|
TENDON EXCISION PALM/FINGER
|
Professional
|
Both
|
$1,450.00
|
|
|
Service Code
|
HCPCS 26145
|
| Hospital Charge Code |
76100677
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$322.71 |
| Max. Negotiated Rate |
$870.00 |
| Rate for Payer: Aetna Commercial |
$731.19
|
| Rate for Payer: Ambetter Exchange |
$495.02
|
| Rate for Payer: Anthem Medicaid |
$322.71
|
| Rate for Payer: Buckeye Individual/Medicaid |
$495.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$495.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$594.02
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cigna Commercial |
$809.90
|
| Rate for Payer: Healthspan PPO |
$662.30
|
| Rate for Payer: Humana Medicaid |
$322.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$627.22
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$495.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$495.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$329.16
|
| Rate for Payer: Molina Healthcare Passport |
$322.71
|
| Rate for Payer: Multiplan PHCS |
$870.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$643.53
|
| Rate for Payer: UHCCP Medicaid |
$507.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$325.94
|
| Rate for Payer: Wellcare Medicare Advantage |
$495.02
|
|
|
TENDON EXCISION PALM/FINGER(P
|
Professional
|
Both
|
$1,450.00
|
|
|
Service Code
|
HCPCS 26145
|
| Hospital Charge Code |
761P0677
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$322.71 |
| Max. Negotiated Rate |
$870.00 |
| Rate for Payer: Aetna Commercial |
$731.19
|
| Rate for Payer: Ambetter Exchange |
$495.02
|
| Rate for Payer: Anthem Medicaid |
$322.71
|
| Rate for Payer: Buckeye Individual/Medicaid |
$495.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$495.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$594.02
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cigna Commercial |
$809.90
|
| Rate for Payer: Healthspan PPO |
$662.30
|
| Rate for Payer: Humana Medicaid |
$322.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$627.22
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$495.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$495.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$329.16
|
| Rate for Payer: Molina Healthcare Passport |
$322.71
|
| Rate for Payer: Multiplan PHCS |
$870.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$643.53
|
| Rate for Payer: UHCCP Medicaid |
$507.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$325.94
|
| Rate for Payer: Wellcare Medicare Advantage |
$495.02
|
|
|
TENDON SHEATH INCISION (EG, FOR TRIGGER FINGER)
|
Facility
|
OP
|
$2,070.25
|
|
|
Service Code
|
CPT 26055
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,478.75 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
|
|
TENDON SHORTENING
|
Facility
|
OP
|
$985.00
|
|
|
Service Code
|
HCPCS 26477
|
| Hospital Charge Code |
76100706
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$338.74 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$758.45
|
| Rate for Payer: Anthem Medicaid |
$338.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$768.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$492.50
|
| Rate for Payer: Cash Price |
$492.50
|
| Rate for Payer: Cigna Commercial |
$817.55
|
| Rate for Payer: First Health Commercial |
$935.75
|
| Rate for Payer: Humana Commercial |
$837.25
|
| Rate for Payer: Humana KY Medicaid |
$338.74
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$342.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$807.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$726.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$345.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$866.80
|
| Rate for Payer: Ohio Health Group HMO |
$738.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$788.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$856.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$679.65
|
| Rate for Payer: PHCS Commercial |
$945.60
|
| Rate for Payer: United Healthcare All Payer |
$866.80
|
|
|
TENDON SHORTENING
|
Facility
|
IP
|
$985.00
|
|
|
Service Code
|
HCPCS 26477
|
| Hospital Charge Code |
76100706
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$295.50 |
| Max. Negotiated Rate |
$945.60 |
| Rate for Payer: Aetna Commercial |
$758.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$768.30
|
| Rate for Payer: Cash Price |
$492.50
|
| Rate for Payer: Cigna Commercial |
$817.55
|
| Rate for Payer: First Health Commercial |
$935.75
|
| Rate for Payer: Humana Commercial |
$837.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$807.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$726.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$295.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$866.80
|
| Rate for Payer: Ohio Health Group HMO |
$738.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$788.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$856.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$679.65
|
