|
ARTERY X-RAYS LUNG(T
|
Facility
|
OP
|
$4,620.00
|
|
|
Service Code
|
HCPCS 75741
|
| Hospital Charge Code |
320T0160
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,588.82 |
| Max. Negotiated Rate |
$4,435.20 |
| Rate for Payer: Aetna Commercial |
$3,557.40
|
| Rate for Payer: Anthem Medicaid |
$1,588.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,603.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| Rate for Payer: Cash Price |
$2,310.00
|
| Rate for Payer: Cash Price |
$2,310.00
|
| Rate for Payer: Cigna Commercial |
$3,834.60
|
| Rate for Payer: First Health Commercial |
$4,389.00
|
| Rate for Payer: Humana Commercial |
$3,927.00
|
| Rate for Payer: Humana KY Medicaid |
$1,588.82
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,604.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,788.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,409.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,620.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,065.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,465.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,696.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,019.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,187.80
|
| Rate for Payer: PHCS Commercial |
$4,435.20
|
| Rate for Payer: United Healthcare All Payer |
$4,065.60
|
|
|
ARTERY X-RAYS LUNG(T
|
Facility
|
OP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 75746
|
| Hospital Charge Code |
320T0284
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$962.92 |
| Max. Negotiated Rate |
$4,071.52 |
| Rate for Payer: Aetna Commercial |
$2,156.00
|
| Rate for Payer: Anthem Medicaid |
$962.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,184.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cigna Commercial |
$2,324.00
|
| Rate for Payer: First Health Commercial |
$2,660.00
|
| Rate for Payer: Humana Commercial |
$2,380.00
|
| Rate for Payer: Humana KY Medicaid |
$962.92
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Kentucky WC Medicaid |
$972.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,296.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,066.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$982.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,464.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,100.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,436.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,932.00
|
| Rate for Payer: PHCS Commercial |
$2,688.00
|
| Rate for Payer: United Healthcare All Payer |
$2,464.00
|
|
|
ARTERY X-RAYS LUNG(T
|
Facility
|
IP
|
$4,620.00
|
|
|
Service Code
|
HCPCS 75741
|
| Hospital Charge Code |
320T0160
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,386.00 |
| Max. Negotiated Rate |
$4,435.20 |
| Rate for Payer: Aetna Commercial |
$3,557.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,603.60
|
| Rate for Payer: Cash Price |
$2,310.00
|
| Rate for Payer: Cigna Commercial |
$3,834.60
|
| Rate for Payer: First Health Commercial |
$4,389.00
|
| Rate for Payer: Humana Commercial |
$3,927.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,788.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,409.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,386.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,065.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,465.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,696.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,019.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,187.80
|
| Rate for Payer: PHCS Commercial |
$4,435.20
|
| Rate for Payer: United Healthcare All Payer |
$4,065.60
|
|
|
ARTERY X-RAYS LUNG(T
|
Facility
|
IP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 75746
|
| Hospital Charge Code |
320T0284
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$840.00 |
| Max. Negotiated Rate |
$2,688.00 |
| Rate for Payer: Aetna Commercial |
$2,156.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,184.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cigna Commercial |
$2,324.00
|
| Rate for Payer: First Health Commercial |
$2,660.00
|
| Rate for Payer: Humana Commercial |
$2,380.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,296.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,066.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$840.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,464.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,100.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,436.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,932.00
|
| Rate for Payer: PHCS Commercial |
$2,688.00
|
| Rate for Payer: United Healthcare All Payer |
$2,464.00
|
|
|
ARTH ACET/PRXFEMPROSAGRFALGRFT
|
Facility
|
OP
|
$4,100.00
|
|
|
Service Code
|
HCPCS 27130
|
| Hospital Charge Code |
76100781
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,409.99 |
| Max. Negotiated Rate |
$16,644.15 |
| Rate for Payer: Aetna Commercial |
$3,157.00
|
| Rate for Payer: Anthem Medicaid |
$1,409.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,888.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,198.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16,644.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$16,049.72
|
| Rate for Payer: Cash Price |
$2,050.00
|
| Rate for Payer: Cash Price |
