|
EXPLORATION FOREARM
|
Professional
|
Both
|
$1,385.00
|
|
|
Service Code
|
HCPCS 25999
|
| Hospital Charge Code |
76100650
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1,385.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$1,385.00
|
| Rate for Payer: Cash Price |
$692.50
|
| Rate for Payer: Cash Price |
$692.50
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$831.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$969.50
|
| Rate for Payer: UHCCP Medicaid |
$484.75
|
|
|
EXPLORATION FOREARM
|
Facility
|
OP
|
$1,385.00
|
|
|
Service Code
|
HCPCS 25999
|
| Hospital Charge Code |
76100650
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$180.05 |
| Max. Negotiated Rate |
$1,329.60 |
| Rate for Payer: Aetna Commercial |
$1,066.45
|
| Rate for Payer: Anthem Medicaid |
$476.30
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,080.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$692.50
|
| Rate for Payer: Cash Price |
$692.50
|
| Rate for Payer: Cigna Commercial |
$1,149.55
|
| Rate for Payer: First Health Commercial |
$1,315.75
|
| Rate for Payer: Humana Commercial |
$1,177.25
|
| Rate for Payer: Humana KY Medicaid |
$476.30
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$481.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,135.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,022.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$485.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,218.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,038.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$277.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$180.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$429.35
|
| Rate for Payer: PHCS Commercial |
$1,329.60
|
| Rate for Payer: United Healthcare All Payer |
$1,218.80
|
|
|
EXPLORATION FOREARM(P
|
Professional
|
Both
|
$1,385.00
|
|
|
Service Code
|
HCPCS 25999
|
| Hospital Charge Code |
761P0650
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1,385.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$1,385.00
|
| Rate for Payer: Cash Price |
$692.50
|
| Rate for Payer: Cash Price |
$692.50
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$831.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$969.50
|
| Rate for Payer: UHCCP Medicaid |
$484.75
|
|
|
EXPLORATION MAXILLARY SINUS
|
Facility
|
IP
|
$860.00
|
|
|
Service Code
|
HCPCS 31020
|
| Hospital Charge Code |
76101144
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$111.80 |
| Max. Negotiated Rate |
$825.60 |
| Rate for Payer: Aetna Commercial |
$662.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$670.80
|
| Rate for Payer: Cash Price |
$430.00
|
| Rate for Payer: Cigna Commercial |
$713.80
|
| Rate for Payer: First Health Commercial |
$817.00
|
| Rate for Payer: Humana Commercial |
$731.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$705.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$634.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$258.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$756.80
|
| Rate for Payer: Ohio Health Group HMO |
$645.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$172.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$111.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$266.60
|
| Rate for Payer: PHCS Commercial |
$825.60
|
| Rate for Payer: United Healthcare All Payer |
$756.80
|
|
|
EXPLORATION MAXILLARY SINUS
|
Facility
|
OP
|
$860.00
|
|
|
Service Code
|
HCPCS 31020
|
| Hospital Charge Code |
76101144
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$111.80 |
| Max. Negotiated Rate |
$3,897.84 |
| Rate for Payer: Aetna Commercial |
$662.20
|
| Rate for Payer: Anthem Medicaid |
$295.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$670.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,897.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,758.63
|
| Rate for Payer: Cash Price |
$430.00
|
| Rate for Payer: Cash Price |
$430.00
|
| Rate for Payer: Cigna Commercial |
$713.80
|
| Rate for Payer: First Health Commercial |
$817.00
|
| Rate for Payer: Humana Commercial |
$731.00
|
| Rate for Payer: Humana KY Medicaid |
$295.75
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Kentucky WC Medicaid |
$298.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$705.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$634.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$301.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$756.80
|
| Rate for Payer: Ohio Health Group HMO |
$645.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$172.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$111.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$266.60
|
| Rate for Payer: PHCS Commercial |
$825.60
|
| Rate for Payer: United Healthcare All Payer |
$756.80
|
|
|
EXPLORATION MAXILLARY SINUS
|
Professional
|
Both
|
$860.00
|
|
|
Service Code
|
HCPCS 31020
|
| Hospital Charge Code |
76101144
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$160.85 |
| Max. Negotiated Rate |
$860.00 |
| Rate for Payer: Aetna Commercial |
$484.41
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$192.59
|
| Rate for Payer: Anthem Medicaid |
$160.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$860.00
|
| Rate for Payer: Cash Price |
$430.00
|
| Rate for Payer: Cash Price |
$430.00
|
| Rate for Payer: Cigna Commercial |
$472.92
|
| Rate for Payer: Healthspan PPO |
$547.53
|
| Rate for Payer: Humana Medicaid |
$160.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$442.29
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$164.07
|
