Southern Ohio Medical Center

All Charges

Charge

Type

Setting

Price

OPEN TREAT DEPRESS ARCH FRACT

Facility

$8,910.00

Service Code	HCPCS 21356
Hospital Charge Code	76100386
Hospital Revenue Code	761
Min. Negotiated Rate	$3,064.15
Max. Negotiated Rate	$8,553.60
Rate for Payer: Aetna Commercial	$6,860.70
Rate for Payer: Anthem Medicaid	$3,064.15
Rate for Payer: Anthem Medicare Advantage/PPO	$5,465.95
Rate for Payer: Anthem POS/PPO/Traditional	$6,949.80
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$7,652.33
Rate for Payer: CareSource Just4Me Medicare	$7,379.03
Rate for Payer: Cash Price	$4,455.00
Rate for Payer: Cash Price	$4,455.00
Rate for Payer: Cigna Commercial	$7,395.30
Rate for Payer: First Health Commercial	$8,464.50
Rate for Payer: Humana Commercial	$7,573.50
Rate for Payer: Humana KY Medicaid	$3,064.15
Rate for Payer: Humana Medicare Advantage	$5,465.95
Rate for Payer: Kentucky WC Medicaid	$3,095.33
Rate for Payer: Medical Mutual Of Ohio HMO	$7,306.20
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$6,575.58
Rate for Payer: Molina Healthcare Benefit Exchange	$6,559.14
Rate for Payer: Molina Healthcare Medicaid	$3,125.63
Rate for Payer: Ohio Health Choice Commercial	$7,840.80
Rate for Payer: Ohio Health Group HMO	$6,682.50
Rate for Payer: Ohio Health Group PPO Differential	$7,128.00
Rate for Payer: Ohio Health Group PPO No Differential	$7,751.70
Rate for Payer: Ohio Health Group PPO SOMC Employees	$6,147.90
Rate for Payer: PHCS Commercial	$8,553.60
Rate for Payer: United Healthcare All Payer	$7,840.80

OPEN TREAT DEPRESS ARCH FRACT

Facility

$8,910.00

Service Code	HCPCS 21356
Hospital Charge Code	76100386
Hospital Revenue Code	761
Min. Negotiated Rate	$2,673.00
Max. Negotiated Rate	$8,553.60
Rate for Payer: Aetna Commercial	$6,860.70
Rate for Payer: Anthem POS/PPO/Traditional	$6,949.80
Rate for Payer: Cash Price	$4,455.00
Rate for Payer: Cigna Commercial	$7,395.30
Rate for Payer: First Health Commercial	$8,464.50
Rate for Payer: Humana Commercial	$7,573.50
Rate for Payer: Medical Mutual Of Ohio HMO	$7,306.20
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$6,575.58
Rate for Payer: Molina Healthcare Benefit Exchange	$2,673.00
Rate for Payer: Ohio Health Choice Commercial	$7,840.80
Rate for Payer: Ohio Health Group HMO	$6,682.50
Rate for Payer: Ohio Health Group PPO Differential	$7,128.00
Rate for Payer: Ohio Health Group PPO No Differential	$7,751.70
Rate for Payer: Ohio Health Group PPO SOMC Employees	$6,147.90
Rate for Payer: PHCS Commercial	$8,553.60
Rate for Payer: United Healthcare All Payer	$7,840.80

