|
FUROSEMIDE 20MG SDV
|
Professional
|
Both
|
$73.48
|
|
|
Service Code
|
HCPCS J1940
|
| Hospital Charge Code |
63600039
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$73.48 |
| Rate for Payer: Aetna Commercial |
$0.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$73.48
|
| Rate for Payer: Cash Price |
$36.74
|
| Rate for Payer: Cash Price |
$36.74
|
| Rate for Payer: Healthspan PPO |
$0.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1.09
|
| Rate for Payer: Multiplan PHCS |
$44.09
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$51.44
|
| Rate for Payer: UHCCP Medicaid |
$25.72
|
|
|
FUROSEMIDE 20MG SDV
|
Facility
|
IP
|
$73.48
|
|
|
Service Code
|
HCPCS J1940
|
| Hospital Charge Code |
63600039
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.55 |
| Max. Negotiated Rate |
$70.54 |
| Rate for Payer: Aetna Commercial |
$56.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.31
|
| Rate for Payer: Cash Price |
$36.74
|
| Rate for Payer: Cigna Commercial |
$60.99
|
| Rate for Payer: First Health Commercial |
$69.81
|
| Rate for Payer: Humana Commercial |
$62.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$64.66
|
| Rate for Payer: Ohio Health Group HMO |
$55.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.78
|
| Rate for Payer: PHCS Commercial |
$70.54
|
| Rate for Payer: United Healthcare All Payer |
$64.66
|
|
|
FUROSEMIDE 20MG SDV
|
Facility
|
OP
|
$73.48
|
|
|
Service Code
|
HCPCS J1940
|
| Hospital Charge Code |
63600039
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.55 |
| Max. Negotiated Rate |
$70.54 |
| Rate for Payer: Aetna Commercial |
$56.58
|
| Rate for Payer: Anthem Medicaid |
$25.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.31
|
| Rate for Payer: Cash Price |
$36.74
|
| Rate for Payer: Cigna Commercial |
$60.99
|
| Rate for Payer: First Health Commercial |
$69.81
|
| Rate for Payer: Humana Commercial |
$62.46
|
| Rate for Payer: Humana KY Medicaid |
$25.27
|
| Rate for Payer: Kentucky WC Medicaid |
$25.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$25.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$64.66
|
| Rate for Payer: Ohio Health Group HMO |
$55.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.78
|
| Rate for Payer: PHCS Commercial |
$70.54
|
| Rate for Payer: United Healthcare All Payer |
$64.66
|
|
|
FUROSEMIDE 20MG SDV
|
Facility
|
OP
|
$73.48
|
|
|
Service Code
|
HCPCS J1940
|
| Hospital Charge Code |
636T0039
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.55 |
| Max. Negotiated Rate |
$70.54 |
| Rate for Payer: Aetna Commercial |
$56.58
|
| Rate for Payer: Anthem Medicaid |
$25.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.31
|
| Rate for Payer: Cash Price |
$36.74
|
| Rate for Payer: Cigna Commercial |
$60.99
|
| Rate for Payer: First Health Commercial |
$69.81
|
| Rate for Payer: Humana Commercial |
$62.46
|
| Rate for Payer: Humana KY Medicaid |
$25.27
|
| Rate for Payer: Kentucky WC Medicaid |
$25.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$25.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$64.66
|
| Rate for Payer: Ohio Health Group HMO |
$55.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.78
|
| Rate for Payer: PHCS Commercial |
$70.54
|
| Rate for Payer: United Healthcare All Payer |
$64.66
|
|
|
FUSE HAND BONES WITH GRAFT
|
Professional
|
Both
|
$955.00
|
|
|
Service Code
|
HCPCS 25825
|
| Hospital Charge Code |
76100649
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$334.25 |
| Max. Negotiated Rate |
$1,213.39 |
| Rate for Payer: Aetna Commercial |
$1,089.44
|
| Rate for Payer: Anthem Medicaid |
$596.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$955.00
|
| Rate for Payer: Cash Price |
$477.50
|
| Rate for Payer: Cash Price |
$477.50
|
| Rate for Payer: Cigna Commercial |
$1,213.39
|
| Rate for Payer: Healthspan PPO |
$986.80
|
| Rate for Payer: Humana Medicaid |
$596.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$929.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$608.22
|
| Rate for Payer: Molina Healthcare Passport |
$596.29
|
| Rate for Payer: Multiplan PHCS |
$573.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$668.50
|
| Rate for Payer: UHCCP Medicaid |
$334.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$602.25
|
|
|
FUSE HAND BONES WITH GRAFT
|
Facility
|
OP
|
$955.00
|
|
|
Service Code
|
HCPCS 25825
|
| Hospital Charge Code |
76100649
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$124.15 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$735.35
|
| Rate for Payer: Anthem Medicaid |
$328.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$744.90
|
| 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 |
$477.50
|
| Rate for Payer: Cash Price |
$477.50
|
| Rate for Payer: Cigna Commercial |
$792.65
|
| Rate for Payer: First Health Commercial |
$907.25
|
| Rate for Payer: Humana Commercial |
$811.75
|
| Rate for Payer: Humana KY Medicaid |
$328.42
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$331.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$783.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$704.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$335.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$840.40
