KNEE ARTHROSCOPY/SURGERY
|
Professional
|
Both
|
$1,877.00
|
|
Service Code
|
HCPCS 29875
|
Hospital Charge Code |
76101097
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$431.23 |
Max. Negotiated Rate |
$1,877.00 |
Rate for Payer: Aetna Commercial |
$724.11
|
Rate for Payer: Anthem Medicaid |
$431.23
|
Rate for Payer: Buckeye Medicare Advantage |
$1,877.00
|
Rate for Payer: Cash Price |
$938.50
|
Rate for Payer: Cash Price |
$938.50
|
Rate for Payer: Cigna Commercial |
$801.91
|
Rate for Payer: Healthspan PPO |
$655.89
|
Rate for Payer: Humana Medicaid |
$431.23
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$612.71
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$439.85
|
Rate for Payer: Molina Healthcare Passport |
$431.23
|
Rate for Payer: Multiplan PHCS |
$1,126.20
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,313.90
|
Rate for Payer: UHCCP Medicaid |
$656.95
|
Rate for Payer: Wellcare CHIP/Medicaid |
$435.54
|
|
KNEE ARTHROSCOPY/SURGERY
|
Facility
|
IP
|
$830.00
|
|
Service Code
|
HCPCS 29873
|
Hospital Charge Code |
76101095
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$107.90 |
Max. Negotiated Rate |
$796.80 |
Rate for Payer: Aetna Commercial |
$639.10
|
Rate for Payer: Anthem POS/PPO/Traditional |
$647.40
|
Rate for Payer: Cash Price |
$415.00
|
Rate for Payer: Cigna Commercial |
$688.90
|
Rate for Payer: First Health Commercial |
$788.50
|
Rate for Payer: Humana Commercial |
$705.50
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$680.60
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$612.54
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$249.00
|
Rate for Payer: Ohio Health Choice Commercial |
$730.40
|
Rate for Payer: Ohio Health Group HMO |
$622.50
|
Rate for Payer: Ohio Health Group PPO Differential |
$166.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$107.90
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$257.30
|
Rate for Payer: PHCS Commercial |
$796.80
|
Rate for Payer: United Healthcare All Payer |
$730.40
|
|
KNEE ARTHROSCOPY/SURGERY
|
Facility
|
OP
|
$1,877.00
|
|
Service Code
|
HCPCS 29875
|
Hospital Charge Code |
76101097
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$244.01 |
Max. Negotiated Rate |
$3,918.70 |
Rate for Payer: Aetna Commercial |
$1,445.29
|
Rate for Payer: Anthem Medicaid |
$645.50
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,464.06
|
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 |
$938.50
|
Rate for Payer: Cash Price |
$938.50
|
Rate for Payer: Cigna Commercial |
$1,557.91
|
Rate for Payer: First Health Commercial |
$1,783.15
|
Rate for Payer: Humana Commercial |
$1,595.45
|
Rate for Payer: Humana KY Medicaid |
$645.50
|
Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
Rate for Payer: Kentucky WC Medicaid |
$652.07
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,539.14
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,385.23
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
Rate for Payer: Molina Healthcare Medicaid |
$658.45
|
Rate for Payer: Ohio Health Choice Commercial |
$1,651.76
|
Rate for Payer: Ohio Health Group HMO |
$1,407.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$375.40
|
Rate for Payer: Ohio Health Group PPO No Differential |
$244.01
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$581.87
|
Rate for Payer: PHCS Commercial |
$1,801.92
|
Rate for Payer: United Healthcare All Payer |
$1,651.76
|
|
KNEE ARTHROSCOPY/SURGERY
|
Professional
|
Both
|
$1,425.00
|
|
Service Code
|
HCPCS 29889
|
Hospital Charge Code |
76102693
|
Hospital Revenue Code
|
360
|
Min. Negotiated Rate |
$498.75 |
Max. Negotiated Rate |
$1,957.16 |
Rate for Payer: Aetna Commercial |
$1,804.67
|
Rate for Payer: Anthem Medicaid |
$631.75
|
Rate for Payer: Buckeye Medicare Advantage |
$1,425.00
|
Rate for Payer: Cash Price |
$712.50
|
Rate for Payer: Cash Price |
$712.50
|
Rate for Payer: Cigna Commercial |
$1,957.16
|
Rate for Payer: Healthspan PPO |
$1,634.64
|
Rate for Payer: Humana Medicaid |
$631.75
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,522.02
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$644.38
|
Rate for Payer: Molina Healthcare Passport |
