|
ARTH ELBOW WEXP DRAIN/RMV(T
|
Facility
|
IP
|
$5,408.00
|
|
|
Service Code
|
HCPCS 24000
|
| Hospital Charge Code |
761T0496
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,622.40 |
| Max. Negotiated Rate |
$5,191.68 |
| Rate for Payer: Aetna Commercial |
$4,164.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,218.24
|
| Rate for Payer: Cash Price |
$2,704.00
|
| Rate for Payer: Cigna Commercial |
$4,488.64
|
| Rate for Payer: First Health Commercial |
$5,137.60
|
| Rate for Payer: Humana Commercial |
$4,596.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,434.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,991.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,622.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,759.04
|
| Rate for Payer: Ohio Health Group HMO |
$4,056.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,326.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,704.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,731.52
|
| Rate for Payer: PHCS Commercial |
$5,191.68
|
| Rate for Payer: United Healthcare All Payer |
$4,759.04
|
|
|
ARTH ELBOW WEXP DRAIN/RMV(T
|
Facility
|
OP
|
$5,408.00
|
|
|
Service Code
|
HCPCS 24000
|
| Hospital Charge Code |
761T0496
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,859.81 |
| Max. Negotiated Rate |
$5,191.68 |
| Rate for Payer: Aetna Commercial |
$4,164.16
|
| Rate for Payer: Anthem Medicaid |
$1,859.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,218.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$2,704.00
|
| Rate for Payer: Cash Price |
$2,704.00
|
| Rate for Payer: Cigna Commercial |
$4,488.64
|
| Rate for Payer: First Health Commercial |
$5,137.60
|
| Rate for Payer: Humana Commercial |
$4,596.80
|
| Rate for Payer: Humana KY Medicaid |
$1,859.81
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,878.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,434.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,991.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,897.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,759.04
|
| Rate for Payer: Ohio Health Group HMO |
$4,056.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,326.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,704.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,731.52
|
| Rate for Payer: PHCS Commercial |
$5,191.68
|
| Rate for Payer: United Healthcare All Payer |
$4,759.04
|
|
|
ARTH GLEN JT EXPL/DRG/RMVL FB
|
Facility
|
IP
|
$915.00
|
|
|
Service Code
|
HCPCS 23040
|
| Hospital Charge Code |
76100434
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$274.50 |
| Max. Negotiated Rate |
$878.40 |
| Rate for Payer: Aetna Commercial |
$704.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$713.70
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cigna Commercial |
$759.45
|
| Rate for Payer: First Health Commercial |
$869.25
|
| Rate for Payer: Humana Commercial |
$777.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$750.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$675.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$274.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$805.20
|
| Rate for Payer: Ohio Health Group HMO |
$686.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$732.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$796.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$631.35
|
| Rate for Payer: PHCS Commercial |
$878.40
|
| Rate for Payer: United Healthcare All Payer |
$805.20
|
|
|
ARTH GLEN JT EXPL/DRG/RMVL FB
|
Facility
|
OP
|
$915.00
|
|
|
Service Code
|
HCPCS 23040
|
| Hospital Charge Code |
76100434
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$314.67 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$704.55
|
| Rate for Payer: Anthem Medicaid |
$314.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$713.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cigna Commercial |
$759.45
|
| Rate for Payer: First Health Commercial |
$869.25
|
| Rate for Payer: Humana Commercial |
$777.75
|
| Rate for Payer: Humana KY Medicaid |
$314.67
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$317.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$750.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$675.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$320.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$805.20
|
| Rate for Payer: Ohio Health Group HMO |
$686.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$732.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$796.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$631.35
|
| Rate for Payer: PHCS Commercial |
$878.40
|
| Rate for Payer: United Healthcare All Payer |
$805.20
|
|
|
ARTH GLEN JT EXPL/DRG/RMVL FB
|
Professional
|
Both
|
$915.00
|
|
|
Service Code
|
HCPCS 23040
|
| Hospital Charge Code |
76100434
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$320.25 |
| Max. Negotiated Rate |
$1,154.23 |
| Rate for Payer: Aetna Commercial |
$1,054.09