|
| Rate for Payer: Ohio Health Group HMO |
$716.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$191.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$124.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$296.05
|
| Rate for Payer: PHCS Commercial |
$916.80
|
| Rate for Payer: United Healthcare All Payer |
$840.40
|
|
|
FUSE HAND BONES WITH GRAFT
|
Facility
|
IP
|
$955.00
|
|
|
Service Code
|
HCPCS 25825
|
| Hospital Charge Code |
76100649
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$124.15 |
| Max. Negotiated Rate |
$916.80 |
| Rate for Payer: Aetna Commercial |
$735.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$744.90
|
| Rate for Payer: Cash Price |
$477.50
|
| Rate for Payer: Cigna Commercial |
$792.65
|
| Rate for Payer: First Health Commercial |
$907.25
|
| Rate for Payer: Humana Commercial |
$811.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$783.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$704.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$286.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$840.40
|
| Rate for Payer: Ohio Health Group HMO |
$716.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$191.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$124.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$296.05
|
| Rate for Payer: PHCS Commercial |
$916.80
|
| Rate for Payer: United Healthcare All Payer |
$840.40
|
|
|
FUSE HAND BONES WITH GRAFT(P
|
Professional
|
Both
|
$955.00
|
|
|
Service Code
|
HCPCS 25825
|
| Hospital Charge Code |
761P0649
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$334.25 |
| Max. Negotiated Rate |
$1,213.39 |
| Rate for Payer: Aetna Commercial |
$1,089.44
|
| Rate for Payer: Anthem Medicaid |
$596.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$955.00
|
| Rate for Payer: Cash Price |
$477.50
|
| Rate for Payer: Cash Price |
$477.50
|
| Rate for Payer: Cigna Commercial |
$1,213.39
|
| Rate for Payer: Healthspan PPO |
$986.80
|
| Rate for Payer: Humana Medicaid |
$596.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$929.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$608.22
|
| Rate for Payer: Molina Healthcare Passport |
$596.29
|
| Rate for Payer: Multiplan PHCS |
$573.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$668.50
|
| Rate for Payer: UHCCP Medicaid |
$334.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$602.25
|
|
|
FUSION/GRAFT OF WRIST JOINT
|
Facility
|
OP
|
$1,065.00
|
|
|
Service Code
|
HCPCS 25810
|
| Hospital Charge Code |
76100647
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$138.45 |
| Max. Negotiated Rate |
$15,933.60 |
| Rate for Payer: Aetna Commercial |
$820.05
|
| Rate for Payer: Anthem Medicaid |
$366.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,381.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$830.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15,933.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$15,364.54
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$883.95
|
| Rate for Payer: First Health Commercial |
$1,011.75
|
| Rate for Payer: Humana Commercial |
$905.25
|
| Rate for Payer: Humana KY Medicaid |
$366.25
|
| Rate for Payer: Humana Medicare Advantage |
$11,381.14
|
| Rate for Payer: Kentucky WC Medicaid |
$369.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$873.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$785.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13,657.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$373.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$937.20
|
| Rate for Payer: Ohio Health Group HMO |
$798.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$213.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$138.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$330.15
|
| Rate for Payer: PHCS Commercial |
$1,022.40
|
| Rate for Payer: United Healthcare All Payer |
$937.20
|
|
|
FUSION/GRAFT OF WRIST JOINT
|
Facility
|
IP
|
$1,065.00
|
|
|
Service Code
|
HCPCS 25810
|
| Hospital Charge Code |
76100647
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$138.45 |
| Max. Negotiated Rate |
$1,022.40 |
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Aetna Commercial |
$820.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$830.70
|
| Rate for Payer: Cigna Commercial |
$883.95
|
| Rate for Payer: First Health Commercial |
$1,011.75
|
| Rate for Payer: Humana Commercial |
$905.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$873.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$785.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$319.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$937.20
|
| Rate for Payer: Ohio Health Group HMO |
$798.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$213.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$138.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$330.15
|
| Rate for Payer: PHCS Commercial |
$1,022.40
|
| Rate for Payer: United Healthcare All Payer |
$937.20
|
|
|
FUSION/GRAFT OF WRIST JOINT
|
Professional
|
