|
KIT PERC SHEATH INTRO 8.5FR
|
Facility
|
OP
|
$790.79
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$102.80 |
| Max. Negotiated Rate |
$759.16 |
| Rate for Payer: Aetna Commercial |
$608.91
|
| Rate for Payer: Anthem Medicaid |
$271.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$616.82
|
| Rate for Payer: Cash Price |
$395.40
|
| Rate for Payer: Cigna Commercial |
$656.36
|
| Rate for Payer: First Health Commercial |
$751.25
|
| Rate for Payer: Humana Commercial |
$672.17
|
| Rate for Payer: Humana KY Medicaid |
$271.95
|
| Rate for Payer: Kentucky WC Medicaid |
$274.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$648.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$583.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$237.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$277.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$695.90
|
| Rate for Payer: Ohio Health Group HMO |
$593.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$158.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$245.14
|
| Rate for Payer: PHCS Commercial |
$759.16
|
| Rate for Payer: United Healthcare All Payer |
$695.90
|
|
|
KIT PERC SHEATH INTRO 8.5FR
|
Facility
|
IP
|
$790.79
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$102.80 |
| Max. Negotiated Rate |
$759.16 |
| Rate for Payer: Aetna Commercial |
$608.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$616.82
|
| Rate for Payer: Cash Price |
$395.40
|
| Rate for Payer: Cigna Commercial |
$656.36
|
| Rate for Payer: First Health Commercial |
$751.25
|
| Rate for Payer: Humana Commercial |
$672.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$648.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$583.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$237.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$695.90
|
| Rate for Payer: Ohio Health Group HMO |
$593.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$158.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$245.14
|
| Rate for Payer: PHCS Commercial |
$759.16
|
| Rate for Payer: United Healthcare All Payer |
$695.90
|
|
|
KIT TITAN STANDARD ASSEMBLY
|
Facility
|
OP
|
$4,814.50
|
|
|
Service Code
|
HCPCS C1813
|
| Hospital Charge Code |
27000110
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$625.88 |
| Max. Negotiated Rate |
$4,621.92 |
| Rate for Payer: Aetna Commercial |
$3,707.16
|
| Rate for Payer: Anthem Medicaid |
$1,655.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,755.31
|
| Rate for Payer: Cash Price |
$2,407.25
|
| Rate for Payer: Cigna Commercial |
$3,996.04
|
| Rate for Payer: First Health Commercial |
$4,573.78
|
| Rate for Payer: Humana Commercial |
$4,092.32
|
| Rate for Payer: Humana KY Medicaid |
$1,655.71
|
| Rate for Payer: Kentucky WC Medicaid |
$1,672.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,947.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,553.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,444.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,688.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,236.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,610.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$962.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$625.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,492.50
|
| Rate for Payer: PHCS Commercial |
$4,621.92
|
| Rate for Payer: United Healthcare All Payer |
$4,236.76
|
|
|
KIT TITAN STANDARD ASSEMBLY
|
Facility
|
IP
|
$4,814.50
|
|
|
Service Code
|
HCPCS C1813
|
| Hospital Charge Code |
27000110
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$625.88 |
| Max. Negotiated Rate |
$4,621.92 |
| Rate for Payer: Aetna Commercial |
$3,707.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,755.31
|
| Rate for Payer: Cash Price |
$2,407.25
|
| Rate for Payer: Cigna Commercial |
$3,996.04
|
| Rate for Payer: First Health Commercial |
$4,573.78
|
| Rate for Payer: Humana Commercial |
$4,092.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,947.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,553.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,444.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,236.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,610.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$962.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$625.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,492.50
|
| Rate for Payer: PHCS Commercial |
$4,621.92
|
| Rate for Payer: United Healthcare All Payer |
$4,236.76
|
|
|
KLEBSIELLA OXYTOCA OMPA GENE
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001306
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$65.28 |
| Rate for Payer: Aetna Commercial |
$52.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.60
|
| Rate for Payer: Cash Price |
