|
ARTHRPLSTY FEMCNDYLE/TIBPLTUKN
|
Facility
|
OP
|
$2,840.00
|
|
|
Service Code
|
HCPCS 27443
|
| Hospital Charge Code |
76100847
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$369.20 |
| Max. Negotiated Rate |
$15,933.60 |
| Rate for Payer: Aetna Commercial |
$2,186.80
|
| Rate for Payer: Anthem Medicaid |
$976.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,381.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,215.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15,933.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$15,364.54
|
| Rate for Payer: Cash Price |
$1,420.00
|
| Rate for Payer: Cash Price |
$1,420.00
|
| Rate for Payer: Cigna Commercial |
$2,357.20
|
| Rate for Payer: First Health Commercial |
$2,698.00
|
| Rate for Payer: Humana Commercial |
$2,414.00
|
| Rate for Payer: Humana KY Medicaid |
$976.68
|
| Rate for Payer: Humana Medicare Advantage |
$11,381.14
|
| Rate for Payer: Kentucky WC Medicaid |
$986.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,328.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,095.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13,657.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$996.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,499.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,130.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$568.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$369.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$880.40
|
| Rate for Payer: PHCS Commercial |
$2,726.40
|
| Rate for Payer: United Healthcare All Payer |
$2,499.20
|
|
|
ARTHRPLSTY FEMCNDYLE/TIBPLTUKN
|
Professional
|
Both
|
$2,840.00
|
|
|
Service Code
|
HCPCS 27443
|
| Hospital Charge Code |
761P0847
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$729.37 |
| Max. Negotiated Rate |
$2,840.00 |
| Rate for Payer: Aetna Commercial |
$1,207.85
|
| Rate for Payer: Anthem Medicaid |
$729.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,840.00
|
| Rate for Payer: Cash Price |
$1,420.00
|
| Rate for Payer: Cash Price |
$1,420.00
|
| Rate for Payer: Cigna Commercial |
$1,323.42
|
| Rate for Payer: Healthspan PPO |
$1,094.05
|
| Rate for Payer: Humana Medicaid |
$729.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,014.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$743.96
|
| Rate for Payer: Molina Healthcare Passport |
$729.37
|
| Rate for Payer: Multiplan PHCS |
$1,704.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,988.00
|
| Rate for Payer: UHCCP Medicaid |
$994.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$736.66
|
|
|
ARTHR SHLDR W/COR ALIMNT RLS
|
Facility
|
OP
|
$2,325.00
|
|
|
Service Code
|
HCPCS 29826
|
| Hospital Charge Code |
76101084
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$302.25 |
| Max. Negotiated Rate |
$2,232.00 |
| Rate for Payer: Aetna Commercial |
$1,790.25
|
| Rate for Payer: Anthem Medicaid |
$799.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,813.50
|
| Rate for Payer: Cash Price |
$1,162.50
|
| Rate for Payer: Cigna Commercial |
$1,929.75
|
| Rate for Payer: First Health Commercial |
$2,208.75
|
| Rate for Payer: Humana Commercial |
$1,976.25
|
| Rate for Payer: Humana KY Medicaid |
$799.57
|
| Rate for Payer: Kentucky WC Medicaid |
$807.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,906.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,715.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$697.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$815.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,046.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,743.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$465.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$302.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$720.75
|
| Rate for Payer: PHCS Commercial |
$2,232.00
|
| Rate for Payer: United Healthcare All Payer |
$2,046.00
|
|
|
ARTHR SHLDR W/COR ALIMNT RLS
|
Facility
|
IP
|
$2,325.00
|
|
|
Service Code
|
HCPCS 29826
|
| Hospital Charge Code |
76101084
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$302.25 |
| Max. Negotiated Rate |
$2,232.00 |
| Rate for Payer: Aetna Commercial |
$1,790.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,813.50
|
| Rate for Payer: Cash Price |
$1,162.50
|
| Rate for Payer: Cigna Commercial |
$1,929.75
|
| Rate for Payer: First Health Commercial |
$2,208.75
|
| Rate for Payer: Humana Commercial |
$1,976.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,906.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,715.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$697.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,046.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,743.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$465.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$302.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$720.75
|
| Rate for Payer: PHCS Commercial |
$2,232.00
|
| Rate for Payer: United Healthcare All Payer |
$2,046.00
|
|
|
ARTHR SHLDR W/COR ALIMNT RLS
|
Professional
|
Both
|
$2,325.00
|
|
|
Service Code
|
HCPCS 29826
|
| Hospital Charge Code |
76101084
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$610.22 |
| Max. Negotiated Rate |
$2,325.00 |
| Rate for Payer: Aetna Commercial |
$989.75
|
| Rate for Payer: Anthem Medicaid |
$610.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,325.00
|
