|
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
|
$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
|
|
|
ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, MAJOR JOINT OR BURSA (EG, SHOULDER, HIP, KNEE, SUBACROMIAL BURSA); WITHOUT ULTRASOUND GUIDANCE
|
Facility
|
OP
|
$381.85
|
|
|
Service Code
|
CPT 20610
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$272.75 |
| Max. Negotiated Rate |
$381.85 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$272.75
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$381.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$368.21
|
| Rate for Payer: Humana Medicare Advantage |
$272.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.30
|
|
|
ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, SMALL JOINT OR BURSA (EG, FINGERS, TOES); WITHOUT ULTRASOUND GUIDANCE
|
Facility
|
OP
|
$381.85
|
|
|
Service Code
|
CPT 20600
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$272.75 |
| Max. Negotiated Rate |
$381.85 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$272.75
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$381.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$368.21
|
| Rate for Payer: Humana Medicare Advantage |
$272.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.30
|
|
|
ARTHRODESIS, ANKLE, OPEN
|
Professional
|
Both
|
$2,285.00
|
|
|
Service Code
|
HCPCS 27870
|
| Hospital Charge Code |
76100954
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$717.51 |
| Max. Negotiated Rate |
$1,700.69 |
| Rate for Payer: Aetna Commercial |
$1,565.36
|
| Rate for Payer: Ambetter Exchange |
$957.12
|
| Rate for Payer: Anthem Medicaid |
$717.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$957.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$957.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,148.54
|
| Rate for Payer: Cash Price |
$1,142.50
|
| Rate for Payer: Cash Price |
$1,142.50
|
| Rate for Payer: Cigna Commercial |
$1,700.69
|
| Rate for Payer: Healthspan PPO |
$1,417.88
|
| Rate for Payer: Humana Medicaid |
$717.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,304.65
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$957.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$957.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$731.86
|
| Rate for Payer: Molina Healthcare Passport |
$717.51
|
| Rate for Payer: Multiplan PHCS |
$1,371.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,244.26
|
| Rate for Payer: UHCCP Medicaid |
$799.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$724.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$957.12
|
|
|
ARTHRODESIS, ANKLE, OPEN
|
Facility
|
IP
|
$2,285.00
|
|
|
Service Code
|
HCPCS 27870
|
| Hospital Charge Code |
76100954
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$685.50 |
| Max. Negotiated Rate |
$2,193.60 |
| Rate for Payer: Aetna Commercial |
$1,759.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,782.30
|
| Rate for Payer: Cash Price |
$1,142.50
|
| Rate for Payer: Cigna Commercial |
$1,896.55
|
| Rate for Payer: First Health Commercial |
$2,170.75
|
| Rate for Payer: Humana Commercial |
$1,942.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,873.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,686.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$685.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,010.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,713.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,828.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,987.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,576.65
|
| Rate for Payer: PHCS Commercial |
$2,193.60
|
| Rate for Payer: United Healthcare All Payer |
$2,010.80
|
|
|
ARTHRODESIS, ANKLE, OPEN
|
Facility
|
OP
|
$2,285.00
|
|
|
Service Code
|
HCPCS 27870
|
| Hospital Charge Code |
76100954
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$785.81 |
| Max. Negotiated Rate |
$16,644.15 |
| Rate for Payer: Aetna Commercial |
$1,759.45
|
| Rate for Payer: Anthem Medicaid |
$785.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,888.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,782.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16,644.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$16,049.72
|
| Rate for Payer: Cash Price |
$1,142.50
|
| Rate for Payer: Cash Price |
$1,142.50
|
| Rate for Payer: Cigna Commercial |
$1,896.55
|
| Rate for Payer: First Health Commercial |
$2,170.75
|
| Rate for Payer: Humana Commercial |
$1,942.25
|
| Rate for Payer: Humana KY Medicaid |
$785.81
|
| Rate for Payer: Humana Medicare Advantage |
$11,888.68
|
| Rate for Payer: Kentucky WC Medicaid |
$793.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,873.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,686.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14,266.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$801.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,010.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,713.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,828.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,987.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,576.65
|
| Rate for Payer: PHCS Commercial |
$2,193.60
|
| Rate for Payer: United Healthcare All Payer |
$2,010.80
|
|
|
ARTHRODESIS, ANKLE, OPEN(P
|
Professional
|
Both
|
$2,285.00
|
|
|
Service Code
|
HCPCS 27870
|
| Hospital Charge Code |
761P0954
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$717.51 |
| Max. Negotiated Rate |
$1,700.69 |
| Rate for Payer: Aetna Commercial |
$1,565.36
|
| Rate for Payer: Ambetter Exchange |
$957.12
|
