|
SUTURE OF SMALL INTESTINE (ENT
|
Professional
|
Both
|
$1,850.00
|
|
|
Service Code
|
HCPCS 44602
|
| Hospital Charge Code |
76101854
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$529.77 |
| Max. Negotiated Rate |
$1,978.04 |
| Rate for Payer: Aetna Commercial |
$1,978.04
|
| Rate for Payer: 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
|
|
|
SUTURE OF SMALL INTESTINE (ENT
|
Facility
|
OP
|
$1,850.00
|
|
|
Service Code
|
HCPCS 44602
|
| Hospital Charge Code |
76101854
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$555.00 |
| Max. Negotiated Rate |
$1,776.00 |
| Rate for Payer: Aetna Commercial |
$1,424.50
|
| Rate for Payer: Anthem Medicaid |
$636.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,443.00
|
| Rate for Payer: Cash Price |
$925.00
|
| Rate for Payer: Cigna Commercial |
$1,535.50
|
| Rate for Payer: First Health Commercial |
$1,757.50
|
| Rate for Payer: Humana Commercial |
$1,572.50
|
| Rate for Payer: Humana KY Medicaid |
$636.22
|
| Rate for Payer: Kentucky WC Medicaid |
$642.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,517.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,365.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$555.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$648.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,628.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,387.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$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 PASSING WIRE
|
Facility
|
OP
|
$1,485.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$445.50 |
| Max. Negotiated Rate |
$1,425.60 |
| Rate for Payer: Aetna Commercial |
$1,143.45
|
| Rate for Payer: Anthem Medicaid |
$510.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,158.30
|
| Rate for Payer: Cash Price |
$742.50
|
| Rate for Payer: Cigna Commercial |
$1,232.55
|
| Rate for Payer: First Health Commercial |
$1,410.75
|
| Rate for Payer: Humana Commercial |
$1,262.25
|
| Rate for Payer: Humana KY Medicaid |
$510.69
|
| Rate for Payer: Kentucky WC Medicaid |
$515.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,217.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,095.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$445.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$520.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,306.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,113.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,188.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,291.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,024.65
|
| Rate for Payer: PHCS Commercial |
$1,425.60
|
| Rate for Payer: United Healthcare All Payer |
$1,306.80
|
|
|
SUTURE PASSING WIRE
|
Facility
|
IP
|
$1,485.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$445.50 |
| Max. Negotiated Rate |
$1,425.60 |
| Rate for Payer: Aetna Commercial |
$1,143.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,158.30
|
| Rate for Payer: Cash Price |
$742.50
|
| Rate for Payer: Cigna Commercial |
$1,232.55
|
| Rate for Payer: First Health Commercial |
$1,410.75
|
| Rate for Payer: Humana Commercial |
$1,262.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,217.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,095.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$445.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,306.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,113.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,188.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,291.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,024.65
|
| Rate for Payer: PHCS Commercial |
$1,425.60
|
| Rate for Payer: United Healthcare All Payer |
$1,306.80
|
|
|
SUTURE REPAIR AORTA
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 33320
|
| Hospital Charge Code |
76101284
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$560.00 |
| Max. Negotiated Rate |
$1,785.60 |
| Rate for Payer: Aetna Commercial |
$1,785.60
|
| Rate for Payer: Ambetter Exchange |
$1,006.81
|
| Rate for Payer: Anthem Medicaid |
$891.85
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,006.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,006.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,208.17
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,693.30
|
| Rate for Payer: Healthspan PPO |
$1,755.59
|
| Rate for Payer: Humana Medicaid |
$891.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,488.88
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,006.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,006.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$909.69
|
| Rate for Payer: Molina Healthcare Passport |
$891.85
|
| Rate for Payer: Multiplan PHCS |
$960.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,308.85
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$900.77
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,006.81
|
|
|
SUTURE REPAIR AORTA
|
Facility
|
IP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 33320
|
| Hospital Charge Code |
76101284
|
|
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 REPAIR AORTA
|
Facility
|
OP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 33320
|
| Hospital Charge Code |
76101284
|
|
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 Medicaid |
$550.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,248.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,328.00
|
| Rate for Payer: First Health Commercial |
$1,520.00
|
| Rate for Payer: Humana Commercial |
$1,360.00
|
| Rate for Payer: Humana KY Medicaid |
$550.24
|
| Rate for Payer: Kentucky WC Medicaid |
