|
ARTHROGRAM - LT SHOULDER
|
Facility
|
OP
|
$771.00
|
|
|
Service Code
|
HCPCS 73040
|
| Hospital Charge Code |
32000076
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$265.15 |
| Max. Negotiated Rate |
$740.16 |
| Rate for Payer: Aetna Commercial |
$593.67
|
| Rate for Payer: Anthem Medicaid |
$265.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$329.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$601.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$461.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$445.47
|
| Rate for Payer: Cash Price |
$385.50
|
| Rate for Payer: Cash Price |
$385.50
|
| Rate for Payer: Cigna Commercial |
$639.93
|
| Rate for Payer: First Health Commercial |
$732.45
|
| Rate for Payer: Humana Commercial |
$655.35
|
| Rate for Payer: Humana KY Medicaid |
$265.15
|
| Rate for Payer: Humana Medicare Advantage |
$329.98
|
| Rate for Payer: Kentucky WC Medicaid |
$267.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$632.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$569.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$270.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$678.48
|
| Rate for Payer: Ohio Health Group HMO |
$578.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$616.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$670.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$531.99
|
| Rate for Payer: PHCS Commercial |
$740.16
|
| Rate for Payer: United Healthcare All Payer |
$678.48
|
|
|
ARTHROGRAM - LT SHOULDER
|
Professional
|
Both
|
$771.00
|
|
|
Service Code
|
HCPCS 73040
|
| Hospital Charge Code |
32000076
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$35.13 |
| Max. Negotiated Rate |
$462.60 |
| Rate for Payer: Aetna Commercial |
$161.55
|
| Rate for Payer: Ambetter Exchange |
$116.05
|
| Rate for Payer: Anthem Medicaid |
$80.33
|
| Rate for Payer: Buckeye Individual/Medicaid |
$116.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$116.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$139.26
|
| Rate for Payer: Cash Price |
$385.50
|
| Rate for Payer: Cash Price |
$385.50
|
| Rate for Payer: Cigna Commercial |
$160.38
|
| Rate for Payer: Healthspan PPO |
$151.38
|
| Rate for Payer: Humana Medicaid |
$80.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$35.13
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$116.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$116.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$81.94
|
| Rate for Payer: Molina Healthcare Passport |
$80.33
|
| Rate for Payer: Multiplan PHCS |
$462.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$150.87
|
| Rate for Payer: UHCCP Medicaid |
$269.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$81.13
|
| Rate for Payer: Wellcare Medicare Advantage |
$116.05
|
|
|
ARTHROGRAM - LT SHOULDER
|
Facility
|
IP
|
$771.00
|
|
|
Service Code
|
HCPCS 73040
|
| Hospital Charge Code |
32000076
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$231.30 |
| Max. Negotiated Rate |
$740.16 |
| Rate for Payer: Aetna Commercial |
$593.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$601.38
|
| Rate for Payer: Cash Price |
$385.50
|
| Rate for Payer: Cigna Commercial |
$639.93
|
| Rate for Payer: First Health Commercial |
$732.45
|
| Rate for Payer: Humana Commercial |
$655.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$632.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$569.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$231.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$678.48
|
| Rate for Payer: Ohio Health Group HMO |
$578.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$616.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$670.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$531.99
|
| Rate for Payer: PHCS Commercial |
$740.16
|
| Rate for Payer: United Healthcare All Payer |
$678.48
|
|
|
ARTHROGRAM - LT SHOULDER(P
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 73040
|
| Hospital Charge Code |
320P0076
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$161.55 |
| Rate for Payer: Aetna Commercial |
$161.55
|
| Rate for Payer: Ambetter Exchange |
$116.05
|
| Rate for Payer: Anthem Medicaid |
$80.33
|
| Rate for Payer: Buckeye Individual/Medicaid |
$116.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$116.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$139.26
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$160.38
|
| Rate for Payer: Healthspan PPO |
$151.38
|
| Rate for Payer: Humana Medicaid |
$80.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$35.13
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$116.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$116.05
|
| 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 |
$150.87
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$81.13
|
| Rate for Payer: Wellcare Medicare Advantage |
$116.05
|
|
|
ARTHROGRAM - LT SHOULDER(T
|
Facility
|
OP
|
$671.00
|
|
|
Service Code
|
HCPCS 73040
|
| Hospital Charge Code |
320T0076
|
|
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 SHOULDER(T
|
Facility
|
IP
|
$671.00
|
|
|
Service Code
|
HCPCS 73040
|
| Hospital Charge Code |
320T0076
|
|
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 - RT WRIST
|
Professional
|
Both
|
$771.00
|
|
|
Service Code
|
HCPCS 73115
|
| Hospital Charge Code |
32000086
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$35.96 |
| Max. Negotiated Rate |
$462.60 |
| Rate for Payer: Aetna Commercial |
$154.25
|
| Rate for Payer: Ambetter Exchange |
