|
ARTH ACRO STCV JT EXP/DRG/RMFB
|
Professional
|
Both
|
$1,170.00
|
|
|
Service Code
|
HCPCS 23044
|
| Hospital Charge Code |
761P0435
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$401.81 |
| Max. Negotiated Rate |
$1,170.00 |
| Rate for Payer: Aetna Commercial |
$834.23
|
| Rate for Payer: Anthem Medicaid |
$401.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,170.00
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cigna Commercial |
$916.34
|
| Rate for Payer: Healthspan PPO |
$755.64
|
| Rate for Payer: Humana Medicaid |
$401.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$705.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$409.85
|
| Rate for Payer: Molina Healthcare Passport |
$401.81
|
| Rate for Payer: Multiplan PHCS |
$702.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$819.00
|
| Rate for Payer: UHCCP Medicaid |
$409.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$405.83
|
|
|
ARTH ACRO STCV JT EXP/DRG/RMFB
|
Facility
|
IP
|
$1,170.00
|
|
|
Service Code
|
HCPCS 23044
|
| Hospital Charge Code |
76100435
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$152.10 |
| Max. Negotiated Rate |
$1,123.20 |
| Rate for Payer: Aetna Commercial |
$900.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$912.60
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cigna Commercial |
$971.10
|
| Rate for Payer: First Health Commercial |
$1,111.50
|
| Rate for Payer: Humana Commercial |
$994.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$959.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$863.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$351.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,029.60
|
| Rate for Payer: Ohio Health Group HMO |
$877.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$152.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$362.70
|
| Rate for Payer: PHCS Commercial |
$1,123.20
|
| Rate for Payer: United Healthcare All Payer |
$1,029.60
|
|
|
ARTH ACRO STCV JT EXP/DRG/RMFB
|
Professional
|
Both
|
$1,170.00
|
|
|
Service Code
|
HCPCS 23044
|
| Hospital Charge Code |
76100435
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$401.81 |
| Max. Negotiated Rate |
$1,170.00 |
| Rate for Payer: Aetna Commercial |
$834.23
|
| Rate for Payer: Anthem Medicaid |
$401.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,170.00
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cigna Commercial |
$916.34
|
| Rate for Payer: Healthspan PPO |
$755.64
|
| Rate for Payer: Humana Medicaid |
$401.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$705.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$409.85
|
| Rate for Payer: Molina Healthcare Passport |
$401.81
|
| Rate for Payer: Multiplan PHCS |
$702.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$819.00
|
| Rate for Payer: UHCCP Medicaid |
$409.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$405.83
|
|
|
ARTH AID ANT CRCTE LIG RPR
|
Facility
|
OP
|
$3,575.00
|
|
|
Service Code
|
HCPCS 29888
|
| Hospital Charge Code |
76101108
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$464.75 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$2,752.75
|
| Rate for Payer: Anthem Medicaid |
$1,229.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,788.50
|
| 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 |
$1,787.50
|
| Rate for Payer: Cash Price |
$1,787.50
|
| Rate for Payer: Cigna Commercial |
$2,967.25
|
| Rate for Payer: First Health Commercial |
$3,396.25
|
| Rate for Payer: Humana Commercial |
$3,038.75
|
| Rate for Payer: Humana KY Medicaid |
$1,229.44
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,241.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,931.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,638.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,254.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,146.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,681.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$715.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$464.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,108.25
|
| Rate for Payer: PHCS Commercial |
$3,432.00
|
| Rate for Payer: United Healthcare All Payer |
$3,146.00
|
|
|
ARTH AID ANT CRCTE LIG RPR
|
Facility
|
IP
|
$3,575.00
|
|
|
Service Code
|
HCPCS 29888
|
| Hospital Charge Code |
76101108
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$464.75 |
| Max. Negotiated Rate |
$3,432.00 |
| Rate for Payer: Aetna Commercial |
$2,752.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,788.50
|
| Rate for Payer: Cash Price |
$1,787.50
|
| Rate for Payer: Cigna Commercial |
$2,967.25
|
| Rate for Payer: First Health Commercial |
$3,396.25
|
| Rate for Payer: Humana Commercial |
$3,038.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,931.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,638.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,072.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,146.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,681.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$715.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$464.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,108.25
|
| Rate for Payer: PHCS Commercial |
$3,432.00
|
| Rate for Payer: United Healthcare All Payer |
$3,146.00
|
|
|