|
| Rate for Payer: Ambetter Exchange |
$683.34
|
| Rate for Payer: Anthem Medicaid |
$530.55
|
| Rate for Payer: Buckeye Individual/Medicaid |
$683.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$683.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$820.01
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cigna Commercial |
$1,154.23
|
| Rate for Payer: Healthspan PPO |
$954.78
|
| Rate for Payer: Humana Medicaid |
$530.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$889.91
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$683.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$683.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$541.16
|
| Rate for Payer: Molina Healthcare Passport |
$530.55
|
| Rate for Payer: Multiplan PHCS |
$549.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$888.34
|
| Rate for Payer: UHCCP Medicaid |
$320.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$535.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$683.34
|
|
|
ARTH GLEN JT EXPL/DRG/RMVL F(P
|
Professional
|
Both
|
$915.00
|
|
|
Service Code
|
HCPCS 23040
|
| Hospital Charge Code |
761P0434
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$320.25 |
| Max. Negotiated Rate |
$1,154.23 |
| Rate for Payer: Aetna Commercial |
$1,054.09
|
| Rate for Payer: Ambetter Exchange |
$683.34
|
| Rate for Payer: Anthem Medicaid |
$530.55
|
| Rate for Payer: Buckeye Individual/Medicaid |
$683.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$683.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$820.01
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cigna Commercial |
$1,154.23
|
| Rate for Payer: Healthspan PPO |
$954.78
|
| Rate for Payer: Humana Medicaid |
$530.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$889.91
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$683.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$683.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$541.16
|
| Rate for Payer: Molina Healthcare Passport |
$530.55
|
| Rate for Payer: Multiplan PHCS |
$549.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$888.34
|
| Rate for Payer: UHCCP Medicaid |
$320.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$535.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$683.34
|
|
|
ARTH GLENOHUMERAL JT TOT SHLDR
|
Professional
|
Both
|
$4,400.00
|
|
|
Service Code
|
HCPCS 23472
|
| Hospital Charge Code |
761P0466
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,143.49 |
| Max. Negotiated Rate |
$2,640.00 |
| Rate for Payer: Aetna Commercial |
$2,262.18
|
| Rate for Payer: Ambetter Exchange |
$1,369.75
|
| Rate for Payer: Anthem Medicaid |
$1,143.49
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,369.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,369.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,643.70
|
| Rate for Payer: Cash Price |
$2,200.00
|
| Rate for Payer: Cash Price |
$2,200.00
|
| Rate for Payer: Cigna Commercial |
$2,449.78
|
| Rate for Payer: Healthspan PPO |
$2,049.05
|
| Rate for Payer: Humana Medicaid |
$1,143.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,881.09
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,369.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,369.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,166.36
|
| Rate for Payer: Molina Healthcare Passport |
$1,143.49
|
| Rate for Payer: Multiplan PHCS |
$2,640.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,780.67
|
| Rate for Payer: UHCCP Medicaid |
$1,540.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,154.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,369.75
|
|
|
ARTH GLENOHUMERAL JT TOT SHLDR
|
Facility
|
IP
|
$4,400.00
|
|
|
Service Code
|
HCPCS 23472
|
| Hospital Charge Code |
76100466
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,320.00 |
| Max. Negotiated Rate |
$4,224.00 |
| Rate for Payer: Aetna Commercial |
$3,388.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,432.00
|
| Rate for Payer: Cash Price |
$2,200.00
|
| Rate for Payer: Cigna Commercial |
$3,652.00
|
| Rate for Payer: First Health Commercial |
$4,180.00
|
| Rate for Payer: Humana Commercial |
$3,740.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,608.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,247.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,320.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,872.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,300.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,520.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,828.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,036.00
|
| Rate for Payer: PHCS Commercial |
$4,224.00
|
| Rate for Payer: United Healthcare All Payer |
$3,872.00
|
|
|
ARTH GLENOHUMERAL JT TOT SHLDR
|
Professional
|
Both
|
$4,400.00
|
|
|
Service Code
|
HCPCS 23472
|
| Hospital Charge Code |
76100466
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,143.49 |
| Max. Negotiated Rate |
$2,640.00 |
