|
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
|
|
|
ARTHRO ASP +/- IMJ INT JNT WUS
|
Facility
|
IP
|
$973.00
|
|
|
Service Code
|
HCPCS 20606
|
| Hospital Charge Code |
45000092
|
|
Hospital Revenue Code
|
450
|
| 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
|
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
|
Facility
|
OP
|
$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 Medicaid |
$334.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$598.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$758.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$837.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$807.33
|
| Rate for Payer: Cash Price |
$486.50
|
| 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: Humana KY Medicaid |
$334.61
|
| Rate for Payer: Humana Medicare Advantage |
$598.02
|
| Rate for Payer: Kentucky WC Medicaid |
$338.02
|
| 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 |
$717.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$341.33
|
| 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
|
Facility
|
OP
|
$973.00
|
|
|
Service Code
|
HCPCS 20606
|
| Hospital Charge Code |
45000092
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$126.49 |
| Max. Negotiated Rate |
$934.08 |
| Rate for Payer: Aetna Commercial |
$749.21
|
| Rate for Payer: Anthem Medicaid |
$334.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$598.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$758.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$837.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$807.33
|
| Rate for Payer: Cash Price |
$486.50
|
| 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: Humana KY Medicaid |
$334.61
|
| Rate for Payer: Humana Medicare Advantage |
$598.02
|
| Rate for Payer: Kentucky WC Medicaid |
$338.02
|
| 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 |
$717.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$341.33
|
| 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
|
$1,228.00
|
|
|
Service Code
|
HCPCS 20606
|
| Hospital Charge Code |
76100344
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$40.89 |
| Max. Negotiated Rate |
$1,228.00 |
| 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 |
$1,228.00
|
| Rate for Payer: Cash Price |
$614.00
|
| Rate for Payer: Cash Price |
$614.00
|
| 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 |
$736.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$859.60
|
| Rate for Payer: UHCCP Medicaid |
$42.93
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$43.02
|
|
|
ARTHRO ASP+/OR INJ SM JNT W/US
|
Facility
|
IP
|
$391.00
|
|
|
Service Code
|
HCPCS 20604
|
| Hospital Charge Code |
761T0342
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$50.83 |
| Max. Negotiated Rate |
$375.36 |
| Rate for Payer: Aetna Commercial |
$301.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$304.98
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cigna Commercial |
$324.53
|
| Rate for Payer: First Health Commercial |
$371.45
|
| Rate for Payer: Humana Commercial |
$332.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$320.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$288.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$344.08
|
| Rate for Payer: Ohio Health Group HMO |
$293.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$78.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$121.21
|
| Rate for Payer: PHCS Commercial |
$375.36
|
| Rate for Payer: United Healthcare All Payer |
$344.08
|
|
|
ARTHRO ASP+/OR INJ SM JNT W/US
|
Facility
|
OP
|
$751.00
|
|
|
Service Code
|
HCPCS 20604
|
| Hospital Charge Code |
76100342
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.63 |
| Max. Negotiated Rate |
$720.96 |
| Rate for Payer: Aetna Commercial |
$578.27
|
| Rate for Payer: Anthem Medicaid |
$258.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$256.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$358.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$345.76
|
| Rate for Payer: Cash Price |
$375.50
|
| Rate for Payer: Cash Price |
$375.50
|
| Rate for Payer: Cigna Commercial |
$623.33
|
| Rate for Payer: First Health Commercial |
$713.45
|
| Rate for Payer: Humana Commercial |
$638.35
|
| Rate for Payer: Humana KY Medicaid |
$258.27
|
| Rate for Payer: Humana Medicare Advantage |
$256.12
|
| Rate for Payer: Kentucky WC Medicaid |
$260.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$554.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$307.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$263.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.88
|
| Rate for Payer: Ohio Health Group HMO |
$563.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$150.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$232.81
|
| Rate for Payer: PHCS Commercial |
$720.96
|
| Rate for Payer: United Healthcare All Payer |
$660.88
|
|
|
ARTHRO ASP+/OR INJ SM JNT W/US
|
Professional
|
Both
|
$751.00
|
|
|
Service Code
|
HCPCS 20604
|
| Hospital Charge Code |
76100342
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$36.16 |
| Max. Negotiated Rate |
