|
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 |
$1,126.20 |
| 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(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 |
$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 FIBERTAK BUTTON
|
Facility
|
OP
|
$12,583.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,774.97 |
| Max. Negotiated Rate |
$12,079.92 |
| Rate for Payer: Aetna Commercial |
$9,689.10
|
| Rate for Payer: Anthem Medicaid |
$4,327.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,814.93
|
| Rate for Payer: Cash Price |
$6,291.62
|
| Rate for Payer: Cigna Commercial |
$10,444.10
|
| Rate for Payer: First Health Commercial |
$11,954.09
|
| Rate for Payer: Humana Commercial |
$10,695.76
|
| Rate for Payer: Humana KY Medicaid |
$4,327.38
|
| Rate for Payer: Kentucky WC Medicaid |
$4,371.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,318.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,286.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,774.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,414.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,073.26
|
| Rate for Payer: Ohio Health Group HMO |
$9,437.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,066.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,947.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,682.44
|
| Rate for Payer: PHCS Commercial |
$12,079.92
|
| Rate for Payer: United Healthcare All Payer |
$11,073.26
|
|
|
KNEE FIBERTAK BUTTON
|
Facility
|
IP
|
$12,583.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,774.97 |
| Max. Negotiated Rate |
$12,079.92 |
| Rate for Payer: Aetna Commercial |
$9,689.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,814.93
|
| Rate for Payer: Cash Price |
$6,291.62
|
| Rate for Payer: Cigna Commercial |
$10,444.10
|
| Rate for Payer: First Health Commercial |
$11,954.09
|
| Rate for Payer: Humana Commercial |
$10,695.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,318.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,286.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,774.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,073.26
|
| Rate for Payer: Ohio Health Group HMO |
$9,437.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,066.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,947.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,682.44
|
| Rate for Payer: PHCS Commercial |
$12,079.92
|
| Rate for Payer: United Healthcare All Payer |
$11,073.26
|
|
|
KNEE FIBERTAK INTERNALBRACE
|
Facility
|
OP
|
$12,583.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,774.97 |
| Max. Negotiated Rate |
$12,079.92 |
| Rate for Payer: Aetna Commercial |
$9,689.10
|
| Rate for Payer: Anthem Medicaid |
$4,327.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,814.93
|
| Rate for Payer: Cash Price |
$6,291.62
|
| Rate for Payer: Cigna Commercial |
$10,444.10
|
| Rate for Payer: First Health Commercial |
$11,954.09
|
| Rate for Payer: Humana Commercial |
$10,695.76
|
| Rate for Payer: Humana KY Medicaid |
$4,327.38
|
| Rate for Payer: Kentucky WC Medicaid |
$4,371.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,318.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,286.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,774.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,414.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,073.26
|
| Rate for Payer: Ohio Health Group HMO |
$9,437.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,066.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,947.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,682.44
|
| Rate for Payer: PHCS Commercial |
$12,079.92
|
| Rate for Payer: United Healthcare All Payer |
$11,073.26
|
|
|
KNEE FIBERTAK INTERNALBRACE
|
Facility
|
IP
|
$12,583.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,774.97 |
| Max. Negotiated Rate |
$12,079.92 |
| Rate for Payer: Aetna Commercial |
$9,689.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,814.93
|
| Rate for Payer: Cash Price |
$6,291.62
|
| Rate for Payer: Cigna Commercial |
$10,444.10
|
| Rate for Payer: First Health Commercial |
$11,954.09
|
| Rate for Payer: Humana Commercial |
$10,695.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,318.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,286.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,774.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,073.26
|
| Rate for Payer: Ohio Health Group HMO |
$9,437.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,066.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,947.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,682.44
|
| Rate for Payer: PHCS Commercial |
$12,079.92
|
| Rate for Payer: United Healthcare All Payer |
$11,073.26
|
|
|
KNEE HINGE RAIL ASSY
|
