|
OPEN TX RAD HEAD/NECK FX PROST
|
Facility
|
OP
|
$1,525.00
|
|
|
Service Code
|
HCPCS 24666
|
| Hospital Charge Code |
76100560
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$198.25 |
| Max. Negotiated Rate |
$15,933.60 |
| Rate for Payer: Aetna Commercial |
$1,174.25
|
| Rate for Payer: Anthem Medicaid |
$524.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,381.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,189.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15,933.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$15,364.54
|
| Rate for Payer: Cash Price |
$762.50
|
| 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: Humana KY Medicaid |
$524.45
|
| Rate for Payer: Humana Medicare Advantage |
$11,381.14
|
| Rate for Payer: Kentucky WC Medicaid |
$529.78
|
| 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 |
$13,657.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$534.97
|
| 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
|
|
|
OPEN TX RAD HEAD/NECK FX PROST
|
Professional
|
Both
|
$1,525.00
|
|
|
Service Code
|
HCPCS 24666
|
| Hospital Charge Code |
761P0560
|
|
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&ULN SHFT FX W/FI(P
|
Professional
|
Both
|
$1,915.00
|
|
|
Service Code
|
HCPCS 25575
|
| Hospital Charge Code |
761P0629
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$606.91 |
| Max. Negotiated Rate |
$1,915.00 |
| Rate for Payer: Aetna Commercial |
$1,302.27
|
| Rate for Payer: Anthem Medicaid |
$606.91
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,915.00
|
| Rate for Payer: Cash Price |
$957.50
|
| Rate for Payer: Cash Price |
$957.50
|
| Rate for Payer: Cigna Commercial |
$1,423.39
|
| Rate for Payer: Healthspan PPO |
$1,179.58
|
| Rate for Payer: Humana Medicaid |
$606.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,110.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$619.05
|
| Rate for Payer: Molina Healthcare Passport |
$606.91
|
| Rate for Payer: Multiplan PHCS |
$1,149.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,340.50
|
| Rate for Payer: UHCCP Medicaid |
$670.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$612.98
|
|
|
OPEN TX RAD&ULN SHFT FX W/FIX
|
Facility
|
OP
|
$1,915.00
|
|
|
Service Code
|
HCPCS 25575
|
| Hospital Charge Code |
76100629
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$248.95 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$1,474.55
|
| Rate for Payer: Anthem Medicaid |
$658.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,493.70
|
| 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 |
$957.50
|
| Rate for Payer: Cash Price |
$957.50
|
| Rate for Payer: Cigna Commercial |
$1,589.45
|
| Rate for Payer: First Health Commercial |
$1,819.25
|
| Rate for Payer: Humana Commercial |
$1,627.75
|
| Rate for Payer: Humana KY Medicaid |
$658.57
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$665.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,570.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,413.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$671.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,685.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,436.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$383.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$248.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$593.65
|
| Rate for Payer: PHCS Commercial |
$1,838.40
|
| Rate for Payer: United Healthcare All Payer |
$1,685.20
|
|
|
OPEN TX RAD&ULN SHFT FX W/FIX
|
Professional
|
Both
|
$1,915.00
|
|
|
Service Code
|
HCPCS 25575
|
| Hospital Charge Code |
76100629
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$606.91 |
| Max. Negotiated Rate |
$1,915.00 |
| Rate for Payer: Aetna Commercial |
$1,302.27
|
| Rate for Payer: Anthem Medicaid |
$606.91
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,915.00
|
| Rate for Payer: Cash Price |
$957.50
|
| Rate for Payer: Cash Price |
$957.50
|
| Rate for Payer: Cigna Commercial |
$1,423.39
|
| Rate for Payer: Healthspan PPO |
$1,179.58
|
| Rate for Payer: Humana Medicaid |
$606.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,110.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$619.05
|
| Rate for Payer: Molina Healthcare Passport |
$606.91
|
| Rate for Payer: Multiplan PHCS |
$1,149.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,340.50
|
| Rate for Payer: UHCCP Medicaid |
$670.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$612.98
|
|
|
OPEN TX RAD&ULN SHFT FX W/FIX
|
Facility
|
IP
|
$1,915.00
|
|
|
Service Code
|
HCPCS 25575
|
| Hospital Charge Code |
76100629
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$248.95 |
| Max. Negotiated Rate |
$1,838.40 |
| Rate for Payer: Aetna Commercial |
$1,474.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,493.70
|
| Rate for Payer: Cash Price |
$957.50
|
| Rate for Payer: Cigna Commercial |
$1,589.45
|
| Rate for Payer: First Health Commercial |
$1,819.25
|
| Rate for Payer: Humana Commercial |
