|
TENODESIS SCREW 5.5MMX10
|
Facility
|
IP
|
$3,068.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$920.62 |
| Max. Negotiated Rate |
$2,946.00 |
| Rate for Payer: Aetna Commercial |
$2,362.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,393.62
|
| Rate for Payer: Cash Price |
$1,534.38
|
| Rate for Payer: Cigna Commercial |
$2,547.06
|
| Rate for Payer: First Health Commercial |
$2,915.31
|
| Rate for Payer: Humana Commercial |
$2,608.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,516.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,264.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$920.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,700.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,301.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,455.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,669.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,117.44
|
| Rate for Payer: PHCS Commercial |
$2,946.00
|
| Rate for Payer: United Healthcare All Payer |
$2,700.50
|
|
|
TENODESIS SCREW 5.5MMX10
|
Facility
|
OP
|
$3,068.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$920.62 |
| Max. Negotiated Rate |
$2,946.00 |
| Rate for Payer: Aetna Commercial |
$2,362.94
|
| Rate for Payer: Anthem Medicaid |
$1,055.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,393.62
|
| Rate for Payer: Cash Price |
$1,534.38
|
| Rate for Payer: Cigna Commercial |
$2,547.06
|
| Rate for Payer: First Health Commercial |
$2,915.31
|
| Rate for Payer: Humana Commercial |
$2,608.44
|
| Rate for Payer: Humana KY Medicaid |
$1,055.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,066.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,516.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,264.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$920.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,076.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,700.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,301.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,455.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,669.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,117.44
|
| Rate for Payer: PHCS Commercial |
$2,946.00
|
| Rate for Payer: United Healthcare All Payer |
$2,700.50
|
|
|
TENOGLIDE TENDON PROT SHT 4*5
|
Facility
|
IP
|
$11,553.82
|
|
|
Service Code
|
HCPCS C9356
|
| Hospital Charge Code |
27000132
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,466.15 |
| Max. Negotiated Rate |
$11,091.67 |
| Rate for Payer: Aetna Commercial |
$8,896.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,011.98
|
| Rate for Payer: Cash Price |
$5,776.91
|
| Rate for Payer: Cigna Commercial |
$9,589.67
|
| Rate for Payer: First Health Commercial |
$10,976.13
|
| Rate for Payer: Humana Commercial |
$9,820.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,474.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,526.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,466.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,167.36
|
| Rate for Payer: Ohio Health Group HMO |
$8,665.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,243.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,051.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,972.14
|
| Rate for Payer: PHCS Commercial |
$11,091.67
|
| Rate for Payer: United Healthcare All Payer |
$10,167.36
|
|
|
TENOGLIDE TENDON PROT SHT 4*5
|
Facility
|
OP
|
$11,553.82
|
|
|
Service Code
|
HCPCS C9356
|
| Hospital Charge Code |
27000132
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,466.15 |
| Max. Negotiated Rate |
$11,091.67 |
| Rate for Payer: Aetna Commercial |
$8,896.44
|
| Rate for Payer: Anthem Medicaid |
$3,973.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,011.98
|
| Rate for Payer: Cash Price |
$5,776.91
|
| Rate for Payer: Cigna Commercial |
$9,589.67
|
| Rate for Payer: First Health Commercial |
$10,976.13
|
| Rate for Payer: Humana Commercial |
$9,820.75
|
| Rate for Payer: Humana KY Medicaid |
$3,973.36
|
| Rate for Payer: Kentucky WC Medicaid |
$4,013.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,474.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,526.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,466.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,053.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,167.36
|
| Rate for Payer: Ohio Health Group HMO |
$8,665.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,243.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,051.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,972.14
