|
ARTH GLENOHUMERAL JT TOT SHLDR
|
Facility
|
OP
|
$4,400.00
|
|
|
Service Code
|
HCPCS 23472
|
| Hospital Charge Code |
76100466
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$572.00 |
| Max. Negotiated Rate |
$22,561.84 |
| Rate for Payer: Aetna Commercial |
$3,388.00
|
| Rate for Payer: Anthem Medicaid |
$1,513.16
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16,115.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,432.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$22,561.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$21,756.06
|
| Rate for Payer: Cash Price |
$2,200.00
|
| Rate for Payer: Cash Price |
$2,200.00
|
| Rate for Payer: Cigna Commercial |
$3,652.00
|
| Rate for Payer: First Health Commercial |
$4,180.00
|
| Rate for Payer: Humana Commercial |
$3,740.00
|
| Rate for Payer: Humana KY Medicaid |
$1,513.16
|
| Rate for Payer: Humana Medicare Advantage |
$16,115.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1,528.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,608.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,247.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19,338.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,543.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,872.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,300.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$572.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,364.00
|
| Rate for Payer: PHCS Commercial |
$4,224.00
|
| Rate for Payer: United Healthcare All Payer |
$3,872.00
|
|
|
ARTH KNEE ABR ARTH/MLT DRL/MFX
|
Professional
|
Both
|
$1,875.00
|
|
|
Service Code
|
HCPCS 29879
|
| Hospital Charge Code |
76101100
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$538.89 |
| Max. Negotiated Rate |
$1,875.00 |
| Rate for Payer: Aetna Commercial |
$963.04
|
| Rate for Payer: Anthem Medicaid |
$538.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,875.00
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,050.37
|
| Rate for Payer: Healthspan PPO |
$872.31
|
| Rate for Payer: Humana Medicaid |
$538.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$822.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$549.67
|
| Rate for Payer: Molina Healthcare Passport |
$538.89
|
| Rate for Payer: Multiplan PHCS |
$1,125.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,312.50
|
| Rate for Payer: UHCCP Medicaid |
$656.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$544.28
|
|
|
ARTH KNEE ABR ARTH/MLT DRL/MFX
|
Professional
|
Both
|
$1,875.00
|
|
|
Service Code
|
HCPCS 29879
|
| Hospital Charge Code |
761P1100
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$538.89 |
| Max. Negotiated Rate |
$1,875.00 |
| Rate for Payer: Aetna Commercial |
$963.04
|
| Rate for Payer: Anthem Medicaid |
$538.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,875.00
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,050.37
|
| Rate for Payer: Healthspan PPO |
$872.31
|
| Rate for Payer: Humana Medicaid |
$538.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$822.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$549.67
|
| Rate for Payer: Molina Healthcare Passport |
$538.89
|
| Rate for Payer: Multiplan PHCS |
$1,125.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,312.50
|
| Rate for Payer: UHCCP Medicaid |
$656.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$544.28
|
|
|
ARTH KNEE ABR ARTH/MLT DRL/MFX
|
Facility
|
OP
|
$1,875.00
|
|
|
Service Code
|
HCPCS 29879
|
| Hospital Charge Code |
76101100
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$243.75 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$1,443.75
|
| Rate for Payer: Anthem Medicaid |
$644.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,462.50
|
| 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 |
$937.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,556.25
|
| Rate for Payer: First Health Commercial |
$1,781.25
|
| Rate for Payer: Humana Commercial |
$1,593.75
|
| Rate for Payer: Humana KY Medicaid |
$644.81
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$651.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,537.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,383.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$657.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,650.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$375.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$581.25
|
| Rate for Payer: PHCS Commercial |
$1,800.00
|
| Rate for Payer: United Healthcare All Payer |
$1,650.00
|
|
|
ARTH KNEE ABR ARTH/MLT DRL/MFX
|
Facility
|
IP
|
$1,875.00
|
|
|
Service Code
|
HCPCS 29879
|
| Hospital Charge Code |
76101100
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$243.75 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,443.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,462.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,556.25
|
| Rate for Payer: First Health Commercial |
$1,781.25
|
| Rate for Payer: Humana Commercial |
$1,593.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,537.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,383.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,650.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$375.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$581.25
