|
OPEN TREAT. OF METACAR. DISLOC
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 26686
|
| Hospital Charge Code |
761P0732
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$385.00 |
| Max. Negotiated Rate |
$982.20 |
| Rate for Payer: Aetna Commercial |
$894.49
|
| Rate for Payer: Ambetter Exchange |
$595.34
|
| Rate for Payer: Anthem Medicaid |
$414.01
|
| Rate for Payer: Buckeye Individual/Medicaid |
$595.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$595.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$714.41
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$982.20
|
| Rate for Payer: Healthspan PPO |
$810.22
|
| Rate for Payer: Humana Medicaid |
$414.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$766.11
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$595.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$595.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$422.29
|
| Rate for Payer: Molina Healthcare Passport |
$414.01
|
| Rate for Payer: Multiplan PHCS |
$660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$773.94
|
| Rate for Payer: UHCCP Medicaid |
$385.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$418.15
|
| Rate for Payer: Wellcare Medicare Advantage |
$595.34
|
|
|
OPEN TRMT GRT HUM TUBRSTY FX
|
Professional
|
Both
|
$1,975.00
|
|
|
Service Code
|
HCPCS 23630
|
| Hospital Charge Code |
76100484
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$472.76 |
| Max. Negotiated Rate |
$1,185.00 |
| Rate for Payer: Aetna Commercial |
$1,084.67
|
| Rate for Payer: Ambetter Exchange |
$745.39
|
| Rate for Payer: Anthem Medicaid |
$472.76
|
| Rate for Payer: Buckeye Individual/Medicaid |
$745.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$745.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$894.47
|
| Rate for Payer: Cash Price |
$987.50
|
| Rate for Payer: Cash Price |
$987.50
|
| Rate for Payer: Cigna Commercial |
$928.81
|
| Rate for Payer: Healthspan PPO |
$982.48
|
| Rate for Payer: Humana Medicaid |
$472.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$957.05
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$745.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$745.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$482.22
|
| Rate for Payer: Molina Healthcare Passport |
$472.76
|
| Rate for Payer: Multiplan PHCS |
$1,185.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$969.01
|
| Rate for Payer: UHCCP Medicaid |
$691.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$477.49
|
| Rate for Payer: Wellcare Medicare Advantage |
$745.39
|
|
|
OPEN TRMT GRT HUM TUBRSTY FX
|
Facility
|
OP
|
$1,975.00
|
|
|
Service Code
|
HCPCS 23630
|
| Hospital Charge Code |
76100484
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$679.20 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,520.75
|
| Rate for Payer: Anthem Medicaid |
$679.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,540.50
|
| 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 |
$987.50
|
| Rate for Payer: Cash Price |
$987.50
|
| Rate for Payer: Cigna Commercial |
$1,639.25
|
| Rate for Payer: First Health Commercial |
$1,876.25
|
| Rate for Payer: Humana Commercial |
$1,678.75
|
| Rate for Payer: Humana KY Medicaid |
$679.20
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$686.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,619.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,457.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$692.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,738.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,481.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,580.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,718.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,362.75
|
| Rate for Payer: PHCS Commercial |
$1,896.00
|
| Rate for Payer: United Healthcare All Payer |
$1,738.00
|
|
|
OPEN TRMT GRT HUM TUBRSTY FX
|
Facility
|
IP
|
$1,975.00
|
|
|
Service Code
|
HCPCS 23630
|
| Hospital Charge Code |
76100484
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$592.50 |
| Max. Negotiated Rate |
$1,896.00 |
| Rate for Payer: Aetna Commercial |
$1,520.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,540.50
|
| Rate for Payer: Cash Price |
$987.50
|
| Rate for Payer: Cigna Commercial |
$1,639.25
|
| Rate for Payer: First Health Commercial |
$1,876.25
|
| Rate for Payer: Humana Commercial |
$1,678.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,619.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,457.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$592.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,738.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,481.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,580.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,718.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,362.75