ARTH AID ANT CRCTE LIG RPR
|
Professional
|
Both
|
$3,575.00
|
|
|
Service Code
|
HCPCS 29888
|
| Hospital Charge Code |
76101108
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$922.93 |
| Max. Negotiated Rate |
$3,575.00 |
| Rate for Payer: Aetna Commercial |
$1,482.53
|
| Rate for Payer: Anthem Medicaid |
$922.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,575.00
|
| Rate for Payer: Cash Price |
$1,787.50
|
| Rate for Payer: Cash Price |
$1,787.50
|
| Rate for Payer: Cigna Commercial |
$1,611.77
|
| Rate for Payer: Healthspan PPO |
$1,342.86
|
| Rate for Payer: Humana Medicaid |
$922.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,237.21
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$941.39
|
| Rate for Payer: Molina Healthcare Passport |
$922.93
|
| Rate for Payer: Multiplan PHCS |
$2,145.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,502.50
|
| Rate for Payer: UHCCP Medicaid |
$1,251.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$932.16
|
|
|
ARTH AID ANT CRCTE LIG RPR(P
|
Professional
|
Both
|
$3,575.00
|
|
|
Service Code
|
HCPCS 29888
|
| Hospital Charge Code |
761P1108
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$922.93 |
| Max. Negotiated Rate |
$3,575.00 |
| Rate for Payer: Aetna Commercial |
$1,482.53
|
| Rate for Payer: Anthem Medicaid |
$922.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,575.00
|
| Rate for Payer: Cash Price |
$1,787.50
|
| Rate for Payer: Cash Price |
$1,787.50
|
| Rate for Payer: Cigna Commercial |
$1,611.77
|
| Rate for Payer: Healthspan PPO |
$1,342.86
|
| Rate for Payer: Humana Medicaid |
$922.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,237.21
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$941.39
|
| Rate for Payer: Molina Healthcare Passport |
$922.93
|
| Rate for Payer: Multiplan PHCS |
$2,145.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,502.50
|
| Rate for Payer: UHCCP Medicaid |
$1,251.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$932.16
|
|
|
ARTH ANK EXC OSTCHNDRL DFCT
|
Facility
|
IP
|
$2,090.00
|
|
|
Service Code
|
HCPCS 29891
|
| Hospital Charge Code |
76101109
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$271.70 |
| Max. Negotiated Rate |
$2,006.40 |
| Rate for Payer: Aetna Commercial |
$1,609.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,630.20
|
| Rate for Payer: Cash Price |
$1,045.00
|
| Rate for Payer: Cigna Commercial |
$1,734.70
|
| Rate for Payer: First Health Commercial |
$1,985.50
|
| Rate for Payer: Humana Commercial |
$1,776.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,713.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,542.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$627.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,839.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,567.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$418.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$271.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$647.90
|
| Rate for Payer: PHCS Commercial |
$2,006.40
|
| Rate for Payer: United Healthcare All Payer |
$1,839.20
|
|
|
ARTH ANK EXC OSTCHNDRL DFCT
|
Facility
|
OP
|
$2,090.00
|
|
|
Service Code
|
HCPCS 29891
|
| Hospital Charge Code |
76101109
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$271.70 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$1,609.30
|
| Rate for Payer: Anthem Medicaid |
$718.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,630.20
|
| 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 |
$1,045.00
|
| Rate for Payer: Cash Price |
$1,045.00
|
| Rate for Payer: Cigna Commercial |
$1,734.70
|
| Rate for Payer: First Health Commercial |
$1,985.50
|
| Rate for Payer: Humana Commercial |
$1,776.50
|
| Rate for Payer: Humana KY Medicaid |
$718.75
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$726.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,713.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,542.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$733.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,839.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,567.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$418.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$271.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$647.90
|
| Rate for Payer: PHCS Commercial |
$2,006.40
|
| Rate for Payer: United Healthcare All Payer |
$1,839.20
|
|
|
ARTH ANK EXC OSTCHNDRL DFCT
|
Professional
|
Both
|
$2,090.00
|
|
|
Service Code
|
HCPCS 29891
|
| Hospital Charge Code |
76101109
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$513.66 |
| Max. Negotiated Rate |
$2,090.00 |
| Rate for Payer: Aetna Commercial |
$1,018.14
|
| Rate for Payer: Anthem Medicaid |
$513.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,090.00
|
| Rate for Payer: Cash Price |
$1,045.00
|
| Rate for Payer: Cash Price |
$1,045.00
|
| Rate for Payer: Cigna Commercial |
$1,113.35
|
| Rate for Payer: Healthspan PPO |
$922.21
|
| Rate for Payer: Humana Medicaid |
$513.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$857.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$523.93
|
| Rate for Payer: Molina Healthcare Passport |
$513.66
|
| Rate for Payer: Multiplan PHCS |
$1,254.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,463.00
|
| Rate for Payer: UHCCP Medicaid |
