|
OPEN TRTMNT RADIAL SHAFT FX
|
Facility
|
OP
|
$1,410.00
|
|
|
Service Code
|
HCPCS 25515
|
| Hospital Charge Code |
76100619
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$183.30 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$1,085.70
|
| Rate for Payer: Anthem Medicaid |
$484.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,099.80
|
| 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 |
$705.00
|
| Rate for Payer: Cash Price |
$705.00
|
| Rate for Payer: Cigna Commercial |
$1,170.30
|
| Rate for Payer: First Health Commercial |
$1,339.50
|
| Rate for Payer: Humana Commercial |
$1,198.50
|
| Rate for Payer: Humana KY Medicaid |
$484.90
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$489.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,156.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,040.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$494.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,240.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,057.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$282.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$183.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$437.10
|
| Rate for Payer: PHCS Commercial |
$1,353.60
|
| Rate for Payer: United Healthcare All Payer |
$1,240.80
|
|
|
OPEN TRTMNT RADIAL SHAFT FX
|
Facility
|
IP
|
$1,410.00
|
|
|
Service Code
|
HCPCS 25515
|
| Hospital Charge Code |
76100619
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$183.30 |
| Max. Negotiated Rate |
$1,353.60 |
| Rate for Payer: Aetna Commercial |
$1,085.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,099.80
|
| Rate for Payer: Cash Price |
$705.00
|
| Rate for Payer: Cigna Commercial |
$1,170.30
|
| Rate for Payer: First Health Commercial |
$1,339.50
|
| Rate for Payer: Humana Commercial |
$1,198.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,156.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,040.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$423.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,240.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,057.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$282.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$183.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$437.10
|
| Rate for Payer: PHCS Commercial |
$1,353.60
|
| Rate for Payer: United Healthcare All Payer |
$1,240.80
|
|
|
OPEN TRTMNT RADIAL SHAFT FX
|
Professional
|
Both
|
$1,410.00
|
|
|
Service Code
|
HCPCS 25515
|
| Hospital Charge Code |
76100619
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$487.53 |
| Max. Negotiated Rate |
$1,410.00 |
| Rate for Payer: Aetna Commercial |
$979.64
|
| Rate for Payer: Anthem Medicaid |
$487.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,410.00
|
| Rate for Payer: Cash Price |
$705.00
|
| Rate for Payer: Cash Price |
$705.00
|
| Rate for Payer: Cigna Commercial |
$1,118.92
|
| Rate for Payer: Healthspan PPO |
$887.34
|
| Rate for Payer: Humana Medicaid |
$487.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$822.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$497.28
|
| Rate for Payer: Molina Healthcare Passport |
$487.53
|
| Rate for Payer: Multiplan PHCS |
$846.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$987.00
|
| Rate for Payer: UHCCP Medicaid |
$493.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$492.41
|
|
|
OPEN TRTMNT RADIAL SHAFT FX(P
|
Professional
|
Both
|
$1,410.00
|
|
|
Service Code
|
HCPCS 25515
|
| Hospital Charge Code |
761P0619
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$487.53 |
| Max. Negotiated Rate |
$1,410.00 |
| Rate for Payer: Aetna Commercial |
$979.64
|
| Rate for Payer: Anthem Medicaid |
$487.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,410.00
|
| Rate for Payer: Cash Price |
$705.00
|
| Rate for Payer: Cash Price |
$705.00
|
| Rate for Payer: Cigna Commercial |
$1,118.92
|
| Rate for Payer: Healthspan PPO |
$887.34
|
| Rate for Payer: Humana Medicaid |
$487.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$822.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$497.28
|
| Rate for Payer: Molina Healthcare Passport |
$487.53
|
| Rate for Payer: Multiplan PHCS |
$846.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$987.00
|
| Rate for Payer: UHCCP Medicaid |
$493.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$492.41
|
|
|
OPEN TX ART FX MCP/IP JNT
|
Facility
|
IP
|
$1,035.00
|
|
|
Service Code
|
HCPCS 26746
|
| Hospital Charge Code |
76100742
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$134.55 |
| Max. Negotiated Rate |
$993.60 |
| Rate for Payer: Aetna Commercial |
$796.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$807.30
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: Cigna Commercial |
$859.05
|
| Rate for Payer: First Health Commercial |
$983.25
|
| Rate for Payer: Humana Commercial |
$879.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$848.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$763.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$310.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$910.80
|
| Rate for Payer: Ohio Health Group HMO |
$776.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$207.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$134.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$320.85
