|
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
|
|
|
ARTH KNEE SYNVCTMY 2/>COMP
|
Facility
|
IP
|
$2,117.00
|
|
|
Service Code
|
HCPCS 29876
|
| Hospital Charge Code |
76101098
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$635.10 |
| Max. Negotiated Rate |
$2,032.32 |
| Rate for Payer: Aetna Commercial |
$1,630.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,651.26
|
| Rate for Payer: Cash Price |
$1,058.50
|
| Rate for Payer: Cigna Commercial |
$1,757.11
|
| Rate for Payer: First Health Commercial |
$2,011.15
|
| Rate for Payer: Humana Commercial |
$1,799.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,735.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,562.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$635.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,862.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,587.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,693.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,841.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,460.73
|
| Rate for Payer: PHCS Commercial |
$2,032.32
|
| Rate for Payer: United Healthcare All Payer |
$1,862.96
|
|
|
ARTH KNEE SYNVCTMY 2/>COMP
|
Facility
|
OP
|
$2,117.00
|
|
|
Service Code
|
HCPCS 29876
|
| Hospital Charge Code |
76101098
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$728.04 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$1,630.09
|
| Rate for Payer: Anthem Medicaid |
$728.04
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,651.26
|
| 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 |
$1,058.50
|
| Rate for Payer: Cash Price |
$1,058.50
|
| Rate for Payer: Cigna Commercial |
$1,757.11
|
| Rate for Payer: First Health Commercial |
$2,011.15
|
| Rate for Payer: Humana Commercial |
$1,799.45
|
| Rate for Payer: Humana KY Medicaid |
$728.04
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$735.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,735.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,562.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$742.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,862.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,587.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,693.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,841.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,460.73
|
| Rate for Payer: PHCS Commercial |
$2,032.32
|
| Rate for Payer: United Healthcare All Payer |
$1,862.96
|
|
|
ARTH KNEE SYNVCTMY 2/>COMP
|
Professional
|
Both
|
$2,117.00
|
|
|
Service Code
|
HCPCS 29876
|
| Hospital Charge Code |
76101098
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$525.51 |
| Max. Negotiated Rate |
$1,270.20 |
| Rate for Payer: Aetna Commercial |
$950.93
|
| Rate for Payer: Ambetter Exchange |
$622.76
|
| Rate for Payer: Anthem Medicaid |
$525.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$622.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$622.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$747.31
|
| Rate for Payer: Cash Price |
$1,058.50
|
| Rate for Payer: Cash Price |
$1,058.50
|
| Rate for Payer: Cigna Commercial |
$1,036.77
|
| Rate for Payer: Healthspan PPO |
$861.34
|
| Rate for Payer: Humana Medicaid |
$525.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$813.16
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$622.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$622.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$536.02
|
| Rate for Payer: Molina Healthcare Passport |
$525.51
|
| Rate for Payer: Multiplan PHCS |
$1,270.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$809.59
|
| Rate for Payer: UHCCP Medicaid |
$740.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$530.77
|
| Rate for Payer: Wellcare Medicare Advantage |
$622.76
|
|
|
ARTH KNEE SYNVCTMY 2/>COMP(P
|
Professional
|
Both
|
$2,117.00
|
|
|
Service Code
|
HCPCS 29876
|
| Hospital Charge Code |
761P1098
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$525.51 |
| Max. Negotiated Rate |
$1,270.20 |
| Rate for Payer: Aetna Commercial |
$950.93
|
| Rate for Payer: Ambetter Exchange |
$622.76
|
| Rate for Payer: Anthem Medicaid |
$525.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$622.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$622.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$747.31
|
| Rate for Payer: Cash Price |
$1,058.50
|
| Rate for Payer: Cash Price |
$1,058.50
|
| Rate for Payer: Cigna Commercial |
$1,036.77
|
| Rate for Payer: Healthspan PPO |
$861.34
|
| Rate for Payer: Humana Medicaid |
$525.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$813.16
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$622.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$622.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$536.02
|
| Rate for Payer: Molina Healthcare Passport |
$525.51
|
| Rate for Payer: Multiplan PHCS |
$1,270.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$809.59
|
| Rate for Payer: UHCCP Medicaid |
$740.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$530.77
|
| Rate for Payer: Wellcare Medicare Advantage |
$622.76
|
|
|
ARTH KNEE W/MNSCCTMY M/L WSHAV
|
Facility
|
OP
|
$2,375.00
|
|
|
Service Code
|
HCPCS 29880
|
| Hospital Charge Code |
76101101
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$816.76 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$1,828.75