|
| Rate for Payer: PHCS Commercial |
$11,091.67
|
| Rate for Payer: United Healthcare All Payer |
$10,167.36
|
|
|
TENOLYSIS, EXTENSOR, FOOT; SINGLE TENDON
|
Facility
|
OP
|
$4,197.13
|
|
|
Service Code
|
CPT 28225
|
|
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
|
|
|
TENORMIN (ATENOLOL) 25MG/1TAB
|
Facility
|
IP
|
$4.46
|
|
|
Service Code
|
NDC 60687060501
|
| Hospital Charge Code |
25001507
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna Commercial |
$3.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.48
|
| Rate for Payer: Cash Price |
$2.23
|
| Rate for Payer: Cigna Commercial |
$3.70
|
| Rate for Payer: First Health Commercial |
$4.24
|
| Rate for Payer: Humana Commercial |
$3.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.92
|
| Rate for Payer: Ohio Health Group HMO |
$3.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.08
|
| Rate for Payer: PHCS Commercial |
$4.28
|
| Rate for Payer: United Healthcare All Payer |
$3.92
|
|
|
TENORMIN (ATENOLOL) 25MG/1TAB
|
Facility
|
OP
|
$4.46
|
|
|
Service Code
|
NDC 60687060501
|
| Hospital Charge Code |
25001507
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna Commercial |
$3.43
|
| Rate for Payer: Anthem Medicaid |
$1.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.48
|
| Rate for Payer: Cash Price |
$2.23
|
| Rate for Payer: Cigna Commercial |
$3.70
|
| Rate for Payer: First Health Commercial |
$4.24
|
| Rate for Payer: Humana Commercial |
$3.79
|
| Rate for Payer: Humana KY Medicaid |
$1.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.92
|
| Rate for Payer: Ohio Health Group HMO |
$3.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.08
|
| Rate for Payer: PHCS Commercial |
$4.28
|
| Rate for Payer: United Healthcare All Payer |
$3.92
|
|
|
TENORMIN (ATENOLOL) 50MG/1TAB
|
Facility
|
IP
|
$4.29
|
|
|
Service Code
|
NDC 51079068420
|
| Hospital Charge Code |
25001508
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$4.12 |
| Rate for Payer: Aetna Commercial |
$3.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.35
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cigna Commercial |
$3.56
|
| Rate for Payer: First Health Commercial |
$4.08
|
| Rate for Payer: Humana Commercial |
$3.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.78
|
| Rate for Payer: Ohio Health Group HMO |
$3.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.96
|
| Rate for Payer: PHCS Commercial |
$4.12
|
| Rate for Payer: United Healthcare All Payer |
$3.78
|
|
|
TENORMIN (ATENOLOL) 50MG/1TAB
|
Facility
|
OP
|
$4.29
|
|
|
Service Code
|
NDC 51079068420
|
| Hospital Charge Code |
25001508
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$4.12 |
| Rate for Payer: Aetna Commercial |
$3.30
|
| Rate for Payer: Anthem Medicaid |
$1.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.35
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cigna Commercial |
$3.56
|
| Rate for Payer: First Health Commercial |
$4.08
|
| Rate for Payer: Humana Commercial |
$3.65
|
| Rate for Payer: Humana KY Medicaid |
$1.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.78
|
| Rate for Payer: Ohio Health Group HMO |
$3.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.96
|
| Rate for Payer: PHCS Commercial |
$4.12
|
| Rate for Payer: United Healthcare All Payer |
$3.78
|
|
|
TENOTMYLENTHNGRELEAS ABDUHALU
|
Facility
|
IP
|
$3,921.00
|
|
|
Service Code
|
HCPCS 28240
|
| Hospital Charge Code |
45000174
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,176.30 |
| Max. Negotiated Rate |
$3,764.16 |
| Rate for Payer: Aetna Commercial |
$3,019.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,058.38
|
| Rate for Payer: Cash Price |
$1,960.50
|
| Rate for Payer: Cigna Commercial |
$3,254.43
|
| Rate for Payer: First Health Commercial |
$3,724.95
|
| Rate for Payer: Humana Commercial |
$3,332.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,215.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,893.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,176.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,450.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,940.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,136.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,411.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,705.49
|
| Rate for Payer: PHCS Commercial |
$3,764.16
|
| Rate for Payer: United Healthcare All Payer |
$3,450.48
|
|
|
TENOTMYLENTHNGRELEAS ABDUHALU
|
Facility
|
OP
|
