|
KNEE 3V LEFT
|
Professional
|
Both
|
$553.00
|
|
|
Service Code
|
HCPCS 73562
|
| Hospital Charge Code |
32000100
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$13.15 |
| Max. Negotiated Rate |
$331.80 |
| Rate for Payer: Aetna Commercial |
$51.42
|
| Rate for Payer: Ambetter Exchange |
$36.55
|
| Rate for Payer: Anthem Medicaid |
$23.39
|
| Rate for Payer: Buckeye Individual/Medicaid |
$36.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$36.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$43.86
|
| Rate for Payer: Cash Price |
$276.50
|
| Rate for Payer: Cash Price |
$276.50
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$36.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$23.86
|
| Rate for Payer: Molina Healthcare Passport |
$23.39
|
| Rate for Payer: Multiplan PHCS |
$331.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$47.52
|
| Rate for Payer: UHCCP Medicaid |
$193.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$23.62
|
| Rate for Payer: Wellcare Medicare Advantage |
$36.55
|
|
|
KNEE 3V LEFT
|
Facility
|
OP
|
$553.00
|
|
|
Service Code
|
HCPCS 73562
|
| Hospital Charge Code |
32000100
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$530.88 |
| Rate for Payer: Aetna Commercial |
$425.81
|
| Rate for Payer: Anthem Medicaid |
$190.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$431.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$276.50
|
| Rate for Payer: Cash Price |
$276.50
|
| Rate for Payer: Cigna Commercial |
$458.99
|
| Rate for Payer: First Health Commercial |
$525.35
|
| Rate for Payer: Humana Commercial |
$470.05
|
| Rate for Payer: Humana KY Medicaid |
$190.18
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$192.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$453.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$408.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$193.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$486.64
|
| Rate for Payer: Ohio Health Group HMO |
$414.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$442.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$481.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$381.57
|
| Rate for Payer: PHCS Commercial |
$530.88
|
| Rate for Payer: United Healthcare All Payer |
$486.64
|
|
|
KNEE 3V LEFT
|
Facility
|
IP
|
$553.00
|
|
|
Service Code
|
HCPCS 73562
|
| Hospital Charge Code |
32000100
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$165.90 |
| Max. Negotiated Rate |
$530.88 |
| Rate for Payer: Aetna Commercial |
$425.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$431.34
|
| Rate for Payer: Cash Price |
$276.50
|
| Rate for Payer: Cigna Commercial |
$458.99
|
| Rate for Payer: First Health Commercial |
$525.35
|
| Rate for Payer: Humana Commercial |
$470.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$453.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$408.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$486.64
|
| Rate for Payer: Ohio Health Group HMO |
$414.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$442.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$481.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$381.57
|
| Rate for Payer: PHCS Commercial |
$530.88
|
| Rate for Payer: United Healthcare All Payer |
$486.64
|
|
|
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 |
$75.00 |
| Rate for Payer: Aetna Commercial |
$51.42
|
| Rate for Payer: Ambetter Exchange |
$36.55
|
| Rate for Payer: Anthem Medicaid |
$23.39
|
| Rate for Payer: Buckeye Individual/Medicaid |
$36.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$36.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$43.86
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$36.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.55
|
| 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 |
$47.52
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$23.62
|
| Rate for Payer: Wellcare Medicare Advantage |
$36.55
|
|
|
KNEE 3V LEFT(T
|
Facility
|
OP
|
$428.00
|
|
|
Service Code
|
HCPCS 73562
|
| Hospital Charge Code |
320T0100
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$410.88 |
| Rate for Payer: Aetna Commercial |
$329.56
|
| Rate for Payer: Anthem Medicaid |
$147.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$333.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$214.00
|
| Rate for Payer: Cash Price |
$214.00
|
| Rate for Payer: Cigna Commercial |
$355.24
|
| Rate for Payer: First Health Commercial |
$406.60
|
| Rate for Payer: Humana Commercial |
$363.80
|
| Rate for Payer: Humana KY Medicaid |
$147.19
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$148.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$350.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$315.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$150.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$376.64
|
| Rate for Payer: Ohio Health Group HMO |
$321.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$342.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$372.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$295.32
|
| Rate for Payer: PHCS Commercial |
$410.88
|
| Rate for Payer: United Healthcare All Payer |
$376.64
|
|
|
KNEE 3V LEFT(T
|
Facility
|
IP
|
$428.00
|
|
|
Service Code
|
HCPCS 73562
|
| Hospital Charge Code |
320T0100
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$128.40 |
| Max. Negotiated Rate |
$410.88 |
| Rate for Payer: Aetna Commercial |
$329.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$333.84
|
| Rate for Payer: Cash Price |
$214.00
|
| Rate for Payer: Cigna Commercial |
$355.24
|
| Rate for Payer: First Health Commercial |
$406.60
|
| Rate for Payer: Humana Commercial |
$363.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$350.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$315.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$128.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$376.64
|
| Rate for Payer: Ohio Health Group HMO |
$321.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$342.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$372.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$295.32
|
| Rate for Payer: PHCS Commercial |
$410.88
|
| Rate for Payer: United Healthcare All Payer |
$376.64
|
|
|
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 |
