|
OPEN TX FX DIS TIB&FIB(P
|
Professional
|
Both
|
$2,800.00
|
|
|
Service Code
|
HCPCS 27828
|
| Hospital Charge Code |
761P0950
|
|
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(P
|
Professional
|
Both
|
$1,900.00
|
|
|
Service Code
|
HCPCS 27826
|
| Hospital Charge Code |
761P0948
|
|
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 TIB(P
|
Professional
|
Both
|
$2,550.00
|
|
|
Service Code
|
HCPCS 27827
|
| Hospital Charge Code |
761P0949
|
|
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 GRT TOE/PHLNX/PHLNG
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 28505
|
| Hospital Charge Code |
761P1025
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$194.82 |
| Max. Negotiated Rate |
$818.21 |
| Rate for Payer: Aetna Commercial |
$706.35
|
| Rate for Payer: Ambetter Exchange |
$471.07
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$254.70
|
| Rate for Payer: Anthem Medicaid |
$194.82
|
| Rate for Payer: Buckeye Individual/Medicaid |
$471.07
|
| Rate for Payer: Buckeye Medicare Advantage |
$471.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$565.28
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$501.23
|
| Rate for Payer: Healthspan PPO |
$818.21
|
| Rate for Payer: Humana Medicaid |
$194.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$611.68
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$471.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$471.07
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$198.72
|
| Rate for Payer: Molina Healthcare Passport |
$194.82
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$612.39
|
| Rate for Payer: UHCCP Medicaid |
$267.44
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$196.77
|
| Rate for Payer: Wellcare Medicare Advantage |
$471.07
|
|
|
OPEN TX FX GRT TOE/PHLNX/PHLNG
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 28505
|
| Hospital Charge Code |
76101025
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$690.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
OPEN TX FX GRT TOE/PHLNX/PHLNG
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 28505
|
| Hospital Charge Code |
76101025
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$343.90 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem Medicaid |
$343.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| 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 |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Humana KY Medicaid |
$343.90
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$347.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$350.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$690.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
OPEN TX FX GRT TOE/PHLNX/PHLNG
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 28505
|
| Hospital Charge Code |
76101025
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$194.82 |
| Max. Negotiated Rate |
$818.21 |
| Rate for Payer: Aetna Commercial |
$706.35
|
| Rate for Payer: Ambetter Exchange |
$471.07
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$254.70
|
| Rate for Payer: Anthem Medicaid |
$194.82
|
| Rate for Payer: Buckeye Individual/Medicaid |
$471.07
|
| Rate for Payer: Buckeye Medicare Advantage |
$471.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$565.28
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$501.23
|
| Rate for Payer: Healthspan PPO |
$818.21
|
| Rate for Payer: Humana Medicaid |
$194.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$611.68
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$471.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$471.07
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$198.72
|
| Rate for Payer: Molina Healthcare Passport |
$194.82
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$612.39
|
| Rate for Payer: UHCCP Medicaid |
$267.44
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$196.77
|
| Rate for Payer: Wellcare Medicare Advantage |
$471.07
|
|
|
OPEN TX HUM EPICONDYLAR FX
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 24575
|
| Hospital Charge Code |
76100544
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$1,344.00 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$420.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,218.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$966.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
OPEN TX HUM EPICONDYLAR FX
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 24575
|
| Hospital Charge Code |
76100545
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$1,344.00 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$420.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,218.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$966.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
OPEN TX HUM EPICONDYLAR FX
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 24575
|
| Hospital Charge Code |
76100544
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$490.00 |
| Max. Negotiated Rate |
$1,288.00 |
| Rate for Payer: Aetna Commercial |
$1,087.32
|
| Rate for Payer: Ambetter Exchange |
$700.87
|
| Rate for Payer: Anthem Medicaid |
$529.87
|
| Rate for Payer: Buckeye Individual/Medicaid |
$700.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$700.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$841.04
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,288.00
|
| Rate for Payer: Healthspan PPO |
$984.88
|
| Rate for Payer: Humana Medicaid |
$529.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$904.98
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$700.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$700.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$540.47
|
| Rate for Payer: Molina Healthcare Passport |
$529.87
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$911.13
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$535.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$700.87
|
|
|
OPEN TX HUM EPICONDYLAR FX
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 24575
|
| Hospital Charge Code |
76100545
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$481.46 |
| Max. Negotiated Rate |
$16,644.15 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem Medicaid |
$481.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,888.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| 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 |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Humana KY Medicaid |
$481.46
|
| Rate for Payer: Humana Medicare Advantage |
$11,888.68
|
| Rate for Payer: Kentucky WC Medicaid |
$486.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14,266.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$491.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,218.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$966.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
OPEN TX HUM EPICONDYLAR FX
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 24575
|
| Hospital Charge Code |
76100545
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$490.00 |