$3,921.00
|
|
|
Service Code
|
HCPCS 28240
|
| Hospital Charge Code |
45000174
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,348.43 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$3,019.17
|
| Rate for Payer: Anthem Medicaid |
$1,348.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,058.38
|
| 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 |
$1,960.50
|
| Rate for Payer: Cash Price |
$1,960.50
|
| Rate for Payer: Cigna Commercial |
$3,254.43
|
| Rate for Payer: First Health Commercial |
$3,724.95
|
| Rate for Payer: Humana Commercial |
$3,332.85
|
| Rate for Payer: Humana KY Medicaid |
$1,348.43
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,362.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,215.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,893.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,375.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,450.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,940.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,136.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,411.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,705.49
|
| Rate for Payer: PHCS Commercial |
$3,764.16
|
| Rate for Payer: United Healthcare All Payer |
$3,450.48
|
|
|
TENOTOMY, ADDUCTOR HIP, OPEN
|
Facility
|
IP
|
$710.00
|
|
|
Service Code
|
HCPCS 27001
|
| Hospital Charge Code |
76100760
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$213.00 |
| Max. Negotiated Rate |
$681.60 |
| Rate for Payer: Aetna Commercial |
$546.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$553.80
|
| Rate for Payer: Cash Price |
$355.00
|
| Rate for Payer: Cigna Commercial |
$589.30
|
| Rate for Payer: First Health Commercial |
$674.50
|
| Rate for Payer: Humana Commercial |
$603.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$582.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$523.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$213.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$624.80
|
| Rate for Payer: Ohio Health Group HMO |
$532.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$568.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$617.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$489.90
|
| Rate for Payer: PHCS Commercial |
$681.60
|
| Rate for Payer: United Healthcare All Payer |
$624.80
|
|
|
TENOTOMY, ADDUCTOR HIP, OPEN
|
Facility
|
OP
|
$710.00
|
|
|
Service Code
|
HCPCS 27001
|
| Hospital Charge Code |
76100760
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$244.17 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$546.70
|
| Rate for Payer: Anthem Medicaid |
$244.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$553.80
|
| 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 |
$355.00
|
| Rate for Payer: Cash Price |
$355.00
|
| Rate for Payer: Cigna Commercial |
$589.30
|
| Rate for Payer: First Health Commercial |
$674.50
|
| Rate for Payer: Humana Commercial |
$603.50
|
| Rate for Payer: Humana KY Medicaid |
$244.17
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$246.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$582.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$523.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$249.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$624.80
|
| Rate for Payer: Ohio Health Group HMO |
$532.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$568.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$617.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$489.90
|
| Rate for Payer: PHCS Commercial |
$681.60
|
| Rate for Payer: United Healthcare All Payer |
$624.80
|
|
|
TENOTOMY, ADDUCTOR HIP, OPEN
|
Professional
|
Both
|
$710.00
|
|
|
Service Code
|
HCPCS 27001
|
| Hospital Charge Code |
76100760
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$248.50 |
| Max. Negotiated Rate |
$869.11 |
| Rate for Payer: Aetna Commercial |
$791.75
|
| Rate for Payer: Ambetter Exchange |
$514.60
|
| Rate for Payer: Anthem Medicaid |
$297.94
|
| Rate for Payer: Buckeye Individual/Medicaid |
$514.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$514.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$617.52
|
| Rate for Payer: Cash Price |
$355.00
|
| Rate for Payer: Cash Price |
$355.00
|
| Rate for Payer: Cigna Commercial |
$869.11
|
| Rate for Payer: Healthspan PPO |
$717.16
|
| Rate for Payer: Humana Medicaid |
$297.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$666.26
