|
ARTHO ASP+.OR INJ JNT WO US
|
Facility
|
OP
|
$809.00
|
|
|
Service Code
|
HCPCS 20610
|
| Hospital Charge Code |
76102849
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$272.75 |
| Max. Negotiated Rate |
$776.64 |
| Rate for Payer: Aetna Commercial |
$622.93
|
| Rate for Payer: Anthem Medicaid |
$278.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$272.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$631.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$381.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$368.21
|
| Rate for Payer: Cash Price |
$404.50
|
| Rate for Payer: Cash Price |
$404.50
|
| Rate for Payer: Cigna Commercial |
$671.47
|
| Rate for Payer: First Health Commercial |
$768.55
|
| Rate for Payer: Humana Commercial |
$687.65
|
| Rate for Payer: Humana KY Medicaid |
$278.22
|
| Rate for Payer: Humana Medicare Advantage |
$272.75
|
| Rate for Payer: Kentucky WC Medicaid |
$281.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$663.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$597.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$283.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$711.92
|
| Rate for Payer: Ohio Health Group HMO |
$606.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$647.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$703.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$558.21
|
| Rate for Payer: PHCS Commercial |
$776.64
|
| Rate for Payer: United Healthcare All Payer |
$711.92
|
|
|
ARTHO ASP+.OR INJ JNT WO US
|
Facility
|
IP
|
$809.00
|
|
|
Service Code
|
HCPCS 20610
|
| Hospital Charge Code |
76102849
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$242.70 |
| Max. Negotiated Rate |
$776.64 |
| Rate for Payer: Aetna Commercial |
$622.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$631.02
|
| Rate for Payer: Cash Price |
$404.50
|
| Rate for Payer: Cigna Commercial |
$671.47
|
| Rate for Payer: First Health Commercial |
$768.55
|
| Rate for Payer: Humana Commercial |
$687.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$663.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$597.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$242.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$711.92
|
| Rate for Payer: Ohio Health Group HMO |
$606.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$647.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$703.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$558.21
|
| Rate for Payer: PHCS Commercial |
$776.64
|
| Rate for Payer: United Healthcare All Payer |
$711.92
|
|
|
ARTHO ASP+.OR INJ JNT WO US
|
Facility
|
IP
|
$809.00
|
|
|
Service Code
|
HCPCS 20610
|
| Hospital Charge Code |
76100345
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$242.70 |
| Max. Negotiated Rate |
$776.64 |
| Rate for Payer: Aetna Commercial |
$622.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$631.02
|
| Rate for Payer: Cash Price |
$404.50
|
| Rate for Payer: Cigna Commercial |
$671.47
|
| Rate for Payer: First Health Commercial |
$768.55
|
| Rate for Payer: Humana Commercial |
$687.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$663.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$597.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$242.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$711.92
|
| Rate for Payer: Ohio Health Group HMO |
$606.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$647.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$703.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$558.21
|
| Rate for Payer: PHCS Commercial |
$776.64
|
| Rate for Payer: United Healthcare All Payer |
$711.92
|
|
|
ARTHO ASP+.OR INJ JNT WO US
|
Professional
|
Both
|
$809.00
|
|
|
Service Code
|
HCPCS 20610
|
| Hospital Charge Code |
76100345
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$29.83 |
| Max. Negotiated Rate |
$485.40 |
| Rate for Payer: Aetna Commercial |
$75.91
|
| Rate for Payer: Ambetter Exchange |
$42.86
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$29.83
|
| Rate for Payer: Anthem Medicaid |
$50.81
|
| Rate for Payer: Buckeye Individual/Medicaid |
$42.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$42.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$51.43
|
| Rate for Payer: Cash Price |
$404.50
|
| Rate for Payer: Cash Price |
$404.50
|
| Rate for Payer: Cigna Commercial |
$115.53
|
| Rate for Payer: Healthspan PPO |
$98.82
|
| Rate for Payer: Humana Medicaid |
$50.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$62.15
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$42.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$51.83
|
| Rate for Payer: Molina Healthcare Passport |
$50.81
|
| Rate for Payer: Multiplan PHCS |
$485.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$55.72
|
| Rate for Payer: UHCCP Medicaid |
$31.32
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$51.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$42.86
|
|
|
ARTHO ASP+.OR INJ JNT WO US
|
Facility
|
IP
|
$667.00
|
|
|
Service Code
|
HCPCS 20605
|
| Hospital Charge Code |
76102848
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$200.10 |
| Max. Negotiated Rate |
$640.32 |
| Rate for Payer: Aetna Commercial |
$513.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$520.26