|
| Rate for Payer: PHCS Commercial |
$1,896.00
|
| Rate for Payer: United Healthcare All Payer |
$1,738.00
|
|
|
OPEN TRMT GRT HUM TUBRSTY FX(P
|
Professional
|
Both
|
$1,975.00
|
|
|
Service Code
|
HCPCS 23630
|
| Hospital Charge Code |
761P0484
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$472.76 |
| Max. Negotiated Rate |
$1,185.00 |
| Rate for Payer: Aetna Commercial |
$1,084.67
|
| Rate for Payer: Ambetter Exchange |
$745.39
|
| Rate for Payer: Anthem Medicaid |
$472.76
|
| Rate for Payer: Buckeye Individual/Medicaid |
$745.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$745.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$894.47
|
| Rate for Payer: Cash Price |
$987.50
|
| Rate for Payer: Cash Price |
$987.50
|
| Rate for Payer: Cigna Commercial |
$928.81
|
| Rate for Payer: Healthspan PPO |
$982.48
|
| Rate for Payer: Humana Medicaid |
$472.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$957.05
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$745.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$745.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$482.22
|
| Rate for Payer: Molina Healthcare Passport |
$472.76
|
| Rate for Payer: Multiplan PHCS |
$1,185.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$969.01
|
| Rate for Payer: UHCCP Medicaid |
$691.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$477.49
|
| Rate for Payer: Wellcare Medicare Advantage |
$745.39
|
|
|
OPEN TRMT HUM CNDYLR FX M/L
|
Professional
|
Both
|
$1,490.00
|
|
|
Service Code
|
HCPCS 24579
|
| Hospital Charge Code |
76100549
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$521.50 |
| Max. Negotiated Rate |
$1,384.28 |
| Rate for Payer: Aetna Commercial |
$1,233.91
|
| Rate for Payer: Ambetter Exchange |
$797.07
|
| Rate for Payer: Anthem Medicaid |
$575.68
|
| Rate for Payer: Buckeye Individual/Medicaid |
$797.07
|
| Rate for Payer: Buckeye Medicare Advantage |
$797.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$956.48
|
| Rate for Payer: Cash Price |
$745.00
|
| Rate for Payer: Cash Price |
$745.00
|
| Rate for Payer: Cigna Commercial |
$1,384.28
|
| Rate for Payer: Healthspan PPO |
$1,117.66
|
| Rate for Payer: Humana Medicaid |
$575.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,033.32
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$797.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$797.07
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$587.19
|
| Rate for Payer: Molina Healthcare Passport |
$575.68
|
| Rate for Payer: Multiplan PHCS |
$894.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,036.19
|
| Rate for Payer: UHCCP Medicaid |
$521.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$581.44
|
| Rate for Payer: Wellcare Medicare Advantage |
$797.07
|
|
|
OPEN TRMT HUM CNDYLR FX M/L
|
Facility
|
IP
|
$1,490.00
|
|
|
Service Code
|
HCPCS 24579
|
| Hospital Charge Code |
76100549
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$447.00 |
| Max. Negotiated Rate |
$1,430.40 |
| Rate for Payer: Aetna Commercial |
$1,147.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,162.20
|
| Rate for Payer: Cash Price |
$745.00
|
| Rate for Payer: Cigna Commercial |
$1,236.70
|
| Rate for Payer: First Health Commercial |
$1,415.50
|
| Rate for Payer: Humana Commercial |
$1,266.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,221.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,099.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$447.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,311.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,117.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,192.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,296.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,028.10
|
| Rate for Payer: PHCS Commercial |
$1,430.40
|
| Rate for Payer: United Healthcare All Payer |
$1,311.20
|
|
|
OPEN TRMT HUM CNDYLR FX M/L
|
Facility
|
OP
|
$1,490.00
|
|
|
Service Code
|
HCPCS 24579
|
| Hospital Charge Code |
76100549
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$512.41 |
| Max. Negotiated Rate |
$16,644.15 |
| Rate for Payer: Aetna Commercial |
$1,147.30
|
| Rate for Payer: Anthem Medicaid |
$512.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,888.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,162.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16,644.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$16,049.72
|
| Rate for Payer: Cash Price |
$745.00
|
| Rate for Payer: Cash Price |
$745.00
|
| Rate for Payer: Cigna Commercial |
$1,236.70
|
| Rate for Payer: First Health Commercial |
$1,415.50
|
| Rate for Payer: Humana Commercial |
$1,266.50
|
| Rate for Payer: Humana KY Medicaid |
$512.41
|
| Rate for Payer: Humana Medicare Advantage |
$11,888.68
|
| Rate for Payer: Kentucky WC Medicaid |
