|
SUSCEPTIBILITY STUDIES MIC
|
Professional
|
Both
|
$111.00
|
|
|
Service Code
|
HCPCS 87186
|
| Hospital Charge Code |
30001322
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.19 |
| Max. Negotiated Rate |
$66.60 |
| Rate for Payer: Aetna Commercial |
$13.48
|
| Rate for Payer: Ambetter Exchange |
$8.65
|
| Rate for Payer: Buckeye Individual/Medicaid |
$8.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$8.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$10.38
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cigna Commercial |
$7.67
|
| Rate for Payer: Healthspan PPO |
$8.09
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$8.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.65
|
| Rate for Payer: Multiplan PHCS |
$66.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$11.24
|
| Rate for Payer: UHCCP Medicaid |
$38.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$5.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$8.65
|
|
|
SUSCEPTIBILITY STUDIES MIC
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
HCPCS 87186
|
| Hospital Charge Code |
30001322
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.30 |
| Max. Negotiated Rate |
$106.56 |
| Rate for Payer: Aetna Commercial |
$85.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$89.13
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cigna Commercial |
$92.13
|
| Rate for Payer: First Health Commercial |
$105.45
|
| Rate for Payer: Humana Commercial |
$94.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$91.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$81.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$97.68
|
| Rate for Payer: Ohio Health Group HMO |
$83.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$88.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$96.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$76.59
|
| Rate for Payer: PHCS Commercial |
$106.56
|
| Rate for Payer: United Healthcare All Payer |
$97.68
|
|
|
SUSCEPTIBILITY STUDIES MIC
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
HCPCS 87186
|
| Hospital Charge Code |
30001322
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.65 |
| Max. Negotiated Rate |
$106.56 |
| Rate for Payer: Aetna Commercial |
$85.47
|
| Rate for Payer: Anthem Medicaid |
$8.65
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$89.13
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$8.65
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cigna Commercial |
$92.13
|
| Rate for Payer: First Health Commercial |
$105.45
|
| Rate for Payer: Humana Commercial |
$94.35
|
| Rate for Payer: Humana KY Medicaid |
$8.65
|
| Rate for Payer: Humana Medicare Advantage |
$8.65
|
| Rate for Payer: Kentucky WC Medicaid |
$8.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$91.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$81.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$97.68
|
| Rate for Payer: Ohio Health Group HMO |
$83.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$88.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$96.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$76.59
|
| Rate for Payer: PHCS Commercial |
$106.56
|
| Rate for Payer: United Healthcare All Payer |
$97.68
|
|
|
SUSPENSION OF TESTIS
|
Professional
|
Both
|
$505.00
|
|
|
Service Code
|
HCPCS 54620
|
| Hospital Charge Code |
76102139
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$176.75 |
| Max. Negotiated Rate |
$493.36 |
| Rate for Payer: Aetna Commercial |
$493.36
|
| Rate for Payer: Ambetter Exchange |
$282.40
|
| Rate for Payer: Anthem Medicaid |
$234.69
|
| Rate for Payer: Buckeye Individual/Medicaid |
$282.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$282.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$338.88
|
| Rate for Payer: Cash Price |
$252.50
|
| Rate for Payer: Cash Price |
$252.50
|
| Rate for Payer: Cigna Commercial |
$441.03
|
| Rate for Payer: Healthspan PPO |
$477.69
|
| Rate for Payer: Humana Medicaid |
$234.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$409.57
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$282.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$282.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$239.38
|
| Rate for Payer: Molina Healthcare Passport |
$234.69
|
| Rate for Payer: Multiplan PHCS |
$303.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$367.12
|
| Rate for Payer: UHCCP Medicaid |
$176.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$237.04
|
| Rate for Payer: Wellcare Medicare Advantage |
$282.40
|
|
|
SUSPENSION OF TESTIS
|
Facility
|
IP
|
$505.00
|
|
|
Service Code
|
HCPCS 54620
|
| Hospital Charge Code |
76102139
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$151.50 |
| Max. Negotiated Rate |
$484.80 |
| Rate for Payer: Aetna Commercial |
$388.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$393.90
|
| Rate for Payer: Cash Price |
$252.50
|
| Rate for Payer: Cigna Commercial |
$419.15
|
| Rate for Payer: First Health Commercial |
$479.75
|
| Rate for Payer: Humana Commercial |