$34.00
|
| Rate for Payer: Cigna Commercial |
$56.44
|
| Rate for Payer: First Health Commercial |
$64.60
|
| Rate for Payer: Humana Commercial |
$57.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$55.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$59.84
|
| Rate for Payer: Ohio Health Group HMO |
$51.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.08
|
| Rate for Payer: PHCS Commercial |
$65.28
|
| Rate for Payer: United Healthcare All Payer |
$59.84
|
|
|
KLEBSIELLA OXYTOCA OMPA GENE
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001306
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$65.28 |
| Rate for Payer: Aetna Commercial |
$52.36
|
| Rate for Payer: Anthem Medicaid |
$20.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$20.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$28.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$20.05
|
| Rate for Payer: Cash Price |
$34.00
|
| Rate for Payer: Cash Price |
$34.00
|
| Rate for Payer: Cigna Commercial |
$56.44
|
| Rate for Payer: First Health Commercial |
$64.60
|
| Rate for Payer: Humana Commercial |
$57.80
|
| Rate for Payer: Humana KY Medicaid |
$20.05
|
| Rate for Payer: Humana Medicare Advantage |
$20.05
|
| Rate for Payer: Kentucky WC Medicaid |
$20.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$55.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$20.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$59.84
|
| Rate for Payer: Ohio Health Group HMO |
$51.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.08
|
| Rate for Payer: PHCS Commercial |
$65.28
|
| Rate for Payer: United Healthcare All Payer |
$59.84
|
|
|
KLEBSIELLA PNEUMONIAE YGGEGENE
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001298
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$65.28 |
| Rate for Payer: Aetna Commercial |
$52.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.60
|
| Rate for Payer: Cash Price |
$34.00
|
| Rate for Payer: Cigna Commercial |
$56.44
|
| Rate for Payer: First Health Commercial |
$64.60
|
| Rate for Payer: Humana Commercial |
$57.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$55.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$59.84
|
| Rate for Payer: Ohio Health Group HMO |
$51.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.08
|
| Rate for Payer: PHCS Commercial |
$65.28
|
| Rate for Payer: United Healthcare All Payer |
$59.84
|
|
|
KLEBSIELLA PNEUMONIAE YGGEGENE
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001298
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$65.28 |
| Rate for Payer: Aetna Commercial |
$52.36
|
| Rate for Payer: Anthem Medicaid |
$20.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$20.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$28.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$20.05
|
| Rate for Payer: Cash Price |
$34.00
|
| Rate for Payer: Cash Price |
$34.00
|
| Rate for Payer: Cigna Commercial |
$56.44
|
| Rate for Payer: First Health Commercial |
$64.60
|
| Rate for Payer: Humana Commercial |
$57.80
|
| Rate for Payer: Humana KY Medicaid |
$20.05
|
| Rate for Payer: Humana Medicare Advantage |
$20.05
|
| Rate for Payer: Kentucky WC Medicaid |
$20.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$55.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$20.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$59.84
|
| Rate for Payer: Ohio Health Group HMO |
$51.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.08
|
| Rate for Payer: PHCS Commercial |
$65.28
|
| Rate for Payer: United Healthcare All Payer |
$59.84
|
|
|
KLOR CON (POT CHLR) 10 MEQ TAB
|
Facility
|
IP
|
$4.70
|
|
|
Service Code
|
NDC 245531601
|
| Hospital Charge Code |
25000823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$4.51 |
| Rate for Payer: Aetna Commercial |
$3.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.67
|
| Rate for Payer: Cash Price |
$2.35
|
| Rate for Payer: Cigna Commercial |
$3.90
|
| Rate for Payer: First Health Commercial |
$4.46
|
| Rate for Payer: Humana Commercial |
$4.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.14
|
| Rate for Payer: Ohio Health Group HMO |
$3.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.46
|
| Rate for Payer: PHCS Commercial |
$4.51
|
| Rate for Payer: United Healthcare All Payer |
$4.14
|
|
|
KLOR CON (POT CHLR) 10 MEQ TAB
|
Facility
|
OP
|
$4.70
|
|
|
Service Code
|
NDC 245531601
|
| Hospital Charge Code |
25000823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$4.51 |
| Rate for Payer: Aetna Commercial |
$3.62
|
| Rate for Payer: Anthem Medicaid |
$1.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.67
|
| Rate for Payer: Cash Price |
$2.35
|
| Rate for Payer: Cigna Commercial |
$3.90
|
| Rate for Payer: First Health Commercial |
$4.46
|