$517.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,221.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,099.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14,266.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$522.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,311.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,117.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,192.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,296.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,028.10
|
| Rate for Payer: PHCS Commercial |
$1,430.40
|
| Rate for Payer: United Healthcare All Payer |
$1,311.20
|
|
|
OPEN TRMT HUM CNDYLR FX M/L(P
|
Professional
|
Both
|
$1,490.00
|
|
|
Service Code
|
HCPCS 24579
|
| Hospital Charge Code |
761P0549
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$521.50 |
| Max. Negotiated Rate |
$1,384.28 |
| Rate for Payer: Aetna Commercial |
$1,233.91
|
| Rate for Payer: Ambetter Exchange |
$797.07
|
| Rate for Payer: Anthem Medicaid |
$575.68
|
| Rate for Payer: Buckeye Individual/Medicaid |
$797.07
|
| Rate for Payer: Buckeye Medicare Advantage |
$797.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$956.48
|
| Rate for Payer: Cash Price |
$745.00
|
| Rate for Payer: Cash Price |
$745.00
|
| Rate for Payer: Cigna Commercial |
$1,384.28
|
| Rate for Payer: Healthspan PPO |
$1,117.66
|
| Rate for Payer: Humana Medicaid |
$575.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,033.32
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$797.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$797.07
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$587.19
|
| Rate for Payer: Molina Healthcare Passport |
$575.68
|
| Rate for Payer: Multiplan PHCS |
$894.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,036.19
|
| Rate for Payer: UHCCP Medicaid |
$521.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$581.44
|
| Rate for Payer: Wellcare Medicare Advantage |
$797.07
|
|
|
OPEN TRTMENT - METACARPAL -
|
Facility
|
OP
|
$900.00
|
|
|
Service Code
|
HCPCS 26615
|
| Hospital Charge Code |
76100725
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$309.51 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$693.00
|
| Rate for Payer: Anthem Medicaid |
$309.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$702.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$747.00
|
| Rate for Payer: First Health Commercial |
$855.00
|
| Rate for Payer: Humana Commercial |
$765.00
|
| Rate for Payer: Humana KY Medicaid |
$309.51
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$312.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$738.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$664.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$315.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$792.00
|
| Rate for Payer: Ohio Health Group HMO |
$675.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$720.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$783.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$621.00
|
| Rate for Payer: PHCS Commercial |
$864.00
|
| Rate for Payer: United Healthcare All Payer |
$792.00
|
|
|
OPEN TRTMENT - METACARPAL -
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 26615
|
| Hospital Charge Code |
76100725
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$302.06 |
| Max. Negotiated Rate |
$777.52 |
| Rate for Payer: Aetna Commercial |
$777.52
|
| Rate for Payer: Ambetter Exchange |
$551.09
|
| Rate for Payer: Anthem Medicaid |
$302.06
|
| Rate for Payer: Buckeye Individual/Medicaid |
$551.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$551.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$661.31
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$700.39
|
| Rate for Payer: Healthspan PPO |
$704.26
|
| Rate for Payer: Humana Medicaid |
$302.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$693.01
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$551.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$551.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$308.10
|
| Rate for Payer: Molina Healthcare Passport |
$302.06
|
| Rate for Payer: Multiplan PHCS |
$540.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$716.42
|
| Rate for Payer: UHCCP Medicaid |
$315.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$305.08
|
| Rate for Payer: Wellcare Medicare Advantage |
$551.09
|
|
|
OPEN TRTMENT - METACARPAL -
|
Facility
|
IP
|
$900.00
|
|
|
Service Code
|
HCPCS 26615
|
| Hospital Charge Code |
76100725
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$864.00 |
| Rate for Payer: Aetna Commercial |
$693.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$702.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$747.00
|
| Rate for Payer: First Health Commercial |
$855.00
|
| Rate for Payer: Humana Commercial |
