|
ARTHROTOMY/SYNOVECTOMY KNEEA/P
|
Professional
|
Both
|
$2,350.00
|
|
|
Service Code
|
HCPCS 27334
|
| Hospital Charge Code |
761P0817
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$549.34 |
| Max. Negotiated Rate |
$1,410.00 |
| Rate for Payer: Aetna Commercial |
$994.48
|
| Rate for Payer: Ambetter Exchange |
$656.53
|
| Rate for Payer: Anthem Medicaid |
$549.34
|
| Rate for Payer: Buckeye Individual/Medicaid |
$656.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$656.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$787.84
|
| Rate for Payer: Cash Price |
$1,175.00
|
| Rate for Payer: Cash Price |
$1,175.00
|
| Rate for Payer: Cigna Commercial |
$1,089.53
|
| Rate for Payer: Healthspan PPO |
$900.78
|
| Rate for Payer: Humana Medicaid |
$549.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$843.42
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$656.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$656.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$560.33
|
| Rate for Payer: Molina Healthcare Passport |
$549.34
|
| Rate for Payer: Multiplan PHCS |
$1,410.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$853.49
|
| Rate for Payer: UHCCP Medicaid |
$822.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$554.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$656.53
|
|
|
ARTHROTOMY/SYNOVECTOMY KNEEA/P
|
Professional
|
Both
|
$2,350.00
|
|
|
Service Code
|
HCPCS 27334
|
| Hospital Charge Code |
76100817
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$549.34 |
| Max. Negotiated Rate |
$1,410.00 |
| Rate for Payer: Aetna Commercial |
$994.48
|
| Rate for Payer: Ambetter Exchange |
$656.53
|
| Rate for Payer: Anthem Medicaid |
$549.34
|
| Rate for Payer: Buckeye Individual/Medicaid |
$656.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$656.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$787.84
|
| Rate for Payer: Cash Price |
$1,175.00
|
| Rate for Payer: Cash Price |
$1,175.00
|
| Rate for Payer: Cigna Commercial |
$1,089.53
|
| Rate for Payer: Healthspan PPO |
$900.78
|
| Rate for Payer: Humana Medicaid |
$549.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$843.42
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$656.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$656.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$560.33
|
| Rate for Payer: Molina Healthcare Passport |
$549.34
|
| Rate for Payer: Multiplan PHCS |
$1,410.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$853.49
|
| Rate for Payer: UHCCP Medicaid |
$822.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$554.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$656.53
|
|
|
ARTHROTOMY/SYNOVECTOMY KNEEA/P
|
Facility
|
OP
|
$2,350.00
|
|
|
Service Code
|
HCPCS 27334
|
| Hospital Charge Code |
76100817
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$808.16 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$1,809.50
|
| Rate for Payer: Anthem Medicaid |
$808.16
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,833.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$1,175.00
|
| Rate for Payer: Cash Price |
$1,175.00
|
| Rate for Payer: Cigna Commercial |
$1,950.50
|
| Rate for Payer: First Health Commercial |
$2,232.50
|
| Rate for Payer: Humana Commercial |
$1,997.50
|
| Rate for Payer: Humana KY Medicaid |
$808.16
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$816.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,927.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,734.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$824.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,068.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,762.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,044.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,621.50
|
| Rate for Payer: PHCS Commercial |
$2,256.00
|
| Rate for Payer: United Healthcare All Payer |
$2,068.00
|
|
|
ARTHROTOMY/SYNOVECTOMY KNEEA/P
|
Facility
|
IP
|
$2,350.00
|
|
|
Service Code
|
HCPCS 27334
|
| Hospital Charge Code |
76100817
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$705.00 |
| Max. Negotiated Rate |
$2,256.00 |
| Rate for Payer: Aetna Commercial |
$1,809.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,833.00
|
| Rate for Payer: Cash Price |
$1,175.00
|
| Rate for Payer: Cigna Commercial |
$1,950.50
|
| Rate for Payer: First Health Commercial |
$2,232.50
|
| Rate for Payer: Humana Commercial |
$1,997.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,927.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,734.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$705.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,068.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,762.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,044.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,621.50
|
| Rate for Payer: PHCS Commercial |
$2,256.00
|
| Rate for Payer: United Healthcare All Payer |
$2,068.00
|
|
|
ARTHROTOMY W/BIOPSY; HIP JOINT
|
Facility
|
IP
|
$775.00
|
|
|
Service Code
|
HCPCS 27052
|
| Hospital Charge Code |
76100770
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$232.50 |
| Max. Negotiated Rate |
$744.00 |
| Rate for Payer: Aetna Commercial |
$596.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$604.50