$2,050.00
|
| Rate for Payer: Cigna Commercial |
$3,403.00
|
| Rate for Payer: First Health Commercial |
$3,895.00
|
| Rate for Payer: Humana Commercial |
$3,485.00
|
| Rate for Payer: Humana KY Medicaid |
$1,409.99
|
| Rate for Payer: Humana Medicare Advantage |
$11,888.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1,424.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,362.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,025.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14,266.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,438.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,608.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,075.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,567.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,829.00
|
| Rate for Payer: PHCS Commercial |
$3,936.00
|
| Rate for Payer: United Healthcare All Payer |
$3,608.00
|
|
|
ARTH ACET/PRXFEMPROSAGRFALGRFT
|
Professional
|
Both
|
$4,100.00
|
|
|
Service Code
|
HCPCS 27130
|
| Hospital Charge Code |
761P0781
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,219.35 |
| Max. Negotiated Rate |
$2,460.00 |
| Rate for Payer: Aetna Commercial |
$2,170.65
|
| Rate for Payer: Ambetter Exchange |
$1,219.35
|
| Rate for Payer: Anthem Medicaid |
$1,300.74
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,219.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,219.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,463.22
|
| Rate for Payer: Cash Price |
$2,050.00
|
| Rate for Payer: Cash Price |
$2,050.00
|
| Rate for Payer: Cigna Commercial |
$2,330.19
|
| Rate for Payer: Healthspan PPO |
$1,966.14
|
| Rate for Payer: Humana Medicaid |
$1,300.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,812.17
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,219.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,219.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,326.75
|
| Rate for Payer: Molina Healthcare Passport |
$1,300.74
|
| Rate for Payer: Multiplan PHCS |
$2,460.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,585.15
|
| Rate for Payer: UHCCP Medicaid |
$1,435.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,313.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,219.35
|
|
|
ARTH ACET/PRXFEMPROSAGRFALGRFT
|
Facility
|
IP
|
$4,100.00
|
|
|
Service Code
|
HCPCS 27130
|
| Hospital Charge Code |
76100781
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,230.00 |
| Max. Negotiated Rate |
$3,936.00 |
| Rate for Payer: Aetna Commercial |
$3,157.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,198.00
|
| Rate for Payer: Cash Price |
$2,050.00
|
| Rate for Payer: Cigna Commercial |
$3,403.00
|
| Rate for Payer: First Health Commercial |
$3,895.00
|
| Rate for Payer: Humana Commercial |
$3,485.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,362.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,025.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,230.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,608.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,075.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,567.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,829.00
|
| Rate for Payer: PHCS Commercial |
$3,936.00
|
| Rate for Payer: United Healthcare All Payer |
$3,608.00
|
|
|
ARTH ACET/PRXFEMPROSAGRFALGRFT
|
Professional
|
Both
|
$4,100.00
|
|
|
Service Code
|
HCPCS 27130
|
| Hospital Charge Code |
76100781
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,219.35 |
| Max. Negotiated Rate |
$2,460.00 |
| Rate for Payer: Aetna Commercial |
$2,170.65
|
| Rate for Payer: Ambetter Exchange |
$1,219.35
|
| Rate for Payer: Anthem Medicaid |
$1,300.74
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,219.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,219.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,463.22
|
| Rate for Payer: Cash Price |
$2,050.00
|
| Rate for Payer: Cash Price |
$2,050.00
|
| Rate for Payer: Cigna Commercial |
$2,330.19
|
| Rate for Payer: Healthspan PPO |
$1,966.14
|
| Rate for Payer: Humana Medicaid |
$1,300.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,812.17
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,219.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,219.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,326.75
|
| Rate for Payer: Molina Healthcare Passport |
$1,300.74
|
| Rate for Payer: Multiplan PHCS |
$2,460.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,585.15
|
| Rate for Payer: UHCCP Medicaid |
$1,435.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,313.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,219.35
|
|
|
ARTH ACRO STCV JT EXP/DRG/RMFB
|
Facility
|
OP
|
$1,170.00
|
|
|
Service Code
|
HCPCS 23044
|
| Hospital Charge Code |
76100435
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$402.36 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$900.90
|
| Rate for Payer: Anthem Medicaid |
$402.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$912.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$585.00
|
| 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: Humana KY Medicaid |
$402.36
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$406.46
|
| 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 |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$410.44