| Rate for Payer: Aetna Commercial |
$2,262.18
|
| Rate for Payer: Ambetter Exchange |
$1,369.75
|
| Rate for Payer: Anthem Medicaid |
$1,143.49
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,369.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,369.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,643.70
|
| Rate for Payer: Cash Price |
$2,200.00
|
| Rate for Payer: Cash Price |
$2,200.00
|
| Rate for Payer: Cigna Commercial |
$2,449.78
|
| Rate for Payer: Healthspan PPO |
$2,049.05
|
| Rate for Payer: Humana Medicaid |
$1,143.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,881.09
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,369.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,369.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,166.36
|
| Rate for Payer: Molina Healthcare Passport |
$1,143.49
|
| Rate for Payer: Multiplan PHCS |
$2,640.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,780.67
|
| Rate for Payer: UHCCP Medicaid |
$1,540.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,154.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,369.75
|
|
|
ARTH GLENOHUMERAL JT TOT SHLDR
|
Facility
|
OP
|
$4,400.00
|
|
|
Service Code
|
HCPCS 23472
|
| Hospital Charge Code |
76100466
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,513.16 |
| Max. Negotiated Rate |
$23,788.86 |
| Rate for Payer: Aetna Commercial |
$3,388.00
|
| Rate for Payer: Anthem Medicaid |
$1,513.16
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16,992.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,432.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$23,788.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$22,939.25
|
| Rate for Payer: Cash Price |
$2,200.00
|
| Rate for Payer: Cash Price |
$2,200.00
|
| Rate for Payer: Cigna Commercial |
$3,652.00
|
| Rate for Payer: First Health Commercial |
$4,180.00
|
| Rate for Payer: Humana Commercial |
$3,740.00
|
| Rate for Payer: Humana KY Medicaid |
$1,513.16
|
| Rate for Payer: Humana Medicare Advantage |
$16,992.04
|
| Rate for Payer: Kentucky WC Medicaid |
$1,528.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,608.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,247.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,390.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,543.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,872.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,300.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,520.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,828.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,036.00
|
| Rate for Payer: PHCS Commercial |
$4,224.00
|
| Rate for Payer: United Healthcare All Payer |
$3,872.00
|
|
|
ARTH KNEE ABR ARTH/MLT DRL/MFX
|
Facility
|
IP
|
$1,875.00
|
|
|
Service Code
|
HCPCS 29879
|
| Hospital Charge Code |
76101100
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$562.50 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,443.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,462.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,556.25
|
| Rate for Payer: First Health Commercial |
$1,781.25
|
| Rate for Payer: Humana Commercial |
$1,593.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,537.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,383.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,650.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,631.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,293.75
|
| Rate for Payer: PHCS Commercial |
$1,800.00
|
| Rate for Payer: United Healthcare All Payer |
$1,650.00
|
|
|
ARTH KNEE ABR ARTH/MLT DRL/MFX
|
Professional
|
Both
|
$1,875.00
|
|
|
Service Code
|
HCPCS 29879
|
| Hospital Charge Code |
761P1100
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$538.89 |
| Max. Negotiated Rate |
$1,125.00 |
| Rate for Payer: Aetna Commercial |
$963.04
|
| Rate for Payer: Ambetter Exchange |
$631.18
|
| Rate for Payer: Anthem Medicaid |
$538.89
|
| Rate for Payer: Buckeye Individual/Medicaid |
$631.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$631.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$757.42
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,050.37
|
| Rate for Payer: Healthspan PPO |
$872.31
|
| Rate for Payer: Humana Medicaid |
$538.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$822.26
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$631.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$631.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$549.67
|
| Rate for Payer: Molina Healthcare Passport |
$538.89
|
| Rate for Payer: Multiplan PHCS |
$1,125.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$820.53
|
| Rate for Payer: UHCCP Medicaid |
$656.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$544.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$631.18
|
|
|
ARTH KNEE ABR ARTH/MLT DRL/MFX
|
Facility
|
OP
|
$1,875.00
|
|
|
Service Code
|
HCPCS 29879
|
| Hospital Charge Code |
76101100