$765.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$738.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$664.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$270.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$792.00
|
| Rate for Payer: Ohio Health Group HMO |
$675.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$720.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$783.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$621.00
|
| Rate for Payer: PHCS Commercial |
$864.00
|
| Rate for Payer: United Healthcare All Payer |
$792.00
|
|
|
OPEN TRTMENT - METACARPAL -(P
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 26615
|
| Hospital Charge Code |
761P0725
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$302.06 |
| Max. Negotiated Rate |
$777.52 |
| Rate for Payer: Aetna Commercial |
$777.52
|
| Rate for Payer: Ambetter Exchange |
$551.09
|
| Rate for Payer: Anthem Medicaid |
$302.06
|
| Rate for Payer: Buckeye Individual/Medicaid |
$551.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$551.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$661.31
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$700.39
|
| Rate for Payer: Healthspan PPO |
$704.26
|
| Rate for Payer: Humana Medicaid |
$302.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$693.01
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$551.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$551.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$308.10
|
| Rate for Payer: Molina Healthcare Passport |
$302.06
|
| Rate for Payer: Multiplan PHCS |
$540.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$716.42
|
| Rate for Payer: UHCCP Medicaid |
$315.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$305.08
|
| Rate for Payer: Wellcare Medicare Advantage |
$551.09
|
|
|
OPEN TRTMNT LUNATE DISLOCATION
|
Facility
|
OP
|
$1,300.00
|
|
|
Service Code
|
HCPCS 25695
|
| Hospital Charge Code |
76100646
|
|
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 TRTMNT LUNATE DISLOCATION
|
Professional
|
Both
|
$1,300.00
|
|
|
Service Code
|
HCPCS 25695
|
| Hospital Charge Code |
76100646
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$450.24 |
| Max. Negotiated Rate |
$1,017.32 |
| Rate for Payer: Aetna Commercial |
$920.34
|
| Rate for Payer: Ambetter Exchange |
$607.16
|
| Rate for Payer: Anthem Medicaid |
$450.24
|
| Rate for Payer: Buckeye Individual/Medicaid |
$607.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$607.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$728.59
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$1,017.32
|
| Rate for Payer: Healthspan PPO |
$833.63
|
| Rate for Payer: Humana Medicaid |
$450.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$781.92
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$607.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$607.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$459.24
|
| Rate for Payer: Molina Healthcare Passport |
$450.24
|
| Rate for Payer: Multiplan PHCS |
$780.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$789.31
|
| Rate for Payer: UHCCP Medicaid |
$455.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$454.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$607.16
|
|
|
OPEN TRTMNT LUNATE DISLOCATION
|
Professional
|
Both
|
$1,300.00
|
|
|
Service Code
|
HCPCS 25695
|
| Hospital Charge Code |
761P0646
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$450.24 |
| Max. Negotiated Rate |
$1,017.32 |
| Rate for Payer: Aetna Commercial |
$920.34
|
| Rate for Payer: Ambetter Exchange |
$607.16
|
| Rate for Payer: Anthem Medicaid |
$450.24
|
| Rate for Payer: Buckeye Individual/Medicaid |
$607.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$607.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$728.59
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$1,017.32
|
| Rate for Payer: Healthspan PPO |
$833.63
|
| Rate for Payer: Humana Medicaid |
$450.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$781.92
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$607.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$607.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$459.24
|
| Rate for Payer: Molina Healthcare Passport |
$450.24
|
| Rate for Payer: Multiplan PHCS |
$780.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$789.31
|
| Rate for Payer: UHCCP Medicaid |
$455.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$454.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$607.16
|
|
|
OPEN TRTMNT LUNATE DISLOCATION
|
Facility
|
IP
|
$1,300.00
|
|
|
Service Code
|
HCPCS 25695
|
| Hospital Charge Code |
76100646
|
|
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 TRTMNT RADIAL SHAFT FX
|
Facility
|
IP
|
$1,410.00
|
|
|
Service Code
|
HCPCS 25515
|
| Hospital Charge Code |
76100619
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$423.00 |