$555.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,312.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,180.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$480.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$561.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,408.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$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 REPAIR AORTA(P
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 33320
|
| Hospital Charge Code |
761P1284
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$560.00 |
| Max. Negotiated Rate |
$1,785.60 |
| Rate for Payer: Aetna Commercial |
$1,785.60
|
| Rate for Payer: Ambetter Exchange |
$1,006.81
|
| Rate for Payer: Anthem Medicaid |
$891.85
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,006.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,006.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,208.17
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,693.30
|
| Rate for Payer: Healthspan PPO |
$1,755.59
|
| Rate for Payer: Humana Medicaid |
$891.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,488.88
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,006.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,006.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$909.69
|
| Rate for Payer: Molina Healthcare Passport |
$891.85
|
| Rate for Payer: Multiplan PHCS |
$960.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,308.85
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$900.77
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,006.81
|
|
|
SUTURE REPAIR INTERMED >30CM
|
Facility
|
OP
|
$218.00
|
|
| Hospital Charge Code |
45000330
|
|
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 REPAIR INTERMED >30CM
|
Facility
|
IP
|
$218.00
|
|
| Hospital Charge Code |
45000330
|
|
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
|
|
|
SUTURE REPAIR INTERMED >30CM
|
Facility
|
IP
|
$209.00
|
|
| Hospital Charge Code |
76102550
|
|
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 REPAIR INTERMED >30CM
|
Facility
|
OP
|
$209.00
|
|
| Hospital Charge Code |
76102550
|
|
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 REPAIR INTERMED >30CM
|
Facility
|
OP
|
$218.00
|
|
| Hospital Charge Code |
45000323
|
|
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 REPAIR INTERMED >30CM
|
Facility
|
IP
|
$209.00
|
|
| Hospital Charge Code |
76102558
|
|
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 REPAIR INTERMED >30CM
|
Facility
|
IP
|
$218.00
|
|
| Hospital Charge Code |
45000323
|
|
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
|
|
|
SUTURE REPAIR INTERMED >30CM
|
Facility
|
OP
|
$209.00
|
|
| Hospital Charge Code |
76102558
|
|
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 REPAIR SIMPLE
|
Facility
|
IP
|
$218.00
|
|
| Hospital Charge Code |
45000322
|
|
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
|
|
|
SUTURE REPAIR SIMPLE
|
Facility
|
OP
|
$218.00
|
|
| Hospital Charge Code |
45000322
|
|
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 SECDRY ABDOM WALL EVI(P
|
Professional
|
Both
|
$1,115.00
|
|
|
Service Code
|
HCPCS 49900
|
| Hospital Charge Code |
761P2041
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$249.61 |
| Max. Negotiated Rate |
$1,166.15 |
| Rate for Payer: Aetna Commercial |
$1,166.15
|
| Rate for Payer: Ambetter Exchange |
$785.71
|
| Rate for Payer: Anthem Medicaid |
$249.61
|
| Rate for Payer: Buckeye Individual/Medicaid |
$785.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$785.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$942.85
|
| Rate for Payer: Cash Price |
$557.50
|
| Rate for Payer: Cash Price |
$557.50
|
| Rate for Payer: Cigna Commercial |
$1,087.10
|
| Rate for Payer: Healthspan PPO |
$983.43
|
| Rate for Payer: Humana Medicaid |
$249.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,031.28
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$785.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$785.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$254.60
|
| Rate for Payer: Molina Healthcare Passport |
$249.61
|
| Rate for Payer: Multiplan PHCS |
$669.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,021.42
|
| Rate for Payer: UHCCP Medicaid |
$390.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$252.11
|
| Rate for Payer: Wellcare Medicare Advantage |
$785.71
|
|
|
SUTURE SECDRY ABDOM WALL EVIS
|
Professional
|
Both
|
$1,115.00
|
|
|
Service Code
|
HCPCS 49900
|
| Hospital Charge Code |
76102041
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$249.61 |
| Max. Negotiated Rate |
$1,166.15 |
| Rate for Payer: Aetna Commercial |
$1,166.15
|
| Rate for Payer: Ambetter Exchange |
$785.71
|
| Rate for Payer: Anthem Medicaid |
$249.61
|
| Rate for Payer: Buckeye Individual/Medicaid |
$785.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$785.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$942.85
|
| Rate for Payer: Cash Price |
$557.50
|
| Rate for Payer: Cash Price |
$557.50
|
| Rate for Payer: Cigna Commercial |
$1,087.10
|
| Rate for Payer: Healthspan PPO |
$983.43
|
| Rate for Payer: Humana Medicaid |
$249.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,031.28
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$785.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$785.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$254.60
|
| Rate for Payer: Molina Healthcare Passport |
$249.61
|
| Rate for Payer: Multiplan PHCS |
$669.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,021.42
|
| Rate for Payer: UHCCP Medicaid |
$390.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$252.11
|
| Rate for Payer: Wellcare Medicare Advantage |
$785.71
|
|
|
SUTURE SECDRY ABDOM WALL EVIS
|
Facility
|
OP
|
$1,115.00
|
|
|
Service Code
|
HCPCS 49900
|
| Hospital Charge Code |
76102041
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$334.50 |
| Max. Negotiated Rate |
$1,070.40 |
| Rate for Payer: Aetna Commercial |
$858.55
|