|
| Rate for Payer: PHCS Commercial |
$1,800.00
|
| Rate for Payer: United Healthcare All Payer |
$1,650.00
|
|
|
ARTH KNEE DBD/SHAV ARTCLR CR(P
|
Professional
|
Both
|
$1,875.00
|
|
|
Service Code
|
HCPCS 29877
|
| Hospital Charge Code |
761P1099
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$493.05 |
| Max. Negotiated Rate |
$1,875.00 |
| Rate for Payer: Aetna Commercial |
$898.78
|
| Rate for Payer: Anthem Medicaid |
$493.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,875.00
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$980.12
|
| Rate for Payer: Healthspan PPO |
$814.10
|
| Rate for Payer: Humana Medicaid |
$493.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$769.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$502.91
|
| Rate for Payer: Molina Healthcare Passport |
$493.05
|
| Rate for Payer: Multiplan PHCS |
$1,125.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,312.50
|
| Rate for Payer: UHCCP Medicaid |
$656.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$497.98
|
|
|
ARTH KNEE DBD/SHAV ARTCLR CRT
|
Facility
|
IP
|
$1,875.00
|
|
|
Service Code
|
HCPCS 29877
|
| Hospital Charge Code |
76101099
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$243.75 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,443.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,462.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,556.25
|
| Rate for Payer: First Health Commercial |
$1,781.25
|
| Rate for Payer: Humana Commercial |
$1,593.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,537.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,383.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,650.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$375.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$581.25
|
| Rate for Payer: PHCS Commercial |
$1,800.00
|
| Rate for Payer: United Healthcare All Payer |
$1,650.00
|
|
|
ARTH KNEE DBD/SHAV ARTCLR CRT
|
Facility
|
OP
|
$1,875.00
|
|
|
Service Code
|
HCPCS 29877
|
| Hospital Charge Code |
76101099
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$243.75 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$1,443.75
|
| Rate for Payer: Anthem Medicaid |
$644.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,462.50
|
| 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 |
$937.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,556.25
|
| Rate for Payer: First Health Commercial |
$1,781.25
|
| Rate for Payer: Humana Commercial |
$1,593.75
|
| Rate for Payer: Humana KY Medicaid |
$644.81
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$651.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,537.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,383.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$657.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,650.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$375.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$581.25
|
| Rate for Payer: PHCS Commercial |
$1,800.00
|
| Rate for Payer: United Healthcare All Payer |
$1,650.00
|
|
|
ARTH KNEE DBD/SHAV ARTCLR CRT
|
Professional
|
Both
|
$1,875.00
|
|
|
Service Code
|
HCPCS 29877
|
| Hospital Charge Code |
76101099
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$493.05 |
| Max. Negotiated Rate |
$1,875.00 |
| Rate for Payer: Aetna Commercial |
$898.78
|
| Rate for Payer: Anthem Medicaid |
$493.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,875.00
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$980.12
|
| Rate for Payer: Healthspan PPO |
$814.10
|
| Rate for Payer: Humana Medicaid |
$493.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$769.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$502.91
|
| Rate for Payer: Molina Healthcare Passport |
$493.05
|
| Rate for Payer: Multiplan PHCS |
$1,125.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,312.50
|
| Rate for Payer: UHCCP Medicaid |
$656.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$497.98
|
|
|
ARTH KNEE DRLG OSTCHND DSSCN(P
|
Professional
|
Both
|
$2,300.00
|
|
|
Service Code
|
HCPCS 29887
|
| Hospital Charge Code |
761P1107
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$575.48 |
| Max. Negotiated Rate |
$2,300.00 |
| Rate for Payer: Aetna Commercial |
$1,082.87
|
| Rate for Payer: Anthem Medicaid |
$575.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,300.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cigna Commercial |
$1,180.53
|
| Rate for Payer: Healthspan PPO |
$980.85
|
| Rate for Payer: Humana Medicaid |
$575.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$924.91
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$586.99
|
| Rate for Payer: Molina Healthcare Passport |
$575.48
|
| Rate for Payer: Multiplan PHCS |
$1,380.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,610.00
|
| Rate for Payer: UHCCP Medicaid |
$805.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$581.23
|
|
|
ARTH KNEE DRLG OSTCHND DSSCNS
|
Facility
|
OP
|
$2,300.00
|
|
|
Service Code
|
HCPCS 29887
|
| Hospital Charge Code |
76101107
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$299.00 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$1,771.00
|
| Rate for Payer: Anthem Medicaid |
