|
ARTH ANKLE SYNOVECTOMY PTL
|
Professional
|
Both
|
$1,905.00
|
|
|
Service Code
|
HCPCS 29895
|
| Hospital Charge Code |
76101112
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$464.84 |
| Max. Negotiated Rate |
$1,905.00 |
| Rate for Payer: Aetna Commercial |
$743.39
|
| Rate for Payer: Anthem Medicaid |
$464.84
|
| 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 |
$820.84
|
| Rate for Payer: Healthspan PPO |
$673.35
|
| Rate for Payer: Humana Medicaid |
$464.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$611.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$474.14
|
| Rate for Payer: Molina Healthcare Passport |
$464.84
|
| 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 |
$469.49
|
|
|
ARTH ANKLE SYNOVECTOMY PTL(P
|
Professional
|
Both
|
$1,905.00
|
|
|
Service Code
|
HCPCS 29895
|
| Hospital Charge Code |
761P1112
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$464.84 |
| Max. Negotiated Rate |
$1,905.00 |
| Rate for Payer: Aetna Commercial |
$743.39
|
| Rate for Payer: Anthem Medicaid |
$464.84
|
| 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 |
$820.84
|
| Rate for Payer: Healthspan PPO |
$673.35
|
| Rate for Payer: Humana Medicaid |
$464.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$611.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$474.14
|
| Rate for Payer: Molina Healthcare Passport |
$464.84
|
| 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 |
$469.49
|
|
|
ARTH ANKLE W/RMV LOOSE/FB
|
Facility
|
OP
|
$2,075.00
|
|
|
Service Code
|
HCPCS 29894
|
| Hospital Charge Code |
76101111
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$269.75 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$1,597.75
|
| Rate for Payer: Anthem Medicaid |
$713.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,618.50
|
| 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 |
$1,037.50
|
| Rate for Payer: Cash Price |
$1,037.50
|
| Rate for Payer: Cigna Commercial |
$1,722.25
|
| Rate for Payer: First Health Commercial |
$1,971.25
|
| Rate for Payer: Humana Commercial |
$1,763.75
|
| Rate for Payer: Humana KY Medicaid |
$713.59
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$720.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,701.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,531.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$727.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,826.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,556.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$415.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$269.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$643.25
|
| Rate for Payer: PHCS Commercial |
$1,992.00
|
| Rate for Payer: United Healthcare All Payer |
$1,826.00
|
|
|
ARTH ANKLE W/RMV LOOSE/FB
|
Facility
|
IP
|
$2,075.00
|
|
|
Service Code
|
HCPCS 29894
|
| Hospital Charge Code |
76101111
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$269.75 |
| Max. Negotiated Rate |
$1,992.00 |
| Rate for Payer: Aetna Commercial |
$1,597.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,618.50
|
| Rate for Payer: Cash Price |
$1,037.50
|
| Rate for Payer: Cigna Commercial |
$1,722.25
|
| Rate for Payer: First Health Commercial |
$1,971.25
|
| Rate for Payer: Humana Commercial |
$1,763.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,701.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,531.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$622.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,826.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,556.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$415.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$269.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$643.25
|
| Rate for Payer: PHCS Commercial |
$1,992.00
|
| Rate for Payer: United Healthcare All Payer |
$1,826.00
|
|
|
ARTH ANKLE W/RMV LOOSE/FB
|
Professional
|
Both
|
$2,075.00
|
|
|
Service Code
|
HCPCS 29894
|
| Hospital Charge Code |
76101111
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$478.37 |
| Max. Negotiated Rate |
$2,075.00 |
| Rate for Payer: Aetna Commercial |
$768.57
|
| Rate for Payer: Anthem Medicaid |
$478.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,075.00
|
| Rate for Payer: Cash Price |
$1,037.50
|
| Rate for Payer: Cash Price |
$1,037.50
|
| Rate for Payer: Cigna Commercial |
$839.26
|
| Rate for Payer: Healthspan PPO |
$696.16
|
| Rate for Payer: Humana Medicaid |
$478.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$640.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$487.94
