Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

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

ARTHROSCOPY

Facility

$15,980.90

Service Code	MSDRG 509
Min. Negotiated Rate	$10,844.18
Max. Negotiated Rate	$15,980.90
Rate for Payer: Anthem Medicaid	$10,844.18
Rate for Payer: Anthem Medicare Advantage/PPO	$11,414.93
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$15,980.90
Rate for Payer: CareSource Just4Me Medicare	$15,410.16
Rate for Payer: Humana KY Medicaid	$10,844.18
Rate for Payer: Humana Medicare Advantage	$11,414.93
Rate for Payer: Kentucky WC Medicaid	$10,952.63
Rate for Payer: Molina Healthcare Benefit Exchange	$13,697.92
Rate for Payer: Molina Healthcare Medicaid	$11,061.07

ARTHROSCOPY, ANKLE, SURGICAL, EXCISION OF OSTEOCHONDRAL DEFECT OF TALUS AND/OR TIBIA, INCLUDING DRILLING OF THE DEFECT

Facility

$3,918.70

Service Code	CPT 29891
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

ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR JOINTS), SURGICAL; DEBRIDEMENT, EXTENSIVE

Facility

$3,918.70

Service Code	CPT 29898
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

ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR JOINTS), SURGICAL; DEBRIDEMENT, LIMITED

Facility

$3,918.70

Service Code	CPT 29897
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

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	$1,500.00
Rate for Payer: Aetna Commercial	$1,357.72
Rate for Payer: Anthem Medicaid	$692.79
Rate for Payer: Buckeye Medicare Advantage	$1,500.00
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: 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	$1,050.00
Rate for Payer: UHCCP Medicaid	$525.00
Rate for Payer: Wellcare CHIP/Medicaid	$699.72

ARTHROSCOPY BICEPS TENODESIS

Facility

$1,500.00

Service Code	HCPCS 29828
Hospital Charge Code	76101086
Hospital Revenue Code	761
Min. Negotiated Rate	$195.00
Max. Negotiated Rate	$8,661.10
Rate for Payer: Aetna Commercial	$1,155.00
Rate for Payer: Anthem Medicaid	$515.85
Rate for Payer: Anthem Medicare Advantage/PPO	$6,186.50
Rate for Payer: Anthem POS/PPO/Traditional	$1,170.00
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	$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	$6,186.50
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	$7,423.80
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	$300.00
Rate for Payer: Ohio Health Group PPO No Differential	$195.00
Rate for Payer: Ohio Health Group PPO SOMC Employees	$465.00
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	$1,500.00
Rate for Payer: Aetna Commercial	$1,357.72
Rate for Payer: Anthem Medicaid	$692.79
Rate for Payer: Buckeye Medicare Advantage	$1,500.00
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: 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	$1,050.00
Rate for Payer: UHCCP Medicaid	$525.00
Rate for Payer: Wellcare CHIP/Medicaid	$699.72

ARTHROSCOPY BICEPS TENODESIS

Facility

$1,500.00

Service Code	HCPCS 29828
Hospital Charge Code	76101086
Hospital Revenue Code	761
Min. Negotiated Rate	$195.00
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	$300.00
Rate for Payer: Ohio Health Group PPO No Differential	$195.00
Rate for Payer: Ohio Health Group PPO SOMC Employees	$465.00
Rate for Payer: PHCS Commercial	$1,440.00
Rate for Payer: United Healthcare All Payer	$1,320.00

ARTHROSCOPY, KNEE, DIAGNOSTIC, WITH OR WITHOUT SYNOVIAL BIOPSY (SEPARATE PROCEDURE)

Facility

$3,918.70

Service Code	CPT 29870
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

ARTHROSCOPY, KNEE, SURGICAL; ABRASION ARTHROPLASTY (INCLUDES CHONDROPLASTY WHERE NECESSARY) OR MULTIPLE DRILLING OR MICROFRACTURE

Facility

$3,918.70

Service Code	CPT 29879
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

ARTHROSCOPY, KNEE, SURGICAL; DEBRIDEMENT/SHAVING OF ARTICULAR CARTILAGE (CHONDROPLASTY)

Facility

$3,918.70

Service Code	CPT 29877
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

ARTHROSCOPY, KNEE, SURGICAL; FOR INFECTION, LAVAGE AND DRAINAGE

Facility

$3,918.70

Service Code	CPT 29871
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

ARTHROSCOPY, KNEE, SURGICAL; SYNOVECTOMY, LIMITED (EG, PLICA OR SHELF RESECTION) (SEPARATE PROCEDURE)

Facility

$3,918.70

Service Code	CPT 29875
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

ARTHROSCOPY, KNEE, SURGICAL; WITH LATERAL RELEASE

Facility

$3,918.70

Service Code	CPT 29873
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

ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCECTOMY (MEDIAL AND LATERAL, INCLUDING ANY MENISCAL SHAVING) INCLUDING DEBRIDEMENT/SHAVING OF ARTICULAR CARTILAGE (CHONDROPLASTY), SAME OR SEPARATE COMPARTMENT(S), WHEN PERFORMED

