|
ARTHRTMY WRIST W/JNT EXPL W/WO
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS 25101
|
| Hospital Charge Code |
76100578
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$206.34 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Anthem Medicaid |
$206.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$468.00
|
| 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 |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$498.00
|
| Rate for Payer: First Health Commercial |
$570.00
|
| Rate for Payer: Humana Commercial |
$510.00
|
| Rate for Payer: Humana KY Medicaid |
$206.34
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$208.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$492.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$210.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$528.00
|
| Rate for Payer: Ohio Health Group HMO |
$450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$480.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$522.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$414.00
|
| Rate for Payer: PHCS Commercial |
$576.00
|
| Rate for Payer: United Healthcare All Payer |
$528.00
|
|
|
ARTHRTMY WRIST W/JNT EXPL W/WO
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
HCPCS 25101
|
| Hospital Charge Code |
76100578
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$180.00 |
| Max. Negotiated Rate |
$576.00 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$468.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$498.00
|
| Rate for Payer: First Health Commercial |
$570.00
|
| Rate for Payer: Humana Commercial |
$510.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$492.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$180.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$528.00
|
| Rate for Payer: Ohio Health Group HMO |
$450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$480.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$522.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$414.00
|
| Rate for Payer: PHCS Commercial |
$576.00
|
| Rate for Payer: United Healthcare All Payer |
$528.00
|
|
|
ARTH SHLDR DIS CLAVICULECTOM(P
|
Professional
|
Both
|
$1,025.00
|
|
|
Service Code
|
HCPCS 29824
|
| Hospital Charge Code |
761P1082
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$358.75 |
| Max. Negotiated Rate |
$1,075.28 |
| Rate for Payer: Aetna Commercial |
$980.61
|
| Rate for Payer: Ambetter Exchange |
$644.88
|
| Rate for Payer: Anthem Medicaid |
$459.49
|
| Rate for Payer: Buckeye Individual/Medicaid |
$644.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$644.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$773.86
|
| Rate for Payer: Cash Price |
$512.50
|
| Rate for Payer: Cash Price |
$512.50
|
| Rate for Payer: Cigna Commercial |
$1,075.28
|
| Rate for Payer: Healthspan PPO |
$888.23
|
| Rate for Payer: Humana Medicaid |
$459.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$835.68
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$644.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$644.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$468.68
|
| Rate for Payer: Molina Healthcare Passport |
$459.49
|
| Rate for Payer: Multiplan PHCS |
$615.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$838.34
|
| Rate for Payer: UHCCP Medicaid |
$358.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$464.08
|
| Rate for Payer: Wellcare Medicare Advantage |
$644.88
|
|
|
ARTH SHLDR DIS CLAVICULECTOMY
|
Facility
|
IP
|
$1,025.00
|
|
|
Service Code
|
HCPCS 29824
|
| Hospital Charge Code |
76101082
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$307.50 |
| Max. Negotiated Rate |
$984.00 |
| Rate for Payer: Aetna Commercial |
$789.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$799.50
|
| Rate for Payer: Cash Price |
$512.50
|
| Rate for Payer: Cigna Commercial |
$850.75
|
| Rate for Payer: First Health Commercial |
$973.75
|
| Rate for Payer: Humana Commercial |
$871.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$840.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$756.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$307.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$902.00
|
| Rate for Payer: Ohio Health Group HMO |
$768.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$820.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$891.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$707.25
|
| Rate for Payer: PHCS Commercial |
$984.00
|
| Rate for Payer: United Healthcare All Payer |
$902.00
|
|
|
ARTH SHLDR DIS CLAVICULECTOMY
|
Professional
|
Both
|
$1,025.00
|
|
|
Service Code
|
HCPCS 29824
|
| Hospital Charge Code |
76101082
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$358.75 |
| Max. Negotiated Rate |
$1,075.28 |
| Rate for Payer: Aetna Commercial |
$980.61
|
| Rate for Payer: Ambetter Exchange |
