|
OPEN TX HUMRL SUPR/TRNSCDLR FX
|
Facility
|
IP
|
$1,245.00
|
|
|
Service Code
|
HCPCS 24546
|
| Hospital Charge Code |
76100540
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$161.85 |
| Max. Negotiated Rate |
$1,195.20 |
| Rate for Payer: Aetna Commercial |
$958.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$971.10
|
| Rate for Payer: Cash Price |
$622.50
|
| Rate for Payer: Cigna Commercial |
$1,033.35
|
| Rate for Payer: First Health Commercial |
$1,182.75
|
| Rate for Payer: Humana Commercial |
$1,058.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,020.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$918.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$373.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,095.60
|
| Rate for Payer: Ohio Health Group HMO |
$933.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$249.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$161.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$385.95
|
| Rate for Payer: PHCS Commercial |
$1,195.20
|
| Rate for Payer: United Healthcare All Payer |
$1,095.60
|
|
|
OPEN TX HUMRL SUPR/TRNSCDLR FX
|
Professional
|
Both
|
$1,245.00
|
|
|
Service Code
|
HCPCS 24546
|
| Hospital Charge Code |
76100540
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$435.75 |
| Max. Negotiated Rate |
$1,813.48 |
| Rate for Payer: Aetna Commercial |
$1,576.28
|
| Rate for Payer: Anthem Medicaid |
$736.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,245.00
|
| Rate for Payer: Cash Price |
$622.50
|
| Rate for Payer: Cash Price |
$622.50
|
| Rate for Payer: Cigna Commercial |
$1,813.48
|
| Rate for Payer: Healthspan PPO |
$1,427.77
|
| Rate for Payer: Humana Medicaid |
$736.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,301.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$750.95
|
| Rate for Payer: Molina Healthcare Passport |
$736.23
|
| Rate for Payer: Multiplan PHCS |
$747.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$871.50
|
| Rate for Payer: UHCCP Medicaid |
$435.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$743.59
|
|
|
OPENTX INTCONDYLAR SPINE/TUBRS
|
Facility
|
IP
|
$2,100.00
|
|
|
Service Code
|
HCPCS 27540
|
| Hospital Charge Code |
76100873
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$273.00 |
| Max. Negotiated Rate |
$2,016.00 |
| Rate for Payer: Aetna Commercial |
$1,617.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,638.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,743.00
|
| Rate for Payer: First Health Commercial |
$1,995.00
|
| Rate for Payer: Humana Commercial |
$1,785.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,722.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,549.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,848.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$651.00
|
| Rate for Payer: PHCS Commercial |
$2,016.00
|
| Rate for Payer: United Healthcare All Payer |
$1,848.00
|
|
|
OPENTX INTCONDYLAR SPINE/TUBRS
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 27540
|
| Hospital Charge Code |
761P0873
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$699.25 |
| Max. Negotiated Rate |
$2,100.00 |
| Rate for Payer: Aetna Commercial |
$1,243.24
|
| Rate for Payer: Anthem Medicaid |
$699.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,100.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,524.00
|
| Rate for Payer: Healthspan PPO |
$1,126.11
|
| Rate for Payer: Humana Medicaid |
$699.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,017.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$713.24
|
| Rate for Payer: Molina Healthcare Passport |
$699.25
|
| Rate for Payer: Multiplan PHCS |
$1,260.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,470.00
|
| Rate for Payer: UHCCP Medicaid |
$735.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$706.24
|
|
|
OPENTX INTCONDYLAR SPINE/TUBRS
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 27540
|
| Hospital Charge Code |
76100873
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$699.25 |
| Max. Negotiated Rate |
$2,100.00 |
| Rate for Payer: Aetna Commercial |
$1,243.24
|
| Rate for Payer: Anthem Medicaid |
$699.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,100.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,524.00
|
| Rate for Payer: Healthspan PPO |
$1,126.11
|
| Rate for Payer: Humana Medicaid |
$699.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,017.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$713.24
|
| Rate for Payer: Molina Healthcare Passport |
$699.25
|
| Rate for Payer: Multiplan PHCS |
$1,260.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,470.00
|
