|
SHOULDER ARTHROSCOPY/SURGERY
|
Professional
|
Both
|
$2,200.00
|
|
|
Service Code
|
HCPCS 29821
|
| Hospital Charge Code |
76101079
|
|
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
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 29807
|
| Hospital Charge Code |
76101076
|
|
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/SURGERY
|
Professional
|
Both
|
$2,057.00
|
|
|
Service Code
|
HCPCS 29823
|
| Hospital Charge Code |
76101081
|
|
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/SURGERY
|
Facility
|
IP
|
$2,200.00
|
|
|
Service Code
|
HCPCS 29821
|
| Hospital Charge Code |
76101079
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$286.00 |
| Max. Negotiated Rate |
$2,112.00 |
| Rate for Payer: Aetna Commercial |
$1,694.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,716.00
|
| 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: 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 |
$660.00
|
| 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
|
$1,760.00
|
|
|
Service Code
|
HCPCS 29820
|
| Hospital Charge Code |
76101078
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$228.80 |
| Max. Negotiated Rate |
$1,689.60 |
| Rate for Payer: Aetna Commercial |
$1,355.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,372.80
|
| Rate for Payer: Cash Price |
$880.00
|
| Rate for Payer: Cigna Commercial |
$1,460.80
|
| Rate for Payer: First Health Commercial |
$1,672.00
|
| Rate for Payer: Humana Commercial |
$1,496.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,443.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,298.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$528.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,548.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,320.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$352.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$228.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$545.60
|
| Rate for Payer: PHCS Commercial |
$1,689.60
|
| Rate for Payer: United Healthcare All Payer |
$1,548.80
|
|
|
SHOULDER ARTHROSCOPY/SURGERY
|
Facility
|
OP
|
$1,760.00
|
|
|
Service Code
|
HCPCS 29820
|
| Hospital Charge Code |
76101078
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$228.80 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$1,355.20
|
| Rate for Payer: Anthem Medicaid |
$605.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,372.80
|
| 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 |
$880.00
|
| Rate for Payer: Cash Price |
$880.00
|
| Rate for Payer: Cigna Commercial |
$1,460.80
|
| Rate for Payer: First Health Commercial |
$1,672.00
|
| Rate for Payer: Humana Commercial |
$1,496.00
|
| Rate for Payer: Humana KY Medicaid |
$605.26
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$611.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,443.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,298.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$617.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,548.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,320.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$352.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$228.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$545.60
|
| Rate for Payer: PHCS Commercial |
$1,689.60
|
| Rate for Payer: United Healthcare All Payer |
$1,548.80
|
|
|
SHOULDER ARTHROSCOPY/SURGERY
|
Facility
|
OP
|
$2,057.00
|
|
|
Service Code
|
HCPCS 29823
|
| Hospital Charge Code |
76101081
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$267.41 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$1,583.89
|
| Rate for Payer: Anthem Medicaid |
$707.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,604.46
|
| 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 |
$1,028.50
|
| Rate for Payer: Cash Price |
$1,028.50
|
| Rate for Payer: Cigna Commercial |
$1,707.31
|
| Rate for Payer: First Health Commercial |
$1,954.15
|
| Rate for Payer: Humana Commercial |
$1,748.45
|
| Rate for Payer: Humana KY Medicaid |
$707.40
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$714.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,686.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,518.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$721.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,810.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,542.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$411.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$267.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$637.67
|
| Rate for Payer: PHCS Commercial |
$1,974.72
|
| Rate for Payer: United Healthcare All Payer |
$1,810.16
|
|
|
SHOULDER ARTHROSCOPY/SURGERY
|
Facility
|
OP
|
$1,997.00
|
|
|
Service Code
|
HCPCS 29822
|
| Hospital Charge Code |
76101080
