|
SHOCKWAVE C2 BALLOON 3*12
|
Facility
|
OP
|
$21,955.00
|
|
|
Service Code
|
HCPCS C1761
|
| Hospital Charge Code |
27000275
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,854.15 |
| Max. Negotiated Rate |
$21,076.80 |
| Rate for Payer: Aetna Commercial |
$16,905.35
|
| Rate for Payer: Anthem Medicaid |
$7,550.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,124.90
|
| Rate for Payer: Cash Price |
$10,977.50
|
| Rate for Payer: Cigna Commercial |
$18,222.65
|
| Rate for Payer: First Health Commercial |
$20,857.25
|
| Rate for Payer: Humana Commercial |
$18,661.75
|
| Rate for Payer: Humana KY Medicaid |
$7,550.32
|
| Rate for Payer: Kentucky WC Medicaid |
$7,627.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,003.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,202.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,586.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,701.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,320.40
|
| Rate for Payer: Ohio Health Group HMO |
$16,466.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,391.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,854.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,806.05
|
| Rate for Payer: PHCS Commercial |
$21,076.80
|
| Rate for Payer: United Healthcare All Payer |
$19,320.40
|
|
|
SHOCKWAVE C2 BALLOON 3*12
|
Facility
|
IP
|
$21,955.00
|
|
|
Service Code
|
HCPCS C1761
|
| Hospital Charge Code |
27000275
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,854.15 |
| Max. Negotiated Rate |
$21,076.80 |
| Rate for Payer: Aetna Commercial |
$16,905.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,124.90
|
| Rate for Payer: Cash Price |
$10,977.50
|
| Rate for Payer: Cigna Commercial |
$18,222.65
|
| Rate for Payer: First Health Commercial |
$20,857.25
|
| Rate for Payer: Humana Commercial |
$18,661.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,003.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,202.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,586.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,320.40
|
| Rate for Payer: Ohio Health Group HMO |
$16,466.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,391.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,854.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,806.05
|
| Rate for Payer: PHCS Commercial |
$21,076.80
|
| Rate for Payer: United Healthcare All Payer |
$19,320.40
|
|
|
SHOCKWAVE C2 BALLOON 3.5*12
|
Facility
|
OP
|
$21,955.00
|
|
|
Service Code
|
HCPCS C1761
|
| Hospital Charge Code |
27000275
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,854.15 |
| Max. Negotiated Rate |
$21,076.80 |
| Rate for Payer: Aetna Commercial |
$16,905.35
|
| Rate for Payer: Anthem Medicaid |
$7,550.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,124.90
|
| Rate for Payer: Cash Price |
$10,977.50
|
| Rate for Payer: Cigna Commercial |
$18,222.65
|
| Rate for Payer: First Health Commercial |
$20,857.25
|
| Rate for Payer: Humana Commercial |
$18,661.75
|
| Rate for Payer: Humana KY Medicaid |
$7,550.32
|
| Rate for Payer: Kentucky WC Medicaid |
$7,627.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,003.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,202.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,586.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,701.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,320.40
|
| Rate for Payer: Ohio Health Group HMO |
$16,466.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,391.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,854.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,806.05
|
| Rate for Payer: PHCS Commercial |
$21,076.80
|
| Rate for Payer: United Healthcare All Payer |
$19,320.40
|
|
|
SHOCKWAVE C2 BALLOON 3.5*12
|
Facility
|
IP
|
$21,955.00
|
|
|
Service Code
|
HCPCS C1761
|
| Hospital Charge Code |
27000275
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,854.15 |
| Max. Negotiated Rate |
$21,076.80 |
| Rate for Payer: Aetna Commercial |
$16,905.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,124.90
|
| Rate for Payer: Cash Price |
$10,977.50
|
| Rate for Payer: Cigna Commercial |
$18,222.65
|
| Rate for Payer: First Health Commercial |
$20,857.25
|
| Rate for Payer: Humana Commercial |
$18,661.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,003.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,202.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,586.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,320.40
|
| Rate for Payer: Ohio Health Group HMO |
$16,466.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,391.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,854.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,806.05
|
| Rate for Payer: PHCS Commercial |
$21,076.80
|
| Rate for Payer: United Healthcare All Payer |
$19,320.40
|
|
|
SHOCKWAVE C2 BALLOON 4*12
|
Facility
|
IP
|
$21,955.00
|
|
|
Service Code
|
HCPCS C1761
|
| Hospital Charge Code |
27000275
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,854.15 |
| Max. Negotiated Rate |
$21,076.80 |
| Rate for Payer: Aetna Commercial |
$16,905.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,124.90
|
| Rate for Payer: Cash Price |
$10,977.50
|
| Rate for Payer: Cigna Commercial |
$18,222.65
|
