|
ARTH KNEE W/MNSCCTMY M/L WSH(P
|
Professional
|
Both
|
$2,050.00
|
|
|
Service Code
|
HCPCS 29881
|
| Hospital Charge Code |
761P1102
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$519.01 |
| Max. Negotiated Rate |
$2,050.00 |
| Rate for Payer: Aetna Commercial |
$936.35
|
| Rate for Payer: Anthem Medicaid |
$519.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,050.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,021.76
|
| Rate for Payer: Healthspan PPO |
$848.13
|
| Rate for Payer: Humana Medicaid |
$519.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$800.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$529.39
|
| Rate for Payer: Molina Healthcare Passport |
$519.01
|
| Rate for Payer: Multiplan PHCS |
$1,230.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,435.00
|
| Rate for Payer: UHCCP Medicaid |
$717.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$524.20
|
|
|
ARTH KNEE W/MNSCCTMY M/L WSHV
|
Facility
|
OP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 29881
|
| Hospital Charge Code |
76101102
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem Medicaid |
$705.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Humana KY Medicaid |
$705.00
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$712.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
ARTH KNEE W/MNSCCTMY M/L WSHV
|
Facility
|
IP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 29881
|
| Hospital Charge Code |
76101102
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
ARTH KNEE W/MNSCCTMY M/L WSHV
|
Professional
|
Both
|
$2,050.00
|
|
|
Service Code
|
HCPCS 29881
|
| Hospital Charge Code |
76101102
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$519.01 |
| Max. Negotiated Rate |
$2,050.00 |
| Rate for Payer: Aetna Commercial |
$936.35
|
| Rate for Payer: Anthem Medicaid |
$519.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,050.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,021.76
|
| Rate for Payer: Healthspan PPO |
$848.13
|
| Rate for Payer: Humana Medicaid |
$519.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$800.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$529.39
|
| Rate for Payer: Molina Healthcare Passport |
$519.01
|
| Rate for Payer: Multiplan PHCS |
$1,230.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,435.00
|
| Rate for Payer: UHCCP Medicaid |
$717.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$524.20
|
|
|
ARTH KNEE W/MNSCS RPR M/L
|
Professional
|
Both
|
$2,300.00
|
|
|
Service Code
|
HCPCS 29882
|
| Hospital Charge Code |
76101103
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$570.66 |
| Max. Negotiated Rate |
$2,300.00 |
| Rate for Payer: Aetna Commercial |
$1,016.78
|
| Rate for Payer: Anthem Medicaid |
$570.66
|
| 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 |
$1,103.47
|
| Rate for Payer: Healthspan PPO |
$920.98
|
| Rate for Payer: Humana Medicaid |
$570.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$866.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$582.07
|
| Rate for Payer: Molina Healthcare Passport |
$570.66
|
| 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 |
$576.37
|
|
|
ARTH KNEE W/MNSCS RPR M/L
|
Facility
|
OP
|
$2,300.00
|
|
|
Service Code
|
HCPCS 29882
|
| Hospital Charge Code |
76101103
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$299.00 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$1,771.00
|
| Rate for Payer: Anthem Medicaid |
$790.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,794.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$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 |
$2,799.07
|
| 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 |
$3,358.88
|
| 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 W/MNSCS RPR M/L
|
Facility
|
IP
|
$2,300.00
|
|
|
Service Code
|
HCPCS 29882
|
| Hospital Charge Code |
76101103
|
|
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 WMNSCS RPR M/L
|
Facility
|
OP
|
$2,700.00
|
|
|
Service Code
|
HCPCS 29883
|
| Hospital Charge Code |
76101104
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$351.00 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$2,079.00
|
| Rate for Payer: Anthem Medicaid |
$928.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,106.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$2,241.00
|
| Rate for Payer: First Health Commercial |
$2,565.00
|
| Rate for Payer: Humana Commercial |
$2,295.00
|
| Rate for Payer: Humana KY Medicaid |
$928.53