$117.56
|
| Rate for Payer: Anthem Medicaid |
$66.19
|
| Rate for Payer: Buckeye Individual/Medicaid |
$117.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$117.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$141.07
|
| Rate for Payer: Cash Price |
$385.50
|
| Rate for Payer: Cash Price |
$385.50
|
| Rate for Payer: Cigna Commercial |
$139.94
|
| Rate for Payer: Healthspan PPO |
$144.54
|
| Rate for Payer: Humana Medicaid |
$66.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$35.96
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$117.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$67.51
|
| Rate for Payer: Molina Healthcare Passport |
$66.19
|
| Rate for Payer: Multiplan PHCS |
$462.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$152.83
|
| Rate for Payer: UHCCP Medicaid |
$269.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$66.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$117.56
|
|
|
ARTHROGRAM - RT WRIST
|
Facility
|
OP
|
$771.00
|
|
|
Service Code
|
HCPCS 73115
|
| Hospital Charge Code |
32000086
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$265.15 |
| Max. Negotiated Rate |
$740.16 |
| Rate for Payer: Aetna Commercial |
$593.67
|
| Rate for Payer: Anthem Medicaid |
$265.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$329.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$601.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$461.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$445.47
|
| Rate for Payer: Cash Price |
$385.50
|
| Rate for Payer: Cash Price |
$385.50
|
| Rate for Payer: Cigna Commercial |
$639.93
|
| Rate for Payer: First Health Commercial |
$732.45
|
| Rate for Payer: Humana Commercial |
$655.35
|
| Rate for Payer: Humana KY Medicaid |
$265.15
|
| Rate for Payer: Humana Medicare Advantage |
$329.98
|
| Rate for Payer: Kentucky WC Medicaid |
$267.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$632.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$569.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$270.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$678.48
|
| Rate for Payer: Ohio Health Group HMO |
$578.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$616.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$670.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$531.99
|
| Rate for Payer: PHCS Commercial |
$740.16
|
| Rate for Payer: United Healthcare All Payer |
$678.48
|
|
|
ARTHROGRAM - RT WRIST
|
Facility
|
IP
|
$771.00
|
|
|
Service Code
|
HCPCS 73115
|
| Hospital Charge Code |
32000086
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$231.30 |
| Max. Negotiated Rate |
$740.16 |
| Rate for Payer: Aetna Commercial |
$593.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$601.38
|
| Rate for Payer: Cash Price |
$385.50
|
| Rate for Payer: Cigna Commercial |
$639.93
|
| Rate for Payer: First Health Commercial |
$732.45
|
| Rate for Payer: Humana Commercial |
$655.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$632.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$569.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$231.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$678.48
|
| Rate for Payer: Ohio Health Group HMO |
$578.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$616.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$670.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$531.99
|
| Rate for Payer: PHCS Commercial |
$740.16
|
| Rate for Payer: United Healthcare All Payer |
$678.48
|
|
|
ARTHROGRAM - RT WRIST(P
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 73115
|
| Hospital Charge Code |
320P0086
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$154.25 |
| Rate for Payer: Aetna Commercial |
$154.25
|
| Rate for Payer: Ambetter Exchange |
$117.56
|
| Rate for Payer: Anthem Medicaid |
$66.19
|
| Rate for Payer: Buckeye Individual/Medicaid |
$117.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$117.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$141.07
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$139.94
|
| Rate for Payer: Healthspan PPO |
$144.54
|
| Rate for Payer: Humana Medicaid |
$66.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$35.96
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$117.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$67.51
|
| Rate for Payer: Molina Healthcare Passport |
$66.19
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$152.83
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$66.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$117.56
|
|
|
ARTHROGRAM - RT WRIST(T
|
Facility
|
OP
|
$671.00
|
|
|
Service Code
|
HCPCS 73115
|
| Hospital Charge Code |
320T0086
|
|
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 - RT WRIST(T
|
Facility
|
IP
|
$671.00
|
|
|
Service Code
|
HCPCS 73115
|
| Hospital Charge Code |
320T0086
|
|
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
|
|
|
ARTHRO PATELLA WITH PROSTHESIS
|
Professional
|
Both
|
$2,700.00
|
|
|
Service Code
|
HCPCS 27438
|
| Hospital Charge Code |
76100844
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$706.12 |
| Max. Negotiated Rate |
$1,620.00 |
| Rate for Payer: Aetna Commercial |
$1,245.53
|
| Rate for Payer: Ambetter Exchange |
$801.86
|
| Rate for Payer: Anthem Medicaid |
$706.12
|
| Rate for Payer: Buckeye Individual/Medicaid |
$801.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$801.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$962.23
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$1,350.35