| Rate for Payer: Cash Price |
$1,162.50
|
| Rate for Payer: Cash Price |
$1,162.50
|
| Rate for Payer: Cigna Commercial |
$1,092.02
|
| Rate for Payer: Healthspan PPO |
$896.51
|
| Rate for Payer: Humana Medicaid |
$610.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$829.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$622.42
|
| Rate for Payer: Molina Healthcare Passport |
$610.22
|
| Rate for Payer: Multiplan PHCS |
$1,395.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,627.50
|
| Rate for Payer: UHCCP Medicaid |
$813.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$616.32
|
|
|
ARTHR SHLDR W/COR ALIMNT RLS(P
|
Professional
|
Both
|
$2,325.00
|
|
|
Service Code
|
HCPCS 29826
|
| Hospital Charge Code |
761P1084
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$610.22 |
| Max. Negotiated Rate |
$2,325.00 |
| Rate for Payer: Aetna Commercial |
$989.75
|
| Rate for Payer: Anthem Medicaid |
$610.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,325.00
|
| Rate for Payer: Cash Price |
$1,162.50
|
| Rate for Payer: Cash Price |
$1,162.50
|
| Rate for Payer: Cigna Commercial |
$1,092.02
|
| Rate for Payer: Healthspan PPO |
$896.51
|
| Rate for Payer: Humana Medicaid |
$610.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$829.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$622.42
|
| Rate for Payer: Molina Healthcare Passport |
$610.22
|
| Rate for Payer: Multiplan PHCS |
$1,395.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,627.50
|
| Rate for Payer: UHCCP Medicaid |
$813.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$616.32
|
|
|
ARTHRTMY WRIST W/JNT EXPL W/WO
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
HCPCS 25101
|
| Hospital Charge Code |
76100578
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$576.00 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$468.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$498.00
|
| Rate for Payer: First Health Commercial |
$570.00
|
| Rate for Payer: Humana Commercial |
$510.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$492.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$180.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$528.00
|
| Rate for Payer: Ohio Health Group HMO |
$450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$186.00
|
| Rate for Payer: PHCS Commercial |
$576.00
|
| Rate for Payer: United Healthcare All Payer |
$528.00
|
|
|
ARTHRTMY WRIST W/JNT EXPL W/WO
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 25101
|
| Hospital Charge Code |
761P0578
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$683.30 |
| Rate for Payer: Aetna Commercial |
$581.79
|
| Rate for Payer: Anthem Medicaid |
$304.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$600.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$683.30
|
| Rate for Payer: Healthspan PPO |
$526.97
|
| Rate for Payer: Humana Medicaid |
$304.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$496.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$310.37
|
| Rate for Payer: Molina Healthcare Passport |
$304.28
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$420.00
|
| Rate for Payer: UHCCP Medicaid |
$210.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$307.32
|
|
|
ARTHRTMY WRIST W/JNT EXPL W/WO
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS 25101
|
| Hospital Charge Code |
76100578
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Anthem Medicaid |
$206.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$468.00
|
| 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 |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$498.00
|
| Rate for Payer: First Health Commercial |
$570.00
|
| Rate for Payer: Humana Commercial |
$510.00
|
| Rate for Payer: Humana KY Medicaid |
$206.34
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$208.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$492.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$210.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$528.00
|
| Rate for Payer: Ohio Health Group HMO |
$450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$186.00
|
| Rate for Payer: PHCS Commercial |
$576.00
|
| Rate for Payer: United Healthcare All Payer |
$528.00
|
|
|
ARTHRTMY WRIST W/JNT EXPL W/WO
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 25101
|
| Hospital Charge Code |
76100578
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$683.30 |
| Rate for Payer: Aetna Commercial |
$581.79
|
| Rate for Payer: Anthem Medicaid |
$304.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$600.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$683.30
|
| Rate for Payer: Healthspan PPO |
$526.97
|
| Rate for Payer: Humana Medicaid |
$304.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$496.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$310.37
|
| Rate for Payer: Molina Healthcare Passport |
$304.28
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$420.00
|
| Rate for Payer: UHCCP Medicaid |
$210.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$307.32
|
|
|
ARTH SHLDR DIS CLAVICULECTOM(P
|
Professional
|
Both
|
$1,025.00
|
|
|
Service Code
|
HCPCS 29824
|
| Hospital Charge Code |
761P1082
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$358.75 |
| Max. Negotiated Rate |
$1,075.28 |
| Rate for Payer: Aetna Commercial |
$980.61
|
| Rate for Payer: Anthem Medicaid |