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$937.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,214.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,992.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$947.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,376.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,025.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$351.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$837.00
|
| Rate for Payer: PHCS Commercial |
$2,592.00
|
| Rate for Payer: United Healthcare All Payer |
$2,376.00
|
|
|
ARTH KNEE WMNSCS RPR M/L
|
Professional
|
Both
|
$2,700.00
|
|
|
Service Code
|
HCPCS 29883
|
| Hospital Charge Code |
76101104
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$641.12 |
| Max. Negotiated Rate |
$2,700.00 |
| Rate for Payer: Aetna Commercial |
$1,245.41
|
| Rate for Payer: Anthem Medicaid |
$641.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,700.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$1,363.37
|
| Rate for Payer: Healthspan PPO |
$1,128.07
|
| Rate for Payer: Humana Medicaid |
$641.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,046.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$653.94
|
| Rate for Payer: Molina Healthcare Passport |
$641.12
|
| Rate for Payer: Multiplan PHCS |
$1,620.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,890.00
|
| Rate for Payer: UHCCP Medicaid |
$945.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$647.53
|
|
|
ARTH KNEE WMNSCS RPR M/L
|
Facility
|
IP
|
$2,700.00
|
|
|
Service Code
|
HCPCS 29883
|
| Hospital Charge Code |
76101104
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$351.00 |
| Max. Negotiated Rate |
$2,592.00 |
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Aetna Commercial |
$2,079.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,106.00
|
| Rate for Payer: Cigna Commercial |
$2,241.00
|
| Rate for Payer: First Health Commercial |
$2,565.00
|
| Rate for Payer: Humana Commercial |
$2,295.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,214.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,992.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$810.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,376.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,025.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$351.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$837.00
|
| Rate for Payer: PHCS Commercial |
$2,592.00
|
| Rate for Payer: United Healthcare All Payer |
$2,376.00
|
|
|
ARTH KNEE W/MNSCS RPR M/L(P
|
Professional
|
Both
|
$2,300.00
|
|
|
Service Code
|
HCPCS 29882
|
| Hospital Charge Code |
761P1103
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$570.66 |
| Max. Negotiated Rate |
$2,300.00 |
| Rate for Payer: Aetna Commercial |
$1,016.78
|
| Rate for Payer: Anthem Medicaid |
$570.66
|
| 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 |
$1,103.47
|
| Rate for Payer: Healthspan PPO |
$920.98
|
| Rate for Payer: Humana Medicaid |
$570.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$866.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$582.07
|
| Rate for Payer: Molina Healthcare Passport |
$570.66
|
| 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 |
$576.37
|
|
|
ARTH KNEE WMNSCS RPR M/L(P
|
Professional
|
Both
|
$2,700.00
|
|
|
Service Code
|
HCPCS 29883
|
| Hospital Charge Code |
761P1104
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$641.12 |
| Max. Negotiated Rate |
$2,700.00 |
| Rate for Payer: Aetna Commercial |
$1,245.41
|
| Rate for Payer: Anthem Medicaid |
$641.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,700.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$1,363.37
|
| Rate for Payer: Healthspan PPO |
$1,128.07
|
| Rate for Payer: Humana Medicaid |
$641.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,046.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$653.94
|
| Rate for Payer: Molina Healthcare Passport |
$641.12
|
| Rate for Payer: Multiplan PHCS |
$1,620.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,890.00
|
| Rate for Payer: UHCCP Medicaid |
$945.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$647.53
|
|
|
ARTH LES/TALAR DOME FX PLAFOND
|
Professional
|
Both
|
$2,400.00
|
|
|
Service Code
|
HCPCS 29892
|
| Hospital Charge Code |
76101110
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$530.95 |
| Max. Negotiated Rate |
$2,400.00 |
| Rate for Payer: Aetna Commercial |
$1,041.89
|
| Rate for Payer: Anthem Medicaid |
$530.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,400.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cigna Commercial |
$1,160.03
|
| Rate for Payer: Healthspan PPO |
$943.73
|
| Rate for Payer: Humana Medicaid |
