|
EXPLORE/TREAT KNEE JOINT
|
Facility
|
IP
|
$1,820.00
|
|
|
Service Code
|
HCPCS 27331
|
| Hospital Charge Code |
76100816
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$236.60 |
| Max. Negotiated Rate |
$1,747.20 |
| Rate for Payer: Aetna Commercial |
$1,401.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,419.60
|
| Rate for Payer: Cash Price |
$910.00
|
| Rate for Payer: Cigna Commercial |
$1,510.60
|
| Rate for Payer: First Health Commercial |
$1,729.00
|
| Rate for Payer: Humana Commercial |
$1,547.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,492.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,343.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$546.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,601.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,365.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$364.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$236.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$564.20
|
| Rate for Payer: PHCS Commercial |
$1,747.20
|
| Rate for Payer: United Healthcare All Payer |
$1,601.60
|
|
|
EXPLORE/TREAT KNEE JOINT
|
Facility
|
OP
|
$1,820.00
|
|
|
Service Code
|
HCPCS 27331
|
| Hospital Charge Code |
76100816
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$236.60 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$1,401.40
|
| Rate for Payer: Anthem Medicaid |
$625.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,419.60
|
| 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 |
$910.00
|
| Rate for Payer: Cash Price |
$910.00
|
| Rate for Payer: Cigna Commercial |
$1,510.60
|
| Rate for Payer: First Health Commercial |
$1,729.00
|
| Rate for Payer: Humana Commercial |
$1,547.00
|
| Rate for Payer: Humana KY Medicaid |
$625.90
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$632.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,492.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,343.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$638.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,601.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,365.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$364.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$236.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$564.20
|
| Rate for Payer: PHCS Commercial |
$1,747.20
|
| Rate for Payer: United Healthcare All Payer |
$1,601.60
|
|
|
EXPLORE/TREAT KNEE JOINT(P
|
Professional
|
Both
|
$1,820.00
|
|
|
Service Code
|
HCPCS 27331
|
| Hospital Charge Code |
761P0816
|
|
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
|
|
|
EXPLORE TREAT SHOULDER JOIN(P
|
Professional
|
Both
|
$860.00
|
|
|
Service Code
|
HCPCS 23107
|
| Hospital Charge Code |
761P0444
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$1,064.54 |
| Rate for Payer: Aetna Commercial |
$968.70
|
| Rate for Payer: Anthem Medicaid |
$534.66
|
| 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 |
$1,064.54
|
| Rate for Payer: Healthspan PPO |
$877.44
|
| Rate for Payer: Humana Medicaid |
$534.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$815.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$545.35
|
| Rate for Payer: Molina Healthcare Passport |
$534.66
|
| Rate for Payer: Multiplan PHCS |
$516.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$602.00
|
| Rate for Payer: UHCCP Medicaid |
$301.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$540.01
|
|
|
EXPLORE TREAT SHOULDER JOINT
|
Professional
|
Both
|
$860.00
|
|
|
Service Code
|
HCPCS 23107
|
| Hospital Charge Code |
76100444
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$1,064.54 |
| Rate for Payer: Aetna Commercial |
$968.70
|
| Rate for Payer: Anthem Medicaid |
$534.66
|
| 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 |
$1,064.54
|
| Rate for Payer: Healthspan PPO |
$877.44
|
| Rate for Payer: Humana Medicaid |
$534.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$815.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$545.35
|
| Rate for Payer: Molina Healthcare Passport |
$534.66
|
| Rate for Payer: Multiplan PHCS |
$516.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$602.00
|
| Rate for Payer: UHCCP Medicaid |
$301.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$540.01
|
|
|
EXPLORE TREAT SHOULDER JOINT
|
Facility
|
OP
|
$860.00
|
|
|
Service Code
|
HCPCS 23107
|
| Hospital Charge Code |
76100444
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$111.80 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$662.20
|
| Rate for Payer: Anthem Medicaid |
$295.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$670.80
|
| 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 |
$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 |
$6,186.50
|
| 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 |
$7,423.80
|
| 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
|
|
|