| Rate for Payer: First Health Commercial |
$20,857.25
|
| Rate for Payer: Humana Commercial |
$18,661.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,003.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,202.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,586.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,320.40
|
| Rate for Payer: Ohio Health Group HMO |
$16,466.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,391.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,854.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,806.05
|
| Rate for Payer: PHCS Commercial |
$21,076.80
|
| Rate for Payer: United Healthcare All Payer |
$19,320.40
|
|
|
SHOCKWAVE C2 BALLOON 4*12
|
Facility
|
OP
|
$21,955.00
|
|
|
Service Code
|
HCPCS C1761
|
| Hospital Charge Code |
27000275
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,854.15 |
| Max. Negotiated Rate |
$21,076.80 |
| Rate for Payer: Aetna Commercial |
$16,905.35
|
| Rate for Payer: Anthem Medicaid |
$7,550.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,124.90
|
| Rate for Payer: Cash Price |
$10,977.50
|
| Rate for Payer: Cigna Commercial |
$18,222.65
|
| Rate for Payer: First Health Commercial |
$20,857.25
|
| Rate for Payer: Humana Commercial |
$18,661.75
|
| Rate for Payer: Humana KY Medicaid |
$7,550.32
|
| Rate for Payer: Kentucky WC Medicaid |
$7,627.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,003.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,202.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,586.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,701.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,320.40
|
| Rate for Payer: Ohio Health Group HMO |
$16,466.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,391.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,854.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,806.05
|
| Rate for Payer: PHCS Commercial |
$21,076.80
|
| Rate for Payer: United Healthcare All Payer |
$19,320.40
|
|
|
SHORTEN RADIUS OR ULNA
|
Facility
|
IP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 25390
|
| Hospital Charge Code |
76100610
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$1,536.00 |
| Rate for Payer: Aetna Commercial |
$1,232.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,248.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,328.00
|
| Rate for Payer: First Health Commercial |
$1,520.00
|
| Rate for Payer: Humana Commercial |
$1,360.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,312.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,180.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$480.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,408.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$208.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$496.00
|
| Rate for Payer: PHCS Commercial |
$1,536.00
|
| Rate for Payer: United Healthcare All Payer |
$1,408.00
|
|
|
SHORTEN RADIUS OR ULNA
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 25390
|
| Hospital Charge Code |
76100610
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$560.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: Aetna Commercial |
$1,216.86
|
| Rate for Payer: Anthem Medicaid |
$562.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,600.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,578.24
|
| Rate for Payer: Healthspan PPO |
$1,102.22
|
| Rate for Payer: Humana Medicaid |
$562.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$990.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$573.29
|
| Rate for Payer: Molina Healthcare Passport |
$562.05
|
| Rate for Payer: Multiplan PHCS |
$960.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,120.00
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$567.67
|
|
|
SHORTEN RADIUS OR ULNA
|
Facility
|
OP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 25390
|
| Hospital Charge Code |
76100610
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$1,232.00
|
| Rate for Payer: Anthem Medicaid |
$550.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,248.00
|
| 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 |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,328.00
|
| Rate for Payer: First Health Commercial |
$1,520.00
|
| Rate for Payer: Humana Commercial |
$1,360.00
|
| Rate for Payer: Humana KY Medicaid |
$550.24
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$555.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,312.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,180.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$561.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,408.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$208.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$496.00
|
| Rate for Payer: PHCS Commercial |
$1,536.00
|
| Rate for Payer: United Healthcare All Payer |
$1,408.00
|
|
|
SHORTEN RADIUS OR ULNA(P
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 25390
|
| Hospital Charge Code |
761P0610
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$560.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: Aetna Commercial |
$1,216.86
|
| Rate for Payer: Anthem Medicaid |
$562.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,600.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,578.24