$644.88
|
| Rate for Payer: Anthem Medicaid |
$459.49
|
| Rate for Payer: Buckeye Individual/Medicaid |
$644.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$644.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$773.86
|
| Rate for Payer: Cash Price |
$512.50
|
| Rate for Payer: Cash Price |
$512.50
|
| Rate for Payer: Cigna Commercial |
$1,075.28
|
| Rate for Payer: Healthspan PPO |
$888.23
|
| Rate for Payer: Humana Medicaid |
$459.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$835.68
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$644.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$644.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$468.68
|
| Rate for Payer: Molina Healthcare Passport |
$459.49
|
| Rate for Payer: Multiplan PHCS |
$615.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$838.34
|
| Rate for Payer: UHCCP Medicaid |
$358.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$464.08
|
| Rate for Payer: Wellcare Medicare Advantage |
$644.88
|
|
|
ARTH SHLDR DIS CLAVICULECTOMY
|
Facility
|
OP
|
$1,025.00
|
|
|
Service Code
|
HCPCS 29824
|
| Hospital Charge Code |
76101082
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$352.50 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$789.25
|
| Rate for Payer: Anthem Medicaid |
$352.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$799.50
|
| 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 |
$512.50
|
| Rate for Payer: Cash Price |
$512.50
|
| Rate for Payer: Cigna Commercial |
$850.75
|
| Rate for Payer: First Health Commercial |
$973.75
|
| Rate for Payer: Humana Commercial |
$871.25
|
| Rate for Payer: Humana KY Medicaid |
$352.50
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$356.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$840.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$756.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$359.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$902.00
|
| Rate for Payer: Ohio Health Group HMO |
$768.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$820.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$891.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$707.25
|
| Rate for Payer: PHCS Commercial |
$984.00
|
| Rate for Payer: United Healthcare All Payer |
$902.00
|
|
|
ARTH WR EXC/RPR TRING FIBROCJT
|
Professional
|
Both
|
$715.00
|
|
|
Service Code
|
HCPCS 29846
|
| Hospital Charge Code |
761P1087
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$250.25 |
| Max. Negotiated Rate |
$839.80 |
| Rate for Payer: Aetna Commercial |
$759.88
|
| Rate for Payer: Ambetter Exchange |
$499.65
|
| Rate for Payer: Anthem Medicaid |
$473.77
|
| Rate for Payer: Buckeye Individual/Medicaid |
$499.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$499.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$599.58
|
| Rate for Payer: Cash Price |
$357.50
|
| Rate for Payer: Cash Price |
$357.50
|
| Rate for Payer: Cigna Commercial |
$839.80
|
| Rate for Payer: Healthspan PPO |
$688.29
|
| Rate for Payer: Humana Medicaid |
$473.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$643.41
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$499.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$499.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$483.25
|
| Rate for Payer: Molina Healthcare Passport |
$473.77
|
| Rate for Payer: Multiplan PHCS |
$429.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$649.54
|
| Rate for Payer: UHCCP Medicaid |
$250.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$478.51
|
| Rate for Payer: Wellcare Medicare Advantage |
$499.65
|
|
|
ARTH WR EXC/RPR TRING FIBROCJT
|
Facility
|
OP
|
$715.00
|
|
|
Service Code
|
HCPCS 29846
|
| Hospital Charge Code |
76101087
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$245.89 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$550.55
|
| Rate for Payer: Anthem Medicaid |
$245.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$557.70
|
| 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 |
$357.50
|
| Rate for Payer: Cash Price |
$357.50
|
| Rate for Payer: Cigna Commercial |
$593.45
|
| Rate for Payer: First Health Commercial |
$679.25
|
| Rate for Payer: Humana Commercial |
$607.75
|
| Rate for Payer: Humana KY Medicaid |
$245.89
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$248.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$586.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$527.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$250.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$629.20
|
| Rate for Payer: Ohio Health Group HMO |
$536.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$572.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$622.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$493.35
|
| Rate for Payer: PHCS Commercial |
$686.40
|
