|
ARTHO ASP+.OR INJ JNT WO US (T
|
Facility
|
IP
|
$509.00
|
|
|
Service Code
|
HCPCS 20610
|
| Hospital Charge Code |
761T2849
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$152.70 |
| Max. Negotiated Rate |
$488.64 |
| Rate for Payer: Aetna Commercial |
$391.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$397.02
|
| Rate for Payer: Cash Price |
$254.50
|
| Rate for Payer: Cigna Commercial |
$422.47
|
| Rate for Payer: First Health Commercial |
$483.55
|
| Rate for Payer: Humana Commercial |
$432.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$417.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$375.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$152.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$447.92
|
| Rate for Payer: Ohio Health Group HMO |
$381.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$407.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$351.21
|
| Rate for Payer: PHCS Commercial |
$488.64
|
| Rate for Payer: United Healthcare All Payer |
$447.92
|
|
|
ARTHO ASP+.OR INJ JNT WO US (T
|
Facility
|
IP
|
$444.00
|
|
|
Service Code
|
HCPCS 20605
|
| Hospital Charge Code |
761T0343
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$133.20 |
| Max. Negotiated Rate |
$426.24 |
| Rate for Payer: Aetna Commercial |
$341.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$346.32
|
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Cigna Commercial |
$368.52
|
| Rate for Payer: First Health Commercial |
$421.80
|
| Rate for Payer: Humana Commercial |
$377.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$364.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$327.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$133.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$390.72
|
| Rate for Payer: Ohio Health Group HMO |
$333.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$355.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$386.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$306.36
|
| Rate for Payer: PHCS Commercial |
$426.24
|
| Rate for Payer: United Healthcare All Payer |
$390.72
|
|
|
ARTHO ASP+.OR INJ JNT WO US (T
|
Facility
|
IP
|
$417.00
|
|
|
Service Code
|
HCPCS 20605
|
| Hospital Charge Code |
761T2848
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$125.10 |
| Max. Negotiated Rate |
$400.32 |
| Rate for Payer: Aetna Commercial |
$321.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$325.26
|
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: Cigna Commercial |
$346.11
|
| Rate for Payer: First Health Commercial |
$396.15
|
| Rate for Payer: Humana Commercial |
$354.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$341.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$307.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$125.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$366.96
|
| Rate for Payer: Ohio Health Group HMO |
$312.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$333.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$362.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$287.73
|
| Rate for Payer: PHCS Commercial |
$400.32
|
| Rate for Payer: United Healthcare All Payer |
$366.96
|
|
|
ARTHRFLX DERML ALLGRAFT 25*30
|
Facility
|
OP
|
$7,467.60
|
|
|
Service Code
|
HCPCS Q4125
|
| Hospital Charge Code |
27000123
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,240.28 |
| Max. Negotiated Rate |
$7,168.90 |
| Rate for Payer: Aetna Commercial |
$5,750.05
|
| Rate for Payer: Anthem Medicaid |
$2,568.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,824.73
|
| Rate for Payer: Cash Price |
$3,733.80
|
| Rate for Payer: Cigna Commercial |
$6,198.11
|
| Rate for Payer: First Health Commercial |
$7,094.22
|
| Rate for Payer: Humana Commercial |
$6,347.46
|
| Rate for Payer: Humana KY Medicaid |
$2,568.11
|
| Rate for Payer: Kentucky WC Medicaid |
$2,594.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,123.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,511.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,240.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,619.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,571.49
|
| Rate for Payer: Ohio Health Group HMO |
$5,600.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,974.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,496.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,152.64
|
| Rate for Payer: PHCS Commercial |
$7,168.90
|
| Rate for Payer: United Healthcare All Payer |
$6,571.49
|
|
|
ARTHRFLX DERML ALLGRAFT 25*30
|
Facility
|
IP
|
$7,467.60
|
|
|
Service Code
|
HCPCS Q4125
|
| Hospital Charge Code |
27000123
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,240.28 |
| Max. Negotiated Rate |
$7,168.90 |
| Rate for Payer: Aetna Commercial |
$5,750.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,824.73
|
| Rate for Payer: Cash Price |
$3,733.80
|
| Rate for Payer: Cigna Commercial |
$6,198.11
|
| Rate for Payer: First Health Commercial |
$7,094.22
|
| Rate for Payer: Humana Commercial |
$6,347.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,123.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,511.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,240.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,571.49