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cigna Commercial |
$643.25
|
| Rate for Payer: First Health Commercial |
$736.25
|
| Rate for Payer: Humana Commercial |
$658.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$635.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$571.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$232.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$682.00
|
| Rate for Payer: Ohio Health Group HMO |
$581.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$620.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$674.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$534.75
|
| Rate for Payer: PHCS Commercial |
$744.00
|
| Rate for Payer: United Healthcare All Payer |
$682.00
|
|
|
ARTHROTOMY W/BIOPSY; HIP JOINT
|
Professional
|
Both
|
$775.00
|
|
|
Service Code
|
HCPCS 27052
|
| Hospital Charge Code |
761P0770
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$271.25 |
| Max. Negotiated Rate |
$869.08 |
| Rate for Payer: Aetna Commercial |
$805.39
|
| Rate for Payer: Ambetter Exchange |
$554.54
|
| Rate for Payer: Anthem Medicaid |
$385.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$554.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$554.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$665.45
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cigna Commercial |
$869.08
|
| Rate for Payer: Healthspan PPO |
$729.51
|
| Rate for Payer: Humana Medicaid |
$385.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$701.33
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$554.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$554.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$393.22
|
| Rate for Payer: Molina Healthcare Passport |
$385.51
|
| Rate for Payer: Multiplan PHCS |
$465.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$720.90
|
| Rate for Payer: UHCCP Medicaid |
$271.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$389.37
|
| Rate for Payer: Wellcare Medicare Advantage |
$554.54
|
|
|
ARTHROTOMY W/BIOPSY; HIP JOINT
|
Professional
|
Both
|
$775.00
|
|
|
Service Code
|
HCPCS 27052
|
| Hospital Charge Code |
76100770
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$271.25 |
| Max. Negotiated Rate |
$869.08 |
| Rate for Payer: Aetna Commercial |
$805.39
|
| Rate for Payer: Ambetter Exchange |
$554.54
|
| Rate for Payer: Anthem Medicaid |
$385.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$554.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$554.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$665.45
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cigna Commercial |
$869.08
|
| Rate for Payer: Healthspan PPO |
$729.51
|
| Rate for Payer: Humana Medicaid |
$385.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$701.33
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$554.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$554.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$393.22
|
| Rate for Payer: Molina Healthcare Passport |
$385.51
|
| Rate for Payer: Multiplan PHCS |
$465.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$720.90
|
| Rate for Payer: UHCCP Medicaid |
$271.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$389.37
|
| Rate for Payer: Wellcare Medicare Advantage |
$554.54
|
|
|
ARTHROTOMY W/BIOPSY; HIP JOINT
|
Facility
|
OP
|
$775.00
|
|
|
Service Code
|
HCPCS 27052
|
| Hospital Charge Code |
76100770
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$266.52 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$596.75
|
| Rate for Payer: Anthem Medicaid |
$266.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$604.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cigna Commercial |
$643.25
|
| Rate for Payer: First Health Commercial |
$736.25
|
| Rate for Payer: Humana Commercial |
$658.75
|
| Rate for Payer: Humana KY Medicaid |
$266.52
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$269.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$635.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$571.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$271.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$682.00
|
| Rate for Payer: Ohio Health Group HMO |
$581.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$620.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$674.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$534.75
|
| Rate for Payer: PHCS Commercial |
$744.00
|
| Rate for Payer: United Healthcare All Payer |
$682.00
|
|
|
ARTHROTOMY WITH BIOPSY; INTERPHALANGEAL JOINT, EACH
|
Facility
|
OP
|
$2,070.25
|
|
|
Service Code
|
CPT 26110
|
|
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
|
|
|
ARTHROTOMY, WITH EXPLORATION, DRAINAGE, OR REMOVAL OF LOOSE OR FOREIGN BODY; INTERPHALANGEAL JOINT, EACH
|
Facility
|
OP
|
$2,070.25
|
|
|
Service Code
|
CPT 26080
|
|
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
|
|
|
ARTHROTOMY W/SYNOVECTOMY ANKLE
|
Professional
|
Both
|
$780.00
|
|
|
Service Code
|
HCPCS 27625
|
| Hospital Charge Code |
761P0899
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$273.00 |
| Max. Negotiated Rate |
$974.17 |
| Rate for Payer: Aetna Commercial |
$879.91
|
| Rate for Payer: Ambetter Exchange |
$542.96
|
| Rate for Payer: Anthem Medicaid |
$495.71
|
| Rate for Payer: Buckeye Individual/Medicaid |