| Rate for Payer: United Healthcare All Payer |
$629.20
|
|
|
ARTH WR EXC/RPR TRING FIBROCJT
|
Facility
|
IP
|
$715.00
|
|
|
Service Code
|
HCPCS 29846
|
| Hospital Charge Code |
76101087
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$214.50 |
| Max. Negotiated Rate |
$686.40 |
| Rate for Payer: Aetna Commercial |
$550.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$557.70
|
| Rate for Payer: Cash Price |
$357.50
|
| Rate for Payer: Cigna Commercial |
$593.45
|
| Rate for Payer: First Health Commercial |
$679.25
|
| Rate for Payer: Humana Commercial |
$607.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$586.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$527.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$214.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$629.20
|
| Rate for Payer: Ohio Health Group HMO |
$536.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$572.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$622.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$493.35
|
| Rate for Payer: PHCS Commercial |
$686.40
|
| Rate for Payer: United Healthcare All Payer |
$629.20
|
|
|
ARTH WR EXC/RPR TRING FIBROCJT
|
Professional
|
Both
|
$715.00
|
|
|
Service Code
|
HCPCS 29846
|
| Hospital Charge Code |
76101087
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$250.25 |
| Max. Negotiated Rate |
$839.80 |
| Rate for Payer: Aetna Commercial |
$759.88
|
| Rate for Payer: Ambetter Exchange |
$499.65
|
| Rate for Payer: Anthem Medicaid |
$473.77
|
| Rate for Payer: Buckeye Individual/Medicaid |
$499.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$499.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$599.58
|
| Rate for Payer: Cash Price |
$357.50
|
| Rate for Payer: Cash Price |
$357.50
|
| Rate for Payer: Cigna Commercial |
$839.80
|
| Rate for Payer: Healthspan PPO |
$688.29
|
| Rate for Payer: Humana Medicaid |
$473.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$643.41
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$499.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$499.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$483.25
|
| Rate for Payer: Molina Healthcare Passport |
$473.77
|
| Rate for Payer: Multiplan PHCS |
$429.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$649.54
|
| Rate for Payer: UHCCP Medicaid |
$250.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$478.51
|
| Rate for Payer: Wellcare Medicare Advantage |
$499.65
|
|
|
ARTICULAR INSERT SZ5-6 13MM
|
Facility
|
IP
|
$5,090.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,527.00 |
| Max. Negotiated Rate |
$4,886.40 |
| Rate for Payer: Aetna Commercial |
$3,919.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,970.20
|
| Rate for Payer: Cash Price |
$2,545.00
|
| Rate for Payer: Cigna Commercial |
$4,224.70
|
| Rate for Payer: First Health Commercial |
$4,835.50
|
| Rate for Payer: Humana Commercial |
$4,326.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,173.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,756.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,527.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,479.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,817.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,072.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,428.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,512.10
|
| Rate for Payer: PHCS Commercial |
$4,886.40
|
| Rate for Payer: United Healthcare All Payer |
$4,479.20
|
|
|
ARTICULAR INSERT SZ5-6 13MM
|
Facility
|
OP
|
$5,090.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,527.00 |
| Max. Negotiated Rate |
$4,886.40 |
| Rate for Payer: Aetna Commercial |
$3,919.30
|
| Rate for Payer: Anthem Medicaid |
$1,750.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,970.20
|
| Rate for Payer: Cash Price |
$2,545.00
|
| Rate for Payer: Cigna Commercial |
$4,224.70
|
| Rate for Payer: First Health Commercial |
$4,835.50
|
| Rate for Payer: Humana Commercial |
$4,326.50
|
| Rate for Payer: Humana KY Medicaid |
$1,750.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1,768.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,173.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,756.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,527.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,785.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,479.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,817.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,072.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,428.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,512.10
|
| Rate for Payer: PHCS Commercial |
$4,886.40
|
| Rate for Payer: United Healthcare All Payer |
$4,479.20
|
|
|
ARTICULEZ 12/14 44MM SPEC+15.5
|
Facility
|
IP
|
$9,191.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,757.34 |
