|
FUROSEMIDE 1mg (40mg SDV)
|
Facility
|
OP
|
$78.90
|
|
|
Service Code
|
HCPCS J1938
|
| Hospital Charge Code |
25002199
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.67 |
| Max. Negotiated Rate |
$75.74 |
| Rate for Payer: Aetna Commercial |
$60.75
|
| Rate for Payer: Anthem Medicaid |
$27.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.54
|
| Rate for Payer: Cash Price |
$39.45
|
| Rate for Payer: Cigna Commercial |
$65.49
|
| Rate for Payer: First Health Commercial |
$74.95
|
| Rate for Payer: Humana Commercial |
$67.06
|
| Rate for Payer: Humana KY Medicaid |
$27.13
|
| Rate for Payer: Kentucky WC Medicaid |
$27.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.43
|
| Rate for Payer: Ohio Health Group HMO |
$59.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.44
|
| Rate for Payer: PHCS Commercial |
$75.74
|
| Rate for Payer: United Healthcare All Payer |
$69.43
|
|
|
FUROSEMIDE 1MG SDV
|
Facility
|
IP
|
$3.91
|
|
|
Service Code
|
HCPCS J1938
|
| Hospital Charge Code |
636T0039
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$3.75 |
| Rate for Payer: Aetna Commercial |
$3.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.05
|
| Rate for Payer: Cash Price |
$1.96
|
| Rate for Payer: Cigna Commercial |
$3.25
|
| Rate for Payer: First Health Commercial |
$3.71
|
| Rate for Payer: Humana Commercial |
$3.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.44
|
| Rate for Payer: Ohio Health Group HMO |
$2.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.70
|
| Rate for Payer: PHCS Commercial |
$3.75
|
| Rate for Payer: United Healthcare All Payer |
$3.44
|
|
|
FUROSEMIDE 1MG SDV
|
Facility
|
OP
|
$3.91
|
|
|
Service Code
|
HCPCS J1938
|
| Hospital Charge Code |
636T0039
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$3.75 |
| Rate for Payer: Aetna Commercial |
$3.01
|
| Rate for Payer: Anthem Medicaid |
$1.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.05
|
| Rate for Payer: Cash Price |
$1.96
|
| Rate for Payer: Cigna Commercial |
$3.25
|
| Rate for Payer: First Health Commercial |
$3.71
|
| Rate for Payer: Humana Commercial |
$3.32
|
| Rate for Payer: Humana KY Medicaid |
$1.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.44
|
| Rate for Payer: Ohio Health Group HMO |
$2.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.70
|
| Rate for Payer: PHCS Commercial |
$3.75
|
| Rate for Payer: United Healthcare All Payer |
$3.44
|
|
|
FUROSEMIDE 1MG SDV
|
Facility
|
OP
|
$3.91
|
|
|
Service Code
|
HCPCS J1938
|
| Hospital Charge Code |
63600039
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$3.75 |
| Rate for Payer: Aetna Commercial |
$3.01
|
| Rate for Payer: Anthem Medicaid |
$1.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.05
|
| Rate for Payer: Cash Price |
$1.96
|
| Rate for Payer: Cigna Commercial |
$3.25
|
| Rate for Payer: First Health Commercial |
$3.71
|
| Rate for Payer: Humana Commercial |
$3.32
|
| Rate for Payer: Humana KY Medicaid |
$1.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.44
|
| Rate for Payer: Ohio Health Group HMO |
$2.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.70
|
| Rate for Payer: PHCS Commercial |
$3.75
|
| Rate for Payer: United Healthcare All Payer |
$3.44
|
|
|
FUROSEMIDE 1MG SDV
|
Facility
|
IP
|
$3.91
|
|
|
Service Code
|
HCPCS J1938
|
| Hospital Charge Code |
63600039
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$3.75 |
| Rate for Payer: Aetna Commercial |
$3.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.05
|
| Rate for Payer: Cash Price |
$1.96
|
| Rate for Payer: Cigna Commercial |
$3.25
|
| Rate for Payer: First Health Commercial |
$3.71
|
| Rate for Payer: Humana Commercial |
$3.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.44
|
| Rate for Payer: Ohio Health Group HMO |
$2.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.70
|
| Rate for Payer: PHCS Commercial |
$3.75
|
| Rate for Payer: United Healthcare All Payer |
$3.44
|
|
|
FUROSEMIDE 1MG SDV
|
Professional
|
Both
|
$3.91
|
|
|
Service Code
|
HCPCS J1938
|
| Hospital Charge Code |
63600039
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$2.35 |
| Rate for Payer: Ambetter Exchange |
$0.02
|
| Rate for Payer: Buckeye Individual/Medicaid |
$0.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$0.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.02
|
| Rate for Payer: Cash Price |
$1.96
|
| Rate for Payer: Cash Price |
$1.96
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$0.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.02
|
| Rate for Payer: Multiplan PHCS |
$2.35
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$0.03
|
| Rate for Payer: UHCCP Medicaid |
$1.37
|
| Rate for Payer: Wellcare Medicare Advantage |
$0.02
|
|
|
FUSE HAND BONES WITH GRAFT
|
Facility
|
OP
|