EXPLORE TREAT SHOULDER JOINT
|
Facility
|
IP
|
$860.00
|
|
|
Service Code
|
HCPCS 23107
|
| Hospital Charge Code |
76100444
|
|
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
|
|
|
EXPLORE/TREAT WRIST JOINT
|
Facility
|
OP
|
$760.00
|
|
|
Service Code
|
HCPCS 25040
|
| Hospital Charge Code |
76100570
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$98.80 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$585.20
|
| Rate for Payer: Anthem Medicaid |
$261.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$592.80
|
| 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 |
$380.00
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cigna Commercial |
$630.80
|
| Rate for Payer: First Health Commercial |
$722.00
|
| Rate for Payer: Humana Commercial |
$646.00
|
| Rate for Payer: Humana KY Medicaid |
$261.36
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$264.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$623.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$560.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$266.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$668.80
|
| Rate for Payer: Ohio Health Group HMO |
$570.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$152.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$235.60
|
| Rate for Payer: PHCS Commercial |
$729.60
|
| Rate for Payer: United Healthcare All Payer |
$668.80
|
|
|
EXPLORE/TREAT WRIST JOINT
|
Facility
|
IP
|
$760.00
|
|
|
Service Code
|
HCPCS 25040
|
| Hospital Charge Code |
76100570
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$98.80 |
| Max. Negotiated Rate |
$729.60 |
| Rate for Payer: Aetna Commercial |
$585.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$592.80
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cigna Commercial |
$630.80
|
| Rate for Payer: First Health Commercial |
$722.00
|
| Rate for Payer: Humana Commercial |
$646.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$623.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$560.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$228.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$668.80
|
| Rate for Payer: Ohio Health Group HMO |
$570.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$152.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$235.60
|
| Rate for Payer: PHCS Commercial |
$729.60
|
| Rate for Payer: United Healthcare All Payer |
$668.80
|
|
|
EXPLORE/TREAT WRIST JOINT
|
Professional
|
Both
|
$760.00
|
|
|
Service Code
|
HCPCS 25040
|
| Hospital Charge Code |
76100570
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$266.00 |
| Max. Negotiated Rate |
$952.03 |
| Rate for Payer: Aetna Commercial |
$830.76
|
| Rate for Payer: Anthem Medicaid |
$368.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$760.00
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cigna Commercial |
$952.03
|
| Rate for Payer: Healthspan PPO |
$752.49
|
| Rate for Payer: Humana Medicaid |
$368.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$697.78
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$375.82
|
| Rate for Payer: Molina Healthcare Passport |
$368.45
|
| Rate for Payer: Multiplan PHCS |
$456.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$532.00
|
| Rate for Payer: UHCCP Medicaid |
$266.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$372.13
|
|
|
EXPLORE/TREAT WRIST JOINT(P
|
Professional
|
Both
|
$760.00
|
|
|
Service Code
|
HCPCS 25040
|
| Hospital Charge Code |
761P0570
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$266.00 |
| Max. Negotiated Rate |
$952.03 |
| Rate for Payer: Aetna Commercial |
$830.76
|
| Rate for Payer: Anthem Medicaid |
$368.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$760.00
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cigna Commercial |
$952.03
|
| Rate for Payer: Healthspan PPO |
$752.49
|
| Rate for Payer: Humana Medicaid |
$368.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$697.78
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$375.82
|
| Rate for Payer: Molina Healthcare Passport |
$368.45
|
| Rate for Payer: Multiplan PHCS |
$456.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$532.00
|
| Rate for Payer: UHCCP Medicaid |
$266.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$372.13
|
|
|
EXPLORE WOUND CHEST
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
HCPCS 20101
|
| Hospital Charge Code |
76102934
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$2,207.77 |
| Rate for Payer: Aetna Commercial |
$385.00
|
| Rate for Payer: Anthem Medicaid |
$171.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,576.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$390.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,207.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,128.92
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$415.00
|