|
| Rate for Payer: PHCS Commercial |
$993.60
|
| Rate for Payer: United Healthcare All Payer |
$910.80
|
|
|
OPEN TX ART FX MCP/IP JNT
|
Professional
|
Both
|
$1,035.00
|
|
|
Service Code
|
HCPCS 26746
|
| Hospital Charge Code |
76100742
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$309.70 |
| Max. Negotiated Rate |
$1,035.00 |
| Rate for Payer: Aetna Commercial |
$989.32
|
| Rate for Payer: Anthem Medicaid |
$309.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,035.00
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: Cigna Commercial |
$747.88
|
| Rate for Payer: Healthspan PPO |
$896.11
|
| Rate for Payer: Humana Medicaid |
$309.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$895.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$315.89
|
| Rate for Payer: Molina Healthcare Passport |
$309.70
|
| Rate for Payer: Multiplan PHCS |
$621.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$724.50
|
| Rate for Payer: UHCCP Medicaid |
$362.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$312.80
|
|
|
OPEN TX ART FX MCP/IP JNT
|
Facility
|
OP
|
$1,035.00
|
|
|
Service Code
|
HCPCS 26746
|
| Hospital Charge Code |
76100742
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$134.55 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$796.95
|
| Rate for Payer: Anthem Medicaid |
$355.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$807.30
|
| 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 |
$517.50
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: Cigna Commercial |
$859.05
|
| Rate for Payer: First Health Commercial |
$983.25
|
| Rate for Payer: Humana Commercial |
$879.75
|
| Rate for Payer: Humana KY Medicaid |
$355.94
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$359.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$848.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$763.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$363.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$910.80
|
| Rate for Payer: Ohio Health Group HMO |
$776.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$207.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$134.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$320.85
|
| Rate for Payer: PHCS Commercial |
$993.60
|
| Rate for Payer: United Healthcare All Payer |
$910.80
|
|
|
OPEN TX ART FX MCP/IP JNT(P
|
Professional
|
Both
|
$1,035.00
|
|
|
Service Code
|
HCPCS 26746
|
| Hospital Charge Code |
761P0742
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$309.70 |
| Max. Negotiated Rate |
$1,035.00 |
| Rate for Payer: Aetna Commercial |
$989.32
|
| Rate for Payer: Anthem Medicaid |
$309.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,035.00
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: Cigna Commercial |
$747.88
|
| Rate for Payer: Healthspan PPO |
$896.11
|
| Rate for Payer: Humana Medicaid |
$309.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$895.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$315.89
|
| Rate for Payer: Molina Healthcare Passport |
$309.70
|
| Rate for Payer: Multiplan PHCS |
$621.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$724.50
|
| Rate for Payer: UHCCP Medicaid |
$362.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$312.80
|
|
|
OPEN TX BIMALLEOLAR ANKLE FX
|
Facility
|
OP
|
$1,700.00
|
|
|
Service Code
|
HCPCS 27814
|
| Hospital Charge Code |
76100941
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.00 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$1,309.00
|
| Rate for Payer: Anthem Medicaid |
$584.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,326.00
|
| 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 |
$850.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,411.00
|
| Rate for Payer: First Health Commercial |
$1,615.00
|
| Rate for Payer: Humana Commercial |
$1,445.00
|
| Rate for Payer: Humana KY Medicaid |
$584.63
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$590.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,394.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,254.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$596.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$527.00
|
| Rate for Payer: PHCS Commercial |
$1,632.00
|
| Rate for Payer: United Healthcare All Payer |
$1,496.00
|
|
|
OPEN TX BIMALLEOLAR ANKLE FX
|
Professional
|
Both
|
$1,700.00
|
|
|
Service Code
|
HCPCS 27814
|
| Hospital Charge Code |
76100941
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$595.00 |
| Max. Negotiated Rate |
$1,700.00 |
| Rate for Payer: Aetna Commercial |
$1,150.48
|
| Rate for Payer: Anthem Medicaid |
$596.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,700.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,299.52
|
| Rate for Payer: Healthspan PPO |
$1,042.09
|
| Rate for Payer: Humana Medicaid |
$596.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$961.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$608.65
|
| Rate for Payer: Molina Healthcare Passport |
$596.72
|
| Rate for Payer: Multiplan PHCS |
$1,020.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,190.00
|
| Rate for Payer: UHCCP Medicaid |
$595.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$602.69
