|
ARTHROPLASTY KNEE TIB PLATEAU
|
Professional
|
Both
|
$2,850.00
|
|
|
Service Code
|
HCPCS 27440
|
| Hospital Charge Code |
76100845
|
|
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, PATELLA; WITH PROSTHESIS
|
Facility
|
OP
|
$16,644.15
|
|
|
Service Code
|
CPT 27438
|
|
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, RADIAL HEAD
|
Facility
|
IP
|
$840.00
|
|
|
Service Code
|
HCPCS 24365
|
| Hospital Charge Code |
76100526
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$806.40 |
| Rate for Payer: Aetna Commercial |
$646.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$655.20
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$697.20
|
| Rate for Payer: First Health Commercial |
$798.00
|
| Rate for Payer: Humana Commercial |
$714.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$688.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$619.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$252.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$739.20
|
| Rate for Payer: Ohio Health Group HMO |
$630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$730.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$579.60
|
| Rate for Payer: PHCS Commercial |
$806.40
|
| Rate for Payer: United Healthcare All Payer |
$739.20
|
|
|
ARTHROPLASTY, RADIAL HEAD
|
Professional
|
Both
|
$840.00
|
|
|
Service Code
|
HCPCS 24365
|
| Hospital Charge Code |
76100526
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$294.00 |
| Max. Negotiated Rate |
$1,030.39 |
| Rate for Payer: Aetna Commercial |
$936.30
|
| Rate for Payer: Ambetter Exchange |
$613.49
|
| Rate for Payer: Anthem Medicaid |
$463.31
|
| Rate for Payer: Buckeye Individual/Medicaid |
$613.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$613.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$736.19
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$1,030.39
|
| Rate for Payer: Healthspan PPO |
$848.09
|
| Rate for Payer: Humana Medicaid |
$463.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$791.00
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$613.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$613.49
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$472.58
|
| Rate for Payer: Molina Healthcare Passport |
$463.31
|
| Rate for Payer: Multiplan PHCS |
$504.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$797.54
|
| Rate for Payer: UHCCP Medicaid |
$294.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$467.94
|
| Rate for Payer: Wellcare Medicare Advantage |
$613.49
|
|
|
ARTHROPLASTY, RADIAL HEAD
|
Facility
|
OP
|
$840.00
|
|
|
Service Code
|
HCPCS 24365
|
| Hospital Charge Code |
76100526
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$288.88 |
| Max. Negotiated Rate |
$16,644.15 |
| Rate for Payer: Aetna Commercial |
$646.80
|
| Rate for Payer: Anthem Medicaid |
$288.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,888.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$655.20
|
| 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 |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$697.20
|
| Rate for Payer: First Health Commercial |
$798.00
|
| Rate for Payer: Humana Commercial |
$714.00
|
| Rate for Payer: Humana KY Medicaid |
$288.88
|
| Rate for Payer: Humana Medicare Advantage |
$11,888.68
|
| Rate for Payer: Kentucky WC Medicaid |
$291.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$688.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$619.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14,266.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$294.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$739.20
|
| Rate for Payer: Ohio Health Group HMO |
$630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$730.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$579.60
|
| Rate for Payer: PHCS Commercial |
$806.40
|
| Rate for Payer: United Healthcare All Payer |
$739.20
|
|
|
ARTHROPLASTY, RADIAL HEAD;(P
|
Professional
|
Both
|
$840.00
|
|
|
Service Code
|
HCPCS 24365
|
| Hospital Charge Code |
761P0526
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$294.00 |
| Max. Negotiated Rate |
$1,030.39 |
| Rate for Payer: Aetna Commercial |
$936.30
|
| Rate for Payer: Ambetter Exchange |
$613.49
|
| Rate for Payer: Anthem Medicaid |
$463.31
|
| Rate for Payer: Buckeye Individual/Medicaid |
$613.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$613.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$736.19
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$1,030.39
|
| Rate for Payer: Healthspan PPO |
$848.09
|
| Rate for Payer: Humana Medicaid |
$463.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$791.00
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$613.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$613.49
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$472.58
|
| Rate for Payer: Molina Healthcare Passport |
$463.31
|
| Rate for Payer: Multiplan PHCS |
$504.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$797.54
|
| Rate for Payer: UHCCP Medicaid |
$294.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$467.94
|
| Rate for Payer: Wellcare Medicare Advantage |
$613.49
|
|
|
ARTHROPLASTY, RADIAL HEAD; WITH IMPLANT
|
Facility
|
OP
|
$16,644.15
|
|
|
Service Code
|
CPT 24366
|
|
