Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

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	$2,700.00
Rate for Payer: Aetna Commercial	$1,245.53
Rate for Payer: Anthem Medicaid	$706.12
Rate for Payer: Buckeye Medicare Advantage	$2,700.00
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: 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	$1,890.00
Rate for Payer: UHCCP Medicaid	$945.00
Rate for Payer: Wellcare CHIP/Medicaid	$713.18

ARTHRO PATELLA WITH PROSTHESIS

Facility

$2,700.00

Service Code	HCPCS 27438
Hospital Charge Code	76100844
Hospital Revenue Code	761
Min. Negotiated Rate	$351.00
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	$540.00
Rate for Payer: Ohio Health Group PPO No Differential	$351.00
Rate for Payer: Ohio Health Group PPO SOMC Employees	$837.00
Rate for Payer: PHCS Commercial	$2,592.00
Rate for Payer: United Healthcare All Payer	$2,376.00

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	$2,700.00
Rate for Payer: Aetna Commercial	$1,245.53
Rate for Payer: Anthem Medicaid	$706.12
Rate for Payer: Buckeye Medicare Advantage	$2,700.00
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: 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	$1,890.00
Rate for Payer: UHCCP Medicaid	$945.00
Rate for Payer: Wellcare CHIP/Medicaid	$713.18

ARTHROPLASTY, ACETABULAR AND PROXIMAL FEMORAL PROSTHETIC REPLACEMENT (TOTAL HIP ARTHROPLASTY), WITH OR WITHOUT AUTOGRAFT OR ALLOGRAFT

Facility

$15,933.60

Service Code	CPT 27130
Hospital Revenue Code	360
Min. Negotiated Rate	$11,381.14
Max. Negotiated Rate	$15,933.60
Rate for Payer: Anthem Medicare Advantage/PPO	$11,381.14
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$15,933.60
Rate for Payer: CareSource Just4Me Medicare	$15,364.54
Rate for Payer: Humana Medicare Advantage	$11,381.14
Rate for Payer: Molina Healthcare Benefit Exchange	$13,657.37

ARTHROPLASTY, GLENOHUMERAL JOINT; TOTAL SHOULDER (GLENOID AND PROXIMAL HUMERAL REPLACEMENT (EG, TOTAL SHOULDER))

Facility

$22,561.84

Service Code	CPT 23472
Hospital Revenue Code	360
Min. Negotiated Rate	$16,115.60
Max. Negotiated Rate	$22,561.84
Rate for Payer: Anthem Medicare Advantage/PPO	$16,115.60
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$22,561.84
Rate for Payer: CareSource Just4Me Medicare	$21,756.06
Rate for Payer: Humana Medicare Advantage	$16,115.60
Rate for Payer: Molina Healthcare Benefit Exchange	$19,338.72

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	$635.00
Rate for Payer: Aetna Commercial	$574.34
Rate for Payer: Anthem Medicaid	$289.16
Rate for Payer: Buckeye Medicare Advantage	$635.00
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: 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	$444.50
Rate for Payer: UHCCP Medicaid	$222.25
Rate for Payer: Wellcare CHIP/Medicaid	$292.05

ARTHROPLASTY, INTERPOSITION, INTERCARPAL OR CARPOMETACARPAL JOINTS

Facility

$3,918.70

Service Code	CPT 25447
Hospital Revenue Code	360
Min. Negotiated Rate	$2,799.07
Max. Negotiated Rate	$3,918.70
Rate for Payer: Anthem Medicare Advantage/PPO	$2,799.07
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$3,918.70
Rate for Payer: CareSource Just4Me Medicare	$3,778.74
Rate for Payer: Humana Medicare Advantage	$2,799.07
Rate for Payer: Molina Healthcare Benefit Exchange	$3,358.88

ARTHROPLASTY, KNEE, CONDYLE AND PLATEAU; MEDIAL AND LATERAL COMPARTMENTS WITH OR WITHOUT PATELLA RESURFACING (TOTAL KNEE ARTHROPLASTY)

Facility

$15,933.60

Service Code	CPT 27447
Hospital Revenue Code	360
Min. Negotiated Rate	$11,381.14
Max. Negotiated Rate	$15,933.60
Rate for Payer: Anthem Medicare Advantage/PPO	$11,381.14
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$15,933.60
Rate for Payer: CareSource Just4Me Medicare	$15,364.54
Rate for Payer: Humana Medicare Advantage	$11,381.14
Rate for Payer: Molina Healthcare Benefit Exchange	$13,657.37