| Rate for Payer: Anthem Medicaid |
$717.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$957.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$957.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,148.54
|
| Rate for Payer: Cash Price |
$1,142.50
|
| Rate for Payer: Cash Price |
$1,142.50
|
| Rate for Payer: Cigna Commercial |
$1,700.69
|
| Rate for Payer: Healthspan PPO |
$1,417.88
|
| Rate for Payer: Humana Medicaid |
$717.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,304.65
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$957.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$957.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$731.86
|
| Rate for Payer: Molina Healthcare Passport |
$717.51
|
| Rate for Payer: Multiplan PHCS |
$1,371.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,244.26
|
| Rate for Payer: UHCCP Medicaid |
$799.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$724.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$957.12
|
|
|
ARTHRODESIS, GREAT TOE; METATARSOPHALANGEAL JOINT
|
Facility
|
OP
|
$9,240.92
|
|
|
Service Code
|
CPT 28750
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,600.66 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
|
|
ARTHRODESIS KNEE ANY TECHNIQUE
|
Professional
|
Both
|
$1,670.00
|
|
|
Service Code
|
HCPCS 27580
|
| Hospital Charge Code |
76102694
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$584.50 |
| Max. Negotiated Rate |
$2,356.43 |
| Rate for Payer: Aetna Commercial |
$2,156.27
|
| Rate for Payer: Ambetter Exchange |
$1,394.07
|
| Rate for Payer: Anthem Medicaid |
$843.06
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,394.07
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,394.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,672.88
|
| Rate for Payer: Cash Price |
$835.00
|
| Rate for Payer: Cash Price |
$835.00
|
| Rate for Payer: Cigna Commercial |
$2,356.43
|
| Rate for Payer: Healthspan PPO |
$1,953.12
|
| Rate for Payer: Humana Medicaid |
$843.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,805.37
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,394.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,394.07
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$859.92
|
| Rate for Payer: Molina Healthcare Passport |
$843.06
|
| Rate for Payer: Multiplan PHCS |
$1,002.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,812.29
|
| Rate for Payer: UHCCP Medicaid |
$584.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$851.49
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,394.07
|
|
|
ARTHRODESIS, MIDTARSAL OR TARSOMETATARSAL, SINGLE JOINT
|
Facility
|
OP
|
$9,240.92
|
|
|
Service Code
|
CPT 28740
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,600.66 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
|
|
ARTHRODESIS, PANTALAR
|
Professional
|
Both
|
$1,425.00
|
|
|
Service Code
|
HCPCS 28705
|
| Hospital Charge Code |
76102679
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$498.75 |
| Max. Negotiated Rate |
$2,156.49 |
| Rate for Payer: Aetna Commercial |
$1,988.38
|
| Rate for Payer: Ambetter Exchange |
$1,159.53
|
| Rate for Payer: Anthem Medicaid |
$879.94
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,159.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,159.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,391.44
|
| Rate for Payer: Cash Price |
$712.50
|
| Rate for Payer: Cash Price |
$712.50
|
| Rate for Payer: Cigna Commercial |
$2,156.49
|
| Rate for Payer: Healthspan PPO |
$1,801.05
|
| Rate for Payer: Humana Medicaid |
$879.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,629.17
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,159.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,159.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$897.54
|
| Rate for Payer: Molina Healthcare Passport |
$879.94
|
| Rate for Payer: Multiplan PHCS |
$855.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,507.39
|
| Rate for Payer: UHCCP Medicaid |
$498.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$888.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,159.53
|
|
|
ARTHRODESIS; SUBTALAR
|
Facility
|
OP
|
$16,644.15
|
|
|
Service Code
|
CPT 28725
|
| Hospital Charge Code |
76102702
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$11,888.68 |
| Max. Negotiated Rate |
$16,644.15 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,888.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16,644.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$16,049.72
|
| Rate for Payer: Humana Medicare Advantage |
$11,888.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14,266.42
|
|
|
ARTHRODESIS; SUBTALAR
|
Professional
|
Both
|
$975.00
|
|
|
Service Code
|
HCPCS 28725
|
| Hospital Charge Code |
76102702
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$341.25 |
| Max. Negotiated Rate |
$1,332.92 |
| Rate for Payer: Aetna Commercial |
$1,210.01
|
| Rate for Payer: Ambetter Exchange |
$738.71
|
| Rate for Payer: Anthem Medicaid |
$606.86
|
| Rate for Payer: Buckeye Individual/Medicaid |
$738.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$738.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$886.45
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cigna Commercial |
$1,332.92
|
| Rate for Payer: Healthspan PPO |
$1,096.01
|
| Rate for Payer: Humana Medicaid |
$606.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$989.74
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$738.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$738.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$619.00
|
