|
FUSION OF KNUCKLE JOINT
|
Facility
|
OP
|
$1,300.00
|
|
|
Service Code
|
HCPCS 26516
|
| Hospital Charge Code |
76100711
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$169.00 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$1,001.00
|
| Rate for Payer: Anthem Medicaid |
$447.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,014.00
|
| 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 |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$1,079.00
|
| Rate for Payer: First Health Commercial |
$1,235.00
|
| Rate for Payer: Humana Commercial |
$1,105.00
|
| Rate for Payer: Humana KY Medicaid |
$447.07
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$451.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,066.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$959.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$456.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,144.00
|
| Rate for Payer: Ohio Health Group HMO |
$975.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$169.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$403.00
|
| Rate for Payer: PHCS Commercial |
$1,248.00
|
| Rate for Payer: United Healthcare All Payer |
$1,144.00
|
|
|
FUSION OF KNUCKLE JOINT(P
|
Professional
|
Both
|
$1,300.00
|
|
|
Service Code
|
HCPCS 26516
|
| Hospital Charge Code |
761P0711
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$325.93 |
| Max. Negotiated Rate |
$1,300.00 |
| Rate for Payer: Aetna Commercial |
$991.74
|
| Rate for Payer: Anthem Medicaid |
$325.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,300.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$1,202.98
|
| Rate for Payer: Healthspan PPO |
$898.30
|
| Rate for Payer: Humana Medicaid |
$325.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$846.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$332.45
|
| Rate for Payer: Molina Healthcare Passport |
$325.93
|
| Rate for Payer: Multiplan PHCS |
$780.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$910.00
|
| Rate for Payer: UHCCP Medicaid |
$455.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$329.19
|
|
|
FUSION OF KNUCKLE(P
|
Professional
|
Both
|
$870.00
|
|
|
Service Code
|
HCPCS 26850
|
| Hospital Charge Code |
761P0752
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$304.50 |
| Max. Negotiated Rate |
$1,189.75 |
| Rate for Payer: Aetna Commercial |
$980.10
|
| Rate for Payer: Anthem Medicaid |
$335.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$870.00
|
| Rate for Payer: Cash Price |
$435.00
|
| Rate for Payer: Cash Price |
$435.00
|
| Rate for Payer: Cigna Commercial |
$1,189.75
|
| Rate for Payer: Healthspan PPO |
$887.76
|
| Rate for Payer: Humana Medicaid |
$335.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$837.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$342.15
|
| Rate for Payer: Molina Healthcare Passport |
$335.44
|
| Rate for Payer: Multiplan PHCS |
$522.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$609.00
|
| Rate for Payer: UHCCP Medicaid |
$304.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$338.79
|
|
|
FUSION OF STOMACH AND BOWEL
|
Facility
|
IP
|
$1,395.00
|
|
|
Service Code
|
HCPCS 43820
|
| Hospital Charge Code |
76102799
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$181.35 |
| Max. Negotiated Rate |
$1,339.20 |
| Rate for Payer: Aetna Commercial |
$1,074.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,088.10
|
| Rate for Payer: Cash Price |
$697.50
|
| Rate for Payer: Cigna Commercial |
$1,157.85
|
| Rate for Payer: First Health Commercial |
$1,325.25
|
| Rate for Payer: Humana Commercial |
$1,185.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,143.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,029.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$418.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,227.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,046.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$279.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$181.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$432.45
|
| Rate for Payer: PHCS Commercial |
$1,339.20
|
| Rate for Payer: United Healthcare All Payer |
$1,227.60
|
|
|
FUSION OF STOMACH AND BOWEL
|
Professional
|
Both
|
$1,395.00
|
|
|
Service Code
|
HCPCS 43820
|
| Hospital Charge Code |
76102799
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$488.25 |
| Max. Negotiated Rate |
$1,863.90 |
| Rate for Payer: Aetna Commercial |
$1,863.90
|