|
| Rate for Payer: Healthspan PPO |
$1,102.22
|
| Rate for Payer: Humana Medicaid |
$562.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$990.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$573.29
|
| Rate for Payer: Molina Healthcare Passport |
$562.05
|
| Rate for Payer: Multiplan PHCS |
$960.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,120.00
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$567.67
|
|
|
SHOULDER ARTHROSCOPY DX
|
Facility
|
IP
|
$670.00
|
|
|
Service Code
|
HCPCS 29805
|
| Hospital Charge Code |
76101074
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$87.10 |
| Max. Negotiated Rate |
$643.20 |
| Rate for Payer: Aetna Commercial |
$515.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$522.60
|
| Rate for Payer: Cash Price |
$335.00
|
| Rate for Payer: Cigna Commercial |
$556.10
|
| Rate for Payer: First Health Commercial |
$636.50
|
| Rate for Payer: Humana Commercial |
$569.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$549.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$494.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$201.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$589.60
|
| Rate for Payer: Ohio Health Group HMO |
$502.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$134.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$87.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$207.70
|
| Rate for Payer: PHCS Commercial |
$643.20
|
| Rate for Payer: United Healthcare All Payer |
$589.60
|
|
|
SHOULDER ARTHROSCOPY DX
|
Facility
|
OP
|
$670.00
|
|
|
Service Code
|
HCPCS 29805
|
| Hospital Charge Code |
76101074
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$87.10 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$515.90
|
| Rate for Payer: Anthem Medicaid |
$230.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$522.60
|
| 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 |
$335.00
|
| Rate for Payer: Cash Price |
$335.00
|
| Rate for Payer: Cigna Commercial |
$556.10
|
| Rate for Payer: First Health Commercial |
$636.50
|
| Rate for Payer: Humana Commercial |
$569.50
|
| Rate for Payer: Humana KY Medicaid |
$230.41
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$232.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$549.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$494.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$235.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$589.60
|
| Rate for Payer: Ohio Health Group HMO |
$502.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$134.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$87.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$207.70
|
| Rate for Payer: PHCS Commercial |
$643.20
|
| Rate for Payer: United Healthcare All Payer |
$589.60
|
|
|
SHOULDER ARTHROSCOPY DX
|
Professional
|
Both
|
$670.00
|
|
|
Service Code
|
HCPCS 29805
|
| Hospital Charge Code |
76101074
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$234.50 |
| Max. Negotiated Rate |
$760.85 |
| Rate for Payer: Aetna Commercial |
$685.25
|
| Rate for Payer: Anthem Medicaid |
$273.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$670.00
|
| Rate for Payer: Cash Price |
$335.00
|
| Rate for Payer: Cash Price |
$335.00
|
| Rate for Payer: Cigna Commercial |
$760.85
|
| Rate for Payer: Healthspan PPO |
$620.69
|
| Rate for Payer: Humana Medicaid |
$273.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$580.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$279.09
|
| Rate for Payer: Molina Healthcare Passport |
$273.62
|
| Rate for Payer: Multiplan PHCS |
$402.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$469.00
|
| Rate for Payer: UHCCP Medicaid |
$234.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$276.36
|
|
|
SHOULDER ARTHROSCOPY DX(P
|
Professional
|
Both
|
$670.00
|
|
|
Service Code
|
HCPCS 29805
|
| Hospital Charge Code |
761P1074
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$234.50 |
| Max. Negotiated Rate |
$760.85 |
| Rate for Payer: Aetna Commercial |
$685.25
|
| Rate for Payer: Anthem Medicaid |
$273.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$670.00
|
| Rate for Payer: Cash Price |
$335.00
|
| Rate for Payer: Cash Price |
$335.00
|
| Rate for Payer: Cigna Commercial |
$760.85
|
| Rate for Payer: Healthspan PPO |
$620.69
|
| Rate for Payer: Humana Medicaid |
$273.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$580.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$279.09
|
| Rate for Payer: Molina Healthcare Passport |
$273.62
|
| Rate for Payer: Multiplan PHCS |
$402.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$469.00
|
| Rate for Payer: UHCCP Medicaid |
$234.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$276.36
|
|
|
SHOULDER ARTHROSCOPY/SURGER(P
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 29807
|
| Hospital Charge Code |
761P1076
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$1,682.91 |
| Rate for Payer: Aetna Commercial |
$1,539.09
|
| Rate for Payer: Anthem Medicaid |
$735.75
|
| 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 |
$1,682.91
|
| Rate for Payer: Healthspan PPO |
$1,394.09
|
| Rate for Payer: Humana Medicaid |
$735.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,292.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$750.46
