|
EXPLORE NECK VESSELS
|
Professional
|
Both
|
$1,870.00
|
|
|
Service Code
|
HCPCS 35800
|
| Hospital Charge Code |
76101420
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$342.42 |
| Max. Negotiated Rate |
$1,870.00 |
| Rate for Payer: Aetna Commercial |
$816.36
|
| Rate for Payer: Anthem Medicaid |
$342.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,870.00
|
| Rate for Payer: Cash Price |
$935.00
|
| Rate for Payer: Cash Price |
$935.00
|
| Rate for Payer: Cigna Commercial |
$788.44
|
| Rate for Payer: Healthspan PPO |
$802.64
|
| Rate for Payer: Humana Medicaid |
$342.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$650.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$349.27
|
| Rate for Payer: Molina Healthcare Passport |
$342.42
|
| Rate for Payer: Multiplan PHCS |
$1,122.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,309.00
|
| Rate for Payer: UHCCP Medicaid |
$654.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$345.84
|
|
|
EXPLORE NECK VESSELS
|
Facility
|
OP
|
$1,870.00
|
|
|
Service Code
|
HCPCS 35800
|
| Hospital Charge Code |
76101420
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$243.10 |
| Max. Negotiated Rate |
$1,795.20 |
| Rate for Payer: Aetna Commercial |
$1,439.90
|
| Rate for Payer: Anthem Medicaid |
$643.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,458.60
|
| Rate for Payer: Cash Price |
$935.00
|
| Rate for Payer: Cigna Commercial |
$1,552.10
|
| Rate for Payer: First Health Commercial |
$1,776.50
|
| Rate for Payer: Humana Commercial |
$1,589.50
|
| Rate for Payer: Humana KY Medicaid |
$643.09
|
| Rate for Payer: Kentucky WC Medicaid |
$649.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,533.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,380.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$561.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$656.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,645.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,402.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$374.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$579.70
|
| Rate for Payer: PHCS Commercial |
$1,795.20
|
| Rate for Payer: United Healthcare All Payer |
$1,645.60
|
|
|
EXPLORE NECK VESSELS
|
Facility
|
IP
|
$1,870.00
|
|
|
Service Code
|
HCPCS 35800
|
| Hospital Charge Code |
76101420
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$243.10 |
| Max. Negotiated Rate |
$1,795.20 |
| Rate for Payer: Aetna Commercial |
$1,439.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,458.60
|
| Rate for Payer: Cash Price |
$935.00
|
| Rate for Payer: Cigna Commercial |
$1,552.10
|
| Rate for Payer: First Health Commercial |
$1,776.50
|
| Rate for Payer: Humana Commercial |
$1,589.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,533.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,380.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$561.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,645.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,402.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$374.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$579.70
|
| Rate for Payer: PHCS Commercial |
$1,795.20
|
| Rate for Payer: United Healthcare All Payer |
$1,645.60
|
|
|
EXPLORE NECK VESSELS(P
|
Professional
|
Both
|
$1,870.00
|
|
|
Service Code
|
HCPCS 35800
|
| Hospital Charge Code |
761P1420
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$342.42 |
| Max. Negotiated Rate |
$1,870.00 |
| Rate for Payer: Aetna Commercial |
$816.36
|
| Rate for Payer: Anthem Medicaid |
$342.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,870.00
|
| Rate for Payer: Cash Price |
$935.00
|
| Rate for Payer: Cash Price |
$935.00
|
| Rate for Payer: Cigna Commercial |
$788.44
|
| Rate for Payer: Healthspan PPO |
$802.64
|
| Rate for Payer: Humana Medicaid |
$342.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$650.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$349.27
|
| Rate for Payer: Molina Healthcare Passport |
$342.42
|
| Rate for Payer: Multiplan PHCS |
$1,122.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,309.00
|
| Rate for Payer: UHCCP Medicaid |
$654.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$345.84
|
|
|
EXPLORE - REMOVE FOREIGN BOD(P
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 26080
|
| Hospital Charge Code |
761P0663
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$207.53 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Aetna Commercial |
$539.52
|
| Rate for Payer: Anthem Medicaid |
$207.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$900.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$598.75
|
| Rate for Payer: Healthspan PPO |
$488.69
|
| Rate for Payer: Humana Medicaid |
$207.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$469.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$211.68
|
| Rate for Payer: Molina Healthcare Passport |
$207.53
|
| Rate for Payer: Multiplan PHCS |
$540.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$630.00
|
| Rate for Payer: UHCCP Medicaid |
$315.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$209.61
|
|
|
EXPLORE - REMOVE FOREIGN BODY
|
Facility
|
OP
|
$900.00
|
|
|
Service Code
|
HCPCS 26080
|
| Hospital Charge Code |
76100663
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Aetna Commercial |
$693.00
|
| Rate for Payer: Anthem Medicaid |
