|
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
|
|
|
ARTHROGRAM - LT ANKLE
|
Facility
|
IP
|
$778.00
|
|
|
Service Code
|
HCPCS 73615
|
| Hospital Charge Code |
32000108
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$233.40 |
| Max. Negotiated Rate |
$746.88 |
| Rate for Payer: Aetna Commercial |
$599.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$606.84
|
| Rate for Payer: Cash Price |
$389.00
|
| Rate for Payer: Cigna Commercial |
$645.74
|
| Rate for Payer: First Health Commercial |
$739.10
|
| Rate for Payer: Humana Commercial |
$661.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$637.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$574.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$233.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$684.64
|
| Rate for Payer: Ohio Health Group HMO |
$583.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$622.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$676.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$536.82
|
| Rate for Payer: PHCS Commercial |
$746.88
|
| Rate for Payer: United Healthcare All Payer |
$684.64
|
|
|
ARTHROGRAM - LT ANKLE
|
Facility
|
OP
|
$778.00
|
|
|
Service Code
|
HCPCS 73615
|
| Hospital Charge Code |
32000108
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$267.55 |
| Max. Negotiated Rate |
$746.88 |
| Rate for Payer: Aetna Commercial |
$599.06
|
| Rate for Payer: Anthem Medicaid |
$267.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$329.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$606.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$461.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$445.47
|
| Rate for Payer: Cash Price |
$389.00
|
| Rate for Payer: Cash Price |
$389.00
|
| Rate for Payer: Cigna Commercial |
$645.74
|
| Rate for Payer: First Health Commercial |
$739.10
|
| Rate for Payer: Humana Commercial |
$661.30
|
| Rate for Payer: Humana KY Medicaid |
$267.55
|
| Rate for Payer: Humana Medicare Advantage |
$329.98
|
| Rate for Payer: Kentucky WC Medicaid |
$270.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$637.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$574.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$272.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$684.64
|
| Rate for Payer: Ohio Health Group HMO |
$583.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$622.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$676.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$536.82
|
| Rate for Payer: PHCS Commercial |
$746.88
|
| Rate for Payer: United Healthcare All Payer |
$684.64
|
|
|
ARTHROGRAM - LT ANKLE
|
Professional
|
Both
|
$778.00
|
|
|
Service Code
|
HCPCS 73615
|
| Hospital Charge Code |
32000108
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$35.96 |
| Max. Negotiated Rate |
$466.80 |
| Rate for Payer: Aetna Commercial |
$150.49
|
| Rate for Payer: Ambetter Exchange |
$111.63
|
| Rate for Payer: Anthem Medicaid |
$80.33
|
| Rate for Payer: Buckeye Individual/Medicaid |
$111.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$111.63
|
| Rate for Payer: CareSource Just4Me Medicare |
$133.96
|
| Rate for Payer: Cash Price |
$389.00
|
| Rate for Payer: Cash Price |
$389.00
|
| Rate for Payer: Cigna Commercial |
$157.10
|
| Rate for Payer: Healthspan PPO |
$141.01
|
| Rate for Payer: Humana Medicaid |
$80.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$35.96
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$111.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$111.63
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$81.94
|
| Rate for Payer: Molina Healthcare Passport |
$80.33
|
| Rate for Payer: Multiplan PHCS |
$466.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$145.12
|
| Rate for Payer: UHCCP Medicaid |
$272.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$81.13
|
| Rate for Payer: Wellcare Medicare Advantage |
$111.63
|
|
|
ARTHROGRAM - LT ANKLE(P
|
Professional
|
Both
|
$130.00
|
|
|
Service Code
|
HCPCS 73615
|
| Hospital Charge Code |
320P0108
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$35.96 |
| Max. Negotiated Rate |
$157.10 |
| Rate for Payer: Aetna Commercial |
$150.49
|
| Rate for Payer: Ambetter Exchange |
$111.63
|
| Rate for Payer: Anthem Medicaid |
$80.33
|
| Rate for Payer: Buckeye Individual/Medicaid |
$111.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$111.63
|
| Rate for Payer: CareSource Just4Me Medicare |
$133.96
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna Commercial |
$157.10
|
| Rate for Payer: Healthspan PPO |
$141.01
|
| Rate for Payer: Humana Medicaid |
$80.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$35.96
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$111.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$111.63
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$81.94
|
| Rate for Payer: Molina Healthcare Passport |
$80.33
|
| Rate for Payer: Multiplan PHCS |
$78.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$145.12
|