$459.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,025.00
|
| Rate for Payer: Cash Price |
$512.50
|
| Rate for Payer: Cash Price |
$512.50
|
| Rate for Payer: Cigna Commercial |
$1,075.28
|
| Rate for Payer: Healthspan PPO |
$888.23
|
| Rate for Payer: Humana Medicaid |
$459.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$835.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$468.68
|
| Rate for Payer: Molina Healthcare Passport |
$459.49
|
| Rate for Payer: Multiplan PHCS |
$615.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$717.50
|
| Rate for Payer: UHCCP Medicaid |
$358.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$464.08
|
|
|
ARTH SHLDR DIS CLAVICULECTOMY
|
Professional
|
Both
|
$1,025.00
|
|
|
Service Code
|
HCPCS 29824
|
| Hospital Charge Code |
76101082
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$358.75 |
| Max. Negotiated Rate |
$1,075.28 |
| Rate for Payer: Aetna Commercial |
$980.61
|
| Rate for Payer: Anthem Medicaid |
$459.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,025.00
|
| Rate for Payer: Cash Price |
$512.50
|
| Rate for Payer: Cash Price |
$512.50
|
| Rate for Payer: Cigna Commercial |
$1,075.28
|
| Rate for Payer: Healthspan PPO |
$888.23
|
| Rate for Payer: Humana Medicaid |
$459.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$835.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$468.68
|
| Rate for Payer: Molina Healthcare Passport |
$459.49
|
| Rate for Payer: Multiplan PHCS |
$615.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$717.50
|
| Rate for Payer: UHCCP Medicaid |
$358.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$464.08
|
|
|
ARTH SHLDR DIS CLAVICULECTOMY
|
Facility
|
IP
|
$1,025.00
|
|
|
Service Code
|
HCPCS 29824
|
| Hospital Charge Code |
76101082
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$133.25 |
| Max. Negotiated Rate |
$984.00 |
| Rate for Payer: Aetna Commercial |
$789.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$799.50
|
| Rate for Payer: Cash Price |
$512.50
|
| Rate for Payer: Cigna Commercial |
$850.75
|
| Rate for Payer: First Health Commercial |
$973.75
|
| Rate for Payer: Humana Commercial |
$871.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$840.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$756.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$307.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$902.00
|
| Rate for Payer: Ohio Health Group HMO |
$768.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$205.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$133.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$317.75
|
| Rate for Payer: PHCS Commercial |
$984.00
|
| Rate for Payer: United Healthcare All Payer |
$902.00
|
|
|
ARTH SHLDR DIS CLAVICULECTOMY
|
Facility
|
OP
|
$1,025.00
|
|
|
Service Code
|
HCPCS 29824
|
| Hospital Charge Code |
76101082
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$133.25 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$789.25
|
| Rate for Payer: Anthem Medicaid |
$352.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$799.50
|
| 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 |
$512.50
|
| Rate for Payer: Cash Price |
$512.50
|
| Rate for Payer: Cigna Commercial |
$850.75
|
| Rate for Payer: First Health Commercial |
$973.75
|
| Rate for Payer: Humana Commercial |
$871.25
|
| Rate for Payer: Humana KY Medicaid |
$352.50
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$356.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$840.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$756.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$359.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$902.00
|
| Rate for Payer: Ohio Health Group HMO |
$768.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$205.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$133.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$317.75
|
| Rate for Payer: PHCS Commercial |
$984.00
|
| Rate for Payer: United Healthcare All Payer |
$902.00
|
|
|
ARTH WR EXC/RPR TRING FIBROCJT
|
Professional
|
Both
|
$715.00
|
|
|
Service Code
|
HCPCS 29846
|
| Hospital Charge Code |
761P1087
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$250.25 |
| Max. Negotiated Rate |
$839.80 |
| Rate for Payer: Aetna Commercial |
$759.88
|
| Rate for Payer: Anthem Medicaid |
$473.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$715.00
|
| Rate for Payer: Cash Price |
$357.50
|
| Rate for Payer: Cash Price |
$357.50
|
| Rate for Payer: Cigna Commercial |
$839.80
|
| Rate for Payer: Healthspan PPO |
$688.29
|
| Rate for Payer: Humana Medicaid |
$473.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$643.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$483.25
|
| Rate for Payer: Molina Healthcare Passport |
$473.77
|
| Rate for Payer: Multiplan PHCS |
$429.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$500.50
|
| Rate for Payer: UHCCP Medicaid |
$250.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$478.51
|
|
|
ARTH WR EXC/RPR TRING FIBROCJT
|
Professional
|
Both
|
$715.00
|
|
|
Service Code
|
HCPCS 29846
|
| Hospital Charge Code |
76101087
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$250.25 |
| Max. Negotiated Rate |
$839.80 |
| Rate for Payer: Aetna Commercial |
$759.88
|
| Rate for Payer: Anthem Medicaid |
$473.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$715.00
|
| Rate for Payer: Cash Price |
$357.50