OPEN TREATMENT CALCANEAL FX

Professional

Both

$2,550.00

Service Code	HCPCS 28415
Hospital Charge Code	76101013
Hospital Revenue Code	761
Min. Negotiated Rate	$665.39
Max. Negotiated Rate	$2,016.52
Rate for Payer: Aetna Commercial	$1,704.94
Rate for Payer: Ambetter Exchange	$1,060.44
Rate for Payer: Anthem Medicaid	$665.39
Rate for Payer: Buckeye Individual/Medicaid	$1,060.44
Rate for Payer: Buckeye Medicare Advantage	$1,060.44
Rate for Payer: CareSource Just4Me Medicare	$1,272.53
Rate for Payer: Cash Price	$1,275.00
Rate for Payer: Cash Price	$1,275.00
Rate for Payer: Cigna Commercial	$2,016.52
Rate for Payer: Healthspan PPO	$1,544.31
Rate for Payer: Humana Medicaid	$665.39
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation	$1,403.67
Rate for Payer: Medical Mutual Of Ohio Medicare Advantage	$1,060.44
Rate for Payer: Molina Healthcare Benefit Exchange	$1,060.44
Rate for Payer: Molina Healthcare CHIP/Medicaid	$678.70
Rate for Payer: Molina Healthcare Passport	$665.39
Rate for Payer: Multiplan PHCS	$1,530.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$1,378.57
Rate for Payer: UHCCP Medicaid	$892.50
Rate for Payer: Wellcare CHIP/Medicaid	$672.04
Rate for Payer: Wellcare Medicare Advantage	$1,060.44

OPEN TREATMENT CALCANEAL FX

Facility

$2,550.00

Service Code	HCPCS 28415
Hospital Charge Code	76101013
Hospital Revenue Code	761
Min. Negotiated Rate	$765.00
Max. Negotiated Rate	$2,448.00
Rate for Payer: Aetna Commercial	$1,963.50
Rate for Payer: Anthem POS/PPO/Traditional	$1,989.00
Rate for Payer: Cash Price	$1,275.00
Rate for Payer: Cigna Commercial	$2,116.50
Rate for Payer: First Health Commercial	$2,422.50
Rate for Payer: Humana Commercial	$2,167.50
Rate for Payer: Medical Mutual Of Ohio HMO	$2,091.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$1,881.90
Rate for Payer: Molina Healthcare Benefit Exchange	$765.00
Rate for Payer: Ohio Health Choice Commercial	$2,244.00
Rate for Payer: Ohio Health Group HMO	$1,912.50
Rate for Payer: Ohio Health Group PPO Differential	$2,040.00
Rate for Payer: Ohio Health Group PPO No Differential	$2,218.50
Rate for Payer: Ohio Health Group PPO SOMC Employees	$1,759.50
Rate for Payer: PHCS Commercial	$2,448.00
Rate for Payer: United Healthcare All Payer	$2,244.00

OPEN TREATMENT CALCANEAL FX

Facility

$2,550.00

Service Code	HCPCS 28415
Hospital Charge Code	76101013
Hospital Revenue Code	761
Min. Negotiated Rate	$876.95
Max. Negotiated Rate	$9,240.92
Rate for Payer: Aetna Commercial	$1,963.50
Rate for Payer: Anthem Medicaid	$876.95
Rate for Payer: Anthem Medicare Advantage/PPO	$6,600.66
Rate for Payer: Anthem POS/PPO/Traditional	$1,989.00
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$9,240.92
Rate for Payer: CareSource Just4Me Medicare	$8,910.89
Rate for Payer: Cash Price	$1,275.00
Rate for Payer: Cash Price	$1,275.00
Rate for Payer: Cigna Commercial	$2,116.50
Rate for Payer: First Health Commercial	$2,422.50
Rate for Payer: Humana Commercial	$2,167.50
Rate for Payer: Humana KY Medicaid	$876.95
Rate for Payer: Humana Medicare Advantage	$6,600.66
Rate for Payer: Kentucky WC Medicaid	$885.87
Rate for Payer: Medical Mutual Of Ohio HMO	$2,091.00
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional	$1,881.90
Rate for Payer: Molina Healthcare Benefit Exchange	$7,920.79
Rate for Payer: Molina Healthcare Medicaid	$894.54
Rate for Payer: Ohio Health Choice Commercial	$2,244.00
Rate for Payer: Ohio Health Group HMO	$1,912.50
Rate for Payer: Ohio Health Group PPO Differential	$2,040.00
Rate for Payer: Ohio Health Group PPO No Differential	$2,218.50
Rate for Payer: Ohio Health Group PPO SOMC Employees	$1,759.50
Rate for Payer: PHCS Commercial	$2,448.00
Rate for Payer: United Healthcare All Payer	$2,244.00

