|
ARTHROTOMY, ELBOW/SYNOVECTOM(T
|
Facility
|
IP
|
$5,593.61
|
|
|
Service Code
|
HCPCS 24102
|
| Hospital Charge Code |
761T0507
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$727.17 |
| Max. Negotiated Rate |
$5,369.87 |
| Rate for Payer: Aetna Commercial |
$4,307.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,363.02
|
| Rate for Payer: Cash Price |
$2,796.80
|
| Rate for Payer: Cigna Commercial |
$4,642.70
|
| Rate for Payer: First Health Commercial |
$5,313.93
|
| Rate for Payer: Humana Commercial |
$4,754.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,586.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,128.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,678.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,922.38
|
| Rate for Payer: Ohio Health Group HMO |
$4,195.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,118.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$727.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,734.02
|
| Rate for Payer: PHCS Commercial |
$5,369.87
|
| Rate for Payer: United Healthcare All Payer |
$4,922.38
|
|
|
ARTHROTOMY, ELBOW/SYNOVECTOMY
|
Facility
|
OP
|
$6,693.61
|
|
|
Service Code
|
HCPCS 24102
|
| Hospital Charge Code |
76100507
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$870.17 |
| Max. Negotiated Rate |
$6,425.87 |
| Rate for Payer: Aetna Commercial |
$5,154.08
|
| Rate for Payer: Anthem Medicaid |
$2,301.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,221.02
|
| 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 |
$3,346.80
|
| Rate for Payer: Cash Price |
$3,346.80
|
| Rate for Payer: Cigna Commercial |
$5,555.70
|
| Rate for Payer: First Health Commercial |
$6,358.93
|
| Rate for Payer: Humana Commercial |
$5,689.57
|
| Rate for Payer: Humana KY Medicaid |
$2,301.93
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$2,325.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,488.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,939.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,348.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,890.38
|
| Rate for Payer: Ohio Health Group HMO |
$5,020.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,338.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,075.02
|
| Rate for Payer: PHCS Commercial |
$6,425.87
|
| Rate for Payer: United Healthcare All Payer |
$5,890.38
|
|
|
ARTHROTOMY, ELBOW/SYNOVECTOMY
|
Professional
|
Both
|
$6,693.61
|
|
|
Service Code
|
HCPCS 24102
|
| Hospital Charge Code |
76100507
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$525.75 |
| Max. Negotiated Rate |
$6,693.61 |
| Rate for Payer: Aetna Commercial |
$895.91
|
| Rate for Payer: Anthem Medicaid |
$525.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,693.61
|
| Rate for Payer: Cash Price |
$3,346.80
|
| Rate for Payer: Cash Price |
$3,346.80
|
| Rate for Payer: Cigna Commercial |
$986.46
|
| Rate for Payer: Healthspan PPO |
$811.51
|
| Rate for Payer: Humana Medicaid |
$525.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$757.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$536.26
|
| Rate for Payer: Molina Healthcare Passport |
$525.75
|
| Rate for Payer: Multiplan PHCS |
$4,016.17
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,685.53
|
| Rate for Payer: UHCCP Medicaid |
$2,342.76
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$531.01
|
|
|
ARTHROTOMY, ELBOW/SYNOVECTOMY
|
Facility
|
IP
|
$6,693.61
|
|
|
Service Code
|
HCPCS 24102
|
| Hospital Charge Code |
76100507
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$870.17 |
| Max. Negotiated Rate |
$6,425.87 |
| Rate for Payer: Aetna Commercial |
$5,154.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,221.02
|
| Rate for Payer: Cash Price |
$3,346.80
|
| Rate for Payer: Cigna Commercial |
$5,555.70
|
| Rate for Payer: First Health Commercial |
$6,358.93
|
| Rate for Payer: Humana Commercial |
$5,689.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,488.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,939.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,008.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,890.38
|
| Rate for Payer: Ohio Health Group HMO |
$5,020.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,338.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,075.02
|
| Rate for Payer: PHCS Commercial |
$6,425.87
|
| Rate for Payer: United Healthcare All Payer |
$5,890.38
|
|
|
ARTHROTOMY EXP DRNGE
|
Facility
|
IP
|
$560.00
|
|
|
Service Code
|
HCPCS 28020
|
| Hospital Charge Code |
76100968
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$72.80 |
| Max. Negotiated Rate |
$537.60 |
| Rate for Payer: Aetna Commercial |
$431.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$436.80