$955.00
|
|
|
Service Code
|
HCPCS 25825
|
| Hospital Charge Code |
76100649
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$328.42 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$735.35
|
| Rate for Payer: Anthem Medicaid |
$328.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$744.90
|
| 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 |
$477.50
|
| Rate for Payer: Cash Price |
$477.50
|
| Rate for Payer: Cigna Commercial |
$792.65
|
| Rate for Payer: First Health Commercial |
$907.25
|
| Rate for Payer: Humana Commercial |
$811.75
|
| Rate for Payer: Humana KY Medicaid |
$328.42
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$331.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$783.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$704.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$335.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$840.40
|
| Rate for Payer: Ohio Health Group HMO |
$716.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$764.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$830.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$658.95
|
| Rate for Payer: PHCS Commercial |
$916.80
|
| Rate for Payer: United Healthcare All Payer |
$840.40
|
|
|
FUSE HAND BONES WITH GRAFT
|
Professional
|
Both
|
$955.00
|
|
|
Service Code
|
HCPCS 25825
|
| Hospital Charge Code |
76100649
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$334.25 |
| Max. Negotiated Rate |
$1,213.39 |
| Rate for Payer: Aetna Commercial |
$1,089.44
|
| Rate for Payer: Ambetter Exchange |
$751.36
|
| Rate for Payer: Anthem Medicaid |
$596.29
|
| Rate for Payer: Buckeye Individual/Medicaid |
$751.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$751.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$901.63
|
| Rate for Payer: Cash Price |
$477.50
|
| Rate for Payer: Cash Price |
$477.50
|
| Rate for Payer: Cigna Commercial |
$1,213.39
|
| Rate for Payer: Healthspan PPO |
$986.80
|
| Rate for Payer: Humana Medicaid |
$596.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$929.27
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$751.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$751.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$608.22
|
| Rate for Payer: Molina Healthcare Passport |
$596.29
|
| Rate for Payer: Multiplan PHCS |
$573.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$976.77
|
| Rate for Payer: UHCCP Medicaid |
$334.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$602.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$751.36
|
|
|
FUSE HAND BONES WITH GRAFT
|
Facility
|
IP
|
$955.00
|
|
|
Service Code
|
HCPCS 25825
|
| Hospital Charge Code |
76100649
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$286.50 |
| Max. Negotiated Rate |
$916.80 |
| Rate for Payer: Aetna Commercial |
$735.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$744.90
|
| Rate for Payer: Cash Price |
$477.50
|
| Rate for Payer: Cigna Commercial |
$792.65
|
| Rate for Payer: First Health Commercial |
$907.25
|
| Rate for Payer: Humana Commercial |
$811.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$783.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$704.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$286.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$840.40
|
| Rate for Payer: Ohio Health Group HMO |
$716.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$764.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$830.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$658.95
|
| Rate for Payer: PHCS Commercial |
$916.80
|
| Rate for Payer: United Healthcare All Payer |
$840.40
|
|
|
FUSE HAND BONES WITH GRAFT(P
|
Professional
|
Both
|
$955.00
|
|
|
Service Code
|
HCPCS 25825
|
| Hospital Charge Code |
761P0649
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$334.25 |
| Max. Negotiated Rate |
$1,213.39 |
| Rate for Payer: Aetna Commercial |
$1,089.44
|
| Rate for Payer: Ambetter Exchange |
$751.36
|
| Rate for Payer: Anthem Medicaid |
$596.29
|
| Rate for Payer: Buckeye Individual/Medicaid |
$751.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$751.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$901.63
|
| Rate for Payer: Cash Price |
$477.50
|
| Rate for Payer: Cash Price |
$477.50
|
| Rate for Payer: Cigna Commercial |
$1,213.39
|
| Rate for Payer: Healthspan PPO |
$986.80
|
| Rate for Payer: Humana Medicaid |
$596.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$929.27
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$751.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$751.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$608.22
|
| Rate for Payer: Molina Healthcare Passport |
$596.29
|
| Rate for Payer: Multiplan PHCS |
$573.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$976.77
