|
OPEN TREATMENT OF ULNAR FRACTURE, PROXIMAL END (EG, OLECRANON OR CORONOID PROCESS[ES]), INCLUDES INTERNAL FIXATION, WHEN PERFORMED
|
Facility
|
OP
|
$8,661.10
|
|
|
Service Code
|
CPT 24685
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,186.50 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,661.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,351.78
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
|
|
OPEN TREATMENT OF ULNAR SHAFT FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED
|
Facility
|
OP
|
$8,661.10
|
|
|
Service Code
|
CPT 25545
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,186.50 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,661.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,351.78
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
|
|
OPEN TREATMENT ULNAR FX PROX
|
Facility
|
OP
|
$1,375.00
|
|
|
Service Code
|
HCPCS 24685
|
| Hospital Charge Code |
76100563
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$178.75 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$1,058.75
|
| Rate for Payer: Anthem Medicaid |
$472.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,072.50
|
| 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 |
$687.50
|
| Rate for Payer: Cash Price |
$687.50
|
| Rate for Payer: Cigna Commercial |
$1,141.25
|
| Rate for Payer: First Health Commercial |
$1,306.25
|
| Rate for Payer: Humana Commercial |
$1,168.75
|
| Rate for Payer: Humana KY Medicaid |
$472.86
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$477.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,127.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,014.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$482.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,210.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,031.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$275.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$178.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$426.25
|
| Rate for Payer: PHCS Commercial |
$1,320.00
|
| Rate for Payer: United Healthcare All Payer |
$1,210.00
|
|
|
OPEN TREATMENT ULNAR FX PROX
|
Facility
|
IP
|
$1,375.00
|
|
|
Service Code
|
HCPCS 24685
|
| Hospital Charge Code |
76100563
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$178.75 |
| Max. Negotiated Rate |
$1,320.00 |
| Rate for Payer: Aetna Commercial |
$1,058.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,072.50
|
| Rate for Payer: Cash Price |
$687.50
|
| Rate for Payer: Cigna Commercial |
$1,141.25
|
| Rate for Payer: First Health Commercial |
$1,306.25
|
| Rate for Payer: Humana Commercial |
$1,168.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,127.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,014.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$412.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,210.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,031.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$275.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$178.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$426.25
|
| Rate for Payer: PHCS Commercial |
$1,320.00
|
| Rate for Payer: United Healthcare All Payer |
$1,210.00
|
|
|
OPEN TREATMENT ULNAR FX PROX
|
Professional
|
Both
|
$1,375.00
|
|
|
Service Code
|
HCPCS 24685
|
| Hospital Charge Code |
76100563
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$481.25 |
| Max. Negotiated Rate |
$1,375.00 |
| Rate for Payer: Aetna Commercial |
$950.90
|
| Rate for Payer: Anthem Medicaid |
$502.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,375.00
|
| Rate for Payer: Cash Price |
$687.50
|
| Rate for Payer: Cash Price |
$687.50
|
| Rate for Payer: Cigna Commercial |
$1,085.82
|
| Rate for Payer: Healthspan PPO |
$861.31
|
| Rate for Payer: Humana Medicaid |
$502.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$802.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$512.64
|
| Rate for Payer: Molina Healthcare Passport |
$502.59
|
| Rate for Payer: Multiplan PHCS |
$825.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$962.50
|
| Rate for Payer: UHCCP Medicaid |
$481.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$507.62
|
|
|
OPEN TREATMENT ULNAR FX PROX(P
|
Professional
|
Both
|
$1,375.00
|
|
|
Service Code
|
HCPCS 24685
|
| Hospital Charge Code |
761P0563
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$481.25 |
| Max. Negotiated Rate |
$1,375.00 |
| Rate for Payer: Aetna Commercial |
$950.90
|
| Rate for Payer: Anthem Medicaid |
$502.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,375.00
|
| Rate for Payer: Cash Price |
$687.50
|
| Rate for Payer: Cash Price |
$687.50
|
| Rate for Payer: Cigna Commercial |
$1,085.82
|
| Rate for Payer: Healthspan PPO |
$861.31
|
| Rate for Payer: Humana Medicaid |
$502.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$802.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$512.64
|
| Rate for Payer: Molina Healthcare Passport |
