|
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
|
|
|
ARTHRODESIS; SUBTALAR
|
Facility
|
OP
|
$15,933.60
|
|
|
Service Code
|
CPT 28725
|
|
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
|
|
|
ARTHRODESIS; TRIPLE
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 28715
|
| Hospital Charge Code |
76101036
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$620.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
ARTHRODESIS; TRIPLE
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 28715
|
| Hospital Charge Code |
76101036
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$700.00 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna Commercial |
$1,465.84
|
| Rate for Payer: Anthem Medicaid |
$734.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,593.01
|
| Rate for Payer: Healthspan PPO |
$1,327.74
|
| Rate for Payer: Humana Medicaid |
$734.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,216.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$748.72
|
| Rate for Payer: Molina Healthcare Passport |
$734.04
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,400.00
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$741.38
|
|
|
ARTHRODESIS; TRIPLE
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 28715
|
| Hospital Charge Code |
76101036
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$15,933.60 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem Medicaid |
$687.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,381.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| 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 |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Humana KY Medicaid |
$687.80
|
| Rate for Payer: Humana Medicare Advantage |
$11,381.14
|
| Rate for Payer: Kentucky WC Medicaid |
$694.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13,657.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$701.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$620.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
ARTHRODESIS; TRIPLE(P
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 28715
|
| Hospital Charge Code |
761P1036
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$700.00 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna Commercial |
$1,465.84
|
| Rate for Payer: Anthem Medicaid |
$734.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,593.01
|
| Rate for Payer: Healthspan PPO |
$1,327.74
|
| Rate for Payer: Humana Medicaid |
$734.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,216.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$748.72
|
| Rate for Payer: Molina Healthcare Passport |
$734.04
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,400.00
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$741.38
|
|
|
ARTHRODESIS, WITH TENDON LENGTHENING AND ADVANCEMENT, MIDTARSAL, TARSAL NAVICULAR-CUNEIFORM (EG, MILLER TYPE PROCEDURE)
|
Facility
|
OP
|
$15,933.60
|
|
|
Service Code
|
CPT 28737
|
|
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
|
|
|
ARTHROFEMCONDYLE/TIBPLATEAKNEE
|
Professional
|
Both
|
$2,325.00
|
|
|
Service Code
|
HCPCS 27442
|
| Hospital Charge Code |
761P0846
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$783.21 |
| Max. Negotiated Rate |
$2,325.00 |
| Rate for Payer: Aetna Commercial |
$1,292.84
|
| Rate for Payer: Anthem Medicaid |
$783.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,325.00
|
| Rate for Payer: Cash Price |
$1,162.50
|
| Rate for Payer: Cash Price |
$1,162.50
|
| Rate for Payer: Cigna Commercial |
$1,408.60
|
| Rate for Payer: Healthspan PPO |
$1,171.03
|
| Rate for Payer: Humana Medicaid |
$783.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,081.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$798.87
|
| Rate for Payer: Molina Healthcare Passport |
$783.21
|
| Rate for Payer: Multiplan PHCS |
$1,395.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,627.50
|
| Rate for Payer: UHCCP Medicaid |
$813.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$791.04
|
|
|
ARTHROFEMCONDYLE/TIBPLATEAKNEE
|
Facility
|
IP
|
$2,325.00
|
|
|
Service Code
|
HCPCS 27442
|
| Hospital Charge Code |
76100846
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$302.25 |
| Max. Negotiated Rate |
$2,232.00 |
| Rate for Payer: Aetna Commercial |
$1,790.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,813.50
|
| Rate for Payer: Cash Price |
$1,162.50
|
| Rate for Payer: Cigna Commercial |
$1,929.75
|
| Rate for Payer: First Health Commercial |
$2,208.75
|
| Rate for Payer: Humana Commercial |
$1,976.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,906.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,715.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$697.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,046.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,743.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$465.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$302.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$720.75
|
| Rate for Payer: PHCS Commercial |
$2,232.00
|
| Rate for Payer: United Healthcare All Payer |
$2,046.00
|
|
|
ARTHROFEMCONDYLE/TIBPLATEAKNEE
|
Professional
|
Both
|
$2,325.00
|
|
|
Service Code
|
HCPCS 27442
|
| Hospital Charge Code |
76100846
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$783.21 |
| Max. Negotiated Rate |
$2,325.00 |
| Rate for Payer: Aetna Commercial |