| Rate for Payer: PHCS Commercial |
$945.60
|
| Rate for Payer: United Healthcare All Payer |
$866.80
|
|
|
TENDON SHORTENING
|
Professional
|
Both
|
$985.00
|
|
|
Service Code
|
HCPCS 26477
|
| Hospital Charge Code |
76100706
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$270.60 |
| Max. Negotiated Rate |
$998.85 |
| Rate for Payer: Aetna Commercial |
$806.92
|
| Rate for Payer: Ambetter Exchange |
$580.58
|
| Rate for Payer: Anthem Medicaid |
$270.60
|
| Rate for Payer: Buckeye Individual/Medicaid |
$580.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$580.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$696.70
|
| Rate for Payer: Cash Price |
$492.50
|
| Rate for Payer: Cash Price |
$492.50
|
| Rate for Payer: Cigna Commercial |
$998.85
|
| Rate for Payer: Healthspan PPO |
$730.90
|
| Rate for Payer: Humana Medicaid |
$270.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$700.89
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$580.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.58
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$276.01
|
| Rate for Payer: Molina Healthcare Passport |
$270.60
|
| Rate for Payer: Multiplan PHCS |
$591.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$754.75
|
| Rate for Payer: UHCCP Medicaid |
$344.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$273.31
|
| Rate for Payer: Wellcare Medicare Advantage |
$580.58
|
|
|
TENDON SHORTENING(P
|
Professional
|
Both
|
$985.00
|
|
|
Service Code
|
HCPCS 26477
|
| Hospital Charge Code |
761P0706
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$270.60 |
| Max. Negotiated Rate |
$998.85 |
| Rate for Payer: Aetna Commercial |
$806.92
|
| Rate for Payer: Ambetter Exchange |
$580.58
|
| Rate for Payer: Anthem Medicaid |
$270.60
|
| Rate for Payer: Buckeye Individual/Medicaid |
$580.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$580.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$696.70
|
| Rate for Payer: Cash Price |
$492.50
|
| Rate for Payer: Cash Price |
$492.50
|
| Rate for Payer: Cigna Commercial |
$998.85
|
| Rate for Payer: Healthspan PPO |
$730.90
|
| Rate for Payer: Humana Medicaid |
$270.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$700.89
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$580.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.58
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$276.01
|
| Rate for Payer: Molina Healthcare Passport |
$270.60
|
| Rate for Payer: Multiplan PHCS |
$591.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$754.75
|
| Rate for Payer: UHCCP Medicaid |
$344.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$273.31
|
| Rate for Payer: Wellcare Medicare Advantage |
$580.58
|
|
|
TENDON TRANSPLANTATION OR TRANSFER, FLEXOR OR EXTENSOR, FOREARM AND/OR WRIST, SINGLE; EACH TENDON
|
Facility
|
OP
|
$4,197.13
|
|
|
Service Code
|
CPT 25310
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,997.95 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
|
|
TENDRIL SDX A-LEAD 46CM
|
Facility
|
OP
|
$3,875.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,162.50 |
| Max. Negotiated Rate |
$3,720.00 |
| Rate for Payer: Aetna Commercial |
$2,983.75
|
| Rate for Payer: Anthem Medicaid |
$1,332.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,022.50
|
| Rate for Payer: Cash Price |
$1,937.50
|
| Rate for Payer: Cigna Commercial |
$3,216.25
|
| Rate for Payer: First Health Commercial |
$3,681.25
|
| Rate for Payer: Humana Commercial |
$3,293.75
|
| Rate for Payer: Humana KY Medicaid |
$1,332.61
|
| Rate for Payer: Kentucky WC Medicaid |
$1,346.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,177.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,859.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,162.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,359.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,410.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,906.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,371.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,673.75
|
| Rate for Payer: PHCS Commercial |
$3,720.00
|
| Rate for Payer: United Healthcare All Payer |
$3,410.00
|
|
|
TENDRIL SDX A-LEAD 46CM
|
Facility
|
IP
|
$3,875.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,162.50 |
| Max. Negotiated Rate |
$3,720.00 |
| Rate for Payer: Aetna Commercial |
$2,983.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,022.50
|
| Rate for Payer: Cash Price |
$1,937.50
|
| Rate for Payer: Cigna Commercial |
$3,216.25
|
| Rate for Payer: First Health Commercial |
$3,681.25
|
| Rate for Payer: Humana Commercial |
$3,293.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,177.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,859.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,162.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,410.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,906.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,371.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,673.75