Facility

$3,918.70

Service Code	CPT 29880
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

ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCECTOMY (MEDIAL OR LATERAL, INCLUDING ANY MENISCAL SHAVING) INCLUDING DEBRIDEMENT/SHAVING OF ARTICULAR CARTILAGE (CHONDROPLASTY), SAME OR SEPARATE COMPARTMENT(S), WHEN PERFORMED

Facility

$3,918.70

Service Code	CPT 29881
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

ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCUS REPAIR (MEDIAL OR LATERAL)

Facility

$3,918.70

Service Code	CPT 29882
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

ARTHROSCOPY KNEE W/LYSIS ADH

Professional

Both

$2,117.00

Service Code	HCPCS 29884
Hospital Charge Code	76101105
Hospital Revenue Code	761
Min. Negotiated Rate	$478.61
Max. Negotiated Rate	$2,117.00
Rate for Payer: Aetna Commercial	$895.85
Rate for Payer: Anthem Medicaid	$478.61
Rate for Payer: Buckeye Medicare Advantage	$2,117.00
Rate for Payer: Cash Price	$1,058.50
Rate for Payer: Cash Price	$1,058.50
Rate for Payer: Cigna Commercial	$976.29
Rate for Payer: Healthspan PPO	$811.45
Rate for Payer: Humana Medicaid	$478.61
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation	$767.63
Rate for Payer: Molina Healthcare CHIP/Medicaid	$488.18
Rate for Payer: Molina Healthcare Passport	$478.61
Rate for Payer: Multiplan PHCS	$1,270.20
Rate for Payer: Ohio Health Choice Preferred Health Choice	$1,481.90
Rate for Payer: UHCCP Medicaid	$740.95
Rate for Payer: Wellcare CHIP/Medicaid	$483.40

ARTHROSCOPY KNEE W/LYSIS ADH

Facility

$2,117.00

Service Code	HCPCS 29884
Hospital Charge Code	76101105
Hospital Revenue Code	761
Min. Negotiated Rate	$275.21
Max. Negotiated Rate	$3,918.70
Rate for Payer: Aetna Commercial	$1,630.09
Rate for Payer: Anthem Medicaid	$728.04
Rate for Payer: Anthem Medicare Advantage/PPO	$2,799.07
Rate for Payer: Anthem POS/PPO/Traditional	$1,651.26
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$3,918.70
Rate for Payer: CareSource Just4Me Medicare	$3,778.74
Rate for Payer: Cash Price	$1,058.50
Rate for Payer: Cash Price	$1,058.50
Rate for Payer: Cigna Commercial	$1,757.11
Rate for Payer: First Health Commercial	$2,011.15
Rate for Payer: Humana Commercial	$1,799.45
Rate for Payer: Humana KY Medicaid	$728.04
Rate for Payer: Humana Medicare Advantage	$2,799.07
Rate for Payer: Kentucky WC Medicaid	$735.45
Rate for Payer: Medical Mutual Of Ohio HMO	$1,735.94
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$1,562.35
Rate for Payer: Molina Healthcare Benefit Exchange	$3,358.88
Rate for Payer: Molina Healthcare Medicaid	$742.64
Rate for Payer: Ohio Health Choice Commercial	$1,862.96
Rate for Payer: Ohio Health Group HMO	$1,587.75
Rate for Payer: Ohio Health Group PPO Differential	$423.40
Rate for Payer: Ohio Health Group PPO No Differential	$275.21
Rate for Payer: Ohio Health Group PPO SOMC Employees	$656.27
Rate for Payer: PHCS Commercial	$2,032.32
Rate for Payer: United Healthcare All Payer	$1,862.96

ARTHROSCOPY KNEE W/LYSIS ADH

Facility

$2,117.00

Service Code	HCPCS 29884
Hospital Charge Code	76101105
Hospital Revenue Code	761
Min. Negotiated Rate	$275.21
Max. Negotiated Rate	$2,032.32
Rate for Payer: Aetna Commercial	$1,630.09
Rate for Payer: Anthem POS/PPO/Traditional	$1,651.26
Rate for Payer: Cash Price	$1,058.50
Rate for Payer: Cigna Commercial	$1,757.11
Rate for Payer: First Health Commercial	$2,011.15
Rate for Payer: Humana Commercial	$1,799.45
Rate for Payer: Medical Mutual Of Ohio HMO	$1,735.94
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$1,562.35
Rate for Payer: Molina Healthcare Benefit Exchange	$635.10
Rate for Payer: Ohio Health Choice Commercial	$1,862.96
Rate for Payer: Ohio Health Group HMO	$1,587.75
Rate for Payer: Ohio Health Group PPO Differential	$423.40
Rate for Payer: Ohio Health Group PPO No Differential	$275.21
Rate for Payer: Ohio Health Group PPO SOMC Employees	$656.27
Rate for Payer: PHCS Commercial	$2,032.32
Rate for Payer: United Healthcare All Payer	$1,862.96

