|
OPTX OF ULNAR SHAFT FX(P
|
Professional
|
Both
|
$1,300.00
|
|
|
Service Code
|
HCPCS 25545
|
| Hospital Charge Code |
761P0625
|
|
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 PATLLR FX PATLLC&SFTS RPR
|
Facility
|
IP
|
$1,650.00
|
|
|
Service Code
|
HCPCS 27524
|
| Hospital Charge Code |
76100867
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$214.50 |
| Max. Negotiated Rate |
$1,584.00 |
| Rate for Payer: Aetna Commercial |
$1,270.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,287.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cigna Commercial |
$1,369.50
|
| Rate for Payer: First Health Commercial |
$1,567.50
|
| Rate for Payer: Humana Commercial |
$1,402.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,353.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,217.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$495.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,452.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,237.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$330.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$214.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$511.50
|
| Rate for Payer: PHCS Commercial |
$1,584.00
|
| Rate for Payer: United Healthcare All Payer |
$1,452.00
|
|
|
OPTX PATLLR FX PATLLC&SFTS RPR
|
Facility
|
OP
|
$1,650.00
|
|
|
Service Code
|
HCPCS 27524
|
| Hospital Charge Code |
76100867
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$214.50 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$1,270.50
|
| Rate for Payer: Anthem Medicaid |
$567.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,287.00
|
| 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 |
$825.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cigna Commercial |
$1,369.50
|
| Rate for Payer: First Health Commercial |
$1,567.50
|
| Rate for Payer: Humana Commercial |
$1,402.50
|
| Rate for Payer: Humana KY Medicaid |
$567.44
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$573.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,353.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,217.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$578.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,452.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,237.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$330.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$214.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$511.50
|
| Rate for Payer: PHCS Commercial |
$1,584.00
|
| Rate for Payer: United Healthcare All Payer |
$1,452.00
|
|
|
OPTX PATLLR FX PATLLC&SFTS RPR
|
Professional
|
Both
|
$1,650.00
|
|
|
Service Code
|
HCPCS 27524
|
| Hospital Charge Code |
761P0867
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$577.50 |
| Max. Negotiated Rate |
$1,650.00 |
| Rate for Payer: Aetna Commercial |
$1,113.93
|
| Rate for Payer: Anthem Medicaid |
$592.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,650.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cigna Commercial |
$1,221.16
|
| Rate for Payer: Healthspan PPO |
$1,008.98
|
| Rate for Payer: Humana Medicaid |
$592.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$934.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$604.52
|
| Rate for Payer: Molina Healthcare Passport |
$592.67
|
| Rate for Payer: Multiplan PHCS |
$990.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,155.00
|
| Rate for Payer: UHCCP Medicaid |
$577.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$598.60
|
|
|
OPTX PATLLR FX PATLLC&SFTS RPR
|
Professional
|
Both
|
$1,650.00
|
|
|
Service Code
|
HCPCS 27524
|
| Hospital Charge Code |
76100867
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$577.50 |
| Max. Negotiated Rate |
$1,650.00 |
| Rate for Payer: Aetna Commercial |
$1,113.93
|
| Rate for Payer: Anthem Medicaid |
$592.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,650.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cigna Commercial |
$1,221.16
|
| Rate for Payer: Healthspan PPO |
$1,008.98
|
| Rate for Payer: Humana Medicaid |
$592.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$934.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$604.52
|
| Rate for Payer: Molina Healthcare Passport |
$592.67
|
| Rate for Payer: Multiplan PHCS |
$990.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,155.00
|
| Rate for Payer: UHCCP Medicaid |
$577.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$598.60
|
|
|
OPTX PERIARTICULAR FX&/DIS ELB