|
| Rate for Payer: Cash Price |
$333.50
|
| Rate for Payer: Cigna Commercial |
$553.61
|
| Rate for Payer: First Health Commercial |
$633.65
|
| Rate for Payer: Humana Commercial |
$566.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$546.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$492.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$200.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$586.96
|
| Rate for Payer: Ohio Health Group HMO |
$500.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$533.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$580.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$460.23
|
| Rate for Payer: PHCS Commercial |
$640.32
|
| Rate for Payer: United Healthcare All Payer |
$586.96
|
|
|
ARTHO ASP+.OR INJ JNT WO US
|
Facility
|
OP
|
$509.00
|
|
|
Service Code
|
HCPCS 20610
|
| Hospital Charge Code |
45000093
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$175.05 |
| Max. Negotiated Rate |
$488.64 |
| Rate for Payer: Aetna Commercial |
$391.93
|
| Rate for Payer: Anthem Medicaid |
$175.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$272.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$397.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$381.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$368.21
|
| Rate for Payer: Cash Price |
$254.50
|
| Rate for Payer: Cash Price |
$254.50
|
| Rate for Payer: Cigna Commercial |
$422.47
|
| Rate for Payer: First Health Commercial |
$483.55
|
| Rate for Payer: Humana Commercial |
$432.65
|
| Rate for Payer: Humana KY Medicaid |
$175.05
|
| Rate for Payer: Humana Medicare Advantage |
$272.75
|
| Rate for Payer: Kentucky WC Medicaid |
$176.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$417.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$375.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$178.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$447.92
|
| Rate for Payer: Ohio Health Group HMO |
$381.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$407.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$351.21
|
| Rate for Payer: PHCS Commercial |
$488.64
|
| Rate for Payer: United Healthcare All Payer |
$447.92
|
|
|
ARTHO ASP+.OR INJ JNT WO US
|
Facility
|
IP
|
$444.00
|
|
|
Service Code
|
HCPCS 20605
|
| Hospital Charge Code |
45000091
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$133.20 |
| Max. Negotiated Rate |
$426.24 |
| Rate for Payer: Aetna Commercial |
$341.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$346.32
|
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Cigna Commercial |
$368.52
|
| Rate for Payer: First Health Commercial |
$421.80
|
| Rate for Payer: Humana Commercial |
$377.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$364.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$327.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$133.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$390.72
|
| Rate for Payer: Ohio Health Group HMO |
$333.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$355.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$386.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$306.36
|
| Rate for Payer: PHCS Commercial |
$426.24
|
| Rate for Payer: United Healthcare All Payer |
$390.72
|
|
|
ARTHO ASP+.OR INJ JNT WO US
|
Facility
|
OP
|
$444.00
|
|
|
Service Code
|
HCPCS 20605
|
| Hospital Charge Code |
45000091
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$152.69 |
| Max. Negotiated Rate |
$426.24 |
| Rate for Payer: Aetna Commercial |
$341.88
|
| Rate for Payer: Anthem Medicaid |
$152.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$272.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$346.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$381.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$368.21
|
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Cigna Commercial |
$368.52
|
| Rate for Payer: First Health Commercial |
$421.80
|
| Rate for Payer: Humana Commercial |
$377.40
|
| Rate for Payer: Humana KY Medicaid |
$152.69
|
| Rate for Payer: Humana Medicare Advantage |
$272.75
|
| Rate for Payer: Kentucky WC Medicaid |
$154.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$364.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$327.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$155.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$390.72
|
| Rate for Payer: Ohio Health Group HMO |
$333.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$355.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$386.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$306.36
|
| Rate for Payer: PHCS Commercial |
$426.24
|
| Rate for Payer: United Healthcare All Payer |
$390.72
|
|
|
ARTHO ASP+.OR INJ JNT WO US
|
Professional
|
Both
|
$694.00
|
|
|
Service Code
|
HCPCS 20605
|
| Hospital Charge Code |
76100343
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$33.24 |
| Max. Negotiated Rate |
$416.40 |
| Rate for Payer: Aetna Commercial |
$63.15
|
| Rate for Payer: Ambetter Exchange |
$34.69
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$36.82
|
| Rate for Payer: Anthem Medicaid |
$33.24
|
| Rate for Payer: Buckeye Individual/Medicaid |
$34.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$34.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$41.63