|
|
|
OPEN TX BIMALLEOLAR ANKLE FX
|
Facility
|
IP
|
$1,700.00
|
|
|
Service Code
|
HCPCS 27814
|
| Hospital Charge Code |
76100941
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.00 |
| Max. Negotiated Rate |
$1,632.00 |
| Rate for Payer: Aetna Commercial |
$1,309.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,326.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,411.00
|
| Rate for Payer: First Health Commercial |
$1,615.00
|
| Rate for Payer: Humana Commercial |
$1,445.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,394.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,254.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$527.00
|
| Rate for Payer: PHCS Commercial |
$1,632.00
|
| Rate for Payer: United Healthcare All Payer |
$1,496.00
|
|
|
OPEN TX BIMALLEOLAR ANKLE FX(P
|
Professional
|
Both
|
$1,700.00
|
|
|
Service Code
|
HCPCS 27814
|
| Hospital Charge Code |
761P0941
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$595.00 |
| Max. Negotiated Rate |
$1,700.00 |
| Rate for Payer: Aetna Commercial |
$1,150.48
|
| Rate for Payer: Anthem Medicaid |
$596.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,700.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,299.52
|
| Rate for Payer: Healthspan PPO |
$1,042.09
|
| Rate for Payer: Humana Medicaid |
$596.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$961.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$608.65
|
| Rate for Payer: Molina Healthcare Passport |
$596.72
|
| Rate for Payer: Multiplan PHCS |
$1,020.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,190.00
|
| Rate for Payer: UHCCP Medicaid |
$595.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$602.69
|
|
|
OPEN TX DIS FIB FX LAT MALL
|
Professional
|
Both
|
$1,280.00
|
|
|
Service Code
|
HCPCS 27792
|
| Hospital Charge Code |
76100938
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$432.95 |
| Max. Negotiated Rate |
$1,280.00 |
| Rate for Payer: Aetna Commercial |
$1,018.86
|
| Rate for Payer: Anthem Medicaid |
$432.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,280.00
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cigna Commercial |
$977.36
|
| Rate for Payer: Healthspan PPO |
$922.87
|
| Rate for Payer: Humana Medicaid |
$432.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$880.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$441.61
|
| Rate for Payer: Molina Healthcare Passport |
$432.95
|
| Rate for Payer: Multiplan PHCS |
$768.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$896.00
|
| Rate for Payer: UHCCP Medicaid |
$448.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$437.28
|
|
|
OPEN TX DIS FIB FX LAT MALL
|
Facility
|
OP
|
$1,280.00
|
|
|
Service Code
|
HCPCS 27792
|
| Hospital Charge Code |
76100938
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$166.40 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$985.60
|
| Rate for Payer: Anthem Medicaid |
$440.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$998.40
|
| 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 |
$640.00
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cigna Commercial |
$1,062.40
|
| Rate for Payer: First Health Commercial |
$1,216.00
|
| Rate for Payer: Humana Commercial |
$1,088.00
|
| Rate for Payer: Humana KY Medicaid |
$440.19
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$444.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,049.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$944.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$449.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,126.40
|
| Rate for Payer: Ohio Health Group HMO |
$960.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$256.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$166.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$396.80
|
| Rate for Payer: PHCS Commercial |
$1,228.80
|
| Rate for Payer: United Healthcare All Payer |
$1,126.40
|
|
|
OPEN TX DIS FIB FX LAT MALL
|
Facility
|
IP
|
$1,280.00
|
|
|
Service Code
|
HCPCS 27792
|
| Hospital Charge Code |
76100938
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$166.40 |
| Max. Negotiated Rate |
$1,228.80 |
| Rate for Payer: Aetna Commercial |
$985.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$998.40
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cigna Commercial |
$1,062.40
|
| Rate for Payer: First Health Commercial |
$1,216.00
|
| Rate for Payer: Humana Commercial |
$1,088.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,049.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$944.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$384.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,126.40
|
| Rate for Payer: Ohio Health Group HMO |
$960.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$256.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$166.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$396.80
|
| Rate for Payer: PHCS Commercial |
$1,228.80
|
| Rate for Payer: United Healthcare All Payer |
$1,126.40
|
|
|
OPEN TX DIS FIB FX LAT MALL(P
|
Professional
|
Both
|
$1,280.00
|
|
|
Service Code
|
HCPCS 27792
|
| Hospital Charge Code |
761P0938
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$432.95 |
| Max. Negotiated Rate |
$1,280.00 |