OPEN TREATMENT CALCANEAL FX(P

Professional

Both

$2,550.00

Service Code	HCPCS 28415
Hospital Charge Code	761P1013
Hospital Revenue Code	761
Min. Negotiated Rate	$665.39
Max. Negotiated Rate	$2,016.52
Rate for Payer: Aetna Commercial	$1,704.94
Rate for Payer: Ambetter Exchange	$1,060.44
Rate for Payer: Anthem Medicaid	$665.39
Rate for Payer: Buckeye Individual/Medicaid	$1,060.44
Rate for Payer: Buckeye Medicare Advantage	$1,060.44
Rate for Payer: CareSource Just4Me Medicare	$1,272.53
Rate for Payer: Cash Price	$1,275.00
Rate for Payer: Cash Price	$1,275.00
Rate for Payer: Cigna Commercial	$2,016.52
Rate for Payer: Healthspan PPO	$1,544.31
Rate for Payer: Humana Medicaid	$665.39
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation	$1,403.67
Rate for Payer: Medical Mutual Of Ohio Medicare Advantage	$1,060.44
Rate for Payer: Molina Healthcare Benefit Exchange	$1,060.44
Rate for Payer: Molina Healthcare CHIP/Medicaid	$678.70
Rate for Payer: Molina Healthcare Passport	$665.39
Rate for Payer: Multiplan PHCS	$1,530.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$1,378.57
Rate for Payer: UHCCP Medicaid	$892.50
Rate for Payer: Wellcare CHIP/Medicaid	$672.04
Rate for Payer: Wellcare Medicare Advantage	$1,060.44

OPEN TREATMENT METATARSAL FX

Facility

$1,300.00

Service Code	HCPCS 28485
Hospital Charge Code	76101022
Hospital Revenue Code	761
Min. Negotiated Rate	$447.07
Max. Negotiated Rate	$9,240.92
Rate for Payer: Aetna Commercial	$1,001.00
Rate for Payer: Anthem Medicaid	$447.07
Rate for Payer: Anthem Medicare Advantage/PPO	$6,600.66
Rate for Payer: Anthem POS/PPO/Traditional	$1,014.00
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$9,240.92
Rate for Payer: CareSource Just4Me Medicare	$8,910.89
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	$6,600.66
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	$7,920.79
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	$1,040.00
Rate for Payer: Ohio Health Group PPO No Differential	$1,131.00
Rate for Payer: Ohio Health Group PPO SOMC Employees	$897.00
Rate for Payer: PHCS Commercial	$1,248.00
Rate for Payer: United Healthcare All Payer	$1,144.00

OPEN TREATMENT METATARSAL FX

Facility

$1,300.00

Service Code	HCPCS 28485
Hospital Charge Code	76101022
Hospital Revenue Code	761
Min. Negotiated Rate	$390.00
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	$1,040.00
Rate for Payer: Ohio Health Group PPO No Differential	$1,131.00
Rate for Payer: Ohio Health Group PPO SOMC Employees	$897.00
Rate for Payer: PHCS Commercial	$1,248.00
Rate for Payer: United Healthcare All Payer	$1,144.00

OPEN TREATMENT METATARSAL FX

Professional

Both

$1,300.00

Service Code	HCPCS 28485
Hospital Charge Code	76101022
Hospital Revenue Code	761
Min. Negotiated Rate	$295.92
Max. Negotiated Rate	$780.00
Rate for Payer: Aetna Commercial	$774.27
Rate for Payer: Ambetter Exchange	$531.80
Rate for Payer: Anthem Medicaid	$295.92
Rate for Payer: Buckeye Individual/Medicaid	$531.80
Rate for Payer: Buckeye Medicare Advantage	$531.80
Rate for Payer: CareSource Just4Me Medicare	$638.16
Rate for Payer: Cash Price	$650.00
Rate for Payer: Cash Price	$650.00
Rate for Payer: Cigna Commercial	$725.58
Rate for Payer: Healthspan PPO	$701.32
Rate for Payer: Humana Medicaid	$295.92
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation	$653.48
Rate for Payer: Medical Mutual Of Ohio Medicare Advantage	$531.80
Rate for Payer: Molina Healthcare Benefit Exchange	$531.80
Rate for Payer: Molina Healthcare CHIP/Medicaid	$301.84
Rate for Payer: Molina Healthcare Passport	$295.92
Rate for Payer: Multiplan PHCS	$780.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$691.34
Rate for Payer: UHCCP Medicaid	$455.00
Rate for Payer: Wellcare CHIP/Medicaid	$298.88
Rate for Payer: Wellcare Medicare Advantage	$531.80