|
Professional
|
Both
|
$1,290.00
|
|
|
Service Code
|
HCPCS 24586
|
| Hospital Charge Code |
76100550
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$451.50 |
| Max. Negotiated Rate |
$1,780.79 |
| Rate for Payer: Aetna Commercial |
$1,633.12
|
| Rate for Payer: Anthem Medicaid |
$873.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,290.00
|
| Rate for Payer: Cash Price |
$645.00
|
| Rate for Payer: Cash Price |
$645.00
|
| Rate for Payer: Cigna Commercial |
$1,780.79
|
| Rate for Payer: Healthspan PPO |
$1,479.26
|
| Rate for Payer: Humana Medicaid |
$873.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,358.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$891.31
|
| Rate for Payer: Molina Healthcare Passport |
$873.83
|
| Rate for Payer: Multiplan PHCS |
$774.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$903.00
|
| Rate for Payer: UHCCP Medicaid |
$451.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$882.57
|
|
|
OPTX PERIARTICULAR FX&/DIS ELB
|
Professional
|
Both
|
$1,290.00
|
|
|
Service Code
|
HCPCS 24586
|
| Hospital Charge Code |
761P0550
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$451.50 |
| Max. Negotiated Rate |
$1,780.79 |
| Rate for Payer: Aetna Commercial |
$1,633.12
|
| Rate for Payer: Anthem Medicaid |
$873.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,290.00
|
| Rate for Payer: Cash Price |
$645.00
|
| Rate for Payer: Cash Price |
$645.00
|
| Rate for Payer: Cigna Commercial |
$1,780.79
|
| Rate for Payer: Healthspan PPO |
$1,479.26
|
| Rate for Payer: Humana Medicaid |
$873.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,358.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$891.31
|
| Rate for Payer: Molina Healthcare Passport |
$873.83
|
| Rate for Payer: Multiplan PHCS |
$774.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$903.00
|
| Rate for Payer: UHCCP Medicaid |
$451.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$882.57
|
|
|
OPTX PERIARTICULAR FX&/DIS ELB
|
Facility
|
OP
|
$1,290.00
|
|
|
Service Code
|
HCPCS 24586
|
| Hospital Charge Code |
76100550
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$167.70 |
| Max. Negotiated Rate |
$15,933.60 |
| Rate for Payer: Aetna Commercial |
$993.30
|
| Rate for Payer: Anthem Medicaid |
$443.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,381.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,006.20
|
| 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 |
$645.00
|
| Rate for Payer: Cash Price |
$645.00
|
| Rate for Payer: Cigna Commercial |
$1,070.70
|
| Rate for Payer: First Health Commercial |
$1,225.50
|
| Rate for Payer: Humana Commercial |
$1,096.50
|
| Rate for Payer: Humana KY Medicaid |
$443.63
|
| Rate for Payer: Humana Medicare Advantage |
$11,381.14
|
| Rate for Payer: Kentucky WC Medicaid |
$448.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,057.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$952.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13,657.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$452.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,135.20
|
| Rate for Payer: Ohio Health Group HMO |
$967.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$258.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$167.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$399.90
|
| Rate for Payer: PHCS Commercial |
$1,238.40
|
| Rate for Payer: United Healthcare All Payer |
$1,135.20
|
|
|
OPTX PERIARTICULAR FX&/DIS ELB
|
Facility
|
IP
|
$1,290.00
|
|
|
Service Code
|
HCPCS 24586
|
| Hospital Charge Code |
76100550
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$167.70 |
| Max. Negotiated Rate |
$1,238.40 |
| Rate for Payer: Aetna Commercial |
$993.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,006.20
|
| Rate for Payer: Cash Price |
$645.00
|
| Rate for Payer: Cigna Commercial |
$1,070.70
|
| Rate for Payer: First Health Commercial |
$1,225.50
|
| Rate for Payer: Humana Commercial |
$1,096.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,057.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$952.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$387.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,135.20
|
| Rate for Payer: Ohio Health Group HMO |
$967.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$258.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$167.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$399.90
|
| Rate for Payer: PHCS Commercial |