|
| Rate for Payer: PHCS Commercial |
$3,720.00
|
| Rate for Payer: United Healthcare All Payer |
$3,410.00
|
|
|
TENECTEPLASE 1mg (50mg SDV)
|
Facility
|
OP
|
$45,220.07
|
|
|
Service Code
|
HCPCS J3101
|
| Hospital Charge Code |
25004340
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$171.94 |
| Max. Negotiated Rate |
$43,411.27 |
| Rate for Payer: Aetna Commercial |
$34,819.45
|
| Rate for Payer: Anthem Medicaid |
$15,551.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$171.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$35,271.65
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$240.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$232.12
|
| Rate for Payer: Cash Price |
$22,610.04
|
| Rate for Payer: Cash Price |
$22,610.04
|
| Rate for Payer: Cigna Commercial |
$37,532.66
|
| Rate for Payer: First Health Commercial |
$42,959.07
|
| Rate for Payer: Humana Commercial |
$38,437.06
|
| Rate for Payer: Humana KY Medicaid |
$15,551.18
|
| Rate for Payer: Humana Medicare Advantage |
$171.94
|
| Rate for Payer: Kentucky WC Medicaid |
$15,709.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$37,080.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$33,372.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$206.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$15,863.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$39,793.66
|
| Rate for Payer: Ohio Health Group HMO |
$33,915.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36,176.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39,341.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31,201.85
|
| Rate for Payer: PHCS Commercial |
$43,411.27
|
| Rate for Payer: United Healthcare All Payer |
$39,793.66
|
|
|
TENECTEPLASE 1mg (50mg SDV)
|
Facility
|
IP
|
$45,220.07
|
|
|
Service Code
|
HCPCS J3101
|
| Hospital Charge Code |
25004340
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13,566.02 |
| Max. Negotiated Rate |
$43,411.27 |
| Rate for Payer: Aetna Commercial |
$34,819.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$35,271.65
|
| Rate for Payer: Cash Price |
$22,610.04
|
| Rate for Payer: Cigna Commercial |
$37,532.66
|
| Rate for Payer: First Health Commercial |
$42,959.07
|
| Rate for Payer: Humana Commercial |
$38,437.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$37,080.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$33,372.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13,566.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$39,793.66
|
| Rate for Payer: Ohio Health Group HMO |
$33,915.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36,176.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39,341.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31,201.85
|
| Rate for Payer: PHCS Commercial |
$43,411.27
|
| Rate for Payer: United Healthcare All Payer |
$39,793.66
|
|
|
TENEX (GUANFACINE) 1 1MG/1TAB
|
Facility
|
IP
|
$4.76
|
|
|
Service Code
|
NDC 29300045801
|
| Hospital Charge Code |
25001506
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$4.57 |
| Rate for Payer: Aetna Commercial |
$3.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.71
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cigna Commercial |
$3.95
|
| Rate for Payer: First Health Commercial |
$4.52
|
| Rate for Payer: Humana Commercial |
$4.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.19
|
| Rate for Payer: Ohio Health Group HMO |
$3.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.28
|
| Rate for Payer: PHCS Commercial |
$4.57
|
| Rate for Payer: United Healthcare All Payer |
$4.19
|
|
|
TENEX (GUANFACINE) 1 1MG/1TAB
|
Facility
|
OP
|
$4.76
|
|
|
Service Code
|
NDC 29300045801
|
| Hospital Charge Code |
25001506
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$4.57 |
| Rate for Payer: Aetna Commercial |
$3.67
|
| Rate for Payer: Anthem Medicaid |
$1.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.71
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cigna Commercial |
$3.95
|
| Rate for Payer: First Health Commercial |
$4.52
|
| Rate for Payer: Humana Commercial |
$4.05
|
| Rate for Payer: Humana KY Medicaid |
$1.64
|
| Rate for Payer: Kentucky WC Medicaid |
$1.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.19
|
| Rate for Payer: Ohio Health Group HMO |
$3.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.28
|
| Rate for Payer: PHCS Commercial |
$4.57
|
| Rate for Payer: United Healthcare All Payer |
$4.19
|
|
|
TENFUSE 2.7*16MM STRAIGHT
|
Facility
|
OP
|
$5,731.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,719.38 |
| Max. Negotiated Rate |
$5,502.00 |
| Rate for Payer: Aetna Commercial |
$4,413.06
|
| Rate for Payer: Anthem Medicaid |
$1,970.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,470.38
|
| Rate for Payer: Cash Price |
$2,865.62
|
| Rate for Payer: Cigna Commercial |
$4,756.94
|
| Rate for Payer: First Health Commercial |
$5,444.69
|
| Rate for Payer: Humana Commercial |
$4,871.56
|
| Rate for Payer: Humana KY Medicaid |
