|
DECOMP. LOWER LET(T
|
Facility
|
OP
|
$4,818.00
|
|
|
Service Code
|
HCPCS 27600
|
| Hospital Charge Code |
761T0883
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$626.34 |
| Max. Negotiated Rate |
$4,625.28 |
| Rate for Payer: Aetna Commercial |
$3,709.86
|
| Rate for Payer: Anthem Medicaid |
$1,656.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,758.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$2,409.00
|
| Rate for Payer: Cash Price |
$2,409.00
|
| Rate for Payer: Cigna Commercial |
$3,998.94
|
| Rate for Payer: First Health Commercial |
$4,577.10
|
| Rate for Payer: Humana Commercial |
$4,095.30
|
| Rate for Payer: Humana KY Medicaid |
$1,656.91
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,673.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,950.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,555.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,690.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,239.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,613.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$963.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$626.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,493.58
|
| Rate for Payer: PHCS Commercial |
$4,625.28
|
| Rate for Payer: United Healthcare All Payer |
$4,239.84
|
|
|
DECOMP. LOWER LET(T
|
Facility
|
IP
|
$4,818.00
|
|
|
Service Code
|
HCPCS 27600
|
| Hospital Charge Code |
761T0883
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$626.34 |
| Max. Negotiated Rate |
$4,625.28 |
| Rate for Payer: Aetna Commercial |
$3,709.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,758.04
|
| Rate for Payer: Cash Price |
$2,409.00
|
| Rate for Payer: Cigna Commercial |
$3,998.94
|
| Rate for Payer: First Health Commercial |
$4,577.10
|
| Rate for Payer: Humana Commercial |
$4,095.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,950.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,555.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,445.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,239.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,613.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$963.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$626.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,493.58
|
| Rate for Payer: PHCS Commercial |
$4,625.28
|
| Rate for Payer: United Healthcare All Payer |
$4,239.84
|
|
|
DECOMPRESS FASCIOTOMY - FOREAR
|
Facility
|
OP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 25023
|
| Hospital Charge Code |
76100566
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$1,386.00
|
| Rate for Payer: Anthem Medicaid |
$619.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,404.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,494.00
|
| Rate for Payer: First Health Commercial |
$1,710.00
|
| Rate for Payer: Humana Commercial |
$1,530.00
|
| Rate for Payer: Humana KY Medicaid |
$619.02
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$625.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,476.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,328.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$631.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,584.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,350.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$558.00
|
| Rate for Payer: PHCS Commercial |
$1,728.00
|
| Rate for Payer: United Healthcare All Payer |
$1,584.00
|
|
|
DECOMPRESS FASCIOTOMY - FOREAR
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
HCPCS 25023
|
| Hospital Charge Code |
76100566
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$515.01 |
| Max. Negotiated Rate |
$1,830.59 |
| Rate for Payer: Aetna Commercial |
$1,587.93
|
| Rate for Payer: Anthem Medicaid |
$515.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,800.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,830.59
|
| Rate for Payer: Healthspan PPO |
$1,438.33
|
| Rate for Payer: Humana Medicaid |
$515.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,362.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$525.31
|
| Rate for Payer: Molina Healthcare Passport |
$515.01
|
| Rate for Payer: Multiplan PHCS |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,260.00
|
| Rate for Payer: UHCCP Medicaid |
$630.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$520.16
|
|
|
DECOMPRESS FASCIOTOMY - FOREAR
|
Facility
|
IP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 25023
|
| Hospital Charge Code |
76100566
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$1,728.00 |
| Rate for Payer: Aetna Commercial |
$1,386.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,404.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,494.00
|
| Rate for Payer: First Health Commercial |
$1,710.00
|
| Rate for Payer: Humana Commercial |
$1,530.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,476.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,328.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$540.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,584.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,350.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$558.00
|
| Rate for Payer: PHCS Commercial |
$1,728.00
|
| Rate for Payer: United Healthcare All Payer |
$1,584.00
|
|
|
DECOMPRESS FASCIOTOMY - FOREAR
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
HCPCS 25023
|
| Hospital Charge Code |
761P0566
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$515.01 |
| Max. Negotiated Rate |
$1,830.59 |
| Rate for Payer: Aetna Commercial |
$1,587.93
|
| Rate for Payer: Anthem Medicaid |
$515.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,800.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,830.59
|
| Rate for Payer: Healthspan PPO |
$1,438.33
|
| Rate for Payer: Humana Medicaid |
$515.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,362.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$525.31
|
| Rate for Payer: Molina Healthcare Passport |
$515.01
|
| Rate for Payer: Multiplan PHCS |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,260.00
|
| Rate for Payer: UHCCP Medicaid |
$630.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$520.16