|
| 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 |
$936.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,017.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$807.30
|
| 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
|
Facility
|
IP
|
$1,170.00
|
|
|
Service Code
|
HCPCS 23044
|
| Hospital Charge Code |
76100435
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$351.00 |
| 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 |
$936.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,017.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$807.30
|
| 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 |
761P0435
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$401.81 |
| Max. Negotiated Rate |
$916.34 |
| Rate for Payer: Aetna Commercial |
$834.23
|
| Rate for Payer: Ambetter Exchange |
$535.34
|
| Rate for Payer: Anthem Medicaid |
$401.81
|
| Rate for Payer: Buckeye Individual/Medicaid |
$535.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$535.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$642.41
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$535.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$535.34
|
| 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 |
$695.94
|
| Rate for Payer: UHCCP Medicaid |
$409.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$405.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$535.34
|
|
|
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 |
$916.34 |
| Rate for Payer: Aetna Commercial |
$834.23
|
| Rate for Payer: Ambetter Exchange |
$535.34
|
| Rate for Payer: Anthem Medicaid |
$401.81
|
| Rate for Payer: Buckeye Individual/Medicaid |
$535.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$535.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$642.41
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$535.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$535.34
|
| 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 |
$695.94
|
| Rate for Payer: UHCCP Medicaid |
$409.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$405.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$535.34
|
|
|
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 |
$1,072.50 |
| 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 |
$2,860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,110.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,466.75
|
| 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
|
OP
|
$3,575.00
|
|
|
Service Code
|
HCPCS 29888
|
| Hospital Charge Code |
76101108
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,229.44 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$2,752.75
|
| Rate for Payer: Anthem Medicaid |
$1,229.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,788.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| Rate for Payer: Cash Price |
$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 |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$1,241.95
|
| 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 |
$7,920.79
|
| 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 |
$2,860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,110.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,466.75
|
| 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 |
$2,145.00 |
| Rate for Payer: Aetna Commercial |
$1,482.53
|
| Rate for Payer: Ambetter Exchange |
$924.18
|
| Rate for Payer: Anthem Medicaid |
$922.93
|
| Rate for Payer: Buckeye Individual/Medicaid |
$924.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$924.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,109.02
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$924.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$924.18
|
| 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 |
$1,201.43
|
| Rate for Payer: UHCCP Medicaid |
$1,251.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$932.16
|
| Rate for Payer: Wellcare Medicare Advantage |
$924.18
|
|
|
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 |
$2,145.00 |
| Rate for Payer: Aetna Commercial |
$1,482.53
|
| Rate for Payer: Ambetter Exchange |
$924.18
|
| Rate for Payer: Anthem Medicaid |
$922.93
|
| Rate for Payer: Buckeye Individual/Medicaid |
$924.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$924.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,109.02
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$924.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$924.18
|
| 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 |
$1,201.43
|
| Rate for Payer: UHCCP Medicaid |
$1,251.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$932.16
|
| Rate for Payer: Wellcare Medicare Advantage |
$924.18
|
|
|
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 |
$627.00 |
| 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 |
$1,672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,818.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,442.10
|
| 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 |
$1,254.00 |
| Rate for Payer: Aetna Commercial |
$1,018.14
|
| Rate for Payer: Ambetter Exchange |
$641.62
|
| Rate for Payer: Anthem Medicaid |
$513.66
|
| Rate for Payer: Buckeye Individual/Medicaid |
$641.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$641.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$769.94
