|
ARTHROSCOPY OF JOINT(P
|
Professional
|
Both
|
$2,300.00
|
|
|
Service Code
|
HCPCS 29999
|
| Hospital Charge Code |
761P1116
|
|
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 SHLDR AHESIOLYSI(P
|
Professional
|
Both
|
$1,604.00
|
|
|
Service Code
|
HCPCS 29825
|
| Hospital Charge Code |
761P1083
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$516.49 |
| Max. Negotiated Rate |
$1,604.00 |
| Rate for Payer: Aetna Commercial |
$860.57
|
| Rate for Payer: Anthem Medicaid |
$516.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,604.00
|
| Rate for Payer: Cash Price |
$802.00
|
| Rate for Payer: Cash Price |
$802.00
|
| Rate for Payer: Cigna Commercial |
$950.31
|
| Rate for Payer: Healthspan PPO |
$779.49
|
| Rate for Payer: Humana Medicaid |
$516.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$724.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$526.82
|
| Rate for Payer: Molina Healthcare Passport |
$516.49
|
| Rate for Payer: Multiplan PHCS |
$962.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,122.80
|
| Rate for Payer: UHCCP Medicaid |
$561.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$521.65
|
|
|
ARTHROSCOPY SHLDR AHESIOLYSIS
|
Facility
|
IP
|
$1,604.00
|
|
|
Service Code
|
HCPCS 29825
|
| Hospital Charge Code |
76101083
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.52 |
| Max. Negotiated Rate |
$1,539.84 |
| Rate for Payer: Aetna Commercial |
$1,235.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,251.12
|
| Rate for Payer: Cash Price |
$802.00
|
| Rate for Payer: Cigna Commercial |
$1,331.32
|
| Rate for Payer: First Health Commercial |
$1,523.80
|
| Rate for Payer: Humana Commercial |
$1,363.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,315.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,183.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$481.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,411.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,203.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$320.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$208.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$497.24
|
| Rate for Payer: PHCS Commercial |
$1,539.84
|
| Rate for Payer: United Healthcare All Payer |
$1,411.52
|
|
|
ARTHROSCOPY SHLDR AHESIOLYSIS
|
Facility
|
OP
|
$1,604.00
|
|
|
Service Code
|
HCPCS 29825
|
| Hospital Charge Code |
76101083
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.52 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$1,235.08
|
| Rate for Payer: Anthem Medicaid |
$551.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,251.12
|
| 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 |
$802.00
|
| Rate for Payer: Cash Price |
$802.00
|
| Rate for Payer: Cigna Commercial |
$1,331.32
|
| Rate for Payer: First Health Commercial |
$1,523.80
|
| Rate for Payer: Humana Commercial |
$1,363.40
|
| Rate for Payer: Humana KY Medicaid |
$551.62
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$557.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,315.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,183.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$562.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,411.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,203.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$320.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$208.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$497.24
|
| Rate for Payer: PHCS Commercial |
$1,539.84
|
| Rate for Payer: United Healthcare All Payer |
$1,411.52
|
|
|
ARTHROSCOPY SHLDR AHESIOLYSIS
|
Professional
|
Both
|
$1,604.00
|
|
|
Service Code
|
HCPCS 29825
|
| Hospital Charge Code |
76101083
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$516.49 |
| Max. Negotiated Rate |
$1,604.00 |
| Rate for Payer: Aetna Commercial |
$860.57
|
| Rate for Payer: Anthem Medicaid |
$516.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,604.00
|
| Rate for Payer: Cash Price |
$802.00
|
| Rate for Payer: Cash Price |
$802.00
|
| Rate for Payer: Cigna Commercial |
$950.31
|
| Rate for Payer: Healthspan PPO |
$779.49
|
| Rate for Payer: Humana Medicaid |
$516.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$724.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$526.82
|
| Rate for Payer: Molina Healthcare Passport |
$516.49
|
| Rate for Payer: Multiplan PHCS |