$1,627.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,570.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,413.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$574.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,685.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,436.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$383.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$248.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$593.65
|
| Rate for Payer: PHCS Commercial |
$1,838.40
|
| Rate for Payer: United Healthcare All Payer |
$1,685.20
|
|
|
OPEN TX SHOULDER DIS W/NECK FX
|
Professional
|
Both
|
$1,130.00
|
|
|
Service Code
|
HCPCS 23680
|
| Hospital Charge Code |
761P0491
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$395.50 |
| Max. Negotiated Rate |
$1,328.50 |
| Rate for Payer: Aetna Commercial |
$1,328.50
|
| Rate for Payer: Anthem Medicaid |
$653.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,130.00
|
| Rate for Payer: Cash Price |
$565.00
|
| Rate for Payer: Cash Price |
$565.00
|
| Rate for Payer: Cigna Commercial |
$1,219.49
|
| Rate for Payer: Healthspan PPO |
$1,203.34
|
| Rate for Payer: Humana Medicaid |
$653.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,147.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$666.10
|
| Rate for Payer: Molina Healthcare Passport |
$653.04
|
| Rate for Payer: Multiplan PHCS |
$678.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$791.00
|
| Rate for Payer: UHCCP Medicaid |
$395.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$659.57
|
|
|
OPEN TX SHOULDER DIS W/NECK FX
|
Professional
|
Both
|
$1,130.00
|
|
|
Service Code
|
HCPCS 23680
|
| Hospital Charge Code |
76100491
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$395.50 |
| Max. Negotiated Rate |
$1,328.50 |
| Rate for Payer: Aetna Commercial |
$1,328.50
|
| Rate for Payer: Anthem Medicaid |
$653.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,130.00
|
| Rate for Payer: Cash Price |
$565.00
|
| Rate for Payer: Cash Price |
$565.00
|
| Rate for Payer: Cigna Commercial |
$1,219.49
|
| Rate for Payer: Healthspan PPO |
$1,203.34
|
| Rate for Payer: Humana Medicaid |
$653.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,147.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$666.10
|
| Rate for Payer: Molina Healthcare Passport |
$653.04
|
| Rate for Payer: Multiplan PHCS |
$678.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$791.00
|
| Rate for Payer: UHCCP Medicaid |
$395.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$659.57
|
|
|
OPEN TX SHOULDER DIS W/NECK FX
|
Facility
|
OP
|
$1,130.00
|
|
|
Service Code
|
HCPCS 23680
|
| Hospital Charge Code |
76100491
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$146.90 |
| Max. Negotiated Rate |
$15,933.60 |
| Rate for Payer: Aetna Commercial |
$870.10
|
| Rate for Payer: Anthem Medicaid |
$388.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,381.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$881.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15,933.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$15,364.54
|
| Rate for Payer: Cash Price |
$565.00
|
| Rate for Payer: Cash Price |
$565.00
|
| Rate for Payer: Cigna Commercial |
$937.90
|
| Rate for Payer: First Health Commercial |
$1,073.50
|
| Rate for Payer: Humana Commercial |
$960.50
|
| Rate for Payer: Humana KY Medicaid |
$388.61
|
| Rate for Payer: Humana Medicare Advantage |
$11,381.14
|
| Rate for Payer: Kentucky WC Medicaid |
$392.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$926.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$833.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13,657.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$396.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$994.40
|
| Rate for Payer: Ohio Health Group HMO |
$847.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$226.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$350.30
|
| Rate for Payer: PHCS Commercial |
$1,084.80
|
| Rate for Payer: United Healthcare All Payer |
$994.40
|
|
|
OPEN TX SHOULDER DIS W/NECK FX
|
Facility
|
IP
|
$1,130.00
|
|
|
Service Code
|
HCPCS 23680
|
| Hospital Charge Code |
76100491
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$146.90 |
| Max. Negotiated Rate |
$1,084.80 |
| Rate for Payer: Aetna Commercial |
$870.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$881.40
|
| Rate for Payer: Cash Price |
$565.00
|
| Rate for Payer: Cigna Commercial |
$937.90
|
| Rate for Payer: First Health Commercial |
$1,073.50
|
| Rate for Payer: Humana Commercial |
$960.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$926.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$833.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$339.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$994.40
|
| Rate for Payer: Ohio Health Group HMO |
$847.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$226.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$350.30
|
| Rate for Payer: PHCS Commercial |