ARTHROPLASTY, KNEE, CONDYLE AND PLATEAU; MEDIAL OR LATERAL COMPARTMENT

Facility

$15,933.60

Service Code	CPT 27446
Hospital Revenue Code	360
Min. Negotiated Rate	$11,381.14
Max. Negotiated Rate	$15,933.60
Rate for Payer: Anthem Medicare Advantage/PPO	$11,381.14
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$15,933.60
Rate for Payer: CareSource Just4Me Medicare	$15,364.54
Rate for Payer: Humana Medicare Advantage	$11,381.14
Rate for Payer: Molina Healthcare Benefit Exchange	$13,657.37

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	$2,850.00
Rate for Payer: Aetna Commercial	$1,139.61
Rate for Payer: Anthem Medicaid	$646.80
Rate for Payer: Buckeye Medicare Advantage	$2,850.00
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: 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	$1,995.00
Rate for Payer: UHCCP Medicaid	$997.50
Rate for Payer: Wellcare CHIP/Medicaid	$653.27

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	$2,850.00
Rate for Payer: Aetna Commercial	$1,139.61
Rate for Payer: Anthem Medicaid	$646.80
Rate for Payer: Buckeye Medicare Advantage	$2,850.00
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: 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	$1,995.00
Rate for Payer: UHCCP Medicaid	$997.50
Rate for Payer: Wellcare CHIP/Medicaid	$653.27

ARTHROPLASTY KNEE TIB PLATEAU

Facility

$2,850.00

Service Code	HCPCS 27440
Hospital Charge Code	76100845
Hospital Revenue Code	761
Min. Negotiated Rate	$370.50
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	$570.00
Rate for Payer: Ohio Health Group PPO No Differential	$370.50
Rate for Payer: Ohio Health Group PPO SOMC Employees	$883.50
Rate for Payer: PHCS Commercial	$2,736.00
Rate for Payer: United Healthcare All Payer	$2,508.00

ARTHROPLASTY KNEE TIB PLATEAU

Facility

$2,850.00

Service Code	HCPCS 27440
Hospital Charge Code	76100845
Hospital Revenue Code	761
Min. Negotiated Rate	$370.50
Max. Negotiated Rate	$15,933.60
Rate for Payer: Aetna Commercial	$2,194.50
Rate for Payer: Anthem Medicaid	$980.12
Rate for Payer: Anthem Medicare Advantage/PPO	$11,381.14
Rate for Payer: Anthem POS/PPO/Traditional	$2,223.00
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$15,933.60
Rate for Payer: CareSource Just4Me Medicare	$15,364.54
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	$11,381.14
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	$13,657.37
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	$570.00
Rate for Payer: Ohio Health Group PPO No Differential	$370.50
Rate for Payer: Ohio Health Group PPO SOMC Employees	$883.50
Rate for Payer: PHCS Commercial	$2,736.00
Rate for Payer: United Healthcare All Payer	$2,508.00

ARTHROPLASTY, PATELLA; WITH PROSTHESIS

Facility

$15,933.60

Service Code	CPT 27438
Hospital Revenue Code	360
Min. Negotiated Rate	$11,381.14
Max. Negotiated Rate	$15,933.60
Rate for Payer: Anthem Medicare Advantage/PPO	$11,381.14
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$15,933.60
Rate for Payer: CareSource Just4Me Medicare	$15,364.54
Rate for Payer: Humana Medicare Advantage	$11,381.14
Rate for Payer: Molina Healthcare Benefit Exchange	$13,657.37

ARTHROPLASTY, RADIAL HEAD

Facility

$840.00

Service Code	HCPCS 24365
Hospital Charge Code	76100526
Hospital Revenue Code	761
Min. Negotiated Rate	$109.20
Max. Negotiated Rate	$15,933.60
Rate for Payer: Aetna Commercial	$646.80
Rate for Payer: Anthem Medicaid	$288.88
Rate for Payer: Anthem Medicare Advantage/PPO	$11,381.14
Rate for Payer: Anthem POS/PPO/Traditional	$655.20
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$15,933.60
Rate for Payer: CareSource Just4Me Medicare	$15,364.54
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	$11,381.14
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	$13,657.37
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	$168.00
Rate for Payer: Ohio Health Group PPO No Differential	$109.20
Rate for Payer: Ohio Health Group PPO SOMC Employees	$260.40
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: Anthem Medicaid	$463.31
Rate for Payer: Buckeye Medicare Advantage	$840.00
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: 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	$588.00
Rate for Payer: UHCCP Medicaid	$294.00
Rate for Payer: Wellcare CHIP/Medicaid	$467.94

