|
ARTH ANKLE DEBRID LTD
|
Professional
|
Both
|
$952.50
|
|
|
Service Code
|
HCPCS 29897
|
| Hospital Charge Code |
76101114
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$333.38 |
| Max. Negotiated Rate |
$861.59 |
| Rate for Payer: Aetna Commercial |
$778.43
|
| Rate for Payer: Ambetter Exchange |
$469.02
|
| Rate for Payer: Anthem Medicaid |
$483.71
|
| Rate for Payer: Buckeye Individual/Medicaid |
$469.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$469.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$562.82
|
| Rate for Payer: Cash Price |
$476.25
|
| Rate for Payer: Cash Price |
$476.25
|
| Rate for Payer: Cigna Commercial |
$861.59
|
| Rate for Payer: Healthspan PPO |
$705.09
|
| Rate for Payer: Humana Medicaid |
$483.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$641.51
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$469.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$469.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$493.38
|
| Rate for Payer: Molina Healthcare Passport |
$483.71
|
| Rate for Payer: Multiplan PHCS |
$571.50
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$609.73
|
| Rate for Payer: UHCCP Medicaid |
$333.38
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$488.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$469.02
|
|
|
ARTH ANKLE DEBRID LTD
|
Facility
|
OP
|
$952.50
|
|
|
Service Code
|
HCPCS 29897
|
| Hospital Charge Code |
76101114
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$327.56 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$733.42
|
| Rate for Payer: Anthem Medicaid |
$327.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$742.95
|
| 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 |
$476.25
|
| Rate for Payer: Cash Price |
$476.25
|
| Rate for Payer: Cigna Commercial |
$790.58
|
| Rate for Payer: First Health Commercial |
$904.88
|
| Rate for Payer: Humana Commercial |
$809.62
|
| Rate for Payer: Humana KY Medicaid |
$327.56
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$330.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$781.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$702.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$334.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$838.20
|
| Rate for Payer: Ohio Health Group HMO |
$714.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$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
|
|
|
ARTH ANKLE DEBRID LTD
|
Professional
|
Both
|
$1,905.00
|
|
|
Service Code
|
HCPCS 29897
|
| Hospital Charge Code |
76101113
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$469.02 |
| Max. Negotiated Rate |
$1,143.00 |
| Rate for Payer: Aetna Commercial |
$778.43
|
| Rate for Payer: Ambetter Exchange |
$469.02
|
| Rate for Payer: Anthem Medicaid |
$483.71
|
| Rate for Payer: Buckeye Individual/Medicaid |
$469.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$469.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$562.82
|
| Rate for Payer: Cash Price |
$952.50
|
| Rate for Payer: Cash Price |
$952.50
|
| Rate for Payer: Cigna Commercial |
$861.59
|
| Rate for Payer: Healthspan PPO |
$705.09
|
| Rate for Payer: Humana Medicaid |
$483.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$641.51
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$469.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$469.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$493.38
|
| Rate for Payer: Molina Healthcare Passport |
$483.71
|
| Rate for Payer: Multiplan PHCS |
$1,143.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$609.73
|
| Rate for Payer: UHCCP Medicaid |
$666.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$488.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$469.02
|
|
|
ARTH ANKLE DEBRID LTD
|
Facility
|
IP
|
$1,905.00
|
|
|
Service Code
|
HCPCS 29897
|
| Hospital Charge Code |
76101113
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$571.50 |
| Max. Negotiated Rate |
$1,828.80 |
| Rate for Payer: Aetna Commercial |
$1,466.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,485.90
|
| Rate for Payer: Cash Price |
$952.50
|
| Rate for Payer: Cigna Commercial |
$1,581.15
|
| Rate for Payer: First Health Commercial |
$1,809.75
|
| Rate for Payer: Humana Commercial |
$1,619.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,562.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,405.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$571.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,676.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,428.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,524.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,657.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,314.45
|
| Rate for Payer: PHCS Commercial |
$1,828.80
|
| Rate for Payer: United Healthcare All Payer |
$1,676.40
|
|
|
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
|
|
|
ARTH ANKLE DEBRID LTD(P
|
Professional
|
Both
|
$952.50
|
|
|
Service Code
|
HCPCS 29897
|
| Hospital Charge Code |
761P1114