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$644.81 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$1,443.75
|
| Rate for Payer: Anthem Medicaid |
$644.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,462.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,556.25
|
| Rate for Payer: First Health Commercial |
$1,781.25
|
| Rate for Payer: Humana Commercial |
$1,593.75
|
| Rate for Payer: Humana KY Medicaid |
$644.81
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$651.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,537.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,383.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$657.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,650.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,631.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,293.75
|
| Rate for Payer: PHCS Commercial |
$1,800.00
|
| Rate for Payer: United Healthcare All Payer |
$1,650.00
|
|
|
ARTH KNEE ABR ARTH/MLT DRL/MFX
|
Professional
|
Both
|
$1,875.00
|
|
|
Service Code
|
HCPCS 29879
|
| Hospital Charge Code |
76101100
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$538.89 |
| Max. Negotiated Rate |
$1,125.00 |
| Rate for Payer: Aetna Commercial |
$963.04
|
| Rate for Payer: Ambetter Exchange |
$631.18
|
| Rate for Payer: Anthem Medicaid |
$538.89
|
| Rate for Payer: Buckeye Individual/Medicaid |
$631.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$631.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$757.42
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,050.37
|
| Rate for Payer: Healthspan PPO |
$872.31
|
| Rate for Payer: Humana Medicaid |
$538.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$822.26
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$631.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$631.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$549.67
|
| Rate for Payer: Molina Healthcare Passport |
$538.89
|
| Rate for Payer: Multiplan PHCS |
$1,125.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$820.53
|
| Rate for Payer: UHCCP Medicaid |
$656.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$544.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$631.18
|
|
|
ARTH KNEE DBD/SHAV ARTCLR CR(P
|
Professional
|
Both
|
$1,875.00
|
|
|
Service Code
|
HCPCS 29877
|
| Hospital Charge Code |
761P1099
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$493.05 |
| Max. Negotiated Rate |
$1,125.00 |
| Rate for Payer: Aetna Commercial |
$898.78
|
| Rate for Payer: Ambetter Exchange |
$592.02
|
| Rate for Payer: Anthem Medicaid |
$493.05
|
| Rate for Payer: Buckeye Individual/Medicaid |
$592.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$592.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$710.42
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$980.12
|
| Rate for Payer: Healthspan PPO |
$814.10
|
| Rate for Payer: Humana Medicaid |
$493.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$769.70
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$592.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$592.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$502.91
|
| Rate for Payer: Molina Healthcare Passport |
$493.05
|
| Rate for Payer: Multiplan PHCS |
$1,125.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$769.63
|
| Rate for Payer: UHCCP Medicaid |
$656.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$497.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$592.02
|
|
|
ARTH KNEE DBD/SHAV ARTCLR CRT
|
Professional
|
Both
|
$1,875.00
|
|
|
Service Code
|
HCPCS 29877
|
| Hospital Charge Code |
76101099
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$493.05 |
| Max. Negotiated Rate |
$1,125.00 |
| Rate for Payer: Aetna Commercial |
$898.78
|
| Rate for Payer: Ambetter Exchange |
$592.02
|
| Rate for Payer: Anthem Medicaid |
$493.05
|
| Rate for Payer: Buckeye Individual/Medicaid |
$592.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$592.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$710.42
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$980.12
|
| Rate for Payer: Healthspan PPO |
$814.10
|
| Rate for Payer: Humana Medicaid |
$493.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$769.70
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$592.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$592.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$502.91
|
| Rate for Payer: Molina Healthcare Passport |
$493.05
|
| Rate for Payer: Multiplan PHCS |
$1,125.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$769.63
|
| Rate for Payer: UHCCP Medicaid |
$656.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$497.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$592.02
|
|
|
ARTH KNEE DBD/SHAV ARTCLR CRT
|
Facility
|
IP
|
$1,875.00
|
|
|
Service Code
|
HCPCS 29877
|
| Hospital Charge Code |
76101099