Facility
|
OP
|
$7,117.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,135.16 |
| Max. Negotiated Rate |
$6,832.51 |
| Rate for Payer: Aetna Commercial |
$5,480.24
|
| Rate for Payer: Anthem Medicaid |
$2,447.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,551.42
|
| Rate for Payer: Cash Price |
$3,558.60
|
| Rate for Payer: Cigna Commercial |
$5,907.28
|
| Rate for Payer: First Health Commercial |
$6,761.34
|
| Rate for Payer: Humana Commercial |
$6,049.62
|
| Rate for Payer: Humana KY Medicaid |
$2,447.61
|
| Rate for Payer: Kentucky WC Medicaid |
$2,472.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,836.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,252.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,135.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,496.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,263.14
|
| Rate for Payer: Ohio Health Group HMO |
$5,337.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,693.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,191.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,910.87
|
| Rate for Payer: PHCS Commercial |
$6,832.51
|
| Rate for Payer: United Healthcare All Payer |
$6,263.14
|
|
|
KNEE HINGE RAIL ASSY
|
Facility
|
IP
|
$7,117.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,135.16 |
| Max. Negotiated Rate |
$6,832.51 |
| Rate for Payer: Aetna Commercial |
$5,480.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,551.42
|
| Rate for Payer: Cash Price |
$3,558.60
|
| Rate for Payer: Cigna Commercial |
$5,907.28
|
| Rate for Payer: First Health Commercial |
$6,761.34
|
| Rate for Payer: Humana Commercial |
$6,049.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,836.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,252.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,135.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,263.14
|
| Rate for Payer: Ohio Health Group HMO |
$5,337.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,693.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,191.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,910.87
|
| Rate for Payer: PHCS Commercial |
$6,832.51
|
| Rate for Payer: United Healthcare All Payer |
$6,263.14
|
|
|
KNEE HINGE RAIL SM ASSY
|
Facility
|
IP
|
$6,843.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,053.03 |
| Max. Negotiated Rate |
$6,569.71 |
| Rate for Payer: Aetna Commercial |
$5,269.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,337.89
|
| Rate for Payer: Cash Price |
$3,421.72
|
| Rate for Payer: Cigna Commercial |
$5,680.06
|
| Rate for Payer: First Health Commercial |
$6,501.28
|
| Rate for Payer: Humana Commercial |
$5,816.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,611.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,050.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,053.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,022.24
|
| Rate for Payer: Ohio Health Group HMO |
$5,132.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,474.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,953.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,721.98
|
| Rate for Payer: PHCS Commercial |
$6,569.71
|
| Rate for Payer: United Healthcare All Payer |
$6,022.24
|
|
|
KNEE HINGE RAIL SM ASSY
|
Facility
|
OP
|
$6,843.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,053.03 |
| Max. Negotiated Rate |
$6,569.71 |
| Rate for Payer: Aetna Commercial |
$5,269.46
|
| Rate for Payer: Anthem Medicaid |
$2,353.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,337.89
|
| Rate for Payer: Cash Price |
$3,421.72
|
| Rate for Payer: Cigna Commercial |
$5,680.06
|
| Rate for Payer: First Health Commercial |
$6,501.28
|
| Rate for Payer: Humana Commercial |
$5,816.93
|
| Rate for Payer: Humana KY Medicaid |
$2,353.46
|
| Rate for Payer: Kentucky WC Medicaid |
$2,377.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,611.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,050.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,053.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,400.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,022.24
|
| Rate for Payer: Ohio Health Group HMO |
$5,132.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,474.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,953.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,721.98
|
| Rate for Payer: PHCS Commercial |
$6,569.71
|
| Rate for Payer: United Healthcare All Payer |
$6,022.24
|
|
|
KNEE LT: COMPLETE 4 OR MORE V
|
Facility
|
IP
|
$544.00
|
|
|
Service Code
|
HCPCS 73564
|
| Hospital Charge Code |
320T0101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$163.20 |
| Max. Negotiated Rate |
$522.24 |
| Rate for Payer: Aetna Commercial |
$418.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$424.32