$1,292.84
|
| Rate for Payer: Anthem Medicaid |
$783.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,325.00
|
| Rate for Payer: Cash Price |
$1,162.50
|
| Rate for Payer: Cash Price |
$1,162.50
|
| Rate for Payer: Cigna Commercial |
$1,408.60
|
| Rate for Payer: Healthspan PPO |
$1,171.03
|
| Rate for Payer: Humana Medicaid |
$783.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,081.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$798.87
|
| Rate for Payer: Molina Healthcare Passport |
$783.21
|
| Rate for Payer: Multiplan PHCS |
$1,395.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,627.50
|
| Rate for Payer: UHCCP Medicaid |
$813.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$791.04
|
|
|
ARTHROFEMCONDYLE/TIBPLATEAKNEE
|
Facility
|
OP
|
$2,325.00
|
|
|
Service Code
|
HCPCS 27442
|
| Hospital Charge Code |
76100846
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$302.25 |
| Max. Negotiated Rate |
$15,933.60 |
| Rate for Payer: Aetna Commercial |
$1,790.25
|
| Rate for Payer: Anthem Medicaid |
$799.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,381.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,813.50
|
| 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 |
$1,162.50
|
| Rate for Payer: Cash Price |
$1,162.50
|
| Rate for Payer: Cigna Commercial |
$1,929.75
|
| Rate for Payer: First Health Commercial |
$2,208.75
|
| Rate for Payer: Humana Commercial |
$1,976.25
|
| Rate for Payer: Humana KY Medicaid |
$799.57
|
| Rate for Payer: Humana Medicare Advantage |
$11,381.14
|
| Rate for Payer: Kentucky WC Medicaid |
$807.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,906.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,715.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13,657.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$815.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,046.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,743.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$465.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$302.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$720.75
|
| Rate for Payer: PHCS Commercial |
$2,232.00
|
| Rate for Payer: United Healthcare All Payer |
$2,046.00
|
|
|
ARTHROFLX DERMIS 40MM*70MM*1MM
|
Facility
|
IP
|
$9,780.62
|
|
|
Service Code
|
HCPCS Q4125
|
| Hospital Charge Code |
27000123
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,271.48 |
| Max. Negotiated Rate |
$9,389.40 |
| Rate for Payer: Aetna Commercial |
$7,531.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,628.88
|
| Rate for Payer: Cash Price |
$4,890.31
|
| Rate for Payer: Cigna Commercial |
$8,117.91
|
| Rate for Payer: First Health Commercial |
$9,291.59
|
| Rate for Payer: Humana Commercial |
$8,313.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,020.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,218.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,934.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,606.95
|
| Rate for Payer: Ohio Health Group HMO |
$7,335.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,956.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,271.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,031.99
|
| Rate for Payer: PHCS Commercial |
$9,389.40
|
| Rate for Payer: United Healthcare All Payer |
$8,606.95
|
|
|
ARTHROFLX DERMIS 40MM*70MM*1MM
|
Facility
|
OP
|
$9,780.62
|
|
|
Service Code
|
HCPCS Q4125
|
| Hospital Charge Code |
27000123
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,271.48 |
| Max. Negotiated Rate |
$9,389.40 |
| Rate for Payer: Aetna Commercial |
$7,531.08
|
| Rate for Payer: Anthem Medicaid |
$3,363.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,628.88
|
| Rate for Payer: Cash Price |
$4,890.31
|
| Rate for Payer: Cigna Commercial |
$8,117.91
|
| Rate for Payer: First Health Commercial |
$9,291.59
|
| Rate for Payer: Humana Commercial |
$8,313.53
|
| Rate for Payer: Humana KY Medicaid |
$3,363.56
|
| Rate for Payer: Kentucky WC Medicaid |
$3,397.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,020.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,218.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,934.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,431.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,606.95
|
| Rate for Payer: Ohio Health Group HMO |
$7,335.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,956.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,271.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,031.99
|
| Rate for Payer: PHCS Commercial |
$9,389.40
|
| Rate for Payer: United Healthcare All Payer |
$8,606.95
|
|
|
ARTHROGRAM - LT ANKLE
|
Professional
|
Both
|
$778.00
|
|
|
Service Code
|
HCPCS 73615
|
| Hospital Charge Code |
32000108
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$35.96 |
| Max. Negotiated Rate |
$778.00 |
| Rate for Payer: Aetna Commercial |
$150.49
|
| Rate for Payer: Anthem Medicaid |
$80.33
|
| 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 |
$157.10
|
| Rate for Payer: Healthspan PPO |
$141.02
|
| Rate for Payer: Humana Medicaid |
$80.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$35.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$81.94
|
| Rate for Payer: Molina Healthcare Passport |
$80.33
|
| Rate for Payer: Multiplan PHCS |
$466.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$544.60
|
