|
OPEN TX BIMALLEOLAR ANKLE FX
|
Facility
|
OP
|
$1,700.00
|
|
|
Service Code
|
HCPCS 27814
|
| Hospital Charge Code |
76100941
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$584.63 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,309.00
|
| Rate for Payer: Anthem Medicaid |
$584.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,326.00
|
| 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 |
$850.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,411.00
|
| Rate for Payer: First Health Commercial |
$1,615.00
|
| Rate for Payer: Humana Commercial |
$1,445.00
|
| Rate for Payer: Humana KY Medicaid |
$584.63
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$590.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,394.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,254.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$596.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,479.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,173.00
|
| Rate for Payer: PHCS Commercial |
$1,632.00
|
| Rate for Payer: United Healthcare All Payer |
$1,496.00
|
|
|
OPEN TX BIMALLEOLAR ANKLE FX
|
Facility
|
IP
|
$1,700.00
|
|
|
Service Code
|
HCPCS 27814
|
| Hospital Charge Code |
76100941
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$510.00 |
| Max. Negotiated Rate |
$1,632.00 |
| Rate for Payer: Aetna Commercial |
$1,309.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,326.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,411.00
|
| Rate for Payer: First Health Commercial |
$1,615.00
|
| Rate for Payer: Humana Commercial |
$1,445.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,394.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,254.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,479.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,173.00
|
| Rate for Payer: PHCS Commercial |
$1,632.00
|
| Rate for Payer: United Healthcare All Payer |
$1,496.00
|
|
|
OPEN TX BIMALLEOLAR ANKLE FX
|
Professional
|
Both
|
$1,700.00
|
|
|
Service Code
|
HCPCS 27814
|
| Hospital Charge Code |
76100941
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$595.00 |
| Max. Negotiated Rate |
$1,299.52 |
| Rate for Payer: Aetna Commercial |
$1,150.48
|
| Rate for Payer: Ambetter Exchange |
$725.95
|
| Rate for Payer: Anthem Medicaid |
$596.72
|
| Rate for Payer: Buckeye Individual/Medicaid |
$725.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$725.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$871.14
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,299.52
|
| Rate for Payer: Healthspan PPO |
$1,042.09
|
| Rate for Payer: Humana Medicaid |
$596.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$961.69
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$725.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$725.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$608.65
|
| Rate for Payer: Molina Healthcare Passport |
$596.72
|
| Rate for Payer: Multiplan PHCS |
$1,020.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$943.74
|
| Rate for Payer: UHCCP Medicaid |
$595.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$602.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$725.95
|
|
|
OPEN TX BIMALLEOLAR ANKLE FX(P
|
Professional
|
Both
|
$1,700.00
|
|
|
Service Code
|
HCPCS 27814
|
| Hospital Charge Code |
761P0941
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$595.00 |
| Max. Negotiated Rate |
$1,299.52 |
| Rate for Payer: Aetna Commercial |
$1,150.48
|
| Rate for Payer: Ambetter Exchange |
$725.95
|
| Rate for Payer: Anthem Medicaid |
$596.72
|
| Rate for Payer: Buckeye Individual/Medicaid |
$725.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$725.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$871.14
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,299.52
|
| Rate for Payer: Healthspan PPO |
$1,042.09
|
| Rate for Payer: Humana Medicaid |
$596.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$961.69
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$725.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$725.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$608.65
|
| Rate for Payer: Molina Healthcare Passport |
$596.72
|
| Rate for Payer: Multiplan PHCS |
$1,020.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$943.74
|
| Rate for Payer: UHCCP Medicaid |
$595.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$602.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$725.95
|
|
|
OPEN TX DIS FIB FX LAT MALL
|
Professional
|
Both
|
$1,280.00
|
|
|
Service Code
|
HCPCS 27792
|
| Hospital Charge Code |
76100938
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$432.95 |
| Max. Negotiated Rate |
$1,018.86 |
| Rate for Payer: Aetna Commercial |
$1,018.86
|
| Rate for Payer: Ambetter Exchange |
$612.23
|
| Rate for Payer: Anthem Medicaid |
$432.95