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$333.38 |
| Max. Negotiated Rate |
$861.59 |
| Rate for Payer: Aetna Commercial |
$778.43
|
| Rate for Payer: Ambetter Exchange |
$469.02
|
| Rate for Payer: Anthem Medicaid |
$483.71
|
| Rate for Payer: Buckeye Individual/Medicaid |
$469.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$469.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$562.82
|
| Rate for Payer: Cash Price |
$476.25
|
| Rate for Payer: Cash Price |
$476.25
|
| Rate for Payer: Cigna Commercial |
$861.59
|
| Rate for Payer: Healthspan PPO |
$705.09
|
| Rate for Payer: Humana Medicaid |
$483.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$641.51
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$469.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$469.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$493.38
|
| Rate for Payer: Molina Healthcare Passport |
$483.71
|
| Rate for Payer: Multiplan PHCS |
$571.50
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$609.73
|
| Rate for Payer: UHCCP Medicaid |
$333.38
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$488.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$469.02
|
|
|
ARTH ANKLE DEBRID LTD(P
|
Professional
|
Both
|
$1,905.00
|
|
|
Service Code
|
HCPCS 29897
|
| Hospital Charge Code |
761P1113
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$469.02 |
| Max. Negotiated Rate |
$1,143.00 |
| Rate for Payer: Aetna Commercial |
$778.43
|
| Rate for Payer: Ambetter Exchange |
$469.02
|
| Rate for Payer: Anthem Medicaid |
$483.71
|
| Rate for Payer: Buckeye Individual/Medicaid |
$469.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$469.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$562.82
|
| Rate for Payer: Cash Price |
$952.50
|
| Rate for Payer: Cash Price |
$952.50
|
| Rate for Payer: Cigna Commercial |
$861.59
|
| Rate for Payer: Healthspan PPO |
$705.09
|
| Rate for Payer: Humana Medicaid |
$483.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$641.51
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$469.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$469.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$493.38
|
| Rate for Payer: Molina Healthcare Passport |
$483.71
|
| Rate for Payer: Multiplan PHCS |
$1,143.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$609.73
|
| Rate for Payer: UHCCP Medicaid |
$666.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$488.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$469.02
|
|
|
ARTH ANKLE SYNOVECTOMY PTL
|
Facility
|
IP
|
$1,905.00
|
|
|
Service Code
|
HCPCS 29895
|
| Hospital Charge Code |
76101112
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$571.50 |
| Max. Negotiated Rate |
$1,828.80 |
| Rate for Payer: Aetna Commercial |
$1,466.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,485.90
|
| Rate for Payer: Cash Price |
$952.50
|
| Rate for Payer: Cigna Commercial |
$1,581.15
|
| Rate for Payer: First Health Commercial |
$1,809.75
|
| Rate for Payer: Humana Commercial |
$1,619.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,562.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,405.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$571.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,676.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,428.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,524.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,657.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,314.45
|
| Rate for Payer: PHCS Commercial |
$1,828.80
|
| Rate for Payer: United Healthcare All Payer |
$1,676.40
|
|
|
ARTH ANKLE SYNOVECTOMY PTL
|
Facility
|
OP
|
$1,905.00
|
|
|
Service Code
|
HCPCS 29895
|
| Hospital Charge Code |
76101112
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$655.13 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$1,466.85
|
| Rate for Payer: Anthem Medicaid |
$655.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,485.90
|
| 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 |
$952.50
|
| Rate for Payer: Cash Price |
$952.50
|
| Rate for Payer: Cigna Commercial |
$1,581.15
|
| Rate for Payer: First Health Commercial |
$1,809.75
|
| Rate for Payer: Humana Commercial |
$1,619.25
|
| Rate for Payer: Humana KY Medicaid |
$655.13
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$661.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,562.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,405.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$668.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,676.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,428.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,524.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,657.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,314.45
|
| Rate for Payer: PHCS Commercial |
$1,828.80
|
| Rate for Payer: United Healthcare All Payer |
$1,676.40
|
|
|
ARTH ANKLE SYNOVECTOMY PTL
|
Professional
|
Both
|
$1,905.00
|
|
|
Service Code
|
HCPCS 29895
|
| Hospital Charge Code |
76101112