| Rate for Payer: UHCCP Medicaid |
$735.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$706.24
|
|
|
OPENTX INTCONDYLAR SPINE/TUBRS
|
Facility
|
OP
|
$2,100.00
|
|
|
Service Code
|
HCPCS 27540
|
| Hospital Charge Code |
76100873
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$273.00 |
| Max. Negotiated Rate |
$2,016.00 |
| Rate for Payer: Aetna Commercial |
$1,617.00
|
| Rate for Payer: Anthem Medicaid |
$722.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,638.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,743.00
|
| Rate for Payer: First Health Commercial |
$1,995.00
|
| Rate for Payer: Humana Commercial |
$1,785.00
|
| Rate for Payer: Humana KY Medicaid |
$722.19
|
| Rate for Payer: Kentucky WC Medicaid |
$729.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,722.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,549.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$736.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,848.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$651.00
|
| Rate for Payer: PHCS Commercial |
$2,016.00
|
| Rate for Payer: United Healthcare All Payer |
$1,848.00
|
|
|
OPEN TX MONTEGGIA FX DIS ELB
|
Facility
|
OP
|
$1,965.00
|
|
|
Service Code
|
HCPCS 24635
|
| Hospital Charge Code |
76100555
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$255.45 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$1,513.05
|
| Rate for Payer: Anthem Medicaid |
$675.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,532.70
|
| 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 |
$982.50
|
| Rate for Payer: Cash Price |
$982.50
|
| Rate for Payer: Cigna Commercial |
$1,630.95
|
| Rate for Payer: First Health Commercial |
$1,866.75
|
| Rate for Payer: Humana Commercial |
$1,670.25
|
| Rate for Payer: Humana KY Medicaid |
$675.76
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$682.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,611.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,450.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$689.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,729.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,473.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$393.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$255.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$609.15
|
| Rate for Payer: PHCS Commercial |
$1,886.40
|
| Rate for Payer: United Healthcare All Payer |
$1,729.20
|
|
|
OPEN TX MONTEGGIA FX DIS ELB
|
Professional
|
Both
|
$1,965.00
|
|
|
Service Code
|
HCPCS 24635
|
| Hospital Charge Code |
76100555
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$687.75 |
| Max. Negotiated Rate |
$1,965.00 |
| Rate for Payer: Aetna Commercial |
$1,120.94
|
| Rate for Payer: Anthem Medicaid |
$704.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,965.00
|
| Rate for Payer: Cash Price |
$982.50
|
| Rate for Payer: Cash Price |
$982.50
|
| Rate for Payer: Cigna Commercial |
$1,777.55
|
| Rate for Payer: Healthspan PPO |
$1,015.33
|
| Rate for Payer: Humana Medicaid |
$704.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$866.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$718.44
|
| Rate for Payer: Molina Healthcare Passport |
$704.35
|
| Rate for Payer: Multiplan PHCS |
$1,179.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,375.50
|
| Rate for Payer: UHCCP Medicaid |
$687.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$711.39
|
|
|
OPEN TX MONTEGGIA FX DIS ELB
|
Facility
|
IP
|
$1,965.00
|
|
|
Service Code
|
HCPCS 24635
|
| Hospital Charge Code |
76100555
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$255.45 |
| Max. Negotiated Rate |
$1,886.40 |
| Rate for Payer: Aetna Commercial |
$1,513.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,532.70
|
| Rate for Payer: Cash Price |
$982.50
|
| Rate for Payer: Cigna Commercial |
$1,630.95
|
| Rate for Payer: First Health Commercial |
$1,866.75
|
| Rate for Payer: Humana Commercial |
$1,670.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,611.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,450.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$589.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,729.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,473.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$393.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$255.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$609.15
|
| Rate for Payer: PHCS Commercial |
$1,886.40
|
| Rate for Payer: United Healthcare All Payer |
$1,729.20
|
|
|
OPEN TX MONTEGGIA FX DIS ELB(P
|
Professional
|
Both
|
$1,965.00
|
|
|
Service Code
|
HCPCS 24635
|