Both
|
$1,065.00
|
|
|
Service Code
|
HCPCS 25810
|
| Hospital Charge Code |
76100647
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$372.75 |
| Max. Negotiated Rate |
$1,410.25 |
| Rate for Payer: Aetna Commercial |
$1,263.00
|
| Rate for Payer: Anthem Medicaid |
$673.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,065.00
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$1,410.25
|
| Rate for Payer: Healthspan PPO |
$1,144.01
|
| Rate for Payer: Humana Medicaid |
$673.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,075.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$686.88
|
| Rate for Payer: Molina Healthcare Passport |
$673.41
|
| Rate for Payer: Multiplan PHCS |
$639.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$745.50
|
| Rate for Payer: UHCCP Medicaid |
$372.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$680.14
|
|
|
FUSION/GRAFT OF WRIST JOINT(P
|
Professional
|
Both
|
$1,065.00
|
|
|
Service Code
|
HCPCS 25810
|
| Hospital Charge Code |
761P0647
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$372.75 |
| Max. Negotiated Rate |
$1,410.25 |
| Rate for Payer: Aetna Commercial |
$1,263.00
|
| Rate for Payer: Anthem Medicaid |
$673.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,065.00
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$1,410.25
|
| Rate for Payer: Healthspan PPO |
$1,144.01
|
| Rate for Payer: Humana Medicaid |
$673.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,075.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$686.88
|
| Rate for Payer: Molina Healthcare Passport |
$673.41
|
| Rate for Payer: Multiplan PHCS |
$639.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$745.50
|
| Rate for Payer: UHCCP Medicaid |
$372.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$680.14
|
|
|
FUSION OF BIG TOE JOINT
|
Facility
|
IP
|
$530.00
|
|
|
Service Code
|
HCPCS 28755
|
| Hospital Charge Code |
76101040
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$68.90 |
| Max. Negotiated Rate |
$508.80 |
| Rate for Payer: Aetna Commercial |
$408.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$413.40
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cigna Commercial |
$439.90
|
| Rate for Payer: First Health Commercial |
$503.50
|
| Rate for Payer: Humana Commercial |
$450.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$434.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$391.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$159.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$466.40
|
| Rate for Payer: Ohio Health Group HMO |
$397.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$106.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$164.30
|
| Rate for Payer: PHCS Commercial |
$508.80
|
| Rate for Payer: United Healthcare All Payer |
$466.40
|
|
|
FUSION OF BIG TOE JOINT
|
Facility
|
IP
|
$785.00
|
|
|
Service Code
|
HCPCS 28750
|
| Hospital Charge Code |
76101039
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$102.05 |
| Max. Negotiated Rate |
$753.60 |
| Rate for Payer: Aetna Commercial |
$604.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$612.30
|
| Rate for Payer: Cash Price |
$392.50
|
| Rate for Payer: Cigna Commercial |
$651.55
|
| Rate for Payer: First Health Commercial |
$745.75
|
| Rate for Payer: Humana Commercial |
$667.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$643.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$579.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$235.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$690.80
|
| Rate for Payer: Ohio Health Group HMO |
$588.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$157.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$243.35
|
| Rate for Payer: PHCS Commercial |
$753.60
|
| Rate for Payer: United Healthcare All Payer |
$690.80
|
|
|
FUSION OF BIG TOE JOINT
|
Professional
|
Both
|
$785.00
|
|
|
Service Code
|
HCPCS 28750
|
| Hospital Charge Code |
76101039
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$295.89 |
| Max. Negotiated Rate |
$1,042.83 |
| Rate for Payer: Aetna Commercial |
$891.72
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$295.89
|
| Rate for Payer: Anthem Medicaid |
$302.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$785.00
|
| Rate for Payer: Cash Price |
$392.50
|
| Rate for Payer: Cash Price |
$392.50
|
| Rate for Payer: Cigna Commercial |
$979.51
|
| Rate for Payer: Healthspan PPO |
$1,042.83
|
| Rate for Payer: Humana Medicaid |
$302.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$748.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$308.64
|
| Rate for Payer: Molina Healthcare Passport |
$302.59
|
| Rate for Payer: Multiplan PHCS |
$471.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$549.50
|
| Rate for Payer: UHCCP Medicaid |
$310.68
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$305.62
|
|
|
FUSION OF BIG TOE JOINT
|
Facility
|
OP
|
$530.00
|
|
|
Service Code
|
HCPCS 28755
|
| Hospital Charge Code |
76101040
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$68.90 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$408.10
|