$631.75
|
Rate for Payer: Multiplan PHCS |
$855.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$997.50
|
Rate for Payer: UHCCP Medicaid |
$498.75
|
Rate for Payer: Wellcare CHIP/Medicaid |
$638.07
|
|
KNEE ARTHROSCOPY/SURGERY
|
Professional
|
Both
|
$2,345.00
|
|
Service Code
|
HCPCS 29851
|
Hospital Charge Code |
76101090
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$699.25 |
Max. Negotiated Rate |
$2,345.00 |
Rate for Payer: Aetna Commercial |
$1,396.01
|
Rate for Payer: Anthem Medicaid |
$699.25
|
Rate for Payer: Buckeye Medicare Advantage |
$2,345.00
|
Rate for Payer: Cash Price |
$1,172.50
|
Rate for Payer: Cash Price |
$1,172.50
|
Rate for Payer: Cigna Commercial |
$1,522.63
|
Rate for Payer: Healthspan PPO |
$1,264.49
|
Rate for Payer: Humana Medicaid |
$699.25
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,163.65
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$713.24
|
Rate for Payer: Molina Healthcare Passport |
$699.25
|
Rate for Payer: Multiplan PHCS |
$1,407.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,641.50
|
Rate for Payer: UHCCP Medicaid |
$820.75
|
Rate for Payer: Wellcare CHIP/Medicaid |
$706.24
|
|
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
|
|
KNEE ARTHROSCOPY/SURGERY
|
Facility
|
IP
|
$1,877.00
|
|
Service Code
|
HCPCS 29875
|
Hospital Charge Code |
76101097
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$244.01 |
Max. Negotiated Rate |
$1,801.92 |
Rate for Payer: Aetna Commercial |
$1,445.29
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,464.06
|
Rate for Payer: Cash Price |
$938.50
|
Rate for Payer: Cigna Commercial |
$1,557.91
|
Rate for Payer: First Health Commercial |
$1,783.15
|
Rate for Payer: Humana Commercial |
$1,595.45
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,539.14
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,385.23
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$563.10
|
Rate for Payer: Ohio Health Choice Commercial |
$1,651.76
|
Rate for Payer: Ohio Health Group HMO |
$1,407.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$375.40
|
Rate for Payer: Ohio Health Group PPO No Differential |
$244.01
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$581.87
|
Rate for Payer: PHCS Commercial |
$1,801.92
|
Rate for Payer: United Healthcare All Payer |
$1,651.76
|
|
KNEE ARTHROSCOPY/SURGERY
|
Facility
|
OP
|
$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 Medicaid |
$806.45
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,829.10
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
Rate for Payer: Cash Price |
$1,172.50
|
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: Humana KY Medicaid |
$806.45
|
Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
Rate for Payer: Kentucky WC Medicaid |
$814.65
|
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 |
$1,667.81
|
Rate for Payer: Molina Healthcare Medicaid |
$822.63
|
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
|
|
KNEE ARTHROSCOPY/SURGERY
|
Facility
|
OP
|
$830.00
|
|
Service Code
|
HCPCS 29873
|
Hospital Charge Code |
76101095
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$107.90 |
Max. Negotiated Rate |
$3,918.70 |
Rate for Payer: Aetna Commercial |
$639.10
|
Rate for Payer: Anthem Medicaid |
$285.44
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
Rate for Payer: Anthem POS/PPO/Traditional |
$647.40
|
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 |
$415.00
|
Rate for Payer: Cash Price |
$415.00
|
Rate for Payer: Cigna Commercial |
$688.90
|
Rate for Payer: First Health Commercial |
$788.50
|
Rate for Payer: Humana Commercial |
$705.50
|
Rate for Payer: Humana KY Medicaid |
$285.44
|
Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
Rate for Payer: Kentucky WC Medicaid |
$288.34
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$680.60
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$612.54
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
Rate for Payer: Molina Healthcare Medicaid |
$291.16
|
Rate for Payer: Ohio Health Choice Commercial |
$730.40
|
Rate for Payer: Ohio Health Group HMO |
$622.50
|
Rate for Payer: Ohio Health Group PPO Differential |