$962.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,122.80
|
| Rate for Payer: UHCCP Medicaid |
$561.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$521.65
|
|
|
ARTHROSCOPY SHLDR RMV LOOSE/FB
|
Professional
|
Both
|
$1,640.00
|
|
|
Service Code
|
HCPCS 29819
|
| Hospital Charge Code |
76101077
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$508.71 |
| Max. Negotiated Rate |
$1,640.00 |
| Rate for Payer: Aetna Commercial |
$861.64
|
| Rate for Payer: Anthem Medicaid |
$508.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,640.00
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Cigna Commercial |
$951.56
|
| Rate for Payer: Healthspan PPO |
$780.46
|
| Rate for Payer: Humana Medicaid |
$508.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$726.57
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$518.88
|
| Rate for Payer: Molina Healthcare Passport |
$508.71
|
| Rate for Payer: Multiplan PHCS |
$984.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,148.00
|
| Rate for Payer: UHCCP Medicaid |
$574.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$513.80
|
|
|
ARTHROSCOPY SHLDR RMV LOOSE/FB
|
Facility
|
OP
|
$1,640.00
|
|
|
Service Code
|
HCPCS 29819
|
| Hospital Charge Code |
76101077
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$213.20 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$1,262.80
|
| Rate for Payer: Anthem Medicaid |
$564.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,279.20
|
| 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 |
$820.00
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Cigna Commercial |
$1,361.20
|
| Rate for Payer: First Health Commercial |
$1,558.00
|
| Rate for Payer: Humana Commercial |
$1,394.00
|
| Rate for Payer: Humana KY Medicaid |
$564.00
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$569.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,344.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,210.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$575.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,443.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,230.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$328.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$213.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$508.40
|
| Rate for Payer: PHCS Commercial |
$1,574.40
|
| Rate for Payer: United Healthcare All Payer |
$1,443.20
|
|
|
ARTHROSCOPY SHLDR RMV LOOSE/FB
|
Facility
|
IP
|
$1,640.00
|
|
|
Service Code
|
HCPCS 29819
|
| Hospital Charge Code |
76101077
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$213.20 |
| Max. Negotiated Rate |
$1,574.40 |
| Rate for Payer: Aetna Commercial |
$1,262.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,279.20
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Cigna Commercial |
$1,361.20
|
| Rate for Payer: First Health Commercial |
$1,558.00
|
| Rate for Payer: Humana Commercial |
$1,394.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,344.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,210.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$492.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,443.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,230.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$328.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$213.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$508.40
|
| Rate for Payer: PHCS Commercial |
$1,574.40
|
| Rate for Payer: United Healthcare All Payer |
$1,443.20
|
|
|
ARTHROSCOPY SHLDR RMV LOOSE/FB
|
Professional
|
Both
|
$1,640.00
|
|
|
Service Code
|
HCPCS 29819
|
| Hospital Charge Code |
761P1077
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$508.71 |
| Max. Negotiated Rate |
$1,640.00 |
| Rate for Payer: Aetna Commercial |
$861.64
|
| Rate for Payer: Anthem Medicaid |
$508.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,640.00
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Cigna Commercial |
$951.56
|
| Rate for Payer: Healthspan PPO |
$780.46
|
| Rate for Payer: Humana Medicaid |
$508.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$726.57
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$518.88
|
| Rate for Payer: Molina Healthcare Passport |
$508.71
|
| Rate for Payer: Multiplan PHCS |
$984.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,148.00
|
| Rate for Payer: UHCCP Medicaid |
$574.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$513.80
