|
OPEN TX NOSE & SEPTAL FX(P
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 21335
|
| Hospital Charge Code |
761P0383
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$550.66 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Aetna Commercial |
$1,041.80
|
| Rate for Payer: Anthem Medicaid |
$550.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,500.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| 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 |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,750.00
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$556.17
|
|
|
OPEN TX NOSE & SEPTAL FX(T
|
Facility
|
IP
|
$6,036.00
|
|
|
Service Code
|
HCPCS 21335
|
| Hospital Charge Code |
761T0383
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$784.68 |
| Max. Negotiated Rate |
$5,794.56 |
| Rate for Payer: Aetna Commercial |
$4,647.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,708.08
|
| Rate for Payer: Cash Price |
$3,018.00
|
| Rate for Payer: Cigna Commercial |
$5,009.88
|
| Rate for Payer: First Health Commercial |
$5,734.20
|
| Rate for Payer: Humana Commercial |
$5,130.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,949.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,454.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,810.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,311.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,527.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,207.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$784.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,871.16
|
| Rate for Payer: PHCS Commercial |
$5,794.56
|
| Rate for Payer: United Healthcare All Payer |
$5,311.68
|
|
|
OPEN TX NOSE & SEPTAL FX(T
|
Facility
|
OP
|
$6,036.00
|
|
|
Service Code
|
HCPCS 21335
|
| Hospital Charge Code |
761T0383
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$784.68 |
| Max. Negotiated Rate |
$5,794.56 |
| Rate for Payer: Aetna Commercial |
$4,647.72
|
| Rate for Payer: Anthem Medicaid |
$2,075.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,708.08
|
| 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 |
$3,018.00
|
| Rate for Payer: Cash Price |
$3,018.00
|
| Rate for Payer: Cigna Commercial |
$5,009.88
|
| Rate for Payer: First Health Commercial |
$5,734.20
|
| Rate for Payer: Humana Commercial |
$5,130.60
|
| Rate for Payer: Humana KY Medicaid |
$2,075.78
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Kentucky WC Medicaid |
$2,096.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,949.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,454.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,117.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,311.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,527.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,207.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$784.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,871.16
|
| Rate for Payer: PHCS Commercial |
$5,794.56
|
| Rate for Payer: United Healthcare All Payer |
$5,311.68
|
|
|
OPEN TX. OF INTERPHALAN. JOINT
|
Facility
|
IP
|
$684.00
|
|
|
Service Code
|
HCPCS 26785
|
| Hospital Charge Code |
76100750
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$88.92 |
| Max. Negotiated Rate |
$656.64 |
| Rate for Payer: Aetna Commercial |
$526.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$533.52
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Cigna Commercial |
$567.72
|
| Rate for Payer: First Health Commercial |
$649.80
|
| Rate for Payer: Humana Commercial |
$581.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$560.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$504.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$205.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$601.92
|
| Rate for Payer: Ohio Health Group HMO |
$513.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$136.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$88.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$212.04
|
| Rate for Payer: PHCS Commercial |
$656.64
|
| Rate for Payer: United Healthcare All Payer |
$601.92
|
|
|
OPEN TX. OF INTERPHALAN. JOINT
|
Professional
|
Both
|
$684.00
|
|
|
Service Code
|
HCPCS 26785
|
| Hospital Charge Code |
76100750
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$211.05 |
| Max. Negotiated Rate |
$715.63 |