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$259.61 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$1,537.69
|
| Rate for Payer: Anthem Medicaid |
$686.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,557.66
|
| 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 |
$998.50
|
| 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: Humana KY Medicaid |
$686.77
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$693.76
|
| 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 |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$700.55
|
| 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
|
|
|
SHOULDER ARTHROSCOPY/SURGERY
|
Professional
|
Both
|
$1,536.00
|
|
|
Service Code
|
HCPCS 29806
|
| Hospital Charge Code |
76101075
|
|
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/SURGERY
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 29807
|
| Hospital Charge Code |
76101076
|
|
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
|
|
|
SHOULDER ARTHROSCOPY/SURGERY
|
Professional
|
Both
|
$1,997.00
|
|
|
Service Code
|
HCPCS 29822
|
| Hospital Charge Code |
76101080
|
|
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/SURGERY
|
Facility
|
IP
|
$2,057.00
|
|
|
Service Code
|
HCPCS 29823
|
| Hospital Charge Code |
76101081
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$267.41 |
| Max. Negotiated Rate |
$1,974.72 |
| Rate for Payer: Aetna Commercial |
$1,583.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,604.46
|
| Rate for Payer: Cash Price |
$1,028.50
|
| Rate for Payer: Cigna Commercial |
$1,707.31
|
| Rate for Payer: First Health Commercial |
$1,954.15
|
| Rate for Payer: Humana Commercial |
$1,748.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,686.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,518.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$617.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,810.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,542.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$411.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$267.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$637.67
|
| Rate for Payer: PHCS Commercial |
$1,974.72
|
| Rate for Payer: United Healthcare All Payer |
$1,810.16
|
|
|
SHOULDER ARTHROSCOPY/SURGERY
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 29807
|
| Hospital Charge Code |
76101076
|
|
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
|
|
|
SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH CC
|
Facility
|
IP
|
$23,323.89
|
|
|
Service Code
|
MSDRG 511
|
| Min. Negotiated Rate |
$15,826.92 |
| Max. Negotiated Rate |
$23,323.89 |
| Rate for Payer: Anthem Medicaid |
$15,826.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16,659.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$23,323.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$22,490.89
|
| Rate for Payer: Humana KY Medicaid |
$15,826.92
|
| Rate for Payer: Humana Medicare Advantage |
$16,659.92
|
| Rate for Payer: Kentucky WC Medicaid |
$15,985.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19,991.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$16,143.46
|
|
|
SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH MCC
|
Facility
|
IP
|
$31,826.13
|
|
|
Service Code
|
MSDRG 510
|
| Min. Negotiated Rate |
$21,596.30 |
| Max. Negotiated Rate |
$31,826.13 |
| Rate for Payer: Anthem Medicaid |
$21,596.30
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$22,732.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$31,826.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$30,689.48
|
| Rate for Payer: Humana KY Medicaid |
$21,596.30
|
| Rate for Payer: Humana Medicare Advantage |
$22,732.95
|
| Rate for Payer: Kentucky WC Medicaid |
$21,812.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27,279.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$22,028.23
|
|
|
SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$18,878.55
|
|
|
Service Code
|
MSDRG 512
|
| Min. Negotiated Rate |
$12,810.45 |
| Max. Negotiated Rate |
$18,878.55 |
| Rate for Payer: Anthem Medicaid |
$12,810.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13,484.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18,878.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$18,204.32
|
| Rate for Payer: Humana KY Medicaid |
$12,810.45
|
| Rate for Payer: Humana Medicare Advantage |
$13,484.68
|
| Rate for Payer: Kentucky WC Medicaid |
$12,938.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16,181.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,066.65
|
|
|
SHOULDER JOINT SURGERY
|
Professional
|
Both
|
$660.00
|
|
|
Service Code
|
HCPCS 23101
|
| Hospital Charge Code |
76102715
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$231.00 |
| Max. Negotiated Rate |
$719.61 |
| Rate for Payer: Aetna Commercial |
$651.31
|
| Rate for Payer: Anthem Medicaid |