|
| Rate for Payer: Molina Healthcare Passport |
$735.75
|
| 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 |
$743.11
|
|
|
SHOULDER ARTHROSCOPY/SURGER(P
|
Professional
|
Both
|
$1,760.00
|
|
|
Service Code
|
HCPCS 29820
|
| Hospital Charge Code |
761P1078
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$475.75 |
| Max. Negotiated Rate |
$1,760.00 |
| Rate for Payer: Aetna Commercial |
$795.45
|
| Rate for Payer: Anthem Medicaid |
$475.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,760.00
|
| Rate for Payer: Cash Price |
$880.00
|
| Rate for Payer: Cash Price |
$880.00
|
| Rate for Payer: Cigna Commercial |
$877.44
|
| Rate for Payer: Healthspan PPO |
$720.50
|
| Rate for Payer: Humana Medicaid |
$475.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$668.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$485.26
|
| Rate for Payer: Molina Healthcare Passport |
$475.75
|
| Rate for Payer: Multiplan PHCS |
$1,056.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,232.00
|
| Rate for Payer: UHCCP Medicaid |
$616.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$480.51
|
|
|
SHOULDER ARTHROSCOPY/SURGER(P
|
Professional
|
Both
|
$1,536.00
|
|
|
Service Code
|
HCPCS 29806
|
| Hospital Charge Code |
761P1075
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$537.60 |
| Max. Negotiated Rate |
$1,726.69 |
| Rate for Payer: Aetna Commercial |
$1,581.02
|
| Rate for Payer: Anthem Medicaid |
$756.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,536.00
|
| Rate for Payer: Cash Price |
$768.00
|
| Rate for Payer: Cash Price |
$768.00
|
| Rate for Payer: Cigna Commercial |
$1,726.69
|
| Rate for Payer: Healthspan PPO |
$1,432.06
|
| Rate for Payer: Humana Medicaid |
$756.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,325.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$771.36
|
| Rate for Payer: Molina Healthcare Passport |
$756.24
|
| Rate for Payer: Multiplan PHCS |
$921.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,075.20
|
| Rate for Payer: UHCCP Medicaid |
$537.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$763.80
|
|
|
SHOULDER ARTHROSCOPY/SURGER(P
|
Professional
|
Both
|
$2,057.00
|
|
|
Service Code
|
HCPCS 29823
|
| Hospital Charge Code |
761P1081
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$557.11 |
| Max. Negotiated Rate |
$2,057.00 |
| Rate for Payer: Aetna Commercial |
$922.86
|
| Rate for Payer: Anthem Medicaid |
$557.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,057.00
|
| Rate for Payer: Cash Price |
$1,028.50
|
| Rate for Payer: Cash Price |
$1,028.50
|
| Rate for Payer: Cigna Commercial |
$1,017.50
|
| Rate for Payer: Healthspan PPO |
$835.91
|
| Rate for Payer: Humana Medicaid |
$557.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$776.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$568.25
|
| Rate for Payer: Molina Healthcare Passport |
$557.11
|
| Rate for Payer: Multiplan PHCS |
$1,234.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,439.90
|
| Rate for Payer: UHCCP Medicaid |
$719.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$562.68
|
|
|
SHOULDER ARTHROSCOPY/SURGER(P
|
Professional
|
Both
|
$1,997.00
|
|
|
Service Code
|
HCPCS 29822
|
| Hospital Charge Code |
761P1080
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$496.95 |
| Max. Negotiated Rate |
$1,997.00 |
| Rate for Payer: Aetna Commercial |
$843.01
|
| Rate for Payer: Anthem Medicaid |
$496.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,997.00
|
| Rate for Payer: Cash Price |
$998.50
|
| Rate for Payer: Cash Price |
$998.50
|
| Rate for Payer: Cigna Commercial |
$932.65
|
| Rate for Payer: Healthspan PPO |
$763.58
|
| Rate for Payer: Humana Medicaid |
$496.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$711.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$506.89
|
| Rate for Payer: Molina Healthcare Passport |
$496.95
|
| Rate for Payer: Multiplan PHCS |
$1,198.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,397.90
|
| Rate for Payer: UHCCP Medicaid |
$698.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$501.92
|
|
|
SHOULDER ARTHROSCOPY/SURGER(P
|
Professional
|
Both
|
$2,200.00
|
|
|
Service Code
|
HCPCS 29821
|
| Hospital Charge Code |
761P1079
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$524.59 |
| Max. Negotiated Rate |
$2,200.00 |
| Rate for Payer: Aetna Commercial |
$868.67
|
| Rate for Payer: Anthem Medicaid |
$524.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,200.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$959.45
|
| Rate for Payer: Healthspan PPO |
$786.83
|
| Rate for Payer: Humana Medicaid |
$524.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$732.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$535.08
|
| Rate for Payer: Molina Healthcare Passport |
$524.59
|
| Rate for Payer: Multiplan PHCS |
$1,320.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,540.00
|
| Rate for Payer: UHCCP Medicaid |
$770.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$529.84
|
|
|
SHOULDER ARTHROSCOPY/SURGERY
|
Facility
|
OP
|
$1,536.00
|
|
|
Service Code
|
HCPCS 29806
|
| Hospital Charge Code |
76101075
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$199.68 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$1,182.72