| Rate for Payer: UHCCP Medicaid |
$45.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$81.13
|
| Rate for Payer: Wellcare Medicare Advantage |
$111.63
|
|
|
ARTHROGRAM - LT ANKLE(T
|
Facility
|
OP
|
$648.00
|
|
|
Service Code
|
HCPCS 73615
|
| Hospital Charge Code |
320T0108
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$222.85 |
| Max. Negotiated Rate |
$622.08 |
| Rate for Payer: Aetna Commercial |
$498.96
|
| Rate for Payer: Anthem Medicaid |
$222.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$329.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$505.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$461.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$445.47
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cigna Commercial |
$537.84
|
| Rate for Payer: First Health Commercial |
$615.60
|
| Rate for Payer: Humana Commercial |
$550.80
|
| Rate for Payer: Humana KY Medicaid |
$222.85
|
| Rate for Payer: Humana Medicare Advantage |
$329.98
|
| Rate for Payer: Kentucky WC Medicaid |
$225.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$531.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$478.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$227.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$570.24
|
| Rate for Payer: Ohio Health Group HMO |
$486.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$518.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$563.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$447.12
|
| Rate for Payer: PHCS Commercial |
$622.08
|
| Rate for Payer: United Healthcare All Payer |
$570.24
|
|
|
ARTHROGRAM - LT ANKLE(T
|
Facility
|
IP
|
$648.00
|
|
|
Service Code
|
HCPCS 73615
|
| Hospital Charge Code |
320T0108
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$194.40 |
| Max. Negotiated Rate |
$622.08 |
| Rate for Payer: Aetna Commercial |
$498.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$505.44
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cigna Commercial |
$537.84
|
| Rate for Payer: First Health Commercial |
$615.60
|
| Rate for Payer: Humana Commercial |
$550.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$531.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$478.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$194.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$570.24
|
| Rate for Payer: Ohio Health Group HMO |
$486.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$518.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$563.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$447.12
|
| Rate for Payer: PHCS Commercial |
$622.08
|
| Rate for Payer: United Healthcare All Payer |
$570.24
|
|
|
ARTHROGRAM - LT ELBOW
|
Facility
|
OP
|
$748.00
|
|
|
Service Code
|
HCPCS 73085
|
| Hospital Charge Code |
32000081
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$257.24 |
| Max. Negotiated Rate |
$718.08 |
| Rate for Payer: Aetna Commercial |
$575.96
|
| Rate for Payer: Anthem Medicaid |
$257.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$329.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$583.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$461.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$445.47
|
| Rate for Payer: Cash Price |
$374.00
|
| Rate for Payer: Cash Price |
$374.00
|
| Rate for Payer: Cigna Commercial |
$620.84
|
| Rate for Payer: First Health Commercial |
$710.60
|
| Rate for Payer: Humana Commercial |
$635.80
|
| Rate for Payer: Humana KY Medicaid |
$257.24
|
| Rate for Payer: Humana Medicare Advantage |
$329.98
|
| Rate for Payer: Kentucky WC Medicaid |
$259.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$613.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$552.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$262.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$658.24
|
| Rate for Payer: Ohio Health Group HMO |
$561.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$598.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$516.12
|
| Rate for Payer: PHCS Commercial |
$718.08
|
| Rate for Payer: United Healthcare All Payer |
$658.24
|
|
|
ARTHROGRAM - LT ELBOW
|
Professional
|
Both
|
$748.00
|
|
|
Service Code
|
HCPCS 73085
|
| Hospital Charge Code |
32000081
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$35.01 |
| Max. Negotiated Rate |
$448.80 |
| Rate for Payer: Aetna Commercial |
$146.57
|
| Rate for Payer: Ambetter Exchange |
$88.35
|
| Rate for Payer: Anthem Medicaid |
$80.33
|
| Rate for Payer: Buckeye Individual/Medicaid |
$88.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$88.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.02
|
| Rate for Payer: Cash Price |
$374.00
|
| Rate for Payer: Cash Price |
$374.00
|
| Rate for Payer: Cigna Commercial |
$155.41
|
| Rate for Payer: Healthspan PPO |
$137.34
|
| Rate for Payer: Humana Medicaid |
$80.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$35.01
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$88.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$88.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$81.94