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cigna Commercial |
$464.80
|
| Rate for Payer: First Health Commercial |
$532.00
|
| Rate for Payer: Humana Commercial |
$476.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$459.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$413.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$168.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$492.80
|
| Rate for Payer: Ohio Health Group HMO |
$420.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$173.60
|
| Rate for Payer: PHCS Commercial |
$537.60
|
| Rate for Payer: United Healthcare All Payer |
$492.80
|
|
|
ARTHROTOMY EXP DRNGE
|
Professional
|
Both
|
$560.00
|
|
|
Service Code
|
HCPCS 28020
|
| Hospital Charge Code |
76100968
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$189.13 |
| Max. Negotiated Rate |
$748.73 |
| Rate for Payer: Aetna Commercial |
$541.38
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$189.13
|
| Rate for Payer: Anthem Medicaid |
$271.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$560.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cigna Commercial |
$748.73
|
| Rate for Payer: Healthspan PPO |
$645.03
|
| Rate for Payer: Humana Medicaid |
$271.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$443.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$276.43
|
| Rate for Payer: Molina Healthcare Passport |
$271.01
|
| Rate for Payer: Multiplan PHCS |
$336.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$392.00
|
| Rate for Payer: UHCCP Medicaid |
$198.59
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$273.72
|
|
|
ARTHROTOMY EXP DRNGE
|
Facility
|
OP
|
$560.00
|
|
|
Service Code
|
HCPCS 28020
|
| Hospital Charge Code |
76100968
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$72.80 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$431.20
|
| Rate for Payer: Anthem Medicaid |
$192.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$436.80
|
| 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 |
$280.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cigna Commercial |
$464.80
|
| Rate for Payer: First Health Commercial |
$532.00
|
| Rate for Payer: Humana Commercial |
$476.00
|
| Rate for Payer: Humana KY Medicaid |
$192.58
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$194.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$459.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$413.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$196.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$492.80
|
| Rate for Payer: Ohio Health Group HMO |
$420.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$173.60
|
| Rate for Payer: PHCS Commercial |
$537.60
|
| Rate for Payer: United Healthcare All Payer |
$492.80
|
|
|
ARTHROTOMY EXP DRNGE(P
|
Professional
|
Both
|
$560.00
|
|
|
Service Code
|
HCPCS 28020
|
| Hospital Charge Code |
761P0968
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$189.13 |
| Max. Negotiated Rate |
$748.73 |
| Rate for Payer: Aetna Commercial |
$541.38
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$189.13
|
| Rate for Payer: Anthem Medicaid |
$271.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$560.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cigna Commercial |
$748.73
|
| Rate for Payer: Healthspan PPO |
$645.03
|
| Rate for Payer: Humana Medicaid |
$271.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$443.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$276.43
|
| Rate for Payer: Molina Healthcare Passport |
$271.01
|
| Rate for Payer: Multiplan PHCS |
$336.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$392.00
|
| Rate for Payer: UHCCP Medicaid |
$198.59
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$273.72
|
|
|
ARTHROTOMY, KNEE; INCLUDING JOINT EXPLORATION, BIOPSY, OR REMOVAL OF LOOSE OR FOREIGN BODIES
|
Facility
|
OP
|
$3,918.70
|
|
|
Service Code
|
CPT 27331
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,799.07 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
|
|
ARTHROTOMY/SYNOVECTOMY KNEEA/P
|
Professional
|
Both
|
$2,350.00
|
|
|
Service Code
|
HCPCS 27334
|
| Hospital Charge Code |
76100817
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$549.34 |
| Max. Negotiated Rate |
$2,350.00 |
| Rate for Payer: Aetna Commercial |
$994.48
|
| Rate for Payer: Anthem Medicaid |
$549.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,350.00
|
| Rate for Payer: Cash Price |
$1,175.00
|
| Rate for Payer: Cash Price |
$1,175.00
|
| Rate for Payer: Cigna Commercial |
$1,089.53
|
| Rate for Payer: Healthspan PPO |
$900.78
|
| Rate for Payer: Humana Medicaid |
$549.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$843.42
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$560.33
|