$502.59
|
| Rate for Payer: Multiplan PHCS |
$825.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$962.50
|
| Rate for Payer: UHCCP Medicaid |
$481.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$507.62
|
|
|
OPEN TREAT. OF METACAR. DISLOC
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 26686
|
| Hospital Charge Code |
76100732
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$143.00 |
| Max. Negotiated Rate |
$1,056.00 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$913.00
|
| Rate for Payer: First Health Commercial |
$1,045.00
|
| Rate for Payer: Humana Commercial |
$935.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$902.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$330.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$968.00
|
| Rate for Payer: Ohio Health Group HMO |
$825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$143.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$341.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
OPEN TREAT. OF METACAR. DISLOC
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 26686
|
| Hospital Charge Code |
76100732
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$385.00 |
| Max. Negotiated Rate |
$1,100.00 |
| Rate for Payer: Aetna Commercial |
$894.49
|
| Rate for Payer: Anthem Medicaid |
$414.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,100.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$982.20
|
| Rate for Payer: Healthspan PPO |
$810.22
|
| Rate for Payer: Humana Medicaid |
$414.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$766.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$422.29
|
| Rate for Payer: Molina Healthcare Passport |
$414.01
|
| Rate for Payer: Multiplan PHCS |
$660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$770.00
|
| Rate for Payer: UHCCP Medicaid |
$385.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$418.15
|
|
|
OPEN TREAT. OF METACAR. DISLOC
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 26686
|
| Hospital Charge Code |
76100732
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$143.00 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem Medicaid |
$378.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| 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 |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$913.00
|
| Rate for Payer: First Health Commercial |
$1,045.00
|
| Rate for Payer: Humana Commercial |
$935.00
|
| Rate for Payer: Humana KY Medicaid |
$378.29
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$382.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$902.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$385.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$968.00
|
| Rate for Payer: Ohio Health Group HMO |
$825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$143.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$341.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
OPEN TREAT. OF METACAR. DISLOC
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 26686
|
| Hospital Charge Code |
761P0732
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$385.00 |
| Max. Negotiated Rate |
$1,100.00 |
| Rate for Payer: Aetna Commercial |
$894.49
|
| Rate for Payer: Anthem Medicaid |
$414.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,100.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$982.20
|
| Rate for Payer: Healthspan PPO |
$810.22
|
| Rate for Payer: Humana Medicaid |
$414.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$766.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$422.29
|
| Rate for Payer: Molina Healthcare Passport |
$414.01
|
| Rate for Payer: Multiplan PHCS |
$660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$770.00
|
| Rate for Payer: UHCCP Medicaid |
$385.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$418.15
|
|
|
OPEN TRMT GRT HUM TUBRSTY FX
|
Facility
|
IP
|
$1,975.00
|
|
|
Service Code
|
HCPCS 23630
|
| Hospital Charge Code |
76100484
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$256.75 |
| Max. Negotiated Rate |
$1,896.00 |
| Rate for Payer: Aetna Commercial |
$1,520.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,540.50
|
| Rate for Payer: Cash Price |
$987.50
|
| Rate for Payer: Cigna Commercial |
$1,639.25
|
| Rate for Payer: First Health Commercial |
$1,876.25
|
| Rate for Payer: Humana Commercial |
$1,678.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,619.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,457.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$592.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,738.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,481.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$395.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$256.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$612.25
|
| Rate for Payer: PHCS Commercial |
$1,896.00
|
| Rate for Payer: United Healthcare All Payer |
$1,738.00
|
|
|