$166.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$107.90
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$257.30
|
Rate for Payer: PHCS Commercial |
$796.80
|
Rate for Payer: United Healthcare All Payer |
$730.40
|
|
KNEE ARTHROSCOPY/SURGERY(P
|
Professional
|
Both
|
$2,345.00
|
|
Service Code
|
HCPCS 29851
|
Hospital Charge Code |
761P1090
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$699.25 |
Max. Negotiated Rate |
$2,345.00 |
Rate for Payer: Aetna Commercial |
$1,396.01
|
Rate for Payer: Anthem Medicaid |
$699.25
|
Rate for Payer: Buckeye Medicare Advantage |
$2,345.00
|
Rate for Payer: Cash Price |
$1,172.50
|
Rate for Payer: Cash Price |
$1,172.50
|
Rate for Payer: Cigna Commercial |
$1,522.63
|
Rate for Payer: Healthspan PPO |
$1,264.49
|
Rate for Payer: Humana Medicaid |
$699.25
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,163.65
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$713.24
|
Rate for Payer: Molina Healthcare Passport |
$699.25
|
Rate for Payer: Multiplan PHCS |
$1,407.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,641.50
|
Rate for Payer: UHCCP Medicaid |
$820.75
|
Rate for Payer: Wellcare CHIP/Medicaid |
$706.24
|
|
KNEE ARTHROSCOPY/SURGERY(P
|
Professional
|
Both
|
$830.00
|
|
Service Code
|
HCPCS 29873
|
Hospital Charge Code |
761P1095
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$290.50 |
Max. Negotiated Rate |
$830.00 |
Rate for Payer: Aetna Commercial |
$742.43
|
Rate for Payer: Anthem Medicaid |
$360.23
|
Rate for Payer: Buckeye Medicare Advantage |
$830.00
|
Rate for Payer: Cash Price |
$415.00
|
Rate for Payer: Cash Price |
$415.00
|
Rate for Payer: Cigna Commercial |
$826.96
|
Rate for Payer: Healthspan PPO |
$672.48
|
Rate for Payer: Humana Medicaid |
$360.23
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$639.49
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$367.43
|
Rate for Payer: Molina Healthcare Passport |
$360.23
|
Rate for Payer: Multiplan PHCS |
$498.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$581.00
|
Rate for Payer: UHCCP Medicaid |
$290.50
|
Rate for Payer: Wellcare CHIP/Medicaid |
$363.83
|
|
KNEE ARTHROSCOPY/SURGERY(P
|
Professional
|
Both
|
$1,877.00
|
|
Service Code
|
HCPCS 29875
|
Hospital Charge Code |
761P1097
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$431.23 |
Max. Negotiated Rate |
$1,877.00 |
Rate for Payer: Aetna Commercial |
$724.11
|
Rate for Payer: Anthem Medicaid |
$431.23
|
Rate for Payer: Buckeye Medicare Advantage |
$1,877.00
|
Rate for Payer: Cash Price |
$938.50
|
Rate for Payer: Cash Price |
$938.50
|
Rate for Payer: Cigna Commercial |
$801.91
|
Rate for Payer: Healthspan PPO |
$655.89
|
Rate for Payer: Humana Medicaid |
$431.23
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$612.71
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$439.85
|
Rate for Payer: Molina Healthcare Passport |
$431.23
|
Rate for Payer: Multiplan PHCS |
$1,126.20
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,313.90
|
Rate for Payer: UHCCP Medicaid |
$656.95
|
Rate for Payer: Wellcare CHIP/Medicaid |
$435.54
|
|
KNEE HINGE RAIL ASSY
|
Facility
|
IP
|
$6,917.20
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$899.24 |
Max. Negotiated Rate |
$6,640.51 |
Rate for Payer: Aetna Commercial |
$5,326.24
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,395.42
|
Rate for Payer: Cash Price |
$3,458.60
|
Rate for Payer: Cigna Commercial |
$5,741.28
|
Rate for Payer: First Health Commercial |
$6,571.34
|
Rate for Payer: Humana Commercial |
$5,879.62
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$5,672.10
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,104.89
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,075.16
|
Rate for Payer: Ohio Health Choice Commercial |
$6,087.14
|
Rate for Payer: Ohio Health Group HMO |
$5,187.90
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,383.44
|
Rate for Payer: Ohio Health Group PPO No Differential |
$899.24
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,144.33
|
Rate for Payer: PHCS Commercial |
$6,640.51
|
Rate for Payer: United Healthcare All Payer |
$6,087.14
|
|
KNEE HINGE RAIL ASSY
|
Facility
|
OP
|
$6,917.20