$1,238.40
|
| Rate for Payer: United Healthcare All Payer |
$1,135.20
|
|
|
OPTX POST ANKLE FX
|
Professional
|
Both
|
$1,060.00
|
|
|
Service Code
|
HCPCS 27769
|
| Hospital Charge Code |
76100933
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$371.00 |
| Max. Negotiated Rate |
$1,060.00 |
| Rate for Payer: Aetna Commercial |
$1,019.83
|
| Rate for Payer: Anthem Medicaid |
$520.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,060.00
|
| Rate for Payer: Cash Price |
$530.00
|
| Rate for Payer: Cash Price |
$530.00
|
| Rate for Payer: Cigna Commercial |
$1,059.88
|
| Rate for Payer: Healthspan PPO |
$923.75
|
| Rate for Payer: Humana Medicaid |
$520.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$892.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$530.52
|
| Rate for Payer: Molina Healthcare Passport |
$520.12
|
| Rate for Payer: Multiplan PHCS |
$636.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$742.00
|
| Rate for Payer: UHCCP Medicaid |
$371.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$525.32
|
|
|
OPTX POST ANKLE FX
|
Facility
|
IP
|
$1,060.00
|
|
|
Service Code
|
HCPCS 27769
|
| Hospital Charge Code |
76100933
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$137.80 |
| Max. Negotiated Rate |
$1,017.60 |
| Rate for Payer: Aetna Commercial |
$816.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$826.80
|
| Rate for Payer: Cash Price |
$530.00
|
| Rate for Payer: Cigna Commercial |
$879.80
|
| Rate for Payer: First Health Commercial |
$1,007.00
|
| Rate for Payer: Humana Commercial |
$901.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$869.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$782.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$318.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$932.80
|
| Rate for Payer: Ohio Health Group HMO |
$795.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$212.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$137.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$328.60
|
| Rate for Payer: PHCS Commercial |
$1,017.60
|
| Rate for Payer: United Healthcare All Payer |
$932.80
|
|
|
OPTX POST ANKLE FX
|
Facility
|
OP
|
$1,060.00
|
|
|
Service Code
|
HCPCS 27769
|
| Hospital Charge Code |
76100933
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$137.80 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$816.20
|
| Rate for Payer: Anthem Medicaid |
$364.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$826.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,661.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,351.78
|
| Rate for Payer: Cash Price |
$530.00
|
| Rate for Payer: Cash Price |
$530.00
|
| Rate for Payer: Cigna Commercial |
$879.80
|
| Rate for Payer: First Health Commercial |
$1,007.00
|
| Rate for Payer: Humana Commercial |
$901.00
|
| Rate for Payer: Humana KY Medicaid |
$364.53
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$368.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$869.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$782.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$371.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$932.80
|
| Rate for Payer: Ohio Health Group HMO |
$795.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$212.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$137.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$328.60
|
| Rate for Payer: PHCS Commercial |
$1,017.60
|
| Rate for Payer: United Healthcare All Payer |
$932.80
|
|
|
OPTX POST ANKLE FX(P
|
Professional
|
Both
|
$1,060.00
|
|
|
Service Code
|
HCPCS 27769
|
| Hospital Charge Code |
761P0933
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$371.00 |
| Max. Negotiated Rate |
$1,060.00 |
| Rate for Payer: Aetna Commercial |
$1,019.83
|
| Rate for Payer: Anthem Medicaid |
$520.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,060.00
|
| Rate for Payer: Cash Price |
$530.00
|
| Rate for Payer: Cash Price |
$530.00
|
| Rate for Payer: Cigna Commercial |
$1,059.88
|
| Rate for Payer: Healthspan PPO |
$923.75
|
| Rate for Payer: Humana Medicaid |
$520.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$892.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$530.52
|
| Rate for Payer: Molina Healthcare Passport |
$520.12
|
| Rate for Payer: Multiplan PHCS |
$636.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$742.00
|
| Rate for Payer: UHCCP Medicaid |
$371.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$525.32