OPEN TRMT GRT HUM TUBRSTY FX
|
Facility
|
OP
|
$1,975.00
|
|
|
Service Code
|
HCPCS 23630
|
| Hospital Charge Code |
76100484
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$256.75 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$1,520.75
|
| Rate for Payer: Anthem Medicaid |
$679.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,540.50
|
| 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 |
$987.50
|
| Rate for Payer: Cash Price |
$987.50
|
| Rate for Payer: Cigna Commercial |
$1,639.25
|
| Rate for Payer: First Health Commercial |
$1,876.25
|
| Rate for Payer: Humana Commercial |
$1,678.75
|
| Rate for Payer: Humana KY Medicaid |
$679.20
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$686.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,619.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,457.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$692.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,738.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,481.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$395.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$256.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$612.25
|
| Rate for Payer: PHCS Commercial |
$1,896.00
|
| Rate for Payer: United Healthcare All Payer |
$1,738.00
|
|
|
OPEN TRMT GRT HUM TUBRSTY FX(P
|
Professional
|
Both
|
$1,975.00
|
|
|
Service Code
|
HCPCS 23630
|
| Hospital Charge Code |
761P0484
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$472.76 |
| Max. Negotiated Rate |
$1,975.00 |
| Rate for Payer: Aetna Commercial |
$1,084.67
|
| Rate for Payer: Anthem Medicaid |
$472.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,975.00
|
| Rate for Payer: Cash Price |
$987.50
|
| Rate for Payer: Cash Price |
$987.50
|
| Rate for Payer: Cigna Commercial |
$928.81
|
| Rate for Payer: Healthspan PPO |
$982.48
|
| Rate for Payer: Humana Medicaid |
$472.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$957.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$482.22
|
| Rate for Payer: Molina Healthcare Passport |
$472.76
|
| Rate for Payer: Multiplan PHCS |
$1,185.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,382.50
|
| Rate for Payer: UHCCP Medicaid |
$691.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$477.49
|
|
|
OPEN TRMT HUM CNDYLR FX M/L
|
Facility
|
OP
|
$1,490.00
|
|
|
Service Code
|
HCPCS 24579
|
| Hospital Charge Code |
76100549
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$193.70 |
| Max. Negotiated Rate |
$15,933.60 |
| Rate for Payer: Aetna Commercial |
$1,147.30
|
| Rate for Payer: Anthem Medicaid |
$512.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,381.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,162.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15,933.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$15,364.54
|
| Rate for Payer: Cash Price |
$745.00
|
| Rate for Payer: Cash Price |
$745.00
|
| Rate for Payer: Cigna Commercial |
$1,236.70
|
| Rate for Payer: First Health Commercial |
$1,415.50
|
| Rate for Payer: Humana Commercial |
$1,266.50
|
| Rate for Payer: Humana KY Medicaid |
$512.41
|
| Rate for Payer: Humana Medicare Advantage |
$11,381.14
|
| Rate for Payer: Kentucky WC Medicaid |
$517.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,221.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,099.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13,657.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$522.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,311.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,117.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$298.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$193.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$461.90
|
| Rate for Payer: PHCS Commercial |
$1,430.40
|
| Rate for Payer: United Healthcare All Payer |
$1,311.20
|
|
|
OPEN TRMT HUM CNDYLR FX M/L
|
Professional
|
Both
|
$1,490.00
|
|
|
Service Code
|
HCPCS 24579
|
| Hospital Charge Code |
76100549
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$521.50 |
| Max. Negotiated Rate |
$1,490.00 |
| Rate for Payer: Aetna Commercial |
$1,233.91
|
| Rate for Payer: Anthem Medicaid |
$575.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,490.00
|
| Rate for Payer: Cash Price |
$745.00
|
| Rate for Payer: Cash Price |
$745.00
|
| Rate for Payer: Cigna Commercial |
$1,384.28
|
| Rate for Payer: Healthspan PPO |
$1,117.66
|
| Rate for Payer: Humana Medicaid |
$575.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,033.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$587.19
|
| Rate for Payer: Molina Healthcare Passport |
$575.68
|
| Rate for Payer: Multiplan PHCS |
$894.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,043.00
|
| Rate for Payer: UHCCP Medicaid |
$521.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$581.44
|
|
|
OPEN TRMT HUM CNDYLR FX M/L
|
Facility
|
IP
|
$1,490.00
|
|
|
Service Code
|
HCPCS 24579
|