| Hospital Charge Code |
761P0555
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$687.75 |
| Max. Negotiated Rate |
$1,965.00 |
| Rate for Payer: Aetna Commercial |
$1,120.94
|
| Rate for Payer: Anthem Medicaid |
$704.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,965.00
|
| Rate for Payer: Cash Price |
$982.50
|
| Rate for Payer: Cash Price |
$982.50
|
| Rate for Payer: Cigna Commercial |
$1,777.55
|
| Rate for Payer: Healthspan PPO |
$1,015.33
|
| Rate for Payer: Humana Medicaid |
$704.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$866.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$718.44
|
| Rate for Payer: Molina Healthcare Passport |
$704.35
|
| Rate for Payer: Multiplan PHCS |
$1,179.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,375.50
|
| Rate for Payer: UHCCP Medicaid |
$687.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$711.39
|
|
|
OPEN TX NOSE FX UNCOMPLICATD
|
Professional
|
Both
|
$5,977.00
|
|
|
Service Code
|
HCPCS 21325
|
| Hospital Charge Code |
76100381
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$225.63 |
| Max. Negotiated Rate |
$5,977.00 |
| Rate for Payer: Aetna Commercial |
$647.21
|
| Rate for Payer: Anthem Medicaid |
$225.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,977.00
|
| Rate for Payer: Cash Price |
$2,988.50
|
| Rate for Payer: Cash Price |
$2,988.50
|
| Rate for Payer: Cigna Commercial |
$772.79
|
| Rate for Payer: Healthspan PPO |
$586.24
|
| Rate for Payer: Humana Medicaid |
$225.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$579.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$230.14
|
| Rate for Payer: Molina Healthcare Passport |
$225.63
|
| Rate for Payer: Multiplan PHCS |
$3,586.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,183.90
|
| Rate for Payer: UHCCP Medicaid |
$2,091.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$227.89
|
|
|
OPEN TX NOSE FX UNCOMPLICATD
|
Facility
|
IP
|
$5,977.00
|
|
|
Service Code
|
HCPCS 21325
|
| Hospital Charge Code |
76100381
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$777.01 |
| Max. Negotiated Rate |
$5,737.92 |
| Rate for Payer: Aetna Commercial |
$4,602.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,662.06
|
| Rate for Payer: Cash Price |
$2,988.50
|
| Rate for Payer: Cigna Commercial |
$4,960.91
|
| Rate for Payer: First Health Commercial |
$5,678.15
|
| Rate for Payer: Humana Commercial |
$5,080.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,901.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,411.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,793.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,259.76
|
| Rate for Payer: Ohio Health Group HMO |
$4,482.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,195.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$777.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,852.87
|
| Rate for Payer: PHCS Commercial |
$5,737.92
|
| Rate for Payer: United Healthcare All Payer |
$5,259.76
|
|
|
OPEN TX NOSE FX UNCOMPLICATD
|
Facility
|
OP
|
$5,977.00
|
|
|
Service Code
|
HCPCS 21325
|
| Hospital Charge Code |
76100381
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$777.01 |
| Max. Negotiated Rate |
$5,737.92 |
| Rate for Payer: Aetna Commercial |
$4,602.29
|
| Rate for Payer: Anthem Medicaid |
$2,055.49
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,662.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,897.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,758.63
|
| Rate for Payer: Cash Price |
$2,988.50
|
| Rate for Payer: Cash Price |
$2,988.50
|
| Rate for Payer: Cigna Commercial |
$4,960.91
|
| Rate for Payer: First Health Commercial |
$5,678.15
|
| Rate for Payer: Humana Commercial |
$5,080.45
|
| Rate for Payer: Humana KY Medicaid |
$2,055.49
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Kentucky WC Medicaid |
$2,076.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,901.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,411.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,096.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,259.76
|
| Rate for Payer: Ohio Health Group HMO |
$4,482.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,195.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$777.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,852.87
|
| Rate for Payer: PHCS Commercial |
$5,737.92
|
| Rate for Payer: United Healthcare All Payer |
$5,259.76
|
|
|
OPEN TX NOSE FX UNCOMPLICAT(P
|
Professional
|
Both
|
$675.00
|
|
|
Service Code
|
HCPCS 21325
|
| Hospital Charge Code |
761P0381
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$225.63 |
| Max. Negotiated Rate |
$772.79 |