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$641.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$641.62
|
| 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 |
$834.11
|
| Rate for Payer: UHCCP Medicaid |
$731.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$518.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$641.62
|
|
|
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 |
$718.75 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$1,609.30
|
| Rate for Payer: Anthem Medicaid |
$718.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,630.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| 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 |
$2,997.95
|
| 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 |
$3,597.54
|
| 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 |
$1,672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,818.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,442.10
|
| Rate for Payer: PHCS Commercial |
$2,006.40
|
| Rate for Payer: United Healthcare All Payer |
$1,839.20
|
|
|
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 |
$1,254.00 |
| Rate for Payer: Aetna Commercial |
$1,018.14
|
| Rate for Payer: Ambetter Exchange |
$641.62
|
| Rate for Payer: Anthem Medicaid |
$513.66
|
| Rate for Payer: Buckeye Individual/Medicaid |
$641.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$641.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$769.94
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$641.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$641.62
|
| 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 |
$834.11
|
| Rate for Payer: UHCCP Medicaid |
$731.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$518.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$641.62
|
|
|
ARTH ANKLE DEBRID EXT
|
Facility
|
OP
|
$2,700.00
|
|
|
Service Code
|
HCPCS 29898
|
| Hospital Charge Code |
76101115
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$928.53 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$2,079.00
|
| Rate for Payer: Anthem Medicaid |
$928.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,106.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| 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 |
$2,997.95
|
| 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 |
$3,597.54
|
| 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 |
$2,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,349.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,863.00
|
| Rate for Payer: PHCS Commercial |
$2,592.00
|
| Rate for Payer: United Healthcare All Payer |
$2,376.00
|
|
|
ARTH ANKLE DEBRID EXT
|
Facility
|
IP
|
$2,700.00
|
|
|
Service Code
|
HCPCS 29898
|
| Hospital Charge Code |
76101115
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$810.00 |
| 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 |
$2,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,349.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,863.00
|
| Rate for Payer: PHCS Commercial |
$2,592.00
|
| Rate for Payer: United Healthcare All Payer |
$2,376.00
|
|
|
ARTH ANKLE DEBRID EXT
|
Professional
|
Both
|
$2,700.00
|
|
|
Service Code
|
HCPCS 29898
|
| Hospital Charge Code |
76101115
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$532.94 |
| Max. Negotiated Rate |
$1,620.00 |
| Rate for Payer: Aetna Commercial |
$870.32
|
| Rate for Payer: Ambetter Exchange |
$532.94
|
| Rate for Payer: Anthem Medicaid |
$557.77
|
| Rate for Payer: Buckeye Individual/Medicaid |
$532.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$532.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$639.53
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$532.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$532.94
|
| 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 |
$692.82
|
| Rate for Payer: UHCCP Medicaid |
$945.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$563.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$532.94
|
|
|
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 |
$532.94 |
| Max. Negotiated Rate |
$1,620.00 |
| Rate for Payer: Aetna Commercial |
$870.32
|
| Rate for Payer: Ambetter Exchange |
$532.94
|
| Rate for Payer: Anthem Medicaid |
$557.77
|
| Rate for Payer: Buckeye Individual/Medicaid |
$532.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$532.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$639.53
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$532.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$532.94
|
| 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 |
$692.82
|
| Rate for Payer: UHCCP Medicaid |
$945.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$563.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$532.94
|
|
|
ARTH ANKLE DEBRID LTD
|
Facility
|
IP
|
$952.50
|
|
|
Service Code
|
HCPCS 29897
|
| Hospital Charge Code |
76101114
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$285.75 |
| 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 |
$702.95
|
| 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 |
$762.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$828.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$657.23
|
| Rate for Payer: PHCS Commercial |
$914.40
|
| Rate for Payer: United Healthcare All Payer |
$838.20
|
|