| Rate for Payer: First Health Commercial |
$475.00
|
| Rate for Payer: Humana Commercial |
$425.00
|
| Rate for Payer: Humana KY Medicaid |
$171.95
|
| Rate for Payer: Humana Medicare Advantage |
$1,576.98
|
| Rate for Payer: Kentucky WC Medicaid |
$173.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$410.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$369.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,892.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$175.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$440.00
|
| Rate for Payer: Ohio Health Group HMO |
$375.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$155.00
|
| Rate for Payer: PHCS Commercial |
$480.00
|
| Rate for Payer: United Healthcare All Payer |
$440.00
|
|
|
EXPLORE WOUND CHEST
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
HCPCS 20101
|
| Hospital Charge Code |
76102934
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: Aetna Commercial |
$385.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$390.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$415.00
|
| Rate for Payer: First Health Commercial |
$475.00
|
| Rate for Payer: Humana Commercial |
$425.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$410.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$369.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$150.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$440.00
|
| Rate for Payer: Ohio Health Group HMO |
$375.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$155.00
|
| Rate for Payer: PHCS Commercial |
$480.00
|
| Rate for Payer: United Healthcare All Payer |
$440.00
|
|
|
EXPLORE WOUND CHEST
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 20101
|
| Hospital Charge Code |
76102934
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$108.84 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna Commercial |
$300.70
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$108.84
|
| Rate for Payer: Anthem Medicaid |
$139.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$500.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$320.85
|
| Rate for Payer: Healthspan PPO |
$494.88
|
| Rate for Payer: Humana Medicaid |
$139.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$253.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$141.91
|
| Rate for Payer: Molina Healthcare Passport |
$139.13
|
| Rate for Payer: Multiplan PHCS |
$300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$350.00
|
| Rate for Payer: UHCCP Medicaid |
$114.28
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$140.52
|
|
|
EXPLOR PENETRTNG WND EXTREMITY
|
Professional
|
Both
|
$4,038.00
|
|
|
Service Code
|
HCPCS 20103
|
| Hospital Charge Code |
76100325
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$176.49 |
| Max. Negotiated Rate |
$4,038.00 |
| Rate for Payer: Aetna Commercial |
$521.02
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$176.49
|
| Rate for Payer: Anthem Medicaid |
$229.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,038.00
|
| Rate for Payer: Cash Price |
$2,019.00
|
| Rate for Payer: Cash Price |
$2,019.00
|
| Rate for Payer: Cigna Commercial |
$568.43
|
| Rate for Payer: Healthspan PPO |
$711.91
|
| Rate for Payer: Humana Medicaid |
$229.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$437.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$233.89
|
| Rate for Payer: Molina Healthcare Passport |
$229.30
|
| Rate for Payer: Multiplan PHCS |
$2,422.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,826.60
|
| Rate for Payer: UHCCP Medicaid |
$185.31
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$231.59
|
|
|
EXPLOR PENETRTNG WND EXTREMITY
|
Facility
|
IP
|
$4,038.00
|
|
|
Service Code
|
HCPCS 20103
|
| Hospital Charge Code |
76100325
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$524.94 |
| Max. Negotiated Rate |
$3,876.48 |
| Rate for Payer: Aetna Commercial |
$3,109.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,149.64
|
| Rate for Payer: Cash Price |
$2,019.00
|
| Rate for Payer: Cigna Commercial |
$3,351.54
|
| Rate for Payer: First Health Commercial |
$3,836.10
|
| Rate for Payer: Humana Commercial |
$3,432.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,311.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,980.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,211.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,553.44
|
| Rate for Payer: Ohio Health Group HMO |
$3,028.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$807.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$524.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,251.78
|
| Rate for Payer: PHCS Commercial |
$3,876.48
|
| Rate for Payer: United Healthcare All Payer |
$3,553.44
|
|
|
EXPLOR PENETRTNG WND EXTREMITY
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 20103
|
| Hospital Charge Code |
761P0325