| Rate for Payer: Aetna Commercial |
$715.63
|
| Rate for Payer: Anthem Medicaid |
$211.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$684.00
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Cigna Commercial |
$574.04
|
| Rate for Payer: Healthspan PPO |
$648.21
|
| Rate for Payer: Humana Medicaid |
$211.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$651.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$215.27
|
| Rate for Payer: Molina Healthcare Passport |
$211.05
|
| Rate for Payer: Multiplan PHCS |
$410.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$478.80
|
| Rate for Payer: UHCCP Medicaid |
$239.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$213.16
|
|
|
OPEN TX. OF INTERPHALAN. JOINT
|
Facility
|
OP
|
$684.00
|
|
|
Service Code
|
HCPCS 26785
|
| Hospital Charge Code |
76100750
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$88.92 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$526.68
|
| Rate for Payer: Anthem Medicaid |
$235.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$533.52
|
| 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 |
$342.00
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Cigna Commercial |
$567.72
|
| Rate for Payer: First Health Commercial |
$649.80
|
| Rate for Payer: Humana Commercial |
$581.40
|
| Rate for Payer: Humana KY Medicaid |
$235.23
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$237.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$560.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$504.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$239.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$601.92
|
| Rate for Payer: Ohio Health Group HMO |
$513.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$136.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$88.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$212.04
|
| Rate for Payer: PHCS Commercial |
$656.64
|
| Rate for Payer: United Healthcare All Payer |
$601.92
|
|
|
OPEN TX. OF INTERPHALAN. JOINT
|
Professional
|
Both
|
$684.00
|
|
|
Service Code
|
HCPCS 26785
|
| Hospital Charge Code |
761P0750
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$211.05 |
| Max. Negotiated Rate |
$715.63 |
| Rate for Payer: Aetna Commercial |
$715.63
|
| Rate for Payer: Anthem Medicaid |
$211.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$684.00
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Cigna Commercial |
$574.04
|
| Rate for Payer: Healthspan PPO |
$648.21
|
| Rate for Payer: Humana Medicaid |
$211.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$651.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$215.27
|
| Rate for Payer: Molina Healthcare Passport |
$211.05
|
| Rate for Payer: Multiplan PHCS |
$410.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$478.80
|
| Rate for Payer: UHCCP Medicaid |
$239.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$213.16
|
|
|
OPEN TX OF PHALANGEAL FRAC.
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 26735
|
| Hospital Charge Code |
76100739
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$280.00 |
| Max. Negotiated Rate |
$813.22 |
| Rate for Payer: Aetna Commercial |
$813.22
|
| Rate for Payer: Anthem Medicaid |
$282.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$800.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$760.46
|
| Rate for Payer: Healthspan PPO |
$736.60
|
| Rate for Payer: Humana Medicaid |
$282.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$720.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$288.36
|
| Rate for Payer: Molina Healthcare Passport |
$282.71
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$560.00
|
| Rate for Payer: UHCCP Medicaid |
$280.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$285.54
|
|
|
OPEN TX OF PHALANGEAL FRAC.
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS 26735
|
| Hospital Charge Code |
76100739
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem Medicaid |
$275.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| 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 |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Humana KY Medicaid |
$275.12
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$277.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$280.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
OPEN TX OF PHALANGEAL FRAC.