|
| Rate for Payer: Cash Price |
$347.00
|
| Rate for Payer: Cash Price |
$347.00
|
| Rate for Payer: Cigna Commercial |
$93.23
|
| Rate for Payer: Healthspan PPO |
$76.59
|
| Rate for Payer: Humana Medicaid |
$33.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$50.92
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$34.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$33.90
|
| Rate for Payer: Molina Healthcare Passport |
$33.24
|
| Rate for Payer: Multiplan PHCS |
$416.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$45.10
|
| Rate for Payer: UHCCP Medicaid |
$38.66
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$33.57
|
| Rate for Payer: Wellcare Medicare Advantage |
$34.69
|
|
|
ARTHO ASP+.OR INJ JNT WO US
|
Facility
|
IP
|
$694.00
|
|
|
Service Code
|
HCPCS 20605
|
| Hospital Charge Code |
76100343
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.20 |
| Max. Negotiated Rate |
$666.24 |
| Rate for Payer: Aetna Commercial |
$534.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$541.32
|
| Rate for Payer: Cash Price |
$347.00
|
| Rate for Payer: Cigna Commercial |
$576.02
|
| Rate for Payer: First Health Commercial |
$659.30
|
| Rate for Payer: Humana Commercial |
$589.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$569.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$512.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$208.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$610.72
|
| Rate for Payer: Ohio Health Group HMO |
$520.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$555.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$603.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$478.86
|
| Rate for Payer: PHCS Commercial |
$666.24
|
| Rate for Payer: United Healthcare All Payer |
$610.72
|
|
|
ARTHO ASP+.OR INJ JNT WO US
|
Facility
|
IP
|
$509.00
|
|
|
Service Code
|
HCPCS 20610
|
| Hospital Charge Code |
45000093
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$152.70 |
| Max. Negotiated Rate |
$488.64 |
| Rate for Payer: Aetna Commercial |
$391.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$397.02
|
| Rate for Payer: Cash Price |
$254.50
|
| Rate for Payer: Cigna Commercial |
$422.47
|
| Rate for Payer: First Health Commercial |
$483.55
|
| Rate for Payer: Humana Commercial |
$432.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$417.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$375.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$152.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$447.92
|
| Rate for Payer: Ohio Health Group HMO |
$381.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$407.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$351.21
|
| Rate for Payer: PHCS Commercial |
$488.64
|
| Rate for Payer: United Healthcare All Payer |
$447.92
|
|
|
ARTHO ASP+.OR INJ JNT WO US
|
Facility
|
OP
|
$694.00
|
|
|
Service Code
|
HCPCS 20605
|
| Hospital Charge Code |
76100343
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$238.67 |
| Max. Negotiated Rate |
$666.24 |
| Rate for Payer: Aetna Commercial |
$534.38
|
| Rate for Payer: Anthem Medicaid |
$238.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$272.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$541.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$381.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$368.21
|
| Rate for Payer: Cash Price |
$347.00
|
| Rate for Payer: Cash Price |
$347.00
|
| Rate for Payer: Cigna Commercial |
$576.02
|
| Rate for Payer: First Health Commercial |
$659.30
|
| Rate for Payer: Humana Commercial |
$589.90
|
| Rate for Payer: Humana KY Medicaid |
$238.67
|
| Rate for Payer: Humana Medicare Advantage |
$272.75
|
| Rate for Payer: Kentucky WC Medicaid |
$241.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$569.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$512.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$243.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$610.72
|
| Rate for Payer: Ohio Health Group HMO |
$520.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$555.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$603.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$478.86
|
| Rate for Payer: PHCS Commercial |
$666.24
|
| Rate for Payer: United Healthcare All Payer |
$610.72
|
|
|
ARTHO ASP+.OR INJ JNT WO US
|
Facility
|
OP
|
$809.00
|
|
|
Service Code
|
HCPCS 20610
|
| Hospital Charge Code |
76100345
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$272.75 |
| Max. Negotiated Rate |
$776.64 |
| Rate for Payer: Aetna Commercial |
$622.93
|
| Rate for Payer: Anthem Medicaid |
$278.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$272.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$631.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$381.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$368.21
|
| Rate for Payer: Cash Price |
$404.50
|
| Rate for Payer: Cash Price |
$404.50
|
| Rate for Payer: Cigna Commercial |
$671.47
|
| Rate for Payer: First Health Commercial |
$768.55
|
| Rate for Payer: Humana Commercial |
$687.65
|
| Rate for Payer: Humana KY Medicaid |
$278.22
|
| Rate for Payer: Humana Medicare Advantage |
$272.75
|
| Rate for Payer: Kentucky WC Medicaid |