|
| Rate for Payer: Molina Healthcare Passport |
$478.37
|
| Rate for Payer: Multiplan PHCS |
$1,245.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,452.50
|
| Rate for Payer: UHCCP Medicaid |
$726.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$483.15
|
|
|
ARTH ANKLE W/RMV LOOSE/FB(P
|
Professional
|
Both
|
$2,075.00
|
|
|
Service Code
|
HCPCS 29894
|
| Hospital Charge Code |
761P1111
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$478.37 |
| Max. Negotiated Rate |
$2,075.00 |
| Rate for Payer: Aetna Commercial |
$768.57
|
| Rate for Payer: Anthem Medicaid |
$478.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,075.00
|
| Rate for Payer: Cash Price |
$1,037.50
|
| Rate for Payer: Cash Price |
$1,037.50
|
| Rate for Payer: Cigna Commercial |
$839.26
|
| Rate for Payer: Healthspan PPO |
$696.16
|
| Rate for Payer: Humana Medicaid |
$478.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$640.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$487.94
|
| Rate for Payer: Molina Healthcare Passport |
$478.37
|
| Rate for Payer: Multiplan PHCS |
$1,245.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,452.50
|
| Rate for Payer: UHCCP Medicaid |
$726.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$483.15
|
|
|
ARTH ELBOW W/CAP EXC/CAP REL
|
Facility
|
OP
|
$8,698.69
|
|
|
Service Code
|
HCPCS 24006
|
| Hospital Charge Code |
76100497
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,130.83 |
| Max. Negotiated Rate |
$8,350.74 |
| Rate for Payer: Aetna Commercial |
$6,697.99
|
| Rate for Payer: Anthem Medicaid |
$2,991.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,784.98
|
| 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 |
$4,349.34
|
| Rate for Payer: Cash Price |
$4,349.34
|
| Rate for Payer: Cigna Commercial |
$7,219.91
|
| Rate for Payer: First Health Commercial |
$8,263.76
|
| Rate for Payer: Humana Commercial |
$7,393.89
|
| Rate for Payer: Humana KY Medicaid |
$2,991.48
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$3,021.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,132.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,419.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,051.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,654.85
|
| Rate for Payer: Ohio Health Group HMO |
$6,524.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,739.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,130.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,696.59
|
| Rate for Payer: PHCS Commercial |
$8,350.74
|
| Rate for Payer: United Healthcare All Payer |
$7,654.85
|
|
|
ARTH ELBOW W/CAP EXC/CAP REL
|
Professional
|
Both
|
$8,698.69
|
|
|
Service Code
|
HCPCS 24006
|
| Hospital Charge Code |
76100497
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$475.23 |
| Max. Negotiated Rate |
$8,698.69 |
| Rate for Payer: Aetna Commercial |
$1,038.37
|
| Rate for Payer: Anthem Medicaid |
$475.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$8,698.69
|
| Rate for Payer: Cash Price |
$4,349.34
|
| Rate for Payer: Cash Price |
$4,349.34
|
| Rate for Payer: Cigna Commercial |
$1,140.29
|
| Rate for Payer: Healthspan PPO |
$940.54
|
| Rate for Payer: Humana Medicaid |
$475.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$879.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$484.73
|
| Rate for Payer: Molina Healthcare Passport |
$475.23
|
| Rate for Payer: Multiplan PHCS |
$5,219.21
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$6,089.08
|
| Rate for Payer: UHCCP Medicaid |
$3,044.54
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$479.98
|
|
|
ARTH ELBOW W/CAP EXC/CAP REL
|
Facility
|
IP
|
$8,698.69
|
|
|
Service Code
|
HCPCS 24006
|
| Hospital Charge Code |
76100497
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,130.83 |
| Max. Negotiated Rate |
$8,350.74 |
| Rate for Payer: Aetna Commercial |
$6,697.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,784.98
|
| Rate for Payer: Cash Price |
$4,349.34
|
| Rate for Payer: Cigna Commercial |
$7,219.91
|
| Rate for Payer: First Health Commercial |
$8,263.76
|
| Rate for Payer: Humana Commercial |
$7,393.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,132.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,419.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,609.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,654.85
|
| Rate for Payer: Ohio Health Group HMO |
