|
SUTURE COMPLEX
|
Facility
|
OP
|
$209.00
|
|
| Hospital Charge Code |
76102557
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$62.70 |
| 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 |
$167.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$181.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$144.21
|
| Rate for Payer: PHCS Commercial |
$200.64
|
| Rate for Payer: United Healthcare All Payer |
$183.92
|
|
|
SUTURE COMPLEX
|
Facility
|
IP
|
$209.00
|
|
| Hospital Charge Code |
76102557
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$62.70 |
| 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 |
$167.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$181.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$144.21
|
| Rate for Payer: PHCS Commercial |
$200.64
|
| Rate for Payer: United Healthcare All Payer |
$183.92
|
|
|
SUTURE COMPLEX
|
Professional
|
Both
|
$1,650.00
|
|
|
Service Code
|
HCPCS 64856
|
| Hospital Charge Code |
76102376
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$577.50 |
| Max. Negotiated Rate |
$1,612.71 |
| Rate for Payer: Aetna Commercial |
$1,612.71
|
| Rate for Payer: Ambetter Exchange |
$959.71
|
| Rate for Payer: Anthem Medicaid |
$631.58
|
| Rate for Payer: Buckeye Individual/Medicaid |
$959.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$959.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,151.65
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cigna Commercial |
$1,475.87
|
| Rate for Payer: Healthspan PPO |
$1,259.16
|
| Rate for Payer: Humana Medicaid |
$631.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,299.20
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$959.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$959.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$644.21
|
| Rate for Payer: Molina Healthcare Passport |
$631.58
|
| Rate for Payer: Multiplan PHCS |
$990.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,247.62
|
| Rate for Payer: UHCCP Medicaid |
$577.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$637.90
|
| Rate for Payer: Wellcare Medicare Advantage |
$959.71
|
|
|
SUTURE COMPLEX(P
|
Professional
|
Both
|
$1,650.00
|
|
|
Service Code
|
HCPCS 64856
|
| Hospital Charge Code |
761P2376
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$577.50 |
| Max. Negotiated Rate |
$1,612.71 |
| Rate for Payer: Aetna Commercial |
$1,612.71
|
| Rate for Payer: Ambetter Exchange |
$959.71
|
| Rate for Payer: Anthem Medicaid |
$631.58
|
| Rate for Payer: Buckeye Individual/Medicaid |
$959.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$959.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,151.65
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cigna Commercial |
$1,475.87
|
| Rate for Payer: Healthspan PPO |
$1,259.16
|
| Rate for Payer: Humana Medicaid |
$631.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,299.20
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$959.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$959.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$644.21
|
| Rate for Payer: Molina Healthcare Passport |
$631.58
|
| Rate for Payer: Multiplan PHCS |
$990.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,247.62
|
| Rate for Payer: UHCCP Medicaid |
$577.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$637.90
|
| Rate for Payer: Wellcare Medicare Advantage |
$959.71
|
|
|
SUTURE CUP 33MM +2LEFT
|
Facility
|
OP
|
$9,515.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,854.57 |
| Max. Negotiated Rate |
$9,134.64 |
| Rate for Payer: Aetna Commercial |
$7,326.74
|
| Rate for Payer: Anthem Medicaid |
$3,272.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,421.90
|
| Rate for Payer: Cash Price |
$4,757.62
|
| Rate for Payer: Cigna Commercial |
$7,897.66
|
| Rate for Payer: First Health Commercial |
$9,039.49
|
| Rate for Payer: Humana Commercial |
$8,087.96
|
| Rate for Payer: Humana KY Medicaid |
$3,272.29
|
| Rate for Payer: Kentucky WC Medicaid |
$3,305.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,802.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,022.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,854.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,337.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,373.42
|
| Rate for Payer: Ohio Health Group HMO |
$7,136.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,612.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,278.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,565.52
|
| Rate for Payer: PHCS Commercial |
$9,134.64
|
| Rate for Payer: United Healthcare All Payer |
$8,373.42
|
|
|
SUTURE CUP 33MM +2LEFT
|
Facility
|
IP
|
$9,515.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,854.57 |
| Max. Negotiated Rate |
$9,134.64 |
| Rate for Payer: Aetna Commercial |
$7,326.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,421.90
|
| Rate for Payer: Cash Price |
$4,757.62
|
| Rate for Payer: Cigna Commercial |
$7,897.66
|
| Rate for Payer: First Health Commercial |
$9,039.49
|
| Rate for Payer: Humana Commercial |
$8,087.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,802.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,022.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,854.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,373.42
|
| Rate for Payer: Ohio Health Group HMO |
$7,136.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,612.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,278.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,565.52
|
| Rate for Payer: PHCS Commercial |
$9,134.64
|
| Rate for Payer: United Healthcare All Payer |
$8,373.42
|
|
|
SUTURE FAC NERVE; EXTRACRANIAL
|
Facility
|
IP
|
$1,075.00
|
|
|
Service Code
|
HCPCS 64864
|
| Hospital Charge Code |
76102377
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$322.50 |
| Max. Negotiated Rate |
$1,032.00 |
| Rate for Payer: Aetna Commercial |
$827.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$838.50
|
| Rate for Payer: Cash Price |
$537.50
|
| Rate for Payer: Cigna Commercial |
$892.25
|
| Rate for Payer: First Health Commercial |
$1,021.25
|
| Rate for Payer: Humana Commercial |
$913.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$881.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$793.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$322.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$946.00
|
| Rate for Payer: Ohio Health Group HMO |
$806.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$935.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$741.75