| Rate for Payer: Molina Healthcare Passport |
$549.34
|
| Rate for Payer: Multiplan PHCS |
$1,410.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,645.00
|
| Rate for Payer: UHCCP Medicaid |
$822.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$554.83
|
|
|
ARTHROTOMY/SYNOVECTOMY KNEEA/P
|
Professional
|
Both
|
$2,350.00
|
|
|
Service Code
|
HCPCS 27334
|
| Hospital Charge Code |
761P0817
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$549.34 |
| Max. Negotiated Rate |
$2,350.00 |
| Rate for Payer: Aetna Commercial |
$994.48
|
| Rate for Payer: Anthem Medicaid |
$549.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,350.00
|
| Rate for Payer: Cash Price |
$1,175.00
|
| Rate for Payer: Cash Price |
$1,175.00
|
| Rate for Payer: Cigna Commercial |
$1,089.53
|
| Rate for Payer: Healthspan PPO |
$900.78
|
| Rate for Payer: Humana Medicaid |
$549.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$843.42
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$560.33
|
| Rate for Payer: Molina Healthcare Passport |
$549.34
|
| Rate for Payer: Multiplan PHCS |
$1,410.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,645.00
|
| Rate for Payer: UHCCP Medicaid |
$822.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$554.83
|
|
|
ARTHROTOMY/SYNOVECTOMY KNEEA/P
|
Facility
|
IP
|
$2,350.00
|
|
|
Service Code
|
HCPCS 27334
|
| Hospital Charge Code |
76100817
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$305.50 |
| Max. Negotiated Rate |
$2,256.00 |
| Rate for Payer: Aetna Commercial |
$1,809.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,833.00
|
| Rate for Payer: Cash Price |
$1,175.00
|
| Rate for Payer: Cigna Commercial |
$1,950.50
|
| Rate for Payer: First Health Commercial |
$2,232.50
|
| Rate for Payer: Humana Commercial |
$1,997.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,927.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,734.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$705.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,068.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,762.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$470.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$305.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$728.50
|
| Rate for Payer: PHCS Commercial |
$2,256.00
|
| Rate for Payer: United Healthcare All Payer |
$2,068.00
|
|
|
ARTHROTOMY/SYNOVECTOMY KNEEA/P
|
Facility
|
OP
|
$2,350.00
|
|
|
Service Code
|
HCPCS 27334
|
| Hospital Charge Code |
76100817
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$305.50 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$1,809.50
|
| Rate for Payer: Anthem Medicaid |
$808.16
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,833.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$1,175.00
|
| Rate for Payer: Cash Price |
$1,175.00
|
| Rate for Payer: Cigna Commercial |
$1,950.50
|
| Rate for Payer: First Health Commercial |
$2,232.50
|
| Rate for Payer: Humana Commercial |
$1,997.50
|
| Rate for Payer: Humana KY Medicaid |
$808.16
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$816.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,927.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,734.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$824.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,068.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,762.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$470.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$305.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$728.50
|
| Rate for Payer: PHCS Commercial |
$2,256.00
|
| Rate for Payer: United Healthcare All Payer |
$2,068.00
|
|
|
ARTHROTOMY W/BIOPSY; HIP JOINT
|
Facility
|
IP
|
$775.00
|
|
|
Service Code
|
HCPCS 27052
|
| Hospital Charge Code |
76100770
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$100.75 |
| Max. Negotiated Rate |
$744.00 |
| Rate for Payer: Aetna Commercial |
$596.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$604.50
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cigna Commercial |
$643.25
|
| Rate for Payer: First Health Commercial |
$736.25
|
| Rate for Payer: Humana Commercial |
$658.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$635.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$571.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$232.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$682.00
|
| Rate for Payer: Ohio Health Group HMO |
$581.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$155.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$240.25
|
| Rate for Payer: PHCS Commercial |
$744.00
|
| Rate for Payer: United Healthcare All Payer |
$682.00
|
|
|
ARTHROTOMY W/BIOPSY; HIP JOINT
|
Professional
|
Both