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS 26735
|
| Hospital Charge Code |
76100739
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
OPEN TX OF PHALANGEAL FRAC.(P
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 26735
|
| Hospital Charge Code |
761P0739
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$280.00 |
| Max. Negotiated Rate |
$813.22 |
| Rate for Payer: Aetna Commercial |
$813.22
|
| Rate for Payer: Anthem Medicaid |
$282.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$800.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$760.46
|
| Rate for Payer: Healthspan PPO |
$736.60
|
| Rate for Payer: Humana Medicaid |
$282.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$720.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$288.36
|
| Rate for Payer: Molina Healthcare Passport |
$282.71
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$560.00
|
| Rate for Payer: UHCCP Medicaid |
$280.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$285.54
|
|
|
OPEN TX PATELLAR DISLOC
|
Facility
|
OP
|
$8,568.00
|
|
|
Service Code
|
HCPCS 27566
|
| Hospital Charge Code |
76100877
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,113.84 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$6,597.36
|
| Rate for Payer: Anthem Medicaid |
$2,946.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,683.04
|
| 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 |
$4,284.00
|
| Rate for Payer: Cash Price |
$4,284.00
|
| Rate for Payer: Cigna Commercial |
$7,111.44
|
| Rate for Payer: First Health Commercial |
$8,139.60
|
| Rate for Payer: Humana Commercial |
$7,282.80
|
| Rate for Payer: Humana KY Medicaid |
$2,946.54
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$2,976.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,025.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,323.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,005.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,539.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,426.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,713.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,113.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,656.08
|
| Rate for Payer: PHCS Commercial |
$8,225.28
|
| Rate for Payer: United Healthcare All Payer |
$7,539.84
|
|
|
OPEN TX PATELLAR DISLOC
|
Facility
|
IP
|
$8,568.00
|
|
|
Service Code
|
HCPCS 27566
|
| Hospital Charge Code |
45000163
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,113.84 |
| Max. Negotiated Rate |
$8,225.28 |
| Rate for Payer: Aetna Commercial |
$6,597.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,683.04
|
| Rate for Payer: Cash Price |
$4,284.00
|
| Rate for Payer: Cigna Commercial |
$7,111.44
|
| Rate for Payer: First Health Commercial |
$8,139.60
|
| Rate for Payer: Humana Commercial |
$7,282.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,025.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,323.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,570.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,539.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,426.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,713.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,113.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,656.08
|
| Rate for Payer: PHCS Commercial |
$8,225.28
|
| Rate for Payer: United Healthcare All Payer |
$7,539.84
|
|
|
OPEN TX PATELLAR DISLOC
|
Facility
|
OP
|
$8,568.00
|
|
|
Service Code
|
HCPCS 27566
|
| Hospital Charge Code |
45000163
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,113.84 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$6,597.36
|
| Rate for Payer: Anthem Medicaid |
$2,946.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,683.04
|
| 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 |
$4,284.00
|
| Rate for Payer: Cash Price |
$4,284.00
|
| Rate for Payer: Cigna Commercial |
$7,111.44
|
| Rate for Payer: First Health Commercial |
$8,139.60
|
| Rate for Payer: Humana Commercial |
$7,282.80
|
| Rate for Payer: Humana KY Medicaid |
$2,946.54
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$2,976.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,025.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,323.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,005.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,539.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,426.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,713.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,113.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,656.08
|
| Rate for Payer: PHCS Commercial |
$8,225.28
|
| Rate for Payer: United Healthcare All Payer |
$7,539.84
|
|
|
OPEN TX PATELLAR DISLOC
|
Facility
|
IP
|
$8,568.00
|
|
|
Service Code
|
HCPCS 27566
|
| Hospital Charge Code |
76100877
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,113.84 |
| Max. Negotiated Rate |
$8,225.28 |
| Rate for Payer: Aetna Commercial |
$6,597.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,683.04
|
| Rate for Payer: Cash Price |
$4,284.00
|
| Rate for Payer: Cigna Commercial |
$7,111.44
|
| Rate for Payer: First Health Commercial |
$8,139.60
|
| Rate for Payer: Humana Commercial |