$530.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$832.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$541.57
|
| Rate for Payer: Molina Healthcare Passport |
$530.95
|
| Rate for Payer: Multiplan PHCS |
$1,440.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,680.00
|
| Rate for Payer: UHCCP Medicaid |
$840.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$536.26
|
|
|
ARTH LES/TALAR DOME FX PLAFOND
|
Professional
|
Both
|
$2,400.00
|
|
|
Service Code
|
HCPCS 29892
|
| Hospital Charge Code |
761P1110
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$530.95 |
| Max. Negotiated Rate |
$2,400.00 |
| Rate for Payer: Aetna Commercial |
$1,041.89
|
| Rate for Payer: Anthem Medicaid |
$530.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,400.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cigna Commercial |
$1,160.03
|
| Rate for Payer: Healthspan PPO |
$943.73
|
| Rate for Payer: Humana Medicaid |
$530.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$832.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$541.57
|
| Rate for Payer: Molina Healthcare Passport |
$530.95
|
| Rate for Payer: Multiplan PHCS |
$1,440.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,680.00
|
| Rate for Payer: UHCCP Medicaid |
$840.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$536.26
|
|
|
ARTH LES/TALAR DOME FX PLAFOND
|
Facility
|
OP
|
$2,400.00
|
|
|
Service Code
|
HCPCS 29892
|
| Hospital Charge Code |
76101110
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$312.00 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$1,848.00
|
| Rate for Payer: Anthem Medicaid |
$825.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,872.00
|
| 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 |
$1,200.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cigna Commercial |
$1,992.00
|
| Rate for Payer: First Health Commercial |
$2,280.00
|
| Rate for Payer: Humana Commercial |
$2,040.00
|
| Rate for Payer: Humana KY Medicaid |
$825.36
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$833.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,968.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,771.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$841.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,112.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,800.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$480.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$312.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$744.00
|
| Rate for Payer: PHCS Commercial |
$2,304.00
|
| Rate for Payer: United Healthcare All Payer |
$2,112.00
|
|
|
ARTH LES/TALAR DOME FX PLAFOND
|
Facility
|
IP
|
$2,400.00
|
|
|
Service Code
|
HCPCS 29892
|
| Hospital Charge Code |
76101110
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$312.00 |
| Max. Negotiated Rate |
$2,304.00 |
| Rate for Payer: Aetna Commercial |
$1,848.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,872.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cigna Commercial |
$1,992.00
|
| Rate for Payer: First Health Commercial |
$2,280.00
|
| Rate for Payer: Humana Commercial |
$2,040.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,968.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,771.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$720.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,112.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,800.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$480.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$312.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$744.00
|
| Rate for Payer: PHCS Commercial |
$2,304.00
|
| Rate for Payer: United Healthcare All Payer |
$2,112.00
|
|
|
ARTHO ASP+.OR INJ JNT WO US
|
Facility
|
IP
|
$667.00
|
|
|
Service Code
|
HCPCS 20605
|
| Hospital Charge Code |
76100343
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$86.71 |
| Max. Negotiated Rate |
$640.32 |
| Rate for Payer: Aetna Commercial |
$513.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$520.26
|
| Rate for Payer: Cash Price |
$333.50
|
| Rate for Payer: Cigna Commercial |
$553.61
|
| Rate for Payer: First Health Commercial |
$633.65
|
| Rate for Payer: Humana Commercial |
$566.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$546.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$492.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$200.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$586.96
|
| Rate for Payer: Ohio Health Group HMO |
$500.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$133.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$86.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$206.77
