|
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: Ambetter Exchange |
$980.98
|
| Rate for Payer: Anthem Medicaid |
$735.75
|
| Rate for Payer: Buckeye Individual/Medicaid |
$980.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$980.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,177.18
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$980.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$980.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$750.47
|
| Rate for Payer: Molina Healthcare Passport |
$735.75
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,275.27
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$743.11
|
| Rate for Payer: Wellcare Medicare Advantage |
$980.98
|
|
|
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 |
$1,056.00 |
| Rate for Payer: Aetna Commercial |
$795.45
|
| Rate for Payer: Ambetter Exchange |
$510.36
|
| Rate for Payer: Anthem Medicaid |
$475.75
|
| Rate for Payer: Buckeye Individual/Medicaid |
$510.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$510.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$612.43
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$510.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.36
|
| 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 |
$663.47
|
| Rate for Payer: UHCCP Medicaid |
$616.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$480.51
|
| Rate for Payer: Wellcare Medicare Advantage |
$510.36
|
|
|
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 |
$1,198.20 |
| Rate for Payer: Aetna Commercial |
$843.01
|
| Rate for Payer: Ambetter Exchange |
$516.65
|
| Rate for Payer: Anthem Medicaid |
$496.95
|
| Rate for Payer: Buckeye Individual/Medicaid |
$516.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$516.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$619.98
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$516.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$516.65
|
| 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 |
$671.64
|
| Rate for Payer: UHCCP Medicaid |
$698.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$501.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$516.65
|
|
|
SHOULDER ARTHROSCOPY/SURGERY
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 29807
|
| Hospital Charge Code |
76101076
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$515.85 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem Medicaid |
$515.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| 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 |
$6,600.66
|
| 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 |
$7,920.79
|
| 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 |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,305.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,035.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
SHOULDER ARTHROSCOPY/SURGERY
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 29807
|
| Hospital Charge Code |
76101076
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$450.00 |
| 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 |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,305.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,035.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
SHOULDER ARTHROSCOPY/SURGERY
|
Facility
|
IP
|
$2,057.00
|
|
|
Service Code
|
HCPCS 29823
|
| Hospital Charge Code |
76101081
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$617.10 |
| 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 |
$1,645.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,789.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,419.33
|
| Rate for Payer: PHCS Commercial |
$1,974.72
|
| Rate for Payer: United Healthcare All Payer |
$1,810.16
|
|
|
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 |
$1,234.20 |
| Rate for Payer: Aetna Commercial |
$922.86
|
| Rate for Payer: Ambetter Exchange |
$564.52
|
| Rate for Payer: Anthem Medicaid |
$557.11
|
| Rate for Payer: Buckeye Individual/Medicaid |
$564.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$564.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$677.42
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$564.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$564.52
|
| 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 |
$733.88
|
| Rate for Payer: UHCCP Medicaid |
$719.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$562.68
|
| Rate for Payer: Wellcare Medicare Advantage |
$564.52
|
|
|
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 |
$1,198.20 |
| Rate for Payer: Aetna Commercial |
$843.01
|
| Rate for Payer: Ambetter Exchange |
$516.65
|
| Rate for Payer: Anthem Medicaid |
$496.95
|
| Rate for Payer: Buckeye Individual/Medicaid |
$516.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$516.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$619.98
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$516.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$516.65
|
| 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 |
$671.64
|
| Rate for Payer: UHCCP Medicaid |
$698.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$501.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$516.65
|
|
|
SHOULDER ARTHROSCOPY/SURGERY
|
Facility
|
OP
|
$1,536.00
|
|
|
Service Code
|
HCPCS 29806
|
| Hospital Charge Code |
76101075
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$528.23 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,182.72
|
| Rate for Payer: Anthem Medicaid |
$528.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,198.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| 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 |
$6,600.66
|
| 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 |
$7,920.79
|
| 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 |
$1,228.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,336.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,059.84
|
| Rate for Payer: PHCS Commercial |