$7,282.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,025.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,323.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,570.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,539.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,426.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,713.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,113.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,656.08
|
| Rate for Payer: PHCS Commercial |
$8,225.28
|
| Rate for Payer: United Healthcare All Payer |
$7,539.84
|
|
|
OPEN TX PRX FIBULA/SHAFT FX
|
Facility
|
IP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 27784
|
| Hospital Charge Code |
76100935
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$1,536.00 |
| Rate for Payer: Aetna Commercial |
$1,232.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,248.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,328.00
|
| Rate for Payer: First Health Commercial |
$1,520.00
|
| Rate for Payer: Humana Commercial |
$1,360.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,312.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,180.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$480.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,408.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$208.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$496.00
|
| Rate for Payer: PHCS Commercial |
$1,536.00
|
| Rate for Payer: United Healthcare All Payer |
$1,408.00
|
|
|
OPEN TX PRX FIBULA/SHAFT FX
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 27784
|
| Hospital Charge Code |
76100935
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$360.34 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: Aetna Commercial |
$1,005.33
|
| Rate for Payer: Anthem Medicaid |
$360.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,600.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$913.52
|
| Rate for Payer: Healthspan PPO |
$910.61
|
| Rate for Payer: Humana Medicaid |
$360.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$880.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$367.55
|
| Rate for Payer: Molina Healthcare Passport |
$360.34
|
| Rate for Payer: Multiplan PHCS |
$960.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,120.00
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$363.94
|
|
|
OPEN TX PRX FIBULA/SHAFT FX
|
Facility
|
OP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 27784
|
| Hospital Charge Code |
76100935
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$1,232.00
|
| Rate for Payer: Anthem Medicaid |
$550.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,248.00
|
| 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 |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,328.00
|
| Rate for Payer: First Health Commercial |
$1,520.00
|
| Rate for Payer: Humana Commercial |
$1,360.00
|
| Rate for Payer: Humana KY Medicaid |
$550.24
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$555.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,312.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,180.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$561.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,408.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$208.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$496.00
|
| Rate for Payer: PHCS Commercial |
$1,536.00
|
| Rate for Payer: United Healthcare All Payer |
$1,408.00
|
|
|
OPEN TX PRX FIBULA/SHAFT FX(P
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 27784
|
| Hospital Charge Code |
761P0935
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$360.34 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: Aetna Commercial |
$1,005.33
|
| Rate for Payer: Anthem Medicaid |
$360.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,600.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$913.52
|
| Rate for Payer: Healthspan PPO |
$910.61
|
| Rate for Payer: Humana Medicaid |
$360.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$880.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$367.55
|
| Rate for Payer: Molina Healthcare Passport |
$360.34
|
| Rate for Payer: Multiplan PHCS |
$960.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,120.00
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$363.94
|
|
|
OPEN TX RAD HEAD/NECK FX
|
Facility
|
OP
|
$1,285.00
|
|
|
Service Code
|
HCPCS 24665
|
| Hospital Charge Code |
76100559
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$167.05 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$989.45
|
| Rate for Payer: Anthem Medicaid |
$441.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,002.30
|
| 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 |
$642.50
|
| Rate for Payer: Cash Price |
$642.50
|
| Rate for Payer: Cigna Commercial |
$1,066.55
|
| Rate for Payer: First Health Commercial |
$1,220.75
|
| Rate for Payer: Humana Commercial |
$1,092.25
|
| Rate for Payer: Humana KY Medicaid |
$441.91
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$446.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,053.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$948.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$450.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,130.80
|
| Rate for Payer: Ohio Health Group HMO |