|
| Rate for Payer: Healthspan PPO |
$1,128.19
|
| Rate for Payer: Humana Medicaid |
$706.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,045.33
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$801.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$801.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$720.24
|
| Rate for Payer: Molina Healthcare Passport |
$706.12
|
| Rate for Payer: Multiplan PHCS |
$1,620.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,042.42
|
| Rate for Payer: UHCCP Medicaid |
$945.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$713.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$801.86
|
|
|
ARTHRO PATELLA WITH PROSTHESIS
|
Professional
|
Both
|
$2,700.00
|
|
|
Service Code
|
HCPCS 27438
|
| Hospital Charge Code |
761P0844
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$706.12 |
| Max. Negotiated Rate |
$1,620.00 |
| Rate for Payer: Aetna Commercial |
$1,245.53
|
| Rate for Payer: Ambetter Exchange |
$801.86
|
| Rate for Payer: Anthem Medicaid |
$706.12
|
| Rate for Payer: Buckeye Individual/Medicaid |
$801.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$801.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$962.23
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$1,350.35
|
| Rate for Payer: Healthspan PPO |
$1,128.19
|
| Rate for Payer: Humana Medicaid |
$706.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,045.33
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$801.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$801.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$720.24
|
| Rate for Payer: Molina Healthcare Passport |
$706.12
|
| Rate for Payer: Multiplan PHCS |
$1,620.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,042.42
|
| Rate for Payer: UHCCP Medicaid |
$945.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$713.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$801.86
|
|
|
ARTHRO PATELLA WITH PROSTHESIS
|
Facility
|
OP
|
$2,700.00
|
|
|
Service Code
|
HCPCS 27438
|
| Hospital Charge Code |
76100844
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$928.53 |
| Max. Negotiated Rate |
$16,644.15 |
| Rate for Payer: Aetna Commercial |
$2,079.00
|
| Rate for Payer: Anthem Medicaid |
$928.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,888.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,106.00
|
| 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 |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$2,241.00
|
| Rate for Payer: First Health Commercial |
$2,565.00
|
| Rate for Payer: Humana Commercial |
$2,295.00
|
| Rate for Payer: Humana KY Medicaid |
$928.53
|
| Rate for Payer: Humana Medicare Advantage |
$11,888.68
|
| Rate for Payer: Kentucky WC Medicaid |
$937.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,214.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,992.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14,266.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$947.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,376.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,025.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,349.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,863.00
|
| Rate for Payer: PHCS Commercial |
$2,592.00
|
| Rate for Payer: United Healthcare All Payer |
$2,376.00
|
|
|
ARTHRO PATELLA WITH PROSTHESIS
|
Facility
|
IP
|
$2,700.00
|
|
|
Service Code
|
HCPCS 27438
|
| Hospital Charge Code |
76100844
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$810.00 |
| Max. Negotiated Rate |
$2,592.00 |
| Rate for Payer: Aetna Commercial |
$2,079.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,106.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$2,241.00
|
| Rate for Payer: First Health Commercial |
$2,565.00
|
| Rate for Payer: Humana Commercial |
$2,295.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,214.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,992.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$810.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,376.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,025.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,349.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,863.00
|
| Rate for Payer: PHCS Commercial |
$2,592.00
|
| Rate for Payer: United Healthcare All Payer |
$2,376.00
|
|
|
ARTHROPLASTY, ACETABULAR AND PROXIMAL FEMORAL PROSTHETIC REPLACEMENT (TOTAL HIP ARTHROPLASTY), WITH OR WITHOUT AUTOGRAFT OR ALLOGRAFT
|
Facility
|
OP
|
$16,644.15
|
|
|
Service Code
|
CPT 27130
|
|
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
|
|
|
ARTHROPLASTY, GLENOHUMERAL JOINT; TOTAL SHOULDER (GLENOID AND PROXIMAL HUMERAL REPLACEMENT (EG, TOTAL SHOULDER))
|
Facility
|
OP
|
$23,788.86
|
|
|
Service Code
|
CPT 23472
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$16,992.04 |
| Max. Negotiated Rate |
$23,788.86 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16,992.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$23,788.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$22,939.25
|
| Rate for Payer: Humana Medicare Advantage |
$16,992.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,390.45
|
|
|
ARTHROPLASTY INTERPHALA JOINT
|
Professional
|
Both
|
$635.00
|
|
|
Service Code
|
HCPCS 26535
|
| Hospital Charge Code |
76102701
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$222.25 |
| Max. Negotiated Rate |
$602.59 |
| Rate for Payer: Aetna Commercial |
$574.34
|
| Rate for Payer: Ambetter Exchange |
$422.85
|