|
|
|
DECOMPRESS. FASCIOTOMY FOREARM
|
Facility
|
OP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 24495
|
| Hospital Charge Code |
76100531
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$1,232.00
|
| Rate for Payer: Anthem Medicaid |
$550.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,248.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,661.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,351.78
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,328.00
|
| Rate for Payer: First Health Commercial |
$1,520.00
|
| Rate for Payer: Humana Commercial |
$1,360.00
|
| Rate for Payer: Humana KY Medicaid |
$550.24
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$555.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,312.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,180.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| 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 |
$320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$208.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$496.00
|
| Rate for Payer: PHCS Commercial |
$1,536.00
|
| Rate for Payer: United Healthcare All Payer |
$1,408.00
|
|
|
DECOMPRESS. FASCIOTOMY FOREARM
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 24495
|
| Hospital Charge Code |
761P0531
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$403.67 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: Aetna Commercial |
$949.57
|
| Rate for Payer: Anthem Medicaid |
$403.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,600.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,086.54
|
| Rate for Payer: Healthspan PPO |
$860.11
|
| Rate for Payer: Humana Medicaid |
$403.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$814.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$411.74
|
| Rate for Payer: Molina Healthcare Passport |
$403.67
|
| Rate for Payer: Multiplan PHCS |
$960.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,120.00
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$407.71
|
|
|
DECOMPRESS. FASCIOTOMY FOREARM
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 24495
|
| Hospital Charge Code |
76100531
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$403.67 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: Aetna Commercial |
$949.57
|
| Rate for Payer: Anthem Medicaid |
$403.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,600.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,086.54
|
| Rate for Payer: Healthspan PPO |
$860.11
|
| Rate for Payer: Humana Medicaid |
$403.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$814.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$411.74
|
| Rate for Payer: Molina Healthcare Passport |
$403.67
|
| Rate for Payer: Multiplan PHCS |
$960.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,120.00
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$407.71
|
|
|
DECOMPRESS. FASCIOTOMY FOREARM
|
Facility
|
IP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 24495
|
| Hospital Charge Code |
76100531
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.00 |
| 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 |
$320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$208.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$496.00
|
| Rate for Payer: PHCS Commercial |
$1,536.00
|
| Rate for Payer: United Healthcare All Payer |
$1,408.00
|
|
|
DECOMPRESS FINGERS/HAND
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 26037
|
| Hospital Charge Code |
76100657
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$392.38 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: Aetna Commercial |
$822.13
|
| Rate for Payer: Anthem Medicaid |
$392.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,600.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$903.68
|
| Rate for Payer: Healthspan PPO |
$744.68
|
| Rate for Payer: Humana Medicaid |
$392.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$703.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$400.23
|
| Rate for Payer: Molina Healthcare Passport |
$392.38
|
| Rate for Payer: Multiplan PHCS |
$960.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,120.00
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$396.30
|
|
|
DECOMPRESS FINGERS/HAND
|
Facility
|
IP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 26037
|
| Hospital Charge Code |
76100657
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.00 |
| 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 |
$320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$208.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$496.00
|
| Rate for Payer: PHCS Commercial |
$1,536.00
|
| Rate for Payer: United Healthcare All Payer |
$1,408.00
|
|
|
DECOMPRESS FINGERS/HAND
|
Facility
|
IP
|
$2,125.00
|
|
|
Service Code
|
HCPCS 26035
|
| Hospital Charge Code |
76102891
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$276.25 |
| Max. Negotiated Rate |
$2,040.00 |
| Rate for Payer: Aetna Commercial |
$1,636.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,657.50
|
| Rate for Payer: Cash Price |
$1,062.50
|
| Rate for Payer: Cigna Commercial |
$1,763.75
|
| Rate for Payer: First Health Commercial |
$2,018.75
|
| Rate for Payer: Humana Commercial |
$1,806.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,742.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,568.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$637.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,870.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,593.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$425.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$276.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$658.75
|
| Rate for Payer: PHCS Commercial |
$2,040.00
|
| Rate for Payer: United Healthcare All Payer |
$1,870.00
|
|
|
DECOMPRESS FINGERS/HAND
|
Facility
|
OP
|
$2,125.00
|
|
|
Service Code
|
HCPCS 26035
|
| Hospital Charge Code |
76102891
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$276.25 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$1,636.25
|
| Rate for Payer: Anthem Medicaid |
$730.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,657.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$1,062.50