$6,524.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,739.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,130.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,696.59
|
| Rate for Payer: PHCS Commercial |
$8,350.74
|
| Rate for Payer: United Healthcare All Payer |
$7,654.85
|
|
|
ARTH ELBOW W/CAP EXC/CAP REL(P
|
Professional
|
Both
|
$1,900.00
|
|
|
Service Code
|
HCPCS 24006
|
| Hospital Charge Code |
761P0497
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$475.23 |
| Max. Negotiated Rate |
$1,900.00 |
| Rate for Payer: Aetna Commercial |
$1,038.37
|
| Rate for Payer: Anthem Medicaid |
$475.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,900.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cigna Commercial |
$1,140.29
|
| Rate for Payer: Healthspan PPO |
$940.54
|
| Rate for Payer: Humana Medicaid |
$475.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$879.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$484.73
|
| Rate for Payer: Molina Healthcare Passport |
$475.23
|
| Rate for Payer: Multiplan PHCS |
$1,140.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,330.00
|
| Rate for Payer: UHCCP Medicaid |
$665.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$479.98
|
|
|
ARTH ELBOW W/CAP EXC/CAP REL(T
|
Facility
|
OP
|
$6,798.69
|
|
|
Service Code
|
HCPCS 24006
|
| Hospital Charge Code |
761T0497
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$883.83 |
| Max. Negotiated Rate |
$6,526.74 |
| Rate for Payer: Aetna Commercial |
$5,234.99
|
| Rate for Payer: Anthem Medicaid |
$2,338.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,302.98
|
| 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 |
$3,399.34
|
| Rate for Payer: Cash Price |
$3,399.34
|
| Rate for Payer: Cigna Commercial |
$5,642.91
|
| Rate for Payer: First Health Commercial |
$6,458.76
|
| Rate for Payer: Humana Commercial |
$5,778.89
|
| Rate for Payer: Humana KY Medicaid |
$2,338.07
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$2,361.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,574.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,017.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,384.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,982.85
|
| Rate for Payer: Ohio Health Group HMO |
$5,099.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,359.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$883.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,107.59
|
| Rate for Payer: PHCS Commercial |
$6,526.74
|
| Rate for Payer: United Healthcare All Payer |
$5,982.85
|
|
|
ARTH ELBOW W/CAP EXC/CAP REL(T
|
Facility
|
IP
|
$6,798.69
|
|
|
Service Code
|
HCPCS 24006
|
| Hospital Charge Code |
761T0497
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$883.83 |
| Max. Negotiated Rate |
$6,526.74 |
| Rate for Payer: Aetna Commercial |
$5,234.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,302.98
|
| Rate for Payer: Cash Price |
$3,399.34
|
| Rate for Payer: Cigna Commercial |
$5,642.91
|
| Rate for Payer: First Health Commercial |
$6,458.76
|
| Rate for Payer: Humana Commercial |
$5,778.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,574.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,017.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,039.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,982.85
|
| Rate for Payer: Ohio Health Group HMO |
$5,099.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,359.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$883.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,107.59
|
| Rate for Payer: PHCS Commercial |
$6,526.74
|
| Rate for Payer: United Healthcare All Payer |
$5,982.85
|
|
|
ARTH ELBOW WEXP DRAIN/RMV
|
Professional
|
Both
|
$6,907.98
|
|
|
Service Code
|
HCPCS 24000
|
| Hospital Charge Code |
76100496
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$373.76 |
| Max. Negotiated Rate |
$6,907.98 |
| Rate for Payer: Aetna Commercial |
$683.52
|
| Rate for Payer: Anthem Medicaid |
$373.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,907.98
|
| Rate for Payer: Cash Price |
$3,453.99
|
| Rate for Payer: Cash Price |
$3,453.99
|
| Rate for Payer: Cigna Commercial |
$749.76
|
| Rate for Payer: Healthspan PPO |
$619.12
|
| Rate for Payer: Humana Medicaid |
$373.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$584.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$381.24
|
| Rate for Payer: Molina Healthcare Passport |
$373.76
|
| Rate for Payer: Multiplan PHCS |
$4,144.79
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,835.59
|
| Rate for Payer: UHCCP Medicaid |