|
| Rate for Payer: PHCS Commercial |
$1,032.00
|
| Rate for Payer: United Healthcare All Payer |
$946.00
|
|
|
SUTURE FAC NERVE; EXTRACRANIAL
|
Facility
|
OP
|
$1,075.00
|
|
|
Service Code
|
HCPCS 64864
|
| Hospital Charge Code |
76102377
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$369.69 |
| Max. Negotiated Rate |
$8,284.12 |
| Rate for Payer: Aetna Commercial |
$827.75
|
| Rate for Payer: Anthem Medicaid |
$369.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,917.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$838.50
|
| 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 |
$537.50
|
| Rate for Payer: Cash Price |
$537.50
|
| Rate for Payer: Cigna Commercial |
$892.25
|
| Rate for Payer: First Health Commercial |
$1,021.25
|
| Rate for Payer: Humana Commercial |
$913.75
|
| Rate for Payer: Humana KY Medicaid |
$369.69
|
| Rate for Payer: Humana Medicare Advantage |
$5,917.23
|
| Rate for Payer: Kentucky WC Medicaid |
$373.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$881.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$793.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,100.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$377.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$946.00
|
| Rate for Payer: Ohio Health Group HMO |
$806.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$935.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$741.75
|
| Rate for Payer: PHCS Commercial |
$1,032.00
|
| Rate for Payer: United Healthcare All Payer |
$946.00
|
|
|
SUTURE FAC NERVE; EXTRACRANIAL
|
Professional
|
Both
|
$1,075.00
|
|
|
Service Code
|
HCPCS 64864
|
| Hospital Charge Code |
76102377
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$376.25 |
| Max. Negotiated Rate |
$1,376.59 |
| Rate for Payer: Aetna Commercial |
$1,376.59
|
| Rate for Payer: Ambetter Exchange |
$813.27
|
| Rate for Payer: Anthem Medicaid |
$587.31
|
| Rate for Payer: Buckeye Individual/Medicaid |
$813.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$813.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$975.92
|
| Rate for Payer: Cash Price |
$537.50
|
| Rate for Payer: Cash Price |
$537.50
|
| Rate for Payer: Cigna Commercial |
$1,293.55
|
| Rate for Payer: Healthspan PPO |
$1,074.80
|
| Rate for Payer: Humana Medicaid |
$587.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,101.81
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$813.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$813.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$599.06
|
| Rate for Payer: Molina Healthcare Passport |
$587.31
|
| Rate for Payer: Multiplan PHCS |
$645.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,057.25
|
| Rate for Payer: UHCCP Medicaid |
$376.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$593.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$813.27
|
|
|
SUTURE FAC NERVE; EXTRACRANIAL
|
Professional
|
Both
|
$1,075.00
|
|
|
Service Code
|
HCPCS 64864
|
| Hospital Charge Code |
761P2377
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$376.25 |
| Max. Negotiated Rate |
$1,376.59 |
| Rate for Payer: Aetna Commercial |
$1,376.59
|
| Rate for Payer: Ambetter Exchange |
$813.27
|
| Rate for Payer: Anthem Medicaid |
$587.31
|
| Rate for Payer: Buckeye Individual/Medicaid |
$813.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$813.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$975.92
|
| Rate for Payer: Cash Price |
$537.50
|
| Rate for Payer: Cash Price |
$537.50
|
| Rate for Payer: Cigna Commercial |
$1,293.55
|
| Rate for Payer: Healthspan PPO |
$1,074.80
|
| Rate for Payer: Humana Medicaid |
$587.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,101.81
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$813.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$813.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$599.06
|
| Rate for Payer: Molina Healthcare Passport |
$587.31
|
| Rate for Payer: Multiplan PHCS |
$645.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,057.25
|
| Rate for Payer: UHCCP Medicaid |
$376.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$593.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$813.27
|
|
|
SUTURELASSO SD WIRE LOOP
|
Facility
|
OP
|
$835.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$250.50 |
| Max. Negotiated Rate |
$801.60 |
| Rate for Payer: Aetna Commercial |
$642.95
|
| Rate for Payer: Anthem Medicaid |
$287.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$651.30
|
| Rate for Payer: Cash Price |
$417.50
|
| Rate for Payer: Cigna Commercial |
$693.05
|
| Rate for Payer: First Health Commercial |
$793.25
|
| Rate for Payer: Humana Commercial |
$709.75
|
| Rate for Payer: Humana KY Medicaid |
$287.16
|
| Rate for Payer: Kentucky WC Medicaid |
$290.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$684.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$616.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$250.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$292.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$734.80
|
| Rate for Payer: Ohio Health Group HMO |
$626.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$668.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$726.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$576.15
|
| Rate for Payer: PHCS Commercial |
$801.60
|
| Rate for Payer: United Healthcare All Payer |
$734.80
|
|
|
SUTURELASSO SD WIRE LOOP
|
Facility
|
IP
|
$835.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$250.50 |
| Max. Negotiated Rate |
$801.60 |
| Rate for Payer: Aetna Commercial |
$642.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$651.30
|
| Rate for Payer: Cash Price |
$417.50
|
| Rate for Payer: Cigna Commercial |
$693.05
|
| Rate for Payer: First Health Commercial |
$793.25
|
| Rate for Payer: Humana Commercial |
$709.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$684.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$616.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$250.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$734.80
|
| Rate for Payer: Ohio Health Group HMO |
$626.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$668.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$726.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$576.15
|
| Rate for Payer: PHCS Commercial |
$801.60
|
| Rate for Payer: United Healthcare All Payer |
$734.80
|
|
|
SUTURE OF INFRAPATELLAR TENDON; PRIMARY
|
Facility
|
OP
|
$9,240.92
|
|
|
Service Code
|
CPT 27380