|
| Rate for Payer: Cash Price |
$1,062.50
|
| Rate for Payer: Cigna Commercial |
$1,763.75
|
| Rate for Payer: First Health Commercial |
$2,018.75
|
| Rate for Payer: Humana Commercial |
$1,806.25
|
| Rate for Payer: Humana KY Medicaid |
$730.79
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$738.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,742.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,568.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$745.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,870.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,593.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$425.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$276.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$658.75
|
| Rate for Payer: PHCS Commercial |
$2,040.00
|
| Rate for Payer: United Healthcare All Payer |
$1,870.00
|
|
|
DECOMPRESS FINGERS/HAND
|
Facility
|
OP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 26037
|
| Hospital Charge Code |
76100657
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$1,232.00
|
| Rate for Payer: Anthem Medicaid |
$550.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,248.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,328.00
|
| Rate for Payer: First Health Commercial |
$1,520.00
|
| Rate for Payer: Humana Commercial |
$1,360.00
|
| Rate for Payer: Humana KY Medicaid |
$550.24
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| 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 |
$3,358.88
|
| 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 |
$320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$208.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$496.00
|
| Rate for Payer: PHCS Commercial |
$1,536.00
|
| Rate for Payer: United Healthcare All Payer |
$1,408.00
|
|
|
DECOMPRESS FINGERS/HAND
|
Professional
|
Both
|
$2,125.00
|
|
|
Service Code
|
HCPCS 26035
|
| Hospital Charge Code |
76102891
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$405.47 |
| Max. Negotiated Rate |
$2,125.00 |
| Rate for Payer: Aetna Commercial |
$1,184.48
|
| Rate for Payer: Anthem Medicaid |
$405.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,125.00
|
| Rate for Payer: Cash Price |
$1,062.50
|
| Rate for Payer: Cash Price |
$1,062.50
|
| Rate for Payer: Cigna Commercial |
$1,257.24
|
| Rate for Payer: Healthspan PPO |
$1,072.88
|
| Rate for Payer: Humana Medicaid |
$405.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,043.33
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$413.58
|
| Rate for Payer: Molina Healthcare Passport |
$405.47
|
| Rate for Payer: Multiplan PHCS |
$1,275.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,487.50
|
| Rate for Payer: UHCCP Medicaid |
$743.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$409.52
|
|
|
DECOMPRESS FINGERS/HAND(P
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 26037
|
| Hospital Charge Code |
761P0657
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$392.38 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: Aetna Commercial |
$822.13
|
| Rate for Payer: Anthem Medicaid |
$392.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,600.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$903.68
|
| Rate for Payer: Healthspan PPO |
$744.68
|
| Rate for Payer: Humana Medicaid |
$392.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$703.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$400.23
|
| Rate for Payer: Molina Healthcare Passport |
$392.38
|
| Rate for Payer: Multiplan PHCS |
$960.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,120.00
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$396.30
|
|
|
DECOMPRESS FOREARM 1 SPACE
|
Facility
|
IP
|
$1,120.00
|
|
|
Service Code
|
HCPCS 25020
|
| Hospital Charge Code |
76100565
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$145.60 |
| Max. Negotiated Rate |
$1,075.20 |
| Rate for Payer: Aetna Commercial |
$862.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$873.60
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Cigna Commercial |
$929.60
|
| Rate for Payer: First Health Commercial |
$1,064.00
|
| Rate for Payer: Humana Commercial |
$952.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$918.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$826.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$336.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$985.60
|
| Rate for Payer: Ohio Health Group HMO |
$840.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$224.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$145.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$347.20
|
| Rate for Payer: PHCS Commercial |
$1,075.20
|
| Rate for Payer: United Healthcare All Payer |
$985.60
|
|
|
DECOMPRESS FOREARM 1 SPACE
|
Professional
|
Both
|
$1,120.00
|
|
|
Service Code
|
HCPCS 25020
|
| Hospital Charge Code |
76100565
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$298.24 |
| Max. Negotiated Rate |
$1,120.00 |
| Rate for Payer: Aetna Commercial |
$815.99
|
| Rate for Payer: Anthem Medicaid |
$298.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,120.00
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Cigna Commercial |
$972.76
|
| Rate for Payer: Healthspan PPO |
$739.11
|
| Rate for Payer: Humana Medicaid |
$298.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$701.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$304.20
|
| Rate for Payer: Molina Healthcare Passport |
$298.24
|
| Rate for Payer: Multiplan PHCS |
$672.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$784.00
|
| Rate for Payer: UHCCP Medicaid |
$392.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$301.22
|
|
|
DECOMPRESS FOREARM 1 SPACE
|
Facility
|
OP
|
$1,120.00
|
|
|
Service Code
|
HCPCS 25020
|
| Hospital Charge Code |
76100565
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$145.60 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Aetna Commercial |
$862.40
|
| Rate for Payer: Anthem Medicaid |
$385.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$873.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Cigna Commercial |
$929.60
|