$542.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$542.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$651.55
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$974.17
|
| Rate for Payer: Healthspan PPO |
$797.01
|
| Rate for Payer: Humana Medicaid |
$495.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$717.54
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$542.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$542.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$505.62
|
| Rate for Payer: Molina Healthcare Passport |
$495.71
|
| Rate for Payer: Multiplan PHCS |
$468.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$705.85
|
| Rate for Payer: UHCCP Medicaid |
$273.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$500.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$542.96
|
|
|
ARTHROTOMY W/SYNOVECTOMY ANKLE
|
Facility
|
OP
|
$780.00
|
|
|
Service Code
|
HCPCS 27625
|
| Hospital Charge Code |
76100899
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$268.24 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$600.60
|
| Rate for Payer: Anthem Medicaid |
$268.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$608.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$647.40
|
| Rate for Payer: First Health Commercial |
$741.00
|
| Rate for Payer: Humana Commercial |
$663.00
|
| Rate for Payer: Humana KY Medicaid |
$268.24
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$270.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$639.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$575.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$273.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$686.40
|
| Rate for Payer: Ohio Health Group HMO |
$585.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$624.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$678.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$538.20
|
| Rate for Payer: PHCS Commercial |
$748.80
|
| Rate for Payer: United Healthcare All Payer |
$686.40
|
|
|
ARTHROTOMY W/SYNOVECTOMY ANKLE
|
Facility
|
IP
|
$780.00
|
|
|
Service Code
|
HCPCS 27625
|
| Hospital Charge Code |
76100899
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$748.80 |
| Rate for Payer: Aetna Commercial |
$600.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$608.40
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$647.40
|
| Rate for Payer: First Health Commercial |
$741.00
|
| Rate for Payer: Humana Commercial |
$663.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$639.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$575.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$234.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$686.40
|
| Rate for Payer: Ohio Health Group HMO |
$585.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$624.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$678.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$538.20
|
| Rate for Payer: PHCS Commercial |
$748.80
|
| Rate for Payer: United Healthcare All Payer |
$686.40
|
|
|
ARTHROTOMY W/SYNOVECTOMY ANKLE
|
Professional
|
Both
|
$780.00
|
|
|
Service Code
|
HCPCS 27625
|
| Hospital Charge Code |
76100899
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$273.00 |
| Max. Negotiated Rate |
$974.17 |
| Rate for Payer: Aetna Commercial |
$879.91
|
| Rate for Payer: Ambetter Exchange |
$542.96
|
| Rate for Payer: Anthem Medicaid |
$495.71
|
| Rate for Payer: Buckeye Individual/Medicaid |
$542.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$542.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$651.55
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$974.17
|
| Rate for Payer: Healthspan PPO |
$797.01
|
| Rate for Payer: Humana Medicaid |
$495.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$717.54
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$542.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$542.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$505.62
|
| Rate for Payer: Molina Healthcare Passport |
$495.71
|
| Rate for Payer: Multiplan PHCS |
$468.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$705.85
|
| Rate for Payer: UHCCP Medicaid |
$273.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$500.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$542.96
|
|
|
ARTHRPLSTY FEMCNDYLE/TIBPLTUKN
|
Professional
|
Both
|
$2,840.00
|
|
|
Service Code
|
HCPCS 27443
|
| Hospital Charge Code |
761P0847
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$729.37 |
| Max. Negotiated Rate |
$1,704.00 |
| Rate for Payer: Aetna Commercial |
$1,207.85
|
| Rate for Payer: Ambetter Exchange |
$778.73
|
| Rate for Payer: Anthem Medicaid |
$729.37
|
| Rate for Payer: Buckeye Individual/Medicaid |
$778.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$778.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$934.48
|
| Rate for Payer: Cash Price |
$1,420.00
|
| Rate for Payer: Cash Price |
$1,420.00
|
| Rate for Payer: Cigna Commercial |
$1,323.42
|
| Rate for Payer: Healthspan PPO |
$1,094.05
|
| Rate for Payer: Humana Medicaid |
$729.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,014.68
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$778.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$778.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$743.96
|
| Rate for Payer: Molina Healthcare Passport |