OPEN TREATMENT METATARSAL FX(P

Professional

Both

$1,300.00

Service Code	HCPCS 28485
Hospital Charge Code	761P1022
Hospital Revenue Code	761
Min. Negotiated Rate	$295.92
Max. Negotiated Rate	$780.00
Rate for Payer: Aetna Commercial	$774.27
Rate for Payer: Ambetter Exchange	$531.80
Rate for Payer: Anthem Medicaid	$295.92
Rate for Payer: Buckeye Individual/Medicaid	$531.80
Rate for Payer: Buckeye Medicare Advantage	$531.80
Rate for Payer: CareSource Just4Me Medicare	$638.16
Rate for Payer: Cash Price	$650.00
Rate for Payer: Cash Price	$650.00
Rate for Payer: Cigna Commercial	$725.58
Rate for Payer: Healthspan PPO	$701.32
Rate for Payer: Humana Medicaid	$295.92
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation	$653.48
Rate for Payer: Medical Mutual Of Ohio Medicare Advantage	$531.80
Rate for Payer: Molina Healthcare Benefit Exchange	$531.80
Rate for Payer: Molina Healthcare CHIP/Medicaid	$301.84
Rate for Payer: Molina Healthcare Passport	$295.92
Rate for Payer: Multiplan PHCS	$780.00
Rate for Payer: Ohio Health Choice Preferred Health Choice	$691.34
Rate for Payer: UHCCP Medicaid	$455.00
Rate for Payer: Wellcare CHIP/Medicaid	$298.88
Rate for Payer: Wellcare Medicare Advantage	$531.80

OPEN TREATMENT OF ACROMIOCLAVICULAR DISLOCATION, ACUTE OR CHRONIC;

Facility

$9,240.92

Service Code	CPT 23550
Hospital Revenue Code	360
Min. Negotiated Rate	$6,600.66
Max. Negotiated Rate	$9,240.92
Rate for Payer: Anthem Medicare Advantage/PPO	$6,600.66
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$9,240.92
Rate for Payer: CareSource Just4Me Medicare	$8,910.89
Rate for Payer: Humana Medicare Advantage	$6,600.66
Rate for Payer: Molina Healthcare Benefit Exchange	$7,920.79

OPEN TREATMENT OF ACROMIOCLAVICULAR DISLOCATION, ACUTE OR CHRONIC; WITH FASCIAL GRAFT (INCLUDES OBTAINING GRAFT)

Facility

$9,240.92

Service Code	CPT 23552
Hospital Revenue Code	360
Min. Negotiated Rate	$6,600.66
Max. Negotiated Rate	$9,240.92
Rate for Payer: Anthem Medicare Advantage/PPO	$6,600.66
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$9,240.92
Rate for Payer: CareSource Just4Me Medicare	$8,910.89
Rate for Payer: Humana Medicare Advantage	$6,600.66
Rate for Payer: Molina Healthcare Benefit Exchange	$7,920.79

OPEN TREATMENT OF BIMALLEOLAR ANKLE FRACTURE (EG, LATERAL AND MEDIAL MALLEOLI, OR LATERAL AND POSTERIOR MALLEOLI, OR MEDIAL AND POSTERIOR MALLEOLI), INCLUDES INTERNAL FIXATION, WHEN PERFORMED

Facility

$9,240.92

Service Code	CPT 27814
Hospital Revenue Code	360
Min. Negotiated Rate	$6,600.66
Max. Negotiated Rate	$9,240.92
Rate for Payer: Anthem Medicare Advantage/PPO	$6,600.66
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$9,240.92
Rate for Payer: CareSource Just4Me Medicare	$8,910.89
Rate for Payer: Humana Medicare Advantage	$6,600.66
Rate for Payer: Molina Healthcare Benefit Exchange	$7,920.79