| Rate for Payer: First Health Commercial |
$1,064.00
|
| Rate for Payer: Humana Commercial |
$952.00
|
| Rate for Payer: Humana KY Medicaid |
$385.17
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$389.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$918.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$826.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$392.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$985.60
|
| Rate for Payer: Ohio Health Group HMO |
$840.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$224.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$145.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$347.20
|
| Rate for Payer: PHCS Commercial |
$1,075.20
|
| Rate for Payer: United Healthcare All Payer |
$985.60
|
|
|
DECOMPRESS FOREARM 1 SPACE(P
|
Professional
|
Both
|
$1,120.00
|
|
|
Service Code
|
HCPCS 25020
|
| Hospital Charge Code |
761P0565
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$298.24 |
| Max. Negotiated Rate |
$1,120.00 |
| Rate for Payer: Aetna Commercial |
$815.99
|
| Rate for Payer: Anthem Medicaid |
$298.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,120.00
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Cigna Commercial |
$972.76
|
| Rate for Payer: Healthspan PPO |
$739.11
|
| Rate for Payer: Humana Medicaid |
$298.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$701.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$304.20
|
| Rate for Payer: Molina Healthcare Passport |
$298.24
|
| Rate for Payer: Multiplan PHCS |
$672.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$784.00
|
| Rate for Payer: UHCCP Medicaid |
$392.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$301.22
|
|
|
DECOMPRESS FOREARM 2 SPACES
|
Professional
|
Both
|
$1,420.00
|
|
|
Service Code
|
HCPCS 25025
|
| Hospital Charge Code |
761P2600
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$497.00 |
| Max. Negotiated Rate |
$1,792.16 |
| Rate for Payer: Aetna Commercial |
$1,710.62
|
| Rate for Payer: Anthem Medicaid |
$834.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,420.00
|
| Rate for Payer: Cash Price |
$710.00
|
| Rate for Payer: Cash Price |
$710.00
|
| Rate for Payer: Cigna Commercial |
$1,792.16
|
| Rate for Payer: Healthspan PPO |
$1,549.46
|
| Rate for Payer: Humana Medicaid |
$834.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,514.49
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$851.48
|
| Rate for Payer: Molina Healthcare Passport |
$834.78
|
| Rate for Payer: Multiplan PHCS |
$852.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$994.00
|
| Rate for Payer: UHCCP Medicaid |
$497.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$843.13
|
|
|
DECOMPRESS FOREARM 2 SPACES
|
Facility
|
IP
|
$1,420.00
|
|
|
Service Code
|
HCPCS 25025
|
| Hospital Charge Code |
76102600
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$184.60 |
| Max. Negotiated Rate |
$1,363.20 |
| Rate for Payer: Aetna Commercial |
$1,093.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,107.60
|
| Rate for Payer: Cash Price |
$710.00
|
| Rate for Payer: Cigna Commercial |
$1,178.60
|
| Rate for Payer: First Health Commercial |
$1,349.00
|
| Rate for Payer: Humana Commercial |
$1,207.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,164.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,047.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$426.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,249.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,065.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$284.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$184.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$440.20
|
| Rate for Payer: PHCS Commercial |
$1,363.20
|
| Rate for Payer: United Healthcare All Payer |
$1,249.60
|
|
|
DECOMPRESS FOREARM 2 SPACES
|
Facility
|
IP
|
$1,140.00
|
|
|
Service Code
|
HCPCS 25024
|
| Hospital Charge Code |
76100567
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$148.20 |
| Max. Negotiated Rate |
$1,094.40 |
| Rate for Payer: Aetna Commercial |
$877.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$889.20
|
| Rate for Payer: Cash Price |
$570.00
|
| Rate for Payer: Cigna Commercial |
$946.20
|
| Rate for Payer: First Health Commercial |
$1,083.00
|
| Rate for Payer: Humana Commercial |
$969.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$934.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$841.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$342.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,003.20
|
| Rate for Payer: Ohio Health Group HMO |
$855.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$228.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$148.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$353.40
|
| Rate for Payer: PHCS Commercial |
$1,094.40
|
| Rate for Payer: United Healthcare All Payer |
$1,003.20
|
|
|
DECOMPRESS FOREARM 2 SPACES
|
Facility
|
OP
|
$1,420.00
|
|
|
Service Code
|
HCPCS 25025
|
| Hospital Charge Code |
76102600
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$184.60 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,107.60
|
| Rate for Payer: Aetna Commercial |
$1,093.40
|
| Rate for Payer: Anthem Medicaid |
$488.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| Rate for Payer: Cash Price |
$710.00
|
| Rate for Payer: Cash Price |
$710.00
|
| Rate for Payer: Cigna Commercial |
$1,178.60
|
| Rate for Payer: First Health Commercial |
$1,349.00
|
| Rate for Payer: Humana Commercial |
$1,207.00
|
| Rate for Payer: Humana KY Medicaid |
$488.34
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$493.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,164.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,047.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$498.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,249.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,065.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$284.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$184.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$440.20
|
| Rate for Payer: PHCS Commercial |
$1,363.20
|
| Rate for Payer: United Healthcare All Payer |
$1,249.60
|
|
