|
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
|
Facility
|
OP
|
$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 Medicaid |
$267.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$256.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$606.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$358.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$345.76
|
| Rate for Payer: Cash Price |
$389.00
|
| 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: Humana KY Medicaid |
$267.55
|
| Rate for Payer: Humana Medicare Advantage |
$256.12
|
| Rate for Payer: Kentucky WC Medicaid |
$270.28
|
| 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 |
$307.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$272.92
|
| 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
|
$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 POS/PPO/Traditional |
$372.84
|
| 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: 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 |
$143.40
|
| 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
|
|
|
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
|
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
|
Facility
|
OP
|
$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 Medicaid |
$267.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$256.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$606.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$358.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$345.76
|
| Rate for Payer: Cash Price |
$389.00
|
| 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: Humana KY Medicaid |
$267.55
|
| Rate for Payer: Humana Medicare Advantage |
$256.12
|
| Rate for Payer: Kentucky WC Medicaid |
$270.28
|
| 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 |
$307.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$272.92
|
| 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
|
$417.00
|
|
|
Service Code
|
HCPCS 20605
|
| Hospital Charge Code |
45000091
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$54.21 |
| Max. Negotiated Rate |
$400.32 |
| Rate for Payer: Aetna Commercial |
$321.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$325.26
|
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: Cigna Commercial |
$346.11
|
| Rate for Payer: First Health Commercial |
$396.15
|
| Rate for Payer: Humana Commercial |
$354.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$341.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$307.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$125.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$366.96
|
| Rate for Payer: Ohio Health Group HMO |
$312.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$83.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$54.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$129.27
|
| Rate for Payer: PHCS Commercial |
$400.32
|
| Rate for Payer: United Healthcare All Payer |
$366.96
|
|
|
ARTHO ASP+.OR INJ JNT WO US (P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 20610
|
| Hospital Charge Code |
761P0345
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$29.83 |
| Max. Negotiated Rate |
$300.00 |
| 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 |
$300.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| 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 |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.00
|
| Rate for Payer: UHCCP Medicaid |
$31.32
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$51.32
|
|
|
ARTHO ASP+.OR INJ JNT WO US (P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 20605
|
| Hospital Charge Code |
761P0343
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$250.00 |
| 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 |
$250.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| 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 |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$38.66
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$27.47
|
|
|
ARTHO ASP+.OR INJ JNT WO US (P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 20610
|
| Hospital Charge Code |
761P2849
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$29.83 |
| Max. Negotiated Rate |
$300.00 |
| 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 |
$300.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| 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 |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.00
|
| Rate for Payer: UHCCP Medicaid |
$31.32
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$51.32
|
|
|
ARTHO ASP+.OR INJ JNT WO US (P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 20605
|
| Hospital Charge Code |
761P2848
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$250.00 |
| 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 |
$250.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| 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 |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$38.66
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$27.47
|
|
|
ARTHO ASP+.OR INJ JNT WO US (T
|
Facility
|
OP
|
$417.00
|
|
|
Service Code
|
HCPCS 20605
|
| Hospital Charge Code |
761T2848
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$54.21 |
| Max. Negotiated Rate |
$400.32 |
| Rate for Payer: Aetna Commercial |
$321.09
|
| Rate for Payer: Anthem Medicaid |
$143.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$256.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$325.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$358.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$345.76
|
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: Cigna Commercial |
$346.11
|
| Rate for Payer: First Health Commercial |
$396.15
|
| Rate for Payer: Humana Commercial |
$354.45
|
| Rate for Payer: Humana KY Medicaid |
$143.41
|
| Rate for Payer: Humana Medicare Advantage |
$256.12
|
| Rate for Payer: Kentucky WC Medicaid |