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$514.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$514.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$303.90
|
| Rate for Payer: Molina Healthcare Passport |
$297.94
|
| Rate for Payer: Multiplan PHCS |
$426.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$668.98
|
| Rate for Payer: UHCCP Medicaid |
$248.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$300.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$514.60
|
|
|
TENOTOMY, ADDUCTOR HIP, OPEN(P
|
Professional
|
Both
|
$710.00
|
|
|
Service Code
|
HCPCS 27001
|
| Hospital Charge Code |
761P0760
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$248.50 |
| Max. Negotiated Rate |
$869.11 |
| Rate for Payer: Aetna Commercial |
$791.75
|
| Rate for Payer: Ambetter Exchange |
$514.60
|
| Rate for Payer: Anthem Medicaid |
$297.94
|
| Rate for Payer: Buckeye Individual/Medicaid |
$514.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$514.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$617.52
|
| Rate for Payer: Cash Price |
$355.00
|
| Rate for Payer: Cash Price |
$355.00
|
| Rate for Payer: Cigna Commercial |
$869.11
|
| Rate for Payer: Healthspan PPO |
$717.16
|
| Rate for Payer: Humana Medicaid |
$297.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$666.26
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$514.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$514.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$303.90
|
| Rate for Payer: Molina Healthcare Passport |
$297.94
|
| Rate for Payer: Multiplan PHCS |
$426.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$668.98
|
| Rate for Payer: UHCCP Medicaid |
$248.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$300.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$514.60
|
|
|
TENOTOMY, ELBOW, LATERAL OR MEDIAL (EG, EPICONDYLITIS, TENNIS ELBOW, GOLFER'S ELBOW); DEBRIDEMENT, SOFT TISSUE AND/OR BONE, OPEN WITH TENDON REPAIR OR REATTACHMENT
|
Facility
|
OP
|
$4,197.13
|
|
|
Service Code
|
CPT 24359
|
|
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
|
|
|
TENOTOMY, OPEN, EXTENSOR, FOOT OR TOE, EACH TENDON
|
Facility
|
OP
|
$2,070.25
|
|
|
Service Code
|
CPT 28234
|
|
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
|
|
|
TENOTOMY, OPEN, HAMSTRING, KNEE TO HIP; MULTIPLE TENDONS, 1 LEG
|
Facility
|
OP
|
$4,197.13
|
|
|
Service Code
|
CPT 27391
|
|
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
|
|
|
TENOTOMY, OPEN, TENDON FLEXOR; TOE, SINGLE TENDON (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$2,070.25
|
|
|
Service Code
|
CPT 28232
|
|
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
|
|
|
TENOTOMY, PERCUTANEOUS, TOE; SINGLE TENDON
|
Facility
|
OP
|
$2,070.25
|
|
|
Service Code
|
CPT 28010
|
|
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
|
|
|
TENOTOMY PERCUTAN, SINGLE TEND
|
Professional
|
Both
|
$2,970.00
|
|
|
Service Code
|
HCPCS 28010
|
| Hospital Charge Code |
76102678
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$157.84 |
| Max. Negotiated Rate |
$1,782.00 |
| Rate for Payer: Aetna Commercial |
$316.64
|
| Rate for Payer: Ambetter Exchange |
$197.84
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$157.84
|
| Rate for Payer: Anthem Medicaid |
$192.26
|
| Rate for Payer: Buckeye Individual/Medicaid |
$197.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$197.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$237.41
|
| Rate for Payer: Cash Price |
$1,485.00
|
| Rate for Payer: Cash Price |
$1,485.00
|
| Rate for Payer: Cigna Commercial |
$344.32
|
| Rate for Payer: Healthspan PPO |
$304.75
|
| Rate for Payer: Humana Medicaid |
$192.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$258.57
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$197.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$197.84
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$196.11
|
| Rate for Payer: Molina Healthcare Passport |
$192.26
|
| Rate for Payer: Multiplan PHCS |
$1,782.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$257.19
|
| Rate for Payer: UHCCP Medicaid |
$165.73
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$194.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$197.84
|
|
|
TENOTOMY PERCUTAN, SINGLE TEND
|
Facility
|
IP
|
$2,970.00
|
|
|
Service Code
|
HCPCS 28010
|
| Hospital Charge Code |
76102678
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$891.00 |
| Max. Negotiated Rate |
$2,851.20 |
| Rate for Payer: Aetna Commercial |
$2,286.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,316.60
|
| Rate for Payer: Cash Price |