|
| Rate for Payer: Molina Healthcare Passport |
$80.33
|
| Rate for Payer: Multiplan PHCS |
$448.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$114.86
|
| Rate for Payer: UHCCP Medicaid |
$261.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$81.13
|
| Rate for Payer: Wellcare Medicare Advantage |
$88.35
|
|
|
ARTHROGRAM - LT ELBOW
|
Facility
|
IP
|
$748.00
|
|
|
Service Code
|
HCPCS 73085
|
| Hospital Charge Code |
32000081
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$224.40 |
| Max. Negotiated Rate |
$718.08 |
| Rate for Payer: Aetna Commercial |
$575.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$583.44
|
| Rate for Payer: Cash Price |
$374.00
|
| Rate for Payer: Cigna Commercial |
$620.84
|
| Rate for Payer: First Health Commercial |
$710.60
|
| Rate for Payer: Humana Commercial |
$635.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$613.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$552.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$224.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$658.24
|
| Rate for Payer: Ohio Health Group HMO |
$561.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$598.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$516.12
|
| Rate for Payer: PHCS Commercial |
$718.08
|
| Rate for Payer: United Healthcare All Payer |
$658.24
|
|
|
ARTHROGRAM - LT ELBOW(P
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 73085
|
| Hospital Charge Code |
320P0081
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$155.41 |
| Rate for Payer: Aetna Commercial |
$146.57
|
| Rate for Payer: Ambetter Exchange |
$88.35
|
| Rate for Payer: Anthem Medicaid |
$80.33
|
| Rate for Payer: Buckeye Individual/Medicaid |
$88.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$88.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.02
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$155.41
|
| Rate for Payer: Healthspan PPO |
$137.34
|
| Rate for Payer: Humana Medicaid |
$80.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$35.01
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$88.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$88.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$81.94
|
| Rate for Payer: Molina Healthcare Passport |
$80.33
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$114.86
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$81.13
|
| Rate for Payer: Wellcare Medicare Advantage |
$88.35
|
|
|
ARTHROGRAM - LT ELBOW(T
|
Facility
|
IP
|
$648.00
|
|
|
Service Code
|
HCPCS 73085
|
| Hospital Charge Code |
320T0081
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$194.40 |
| Max. Negotiated Rate |
$622.08 |
| Rate for Payer: Aetna Commercial |
$498.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$505.44
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cigna Commercial |
$537.84
|
| Rate for Payer: First Health Commercial |
$615.60
|
| Rate for Payer: Humana Commercial |
$550.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$531.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$478.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$194.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$570.24
|
| Rate for Payer: Ohio Health Group HMO |
$486.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$518.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$563.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$447.12
|
| Rate for Payer: PHCS Commercial |
$622.08
|
| Rate for Payer: United Healthcare All Payer |
$570.24
|
|
|
ARTHROGRAM - LT ELBOW(T
|
Facility
|
OP
|
$648.00
|
|
|
Service Code
|
HCPCS 73085
|
| Hospital Charge Code |
320T0081
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$222.85 |
| Max. Negotiated Rate |
$622.08 |
| Rate for Payer: Aetna Commercial |
$498.96
|
| Rate for Payer: Anthem Medicaid |
$222.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$329.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$505.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$461.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$445.47
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cigna Commercial |
$537.84
|
| Rate for Payer: First Health Commercial |
$615.60
|
| Rate for Payer: Humana Commercial |
$550.80
|
| Rate for Payer: Humana KY Medicaid |
$222.85
|
| Rate for Payer: Humana Medicare Advantage |
$329.98
|
| Rate for Payer: Kentucky WC Medicaid |
$225.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$531.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$478.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$227.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$570.24
|
| Rate for Payer: Ohio Health Group HMO |
$486.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$518.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$563.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$447.12
|
| Rate for Payer: PHCS Commercial |
$622.08
|
| Rate for Payer: United Healthcare All Payer |
$570.24
|
|
|
ARTHROGRAM - LT HIP
|
Professional
|
Both
|
$831.00
|
|