|
| Rate for Payer: Ohio Health Group HMO |
$5,600.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,974.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,496.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,152.64
|
| Rate for Payer: PHCS Commercial |
$7,168.90
|
| Rate for Payer: United Healthcare All Payer |
$6,571.49
|
|
|
ARTHRFLX DERML ALLOGRAFT 20*25
|
Facility
|
IP
|
$7,095.30
|
|
|
Service Code
|
HCPCS Q4125
|
| Hospital Charge Code |
27000123
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,128.59 |
| Max. Negotiated Rate |
$6,811.49 |
| Rate for Payer: Aetna Commercial |
$5,463.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,534.33
|
| Rate for Payer: Cash Price |
$3,547.65
|
| Rate for Payer: Cigna Commercial |
$5,889.10
|
| Rate for Payer: First Health Commercial |
$6,740.53
|
| Rate for Payer: Humana Commercial |
$6,031.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,818.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,236.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,128.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,243.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,321.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,676.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,172.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,895.76
|
| Rate for Payer: PHCS Commercial |
$6,811.49
|
| Rate for Payer: United Healthcare All Payer |
$6,243.86
|
|
|
ARTHRFLX DERML ALLOGRAFT 20*25
|
Facility
|
OP
|
$7,095.30
|
|
|
Service Code
|
HCPCS Q4125
|
| Hospital Charge Code |
27000123
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,128.59 |
| Max. Negotiated Rate |
$6,811.49 |
| Rate for Payer: Aetna Commercial |
$5,463.38
|
| Rate for Payer: Anthem Medicaid |
$2,440.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,534.33
|
| Rate for Payer: Cash Price |
$3,547.65
|
| Rate for Payer: Cigna Commercial |
$5,889.10
|
| Rate for Payer: First Health Commercial |
$6,740.53
|
| Rate for Payer: Humana Commercial |
$6,031.01
|
| Rate for Payer: Humana KY Medicaid |
$2,440.07
|
| Rate for Payer: Kentucky WC Medicaid |
$2,464.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,818.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,236.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,128.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,489.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,243.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,321.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,676.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,172.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,895.76
|
| Rate for Payer: PHCS Commercial |
$6,811.49
|
| Rate for Payer: United Healthcare All Payer |
$6,243.86
|
|
|
ARTHR KNEE RMV LOOSE/FB
|
Facility
|
IP
|
$1,642.00
|
|
|
Service Code
|
HCPCS 29874
|
| Hospital Charge Code |
76101096
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$492.60 |
| Max. Negotiated Rate |
$1,576.32 |
| Rate for Payer: Aetna Commercial |
$1,264.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,280.76
|
| Rate for Payer: Cash Price |
$821.00
|
| Rate for Payer: Cigna Commercial |
$1,362.86
|
| Rate for Payer: First Health Commercial |
$1,559.90
|
| Rate for Payer: Humana Commercial |
$1,395.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,346.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,211.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$492.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,444.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,231.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,313.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,428.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,132.98
|
| Rate for Payer: PHCS Commercial |
$1,576.32
|
| Rate for Payer: United Healthcare All Payer |
$1,444.96
|
|
|
ARTHR KNEE RMV LOOSE/FB
|
Facility
|
OP
|
$1,642.00
|
|
|
Service Code
|
HCPCS 29874
|
| Hospital Charge Code |
76101096
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$564.68 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$1,264.34
|
| Rate for Payer: Anthem Medicaid |
$564.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,280.76
|
| 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 |
$821.00
|
| Rate for Payer: Cash Price |
$821.00
|
| Rate for Payer: Cigna Commercial |
$1,362.86
|
| Rate for Payer: First Health Commercial |
$1,559.90
|
| Rate for Payer: Humana Commercial |
$1,395.70
|
| Rate for Payer: Humana KY Medicaid |
$564.68
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$570.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,346.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,211.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$576.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,444.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,231.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,313.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,428.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,132.98
|
| Rate for Payer: PHCS Commercial |
$1,576.32
|