$2,417.79
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$377.50
|
|
|
ARTH ELBOW WEXP DRAIN/RMV
|
Facility
|
IP
|
$6,907.98
|
|
|
Service Code
|
HCPCS 24000
|
| Hospital Charge Code |
76100496
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$898.04 |
| Max. Negotiated Rate |
$6,631.66 |
| Rate for Payer: Aetna Commercial |
$5,319.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,388.22
|
| Rate for Payer: Cash Price |
$3,453.99
|
| Rate for Payer: Cigna Commercial |
$5,733.62
|
| Rate for Payer: First Health Commercial |
$6,562.58
|
| Rate for Payer: Humana Commercial |
$5,871.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,664.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,098.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,072.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,079.02
|
| Rate for Payer: Ohio Health Group HMO |
$5,180.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,381.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$898.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,141.47
|
| Rate for Payer: PHCS Commercial |
$6,631.66
|
| Rate for Payer: United Healthcare All Payer |
$6,079.02
|
|
|
ARTH ELBOW WEXP DRAIN/RMV
|
Facility
|
OP
|
$6,907.98
|
|
|
Service Code
|
HCPCS 24000
|
| Hospital Charge Code |
76100496
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$898.04 |
| Max. Negotiated Rate |
$6,631.66 |
| Rate for Payer: Aetna Commercial |
$5,319.14
|
| Rate for Payer: Anthem Medicaid |
$2,375.65
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,388.22
|
| 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 |
$3,453.99
|
| Rate for Payer: Cash Price |
$3,453.99
|
| Rate for Payer: Cigna Commercial |
$5,733.62
|
| Rate for Payer: First Health Commercial |
$6,562.58
|
| Rate for Payer: Humana Commercial |
$5,871.78
|
| Rate for Payer: Humana KY Medicaid |
$2,375.65
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$2,399.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,664.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,098.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,423.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,079.02
|
| Rate for Payer: Ohio Health Group HMO |
$5,180.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,381.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$898.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,141.47
|
| Rate for Payer: PHCS Commercial |
$6,631.66
|
| Rate for Payer: United Healthcare All Payer |
$6,079.02
|
|
|
ARTH ELBOW WEXP DRAIN/RMV(P
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 24000
|
| Hospital Charge Code |
761P0496
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$373.76 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$683.52
|
| Rate for Payer: Anthem Medicaid |
$373.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,500.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$749.76
|
| Rate for Payer: Healthspan PPO |
$619.12
|
| Rate for Payer: Humana Medicaid |
$373.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$584.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$381.24
|
| Rate for Payer: Molina Healthcare Passport |
$373.76
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,050.00
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$377.50
|
|
|
ARTH ELBOW WEXP DRAIN/RMV(T
|
Facility
|
OP
|
$5,407.98
|
|
|
Service Code
|
HCPCS 24000
|
| Hospital Charge Code |
761T0496
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$703.04 |
| Max. Negotiated Rate |
$5,191.66 |
| Rate for Payer: Aetna Commercial |
$4,164.14
|
| Rate for Payer: Anthem Medicaid |
$1,859.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,218.22
|
| 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 |
$2,703.99
|
| Rate for Payer: Cash Price |
$2,703.99
|
| Rate for Payer: Cigna Commercial |
$4,488.62
|
| Rate for Payer: First Health Commercial |
$5,137.58
|
| Rate for Payer: Humana Commercial |
$4,596.78
|
| Rate for Payer: Humana KY Medicaid |
$1,859.80
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,878.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,434.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,991.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,897.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,759.02
|
| Rate for Payer: Ohio Health Group HMO |
$4,055.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,081.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$703.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,676.47
|