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$899.24 |
Max. Negotiated Rate |
$6,640.51 |
Rate for Payer: Aetna Commercial |
$5,326.24
|
Rate for Payer: Anthem Medicaid |
$2,378.83
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,395.42
|
Rate for Payer: Cash Price |
$3,458.60
|
Rate for Payer: Cigna Commercial |
$5,741.28
|
Rate for Payer: First Health Commercial |
$6,571.34
|
Rate for Payer: Humana Commercial |
$5,879.62
|
Rate for Payer: Humana KY Medicaid |
$2,378.83
|
Rate for Payer: Kentucky WC Medicaid |
$2,403.04
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$5,672.10
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,104.89
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,075.16
|
Rate for Payer: Molina Healthcare Medicaid |
$2,426.55
|
Rate for Payer: Ohio Health Choice Commercial |
$6,087.14
|
Rate for Payer: Ohio Health Group HMO |
$5,187.90
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,383.44
|
Rate for Payer: Ohio Health Group PPO No Differential |
$899.24
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,144.33
|
Rate for Payer: PHCS Commercial |
$6,640.51
|
Rate for Payer: United Healthcare All Payer |
$6,087.14
|
|
KNEE HINGE RAIL SM ASSY
|
Facility
|
IP
|
$6,643.45
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$863.65 |
Max. Negotiated Rate |
$6,377.71 |
Rate for Payer: Aetna Commercial |
$5,115.46
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,181.89
|
Rate for Payer: Cash Price |
$3,321.72
|
Rate for Payer: Cigna Commercial |
$5,514.06
|
Rate for Payer: First Health Commercial |
$6,311.28
|
Rate for Payer: Humana Commercial |
$5,646.93
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$5,447.63
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,902.87
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,993.04
|
Rate for Payer: Ohio Health Choice Commercial |
$5,846.24
|
Rate for Payer: Ohio Health Group HMO |
$4,982.59
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,328.69
|
Rate for Payer: Ohio Health Group PPO No Differential |
$863.65
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,059.47
|
Rate for Payer: PHCS Commercial |
$6,377.71
|
Rate for Payer: United Healthcare All Payer |
$5,846.24
|
|
KNEE HINGE RAIL SM ASSY
|
Facility
|
OP
|
$6,643.45
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$863.65 |
Max. Negotiated Rate |
$6,377.71 |
Rate for Payer: Aetna Commercial |
$5,115.46
|
Rate for Payer: Anthem Medicaid |
$2,284.68
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,181.89
|
Rate for Payer: Cash Price |
$3,321.72
|
Rate for Payer: Cigna Commercial |
$5,514.06
|
Rate for Payer: First Health Commercial |
$6,311.28
|
Rate for Payer: Humana Commercial |
$5,646.93
|
Rate for Payer: Humana KY Medicaid |
$2,284.68
|
Rate for Payer: Kentucky WC Medicaid |
$2,307.93
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$5,447.63
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,902.87
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,993.04
|
Rate for Payer: Molina Healthcare Medicaid |
$2,330.52
|
Rate for Payer: Ohio Health Choice Commercial |
$5,846.24
|
Rate for Payer: Ohio Health Group HMO |
$4,982.59
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,328.69
|
Rate for Payer: Ohio Health Group PPO No Differential |
$863.65
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,059.47
|
Rate for Payer: PHCS Commercial |
$6,377.71
|
Rate for Payer: United Healthcare All Payer |
$5,846.24
|
|
KNEE LT: COMPLETE 4 OR MORE V
|
Facility
|
OP
|
$606.00
|
|
Service Code
|
HCPCS 73564
|
Hospital Charge Code |
32000101
|
Hospital Revenue Code
|
320
|
Min. Negotiated Rate |
$78.78 |
Max. Negotiated Rate |
$581.76 |
Rate for Payer: Aetna Commercial |
$466.62
|
Rate for Payer: Anthem Medicaid |
$208.40
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
Rate for Payer: Anthem POS/PPO/Traditional |
$472.68
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
Rate for Payer: Cash Price |
$303.00
|
Rate for Payer: Cash Price |
$303.00
|
Rate for Payer: Cigna Commercial |
$502.98
|
Rate for Payer: First Health Commercial |
$575.70
|
Rate for Payer: Humana Commercial |
$515.10
|
Rate for Payer: Humana KY Medicaid |