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,600.66 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
|
|
SUTURE OF INFRAPATELLAR TENDON; SECONDARY RECONSTRUCTION, INCLUDING FASCIAL OR TENDON GRAFT
|
Facility
|
OP
|
$9,240.92
|
|
|
Service Code
|
CPT 27381
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,600.66 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
|
|
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 |
$645.00 |
| 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 |
$1,720.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,870.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,483.50
|
| Rate for Payer: PHCS Commercial |
$2,064.00
|
| Rate for Payer: United Healthcare All Payer |
$1,892.00
|
|
|
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 |
$645.00 |
| 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 |
$1,720.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,870.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,483.50
|
| 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 |
$1,535.51 |
| Rate for Payer: Aetna Commercial |
$1,535.51
|
| Rate for Payer: Ambetter Exchange |
$1,001.94
|
| Rate for Payer: Anthem Medicaid |
$631.37
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,001.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,001.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,202.33
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,001.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,001.94
|
| 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 |
$1,302.52
|
| Rate for Payer: UHCCP Medicaid |
$752.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$637.68
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,001.94
|
|
|
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 |
$1,535.51 |
| Rate for Payer: Aetna Commercial |
$1,535.51
|
| Rate for Payer: Ambetter Exchange |
$1,001.94
|
| Rate for Payer: Anthem Medicaid |
$631.37
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,001.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,001.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,202.33
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,001.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,001.94
|
| 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 |
$1,302.52
|
| Rate for Payer: UHCCP Medicaid |
$752.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$637.68
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,001.94
|
|
|
SUTURE OF QUADRICEPS OR HAMSTRING MUSCLE RUPTURE; PRIMARY
|
Facility
|
OP
|
$9,240.92
|
|
|
Service Code
|
CPT 27385
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,600.66 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
|
|
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 |
$343.90 |
| Max. Negotiated Rate |
$3,017.85 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem Medicaid |
$343.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,155.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,017.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,910.07
|
| 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 |
$2,155.61
|
| 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 |
$2,586.73
|
| 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 |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$690.00
|
| 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 |
$600.00 |
| Rate for Payer: Aetna Commercial |
$328.49
|
| Rate for Payer: Ambetter Exchange |
$218.08
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$118.18
|
| Rate for Payer: Anthem Medicaid |
$140.47
|
| Rate for Payer: Buckeye Individual/Medicaid |
$218.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$218.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$261.70
|
| 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 |
$140.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$312.40
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$218.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$218.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$143.28
|
| Rate for Payer: Molina Healthcare Passport |
$140.47
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$283.50
|
| Rate for Payer: UHCCP Medicaid |
$124.09
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$141.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$218.08
|
|
|
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 |
$300.00 |
| 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 |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$690.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
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 |
$600.00 |
| Rate for Payer: Aetna Commercial |
$328.49
|
| Rate for Payer: Ambetter Exchange |
$218.08
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$118.18
|
| Rate for Payer: Anthem Medicaid |
$140.47
|
| Rate for Payer: Buckeye Individual/Medicaid |
$218.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$218.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$261.70
|
| 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 |
$140.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$312.40
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$218.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$218.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$143.28
|
| Rate for Payer: Molina Healthcare Passport |
$140.47
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$283.50
|
| Rate for Payer: UHCCP Medicaid |
$124.09
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$141.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$218.08
|
|
|
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 |
$555.00 |
| 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 |
$1,480.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,609.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,276.50
|
| 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 |
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: Ambetter Exchange |
$1,336.57
|
| Rate for Payer: Anthem Medicaid |
$529.77
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,336.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,336.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,603.88
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,336.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,336.57
|
| 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 |
$1,737.54
|
| Rate for Payer: UHCCP Medicaid |
$647.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$535.07
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,336.57
|
|