$1,970.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,991.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,699.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,229.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,719.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,010.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,043.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,298.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,585.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,986.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,954.56
|
| Rate for Payer: PHCS Commercial |
$5,502.00
|
| Rate for Payer: United Healthcare All Payer |
$5,043.50
|
|
|
TENFUSE 2.7*16MM STRAIGHT
|
Facility
|
IP
|
$5,731.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,719.38 |
| Max. Negotiated Rate |
$5,502.00 |
| Rate for Payer: Aetna Commercial |
$4,413.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,470.38
|
| Rate for Payer: Cash Price |
$2,865.62
|
| Rate for Payer: Cigna Commercial |
$4,756.94
|
| Rate for Payer: First Health Commercial |
$5,444.69
|
| Rate for Payer: Humana Commercial |
$4,871.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,699.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,229.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,719.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,043.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,298.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,585.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,986.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,954.56
|
| Rate for Payer: PHCS Commercial |
$5,502.00
|
| Rate for Payer: United Healthcare All Payer |
$5,043.50
|
|
|
TENODESIS DISTAL JOINT EACH
|
Professional
|
Both
|
$1,520.00
|
|
|
Service Code
|
HCPCS 26474
|
| Hospital Charge Code |
76100705
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$292.70 |
| Max. Negotiated Rate |
$1,021.25 |
| Rate for Payer: Aetna Commercial |
$819.62
|
| Rate for Payer: Ambetter Exchange |
$601.96
|
| Rate for Payer: Anthem Medicaid |
$292.70
|
| Rate for Payer: Buckeye Individual/Medicaid |
$601.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$601.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$722.35
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cigna Commercial |
$1,021.25
|
| Rate for Payer: Healthspan PPO |
$742.39
|
| Rate for Payer: Humana Medicaid |
$292.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$721.81
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$601.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$601.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$298.55
|
| Rate for Payer: Molina Healthcare Passport |
$292.70
|
| Rate for Payer: Multiplan PHCS |
$912.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$782.55
|
| Rate for Payer: UHCCP Medicaid |
$532.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$295.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$601.96
|
|
|
TENODESIS DISTAL JOINT EACH
|
Facility
|
OP
|
$1,520.00
|
|
|
Service Code
|
HCPCS 26474
|
| Hospital Charge Code |
76100705
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$522.73 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$1,170.40
|
| Rate for Payer: Anthem Medicaid |
$522.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,185.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cigna Commercial |
$1,261.60
|
| Rate for Payer: First Health Commercial |
$1,444.00
|
| Rate for Payer: Humana Commercial |
$1,292.00
|
| Rate for Payer: Humana KY Medicaid |
$522.73
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$528.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,246.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,121.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$533.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,337.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,140.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,322.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,048.80
|
| Rate for Payer: PHCS Commercial |
$1,459.20
|
| Rate for Payer: United Healthcare All Payer |
$1,337.60
|
|
|
TENODESIS DISTAL JOINT EACH
|
Facility
|
IP
|
$1,520.00
|
|
|
Service Code
|
HCPCS 26474
|
| Hospital Charge Code |
76100705
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$456.00 |
| Max. Negotiated Rate |
$1,459.20 |
| Rate for Payer: Aetna Commercial |
$1,170.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,185.60
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cigna Commercial |
$1,261.60
|
| Rate for Payer: First Health Commercial |
$1,444.00
|
| Rate for Payer: Humana Commercial |
$1,292.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,246.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,121.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$456.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,337.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,140.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,322.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,048.80
