|
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 |
$840.00 |
| Rate for Payer: Aetna Commercial |
$677.31
|
| Rate for Payer: Ambetter Exchange |
$427.81
|
| Rate for Payer: Anthem Medicaid |
$352.03
|
| Rate for Payer: Buckeye Individual/Medicaid |
$427.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$427.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$513.37
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$427.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$427.81
|
| 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 |
$556.15
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$355.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$427.81
|
|
|
EXPLORE/TREAT ANKLE JOINT
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 27620
|
| Hospital Charge Code |
76100898
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$481.46 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem Medicaid |
$481.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| 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 |
$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 |
$2,997.95
|
| 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 |
$3,597.54
|
| 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 |
$1,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,218.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$966.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
EXPLORE/TREAT ANKLE JOINT
|
Facility
|
IP
|
$1,690.00
|
|
|
Service Code
|
HCPCS 27610
|
| Hospital Charge Code |
76100890
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$507.00 |
| 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 |
$1,352.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,470.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,166.10
|
| Rate for Payer: PHCS Commercial |
$1,622.40
|
| Rate for Payer: United Healthcare All Payer |
$1,487.20
|
|
|
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 |
$1,054.18 |
| Rate for Payer: Aetna Commercial |
$965.53
|
| Rate for Payer: Ambetter Exchange |
$614.45
|
| Rate for Payer: Anthem Medicaid |
$440.07
|
| Rate for Payer: Buckeye Individual/Medicaid |
$614.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$614.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$737.34
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$614.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$614.45
|
| 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 |
$798.78
|
| Rate for Payer: UHCCP Medicaid |
$591.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$444.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$614.45
|
|
|
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 |
$840.00 |
| Rate for Payer: Aetna Commercial |
$677.31
|
| Rate for Payer: Ambetter Exchange |
$427.81
|
| Rate for Payer: Anthem Medicaid |
$352.03
|
| Rate for Payer: Buckeye Individual/Medicaid |
$427.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$427.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$513.37
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$427.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$427.81
|
| 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 |
$556.15
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$355.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$427.81
|
|
|
EXPLORE/TREAT ELBOW JOINT
|
Facility
|
IP
|
$1,520.00
|
|
|
Service Code
|
HCPCS 24101
|
| Hospital Charge Code |
76100506
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$456.00 |
| 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 |
$1,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,322.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,048.80
|
| Rate for Payer: PHCS Commercial |
$1,459.20
|
| Rate for Payer: United Healthcare All Payer |
$1,337.60
|
|
|
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 |
$912.00 |
| Rate for Payer: Aetna Commercial |
$718.59
|
| Rate for Payer: Ambetter Exchange |
$482.10
|
| Rate for Payer: Anthem Medicaid |
$405.99
|
| Rate for Payer: Buckeye Individual/Medicaid |
$482.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$482.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$578.52
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$482.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$482.10
|
| 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 |
$626.73
|
| Rate for Payer: UHCCP Medicaid |
$532.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$410.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$482.10
|
|
|
EXPLORE/TREAT ELBOW JOINT
|
Facility
|
OP
|
$1,520.00
|
|
|
Service Code
|
HCPCS 24101
|
| Hospital Charge Code |
76100506
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$522.73 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$1,170.40
|
| Rate for Payer: Anthem Medicaid |
$522.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,185.60
|
| 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 |
$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 |
$2,997.95
|
| 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 |
$3,597.54
|
| 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 |
$1,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,322.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,048.80
|
| 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 |
$912.00 |
| Rate for Payer: Aetna Commercial |
$718.59
|
| Rate for Payer: Ambetter Exchange |
$482.10
|
| Rate for Payer: Anthem Medicaid |
$405.99
|
| Rate for Payer: Buckeye Individual/Medicaid |
$482.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$482.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$578.52
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$482.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$482.10
|
| 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 |
$626.73
|
| Rate for Payer: UHCCP Medicaid |
$532.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$410.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$482.10
|
|
|
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 |
$585.00 |
| Rate for Payer: Aetna Commercial |
$447.22
|
| Rate for Payer: Ambetter Exchange |
$324.73
|
| Rate for Payer: Anthem Medicaid |
$217.39
|
| Rate for Payer: Buckeye Individual/Medicaid |
$324.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$324.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$389.68
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$324.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$324.73
|
| 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 |
$422.15
|
| Rate for Payer: UHCCP Medicaid |
$341.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$219.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$324.73
|
|
|
EXPLORE/TREAT FINGER JOINT
|
Facility
|
IP
|
$975.00
|
|
|
Service Code
|
HCPCS 26075
|
| Hospital Charge Code |
76100662
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$292.50 |
| 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 |
$780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$848.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$672.75
|
| Rate for Payer: PHCS Commercial |
$936.00
|
| Rate for Payer: United Healthcare All Payer |
$858.00
|
|
|
EXPLORE/TREAT FINGER JOINT
|
Facility
|
OP
|
$975.00
|
|
|
Service Code
|
HCPCS 26075
|
| Hospital Charge Code |
76100662
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$335.30 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$750.75
|
| Rate for Payer: Anthem Medicaid |
$335.30
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$760.50
|
| 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 |
$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 |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$338.71
|
| 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 |
$3,597.54
|
| 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 |
$780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$848.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$672.75
|
| 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 |
$585.00 |
| Rate for Payer: Aetna Commercial |
$447.22
|
| Rate for Payer: Ambetter Exchange |
$324.73
|
| Rate for Payer: Anthem Medicaid |
$217.39
|
| Rate for Payer: Buckeye Individual/Medicaid |