|
| Rate for Payer: Anthem Medicaid |
$816.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,852.50
|
| 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 |
$1,187.50
|
| Rate for Payer: Cash Price |
$1,187.50
|
| Rate for Payer: Cigna Commercial |
$1,971.25
|
| Rate for Payer: First Health Commercial |
$2,256.25
|
| Rate for Payer: Humana Commercial |
$2,018.75
|
| Rate for Payer: Humana KY Medicaid |
$816.76
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$825.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,947.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,752.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$833.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,090.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,781.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,900.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,066.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,638.75
|
| Rate for Payer: PHCS Commercial |
$2,280.00
|
| Rate for Payer: United Healthcare All Payer |
$2,090.00
|
|
|
ARTH KNEE W/MNSCCTMY M/L WSHAV
|
Professional
|
Both
|
$2,375.00
|
|
|
Service Code
|
HCPCS 29880
|
| Hospital Charge Code |
76101101
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$535.69 |
| Max. Negotiated Rate |
$1,425.00 |
| Rate for Payer: Aetna Commercial |
$1,006.53
|
| Rate for Payer: Ambetter Exchange |
$535.69
|
| Rate for Payer: Anthem Medicaid |
$568.94
|
| Rate for Payer: Buckeye Individual/Medicaid |
$535.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$535.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$642.83
|
| Rate for Payer: Cash Price |
$1,187.50
|
| Rate for Payer: Cash Price |
$1,187.50
|
| Rate for Payer: Cigna Commercial |
$1,097.20
|
| Rate for Payer: Healthspan PPO |
$911.70
|
| Rate for Payer: Humana Medicaid |
$568.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$857.35
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$535.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$535.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$580.32
|
| Rate for Payer: Molina Healthcare Passport |
$568.94
|
| Rate for Payer: Multiplan PHCS |
$1,425.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$696.40
|
| Rate for Payer: UHCCP Medicaid |
$831.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$574.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$535.69
|
|
|
ARTH KNEE W/MNSCCTMY M/L WSHAV
|
Professional
|
Both
|
$2,375.00
|
|
|
Service Code
|
HCPCS 29880
|
| Hospital Charge Code |
761P1101
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$535.69 |
| Max. Negotiated Rate |
$1,425.00 |
| Rate for Payer: Aetna Commercial |
$1,006.53
|
| Rate for Payer: Ambetter Exchange |
$535.69
|
| Rate for Payer: Anthem Medicaid |
$568.94
|
| Rate for Payer: Buckeye Individual/Medicaid |
$535.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$535.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$642.83
|
| Rate for Payer: Cash Price |
$1,187.50
|
| Rate for Payer: Cash Price |
$1,187.50
|
| Rate for Payer: Cigna Commercial |
$1,097.20
|
| Rate for Payer: Healthspan PPO |
$911.70
|
| Rate for Payer: Humana Medicaid |
$568.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$857.35
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$535.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$535.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$580.32
|
| Rate for Payer: Molina Healthcare Passport |
$568.94
|
| Rate for Payer: Multiplan PHCS |
$1,425.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$696.40
|
| Rate for Payer: UHCCP Medicaid |
$831.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$574.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$535.69
|
|
|
ARTH KNEE W/MNSCCTMY M/L WSHAV
|
Facility
|
IP
|
$2,375.00
|
|
|
Service Code
|
HCPCS 29880
|
| Hospital Charge Code |
76101101
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$712.50 |
| Max. Negotiated Rate |
$2,280.00 |
| Rate for Payer: Aetna Commercial |
$1,828.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,852.50
|
| Rate for Payer: Cash Price |
$1,187.50
|
| Rate for Payer: Cigna Commercial |
$1,971.25
|
| Rate for Payer: First Health Commercial |
$2,256.25
|
| Rate for Payer: Humana Commercial |
$2,018.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,947.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,752.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$712.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,090.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,781.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,900.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,066.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,638.75
|
| Rate for Payer: PHCS Commercial |
$2,280.00
|
| Rate for Payer: United Healthcare All Payer |
$2,090.00
|
|
|
ARTH KNEE W/MNSCCTMY M/L WSH(P
|
Professional
|
Both
|
$2,050.00
|
|
|
Service Code
|
HCPCS 29881
|
| Hospital Charge Code |
761P1102
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$516.07 |
| Max. Negotiated Rate |
$1,230.00 |
| Rate for Payer: Aetna Commercial |
$936.35
|
| Rate for Payer: Ambetter Exchange |
$516.07
|
| Rate for Payer: Anthem Medicaid |
$519.01
|
| Rate for Payer: Buckeye Individual/Medicaid |
$516.07
|
| Rate for Payer: Buckeye Medicare Advantage |