|
| Rate for Payer: PHCS Commercial |
$640.32
|
| Rate for Payer: United Healthcare All Payer |
$586.96
|
|
|
ARTHO ASP+.OR INJ JNT WO US
|
Professional
|
Both
|
$778.00
|
|
|
Service Code
|
HCPCS 20610
|
| Hospital Charge Code |
76100345
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$29.83 |
| Max. Negotiated Rate |
$778.00 |
| Rate for Payer: Aetna Commercial |
$75.91
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$29.83
|
| Rate for Payer: Anthem Medicaid |
$50.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$778.00
|
| Rate for Payer: Cash Price |
$389.00
|
| Rate for Payer: Cash Price |
$389.00
|
| Rate for Payer: Cigna Commercial |
$115.53
|
| Rate for Payer: Healthspan PPO |
$98.82
|
| Rate for Payer: Humana Medicaid |
$50.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$62.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$51.83
|
| Rate for Payer: Molina Healthcare Passport |
$50.81
|
| Rate for Payer: Multiplan PHCS |
$466.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$544.60
|
| Rate for Payer: UHCCP Medicaid |
$31.32
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$51.32
|
|
|
ARTHO ASP+.OR INJ JNT WO US
|
Professional
|
Both
|
$778.00
|
|
|
Service Code
|
HCPCS 20610
|
| Hospital Charge Code |
76102849
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$29.83 |
| Max. Negotiated Rate |
$778.00 |
| Rate for Payer: Aetna Commercial |
$75.91
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$29.83
|
| Rate for Payer: Anthem Medicaid |
$50.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$778.00
|
| Rate for Payer: Cash Price |
$389.00
|
| Rate for Payer: Cash Price |
$389.00
|
| Rate for Payer: Cigna Commercial |
$115.53
|
| Rate for Payer: Healthspan PPO |
$98.82
|
| Rate for Payer: Humana Medicaid |
$50.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$62.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$51.83
|
| Rate for Payer: Molina Healthcare Passport |
$50.81
|
| Rate for Payer: Multiplan PHCS |
$466.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$544.60
|
| Rate for Payer: UHCCP Medicaid |
$31.32
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$51.32
|
|
|
ARTHO ASP+.OR INJ JNT WO US
|
Facility
|
OP
|
$667.00
|
|
|
Service Code
|
HCPCS 20605
|
| Hospital Charge Code |
76102848
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$86.71 |
| Max. Negotiated Rate |
$640.32 |
| Rate for Payer: Aetna Commercial |
$513.59
|
| Rate for Payer: Anthem Medicaid |
$229.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$256.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$520.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$358.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$345.76
|
| Rate for Payer: Cash Price |
$333.50
|
| Rate for Payer: Cash Price |
$333.50
|
| Rate for Payer: Cigna Commercial |
$553.61
|
| Rate for Payer: First Health Commercial |
$633.65
|
| Rate for Payer: Humana Commercial |
$566.95
|
| Rate for Payer: Humana KY Medicaid |
$229.38
|
| Rate for Payer: Humana Medicare Advantage |
$256.12
|
| Rate for Payer: Kentucky WC Medicaid |
$231.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$546.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$492.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$307.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$233.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$586.96
|
| Rate for Payer: Ohio Health Group HMO |
$500.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$133.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$86.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$206.77
|
| Rate for Payer: PHCS Commercial |
$640.32
|
| Rate for Payer: United Healthcare All Payer |
$586.96
|
|
|
ARTHO ASP+.OR INJ JNT WO US
|
Professional
|
Both
|
$667.00
|
|
|
Service Code
|
HCPCS 20605
|
| Hospital Charge Code |
76102848
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$667.00 |
| Rate for Payer: Aetna Commercial |
$63.15
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$36.82
|
| Rate for Payer: Anthem Medicaid |
$27.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$667.00
|
| Rate for Payer: Cash Price |
$333.50
|
| Rate for Payer: Cash Price |
$333.50
|
| Rate for Payer: Cigna Commercial |
$93.23
|
| Rate for Payer: Healthspan PPO |
$76.59
|
| Rate for Payer: Humana Medicaid |
$27.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$50.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$27.74
|
| Rate for Payer: Molina Healthcare Passport |
$27.20
|
| Rate for Payer: Multiplan PHCS |