$281.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$663.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$597.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$283.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$711.92
|
| Rate for Payer: Ohio Health Group HMO |
$606.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$647.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$703.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$558.21
|
| Rate for Payer: PHCS Commercial |
$776.64
|
| Rate for Payer: United Healthcare All Payer |
$711.92
|
|
|
ARTHO ASP+.OR INJ JNT WO US
|
Facility
|
OP
|
$667.00
|
|
|
Service Code
|
HCPCS 20605
|
| Hospital Charge Code |
76102848
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$229.38 |
| Max. Negotiated Rate |
$640.32 |
| Rate for Payer: Aetna Commercial |
$513.59
|
| Rate for Payer: Anthem Medicaid |
$229.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$272.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$520.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$381.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$368.21
|
| Rate for Payer: Cash Price |
$333.50
|
| Rate for Payer: Cash Price |
$333.50
|
| Rate for Payer: Cigna Commercial |
$553.61
|
| Rate for Payer: First Health Commercial |
$633.65
|
| Rate for Payer: Humana Commercial |
$566.95
|
| Rate for Payer: Humana KY Medicaid |
$229.38
|
| Rate for Payer: Humana Medicare Advantage |
$272.75
|
| Rate for Payer: Kentucky WC Medicaid |
$231.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$546.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$492.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$233.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$586.96
|
| Rate for Payer: Ohio Health Group HMO |
$500.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$533.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$580.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$460.23
|
| Rate for Payer: PHCS Commercial |
$640.32
|
| Rate for Payer: United Healthcare All Payer |
$586.96
|
|
|
ARTHO ASP+.OR INJ JNT WO US
|
Professional
|
Both
|
$809.00
|
|
|
Service Code
|
HCPCS 20610
|
| Hospital Charge Code |
76102849
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$29.83 |
| Max. Negotiated Rate |
$485.40 |
| Rate for Payer: Aetna Commercial |
$75.91
|
| Rate for Payer: Ambetter Exchange |
$42.86
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$29.83
|
| Rate for Payer: Anthem Medicaid |
$50.81
|
| Rate for Payer: Buckeye Individual/Medicaid |
$42.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$42.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$51.43
|
| Rate for Payer: Cash Price |
$404.50
|
| Rate for Payer: Cash Price |
$404.50
|
| Rate for Payer: Cigna Commercial |
$115.53
|
| Rate for Payer: Healthspan PPO |
$98.82
|
| Rate for Payer: Humana Medicaid |
$50.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$62.15
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$42.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$51.83
|
| Rate for Payer: Molina Healthcare Passport |
$50.81
|
| Rate for Payer: Multiplan PHCS |
$485.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$55.72
|
| Rate for Payer: UHCCP Medicaid |
$31.32
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$51.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$42.86
|
|
|
ARTHO ASP+.OR INJ JNT WO US
|
Professional
|
Both
|
$667.00
|
|
|
Service Code
|
HCPCS 20605
|
| Hospital Charge Code |
76102848
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$33.24 |
| Max. Negotiated Rate |
$400.20 |
| Rate for Payer: Aetna Commercial |
$63.15
|
| Rate for Payer: Ambetter Exchange |
$34.69
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$36.82
|
| Rate for Payer: Anthem Medicaid |
$33.24
|
| Rate for Payer: Buckeye Individual/Medicaid |
$34.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$34.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$41.63
|
| Rate for Payer: Cash Price |
$333.50
|
| Rate for Payer: Cash Price |
$333.50
|
| Rate for Payer: Cigna Commercial |
$93.23
|
| Rate for Payer: Healthspan PPO |
$76.59
|
| Rate for Payer: Humana Medicaid |
$33.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$50.92
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$34.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$33.90
|
| Rate for Payer: Molina Healthcare Passport |
$33.24
|
| Rate for Payer: Multiplan PHCS |
$400.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$45.10
|
| Rate for Payer: UHCCP Medicaid |
$38.66
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$33.57
|
| Rate for Payer: Wellcare Medicare Advantage |
$34.69
|
|
|
ARTHO ASP+.OR INJ JNT WO US (P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 20610
|
| Hospital Charge Code |
761P0345
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$29.83 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna Commercial |
$75.91
|
| Rate for Payer: Ambetter Exchange |
$42.86
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$29.83
|
| Rate for Payer: Anthem Medicaid |
$50.81
|
| Rate for Payer: Buckeye Individual/Medicaid |
$42.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$42.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$51.43
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$115.53