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 WITH PROSTHETIC REPLACEMENT; TRAPEZIUM
|
Facility
|
OP
|
$9,240.92
|
|
|
Service Code
|
CPT 25445
|
|
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
|
|
|
ARTHROSCOPICALLY AIDED ANTERIOR CRUCIATE LIGAMENT REPAIR/AUGMENTATION OR RECONSTRUCTION
|
Facility
|
OP
|
$9,240.92
|
|
|
Service Code
|
CPT 29888
|
|
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
|
|
|
ARTHROSCOPICALLY AIDED TREATMENT OF INTERCONDYLAR SPINE(S) AND/OR TUBEROSITY FRACTURE(S) OF THE KNEE, WITH OR WITHOUT MANIPULATION; WITH INTERNAL OR EXTERNAL FIXATION (INCLUDES ARTHROSCOPY)
|
Facility
|
OP
|
$2,070.25
|
|
|
Service Code
|
CPT 29851
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,478.75 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
|
|
ARTHROSCOP ROTATOR CUFF REP(P
|
Professional
|
Both
|
$1,570.00
|
|
|
Service Code
|
HCPCS 29827
|
| Hospital Charge Code |
761P1085
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$549.50 |
| Max. Negotiated Rate |
$1,784.39 |
| Rate for Payer: Aetna Commercial |
$1,625.14
|
| Rate for Payer: Ambetter Exchange |
$1,013.65
|
| Rate for Payer: Anthem Medicaid |
$787.23
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,013.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,013.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,216.38
|
| Rate for Payer: Cash Price |
$785.00
|
| Rate for Payer: Cash Price |
$785.00
|
| Rate for Payer: Cigna Commercial |
$1,784.39
|
| Rate for Payer: Healthspan PPO |
$1,472.03
|
| Rate for Payer: Humana Medicaid |
$787.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,350.52
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,013.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,013.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$802.97
|
| Rate for Payer: Molina Healthcare Passport |
$787.23
|
| Rate for Payer: Multiplan PHCS |
$942.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,317.74
|
| Rate for Payer: UHCCP Medicaid |
$549.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$795.10
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,013.65
|
|
|
ARTHROSCOP ROTATOR CUFF REPR
|
Professional
|
Both
|
$1,570.00
|
|
|
Service Code
|
HCPCS 29827
|
| Hospital Charge Code |
76101085
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$549.50 |
| Max. Negotiated Rate |
$1,784.39 |
| Rate for Payer: Aetna Commercial |
$1,625.14
|
| Rate for Payer: Ambetter Exchange |
$1,013.65
|
| Rate for Payer: Anthem Medicaid |
$787.23
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,013.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,013.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,216.38
|
| Rate for Payer: Cash Price |
$785.00
|
| Rate for Payer: Cash Price |
$785.00
|
| Rate for Payer: Cigna Commercial |
$1,784.39
|
| Rate for Payer: Healthspan PPO |
$1,472.03
|
| Rate for Payer: Humana Medicaid |
$787.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,350.52
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,013.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,013.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$802.97
|
| Rate for Payer: Molina Healthcare Passport |
$787.23
|
| Rate for Payer: Multiplan PHCS |
$942.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,317.74
|
| Rate for Payer: UHCCP Medicaid |
$549.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$795.10
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,013.65
|
|
|
ARTHROSCOP ROTATOR CUFF REPR
|
Facility
|
IP
|
$1,570.00
|
|
|
Service Code
|
HCPCS 29827
|
| Hospital Charge Code |
76101085
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$471.00 |
| Max. Negotiated Rate |
$1,507.20 |
| Rate for Payer: Aetna Commercial |
$1,208.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,224.60
|
| Rate for Payer: Cash Price |
$785.00
|
| Rate for Payer: Cigna Commercial |
$1,303.10
|
| Rate for Payer: First Health Commercial |
$1,491.50
|
| Rate for Payer: Humana Commercial |
$1,334.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,287.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,158.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$471.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,381.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,177.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,256.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,365.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,083.30
|
| Rate for Payer: PHCS Commercial |
$1,507.20
|
| Rate for Payer: United Healthcare All Payer |
$1,381.60
|
|
|
ARTHROSCOP ROTATOR CUFF REPR
|
Facility
|
OP
|
$1,570.00
|
|
|
Service Code
|
HCPCS 29827
|
| Hospital Charge Code |
76101085
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$539.92 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,208.90
|
| Rate for Payer: Anthem Medicaid |
$539.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,224.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| Rate for Payer: Cash Price |
$785.00
|
| Rate for Payer: Cash Price |
$785.00
|
| Rate for Payer: Cigna Commercial |
$1,303.10
|
| Rate for Payer: First Health Commercial |
$1,491.50
|
| Rate for Payer: Humana Commercial |
$1,334.50
|
| Rate for Payer: Humana KY Medicaid |
$539.92