$751.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$36.16
|
| Rate for Payer: Anthem Medicaid |
$37.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$751.00
|
| Rate for Payer: Cash Price |
$375.50
|
| Rate for Payer: Cash Price |
$375.50
|
| Rate for Payer: Cigna Commercial |
$132.30
|
| Rate for Payer: Humana Medicaid |
$37.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$60.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$38.05
|
| Rate for Payer: Molina Healthcare Passport |
$37.30
|
| Rate for Payer: Multiplan PHCS |
$450.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$525.70
|
| Rate for Payer: UHCCP Medicaid |
$37.97
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$37.67
|
|
|
ARTHRO ASP+/OR INJ SM JNT W/US
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
HCPCS 20604
|
| Hospital Charge Code |
761T0342
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$50.83 |
| Max. Negotiated Rate |
$375.36 |
| Rate for Payer: Aetna Commercial |
$301.07
|
| Rate for Payer: Anthem Medicaid |
$134.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$256.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$304.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$358.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$345.76
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cigna Commercial |
$324.53
|
| Rate for Payer: First Health Commercial |
$371.45
|
| Rate for Payer: Humana Commercial |
$332.35
|
| Rate for Payer: Humana KY Medicaid |
$134.46
|
| Rate for Payer: Humana Medicare Advantage |
$256.12
|
| Rate for Payer: Kentucky WC Medicaid |
$135.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$320.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$288.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$307.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$137.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$344.08
|
| Rate for Payer: Ohio Health Group HMO |
$293.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$78.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$121.21
|
| Rate for Payer: PHCS Commercial |
$375.36
|
| Rate for Payer: United Healthcare All Payer |
$344.08
|
|
|
ARTHRO ASP+/OR INJ SM JNT W/US
|
Professional
|
Both
|
$360.00
|
|
|
Service Code
|
HCPCS 20604
|
| Hospital Charge Code |
761P0342
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$36.16 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$36.16
|
| Rate for Payer: Anthem Medicaid |
$37.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$360.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cigna Commercial |
$132.30
|
| Rate for Payer: Humana Medicaid |
$37.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$60.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$38.05
|
| Rate for Payer: Molina Healthcare Passport |
$37.30
|
| Rate for Payer: Multiplan PHCS |
$216.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$252.00
|
| Rate for Payer: UHCCP Medicaid |
$37.97
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$37.67
|
|
|
ARTHRO ASP+/OR INJ SM JNT W/US
|
Facility
|
IP
|
$391.00
|
|
|
Service Code
|
HCPCS 20604
|
| Hospital Charge Code |
45000090
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$50.83 |
| Max. Negotiated Rate |
$375.36 |
| Rate for Payer: Aetna Commercial |
$301.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$304.98
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cigna Commercial |
$324.53
|
| Rate for Payer: First Health Commercial |
$371.45
|
| Rate for Payer: Humana Commercial |
$332.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$320.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$288.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$344.08
|
| Rate for Payer: Ohio Health Group HMO |
$293.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$78.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$121.21
|
| Rate for Payer: PHCS Commercial |
$375.36
|
| Rate for Payer: United Healthcare All Payer |
$344.08
|
|
|
ARTHRO ASP+/OR INJ SM JNT W/US
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
HCPCS 20604
|
| Hospital Charge Code |
45000090
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$50.83 |
| Max. Negotiated Rate |
$375.36 |
| Rate for Payer: Aetna Commercial |
$301.07
|
| Rate for Payer: Anthem Medicaid |
$134.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$256.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$304.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$358.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$345.76
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cigna Commercial |
$324.53
|
| Rate for Payer: First Health Commercial |
$371.45
|
| Rate for Payer: Humana Commercial |
$332.35
|
| Rate for Payer: Humana KY Medicaid |
$134.46
|
| Rate for Payer: Humana Medicare Advantage |
$256.12
|
| Rate for Payer: Kentucky WC Medicaid |
$135.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$320.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$288.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$307.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$137.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$344.08