$309.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$702.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$747.00
|
| Rate for Payer: First Health Commercial |
$855.00
|
| Rate for Payer: Humana Commercial |
$765.00
|
| Rate for Payer: Humana KY Medicaid |
$309.51
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$312.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$738.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$664.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$315.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$792.00
|
| Rate for Payer: Ohio Health Group HMO |
$675.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$117.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$279.00
|
| Rate for Payer: PHCS Commercial |
$864.00
|
| Rate for Payer: United Healthcare All Payer |
$792.00
|
|
|
EXPLORE - REMOVE FOREIGN BODY
|
Facility
|
IP
|
$900.00
|
|
|
Service Code
|
HCPCS 26080
|
| Hospital Charge Code |
76100663
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$864.00 |
| Rate for Payer: Aetna Commercial |
$693.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$702.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$747.00
|
| Rate for Payer: First Health Commercial |
$855.00
|
| Rate for Payer: Humana Commercial |
$765.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$738.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$664.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$270.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$792.00
|
| Rate for Payer: Ohio Health Group HMO |
$675.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$117.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$279.00
|
| Rate for Payer: PHCS Commercial |
$864.00
|
| Rate for Payer: United Healthcare All Payer |
$792.00
|
|
|
EXPLORE - REMOVE FOREIGN BODY
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 26080
|
| Hospital Charge Code |
76100663
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$207.53 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Aetna Commercial |
$539.52
|
| Rate for Payer: Anthem Medicaid |
$207.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$900.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$598.75
|
| Rate for Payer: Healthspan PPO |
$488.69
|
| Rate for Payer: Humana Medicaid |
$207.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$469.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$211.68
|
| Rate for Payer: Molina Healthcare Passport |
$207.53
|
| Rate for Payer: Multiplan PHCS |
$540.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$630.00
|
| Rate for Payer: UHCCP Medicaid |
$315.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$209.61
|
|
|
EXPLORE/TREAT ANKLE JOINT
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 27620
|
| Hospital Charge Code |
76100898
|
|
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
|
|
|
EXPLORE/TREAT ANKLE JOINT
|
Professional
|
Both
|
$1,690.00
|
|
|
Service Code
|
HCPCS 27610
|
| Hospital Charge Code |
76100890
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$440.07 |
| Max. Negotiated Rate |
$1,690.00 |
| Rate for Payer: Aetna Commercial |
$965.53
|
| Rate for Payer: Anthem Medicaid |
$440.07
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,690.00
|
| Rate for Payer: Cash Price |
$845.00
|
| Rate for Payer: Cash Price |
$845.00
|
| Rate for Payer: Cigna Commercial |
$1,054.18
|
| Rate for Payer: Healthspan PPO |
$874.57
|
| Rate for Payer: Humana Medicaid |
$440.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$811.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$448.87
|
| Rate for Payer: Molina Healthcare Passport |
$440.07
|
| Rate for Payer: Multiplan PHCS |
$1,014.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,183.00
|
| Rate for Payer: UHCCP Medicaid |
$591.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$444.47
|
|
|
EXPLORE/TREAT ANKLE JOINT
|
Facility
|
IP
|
$1,690.00
|
|
|
Service Code
|
HCPCS 27610
|
| Hospital Charge Code |
76100890
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$219.70 |
| Max. Negotiated Rate |
$1,622.40 |
| Rate for Payer: Aetna Commercial |
$1,301.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,318.20
|
| Rate for Payer: Cash Price |
$845.00
|
| Rate for Payer: Cigna Commercial |
$1,402.70
|
| Rate for Payer: First Health Commercial |
$1,605.50
|
| Rate for Payer: Humana Commercial |
$1,436.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,385.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,247.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$507.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,487.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,267.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$338.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$219.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$523.90
|
| Rate for Payer: PHCS Commercial |
$1,622.40
|
| Rate for Payer: United Healthcare All Payer |
$1,487.20
|
|
|
EXPLORE/TREAT ANKLE JOINT
|
Facility
|
OP
|
$1,690.00
|
|
|
Service Code
|
HCPCS 27610
|
| Hospital Charge Code |
76100890
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$219.70 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$1,301.30
|
| Rate for Payer: Anthem Medicaid |
$581.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,318.20
|
| 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 |
$845.00
|
| Rate for Payer: Cash Price |
$845.00
|
| Rate for Payer: Cigna Commercial |