$516.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$619.28
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,021.76
|
| Rate for Payer: Healthspan PPO |
$848.13
|
| Rate for Payer: Humana Medicaid |
$519.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$800.64
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$516.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$516.07
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$529.39
|
| Rate for Payer: Molina Healthcare Passport |
$519.01
|
| Rate for Payer: Multiplan PHCS |
$1,230.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$670.89
|
| Rate for Payer: UHCCP Medicaid |
$717.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$524.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$516.07
|
|
|
ARTH KNEE W/MNSCCTMY M/L WSHV
|
Facility
|
IP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 29881
|
| Hospital Charge Code |
76101102
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$615.00 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,783.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,414.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
ARTH KNEE W/MNSCCTMY M/L WSHV
|
Facility
|
OP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 29881
|
| Hospital Charge Code |
76101102
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$705.00 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem Medicaid |
$705.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| 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 |
$1,025.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Humana KY Medicaid |
$705.00
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$712.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,783.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,414.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
ARTH KNEE W/MNSCCTMY M/L WSHV
|
Professional
|
Both
|
$2,050.00
|
|
|
Service Code
|
HCPCS 29881
|
| Hospital Charge Code |
76101102
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$516.07 |
| Max. Negotiated Rate |
$1,230.00 |
| Rate for Payer: Aetna Commercial |
$936.35
|
| Rate for Payer: Ambetter Exchange |
$516.07
|
| Rate for Payer: Anthem Medicaid |
$519.01
|
| Rate for Payer: Buckeye Individual/Medicaid |
$516.07
|
| Rate for Payer: Buckeye Medicare Advantage |
$516.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$619.28
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,021.76
|
| Rate for Payer: Healthspan PPO |
$848.13
|
| Rate for Payer: Humana Medicaid |
$519.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$800.64
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$516.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$516.07
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$529.39
|
| Rate for Payer: Molina Healthcare Passport |
$519.01
|
| Rate for Payer: Multiplan PHCS |
$1,230.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$670.89
|
| Rate for Payer: UHCCP Medicaid |
$717.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$524.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$516.07
|
|
|
ARTH KNEE W/MNSCS RPR M/L
|
Facility
|
OP
|
$2,300.00
|
|
|
Service Code
|
HCPCS 29882
|
| Hospital Charge Code |
76101103
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$790.97 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$1,771.00
|
| Rate for Payer: Anthem Medicaid |
$790.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,794.00
|
| 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 |
$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 |
$2,997.95
|
| 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 |
$3,597.54
|
| 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 W/MNSCS RPR M/L
|
Professional
|
Both
|
$2,300.00
|
|
|
Service Code
|
HCPCS 29882
|
| Hospital Charge Code |
76101103
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$570.66 |
| Max. Negotiated Rate |
$1,380.00 |
| Rate for Payer: Aetna Commercial |
$1,016.78
|
| Rate for Payer: Ambetter Exchange |
$656.19
|
| Rate for Payer: Anthem Medicaid |
$570.66
|
| Rate for Payer: Buckeye Individual/Medicaid |
$656.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$656.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$787.43
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cigna Commercial |
$1,103.47
|
| Rate for Payer: Healthspan PPO |
$920.98
|
| Rate for Payer: Humana Medicaid |
$570.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$866.61
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$656.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$656.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$582.07
|
| Rate for Payer: Molina Healthcare Passport |
$570.66
|
| Rate for Payer: Multiplan PHCS |
$1,380.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$853.05
|
| Rate for Payer: UHCCP Medicaid |
$805.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$576.37
|
| Rate for Payer: Wellcare Medicare Advantage |
$656.19
|
|
|
ARTH KNEE W/MNSCS RPR M/L
|
Facility
|
IP
|
$2,300.00
|
|
|
Service Code
|
HCPCS 29882
|
| Hospital Charge Code |
76101103
|
|
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 WMNSCS RPR M/L
|
Facility
|
OP
|
$2,700.00
|
|
|
Service Code
|
HCPCS 29883
|
| Hospital Charge Code |
76101104