|
| Rate for Payer: Cash Price |
$357.50
|
| Rate for Payer: Cigna Commercial |
$839.80
|
| Rate for Payer: Healthspan PPO |
$688.29
|
| Rate for Payer: Humana Medicaid |
$473.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$643.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$483.25
|
| Rate for Payer: Molina Healthcare Passport |
$473.77
|
| Rate for Payer: Multiplan PHCS |
$429.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$500.50
|
| Rate for Payer: UHCCP Medicaid |
$250.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$478.51
|
|
|
ARTH WR EXC/RPR TRING FIBROCJT
|
Facility
|
OP
|
$715.00
|
|
|
Service Code
|
HCPCS 29846
|
| Hospital Charge Code |
76101087
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$92.95 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$550.55
|
| Rate for Payer: Anthem Medicaid |
$245.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$557.70
|
| 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 |
$357.50
|
| Rate for Payer: Cash Price |
$357.50
|
| Rate for Payer: Cigna Commercial |
$593.45
|
| Rate for Payer: First Health Commercial |
$679.25
|
| Rate for Payer: Humana Commercial |
$607.75
|
| Rate for Payer: Humana KY Medicaid |
$245.89
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$248.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$586.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$527.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$250.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$629.20
|
| Rate for Payer: Ohio Health Group HMO |
$536.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$143.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$92.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$221.65
|
| Rate for Payer: PHCS Commercial |
$686.40
|
| Rate for Payer: United Healthcare All Payer |
$629.20
|
|
|
ARTH WR EXC/RPR TRING FIBROCJT
|
Facility
|
IP
|
$715.00
|
|
|
Service Code
|
HCPCS 29846
|
| Hospital Charge Code |
76101087
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$92.95 |
| Max. Negotiated Rate |
$686.40 |
| Rate for Payer: Aetna Commercial |
$550.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$557.70
|
| Rate for Payer: Cash Price |
$357.50
|
| Rate for Payer: Cigna Commercial |
$593.45
|
| Rate for Payer: First Health Commercial |
$679.25
|
| Rate for Payer: Humana Commercial |
$607.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$586.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$527.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$214.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$629.20
|
| Rate for Payer: Ohio Health Group HMO |
$536.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$143.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$92.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$221.65
|
| Rate for Payer: PHCS Commercial |
$686.40
|
| Rate for Payer: United Healthcare All Payer |
$629.20
|
|
|
ARTICULAR INSERT SZ5-6 13MM
|
Facility
|
OP
|
$5,084.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$660.92 |
| Max. Negotiated Rate |
$4,880.64 |
| Rate for Payer: Aetna Commercial |
$3,914.68
|
| Rate for Payer: Anthem Medicaid |
$1,748.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,965.52
|
| Rate for Payer: Cash Price |
$2,542.00
|
| Rate for Payer: Cigna Commercial |
$4,219.72
|
| Rate for Payer: First Health Commercial |
$4,829.80
|
| Rate for Payer: Humana Commercial |
$4,321.40
|
| Rate for Payer: Humana KY Medicaid |
$1,748.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,766.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,168.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,751.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,525.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,783.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,473.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,813.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,016.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$660.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,576.04
|
| Rate for Payer: PHCS Commercial |
$4,880.64
|
| Rate for Payer: United Healthcare All Payer |
$4,473.92
|
|
|
ARTICULAR INSERT SZ5-6 13MM
|
Facility
|
IP
|
$5,084.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$660.92 |
| Max. Negotiated Rate |
$4,880.64 |
| Rate for Payer: Aetna Commercial |
$3,914.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,965.52
|
| Rate for Payer: Cash Price |
$2,542.00
|
| Rate for Payer: Cigna Commercial |
$4,219.72
|
| Rate for Payer: First Health Commercial |
$4,829.80
|
| Rate for Payer: Humana Commercial |
$4,321.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,168.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,751.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,525.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,473.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,813.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,016.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$660.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,576.04
|
| Rate for Payer: PHCS Commercial |
$4,880.64
|
| Rate for Payer: United Healthcare All Payer |
$4,473.92
|
|
|
ARTICULEZ 12/14 44MM SPEC+15.5
|
Facility
|
OP
|
$8,991.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,168.85 |
| Max. Negotiated Rate |
$8,631.48 |
| Rate for Payer: Aetna Commercial |