| Max. Negotiated Rate |
$8,823.48 |
| Rate for Payer: Aetna Commercial |
$7,077.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,169.08
|
| Rate for Payer: Cash Price |
$4,595.56
|
| Rate for Payer: Cigna Commercial |
$7,628.64
|
| Rate for Payer: First Health Commercial |
$8,731.57
|
| Rate for Payer: Humana Commercial |
$7,812.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,536.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,783.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,757.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,088.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,893.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,352.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,996.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,341.88
|
| Rate for Payer: PHCS Commercial |
$8,823.48
|
| Rate for Payer: United Healthcare All Payer |
$8,088.19
|
|
|
ARTICULEZ 12/14 44MM SPEC+15.5
|
Facility
|
OP
|
$9,191.13
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,757.34 |
| Max. Negotiated Rate |
$8,823.48 |
| Rate for Payer: Aetna Commercial |
$7,077.17
|
| Rate for Payer: Anthem Medicaid |
$3,160.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,169.08
|
| Rate for Payer: Cash Price |
$4,595.56
|
| Rate for Payer: Cigna Commercial |
$7,628.64
|
| Rate for Payer: First Health Commercial |
$8,731.57
|
| Rate for Payer: Humana Commercial |
$7,812.46
|
| Rate for Payer: Humana KY Medicaid |
$3,160.83
|
| Rate for Payer: Kentucky WC Medicaid |
$3,193.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,536.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,783.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,757.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,224.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,088.19
|
| Rate for Payer: Ohio Health Group HMO |
$6,893.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,352.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,996.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,341.88
|
| Rate for Payer: PHCS Commercial |
$8,823.48
|
| Rate for Payer: United Healthcare All Payer |
$8,088.19
|
|
|
ARTICULEZE 12/14 40MM SPEC+12
|
Facility
|
OP
|
$4,531.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,359.38 |
| Max. Negotiated Rate |
$4,350.00 |
| Rate for Payer: Aetna Commercial |
$3,489.06
|
| Rate for Payer: Anthem Medicaid |
$1,558.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,534.38
|
| Rate for Payer: Cash Price |
$2,265.62
|
| Rate for Payer: Cigna Commercial |
$3,760.94
|
| Rate for Payer: First Health Commercial |
$4,304.69
|
| Rate for Payer: Humana Commercial |
$3,851.56
|
| Rate for Payer: Humana KY Medicaid |
$1,558.30
|
| Rate for Payer: Kentucky WC Medicaid |
$1,574.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,715.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,344.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,359.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,589.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,987.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,398.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,625.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,942.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,126.56
|
| Rate for Payer: PHCS Commercial |
$4,350.00
|
| Rate for Payer: United Healthcare All Payer |
$3,987.50
|
|
|
ARTICULEZE 12/14 40MM SPEC+12
|
Facility
|
IP
|
$4,531.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,359.38 |
| Max. Negotiated Rate |
$4,350.00 |
| Rate for Payer: Aetna Commercial |
$3,489.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,534.38
|
| Rate for Payer: Cash Price |
$2,265.62
|
| Rate for Payer: Cigna Commercial |
$3,760.94
|
| Rate for Payer: First Health Commercial |
$4,304.69
|
| Rate for Payer: Humana Commercial |
$3,851.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,715.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,344.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,359.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,987.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,398.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,625.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,942.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,126.56
|
| Rate for Payer: PHCS Commercial |
$4,350.00
|
| Rate for Payer: United Healthcare All Payer |
$3,987.50
|
|
|
ARTICULEZE 12/14 40MM SPEC+1.5
|
Facility
|
OP
|
$4,531.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,359.38 |
| Max. Negotiated Rate |
$4,350.00 |
| Rate for Payer: Aetna Commercial |
$3,489.06
|
| Rate for Payer: Anthem Medicaid |
$1,558.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,534.38
|
| Rate for Payer: Cash Price |
$2,265.62
|
| Rate for Payer: Cigna Commercial |
$3,760.94
|