|
|
|
OPTX PROXIMAL HUMERAL FX
|
Facility
|
IP
|
$3,276.00
|
|
|
Service Code
|
HCPCS 23615
|
| Hospital Charge Code |
76100480
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$425.88 |
| Max. Negotiated Rate |
$3,144.96 |
| Rate for Payer: Aetna Commercial |
$2,522.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,555.28
|
| Rate for Payer: Cash Price |
$1,638.00
|
| Rate for Payer: Cigna Commercial |
$2,719.08
|
| Rate for Payer: First Health Commercial |
$3,112.20
|
| Rate for Payer: Humana Commercial |
$2,784.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,686.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,417.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$982.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,882.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,457.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$655.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$425.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,015.56
|
| Rate for Payer: PHCS Commercial |
$3,144.96
|
| Rate for Payer: United Healthcare All Payer |
$2,882.88
|
|
|
OPTX PROXIMAL HUMERAL FX
|
Facility
|
OP
|
$3,276.00
|
|
|
Service Code
|
HCPCS 23615
|
| Hospital Charge Code |
76100480
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$425.88 |
| Max. Negotiated Rate |
$15,933.60 |
| Rate for Payer: Aetna Commercial |
$2,522.52
|
| Rate for Payer: Anthem Medicaid |
$1,126.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,381.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,555.28
|
| 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 |
$1,638.00
|
| Rate for Payer: Cash Price |
$1,638.00
|
| Rate for Payer: Cigna Commercial |
$2,719.08
|
| Rate for Payer: First Health Commercial |
$3,112.20
|
| Rate for Payer: Humana Commercial |
$2,784.60
|
| Rate for Payer: Humana KY Medicaid |
$1,126.62
|
| Rate for Payer: Humana Medicare Advantage |
$11,381.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,138.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,686.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,417.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13,657.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,149.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,882.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,457.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$655.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$425.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,015.56
|
| Rate for Payer: PHCS Commercial |
$3,144.96
|
| Rate for Payer: United Healthcare All Payer |
$2,882.88
|
|
|
OPTX PROXIMAL HUMERAL FX
|
Professional
|
Both
|
$3,276.00
|
|
|
Service Code
|
HCPCS 23615
|
| Hospital Charge Code |
76100480
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$576.68 |
| Max. Negotiated Rate |
$3,276.00 |
| Rate for Payer: Aetna Commercial |
$1,268.31
|
| Rate for Payer: Anthem Medicaid |
$576.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,276.00
|
| Rate for Payer: Cash Price |
$1,638.00
|
| Rate for Payer: Cash Price |
$1,638.00
|
| Rate for Payer: Cigna Commercial |
$1,302.78
|
| Rate for Payer: Healthspan PPO |
$1,148.82
|
| Rate for Payer: Humana Medicaid |
$576.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,096.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$588.21
|
| Rate for Payer: Molina Healthcare Passport |
$576.68
|
| Rate for Payer: Multiplan PHCS |
$1,965.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,293.20
|
| Rate for Payer: UHCCP Medicaid |
$1,146.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$582.45
|
|
|
OPTX PROXIMAL HUMERAL FX(P
|
Professional
|
Both
|
$3,276.00
|
|
|
Service Code
|
HCPCS 23615
|
| Hospital Charge Code |
761P0480
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$576.68 |
| Max. Negotiated Rate |
$3,276.00 |
| Rate for Payer: Aetna Commercial |
$1,268.31
|
| Rate for Payer: Anthem Medicaid |
$576.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,276.00
|
| Rate for Payer: Cash Price |
$1,638.00
|
| Rate for Payer: Cash Price |
$1,638.00
|
| Rate for Payer: Cigna Commercial |
$1,302.78
|
| Rate for Payer: Healthspan PPO |
$1,148.82
|
| Rate for Payer: Humana Medicaid |
$576.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,096.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$588.21
|
| Rate for Payer: Molina Healthcare Passport |
$576.68
|
| Rate for Payer: Multiplan PHCS |