$1,474.56
|
| Rate for Payer: United Healthcare All Payer |
$1,351.68
|
|
|
SHOULDER ARTHROSCOPY/SURGERY
|
Facility
|
IP
|
$1,760.00
|
|
|
Service Code
|
HCPCS 29820
|
| Hospital Charge Code |
76101078
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$528.00 |
| 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 |
$1,408.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,531.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,214.40
|
| Rate for Payer: PHCS Commercial |
$1,689.60
|
| Rate for Payer: United Healthcare All Payer |
$1,548.80
|
|
|
SHOULDER ARTHROSCOPY/SURGERY
|
Facility
|
IP
|
$2,200.00
|
|
|
Service Code
|
HCPCS 29821
|
| Hospital Charge Code |
76101079
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$660.00 |
| 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 |
$1,760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,914.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,518.00
|
| 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 |
$599.10 |
| 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 |
$1,597.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,737.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,377.93
|
| Rate for Payer: PHCS Commercial |
$1,917.12
|
| Rate for Payer: United Healthcare All Payer |
$1,757.36
|
|
|
SHOULDER ARTHROSCOPY/SURGERY
|
Facility
|
OP
|
$2,057.00
|
|
|
Service Code
|
HCPCS 29823
|
| Hospital Charge Code |
76101081
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$707.40 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$1,583.89
|
| Rate for Payer: Anthem Medicaid |
$707.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,604.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| 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 |
$2,997.95
|
| 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 |
$3,597.54
|
| 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 |
$1,645.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,789.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,419.33
|
| Rate for Payer: PHCS Commercial |
$1,974.72
|
| Rate for Payer: United Healthcare All Payer |
$1,810.16
|
|
|
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 |
$1,056.00 |
| Rate for Payer: Aetna Commercial |
$795.45
|
| Rate for Payer: Ambetter Exchange |
$510.36
|
| Rate for Payer: Anthem Medicaid |
$475.75
|
| Rate for Payer: Buckeye Individual/Medicaid |
$510.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$510.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$612.43
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$510.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.36
|
| 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 |
$663.47
|
| Rate for Payer: UHCCP Medicaid |
$616.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$480.51
|
| Rate for Payer: Wellcare Medicare Advantage |
$510.36
|
|
|
SHOULDER ARTHROSCOPY/SURGERY
|
Facility
|
OP
|
$2,200.00
|
|
|
Service Code
|
HCPCS 29821
|
| Hospital Charge Code |
76101079
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$756.58 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$1,694.00
|
| Rate for Payer: Anthem Medicaid |
$756.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,716.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| 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 |
$2,997.95
|
| 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 |
$3,597.54
|
| 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 |
$1,760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,914.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,518.00
|
| Rate for Payer: PHCS Commercial |
$2,112.00
|
| Rate for Payer: United Healthcare All Payer |
$1,936.00
|
|
|
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 |
$1,320.00 |
| Rate for Payer: Aetna Commercial |
$868.67
|
| Rate for Payer: Ambetter Exchange |
$566.36
|
| Rate for Payer: Anthem Medicaid |
$524.59
|
| Rate for Payer: Buckeye Individual/Medicaid |
$566.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$566.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$679.63
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$566.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$566.36
|
| 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 |
$736.27
|
| Rate for Payer: UHCCP Medicaid |
$770.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$529.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$566.36
|
|
|
SHOULDER ARTHROSCOPY/SURGERY
|
Facility
|
IP
|
$1,536.00
|
|
|
Service Code
|
HCPCS 29806
|
| Hospital Charge Code |
76101075
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$460.80 |
| 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 |
$1,228.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,336.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,059.84
|
| Rate for Payer: PHCS Commercial |
$1,474.56
|
| Rate for Payer: United Healthcare All Payer |
$1,351.68
|
|
|
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: Ambetter Exchange |
$980.98
|
| Rate for Payer: Anthem Medicaid |
$735.75
|
| Rate for Payer: Buckeye Individual/Medicaid |
$980.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$980.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,177.18
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$980.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$980.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$750.47
|
| Rate for Payer: Molina Healthcare Passport |
$735.75
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,275.27
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$743.11
|
| Rate for Payer: Wellcare Medicare Advantage |
$980.98
|
|
|
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: Ambetter Exchange |
$1,004.83
|
| Rate for Payer: Anthem Medicaid |
$756.24
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,004.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,004.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,205.80