$1,084.80
|
| Rate for Payer: United Healthcare All Payer |
$994.40
|
|
|
OPEN TX TIB FX PRX UNICONDYLAR
|
Facility
|
IP
|
$1,720.00
|
|
|
Service Code
|
HCPCS 27535
|
| Hospital Charge Code |
76100870
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$223.60 |
| Max. Negotiated Rate |
$1,651.20 |
| Rate for Payer: Aetna Commercial |
$1,324.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,341.60
|
| Rate for Payer: Cash Price |
$860.00
|
| Rate for Payer: Cigna Commercial |
$1,427.60
|
| Rate for Payer: First Health Commercial |
$1,634.00
|
| Rate for Payer: Humana Commercial |
$1,462.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,410.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,269.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$516.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,513.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$344.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$223.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$533.20
|
| Rate for Payer: PHCS Commercial |
$1,651.20
|
| Rate for Payer: United Healthcare All Payer |
$1,513.60
|
|
|
OPEN TX TIB FX PRX UNICONDYLAR
|
Professional
|
Both
|
$1,720.00
|
|
|
Service Code
|
HCPCS 27535
|
| Hospital Charge Code |
761P0870
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$602.00 |
| Max. Negotiated Rate |
$1,720.00 |
| Rate for Payer: Aetna Commercial |
$1,356.57
|
| Rate for Payer: Anthem Medicaid |
$663.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,720.00
|
| Rate for Payer: Cash Price |
$860.00
|
| Rate for Payer: Cash Price |
$860.00
|
| Rate for Payer: Cigna Commercial |
$1,438.43
|
| Rate for Payer: Healthspan PPO |
$1,228.76
|
| Rate for Payer: Humana Medicaid |
$663.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,136.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$676.49
|
| Rate for Payer: Molina Healthcare Passport |
$663.23
|
| Rate for Payer: Multiplan PHCS |
$1,032.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,204.00
|
| Rate for Payer: UHCCP Medicaid |
$602.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$669.86
|
|
|
OPEN TX TIB FX PRX UNICONDYLAR
|
Facility
|
OP
|
$1,720.00
|
|
|
Service Code
|
HCPCS 27535
|
| Hospital Charge Code |
76100870
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$223.60 |
| Max. Negotiated Rate |
$1,651.20 |
| Rate for Payer: Aetna Commercial |
$1,324.40
|
| Rate for Payer: Anthem Medicaid |
$591.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,341.60
|
| Rate for Payer: Cash Price |
$860.00
|
| Rate for Payer: Cigna Commercial |
$1,427.60
|
| Rate for Payer: First Health Commercial |
$1,634.00
|
| Rate for Payer: Humana Commercial |
$1,462.00
|
| Rate for Payer: Humana KY Medicaid |
$591.51
|
| Rate for Payer: Kentucky WC Medicaid |
$597.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,410.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,269.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$516.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$603.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,513.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$344.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$223.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$533.20
|
| Rate for Payer: PHCS Commercial |
$1,651.20
|
| Rate for Payer: United Healthcare All Payer |
$1,513.60
|
|
|
OPEN TX TIB FX PRX UNICONDYLAR
|
Professional
|
Both
|
$1,720.00
|
|
|
Service Code
|
HCPCS 27535
|
| Hospital Charge Code |
76100870
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$602.00 |
| Max. Negotiated Rate |
$1,720.00 |
| Rate for Payer: Aetna Commercial |
$1,356.57
|
| Rate for Payer: Anthem Medicaid |
$663.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,720.00
|
| Rate for Payer: Cash Price |
$860.00
|
| Rate for Payer: Cash Price |
$860.00
|
| Rate for Payer: Cigna Commercial |
$1,438.43
|
| Rate for Payer: Healthspan PPO |
$1,228.76
|
| Rate for Payer: Humana Medicaid |
$663.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,136.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$676.49
|
| Rate for Payer: Molina Healthcare Passport |
$663.23
|
| Rate for Payer: Multiplan PHCS |
$1,032.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,204.00
|
| Rate for Payer: UHCCP Medicaid |
$602.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$669.86
|
|
|
OPEN TX TRIMALLEOLAR ANKLE F(P
|
Professional
|
Both
|
$2,475.00
|
|
|
Service Code
|
HCPCS 27823
|
| Hospital Charge Code |
761P0945
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$712.71 |
| Max. Negotiated Rate |
$2,475.00 |
| Rate for Payer: Aetna Commercial |
$1,433.07
|
| Rate for Payer: Anthem Medicaid |
$712.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,475.00
|
| Rate for Payer: Cash Price |
$1,237.50
|
| Rate for Payer: Cash Price |
$1,237.50
|
| Rate for Payer: Cigna Commercial |
$1,686.14
|
| Rate for Payer: Healthspan PPO |
$1,298.05
|
| Rate for Payer: Humana Medicaid |