$429.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$414.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$372.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$151.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$444.40
|
| Rate for Payer: Ohio Health Group HMO |
$378.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$404.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$439.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$348.45
|
| Rate for Payer: PHCS Commercial |
$484.80
|
| Rate for Payer: United Healthcare All Payer |
$444.40
|
|
|
SUSPENSION OF TESTIS
|
Facility
|
OP
|
$505.00
|
|
|
Service Code
|
HCPCS 54620
|
| Hospital Charge Code |
76102139
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$173.67 |
| Max. Negotiated Rate |
$4,461.49 |
| Rate for Payer: Aetna Commercial |
$388.85
|
| Rate for Payer: Anthem Medicaid |
$173.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,186.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$393.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,461.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,302.15
|
| Rate for Payer: Cash Price |
$252.50
|
| Rate for Payer: Cash Price |
$252.50
|
| Rate for Payer: Cigna Commercial |
$419.15
|
| Rate for Payer: First Health Commercial |
$479.75
|
| Rate for Payer: Humana Commercial |
$429.25
|
| Rate for Payer: Humana KY Medicaid |
$173.67
|
| Rate for Payer: Humana Medicare Advantage |
$3,186.78
|
| Rate for Payer: Kentucky WC Medicaid |
$175.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$414.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$372.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,824.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$177.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$444.40
|
| Rate for Payer: Ohio Health Group HMO |
$378.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$404.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$439.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$348.45
|
| Rate for Payer: PHCS Commercial |
$484.80
|
| Rate for Payer: United Healthcare All Payer |
$444.40
|
|
|
SUSPENSION OF TESTIS(P
|
Professional
|
Both
|
$505.00
|
|
|
Service Code
|
HCPCS 54620
|
| Hospital Charge Code |
761P2139
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$176.75 |
| Max. Negotiated Rate |
$493.36 |
| Rate for Payer: Aetna Commercial |
$493.36
|
| Rate for Payer: Ambetter Exchange |
$282.40
|
| Rate for Payer: Anthem Medicaid |
$234.69
|
| Rate for Payer: Buckeye Individual/Medicaid |
$282.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$282.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$338.88
|
| Rate for Payer: Cash Price |
$252.50
|
| Rate for Payer: Cash Price |
$252.50
|
| Rate for Payer: Cigna Commercial |
$441.03
|
| Rate for Payer: Healthspan PPO |
$477.69
|
| Rate for Payer: Humana Medicaid |
$234.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$409.57
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$282.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$282.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$239.38
|
| Rate for Payer: Molina Healthcare Passport |
$234.69
|
| Rate for Payer: Multiplan PHCS |
$303.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$367.12
|
| Rate for Payer: UHCCP Medicaid |
$176.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$237.04
|
| Rate for Payer: Wellcare Medicare Advantage |
$282.40
|
|
|
SUTR LG INT 1/MULT PERF W/COL
|
Facility
|
OP
|
$2,100.00
|
|
|
Service Code
|
HCPCS 44605
|
| Hospital Charge Code |
76101857
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$630.00 |
| Max. Negotiated Rate |
$2,016.00 |
| Rate for Payer: Aetna Commercial |
$1,617.00
|
| Rate for Payer: Anthem Medicaid |
$722.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,638.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,743.00
|
| Rate for Payer: First Health Commercial |
$1,995.00
|
| Rate for Payer: Humana Commercial |
$1,785.00
|
| Rate for Payer: Humana KY Medicaid |
$722.19
|
| Rate for Payer: Kentucky WC Medicaid |
$729.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,722.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,549.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$736.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,848.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,827.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,449.00
|
| Rate for Payer: PHCS Commercial |
$2,016.00
|
| Rate for Payer: United Healthcare All Payer |
$1,848.00
|
|
|
SUTR LG INT 1/MULT PERF W/COL
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 44605
|
| Hospital Charge Code |
76101857
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$708.57 |
| Max. Negotiated Rate |
$1,889.38 |
| Rate for Payer: Aetna Commercial |
$1,889.38
|
| Rate for Payer: Ambetter Exchange |
$1,224.50
|
| Rate for Payer: Anthem Medicaid |
$708.57
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,224.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,224.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,469.40
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,767.81
|
| Rate for Payer: Healthspan PPO |
$1,593.35
|
| Rate for Payer: Humana Medicaid |