| Rate for Payer: Anthem Medicaid |
$570.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,395.00
|
| Rate for Payer: Cash Price |
$697.50
|
| Rate for Payer: Cash Price |
$697.50
|
| Rate for Payer: Cigna Commercial |
$1,682.45
|
| Rate for Payer: Healthspan PPO |
$1,571.86
|
| Rate for Payer: Humana Medicaid |
$570.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,700.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$582.35
|
| Rate for Payer: Molina Healthcare Passport |
$570.93
|
| Rate for Payer: Multiplan PHCS |
$837.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$976.50
|
| Rate for Payer: UHCCP Medicaid |
$488.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$576.64
|
|
|
FUSION OF STOMACH AND BOWEL
|
Facility
|
OP
|
$1,395.00
|
|
|
Service Code
|
HCPCS 43820
|
| Hospital Charge Code |
76102799
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$181.35 |
| Max. Negotiated Rate |
$1,339.20 |
| Rate for Payer: Aetna Commercial |
$1,074.15
|
| Rate for Payer: Anthem Medicaid |
$479.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,088.10
|
| Rate for Payer: Cash Price |
$697.50
|
| Rate for Payer: Cigna Commercial |
$1,157.85
|
| Rate for Payer: First Health Commercial |
$1,325.25
|
| Rate for Payer: Humana Commercial |
$1,185.75
|
| Rate for Payer: Humana KY Medicaid |
$479.74
|
| Rate for Payer: Kentucky WC Medicaid |
$484.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,143.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,029.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$418.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$489.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,227.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,046.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$279.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$181.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$432.45
|
| Rate for Payer: PHCS Commercial |
$1,339.20
|
| Rate for Payer: United Healthcare All Payer |
$1,227.60
|
|
|
FUSION OF TENDONS AT WRIST
|
Professional
|
Both
|
$1,340.00
|
|
|
Service Code
|
HCPCS 25301
|
| Hospital Charge Code |
76100604
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$447.65 |
| Max. Negotiated Rate |
$1,340.00 |
| Rate for Payer: Aetna Commercial |
$944.72
|
| Rate for Payer: Anthem Medicaid |
$447.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,340.00
|
| Rate for Payer: Cash Price |
$670.00
|
| Rate for Payer: Cash Price |
$670.00
|
| Rate for Payer: Cigna Commercial |
$1,074.31
|
| Rate for Payer: Healthspan PPO |
$855.72
|
| Rate for Payer: Humana Medicaid |
$447.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$798.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$456.60
|
| Rate for Payer: Molina Healthcare Passport |
$447.65
|
| Rate for Payer: Multiplan PHCS |
$804.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$938.00
|
| Rate for Payer: UHCCP Medicaid |
$469.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$452.13
|
|
|
FUSION OF TENDONS AT WRIST
|
Facility
|
OP
|
$1,340.00
|
|
|
Service Code
|
HCPCS 25301
|
| Hospital Charge Code |
76100604
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$174.20 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$1,031.80
|
| Rate for Payer: Anthem Medicaid |
$460.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,045.20
|
| 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 |
$670.00
|
| Rate for Payer: Cash Price |
$670.00
|
| Rate for Payer: Cigna Commercial |
$1,112.20
|
| Rate for Payer: First Health Commercial |
$1,273.00
|
| Rate for Payer: Humana Commercial |
$1,139.00
|
| Rate for Payer: Humana KY Medicaid |
$460.83
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$465.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,098.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$988.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$470.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,179.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,005.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$268.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$174.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$415.40
|
| Rate for Payer: PHCS Commercial |
$1,286.40
|
| Rate for Payer: United Healthcare All Payer |
$1,179.20
|
|
|
FUSION OF TENDONS AT WRIST
|
Facility
|
IP
|
$1,340.00
|
|
|
Service Code
|
HCPCS 25301
|
| Hospital Charge Code |
76100604
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$174.20 |