| Hospital Charge Code |
76100549
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$193.70 |
| Max. Negotiated Rate |
$1,430.40 |
| Rate for Payer: Aetna Commercial |
$1,147.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,162.20
|
| Rate for Payer: Cash Price |
$745.00
|
| Rate for Payer: Cigna Commercial |
$1,236.70
|
| Rate for Payer: First Health Commercial |
$1,415.50
|
| Rate for Payer: Humana Commercial |
$1,266.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,221.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,099.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$447.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,311.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,117.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$298.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$193.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$461.90
|
| Rate for Payer: PHCS Commercial |
$1,430.40
|
| Rate for Payer: United Healthcare All Payer |
$1,311.20
|
|
|
OPEN TRMT HUM CNDYLR FX M/L(P
|
Professional
|
Both
|
$1,490.00
|
|
|
Service Code
|
HCPCS 24579
|
| Hospital Charge Code |
761P0549
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$521.50 |
| Max. Negotiated Rate |
$1,490.00 |
| Rate for Payer: Aetna Commercial |
$1,233.91
|
| Rate for Payer: Anthem Medicaid |
$575.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,490.00
|
| Rate for Payer: Cash Price |
$745.00
|
| Rate for Payer: Cash Price |
$745.00
|
| Rate for Payer: Cigna Commercial |
$1,384.28
|
| Rate for Payer: Healthspan PPO |
$1,117.66
|
| Rate for Payer: Humana Medicaid |
$575.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,033.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$587.19
|
| Rate for Payer: Molina Healthcare Passport |
$575.68
|
| Rate for Payer: Multiplan PHCS |
$894.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,043.00
|
| Rate for Payer: UHCCP Medicaid |
$521.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$581.44
|
|
|
OPEN TRTMENT - METACARPAL -
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 26615
|
| Hospital Charge Code |
76100725
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$302.06 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Aetna Commercial |
$777.52
|
| Rate for Payer: Anthem Medicaid |
$302.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$900.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$700.39
|
| Rate for Payer: Healthspan PPO |
$704.26
|
| Rate for Payer: Humana Medicaid |
$302.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$693.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$308.10
|
| Rate for Payer: Molina Healthcare Passport |
$302.06
|
| Rate for Payer: Multiplan PHCS |
$540.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$630.00
|
| Rate for Payer: UHCCP Medicaid |
$315.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$305.08
|
|
|
OPEN TRTMENT - METACARPAL -
|
Facility
|
IP
|
$900.00
|
|
|
Service Code
|
HCPCS 26615
|
| Hospital Charge Code |
76100725
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$864.00 |
| Rate for Payer: Aetna Commercial |
$693.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$702.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$747.00
|
| Rate for Payer: First Health Commercial |
$855.00
|
| Rate for Payer: Humana Commercial |
$765.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$738.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$664.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$270.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$792.00
|
| Rate for Payer: Ohio Health Group HMO |
$675.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$117.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$279.00
|
| Rate for Payer: PHCS Commercial |
$864.00
|
| Rate for Payer: United Healthcare All Payer |
$792.00
|
|
|
OPEN TRTMENT - METACARPAL -
|
Facility
|
OP
|
$900.00
|
|
|
Service Code
|
HCPCS 26615
|
| Hospital Charge Code |
76100725
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$693.00
|
| Rate for Payer: Anthem Medicaid |
$309.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$702.00
|
| 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 |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$747.00
|
| Rate for Payer: First Health Commercial |
$855.00
|
| Rate for Payer: Humana Commercial |
$765.00
|
| Rate for Payer: Humana KY Medicaid |
$309.51
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$312.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$738.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$664.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$315.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$792.00
|
| Rate for Payer: Ohio Health Group HMO |
$675.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$117.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$279.00
|
| Rate for Payer: PHCS Commercial |
$864.00
|
| Rate for Payer: United Healthcare All Payer |