$790.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,794.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,661.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,351.78
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cigna Commercial |
$1,909.00
|
| Rate for Payer: First Health Commercial |
$2,185.00
|
| Rate for Payer: Humana Commercial |
$1,955.00
|
| Rate for Payer: Humana KY Medicaid |
$790.97
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$799.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,886.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,697.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$806.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,024.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$460.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$299.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$713.00
|
| Rate for Payer: PHCS Commercial |
$2,208.00
|
| Rate for Payer: United Healthcare All Payer |
$2,024.00
|
|
|
ARTH KNEE DRLG OSTCHND DSSCNS
|
Professional
|
Both
|
$2,300.00
|
|
|
Service Code
|
HCPCS 29887
|
| Hospital Charge Code |
76101107
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$575.48 |
| Max. Negotiated Rate |
$2,300.00 |
| Rate for Payer: Aetna Commercial |
$1,082.87
|
| Rate for Payer: Anthem Medicaid |
$575.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,300.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cigna Commercial |
$1,180.53
|
| Rate for Payer: Healthspan PPO |
$980.85
|
| Rate for Payer: Humana Medicaid |
$575.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$924.91
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$586.99
|
| Rate for Payer: Molina Healthcare Passport |
$575.48
|
| Rate for Payer: Multiplan PHCS |
$1,380.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,610.00
|
| Rate for Payer: UHCCP Medicaid |
$805.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$581.23
|
|
|
ARTH KNEE DRLG OSTCHND DSSCNS
|
Facility
|
IP
|
$2,300.00
|
|
|
Service Code
|
HCPCS 29887
|
| Hospital Charge Code |
76101107
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$299.00 |
| Max. Negotiated Rate |
$2,208.00 |
| Rate for Payer: Aetna Commercial |
$1,771.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,794.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cigna Commercial |
$1,909.00
|
| Rate for Payer: First Health Commercial |
$2,185.00
|
| Rate for Payer: Humana Commercial |
$1,955.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,886.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,697.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$690.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,024.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$460.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$299.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$713.00
|
| Rate for Payer: PHCS Commercial |
$2,208.00
|
| Rate for Payer: United Healthcare All Payer |
$2,024.00
|
|
|
ARTH KNEE DRLL OSTCHND DSSCNS
|
Facility
|
IP
|
$840.00
|
|
|
Service Code
|
HCPCS 29886
|
| Hospital Charge Code |
76101106
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$806.40 |
| Rate for Payer: Aetna Commercial |
$646.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$655.20
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$697.20
|
| Rate for Payer: First Health Commercial |
$798.00
|
| Rate for Payer: Humana Commercial |
$714.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$688.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$619.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$252.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$739.20
|
| Rate for Payer: Ohio Health Group HMO |
$630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$168.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$109.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$260.40
|
| Rate for Payer: PHCS Commercial |
$806.40
|
| Rate for Payer: United Healthcare All Payer |
$739.20
|
|
|
ARTH KNEE DRLL OSTCHND DSSCNS
|
Professional
|
Both
|
$840.00
|
|
|
Service Code
|
HCPCS 29886
|
| Hospital Charge Code |
761P1106
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$294.00 |
| Max. Negotiated Rate |
$999.01 |
| Rate for Payer: Aetna Commercial |
$916.53
|
| Rate for Payer: Anthem Medicaid |
$418.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$840.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$999.01
|
| Rate for Payer: Healthspan PPO |
$830.18
|
| Rate for Payer: Humana Medicaid |
$418.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$785.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$427.20
|
| Rate for Payer: Molina Healthcare Passport |
$418.82
|
| Rate for Payer: Multiplan PHCS |
$504.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$588.00
|
| Rate for Payer: UHCCP Medicaid |
$294.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$423.01
|
|
|
ARTH KNEE DRLL OSTCHND DSSCNS
|
Facility
|
OP
|
$840.00
|
|
|
Service Code
|
HCPCS 29886
|
| Hospital Charge Code |
76101106
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$646.80
|
| Rate for Payer: Anthem Medicaid |
$288.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$655.20
|
| 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 |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$697.20