| Rate for Payer: Aetna Commercial |
$1,018.86
|
| Rate for Payer: Anthem Medicaid |
$432.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,280.00
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cigna Commercial |
$977.36
|
| Rate for Payer: Healthspan PPO |
$922.87
|
| Rate for Payer: Humana Medicaid |
$432.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$880.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$441.61
|
| Rate for Payer: Molina Healthcare Passport |
$432.95
|
| Rate for Payer: Multiplan PHCS |
$768.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$896.00
|
| Rate for Payer: UHCCP Medicaid |
$448.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$437.28
|
|
|
OPEN TX FEM FX DIS M/L CONDYLE
|
Facility
|
OP
|
$2,975.00
|
|
|
Service Code
|
HCPCS 27514
|
| Hospital Charge Code |
76100865
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$386.75 |
| Max. Negotiated Rate |
$2,856.00 |
| Rate for Payer: Aetna Commercial |
$2,290.75
|
| Rate for Payer: Anthem Medicaid |
$1,023.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,320.50
|
| Rate for Payer: Cash Price |
$1,487.50
|
| Rate for Payer: Cigna Commercial |
$2,469.25
|
| Rate for Payer: First Health Commercial |
$2,826.25
|
| Rate for Payer: Humana Commercial |
$2,528.75
|
| Rate for Payer: Humana KY Medicaid |
$1,023.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,033.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,439.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,195.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$892.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,043.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,618.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,231.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$595.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$386.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$922.25
|
| Rate for Payer: PHCS Commercial |
$2,856.00
|
| Rate for Payer: United Healthcare All Payer |
$2,618.00
|
|
|
OPEN TX FEM FX DIS M/L CONDYLE
|
Professional
|
Both
|
$2,975.00
|
|
|
Service Code
|
HCPCS 27514
|
| Hospital Charge Code |
761P0865
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$953.10 |
| Max. Negotiated Rate |
$2,975.00 |
| Rate for Payer: Aetna Commercial |
$1,560.09
|
| Rate for Payer: Anthem Medicaid |
$953.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,975.00
|
| Rate for Payer: Cash Price |
$1,487.50
|
| Rate for Payer: Cash Price |
$1,487.50
|
| Rate for Payer: Cigna Commercial |
$2,150.38
|
| Rate for Payer: Healthspan PPO |
$1,413.11
|
| Rate for Payer: Humana Medicaid |
$953.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,242.59
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$972.16
|
| Rate for Payer: Molina Healthcare Passport |
$953.10
|
| Rate for Payer: Multiplan PHCS |
$1,785.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,082.50
|
| Rate for Payer: UHCCP Medicaid |
$1,041.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$962.63
|
|
|
OPEN TX FEM FX DIS M/L CONDYLE
|
Professional
|
Both
|
$2,975.00
|
|
|
Service Code
|
HCPCS 27514
|
| Hospital Charge Code |
76100865
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$953.10 |
| Max. Negotiated Rate |
$2,975.00 |
| Rate for Payer: Aetna Commercial |
$1,560.09
|
| Rate for Payer: Anthem Medicaid |
$953.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,975.00
|
| Rate for Payer: Cash Price |
$1,487.50
|
| Rate for Payer: Cash Price |
$1,487.50
|
| Rate for Payer: Cigna Commercial |
$2,150.38
|
| Rate for Payer: Healthspan PPO |
$1,413.11
|
| Rate for Payer: Humana Medicaid |
$953.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,242.59
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$972.16
|
| Rate for Payer: Molina Healthcare Passport |
$953.10
|
| Rate for Payer: Multiplan PHCS |
$1,785.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,082.50
|
| Rate for Payer: UHCCP Medicaid |
$1,041.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$962.63
|
|
|
OPEN TX FEM FX DIS M/L CONDYLE
|
Facility
|
IP
|
$2,975.00
|
|
|
Service Code
|
HCPCS 27514
|
| Hospital Charge Code |
76100865
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$386.75 |
| Max. Negotiated Rate |
$2,856.00 |
| Rate for Payer: Aetna Commercial |
$2,290.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,320.50
|
| Rate for Payer: Cash Price |
$1,487.50
|
| Rate for Payer: Cigna Commercial |
$2,469.25
|
| Rate for Payer: First Health Commercial |
$2,826.25
|
| Rate for Payer: Humana Commercial |
$2,528.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,439.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,195.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$892.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,618.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,231.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$595.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$386.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$922.25
|
| Rate for Payer: PHCS Commercial |
$2,856.00
|
| Rate for Payer: United Healthcare All Payer |
$2,618.00
|
|
|
OPEN TX FEM SUPRACONDYLR FX
|
Facility
|
OP
|
$2,825.00
|
|
|
Service Code
|
HCPCS 27513
|
| Hospital Charge Code |
76100864