$729.37
|
| Rate for Payer: Multiplan PHCS |
$1,704.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,012.35
|
| Rate for Payer: UHCCP Medicaid |
$994.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$736.66
|
| Rate for Payer: Wellcare Medicare Advantage |
$778.73
|
|
|
ARTHRPLSTY FEMCNDYLE/TIBPLTUKN
|
Facility
|
IP
|
$2,840.00
|
|
|
Service Code
|
HCPCS 27443
|
| Hospital Charge Code |
76100847
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$852.00 |
| Max. Negotiated Rate |
$2,726.40 |
| Rate for Payer: Aetna Commercial |
$2,186.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,215.20
|
| Rate for Payer: Cash Price |
$1,420.00
|
| Rate for Payer: Cigna Commercial |
$2,357.20
|
| Rate for Payer: First Health Commercial |
$2,698.00
|
| Rate for Payer: Humana Commercial |
$2,414.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,328.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,095.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$852.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,499.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,130.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,272.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,470.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,959.60
|
| Rate for Payer: PHCS Commercial |
$2,726.40
|
| Rate for Payer: United Healthcare All Payer |
$2,499.20
|
|
|
ARTHRPLSTY FEMCNDYLE/TIBPLTUKN
|
Facility
|
OP
|
$2,840.00
|
|
|
Service Code
|
HCPCS 27443
|
| Hospital Charge Code |
76100847
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$976.68 |
| Max. Negotiated Rate |
$16,644.15 |
| Rate for Payer: Aetna Commercial |
$2,186.80
|
| Rate for Payer: Anthem Medicaid |
$976.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,888.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,215.20
|
| 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 |
$1,420.00
|
| Rate for Payer: Cash Price |
$1,420.00
|
| Rate for Payer: Cigna Commercial |
$2,357.20
|
| Rate for Payer: First Health Commercial |
$2,698.00
|
| Rate for Payer: Humana Commercial |
$2,414.00
|
| Rate for Payer: Humana KY Medicaid |
$976.68
|
| Rate for Payer: Humana Medicare Advantage |
$11,888.68
|
| Rate for Payer: Kentucky WC Medicaid |
$986.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,328.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,095.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14,266.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$996.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,499.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,130.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,272.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,470.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,959.60
|
| Rate for Payer: PHCS Commercial |
$2,726.40
|
| Rate for Payer: United Healthcare All Payer |
$2,499.20
|
|
|
ARTHRPLSTY FEMCNDYLE/TIBPLTUKN
|
Professional
|
Both
|
$2,840.00
|
|
|
Service Code
|
HCPCS 27443
|
| Hospital Charge Code |
76100847
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$729.37 |
| Max. Negotiated Rate |
$1,704.00 |
| Rate for Payer: Aetna Commercial |
$1,207.85
|
| Rate for Payer: Ambetter Exchange |
$778.73
|
| Rate for Payer: Anthem Medicaid |
$729.37
|
| Rate for Payer: Buckeye Individual/Medicaid |
$778.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$778.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$934.48
|
| Rate for Payer: Cash Price |
$1,420.00
|
| Rate for Payer: Cash Price |
$1,420.00
|
| Rate for Payer: Cigna Commercial |
$1,323.42
|
| Rate for Payer: Healthspan PPO |
$1,094.05
|
| Rate for Payer: Humana Medicaid |
$729.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,014.68
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$778.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$778.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$743.96
|
| Rate for Payer: Molina Healthcare Passport |
$729.37
|
| Rate for Payer: Multiplan PHCS |
$1,704.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,012.35
|
| Rate for Payer: UHCCP Medicaid |
$994.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$736.66
|
| Rate for Payer: Wellcare Medicare Advantage |
$778.73
|
|
|
ARTHRP NTRCRPL/CRP/MTCRP SSP
|
Professional
|
Both
|
$2,115.00
|
|
|
Service Code
|
HCPCS 25448
|
| Hospital Charge Code |
76103019
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$738.11 |
| Max. Negotiated Rate |
$1,269.00 |
| Rate for Payer: Ambetter Exchange |
$842.67
|
| Rate for Payer: Anthem Medicaid |
$738.11
|
| Rate for Payer: Buckeye Individual/Medicaid |
$842.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$842.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,011.20
|
| Rate for Payer: Cash Price |
$1,057.50
|
| Rate for Payer: Cash Price |
$1,057.50
|
| Rate for Payer: Humana Medicaid |
$738.11
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$842.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$842.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$752.87
|
| Rate for Payer: Molina Healthcare Passport |
$738.11
|
| Rate for Payer: Multiplan PHCS |
$1,269.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,095.47
|
| Rate for Payer: UHCCP Medicaid |
$740.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$745.49
|
| Rate for Payer: Wellcare Medicare Advantage |