| Rate for Payer: UHCCP Medicaid |
$272.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$81.13
|
|
|
ARTHROGRAM - LT ANKLE
|
Facility
|
OP
|
$778.00
|
|
|
Service Code
|
HCPCS 73615
|
| Hospital Charge Code |
32000108
|
|
Hospital Revenue Code
|
320
|
| 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 |
$332.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$606.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$448.96
|
| 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 |
$332.56
|
| 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 |
$399.07
|
| 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
|
|
|
ARTHROGRAM - LT ANKLE
|
Facility
|
IP
|
$778.00
|
|
|
Service Code
|
HCPCS 73615
|
| Hospital Charge Code |
32000108
|
|
Hospital Revenue Code
|
320
|
| 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
|
|
|
ARTHROGRAM - LT ANKLE(P
|
Professional
|
Both
|
$130.00
|
|
|
Service Code
|
HCPCS 73615
|
| Hospital Charge Code |
320P0108
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$35.96 |
| Max. Negotiated Rate |
$157.10 |
| Rate for Payer: Aetna Commercial |
$150.49
|
| Rate for Payer: Anthem Medicaid |
$80.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$130.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna Commercial |
$157.10
|
| Rate for Payer: Healthspan PPO |
$141.02
|
| Rate for Payer: Humana Medicaid |
$80.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$35.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$81.94
|
| Rate for Payer: Molina Healthcare Passport |
$80.33
|
| Rate for Payer: Multiplan PHCS |
$78.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$91.00
|
| Rate for Payer: UHCCP Medicaid |
$45.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$81.13
|
|
|
ARTHROGRAM - LT ANKLE(T
|
Facility
|
OP
|
$648.00
|
|
|
Service Code
|
HCPCS 73615
|
| Hospital Charge Code |
320T0108
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$84.24 |
| Max. Negotiated Rate |
$622.08 |
| Rate for Payer: Aetna Commercial |
$498.96
|
| Rate for Payer: Anthem Medicaid |
$222.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$332.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$505.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$448.96
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cigna Commercial |
$537.84
|
| Rate for Payer: First Health Commercial |
$615.60
|
| Rate for Payer: Humana Commercial |
$550.80
|
| Rate for Payer: Humana KY Medicaid |
$222.85
|
| Rate for Payer: Humana Medicare Advantage |
$332.56
|
| Rate for Payer: Kentucky WC Medicaid |
$225.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$531.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$478.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$227.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$570.24
|
| Rate for Payer: Ohio Health Group HMO |
$486.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$129.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$84.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$200.88
|
| Rate for Payer: PHCS Commercial |
$622.08
|
| Rate for Payer: United Healthcare All Payer |
$570.24
|
|
|
ARTHROGRAM - LT ANKLE(T
|
Facility
|
IP
|
$648.00
|
|
|
Service Code
|
HCPCS 73615
|
| Hospital Charge Code |
320T0108
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$84.24 |
| Max. Negotiated Rate |
$622.08 |
| Rate for Payer: Aetna Commercial |
$498.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$505.44
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cigna Commercial |
$537.84
|
| Rate for Payer: First Health Commercial |
$615.60
|
| Rate for Payer: Humana Commercial |
$550.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$531.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$478.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$194.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$570.24
|
| Rate for Payer: Ohio Health Group HMO |
$486.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$129.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$84.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$200.88
|
| Rate for Payer: PHCS Commercial |
$622.08
|
| Rate for Payer: United Healthcare All Payer |
$570.24
|
|
|
ARTHROGRAM - LT ELBOW
|
Facility
|
IP
|
$748.00
|
|
|
Service Code
|
HCPCS 73085
|
| Hospital Charge Code |
32000081
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$97.24 |
| Max. Negotiated Rate |
$718.08 |
| Rate for Payer: Aetna Commercial |
$575.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$583.44
|
| Rate for Payer: Cash Price |
$374.00
|
| Rate for Payer: Cigna Commercial |
$620.84
|
| Rate for Payer: First Health Commercial |
$710.60
|
| Rate for Payer: Humana Commercial |
$635.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$613.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$552.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$224.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$658.24
|
| Rate for Payer: Ohio Health Group HMO |
$561.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$149.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$231.88
|
| Rate for Payer: PHCS Commercial |
$718.08
|
| Rate for Payer: United Healthcare All Payer |
$658.24
|
|
|
ARTHROGRAM - LT ELBOW
|
Facility
|
OP
|
$748.00
|
|
|
Service Code
|
HCPCS 73085
|
| Hospital Charge Code |
32000081
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$97.24 |