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$367.25 |
| Max. Negotiated Rate |
$2,712.00 |
| Rate for Payer: Aetna Commercial |
$2,175.25
|
| Rate for Payer: Anthem Medicaid |
$971.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,203.50
|
| Rate for Payer: Cash Price |
$1,412.50
|
| Rate for Payer: Cigna Commercial |
$2,344.75
|
| Rate for Payer: First Health Commercial |
$2,683.75
|
| Rate for Payer: Humana Commercial |
$2,401.25
|
| Rate for Payer: Humana KY Medicaid |
$971.52
|
| Rate for Payer: Kentucky WC Medicaid |
$981.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,316.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,084.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$847.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$991.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,486.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,118.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$565.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$367.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$875.75
|
| Rate for Payer: PHCS Commercial |
$2,712.00
|
| Rate for Payer: United Healthcare All Payer |
$2,486.00
|
|
|
OPEN TX FEM SUPRACONDYLR FX
|
Facility
|
IP
|
$2,825.00
|
|
|
Service Code
|
HCPCS 27513
|
| Hospital Charge Code |
76100864
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$367.25 |
| Max. Negotiated Rate |
$2,712.00 |
| Rate for Payer: Aetna Commercial |
$2,175.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,203.50
|
| Rate for Payer: Cash Price |
$1,412.50
|
| Rate for Payer: Cigna Commercial |
$2,344.75
|
| Rate for Payer: First Health Commercial |
$2,683.75
|
| Rate for Payer: Humana Commercial |
$2,401.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,316.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,084.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$847.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,486.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,118.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$565.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$367.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$875.75
|
| Rate for Payer: PHCS Commercial |
$2,712.00
|
| Rate for Payer: United Healthcare All Payer |
$2,486.00
|
|
|
OPEN TX FEM SUPRACONDYLR FX
|
Professional
|
Both
|
$2,825.00
|
|
|
Service Code
|
HCPCS 27513
|
| Hospital Charge Code |
76100864
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$984.28 |
| Max. Negotiated Rate |
$2,825.00 |
| Rate for Payer: Aetna Commercial |
$1,924.34
|
| Rate for Payer: Anthem Medicaid |
$984.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,825.00
|
| Rate for Payer: Cash Price |
$1,412.50
|
| Rate for Payer: Cash Price |
$1,412.50
|
| Rate for Payer: Cigna Commercial |
$2,201.86
|
| Rate for Payer: Healthspan PPO |
$1,743.04
|
| Rate for Payer: Humana Medicaid |
$984.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,585.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,003.97
|
| Rate for Payer: Molina Healthcare Passport |
$984.28
|
| Rate for Payer: Multiplan PHCS |
$1,695.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,977.50
|
| Rate for Payer: UHCCP Medicaid |
$988.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$994.12
|
|
|
OPEN TX FEM SUPRACONDYLR FX(P
|
Professional
|
Both
|
$2,825.00
|
|
|
Service Code
|
HCPCS 27513
|
| Hospital Charge Code |
761P0864
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$984.28 |
| Max. Negotiated Rate |
$2,825.00 |
| Rate for Payer: Aetna Commercial |
$1,924.34
|
| Rate for Payer: Anthem Medicaid |
$984.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,825.00
|
| Rate for Payer: Cash Price |
$1,412.50
|
| Rate for Payer: Cash Price |
$1,412.50
|
| Rate for Payer: Cigna Commercial |
$2,201.86
|
| Rate for Payer: Healthspan PPO |
$1,743.04
|
| Rate for Payer: Humana Medicaid |
$984.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,585.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,003.97
|
| Rate for Payer: Molina Healthcare Passport |
$984.28
|
| Rate for Payer: Multiplan PHCS |
$1,695.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,977.50
|
| Rate for Payer: UHCCP Medicaid |
$988.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$994.12
|
|
|
OPEN TX FX DIS TIB
|
Professional
|
Both
|
$2,550.00
|
|
|
Service Code
|
HCPCS 27827
|
| Hospital Charge Code |
76100949
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$650.27 |
| Max. Negotiated Rate |
$2,550.00 |
| Rate for Payer: Aetna Commercial |
$1,605.61
|
| Rate for Payer: Anthem Medicaid |
$650.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,550.00
|
| Rate for Payer: Cash Price |
$1,275.00
|
| Rate for Payer: Cash Price |
$1,275.00
|
| Rate for Payer: Cigna Commercial |
$1,867.50
|
| Rate for Payer: Healthspan PPO |
$1,454.34
|
| Rate for Payer: Humana Medicaid |
$650.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,353.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$663.28
|
| Rate for Payer: Molina Healthcare Passport |
$650.27
|
| Rate for Payer: Multiplan PHCS |
$1,530.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,785.00
|
| Rate for Payer: UHCCP Medicaid |
$892.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$656.77
|
|