OPEN TREATMENT OF CALCANEAL FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED;

Facility

$9,240.92

Service Code	CPT 28415
Hospital Revenue Code	360
Min. Negotiated Rate	$6,600.66
Max. Negotiated Rate	$9,240.92
Rate for Payer: Anthem Medicare Advantage/PPO	$6,600.66
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$9,240.92
Rate for Payer: CareSource Just4Me Medicare	$8,910.89
Rate for Payer: Humana Medicare Advantage	$6,600.66
Rate for Payer: Molina Healthcare Benefit Exchange	$7,920.79

OPEN TREATMENT OF CLAVICULAR FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED

Facility

$9,240.92

Service Code	CPT 23515
Hospital Revenue Code	360
Min. Negotiated Rate	$6,600.66
Max. Negotiated Rate	$9,240.92
Rate for Payer: Anthem Medicare Advantage/PPO	$6,600.66
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$9,240.92
Rate for Payer: CareSource Just4Me Medicare	$8,910.89
Rate for Payer: Humana Medicare Advantage	$6,600.66
Rate for Payer: Molina Healthcare Benefit Exchange	$7,920.79

OPEN TREATMENT OF DISTAL FIBULAR FRACTURE (LATERAL MALLEOLUS), INCLUDES INTERNAL FIXATION, WHEN PERFORMED

Facility

$9,240.92

Service Code	CPT 27792
Hospital Revenue Code	360
Min. Negotiated Rate	$6,600.66
Max. Negotiated Rate	$9,240.92
Rate for Payer: Anthem Medicare Advantage/PPO	$6,600.66
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$9,240.92
Rate for Payer: CareSource Just4Me Medicare	$8,910.89
Rate for Payer: Humana Medicare Advantage	$6,600.66
Rate for Payer: Molina Healthcare Benefit Exchange	$7,920.79

OPEN TREATMENT OF DISTAL PHALANGEAL FRACTURE, FINGER OR THUMB, INCLUDES INTERNAL FIXATION, WHEN PERFORMED, EACH

Facility

$4,197.13

Service Code	CPT 26765
Hospital Revenue Code	360
Min. Negotiated Rate	$2,997.95
Max. Negotiated Rate	$4,197.13
Rate for Payer: Anthem Medicare Advantage/PPO	$2,997.95
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$4,197.13
Rate for Payer: CareSource Just4Me Medicare	$4,047.23
Rate for Payer: Humana Medicare Advantage	$2,997.95
Rate for Payer: Molina Healthcare Benefit Exchange	$3,597.54

OPEN TREATMENT OF DISTAL RADIAL EXTRA-ARTICULAR FRACTURE OR EPIPHYSEAL SEPARATION, WITH INTERNAL FIXATION

Facility

$9,240.92

Service Code	CPT 25607
Hospital Revenue Code	360
Min. Negotiated Rate	$6,600.66
Max. Negotiated Rate	$9,240.92
Rate for Payer: Anthem Medicare Advantage/PPO	$6,600.66
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$9,240.92
Rate for Payer: CareSource Just4Me Medicare	$8,910.89
Rate for Payer: Humana Medicare Advantage	$6,600.66
Rate for Payer: Molina Healthcare Benefit Exchange	$7,920.79

OPEN TREATMENT OF DISTAL RADIAL INTRA-ARTICULAR FRACTURE OR EPIPHYSEAL SEPARATION; WITH INTERNAL FIXATION OF 2 FRAGMENTS

Facility

$9,240.92

Service Code	CPT 25608
Hospital Revenue Code	360
Min. Negotiated Rate	$6,600.66
Max. Negotiated Rate	$9,240.92
Rate for Payer: Anthem Medicare Advantage/PPO	$6,600.66
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$9,240.92
Rate for Payer: CareSource Just4Me Medicare	$8,910.89
Rate for Payer: Humana Medicare Advantage	$6,600.66
Rate for Payer: Molina Healthcare Benefit Exchange	$7,920.79

OPEN TREATMENT OF DISTAL RADIAL INTRA-ARTICULAR FRACTURE OR EPIPHYSEAL SEPARATION; WITH INTERNAL FIXATION OF 3 OR MORE FRAGMENTS