| Rate for Payer: Humana Commercial |
$4.00
|
| Rate for Payer: Humana KY Medicaid |
$1.62
|
| Rate for Payer: Kentucky WC Medicaid |
$1.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.14
|
| Rate for Payer: Ohio Health Group HMO |
$3.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.46
|
| Rate for Payer: PHCS Commercial |
$4.51
|
| Rate for Payer: United Healthcare All Payer |
$4.14
|
|
|
KNEE 3V LEFT
|
Facility
|
OP
|
$527.00
|
|
|
Service Code
|
HCPCS 73562
|
| Hospital Charge Code |
32000100
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$68.51 |
| Max. Negotiated Rate |
$505.92 |
| Rate for Payer: Aetna Commercial |
$405.79
|
| Rate for Payer: Anthem Medicaid |
$181.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$411.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$263.50
|
| Rate for Payer: Cash Price |
$263.50
|
| Rate for Payer: Cigna Commercial |
$437.41
|
| Rate for Payer: First Health Commercial |
$500.65
|
| Rate for Payer: Humana Commercial |
$447.95
|
| Rate for Payer: Humana KY Medicaid |
$181.24
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$183.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$432.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$388.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$184.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$463.76
|
| Rate for Payer: Ohio Health Group HMO |
$395.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$105.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$163.37
|
| Rate for Payer: PHCS Commercial |
$505.92
|
| Rate for Payer: United Healthcare All Payer |
$463.76
|
|
|
KNEE 3V LEFT
|
Facility
|
IP
|
$527.00
|
|
|
Service Code
|
HCPCS 73562
|
| Hospital Charge Code |
32000100
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$68.51 |
| Max. Negotiated Rate |
$505.92 |
| Rate for Payer: Aetna Commercial |
$405.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$411.06
|
| Rate for Payer: Cash Price |
$263.50
|
| Rate for Payer: Cigna Commercial |
$437.41
|
| Rate for Payer: First Health Commercial |
$500.65
|
| Rate for Payer: Humana Commercial |
$447.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$432.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$388.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$158.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$463.76
|
| Rate for Payer: Ohio Health Group HMO |
$395.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$105.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$163.37
|
| Rate for Payer: PHCS Commercial |
$505.92
|
| Rate for Payer: United Healthcare All Payer |
$463.76
|
|
|
KNEE 3V LEFT
|
Professional
|
Both
|
$527.00
|
|
|
Service Code
|
HCPCS 73562
|
| Hospital Charge Code |
32000100
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$13.15 |
| Max. Negotiated Rate |
$527.00 |
| Rate for Payer: Aetna Commercial |
$51.42
|
| Rate for Payer: Anthem Medicaid |
$23.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$527.00
|
| Rate for Payer: Cash Price |
$263.50
|
| Rate for Payer: Cash Price |
$263.50
|
| Rate for Payer: Cigna Commercial |
$48.12
|
| Rate for Payer: Healthspan PPO |
$48.18
|
| Rate for Payer: Humana Medicaid |
$23.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$13.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$23.86
|
| Rate for Payer: Molina Healthcare Passport |
$23.39
|
| Rate for Payer: Multiplan PHCS |
$316.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$368.90
|
| Rate for Payer: UHCCP Medicaid |
$184.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$23.62
|
|
|
KNEE 3V LEFT(P
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 73562
|
| Hospital Charge Code |
320P0100
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$13.15 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Aetna Commercial |
$51.42
|
| Rate for Payer: Anthem Medicaid |
$23.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$125.00
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$48.12
|
| Rate for Payer: Healthspan PPO |
$48.18
|
| Rate for Payer: Humana Medicaid |
$23.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$13.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$23.86
|
| Rate for Payer: Molina Healthcare Passport |
$23.39
|
| Rate for Payer: Multiplan PHCS |
$75.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$87.50
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$23.62
|
|
|
KNEE 3V LEFT(T
|
Facility
|
OP
|
$402.00
|
|
|
Service Code
|
HCPCS 73562
|
| Hospital Charge Code |
320T0100
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$52.26 |
| Max. Negotiated Rate |
$385.92 |
| Rate for Payer: Aetna Commercial |
$309.54
|
| Rate for Payer: Anthem Medicaid |
$138.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$313.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$333.66