| Rate for Payer: Anthem Medicaid |
$182.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$413.40
|
| 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 |
$265.00
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cigna Commercial |
$439.90
|
| Rate for Payer: First Health Commercial |
$503.50
|
| Rate for Payer: Humana Commercial |
$450.50
|
| Rate for Payer: Humana KY Medicaid |
$182.27
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$184.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$434.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$391.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$185.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$466.40
|
| Rate for Payer: Ohio Health Group HMO |
$397.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$106.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$164.30
|
| Rate for Payer: PHCS Commercial |
$508.80
|
| Rate for Payer: United Healthcare All Payer |
$466.40
|
|
|
FUSION OF BIG TOE JOINT
|
Facility
|
OP
|
$785.00
|
|
|
Service Code
|
HCPCS 28750
|
| Hospital Charge Code |
76101039
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$102.05 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$604.45
|
| Rate for Payer: Anthem Medicaid |
$269.96
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$612.30
|
| 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 |
$392.50
|
| Rate for Payer: Cash Price |
$392.50
|
| Rate for Payer: Cigna Commercial |
$651.55
|
| Rate for Payer: First Health Commercial |
$745.75
|
| Rate for Payer: Humana Commercial |
$667.25
|
| Rate for Payer: Humana KY Medicaid |
$269.96
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$272.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$643.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$579.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$275.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$690.80
|
| Rate for Payer: Ohio Health Group HMO |
$588.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$157.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$243.35
|
| Rate for Payer: PHCS Commercial |
$753.60
|
| Rate for Payer: United Healthcare All Payer |
$690.80
|
|
|
FUSION OF BIG TOE JOINT
|
Professional
|
Both
|
$530.00
|
|
|
Service Code
|
HCPCS 28755
|
| Hospital Charge Code |
76101040
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$170.61 |
| Max. Negotiated Rate |
$625.92 |
| Rate for Payer: Aetna Commercial |
$507.44
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$170.61
|
| Rate for Payer: Anthem Medicaid |
$241.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$530.00
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cigna Commercial |
$557.45
|
| Rate for Payer: Healthspan PPO |
$625.92
|
| Rate for Payer: Humana Medicaid |
$241.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$408.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$246.20
|
| Rate for Payer: Molina Healthcare Passport |
$241.37
|
| Rate for Payer: Multiplan PHCS |
$318.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$371.00
|
| Rate for Payer: UHCCP Medicaid |
$179.14
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$243.78
|
|
|
FUSION OF BIG TOE JOINT(P
|
Professional
|
Both
|
$785.00
|
|
|
Service Code
|
HCPCS 28750
|
| Hospital Charge Code |
761P1039
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$295.89 |
| Max. Negotiated Rate |
$1,042.83 |
| Rate for Payer: Aetna Commercial |
$891.72
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$295.89
|
| Rate for Payer: Anthem Medicaid |
$302.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$785.00
|
| Rate for Payer: Cash Price |
$392.50
|
| Rate for Payer: Cash Price |
$392.50
|
| Rate for Payer: Cigna Commercial |
$979.51
|
| Rate for Payer: Healthspan PPO |
$1,042.83
|
| Rate for Payer: Humana Medicaid |
$302.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$748.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$308.64
|
| Rate for Payer: Molina Healthcare Passport |
$302.59
|
| Rate for Payer: Multiplan PHCS |
$471.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$549.50
|
| Rate for Payer: UHCCP Medicaid |
$310.68
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$305.62
|
|
|
FUSION OF BIG TOE JOINT(P
|
Professional
|
Both
|
$530.00
|
|
|
Service Code
|
HCPCS 28755
|
| Hospital Charge Code |
761P1040
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$170.61 |
| Max. Negotiated Rate |
$625.92 |
| Rate for Payer: Aetna Commercial |
$507.44
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$170.61
|
| Rate for Payer: Anthem Medicaid |
$241.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$530.00
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cigna Commercial |
$557.45
|
| Rate for Payer: Healthspan PPO |
$625.92
|
| Rate for Payer: Humana Medicaid |
$241.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$408.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$246.20
|
| Rate for Payer: Molina Healthcare Passport |
$241.37
|
| Rate for Payer: Multiplan PHCS |
$318.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$371.00
|
| Rate for Payer: UHCCP Medicaid |