| Rate for Payer: Molina Healthcare Passport |
$160.85
|
| Rate for Payer: Multiplan PHCS |
$516.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$602.00
|
| Rate for Payer: UHCCP Medicaid |
$202.22
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$162.46
|
|
|
EXPLORATION MAXILLARY SINUS(P
|
Professional
|
Both
|
$860.00
|
|
|
Service Code
|
HCPCS 31020
|
| Hospital Charge Code |
761P1144
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$160.85 |
| Max. Negotiated Rate |
$860.00 |
| Rate for Payer: Aetna Commercial |
$484.41
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$192.59
|
| Rate for Payer: Anthem Medicaid |
$160.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$860.00
|
| Rate for Payer: Cash Price |
$430.00
|
| Rate for Payer: Cash Price |
$430.00
|
| Rate for Payer: Cigna Commercial |
$472.92
|
| Rate for Payer: Healthspan PPO |
$547.53
|
| Rate for Payer: Humana Medicaid |
$160.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$442.29
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$164.07
|
| Rate for Payer: Molina Healthcare Passport |
$160.85
|
| Rate for Payer: Multiplan PHCS |
$516.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$602.00
|
| Rate for Payer: UHCCP Medicaid |
$202.22
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$162.46
|
|
|
EXPLORATION OF ANKLE JOINT
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 27612
|
| Hospital Charge Code |
76100891
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$1,344.00 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$420.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$182.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$434.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
EXPLORATION OF ANKLE JOINT
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 27612
|
| Hospital Charge Code |
76100891
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$428.17 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Aetna Commercial |
$839.89
|
| Rate for Payer: Anthem Medicaid |
$428.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,400.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$921.94
|
| Rate for Payer: Healthspan PPO |
$760.76
|
| Rate for Payer: Humana Medicaid |
$428.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$694.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$436.73
|
| Rate for Payer: Molina Healthcare Passport |
$428.17
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$980.00
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$432.45
|
|
|
EXPLORATION OF ANKLE JOINT
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 27612
|
| Hospital Charge Code |
76100891
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem Medicaid |
$481.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Humana KY Medicaid |
$481.46
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$486.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$491.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$182.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$434.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
EXPLORATION OF ANKLE JOINT(P
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 27612
|
| Hospital Charge Code |
761P0891
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$428.17 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Aetna Commercial |
$839.89
|
| Rate for Payer: Anthem Medicaid |
$428.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,400.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$921.94
|
| Rate for Payer: Healthspan PPO |
$760.76
|
| Rate for Payer: Humana Medicaid |
$428.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$694.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$436.73
|
| Rate for Payer: Molina Healthcare Passport |
$428.17
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$980.00
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$432.45
|
|
|
EXPLORATION OF HIP JOINT
|
Facility
|
IP
|
$1,170.00
|
|
|
Service Code
|
HCPCS 27033
|
| Hospital Charge Code |
76100764
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$152.10 |
| Max. Negotiated Rate |
$1,123.20 |
| Rate for Payer: Aetna Commercial |
$900.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$912.60
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cigna Commercial |
$971.10
|
| Rate for Payer: First Health Commercial |
$1,111.50
|
| Rate for Payer: Humana Commercial |
$994.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$959.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$863.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$351.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,029.60
|
| Rate for Payer: Ohio Health Group HMO |
$877.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$152.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$362.70
|
| Rate for Payer: PHCS Commercial |
$1,123.20
|
| Rate for Payer: United Healthcare All Payer |
$1,029.60
|
|
|
EXPLORATION OF HIP JOINT
|
Professional
|
Both
|
$1,170.00
|
|
|
Service Code
|
HCPCS 27033
|
| Hospital Charge Code |
76100764
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$409.50 |
| Max. Negotiated Rate |
$1,584.80 |
| Rate for Payer: Aetna Commercial |
$1,457.83
|
| Rate for Payer: Anthem Medicaid |
$717.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,170.00
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cigna Commercial |
$1,584.80
|
| Rate for Payer: Healthspan PPO |
$1,320.49
|
| Rate for Payer: Humana Medicaid |
$717.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,217.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$731.55