|
| Rate for Payer: Healthspan PPO |
$98.82
|
| Rate for Payer: Humana Medicaid |
$50.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$62.15
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$42.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$51.83
|
| Rate for Payer: Molina Healthcare Passport |
$50.81
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$55.72
|
| Rate for Payer: UHCCP Medicaid |
$31.32
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$51.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$42.86
|
|
|
ARTHO ASP+.OR INJ JNT WO US (P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 20605
|
| Hospital Charge Code |
761P2848
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$33.24 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna Commercial |
$63.15
|
| Rate for Payer: Ambetter Exchange |
$34.69
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$36.82
|
| Rate for Payer: Anthem Medicaid |
$33.24
|
| Rate for Payer: Buckeye Individual/Medicaid |
$34.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$34.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$41.63
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$93.23
|
| Rate for Payer: Healthspan PPO |
$76.59
|
| Rate for Payer: Humana Medicaid |
$33.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$50.92
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$34.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$33.90
|
| Rate for Payer: Molina Healthcare Passport |
$33.24
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$45.10
|
| Rate for Payer: UHCCP Medicaid |
$38.66
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$33.57
|
| Rate for Payer: Wellcare Medicare Advantage |
$34.69
|
|
|
ARTHO ASP+.OR INJ JNT WO US (P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 20610
|
| Hospital Charge Code |
761P2849
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$29.83 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna Commercial |
$75.91
|
| Rate for Payer: Ambetter Exchange |
$42.86
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$29.83
|
| Rate for Payer: Anthem Medicaid |
$50.81
|
| Rate for Payer: Buckeye Individual/Medicaid |
$42.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$42.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$51.43
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$115.53
|
| Rate for Payer: Healthspan PPO |
$98.82
|
| Rate for Payer: Humana Medicaid |
$50.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$62.15
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$42.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$51.83
|
| Rate for Payer: Molina Healthcare Passport |
$50.81
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$55.72
|
| Rate for Payer: UHCCP Medicaid |
$31.32
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$51.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$42.86
|
|
|
ARTHO ASP+.OR INJ JNT WO US (P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 20605
|
| Hospital Charge Code |
761P0343
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$33.24 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna Commercial |
$63.15
|
| Rate for Payer: Ambetter Exchange |
$34.69
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$36.82
|
| Rate for Payer: Anthem Medicaid |
$33.24
|
| Rate for Payer: Buckeye Individual/Medicaid |
$34.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$34.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$41.63
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$93.23
|
| Rate for Payer: Healthspan PPO |
$76.59
|
| Rate for Payer: Humana Medicaid |
$33.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$50.92
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$34.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$33.90
|
| Rate for Payer: Molina Healthcare Passport |
$33.24
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$45.10
|
| Rate for Payer: UHCCP Medicaid |
$38.66
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$33.57
|
| Rate for Payer: Wellcare Medicare Advantage |
$34.69
|
|
|
ARTHO ASP+.OR INJ JNT WO US (T
|
Facility
|
OP
|
$444.00
|
|
|
Service Code
|
HCPCS 20605
|
| Hospital Charge Code |
761T0343
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$152.69 |
| Max. Negotiated Rate |
$426.24 |
| Rate for Payer: Aetna Commercial |
$341.88
|
| Rate for Payer: Anthem Medicaid |
$152.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$272.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$346.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$381.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$368.21
|
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Cigna Commercial |
$368.52
|
| Rate for Payer: First Health Commercial |
$421.80
|
| Rate for Payer: Humana Commercial |
$377.40
|
| Rate for Payer: Humana KY Medicaid |
$152.69
|
| Rate for Payer: Humana Medicare Advantage |
$272.75
|
| Rate for Payer: Kentucky WC Medicaid |
$154.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$364.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$327.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$155.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$390.72
|
| Rate for Payer: Ohio Health Group HMO |