| Rate for Payer: Anthem Medicaid |
$383.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$869.70
|
| Rate for Payer: Cash Price |
$557.50
|
| Rate for Payer: Cigna Commercial |
$925.45
|
| Rate for Payer: First Health Commercial |
$1,059.25
|
| Rate for Payer: Humana Commercial |
$947.75
|
| Rate for Payer: Humana KY Medicaid |
$383.45
|
| Rate for Payer: Kentucky WC Medicaid |
$387.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$914.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$822.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$334.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$391.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$981.20
|
| Rate for Payer: Ohio Health Group HMO |
$836.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$892.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$970.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$769.35
|
| Rate for Payer: PHCS Commercial |
$1,070.40
|
| Rate for Payer: United Healthcare All Payer |
$981.20
|
|
|
SUTURE SECDRY ABDOM WALL EVIS
|
Facility
|
IP
|
$1,115.00
|
|
|
Service Code
|
HCPCS 49900
|
| Hospital Charge Code |
76102041
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$334.50 |
| Max. Negotiated Rate |
$1,070.40 |
| Rate for Payer: Aetna Commercial |
$858.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$869.70
|
| Rate for Payer: Cash Price |
$557.50
|
| Rate for Payer: Cigna Commercial |
$925.45
|
| Rate for Payer: First Health Commercial |
$1,059.25
|
| Rate for Payer: Humana Commercial |
$947.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$914.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$822.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$334.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$981.20
|
| Rate for Payer: Ohio Health Group HMO |
$836.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$892.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$970.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$769.35
|
| Rate for Payer: PHCS Commercial |
$1,070.40
|
| Rate for Payer: United Healthcare All Payer |
$981.20
|
|
|
SUTURE SMALL INTESTINE
|
Facility
|
OP
|
$2,124.00
|
|
|
Service Code
|
HCPCS 44603
|
| Hospital Charge Code |
76101855
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$637.20 |
| Max. Negotiated Rate |
$2,039.04 |
| Rate for Payer: Aetna Commercial |
$1,635.48
|
| Rate for Payer: Anthem Medicaid |
$730.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,656.72
|
| Rate for Payer: Cash Price |
$1,062.00
|
| Rate for Payer: Cigna Commercial |
$1,762.92
|
| Rate for Payer: First Health Commercial |
$2,017.80
|
| Rate for Payer: Humana Commercial |
$1,805.40
|
| Rate for Payer: Humana KY Medicaid |
$730.44
|
| Rate for Payer: Kentucky WC Medicaid |
$737.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,741.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,567.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$637.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$745.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,869.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,593.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,699.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,847.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,465.56
|
| Rate for Payer: PHCS Commercial |
$2,039.04
|
| Rate for Payer: United Healthcare All Payer |
$1,869.12
|
|
|
SUTURE SMALL INTESTINE
|
Professional
|
Both
|
$2,124.00
|
|
|
Service Code
|
HCPCS 44603
|
| Hospital Charge Code |
76101855
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$671.14 |
| Max. Negotiated Rate |
$2,266.28 |
| Rate for Payer: Aetna Commercial |
$2,266.28
|
| Rate for Payer: Ambetter Exchange |
$1,536.45
|
| Rate for Payer: Anthem Medicaid |
$671.14
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,536.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,536.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,843.74
|
| Rate for Payer: Cash Price |
$1,062.00
|
| Rate for Payer: Cash Price |
$1,062.00
|
| Rate for Payer: Cigna Commercial |
$2,051.23
|
| Rate for Payer: Healthspan PPO |
$1,911.19
|
| Rate for Payer: Humana Medicaid |
$671.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,059.23
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,536.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,536.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$684.56
|
| Rate for Payer: Molina Healthcare Passport |
$671.14
|
| Rate for Payer: Multiplan PHCS |
$1,274.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,997.38
|
| Rate for Payer: UHCCP Medicaid |
$743.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$677.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,536.45
|
|
|
SUTURE SMALL INTESTINE
|
Facility
|
IP
|
$2,124.00
|
|
|
Service Code
|
HCPCS 44603
|
| Hospital Charge Code |
76101855
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$637.20 |
| Max. Negotiated Rate |
$2,039.04 |
| Rate for Payer: Aetna Commercial |
$1,635.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,656.72
|
| Rate for Payer: Cash Price |
$1,062.00
|
| Rate for Payer: Cigna Commercial |
$1,762.92
|
| Rate for Payer: First Health Commercial |
$2,017.80
|
| Rate for Payer: Humana Commercial |
$1,805.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,741.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,567.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$637.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,869.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,593.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,699.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,847.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,465.56
|
| Rate for Payer: PHCS Commercial |
$2,039.04
|
| Rate for Payer: United Healthcare All Payer |
$1,869.12
|
|