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Cigna Commercial |
$451.52
|
| Rate for Payer: First Health Commercial |
$516.80
|
| Rate for Payer: Humana Commercial |
$462.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$446.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$401.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$163.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$478.72
|
| Rate for Payer: Ohio Health Group HMO |
$408.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$435.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$473.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$375.36
|
| Rate for Payer: PHCS Commercial |
$522.24
|
| Rate for Payer: United Healthcare All Payer |
$478.72
|
|
|
KNEE LT: COMPLETE 4 OR MORE V
|
Professional
|
Both
|
$639.00
|
|
|
Service Code
|
HCPCS 73564
|
| Hospital Charge Code |
32000101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$383.40 |
| Rate for Payer: Aetna Commercial |
$59.61
|
| Rate for Payer: Ambetter Exchange |
$42.56
|
| Rate for Payer: Anthem Medicaid |
$26.42
|
| Rate for Payer: Buckeye Individual/Medicaid |
$42.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$42.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$51.07
|
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Cash Price |
$319.50
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$42.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$26.95
|
| Rate for Payer: Molina Healthcare Passport |
$26.42
|
| Rate for Payer: Multiplan PHCS |
$383.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$55.33
|
| Rate for Payer: UHCCP Medicaid |
$223.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$26.68
|
| Rate for Payer: Wellcare Medicare Advantage |
$42.56
|
|
|
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 |
$59.61 |
| Rate for Payer: Aetna Commercial |
$59.61
|
| Rate for Payer: Ambetter Exchange |
$42.56
|
| Rate for Payer: Anthem Medicaid |
$26.42
|
| Rate for Payer: Buckeye Individual/Medicaid |
$42.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$42.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$51.07
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$42.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.56
|
| 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 |
$55.33
|
| Rate for Payer: UHCCP Medicaid |
$33.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$26.68
|
| Rate for Payer: Wellcare Medicare Advantage |
$42.56
|
|
|
KNEE LT: COMPLETE 4 OR MORE V
|
Facility
|
OP
|
$639.00
|
|
|
Service Code
|
HCPCS 73564
|
| Hospital Charge Code |
32000101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$613.44 |
| Rate for Payer: Aetna Commercial |
$492.03
|
| Rate for Payer: Anthem Medicaid |
$219.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$498.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Cigna Commercial |
$530.37
|
| Rate for Payer: First Health Commercial |
$607.05
|
| Rate for Payer: Humana Commercial |
$543.15
|
| Rate for Payer: Humana KY Medicaid |
$219.75
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$221.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$523.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$471.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$224.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$562.32
|
| Rate for Payer: Ohio Health Group HMO |
$479.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$511.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$555.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$440.91
|
| Rate for Payer: PHCS Commercial |
$613.44
|
| Rate for Payer: United Healthcare All Payer |
$562.32
|
|
|
KNEE LT: COMPLETE 4 OR MORE V
|
Facility
|
OP
|
$544.00
|
|
|
Service Code
|
HCPCS 73564
|
| Hospital Charge Code |
320T0101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$522.24 |
| Rate for Payer: Aetna Commercial |
$418.88
|
| Rate for Payer: Anthem Medicaid |
$187.08
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$424.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Cigna Commercial |
$451.52
|
| Rate for Payer: First Health Commercial |
$516.80
|
| Rate for Payer: Humana Commercial |
$462.40
|
| Rate for Payer: Humana KY Medicaid |
$187.08
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$188.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$446.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$401.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$190.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$478.72
|
| Rate for Payer: Ohio Health Group HMO |
$408.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$435.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$473.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$375.36
|
| Rate for Payer: PHCS Commercial |
$522.24
|