|
| Rate for Payer: First Health Commercial |
$798.00
|
| Rate for Payer: Humana Commercial |
$714.00
|
| Rate for Payer: Humana KY Medicaid |
$288.88
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$291.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$688.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$619.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$294.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$739.20
|
| Rate for Payer: Ohio Health Group HMO |
$630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$168.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$109.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$260.40
|
| Rate for Payer: PHCS Commercial |
$806.40
|
| Rate for Payer: United Healthcare All Payer |
$739.20
|
|
|
ARTH KNEE DRLL OSTCHND DSSCNS
|
Professional
|
Both
|
$840.00
|
|
|
Service Code
|
HCPCS 29886
|
| Hospital Charge Code |
76101106
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$294.00 |
| Max. Negotiated Rate |
$999.01 |
| Rate for Payer: Aetna Commercial |
$916.53
|
| Rate for Payer: Anthem Medicaid |
$418.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$840.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$999.01
|
| Rate for Payer: Healthspan PPO |
$830.18
|
| Rate for Payer: Humana Medicaid |
$418.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$785.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$427.20
|
| Rate for Payer: Molina Healthcare Passport |
$418.82
|
| Rate for Payer: Multiplan PHCS |
$504.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$588.00
|
| Rate for Payer: UHCCP Medicaid |
$294.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$423.01
|
|
|
ARTH KNEE SYNVCTMY 2/>COMP
|
Facility
|
IP
|
$2,117.00
|
|
|
Service Code
|
HCPCS 29876
|
| Hospital Charge Code |
76101098
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$275.21 |
| Max. Negotiated Rate |
$2,032.32 |
| Rate for Payer: Aetna Commercial |
$1,630.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,651.26
|
| Rate for Payer: Cash Price |
$1,058.50
|
| Rate for Payer: Cigna Commercial |
$1,757.11
|
| Rate for Payer: First Health Commercial |
$2,011.15
|
| Rate for Payer: Humana Commercial |
$1,799.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,735.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,562.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$635.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,862.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,587.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$423.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$275.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$656.27
|
| Rate for Payer: PHCS Commercial |
$2,032.32
|
| Rate for Payer: United Healthcare All Payer |
$1,862.96
|
|
|
ARTH KNEE SYNVCTMY 2/>COMP
|
Professional
|
Both
|
$2,117.00
|
|
|
Service Code
|
HCPCS 29876
|
| Hospital Charge Code |
76101098
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$525.51 |
| Max. Negotiated Rate |
$2,117.00 |
| Rate for Payer: Aetna Commercial |
$950.93
|
| Rate for Payer: Anthem Medicaid |
$525.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,117.00
|
| Rate for Payer: Cash Price |
$1,058.50
|
| Rate for Payer: Cash Price |
$1,058.50
|
| Rate for Payer: Cigna Commercial |
$1,036.77
|
| Rate for Payer: Healthspan PPO |
$861.34
|
| Rate for Payer: Humana Medicaid |
$525.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$813.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$536.02
|
| Rate for Payer: Molina Healthcare Passport |
$525.51
|
| Rate for Payer: Multiplan PHCS |
$1,270.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,481.90
|
| Rate for Payer: UHCCP Medicaid |
$740.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$530.77
|
|
|
ARTH KNEE SYNVCTMY 2/>COMP
|
Facility
|
OP
|
$2,117.00
|
|
|
Service Code
|
HCPCS 29876
|
| Hospital Charge Code |
76101098
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$275.21 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$1,630.09
|
| Rate for Payer: Anthem Medicaid |
$728.04
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,651.26
|
| 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 |
$1,058.50
|
| Rate for Payer: Cash Price |
$1,058.50
|
| Rate for Payer: Cigna Commercial |
$1,757.11
|
| Rate for Payer: First Health Commercial |
$2,011.15
|
| Rate for Payer: Humana Commercial |
$1,799.45
|
| Rate for Payer: Humana KY Medicaid |
$728.04
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$735.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,735.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,562.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$742.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,862.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,587.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$423.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$275.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$656.27
|
| Rate for Payer: PHCS Commercial |
$2,032.32
|
| Rate for Payer: United Healthcare All Payer |
$1,862.96
|
|
|
ARTH KNEE SYNVCTMY 2/>COMP(P
|
Professional
|
Both
|
$2,117.00
|
|
|
Service Code
|
HCPCS 29876
|
| Hospital Charge Code |
761P1098