| Rate for Payer: Aetna Commercial |
$647.21
|
| Rate for Payer: Anthem Medicaid |
$225.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$675.00
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cigna Commercial |
$772.79
|
| Rate for Payer: Healthspan PPO |
$586.24
|
| Rate for Payer: Humana Medicaid |
$225.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$579.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$230.14
|
| Rate for Payer: Molina Healthcare Passport |
$225.63
|
| Rate for Payer: Multiplan PHCS |
$405.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$472.50
|
| Rate for Payer: UHCCP Medicaid |
$236.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$227.89
|
|
|
OPEN TX NOSE FX UNCOMPLICAT(T
|
Facility
|
OP
|
$5,302.00
|
|
|
Service Code
|
HCPCS 21325
|
| Hospital Charge Code |
761T0381
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$689.26 |
| Max. Negotiated Rate |
$5,089.92 |
| Rate for Payer: Aetna Commercial |
$4,082.54
|
| Rate for Payer: Anthem Medicaid |
$1,823.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,135.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,897.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,758.63
|
| Rate for Payer: Cash Price |
$2,651.00
|
| Rate for Payer: Cash Price |
$2,651.00
|
| Rate for Payer: Cigna Commercial |
$4,400.66
|
| Rate for Payer: First Health Commercial |
$5,036.90
|
| Rate for Payer: Humana Commercial |
$4,506.70
|
| Rate for Payer: Humana KY Medicaid |
$1,823.36
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,841.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,347.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,912.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,859.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,665.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,976.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,060.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$689.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,643.62
|
| Rate for Payer: PHCS Commercial |
$5,089.92
|
| Rate for Payer: United Healthcare All Payer |
$4,665.76
|
|
|
OPEN TX NOSE FX UNCOMPLICAT(T
|
Facility
|
IP
|
$5,302.00
|
|
|
Service Code
|
HCPCS 21325
|
| Hospital Charge Code |
761T0381
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$689.26 |
| Max. Negotiated Rate |
$5,089.92 |
| Rate for Payer: Aetna Commercial |
$4,082.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,135.56
|
| Rate for Payer: Cash Price |
$2,651.00
|
| Rate for Payer: Cigna Commercial |
$4,400.66
|
| Rate for Payer: First Health Commercial |
$5,036.90
|
| Rate for Payer: Humana Commercial |
$4,506.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,347.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,912.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,590.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,665.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,976.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,060.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$689.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,643.62
|
| Rate for Payer: PHCS Commercial |
$5,089.92
|
| Rate for Payer: United Healthcare All Payer |
$4,665.76
|
|
|
OPEN TX NOSE FX W/SKELE FIXJ
|
Facility
|
IP
|
$9,081.50
|
|
|
Service Code
|
HCPCS 21330
|
| Hospital Charge Code |
76100382
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,180.60 |
| Max. Negotiated Rate |
$8,718.24 |
| Rate for Payer: Aetna Commercial |
$6,992.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,083.57
|
| Rate for Payer: Cash Price |
$4,540.75
|
| Rate for Payer: Cigna Commercial |
$7,537.64
|
| Rate for Payer: First Health Commercial |
$8,627.42
|
| Rate for Payer: Humana Commercial |
$7,719.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,446.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,702.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,724.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,991.72
|
| Rate for Payer: Ohio Health Group HMO |
$6,811.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,816.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,180.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,815.26
|
| Rate for Payer: PHCS Commercial |
$8,718.24
|
| Rate for Payer: United Healthcare All Payer |
$7,991.72
|
|
|
OPEN TX NOSE FX W/SKELE FIXJ
|
Professional
|
Both
|
$9,081.50
|
|
|
Service Code
|
HCPCS 21330
|
| Hospital Charge Code |
76100382
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$341.50 |
| Max. Negotiated Rate |
$9,081.50 |
| Rate for Payer: Aetna Commercial |
$802.36
|
| Rate for Payer: Anthem Medicaid |