$144.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$341.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$307.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$307.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$146.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$366.96
|
| Rate for Payer: Ohio Health Group HMO |
$312.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$83.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$54.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$129.27
|
| Rate for Payer: PHCS Commercial |
$400.32
|
| Rate for Payer: United Healthcare All Payer |
$366.96
|
|
|
ARTHO ASP+.OR INJ JNT WO US (T
|
Facility
|
OP
|
$478.00
|
|
|
Service Code
|
HCPCS 20610
|
| Hospital Charge Code |
761T2849
|
|
Hospital Revenue Code
|
761
|
| 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
|
|
|
ARTHO ASP+.OR INJ JNT WO US (T
|
Facility
|
IP
|
$417.00
|
|
|
Service Code
|
HCPCS 20605
|
| Hospital Charge Code |
761T2848
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$54.21 |
| Max. Negotiated Rate |
$400.32 |
| Rate for Payer: Aetna Commercial |
$321.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$325.26
|
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: Cigna Commercial |
$346.11
|
| Rate for Payer: First Health Commercial |
$396.15
|
| Rate for Payer: Humana Commercial |
$354.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$341.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$307.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$125.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$366.96
|
| Rate for Payer: Ohio Health Group HMO |
$312.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$83.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$54.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$129.27
|
| Rate for Payer: PHCS Commercial |
$400.32
|
| Rate for Payer: United Healthcare All Payer |
$366.96
|
|
|
ARTHO ASP+.OR INJ JNT WO US (T
|
Facility
|
IP
|
$478.00
|
|
|
Service Code
|
HCPCS 20610
|
| Hospital Charge Code |
761T0345
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$62.14 |
| Max. Negotiated Rate |
$458.88 |
| Rate for Payer: Aetna Commercial |
$368.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$372.84
|
| 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: 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 |
$143.40
|
| 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
|
|
|
ARTHO ASP+.OR INJ JNT WO US (T
|
Facility
|
IP
|
$417.00
|
|
|
Service Code
|
HCPCS 20605
|
| Hospital Charge Code |
761T0343
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$54.21 |
| Max. Negotiated Rate |
$400.32 |
| Rate for Payer: Aetna Commercial |
$321.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$325.26
|
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: Cigna Commercial |
$346.11
|
| Rate for Payer: First Health Commercial |
$396.15
|
| Rate for Payer: Humana Commercial |
$354.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$341.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$307.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$125.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$366.96
|
| Rate for Payer: Ohio Health Group HMO |
$312.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$83.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$54.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$129.27
|
| Rate for Payer: PHCS Commercial |
$400.32
|
| Rate for Payer: United Healthcare All Payer |
$366.96
|
|
|
ARTHO ASP+.OR INJ JNT WO US (T
|
Facility
|
IP
|
$478.00
|
|
|
Service Code
|
HCPCS 20610
|
| Hospital Charge Code |
761T2849
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$62.14 |
| Max. Negotiated Rate |
$458.88 |
| Rate for Payer: Aetna Commercial |
$368.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$372.84
|
| 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: 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 |
$143.40
|
| 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
|
|
|
ARTHO ASP+.OR INJ JNT WO US (T
|
Facility
|
OP
|
$478.00
|
|
|
Service Code
|
HCPCS 20610
|
| Hospital Charge Code |
761T0345
|
|
Hospital Revenue Code
|
761
|
| 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
|
|
|
ARTHO ASP+.OR INJ JNT WO US (T
|
Facility
|
OP
|
$417.00
|
|
|
Service Code
|
HCPCS 20605
|
| Hospital Charge Code |
761T0343
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$54.21 |
| Max. Negotiated Rate |
$400.32 |
| Rate for Payer: Aetna Commercial |
$321.09
|
| Rate for Payer: Anthem Medicaid |
$143.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$256.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$325.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$358.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$345.76
|
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: Cigna Commercial |
$346.11
|
| Rate for Payer: First Health Commercial |
$396.15
|
| Rate for Payer: Humana Commercial |
$354.45
|
| Rate for Payer: Humana KY Medicaid |
$143.41
|
| Rate for Payer: Humana Medicare Advantage |
$256.12
|
| Rate for Payer: Kentucky WC Medicaid |
$144.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$341.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$307.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$307.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$146.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$366.96
|
| Rate for Payer: Ohio Health Group HMO |
$312.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$83.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$54.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$129.27
|
| Rate for Payer: PHCS Commercial |
$400.32
|
| Rate for Payer: United Healthcare All Payer |
$366.96
|
|
|
ARTHR KNEE RMV LOOSE/FB
|
Professional
|
Both
|
$1,642.00
|
|
|
Service Code
|
HCPCS 29874
|
| Hospital Charge Code |
76101096
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$469.26 |
| Max. Negotiated Rate |
$1,642.00 |
| Rate for Payer: Aetna Commercial |
$783.25
|
| Rate for Payer: Anthem Medicaid |