$900.00 |
| Rate for Payer: Aetna Commercial |
$749.02
|
| Rate for Payer: Ambetter Exchange |
$492.24
|
| Rate for Payer: Anthem Medicaid |
$389.48
|
| Rate for Payer: Buckeye Individual/Medicaid |
$492.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$492.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$590.69
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$492.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$492.24
|
| 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 |
$639.91
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$393.37
|
| Rate for Payer: Wellcare Medicare Advantage |
$492.24
|
|
|
KNEE ARTHROSCOPY/DRAINAGE
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 29871
|
| Hospital Charge Code |
76101094
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$450.00 |
| 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 |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,305.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,035.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
KNEE ARTHROSCOPY/DRAINAGE
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 29871
|
| Hospital Charge Code |
76101094
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$515.85 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem Medicaid |
$515.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| 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 |
$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 |
$2,997.95
|
| 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 |
$3,597.54
|
| 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 |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,305.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,035.00
|
| 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 |
$900.00 |
| Rate for Payer: Aetna Commercial |
$749.02
|
| Rate for Payer: Ambetter Exchange |
$492.24
|
| Rate for Payer: Anthem Medicaid |
$389.48
|
| Rate for Payer: Buckeye Individual/Medicaid |
$492.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$492.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$590.69
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$492.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$492.24
|
| 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 |
$639.91
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$393.37
|
| Rate for Payer: Wellcare Medicare Advantage |
$492.24
|
|
|
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 |
$798.00 |
| Rate for Payer: Aetna Commercial |
$593.14
|
| Rate for Payer: Ambetter Exchange |
$394.93
|
| 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 Individual/Medicaid |
$394.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$394.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$473.92
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$394.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$394.93
|
| 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 |
$513.41
|
| Rate for Payer: UHCCP Medicaid |
$220.21
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$271.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$394.93
|
|
|
KNEE ARTHROSCOPY DX
|
Facility
|
OP
|
$1,330.00
|
|
|
Service Code
|
HCPCS 29870
|
| Hospital Charge Code |
76101093
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$457.39 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$1,024.10
|
| Rate for Payer: Anthem Medicaid |
$457.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,037.40
|
| 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 |
$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 |
$2,997.95
|
| 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 |
$3,597.54
|
| 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 |
$1,064.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,157.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$917.70
|
| 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 |
$399.00 |
| 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 |
$1,064.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,157.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$917.70
|
| Rate for Payer: PHCS Commercial |
$1,276.80
|
| Rate for Payer: United Healthcare All Payer |
$1,170.40
|
|
|
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 |
$798.00 |
| Rate for Payer: Aetna Commercial |
$593.14
|
| Rate for Payer: Ambetter Exchange |
$394.93
|
| 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 Individual/Medicaid |
$394.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$394.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$473.92
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$394.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$394.93
|
| 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 |
$513.41
|
| Rate for Payer: UHCCP Medicaid |
$220.21
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$271.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$394.93
|
|
|
KNEE ARTHROSCOPY/SURGERY
|
Facility
|
IP
|
$1,877.00
|
|
|
Service Code
|
HCPCS 29875
|
| Hospital Charge Code |
76101097
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$563.10 |
| 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 |
$1,501.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,632.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,295.13
|
| Rate for Payer: PHCS Commercial |
$1,801.92
|
| Rate for Payer: United Healthcare All Payer |
$1,651.76
|
|
|
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 |
$1,126.20 |
| Rate for Payer: Aetna Commercial |
$724.11
|
| Rate for Payer: Ambetter Exchange |
$473.93
|
| Rate for Payer: Anthem Medicaid |
$431.23
|
| Rate for Payer: Buckeye Individual/Medicaid |
$473.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$473.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$568.72
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$473.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$473.93
|
| 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 |
$616.11
|
| Rate for Payer: UHCCP Medicaid |
$656.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$435.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$473.93
|
|
|
KNEE ARTHROSCOPY/SURGERY
|
Facility
|
IP
|
$830.00
|
|
|
Service Code
|
HCPCS 29873
|
| Hospital Charge Code |
76101095