| Max. Negotiated Rate |
$1,353.60 |
| Rate for Payer: Aetna Commercial |
$1,085.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,099.80
|
| Rate for Payer: Cash Price |
$705.00
|
| Rate for Payer: Cigna Commercial |
$1,170.30
|
| Rate for Payer: First Health Commercial |
$1,339.50
|
| Rate for Payer: Humana Commercial |
$1,198.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,156.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,040.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$423.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,240.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,057.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,128.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,226.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$972.90
|
| Rate for Payer: PHCS Commercial |
$1,353.60
|
| Rate for Payer: United Healthcare All Payer |
$1,240.80
|
|
|
OPEN TRTMNT RADIAL SHAFT FX
|
Professional
|
Both
|
$1,410.00
|
|
|
Service Code
|
HCPCS 25515
|
| Hospital Charge Code |
76100619
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$487.53 |
| Max. Negotiated Rate |
$1,118.92 |
| Rate for Payer: Aetna Commercial |
$979.64
|
| Rate for Payer: Ambetter Exchange |
$641.22
|
| Rate for Payer: Anthem Medicaid |
$487.53
|
| Rate for Payer: Buckeye Individual/Medicaid |
$641.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$641.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$769.46
|
| Rate for Payer: Cash Price |
$705.00
|
| Rate for Payer: Cash Price |
$705.00
|
| Rate for Payer: Cigna Commercial |
$1,118.92
|
| Rate for Payer: Healthspan PPO |
$887.34
|
| Rate for Payer: Humana Medicaid |
$487.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$822.04
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$641.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$641.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$497.28
|
| Rate for Payer: Molina Healthcare Passport |
$487.53
|
| Rate for Payer: Multiplan PHCS |
$846.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$833.59
|
| Rate for Payer: UHCCP Medicaid |
$493.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$492.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$641.22
|
|
|
OPEN TRTMNT RADIAL SHAFT FX
|
Facility
|
OP
|
$1,410.00
|
|
|
Service Code
|
HCPCS 25515
|
| Hospital Charge Code |
76100619
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$484.90 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,085.70
|
| Rate for Payer: Anthem Medicaid |
$484.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,099.80
|
| 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 |
$705.00
|
| Rate for Payer: Cash Price |
$705.00
|
| Rate for Payer: Cigna Commercial |
$1,170.30
|
| Rate for Payer: First Health Commercial |
$1,339.50
|
| Rate for Payer: Humana Commercial |
$1,198.50
|
| Rate for Payer: Humana KY Medicaid |
$484.90
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$489.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,156.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,040.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$494.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,240.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,057.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,128.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,226.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$972.90
|
| Rate for Payer: PHCS Commercial |
$1,353.60
|
| Rate for Payer: United Healthcare All Payer |
$1,240.80
|
|
|
OPEN TRTMNT RADIAL SHAFT FX(P
|
Professional
|
Both
|
$1,410.00
|
|
|
Service Code
|
HCPCS 25515
|
| Hospital Charge Code |
761P0619
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$487.53 |
| Max. Negotiated Rate |
$1,118.92 |
| Rate for Payer: Aetna Commercial |
$979.64
|
| Rate for Payer: Ambetter Exchange |
$641.22
|
| Rate for Payer: Anthem Medicaid |
$487.53
|
| Rate for Payer: Buckeye Individual/Medicaid |
$641.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$641.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$769.46
|
| Rate for Payer: Cash Price |
$705.00
|
| Rate for Payer: Cash Price |
$705.00
|
| Rate for Payer: Cigna Commercial |
$1,118.92
|
| Rate for Payer: Healthspan PPO |
$887.34
|
| Rate for Payer: Humana Medicaid |
$487.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$822.04
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$641.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$641.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$497.28
|
| Rate for Payer: Molina Healthcare Passport |
$487.53
|
| Rate for Payer: Multiplan PHCS |
$846.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$833.59
|
| Rate for Payer: UHCCP Medicaid |
$493.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$492.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$641.22