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$562.50 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,443.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,462.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,556.25
|
| Rate for Payer: First Health Commercial |
$1,781.25
|
| Rate for Payer: Humana Commercial |
$1,593.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,537.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,383.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,650.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,631.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,293.75
|
| Rate for Payer: PHCS Commercial |
$1,800.00
|
| Rate for Payer: United Healthcare All Payer |
$1,650.00
|
|
|
ARTH KNEE DBD/SHAV ARTCLR CRT
|
Facility
|
OP
|
$1,875.00
|
|
|
Service Code
|
HCPCS 29877
|
| Hospital Charge Code |
76101099
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$644.81 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$1,443.75
|
| Rate for Payer: Anthem Medicaid |
$644.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,462.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,556.25
|
| Rate for Payer: First Health Commercial |
$1,781.25
|
| Rate for Payer: Humana Commercial |
$1,593.75
|
| Rate for Payer: Humana KY Medicaid |
$644.81
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$651.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,537.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,383.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$657.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,650.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,631.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,293.75
|
| Rate for Payer: PHCS Commercial |
$1,800.00
|
| Rate for Payer: United Healthcare All Payer |
$1,650.00
|
|
|
ARTH KNEE DRLG OSTCHND DSSCN(P
|
Professional
|
Both
|
$2,300.00
|
|
|
Service Code
|
HCPCS 29887
|
| Hospital Charge Code |
761P1107
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$575.48 |
| Max. Negotiated Rate |
$1,380.00 |
| Rate for Payer: Aetna Commercial |
$1,082.87
|
| Rate for Payer: Ambetter Exchange |
$719.08
|
| Rate for Payer: Anthem Medicaid |
$575.48
|
| Rate for Payer: Buckeye Individual/Medicaid |
$719.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$719.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$862.90
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cigna Commercial |
$1,180.53
|
| Rate for Payer: Healthspan PPO |
$980.85
|
| Rate for Payer: Humana Medicaid |
$575.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$924.91
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$719.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$719.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$586.99
|
| Rate for Payer: Molina Healthcare Passport |
$575.48
|
| Rate for Payer: Multiplan PHCS |
$1,380.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$934.80
|
| Rate for Payer: UHCCP Medicaid |
$805.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$581.23
|
| Rate for Payer: Wellcare Medicare Advantage |
$719.08
|
|
|
ARTH KNEE DRLG OSTCHND DSSCNS
|
Professional
|
Both
|
$2,300.00
|
|
|
Service Code
|
HCPCS 29887
|
| Hospital Charge Code |
76101107
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$575.48 |
| Max. Negotiated Rate |
$1,380.00 |
| Rate for Payer: Aetna Commercial |
$1,082.87
|
| Rate for Payer: Ambetter Exchange |
$719.08
|
| Rate for Payer: Anthem Medicaid |
$575.48
|
| Rate for Payer: Buckeye Individual/Medicaid |
$719.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$719.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$862.90
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cigna Commercial |
$1,180.53
|
| Rate for Payer: Healthspan PPO |
$980.85
|
| Rate for Payer: Humana Medicaid |
$575.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$924.91
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$719.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$719.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$586.99
|
| Rate for Payer: Molina Healthcare Passport |
$575.48
|
| Rate for Payer: Multiplan PHCS |
$1,380.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$934.80
|
| Rate for Payer: UHCCP Medicaid |
$805.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$581.23
|
| Rate for Payer: Wellcare Medicare Advantage |
$719.08
|
|
|
ARTH KNEE DRLG OSTCHND DSSCNS
|
Facility
|
OP
|
$2,300.00
|
|
|
Service Code
|
HCPCS 29887
|
| Hospital Charge Code |
76101107
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$790.97 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,771.00
|
| Rate for Payer: Anthem Medicaid |
$790.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,794.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cigna Commercial |
$1,909.00
|
| Rate for Payer: First Health Commercial |
$2,185.00
|
| Rate for Payer: Humana Commercial |
$1,955.00
|
| Rate for Payer: Humana KY Medicaid |
$790.97