$712.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,197.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$726.96
|
| Rate for Payer: Molina Healthcare Passport |
$712.71
|
| Rate for Payer: Multiplan PHCS |
$1,485.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,732.50
|
| Rate for Payer: UHCCP Medicaid |
$866.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$719.84
|
|
|
OPEN TX TRIMALLEOLAR ANKLE FX
|
Facility
|
OP
|
$2,475.00
|
|
|
Service Code
|
HCPCS 27823
|
| Hospital Charge Code |
76100945
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$321.75 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$1,905.75
|
| Rate for Payer: Anthem Medicaid |
$851.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,930.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,661.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,351.78
|
| Rate for Payer: Cash Price |
$1,237.50
|
| Rate for Payer: Cash Price |
$1,237.50
|
| Rate for Payer: Cigna Commercial |
$2,054.25
|
| Rate for Payer: First Health Commercial |
$2,351.25
|
| Rate for Payer: Humana Commercial |
$2,103.75
|
| Rate for Payer: Humana KY Medicaid |
$851.15
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$859.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,029.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,826.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$868.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,178.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,856.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$495.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$321.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$767.25
|
| Rate for Payer: PHCS Commercial |
$2,376.00
|
| Rate for Payer: United Healthcare All Payer |
$2,178.00
|
|
|
OPEN TX TRIMALLEOLAR ANKLE FX
|
Facility
|
IP
|
$2,475.00
|
|
|
Service Code
|
HCPCS 27823
|
| Hospital Charge Code |
76100945
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$321.75 |
| Max. Negotiated Rate |
$2,376.00 |
| Rate for Payer: Aetna Commercial |
$1,905.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,930.50
|
| Rate for Payer: Cash Price |
$1,237.50
|
| Rate for Payer: Cigna Commercial |
$2,054.25
|
| Rate for Payer: First Health Commercial |
$2,351.25
|
| Rate for Payer: Humana Commercial |
$2,103.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,029.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,826.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$742.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,178.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,856.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$495.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$321.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$767.25
|
| Rate for Payer: PHCS Commercial |
$2,376.00
|
| Rate for Payer: United Healthcare All Payer |
$2,178.00
|
|
|
OPEN TX TRIMALLEOLAR ANKLE FX
|
Professional
|
Both
|
$2,475.00
|
|
|
Service Code
|
HCPCS 27823
|
| Hospital Charge Code |
76100945
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$712.71 |
| Max. Negotiated Rate |
$2,475.00 |
| Rate for Payer: Aetna Commercial |
$1,433.07
|
| Rate for Payer: Anthem Medicaid |
$712.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,475.00
|
| Rate for Payer: Cash Price |
$1,237.50
|
| Rate for Payer: Cash Price |
$1,237.50
|
| Rate for Payer: Cigna Commercial |
$1,686.14
|
| Rate for Payer: Healthspan PPO |
$1,298.05
|
| Rate for Payer: Humana Medicaid |
$712.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,197.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$726.96
|
| Rate for Payer: Molina Healthcare Passport |
$712.71
|
| Rate for Payer: Multiplan PHCS |
$1,485.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,732.50
|
| Rate for Payer: UHCCP Medicaid |
$866.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$719.84
|
|
|
OPENTX TRIMALLEOLAR ANKLE FX
|
Professional
|
Both
|
$2,135.00
|
|
|
Service Code
|
HCPCS 27822
|
| Hospital Charge Code |
76100944
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$579.67 |
| Max. Negotiated Rate |
$2,135.00 |
| Rate for Payer: Aetna Commercial |
$1,254.02
|
| Rate for Payer: Anthem Medicaid |
$579.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,135.00
|
| Rate for Payer: Cash Price |
$1,067.50
|
| Rate for Payer: Cash Price |
$1,067.50
|
| Rate for Payer: Cigna Commercial |
$1,486.93
|
| Rate for Payer: Healthspan PPO |
$1,135.87
|
| Rate for Payer: Humana Medicaid |
$579.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,050.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$591.26
|
| Rate for Payer: Molina Healthcare Passport |
$579.67
|
| Rate for Payer: Multiplan PHCS |
$1,281.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,494.50
|
| Rate for Payer: UHCCP Medicaid |
$747.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$585.47
|
|
|
OPENTX TRIMALLEOLAR ANKLE FX
|
Facility
|
IP
|
$2,135.00
|
|
|
Service Code
|
HCPCS 27822
|
| Hospital Charge Code |
76100944
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$277.55 |