| Rate for Payer: United Healthcare All Payer |
$478.72
|
|
|
KNEE LT: COMPLETE 4 OR MORE V
|
Facility
|
IP
|
$639.00
|
|
|
Service Code
|
HCPCS 73564
|
| Hospital Charge Code |
32000101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$191.70 |
| Max. Negotiated Rate |
$613.44 |
| Rate for Payer: Aetna Commercial |
$492.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$498.42
|
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Cigna Commercial |
$530.37
|
| Rate for Payer: First Health Commercial |
$607.05
|
| Rate for Payer: Humana Commercial |
$543.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$523.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$471.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$191.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$562.32
|
| Rate for Payer: Ohio Health Group HMO |
$479.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$511.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$555.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$440.91
|
| Rate for Payer: PHCS Commercial |
$613.44
|
| Rate for Payer: United Healthcare All Payer |
$562.32
|
|
|
KNOT PUSH-SUT CUT ULT FAST FIX
|
Facility
|
IP
|
$1,794.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$538.49 |
| Max. Negotiated Rate |
$1,723.15 |
| Rate for Payer: Aetna Commercial |
$1,382.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,400.06
|
| Rate for Payer: Cash Price |
$897.48
|
| Rate for Payer: Cigna Commercial |
$1,489.81
|
| Rate for Payer: First Health Commercial |
$1,705.20
|
| Rate for Payer: Humana Commercial |
$1,525.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,471.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,324.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$538.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,579.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,346.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,435.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,561.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,238.52
|
| Rate for Payer: PHCS Commercial |
$1,723.15
|
| Rate for Payer: United Healthcare All Payer |
$1,579.56
|
|
|
KNOT PUSH-SUT CUT ULT FAST FIX
|
Facility
|
OP
|
$1,794.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$538.49 |
| Max. Negotiated Rate |
$1,723.15 |
| Rate for Payer: Aetna Commercial |
$1,382.11
|
| Rate for Payer: Anthem Medicaid |
$617.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,400.06
|
| Rate for Payer: Cash Price |
$897.48
|
| Rate for Payer: Cigna Commercial |
$1,489.81
|
| Rate for Payer: First Health Commercial |
$1,705.20
|
| Rate for Payer: Humana Commercial |
$1,525.71
|
| Rate for Payer: Humana KY Medicaid |
$617.28
|
| Rate for Payer: Kentucky WC Medicaid |
$623.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,471.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,324.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$538.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$629.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,579.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,346.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,435.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,561.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,238.52
|
| Rate for Payer: PHCS Commercial |
$1,723.15
|
| Rate for Payer: United Healthcare All Payer |
$1,579.56
|
|
|
KOH PREP SKIN/HAIR/NAIL
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
HCPCS 87220
|
| Hospital Charge Code |
30001338
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$35.52 |
| Rate for Payer: Aetna Commercial |
$28.49
|
| Rate for Payer: Anthem Medicaid |
$4.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29.71
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$5.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.27
|
| Rate for Payer: Cash Price |
$18.50
|
| Rate for Payer: Cash Price |
$18.50
|
| Rate for Payer: Cigna Commercial |
$30.71
|
| Rate for Payer: First Health Commercial |
$35.15
|
| Rate for Payer: Humana Commercial |
$31.45
|
| Rate for Payer: Humana KY Medicaid |
$4.27
|
| Rate for Payer: Humana Medicare Advantage |
$4.27
|
| Rate for Payer: Kentucky WC Medicaid |
$4.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$32.56
|
| Rate for Payer: Ohio Health Group HMO |
$27.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25.53
|
| Rate for Payer: PHCS Commercial |
$35.52
|
| Rate for Payer: United Healthcare All Payer |
$32.56
|
|
|
KOH PREP SKIN/HAIR/NAIL
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
HCPCS 87220
|
| Hospital Charge Code |
30001338
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.10 |
| Max. Negotiated Rate |
$35.52 |
| Rate for Payer: Aetna Commercial |
$28.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29.71