$1,965.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,293.20
|
| Rate for Payer: UHCCP Medicaid |
$1,146.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$582.45
|
|
|
OPTX RAD&ULN SHFT FX W/FIX R/U
|
Professional
|
Both
|
$1,420.00
|
|
|
Service Code
|
HCPCS 25574
|
| Hospital Charge Code |
76100628
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$426.04 |
| Max. Negotiated Rate |
$1,420.00 |
| Rate for Payer: Aetna Commercial |
$951.53
|
| Rate for Payer: Anthem Medicaid |
$426.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,420.00
|
| Rate for Payer: Cash Price |
$710.00
|
| Rate for Payer: Cash Price |
$710.00
|
| Rate for Payer: Cigna Commercial |
$966.10
|
| Rate for Payer: Healthspan PPO |
$861.88
|
| Rate for Payer: Humana Medicaid |
$426.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$824.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$434.56
|
| Rate for Payer: Molina Healthcare Passport |
$426.04
|
| Rate for Payer: Multiplan PHCS |
$852.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$994.00
|
| Rate for Payer: UHCCP Medicaid |
$497.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$430.30
|
|
|
OPTX RAD&ULN SHFT FX W/FIX R/U
|
Professional
|
Both
|
$1,420.00
|
|
|
Service Code
|
HCPCS 25574
|
| Hospital Charge Code |
761P0628
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$426.04 |
| Max. Negotiated Rate |
$1,420.00 |
| Rate for Payer: Aetna Commercial |
$951.53
|
| Rate for Payer: Anthem Medicaid |
$426.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,420.00
|
| Rate for Payer: Cash Price |
$710.00
|
| Rate for Payer: Cash Price |
$710.00
|
| Rate for Payer: Cigna Commercial |
$966.10
|
| Rate for Payer: Healthspan PPO |
$861.88
|
| Rate for Payer: Humana Medicaid |
$426.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$824.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$434.56
|
| Rate for Payer: Molina Healthcare Passport |
$426.04
|
| Rate for Payer: Multiplan PHCS |
$852.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$994.00
|
| Rate for Payer: UHCCP Medicaid |
$497.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$430.30
|
|
|
OPTX RAD&ULN SHFT FX W/FIX R/U
|
Facility
|
IP
|
$1,420.00
|
|
|
Service Code
|
HCPCS 25574
|
| Hospital Charge Code |
76100628
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$184.60 |
| Max. Negotiated Rate |
$1,363.20 |
| Rate for Payer: Aetna Commercial |
$1,093.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,107.60
|
| Rate for Payer: Cash Price |
$710.00
|
| Rate for Payer: Cigna Commercial |
$1,178.60
|
| Rate for Payer: First Health Commercial |
$1,349.00
|
| Rate for Payer: Humana Commercial |
$1,207.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,164.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,047.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$426.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,249.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,065.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$284.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$184.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$440.20
|
| Rate for Payer: PHCS Commercial |
$1,363.20
|
| Rate for Payer: United Healthcare All Payer |
$1,249.60
|
|
|
OPTX RAD&ULN SHFT FX W/FIX R/U
|
Facility
|
OP
|
$1,420.00
|
|
|
Service Code
|
HCPCS 25574
|
| Hospital Charge Code |
76100628
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$184.60 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$1,093.40
|
| Rate for Payer: Anthem Medicaid |
$488.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,107.60
|
| 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 |
$710.00
|
| Rate for Payer: Cash Price |
$710.00
|
| Rate for Payer: Cigna Commercial |
$1,178.60
|
| Rate for Payer: First Health Commercial |
$1,349.00
|
| Rate for Payer: Humana Commercial |
$1,207.00
|
| Rate for Payer: Humana KY Medicaid |
$488.34
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$493.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,164.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,047.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$498.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,249.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,065.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$284.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$184.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$440.20
|
| Rate for Payer: PHCS Commercial |
$1,363.20
|