|
| Rate for Payer: Buckeye Individual/Medicaid |
$612.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$612.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$734.68
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cigna Commercial |
$977.36
|
| Rate for Payer: Healthspan PPO |
$922.87
|
| Rate for Payer: Humana Medicaid |
$432.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$880.89
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$612.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$441.61
|
| Rate for Payer: Molina Healthcare Passport |
$432.95
|
| Rate for Payer: Multiplan PHCS |
$768.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$795.90
|
| Rate for Payer: UHCCP Medicaid |
$448.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$437.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$612.23
|
|
|
OPEN TX DIS FIB FX LAT MALL
|
Facility
|
IP
|
$1,280.00
|
|
|
Service Code
|
HCPCS 27792
|
| Hospital Charge Code |
76100938
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$384.00 |
| Max. Negotiated Rate |
$1,228.80 |
| Rate for Payer: Aetna Commercial |
$985.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$998.40
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cigna Commercial |
$1,062.40
|
| Rate for Payer: First Health Commercial |
$1,216.00
|
| Rate for Payer: Humana Commercial |
$1,088.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,049.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$944.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$384.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,126.40
|
| Rate for Payer: Ohio Health Group HMO |
$960.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,024.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,113.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$883.20
|
| Rate for Payer: PHCS Commercial |
$1,228.80
|
| Rate for Payer: United Healthcare All Payer |
$1,126.40
|
|
|
OPEN TX DIS FIB FX LAT MALL
|
Facility
|
OP
|
$1,280.00
|
|
|
Service Code
|
HCPCS 27792
|
| Hospital Charge Code |
76100938
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$440.19 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$985.60
|
| Rate for Payer: Anthem Medicaid |
$440.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$998.40
|
| 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 |
$640.00
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cigna Commercial |
$1,062.40
|
| Rate for Payer: First Health Commercial |
$1,216.00
|
| Rate for Payer: Humana Commercial |
$1,088.00
|
| Rate for Payer: Humana KY Medicaid |
$440.19
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$444.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,049.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$944.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$449.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,126.40
|
| Rate for Payer: Ohio Health Group HMO |
$960.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,024.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,113.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$883.20
|
| Rate for Payer: PHCS Commercial |
$1,228.80
|
| Rate for Payer: United Healthcare All Payer |
$1,126.40
|
|
|
OPEN TX DIS FIB FX LAT MALL(P
|
Professional
|
Both
|
$1,280.00
|
|
|
Service Code
|
HCPCS 27792
|
| Hospital Charge Code |
761P0938
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$432.95 |
| Max. Negotiated Rate |
$1,018.86 |
| Rate for Payer: Aetna Commercial |
$1,018.86
|
| Rate for Payer: Ambetter Exchange |
$612.23
|
| Rate for Payer: Anthem Medicaid |
$432.95
|
| Rate for Payer: Buckeye Individual/Medicaid |
$612.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$612.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$734.68
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cigna Commercial |
$977.36
|
| Rate for Payer: Healthspan PPO |
$922.87
|
| Rate for Payer: Humana Medicaid |
$432.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$880.89
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$612.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$441.61
|
| Rate for Payer: Molina Healthcare Passport |
$432.95
|
| Rate for Payer: Multiplan PHCS |
$768.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$795.90
|
| Rate for Payer: UHCCP Medicaid |
$448.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$437.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$612.23
|
|
|
OPEN TX FEM FX DIS M/L CONDYLE
|
Professional
|
Both
|
$2,975.00
|
|
|
Service Code
|
HCPCS 27514
|
| Hospital Charge Code |
761P0865
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$917.74 |
| Max. Negotiated Rate |
$2,150.38 |
| Rate for Payer: Aetna Commercial |
$1,560.09
|
| Rate for Payer: Ambetter Exchange |
$917.74
|
| Rate for Payer: Anthem Medicaid |
$953.10
|
