|
| Rate for Payer: PHCS Commercial |
$10,857.52
|
| Rate for Payer: United Healthcare All Payer |
$9,952.73
|
|
|
TENOGLIDE TENDON PROT SHT 4*5
|
Facility
|
OP
|
$11,309.92
|
|
|
Service Code
|
HCPCS C9356
|
| Hospital Charge Code |
27000132
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,470.29 |
| Max. Negotiated Rate |
$10,857.52 |
| Rate for Payer: Aetna Commercial |
$8,708.64
|
| Rate for Payer: Anthem Medicaid |
$3,889.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,821.74
|
| Rate for Payer: Cash Price |
$5,654.96
|
| Rate for Payer: Cigna Commercial |
$9,387.23
|
| Rate for Payer: First Health Commercial |
$10,744.42
|
| Rate for Payer: Humana Commercial |
$9,613.43
|
| Rate for Payer: Humana KY Medicaid |
$3,889.48
|
| Rate for Payer: Kentucky WC Medicaid |
$3,929.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,274.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,346.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,392.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,967.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,952.73
|
| Rate for Payer: Ohio Health Group HMO |
$8,482.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,261.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,470.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,506.08
|
| Rate for Payer: PHCS Commercial |
$10,857.52
|
| Rate for Payer: United Healthcare All Payer |
$9,952.73
|
|
|
TENOLYSIS, EXTENSOR, FOOT; SINGLE TENDON
|
Facility
|
OP
|
$3,918.70
|
|
|
Service Code
|
CPT 28225
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,799.07 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
|
|
TENORMIN (ATENOLOL) 25MG/1TAB
|
Facility
|
OP
|
$4.46
|
|
|
Service Code
|
NDC 60687060501
|
| Hospital Charge Code |
25001507
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna Commercial |
$3.43
|
| Rate for Payer: Anthem Medicaid |
$1.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.48
|
| Rate for Payer: Cash Price |
$2.23
|
| Rate for Payer: Cigna Commercial |
$3.70
|
| Rate for Payer: First Health Commercial |
$4.24
|
| Rate for Payer: Humana Commercial |
$3.79
|
| Rate for Payer: Humana KY Medicaid |
$1.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.92
|
| Rate for Payer: Ohio Health Group HMO |
$3.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.38
|
| Rate for Payer: PHCS Commercial |
$4.28
|
| Rate for Payer: United Healthcare All Payer |
$3.92
|
|