Facility

$9,240.92

Service Code	CPT 25609
Hospital Revenue Code	360
Min. Negotiated Rate	$6,600.66
Max. Negotiated Rate	$9,240.92
Rate for Payer: Anthem Medicare Advantage/PPO	$6,600.66
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$9,240.92
Rate for Payer: CareSource Just4Me Medicare	$8,910.89
Rate for Payer: Humana Medicare Advantage	$6,600.66
Rate for Payer: Molina Healthcare Benefit Exchange	$7,920.79

OPEN TREATMENT OF DISTAL TIBIOFIBULAR JOINT (SYNDESMOSIS) DISRUPTION, INCLUDES INTERNAL FIXATION, WHEN PERFORMED

Facility

$9,240.92

Service Code	CPT 27829
Hospital Revenue Code	360
Min. Negotiated Rate	$6,600.66
Max. Negotiated Rate	$9,240.92
Rate for Payer: Anthem Medicare Advantage/PPO	$6,600.66
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$9,240.92
Rate for Payer: CareSource Just4Me Medicare	$8,910.89
Rate for Payer: Humana Medicare Advantage	$6,600.66
Rate for Payer: Molina Healthcare Benefit Exchange	$7,920.79

OPEN TREATMENT OF FRACTURE, GREAT TOE, PHALANX OR PHALANGES, INCLUDES INTERNAL FIXATION, WHEN PERFORMED

Facility

$4,197.13

Service Code	CPT 28505
Hospital Revenue Code	360
Min. Negotiated Rate	$2,997.95
Max. Negotiated Rate	$4,197.13
Rate for Payer: Anthem Medicare Advantage/PPO	$2,997.95
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$4,197.13
Rate for Payer: CareSource Just4Me Medicare	$4,047.23
Rate for Payer: Humana Medicare Advantage	$2,997.95
Rate for Payer: Molina Healthcare Benefit Exchange	$3,597.54

OPEN TREATMENT OF FRACTURE OF WEIGHT BEARING ARTICULAR SURFACE/PORTION OF DISTAL TIBIA (EG, PILON OR TIBIAL PLAFOND), WITH INTERNAL FIXATION, WHEN PERFORMED; OF TIBIA ONLY

Facility

$16,644.15

Service Code	CPT 27827
Hospital Revenue Code	360
Min. Negotiated Rate	$11,888.68
Max. Negotiated Rate	$16,644.15
Rate for Payer: Anthem Medicare Advantage/PPO	$11,888.68
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$16,644.15
Rate for Payer: CareSource Just4Me Medicare	$16,049.72
Rate for Payer: Humana Medicare Advantage	$11,888.68
Rate for Payer: Molina Healthcare Benefit Exchange	$14,266.42

OPEN TREATMENT OF FRACTURE, PHALANX OR PHALANGES, OTHER THAN GREAT TOE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED, EACH

Facility

$4,197.13

Service Code	CPT 28525
Hospital Revenue Code	360
Min. Negotiated Rate	$2,997.95
Max. Negotiated Rate	$4,197.13
Rate for Payer: Anthem Medicare Advantage/PPO	$2,997.95
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$4,197.13
Rate for Payer: CareSource Just4Me Medicare	$4,047.23
Rate for Payer: Humana Medicare Advantage	$2,997.95
Rate for Payer: Molina Healthcare Benefit Exchange	$3,597.54

OPEN TREATMENT OF HUMERAL SHAFT FRACTURE WITH PLATE/SCREWS, WITH OR WITHOUT CERCLAGE

Facility

$16,644.15

Service Code	CPT 24515
Hospital Revenue Code	360
Min. Negotiated Rate	$11,888.68
Max. Negotiated Rate	$16,644.15
Rate for Payer: Anthem Medicare Advantage/PPO	$11,888.68
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage	$16,644.15
Rate for Payer: CareSource Just4Me Medicare	$16,049.72
Rate for Payer: Humana Medicare Advantage	$11,888.68
Rate for Payer: Molina Healthcare Benefit Exchange	$14,266.42

Know your out-of-pocket cost for care.

All Charges