|
| Rate for Payer: PHCS Commercial |
$1,459.20
|
| Rate for Payer: United Healthcare All Payer |
$1,337.60
|
|
|
TENODESIS DISTAL JOINT EACH(P
|
Professional
|
Both
|
$1,520.00
|
|
|
Service Code
|
HCPCS 26474
|
| Hospital Charge Code |
761P0705
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$292.70 |
| Max. Negotiated Rate |
$1,021.25 |
| Rate for Payer: Aetna Commercial |
$819.62
|
| Rate for Payer: Ambetter Exchange |
$601.96
|
| Rate for Payer: Anthem Medicaid |
$292.70
|
| Rate for Payer: Buckeye Individual/Medicaid |
$601.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$601.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$722.35
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cigna Commercial |
$1,021.25
|
| Rate for Payer: Healthspan PPO |
$742.39
|
| Rate for Payer: Humana Medicaid |
$292.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$721.81
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$601.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$601.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$298.55
|
| Rate for Payer: Molina Healthcare Passport |
$292.70
|
| Rate for Payer: Multiplan PHCS |
$912.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$782.55
|
| Rate for Payer: UHCCP Medicaid |
$532.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$295.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$601.96
|
|
|
TENODESIS LONG TENDON BICEPS
|
Facility
|
OP
|
$1,650.00
|
|
|
Service Code
|
HCPCS 23430
|
| Hospital Charge Code |
76100460
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$567.43 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,270.50
|
| Rate for Payer: Anthem Medicaid |
$567.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,287.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| 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 |
$6,600.66
|
| 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 |
$7,920.79
|
| 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
|
|
|
TENODESIS LONG TENDON BICEPS
|
Professional
|
Both
|
$1,650.00
|
|
|
Service Code
|
HCPCS 23430
|
| Hospital Charge Code |
76100460
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$506.31 |
| Max. Negotiated Rate |
$1,199.77 |
| Rate for Payer: Aetna Commercial |
$1,093.12
|
| Rate for Payer: Ambetter Exchange |
$708.66
|
| Rate for Payer: Anthem Medicaid |
$506.31
|
| Rate for Payer: Buckeye Individual/Medicaid |
$708.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$708.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$850.39
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cigna Commercial |
$1,199.77
|
| Rate for Payer: Healthspan PPO |
$990.13
|
| Rate for Payer: Humana Medicaid |
$506.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$919.81
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$708.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$708.66
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$516.44
|
| Rate for Payer: Molina Healthcare Passport |
$506.31
|
| Rate for Payer: Multiplan PHCS |
$990.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$921.26
|
| Rate for Payer: UHCCP Medicaid |
$577.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$511.37
|
| Rate for Payer: Wellcare Medicare Advantage |
$708.66
|
|
|
TENODESIS LONG TENDON BICEPS
|
Facility
|
IP
|
$1,650.00
|
|
|
Service Code
|
HCPCS 23430
|
| Hospital Charge Code |
76100460
|
|
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
|
|
|
TENODESIS LONG TENDON BICEPS(P
|
Professional
|
Both
|
$1,650.00
|
|
|
Service Code
|
HCPCS 23430
|
| Hospital Charge Code |
761P0460
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$506.31 |
| Max. Negotiated Rate |
$1,199.77 |
| Rate for Payer: Aetna Commercial |
$1,093.12
|
| Rate for Payer: Ambetter Exchange |
$708.66
|
| Rate for Payer: Anthem Medicaid |
$506.31
|
| Rate for Payer: Buckeye Individual/Medicaid |
$708.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$708.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$850.39
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cigna Commercial |
$1,199.77
|
| Rate for Payer: Healthspan PPO |
$990.13
|
| Rate for Payer: Humana Medicaid |
$506.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$919.81
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$708.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$708.66
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$516.44
|
| Rate for Payer: Molina Healthcare Passport |
$506.31
|
| Rate for Payer: Multiplan PHCS |
$990.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$921.26
|
| Rate for Payer: UHCCP Medicaid |
$577.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$511.37
|
| Rate for Payer: Wellcare Medicare Advantage |
$708.66
|
|
|
TENODESIS OF LONG TENDON OF BICEPS
|
Facility
|
OP
|
$9,240.92
|
|
|
Service Code
|
CPT 23430
|
|
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
|
|