$324.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$324.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$389.68
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$324.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$324.73
|
| 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 |
$422.15
|
| Rate for Payer: UHCCP Medicaid |
$341.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$219.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$324.73
|
|
|
EXPLORE/TREAT KNEE JOINT
|
Facility
|
IP
|
$1,820.00
|
|
|
Service Code
|
HCPCS 27331
|
| Hospital Charge Code |
76100816
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$546.00 |
| 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 |
$1,456.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,583.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,255.80
|
| 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 |
$625.90 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$1,401.40
|
| Rate for Payer: Anthem Medicaid |
$625.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,419.60
|
| 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 |
$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 |
$2,997.95
|
| 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 |
$3,597.54
|
| 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 |
$1,456.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,583.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,255.80
|
| Rate for Payer: PHCS Commercial |
$1,747.20
|
| Rate for Payer: United Healthcare All Payer |
$1,601.60
|
|
|
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 |
$1,092.00 |
| Rate for Payer: Aetna Commercial |
$685.74
|
| Rate for Payer: Ambetter Exchange |
$457.72
|
| Rate for Payer: Anthem Medicaid |
$386.98
|
| Rate for Payer: Buckeye Individual/Medicaid |
$457.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$457.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$549.26
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$457.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$457.72
|
| 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 |
$595.04
|
| Rate for Payer: UHCCP Medicaid |
$637.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$390.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$457.72
|
|
|
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 |
$1,092.00 |
| Rate for Payer: Aetna Commercial |
$685.74
|
| Rate for Payer: Ambetter Exchange |
$457.72
|
| Rate for Payer: Anthem Medicaid |
$386.98
|
| Rate for Payer: Buckeye Individual/Medicaid |
$457.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$457.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$549.26
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$457.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$457.72
|
| 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 |
$595.04
|
| Rate for Payer: UHCCP Medicaid |
$637.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$390.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$457.72
|
|
|
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: Ambetter Exchange |
$634.62
|
| Rate for Payer: Anthem Medicaid |
$534.66
|
| Rate for Payer: Buckeye Individual/Medicaid |
$634.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$634.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$761.54
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$634.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$634.62
|
| 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 |
$825.01
|
| Rate for Payer: UHCCP Medicaid |
$301.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$540.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$634.62
|
|
|
EXPLORE TREAT SHOULDER JOINT
|
Facility
|
IP
|
$860.00
|
|
|
Service Code
|
HCPCS 23107
|
| Hospital Charge Code |
76100444
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$258.00 |
| 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 |
$688.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$748.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$593.40
|
| Rate for Payer: PHCS Commercial |
$825.60
|
| Rate for Payer: United Healthcare All Payer |
$756.80
|
|
|
EXPLORE TREAT SHOULDER JOINT
|
Facility
|
OP
|
$860.00
|
|
|
Service Code
|
HCPCS 23107
|
| Hospital Charge Code |
76100444
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$295.75 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$662.20
|
| Rate for Payer: Anthem Medicaid |
$295.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$670.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| 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 |
$6,600.66
|
| 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 |
$7,920.79
|
| 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 |
$688.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$748.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$593.40
|
| Rate for Payer: PHCS Commercial |
$825.60
|
| Rate for Payer: United Healthcare All Payer |
$756.80
|
|
|
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: Ambetter Exchange |
$634.62
|
| Rate for Payer: Anthem Medicaid |
$534.66
|
| Rate for Payer: Buckeye Individual/Medicaid |
$634.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$634.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$761.54
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$634.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$634.62
|
| 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 |
$825.01
|
| Rate for Payer: UHCCP Medicaid |
$301.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$540.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$634.62
|
|
|
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: Ambetter Exchange |
$535.67
|
| Rate for Payer: Anthem Medicaid |
$368.45
|
| Rate for Payer: Buckeye Individual/Medicaid |
$535.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$535.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$642.80
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$535.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$535.67
|
| 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 |
$696.37
|
| Rate for Payer: UHCCP Medicaid |
$266.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$372.13
|
| Rate for Payer: Wellcare Medicare Advantage |
$535.67
|
|
|
EXPLORE/TREAT WRIST JOINT
|
Facility
|
IP
|
$760.00
|
|
|
Service Code
|
HCPCS 25040
|
| Hospital Charge Code |
76100570
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$228.00 |
| 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 |
$608.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$661.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$524.40
|
| Rate for Payer: PHCS Commercial |
$729.60
|
| Rate for Payer: United Healthcare All Payer |
$668.80
|
|
|
EXPLORE/TREAT WRIST JOINT
|
Facility
|
OP
|
$760.00
|
|
|
Service Code
|
HCPCS 25040
|
| Hospital Charge Code |
76100570
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$261.36 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$585.20
|
| Rate for Payer: Anthem Medicaid |
$261.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$592.80
|
| 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 |
$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 |
$2,997.95
|
| 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 |
$3,597.54
|
| 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 |
$608.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$661.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$524.40
|
| Rate for Payer: PHCS Commercial |
$729.60
|
| Rate for Payer: United Healthcare All Payer |
$668.80
|
|
|
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: Ambetter Exchange |
$535.67
|
| Rate for Payer: Anthem Medicaid |
$368.45
|
| Rate for Payer: Buckeye Individual/Medicaid |
$535.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$535.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$642.80
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$535.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$535.67
|
| 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 |
$696.37
|
| Rate for Payer: UHCCP Medicaid |
$266.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$372.13
|
| Rate for Payer: Wellcare Medicare Advantage |
$535.67
|
|
