|
OPTX GREATER TROCHANTERIC FX
|
Facility
|
OP
|
$1,565.00
|
|
|
Service Code
|
HCPCS 27248
|
| Hospital Charge Code |
76100797
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$203.45 |
| Max. Negotiated Rate |
$1,502.40 |
| Rate for Payer: Aetna Commercial |
$1,205.05
|
| Rate for Payer: Anthem Medicaid |
$538.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,220.70
|
| Rate for Payer: Cash Price |
$782.50
|
| Rate for Payer: Cigna Commercial |
$1,298.95
|
| Rate for Payer: First Health Commercial |
$1,486.75
|
| Rate for Payer: Humana Commercial |
$1,330.25
|
| Rate for Payer: Humana KY Medicaid |
$538.20
|
| Rate for Payer: Kentucky WC Medicaid |
$543.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,283.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,154.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$469.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$549.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,377.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,173.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$313.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$203.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$485.15
|
| Rate for Payer: PHCS Commercial |
$1,502.40
|
| Rate for Payer: United Healthcare All Payer |
$1,377.20
|
|
|
OPTX GREATER TROCHANTERIC FX
|
Professional
|
Both
|
$1,565.00
|
|
|
Service Code
|
HCPCS 27248
|
| Hospital Charge Code |
76100797
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$547.75 |
| Max. Negotiated Rate |
$1,565.00 |
| Rate for Payer: Aetna Commercial |
$1,121.10
|
| Rate for Payer: Anthem Medicaid |
$670.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,565.00
|
| Rate for Payer: Cash Price |
$782.50
|
| Rate for Payer: Cash Price |
$782.50
|
| Rate for Payer: Cigna Commercial |
$1,258.35
|
| Rate for Payer: Healthspan PPO |
$1,015.48
|
| Rate for Payer: Humana Medicaid |
$670.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$933.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$684.40
|
| Rate for Payer: Molina Healthcare Passport |
$670.98
|
| Rate for Payer: Multiplan PHCS |
$939.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,095.50
|
| Rate for Payer: UHCCP Medicaid |
$547.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$677.69
|
|
|
OPTX GREATER TROCHANTERIC FX
|
Facility
|
IP
|
$1,565.00
|
|
|
Service Code
|
HCPCS 27248
|
| Hospital Charge Code |
76100797
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$203.45 |
| Max. Negotiated Rate |
$1,502.40 |
| Rate for Payer: Aetna Commercial |
$1,205.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,220.70
|
| Rate for Payer: Cash Price |
$782.50
|
| Rate for Payer: Cigna Commercial |
$1,298.95
|
| Rate for Payer: First Health Commercial |
$1,486.75
|
| Rate for Payer: Humana Commercial |
$1,330.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,283.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,154.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$469.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,377.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,173.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$313.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$203.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$485.15
|
| Rate for Payer: PHCS Commercial |
$1,502.40
|
| Rate for Payer: United Healthcare All Payer |
$1,377.20
|
|
|
OPTX GREATER TROCHANTERIC FX(P
|
Professional
|
Both
|
$1,565.00
|
|
|
Service Code
|
HCPCS 27248
|
| Hospital Charge Code |
761P0797
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$547.75 |
| Max. Negotiated Rate |
$1,565.00 |
| Rate for Payer: Aetna Commercial |
$1,121.10
|
| Rate for Payer: Anthem Medicaid |
$670.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,565.00
|
| Rate for Payer: Cash Price |
$782.50
|
| Rate for Payer: Cash Price |
$782.50
|
| Rate for Payer: Cigna Commercial |
$1,258.35
|
| Rate for Payer: Healthspan PPO |
$1,015.48
|
| Rate for Payer: Humana Medicaid |
$670.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$933.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$684.40
|
| Rate for Payer: Molina Healthcare Passport |
$670.98
|
| Rate for Payer: Multiplan PHCS |
$939.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,095.50
|
| Rate for Payer: UHCCP Medicaid |
$547.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$677.69
|
|
|
OPTX HUM SHFT FX WP/S W/WOCERC
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 24515
|
| Hospital Charge Code |
76100534
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$616.68 |
| Max. Negotiated Rate |
$2,100.00 |
| Rate for Payer: Aetna Commercial |
$1,294.18
|
| Rate for Payer: Anthem Medicaid |
$616.68
|
| 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 |
$1,414.22
|
| Rate for Payer: Healthspan PPO |
$1,172.25
|
| Rate for Payer: Humana Medicaid |
$616.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,086.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$629.01
|
| Rate for Payer: Molina Healthcare Passport |
$616.68
|
| 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 |
$622.85
|
|
|
OPTX HUM SHFT FX WP/S W/WOCERC