| Rate for Payer: Buckeye Individual/Medicaid |
$917.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$917.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,101.29
|
| Rate for Payer: Cash Price |
$1,487.50
|
| Rate for Payer: Cash Price |
$1,487.50
|
| Rate for Payer: Cigna Commercial |
$2,150.38
|
| Rate for Payer: Healthspan PPO |
$1,413.11
|
| Rate for Payer: Humana Medicaid |
$953.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,242.59
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$917.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$917.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$972.16
|
| Rate for Payer: Molina Healthcare Passport |
$953.10
|
| Rate for Payer: Multiplan PHCS |
$1,785.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,193.06
|
| Rate for Payer: UHCCP Medicaid |
$1,041.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$962.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$917.74
|
|
|
OPEN TX FEM FX DIS M/L CONDYLE
|
Facility
|
IP
|
$2,975.00
|
|
|
Service Code
|
HCPCS 27514
|
| Hospital Charge Code |
76100865
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$892.50 |
| Max. Negotiated Rate |
$2,856.00 |
| Rate for Payer: Aetna Commercial |
$2,290.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,320.50
|
| Rate for Payer: Cash Price |
$1,487.50
|
| Rate for Payer: Cigna Commercial |
$2,469.25
|
| Rate for Payer: First Health Commercial |
$2,826.25
|
| Rate for Payer: Humana Commercial |
$2,528.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,439.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,195.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$892.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,618.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,231.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,380.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,588.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,052.75
|
| Rate for Payer: PHCS Commercial |
$2,856.00
|
| Rate for Payer: United Healthcare All Payer |
$2,618.00
|
|
|
OPEN TX FEM FX DIS M/L CONDYLE
|
Facility
|
OP
|
$2,975.00
|
|
|
Service Code
|
HCPCS 27514
|
| Hospital Charge Code |
76100865
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$892.50 |
| Max. Negotiated Rate |
$2,856.00 |
| Rate for Payer: Aetna Commercial |
$2,290.75
|
| Rate for Payer: Anthem Medicaid |
$1,023.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,320.50
|
| Rate for Payer: Cash Price |
$1,487.50
|
| Rate for Payer: Cigna Commercial |
$2,469.25
|
| Rate for Payer: First Health Commercial |
$2,826.25
|
| Rate for Payer: Humana Commercial |
$2,528.75
|
| Rate for Payer: Humana KY Medicaid |
$1,023.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,033.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,439.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,195.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$892.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,043.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,618.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,231.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,380.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,588.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,052.75
|
| Rate for Payer: PHCS Commercial |
$2,856.00
|
| Rate for Payer: United Healthcare All Payer |
$2,618.00
|
|
|
OPEN TX FEM FX DIS M/L CONDYLE
|
Professional
|
Both
|
$2,975.00
|
|
|
Service Code
|
HCPCS 27514
|
| Hospital Charge Code |
76100865
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$917.74 |
| Max. Negotiated Rate |
$2,150.38 |
| Rate for Payer: Aetna Commercial |
$1,560.09
|
| Rate for Payer: Ambetter Exchange |
$917.74
|
| Rate for Payer: Anthem Medicaid |
$953.10
|
| Rate for Payer: Buckeye Individual/Medicaid |
$917.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$917.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,101.29
|
| Rate for Payer: Cash Price |
$1,487.50
|
| Rate for Payer: Cash Price |
$1,487.50
|
| Rate for Payer: Cigna Commercial |
$2,150.38
|
| Rate for Payer: Healthspan PPO |
$1,413.11
|
| Rate for Payer: Humana Medicaid |
$953.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,242.59
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$917.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$917.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$972.16
|
| Rate for Payer: Molina Healthcare Passport |
$953.10
|
| Rate for Payer: Multiplan PHCS |
$1,785.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,193.06
|
| Rate for Payer: UHCCP Medicaid |
$1,041.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$962.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$917.74
|
|
|
OPEN TX FEM SUPRACONDYLR FX
|
Facility
|
IP
|
$2,825.00
|
|
|
Service Code
|
HCPCS 27513
|
| Hospital Charge Code |
76100864