|
| Rate for Payer: Molina Healthcare Passport |
$717.21
|
| Rate for Payer: Multiplan PHCS |
$702.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$819.00
|
| Rate for Payer: UHCCP Medicaid |
$409.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$724.38
|
|
|
EXPLORATION OF HIP JOINT
|
Facility
|
OP
|
$1,170.00
|
|
|
Service Code
|
HCPCS 27033
|
| Hospital Charge Code |
76100764
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$152.10 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$900.90
|
| Rate for Payer: Anthem Medicaid |
$402.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$912.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,661.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,351.78
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cigna Commercial |
$971.10
|
| Rate for Payer: First Health Commercial |
$1,111.50
|
| Rate for Payer: Humana Commercial |
$994.50
|
| Rate for Payer: Humana KY Medicaid |
$402.36
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$406.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$959.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$863.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$410.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,029.60
|
| Rate for Payer: Ohio Health Group HMO |
$877.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$152.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$362.70
|
| Rate for Payer: PHCS Commercial |
$1,123.20
|
| Rate for Payer: United Healthcare All Payer |
$1,029.60
|
|
|
EXPLORATION OF HIP JOINT(P
|
Professional
|
Both
|
$1,170.00
|
|
|
Service Code
|
HCPCS 27033
|
| Hospital Charge Code |
761P0764
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$409.50 |
| Max. Negotiated Rate |
$1,584.80 |
| Rate for Payer: Aetna Commercial |
$1,457.83
|
| Rate for Payer: Anthem Medicaid |
$717.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,170.00
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cigna Commercial |
$1,584.80
|
| Rate for Payer: Healthspan PPO |
$1,320.49
|
| Rate for Payer: Humana Medicaid |
$717.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,217.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$731.55
|
| Rate for Payer: Molina Healthcare Passport |
$717.21
|
| Rate for Payer: Multiplan PHCS |
$702.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$819.00
|
| Rate for Payer: UHCCP Medicaid |
$409.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$724.38
|
|
|
EXPLORATION OF KNEE JOINT
|
Professional
|
Both
|
$1,700.00
|
|
|
Service Code
|
HCPCS 27310
|
| Hospital Charge Code |
76100811
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$536.56 |
| Max. Negotiated Rate |
$1,700.00 |
| Rate for Payer: Aetna Commercial |
$1,067.09
|
| Rate for Payer: Anthem Medicaid |
$536.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,700.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,157.77
|
| Rate for Payer: Healthspan PPO |
$966.56
|
| Rate for Payer: Humana Medicaid |
$536.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$903.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$547.29
|
| Rate for Payer: Molina Healthcare Passport |
$536.56
|
| Rate for Payer: Multiplan PHCS |
$1,020.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,190.00
|
| Rate for Payer: UHCCP Medicaid |
$595.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$541.93
|
|
|
EXPLORATION OF KNEE JOINT
|
Facility
|
IP
|
$1,700.00
|
|
|
Service Code
|
HCPCS 27310
|
| Hospital Charge Code |
76100811
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.00 |
| Max. Negotiated Rate |
$1,632.00 |
| Rate for Payer: Aetna Commercial |
$1,309.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,326.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,411.00
|
| Rate for Payer: First Health Commercial |
$1,615.00
|
| Rate for Payer: Humana Commercial |
$1,445.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,394.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,254.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$527.00
|
| Rate for Payer: PHCS Commercial |
$1,632.00
|
| Rate for Payer: United Healthcare All Payer |
$1,496.00
|
|
|
EXPLORATION OF KNEE JOINT
|
Facility
|
OP
|
$1,700.00
|
|
|
Service Code
|
HCPCS 27310
|
| Hospital Charge Code |
76100811
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.00 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$1,309.00
|
| Rate for Payer: Anthem Medicaid |
$584.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,326.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,411.00
|
| Rate for Payer: First Health Commercial |
$1,615.00
|
| Rate for Payer: Humana Commercial |
$1,445.00
|
| Rate for Payer: Humana KY Medicaid |
$584.63
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$590.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,394.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,254.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$596.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$527.00
|
| Rate for Payer: PHCS Commercial |
$1,632.00
|
| Rate for Payer: United Healthcare All Payer |
$1,496.00
|
|
|
EXPLORATION OF KNEE JOINT(P
|
Professional
|
Both
|
$1,700.00
|
|
|
Service Code
|
HCPCS 27310
|
| Hospital Charge Code |
761P0811
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$536.56 |
| Max. Negotiated Rate |
$1,700.00 |
| Rate for Payer: Aetna Commercial |
$1,067.09
|
| Rate for Payer: Anthem Medicaid |
$536.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,700.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,157.77
|