|
| Rate for Payer: Ohio Health Group HMO |
$293.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$78.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$121.21
|
| Rate for Payer: PHCS Commercial |
$375.36
|
| Rate for Payer: United Healthcare All Payer |
$344.08
|
|
|
ARTHRO ASP+/OR INJ SM JNT W/US
|
Facility
|
IP
|
$751.00
|
|
|
Service Code
|
HCPCS 20604
|
| Hospital Charge Code |
76100342
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.63 |
| Max. Negotiated Rate |
$720.96 |
| Rate for Payer: Aetna Commercial |
$578.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.78
|
| Rate for Payer: Cash Price |
$375.50
|
| Rate for Payer: Cigna Commercial |
$623.33
|
| Rate for Payer: First Health Commercial |
$713.45
|
| Rate for Payer: Humana Commercial |
$638.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$554.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.88
|
| Rate for Payer: Ohio Health Group HMO |
$563.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$150.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$232.81
|
| Rate for Payer: PHCS Commercial |
$720.96
|
| Rate for Payer: United Healthcare All Payer |
$660.88
|
|
|
ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, MAJOR JOINT OR BURSA (EG, SHOULDER, HIP, KNEE, SUBACROMIAL BURSA); WITHOUT ULTRASOUND GUIDANCE
|
Facility
|
OP
|
$358.57
|
|
|
Service Code
|
CPT 20610
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$256.12 |
| Max. Negotiated Rate |
$358.57 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$256.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$358.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$345.76
|
| Rate for Payer: Humana Medicare Advantage |
$256.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$307.34
|
|
|
ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, SMALL JOINT OR BURSA (EG, FINGERS, TOES); WITHOUT ULTRASOUND GUIDANCE
|
Facility
|
OP
|
$358.57
|
|
|
Service Code
|
CPT 20600
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$256.12 |
| Max. Negotiated Rate |
$358.57 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$256.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$358.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$345.76
|
| Rate for Payer: Humana Medicare Advantage |
$256.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$307.34
|
|
|
ARTHRODESIS, ANKLE, OPEN
|
Facility
|
OP
|
$2,285.00
|
|
|
Service Code
|
HCPCS 27870
|
| Hospital Charge Code |
76100954
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$297.05 |
| Max. Negotiated Rate |
$15,933.60 |
| Rate for Payer: Aetna Commercial |
$1,759.45
|
| Rate for Payer: Anthem Medicaid |
$785.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,381.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,782.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15,933.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$15,364.54
|
| Rate for Payer: Cash Price |
$1,142.50
|
| Rate for Payer: Cash Price |
$1,142.50
|
| Rate for Payer: Cigna Commercial |
$1,896.55
|
| Rate for Payer: First Health Commercial |
$2,170.75
|
| Rate for Payer: Humana Commercial |
$1,942.25
|
| Rate for Payer: Humana KY Medicaid |
$785.81
|
| Rate for Payer: Humana Medicare Advantage |
$11,381.14
|
| Rate for Payer: Kentucky WC Medicaid |
$793.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,873.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,686.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13,657.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$801.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,010.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,713.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$457.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$297.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$708.35
|
| Rate for Payer: PHCS Commercial |
$2,193.60
|
| Rate for Payer: United Healthcare All Payer |
$2,010.80
|
|
|
ARTHRODESIS, ANKLE, OPEN
|
Facility
|
IP
|
$2,285.00
|
|
|
Service Code
|
HCPCS 27870
|
| Hospital Charge Code |
76100954
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$297.05 |
| Max. Negotiated Rate |
$2,193.60 |
| Rate for Payer: Aetna Commercial |
$1,759.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,782.30
|
| Rate for Payer: Cash Price |
$1,142.50
|
| Rate for Payer: Cigna Commercial |
$1,896.55
|
| Rate for Payer: First Health Commercial |
$2,170.75
|
| Rate for Payer: Humana Commercial |
$1,942.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,873.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,686.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$685.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,010.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,713.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$457.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$297.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$708.35
|
| Rate for Payer: PHCS Commercial |
$2,193.60
|
| Rate for Payer: United Healthcare All Payer |
$2,010.80
|
|
|
ARTHRODESIS, ANKLE, OPEN
|
Professional
|
Both
|
$2,285.00