$469.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,642.00
|
| Rate for Payer: Cash Price |
$821.00
|
| Rate for Payer: Cash Price |
$821.00
|
| Rate for Payer: Cigna Commercial |
$862.24
|
| Rate for Payer: Healthspan PPO |
$709.46
|
| Rate for Payer: Humana Medicaid |
$469.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$667.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$478.65
|
| Rate for Payer: Molina Healthcare Passport |
$469.26
|
| Rate for Payer: Multiplan PHCS |
$985.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,149.40
|
| Rate for Payer: UHCCP Medicaid |
$574.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$473.95
|
|
|
ARTHR KNEE RMV LOOSE/FB
|
Facility
|
IP
|
$1,642.00
|
|
|
Service Code
|
HCPCS 29874
|
| Hospital Charge Code |
76101096
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$213.46 |
| Max. Negotiated Rate |
$1,576.32 |
| Rate for Payer: Aetna Commercial |
$1,264.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,280.76
|
| Rate for Payer: Cash Price |
$821.00
|
| Rate for Payer: Cigna Commercial |
$1,362.86
|
| Rate for Payer: First Health Commercial |
$1,559.90
|
| Rate for Payer: Humana Commercial |
$1,395.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,346.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,211.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$492.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,444.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,231.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$328.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$213.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$509.02
|
| Rate for Payer: PHCS Commercial |
$1,576.32
|
| Rate for Payer: United Healthcare All Payer |
$1,444.96
|
|
|
ARTHR KNEE RMV LOOSE/FB
|
Facility
|
OP
|
$1,642.00
|
|
|
Service Code
|
HCPCS 29874
|
| Hospital Charge Code |
76101096
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$213.46 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$1,264.34
|
| Rate for Payer: Anthem Medicaid |
$564.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,280.76
|
| 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 |
$821.00
|
| Rate for Payer: Cash Price |
$821.00
|
| Rate for Payer: Cigna Commercial |
$1,362.86
|
| Rate for Payer: First Health Commercial |
$1,559.90
|
| Rate for Payer: Humana Commercial |
$1,395.70
|
| Rate for Payer: Humana KY Medicaid |
$564.68
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$570.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,346.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,211.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$576.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,444.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,231.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$328.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$213.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$509.02
|
| Rate for Payer: PHCS Commercial |
$1,576.32
|
| Rate for Payer: United Healthcare All Payer |
$1,444.96
|
|
|
ARTHR KNEE RMV LOOSE/FB(P
|
Professional
|
Both
|
$1,642.00
|
|
|
Service Code
|
HCPCS 29874
|
| Hospital Charge Code |
761P1096
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$469.26 |
| Max. Negotiated Rate |
$1,642.00 |
| Rate for Payer: Aetna Commercial |
$783.25
|
| Rate for Payer: Anthem Medicaid |
$469.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,642.00
|
| Rate for Payer: Cash Price |
$821.00
|
| Rate for Payer: Cash Price |
$821.00
|
| Rate for Payer: Cigna Commercial |
$862.24
|
| Rate for Payer: Healthspan PPO |
$709.46
|
| Rate for Payer: Humana Medicaid |
$469.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$667.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$478.65
|
| Rate for Payer: Molina Healthcare Passport |
$469.26
|
| Rate for Payer: Multiplan PHCS |
$985.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,149.40
|
| Rate for Payer: UHCCP Medicaid |
$574.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$473.95
|
|
|
ARTHRO ASP +/- IMJ INT JNT WUS
|
Facility
|
IP
|
$973.00
|
|
|
Service Code
|
HCPCS 20606
|
| Hospital Charge Code |
761T0344
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$126.49 |
| Max. Negotiated Rate |
$934.08 |
| Rate for Payer: Aetna Commercial |
$749.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$758.94
|
| Rate for Payer: Cash Price |
$486.50
|
| Rate for Payer: Cigna Commercial |
$807.59
|
| Rate for Payer: First Health Commercial |
$924.35
|
| Rate for Payer: Humana Commercial |
$827.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$797.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$718.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$291.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$856.24
|
| Rate for Payer: Ohio Health Group HMO |
$729.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$194.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$126.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$301.63
|
| Rate for Payer: PHCS Commercial |
$934.08
|
| Rate for Payer: United Healthcare All Payer |
$856.24
|
|
|
ARTHRO ASP +/- IMJ INT JNT WUS
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 20606
|
| Hospital Charge Code |
761P0344
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$40.89 |
| Max. Negotiated Rate |
$255.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$40.89
|
| Rate for Payer: Anthem Medicaid |
$42.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$255.00
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cigna Commercial |
$146.58
|
| Rate for Payer: Humana Medicaid |
$42.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$68.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$43.44
|
| Rate for Payer: Molina Healthcare Passport |
$42.59
|
| Rate for Payer: Multiplan PHCS |
$153.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$178.50
|
| Rate for Payer: UHCCP Medicaid |
$42.93
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$43.02
|
|