$708.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,671.57
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,224.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,224.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$722.74
|
| Rate for Payer: Molina Healthcare Passport |
$708.57
|
| Rate for Payer: Multiplan PHCS |
$1,260.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,591.85
|
| Rate for Payer: UHCCP Medicaid |
$735.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$715.66
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,224.50
|
|
|
SUTR LG INT 1/MULT PERF W/COL
|
Facility
|
IP
|
$2,100.00
|
|
|
Service Code
|
HCPCS 44605
|
| Hospital Charge Code |
76101857
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$630.00 |
| Max. Negotiated Rate |
$2,016.00 |
| Rate for Payer: Aetna Commercial |
$1,617.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,638.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,743.00
|
| Rate for Payer: First Health Commercial |
$1,995.00
|
| Rate for Payer: Humana Commercial |
$1,785.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,722.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,549.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,848.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,827.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,449.00
|
| Rate for Payer: PHCS Commercial |
$2,016.00
|
| Rate for Payer: United Healthcare All Payer |
$1,848.00
|
|
|
SUTR LG INT 1/MULT PERF W/CO(P
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 44605
|
| Hospital Charge Code |
761P1857
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$708.57 |
| Max. Negotiated Rate |
$1,889.38 |
| Rate for Payer: Aetna Commercial |
$1,889.38
|
| Rate for Payer: Ambetter Exchange |
$1,224.50
|
| Rate for Payer: Anthem Medicaid |
$708.57
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,224.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,224.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,469.40
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,767.81
|
| Rate for Payer: Healthspan PPO |
$1,593.35
|
| Rate for Payer: Humana Medicaid |
$708.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,671.57
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,224.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,224.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$722.74
|
| Rate for Payer: Molina Healthcare Passport |
$708.57
|
| Rate for Payer: Multiplan PHCS |
$1,260.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,591.85
|
| Rate for Payer: UHCCP Medicaid |
$735.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$715.66
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,224.50
|
|
|
SUTURE 1 NERVE HAND/FOOT ULNAR
|
Facility
|
IP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 64836
|
| Hospital Charge Code |
76102375
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$480.00 |
| 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 |
$1,280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,392.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,104.00
|
| Rate for Payer: PHCS Commercial |
$1,536.00
|
| Rate for Payer: United Healthcare All Payer |
$1,408.00
|
|
|
SUTURE 1 NERVE HAND/FOOT ULNAR
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 64836
|
| Hospital Charge Code |
76102375
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$516.58 |
| Max. Negotiated Rate |
$1,280.24 |
| Rate for Payer: Aetna Commercial |
$1,280.24
|
| Rate for Payer: Ambetter Exchange |
$776.65
|
| Rate for Payer: Anthem Medicaid |
$516.58
|
| Rate for Payer: Buckeye Individual/Medicaid |
$776.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$776.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$931.98
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,175.20
|
| Rate for Payer: Healthspan PPO |
$999.58
|
| Rate for Payer: Humana Medicaid |
$516.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,035.54
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$776.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$776.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$526.91
|
| Rate for Payer: Molina Healthcare Passport |
$516.58
|
| Rate for Payer: Multiplan PHCS |
$960.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,009.64
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$521.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$776.65
|
|
|
SUTURE 1 NERVE HAND/FOOT ULNAR
|
Facility
|
OP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 64836
|
| Hospital Charge Code |
76102375
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$550.24 |
| Max. Negotiated Rate |
$8,284.12 |
| Rate for Payer: Aetna Commercial |
$1,232.00
|
| Rate for Payer: Anthem Medicaid |
$550.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,917.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,248.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,284.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,988.26
|
| Rate for Payer: Cash Price |
$800.00
|
| 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: Humana Medicare Advantage |