|
| Rate for Payer: UHCCP Medicaid |
$334.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$602.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$751.36
|
|
|
FUSION/GRAFT OF WRIST JOINT
|
Facility
|
IP
|
$1,065.00
|
|
|
Service Code
|
HCPCS 25810
|
| Hospital Charge Code |
76100647
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$319.50 |
| Max. Negotiated Rate |
$1,022.40 |
| Rate for Payer: Aetna Commercial |
$820.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$830.70
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$883.95
|
| Rate for Payer: First Health Commercial |
$1,011.75
|
| Rate for Payer: Humana Commercial |
$905.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$873.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$785.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$319.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$937.20
|
| Rate for Payer: Ohio Health Group HMO |
$798.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$852.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$926.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$734.85
|
| Rate for Payer: PHCS Commercial |
$1,022.40
|
| Rate for Payer: United Healthcare All Payer |
$937.20
|
|
|
FUSION/GRAFT OF WRIST JOINT
|
Facility
|
OP
|
$1,065.00
|
|
|
Service Code
|
HCPCS 25810
|
| Hospital Charge Code |
76100647
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$366.25 |
| Max. Negotiated Rate |
$16,644.15 |
| Rate for Payer: Aetna Commercial |
$820.05
|
| Rate for Payer: Anthem Medicaid |
$366.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,888.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$830.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16,644.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$16,049.72
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$883.95
|
| Rate for Payer: First Health Commercial |
$1,011.75
|
| Rate for Payer: Humana Commercial |
$905.25
|
| Rate for Payer: Humana KY Medicaid |
$366.25
|
| Rate for Payer: Humana Medicare Advantage |
$11,888.68
|
| Rate for Payer: Kentucky WC Medicaid |
$369.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$873.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$785.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14,266.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$373.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$937.20
|
| Rate for Payer: Ohio Health Group HMO |
$798.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$852.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$926.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$734.85
|
| Rate for Payer: PHCS Commercial |
$1,022.40
|
| Rate for Payer: United Healthcare All Payer |
$937.20
|
|
|
FUSION/GRAFT OF WRIST JOINT
|
Professional
|
Both
|
$1,065.00
|
|
|
Service Code
|
HCPCS 25810
|
| Hospital Charge Code |
76100647
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$372.75 |
| Max. Negotiated Rate |
$1,410.25 |
| Rate for Payer: Aetna Commercial |
$1,263.00
|
| Rate for Payer: Ambetter Exchange |
$827.97
|
| Rate for Payer: Anthem Medicaid |
$673.41
|
| Rate for Payer: Buckeye Individual/Medicaid |
$827.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$827.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$993.56
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$1,410.25
|
| Rate for Payer: Healthspan PPO |
$1,144.01
|
| Rate for Payer: Humana Medicaid |
$673.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,075.22
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$827.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$827.97
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$686.88
|
| Rate for Payer: Molina Healthcare Passport |
$673.41
|
| Rate for Payer: Multiplan PHCS |
$639.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,076.36
|
| Rate for Payer: UHCCP Medicaid |
$372.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$680.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$827.97
|
|
|
FUSION/GRAFT OF WRIST JOINT(P
|
Professional
|
Both
|
$1,065.00
|
|
|
Service Code
|
HCPCS 25810
|
| Hospital Charge Code |
761P0647
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$372.75 |
| Max. Negotiated Rate |
$1,410.25 |
| Rate for Payer: Aetna Commercial |
$1,263.00
|
| Rate for Payer: Ambetter Exchange |
$827.97
|
| Rate for Payer: Anthem Medicaid |
$673.41
|
| Rate for Payer: Buckeye Individual/Medicaid |
$827.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$827.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$993.56
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$1,410.25
|
| Rate for Payer: Healthspan PPO |
$1,144.01
|
| Rate for Payer: Humana Medicaid |
$673.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,075.22