|
Service Code
|
HCPCS 73525
|
| Hospital Charge Code |
32000097
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$35.96 |
| Max. Negotiated Rate |
$498.60 |
| Rate for Payer: Aetna Commercial |
$146.75
|
| Rate for Payer: Ambetter Exchange |
$111.96
|
| Rate for Payer: Anthem Medicaid |
$80.33
|
| Rate for Payer: Buckeye Individual/Medicaid |
$111.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$111.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$134.35
|
| Rate for Payer: Cash Price |
$415.50
|
| Rate for Payer: Cash Price |
$415.50
|
| Rate for Payer: Cigna Commercial |
$155.99
|
| Rate for Payer: Healthspan PPO |
$137.50
|
| Rate for Payer: Humana Medicaid |
$80.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$35.96
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$111.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$111.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$81.94
|
| Rate for Payer: Molina Healthcare Passport |
$80.33
|
| Rate for Payer: Multiplan PHCS |
$498.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$145.55
|
| Rate for Payer: UHCCP Medicaid |
$290.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$81.13
|
| Rate for Payer: Wellcare Medicare Advantage |
$111.96
|
|
|
ARTHROGRAM - LT HIP
|
Facility
|
IP
|
$831.00
|
|
|
Service Code
|
HCPCS 73525
|
| Hospital Charge Code |
32000097
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$249.30 |
| Max. Negotiated Rate |
$797.76 |
| Rate for Payer: Aetna Commercial |
$639.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$648.18
|
| Rate for Payer: Cash Price |
$415.50
|
| Rate for Payer: Cigna Commercial |
$689.73
|
| Rate for Payer: First Health Commercial |
$789.45
|
| Rate for Payer: Humana Commercial |
$706.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$681.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$613.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$249.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$731.28
|
| Rate for Payer: Ohio Health Group HMO |
$623.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$664.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$722.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$573.39
|
| Rate for Payer: PHCS Commercial |
$797.76
|
| Rate for Payer: United Healthcare All Payer |
$731.28
|
|
|
ARTHROGRAM - LT HIP
|
Facility
|
OP
|
$831.00
|
|
|
Service Code
|
HCPCS 73525
|
| Hospital Charge Code |
32000097
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$285.78 |
| Max. Negotiated Rate |
$797.76 |
| Rate for Payer: Aetna Commercial |
$639.87
|
| Rate for Payer: Anthem Medicaid |
$285.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$329.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$648.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$461.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$445.47
|
| Rate for Payer: Cash Price |
$415.50
|
| Rate for Payer: Cash Price |
$415.50
|
| Rate for Payer: Cigna Commercial |
$689.73
|
| Rate for Payer: First Health Commercial |
$789.45
|
| Rate for Payer: Humana Commercial |
$706.35
|
| Rate for Payer: Humana KY Medicaid |
$285.78
|
| Rate for Payer: Humana Medicare Advantage |
$329.98
|
| Rate for Payer: Kentucky WC Medicaid |
$288.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$681.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$613.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$291.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$731.28
|
| Rate for Payer: Ohio Health Group HMO |
$623.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$664.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$722.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$573.39
|
| Rate for Payer: PHCS Commercial |
$797.76
|
| Rate for Payer: United Healthcare All Payer |
$731.28
|
|
|
ARTHROGRAM - LT HIP(P
|
Professional
|
Both
|
$160.00
|
|
|
Service Code
|
HCPCS 73525
|
| Hospital Charge Code |
320P0097
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$35.96 |
| Max. Negotiated Rate |
$155.99 |
| Rate for Payer: Aetna Commercial |
$146.75
|
| Rate for Payer: Ambetter Exchange |
$111.96
|
| Rate for Payer: Anthem Medicaid |
$80.33
|
| Rate for Payer: Buckeye Individual/Medicaid |
$111.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$111.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$134.35
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cigna Commercial |
$155.99
|
| Rate for Payer: Healthspan PPO |
$137.50
|
| Rate for Payer: Humana Medicaid |
$80.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$35.96
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$111.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$111.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$81.94
|
| Rate for Payer: Molina Healthcare Passport |
$80.33
|
| Rate for Payer: Multiplan PHCS |
$96.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$145.55
|
| Rate for Payer: UHCCP Medicaid |
$56.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$81.13
|
| Rate for Payer: Wellcare Medicare Advantage |