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,004.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,004.83
|
| 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 |
$1,306.28
|
| Rate for Payer: UHCCP Medicaid |
$537.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$763.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,004.83
|
|
|
SHOULDER ARTHROSCOPY/SURGERY
|
Facility
|
OP
|
$1,760.00
|
|
|
Service Code
|
HCPCS 29820
|
| Hospital Charge Code |
76101078
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$605.26 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,355.20
|
| Rate for Payer: Anthem Medicaid |
$605.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,372.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| 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 |
$6,600.66
|
| 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 |
$7,920.79
|
| 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 |
$1,408.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,531.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,214.40
|
| Rate for Payer: PHCS Commercial |
$1,689.60
|
| Rate for Payer: United Healthcare All Payer |
$1,548.80
|
|
|
SHOULDER ARTHROSCOPY/SURGERY
|
Facility
|
OP
|
$1,997.00
|
|
|
Service Code
|
HCPCS 29822
|
| Hospital Charge Code |
76101080
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$686.77 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$1,537.69
|
| Rate for Payer: Anthem Medicaid |
$686.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,557.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| 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 |
$2,997.95
|
| 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 |
$3,597.54
|
| 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 |
$1,597.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,737.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,377.93
|
| Rate for Payer: PHCS Commercial |
$1,917.12
|
| Rate for Payer: United Healthcare All Payer |
$1,757.36
|
|
|
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: Ambetter Exchange |
$438.01
|
| Rate for Payer: Anthem Medicaid |
$361.45
|
| Rate for Payer: Buckeye Individual/Medicaid |
$438.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$438.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$525.61
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$438.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$438.01
|
| 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 |
$569.41
|
| Rate for Payer: UHCCP Medicaid |
$231.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$365.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$438.01
|
|
|
SHOULDER KEELED GLENOID SZ #11
|
Facility
|
IP
|
$7,648.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,294.59 |
| Max. Negotiated Rate |
$7,342.69 |
| Rate for Payer: Aetna Commercial |
$5,889.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,965.94
|
| Rate for Payer: Cash Price |
$3,824.32
|
| Rate for Payer: Cigna Commercial |
$6,348.37
|
| Rate for Payer: First Health Commercial |
$7,266.21
|
| Rate for Payer: Humana Commercial |
$6,501.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,271.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,644.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,294.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,730.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,736.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,118.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,654.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,277.56
|
| Rate for Payer: PHCS Commercial |
$7,342.69
|
| Rate for Payer: United Healthcare All Payer |
$6,730.80
|
|
|
SHOULDER KEELED GLENOID SZ #11
|
Facility
|
OP
|
$7,648.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,294.59 |
| Max. Negotiated Rate |
$7,342.69 |
| Rate for Payer: Aetna Commercial |
$5,889.45
|
| Rate for Payer: Anthem Medicaid |
$2,630.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,965.94
|
| Rate for Payer: Cash Price |
$3,824.32
|
| Rate for Payer: Cigna Commercial |
$6,348.37
|
| Rate for Payer: First Health Commercial |
$7,266.21
|
| Rate for Payer: Humana Commercial |
$6,501.34
|
| Rate for Payer: Humana KY Medicaid |
$2,630.37
|
| Rate for Payer: Kentucky WC Medicaid |
$2,657.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,271.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,644.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,294.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,683.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,730.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,736.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,118.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,654.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,277.56
|
| Rate for Payer: PHCS Commercial |
$7,342.69
|
| Rate for Payer: United Healthcare All Payer |
$6,730.80
|
|
|
SHOULDER KEELED GLENOID SZ #7
|
Facility
|
IP
|
$7,374.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,212.25 |
| Max. Negotiated Rate |
$7,079.19 |
| Rate for Payer: Aetna Commercial |
$5,678.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,751.84
|
| Rate for Payer: Cash Price |
$3,687.08
|
| Rate for Payer: Cigna Commercial |
$6,120.55
|
| Rate for Payer: First Health Commercial |
$7,005.45
|
| Rate for Payer: Humana Commercial |
$6,268.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,046.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,442.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,212.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,489.26
|
| Rate for Payer: Ohio Health Group HMO |
$5,530.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,899.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,415.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,088.17
|
| Rate for Payer: PHCS Commercial |
$7,079.19
|
| Rate for Payer: United Healthcare All Payer |
$6,489.26
|
|