|
|
|
ARTHROSCOPY, SHOULDER, SURGICAL; BICEPS TENODESIS
|
Facility
|
OP
|
$8,661.10
|
|
|
Service Code
|
CPT 29828
|
|
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
|
|
|
ARTHROSCOPY, SHOULDER, SURGICAL; CAPSULORRHAPHY
|
Facility
|
OP
|
$8,661.10
|
|
|
Service Code
|
CPT 29806
|
|
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
|
|
|
ARTHROSCOPY, SHOULDER, SURGICAL; DEBRIDEMENT, EXTENSIVE, 3 OR MORE DISCRETE STRUCTURES (EG, HUMERAL BONE, HUMERAL ARTICULAR CARTILAGE, GLENOID BONE, GLENOID ARTICULAR CARTILAGE, BICEPS TENDON, BICEPS ANCHOR COMPLEX, LABRUM, ARTICULAR CAPSULE, ARTICULAR SIDE OF THE ROTATOR CUFF, BURSAL SIDE OF THE ROTATOR CUFF, SUBACROMIAL BURSA, FOREIGN BODY[IES])
|
Facility
|
OP
|
$3,918.70
|
|
|
Service Code
|
CPT 29823
|
|
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, SHOULDER, SURGICAL; DEBRIDEMENT, LIMITED, 1 OR 2 DISCRETE STRUCTURES (EG, HUMERAL BONE, HUMERAL ARTICULAR CARTILAGE, GLENOID BONE, GLENOID ARTICULAR CARTILAGE, BICEPS TENDON, BICEPS ANCHOR COMPLEX, LABRUM, ARTICULAR CAPSULE, ARTICULAR SIDE OF THE ROTATOR CUFF, BURSAL SIDE OF THE ROTATOR CUFF, SUBACROMIAL BURSA, FOREIGN BODY[IES])
|
Facility
|
OP
|
$3,918.70
|
|
|
Service Code
|
CPT 29822
|
|
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, SHOULDER, SURGICAL; DISTAL CLAVICULECTOMY INCLUDING DISTAL ARTICULAR SURFACE (MUMFORD PROCEDURE)
|
Facility
|
OP
|
$3,918.70
|
|
|
Service Code
|
CPT 29824
|
|
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, SHOULDER, SURGICAL; REPAIR OF SLAP LESION
|
Facility
|
OP
|
$8,661.10
|
|
|
Service Code
|
CPT 29807
|
|
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
|
|
|
ARTHROSCOPY, SHOULDER, SURGICAL; SYNOVECTOMY, PARTIAL
|
Facility
|
OP
|
$8,661.10
|
|
|
Service Code
|
CPT 29820
|
|
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
|
|
|
ARTHROSCOPY, SHOULDER, SURGICAL; WITH LYSIS AND RESECTION OF ADHESIONS, WITH OR WITHOUT MANIPULATION
|
Facility
|
OP
|
$3,918.70
|
|
|
Service Code
|
CPT 29825
|
|
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, SHOULDER, SURGICAL; WITH REMOVAL OF LOOSE BODY OR FOREIGN BODY
|
Facility
|
OP
|
$3,918.70
|
|
|
Service Code
|
CPT 29819
|
|
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, SHOULDER, SURGICAL; WITH ROTATOR CUFF REPAIR
|
Facility
|
OP
|
$8,661.10
|
|
|
Service Code
|
CPT 29827
|
|
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
|
|
|
ARTHRO SP +/- INJ MAJ JNT W/US
|
Facility
|
IP
|
$507.00
|
|
|
Service Code
|
HCPCS 20611
|
| Hospital Charge Code |
45000094
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$65.91 |
| Max. Negotiated Rate |
$486.72 |
| Rate for Payer: Aetna Commercial |
$390.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$395.46
|
| Rate for Payer: Cash Price |
$253.50
|
| Rate for Payer: Cigna Commercial |
$420.81
|
| Rate for Payer: First Health Commercial |
$481.65
|
| Rate for Payer: Humana Commercial |
$430.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$415.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$374.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$152.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$446.16
|
| Rate for Payer: Ohio Health Group HMO |
$380.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$101.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$157.17
|
| Rate for Payer: PHCS Commercial |
$486.72
|
| Rate for Payer: United Healthcare All Payer |
$446.16
|
|
|
ARTHRO SP +/- INJ MAJ JNT W/US
|
Facility
|
OP
|
$507.00
|
|
|
Service Code
|
HCPCS 20611
|
| Hospital Charge Code |
45000094
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$65.91 |
| Max. Negotiated Rate |
$486.72 |
| Rate for Payer: Aetna Commercial |
$390.39
|
| Rate for Payer: Anthem Medicaid |
$174.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$256.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$395.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$358.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$345.76
|
| Rate for Payer: Cash Price |
$253.50
|
| Rate for Payer: Cash Price |
$253.50
|
| Rate for Payer: Cigna Commercial |
$420.81
|
| Rate for Payer: First Health Commercial |
$481.65
|
| Rate for Payer: Humana Commercial |
$430.95
|
| Rate for Payer: Humana KY Medicaid |
$174.36
|
| Rate for Payer: Humana Medicare Advantage |
$256.12
|
| Rate for Payer: Kentucky WC Medicaid |