$963.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$257.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$167.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$398.35
|
| Rate for Payer: PHCS Commercial |
$1,233.60
|
| Rate for Payer: United Healthcare All Payer |
$1,130.80
|
|
|
OPEN TX RAD HEAD/NECK FX
|
Facility
|
IP
|
$1,285.00
|
|
|
Service Code
|
HCPCS 24665
|
| Hospital Charge Code |
76100559
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$167.05 |
| Max. Negotiated Rate |
$1,233.60 |
| Rate for Payer: Aetna Commercial |
$989.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,002.30
|
| Rate for Payer: Cash Price |
$642.50
|
| Rate for Payer: Cigna Commercial |
$1,066.55
|
| Rate for Payer: First Health Commercial |
$1,220.75
|
| Rate for Payer: Humana Commercial |
$1,092.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,053.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$948.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$385.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,130.80
|
| Rate for Payer: Ohio Health Group HMO |
$963.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$257.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$167.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$398.35
|
| Rate for Payer: PHCS Commercial |
$1,233.60
|
| Rate for Payer: United Healthcare All Payer |
$1,130.80
|
|
|
OPEN TX RAD HEAD/NECK FX
|
Professional
|
Both
|
$1,285.00
|
|
|
Service Code
|
HCPCS 24665
|
| Hospital Charge Code |
76100559
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$444.59 |
| Max. Negotiated Rate |
$1,285.00 |
| Rate for Payer: Aetna Commercial |
$943.11
|
| Rate for Payer: Anthem Medicaid |
$444.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,285.00
|
| Rate for Payer: Cash Price |
$642.50
|
| Rate for Payer: Cash Price |
$642.50
|
| Rate for Payer: Cigna Commercial |
$1,036.74
|
| Rate for Payer: Healthspan PPO |
$854.25
|
| Rate for Payer: Humana Medicaid |
$444.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$800.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$453.48
|
| Rate for Payer: Molina Healthcare Passport |
$444.59
|
| Rate for Payer: Multiplan PHCS |
$771.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$899.50
|
| Rate for Payer: UHCCP Medicaid |
$449.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$449.04
|
|
|
OPEN TX RAD HEAD/NECK FX(P
|
Professional
|
Both
|
$1,285.00
|
|
|
Service Code
|
HCPCS 24665
|
| Hospital Charge Code |
761P0559
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$444.59 |
| Max. Negotiated Rate |
$1,285.00 |
| Rate for Payer: Aetna Commercial |
$943.11
|
| Rate for Payer: Anthem Medicaid |
$444.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,285.00
|
| Rate for Payer: Cash Price |
$642.50
|
| Rate for Payer: Cash Price |
$642.50
|
| Rate for Payer: Cigna Commercial |
$1,036.74
|
| Rate for Payer: Healthspan PPO |
$854.25
|
| Rate for Payer: Humana Medicaid |
$444.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$800.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$453.48
|
| Rate for Payer: Molina Healthcare Passport |
$444.59
|
| Rate for Payer: Multiplan PHCS |
$771.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$899.50
|
| Rate for Payer: UHCCP Medicaid |
$449.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$449.04
|
|
|
OPEN TX RAD HEAD/NECK FX PROST
|
Professional
|
Both
|
$1,525.00
|
|
|
Service Code
|
HCPCS 24666
|
| Hospital Charge Code |
76100560
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$533.75 |
| Max. Negotiated Rate |
$1,525.00 |
| Rate for Payer: Aetna Commercial |
$1,073.64
|
| Rate for Payer: Anthem Medicaid |
$574.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,525.00
|
| Rate for Payer: Cash Price |
$762.50
|
| Rate for Payer: Cash Price |
$762.50
|
| Rate for Payer: Cigna Commercial |
$1,175.27
|
| Rate for Payer: Healthspan PPO |
$972.49
|
| Rate for Payer: Humana Medicaid |
$574.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$904.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$586.11
|
| Rate for Payer: Molina Healthcare Passport |
$574.62
|
| Rate for Payer: Multiplan PHCS |
$915.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,067.50
|
| Rate for Payer: UHCCP Medicaid |
$533.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$580.37
|
|
|
OPEN TX RAD HEAD/NECK FX PROST
|
Facility
|
IP
|
$1,525.00
|
|
|
Service Code
|
HCPCS 24666
|
| Hospital Charge Code |
76100560
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$198.25 |
| Max. Negotiated Rate |
$1,464.00 |
| Rate for Payer: Aetna Commercial |
$1,174.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,189.50
|
| Rate for Payer: Cash Price |
$762.50
|
| Rate for Payer: Cigna Commercial |
$1,265.75
|
| Rate for Payer: First Health Commercial |
$1,448.75
|
| Rate for Payer: Humana Commercial |
$1,296.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,250.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,125.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$457.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,342.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$305.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$198.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$472.75
|
| Rate for Payer: PHCS Commercial |
$1,464.00
|
| Rate for Payer: United Healthcare All Payer |
$1,342.00
|
|