| Rate for Payer: United Healthcare All Payer |
$1,444.96
|
|
|
ARTHR KNEE RMV LOOSE/FB
|
Professional
|
Both
|
$1,642.00
|
|
|
Service Code
|
HCPCS 29874
|
| Hospital Charge Code |
76101096
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$469.26 |
| Max. Negotiated Rate |
$985.20 |
| Rate for Payer: Aetna Commercial |
$783.25
|
| Rate for Payer: Ambetter Exchange |
$511.30
|
| Rate for Payer: Anthem Medicaid |
$469.26
|
| Rate for Payer: Buckeye Individual/Medicaid |
$511.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$511.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$613.56
|
| Rate for Payer: Cash Price |
$821.00
|
| Rate for Payer: Cash Price |
$821.00
|
| Rate for Payer: Cigna Commercial |
$862.24
|
| Rate for Payer: Healthspan PPO |
$709.46
|
| Rate for Payer: Humana Medicaid |
$469.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$667.15
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$511.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$511.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$478.65
|
| Rate for Payer: Molina Healthcare Passport |
$469.26
|
| Rate for Payer: Multiplan PHCS |
$985.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$664.69
|
| Rate for Payer: UHCCP Medicaid |
$574.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$473.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$511.30
|
|
|
ARTHR KNEE RMV LOOSE/FB(P
|
Professional
|
Both
|
$1,642.00
|
|
|
Service Code
|
HCPCS 29874
|
| Hospital Charge Code |
761P1096
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$469.26 |
| Max. Negotiated Rate |
$985.20 |
| Rate for Payer: Aetna Commercial |
$783.25
|
| Rate for Payer: Ambetter Exchange |
$511.30
|
| Rate for Payer: Anthem Medicaid |
$469.26
|
| Rate for Payer: Buckeye Individual/Medicaid |
$511.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$511.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$613.56
|
| Rate for Payer: Cash Price |
$821.00
|
| Rate for Payer: Cash Price |
$821.00
|
| Rate for Payer: Cigna Commercial |
$862.24
|
| Rate for Payer: Healthspan PPO |
$709.46
|
| Rate for Payer: Humana Medicaid |
$469.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$667.15
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$511.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$511.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$478.65
|
| Rate for Payer: Molina Healthcare Passport |
$469.26
|
| Rate for Payer: Multiplan PHCS |
$985.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$664.69
|
| Rate for Payer: UHCCP Medicaid |
$574.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$473.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$511.30
|
|
|
ARTHRO ASP +/- IMJ INT JNT WUS
|
Facility
|
OP
|
$1,262.00
|
|
|
Service Code
|
HCPCS 20606
|
| Hospital Charge Code |
76100344
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$434.00 |
| Max. Negotiated Rate |
$1,211.52 |
| Rate for Payer: Aetna Commercial |
$971.74
|
| Rate for Payer: Anthem Medicaid |
$434.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$639.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$984.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$895.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$863.82
|
| Rate for Payer: Cash Price |
$631.00
|
| Rate for Payer: Cash Price |
$631.00
|
| Rate for Payer: Cigna Commercial |
$1,047.46
|
| Rate for Payer: First Health Commercial |
$1,198.90
|
| Rate for Payer: Humana Commercial |
$1,072.70
|
| Rate for Payer: Humana KY Medicaid |
$434.00
|
| Rate for Payer: Humana Medicare Advantage |
$639.87
|
| Rate for Payer: Kentucky WC Medicaid |
$438.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,034.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$931.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$767.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$442.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,110.56
|
| Rate for Payer: Ohio Health Group HMO |
$946.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,009.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,097.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$870.78
|
| Rate for Payer: PHCS Commercial |
$1,211.52
|
| Rate for Payer: United Healthcare All Payer |
$1,110.56
|
|
|
ARTHRO ASP +/- IMJ INT JNT WUS
|
Professional
|
Both
|
$1,262.00
|
|
|
Service Code
|
HCPCS 20606
|
| Hospital Charge Code |
76100344
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$40.89 |
| Max. Negotiated Rate |
$757.20 |
| Rate for Payer: Ambetter Exchange |
$49.36
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$40.89
|
| Rate for Payer: Anthem Medicaid |
$62.25
|
| Rate for Payer: Buckeye Individual/Medicaid |
$49.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$49.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$59.23
|
| Rate for Payer: Cash Price |
$631.00
|
| Rate for Payer: Cash Price |
$631.00
|
| Rate for Payer: Cigna Commercial |
$146.58
|
| Rate for Payer: Humana Medicaid |
$62.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$68.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$49.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$63.49
|