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$928.53 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$2,079.00
|
| Rate for Payer: Anthem Medicaid |
$928.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,106.00
|
| 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 |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$2,241.00
|
| Rate for Payer: First Health Commercial |
$2,565.00
|
| Rate for Payer: Humana Commercial |
$2,295.00
|
| Rate for Payer: Humana KY Medicaid |
$928.53
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$937.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,214.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,992.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$947.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,376.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,025.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,349.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,863.00
|
| Rate for Payer: PHCS Commercial |
$2,592.00
|
| Rate for Payer: United Healthcare All Payer |
$2,376.00
|
|
|
ARTH KNEE WMNSCS RPR M/L
|
Professional
|
Both
|
$2,700.00
|
|
|
Service Code
|
HCPCS 29883
|
| Hospital Charge Code |
76101104
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$641.12 |
| Max. Negotiated Rate |
$1,620.00 |
| Rate for Payer: Aetna Commercial |
$1,245.41
|
| Rate for Payer: Ambetter Exchange |
$798.33
|
| Rate for Payer: Anthem Medicaid |
$641.12
|
| Rate for Payer: Buckeye Individual/Medicaid |
$798.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$798.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$958.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$1,363.37
|
| Rate for Payer: Healthspan PPO |
$1,128.07
|
| Rate for Payer: Humana Medicaid |
$641.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,046.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$798.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$798.33
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$653.94
|
| Rate for Payer: Molina Healthcare Passport |
$641.12
|
| Rate for Payer: Multiplan PHCS |
$1,620.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,037.83
|
| Rate for Payer: UHCCP Medicaid |
$945.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$647.53
|
| Rate for Payer: Wellcare Medicare Advantage |
$798.33
|
|
|
ARTH KNEE WMNSCS RPR M/L
|
Facility
|
IP
|
$2,700.00
|
|
|
Service Code
|
HCPCS 29883
|
| Hospital Charge Code |
76101104
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$810.00 |
| Max. Negotiated Rate |
$2,592.00 |
| Rate for Payer: Aetna Commercial |
$2,079.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,106.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$2,241.00
|
| Rate for Payer: First Health Commercial |
$2,565.00
|
| Rate for Payer: Humana Commercial |
$2,295.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,214.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,992.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$810.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,376.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,025.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,349.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,863.00
|
| Rate for Payer: PHCS Commercial |
$2,592.00
|
| Rate for Payer: United Healthcare All Payer |
$2,376.00
|
|
|
ARTH KNEE W/MNSCS RPR M/L(P
|
Professional
|
Both
|
$2,300.00
|
|
|
Service Code
|
HCPCS 29882
|
| Hospital Charge Code |
761P1103
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$570.66 |
| Max. Negotiated Rate |
$1,380.00 |
| Rate for Payer: Aetna Commercial |
$1,016.78
|
| Rate for Payer: Ambetter Exchange |
$656.19
|
| Rate for Payer: Anthem Medicaid |
$570.66
|
| Rate for Payer: Buckeye Individual/Medicaid |
$656.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$656.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$787.43
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cash Price |
$1,150.00
|
| Rate for Payer: Cigna Commercial |
$1,103.47
|
| Rate for Payer: Healthspan PPO |
$920.98
|
| Rate for Payer: Humana Medicaid |
$570.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$866.61
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$656.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$656.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$582.07
|
| Rate for Payer: Molina Healthcare Passport |
$570.66
|
| Rate for Payer: Multiplan PHCS |
$1,380.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$853.05
|
| Rate for Payer: UHCCP Medicaid |
$805.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$576.37
|
| Rate for Payer: Wellcare Medicare Advantage |
$656.19
|
|
|
ARTH KNEE WMNSCS RPR M/L(P
|
Professional
|
Both
|
$2,700.00
|
|
|
Service Code
|
HCPCS 29883
|
| Hospital Charge Code |
761P1104
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$641.12 |
| Max. Negotiated Rate |
$1,620.00 |
| Rate for Payer: Aetna Commercial |
$1,245.41
|
| Rate for Payer: Ambetter Exchange |
$798.33
|
| Rate for Payer: Anthem Medicaid |
$641.12
|
| Rate for Payer: Buckeye Individual/Medicaid |
$798.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$798.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$958.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$1,363.37
|
| Rate for Payer: Healthspan PPO |
$1,128.07
|
| Rate for Payer: Humana Medicaid |