$400.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$466.90
|
| Rate for Payer: UHCCP Medicaid |
$38.66
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$27.47
|
|
|
ARTHO ASP+.OR INJ JNT WO US
|
Facility
|
IP
|
$778.00
|
|
|
Service Code
|
HCPCS 20610
|
| Hospital Charge Code |
76100345
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.14 |
| Max. Negotiated Rate |
$746.88 |
| Rate for Payer: Aetna Commercial |
$599.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$606.84
|
| Rate for Payer: Cash Price |
$389.00
|
| Rate for Payer: Cigna Commercial |
$645.74
|
| Rate for Payer: First Health Commercial |
$739.10
|
| Rate for Payer: Humana Commercial |
$661.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$637.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$574.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$233.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$684.64
|
| Rate for Payer: Ohio Health Group HMO |
$583.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$155.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.18
|
| Rate for Payer: PHCS Commercial |
$746.88
|
| Rate for Payer: United Healthcare All Payer |
$684.64
|
|
|
ARTHO ASP+.OR INJ JNT WO US
|
Facility
|
IP
|
$778.00
|
|
|
Service Code
|
HCPCS 20610
|
| Hospital Charge Code |
76102849
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.14 |
| Max. Negotiated Rate |
$746.88 |
| Rate for Payer: Aetna Commercial |
$599.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$606.84
|
| Rate for Payer: Cash Price |
$389.00
|
| Rate for Payer: Cigna Commercial |
$645.74
|
| Rate for Payer: First Health Commercial |
$739.10
|
| Rate for Payer: Humana Commercial |
$661.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$637.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$574.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$233.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$684.64
|
| Rate for Payer: Ohio Health Group HMO |
$583.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$155.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.18
|
| Rate for Payer: PHCS Commercial |
$746.88
|
| Rate for Payer: United Healthcare All Payer |
$684.64
|
|
|
ARTHO ASP+.OR INJ JNT WO US
|
Professional
|
Both
|
$667.00
|
|
|
Service Code
|
HCPCS 20605
|
| Hospital Charge Code |
76100343
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$667.00 |
| Rate for Payer: Aetna Commercial |
$63.15
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$36.82
|
| Rate for Payer: Anthem Medicaid |
$27.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$667.00
|
| Rate for Payer: Cash Price |
$333.50
|
| Rate for Payer: Cash Price |
$333.50
|
| Rate for Payer: Cigna Commercial |
$93.23
|
| Rate for Payer: Healthspan PPO |
$76.59
|
| Rate for Payer: Humana Medicaid |
$27.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$50.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$27.74
|
| Rate for Payer: Molina Healthcare Passport |
$27.20
|
| Rate for Payer: Multiplan PHCS |
$400.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$466.90
|
| Rate for Payer: UHCCP Medicaid |
$38.66
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$27.47
|
|
|
ARTHO ASP+.OR INJ JNT WO US
|
Facility
|
OP
|
$478.00
|
|
|
Service Code
|
HCPCS 20610
|
| Hospital Charge Code |
45000093
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$62.14 |
| Max. Negotiated Rate |
$458.88 |
| Rate for Payer: Aetna Commercial |
$368.06
|
| Rate for Payer: Anthem Medicaid |
$164.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$256.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$372.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$358.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$345.76
|
| Rate for Payer: Cash Price |
$239.00
|
| Rate for Payer: Cash Price |
$239.00
|
| Rate for Payer: Cigna Commercial |
$396.74
|
| Rate for Payer: First Health Commercial |
$454.10
|
| Rate for Payer: Humana Commercial |
$406.30
|
| Rate for Payer: Humana KY Medicaid |
$164.38
|
| Rate for Payer: Humana Medicare Advantage |
$256.12
|
| Rate for Payer: Kentucky WC Medicaid |
$166.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$391.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$352.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$307.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$167.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$420.64
|
| Rate for Payer: Ohio Health Group HMO |
$358.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$148.18
|
| Rate for Payer: PHCS Commercial |
$458.88
|
| Rate for Payer: United Healthcare All Payer |
$420.64
|
|