| Rate for Payer: Molina Healthcare Passport |
$62.25
|
| Rate for Payer: Multiplan PHCS |
$757.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$64.17
|
| Rate for Payer: UHCCP Medicaid |
$42.93
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$62.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$49.36
|
|
|
ARTHRO ASP +/- IMJ INT JNT WUS
|
Facility
|
IP
|
$1,007.00
|
|
|
Service Code
|
HCPCS 20606
|
| Hospital Charge Code |
761T0344
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$302.10 |
| Max. Negotiated Rate |
$966.72 |
| Rate for Payer: Aetna Commercial |
$775.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$785.46
|
| Rate for Payer: Cash Price |
$503.50
|
| Rate for Payer: Cigna Commercial |
$835.81
|
| Rate for Payer: First Health Commercial |
$956.65
|
| Rate for Payer: Humana Commercial |
$855.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$825.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$743.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$302.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$886.16
|
| Rate for Payer: Ohio Health Group HMO |
$755.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$805.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$876.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$694.83
|
| Rate for Payer: PHCS Commercial |
$966.72
|
| Rate for Payer: United Healthcare All Payer |
$886.16
|
|
|
ARTHRO ASP +/- IMJ INT JNT WUS
|
Facility
|
IP
|
$1,007.00
|
|
|
Service Code
|
HCPCS 20606
|
| Hospital Charge Code |
45000092
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$302.10 |
| Max. Negotiated Rate |
$966.72 |
| Rate for Payer: Aetna Commercial |
$775.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$785.46
|
| Rate for Payer: Cash Price |
$503.50
|
| Rate for Payer: Cigna Commercial |
$835.81
|
| Rate for Payer: First Health Commercial |
$956.65
|
| Rate for Payer: Humana Commercial |
$855.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$825.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$743.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$302.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$886.16
|
| Rate for Payer: Ohio Health Group HMO |
$755.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$805.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$876.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$694.83
|
| Rate for Payer: PHCS Commercial |
$966.72
|
| Rate for Payer: United Healthcare All Payer |
$886.16
|
|
|
ARTHRO ASP +/- IMJ INT JNT WUS
|
Facility
|
OP
|
$1,007.00
|
|
|
Service Code
|
HCPCS 20606
|
| Hospital Charge Code |
45000092
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$346.31 |
| Max. Negotiated Rate |
$966.72 |
| Rate for Payer: Aetna Commercial |
$775.39
|
| Rate for Payer: Anthem Medicaid |
$346.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$639.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$785.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$895.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$863.82
|
| Rate for Payer: Cash Price |
$503.50
|
| Rate for Payer: Cash Price |
$503.50
|
| Rate for Payer: Cigna Commercial |
$835.81
|
| Rate for Payer: First Health Commercial |
$956.65
|
| Rate for Payer: Humana Commercial |
$855.95
|
| Rate for Payer: Humana KY Medicaid |
$346.31
|
| Rate for Payer: Humana Medicare Advantage |
$639.87
|
| Rate for Payer: Kentucky WC Medicaid |
$349.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$825.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$743.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$767.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$353.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$886.16
|
| Rate for Payer: Ohio Health Group HMO |
$755.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$805.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$876.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$694.83
|
| Rate for Payer: PHCS Commercial |
$966.72
|
| Rate for Payer: United Healthcare All Payer |
$886.16
|
|
|
ARTHRO ASP +/- IMJ INT JNT WUS
|
Facility
|
IP
|
$1,262.00
|
|
|
Service Code
|
HCPCS 20606
|
| Hospital Charge Code |
76100344
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$378.60 |
| Max. Negotiated Rate |
$1,211.52 |
| Rate for Payer: Aetna Commercial |
$971.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$984.36
|
| Rate for Payer: Cash Price |
$631.00
|
| Rate for Payer: Cigna Commercial |
$1,047.46
|
| Rate for Payer: First Health Commercial |
$1,198.90
|
| Rate for Payer: Humana Commercial |
$1,072.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,034.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$931.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$378.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,110.56
|
| Rate for Payer: Ohio Health Group HMO |
$946.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,009.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,097.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$870.78
|
| Rate for Payer: PHCS Commercial |
$1,211.52
|
| Rate for Payer: United Healthcare All Payer |
$1,110.56
|
|
|
ARTHRO ASP +/- IMJ INT JNT WUS
|
Facility
|
OP
|