$361.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$660.00
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cigna Commercial |
$719.61
|
| Rate for Payer: Healthspan PPO |
$589.95
|
| Rate for Payer: Humana Medicaid |
$361.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$552.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$368.68
|
| Rate for Payer: Molina Healthcare Passport |
$361.45
|
| Rate for Payer: Multiplan PHCS |
$396.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$462.00
|
| Rate for Payer: UHCCP Medicaid |
$231.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$365.06
|
|
|
SHOULDER KEELED GLENOID SZ #11
|
Facility
|
IP
|
$7,448.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$968.32 |
| Max. Negotiated Rate |
$7,150.69 |
| Rate for Payer: Aetna Commercial |
$5,735.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,809.94
|
| Rate for Payer: Cash Price |
$3,724.32
|
| Rate for Payer: Cigna Commercial |
$6,182.37
|
| Rate for Payer: First Health Commercial |
$7,076.21
|
| Rate for Payer: Humana Commercial |
$6,331.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,107.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,497.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,234.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,554.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,586.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,489.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$968.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,309.08
|
| Rate for Payer: PHCS Commercial |
$7,150.69
|
| Rate for Payer: United Healthcare All Payer |
$6,554.80
|
|
|
SHOULDER KEELED GLENOID SZ #11
|
Facility
|
OP
|
$7,448.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$968.32 |
| Max. Negotiated Rate |
$7,150.69 |
| Rate for Payer: Aetna Commercial |
$5,735.45
|
| Rate for Payer: Anthem Medicaid |
$2,561.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,809.94
|
| Rate for Payer: Cash Price |
$3,724.32
|
| Rate for Payer: Cigna Commercial |
$6,182.37
|
| Rate for Payer: First Health Commercial |
$7,076.21
|
| Rate for Payer: Humana Commercial |
$6,331.34
|
| Rate for Payer: Humana KY Medicaid |
$2,561.59
|
| Rate for Payer: Kentucky WC Medicaid |
$2,587.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,107.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,497.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,234.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,612.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,554.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,586.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,489.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$968.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,309.08
|
| Rate for Payer: PHCS Commercial |
$7,150.69
|
| Rate for Payer: United Healthcare All Payer |
$6,554.80
|
|
|
SHOULDER KEELED GLENOID SZ #7
|
Facility
|
OP
|
$7,174.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$932.64 |
| Max. Negotiated Rate |
$6,887.19 |
| Rate for Payer: Aetna Commercial |
$5,524.10
|
| Rate for Payer: Anthem Medicaid |
$2,467.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,595.84
|
| Rate for Payer: Cash Price |
$3,587.08
|
| Rate for Payer: Cigna Commercial |
$5,954.55
|
| Rate for Payer: First Health Commercial |
$6,815.45
|
| Rate for Payer: Humana Commercial |
$6,098.04
|
| Rate for Payer: Humana KY Medicaid |
$2,467.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,492.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,882.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,294.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,152.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,516.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,313.26
|
| Rate for Payer: Ohio Health Group HMO |
$5,380.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,434.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$932.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,223.99
|
| Rate for Payer: PHCS Commercial |
$6,887.19
|
| Rate for Payer: United Healthcare All Payer |
$6,313.26
|
|
|
SHOULDER KEELED GLENOID SZ #7
|
Facility
|
IP
|
$7,174.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$932.64 |
| Max. Negotiated Rate |
$6,887.19 |
| Rate for Payer: Aetna Commercial |
$5,524.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,595.84
|
| Rate for Payer: Cash Price |
$3,587.08
|
| Rate for Payer: Cigna Commercial |
$5,954.55
|
| Rate for Payer: First Health Commercial |
$6,815.45
|
| Rate for Payer: Humana Commercial |
$6,098.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,882.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,294.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,152.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,313.26
|
| Rate for Payer: Ohio Health Group HMO |