$341.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$9,081.50
|
| Rate for Payer: Cash Price |
$4,540.75
|
| Rate for Payer: Cash Price |
$4,540.75
|
| Rate for Payer: Cigna Commercial |
$947.91
|
| Rate for Payer: Healthspan PPO |
$726.77
|
| Rate for Payer: Humana Medicaid |
$341.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$699.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$348.33
|
| Rate for Payer: Molina Healthcare Passport |
$341.50
|
| Rate for Payer: Multiplan PHCS |
$5,448.90
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$6,357.05
|
| Rate for Payer: UHCCP Medicaid |
$3,178.52
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$344.92
|
|
|
OPEN TX NOSE FX W/SKELE FIXJ
|
Facility
|
OP
|
$9,081.50
|
|
|
Service Code
|
HCPCS 21330
|
| Hospital Charge Code |
76100382
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,180.60 |
| Max. Negotiated Rate |
$8,718.24 |
| Rate for Payer: Aetna Commercial |
$6,992.76
|
| Rate for Payer: Anthem Medicaid |
$3,123.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,064.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,083.57
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,089.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,836.59
|
| Rate for Payer: Cash Price |
$4,540.75
|
| Rate for Payer: Cash Price |
$4,540.75
|
| Rate for Payer: Cigna Commercial |
$7,537.64
|
| Rate for Payer: First Health Commercial |
$8,627.42
|
| Rate for Payer: Humana Commercial |
$7,719.28
|
| Rate for Payer: Humana KY Medicaid |
$3,123.13
|
| Rate for Payer: Humana Medicare Advantage |
$5,064.14
|
| Rate for Payer: Kentucky WC Medicaid |
$3,154.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,446.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,702.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,076.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,185.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,991.72
|
| Rate for Payer: Ohio Health Group HMO |
$6,811.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,816.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,180.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,815.26
|
| Rate for Payer: PHCS Commercial |
$8,718.24
|
| Rate for Payer: United Healthcare All Payer |
$7,991.72
|
|
|
OPEN TX NOSE FX W/SKELE FIX(P
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 21330
|
| Hospital Charge Code |
761P0382
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$341.50 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Aetna Commercial |
$802.36
|
| Rate for Payer: Anthem Medicaid |
$341.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,400.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$947.91
|
| Rate for Payer: Healthspan PPO |
$726.77
|
| Rate for Payer: Humana Medicaid |
$341.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$699.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$348.33
|
| Rate for Payer: Molina Healthcare Passport |
$341.50
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$980.00
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$344.92
|
|
|
OPEN TX NOSE FX W/SKELE FIX(T
|
Facility
|
OP
|
$7,681.50
|
|
|
Service Code
|
HCPCS 21330
|
| Hospital Charge Code |
761T0382
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$998.60 |
| Max. Negotiated Rate |
$7,374.24 |
| Rate for Payer: Aetna Commercial |
$5,914.76
|
| Rate for Payer: Anthem Medicaid |
$2,641.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,064.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,991.57
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,089.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,836.59
|
| Rate for Payer: Cash Price |
$3,840.75
|
| Rate for Payer: Cash Price |
$3,840.75
|
| Rate for Payer: Cigna Commercial |
$6,375.64
|
| Rate for Payer: First Health Commercial |
$7,297.42
|
| Rate for Payer: Humana Commercial |
$6,529.28
|
| Rate for Payer: Humana KY Medicaid |
$2,641.67
|
| Rate for Payer: Humana Medicare Advantage |
$5,064.14
|
| Rate for Payer: Kentucky WC Medicaid |
$2,668.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,298.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,668.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,076.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,694.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,759.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,761.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,536.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$998.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,381.26
|
| Rate for Payer: PHCS Commercial |
$7,374.24
|
| Rate for Payer: United Healthcare All Payer |