$1,007.00
|
|
|
Service Code
|
HCPCS 20606
|
| Hospital Charge Code |
761T0344
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$346.31 |
| Max. Negotiated Rate |
$966.72 |
| Rate for Payer: Aetna Commercial |
$775.39
|
| Rate for Payer: Anthem Medicaid |
$346.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$639.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$785.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$895.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$863.82
|
| Rate for Payer: Cash Price |
$503.50
|
| Rate for Payer: Cash Price |
$503.50
|
| Rate for Payer: Cigna Commercial |
$835.81
|
| Rate for Payer: First Health Commercial |
$956.65
|
| Rate for Payer: Humana Commercial |
$855.95
|
| Rate for Payer: Humana KY Medicaid |
$346.31
|
| Rate for Payer: Humana Medicare Advantage |
$639.87
|
| Rate for Payer: Kentucky WC Medicaid |
$349.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$825.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$743.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$767.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$353.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$886.16
|
| Rate for Payer: Ohio Health Group HMO |
$755.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$805.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$876.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$694.83
|
| Rate for Payer: PHCS Commercial |
$966.72
|
| Rate for Payer: United Healthcare All Payer |
$886.16
|
|
|
ARTHRO ASP +/- IMJ INT JNT WUS
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 20606
|
| Hospital Charge Code |
761P0344
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$40.89 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Ambetter Exchange |
$49.36
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$40.89
|
| Rate for Payer: Anthem Medicaid |
$62.25
|
| Rate for Payer: Buckeye Individual/Medicaid |
$49.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$49.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$59.23
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cigna Commercial |
$146.58
|
| Rate for Payer: Humana Medicaid |
$62.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$68.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$49.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$63.49
|
| Rate for Payer: Molina Healthcare Passport |
$62.25
|
| Rate for Payer: Multiplan PHCS |
$153.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$64.17
|
| Rate for Payer: UHCCP Medicaid |
$42.93
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$62.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$49.36
|
|
|
ARTHRO ASP+/OR INJ SM JNT W/US
|
Professional
|
Both
|
$751.00
|
|
|
Service Code
|
HCPCS 20604
|
| Hospital Charge Code |
76100342
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$36.16 |
| Max. Negotiated Rate |
$450.60 |
| Rate for Payer: Ambetter Exchange |
$44.00
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$36.16
|
| Rate for Payer: Anthem Medicaid |
$56.19
|
| Rate for Payer: Buckeye Individual/Medicaid |
$44.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$44.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$52.80
|
| Rate for Payer: Cash Price |
$375.50
|
| Rate for Payer: Cash Price |
$375.50
|
| Rate for Payer: Cigna Commercial |
$132.30
|
| Rate for Payer: Humana Medicaid |
$56.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$60.18
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$44.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$44.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$57.31
|
| Rate for Payer: Molina Healthcare Passport |
$56.19
|
| Rate for Payer: Multiplan PHCS |
$450.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$57.20
|
| Rate for Payer: UHCCP Medicaid |
$37.97
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$56.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$44.00
|
|
|
ARTHRO ASP+/OR INJ SM JNT W/US
|
Facility
|
IP
|
$391.00
|
|
|
Service Code
|
HCPCS 20604
|
| Hospital Charge Code |
761T0342
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$117.30 |
| Max. Negotiated Rate |
$375.36 |
| Rate for Payer: Aetna Commercial |
$301.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$304.98
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cigna Commercial |
$324.53
|
| Rate for Payer: First Health Commercial |
$371.45
|
| Rate for Payer: Humana Commercial |
$332.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$320.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$288.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$344.08
|
| Rate for Payer: Ohio Health Group HMO |
$293.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$312.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$340.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$269.79
|
| Rate for Payer: PHCS Commercial |
$375.36
|
| Rate for Payer: United Healthcare All Payer |
$344.08
|
|
|
ARTHRO ASP+/OR INJ SM JNT W/US
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
HCPCS 20604
|
| Hospital Charge Code |
761T0342
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$381.85 |