$5,917.23
|
| 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 |
$7,100.68
|
| 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 |
$1,280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,392.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,104.00
|
| Rate for Payer: PHCS Commercial |
$1,536.00
|
| Rate for Payer: United Healthcare All Payer |
$1,408.00
|
|
|
SUTURE 1 NERVE HAND/FOOT ULNAR
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 64836
|
| Hospital Charge Code |
761P2375
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$516.58 |
| Max. Negotiated Rate |
$1,280.24 |
| Rate for Payer: Aetna Commercial |
$1,280.24
|
| Rate for Payer: Ambetter Exchange |
$776.65
|
| Rate for Payer: Anthem Medicaid |
$516.58
|
| Rate for Payer: Buckeye Individual/Medicaid |
$776.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$776.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$931.98
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,175.20
|
| Rate for Payer: Healthspan PPO |
$999.58
|
| Rate for Payer: Humana Medicaid |
$516.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,035.54
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$776.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$776.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$526.91
|
| Rate for Payer: Molina Healthcare Passport |
$516.58
|
| Rate for Payer: Multiplan PHCS |
$960.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,009.64
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$521.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$776.65
|
|
|
SUTURE1 NERVE MED MOTOR THENAR
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 64835
|
| Hospital Charge Code |
76102374
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$490.00 |
| Max. Negotiated Rate |
$1,283.11 |
| Rate for Payer: Aetna Commercial |
$1,283.11
|
| Rate for Payer: Ambetter Exchange |
$776.65
|
| Rate for Payer: Anthem Medicaid |
$492.11
|
| Rate for Payer: Buckeye Individual/Medicaid |
$776.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$776.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$931.98
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,183.92
|
| Rate for Payer: Healthspan PPO |
$1,001.82
|
| Rate for Payer: Humana Medicaid |
$492.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,034.71
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$776.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$776.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$501.95
|
| Rate for Payer: Molina Healthcare Passport |
$492.11
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,009.64
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$497.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$776.65
|
|
|
SUTURE1 NERVE MED MOTOR THENAR
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 64835
|
| Hospital Charge Code |
76102374
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$1,344.00 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$420.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,218.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$966.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
SUTURE1 NERVE MED MOTOR THENAR
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 64835
|
| Hospital Charge Code |
761P2374
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$490.00 |
| Max. Negotiated Rate |
$1,283.11 |
| Rate for Payer: Aetna Commercial |
$1,283.11
|
| Rate for Payer: Ambetter Exchange |
$776.65
|
| Rate for Payer: Anthem Medicaid |
$492.11
|
| Rate for Payer: Buckeye Individual/Medicaid |
$776.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$776.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$931.98
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,183.92
|
| Rate for Payer: Healthspan PPO |
$1,001.82
|
| Rate for Payer: Humana Medicaid |
$492.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,034.71
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$776.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$776.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$501.95
|
| Rate for Payer: Molina Healthcare Passport |
$492.11
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,009.64
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$497.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$776.65
|
|
|
SUTURE1 NERVE MED MOTOR THENAR
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 64835
|
| Hospital Charge Code |
76102374
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$481.46 |
| Max. Negotiated Rate |
$8,284.12 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem Medicaid |
$481.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,917.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,284.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,988.26
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Humana KY Medicaid |
$481.46
|
| Rate for Payer: Humana Medicare Advantage |
$5,917.23
|
| Rate for Payer: Kentucky WC Medicaid |