| Max. Negotiated Rate |
$718.08 |
| Rate for Payer: Aetna Commercial |
$575.96
|
| Rate for Payer: Anthem Medicaid |
$257.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$332.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$583.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$448.96
|
| Rate for Payer: Cash Price |
$374.00
|
| Rate for Payer: Cash Price |
$374.00
|
| Rate for Payer: Cigna Commercial |
$620.84
|
| Rate for Payer: First Health Commercial |
$710.60
|
| Rate for Payer: Humana Commercial |
$635.80
|
| Rate for Payer: Humana KY Medicaid |
$257.24
|
| Rate for Payer: Humana Medicare Advantage |
$332.56
|
| Rate for Payer: Kentucky WC Medicaid |
$259.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$613.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$552.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$262.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$658.24
|
| Rate for Payer: Ohio Health Group HMO |
$561.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$149.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$231.88
|
| Rate for Payer: PHCS Commercial |
$718.08
|
| Rate for Payer: United Healthcare All Payer |
$658.24
|
|
|
ARTHROGRAM - LT ELBOW
|
Professional
|
Both
|
$748.00
|
|
|
Service Code
|
HCPCS 73085
|
| Hospital Charge Code |
32000081
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$35.01 |
| Max. Negotiated Rate |
$748.00 |
| Rate for Payer: Aetna Commercial |
$146.57
|
| Rate for Payer: Anthem Medicaid |
$80.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$748.00
|
| Rate for Payer: Cash Price |
$374.00
|
| Rate for Payer: Cash Price |
$374.00
|
| Rate for Payer: Cigna Commercial |
$155.41
|
| Rate for Payer: Healthspan PPO |
$137.34
|
| Rate for Payer: Humana Medicaid |
$80.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$35.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$81.94
|
| Rate for Payer: Molina Healthcare Passport |
$80.33
|
| Rate for Payer: Multiplan PHCS |
$448.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$523.60
|
| Rate for Payer: UHCCP Medicaid |
$261.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$81.13
|
|
|
ARTHROGRAM - LT ELBOW(P
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 73085
|
| Hospital Charge Code |
320P0081
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$155.41 |
| Rate for Payer: Aetna Commercial |
$146.57
|
| Rate for Payer: Anthem Medicaid |
$80.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$100.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$155.41
|
| Rate for Payer: Healthspan PPO |
$137.34
|
| Rate for Payer: Humana Medicaid |
$80.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$35.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$81.94
|
| Rate for Payer: Molina Healthcare Passport |
$80.33
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.00
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$81.13
|
|
|
ARTHROGRAM - LT ELBOW(T
|
Facility
|
IP
|
$648.00
|
|
|
Service Code
|
HCPCS 73085
|
| Hospital Charge Code |
320T0081
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$84.24 |
| Max. Negotiated Rate |
$622.08 |
| Rate for Payer: Aetna Commercial |
$498.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$505.44
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cigna Commercial |
$537.84
|
| Rate for Payer: First Health Commercial |
$615.60
|
| Rate for Payer: Humana Commercial |
$550.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$531.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$478.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$194.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$570.24
|
| Rate for Payer: Ohio Health Group HMO |
$486.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$129.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$84.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$200.88
|
| Rate for Payer: PHCS Commercial |
$622.08
|
| Rate for Payer: United Healthcare All Payer |
$570.24
|
|
|
ARTHROGRAM - LT ELBOW(T
|
Facility
|
OP
|
$648.00
|
|
|
Service Code
|
HCPCS 73085
|
| Hospital Charge Code |
320T0081
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$84.24 |
| Max. Negotiated Rate |
$622.08 |
| Rate for Payer: Aetna Commercial |
$498.96
|
| Rate for Payer: Anthem Medicaid |
$222.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$332.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$505.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$448.96
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cigna Commercial |
$537.84
|
| Rate for Payer: First Health Commercial |
$615.60
|
| Rate for Payer: Humana Commercial |
$550.80
|
| Rate for Payer: Humana KY Medicaid |
$222.85
|
| Rate for Payer: Humana Medicare Advantage |
$332.56
|
| Rate for Payer: Kentucky WC Medicaid |
$225.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$531.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$478.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$227.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$570.24
|
| Rate for Payer: Ohio Health Group HMO |
$486.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$129.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$84.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$200.88
|
| Rate for Payer: PHCS Commercial |
$622.08
|
| Rate for Payer: United Healthcare All Payer |
$570.24
|
|