$111.96
|
|
|
ARTHROGRAM - LT HIP(T
|
Facility
|
IP
|
$671.00
|
|
|
Service Code
|
HCPCS 73525
|
| Hospital Charge Code |
320T0097
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$201.30 |
| Max. Negotiated Rate |
$644.16 |
| Rate for Payer: Aetna Commercial |
$516.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$523.38
|
| Rate for Payer: Cash Price |
$335.50
|
| Rate for Payer: Cigna Commercial |
$556.93
|
| Rate for Payer: First Health Commercial |
$637.45
|
| Rate for Payer: Humana Commercial |
$570.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$550.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$495.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$201.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$590.48
|
| Rate for Payer: Ohio Health Group HMO |
$503.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$536.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$583.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$462.99
|
| Rate for Payer: PHCS Commercial |
$644.16
|
| Rate for Payer: United Healthcare All Payer |
$590.48
|
|
|
ARTHROGRAM - LT HIP(T
|
Facility
|
OP
|
$671.00
|
|
|
Service Code
|
HCPCS 73525
|
| Hospital Charge Code |
320T0097
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$230.76 |
| Max. Negotiated Rate |
$644.16 |
| Rate for Payer: Aetna Commercial |
$516.67
|
| Rate for Payer: Anthem Medicaid |
$230.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$329.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$523.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$461.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$445.47
|
| Rate for Payer: Cash Price |
$335.50
|
| Rate for Payer: Cash Price |
$335.50
|
| Rate for Payer: Cigna Commercial |
$556.93
|
| Rate for Payer: First Health Commercial |
$637.45
|
| Rate for Payer: Humana Commercial |
$570.35
|
| Rate for Payer: Humana KY Medicaid |
$230.76
|
| Rate for Payer: Humana Medicare Advantage |
$329.98
|
| Rate for Payer: Kentucky WC Medicaid |
$233.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$550.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$495.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$235.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$590.48
|
| Rate for Payer: Ohio Health Group HMO |
$503.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$536.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$583.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$462.99
|
| Rate for Payer: PHCS Commercial |
$644.16
|
| Rate for Payer: United Healthcare All Payer |
$590.48
|
|
|
ARTHROGRAM - LT KNEE
|
Professional
|
Both
|
$796.00
|
|
|
Service Code
|
HCPCS 73580
|
| Hospital Charge Code |
32000103
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$37.32 |
| Max. Negotiated Rate |
$477.60 |
| Rate for Payer: Aetna Commercial |
$181.89
|
| Rate for Payer: Ambetter Exchange |
$97.16
|
| Rate for Payer: Anthem Medicaid |
$94.71
|
| Rate for Payer: Buckeye Individual/Medicaid |
$97.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$97.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$116.59
|
| Rate for Payer: Cash Price |
$398.00
|
| Rate for Payer: Cash Price |
$398.00
|
| Rate for Payer: Cigna Commercial |
$185.80
|
| Rate for Payer: Healthspan PPO |
$170.43
|
| Rate for Payer: Humana Medicaid |
$94.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$37.32
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$97.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$96.60
|
| Rate for Payer: Molina Healthcare Passport |
$94.71
|
| Rate for Payer: Multiplan PHCS |
$477.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$126.31
|
| Rate for Payer: UHCCP Medicaid |
$278.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$95.66
|
| Rate for Payer: Wellcare Medicare Advantage |
$97.16
|
|
|
ARTHROGRAM - LT KNEE
|
Facility
|
OP
|
$796.00
|
|
|
Service Code
|
HCPCS 73580
|
| Hospital Charge Code |
32000103
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$273.74 |
| Max. Negotiated Rate |
$764.16 |
| Rate for Payer: Aetna Commercial |
$612.92
|
| Rate for Payer: Anthem Medicaid |
$273.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$329.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$620.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$461.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$445.47
|
| Rate for Payer: Cash Price |
$398.00
|
| Rate for Payer: Cash Price |
$398.00
|
| Rate for Payer: Cigna Commercial |
$660.68
|
| Rate for Payer: First Health Commercial |
$756.20
|
| Rate for Payer: Humana Commercial |
$676.60
|
| Rate for Payer: Humana KY Medicaid |
$273.74
|
| Rate for Payer: Humana Medicare Advantage |
$329.98
|
| Rate for Payer: Kentucky WC Medicaid |
$276.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$652.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$587.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$279.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$700.48
|
| Rate for Payer: Ohio Health Group HMO |