$179.14
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$243.78
|
|
|
FUSION OF FINGER JNT ADD-ON
|
Facility
|
OP
|
$468.00
|
|
|
Service Code
|
HCPCS 26861
|
| Hospital Charge Code |
76100754
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$60.84 |
| Max. Negotiated Rate |
$449.28 |
| Rate for Payer: Aetna Commercial |
$360.36
|
| Rate for Payer: Anthem Medicaid |
$160.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$365.04
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cigna Commercial |
$388.44
|
| Rate for Payer: First Health Commercial |
$444.60
|
| Rate for Payer: Humana Commercial |
$397.80
|
| Rate for Payer: Humana KY Medicaid |
$160.95
|
| Rate for Payer: Kentucky WC Medicaid |
$162.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$383.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$345.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$140.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$164.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$411.84
|
| Rate for Payer: Ohio Health Group HMO |
$351.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$93.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$145.08
|
| Rate for Payer: PHCS Commercial |
$449.28
|
| Rate for Payer: United Healthcare All Payer |
$411.84
|
|
|
FUSION OF FINGER JNT ADD-ON
|
Facility
|
IP
|
$468.00
|
|
|
Service Code
|
HCPCS 26861
|
| Hospital Charge Code |
76100754
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$60.84 |
| Max. Negotiated Rate |
$449.28 |
| Rate for Payer: Aetna Commercial |
$360.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$365.04
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cigna Commercial |
$388.44
|
| Rate for Payer: First Health Commercial |
$444.60
|
| Rate for Payer: Humana Commercial |
$397.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$383.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$345.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$140.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$411.84
|
| Rate for Payer: Ohio Health Group HMO |
$351.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$93.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$145.08
|
| Rate for Payer: PHCS Commercial |
$449.28
|
| Rate for Payer: United Healthcare All Payer |
$411.84
|
|
|
FUSION OF FINGER JNT ADD-ON
|
Professional
|
Both
|
$468.00
|
|
|
Service Code
|
HCPCS 26861
|
| Hospital Charge Code |
76100754
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$121.32 |
| Max. Negotiated Rate |
$468.00 |
| Rate for Payer: Aetna Commercial |
$161.95
|
| Rate for Payer: Anthem Medicaid |
$121.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$468.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cigna Commercial |
$176.28
|
| Rate for Payer: Healthspan PPO |
$146.70
|
| Rate for Payer: Humana Medicaid |
$121.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$131.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$123.75
|
| Rate for Payer: Molina Healthcare Passport |
$121.32
|
| Rate for Payer: Multiplan PHCS |
$280.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$327.60
|
| Rate for Payer: UHCCP Medicaid |
$163.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$122.53
|
|
|
FUSION OF FINGER JNT ADD-ON(P
|
Professional
|
Both
|
$468.00
|
|
|
Service Code
|
HCPCS 26861
|
| Hospital Charge Code |
761P0754
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$121.32 |
| Max. Negotiated Rate |
$468.00 |
| Rate for Payer: Aetna Commercial |
$161.95
|
| Rate for Payer: Anthem Medicaid |
$121.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$468.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cigna Commercial |
$176.28
|
| Rate for Payer: Healthspan PPO |
$146.70
|
| Rate for Payer: Humana Medicaid |
$121.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$131.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$123.75
|
| Rate for Payer: Molina Healthcare Passport |
$121.32
|
| Rate for Payer: Multiplan PHCS |
$280.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$327.60
|
| Rate for Payer: UHCCP Medicaid |
$163.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$122.53
|
|
|
FUSION OF FINGER JOINT
|
Facility
|
IP
|
$1,090.00
|
|
|
Service Code
|
HCPCS 26860
|
| Hospital Charge Code |
76100753
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$141.70 |
| Max. Negotiated Rate |
$1,046.40 |
| Rate for Payer: Aetna Commercial |
$839.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$850.20
|
| Rate for Payer: Cash Price |
$545.00
|
| Rate for Payer: Cigna Commercial |
$904.70
|
| Rate for Payer: First Health Commercial |
$1,035.50
|
| Rate for Payer: Humana Commercial |
$926.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$893.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$804.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$959.20
|
| Rate for Payer: Ohio Health Group HMO |
$817.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$218.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$337.90
|
| Rate for Payer: PHCS Commercial |
$1,046.40
|
| Rate for Payer: United Healthcare All Payer |
$959.20
|
|