$176.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$415.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$374.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$307.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$177.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$446.16
|
| Rate for Payer: Ohio Health Group HMO |
$380.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$101.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$157.17
|
| Rate for Payer: PHCS Commercial |
$486.72
|
| Rate for Payer: United Healthcare All Payer |
$446.16
|
|
|
ARTHROTEC(DICLOFENAC SOD.MISO)
|
Facility
|
OP
|
$10.68
|
|
|
Service Code
|
NDC 68001023106
|
| Hospital Charge Code |
25000258
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$10.25 |
| Rate for Payer: Aetna Commercial |
$8.22
|
| Rate for Payer: Anthem Medicaid |
$3.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.33
|
| Rate for Payer: Cash Price |
$5.34
|
| Rate for Payer: Cigna Commercial |
$8.86
|
| Rate for Payer: First Health Commercial |
$10.15
|
| Rate for Payer: Humana Commercial |
$9.08
|
| Rate for Payer: Humana KY Medicaid |
$3.67
|
| Rate for Payer: Kentucky WC Medicaid |
$3.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.40
|
| Rate for Payer: Ohio Health Group HMO |
$8.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.31
|
| Rate for Payer: PHCS Commercial |
$10.25
|
| Rate for Payer: United Healthcare All Payer |
$9.40
|
|
|
ARTHROTEC(DICLOFENAC SOD.MISO)
|
Facility
|
IP
|
$10.68
|
|
|
Service Code
|
NDC 68001023106
|
| Hospital Charge Code |
25000258
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$10.25 |
| Rate for Payer: Aetna Commercial |
$8.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.33
|
| Rate for Payer: Cash Price |
$5.34
|
| Rate for Payer: Cigna Commercial |
$8.86
|
| Rate for Payer: First Health Commercial |
$10.15
|
| Rate for Payer: Humana Commercial |
$9.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.40
|
| Rate for Payer: Ohio Health Group HMO |
$8.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.31
|
| Rate for Payer: PHCS Commercial |
$10.25
|
| Rate for Payer: United Healthcare All Payer |
$9.40
|
|
|
ARTHROTOMY, ELBOW/SYNOVECTOM(P
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 24102
|
| Hospital Charge Code |
761P0507
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$385.00 |
| Max. Negotiated Rate |
$1,100.00 |
| Rate for Payer: Aetna Commercial |
$895.91
|
| Rate for Payer: Anthem Medicaid |
$525.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,100.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$986.46
|
| Rate for Payer: Healthspan PPO |
$811.51
|
| Rate for Payer: Humana Medicaid |
$525.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$757.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$536.26
|
| Rate for Payer: Molina Healthcare Passport |
$525.75
|
| Rate for Payer: Multiplan PHCS |
$660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$770.00
|
| Rate for Payer: UHCCP Medicaid |
$385.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$531.01
|
|
|
ARTHROTOMY, ELBOW/SYNOVECTOM(T
|
Facility
|
OP
|
$5,593.61
|
|
|
Service Code
|
HCPCS 24102
|
| Hospital Charge Code |
761T0507
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$727.17 |
| Max. Negotiated Rate |
$5,369.87 |
| Rate for Payer: Aetna Commercial |
$4,307.08
|
| Rate for Payer: Anthem Medicaid |
$1,923.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,363.02
|
| 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 |
$2,796.80
|
| Rate for Payer: Cash Price |
$2,796.80
|
| Rate for Payer: Cigna Commercial |
$4,642.70
|
| Rate for Payer: First Health Commercial |
$5,313.93
|
| Rate for Payer: Humana Commercial |
$4,754.57
|
| Rate for Payer: Humana KY Medicaid |
$1,923.64
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,943.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,586.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,128.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,962.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,922.38
|
| Rate for Payer: Ohio Health Group HMO |
$4,195.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,118.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$727.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,734.02
|
| Rate for Payer: PHCS Commercial |
$5,369.87
|
| Rate for Payer: United Healthcare All Payer |
$4,922.38
|
|