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$847.50 |
| Max. Negotiated Rate |
$2,712.00 |
| Rate for Payer: Aetna Commercial |
$2,175.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,203.50
|
| Rate for Payer: Cash Price |
$1,412.50
|
| Rate for Payer: Cigna Commercial |
$2,344.75
|
| Rate for Payer: First Health Commercial |
$2,683.75
|
| Rate for Payer: Humana Commercial |
$2,401.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,316.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,084.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$847.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,486.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,118.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,260.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,457.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,949.25
|
| Rate for Payer: PHCS Commercial |
$2,712.00
|
| Rate for Payer: United Healthcare All Payer |
$2,486.00
|
|
|
OPEN TX FEM SUPRACONDYLR FX
|
Facility
|
OP
|
$2,825.00
|
|
|
Service Code
|
HCPCS 27513
|
| Hospital Charge Code |
76100864
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$847.50 |
| Max. Negotiated Rate |
$2,712.00 |
| Rate for Payer: Aetna Commercial |
$2,175.25
|
| Rate for Payer: Anthem Medicaid |
$971.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,203.50
|
| Rate for Payer: Cash Price |
$1,412.50
|
| Rate for Payer: Cigna Commercial |
$2,344.75
|
| Rate for Payer: First Health Commercial |
$2,683.75
|
| Rate for Payer: Humana Commercial |
$2,401.25
|
| Rate for Payer: Humana KY Medicaid |
$971.52
|
| Rate for Payer: Kentucky WC Medicaid |
$981.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,316.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,084.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$847.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$991.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,486.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,118.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,260.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,457.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,949.25
|
| Rate for Payer: PHCS Commercial |
$2,712.00
|
| Rate for Payer: United Healthcare All Payer |
$2,486.00
|
|
|
OPEN TX FEM SUPRACONDYLR FX
|
Professional
|
Both
|
$2,825.00
|
|
|
Service Code
|
HCPCS 27513
|
| Hospital Charge Code |
76100864
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$984.28 |
| Max. Negotiated Rate |
$2,201.86 |
| Rate for Payer: Aetna Commercial |
$1,924.34
|
| Rate for Payer: Ambetter Exchange |
$1,170.80
|
| Rate for Payer: Anthem Medicaid |
$984.28
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,170.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,170.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,404.96
|
| Rate for Payer: Cash Price |
$1,412.50
|
| Rate for Payer: Cash Price |
$1,412.50
|
| Rate for Payer: Cigna Commercial |
$2,201.86
|
| Rate for Payer: Healthspan PPO |
$1,743.05
|
| Rate for Payer: Humana Medicaid |
$984.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,585.62
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,170.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,170.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,003.97
|
| Rate for Payer: Molina Healthcare Passport |
$984.28
|
| Rate for Payer: Multiplan PHCS |
$1,695.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,522.04
|
| Rate for Payer: UHCCP Medicaid |
$988.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$994.12
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,170.80
|
|
|
OPEN TX FEM SUPRACONDYLR FX(P
|
Professional
|
Both
|
$2,825.00
|
|
|
Service Code
|
HCPCS 27513
|
| Hospital Charge Code |
761P0864
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$984.28 |
| Max. Negotiated Rate |
$2,201.86 |
| Rate for Payer: Aetna Commercial |
$1,924.34
|
| Rate for Payer: Ambetter Exchange |
$1,170.80
|
| Rate for Payer: Anthem Medicaid |
$984.28
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,170.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,170.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,404.96
|
| Rate for Payer: Cash Price |
$1,412.50
|
| Rate for Payer: Cash Price |
$1,412.50
|
| Rate for Payer: Cigna Commercial |
$2,201.86
|
| Rate for Payer: Healthspan PPO |
$1,743.05
|
| Rate for Payer: Humana Medicaid |
$984.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,585.62
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,170.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,170.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,003.97
|
| Rate for Payer: Molina Healthcare Passport |
$984.28
|
| Rate for Payer: Multiplan PHCS |
$1,695.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,522.04
|
| Rate for Payer: UHCCP Medicaid |