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$176.49 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$521.02
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$176.49
|
| Rate for Payer: Anthem Medicaid |
$229.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,200.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$568.43
|
| Rate for Payer: Healthspan PPO |
$711.91
|
| Rate for Payer: Humana Medicaid |
$229.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$437.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$233.89
|
| Rate for Payer: Molina Healthcare Passport |
$229.30
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$840.00
|
| Rate for Payer: UHCCP Medicaid |
$185.31
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$231.59
|
|
|
EXPLOR PENETRTNG WND EXTREMITY
|
Facility
|
OP
|
$911.00
|
|
|
Service Code
|
HCPCS 20103
|
| Hospital Charge Code |
45000086
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$118.43 |
| Max. Negotiated Rate |
$1,962.83 |
| Rate for Payer: Aetna Commercial |
$701.47
|
| Rate for Payer: Anthem Medicaid |
$313.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$710.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Cash Price |
$455.50
|
| Rate for Payer: Cash Price |
$455.50
|
| Rate for Payer: Cigna Commercial |
$756.13
|
| Rate for Payer: First Health Commercial |
$865.45
|
| Rate for Payer: Humana Commercial |
$774.35
|
| Rate for Payer: Humana KY Medicaid |
$313.29
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$316.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$747.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$672.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$319.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$801.68
|
| Rate for Payer: Ohio Health Group HMO |
$683.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$182.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$118.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$282.41
|
| Rate for Payer: PHCS Commercial |
$874.56
|
| Rate for Payer: United Healthcare All Payer |
$801.68
|
|
|
EXPLOR PENETRTNG WND EXTREMITY
|
Facility
|
IP
|
$2,838.00
|
|
|
Service Code
|
HCPCS 20103
|
| Hospital Charge Code |
761T0325
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$368.94 |
| Max. Negotiated Rate |
$2,724.48 |
| Rate for Payer: Aetna Commercial |
$2,185.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,213.64
|
| Rate for Payer: Cash Price |
$1,419.00
|
| Rate for Payer: Cigna Commercial |
$2,355.54
|
| Rate for Payer: First Health Commercial |
$2,696.10
|
| Rate for Payer: Humana Commercial |
$2,412.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,327.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,094.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$851.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,497.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,128.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$567.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$368.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$879.78
|
| Rate for Payer: PHCS Commercial |
$2,724.48
|
| Rate for Payer: United Healthcare All Payer |
$2,497.44
|
|
|
EXPLOR PENETRTNG WND EXTREMITY
|
Facility
|
OP
|
$2,838.00
|
|
|
Service Code
|
HCPCS 20103
|
| Hospital Charge Code |
761T0325
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$368.94 |
| Max. Negotiated Rate |
$2,724.48 |
| Rate for Payer: Aetna Commercial |
$2,185.26
|
| Rate for Payer: Anthem Medicaid |
$975.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,213.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Cash Price |
$1,419.00
|
| Rate for Payer: Cash Price |
$1,419.00
|
| Rate for Payer: Cigna Commercial |
$2,355.54
|
| Rate for Payer: First Health Commercial |
$2,696.10
|
| Rate for Payer: Humana Commercial |
$2,412.30
|
| Rate for Payer: Humana KY Medicaid |
$975.99
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$985.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,327.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,094.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$995.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,497.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,128.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$567.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$368.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$879.78
|
| Rate for Payer: PHCS Commercial |
$2,724.48
|
| Rate for Payer: United Healthcare All Payer |
$2,497.44
|
|
|
EXPLOR PENETRTNG WND EXTREMITY
|
Facility
|
OP
|
$4,038.00
|
|
|
Service Code
|
HCPCS 20103
|
| Hospital Charge Code |
76100325
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$524.94 |
| Max. Negotiated Rate |
$3,876.48 |
| Rate for Payer: Aetna Commercial |
$3,109.26
|
| Rate for Payer: Anthem Medicaid |