|
| Rate for Payer: First Health Commercial |
$381.90
|
| Rate for Payer: Humana Commercial |
$341.70
|
| Rate for Payer: Humana KY Medicaid |
$138.25
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$139.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$329.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$296.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$141.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$353.76
|
| Rate for Payer: Ohio Health Group HMO |
$301.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.62
|
| Rate for Payer: PHCS Commercial |
$385.92
|
| Rate for Payer: United Healthcare All Payer |
$353.76
|
|
|
KNEE 3V LEFT(T
|
Facility
|
IP
|
$402.00
|
|
|
Service Code
|
HCPCS 73562
|
| Hospital Charge Code |
320T0100
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$52.26 |
| Max. Negotiated Rate |
$385.92 |
| Rate for Payer: Aetna Commercial |
$309.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$313.56
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$333.66
|
| Rate for Payer: First Health Commercial |
$381.90
|
| Rate for Payer: Humana Commercial |
$341.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$329.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$296.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$120.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$353.76
|
| Rate for Payer: Ohio Health Group HMO |
$301.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.62
|
| Rate for Payer: PHCS Commercial |
$385.92
|
| Rate for Payer: United Healthcare All Payer |
$353.76
|
|
|
KNEE ARTHROSCOPY/DRAINAGE
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 29871
|
| Hospital Charge Code |
76101094
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$389.48 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$749.02
|
| Rate for Payer: Anthem Medicaid |
$389.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,500.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$822.31
|
| Rate for Payer: Healthspan PPO |
$678.46
|
| Rate for Payer: Humana Medicaid |
$389.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$633.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$397.27
|
| Rate for Payer: Molina Healthcare Passport |
$389.48
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,050.00
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$393.37
|
|
|
KNEE ARTHROSCOPY/DRAINAGE
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 29871
|
| Hospital Charge Code |
76101094
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem Medicaid |
$515.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Humana KY Medicaid |
$515.85
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$521.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$526.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$195.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$465.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
KNEE ARTHROSCOPY/DRAINAGE
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 29871
|
| Hospital Charge Code |
76101094
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$450.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$195.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$465.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
KNEE ARTHROSCOPY/DRAINAGE(P
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 29871
|
| Hospital Charge Code |
761P1094
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$389.48 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$749.02
|
| Rate for Payer: Anthem Medicaid |
$389.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,500.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$822.31
|
| Rate for Payer: Healthspan PPO |
$678.46
|
| Rate for Payer: Humana Medicaid |
$389.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$633.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$397.27
|
| Rate for Payer: Molina Healthcare Passport |
$389.48
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,050.00
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$393.37
|
|
|
KNEE ARTHROSCOPY DX
|
Facility
|
OP
|
$1,330.00
|
|
|
Service Code
|
HCPCS 29870
|
| Hospital Charge Code |
76101093
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$172.90 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$1,024.10
|
| Rate for Payer: Anthem Medicaid |
$457.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,037.40
|
| 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 |
$665.00
|
| Rate for Payer: Cash Price |
$665.00
|
| Rate for Payer: Cigna Commercial |
$1,103.90
|
| Rate for Payer: First Health Commercial |
$1,263.50
|
| Rate for Payer: Humana Commercial |
$1,130.50
|
| Rate for Payer: Humana KY Medicaid |
$457.39