| Max. Negotiated Rate |
$1,286.40 |
| Rate for Payer: Aetna Commercial |
$1,031.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,045.20
|
| Rate for Payer: Cash Price |
$670.00
|
| Rate for Payer: Cigna Commercial |
$1,112.20
|
| Rate for Payer: First Health Commercial |
$1,273.00
|
| Rate for Payer: Humana Commercial |
$1,139.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,098.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$988.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$402.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,179.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,005.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$268.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$174.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$415.40
|
| Rate for Payer: PHCS Commercial |
$1,286.40
|
| Rate for Payer: United Healthcare All Payer |
$1,179.20
|
|
|
FUSION OF TENDONS AT WRIST(P
|
Professional
|
Both
|
$1,340.00
|
|
|
Service Code
|
HCPCS 25301
|
| Hospital Charge Code |
761P0604
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$447.65 |
| Max. Negotiated Rate |
$1,340.00 |
| Rate for Payer: Aetna Commercial |
$944.72
|
| Rate for Payer: Anthem Medicaid |
$447.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,340.00
|
| Rate for Payer: Cash Price |
$670.00
|
| Rate for Payer: Cash Price |
$670.00
|
| Rate for Payer: Cigna Commercial |
$1,074.31
|
| Rate for Payer: Healthspan PPO |
$855.72
|
| Rate for Payer: Humana Medicaid |
$447.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$798.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$456.60
|
| Rate for Payer: Molina Healthcare Passport |
$447.65
|
| Rate for Payer: Multiplan PHCS |
$804.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$938.00
|
| Rate for Payer: UHCCP Medicaid |
$469.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$452.13
|
|
|
FUSION OF THUMB
|
Facility
|
IP
|
$1,270.00
|
|
|
Service Code
|
HCPCS 26841
|
| Hospital Charge Code |
76100751
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$165.10 |
| Max. Negotiated Rate |
$1,219.20 |
| Rate for Payer: Aetna Commercial |
$977.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$990.60
|
| Rate for Payer: Cash Price |
$635.00
|
| Rate for Payer: Cigna Commercial |
$1,054.10
|
| Rate for Payer: First Health Commercial |
$1,206.50
|
| Rate for Payer: Humana Commercial |
$1,079.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,041.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$937.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$381.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,117.60
|
| Rate for Payer: Ohio Health Group HMO |
$952.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$254.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$165.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$393.70
|
| Rate for Payer: PHCS Commercial |
$1,219.20
|
| Rate for Payer: United Healthcare All Payer |
$1,117.60
|
|
|
FUSION OF THUMB
|
Facility
|
OP
|
$1,270.00
|
|
|
Service Code
|
HCPCS 26841
|
| Hospital Charge Code |
76100751
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$165.10 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$977.90
|
| Rate for Payer: Anthem Medicaid |
$436.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$990.60
|
| 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 |
$635.00
|
| Rate for Payer: Cash Price |
$635.00
|
| Rate for Payer: Cigna Commercial |
$1,054.10
|
| Rate for Payer: First Health Commercial |
$1,206.50
|
| Rate for Payer: Humana Commercial |
$1,079.50
|
| Rate for Payer: Humana KY Medicaid |
$436.75
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$441.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,041.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$937.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$445.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,117.60
|
| Rate for Payer: Ohio Health Group HMO |
$952.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$254.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$165.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$393.70
|
| Rate for Payer: PHCS Commercial |
$1,219.20
|
| Rate for Payer: United Healthcare All Payer |
$1,117.60
|
|
|
FUSION OF THUMB
|
Professional
|
Both
|
$1,270.00
|
|
|
Service Code
|
HCPCS 26841
|
| Hospital Charge Code |
76100751
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$389.03 |
| Max. Negotiated Rate |
$1,270.00 |