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 24515
|
| Hospital Charge Code |
761P0534
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$616.68 |
| Max. Negotiated Rate |
$2,100.00 |
| Rate for Payer: Aetna Commercial |
$1,294.18
|
| Rate for Payer: Anthem Medicaid |
$616.68
|
| 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 |
$1,414.22
|
| Rate for Payer: Healthspan PPO |
$1,172.25
|
| Rate for Payer: Humana Medicaid |
$616.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,086.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$629.01
|
| Rate for Payer: Molina Healthcare Passport |
$616.68
|
| 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 |
$622.85
|
|
|
OPTX HUM SHFT FX WP/S W/WOCERC
|
Facility
|
IP
|
$2,100.00
|
|
|
Service Code
|
HCPCS 24515
|
| Hospital Charge Code |
76100534
|
|
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
|
|
|
OPTX HUM SHFT FX WP/S W/WOCERC
|
Facility
|
OP
|
$2,100.00
|
|
|
Service Code
|
HCPCS 24515
|
| Hospital Charge Code |
76100534
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$273.00 |
| Max. Negotiated Rate |
$15,933.60 |
| Rate for Payer: Aetna Commercial |
$1,617.00
|
| Rate for Payer: Anthem Medicaid |
$722.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,381.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,638.00
|
| 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 |
$1,050.00
|
| 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: Humana Medicare Advantage |
$11,381.14
|
| 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 |
$13,657.37
|
| 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
|
|
|
OPTX HUM SUPRACOND FX W/O XTN
|
Facility
|
IP
|
$1,865.00
|
|
|
Service Code
|
HCPCS 24545
|
| Hospital Charge Code |
76100539
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$242.45 |
| Max. Negotiated Rate |
$1,790.40 |
| Rate for Payer: Aetna Commercial |
$1,436.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,454.70
|
| Rate for Payer: Cash Price |
$932.50
|
| Rate for Payer: Cigna Commercial |
$1,547.95
|
| Rate for Payer: First Health Commercial |
$1,771.75
|
| Rate for Payer: Humana Commercial |
$1,585.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,529.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,376.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$559.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,641.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,398.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$373.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$242.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$578.15
|
| Rate for Payer: PHCS Commercial |
$1,790.40
|
| Rate for Payer: United Healthcare All Payer |
$1,641.20
|
|
|
OPTX HUM SUPRACOND FX W/O XTN
|
Facility
|
OP
|
$1,865.00
|
|
|
Service Code
|
HCPCS 24545
|
| Hospital Charge Code |
76100539
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$242.45 |
| Max. Negotiated Rate |
$15,933.60 |
| Rate for Payer: Aetna Commercial |
$1,436.05
|
| Rate for Payer: Anthem Medicaid |
$641.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,381.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,454.70
|
| 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 |
$932.50
|
| Rate for Payer: Cash Price |
$932.50
|
| Rate for Payer: Cigna Commercial |
$1,547.95
|
| Rate for Payer: First Health Commercial |
$1,771.75
|
| Rate for Payer: Humana Commercial |
$1,585.25
|
| Rate for Payer: Humana KY Medicaid |
$641.37
|
| Rate for Payer: Humana Medicare Advantage |
$11,381.14
|
| Rate for Payer: Kentucky WC Medicaid |
$647.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,529.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,376.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13,657.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$654.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,641.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,398.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$373.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$242.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$578.15
|
| Rate for Payer: PHCS Commercial |
$1,790.40
|
| Rate for Payer: United Healthcare All Payer |
$1,641.20
|
|
|
OPTX HUM SUPRACOND FX W/O XTN
|
Professional
|
Both
|
$1,865.00
|
|
|
Service Code
|
HCPCS 24545
|
| Hospital Charge Code |
76100539
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$589.21 |
| Max. Negotiated Rate |
$1,865.00 |
| Rate for Payer: Aetna Commercial |
$1,338.30
|
| Rate for Payer: Anthem Medicaid |
$589.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,865.00
|
| Rate for Payer: Cash Price |
$932.50
|
| Rate for Payer: Cash Price |
$932.50
|
| Rate for Payer: Cigna Commercial |
$1,279.30
|
| Rate for Payer: Healthspan PPO |
$1,212.21
|
| Rate for Payer: Humana Medicaid |
$589.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,150.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$600.99
|
| Rate for Payer: Molina Healthcare Passport |
$589.21
|
| Rate for Payer: Multiplan PHCS |
$1,119.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,305.50
|
| Rate for Payer: UHCCP Medicaid |