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$827.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$827.97
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$686.88
|
| Rate for Payer: Molina Healthcare Passport |
$673.41
|
| Rate for Payer: Multiplan PHCS |
$639.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,076.36
|
| Rate for Payer: UHCCP Medicaid |
$372.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$680.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$827.97
|
|
|
FUSION OF BIG TOE JOINT
|
Facility
|
OP
|
$530.00
|
|
|
Service Code
|
HCPCS 28755
|
| Hospital Charge Code |
76101040
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.27 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$408.10
|
| Rate for Payer: Anthem Medicaid |
$182.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$413.40
|
| 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 |
$265.00
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cigna Commercial |
$439.90
|
| Rate for Payer: First Health Commercial |
$503.50
|
| Rate for Payer: Humana Commercial |
$450.50
|
| Rate for Payer: Humana KY Medicaid |
$182.27
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$184.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$434.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$391.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$185.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$466.40
|
| Rate for Payer: Ohio Health Group HMO |
$397.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$424.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$461.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$365.70
|
| Rate for Payer: PHCS Commercial |
$508.80
|
| Rate for Payer: United Healthcare All Payer |
$466.40
|
|
|
FUSION OF BIG TOE JOINT
|
Facility
|
IP
|
$530.00
|
|
|
Service Code
|
HCPCS 28755
|
| Hospital Charge Code |
76101040
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.00 |
| Max. Negotiated Rate |
$508.80 |
| Rate for Payer: Aetna Commercial |
$408.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$413.40
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cigna Commercial |
$439.90
|
| Rate for Payer: First Health Commercial |
$503.50
|
| Rate for Payer: Humana Commercial |
$450.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$434.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$391.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$159.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$466.40
|
| Rate for Payer: Ohio Health Group HMO |
$397.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$424.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$461.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$365.70
|
| Rate for Payer: PHCS Commercial |
$508.80
|
| Rate for Payer: United Healthcare All Payer |
$466.40
|
|
|
FUSION OF BIG TOE JOINT
|
Professional
|
Both
|
$785.00
|
|
|
Service Code
|
HCPCS 28750
|
| Hospital Charge Code |
76101039
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$295.89 |
| Max. Negotiated Rate |
$1,042.83 |
| Rate for Payer: Aetna Commercial |
$891.72
|
| Rate for Payer: Ambetter Exchange |
$544.82
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$295.89
|
| Rate for Payer: Anthem Medicaid |
$302.59
|
| Rate for Payer: Buckeye Individual/Medicaid |
$544.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$544.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$653.78
|
| Rate for Payer: Cash Price |
$392.50
|
| Rate for Payer: Cash Price |
$392.50
|
| Rate for Payer: Cigna Commercial |
$979.51
|
| Rate for Payer: Healthspan PPO |
$1,042.83
|
| Rate for Payer: Humana Medicaid |
$302.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$748.68
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$544.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$544.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$308.64
|
| Rate for Payer: Molina Healthcare Passport |
$302.59
|
| Rate for Payer: Multiplan PHCS |
$471.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$708.27
|
| Rate for Payer: UHCCP Medicaid |
$310.68
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$305.62
|
| Rate for Payer: Wellcare Medicare Advantage |
$544.82
|
|
|
FUSION OF BIG TOE JOINT
|
Professional
|
Both
|
$530.00
|
|
|
Service Code
|
HCPCS 28755
|
| Hospital Charge Code |
76101040
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$170.61 |
| Max. Negotiated Rate |
$625.92 |
| Rate for Payer: Aetna Commercial |
$507.44
|
| Rate for Payer: Ambetter Exchange |
$319.56
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$170.61
|
| Rate for Payer: Anthem Medicaid |
$241.37
|
| Rate for Payer: Buckeye Individual/Medicaid |
$319.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$319.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$383.47