| Rate for Payer: Anthem Medicaid |
$289.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$422.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$422.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$507.42
|
| Rate for Payer: Cash Price |
$317.50
|
| Rate for Payer: Cash Price |
$317.50
|
| Rate for Payer: Cigna Commercial |
$602.59
|
| Rate for Payer: Healthspan PPO |
$520.23
|
| Rate for Payer: Humana Medicaid |
$289.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$497.99
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$422.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$422.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$294.94
|
| Rate for Payer: Molina Healthcare Passport |
$289.16
|
| Rate for Payer: Multiplan PHCS |
$381.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$549.71
|
| Rate for Payer: UHCCP Medicaid |
$222.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$292.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$422.85
|
|
|
ARTHROPLASTY, INTERPOSITION, INTERCARPAL OR CARPOMETACARPAL JOINTS
|
Facility
|
OP
|
$4,197.13
|
|
|
Service Code
|
CPT 25447
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,997.95 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
|
|
ARTHROPLASTY, KNEE, CONDYLE AND PLATEAU; MEDIAL AND LATERAL COMPARTMENTS WITH OR WITHOUT PATELLA RESURFACING (TOTAL KNEE ARTHROPLASTY)
|
Facility
|
OP
|
$16,644.15
|
|
|
Service Code
|
CPT 27447
|
|
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
|
|
|
ARTHROPLASTY, KNEE, CONDYLE AND PLATEAU; MEDIAL OR LATERAL COMPARTMENT
|
Facility
|
OP
|
$16,644.15
|
|
|
Service Code
|
CPT 27446
|
|
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
|
|
|
ARTHROPLASTY KNEE TIB PLATEA(P
|
Professional
|
Both
|
$2,850.00
|
|
|
Service Code
|
HCPCS 27440
|
| Hospital Charge Code |
761P0845
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$646.80 |
| Max. Negotiated Rate |
$1,710.00 |
| Rate for Payer: Aetna Commercial |
$1,139.61
|
| Rate for Payer: Ambetter Exchange |
$761.37
|
| Rate for Payer: Anthem Medicaid |
$646.80
|
| Rate for Payer: Buckeye Individual/Medicaid |
$761.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$761.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$913.64
|
| Rate for Payer: Cash Price |
$1,425.00
|
| Rate for Payer: Cash Price |
$1,425.00
|
| Rate for Payer: Cigna Commercial |
$1,167.43
|
| Rate for Payer: Healthspan PPO |
$1,032.24
|
| Rate for Payer: Humana Medicaid |
$646.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$973.84
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$761.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$761.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$659.74
|
| Rate for Payer: Molina Healthcare Passport |
$646.80
|
| Rate for Payer: Multiplan PHCS |
$1,710.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$989.78
|
| Rate for Payer: UHCCP Medicaid |
$997.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$653.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$761.37
|
|
|
ARTHROPLASTY KNEE TIB PLATEAU
|
Facility
|
IP
|
$2,850.00
|
|
|
Service Code
|
HCPCS 27440
|
| Hospital Charge Code |
76100845
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$855.00 |
| Max. Negotiated Rate |
$2,736.00 |
| Rate for Payer: Aetna Commercial |
$2,194.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,223.00
|
| Rate for Payer: Cash Price |
$1,425.00
|
| Rate for Payer: Cigna Commercial |
$2,365.50
|
| Rate for Payer: First Health Commercial |
$2,707.50
|
| Rate for Payer: Humana Commercial |
$2,422.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,337.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,103.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$855.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,508.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,137.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,479.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,966.50
|
| Rate for Payer: PHCS Commercial |
$2,736.00
|
| Rate for Payer: United Healthcare All Payer |
$2,508.00
|
|
|
ARTHROPLASTY KNEE TIB PLATEAU
|
Facility
|
OP
|
$2,850.00
|
|
|
Service Code
|
HCPCS 27440
|
| Hospital Charge Code |
76100845
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$980.12 |
| Max. Negotiated Rate |
$16,644.15 |
| Rate for Payer: Aetna Commercial |
$2,194.50
|
| Rate for Payer: Anthem Medicaid |
$980.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,888.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,223.00
|
| 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 |
$1,425.00
|
| Rate for Payer: Cash Price |
$1,425.00
|
| Rate for Payer: Cigna Commercial |
$2,365.50
|
| Rate for Payer: First Health Commercial |
$2,707.50
|
| Rate for Payer: Humana Commercial |
$2,422.50
|
| Rate for Payer: Humana KY Medicaid |
$980.12
|
| Rate for Payer: Humana Medicare Advantage |
$11,888.68
|
| Rate for Payer: Kentucky WC Medicaid |
$990.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,337.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,103.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14,266.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$999.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,508.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,137.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,479.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,966.50
|
| Rate for Payer: PHCS Commercial |
$2,736.00
|
| Rate for Payer: United Healthcare All Payer |
$2,508.00
|
|