| Rate for Payer: Aetna Commercial |
$301.07
|
| Rate for Payer: Anthem Medicaid |
$134.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$272.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$304.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$381.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$368.21
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cigna Commercial |
$324.53
|
| Rate for Payer: First Health Commercial |
$371.45
|
| Rate for Payer: Humana Commercial |
$332.35
|
| Rate for Payer: Humana KY Medicaid |
$134.46
|
| Rate for Payer: Humana Medicare Advantage |
$272.75
|
| Rate for Payer: Kentucky WC Medicaid |
$135.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$320.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$288.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$137.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$344.08
|
| Rate for Payer: Ohio Health Group HMO |
$293.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$312.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$340.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$269.79
|
| Rate for Payer: PHCS Commercial |
$375.36
|
| Rate for Payer: United Healthcare All Payer |
$344.08
|
|
|
ARTHRO ASP+/OR INJ SM JNT W/US
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
HCPCS 20604
|
| Hospital Charge Code |
45000090
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$381.85 |
| Rate for Payer: Aetna Commercial |
$301.07
|
| Rate for Payer: Anthem Medicaid |
$134.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$272.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$304.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$381.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$368.21
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cigna Commercial |
$324.53
|
| Rate for Payer: First Health Commercial |
$371.45
|
| Rate for Payer: Humana Commercial |
$332.35
|
| Rate for Payer: Humana KY Medicaid |
$134.46
|
| Rate for Payer: Humana Medicare Advantage |
$272.75
|
| Rate for Payer: Kentucky WC Medicaid |
$135.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$320.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$288.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$137.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$344.08
|
| Rate for Payer: Ohio Health Group HMO |
$293.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$312.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$340.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$269.79
|
| Rate for Payer: PHCS Commercial |
$375.36
|
| Rate for Payer: United Healthcare All Payer |
$344.08
|
|
|
ARTHRO ASP+/OR INJ SM JNT W/US
|
Facility
|
OP
|
$751.00
|
|
|
Service Code
|
HCPCS 20604
|
| Hospital Charge Code |
76100342
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$258.27 |
| Max. Negotiated Rate |
$720.96 |
| Rate for Payer: Aetna Commercial |
$578.27
|
| Rate for Payer: Anthem Medicaid |
$258.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$272.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$381.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$368.21
|
| Rate for Payer: Cash Price |
$375.50
|
| Rate for Payer: Cash Price |
$375.50
|
| Rate for Payer: Cigna Commercial |
$623.33
|
| Rate for Payer: First Health Commercial |
$713.45
|
| Rate for Payer: Humana Commercial |
$638.35
|
| Rate for Payer: Humana KY Medicaid |
$258.27
|
| Rate for Payer: Humana Medicare Advantage |
$272.75
|
| Rate for Payer: Kentucky WC Medicaid |
$260.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$554.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$263.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.88
|
| Rate for Payer: Ohio Health Group HMO |
$563.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$653.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$518.19
|
| Rate for Payer: PHCS Commercial |
$720.96
|
| Rate for Payer: United Healthcare All Payer |
$660.88
|
|
|
ARTHRO ASP+/OR INJ SM JNT W/US
|
Professional
|
Both
|
$360.00
|
|
|
Service Code
|
HCPCS 20604
|
| Hospital Charge Code |
761P0342
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$36.16 |
| Max. Negotiated Rate |
$216.00 |
| Rate for Payer: Ambetter Exchange |
$44.00
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$36.16
|
| Rate for Payer: Anthem Medicaid |
$56.19
|
| Rate for Payer: Buckeye Individual/Medicaid |
$44.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$44.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$52.80
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cigna Commercial |
$132.30
|
| Rate for Payer: Humana Medicaid |
$56.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$60.18
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$44.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$44.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$57.31
|
| Rate for Payer: Molina Healthcare Passport |
$56.19
|
| Rate for Payer: Multiplan PHCS |
$216.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$57.20
|
| Rate for Payer: UHCCP Medicaid |
$37.97
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$56.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$44.00
|
|