$333.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$355.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$386.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$306.36
|
| Rate for Payer: PHCS Commercial |
$426.24
|
| Rate for Payer: United Healthcare All Payer |
$390.72
|
|
|
ARTHO ASP+.OR INJ JNT WO US (T
|
Facility
|
IP
|
$444.00
|
|
|
Service Code
|
HCPCS 20605
|
| Hospital Charge Code |
761T0343
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$133.20 |
| Max. Negotiated Rate |
$426.24 |
| Rate for Payer: Aetna Commercial |
$341.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$346.32
|
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Cigna Commercial |
$368.52
|
| Rate for Payer: First Health Commercial |
$421.80
|
| Rate for Payer: Humana Commercial |
$377.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$364.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$327.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$133.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$390.72
|
| Rate for Payer: Ohio Health Group HMO |
$333.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$355.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$386.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$306.36
|
| Rate for Payer: PHCS Commercial |
$426.24
|
| Rate for Payer: United Healthcare All Payer |
$390.72
|
|
|
ARTHO ASP+.OR INJ JNT WO US (T
|
Facility
|
OP
|
$509.00
|
|
|
Service Code
|
HCPCS 20610
|
| Hospital Charge Code |
761T2849
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$175.05 |
| Max. Negotiated Rate |
$488.64 |
| Rate for Payer: Aetna Commercial |
$391.93
|
| Rate for Payer: Anthem Medicaid |
$175.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$272.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$397.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$381.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$368.21
|
| Rate for Payer: Cash Price |
$254.50
|
| Rate for Payer: Cash Price |
$254.50
|
| Rate for Payer: Cigna Commercial |
$422.47
|
| Rate for Payer: First Health Commercial |
$483.55
|
| Rate for Payer: Humana Commercial |
$432.65
|
| Rate for Payer: Humana KY Medicaid |
$175.05
|
| Rate for Payer: Humana Medicare Advantage |
$272.75
|
| Rate for Payer: Kentucky WC Medicaid |
$176.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$417.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$375.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$178.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$447.92
|
| Rate for Payer: Ohio Health Group HMO |
$381.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$407.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$351.21
|
| Rate for Payer: PHCS Commercial |
$488.64
|
| Rate for Payer: United Healthcare All Payer |
$447.92
|
|
|
ARTHO ASP+.OR INJ JNT WO US (T
|
Facility
|
OP
|
$417.00
|
|
|
Service Code
|
HCPCS 20605
|
| Hospital Charge Code |
761T2848
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$143.41 |
| Max. Negotiated Rate |
$400.32 |
| Rate for Payer: Aetna Commercial |
$321.09
|
| Rate for Payer: Anthem Medicaid |
$143.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$272.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$325.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$381.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$368.21
|
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: Cigna Commercial |
$346.11
|
| Rate for Payer: First Health Commercial |
$396.15
|
| Rate for Payer: Humana Commercial |
$354.45
|
| Rate for Payer: Humana KY Medicaid |
$143.41
|
| Rate for Payer: Humana Medicare Advantage |
$272.75
|
| Rate for Payer: Kentucky WC Medicaid |
$144.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$341.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$307.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$146.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$366.96
|
| Rate for Payer: Ohio Health Group HMO |
$312.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$333.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$362.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$287.73
|
| Rate for Payer: PHCS Commercial |
$400.32
|
| Rate for Payer: United Healthcare All Payer |
$366.96
|
|
|
ARTHO ASP+.OR INJ JNT WO US (T
|
Facility
|
IP
|
$509.00
|
|
|
Service Code
|
HCPCS 20610
|
| Hospital Charge Code |
761T0345
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$152.70 |
| Max. Negotiated Rate |
$488.64 |
| Rate for Payer: Aetna Commercial |
$391.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$397.02
|
| Rate for Payer: Cash Price |
$254.50
|
| Rate for Payer: Cigna Commercial |
$422.47
|
| Rate for Payer: First Health Commercial |
$483.55
|
| Rate for Payer: Humana Commercial |
$432.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$417.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$375.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$152.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$447.92
|
| Rate for Payer: Ohio Health Group HMO |
$381.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$407.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$351.21
|
| Rate for Payer: PHCS Commercial |
$488.64
|
| Rate for Payer: United Healthcare All Payer |
$447.92
|
|