$792.00
|
|
|
OPEN TRTMENT - METACARPAL -(P
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 26615
|
| Hospital Charge Code |
761P0725
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$302.06 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Aetna Commercial |
$777.52
|
| Rate for Payer: Anthem Medicaid |
$302.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$900.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$700.39
|
| Rate for Payer: Healthspan PPO |
$704.26
|
| Rate for Payer: Humana Medicaid |
$302.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$693.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$308.10
|
| Rate for Payer: Molina Healthcare Passport |
$302.06
|
| Rate for Payer: Multiplan PHCS |
$540.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$630.00
|
| Rate for Payer: UHCCP Medicaid |
$315.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$305.08
|
|
|
OPEN TRTMNT LUNATE DISLOCATION
|
Facility
|
OP
|
$1,300.00
|
|
|
Service Code
|
HCPCS 25695
|
| Hospital Charge Code |
76100646
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$169.00 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$1,001.00
|
| Rate for Payer: Anthem Medicaid |
$447.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,014.00
|
| 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 |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$1,079.00
|
| Rate for Payer: First Health Commercial |
$1,235.00
|
| Rate for Payer: Humana Commercial |
$1,105.00
|
| Rate for Payer: Humana KY Medicaid |
$447.07
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$451.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,066.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$959.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$456.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,144.00
|
| Rate for Payer: Ohio Health Group HMO |
$975.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$169.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$403.00
|
| Rate for Payer: PHCS Commercial |
$1,248.00
|
| Rate for Payer: United Healthcare All Payer |
$1,144.00
|
|
|
OPEN TRTMNT LUNATE DISLOCATION
|
Professional
|
Both
|
$1,300.00
|
|
|
Service Code
|
HCPCS 25695
|
| Hospital Charge Code |
761P0646
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$450.24 |
| Max. Negotiated Rate |
$1,300.00 |
| Rate for Payer: Aetna Commercial |
$920.34
|
| Rate for Payer: Anthem Medicaid |
$450.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,300.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$1,017.32
|
| Rate for Payer: Healthspan PPO |
$833.63
|
| Rate for Payer: Humana Medicaid |
$450.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$781.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$459.24
|
| Rate for Payer: Molina Healthcare Passport |
$450.24
|
| Rate for Payer: Multiplan PHCS |
$780.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$910.00
|
| Rate for Payer: UHCCP Medicaid |
$455.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$454.74
|
|
|
OPEN TRTMNT LUNATE DISLOCATION
|
Professional
|
Both
|
$1,300.00
|
|
|
Service Code
|
HCPCS 25695
|
| Hospital Charge Code |
76100646
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$450.24 |
| Max. Negotiated Rate |
$1,300.00 |
| Rate for Payer: Aetna Commercial |
$920.34
|
| Rate for Payer: Anthem Medicaid |
$450.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,300.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$1,017.32
|
| Rate for Payer: Healthspan PPO |
$833.63
|
| Rate for Payer: Humana Medicaid |
$450.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$781.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$459.24
|
| Rate for Payer: Molina Healthcare Passport |
$450.24
|
| Rate for Payer: Multiplan PHCS |
$780.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$910.00
|
| Rate for Payer: UHCCP Medicaid |
$455.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$454.74
|
|
|
OPEN TRTMNT LUNATE DISLOCATION
|
Facility
|
IP
|
$1,300.00
|
|
|
Service Code
|
HCPCS 25695
|
| Hospital Charge Code |
76100646
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$169.00 |
| Max. Negotiated Rate |
$1,248.00 |
| Rate for Payer: Aetna Commercial |
$1,001.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,014.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$1,079.00
|
| Rate for Payer: First Health Commercial |
$1,235.00
|
| Rate for Payer: Humana Commercial |
$1,105.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,066.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$959.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$390.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,144.00
|
| Rate for Payer: Ohio Health Group HMO |
$975.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$169.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$403.00
|
| Rate for Payer: PHCS Commercial |
$1,248.00
|
| Rate for Payer: United Healthcare All Payer |
$1,144.00
|
|