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$249.00 |
| 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 |
$664.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$722.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$572.70
|
| Rate for Payer: PHCS Commercial |
$796.80
|
| Rate for Payer: United Healthcare All Payer |
$730.40
|
|
|
KNEE ARTHROSCOPY/SURGERY
|
Facility
|
OP
|
$830.00
|
|
|
Service Code
|
HCPCS 29873
|
| Hospital Charge Code |
76101095
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$285.44 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$639.10
|
| Rate for Payer: Anthem Medicaid |
$285.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$647.40
|
| 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 |
$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 |
$2,997.95
|
| 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 |
$3,597.54
|
| 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 |
$664.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$722.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$572.70
|
| Rate for Payer: PHCS Commercial |
$796.80
|
| Rate for Payer: United Healthcare All Payer |
$730.40
|
|
|
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 |
$1,522.63 |
| Rate for Payer: Aetna Commercial |
$1,396.01
|
| Rate for Payer: Ambetter Exchange |
$886.12
|
| Rate for Payer: Anthem Medicaid |
$699.25
|
| Rate for Payer: Buckeye Individual/Medicaid |
$886.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$886.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,063.34
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$886.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$886.12
|
| 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 |
$1,151.96
|
| Rate for Payer: UHCCP Medicaid |
$820.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$706.24
|
| Rate for Payer: Wellcare Medicare Advantage |
$886.12
|
|
|
KNEE ARTHROSCOPY/SURGERY
|
Facility
|
OP
|
$1,877.00
|
|
|
Service Code
|
HCPCS 29875
|
| Hospital Charge Code |
76101097
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$645.50 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$1,445.29
|
| Rate for Payer: Anthem Medicaid |
$645.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,464.06
|
| 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 |
$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 |
$2,997.95
|
| 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 |
$3,597.54
|
| 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 |
$1,501.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,632.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,295.13
|
| Rate for Payer: PHCS Commercial |
$1,801.92
|
| Rate for Payer: United Healthcare All Payer |
$1,651.76
|
|
|
KNEE ARTHROSCOPY/SURGERY
|
Professional
|
Both
|
$830.00
|
|
|
Service Code
|
HCPCS 29873
|
| Hospital Charge Code |
76101095
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$290.50 |
| Max. Negotiated Rate |
$826.96 |
| Rate for Payer: Aetna Commercial |
$742.43
|
| Rate for Payer: Ambetter Exchange |
$511.18
|
| Rate for Payer: Anthem Medicaid |
$360.23
|
| Rate for Payer: Buckeye Individual/Medicaid |
$511.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$511.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$613.42
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$511.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$511.18
|
| 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 |
$664.53
|
| Rate for Payer: UHCCP Medicaid |
$290.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$363.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$511.18
|
|
|
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: Ambetter Exchange |
$1,164.41
|
| Rate for Payer: Anthem Medicaid |
$631.75
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,164.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,164.41
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,397.29
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,164.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,164.41
|
| 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 |
$1,513.73
|
| Rate for Payer: UHCCP Medicaid |
$498.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$638.07
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,164.41
|
|
|
KNEE ARTHROSCOPY/SURGERY
|
Facility
|
IP
|
$2,345.00
|
|
|
Service Code
|
HCPCS 29851
|
| Hospital Charge Code |
76101090
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$703.50 |
| 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 |
$1,876.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,040.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,618.05
|
| Rate for Payer: PHCS Commercial |
$2,251.20
|
| Rate for Payer: United Healthcare All Payer |
$2,063.60
|
|
|
KNEE ARTHROSCOPY/SURGERY
|
Facility
|
OP
|
$2,345.00
|
|
|
Service Code
|
HCPCS 29851
|
| Hospital Charge Code |
76101090
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$806.45 |
| 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 |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,829.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| 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 |
$1,478.75
|
| 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 |
$1,774.50
|
| 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 |
$1,876.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,040.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,618.05
|
| Rate for Payer: PHCS Commercial |
$2,251.20
|
| Rate for Payer: United Healthcare All Payer |
$2,063.60
|
|
|
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 |
$826.96 |
| Rate for Payer: Aetna Commercial |
$742.43
|
| Rate for Payer: Ambetter Exchange |
$511.18
|
| Rate for Payer: Anthem Medicaid |
$360.23
|
| Rate for Payer: Buckeye Individual/Medicaid |
$511.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$511.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$613.42
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$511.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$511.18
|
| 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 |
$664.53
|
| Rate for Payer: UHCCP Medicaid |
$290.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$363.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$511.18
|
|