| Rate for Payer: PHCS Commercial |
$5,191.66
|
| Rate for Payer: United Healthcare All Payer |
$4,759.02
|
|
|
ARTH ELBOW WEXP DRAIN/RMV(T
|
Facility
|
IP
|
$5,407.98
|
|
|
Service Code
|
HCPCS 24000
|
| Hospital Charge Code |
761T0496
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$703.04 |
| Max. Negotiated Rate |
$5,191.66 |
| Rate for Payer: Aetna Commercial |
$4,164.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,218.22
|
| Rate for Payer: Cash Price |
$2,703.99
|
| Rate for Payer: Cigna Commercial |
$4,488.62
|
| Rate for Payer: First Health Commercial |
$5,137.58
|
| Rate for Payer: Humana Commercial |
$4,596.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,434.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,991.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,622.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,759.02
|
| Rate for Payer: Ohio Health Group HMO |
$4,055.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,081.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$703.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,676.47
|
| Rate for Payer: PHCS Commercial |
$5,191.66
|
| Rate for Payer: United Healthcare All Payer |
$4,759.02
|
|
|
ARTH GLEN JT EXPL/DRG/RMVL FB
|
Professional
|
Both
|
$915.00
|
|
|
Service Code
|
HCPCS 23040
|
| Hospital Charge Code |
76100434
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$320.25 |
| Max. Negotiated Rate |
$1,154.23 |
| Rate for Payer: Aetna Commercial |
$1,054.09
|
| Rate for Payer: Anthem Medicaid |
$530.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$915.00
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cigna Commercial |
$1,154.23
|
| Rate for Payer: Healthspan PPO |
$954.78
|
| Rate for Payer: Humana Medicaid |
$530.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$889.91
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$541.16
|
| Rate for Payer: Molina Healthcare Passport |
$530.55
|
| Rate for Payer: Multiplan PHCS |
$549.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$640.50
|
| Rate for Payer: UHCCP Medicaid |
$320.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$535.86
|
|
|
ARTH GLEN JT EXPL/DRG/RMVL FB
|
Facility
|
OP
|
$915.00
|
|
|
Service Code
|
HCPCS 23040
|
| Hospital Charge Code |
76100434
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$118.95 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$704.55
|
| Rate for Payer: Anthem Medicaid |
$314.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$713.70
|
| 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 |
$457.50
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cigna Commercial |
$759.45
|
| Rate for Payer: First Health Commercial |
$869.25
|
| Rate for Payer: Humana Commercial |
$777.75
|
| Rate for Payer: Humana KY Medicaid |
$314.67
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$317.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$750.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$675.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$320.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$805.20
|
| Rate for Payer: Ohio Health Group HMO |
$686.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$183.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$118.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$283.65
|
| Rate for Payer: PHCS Commercial |
$878.40
|
| Rate for Payer: United Healthcare All Payer |
$805.20
|
|
|
ARTH GLEN JT EXPL/DRG/RMVL FB
|
Facility
|
IP
|
$915.00
|
|
|
Service Code
|
HCPCS 23040
|
| Hospital Charge Code |
76100434
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$118.95 |
| Max. Negotiated Rate |
$878.40 |
| Rate for Payer: Aetna Commercial |
$704.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$713.70
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cigna Commercial |
$759.45
|
| Rate for Payer: First Health Commercial |
$869.25
|
| Rate for Payer: Humana Commercial |
$777.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$750.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$675.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$274.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$805.20
|
| Rate for Payer: Ohio Health Group HMO |
$686.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$183.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$118.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$283.65
|
| Rate for Payer: PHCS Commercial |
$878.40
|
| Rate for Payer: United Healthcare All Payer |
$805.20
|
|
|
ARTH GLEN JT EXPL/DRG/RMVL F(P