| Rate for Payer: Molina Healthcare Passport |
$606.86
|
| Rate for Payer: Multiplan PHCS |
$585.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$960.32
|
| Rate for Payer: UHCCP Medicaid |
$341.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$612.93
|
| Rate for Payer: Wellcare Medicare Advantage |
$738.71
|
|
|
ARTHRODESIS; SUBTALAR
|
Facility
|
OP
|
$16,644.15
|
|
|
Service Code
|
CPT 28725
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$11,888.68 |
| Max. Negotiated Rate |
$16,644.15 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,888.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16,644.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$16,049.72
|
| Rate for Payer: Humana Medicare Advantage |
$11,888.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14,266.42
|
|
|
ARTHRODESIS; TRIPLE
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 28715
|
| Hospital Charge Code |
76101036
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$700.00 |
| Max. Negotiated Rate |
$1,593.01 |
| Rate for Payer: Aetna Commercial |
$1,465.84
|
| Rate for Payer: Ambetter Exchange |
$893.18
|
| Rate for Payer: Anthem Medicaid |
$734.04
|
| Rate for Payer: Buckeye Individual/Medicaid |
$893.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$893.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,071.82
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,593.01
|
| Rate for Payer: Healthspan PPO |
$1,327.74
|
| Rate for Payer: Humana Medicaid |
$734.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,216.12
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$893.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$893.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$748.72
|
| Rate for Payer: Molina Healthcare Passport |
$734.04
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,161.13
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$741.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$893.18
|
|
|
ARTHRODESIS; TRIPLE
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 28715
|
| Hospital Charge Code |
76101036
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
ARTHRODESIS; TRIPLE
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 28715
|
| Hospital Charge Code |
76101036
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$687.80 |
| Max. Negotiated Rate |
$16,644.15 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem Medicaid |
$687.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,888.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16,644.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$16,049.72
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Humana KY Medicaid |
$687.80
|
| Rate for Payer: Humana Medicare Advantage |
$11,888.68
|
| Rate for Payer: Kentucky WC Medicaid |
$694.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14,266.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$701.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
ARTHRODESIS; TRIPLE(P
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 28715
|
| Hospital Charge Code |
761P1036
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$700.00 |
| Max. Negotiated Rate |
$1,593.01 |
| Rate for Payer: Aetna Commercial |
$1,465.84
|
| Rate for Payer: Ambetter Exchange |
$893.18
|
| Rate for Payer: Anthem Medicaid |
$734.04
|
| Rate for Payer: Buckeye Individual/Medicaid |
$893.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$893.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,071.82
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,593.01
|
| Rate for Payer: Healthspan PPO |
$1,327.74
|
| Rate for Payer: Humana Medicaid |
$734.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,216.12
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$893.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$893.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$748.72
|
| Rate for Payer: Molina Healthcare Passport |
$734.04
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,161.13
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$741.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$893.18
|
|
|
ARTHRODESIS, WITH TENDON LENGTHENING AND ADVANCEMENT, MIDTARSAL, TARSAL NAVICULAR-CUNEIFORM (EG, MILLER TYPE PROCEDURE)
|
Facility
|
OP
|
$16,644.15
|
|
|
Service Code
|
CPT 28737
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$11,888.68 |
| Max. Negotiated Rate |
$16,644.15 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,888.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16,644.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$16,049.72
|
| Rate for Payer: Humana Medicare Advantage |
$11,888.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14,266.42
|
|
|
ARTHROFEMCONDYLE/TIBPLATEAKNEE
|
Professional
|
Both
|
$2,325.00
|
|
|
Service Code
|
HCPCS 27442
|
| Hospital Charge Code |
76100846
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$783.21 |
| Max. Negotiated Rate |
$1,408.60 |
| Rate for Payer: Aetna Commercial |
$1,292.84
|
| Rate for Payer: Ambetter Exchange |
$830.83
|
| Rate for Payer: Anthem Medicaid |
$783.21
|
| Rate for Payer: Buckeye Individual/Medicaid |
$830.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$830.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$997.00
|
| Rate for Payer: Cash Price |
$1,162.50
|
| Rate for Payer: Cash Price |
$1,162.50
|
| Rate for Payer: Cigna Commercial |
$1,408.60
|
| Rate for Payer: Healthspan PPO |
$1,171.03
|
| Rate for Payer: Humana Medicaid |
$783.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,081.38
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$830.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$830.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$798.87
