|
ARTHROGRAM - LT HIP
|
Facility
|
IP
|
$808.00
|
|
|
Service Code
|
HCPCS 73525
|
| Hospital Charge Code |
32000097
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$105.04 |
| Max. Negotiated Rate |
$775.68 |
| Rate for Payer: Aetna Commercial |
$622.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$630.24
|
| Rate for Payer: Cash Price |
$404.00
|
| Rate for Payer: Cigna Commercial |
$670.64
|
| Rate for Payer: First Health Commercial |
$767.60
|
| Rate for Payer: Humana Commercial |
$686.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$662.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$596.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$242.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$711.04
|
| Rate for Payer: Ohio Health Group HMO |
$606.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$161.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$250.48
|
| Rate for Payer: PHCS Commercial |
$775.68
|
| Rate for Payer: United Healthcare All Payer |
$711.04
|
|
|
ARTHROGRAM - LT HIP
|
Professional
|
Both
|
$808.00
|
|
|
Service Code
|
HCPCS 73525
|
| Hospital Charge Code |
32000097
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$35.96 |
| Max. Negotiated Rate |
$808.00 |
| Rate for Payer: Aetna Commercial |
$146.75
|
| Rate for Payer: Anthem Medicaid |
$80.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$808.00
|
| Rate for Payer: Cash Price |
$404.00
|
| Rate for Payer: Cash Price |
$404.00
|
| Rate for Payer: Cigna Commercial |
$155.99
|
| Rate for Payer: Healthspan PPO |
$137.50
|
| 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 |
$484.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$565.60
|
| Rate for Payer: UHCCP Medicaid |
$282.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$81.13
|
|
|
ARTHROGRAM - LT HIP
|
Facility
|
OP
|
$808.00
|
|
|
Service Code
|
HCPCS 73525
|
| Hospital Charge Code |
32000097
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$105.04 |
| Max. Negotiated Rate |
$775.68 |
| Rate for Payer: Aetna Commercial |
$622.16
|
| Rate for Payer: Anthem Medicaid |
$277.87
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$332.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$630.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$448.96
|
| Rate for Payer: Cash Price |
$404.00
|
| Rate for Payer: Cash Price |
$404.00
|
| Rate for Payer: Cigna Commercial |
$670.64
|
| Rate for Payer: First Health Commercial |
$767.60
|
| Rate for Payer: Humana Commercial |
$686.80
|
| Rate for Payer: Humana KY Medicaid |
$277.87
|
| Rate for Payer: Humana Medicare Advantage |
$332.56
|
| Rate for Payer: Kentucky WC Medicaid |
$280.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$662.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$596.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$283.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$711.04
|
| Rate for Payer: Ohio Health Group HMO |
$606.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$161.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$250.48
|
| Rate for Payer: PHCS Commercial |
$775.68
|
| Rate for Payer: United Healthcare All Payer |
$711.04
|
|
|
ARTHROGRAM - LT HIP(P
|
Professional
|
Both
|
$160.00
|
|
|
Service Code
|
HCPCS 73525
|
| Hospital Charge Code |
320P0097
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$35.96 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: Aetna Commercial |
$146.75
|
| Rate for Payer: Anthem Medicaid |
$80.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$160.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cigna Commercial |
$155.99
|
| Rate for Payer: Healthspan PPO |
$137.50
|
| 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 |
$96.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$112.00
|
| Rate for Payer: UHCCP Medicaid |
$56.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$81.13
|
|
|
ARTHROGRAM - LT HIP(T
|
Facility
|
OP
|
$648.00
|
|
|
Service Code
|
HCPCS 73525
|
| Hospital Charge Code |
320T0097
|
|
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 HIP(T
|
Facility
|
IP
|
$648.00
|
|
|
Service Code
|
HCPCS 73525
|
| Hospital Charge Code |
320T0097
|
|
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 KNEE
|
Professional
|
Both
|
$773.00
|
|
|
Service Code
|
HCPCS 73580
|
| Hospital Charge Code |
32000103
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$37.32 |