|
|
|
OPEN TX ART FX MCP/IP JNT
|
Facility
|
OP
|
$1,035.00
|
|
|
Service Code
|
HCPCS 26746
|
| Hospital Charge Code |
76100742
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$355.94 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$796.95
|
| Rate for Payer: Anthem Medicaid |
$355.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$807.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: Cigna Commercial |
$859.05
|
| Rate for Payer: First Health Commercial |
$983.25
|
| Rate for Payer: Humana Commercial |
$879.75
|
| Rate for Payer: Humana KY Medicaid |
$355.94
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$359.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$848.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$763.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$363.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$910.80
|
| Rate for Payer: Ohio Health Group HMO |
$776.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$828.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$900.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$714.15
|
| Rate for Payer: PHCS Commercial |
$993.60
|
| Rate for Payer: United Healthcare All Payer |
$910.80
|
|
|
OPEN TX ART FX MCP/IP JNT
|
Facility
|
IP
|
$1,035.00
|
|
|
Service Code
|
HCPCS 26746
|
| Hospital Charge Code |
76100742
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$310.50 |
| Max. Negotiated Rate |
$993.60 |
| Rate for Payer: Aetna Commercial |
$796.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$807.30
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: Cigna Commercial |
$859.05
|
| Rate for Payer: First Health Commercial |
$983.25
|
| Rate for Payer: Humana Commercial |
$879.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$848.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$763.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$310.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$910.80
|
| Rate for Payer: Ohio Health Group HMO |
$776.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$828.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$900.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$714.15
|
| Rate for Payer: PHCS Commercial |
$993.60
|
| Rate for Payer: United Healthcare All Payer |
$910.80
|
|
|
OPEN TX ART FX MCP/IP JNT
|
Professional
|
Both
|
$1,035.00
|
|
|
Service Code
|
HCPCS 26746
|
| Hospital Charge Code |
76100742
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$309.70 |
| Max. Negotiated Rate |
$989.32 |
| Rate for Payer: Aetna Commercial |
$989.32
|
| Rate for Payer: Ambetter Exchange |
$708.22
|
| Rate for Payer: Anthem Medicaid |
$309.70
|
| Rate for Payer: Buckeye Individual/Medicaid |
$708.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$708.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$849.86
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: Cigna Commercial |
$747.88
|
| Rate for Payer: Healthspan PPO |
$896.11
|
| Rate for Payer: Humana Medicaid |
$309.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$895.83
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$708.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$708.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$315.89
|
| Rate for Payer: Molina Healthcare Passport |
$309.70
|
| Rate for Payer: Multiplan PHCS |
$621.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$920.69
|
| Rate for Payer: UHCCP Medicaid |
$362.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$312.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$708.22
|
|
|
OPEN TX ART FX MCP/IP JNT(P
|
Professional
|
Both
|
$1,035.00
|
|
|
Service Code
|
HCPCS 26746
|
| Hospital Charge Code |
761P0742
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$309.70 |
| Max. Negotiated Rate |
$989.32 |
| Rate for Payer: Aetna Commercial |
$989.32
|
| Rate for Payer: Ambetter Exchange |
$708.22
|
| Rate for Payer: Anthem Medicaid |
$309.70
|
| Rate for Payer: Buckeye Individual/Medicaid |
$708.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$708.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$849.86
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: Cigna Commercial |
$747.88
|
| Rate for Payer: Healthspan PPO |
$896.11
|
| Rate for Payer: Humana Medicaid |
$309.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$895.83
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$708.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$708.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$315.89
|
| Rate for Payer: Molina Healthcare Passport |
$309.70
|
| Rate for Payer: Multiplan PHCS |
$621.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$920.69
|
| Rate for Payer: UHCCP Medicaid |
$362.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$312.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$708.22
|
|