| Rate for Payer: Aetna Commercial |
$1,030.08
|
| Rate for Payer: Anthem Medicaid |
$389.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,270.00
|
| Rate for Payer: Cash Price |
$635.00
|
| Rate for Payer: Cash Price |
$635.00
|
| Rate for Payer: Cigna Commercial |
$1,262.33
|
| Rate for Payer: Healthspan PPO |
$933.03
|
| Rate for Payer: Humana Medicaid |
$389.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$882.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$396.81
|
| Rate for Payer: Molina Healthcare Passport |
$389.03
|
| Rate for Payer: Multiplan PHCS |
$762.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$889.00
|
| Rate for Payer: UHCCP Medicaid |
$444.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$392.92
|
|
|
FUSION OF THUMB(P
|
Professional
|
Both
|
$1,270.00
|
|
|
Service Code
|
HCPCS 26841
|
| Hospital Charge Code |
761P0751
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$389.03 |
| Max. Negotiated Rate |
$1,270.00 |
| Rate for Payer: Aetna Commercial |
$1,030.08
|
| Rate for Payer: Anthem Medicaid |
$389.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,270.00
|
| Rate for Payer: Cash Price |
$635.00
|
| Rate for Payer: Cash Price |
$635.00
|
| Rate for Payer: Cigna Commercial |
$1,262.33
|
| Rate for Payer: Healthspan PPO |
$933.03
|
| Rate for Payer: Humana Medicaid |
$389.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$882.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$396.81
|
| Rate for Payer: Molina Healthcare Passport |
$389.03
|
| Rate for Payer: Multiplan PHCS |
$762.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$889.00
|
| Rate for Payer: UHCCP Medicaid |
$444.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$392.92
|
|
|
FUSION OF TIBIOFIBULAR JOIN(P
|
Professional
|
Both
|
$1,640.00
|
|
|
Service Code
|
HCPCS 27871
|
| Hospital Charge Code |
761P0955
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$489.23 |
| Max. Negotiated Rate |
$1,640.00 |
| Rate for Payer: Aetna Commercial |
$1,026.80
|
| Rate for Payer: Anthem Medicaid |
$489.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,640.00
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Cigna Commercial |
$1,123.46
|
| Rate for Payer: Healthspan PPO |
$930.06
|
| Rate for Payer: Humana Medicaid |
$489.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$862.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$499.01
|
| Rate for Payer: Molina Healthcare Passport |
$489.23
|
| Rate for Payer: Multiplan PHCS |
$984.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,148.00
|
| Rate for Payer: UHCCP Medicaid |
$574.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$494.12
|
|
|
FUSION OF TIBIOFIBULAR JOINT
|
Professional
|
Both
|
$1,640.00
|
|
|
Service Code
|
HCPCS 27871
|
| Hospital Charge Code |
76100955
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$489.23 |
| Max. Negotiated Rate |
$1,640.00 |
| Rate for Payer: Aetna Commercial |
$1,026.80
|
| Rate for Payer: Anthem Medicaid |
$489.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,640.00
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Cigna Commercial |
$1,123.46
|
| Rate for Payer: Healthspan PPO |
$930.06
|
| Rate for Payer: Humana Medicaid |
$489.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$862.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$499.01
|
| Rate for Payer: Molina Healthcare Passport |
$489.23
|
| Rate for Payer: Multiplan PHCS |
$984.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,148.00
|
| Rate for Payer: UHCCP Medicaid |
$574.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$494.12
|
|
|
FUSION OF TIBIOFIBULAR JOINT
|
Facility
|
OP
|
$1,640.00
|
|
|
Service Code
|
HCPCS 27871
|
| Hospital Charge Code |
76100955
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$213.20 |
| Max. Negotiated Rate |
$15,933.60 |
| Rate for Payer: Aetna Commercial |
$1,262.80
|
| Rate for Payer: Anthem Medicaid |
$564.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,381.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,279.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15,933.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$15,364.54
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Cigna Commercial |
$1,361.20
|
| Rate for Payer: First Health Commercial |
$1,558.00
|
| Rate for Payer: Humana Commercial |
$1,394.00
|
| Rate for Payer: Humana KY Medicaid |
$564.00
|
| Rate for Payer: Humana Medicare Advantage |
$11,381.14
|