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cigna Commercial |
$557.45
|
| Rate for Payer: Healthspan PPO |
$625.92
|
| Rate for Payer: Humana Medicaid |
$241.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$408.01
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$319.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$319.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$246.20
|
| Rate for Payer: Molina Healthcare Passport |
$241.37
|
| Rate for Payer: Multiplan PHCS |
$318.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$415.43
|
| Rate for Payer: UHCCP Medicaid |
$179.14
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$243.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$319.56
|
|
|
FUSION OF BIG TOE JOINT
|
Professional
|
Both
|
$1,390.00
|
|
|
Service Code
|
HCPCS 28760
|
| Hospital Charge Code |
76102983
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$289.14 |
| Max. Negotiated Rate |
$989.44 |
| Rate for Payer: Aetna Commercial |
$879.33
|
| Rate for Payer: Ambetter Exchange |
$541.86
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$289.14
|
| Rate for Payer: Anthem Medicaid |
$321.14
|
| Rate for Payer: Buckeye Individual/Medicaid |
$541.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$541.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$650.23
|
| Rate for Payer: Cash Price |
$695.00
|
| Rate for Payer: Cash Price |
$695.00
|
| Rate for Payer: Cigna Commercial |
$946.08
|
| Rate for Payer: Healthspan PPO |
$989.44
|
| Rate for Payer: Humana Medicaid |
$321.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$723.03
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$541.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$541.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$327.56
|
| Rate for Payer: Molina Healthcare Passport |
$321.14
|
| Rate for Payer: Multiplan PHCS |
$834.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$704.42
|
| Rate for Payer: UHCCP Medicaid |
$303.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$324.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$541.86
|
|
|
FUSION OF BIG TOE JOINT
|
Facility
|
IP
|
$785.00
|
|
|
Service Code
|
HCPCS 28750
|
| Hospital Charge Code |
76101039
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$235.50 |
| Max. Negotiated Rate |
$753.60 |
| Rate for Payer: Aetna Commercial |
$604.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$612.30
|
| Rate for Payer: Cash Price |
$392.50
|
| Rate for Payer: Cigna Commercial |
$651.55
|
| Rate for Payer: First Health Commercial |
$745.75
|
| Rate for Payer: Humana Commercial |
$667.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$643.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$579.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$235.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$690.80
|
| Rate for Payer: Ohio Health Group HMO |
$588.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$628.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$682.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$541.65
|
| Rate for Payer: PHCS Commercial |
$753.60
|
| Rate for Payer: United Healthcare All Payer |
$690.80
|
|
|
FUSION OF BIG TOE JOINT
|
Facility
|
OP
|
$785.00
|
|
|
Service Code
|
HCPCS 28750
|
| Hospital Charge Code |
76101039
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$269.96 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$604.45
|
| Rate for Payer: Anthem Medicaid |
$269.96
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$612.30
|
| 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 |
$392.50
|
| Rate for Payer: Cash Price |
$392.50
|
| Rate for Payer: Cigna Commercial |
$651.55
|
| Rate for Payer: First Health Commercial |
$745.75
|
| Rate for Payer: Humana Commercial |
$667.25
|
| Rate for Payer: Humana KY Medicaid |
$269.96
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$272.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$643.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$579.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$275.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$690.80
|
| Rate for Payer: Ohio Health Group HMO |
$588.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$628.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$682.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$541.65
|
| Rate for Payer: PHCS Commercial |
$753.60
|
| Rate for Payer: United Healthcare All Payer |
$690.80
|
|
|
FUSION OF BIG TOE JOINT(P
|
Professional
|
Both
|
$785.00
|
|
|
Service Code
|
HCPCS 28750
|
| Hospital Charge Code |
761P1039
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$295.89 |
| Max. Negotiated Rate |
$1,042.83 |
| Rate for Payer: Aetna Commercial |
$891.72
|