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$545.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,287.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,158.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$550.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,381.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,177.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,256.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,365.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,083.30
|
| Rate for Payer: PHCS Commercial |
$1,507.20
|
| Rate for Payer: United Healthcare All Payer |
$1,381.60
|
|
|
ARTHROSCOPY, ANKLE, SURGICAL, EXCISION OF OSTEOCHONDRAL DEFECT OF TALUS AND/OR TIBIA, INCLUDING DRILLING OF THE DEFECT
|
Facility
|
OP
|
$4,197.13
|
|
|
Service Code
|
CPT 29891
|
|
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
|
|
|
ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR JOINTS), SURGICAL; DEBRIDEMENT, EXTENSIVE
|
Facility
|
OP
|
$4,197.13
|
|
|
Service Code
|
CPT 29898
|
|
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
|
|
|
ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR JOINTS), SURGICAL; DEBRIDEMENT, LIMITED
|
Facility
|
OP
|
$4,197.13
|
|
|
Service Code
|
CPT 29897
|
|
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
|
|
|
ARTHROSCOPY BICEPS TENODESI(P
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 29828
|
| Hospital Charge Code |
761P1086
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$1,413.13 |
| Rate for Payer: Aetna Commercial |
$1,357.72
|
| Rate for Payer: Ambetter Exchange |
$870.14
|
| Rate for Payer: Anthem Medicaid |
$692.79
|
| Rate for Payer: Buckeye Individual/Medicaid |
$870.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$870.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,044.17
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,413.13
|
| Rate for Payer: Healthspan PPO |
$1,229.80
|
| Rate for Payer: Humana Medicaid |
$692.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,144.92
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$870.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$870.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$706.65
|
| Rate for Payer: Molina Healthcare Passport |
$692.79
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,131.18
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$699.72
|
| Rate for Payer: Wellcare Medicare Advantage |
$870.14
|
|
|
ARTHROSCOPY BICEPS TENODESIS
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 29828
|
| Hospital Charge Code |
76101086
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$450.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,305.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,035.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
ARTHROSCOPY BICEPS TENODESIS
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 29828
|
| Hospital Charge Code |
76101086
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$515.85 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem Medicaid |
$515.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Humana KY Medicaid |
$515.85
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$521.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$526.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,305.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,035.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
ARTHROSCOPY BICEPS TENODESIS
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 29828
|
| Hospital Charge Code |
76101086
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$1,413.13 |
| Rate for Payer: Aetna Commercial |
$1,357.72
|
| Rate for Payer: Ambetter Exchange |
$870.14
|
| Rate for Payer: Anthem Medicaid |
$692.79
|
| Rate for Payer: Buckeye Individual/Medicaid |
$870.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$870.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,044.17
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,413.13
|
| Rate for Payer: Healthspan PPO |
$1,229.80
|
| Rate for Payer: Humana Medicaid |
$692.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,144.92
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$870.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$870.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$706.65
|
| Rate for Payer: Molina Healthcare Passport |
$692.79
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,131.18
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$699.72
|
| Rate for Payer: Wellcare Medicare Advantage |
$870.14
|
|
|
ARTHROSCOPY, KNEE, DIAGNOSTIC, WITH OR WITHOUT SYNOVIAL BIOPSY (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$4,197.13
|
|
|
Service Code
|
CPT 29870
|
|
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
|
|
|
ARTHROSCOPY, KNEE, SURGICAL; ABRASION ARTHROPLASTY (INCLUDES CHONDROPLASTY WHERE NECESSARY) OR MULTIPLE DRILLING OR MICROFRACTURE
|
Facility
|
OP
|
$4,197.13
|
|
|
Service Code
|
CPT 29879
|
|
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
|
|
|
ARTHROSCOPY, KNEE, SURGICAL; DEBRIDEMENT/SHAVING OF ARTICULAR CARTILAGE (CHONDROPLASTY)
|
Facility
|
OP
|
$4,197.13
|
|
|
Service Code
|
CPT 29877
|
|
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
|
|
|
ARTHROSCOPY, KNEE, SURGICAL; FOR INFECTION, LAVAGE AND DRAINAGE
|
Facility
|
OP
|
$4,197.13
|
|
|
Service Code
|
CPT 29871
|
|
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
|
|