$988.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$994.12
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,170.80
|
|
|
OPEN TX FX DIS TIB
|
Professional
|
Both
|
$2,550.00
|
|
|
Service Code
|
HCPCS 27827
|
| Hospital Charge Code |
76100949
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$650.27 |
| Max. Negotiated Rate |
$1,867.50 |
| Rate for Payer: Aetna Commercial |
$1,605.61
|
| Rate for Payer: Ambetter Exchange |
$1,057.99
|
| Rate for Payer: Anthem Medicaid |
$650.27
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,057.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,057.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,269.59
|
| Rate for Payer: Cash Price |
$1,275.00
|
| Rate for Payer: Cash Price |
$1,275.00
|
| Rate for Payer: Cigna Commercial |
$1,867.50
|
| Rate for Payer: Healthspan PPO |
$1,454.34
|
| Rate for Payer: Humana Medicaid |
$650.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,353.25
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,057.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,057.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$663.28
|
| Rate for Payer: Molina Healthcare Passport |
$650.27
|
| Rate for Payer: Multiplan PHCS |
$1,530.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,375.39
|
| Rate for Payer: UHCCP Medicaid |
$892.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$656.77
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,057.99
|
|
|
OPEN TX FX DIS TIB
|
Facility
|
OP
|
$2,550.00
|
|
|
Service Code
|
HCPCS 27827
|
| Hospital Charge Code |
76100949
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$876.95 |
| Max. Negotiated Rate |
$16,644.15 |
| Rate for Payer: Aetna Commercial |
$1,963.50
|
| Rate for Payer: Anthem Medicaid |
$876.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,888.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,989.00
|
| 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 |
$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 |
$11,888.68
|
| 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 |
$14,266.42
|
| 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 TX FX DIS TIB
|
Facility
|
IP
|
$2,550.00
|
|
|
Service Code
|
HCPCS 27827
|
| Hospital Charge Code |
76100949
|
|
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 TX FX DIS TIB&FIB
|
Facility
|
IP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 27828
|
| Hospital Charge Code |
76100950
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$840.00 |
| Max. Negotiated Rate |
$2,688.00 |
| Rate for Payer: Aetna Commercial |
$2,156.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,184.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cigna Commercial |
$2,324.00
|
| Rate for Payer: First Health Commercial |
$2,660.00
|
| Rate for Payer: Humana Commercial |
$2,380.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,296.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,066.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$840.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,464.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,100.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,436.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,932.00
|
| Rate for Payer: PHCS Commercial |
$2,688.00
|
| Rate for Payer: United Healthcare All Payer |
$2,464.00
|
|
|
OPEN TX FX DIS TIB&FIB
|
Facility
|
OP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 27828
|
| Hospital Charge Code |
76100950
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$962.92 |
| Max. Negotiated Rate |
$16,644.15 |
| Rate for Payer: Aetna Commercial |
$2,156.00
|
| Rate for Payer: Anthem Medicaid |
$962.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,888.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,184.00
|
| 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 |
$1,400.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cigna Commercial |
$2,324.00
|
| Rate for Payer: First Health Commercial |
$2,660.00
|
| Rate for Payer: Humana Commercial |
$2,380.00
|
| Rate for Payer: Humana KY Medicaid |
$962.92
|
| Rate for Payer: Humana Medicare Advantage |
$11,888.68
|
| Rate for Payer: Kentucky WC Medicaid |
$972.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,296.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,066.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14,266.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$982.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,464.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,100.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,436.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,932.00
|
| Rate for Payer: PHCS Commercial |
$2,688.00
|
| Rate for Payer: United Healthcare All Payer |
$2,464.00
|
|
|
OPEN TX FX DIS TIB&FIB
|
Professional