| Rate for Payer: First Health Commercial |
$4,304.69
|
| Rate for Payer: Humana Commercial |
$3,851.56
|
| Rate for Payer: Humana KY Medicaid |
$1,558.30
|
| Rate for Payer: Kentucky WC Medicaid |
$1,574.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,715.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,344.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,359.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,589.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,987.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,398.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,625.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,942.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,126.56
|
| Rate for Payer: PHCS Commercial |
$4,350.00
|
| Rate for Payer: United Healthcare All Payer |
$3,987.50
|
|
|
ARTICULEZE 12/14 40MM SPEC+1.5
|
Facility
|
IP
|
$4,531.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,359.38 |
| Max. Negotiated Rate |
$4,350.00 |
| Rate for Payer: Aetna Commercial |
$3,489.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,534.38
|
| Rate for Payer: Cash Price |
$2,265.62
|
| Rate for Payer: Cigna Commercial |
$3,760.94
|
| Rate for Payer: First Health Commercial |
$4,304.69
|
| Rate for Payer: Humana Commercial |
$3,851.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,715.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,344.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,359.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,987.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,398.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,625.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,942.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,126.56
|
| Rate for Payer: PHCS Commercial |
$4,350.00
|
| Rate for Payer: United Healthcare All Payer |
$3,987.50
|
|
|
ARTICULEZE 12/14 40MM SPEC+15.
|
Facility
|
IP
|
$8,963.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,689.01 |
| Max. Negotiated Rate |
$8,604.84 |
| Rate for Payer: Aetna Commercial |
$6,901.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,991.43
|
| Rate for Payer: Cash Price |
$4,481.69
|
| Rate for Payer: Cigna Commercial |
$7,439.60
|
| Rate for Payer: First Health Commercial |
$8,515.20
|
| Rate for Payer: Humana Commercial |
$7,618.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,349.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,614.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,689.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,887.77
|
| Rate for Payer: Ohio Health Group HMO |
$6,722.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,170.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,798.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,184.73
|
| Rate for Payer: PHCS Commercial |
$8,604.84
|
| Rate for Payer: United Healthcare All Payer |
$7,887.77
|
|
|
ARTICULEZE 12/14 40MM SPEC+15.
|
Facility
|
OP
|
$8,963.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,689.01 |
| Max. Negotiated Rate |
$8,604.84 |
| Rate for Payer: Aetna Commercial |
$6,901.79
|
| Rate for Payer: Anthem Medicaid |
$3,082.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,991.43
|
| Rate for Payer: Cash Price |
$4,481.69
|
| Rate for Payer: Cigna Commercial |
$7,439.60
|
| Rate for Payer: First Health Commercial |
$8,515.20
|
| Rate for Payer: Humana Commercial |
$7,618.86
|
| Rate for Payer: Humana KY Medicaid |
$3,082.50
|
| Rate for Payer: Kentucky WC Medicaid |
$3,113.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,349.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,614.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,689.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,144.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,887.77
|
| Rate for Payer: Ohio Health Group HMO |
$6,722.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,170.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,798.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,184.73
|
| Rate for Payer: PHCS Commercial |
$8,604.84
|
| Rate for Payer: United Healthcare All Payer |
$7,887.77
|
|
|
ARTICULEZE 12/14 40MM SPEC-2
|
Facility
|
OP
|
$4,531.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,359.38 |
| Max. Negotiated Rate |
$4,350.00 |
| Rate for Payer: Aetna Commercial |
$3,489.06
|
| Rate for Payer: Anthem Medicaid |
$1,558.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,534.38
|
| Rate for Payer: Cash Price |
$2,265.62
|
| Rate for Payer: Cigna Commercial |
$3,760.94
|
| Rate for Payer: First Health Commercial |
$4,304.69
|
| Rate for Payer: Humana Commercial |
$3,851.56
|
| Rate for Payer: Humana KY Medicaid |
$1,558.30
|
| Rate for Payer: Kentucky WC Medicaid |