$842.67
|
|
|
ARTHR SHLDR W/COR ALIMNT RLS
|
Professional
|
Both
|
$2,325.00
|
|
|
Service Code
|
HCPCS 29826
|
| Hospital Charge Code |
76101084
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$162.72 |
| Max. Negotiated Rate |
$1,395.00 |
| Rate for Payer: Aetna Commercial |
$989.75
|
| Rate for Payer: Ambetter Exchange |
$162.72
|
| Rate for Payer: Anthem Medicaid |
$610.22
|
| Rate for Payer: Buckeye Individual/Medicaid |
$162.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$162.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$195.26
|
| Rate for Payer: Cash Price |
$1,162.50
|
| Rate for Payer: Cash Price |
$1,162.50
|
| Rate for Payer: Cigna Commercial |
$1,092.02
|
| Rate for Payer: Healthspan PPO |
$896.51
|
| Rate for Payer: Humana Medicaid |
$610.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$829.41
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$162.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$622.42
|
| Rate for Payer: Molina Healthcare Passport |
$610.22
|
| Rate for Payer: Multiplan PHCS |
$1,395.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$211.54
|
| Rate for Payer: UHCCP Medicaid |
$813.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$616.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$162.72
|
|
|
ARTHR SHLDR W/COR ALIMNT RLS
|
Facility
|
IP
|
$2,325.00
|
|
|
Service Code
|
HCPCS 29826
|
| Hospital Charge Code |
76101084
|
|
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
|
|
|
ARTHR SHLDR W/COR ALIMNT RLS
|
Facility
|
OP
|
$2,325.00
|
|
|
Service Code
|
HCPCS 29826
|
| Hospital Charge Code |
76101084
|
|
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 Medicaid |
$799.57
|
| 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: Humana KY Medicaid |
$799.57
|
| 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 |
$697.50
|
| 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
|
|
|
ARTHR SHLDR W/COR ALIMNT RLS(P
|
Professional
|
Both
|
$2,325.00
|
|
|
Service Code
|
HCPCS 29826
|
| Hospital Charge Code |
761P1084
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$162.72 |
| Max. Negotiated Rate |
$1,395.00 |
| Rate for Payer: Aetna Commercial |
$989.75
|
| Rate for Payer: Ambetter Exchange |
$162.72
|
| Rate for Payer: Anthem Medicaid |
$610.22
|
| Rate for Payer: Buckeye Individual/Medicaid |
$162.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$162.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$195.26
|
| Rate for Payer: Cash Price |
$1,162.50
|
| Rate for Payer: Cash Price |
$1,162.50
|
| Rate for Payer: Cigna Commercial |
$1,092.02
|
| Rate for Payer: Healthspan PPO |
$896.51
|
| Rate for Payer: Humana Medicaid |
$610.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$829.41
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$162.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$622.42
|
| Rate for Payer: Molina Healthcare Passport |
$610.22
|
| Rate for Payer: Multiplan PHCS |
$1,395.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$211.54
|
| Rate for Payer: UHCCP Medicaid |
$813.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$616.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$162.72
|
|
|
ARTHRTMY WRIST W/JNT EXPL W/WO
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 25101
|
| Hospital Charge Code |
76100578
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$683.30 |
| Rate for Payer: Aetna Commercial |
$581.79
|
| Rate for Payer: Ambetter Exchange |
$389.67
|
| Rate for Payer: Anthem Medicaid |
$304.28
|
| Rate for Payer: Buckeye Individual/Medicaid |
$389.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$389.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$467.60
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$683.30
|
| Rate for Payer: Healthspan PPO |
$526.97
|
| Rate for Payer: Humana Medicaid |
$304.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$496.60
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$389.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$389.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$310.37
|
| Rate for Payer: Molina Healthcare Passport |
$304.28
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$506.57
|
| Rate for Payer: UHCCP Medicaid |
$210.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$307.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$389.67
|
|
|
ARTHRTMY WRIST W/JNT EXPL W/WO
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
HCPCS 25101
|
| Hospital Charge Code |
76100578
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$180.00 |
| Max. Negotiated Rate |
$576.00 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$468.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$498.00
|
| Rate for Payer: First Health Commercial |
$570.00
|
| Rate for Payer: Humana Commercial |
$510.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$492.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$180.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$528.00
|
| Rate for Payer: Ohio Health Group HMO |
$450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$480.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$522.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$414.00
|
| Rate for Payer: PHCS Commercial |
$576.00
|
| Rate for Payer: United Healthcare All Payer |
$528.00
|
|