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$437.67 |
| Max. Negotiated Rate |
$1,143.00 |
| Rate for Payer: Aetna Commercial |
$743.39
|
| Rate for Payer: Ambetter Exchange |
$437.67
|
| Rate for Payer: Anthem Medicaid |
$464.84
|
| Rate for Payer: Buckeye Individual/Medicaid |
$437.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$437.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$525.20
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$437.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$437.67
|
| 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 |
$568.97
|
| Rate for Payer: UHCCP Medicaid |
$666.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$469.49
|
| Rate for Payer: Wellcare Medicare Advantage |
$437.67
|
|
|
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 |
$437.67 |
| Max. Negotiated Rate |
$1,143.00 |
| Rate for Payer: Aetna Commercial |
$743.39
|
| Rate for Payer: Ambetter Exchange |
$437.67
|
| Rate for Payer: Anthem Medicaid |
$464.84
|
| Rate for Payer: Buckeye Individual/Medicaid |
$437.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$437.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$525.20
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$437.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$437.67
|
| 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 |
$568.97
|
| Rate for Payer: UHCCP Medicaid |
$666.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$469.49
|
| Rate for Payer: Wellcare Medicare Advantage |
$437.67
|
|
|
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 |
$1,245.00 |
| Rate for Payer: Aetna Commercial |
$768.57
|
| Rate for Payer: Ambetter Exchange |
$481.80
|
| Rate for Payer: Anthem Medicaid |
$478.37
|
| Rate for Payer: Buckeye Individual/Medicaid |
$481.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$481.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$578.16
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$481.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$481.80
|
| 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 |
$626.34
|
| Rate for Payer: UHCCP Medicaid |
$726.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$483.15
|
| Rate for Payer: Wellcare Medicare Advantage |
$481.80
|
|
|
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 |
$622.50 |
| 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 |
$1,660.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,805.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,431.75
|
| 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
|
OP
|
$2,075.00
|
|
|
Service Code
|
HCPCS 29894
|
| Hospital Charge Code |
76101111
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$713.59 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$1,597.75
|
| Rate for Payer: Anthem Medicaid |
$713.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,618.50
|
| 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 |
$1,037.50
|
| 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 |
$2,997.95
|
| 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 |
$3,597.54
|
| 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 |
$1,660.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,805.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,431.75
|
| Rate for Payer: PHCS Commercial |
$1,992.00
|
| Rate for Payer: United Healthcare All Payer |
$1,826.00
|
|
|
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 |
$1,245.00 |
| Rate for Payer: Aetna Commercial |
$768.57
|
| Rate for Payer: Ambetter Exchange |
$481.80
|
| Rate for Payer: Anthem Medicaid |
$478.37
|
| Rate for Payer: Buckeye Individual/Medicaid |
$481.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$481.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$578.16
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$481.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$481.80
|
| 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 |
$626.34
|
| Rate for Payer: UHCCP Medicaid |
$726.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$483.15
|
| Rate for Payer: Wellcare Medicare Advantage |
$481.80
|
|
|
ARTH ELBOW W/CAP EXC/CAP REL
|
Professional
|
Both
|
$8,699.00
|
|
|
Service Code
|
HCPCS 24006
|
| Hospital Charge Code |
76100497
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$475.23 |
| Max. Negotiated Rate |
$5,219.40 |
| Rate for Payer: Aetna Commercial |
$1,038.37
|
| Rate for Payer: Ambetter Exchange |
$682.98
|
| Rate for Payer: Anthem Medicaid |
$475.23
|
| Rate for Payer: Buckeye Individual/Medicaid |
$682.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$682.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$819.58
|
| Rate for Payer: Cash Price |
$4,349.50
|
| Rate for Payer: Cash Price |
$4,349.50
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$682.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$682.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$484.73
|
| Rate for Payer: Molina Healthcare Passport |
$475.23
|
| Rate for Payer: Multiplan PHCS |