$641.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,046.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$798.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$798.33
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$653.94
|
| Rate for Payer: Molina Healthcare Passport |
$641.12
|
| Rate for Payer: Multiplan PHCS |
$1,620.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,037.83
|
| Rate for Payer: UHCCP Medicaid |
$945.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$647.53
|
| Rate for Payer: Wellcare Medicare Advantage |
$798.33
|
|
|
ARTH LES/TALAR DOME FX PLAFOND
|
Professional
|
Both
|
$2,400.00
|
|
|
Service Code
|
HCPCS 29892
|
| Hospital Charge Code |
76101110
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$530.95 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Aetna Commercial |
$1,041.89
|
| Rate for Payer: Ambetter Exchange |
$611.14
|
| Rate for Payer: Anthem Medicaid |
$530.95
|
| Rate for Payer: Buckeye Individual/Medicaid |
$611.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$611.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.37
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cigna Commercial |
$1,160.03
|
| Rate for Payer: Healthspan PPO |
$943.73
|
| Rate for Payer: Humana Medicaid |
$530.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$832.81
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$611.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$611.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$541.57
|
| Rate for Payer: Molina Healthcare Passport |
$530.95
|
| Rate for Payer: Multiplan PHCS |
$1,440.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$794.48
|
| Rate for Payer: UHCCP Medicaid |
$840.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$536.26
|
| Rate for Payer: Wellcare Medicare Advantage |
$611.14
|
|
|
ARTH LES/TALAR DOME FX PLAFOND
|
Facility
|
OP
|
$2,400.00
|
|
|
Service Code
|
HCPCS 29892
|
| Hospital Charge Code |
76101110
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$825.36 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,848.00
|
| Rate for Payer: Anthem Medicaid |
$825.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,872.00
|
| 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 |
$1,200.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cigna Commercial |
$1,992.00
|
| Rate for Payer: First Health Commercial |
$2,280.00
|
| Rate for Payer: Humana Commercial |
$2,040.00
|
| Rate for Payer: Humana KY Medicaid |
$825.36
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$833.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,968.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,771.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$841.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,112.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,800.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,088.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,656.00
|
| Rate for Payer: PHCS Commercial |
$2,304.00
|
| Rate for Payer: United Healthcare All Payer |
$2,112.00
|
|
|
ARTH LES/TALAR DOME FX PLAFOND
|
Professional
|
Both
|
$2,400.00
|
|
|
Service Code
|
HCPCS 29892
|
| Hospital Charge Code |
761P1110
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$530.95 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Aetna Commercial |
$1,041.89
|
| Rate for Payer: Ambetter Exchange |
$611.14
|
| Rate for Payer: Anthem Medicaid |
$530.95
|
| Rate for Payer: Buckeye Individual/Medicaid |
$611.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$611.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.37
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cigna Commercial |
$1,160.03
|
| Rate for Payer: Healthspan PPO |
$943.73
|
| Rate for Payer: Humana Medicaid |
$530.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$832.81
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$611.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$611.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$541.57
|
| Rate for Payer: Molina Healthcare Passport |
$530.95
|
| Rate for Payer: Multiplan PHCS |
$1,440.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$794.48
|
| Rate for Payer: UHCCP Medicaid |
$840.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$536.26
|
| Rate for Payer: Wellcare Medicare Advantage |
$611.14
|
|
|
ARTH LES/TALAR DOME FX PLAFOND
|
Facility
|
IP
|
$2,400.00
|
|
|
Service Code
|
HCPCS 29892
|
| Hospital Charge Code |
76101110
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$720.00 |
| Max. Negotiated Rate |
$2,304.00 |
| Rate for Payer: Aetna Commercial |
$1,848.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,872.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cigna Commercial |
$1,992.00
|
| Rate for Payer: First Health Commercial |
$2,280.00
|
| Rate for Payer: Humana Commercial |
$2,040.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,968.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,771.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$720.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,112.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,800.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,088.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,656.00
|
| Rate for Payer: PHCS Commercial |
$2,304.00
|
| Rate for Payer: United Healthcare All Payer |
$2,112.00
|
|