$731.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$518.80
|
|
|
ARTH ANK EXC OSTCHNDRL DFCT(P
|
Professional
|
Both
|
$2,090.00
|
|
|
Service Code
|
HCPCS 29891
|
| Hospital Charge Code |
761P1109
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$513.66 |
| Max. Negotiated Rate |
$2,090.00 |
| Rate for Payer: Aetna Commercial |
$1,018.14
|
| Rate for Payer: Anthem Medicaid |
$513.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,090.00
|
| Rate for Payer: Cash Price |
$1,045.00
|
| Rate for Payer: Cash Price |
$1,045.00
|
| Rate for Payer: Cigna Commercial |
$1,113.35
|
| Rate for Payer: Healthspan PPO |
$922.21
|
| Rate for Payer: Humana Medicaid |
$513.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$857.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$523.93
|
| Rate for Payer: Molina Healthcare Passport |
$513.66
|
| Rate for Payer: Multiplan PHCS |
$1,254.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,463.00
|
| Rate for Payer: UHCCP Medicaid |
$731.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$518.80
|
|
|
ARTH ANKLE DEBRID EXT
|
Professional
|
Both
|
$2,700.00
|
|
|
Service Code
|
HCPCS 29898
|
| Hospital Charge Code |
76101115
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$557.77 |
| Max. Negotiated Rate |
$2,700.00 |
| Rate for Payer: Aetna Commercial |
$870.32
|
| Rate for Payer: Anthem Medicaid |
$557.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,700.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$958.01
|
| Rate for Payer: Healthspan PPO |
$788.32
|
| Rate for Payer: Humana Medicaid |
$557.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$712.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$568.93
|
| Rate for Payer: Molina Healthcare Passport |
$557.77
|
| Rate for Payer: Multiplan PHCS |
$1,620.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,890.00
|
| Rate for Payer: UHCCP Medicaid |
$945.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$563.35
|
|
|
ARTH ANKLE DEBRID EXT
|
Facility
|
IP
|
$2,700.00
|
|
|
Service Code
|
HCPCS 29898
|
| Hospital Charge Code |
76101115
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$351.00 |
| Max. Negotiated Rate |
$2,592.00 |
| Rate for Payer: Aetna Commercial |
$2,079.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,106.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$2,241.00
|
| Rate for Payer: First Health Commercial |
$2,565.00
|
| Rate for Payer: Humana Commercial |
$2,295.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,214.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,992.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$810.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,376.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,025.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$351.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$837.00
|
| Rate for Payer: PHCS Commercial |
$2,592.00
|
| Rate for Payer: United Healthcare All Payer |
$2,376.00
|
|
|
ARTH ANKLE DEBRID EXT
|
Facility
|
OP
|
$2,700.00
|
|
|
Service Code
|
HCPCS 29898
|
| Hospital Charge Code |
76101115
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$351.00 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$2,079.00
|
| Rate for Payer: Anthem Medicaid |
$928.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,106.00
|
| 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 |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$2,241.00
|
| Rate for Payer: First Health Commercial |
$2,565.00
|
| Rate for Payer: Humana Commercial |
$2,295.00
|
| Rate for Payer: Humana KY Medicaid |
$928.53
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$937.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,214.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,992.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$947.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,376.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,025.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$351.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$837.00
|
| Rate for Payer: PHCS Commercial |
$2,592.00
|
| Rate for Payer: United Healthcare All Payer |
$2,376.00
|
|
|
ARTH ANKLE DEBRID EXT(P
|
Professional
|
Both
|
$2,700.00
|
|
|
Service Code
|
HCPCS 29898
|
| Hospital Charge Code |
761P1115
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$557.77 |
| Max. Negotiated Rate |
$2,700.00 |
| Rate for Payer: Aetna Commercial |
$870.32
|
| Rate for Payer: Anthem Medicaid |
$557.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,700.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$958.01
|
| Rate for Payer: Healthspan PPO |
$788.32
|
| Rate for Payer: Humana Medicaid |
$557.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$712.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$568.93
|
| Rate for Payer: Molina Healthcare Passport |
$557.77
|
| Rate for Payer: Multiplan PHCS |
$1,620.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,890.00
|
| Rate for Payer: UHCCP Medicaid |
$945.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$563.35
|
|
|
ARTH ANKLE DEBRID LTD
|
Facility
|
OP
|
$952.50
|
|
|
Service Code
|
HCPCS 29897
|
| Hospital Charge Code |
76101114
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$123.82 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$733.42