| Rate for Payer: United Healthcare All Payer |
$1,249.60
|
|
|
OP TX SHLDR DISLC W/HUM TUB FX
|
Facility
|
OP
|
$2,025.00
|
|
|
Service Code
|
HCPCS 23670
|
| Hospital Charge Code |
76100489
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$263.25 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$1,559.25
|
| Rate for Payer: Anthem Medicaid |
$696.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,579.50
|
| 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 |
$1,012.50
|
| Rate for Payer: Cash Price |
$1,012.50
|
| Rate for Payer: Cigna Commercial |
$1,680.75
|
| Rate for Payer: First Health Commercial |
$1,923.75
|
| Rate for Payer: Humana Commercial |
$1,721.25
|
| Rate for Payer: Humana KY Medicaid |
$696.40
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$703.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,660.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,494.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$710.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,782.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,518.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$405.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$263.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$627.75
|
| Rate for Payer: PHCS Commercial |
$1,944.00
|
| Rate for Payer: United Healthcare All Payer |
$1,782.00
|
|
|
OP TX SHLDR DISLC W/HUM TUB FX
|
Facility
|
IP
|
$2,025.00
|
|
|
Service Code
|
HCPCS 23670
|
| Hospital Charge Code |
76100489
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$263.25 |
| Max. Negotiated Rate |
$1,944.00 |
| Rate for Payer: Aetna Commercial |
$1,559.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,579.50
|
| Rate for Payer: Cash Price |
$1,012.50
|
| Rate for Payer: Cigna Commercial |
$1,680.75
|
| Rate for Payer: First Health Commercial |
$1,923.75
|
| Rate for Payer: Humana Commercial |
$1,721.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,660.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,494.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$607.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,782.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,518.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$405.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$263.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$627.75
|
| Rate for Payer: PHCS Commercial |
$1,944.00
|
| Rate for Payer: United Healthcare All Payer |
$1,782.00
|
|
|
OP TX SHLDR DISLC W/HUM TUB FX
|
Professional
|
Both
|
$2,025.00
|
|
|
Service Code
|
HCPCS 23670
|
| Hospital Charge Code |
761P0489
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$518.61 |
| Max. Negotiated Rate |
$2,025.00 |
| Rate for Payer: Aetna Commercial |
$1,217.71
|
| Rate for Payer: Anthem Medicaid |
$518.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,025.00
|
| Rate for Payer: Cash Price |
$1,012.50
|
| Rate for Payer: Cash Price |
$1,012.50
|
| Rate for Payer: Cigna Commercial |
$979.76
|
| Rate for Payer: Healthspan PPO |
$1,102.99
|
| Rate for Payer: Humana Medicaid |
$518.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,074.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$528.98
|
| Rate for Payer: Molina Healthcare Passport |
$518.61
|
| Rate for Payer: Multiplan PHCS |
$1,215.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,417.50
|
| Rate for Payer: UHCCP Medicaid |
$708.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$523.80
|
|
|
OP TX SHLDR DISLC W/HUM TUB FX
|
Professional
|
Both
|
$2,025.00
|
|
|
Service Code
|
HCPCS 23670
|
| Hospital Charge Code |
76100489
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$518.61 |
| Max. Negotiated Rate |
$2,025.00 |
| Rate for Payer: Aetna Commercial |
$1,217.71
|
| Rate for Payer: Anthem Medicaid |
$518.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,025.00
|
| Rate for Payer: Cash Price |
$1,012.50
|
| Rate for Payer: Cash Price |
$1,012.50
|
| Rate for Payer: Cigna Commercial |
$979.76
|
| Rate for Payer: Healthspan PPO |
$1,102.99
|
| Rate for Payer: Humana Medicaid |
$518.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,074.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$528.98
|
| Rate for Payer: Molina Healthcare Passport |
$518.61
|
| Rate for Payer: Multiplan PHCS |
$1,215.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,417.50
|
| Rate for Payer: UHCCP Medicaid |
$708.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$523.80
|
|