ARTHROPLASTY, RADIAL HEAD

Facility

$840.00

Service Code	HCPCS 24365
Hospital Charge Code	76100526
Hospital Revenue Code	761
Min. Negotiated Rate	$109.20
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	$168.00
Rate for Payer: Ohio Health Group PPO No Differential	$109.20
Rate for Payer: Ohio Health Group PPO SOMC Employees	$260.40
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: Anthem Medicaid	$463.31
Rate for Payer: Buckeye Medicare Advantage	$840.00
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: 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	$588.00
Rate for Payer: UHCCP Medicaid	$294.00
Rate for Payer: Wellcare CHIP/Medicaid	$467.94

ARTHROPLASTY, RADIAL HEAD; WITH IMPLANT

Facility

$15,933.60

Service Code	CPT 24366
Hospital Revenue Code	360
Min. Negotiated Rate	$11,381.14
Max. Negotiated Rate	$15,933.60
Rate for Payer: Anthem Medicare Advantage/PPO	$11,381.14
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$15,933.60
Rate for Payer: CareSource Just4Me Medicare	$15,364.54
Rate for Payer: Humana Medicare Advantage	$11,381.14
Rate for Payer: Molina Healthcare Benefit Exchange	$13,657.37

ARTHROPLASTY WITH PROSTHETIC REPLACEMENT; TRAPEZIUM

Facility

$8,661.10

Service Code	CPT 25445
Hospital Revenue Code	360
Min. Negotiated Rate	$6,186.50
Max. Negotiated Rate	$8,661.10
Rate for Payer: Anthem Medicare Advantage/PPO	$6,186.50
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$8,661.10
Rate for Payer: CareSource Just4Me Medicare	$8,351.78
Rate for Payer: Humana Medicare Advantage	$6,186.50
Rate for Payer: Molina Healthcare Benefit Exchange	$7,423.80

ARTHROSCOPICALLY AIDED ANTERIOR CRUCIATE LIGAMENT REPAIR/AUGMENTATION OR RECONSTRUCTION

Facility

$8,661.10

Service Code	CPT 29888
Hospital Revenue Code	360
Min. Negotiated Rate	$6,186.50
Max. Negotiated Rate	$8,661.10
Rate for Payer: Anthem Medicare Advantage/PPO	$6,186.50
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$8,661.10
Rate for Payer: CareSource Just4Me Medicare	$8,351.78
Rate for Payer: Humana Medicare Advantage	$6,186.50
Rate for Payer: Molina Healthcare Benefit Exchange	$7,423.80

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

$1,945.78

Service Code	CPT 29851
Hospital Revenue Code	360
Min. Negotiated Rate	$1,389.84
Max. Negotiated Rate	$1,945.78
Rate for Payer: Anthem Medicare Advantage/PPO	$1,389.84
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$1,945.78
Rate for Payer: CareSource Just4Me Medicare	$1,876.28
Rate for Payer: Humana Medicare Advantage	$1,389.84
Rate for Payer: Molina Healthcare Benefit Exchange	$1,667.81

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: Anthem Medicaid	$787.23
Rate for Payer: Buckeye Medicare Advantage	$1,570.00
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: 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	$1,099.00
Rate for Payer: UHCCP Medicaid	$549.50
Rate for Payer: Wellcare CHIP/Medicaid	$795.10

ARTHROSCOP ROTATOR CUFF REPR

Facility

$1,570.00

Service Code	HCPCS 29827
Hospital Charge Code	76101085
Hospital Revenue Code	761
Min. Negotiated Rate	$204.10
Max. Negotiated Rate	$8,661.10
Rate for Payer: Aetna Commercial	$1,208.90
Rate for Payer: Anthem Medicaid	$539.92
Rate for Payer: Anthem Medicare Advantage/PPO	$6,186.50
Rate for Payer: Anthem POS/PPO/Traditional	$1,224.60
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$8,661.10
Rate for Payer: CareSource Just4Me Medicare	$8,351.78
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	$6,186.50
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	$7,423.80
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	$314.00
Rate for Payer: Ohio Health Group PPO No Differential	$204.10
Rate for Payer: Ohio Health Group PPO SOMC Employees	$486.70
Rate for Payer: PHCS Commercial	$1,507.20
Rate for Payer: United Healthcare All Payer	$1,381.60

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: Anthem Medicaid	$787.23
Rate for Payer: Buckeye Medicare Advantage	$1,570.00
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: 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	$1,099.00
Rate for Payer: UHCCP Medicaid	$549.50
Rate for Payer: Wellcare CHIP/Medicaid	$795.10

Know your out-of-pocket cost for care.

All Charges