| Max. Negotiated Rate |
$773.00 |
| Rate for Payer: Aetna Commercial |
$181.89
|
| Rate for Payer: Anthem Medicaid |
$94.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$773.00
|
| Rate for Payer: Cash Price |
$386.50
|
| Rate for Payer: Cash Price |
$386.50
|
| Rate for Payer: Cigna Commercial |
$185.80
|
| Rate for Payer: Healthspan PPO |
$170.43
|
| Rate for Payer: Humana Medicaid |
$94.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$37.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$96.60
|
| Rate for Payer: Molina Healthcare Passport |
$94.71
|
| Rate for Payer: Multiplan PHCS |
$463.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$541.10
|
| Rate for Payer: UHCCP Medicaid |
$270.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$95.66
|
|
|
ARTHROGRAM - LT KNEE
|
Facility
|
OP
|
$773.00
|
|
|
Service Code
|
HCPCS 73580
|
| Hospital Charge Code |
32000103
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$100.49 |
| Max. Negotiated Rate |
$742.08 |
| Rate for Payer: Aetna Commercial |
$595.21
|
| Rate for Payer: Anthem Medicaid |
$265.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$332.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$602.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$448.96
|
| Rate for Payer: Cash Price |
$386.50
|
| Rate for Payer: Cash Price |
$386.50
|
| Rate for Payer: Cigna Commercial |
$641.59
|
| Rate for Payer: First Health Commercial |
$734.35
|
| Rate for Payer: Humana Commercial |
$657.05
|
| Rate for Payer: Humana KY Medicaid |
$265.83
|
| Rate for Payer: Humana Medicare Advantage |
$332.56
|
| Rate for Payer: Kentucky WC Medicaid |
$268.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$633.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$570.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$271.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$680.24
|
| Rate for Payer: Ohio Health Group HMO |
$579.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$154.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$239.63
|
| Rate for Payer: PHCS Commercial |
$742.08
|
| Rate for Payer: United Healthcare All Payer |
$680.24
|
|
|
ARTHROGRAM - LT KNEE
|
Facility
|
IP
|
$773.00
|
|
|
Service Code
|
HCPCS 73580
|
| Hospital Charge Code |
32000103
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$100.49 |
| Max. Negotiated Rate |
$742.08 |
| Rate for Payer: Aetna Commercial |
$595.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$602.94
|
| Rate for Payer: Cash Price |
$386.50
|
| Rate for Payer: Cigna Commercial |
$641.59
|
| Rate for Payer: First Health Commercial |
$734.35
|
| Rate for Payer: Humana Commercial |
$657.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$633.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$570.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$231.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$680.24
|
| Rate for Payer: Ohio Health Group HMO |
$579.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$154.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$239.63
|
| Rate for Payer: PHCS Commercial |
$742.08
|
| Rate for Payer: United Healthcare All Payer |
$680.24
|
|
|
ARTHROGRAM - LT KNEE(P
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 73580
|
| Hospital Charge Code |
320P0103
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$37.32 |
| Max. Negotiated Rate |
$185.80 |
| Rate for Payer: Aetna Commercial |
$181.89
|
| Rate for Payer: Anthem Medicaid |
$94.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$125.00
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$185.80
|
| Rate for Payer: Healthspan PPO |
$170.43
|
| Rate for Payer: Humana Medicaid |
$94.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$37.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$96.60
|
| Rate for Payer: Molina Healthcare Passport |
$94.71
|
| Rate for Payer: Multiplan PHCS |
$75.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$87.50
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$95.66
|
|
|
ARTHROGRAM - LT KNEE(T
|
Facility
|
IP
|
$648.00
|
|
|
Service Code
|
HCPCS 73580
|
| Hospital Charge Code |
320T0103
|
|
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 KNEE(T
|
Facility
|
OP
|
$648.00
|
|
|
Service Code
|
HCPCS 73580
|
| Hospital Charge Code |
320T0103
|
|
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 SHOULDER
|
Facility
|
IP
|
$748.00
|
|
|
Service Code