| Max. Negotiated Rate |
$2,049.60 |
| Rate for Payer: Aetna Commercial |
$1,643.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,665.30
|
| Rate for Payer: Cash Price |
$1,067.50
|
| Rate for Payer: Cigna Commercial |
$1,772.05
|
| Rate for Payer: First Health Commercial |
$2,028.25
|
| Rate for Payer: Humana Commercial |
$1,814.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,750.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,575.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$640.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,878.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,601.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$427.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$277.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$661.85
|
| Rate for Payer: PHCS Commercial |
$2,049.60
|
| Rate for Payer: United Healthcare All Payer |
$1,878.80
|
|
|
OPENTX TRIMALLEOLAR ANKLE FX
|
Facility
|
OP
|
$2,135.00
|
|
|
Service Code
|
HCPCS 27822
|
| Hospital Charge Code |
76100944
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$277.55 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$1,643.95
|
| Rate for Payer: Anthem Medicaid |
$734.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,665.30
|
| 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 |
$1,067.50
|
| Rate for Payer: Cash Price |
$1,067.50
|
| Rate for Payer: Cigna Commercial |
$1,772.05
|
| Rate for Payer: First Health Commercial |
$2,028.25
|
| Rate for Payer: Humana Commercial |
$1,814.75
|
| Rate for Payer: Humana KY Medicaid |
$734.23
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$741.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,750.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,575.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$748.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,878.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,601.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$427.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$277.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$661.85
|
| Rate for Payer: PHCS Commercial |
$2,049.60
|
| Rate for Payer: United Healthcare All Payer |
$1,878.80
|
|
|
OPENTX TRIMALLEOLAR ANKLE FX(P
|
Professional
|
Both
|
$2,135.00
|
|
|
Service Code
|
HCPCS 27822
|
| Hospital Charge Code |
761P0944
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$579.67 |
| Max. Negotiated Rate |
$2,135.00 |
| Rate for Payer: Aetna Commercial |
$1,254.02
|
| Rate for Payer: Anthem Medicaid |
$579.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,135.00
|
| Rate for Payer: Cash Price |
$1,067.50
|
| Rate for Payer: Cash Price |
$1,067.50
|
| Rate for Payer: Cigna Commercial |
$1,486.93
|
| Rate for Payer: Healthspan PPO |
$1,135.87
|
| Rate for Payer: Humana Medicaid |
$579.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,050.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$591.26
|
| Rate for Payer: Molina Healthcare Passport |
$579.67
|
| Rate for Payer: Multiplan PHCS |
$1,281.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,494.50
|
| Rate for Payer: UHCCP Medicaid |
$747.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$585.47
|
|
|
OPEN WEDGE/BX LUNG INFILTR
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 32096
|
| Hospital Charge Code |
76101172
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$490.00 |
| Max. Negotiated Rate |
$1,522.82 |
| Rate for Payer: Anthem Medicaid |
$656.11
|
| 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 |
$1,522.82
|
| Rate for Payer: Healthspan PPO |
$814.79
|
| Rate for Payer: Humana Medicaid |
$656.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,099.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$669.23
|
| Rate for Payer: Molina Healthcare Passport |
$656.11
|
| 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 |
$662.67
|
|
|
OPEN WEDGE/BX LUNG INFILTR
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 32096
|
| Hospital Charge Code |
76101172
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$1,344.00 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem Medicaid |
$481.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Humana KY Medicaid |
$481.46
|
| Rate for Payer: Kentucky WC Medicaid |
$486.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$420.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$491.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$182.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$434.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
OPEN WEDGE/BX LUNG INFILTR
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 32096
|
| Hospital Charge Code |
76101172
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$1,344.00 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$420.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$182.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$434.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