$1,402.70
|
| Rate for Payer: First Health Commercial |
$1,605.50
|
| Rate for Payer: Humana Commercial |
$1,436.50
|
| Rate for Payer: Humana KY Medicaid |
$581.19
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$587.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,385.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,247.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$592.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,487.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,267.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$338.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$219.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$523.90
|
| Rate for Payer: PHCS Commercial |
$1,622.40
|
| Rate for Payer: United Healthcare All Payer |
$1,487.20
|
|
|
EXPLORE/TREAT ANKLE JOINT
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 27620
|
| Hospital Charge Code |
76100898
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$352.03 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Aetna Commercial |
$677.31
|
| Rate for Payer: Anthem Medicaid |
$352.03
|
| 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 |
$751.81
|
| Rate for Payer: Healthspan PPO |
$613.50
|
| Rate for Payer: Humana Medicaid |
$352.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$567.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$359.07
|
| Rate for Payer: Molina Healthcare Passport |
$352.03
|
| 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 |
$355.55
|
|
|
EXPLORE/TREAT ANKLE JOINT
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 27620
|
| Hospital Charge Code |
76100898
|
|
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
|
|
|
EXPLORE/TREAT ANKLE JOINT(P
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 27620
|
| Hospital Charge Code |
761P0898
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$352.03 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Aetna Commercial |
$677.31
|
| Rate for Payer: Anthem Medicaid |
$352.03
|
| 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 |
$751.81
|
| Rate for Payer: Healthspan PPO |
$613.50
|
| Rate for Payer: Humana Medicaid |
$352.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$567.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$359.07
|
| Rate for Payer: Molina Healthcare Passport |
$352.03
|
| 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 |
$355.55
|
|
|
EXPLORE/TREAT ANKLE JOINT(P
|
Professional
|
Both
|
$1,690.00
|
|
|
Service Code
|
HCPCS 27610
|
| Hospital Charge Code |
761P0890
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$440.07 |
| Max. Negotiated Rate |
$1,690.00 |
| Rate for Payer: Aetna Commercial |
$965.53
|
| Rate for Payer: Anthem Medicaid |
$440.07
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,690.00
|
| Rate for Payer: Cash Price |
$845.00
|
| Rate for Payer: Cash Price |
$845.00
|
| Rate for Payer: Cigna Commercial |
$1,054.18
|
| Rate for Payer: Healthspan PPO |
$874.57
|
| Rate for Payer: Humana Medicaid |
$440.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$811.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$448.87
|
| Rate for Payer: Molina Healthcare Passport |
$440.07
|
| Rate for Payer: Multiplan PHCS |
$1,014.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,183.00
|
| Rate for Payer: UHCCP Medicaid |
$591.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$444.47
|
|
|
EXPLORE/TREAT ELBOW JOINT
|
Professional
|
Both
|
$1,520.00
|
|
|
Service Code
|
HCPCS 24101
|
| Hospital Charge Code |
76100506
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$405.99 |
| Max. Negotiated Rate |
$1,520.00 |
| Rate for Payer: Aetna Commercial |
$718.59
|
| Rate for Payer: Anthem Medicaid |
$405.99
|
| 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 |
$794.30
|
| Rate for Payer: Healthspan PPO |
$650.89
|
| Rate for Payer: Humana Medicaid |
$405.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$613.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$414.11
|
| Rate for Payer: Molina Healthcare Passport |
$405.99
|
| 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 |
$410.05
|
|
|
EXPLORE/TREAT ELBOW JOINT
|
Facility
|
OP
|
$1,520.00
|
|
|
Service Code
|
HCPCS 24101
|
| Hospital Charge Code |
76100506
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$197.60 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$1,170.40
|
| Rate for Payer: Anthem Medicaid |
$522.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,185.60
|
| 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 |
$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 |
$2,799.07
|
| 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 |
$3,358.88
|
| 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
|
|
|
EXPLORE/TREAT ELBOW JOINT
|
Facility
|
IP
|
$1,520.00
|
|
|
Service Code
|
HCPCS 24101
|
| Hospital Charge Code |
76100506
|
|
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
|
|
|
EXPLORE/TREAT ELBOW JOINT(P
|
Professional
|
Both
|
$1,520.00
|
|
|
Service Code
|
HCPCS 24101
|
| Hospital Charge Code |
761P0506
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$405.99 |
| Max. Negotiated Rate |
$1,520.00 |
| Rate for Payer: Aetna Commercial |
$718.59
|
| Rate for Payer: Anthem Medicaid |
$405.99
|
| 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 |
$794.30
|
| Rate for Payer: Healthspan PPO |
$650.89
|
| Rate for Payer: Humana Medicaid |