| Rate for Payer: Ambetter Exchange |
$544.82
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$295.89
|
| Rate for Payer: Anthem Medicaid |
$302.59
|
| Rate for Payer: Buckeye Individual/Medicaid |
$544.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$544.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$653.78
|
| Rate for Payer: Cash Price |
$392.50
|
| Rate for Payer: Cash Price |
$392.50
|
| Rate for Payer: Cigna Commercial |
$979.51
|
| Rate for Payer: Healthspan PPO |
$1,042.83
|
| Rate for Payer: Humana Medicaid |
$302.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$748.68
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$544.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$544.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$308.64
|
| Rate for Payer: Molina Healthcare Passport |
$302.59
|
| Rate for Payer: Multiplan PHCS |
$471.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$708.27
|
| Rate for Payer: UHCCP Medicaid |
$310.68
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$305.62
|
| Rate for Payer: Wellcare Medicare Advantage |
$544.82
|
|
|
FUSION OF BIG TOE JOINT(P
|
Professional
|
Both
|
$530.00
|
|
|
Service Code
|
HCPCS 28755
|
| Hospital Charge Code |
761P1040
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$170.61 |
| Max. Negotiated Rate |
$625.92 |
| Rate for Payer: Aetna Commercial |
$507.44
|
| Rate for Payer: Ambetter Exchange |
$319.56
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$170.61
|
| Rate for Payer: Anthem Medicaid |
$241.37
|
| Rate for Payer: Buckeye Individual/Medicaid |
$319.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$319.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$383.47
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cigna Commercial |
$557.45
|
| Rate for Payer: Healthspan PPO |
$625.92
|
| Rate for Payer: Humana Medicaid |
$241.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$408.01
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$319.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$319.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$246.20
|
| Rate for Payer: Molina Healthcare Passport |
$241.37
|
| Rate for Payer: Multiplan PHCS |
$318.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$415.43
|
| Rate for Payer: UHCCP Medicaid |
$179.14
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$243.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$319.56
|
|
|
FUSION OF FINGER JNT ADD-ON
|
Facility
|
OP
|
$468.00
|
|
|
Service Code
|
HCPCS 26861
|
| Hospital Charge Code |
76100754
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$140.40 |
| Max. Negotiated Rate |
$449.28 |
| Rate for Payer: Aetna Commercial |
$360.36
|
| Rate for Payer: Anthem Medicaid |
$160.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$365.04
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cigna Commercial |
$388.44
|
| Rate for Payer: First Health Commercial |
$444.60
|
| Rate for Payer: Humana Commercial |
$397.80
|
| Rate for Payer: Humana KY Medicaid |
$160.95
|
| Rate for Payer: Kentucky WC Medicaid |
$162.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$383.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$345.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$140.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$164.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$411.84
|
| Rate for Payer: Ohio Health Group HMO |
$351.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$374.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$407.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$322.92
|
| Rate for Payer: PHCS Commercial |
$449.28
|
| Rate for Payer: United Healthcare All Payer |
$411.84
|
|
|
FUSION OF FINGER JNT ADD-ON
|
Facility
|
IP
|
$468.00
|
|
|
Service Code
|
HCPCS 26861
|
| Hospital Charge Code |
76100754
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$140.40 |
| Max. Negotiated Rate |
$449.28 |
| Rate for Payer: Aetna Commercial |
$360.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$365.04
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cigna Commercial |
$388.44
|
| Rate for Payer: First Health Commercial |
$444.60
|
| Rate for Payer: Humana Commercial |
$397.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$383.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$345.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$140.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$411.84
|
| Rate for Payer: Ohio Health Group HMO |
$351.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$374.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$407.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$322.92
|
| Rate for Payer: PHCS Commercial |
$449.28
|
| Rate for Payer: United Healthcare All Payer |
$411.84
|
|