|
Both
|
$2,800.00
|
|
|
Service Code
|
HCPCS 27828
|
| Hospital Charge Code |
76100950
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$754.67 |
| Max. Negotiated Rate |
$2,117.19 |
| Rate for Payer: Aetna Commercial |
$1,919.86
|
| Rate for Payer: Ambetter Exchange |
$1,250.78
|
| Rate for Payer: Anthem Medicaid |
$754.67
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,250.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,250.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,500.94
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cigna Commercial |
$2,117.19
|
| Rate for Payer: Healthspan PPO |
$1,738.98
|
| Rate for Payer: Humana Medicaid |
$754.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,623.02
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,250.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,250.78
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$769.76
|
| Rate for Payer: Molina Healthcare Passport |
$754.67
|
| Rate for Payer: Multiplan PHCS |
$1,680.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,626.01
|
| Rate for Payer: UHCCP Medicaid |
$980.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$762.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,250.78
|
|
|
OPEN TX FX DIS TIBFIB
|
Professional
|
Both
|
$1,900.00
|
|
|
Service Code
|
HCPCS 27826
|
| Hospital Charge Code |
76100948
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$518.51 |
| Max. Negotiated Rate |
$1,191.04 |
| Rate for Payer: Aetna Commercial |
$1,191.04
|
| Rate for Payer: Ambetter Exchange |
$804.20
|
| Rate for Payer: Anthem Medicaid |
$518.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$804.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$804.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$965.04
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cigna Commercial |
$1,154.53
|
| Rate for Payer: Healthspan PPO |
$1,078.83
|
| Rate for Payer: Humana Medicaid |
$518.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,033.70
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$804.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$804.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$528.88
|
| Rate for Payer: Molina Healthcare Passport |
$518.51
|
| Rate for Payer: Multiplan PHCS |
$1,140.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,045.46
|
| Rate for Payer: UHCCP Medicaid |
$665.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$523.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$804.20
|
|
|
OPEN TX FX DIS TIBFIB
|
Facility
|
IP
|
$1,900.00
|
|
|
Service Code
|
HCPCS 27826
|
| Hospital Charge Code |
76100948
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$570.00 |
| Max. Negotiated Rate |
$1,824.00 |
| Rate for Payer: Aetna Commercial |
$1,463.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,482.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cigna Commercial |
$1,577.00
|
| Rate for Payer: First Health Commercial |
$1,805.00
|
| Rate for Payer: Humana Commercial |
$1,615.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,558.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,402.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,672.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,425.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,520.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,653.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,311.00
|
| Rate for Payer: PHCS Commercial |
$1,824.00
|
| Rate for Payer: United Healthcare All Payer |
$1,672.00
|
|
|
OPEN TX FX DIS TIBFIB
|
Facility
|
OP
|
$1,900.00
|
|
|
Service Code
|
HCPCS 27826
|
| Hospital Charge Code |
76100948
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$653.41 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,463.00
|
| Rate for Payer: Anthem Medicaid |
$653.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,482.00
|
| 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 |
$950.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cigna Commercial |
$1,577.00
|
| Rate for Payer: First Health Commercial |
$1,805.00
|
| Rate for Payer: Humana Commercial |
$1,615.00
|
| Rate for Payer: Humana KY Medicaid |
$653.41
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$660.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,558.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,402.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$666.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,672.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,425.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,520.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,653.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,311.00
|
| Rate for Payer: PHCS Commercial |
$1,824.00
|
| Rate for Payer: United Healthcare All Payer |
$1,672.00
|
|