$1,485.00
|
| Rate for Payer: Cigna Commercial |
$2,465.10
|
| Rate for Payer: First Health Commercial |
$2,821.50
|
| Rate for Payer: Humana Commercial |
$2,524.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,435.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,191.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$891.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,613.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,227.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,376.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,583.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,049.30
|
| Rate for Payer: PHCS Commercial |
$2,851.20
|
| Rate for Payer: United Healthcare All Payer |
$2,613.60
|
|
|
TENOTOMY PERCUTAN, SINGLE TEND
|
Facility
|
OP
|
$2,970.00
|
|
|
Service Code
|
HCPCS 28010
|
| Hospital Charge Code |
76102678
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,021.38 |
| Max. Negotiated Rate |
$2,851.20 |
| Rate for Payer: Aetna Commercial |
$2,286.90
|
| Rate for Payer: Anthem Medicaid |
$1,021.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,316.60
|
| 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 |
$1,485.00
|
| Rate for Payer: Cash Price |
$1,485.00
|
| Rate for Payer: Cigna Commercial |
$2,465.10
|
| Rate for Payer: First Health Commercial |
$2,821.50
|
| Rate for Payer: Humana Commercial |
$2,524.50
|
| Rate for Payer: Humana KY Medicaid |
$1,021.38
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,031.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,435.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,191.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,041.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,613.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,227.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,376.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,583.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,049.30
|
| Rate for Payer: PHCS Commercial |
$2,851.20
|
| Rate for Payer: United Healthcare All Payer |
$2,613.60
|
|
|
TENOTOMY PERCUTAN, SING TEND(P
|
Professional
|
Both
|
$430.00
|
|
|
Service Code
|
HCPCS 28010
|
| Hospital Charge Code |
761P2678
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$157.84 |
| Max. Negotiated Rate |
$344.32 |
| Rate for Payer: Aetna Commercial |
$316.64
|
| Rate for Payer: Ambetter Exchange |
$197.84
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$157.84
|
| Rate for Payer: Anthem Medicaid |
$192.26
|
| Rate for Payer: Buckeye Individual/Medicaid |
$197.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$197.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$237.41
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Cigna Commercial |
$344.32
|
| Rate for Payer: Healthspan PPO |
$304.75
|
| Rate for Payer: Humana Medicaid |
$192.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$258.57
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$197.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$197.84
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$196.11
|
| Rate for Payer: Molina Healthcare Passport |
$192.26
|
| Rate for Payer: Multiplan PHCS |
$258.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$257.19
|
| Rate for Payer: UHCCP Medicaid |
$165.73
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$194.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$197.84
|
|
|
TENOTOMY PERCUTAN, SING TEND(T
|
Facility
|
IP
|
$2,540.00
|
|
|
Service Code
|
HCPCS 28010
|
| Hospital Charge Code |
761T2678
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$762.00 |
| Max. Negotiated Rate |
$2,438.40 |
| Rate for Payer: Aetna Commercial |
$1,955.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,981.20
|
| Rate for Payer: Cash Price |
$1,270.00
|
| Rate for Payer: Cigna Commercial |
$2,108.20
|
| Rate for Payer: First Health Commercial |
$2,413.00
|
| Rate for Payer: Humana Commercial |
$2,159.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,082.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,874.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$762.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,235.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,905.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,032.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,209.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,752.60
|
| Rate for Payer: PHCS Commercial |
$2,438.40
|
| Rate for Payer: United Healthcare All Payer |
$2,235.20
|
|