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$799.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,886.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,697.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$806.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,024.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,840.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,001.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,587.00
|
| Rate for Payer: PHCS Commercial |
$2,208.00
|
| Rate for Payer: United Healthcare All Payer |
$2,024.00
|
|
|
ARTH KNEE DRLG OSTCHND DSSCNS
|
Facility
|
IP
|
$2,300.00
|
|
|
Service Code
|
HCPCS 29887
|
| Hospital Charge Code |
76101107
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$690.00 |
| Max. Negotiated Rate |
$2,208.00 |
| Rate for Payer: Aetna Commercial |
$1,771.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,794.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cigna Commercial |
$1,909.00
|
| Rate for Payer: First Health Commercial |
$2,185.00
|
| Rate for Payer: Humana Commercial |
$1,955.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,886.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,697.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$690.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,024.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,840.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,001.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,587.00
|
| Rate for Payer: PHCS Commercial |
$2,208.00
|
| Rate for Payer: United Healthcare All Payer |
$2,024.00
|
|
|
ARTH KNEE DRLL OSTCHND DSSCNS
|
Professional
|
Both
|
$840.00
|
|
|
Service Code
|
HCPCS 29886
|
| Hospital Charge Code |
761P1106
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$294.00 |
| Max. Negotiated Rate |
$999.01 |
| Rate for Payer: Aetna Commercial |
$916.53
|
| Rate for Payer: Ambetter Exchange |
$608.87
|
| Rate for Payer: Anthem Medicaid |
$418.82
|
| Rate for Payer: Buckeye Individual/Medicaid |
$608.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$608.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$730.64
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$999.01
|
| Rate for Payer: Healthspan PPO |
$830.18
|
| Rate for Payer: Humana Medicaid |
$418.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$785.14
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$608.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$608.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$427.20
|
| Rate for Payer: Molina Healthcare Passport |
$418.82
|
| Rate for Payer: Multiplan PHCS |
$504.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$791.53
|
| Rate for Payer: UHCCP Medicaid |
$294.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$423.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$608.87
|
|
|
ARTH KNEE DRLL OSTCHND DSSCNS
|
Professional
|
Both
|
$840.00
|
|
|
Service Code
|
HCPCS 29886
|
| Hospital Charge Code |
76101106
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$294.00 |
| Max. Negotiated Rate |
$999.01 |
| Rate for Payer: Aetna Commercial |
$916.53
|
| Rate for Payer: Ambetter Exchange |
$608.87
|
| Rate for Payer: Anthem Medicaid |
$418.82
|
| Rate for Payer: Buckeye Individual/Medicaid |
$608.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$608.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$730.64
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$999.01
|
| Rate for Payer: Healthspan PPO |
$830.18
|
| Rate for Payer: Humana Medicaid |
$418.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$785.14
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$608.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$608.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$427.20
|
| Rate for Payer: Molina Healthcare Passport |
$418.82
|
| Rate for Payer: Multiplan PHCS |
$504.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$791.53
|
| Rate for Payer: UHCCP Medicaid |
$294.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$423.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$608.87
|
|
|
ARTH KNEE DRLL OSTCHND DSSCNS
|
Facility
|
IP
|
$840.00
|
|
|
Service Code
|
HCPCS 29886
|
| Hospital Charge Code |
76101106
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$806.40 |
| Rate for Payer: Aetna Commercial |
$646.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$655.20
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$697.20
|
| Rate for Payer: First Health Commercial |
$798.00
|
| Rate for Payer: Humana Commercial |
$714.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$688.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$619.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$252.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$739.20
|
| Rate for Payer: Ohio Health Group HMO |
$630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$730.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$579.60
|
| Rate for Payer: PHCS Commercial |
$806.40
|
| Rate for Payer: United Healthcare All Payer |
$739.20
|
|