$208.40
|
Rate for Payer: Humana Medicare Advantage |
$95.07
|
Rate for Payer: Kentucky WC Medicaid |
$210.52
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$496.92
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$447.23
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
Rate for Payer: Molina Healthcare Medicaid |
$212.58
|
Rate for Payer: Ohio Health Choice Commercial |
$533.28
|
Rate for Payer: Ohio Health Group HMO |
$454.50
|
Rate for Payer: Ohio Health Group PPO Differential |
$121.20
|
Rate for Payer: Ohio Health Group PPO No Differential |
$78.78
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$187.86
|
Rate for Payer: PHCS Commercial |
$581.76
|
Rate for Payer: United Healthcare All Payer |
$533.28
|
|
KNEE LT: COMPLETE 4 OR MORE V
|
Professional
|
Both
|
$95.00
|
|
Service Code
|
HCPCS 73564
|
Hospital Charge Code |
320P0101
|
Hospital Revenue Code
|
320
|
Min. Negotiated Rate |
$15.30 |
Max. Negotiated Rate |
$95.00 |
Rate for Payer: Aetna Commercial |
$59.61
|
Rate for Payer: Anthem Medicaid |
$26.42
|
Rate for Payer: Buckeye Medicare Advantage |
$95.00
|
Rate for Payer: Cash Price |
$47.50
|
Rate for Payer: Cash Price |
$47.50
|
Rate for Payer: Cigna Commercial |
$54.88
|
Rate for Payer: Healthspan PPO |
$55.86
|
Rate for Payer: Humana Medicaid |
$26.42
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$15.30
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$26.95
|
Rate for Payer: Molina Healthcare Passport |
$26.42
|
Rate for Payer: Multiplan PHCS |
$57.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$66.50
|
Rate for Payer: UHCCP Medicaid |
$33.25
|
Rate for Payer: Wellcare CHIP/Medicaid |
$26.68
|
|
KNEE LT: COMPLETE 4 OR MORE V
|
Facility
|
IP
|
$511.00
|
|
Service Code
|
HCPCS 73564
|
Hospital Charge Code |
320T0101
|
Hospital Revenue Code
|
320
|
Min. Negotiated Rate |
$66.43 |
Max. Negotiated Rate |
$490.56 |
Rate for Payer: Aetna Commercial |
$393.47
|
Rate for Payer: Anthem POS/PPO/Traditional |
$398.58
|
Rate for Payer: Cash Price |
$255.50
|
Rate for Payer: Cigna Commercial |
$424.13
|
Rate for Payer: First Health Commercial |
$485.45
|
Rate for Payer: Humana Commercial |
$434.35
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$419.02
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$377.12
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$153.30
|
Rate for Payer: Ohio Health Choice Commercial |
$449.68
|
Rate for Payer: Ohio Health Group HMO |
$383.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$102.20
|
Rate for Payer: Ohio Health Group PPO No Differential |
$66.43
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$158.41
|
Rate for Payer: PHCS Commercial |
$490.56
|
Rate for Payer: United Healthcare All Payer |
$449.68
|
|
KNEE LT: COMPLETE 4 OR MORE V
|
Facility
|
IP
|
$606.00
|
|
Service Code
|
HCPCS 73564
|
Hospital Charge Code |
32000101
|
Hospital Revenue Code
|
320
|
Min. Negotiated Rate |
$78.78 |
Max. Negotiated Rate |
$581.76 |
Rate for Payer: Aetna Commercial |
$466.62
|
Rate for Payer: Anthem POS/PPO/Traditional |
$472.68
|
Rate for Payer: Cash Price |
$303.00
|
Rate for Payer: Cigna Commercial |
$502.98
|
Rate for Payer: First Health Commercial |
$575.70
|
Rate for Payer: Humana Commercial |
$515.10
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$496.92
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$447.23
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$181.80
|
Rate for Payer: Ohio Health Choice Commercial |
$533.28
|
Rate for Payer: Ohio Health Group HMO |
$454.50
|
Rate for Payer: Ohio Health Group PPO Differential |
$121.20
|
Rate for Payer: Ohio Health Group PPO No Differential |
$78.78
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$187.86
|
Rate for Payer: PHCS Commercial |
$581.76
|
Rate for Payer: United Healthcare All Payer |
$533.28
|
|
KNEE LT: COMPLETE 4 OR MORE V
|
Facility
|
OP
|
$511.00
|
|
Service Code
|
HCPCS 73564
|
Hospital Charge Code |
320T0101
|
Hospital Revenue Code
|
320
|
Min. Negotiated Rate |
$66.43 |
Max. Negotiated Rate |
$490.56 |
Rate for Payer: Aetna Commercial |
$393.47
|
Rate for Payer: Anthem Medicaid |
$175.73
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