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$525.51 |
| Max. Negotiated Rate |
$2,117.00 |
| Rate for Payer: Aetna Commercial |
$950.93
|
| Rate for Payer: Anthem Medicaid |
$525.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,117.00
|
| Rate for Payer: Cash Price |
$1,058.50
|
| Rate for Payer: Cash Price |
$1,058.50
|
| Rate for Payer: Cigna Commercial |
$1,036.77
|
| Rate for Payer: Healthspan PPO |
$861.34
|
| Rate for Payer: Humana Medicaid |
$525.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$813.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$536.02
|
| Rate for Payer: Molina Healthcare Passport |
$525.51
|
| Rate for Payer: Multiplan PHCS |
$1,270.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,481.90
|
| Rate for Payer: UHCCP Medicaid |
$740.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$530.77
|
|
|
ARTH KNEE W/MNSCCTMY M/L WSHAV
|
Facility
|
IP
|
$2,375.00
|
|
|
Service Code
|
HCPCS 29880
|
| Hospital Charge Code |
76101101
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$308.75 |
| Max. Negotiated Rate |
$2,280.00 |
| Rate for Payer: Aetna Commercial |
$1,828.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,852.50
|
| Rate for Payer: Cash Price |
$1,187.50
|
| Rate for Payer: Cigna Commercial |
$1,971.25
|
| Rate for Payer: First Health Commercial |
$2,256.25
|
| Rate for Payer: Humana Commercial |
$2,018.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,947.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,752.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$712.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,090.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,781.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$475.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$308.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$736.25
|
| Rate for Payer: PHCS Commercial |
$2,280.00
|
| Rate for Payer: United Healthcare All Payer |
$2,090.00
|
|
|
ARTH KNEE W/MNSCCTMY M/L WSHAV
|
Professional
|
Both
|
$2,375.00
|
|
|
Service Code
|
HCPCS 29880
|
| Hospital Charge Code |
76101101
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$568.94 |
| Max. Negotiated Rate |
$2,375.00 |
| Rate for Payer: Aetna Commercial |
$1,006.53
|
| Rate for Payer: Anthem Medicaid |
$568.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,375.00
|
| Rate for Payer: Cash Price |
$1,187.50
|
| Rate for Payer: Cash Price |
$1,187.50
|
| Rate for Payer: Cigna Commercial |
$1,097.20
|
| Rate for Payer: Healthspan PPO |
$911.70
|
| Rate for Payer: Humana Medicaid |
$568.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$857.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$580.32
|
| Rate for Payer: Molina Healthcare Passport |
$568.94
|
| Rate for Payer: Multiplan PHCS |
$1,425.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,662.50
|
| Rate for Payer: UHCCP Medicaid |
$831.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$574.63
|
|
|
ARTH KNEE W/MNSCCTMY M/L WSHAV
|
Facility
|
OP
|
$2,375.00
|
|
|
Service Code
|
HCPCS 29880
|
| Hospital Charge Code |
76101101
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$308.75 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$1,828.75
|
| Rate for Payer: Anthem Medicaid |
$816.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,852.50
|
| 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 |
$1,187.50
|
| Rate for Payer: Cash Price |
$1,187.50
|
| Rate for Payer: Cigna Commercial |
$1,971.25
|
| Rate for Payer: First Health Commercial |
$2,256.25
|
| Rate for Payer: Humana Commercial |
$2,018.75
|
| Rate for Payer: Humana KY Medicaid |
$816.76
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$825.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,947.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,752.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$833.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,090.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,781.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$475.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$308.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$736.25
|
| Rate for Payer: PHCS Commercial |
$2,280.00
|
| Rate for Payer: United Healthcare All Payer |
$2,090.00
|
|
|
ARTH KNEE W/MNSCCTMY M/L WSHAV
|
Professional
|
Both
|
$2,375.00
|
|
|
Service Code
|
HCPCS 29880
|
| Hospital Charge Code |
761P1101
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$568.94 |
| Max. Negotiated Rate |
$2,375.00 |
| Rate for Payer: Aetna Commercial |
$1,006.53
|
| Rate for Payer: Anthem Medicaid |
$568.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,375.00
|
| Rate for Payer: Cash Price |
$1,187.50
|
| Rate for Payer: Cash Price |
$1,187.50
|
| Rate for Payer: Cigna Commercial |
$1,097.20
|
| Rate for Payer: Healthspan PPO |
$911.70
|
| Rate for Payer: Humana Medicaid |
$568.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$857.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$580.32
|
| Rate for Payer: Molina Healthcare Passport |
$568.94
|
| Rate for Payer: Multiplan PHCS |
$1,425.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,662.50
|
| Rate for Payer: UHCCP Medicaid |
$831.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$574.63
|
|