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$462.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,090.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$981.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$466.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,170.40
|
| Rate for Payer: Ohio Health Group HMO |
$997.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$266.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$172.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$412.30
|
| Rate for Payer: PHCS Commercial |
$1,276.80
|
| Rate for Payer: United Healthcare All Payer |
$1,170.40
|
|
|
KNEE ARTHROSCOPY DX
|
Facility
|
IP
|
$1,330.00
|
|
|
Service Code
|
HCPCS 29870
|
| Hospital Charge Code |
76101093
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$172.90 |
| Max. Negotiated Rate |
$1,276.80 |
| Rate for Payer: Aetna Commercial |
$1,024.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,037.40
|
| Rate for Payer: Cash Price |
$665.00
|
| Rate for Payer: Cigna Commercial |
$1,103.90
|
| Rate for Payer: First Health Commercial |
$1,263.50
|
| Rate for Payer: Humana Commercial |
$1,130.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,090.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$981.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,170.40
|
| Rate for Payer: Ohio Health Group HMO |
$997.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$266.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$172.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$412.30
|
| Rate for Payer: PHCS Commercial |
$1,276.80
|
| Rate for Payer: United Healthcare All Payer |
$1,170.40
|
|
|
KNEE ARTHROSCOPY DX
|
Professional
|
Both
|
$1,330.00
|
|
|
Service Code
|
HCPCS 29870
|
| Hospital Charge Code |
76101093
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$209.72 |
| Max. Negotiated Rate |
$1,330.00 |
| Rate for Payer: Aetna Commercial |
$593.14
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$209.72
|
| Rate for Payer: Anthem Medicaid |
$268.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,330.00
|
| Rate for Payer: Cash Price |
$665.00
|
| Rate for Payer: Cash Price |
$665.00
|
| Rate for Payer: Cigna Commercial |
$655.69
|
| Rate for Payer: Healthspan PPO |
$537.25
|
| Rate for Payer: Humana Medicaid |
$268.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$506.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$273.70
|
| Rate for Payer: Molina Healthcare Passport |
$268.33
|
| Rate for Payer: Multiplan PHCS |
$798.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$931.00
|
| Rate for Payer: UHCCP Medicaid |
$220.21
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$271.01
|
|
|
KNEE ARTHROSCOPY DX(P
|
Professional
|
Both
|
$1,330.00
|
|
|
Service Code
|
HCPCS 29870
|
| Hospital Charge Code |
761P1093
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$209.72 |
| Max. Negotiated Rate |
$1,330.00 |
| Rate for Payer: Aetna Commercial |
$593.14
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$209.72
|
| Rate for Payer: Anthem Medicaid |
$268.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,330.00
|
| Rate for Payer: Cash Price |
$665.00
|
| Rate for Payer: Cash Price |
$665.00
|
| Rate for Payer: Cigna Commercial |
$655.69
|
| Rate for Payer: Healthspan PPO |
$537.25
|
| Rate for Payer: Humana Medicaid |
$268.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$506.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$273.70
|
| Rate for Payer: Molina Healthcare Passport |
$268.33
|
| Rate for Payer: Multiplan PHCS |
$798.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$931.00
|
| Rate for Payer: UHCCP Medicaid |
$220.21
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$271.01
|
|
|
KNEE ARTHROSCOPY/SURGERY
|
Facility
|
IP
|
$2,345.00
|
|
|
Service Code
|
HCPCS 29851
|
| Hospital Charge Code |
76101090
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$304.85 |
| Max. Negotiated Rate |
$2,251.20 |
| Rate for Payer: Aetna Commercial |
$1,805.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,829.10
|
| Rate for Payer: Cash Price |
$1,172.50
|
| Rate for Payer: Cigna Commercial |
$1,946.35
|
| Rate for Payer: First Health Commercial |
$2,227.75
|
| Rate for Payer: Humana Commercial |
$1,993.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,922.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,730.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$703.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,063.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,758.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$469.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$304.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$726.95
|
| Rate for Payer: PHCS Commercial |
$2,251.20
|
| Rate for Payer: United Healthcare All Payer |
$2,063.60
|
|