| Rate for Payer: Kentucky WC Medicaid |
$569.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,344.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,210.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13,657.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$575.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,443.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,230.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$328.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$213.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$508.40
|
| Rate for Payer: PHCS Commercial |
$1,574.40
|
| Rate for Payer: United Healthcare All Payer |
$1,443.20
|
|
|
FUSION OF TIBIOFIBULAR JOINT
|
Facility
|
IP
|
$1,640.00
|
|
|
Service Code
|
HCPCS 27871
|
| Hospital Charge Code |
76100955
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$213.20 |
| Max. Negotiated Rate |
$1,574.40 |
| Rate for Payer: Aetna Commercial |
$1,262.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,279.20
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Cigna Commercial |
$1,361.20
|
| Rate for Payer: First Health Commercial |
$1,558.00
|
| Rate for Payer: Humana Commercial |
$1,394.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,344.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,210.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$492.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,443.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,230.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$328.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$213.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$508.40
|
| Rate for Payer: PHCS Commercial |
$1,574.40
|
| Rate for Payer: United Healthcare All Payer |
$1,443.20
|
|
|
FY Face and Chest
|
Professional
|
Both
|
$575.00
|
|
| Hospital Charge Code |
22200682
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$201.25 |
| Max. Negotiated Rate |
$575.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$575.00
|
| Rate for Payer: Cash Price |
$287.50
|
| Rate for Payer: Multiplan PHCS |
$345.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$402.50
|
| Rate for Payer: UHCCP Medicaid |
$201.25
|
|
|
FY Face and Neck
|
Professional
|
Both
|
$200.00
|
|
| Hospital Charge Code |
22200698
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$200.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$140.00
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
|
|
FY Face and Neck –PP #1 50%
|
Professional
|
Both
|
$256.00
|
|
| Hospital Charge Code |
22200699
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$89.60 |
| Max. Negotiated Rate |
$256.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$256.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Multiplan PHCS |
$153.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$179.20
|
| Rate for Payer: UHCCP Medicaid |
$89.60
|
|
|
FY Face and Neck – PP#2/3 25%
|
Professional
|
Both
|
$127.00
|
|
| Hospital Charge Code |
22200700
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$44.45 |
| Max. Negotiated Rate |
$127.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$127.00
|
| Rate for Payer: Cash Price |
$63.50
|
| Rate for Payer: Multiplan PHCS |
$76.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$88.90
|
| Rate for Payer: UHCCP Medicaid |
$44.45
|
|
|
FY Face,Chest - PP #1 50%
|
Professional
|
Both
|
$734.00
|
|
| Hospital Charge Code |
22200263
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$256.90 |
| Max. Negotiated Rate |
$734.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$734.00
|
| Rate for Payer: Cash Price |
$367.00
|
| Rate for Payer: Multiplan PHCS |
$440.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$513.80
|
| Rate for Payer: UHCCP Medicaid |
$256.90
|
|
|
FY Face,Chest -PP#2/3 25%
|
Professional
|
Both
|
$366.00
|
|
| Hospital Charge Code |
22200681
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$128.10 |
| Max. Negotiated Rate |
$366.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$366.00
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Multiplan PHCS |
$219.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$256.20
|
| Rate for Payer: UHCCP Medicaid |
$128.10
|
|
|
FY Face, Neck and Chest
|
Professional
|
Both
|
$750.00
|
|
| Hospital Charge Code |
22200680
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$750.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$525.00
|
| Rate for Payer: UHCCP Medicaid |
$262.50
|
|