| Rate for Payer: Healthspan PPO |
$966.56
|
| Rate for Payer: Humana Medicaid |
$536.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$903.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$547.29
|
| Rate for Payer: Molina Healthcare Passport |
$536.56
|
| Rate for Payer: Multiplan PHCS |
$1,020.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,190.00
|
| Rate for Payer: UHCCP Medicaid |
$595.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$541.93
|
|
|
EXPLORATION OF MIDDLE EAR
|
Facility
|
IP
|
$1,520.00
|
|
|
Service Code
|
HCPCS 69440
|
| Hospital Charge Code |
76102422
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$197.60 |
| Max. Negotiated Rate |
$1,459.20 |
| Rate for Payer: Aetna Commercial |
$1,170.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,185.60
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cigna Commercial |
$1,261.60
|
| Rate for Payer: First Health Commercial |
$1,444.00
|
| Rate for Payer: Humana Commercial |
$1,292.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,246.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,121.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$456.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,337.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,140.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$304.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$197.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$471.20
|
| Rate for Payer: PHCS Commercial |
$1,459.20
|
| Rate for Payer: United Healthcare All Payer |
$1,337.60
|
|
|
EXPLORATION OF MIDDLE EAR
|
Professional
|
Both
|
$1,520.00
|
|
|
Service Code
|
HCPCS 69440
|
| Hospital Charge Code |
76102422
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$470.18 |
| Max. Negotiated Rate |
$1,520.00 |
| Rate for Payer: Aetna Commercial |
$967.17
|
| Rate for Payer: Anthem Medicaid |
$470.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,520.00
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cigna Commercial |
$941.58
|
| Rate for Payer: Healthspan PPO |
$857.92
|
| Rate for Payer: Humana Medicaid |
$470.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$874.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$479.58
|
| Rate for Payer: Molina Healthcare Passport |
$470.18
|
| Rate for Payer: Multiplan PHCS |
$912.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,064.00
|
| Rate for Payer: UHCCP Medicaid |
$532.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$474.88
|
|
|
EXPLORATION OF MIDDLE EAR
|
Facility
|
OP
|
$1,520.00
|
|
|
Service Code
|
HCPCS 69440
|
| Hospital Charge Code |
76102422
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$197.60 |
| Max. Negotiated Rate |
$3,897.84 |
| Rate for Payer: Aetna Commercial |
$1,170.40
|
| Rate for Payer: Anthem Medicaid |
$522.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,185.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,897.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,758.63
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cigna Commercial |
$1,261.60
|
| Rate for Payer: First Health Commercial |
$1,444.00
|
| Rate for Payer: Humana Commercial |
$1,292.00
|
| Rate for Payer: Humana KY Medicaid |
$522.73
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Kentucky WC Medicaid |
$528.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,246.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,121.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$533.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,337.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,140.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$304.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$197.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$471.20
|
| Rate for Payer: PHCS Commercial |
$1,459.20
|
| Rate for Payer: United Healthcare All Payer |
$1,337.60
|
|
|
EXPLORATION OF MIDDLE EAR(P
|
Professional
|
Both
|
$1,520.00
|
|
|
Service Code
|
HCPCS 69440
|
| Hospital Charge Code |
761P2422
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$470.18 |
| Max. Negotiated Rate |
$1,520.00 |
| Rate for Payer: Aetna Commercial |
$967.17
|
| Rate for Payer: Anthem Medicaid |
$470.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,520.00
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cigna Commercial |
$941.58
|
| Rate for Payer: Healthspan PPO |
$857.92
|
| Rate for Payer: Humana Medicaid |
$470.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$874.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$479.58
|
| Rate for Payer: Molina Healthcare Passport |
$470.18
|
| Rate for Payer: Multiplan PHCS |
$912.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,064.00
|
| Rate for Payer: UHCCP Medicaid |
$532.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$474.88
|
|
|
EXPLORATION OF PENETRATING WOUND (SEPARATE PROCEDURE); CHEST
|
Facility
|
OP
|
$2,207.77
|
|
|
Service Code
|
CPT 20101
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,576.98 |
| Max. Negotiated Rate |
$2,207.77 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,576.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,207.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,128.92
|
| Rate for Payer: Humana Medicare Advantage |
$1,576.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,892.38
|
|
|
EXPLORATION OF PENETRATING WOUND (SEPARATE PROCEDURE); EXTREMITY
|
Facility
|
OP
|
$1,962.83
|
|
|
Service Code
|
CPT 20103
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,402.02 |
| Max. Negotiated Rate |
$1,962.83 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
|