|
| Rate for Payer: Cash Price |
$18.50
|
| Rate for Payer: Cigna Commercial |
$30.71
|
| Rate for Payer: First Health Commercial |
$35.15
|
| Rate for Payer: Humana Commercial |
$31.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$32.56
|
| Rate for Payer: Ohio Health Group HMO |
$27.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25.53
|
| Rate for Payer: PHCS Commercial |
$35.52
|
| Rate for Payer: United Healthcare All Payer |
$32.56
|
|
|
K-PHOS NEUTRAL TAB (COMBI 1TAB
|
Facility
|
OP
|
$4.69
|
|
|
Service Code
|
NDC 39328010710
|
| Hospital Charge Code |
25000825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Aetna Commercial |
$3.61
|
| Rate for Payer: Anthem Medicaid |
$1.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.66
|
| Rate for Payer: Cash Price |
$2.35
|
| Rate for Payer: Cigna Commercial |
$3.89
|
| Rate for Payer: First Health Commercial |
$4.46
|
| Rate for Payer: Humana Commercial |
$3.99
|
| Rate for Payer: Humana KY Medicaid |
$1.61
|
| 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 |
$3.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.13
|
| Rate for Payer: Ohio Health Group HMO |
$3.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.24
|
| Rate for Payer: PHCS Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Payer |
$4.13
|
|
|
K-PHOS NEUTRAL TAB (COMBI 1TAB
|
Facility
|
IP
|
$4.69
|
|
|
Service Code
|
NDC 39328010710
|
| Hospital Charge Code |
25000825
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Aetna Commercial |
$3.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.66
|
| Rate for Payer: Cash Price |
$2.35
|
| Rate for Payer: Cigna Commercial |
$3.89
|
| Rate for Payer: First Health Commercial |
$4.46
|
| Rate for Payer: Humana Commercial |
$3.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.13
|
| Rate for Payer: Ohio Health Group HMO |
$3.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.24
|
| Rate for Payer: PHCS Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Payer |
$4.13
|
|
|
KPHOS(POT PHOSPHATE) 500MG TAB
|
Facility
|
IP
|
$4.69
|
|
|
Service Code
|
NDC 486111101
|
| Hospital Charge Code |
25000826
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Aetna Commercial |
$3.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.66
|
| Rate for Payer: Cash Price |
$2.35
|
| Rate for Payer: Cigna Commercial |
$3.89
|
| Rate for Payer: First Health Commercial |
$4.46
|
| Rate for Payer: Humana Commercial |
$3.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.13
|
| Rate for Payer: Ohio Health Group HMO |
$3.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.24
|
| Rate for Payer: PHCS Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Payer |
$4.13
|
|
|
KPHOS(POT PHOSPHATE) 500MG TAB
|
Facility
|
OP
|
$4.69
|
|
|
Service Code
|
NDC 486111101
|
| Hospital Charge Code |
25000826
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Aetna Commercial |
$3.61
|
| Rate for Payer: Anthem Medicaid |
$1.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.66
|
| Rate for Payer: Cash Price |
$2.35
|
| Rate for Payer: Cigna Commercial |
$3.89
|
| Rate for Payer: First Health Commercial |
$4.46
|
| Rate for Payer: Humana Commercial |
$3.99
|
| Rate for Payer: Humana KY Medicaid |
$1.61
|
| 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 |
$3.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.13
|
| Rate for Payer: Ohio Health Group HMO |
$3.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.24
|
| Rate for Payer: PHCS Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Payer |
$4.13
|
|
|
KREULCK COMP SCREW SS 2.7*12MM
|
Facility
|
OP
|
$3,161.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$948.47 |
| Max. Negotiated Rate |
$3,035.10 |
| Rate for Payer: Aetna Commercial |
$2,434.40
|
| Rate for Payer: Anthem Medicaid |
$1,087.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,466.02
|
| Rate for Payer: Cash Price |
$1,580.78
|
| Rate for Payer: Cigna Commercial |
$2,624.09
|
| Rate for Payer: First Health Commercial |
$3,003.48
|
| Rate for Payer: Humana Commercial |
$2,687.33
|
| Rate for Payer: Humana KY Medicaid |
$1,087.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,098.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,592.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,333.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$948.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,109.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,782.17
|
| Rate for Payer: Ohio Health Group HMO |
$2,371.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,529.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,750.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,181.48
|
| Rate for Payer: PHCS Commercial |
$3,035.10
|
| Rate for Payer: United Healthcare All Payer |
$2,782.17
|
|