|
HCPCS 73040
|
| Hospital Charge Code |
32000076
|
|
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 SHOULDER
|
Professional
|
Both
|
$748.00
|
|
|
Service Code
|
HCPCS 73040
|
| Hospital Charge Code |
32000076
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$35.13 |
| Max. Negotiated Rate |
$748.00 |
| Rate for Payer: Aetna Commercial |
$161.55
|
| 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 |
$160.38
|
| Rate for Payer: Healthspan PPO |
$151.38
|
| Rate for Payer: Humana Medicaid |
$80.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$35.13
|
| 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 SHOULDER
|
Facility
|
OP
|
$748.00
|
|
|
Service Code
|
HCPCS 73040
|
| Hospital Charge Code |
32000076
|
|
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 SHOULDER(P
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 73040
|
| Hospital Charge Code |
320P0076
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$161.55 |
| Rate for Payer: Aetna Commercial |
$161.55
|
| 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 |
$160.38
|
| Rate for Payer: Healthspan PPO |
$151.38
|
| Rate for Payer: Humana Medicaid |
$80.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$35.13
|
| 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 SHOULDER(T
|
Facility
|
OP
|
$648.00
|
|
|
Service Code
|
HCPCS 73040
|
| Hospital Charge Code |
320T0076
|
|
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 SHOULDER(T
|
Facility
|
IP
|
$648.00
|
|
|
Service Code
|
HCPCS 73040
|
| Hospital Charge Code |
320T0076
|
|
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 - RT WRIST
|
Professional
|
Both
|
$748.00
|
|
|
Service Code
|
HCPCS 73115
|
| Hospital Charge Code |
32000086
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$35.96 |
| Max. Negotiated Rate |
$748.00 |
| Rate for Payer: Aetna Commercial |
$154.25
|
| Rate for Payer: Anthem Medicaid |
$66.19
|
| 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 |
$139.94
|
| Rate for Payer: Healthspan PPO |
$144.54
|
| Rate for Payer: Humana Medicaid |
$66.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$35.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$67.51
|
| Rate for Payer: Molina Healthcare Passport |
$66.19
|
| 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 |
$66.85
|
|
|
ARTHROGRAM - RT WRIST
|
Facility
|
IP
|
$748.00
|
|
|
Service Code
|
HCPCS 73115
|
| Hospital Charge Code |
32000086
|
|
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 - RT WRIST
|
Facility
|
OP
|
$748.00
|
|
|
Service Code
|
HCPCS 73115
|
| Hospital Charge Code |
32000086
|
|
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 - RT WRIST(P
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 73115
|
| Hospital Charge Code |
320P0086
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$154.25 |
| Rate for Payer: Aetna Commercial |
$154.25
|
| Rate for Payer: Anthem Medicaid |
$66.19
|
| 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 |
$139.94
|
| Rate for Payer: Healthspan PPO |
$144.54
|
| Rate for Payer: Humana Medicaid |
$66.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$35.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$67.51
|
| Rate for Payer: Molina Healthcare Passport |
$66.19
|
| 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 |
$66.85
|
|
|
ARTHROGRAM - RT WRIST(T
|
Facility
|
IP
|
$648.00
|
|
|
Service Code
|
HCPCS 73115
|
| Hospital Charge Code |
320T0086
|
|
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 - RT WRIST(T
|
Facility
|
OP
|
$648.00
|
|
|
Service Code
|
HCPCS 73115
|
| Hospital Charge Code |
320T0086
|
|
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
|
|
|
ARTHRO PATELLA WITH PROSTHESIS
|
Professional
|
Both
|
$2,700.00
|
|
|
Service Code
|
HCPCS 27438
|
| Hospital Charge Code |
761P0844
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$706.12 |
| Max. Negotiated Rate |
$2,700.00 |
| Rate for Payer: Aetna Commercial |
$1,245.53
|
| Rate for Payer: Anthem Medicaid |
$706.12
|
| 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 |
$1,350.35
|
| Rate for Payer: Healthspan PPO |
$1,128.19
|
| Rate for Payer: Humana Medicaid |
$706.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,045.33
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$720.24
|
| Rate for Payer: Molina Healthcare Passport |
$706.12
|
| 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 |
$713.18
|
|