$5,219.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$887.87
|
| Rate for Payer: UHCCP Medicaid |
$3,044.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$479.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$682.98
|
|
|
ARTH ELBOW W/CAP EXC/CAP REL
|
Facility
|
OP
|
$8,699.00
|
|
|
Service Code
|
HCPCS 24006
|
| Hospital Charge Code |
76100497
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,991.59 |
| Max. Negotiated Rate |
$8,351.04 |
| Rate for Payer: Aetna Commercial |
$6,698.23
|
| Rate for Payer: Anthem Medicaid |
$2,991.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,785.22
|
| 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 |
$4,349.50
|
| Rate for Payer: Cash Price |
$4,349.50
|
| Rate for Payer: Cigna Commercial |
$7,220.17
|
| Rate for Payer: First Health Commercial |
$8,264.05
|
| Rate for Payer: Humana Commercial |
$7,394.15
|
| Rate for Payer: Humana KY Medicaid |
$2,991.59
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$3,022.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,133.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,419.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,051.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,655.12
|
| Rate for Payer: Ohio Health Group HMO |
$6,524.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,959.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,568.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,002.31
|
| Rate for Payer: PHCS Commercial |
$8,351.04
|
| Rate for Payer: United Healthcare All Payer |
$7,655.12
|
|
|
ARTH ELBOW W/CAP EXC/CAP REL
|
Facility
|
IP
|
$8,699.00
|
|
|
Service Code
|
HCPCS 24006
|
| Hospital Charge Code |
76100497
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,609.70 |
| Max. Negotiated Rate |
$8,351.04 |
| Rate for Payer: Aetna Commercial |
$6,698.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,785.22
|
| Rate for Payer: Cash Price |
$4,349.50
|
| Rate for Payer: Cigna Commercial |
$7,220.17
|
| Rate for Payer: First Health Commercial |
$8,264.05
|
| Rate for Payer: Humana Commercial |
$7,394.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,133.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,419.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,609.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,655.12
|
| Rate for Payer: Ohio Health Group HMO |
$6,524.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,959.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,568.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,002.31
|
| Rate for Payer: PHCS Commercial |
$8,351.04
|
| Rate for Payer: United Healthcare All Payer |
$7,655.12
|
|
|
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 |
$1,140.29 |
| Rate for Payer: Aetna Commercial |
$1,038.37
|
| Rate for Payer: Ambetter Exchange |
$682.98
|
| Rate for Payer: Anthem Medicaid |
$475.23
|
| Rate for Payer: Buckeye Individual/Medicaid |
$682.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$682.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$819.58
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$682.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$682.98
|
| 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 |
$887.87
|
| Rate for Payer: UHCCP Medicaid |
$665.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$479.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$682.98
|
|
|
ARTH ELBOW W/CAP EXC/CAP REL(T
|
Facility
|
IP
|
$6,799.00
|
|
|
Service Code
|
HCPCS 24006
|
| Hospital Charge Code |
761T0497
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,039.70 |
| Max. Negotiated Rate |
$6,527.04 |
| Rate for Payer: Aetna Commercial |
$5,235.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,303.22
|
| Rate for Payer: Cash Price |
$3,399.50
|
| Rate for Payer: Cigna Commercial |
$5,643.17
|
| Rate for Payer: First Health Commercial |
$6,459.05
|
| Rate for Payer: Humana Commercial |
$5,779.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,575.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,017.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,039.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,983.12
|
| Rate for Payer: Ohio Health Group HMO |
$5,099.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,439.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,915.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,691.31
|
| Rate for Payer: PHCS Commercial |
$6,527.04
|
| Rate for Payer: United Healthcare All Payer |
$5,983.12
|
|
|
ARTH ELBOW W/CAP EXC/CAP REL(T
|
Facility
|
OP
|
$6,799.00
|
|
|
Service Code
|
HCPCS 24006
|
| Hospital Charge Code |
761T0497
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,338.18 |
| Max. Negotiated Rate |
$6,527.04 |
| Rate for Payer: Aetna Commercial |
$5,235.23
|
| Rate for Payer: Anthem Medicaid |
$2,338.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,303.22
|
| 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 |
$3,399.50
|
| Rate for Payer: Cash Price |
$3,399.50
|
| Rate for Payer: Cigna Commercial |
$5,643.17
|