$405.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$613.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$414.11
|
| Rate for Payer: Molina Healthcare Passport |
$405.99
|
| 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 |
$410.05
|
|
|
EXPLORE/TREAT FINGER JOINT
|
Professional
|
Both
|
$975.00
|
|
|
Service Code
|
HCPCS 26075
|
| Hospital Charge Code |
76100662
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$217.39 |
| Max. Negotiated Rate |
$975.00 |
| Rate for Payer: Aetna Commercial |
$447.22
|
| Rate for Payer: Anthem Medicaid |
$217.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$975.00
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cigna Commercial |
$493.57
|
| Rate for Payer: Healthspan PPO |
$405.09
|
| Rate for Payer: Humana Medicaid |
$217.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$389.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$221.74
|
| Rate for Payer: Molina Healthcare Passport |
$217.39
|
| Rate for Payer: Multiplan PHCS |
$585.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$682.50
|
| Rate for Payer: UHCCP Medicaid |
$341.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$219.56
|
|
|
EXPLORE/TREAT FINGER JOINT
|
Facility
|
OP
|
$975.00
|
|
|
Service Code
|
HCPCS 26075
|
| Hospital Charge Code |
76100662
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$126.75 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$750.75
|
| Rate for Payer: Anthem Medicaid |
$335.30
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$760.50
|
| 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 |
$487.50
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cigna Commercial |
$809.25
|
| Rate for Payer: First Health Commercial |
$926.25
|
| Rate for Payer: Humana Commercial |
$828.75
|
| Rate for Payer: Humana KY Medicaid |
$335.30
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$338.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$799.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$719.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$342.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$858.00
|
| Rate for Payer: Ohio Health Group HMO |
$731.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$195.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$126.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$302.25
|
| Rate for Payer: PHCS Commercial |
$936.00
|
| Rate for Payer: United Healthcare All Payer |
$858.00
|
|
|
EXPLORE/TREAT FINGER JOINT
|
Facility
|
IP
|
$975.00
|
|
|
Service Code
|
HCPCS 26075
|
| Hospital Charge Code |
76100662
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$126.75 |
| Max. Negotiated Rate |
$936.00 |
| Rate for Payer: Aetna Commercial |
$750.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$760.50
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cigna Commercial |
$809.25
|
| Rate for Payer: First Health Commercial |
$926.25
|
| Rate for Payer: Humana Commercial |
$828.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$799.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$719.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$292.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$858.00
|
| Rate for Payer: Ohio Health Group HMO |
$731.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$195.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$126.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$302.25
|
| Rate for Payer: PHCS Commercial |
$936.00
|
| Rate for Payer: United Healthcare All Payer |
$858.00
|
|
|
EXPLORE/TREAT FINGER JOINT(P
|
Professional
|
Both
|
$975.00
|
|
|
Service Code
|
HCPCS 26075
|
| Hospital Charge Code |
761P0662
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$217.39 |
| Max. Negotiated Rate |
$975.00 |
| Rate for Payer: Aetna Commercial |
$447.22
|
| Rate for Payer: Anthem Medicaid |
$217.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$975.00
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cigna Commercial |
$493.57
|
| Rate for Payer: Healthspan PPO |
$405.09
|
| Rate for Payer: Humana Medicaid |
$217.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$389.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$221.74
|
| Rate for Payer: Molina Healthcare Passport |
$217.39
|
| Rate for Payer: Multiplan PHCS |
$585.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$682.50
|
| Rate for Payer: UHCCP Medicaid |
$341.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$219.56
|
|
|
EXPLORE/TREAT KNEE JOINT
|
Professional
|
Both
|
$1,820.00
|
|
|
Service Code
|
HCPCS 27331
|
| Hospital Charge Code |
76100816
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$386.98 |
| Max. Negotiated Rate |
$1,820.00 |
| Rate for Payer: Aetna Commercial |
$685.74
|
| Rate for Payer: Anthem Medicaid |
$386.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,820.00
|
| Rate for Payer: Cash Price |
$910.00
|
| Rate for Payer: Cash Price |
$910.00
|
| Rate for Payer: Cigna Commercial |
$754.56
|
| Rate for Payer: Healthspan PPO |
$621.14
|
| Rate for Payer: Humana Medicaid |
$386.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$582.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$394.72
|
| Rate for Payer: Molina Healthcare Passport |
$386.98
|
| Rate for Payer: Multiplan PHCS |
$1,092.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,274.00
|
| Rate for Payer: UHCCP Medicaid |
$637.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$390.85
|
|