|
$775.00
|
|
|
Service Code
|
HCPCS 27052
|
| Hospital Charge Code |
76100770
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$271.25 |
| Max. Negotiated Rate |
$869.08 |
| Rate for Payer: Aetna Commercial |
$805.39
|
| Rate for Payer: Anthem Medicaid |
$385.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$775.00
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cigna Commercial |
$869.08
|
| Rate for Payer: Healthspan PPO |
$729.51
|
| Rate for Payer: Humana Medicaid |
$385.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$701.33
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$393.22
|
| Rate for Payer: Molina Healthcare Passport |
$385.51
|
| Rate for Payer: Multiplan PHCS |
$465.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$542.50
|
| Rate for Payer: UHCCP Medicaid |
$271.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$389.37
|
|
|
ARTHROTOMY W/BIOPSY; HIP JOINT
|
Professional
|
Both
|
$775.00
|
|
|
Service Code
|
HCPCS 27052
|
| Hospital Charge Code |
761P0770
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$271.25 |
| Max. Negotiated Rate |
$869.08 |
| Rate for Payer: Aetna Commercial |
$805.39
|
| Rate for Payer: Anthem Medicaid |
$385.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$775.00
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cigna Commercial |
$869.08
|
| Rate for Payer: Healthspan PPO |
$729.51
|
| Rate for Payer: Humana Medicaid |
$385.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$701.33
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$393.22
|
| Rate for Payer: Molina Healthcare Passport |
$385.51
|
| Rate for Payer: Multiplan PHCS |
$465.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$542.50
|
| Rate for Payer: UHCCP Medicaid |
$271.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$389.37
|
|
|
ARTHROTOMY W/BIOPSY; HIP JOINT
|
Facility
|
OP
|
$775.00
|
|
|
Service Code
|
HCPCS 27052
|
| Hospital Charge Code |
76100770
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$100.75 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Aetna Commercial |
$596.75
|
| Rate for Payer: Anthem Medicaid |
$266.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$604.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cigna Commercial |
$643.25
|
| Rate for Payer: First Health Commercial |
$736.25
|
| Rate for Payer: Humana Commercial |
$658.75
|
| Rate for Payer: Humana KY Medicaid |
$266.52
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$269.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$635.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$571.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$271.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$682.00
|
| Rate for Payer: Ohio Health Group HMO |
$581.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$155.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$240.25
|
| Rate for Payer: PHCS Commercial |
$744.00
|
| Rate for Payer: United Healthcare All Payer |
$682.00
|
|
|
ARTHROTOMY WITH BIOPSY; INTERPHALANGEAL JOINT, EACH
|
Facility
|
OP
|
$1,945.78
|
|
|
Service Code
|
CPT 26110
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,389.84 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
|
|
ARTHROTOMY, WITH EXPLORATION, DRAINAGE, OR REMOVAL OF LOOSE OR FOREIGN BODY; INTERPHALANGEAL JOINT, EACH
|
Facility
|
OP
|
$1,945.78
|
|
|
Service Code
|
CPT 26080
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,389.84 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
|
|
ARTHROTOMY W/SYNOVECTOMY ANKLE
|
Facility
|
OP
|
$780.00
|
|
|
Service Code
|
HCPCS 27625
|
| Hospital Charge Code |
76100899
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.40 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$600.60
|
| Rate for Payer: Anthem Medicaid |
$268.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$608.40
|
| 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 |
$390.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$647.40
|
| Rate for Payer: First Health Commercial |
$741.00
|
| Rate for Payer: Humana Commercial |
$663.00
|
| Rate for Payer: Humana KY Medicaid |
$268.24
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$270.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$639.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$575.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$273.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$686.40
|
| Rate for Payer: Ohio Health Group HMO |
$585.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.80
|
| Rate for Payer: PHCS Commercial |
$748.80
|
| Rate for Payer: United Healthcare All Payer |
$686.40
|
|
|
ARTHROTOMY W/SYNOVECTOMY ANKLE
|
Professional
|
Both
|
$780.00
|
|
|
Service Code
|
HCPCS 27625
|
| Hospital Charge Code |