$1,388.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,149.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Cash Price |
$2,019.00
|
| Rate for Payer: Cash Price |
$2,019.00
|
| Rate for Payer: Cigna Commercial |
$3,351.54
|
| Rate for Payer: First Health Commercial |
$3,836.10
|
| Rate for Payer: Humana Commercial |
$3,432.30
|
| Rate for Payer: Humana KY Medicaid |
$1,388.67
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,402.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,311.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,980.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,416.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,553.44
|
| Rate for Payer: Ohio Health Group HMO |
$3,028.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$807.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$524.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,251.78
|
| Rate for Payer: PHCS Commercial |
$3,876.48
|
| Rate for Payer: United Healthcare All Payer |
$3,553.44
|
|
|
EXPLOR PENETRTNG WND EXTREMITY
|
Facility
|
IP
|
$911.00
|
|
|
Service Code
|
HCPCS 20103
|
| Hospital Charge Code |
45000086
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$118.43 |
| Max. Negotiated Rate |
$874.56 |
| Rate for Payer: Aetna Commercial |
$701.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$710.58
|
| Rate for Payer: Cash Price |
$455.50
|
| Rate for Payer: Cigna Commercial |
$756.13
|
| Rate for Payer: First Health Commercial |
$865.45
|
| Rate for Payer: Humana Commercial |
$774.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$747.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$672.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$273.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$801.68
|
| Rate for Payer: Ohio Health Group HMO |
$683.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$182.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$118.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$282.41
|
| Rate for Payer: PHCS Commercial |
$874.56
|
| Rate for Payer: United Healthcare All Payer |
$801.68
|
|
|
EXPLOR REPAIR RECTAL INJURY
|
Facility
|
IP
|
$2,100.00
|
|
|
Service Code
|
HCPCS 45562
|
| Hospital Charge Code |
76101906
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$273.00 |
| Max. Negotiated Rate |
$2,016.00 |
| Rate for Payer: Aetna Commercial |
$1,617.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,638.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,743.00
|
| Rate for Payer: First Health Commercial |
$1,995.00
|
| Rate for Payer: Humana Commercial |
$1,785.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,722.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,549.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,848.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$651.00
|
| Rate for Payer: PHCS Commercial |
$2,016.00
|
| Rate for Payer: United Healthcare All Payer |
$1,848.00
|
|
|
EXPLOR REPAIR RECTAL INJURY
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 45562
|
| Hospital Charge Code |
76101906
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$581.98 |
| Max. Negotiated Rate |
$2,100.00 |
| Rate for Payer: Aetna Commercial |
$1,591.66
|
| Rate for Payer: Anthem Medicaid |
$581.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,100.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,452.12
|
| Rate for Payer: Healthspan PPO |
$1,342.28
|
| Rate for Payer: Humana Medicaid |
$581.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,412.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$593.62
|
| Rate for Payer: Molina Healthcare Passport |
$581.98
|
| Rate for Payer: Multiplan PHCS |
$1,260.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,470.00
|
| Rate for Payer: UHCCP Medicaid |
$735.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$587.80
|
|
|
EXPLOR REPAIR RECTAL INJURY
|
Facility
|
OP
|
$2,100.00
|
|
|
Service Code
|
HCPCS 45562
|
| Hospital Charge Code |
76101906
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$273.00 |
| Max. Negotiated Rate |
$2,016.00 |
| Rate for Payer: Aetna Commercial |
$1,617.00
|
| Rate for Payer: Anthem Medicaid |
$722.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,638.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,743.00
|
| Rate for Payer: First Health Commercial |
$1,995.00
|
| Rate for Payer: Humana Commercial |
$1,785.00
|
| Rate for Payer: Humana KY Medicaid |
$722.19
|
| Rate for Payer: Kentucky WC Medicaid |
$729.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,722.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,549.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$736.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,848.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$651.00
|
| Rate for Payer: PHCS Commercial |
$2,016.00
|
| Rate for Payer: United Healthcare All Payer |
$1,848.00
|
|