$1,574.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,715.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,344.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,359.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,589.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,987.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,398.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,625.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,942.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,126.56
|
| Rate for Payer: PHCS Commercial |
$4,350.00
|
| Rate for Payer: United Healthcare All Payer |
$3,987.50
|
|
|
ARTICULEZE 12/14 40MM SPEC-2
|
Facility
|
IP
|
$4,531.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,359.38 |
| Max. Negotiated Rate |
$4,350.00 |
| Rate for Payer: Aetna Commercial |
$3,489.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,534.38
|
| Rate for Payer: Cash Price |
$2,265.62
|
| Rate for Payer: Cigna Commercial |
$3,760.94
|
| Rate for Payer: First Health Commercial |
$4,304.69
|
| Rate for Payer: Humana Commercial |
$3,851.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,715.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,344.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,359.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,987.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,398.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,625.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,942.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,126.56
|
| Rate for Payer: PHCS Commercial |
$4,350.00
|
| Rate for Payer: United Healthcare All Payer |
$3,987.50
|
|
|
ARTICULEZE 12/14 40MM SPEC+5
|
Facility
|
OP
|
$8,963.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,689.01 |
| Max. Negotiated Rate |
$8,604.84 |
| Rate for Payer: Aetna Commercial |
$6,901.79
|
| Rate for Payer: Anthem Medicaid |
$3,082.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,991.43
|
| Rate for Payer: Cash Price |
$4,481.69
|
| Rate for Payer: Cigna Commercial |
$7,439.60
|
| Rate for Payer: First Health Commercial |
$8,515.20
|
| Rate for Payer: Humana Commercial |
$7,618.86
|
| Rate for Payer: Humana KY Medicaid |
$3,082.50
|
| Rate for Payer: Kentucky WC Medicaid |
$3,113.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,349.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,614.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,689.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,144.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,887.77
|
| Rate for Payer: Ohio Health Group HMO |
$6,722.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,170.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,798.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,184.73
|
| Rate for Payer: PHCS Commercial |
$8,604.84
|
| Rate for Payer: United Healthcare All Payer |
$7,887.77
|
|
|
ARTICULEZE 12/14 40MM SPEC+5
|
Facility
|
IP
|
$8,963.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,689.01 |
| Max. Negotiated Rate |
$8,604.84 |
| Rate for Payer: Aetna Commercial |
$6,901.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,991.43
|
| Rate for Payer: Cash Price |
$4,481.69
|
| Rate for Payer: Cigna Commercial |
$7,439.60
|
| Rate for Payer: First Health Commercial |
$8,515.20
|
| Rate for Payer: Humana Commercial |
$7,618.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,349.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,614.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,689.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,887.77
|
| Rate for Payer: Ohio Health Group HMO |
$6,722.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,170.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,798.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,184.73
|
| Rate for Payer: PHCS Commercial |
$8,604.84
|
| Rate for Payer: United Healthcare All Payer |
$7,887.77
|
|
|
ARTICULEZE 12/14 40MM SPEC+8.5
|
Facility
|
IP
|
$4,531.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,359.38 |
| Max. Negotiated Rate |
$4,350.00 |
| Rate for Payer: Aetna Commercial |
$3,489.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,534.38
|
| Rate for Payer: Cash Price |
$2,265.62
|
| Rate for Payer: Cigna Commercial |
$3,760.94
|
| Rate for Payer: First Health Commercial |
$4,304.69
|
| Rate for Payer: Humana Commercial |
$3,851.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,715.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,344.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,359.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,987.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,398.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,625.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,942.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,126.56
|
| Rate for Payer: PHCS Commercial |
$4,350.00
|
| Rate for Payer: United Healthcare All Payer |
$3,987.50
|
|