$652.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$595.10
|
|
|
OPTX HUM SUPRACOND FX W/O XT(P
|
Professional
|
Both
|
$1,865.00
|
|
|
Service Code
|
HCPCS 24545
|
| Hospital Charge Code |
761P0539
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$589.21 |
| Max. Negotiated Rate |
$1,865.00 |
| Rate for Payer: Aetna Commercial |
$1,338.30
|
| Rate for Payer: Anthem Medicaid |
$589.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,865.00
|
| Rate for Payer: Cash Price |
$932.50
|
| Rate for Payer: Cash Price |
$932.50
|
| Rate for Payer: Cigna Commercial |
$1,279.30
|
| Rate for Payer: Healthspan PPO |
$1,212.21
|
| Rate for Payer: Humana Medicaid |
$589.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,150.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$600.99
|
| Rate for Payer: Molina Healthcare Passport |
$589.21
|
| Rate for Payer: Multiplan PHCS |
$1,119.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,305.50
|
| Rate for Payer: UHCCP Medicaid |
$652.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$595.10
|
|
|
OPTX MEDIAL ANKLE FX
|
Facility
|
OP
|
$1,330.00
|
|
|
Service Code
|
HCPCS 27766
|
| Hospital Charge Code |
76100930
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$172.90 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$1,024.10
|
| Rate for Payer: Anthem Medicaid |
$457.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,037.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,661.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,351.78
|
| Rate for Payer: Cash Price |
$665.00
|
| Rate for Payer: Cash Price |
$665.00
|
| Rate for Payer: Cigna Commercial |
$1,103.90
|
| Rate for Payer: First Health Commercial |
$1,263.50
|
| Rate for Payer: Humana Commercial |
$1,130.50
|
| Rate for Payer: Humana KY Medicaid |
$457.39
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$462.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,090.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$981.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$466.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,170.40
|
| Rate for Payer: Ohio Health Group HMO |
$997.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$266.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$172.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$412.30
|
| Rate for Payer: PHCS Commercial |
$1,276.80
|
| Rate for Payer: United Healthcare All Payer |
$1,170.40
|
|
|
OPTX MEDIAL ANKLE FX
|
Professional
|
Both
|
$1,330.00
|
|
|
Service Code
|
HCPCS 27766
|
| Hospital Charge Code |
76100930
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$465.01 |
| Max. Negotiated Rate |
$1,330.00 |
| Rate for Payer: Aetna Commercial |
$896.07
|
| Rate for Payer: Anthem Medicaid |
$465.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,330.00
|
| Rate for Payer: Cash Price |
$665.00
|
| Rate for Payer: Cash Price |
$665.00
|
| Rate for Payer: Cigna Commercial |
$1,051.91
|
| Rate for Payer: Healthspan PPO |
$811.65
|
| Rate for Payer: Humana Medicaid |
$465.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$753.52
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$474.31
|
| Rate for Payer: Molina Healthcare Passport |
$465.01
|
| Rate for Payer: Multiplan PHCS |
$798.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$931.00
|
| Rate for Payer: UHCCP Medicaid |
$465.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$469.66
|
|
|
OPTX MEDIAL ANKLE FX
|
Facility
|
IP
|
$1,330.00
|
|
|
Service Code
|
HCPCS 27766
|
| Hospital Charge Code |
76100930
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$172.90 |
| Max. Negotiated Rate |
$1,276.80 |
| Rate for Payer: Aetna Commercial |
$1,024.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,037.40
|
| Rate for Payer: Cash Price |
$665.00
|
| Rate for Payer: Cigna Commercial |
$1,103.90
|
| Rate for Payer: First Health Commercial |
$1,263.50
|
| Rate for Payer: Humana Commercial |
$1,130.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,090.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$981.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,170.40
|
| Rate for Payer: Ohio Health Group HMO |
$997.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$266.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$172.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$412.30
|
| Rate for Payer: PHCS Commercial |
$1,276.80
|
| Rate for Payer: United Healthcare All Payer |
$1,170.40
|
|
|
OPTX MEDIAL ANKLE FX(P
|
Professional
|
Both
|
$1,330.00
|
|
|
Service Code
|
HCPCS 27766
|
| Hospital Charge Code |
761P0930
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$465.01 |
| Max. Negotiated Rate |
$1,330.00 |
| Rate for Payer: Aetna Commercial |
$896.07
|
| Rate for Payer: Anthem Medicaid |
$465.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,330.00
|
| Rate for Payer: Cash Price |
$665.00
|
| Rate for Payer: Cash Price |
$665.00
|
| Rate for Payer: Cigna Commercial |
$1,051.91
|
| Rate for Payer: Healthspan PPO |
$811.65
|
| Rate for Payer: Humana Medicaid |
$465.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$753.52