|
| Rate for Payer: Anthem Medicaid |
$327.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$742.95
|
| 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 |
$476.25
|
| Rate for Payer: Cash Price |
$476.25
|
| Rate for Payer: Cigna Commercial |
$790.58
|
| Rate for Payer: First Health Commercial |
$904.88
|
| Rate for Payer: Humana Commercial |
$809.62
|
| Rate for Payer: Humana KY Medicaid |
$327.56
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$330.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$781.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$702.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$334.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$838.20
|
| Rate for Payer: Ohio Health Group HMO |
$714.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$190.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$123.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$295.28
|
| Rate for Payer: PHCS Commercial |
$914.40
|
| Rate for Payer: United Healthcare All Payer |
$838.20
|
|
|
ARTH ANKLE DEBRID LTD
|
Facility
|
OP
|
$1,905.00
|
|
|
Service Code
|
HCPCS 29897
|
| Hospital Charge Code |
76101113
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$247.65 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$1,466.85
|
| Rate for Payer: Anthem Medicaid |
$655.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,485.90
|
| 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 |
$952.50
|
| Rate for Payer: Cash Price |
$952.50
|
| Rate for Payer: Cigna Commercial |
$1,581.15
|
| Rate for Payer: First Health Commercial |
$1,809.75
|
| Rate for Payer: Humana Commercial |
$1,619.25
|
| Rate for Payer: Humana KY Medicaid |
$655.13
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$661.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,562.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,405.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$668.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,676.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,428.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$381.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$590.55
|
| Rate for Payer: PHCS Commercial |
$1,828.80
|
| Rate for Payer: United Healthcare All Payer |
$1,676.40
|
|
|
ARTH ANKLE DEBRID LTD
|
Facility
|
IP
|
$1,905.00
|
|
|
Service Code
|
HCPCS 29897
|
| Hospital Charge Code |
76101113
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$247.65 |
| Max. Negotiated Rate |
$1,828.80 |
| Rate for Payer: Aetna Commercial |
$1,466.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,485.90
|
| Rate for Payer: Cash Price |
$952.50
|
| Rate for Payer: Cigna Commercial |
$1,581.15
|
| Rate for Payer: First Health Commercial |
$1,809.75
|
| Rate for Payer: Humana Commercial |
$1,619.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,562.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,405.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$571.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,676.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,428.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$381.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$590.55
|
| Rate for Payer: PHCS Commercial |
$1,828.80
|
| Rate for Payer: United Healthcare All Payer |
$1,676.40
|
|
|
ARTH ANKLE DEBRID LTD
|
Professional
|
Both
|
$952.50
|
|
|
Service Code
|
HCPCS 29897
|
| Hospital Charge Code |
76101114
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$333.38 |
| Max. Negotiated Rate |
$952.50 |
| Rate for Payer: Aetna Commercial |
$778.43
|
| Rate for Payer: Anthem Medicaid |
$483.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$952.50
|
| Rate for Payer: Cash Price |
$476.25
|
| Rate for Payer: Cash Price |
$476.25
|
| Rate for Payer: Cigna Commercial |
$861.59
|
| Rate for Payer: Healthspan PPO |
$705.09
|
| Rate for Payer: Humana Medicaid |
$483.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$641.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$493.38
|
| Rate for Payer: Molina Healthcare Passport |
$483.71
|
| Rate for Payer: Multiplan PHCS |
$571.50
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$666.75
|
| Rate for Payer: UHCCP Medicaid |
$333.38
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$488.55
|
|
|
ARTH ANKLE DEBRID LTD
|
Professional
|
Both
|
$1,905.00
|
|
|
Service Code
|
HCPCS 29897
|
| Hospital Charge Code |
76101113
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$483.71 |
| Max. Negotiated Rate |
$1,905.00 |
| Rate for Payer: Aetna Commercial |
$778.43
|
| Rate for Payer: Anthem Medicaid |
$483.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,905.00
|
| Rate for Payer: Cash Price |
$952.50
|
| Rate for Payer: Cash Price |
$952.50
|
| Rate for Payer: Cigna Commercial |
$861.59
|
| Rate for Payer: Healthspan PPO |
$705.09
|
| Rate for Payer: Humana Medicaid |
$483.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$641.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$493.38
|
| Rate for Payer: Molina Healthcare Passport |
$483.71
|
| Rate for Payer: Multiplan PHCS |
$1,143.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,333.50
|
| Rate for Payer: UHCCP Medicaid |
$666.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$488.55
|
|
|