$597.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$636.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$692.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$549.24
|
| Rate for Payer: PHCS Commercial |
$764.16
|
| Rate for Payer: United Healthcare All Payer |
$700.48
|
|
|
ARTHROGRAM - LT KNEE
|
Facility
|
IP
|
$796.00
|
|
|
Service Code
|
HCPCS 73580
|
| Hospital Charge Code |
32000103
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$238.80 |
| Max. Negotiated Rate |
$764.16 |
| Rate for Payer: Aetna Commercial |
$612.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$620.88
|
| Rate for Payer: Cash Price |
$398.00
|
| Rate for Payer: Cigna Commercial |
$660.68
|
| Rate for Payer: First Health Commercial |
$756.20
|
| Rate for Payer: Humana Commercial |
$676.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$652.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$587.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$238.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$700.48
|
| Rate for Payer: Ohio Health Group HMO |
$597.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$636.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$692.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$549.24
|
| Rate for Payer: PHCS Commercial |
$764.16
|
| Rate for Payer: United Healthcare All Payer |
$700.48
|
|
|
ARTHROGRAM - LT KNEE(P
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 73580
|
| Hospital Charge Code |
320P0103
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$37.32 |
| Max. Negotiated Rate |
$185.80 |
| Rate for Payer: Aetna Commercial |
$181.89
|
| Rate for Payer: Ambetter Exchange |
$97.16
|
| Rate for Payer: Anthem Medicaid |
$94.71
|
| Rate for Payer: Buckeye Individual/Medicaid |
$97.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$97.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$116.59
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$185.80
|
| Rate for Payer: Healthspan PPO |
$170.43
|
| Rate for Payer: Humana Medicaid |
$94.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$37.32
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$97.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$96.60
|
| Rate for Payer: Molina Healthcare Passport |
$94.71
|
| Rate for Payer: Multiplan PHCS |
$75.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$126.31
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$95.66
|
| Rate for Payer: Wellcare Medicare Advantage |
$97.16
|
|
|
ARTHROGRAM - LT KNEE(T
|
Facility
|
IP
|
$671.00
|
|
|
Service Code
|
HCPCS 73580
|
| Hospital Charge Code |
320T0103
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$201.30 |
| Max. Negotiated Rate |
$644.16 |
| Rate for Payer: Aetna Commercial |
$516.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$523.38
|
| Rate for Payer: Cash Price |
$335.50
|
| Rate for Payer: Cigna Commercial |
$556.93
|
| Rate for Payer: First Health Commercial |
$637.45
|
| Rate for Payer: Humana Commercial |
$570.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$550.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$495.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$201.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$590.48
|
| Rate for Payer: Ohio Health Group HMO |
$503.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$536.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$583.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$462.99
|
| Rate for Payer: PHCS Commercial |
$644.16
|
| Rate for Payer: United Healthcare All Payer |
$590.48
|
|
|
ARTHROGRAM - LT KNEE(T
|
Facility
|
OP
|
$671.00
|
|
|
Service Code
|
HCPCS 73580
|
| Hospital Charge Code |
320T0103
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$230.76 |
| Max. Negotiated Rate |
$644.16 |
| Rate for Payer: Aetna Commercial |
$516.67
|
| Rate for Payer: Anthem Medicaid |
$230.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$329.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$523.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$461.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$445.47
|
| Rate for Payer: Cash Price |
$335.50
|
| Rate for Payer: Cash Price |
$335.50
|
| Rate for Payer: Cigna Commercial |
$556.93
|
| Rate for Payer: First Health Commercial |
$637.45
|
| Rate for Payer: Humana Commercial |
$570.35
|
| Rate for Payer: Humana KY Medicaid |
$230.76
|
| Rate for Payer: Humana Medicare Advantage |
$329.98
|
| Rate for Payer: Kentucky WC Medicaid |
$233.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$550.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$495.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$235.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$590.48
|
| Rate for Payer: Ohio Health Group HMO |
$503.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$536.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$583.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$462.99
|
| Rate for Payer: PHCS Commercial |
$644.16
|
| Rate for Payer: United Healthcare All Payer |
$590.48
|
|