$6,923.17
|
| Rate for Payer: Anthem Medicaid |
$3,092.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,013.08
|
| Rate for Payer: Cash Price |
$4,495.56
|
| Rate for Payer: Cigna Commercial |
$7,462.64
|
| Rate for Payer: First Health Commercial |
$8,541.57
|
| Rate for Payer: Humana Commercial |
$7,642.46
|
| Rate for Payer: Humana KY Medicaid |
$3,092.05
|
| Rate for Payer: Kentucky WC Medicaid |
$3,123.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,372.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,635.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,697.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,154.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,912.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,743.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,798.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,168.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,787.25
|
| Rate for Payer: PHCS Commercial |
$8,631.48
|
| Rate for Payer: United Healthcare All Payer |
$7,912.19
|
|
|
ARTICULEZ 12/14 44MM SPEC+15.5
|
Facility
|
IP
|
$8,991.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,168.85 |
| Max. Negotiated Rate |
$8,631.48 |
| Rate for Payer: Aetna Commercial |
$6,923.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,013.08
|
| Rate for Payer: Cash Price |
$4,495.56
|
| Rate for Payer: Cigna Commercial |
$7,462.64
|
| Rate for Payer: First Health Commercial |
$8,541.57
|
| Rate for Payer: Humana Commercial |
$7,642.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,372.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,635.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,697.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,912.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,743.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,798.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,168.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,787.25
|
| Rate for Payer: PHCS Commercial |
$8,631.48
|
| Rate for Payer: United Healthcare All Payer |
$7,912.19
|
|
|
ARTICULEZE 12/14 40MM SPEC+12
|
Facility
|
OP
|
$8,991.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,168.85 |
| Max. Negotiated Rate |
$8,631.48 |
| Rate for Payer: Aetna Commercial |
$6,923.17
|
| Rate for Payer: Anthem Medicaid |
$3,092.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,013.08
|
| Rate for Payer: Cash Price |
$4,495.56
|
| Rate for Payer: Cigna Commercial |
$7,462.64
|
| Rate for Payer: First Health Commercial |
$8,541.57
|
| Rate for Payer: Humana Commercial |
$7,642.46
|
| Rate for Payer: Humana KY Medicaid |
$3,092.05
|
| Rate for Payer: Kentucky WC Medicaid |
$3,123.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,372.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,635.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,697.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,154.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,912.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,743.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,798.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,168.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,787.25
|
| Rate for Payer: PHCS Commercial |
$8,631.48
|
| Rate for Payer: United Healthcare All Payer |
$7,912.19
|
|
|
ARTICULEZE 12/14 40MM SPEC+12
|
Facility
|
IP
|
$8,991.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,168.85 |
| Max. Negotiated Rate |
$8,631.48 |
| Rate for Payer: Aetna Commercial |
$6,923.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,013.08
|
| Rate for Payer: Cash Price |
$4,495.56
|
| Rate for Payer: Cigna Commercial |
$7,462.64
|
| Rate for Payer: First Health Commercial |
$8,541.57
|
| Rate for Payer: Humana Commercial |
$7,642.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,372.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,635.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,697.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,912.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,743.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,798.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,168.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,787.25
|
| Rate for Payer: PHCS Commercial |
$8,631.48
|
| Rate for Payer: United Healthcare All Payer |
$7,912.19
|
|
|
ARTICULEZE 12/14 40MM SPEC+1.5
|
Facility
|
IP
|
$8,763.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,139.24 |
| Max. Negotiated Rate |
$8,412.84 |
| Rate for Payer: Aetna Commercial |
$6,747.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,835.43
|
| Rate for Payer: Cash Price |
$4,381.69
|
| Rate for Payer: Cigna Commercial |
$7,273.60
|
| Rate for Payer: First Health Commercial |
$8,325.20
|
| Rate for Payer: Humana Commercial |
$7,448.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,185.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,467.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,629.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,711.77
|
| Rate for Payer: Ohio Health Group HMO |
$6,572.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,752.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,139.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,716.64
|
| Rate for Payer: PHCS Commercial |
$8,412.84
|
| Rate for Payer: United Healthcare All Payer |
$7,711.77
|
|