Rate for Payer: Anthem POS/PPO/Traditional |
$398.58
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
Rate for Payer: Cash Price |
$255.50
|
Rate for Payer: Cash Price |
$255.50
|
Rate for Payer: Cigna Commercial |
$424.13
|
Rate for Payer: First Health Commercial |
$485.45
|
Rate for Payer: Humana Commercial |
$434.35
|
Rate for Payer: Humana KY Medicaid |
$175.73
|
Rate for Payer: Humana Medicare Advantage |
$95.07
|
Rate for Payer: Kentucky WC Medicaid |
$177.52
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$419.02
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$377.12
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
Rate for Payer: Molina Healthcare Medicaid |
$179.26
|
Rate for Payer: Ohio Health Choice Commercial |
$449.68
|
Rate for Payer: Ohio Health Group HMO |
$383.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$102.20
|
Rate for Payer: Ohio Health Group PPO No Differential |
$66.43
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$158.41
|
Rate for Payer: PHCS Commercial |
$490.56
|
Rate for Payer: United Healthcare All Payer |
$449.68
|
|
KNEE LT: COMPLETE 4 OR MORE V
|
Professional
|
Both
|
$606.00
|
|
Service Code
|
HCPCS 73564
|
Hospital Charge Code |
32000101
|
Hospital Revenue Code
|
320
|
Min. Negotiated Rate |
$15.30 |
Max. Negotiated Rate |
$606.00 |
Rate for Payer: Aetna Commercial |
$59.61
|
Rate for Payer: Anthem Medicaid |
$26.42
|
Rate for Payer: Buckeye Medicare Advantage |
$606.00
|
Rate for Payer: Cash Price |
$303.00
|
Rate for Payer: Cash Price |
$303.00
|
Rate for Payer: Cigna Commercial |
$54.88
|
Rate for Payer: Healthspan PPO |
$55.86
|
Rate for Payer: Humana Medicaid |
$26.42
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$15.30
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$26.95
|
Rate for Payer: Molina Healthcare Passport |
$26.42
|
Rate for Payer: Multiplan PHCS |
$363.60
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$424.20
|
Rate for Payer: UHCCP Medicaid |
$212.10
|
Rate for Payer: Wellcare CHIP/Medicaid |
$26.68
|
|
KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC
|
Facility
|
IP
|
$24,643.44
|
|
Service Code
|
MSDRG 488
|
Min. Negotiated Rate |
$16,722.34 |
Max. Negotiated Rate |
$24,643.44 |
Rate for Payer: Anthem Medicaid |
$16,722.34
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$17,602.46
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24,643.44
|
Rate for Payer: CareSource Just4Me Medicare |
$23,763.32
|
Rate for Payer: Humana KY Medicaid |
$16,722.34
|
Rate for Payer: Humana Medicare Advantage |
$17,602.46
|
Rate for Payer: Kentucky WC Medicaid |
$16,889.56
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$21,122.95
|
Rate for Payer: Molina Healthcare Medicaid |
$17,056.78
|
|
KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC
|
Facility
|
IP
|
$14,478.86
|
|
Service Code
|
MSDRG 489
|
Min. Negotiated Rate |
$9,824.94 |
Max. Negotiated Rate |
$14,478.86 |
Rate for Payer: Anthem Medicaid |
$9,824.94
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$10,342.04
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$14,478.86
|
Rate for Payer: CareSource Just4Me Medicare |
$13,961.75
|
Rate for Payer: Humana KY Medicaid |
$9,824.94
|
Rate for Payer: Humana Medicare Advantage |
$10,342.04
|
Rate for Payer: Kentucky WC Medicaid |
$9,923.19
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$12,410.45
|
Rate for Payer: Molina Healthcare Medicaid |
$10,021.44
|
|
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC
|
Facility
|
IP
|
$23,493.51
|
|
Service Code
|
MSDRG 486
|
Min. Negotiated Rate |
$15,942.03 |
Max. Negotiated Rate |
$23,493.51 |
Rate for Payer: Anthem Medicaid |
$15,942.03
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$16,781.08
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$23,493.51
|
Rate for Payer: CareSource Just4Me Medicare |
$22,654.46
|
Rate for Payer: Humana KY Medicaid |
$15,942.03
|
Rate for Payer: Humana Medicare Advantage |
$16,781.08
|
Rate for Payer: Kentucky WC Medicaid |
$16,101.45
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$20,137.30
|
Rate for Payer: Molina Healthcare Medicaid |
$16,260.87
|
|