$5,380.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,434.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$932.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,223.99
|
| Rate for Payer: PHCS Commercial |
$6,887.19
|
| Rate for Payer: United Healthcare All Payer |
$6,313.26
|
|
|
SHOULDER KEELED GLENOID SZ #9
|
Facility
|
OP
|
$7,448.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$968.32 |
| Max. Negotiated Rate |
$7,150.69 |
| Rate for Payer: Aetna Commercial |
$5,735.45
|
| Rate for Payer: Anthem Medicaid |
$2,561.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,809.94
|
| Rate for Payer: Cash Price |
$3,724.32
|
| Rate for Payer: Cigna Commercial |
$6,182.37
|
| Rate for Payer: First Health Commercial |
$7,076.21
|
| Rate for Payer: Humana Commercial |
$6,331.34
|
| Rate for Payer: Humana KY Medicaid |
$2,561.59
|
| Rate for Payer: Kentucky WC Medicaid |
$2,587.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,107.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,497.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,234.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,612.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,554.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,586.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,489.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$968.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,309.08
|
| Rate for Payer: PHCS Commercial |
$7,150.69
|
| Rate for Payer: United Healthcare All Payer |
$6,554.80
|
|
|
SHOULDER KEELED GLENOID SZ #9
|
Facility
|
IP
|
$7,448.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$968.32 |
| Max. Negotiated Rate |
$7,150.69 |
| Rate for Payer: Aetna Commercial |
$5,735.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,809.94
|
| Rate for Payer: Cash Price |
$3,724.32
|
| Rate for Payer: Cigna Commercial |
$6,182.37
|
| Rate for Payer: First Health Commercial |
$7,076.21
|
| Rate for Payer: Humana Commercial |
$6,331.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,107.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,497.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,234.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,554.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,586.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,489.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$968.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,309.08
|
| Rate for Payer: PHCS Commercial |
$7,150.69
|
| Rate for Payer: United Healthcare All Payer |
$6,554.80
|
|
|
SHOULDER PROSTHESIS REMOVAL
|
Professional
|
Both
|
$3,115.00
|
|
|
Service Code
|
HCPCS 23335
|
| Hospital Charge Code |
76100453
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,009.28 |
| Max. Negotiated Rate |
$3,115.00 |
| Rate for Payer: Anthem Medicaid |
$1,009.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,115.00
|
| Rate for Payer: Cash Price |
$1,557.50
|
| Rate for Payer: Cash Price |
$1,557.50
|
| Rate for Payer: Cigna Commercial |
$2,380.09
|
| Rate for Payer: Healthspan PPO |
$1,867.46
|
| Rate for Payer: Humana Medicaid |
$1,009.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,643.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,029.47
|
| Rate for Payer: Molina Healthcare Passport |
$1,009.28
|
| Rate for Payer: Multiplan PHCS |
$1,869.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,180.50
|
| Rate for Payer: UHCCP Medicaid |
$1,090.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,019.37
|
|
|
SHOULDER PROSTHESIS REMOVAL
|
Facility
|
OP
|
$3,115.00
|
|
|
Service Code
|
HCPCS 23335
|
| Hospital Charge Code |
76100453
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$404.95 |
| Max. Negotiated Rate |
$2,990.40 |
| Rate for Payer: Aetna Commercial |
$2,398.55
|
| Rate for Payer: Anthem Medicaid |
$1,071.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,429.70
|
| Rate for Payer: Cash Price |
$1,557.50
|
| Rate for Payer: Cigna Commercial |
$2,585.45
|
| Rate for Payer: First Health Commercial |
$2,959.25
|
| Rate for Payer: Humana Commercial |
$2,647.75
|
| Rate for Payer: Humana KY Medicaid |
$1,071.25
|
| Rate for Payer: Kentucky WC Medicaid |
$1,082.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,554.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,298.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$934.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,092.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,741.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,336.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$623.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$404.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$965.65
|
| Rate for Payer: PHCS Commercial |
$2,990.40
|
| Rate for Payer: United Healthcare All Payer |
$2,741.20
|
|