$486.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,100.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$491.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,218.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$966.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
SUTURE BUTTON KIT T V
|
Facility
|
OP
|
$7,324.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,197.25 |
| Max. Negotiated Rate |
$7,031.19 |
| Rate for Payer: Aetna Commercial |
$5,639.60
|
| Rate for Payer: Anthem Medicaid |
$2,518.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,712.84
|
| Rate for Payer: Cash Price |
$3,662.08
|
| Rate for Payer: Cigna Commercial |
$6,079.05
|
| Rate for Payer: First Health Commercial |
$6,957.95
|
| Rate for Payer: Humana Commercial |
$6,225.54
|
| Rate for Payer: Humana KY Medicaid |
$2,518.78
|
| Rate for Payer: Kentucky WC Medicaid |
$2,544.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,005.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,405.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,197.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,569.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,445.26
|
| Rate for Payer: Ohio Health Group HMO |
$5,493.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,859.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,372.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,053.67
|
| Rate for Payer: PHCS Commercial |
$7,031.19
|
| Rate for Payer: United Healthcare All Payer |
$6,445.26
|
|
|
SUTURE BUTTON KIT T V
|
Facility
|
IP
|
$7,324.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,197.25 |
| Max. Negotiated Rate |
$7,031.19 |
| Rate for Payer: Aetna Commercial |
$5,639.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,712.84
|
| Rate for Payer: Cash Price |
$3,662.08
|
| Rate for Payer: Cigna Commercial |
$6,079.05
|
| Rate for Payer: First Health Commercial |
$6,957.95
|
| Rate for Payer: Humana Commercial |
$6,225.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,005.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,405.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,197.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,445.26
|
| Rate for Payer: Ohio Health Group HMO |
$5,493.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,859.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,372.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,053.67
|
| Rate for Payer: PHCS Commercial |
$7,031.19
|
| Rate for Payer: United Healthcare All Payer |
$6,445.26
|
|
|
SUTURE COMPLEX
|
Facility
|
IP
|
$1,650.00
|
|
|
Service Code
|
HCPCS 64856
|
| Hospital Charge Code |
76102376
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$495.00 |
| 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 |
$1,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,435.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,138.50
|
| Rate for Payer: PHCS Commercial |
$1,584.00
|
| Rate for Payer: United Healthcare All Payer |
$1,452.00
|
|
|
SUTURE COMPLEX
|
Facility
|
OP
|
$1,650.00
|
|
|
Service Code
|
HCPCS 64856
|
| Hospital Charge Code |
76102376
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$567.43 |
| Max. Negotiated Rate |
$8,284.12 |
| Rate for Payer: Aetna Commercial |
$1,270.50
|
| Rate for Payer: Anthem Medicaid |
$567.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,917.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,287.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,284.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,988.26
|
| 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 |
$567.43
|
| Rate for Payer: Humana Medicare Advantage |
$5,917.23
|
| 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 |
$7,100.68
|
| 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 |
$1,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,435.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,138.50
|
| Rate for Payer: PHCS Commercial |
$1,584.00
|
| Rate for Payer: United Healthcare All Payer |
$1,452.00
|
|
|
SUTURE COMPLEX
|
Facility
|
OP
|
$218.00
|
|
| Hospital Charge Code |
45000329
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$65.40 |
| Max. Negotiated Rate |
$209.28 |
| Rate for Payer: Aetna Commercial |
$167.86
|
| Rate for Payer: Anthem Medicaid |
$74.97
|
| 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: Humana KY Medicaid |
$74.97
|
| Rate for Payer: Kentucky WC Medicaid |
$75.73
|
| 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: Molina Healthcare Medicaid |
$76.47
|
| 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 |
$174.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$189.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$150.42
|
| Rate for Payer: PHCS Commercial |
$209.28
|
| Rate for Payer: United Healthcare All Payer |
$191.84
|
|
|
SUTURE COMPLEX
|
Facility
|
IP
|
$218.00
|
|
| Hospital Charge Code |
45000329
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$65.40 |
| 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 |
$174.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$189.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$150.42
|
| Rate for Payer: PHCS Commercial |
$209.28
|
| Rate for Payer: United Healthcare All Payer |
$191.84
|
|