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$474.31
|
| Rate for Payer: Molina Healthcare Passport |
$465.01
|
| Rate for Payer: Multiplan PHCS |
$798.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$931.00
|
| Rate for Payer: UHCCP Medicaid |
$465.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$469.66
|
|
|
OPTX OF RIB FX W/FIXJ SCOPE
|
Professional
|
Both
|
$10,707.50
|
|
|
Service Code
|
HCPCS 21811
|
| Hospital Charge Code |
76100407
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$448.68 |
| Max. Negotiated Rate |
$10,707.50 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$448.68
|
| Rate for Payer: Anthem Medicaid |
$488.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$10,707.50
|
| Rate for Payer: Cash Price |
$5,353.75
|
| Rate for Payer: Cash Price |
$5,353.75
|
| Rate for Payer: Cigna Commercial |
$1,145.43
|
| Rate for Payer: Humana Medicaid |
$488.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$797.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$497.92
|
| Rate for Payer: Molina Healthcare Passport |
$488.16
|
| Rate for Payer: Multiplan PHCS |
$6,424.50
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$7,495.25
|
| Rate for Payer: UHCCP Medicaid |
$471.11
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$493.04
|
|
|
OPTX OF RIB FX W/FIXJ SCOPE
|
Facility
|
IP
|
$10,707.50
|
|
|
Service Code
|
HCPCS 21811
|
| Hospital Charge Code |
76100407
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,391.98 |
| Max. Negotiated Rate |
$10,279.20 |
| Rate for Payer: Aetna Commercial |
$8,244.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,351.85
|
| Rate for Payer: Cash Price |
$5,353.75
|
| Rate for Payer: Cigna Commercial |
$8,887.22
|
| Rate for Payer: First Health Commercial |
$10,172.12
|
| Rate for Payer: Humana Commercial |
$9,101.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,780.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,902.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,212.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,422.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,030.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,141.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,391.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,319.32
|
| Rate for Payer: PHCS Commercial |
$10,279.20
|
| Rate for Payer: United Healthcare All Payer |
$9,422.60
|
|
|
OPTX OF RIB FX W/FIXJ SCOPE
|
Facility
|
OP
|
$10,707.50
|
|
|
Service Code
|
HCPCS 21811
|
| Hospital Charge Code |
76100407
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,391.98 |
| Max. Negotiated Rate |
$10,279.20 |
| Rate for Payer: Aetna Commercial |
$8,244.78
|
| Rate for Payer: Anthem Medicaid |
$3,682.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,351.85
|
| 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 |
$5,353.75
|
| Rate for Payer: Cash Price |
$5,353.75
|
| Rate for Payer: Cigna Commercial |
$8,887.22
|
| Rate for Payer: First Health Commercial |
$10,172.12
|
| Rate for Payer: Humana Commercial |
$9,101.38
|
| Rate for Payer: Humana KY Medicaid |
$3,682.31
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$3,719.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,780.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,902.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,756.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,422.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,030.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,141.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,391.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,319.32
|
| Rate for Payer: PHCS Commercial |
$10,279.20
|
| Rate for Payer: United Healthcare All Payer |
$9,422.60
|
|
|
OPTX OF RIB FX W/FIXJ SCOPE(P
|
Professional
|
Both
|
$1,175.00
|
|
|
Service Code
|
HCPCS 21811
|
| Hospital Charge Code |
761P0407
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$448.68 |
| Max. Negotiated Rate |
$1,175.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$448.68
|
| Rate for Payer: Anthem Medicaid |
$488.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,175.00
|
| Rate for Payer: Cash Price |
$587.50
|
| Rate for Payer: Cash Price |
$587.50
|
| Rate for Payer: Cigna Commercial |
$1,145.43
|
| Rate for Payer: Humana Medicaid |
$488.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$797.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$497.92
|
| Rate for Payer: Molina Healthcare Passport |
$488.16
|
| Rate for Payer: Multiplan PHCS |
$705.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$822.50
|
| Rate for Payer: UHCCP Medicaid |
$471.11
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$493.04
|
|
|
OPTX OF RIB FX W/FIXJ SCOPE(T
|
Facility
|
OP
|
$9,532.50
|
|
|
Service Code
|
HCPCS 21811
|
| Hospital Charge Code |
761T0407
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,239.22 |
| Max. Negotiated Rate |
$9,151.20 |
| Rate for Payer: Aetna Commercial |
$7,340.02
|
| Rate for Payer: Anthem Medicaid |
$3,278.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,435.35
|
| 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 |
$4,766.25
|