ARTH ANKLE DEBRID LTD
|
Facility
|
IP
|
$952.50
|
|
|
Service Code
|
HCPCS 29897
|
| Hospital Charge Code |
76101114
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$123.82 |
| Max. Negotiated Rate |
$914.40 |
| Rate for Payer: Aetna Commercial |
$733.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$742.95
|
| Rate for Payer: Cash Price |
$476.25
|
| Rate for Payer: Cigna Commercial |
$790.58
|
| Rate for Payer: First Health Commercial |
$904.88
|
| Rate for Payer: Humana Commercial |
$809.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$781.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$702.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$285.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$838.20
|
| Rate for Payer: Ohio Health Group HMO |
$714.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$190.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$123.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$295.28
|
| Rate for Payer: PHCS Commercial |
$914.40
|
| Rate for Payer: United Healthcare All Payer |
$838.20
|
|
|
ARTH ANKLE DEBRID LTD(P
|
Professional
|
Both
|
$1,905.00
|
|
|
Service Code
|
HCPCS 29897
|
| Hospital Charge Code |
761P1113
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$483.71 |
| Max. Negotiated Rate |
$1,905.00 |
| Rate for Payer: Aetna Commercial |
$778.43
|
| Rate for Payer: Anthem Medicaid |
$483.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,905.00
|
| Rate for Payer: Cash Price |
$952.50
|
| Rate for Payer: Cash Price |
$952.50
|
| Rate for Payer: Cigna Commercial |
$861.59
|
| Rate for Payer: Healthspan PPO |
$705.09
|
| Rate for Payer: Humana Medicaid |
$483.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$641.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$493.38
|
| Rate for Payer: Molina Healthcare Passport |
$483.71
|
| Rate for Payer: Multiplan PHCS |
$1,143.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,333.50
|
| Rate for Payer: UHCCP Medicaid |
$666.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$488.55
|
|
|
ARTH ANKLE DEBRID LTD(P
|
Professional
|
Both
|
$952.50
|
|
|
Service Code
|
HCPCS 29897
|
| Hospital Charge Code |
761P1114
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$333.38 |
| Max. Negotiated Rate |
$952.50 |
| Rate for Payer: Aetna Commercial |
$778.43
|
| Rate for Payer: Anthem Medicaid |
$483.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$952.50
|
| Rate for Payer: Cash Price |
$476.25
|
| Rate for Payer: Cash Price |
$476.25
|
| Rate for Payer: Cigna Commercial |
$861.59
|
| Rate for Payer: Healthspan PPO |
$705.09
|
| Rate for Payer: Humana Medicaid |
$483.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$641.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$493.38
|
| Rate for Payer: Molina Healthcare Passport |
$483.71
|
| Rate for Payer: Multiplan PHCS |
$571.50
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$666.75
|
| Rate for Payer: UHCCP Medicaid |
$333.38
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$488.55
|
|
|
ARTH ANKLE SYNOVECTOMY PTL
|
Facility
|
OP
|
$1,905.00
|
|
|
Service Code
|
HCPCS 29895
|
| Hospital Charge Code |
76101112
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$247.65 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$1,466.85
|
| Rate for Payer: Anthem Medicaid |
$655.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,485.90
|
| 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 |
$952.50
|
| Rate for Payer: Cash Price |
$952.50
|
| Rate for Payer: Cigna Commercial |
$1,581.15
|
| Rate for Payer: First Health Commercial |
$1,809.75
|
| Rate for Payer: Humana Commercial |
$1,619.25
|
| Rate for Payer: Humana KY Medicaid |
$655.13
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$661.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,562.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,405.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$668.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,676.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,428.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$381.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$590.55
|
| Rate for Payer: PHCS Commercial |
$1,828.80
|
| Rate for Payer: United Healthcare All Payer |
$1,676.40
|
|
|
ARTH ANKLE SYNOVECTOMY PTL
|
Facility
|
IP
|
$1,905.00
|
|
|
Service Code
|
HCPCS 29895
|
| Hospital Charge Code |
76101112
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$247.65 |
| Max. Negotiated Rate |
$1,828.80 |
| Rate for Payer: Aetna Commercial |
$1,466.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,485.90
|
| Rate for Payer: Cash Price |
$952.50
|
| Rate for Payer: Cigna Commercial |
$1,581.15
|
| Rate for Payer: First Health Commercial |
$1,809.75
|
| Rate for Payer: Humana Commercial |
$1,619.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,562.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,405.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$571.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,676.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,428.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$381.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$590.55
|
| Rate for Payer: PHCS Commercial |
$1,828.80
|
| Rate for Payer: United Healthcare All Payer |
$1,676.40
|
|