76100899
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$273.00 |
| Max. Negotiated Rate |
$974.17 |
| Rate for Payer: Aetna Commercial |
$879.91
|
| Rate for Payer: Anthem Medicaid |
$495.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$780.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$974.17
|
| Rate for Payer: Healthspan PPO |
$797.01
|
| Rate for Payer: Humana Medicaid |
$495.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$717.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$505.62
|
| Rate for Payer: Molina Healthcare Passport |
$495.71
|
| Rate for Payer: Multiplan PHCS |
$468.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$546.00
|
| Rate for Payer: UHCCP Medicaid |
$273.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$500.67
|
|
|
ARTHROTOMY W/SYNOVECTOMY ANKLE
|
Professional
|
Both
|
$780.00
|
|
|
Service Code
|
HCPCS 27625
|
| Hospital Charge Code |
761P0899
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$273.00 |
| Max. Negotiated Rate |
$974.17 |
| Rate for Payer: Aetna Commercial |
$879.91
|
| Rate for Payer: Anthem Medicaid |
$495.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$780.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$974.17
|
| Rate for Payer: Healthspan PPO |
$797.01
|
| Rate for Payer: Humana Medicaid |
$495.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$717.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$505.62
|
| Rate for Payer: Molina Healthcare Passport |
$495.71
|
| Rate for Payer: Multiplan PHCS |
$468.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$546.00
|
| Rate for Payer: UHCCP Medicaid |
$273.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$500.67
|
|
|
ARTHROTOMY W/SYNOVECTOMY ANKLE
|
Facility
|
IP
|
$780.00
|
|
|
Service Code
|
HCPCS 27625
|
| Hospital Charge Code |
76100899
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.40 |
| Max. Negotiated Rate |
$748.80 |
| Rate for Payer: Aetna Commercial |
$600.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$608.40
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$647.40
|
| Rate for Payer: First Health Commercial |
$741.00
|
| Rate for Payer: Humana Commercial |
$663.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$639.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$575.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$234.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$686.40
|
| Rate for Payer: Ohio Health Group HMO |
$585.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.80
|
| Rate for Payer: PHCS Commercial |
$748.80
|
| Rate for Payer: United Healthcare All Payer |
$686.40
|
|
|
ARTHRPLSTY FEMCNDYLE/TIBPLTUKN
|
Professional
|
Both
|
$2,840.00
|
|
|
Service Code
|
HCPCS 27443
|
| Hospital Charge Code |
76100847
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$729.37 |
| Max. Negotiated Rate |
$2,840.00 |
| Rate for Payer: Aetna Commercial |
$1,207.85
|
| Rate for Payer: Anthem Medicaid |
$729.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,840.00
|
| Rate for Payer: Cash Price |
$1,420.00
|
| Rate for Payer: Cash Price |
$1,420.00
|
| Rate for Payer: Cigna Commercial |
$1,323.42
|
| Rate for Payer: Healthspan PPO |
$1,094.05
|
| Rate for Payer: Humana Medicaid |
$729.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,014.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$743.96
|
| Rate for Payer: Molina Healthcare Passport |
$729.37
|
| Rate for Payer: Multiplan PHCS |
$1,704.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,988.00
|
| Rate for Payer: UHCCP Medicaid |
$994.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$736.66
|
|
|
ARTHRPLSTY FEMCNDYLE/TIBPLTUKN
|
Facility
|
IP
|
$2,840.00
|
|
|
Service Code
|
HCPCS 27443
|
| Hospital Charge Code |
76100847
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$369.20 |
| Max. Negotiated Rate |
$2,726.40 |
| Rate for Payer: Aetna Commercial |
$2,186.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,215.20
|
| Rate for Payer: Cash Price |
$1,420.00
|
| Rate for Payer: Cigna Commercial |
$2,357.20
|
| Rate for Payer: First Health Commercial |
$2,698.00
|
| Rate for Payer: Humana Commercial |
$2,414.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,328.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,095.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$852.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,499.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,130.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$568.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$369.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$880.40
|
| Rate for Payer: PHCS Commercial |
$2,726.40
|
| Rate for Payer: United Healthcare All Payer |
$2,499.20
|
|