|
|
|
Service Code
|
HCPCS 27870
|
| Hospital Charge Code |
76100954
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$717.51 |
| Max. Negotiated Rate |
$2,285.00 |
| Rate for Payer: Aetna Commercial |
$1,565.36
|
| Rate for Payer: Anthem Medicaid |
$717.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,285.00
|
| Rate for Payer: Cash Price |
$1,142.50
|
| Rate for Payer: Cash Price |
$1,142.50
|
| Rate for Payer: Cigna Commercial |
$1,700.69
|
| Rate for Payer: Healthspan PPO |
$1,417.88
|
| Rate for Payer: Humana Medicaid |
$717.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,304.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$731.86
|
| Rate for Payer: Molina Healthcare Passport |
$717.51
|
| Rate for Payer: Multiplan PHCS |
$1,371.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,599.50
|
| Rate for Payer: UHCCP Medicaid |
$799.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$724.69
|
|
|
ARTHRODESIS, ANKLE, OPEN(P
|
Professional
|
Both
|
$2,285.00
|
|
|
Service Code
|
HCPCS 27870
|
| Hospital Charge Code |
761P0954
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$717.51 |
| Max. Negotiated Rate |
$2,285.00 |
| Rate for Payer: Aetna Commercial |
$1,565.36
|
| Rate for Payer: Anthem Medicaid |
$717.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,285.00
|
| Rate for Payer: Cash Price |
$1,142.50
|
| Rate for Payer: Cash Price |
$1,142.50
|
| Rate for Payer: Cigna Commercial |
$1,700.69
|
| Rate for Payer: Healthspan PPO |
$1,417.88
|
| Rate for Payer: Humana Medicaid |
$717.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,304.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$731.86
|
| Rate for Payer: Molina Healthcare Passport |
$717.51
|
| Rate for Payer: Multiplan PHCS |
$1,371.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,599.50
|
| Rate for Payer: UHCCP Medicaid |
$799.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$724.69
|
|
|
ARTHRODESIS, GREAT TOE; METATARSOPHALANGEAL JOINT
|
Facility
|
OP
|
$8,661.10
|
|
|
Service Code
|
CPT 28750
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,186.50 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,661.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,351.78
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
|
|
ARTHRODESIS KNEE ANY TECHNIQUE
|
Professional
|
Both
|
$1,670.00
|
|
|
Service Code
|
HCPCS 27580
|
| Hospital Charge Code |
76102694
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$584.50 |
| Max. Negotiated Rate |
$2,356.43 |
| Rate for Payer: Aetna Commercial |
$2,156.27
|
| Rate for Payer: Anthem Medicaid |
$843.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,670.00
|
| Rate for Payer: Cash Price |
$835.00
|
| Rate for Payer: Cash Price |
$835.00
|
| Rate for Payer: Cigna Commercial |
$2,356.43
|
| Rate for Payer: Healthspan PPO |
$1,953.12
|
| Rate for Payer: Humana Medicaid |
$843.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,805.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$859.92
|
| Rate for Payer: Molina Healthcare Passport |
$843.06
|
| Rate for Payer: Multiplan PHCS |
$1,002.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,169.00
|
| Rate for Payer: UHCCP Medicaid |
$584.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$851.49
|
|
|
ARTHRODESIS, MIDTARSAL OR TARSOMETATARSAL, SINGLE JOINT
|
Facility
|
OP
|
$8,661.10
|
|
|
Service Code
|
CPT 28740
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,186.50 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,661.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,351.78
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
|
|
ARTHRODESIS, PANTALAR
|
Professional
|
Both
|
$1,425.00
|
|
|
Service Code
|
HCPCS 28705
|
| Hospital Charge Code |
76102679
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$498.75 |
| Max. Negotiated Rate |
$2,156.49 |
| Rate for Payer: Aetna Commercial |
$1,988.38
|
| Rate for Payer: Anthem Medicaid |
$879.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,425.00
|
| Rate for Payer: Cash Price |
$712.50
|
| Rate for Payer: Cash Price |
$712.50
|
| Rate for Payer: Cigna Commercial |
$2,156.49
|
| Rate for Payer: Healthspan PPO |
$1,801.04
|
| Rate for Payer: Humana Medicaid |
$879.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,629.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$897.54
|
| Rate for Payer: Molina Healthcare Passport |
$879.94
|
| Rate for Payer: Multiplan PHCS |
$855.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$997.50
|
| Rate for Payer: UHCCP Medicaid |
$498.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$888.74
|
|
|
ARTHRODESIS; SUBTALAR
|
Facility
|
OP
|
$15,933.60
|
|
|
Service Code
|
CPT 28725
|
| Hospital Charge Code |
76102702
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$11,381.14 |
| Max. Negotiated Rate |
$15,933.60 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,381.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15,933.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$15,364.54
|
| Rate for Payer: Humana Medicare Advantage |
$11,381.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13,657.37
|
|