|
| Rate for Payer: Anthem Medicaid |
$528.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,198.08
|
| 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 |
$768.00
|
| Rate for Payer: Cash Price |
$768.00
|
| Rate for Payer: Cigna Commercial |
$1,274.88
|
| Rate for Payer: First Health Commercial |
$1,459.20
|
| Rate for Payer: Humana Commercial |
$1,305.60
|
| Rate for Payer: Humana KY Medicaid |
$528.23
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$533.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,259.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,133.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$538.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,351.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,152.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$307.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$199.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$476.16
|
| Rate for Payer: PHCS Commercial |
$1,474.56
|
| Rate for Payer: United Healthcare All Payer |
$1,351.68
|
|
|
SHOULDER ARTHROSCOPY/SURGERY
|
Professional
|
Both
|
$1,760.00
|
|
|
Service Code
|
HCPCS 29820
|
| Hospital Charge Code |
76101078
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$475.75 |
| Max. Negotiated Rate |
$1,760.00 |
| Rate for Payer: Aetna Commercial |
$795.45
|
| Rate for Payer: Anthem Medicaid |
$475.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,760.00
|
| Rate for Payer: Cash Price |
$880.00
|
| Rate for Payer: Cash Price |
$880.00
|
| Rate for Payer: Cigna Commercial |
$877.44
|
| Rate for Payer: Healthspan PPO |
$720.50
|
| Rate for Payer: Humana Medicaid |
$475.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$668.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$485.26
|
| Rate for Payer: Molina Healthcare Passport |
$475.75
|
| Rate for Payer: Multiplan PHCS |
$1,056.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,232.00
|
| Rate for Payer: UHCCP Medicaid |
$616.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$480.51
|
|
|
SHOULDER ARTHROSCOPY/SURGERY
|
Facility
|
IP
|
$1,536.00
|
|
|
Service Code
|
HCPCS 29806
|
| Hospital Charge Code |
76101075
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$199.68 |
| Max. Negotiated Rate |
$1,474.56 |
| Rate for Payer: Aetna Commercial |
$1,182.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,198.08
|
| Rate for Payer: Cash Price |
$768.00
|
| Rate for Payer: Cigna Commercial |
$1,274.88
|
| Rate for Payer: First Health Commercial |
$1,459.20
|
| Rate for Payer: Humana Commercial |
$1,305.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,259.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,133.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$460.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,351.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,152.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$307.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$199.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$476.16
|
| Rate for Payer: PHCS Commercial |
$1,474.56
|
| Rate for Payer: United Healthcare All Payer |
$1,351.68
|
|
|
SHOULDER ARTHROSCOPY/SURGERY
|
Facility
|
OP
|
$2,200.00
|
|
|
Service Code
|
HCPCS 29821
|
| Hospital Charge Code |
76101079
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$286.00 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$1,694.00
|
| Rate for Payer: Anthem Medicaid |
$756.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,716.00
|
| 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 |
$1,100.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,826.00
|
| Rate for Payer: First Health Commercial |
$2,090.00
|
| Rate for Payer: Humana Commercial |
$1,870.00
|
| Rate for Payer: Humana KY Medicaid |
$756.58
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$764.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,804.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,623.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$771.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,936.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,650.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$286.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$682.00
|
| Rate for Payer: PHCS Commercial |
$2,112.00
|
| Rate for Payer: United Healthcare All Payer |
$1,936.00
|
|
|
SHOULDER ARTHROSCOPY/SURGERY
|
Facility
|
IP
|
$1,997.00
|
|
|
Service Code
|
HCPCS 29822
|
| Hospital Charge Code |
76101080
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$259.61 |
| Max. Negotiated Rate |
$1,917.12 |
| Rate for Payer: Aetna Commercial |
$1,537.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,557.66
|
| Rate for Payer: Cash Price |
$998.50
|
| Rate for Payer: Cigna Commercial |
$1,657.51
|
| Rate for Payer: First Health Commercial |
$1,897.15
|
| Rate for Payer: Humana Commercial |
$1,697.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,637.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,473.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,757.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,497.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.07
|
| Rate for Payer: PHCS Commercial |
$1,917.12
|
| Rate for Payer: United Healthcare All Payer |
$1,757.36
|
|