| Rate for Payer: First Health Commercial |
$6,459.05
|
| Rate for Payer: Humana Commercial |
$5,779.15
|
| Rate for Payer: Humana KY Medicaid |
$2,338.18
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$2,361.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,575.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,017.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,385.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,983.12
|
| Rate for Payer: Ohio Health Group HMO |
$5,099.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,439.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,915.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,691.31
|
| Rate for Payer: PHCS Commercial |
$6,527.04
|
| Rate for Payer: United Healthcare All Payer |
$5,983.12
|
|
|
ARTH ELBOW WEXP DRAIN/RMV
|
Facility
|
OP
|
$6,908.00
|
|
|
Service Code
|
HCPCS 24000
|
| Hospital Charge Code |
76100496
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,375.66 |
| Max. Negotiated Rate |
$6,631.68 |
| Rate for Payer: Aetna Commercial |
$5,319.16
|
| Rate for Payer: Anthem Medicaid |
$2,375.66
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,388.24
|
| 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 |
$3,454.00
|
| Rate for Payer: Cash Price |
$3,454.00
|
| Rate for Payer: Cigna Commercial |
$5,733.64
|
| Rate for Payer: First Health Commercial |
$6,562.60
|
| Rate for Payer: Humana Commercial |
$5,871.80
|
| Rate for Payer: Humana KY Medicaid |
$2,375.66
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$2,399.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,664.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,098.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,423.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,079.04
|
| Rate for Payer: Ohio Health Group HMO |
$5,181.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,526.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,009.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,766.52
|
| Rate for Payer: PHCS Commercial |
$6,631.68
|
| Rate for Payer: United Healthcare All Payer |
$6,079.04
|
|
|
ARTH ELBOW WEXP DRAIN/RMV
|
Professional
|
Both
|
$6,908.00
|
|
|
Service Code
|
HCPCS 24000
|
| Hospital Charge Code |
76100496
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$373.76 |
| Max. Negotiated Rate |
$4,144.80 |
| Rate for Payer: Aetna Commercial |
$683.52
|
| Rate for Payer: Ambetter Exchange |
$459.36
|
| Rate for Payer: Anthem Medicaid |
$373.76
|
| Rate for Payer: Buckeye Individual/Medicaid |
$459.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$459.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$551.23
|
| Rate for Payer: Cash Price |
$3,454.00
|
| Rate for Payer: Cash Price |
$3,454.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$459.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$459.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$381.24
|
| Rate for Payer: Molina Healthcare Passport |
$373.76
|
| Rate for Payer: Multiplan PHCS |
$4,144.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$597.17
|
| Rate for Payer: UHCCP Medicaid |
$2,417.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$377.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$459.36
|
|
|
ARTH ELBOW WEXP DRAIN/RMV
|
Facility
|
IP
|
$6,908.00
|
|
|
Service Code
|
HCPCS 24000
|
| Hospital Charge Code |
76100496
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,072.40 |
| Max. Negotiated Rate |
$6,631.68 |
| Rate for Payer: Aetna Commercial |
$5,319.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,388.24
|
| Rate for Payer: Cash Price |
$3,454.00
|
| Rate for Payer: Cigna Commercial |
$5,733.64
|
| Rate for Payer: First Health Commercial |
$6,562.60
|
| Rate for Payer: Humana Commercial |
$5,871.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,664.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,098.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,072.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,079.04
|
| Rate for Payer: Ohio Health Group HMO |
$5,181.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,526.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,009.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,766.52
|
| Rate for Payer: PHCS Commercial |
$6,631.68
|
| Rate for Payer: United Healthcare All Payer |
$6,079.04
|
|
|
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 |
$900.00 |
| Rate for Payer: Aetna Commercial |
$683.52
|
| Rate for Payer: Ambetter Exchange |
$459.36
|
| Rate for Payer: Anthem Medicaid |
$373.76
|
| Rate for Payer: Buckeye Individual/Medicaid |
$459.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$459.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$551.23
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$459.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$459.36
|
| 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 |
$597.17
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$377.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$459.36
|
|