$6,759.72
|
|
|
OPEN TX NOSE FX W/SKELE FIX(T
|
Facility
|
IP
|
$7,681.50
|
|
|
Service Code
|
HCPCS 21330
|
| Hospital Charge Code |
761T0382
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$998.60 |
| Max. Negotiated Rate |
$7,374.24 |
| Rate for Payer: Aetna Commercial |
$5,914.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,991.57
|
| Rate for Payer: Cash Price |
$3,840.75
|
| Rate for Payer: Cigna Commercial |
$6,375.64
|
| Rate for Payer: First Health Commercial |
$7,297.42
|
| Rate for Payer: Humana Commercial |
$6,529.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,298.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,668.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,304.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,759.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,761.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,536.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$998.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,381.26
|
| Rate for Payer: PHCS Commercial |
$7,374.24
|
| Rate for Payer: United Healthcare All Payer |
$6,759.72
|
|
|
OPEN TX NOSE & SEPTAL FX
|
Professional
|
Both
|
$8,536.00
|
|
|
Service Code
|
HCPCS 21335
|
| Hospital Charge Code |
76100383
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$550.66 |
| Max. Negotiated Rate |
$8,536.00 |
| Rate for Payer: Aetna Commercial |
$1,041.80
|
| Rate for Payer: Anthem Medicaid |
$550.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$8,536.00
|
| Rate for Payer: Cash Price |
$4,268.00
|
| Rate for Payer: Cash Price |
$4,268.00
|
| Rate for Payer: Cigna Commercial |
$1,154.23
|
| Rate for Payer: Healthspan PPO |
$943.65
|
| Rate for Payer: Humana Medicaid |
$550.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$908.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$561.67
|
| Rate for Payer: Molina Healthcare Passport |
$550.66
|
| Rate for Payer: Multiplan PHCS |
$5,121.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5,975.20
|
| Rate for Payer: UHCCP Medicaid |
$2,987.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$556.17
|
|
|
OPEN TX NOSE & SEPTAL FX
|
Facility
|
OP
|
$8,536.00
|
|
|
Service Code
|
HCPCS 21335
|
| Hospital Charge Code |
76100383
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,109.68 |
| Max. Negotiated Rate |
$8,194.56 |
| Rate for Payer: Aetna Commercial |
$6,572.72
|
| Rate for Payer: Anthem Medicaid |
$2,935.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,658.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,897.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,758.63
|
| Rate for Payer: Cash Price |
$4,268.00
|
| Rate for Payer: Cash Price |
$4,268.00
|
| Rate for Payer: Cigna Commercial |
$7,084.88
|
| Rate for Payer: First Health Commercial |
$8,109.20
|
| Rate for Payer: Humana Commercial |
$7,255.60
|
| Rate for Payer: Humana KY Medicaid |
$2,935.53
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Kentucky WC Medicaid |
$2,965.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,999.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,299.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,994.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,511.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,402.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,707.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,109.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,646.16
|
| Rate for Payer: PHCS Commercial |
$8,194.56
|
| Rate for Payer: United Healthcare All Payer |
$7,511.68
|
|
|
OPEN TX NOSE & SEPTAL FX
|
Facility
|
IP
|
$8,536.00
|
|
|
Service Code
|
HCPCS 21335
|
| Hospital Charge Code |
76100383
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,109.68 |
| Max. Negotiated Rate |
$8,194.56 |
| Rate for Payer: Aetna Commercial |
$6,572.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,658.08
|
| Rate for Payer: Cash Price |
$4,268.00
|
| Rate for Payer: Cigna Commercial |
$7,084.88
|
| Rate for Payer: First Health Commercial |
$8,109.20
|
| Rate for Payer: Humana Commercial |
$7,255.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,999.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,299.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,560.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,511.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,402.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,707.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,109.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,646.16
|
| Rate for Payer: PHCS Commercial |
$8,194.56
|
| Rate for Payer: United Healthcare All Payer |
$7,511.68
|
|