|
Professional
|
Both
|
$915.00
|
|
|
Service Code
|
HCPCS 23040
|
| Hospital Charge Code |
761P0434
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$320.25 |
| Max. Negotiated Rate |
$1,154.23 |
| Rate for Payer: Aetna Commercial |
$1,054.09
|
| Rate for Payer: Anthem Medicaid |
$530.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$915.00
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cigna Commercial |
$1,154.23
|
| Rate for Payer: Healthspan PPO |
$954.78
|
| Rate for Payer: Humana Medicaid |
$530.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$889.91
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$541.16
|
| Rate for Payer: Molina Healthcare Passport |
$530.55
|
| Rate for Payer: Multiplan PHCS |
$549.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$640.50
|
| Rate for Payer: UHCCP Medicaid |
$320.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$535.86
|
|
|
ARTH GLENOHUMERAL JT TOT SHLDR
|
Facility
|
IP
|
$4,400.00
|
|
|
Service Code
|
HCPCS 23472
|
| Hospital Charge Code |
76100466
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$572.00 |
| Max. Negotiated Rate |
$4,224.00 |
| Rate for Payer: Aetna Commercial |
$3,388.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,432.00
|
| Rate for Payer: Cash Price |
$2,200.00
|
| Rate for Payer: Cigna Commercial |
$3,652.00
|
| Rate for Payer: First Health Commercial |
$4,180.00
|
| Rate for Payer: Humana Commercial |
$3,740.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,608.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,247.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,320.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,872.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,300.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$572.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,364.00
|
| Rate for Payer: PHCS Commercial |
$4,224.00
|
| Rate for Payer: United Healthcare All Payer |
$3,872.00
|
|
|
ARTH GLENOHUMERAL JT TOT SHLDR
|
Professional
|
Both
|
$4,400.00
|
|
|
Service Code
|
HCPCS 23472
|
| Hospital Charge Code |
76100466
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,143.49 |
| Max. Negotiated Rate |
$4,400.00 |
| Rate for Payer: Aetna Commercial |
$2,262.18
|
| Rate for Payer: Anthem Medicaid |
$1,143.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,400.00
|
| Rate for Payer: Cash Price |
$2,200.00
|
| Rate for Payer: Cash Price |
$2,200.00
|
| Rate for Payer: Cigna Commercial |
$2,449.78
|
| Rate for Payer: Healthspan PPO |
$2,049.05
|
| Rate for Payer: Humana Medicaid |
$1,143.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,881.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,166.36
|
| Rate for Payer: Molina Healthcare Passport |
$1,143.49
|
| Rate for Payer: Multiplan PHCS |
$2,640.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,080.00
|
| Rate for Payer: UHCCP Medicaid |
$1,540.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,154.92
|
|
|
ARTH GLENOHUMERAL JT TOT SHLDR
|
Facility
|
OP
|
$4,400.00
|
|
|
Service Code
|
HCPCS 23472
|
| Hospital Charge Code |
76100466
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$572.00 |
| Max. Negotiated Rate |
$22,561.84 |
| Rate for Payer: Aetna Commercial |
$3,388.00
|
| Rate for Payer: Anthem Medicaid |
$1,513.16
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16,115.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,432.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$22,561.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$21,756.06
|
| Rate for Payer: Cash Price |
$2,200.00
|
| Rate for Payer: Cash Price |
$2,200.00
|
| Rate for Payer: Cigna Commercial |
$3,652.00
|
| Rate for Payer: First Health Commercial |
$4,180.00
|
| Rate for Payer: Humana Commercial |
$3,740.00
|
| Rate for Payer: Humana KY Medicaid |
$1,513.16
|
| Rate for Payer: Humana Medicare Advantage |
$16,115.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1,528.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,608.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,247.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19,338.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,543.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,872.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,300.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$572.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,364.00
|
| Rate for Payer: PHCS Commercial |
$4,224.00
|
| Rate for Payer: United Healthcare All Payer |
$3,872.00
|
|