|
| Rate for Payer: Molina Healthcare Passport |
$783.21
|
| Rate for Payer: Multiplan PHCS |
$1,395.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,080.08
|
| Rate for Payer: UHCCP Medicaid |
$813.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$791.04
|
| Rate for Payer: Wellcare Medicare Advantage |
$830.83
|
|
|
ARTHROFEMCONDYLE/TIBPLATEAKNEE
|
Facility
|
OP
|
$2,325.00
|
|
|
Service Code
|
HCPCS 27442
|
| Hospital Charge Code |
76100846
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$799.57 |
| Max. Negotiated Rate |
$16,644.15 |
| Rate for Payer: Aetna Commercial |
$1,790.25
|
| Rate for Payer: Anthem Medicaid |
$799.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,888.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,813.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16,644.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$16,049.72
|
| Rate for Payer: Cash Price |
$1,162.50
|
| Rate for Payer: Cash Price |
$1,162.50
|
| Rate for Payer: Cigna Commercial |
$1,929.75
|
| Rate for Payer: First Health Commercial |
$2,208.75
|
| Rate for Payer: Humana Commercial |
$1,976.25
|
| Rate for Payer: Humana KY Medicaid |
$799.57
|
| Rate for Payer: Humana Medicare Advantage |
$11,888.68
|
| Rate for Payer: Kentucky WC Medicaid |
$807.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,906.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,715.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14,266.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$815.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,046.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,743.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,022.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,604.25
|
| Rate for Payer: PHCS Commercial |
$2,232.00
|
| Rate for Payer: United Healthcare All Payer |
$2,046.00
|
|
|
ARTHROFEMCONDYLE/TIBPLATEAKNEE
|
Professional
|
Both
|
$2,325.00
|
|
|
Service Code
|
HCPCS 27442
|
| Hospital Charge Code |
761P0846
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$783.21 |
| Max. Negotiated Rate |
$1,408.60 |
| Rate for Payer: Aetna Commercial |
$1,292.84
|
| Rate for Payer: Ambetter Exchange |
$830.83
|
| Rate for Payer: Anthem Medicaid |
$783.21
|
| Rate for Payer: Buckeye Individual/Medicaid |
$830.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$830.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$997.00
|
| Rate for Payer: Cash Price |
$1,162.50
|
| Rate for Payer: Cash Price |
$1,162.50
|
| Rate for Payer: Cigna Commercial |
$1,408.60
|
| Rate for Payer: Healthspan PPO |
$1,171.03
|
| Rate for Payer: Humana Medicaid |
$783.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,081.38
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$830.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$830.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$798.87
|
| Rate for Payer: Molina Healthcare Passport |
$783.21
|
| Rate for Payer: Multiplan PHCS |
$1,395.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,080.08
|
| Rate for Payer: UHCCP Medicaid |
$813.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$791.04
|
| Rate for Payer: Wellcare Medicare Advantage |
$830.83
|
|
|
ARTHROFEMCONDYLE/TIBPLATEAKNEE
|
Facility
|
IP
|
$2,325.00
|
|
|
Service Code
|
HCPCS 27442
|
| Hospital Charge Code |
76100846
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$697.50 |
| Max. Negotiated Rate |
$2,232.00 |
| Rate for Payer: Aetna Commercial |
$1,790.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,813.50
|
| Rate for Payer: Cash Price |
$1,162.50
|
| Rate for Payer: Cigna Commercial |
$1,929.75
|
| Rate for Payer: First Health Commercial |
$2,208.75
|
| Rate for Payer: Humana Commercial |
$1,976.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,906.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,715.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$697.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,046.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,743.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,022.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,604.25
|
| Rate for Payer: PHCS Commercial |
$2,232.00
|
| Rate for Payer: United Healthcare All Payer |
$2,046.00
|
|
|
ARTHROFLX DERMIS 40MM*70MM*1MM
|
Facility
|
OP
|
$9,980.62
|
|
|
Service Code
|
HCPCS Q4125
|
| Hospital Charge Code |
27000123
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,994.19 |
| Max. Negotiated Rate |
$9,581.40 |
| Rate for Payer: Aetna Commercial |
$7,685.08
|
| Rate for Payer: Anthem Medicaid |
$3,432.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,784.88
|
| Rate for Payer: Cash Price |
$4,990.31
|
| Rate for Payer: Cigna Commercial |
$8,283.91
|
| Rate for Payer: First Health Commercial |
$9,481.59
|
| Rate for Payer: Humana Commercial |
$8,483.53
|
| Rate for Payer: Humana KY Medicaid |
$3,432.34
|
| Rate for Payer: Kentucky WC Medicaid |
$3,467.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,184.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,365.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,994.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,501.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,782.95
|
| Rate for Payer: Ohio Health Group HMO |
$7,485.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,984.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,683.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,886.63
|
| Rate for Payer: PHCS Commercial |
$9,581.40
|
| Rate for Payer: United Healthcare All Payer |
$8,782.95
|
|