ARTHROSCOPY KNEE W/LYSIS ADH(P

Professional

Both

$2,117.00

Service Code	HCPCS 29884
Hospital Charge Code	761P1105
Hospital Revenue Code	761
Min. Negotiated Rate	$478.61
Max. Negotiated Rate	$2,117.00
Rate for Payer: Aetna Commercial	$895.85
Rate for Payer: Anthem Medicaid	$478.61
Rate for Payer: Buckeye Medicare Advantage	$2,117.00
Rate for Payer: Cash Price	$1,058.50
Rate for Payer: Cash Price	$1,058.50
Rate for Payer: Cigna Commercial	$976.29
Rate for Payer: Healthspan PPO	$811.45
Rate for Payer: Humana Medicaid	$478.61
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation	$767.63
Rate for Payer: Molina Healthcare CHIP/Medicaid	$488.18
Rate for Payer: Molina Healthcare Passport	$478.61
Rate for Payer: Multiplan PHCS	$1,270.20
Rate for Payer: Ohio Health Choice Preferred Health Choice	$1,481.90
Rate for Payer: UHCCP Medicaid	$740.95
Rate for Payer: Wellcare CHIP/Medicaid	$483.40

ARTHROSCOPY OF JOINT

Professional

Both

$2,300.00

Service Code	HCPCS 29999
Hospital Charge Code	76101116
Hospital Revenue Code	761
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$2,300.00
Rate for Payer: Buckeye Medicare Advantage	$2,300.00
Rate for Payer: Cash Price	$1,150.00
Rate for Payer: Cash Price	$1,150.00
Rate for Payer: Healthspan PPO	$0.60
Rate for Payer: Multiplan PHCS	$1,380.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$1,610.00
Rate for Payer: UHCCP Medicaid	$805.00

ARTHROSCOPY OF JOINT

Facility

$2,300.00

Service Code	HCPCS 29999
Hospital Charge Code	76101116
Hospital Revenue Code	761
Min. Negotiated Rate	$299.00
Max. Negotiated Rate	$2,208.00
Rate for Payer: Aetna Commercial	$1,771.00
Rate for Payer: Anthem POS/PPO/Traditional	$1,794.00
Rate for Payer: Cash Price	$1,150.00
Rate for Payer: Cigna Commercial	$1,909.00
Rate for Payer: First Health Commercial	$2,185.00
Rate for Payer: Humana Commercial	$1,955.00
Rate for Payer: Medical Mutual Of Ohio HMO	$1,886.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$1,697.40
Rate for Payer: Molina Healthcare Benefit Exchange	$690.00
Rate for Payer: Ohio Health Choice Commercial	$2,024.00
Rate for Payer: Ohio Health Group HMO	$1,725.00
Rate for Payer: Ohio Health Group PPO Differential	$460.00
Rate for Payer: Ohio Health Group PPO No Differential	$299.00
Rate for Payer: Ohio Health Group PPO SOMC Employees	$713.00
Rate for Payer: PHCS Commercial	$2,208.00
Rate for Payer: United Healthcare All Payer	$2,024.00

ARTHROSCOPY OF JOINT

Facility

$2,300.00

Service Code	HCPCS 29999
Hospital Charge Code	76101116
Hospital Revenue Code	761
Min. Negotiated Rate	$203.93
Max. Negotiated Rate	$2,208.00
Rate for Payer: Aetna Commercial	$1,771.00
Rate for Payer: Anthem Medicaid	$790.97
Rate for Payer: Anthem Medicare Advantage/PPO	$203.93
Rate for Payer: Anthem POS/PPO/Traditional	$1,794.00
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$285.50
Rate for Payer: CareSource Just4Me Medicare	$275.31
Rate for Payer: Cash Price	$1,150.00
Rate for Payer: Cash Price	$1,150.00
Rate for Payer: Cigna Commercial	$1,909.00
Rate for Payer: First Health Commercial	$2,185.00
Rate for Payer: Humana Commercial	$1,955.00
Rate for Payer: Humana KY Medicaid	$790.97
Rate for Payer: Humana Medicare Advantage	$203.93
Rate for Payer: Kentucky WC Medicaid	$799.02
Rate for Payer: Medical Mutual Of Ohio HMO	$1,886.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$1,697.40
Rate for Payer: Molina Healthcare Benefit Exchange	$244.72
Rate for Payer: Molina Healthcare Medicaid	$806.84
Rate for Payer: Ohio Health Choice Commercial	$2,024.00
Rate for Payer: Ohio Health Group HMO	$1,725.00
Rate for Payer: Ohio Health Group PPO Differential	$460.00
Rate for Payer: Ohio Health Group PPO No Differential	$299.00
Rate for Payer: Ohio Health Group PPO SOMC Employees	$713.00
Rate for Payer: PHCS Commercial	$2,208.00
Rate for Payer: United Healthcare All Payer	$2,024.00

Know your out-of-pocket cost for care.

All Charges