| Rate for Payer: Cash Price |
$4,766.25
|
| Rate for Payer: Cigna Commercial |
$7,911.98
|
| Rate for Payer: First Health Commercial |
$9,055.88
|
| Rate for Payer: Humana Commercial |
$8,102.62
|
| Rate for Payer: Humana KY Medicaid |
$3,278.23
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$3,311.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,816.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,034.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,344.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,388.60
|
| Rate for Payer: Ohio Health Group HMO |
$7,149.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,906.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,239.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,955.08
|
| Rate for Payer: PHCS Commercial |
$9,151.20
|
| Rate for Payer: United Healthcare All Payer |
$8,388.60
|
|
|
OPTX OF RIB FX W/FIXJ SCOPE(T
|
Facility
|
IP
|
$9,532.50
|
|
|
Service Code
|
HCPCS 21811
|
| Hospital Charge Code |
761T0407
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,239.22 |
| Max. Negotiated Rate |
$9,151.20 |
| Rate for Payer: Aetna Commercial |
$7,340.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,435.35
|
| Rate for Payer: Cash Price |
$4,766.25
|
| Rate for Payer: Cigna Commercial |
$7,911.98
|
| Rate for Payer: First Health Commercial |
$9,055.88
|
| Rate for Payer: Humana Commercial |
$8,102.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,816.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,034.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,859.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,388.60
|
| Rate for Payer: Ohio Health Group HMO |
$7,149.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,906.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,239.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,955.08
|
| Rate for Payer: PHCS Commercial |
$9,151.20
|
| Rate for Payer: United Healthcare All Payer |
$8,388.60
|
|
|
OPTX OF ULNAR SHAFT FX
|
Professional
|
Both
|
$1,300.00
|
|
|
Service Code
|
HCPCS 25545
|
| Hospital Charge Code |
76100625
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$455.00 |
| Max. Negotiated Rate |
$1,300.00 |
| Rate for Payer: Aetna Commercial |
$917.14
|
| Rate for Payer: Anthem Medicaid |
$477.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,300.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$1,105.86
|
| Rate for Payer: Healthspan PPO |
$830.73
|
| Rate for Payer: Humana Medicaid |
$477.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$765.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$487.04
|
| Rate for Payer: Molina Healthcare Passport |
$477.49
|
| Rate for Payer: Multiplan PHCS |
$780.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$910.00
|
| Rate for Payer: UHCCP Medicaid |
$455.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$482.26
|
|
|
OPTX OF ULNAR SHAFT FX
|
Facility
|
IP
|
$1,300.00
|
|
|
Service Code
|
HCPCS 25545
|
| Hospital Charge Code |
76100625
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$169.00 |
| Max. Negotiated Rate |
$1,248.00 |
| Rate for Payer: Aetna Commercial |
$1,001.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,014.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$1,079.00
|
| Rate for Payer: First Health Commercial |
$1,235.00
|
| Rate for Payer: Humana Commercial |
$1,105.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,066.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$959.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$390.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,144.00
|
| Rate for Payer: Ohio Health Group HMO |
$975.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$169.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$403.00
|
| Rate for Payer: PHCS Commercial |
$1,248.00
|
| Rate for Payer: United Healthcare All Payer |
$1,144.00
|
|
|
OPTX OF ULNAR SHAFT FX
|
Facility
|
OP
|
$1,300.00
|
|
|
Service Code
|
HCPCS 25545
|
| Hospital Charge Code |
76100625
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$169.00 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$1,001.00
|
| Rate for Payer: Anthem Medicaid |
$447.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,014.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,661.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,351.78
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$1,079.00
|
| Rate for Payer: First Health Commercial |
$1,235.00
|
| Rate for Payer: Humana Commercial |
$1,105.00
|
| Rate for Payer: Humana KY Medicaid |
$447.07
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$451.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,066.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$959.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$456.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,144.00
|
| Rate for Payer: Ohio Health Group HMO |
$975.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$169.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$403.00
|
| Rate for Payer: PHCS Commercial |
$1,248.00
|
| Rate for Payer: United Healthcare All Payer |
$1,144.00
|
|