| Max. Negotiated Rate |
$1,288.00 |
| Rate for Payer: Aetna Commercial |
$1,087.32
|
| Rate for Payer: Ambetter Exchange |
$700.87
|
| Rate for Payer: Anthem Medicaid |
$529.87
|
| Rate for Payer: Buckeye Individual/Medicaid |
$700.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$700.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$841.04
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,288.00
|
| Rate for Payer: Healthspan PPO |
$984.88
|
| Rate for Payer: Humana Medicaid |
$529.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$904.98
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$700.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$700.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$540.47
|
| Rate for Payer: Molina Healthcare Passport |
$529.87
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$911.13
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$535.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$700.87
|
|
|
OPEN TX HUM EPICONDYLAR FX
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 24575
|
| Hospital Charge Code |
76100544
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$481.46 |
| Max. Negotiated Rate |
$16,644.15 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem Medicaid |
$481.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,888.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| 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 |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Humana KY Medicaid |
$481.46
|
| Rate for Payer: Humana Medicare Advantage |
$11,888.68
|
| Rate for Payer: Kentucky WC Medicaid |
$486.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14,266.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$491.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,218.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$966.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
OPEN TX HUM EPICONDYLAR FX(P
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 24575
|
| Hospital Charge Code |
761P0545
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$490.00 |
| Max. Negotiated Rate |
$1,288.00 |
| Rate for Payer: Aetna Commercial |
$1,087.32
|
| Rate for Payer: Ambetter Exchange |
$700.87
|
| Rate for Payer: Anthem Medicaid |
$529.87
|
| Rate for Payer: Buckeye Individual/Medicaid |
$700.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$700.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$841.04
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,288.00
|
| Rate for Payer: Healthspan PPO |
$984.88
|
| Rate for Payer: Humana Medicaid |
$529.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$904.98
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$700.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$700.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$540.47
|
| Rate for Payer: Molina Healthcare Passport |
$529.87
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$911.13
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$535.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$700.87
|
|
|
OPEN TX HUM EPICONDYLAR FX(P
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 24575
|
| Hospital Charge Code |
761P0544
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$490.00 |
| Max. Negotiated Rate |
$1,288.00 |
| Rate for Payer: Aetna Commercial |
$1,087.32
|
| Rate for Payer: Ambetter Exchange |
$700.87
|
| Rate for Payer: Anthem Medicaid |
$529.87
|
| Rate for Payer: Buckeye Individual/Medicaid |
$700.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$700.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$841.04
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,288.00
|
| Rate for Payer: Healthspan PPO |
$984.88
|
| Rate for Payer: Humana Medicaid |
$529.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$904.98
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$700.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$700.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$540.47
|
| Rate for Payer: Molina Healthcare Passport |
$529.87
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$911.13
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$535.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$700.87
|
|
|
OPEN TX HUMRL SUPR/TRNSCDLR FX
|
Facility
|
OP
|
$1,245.00
|
|
|
Service Code
|
HCPCS 24546
|
| Hospital Charge Code |
76100540
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$428.16 |
| Max. Negotiated Rate |
$16,644.15 |
| Rate for Payer: Aetna Commercial |
$958.65
|
| Rate for Payer: Anthem Medicaid |
$428.16
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,888.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$971.10
|
| 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 |
$622.50
|
| Rate for Payer: Cash Price |
$622.50
|
| Rate for Payer: Cigna Commercial |
$1,033.35
|
| Rate for Payer: First Health Commercial |
$1,182.75
|
| Rate for Payer: Humana Commercial |
$1,058.25
|
| Rate for Payer: Humana KY Medicaid |
$428.16
|
| Rate for Payer: Humana Medicare Advantage |
$11,888.68
|
| Rate for Payer: Kentucky WC Medicaid |
$432.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,020.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$918.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14,266.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$436.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,095.60
|
| Rate for Payer: Ohio Health Group HMO |
$933.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,083.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$859.05
|
| Rate for Payer: PHCS Commercial |
$1,195.20
|
| Rate for Payer: United Healthcare All Payer |
$1,095.60
|
|
|
OPEN TX HUMRL SUPR/TRNSCDLR FX
|
Professional
|
Both
|
$1,245.00
|
|
|
Service Code
|
HCPCS 24546
|
| Hospital Charge Code |
761P0540
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$435.75 |
| Max. Negotiated Rate |
$1,813.48 |
| Rate for Payer: Aetna Commercial |
$1,576.28
|
| Rate for Payer: Ambetter Exchange |
$988.22
|
| Rate for Payer: Anthem Medicaid |
$736.23
|
| Rate for Payer: Buckeye Individual/Medicaid |
$988.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$988.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,185.86
|
| Rate for Payer: Cash Price |
$622.50
|
| Rate for Payer: Cash Price |
$622.50
|
| Rate for Payer: Cigna Commercial |
$1,813.48
|
| Rate for Payer: Healthspan PPO |
$1,427.77
|
| Rate for Payer: Humana Medicaid |
$736.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,301.71
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$988.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$988.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$750.95
|
| Rate for Payer: Molina Healthcare Passport |
$736.23
|
| Rate for Payer: Multiplan PHCS |
$747.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,284.69
|
| Rate for Payer: UHCCP Medicaid |
$435.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$743.59
|
| Rate for Payer: Wellcare Medicare Advantage |
$988.22
|
|
|
OPEN TX HUMRL SUPR/TRNSCDLR FX
|
Professional
|
Both
|
$1,245.00
|
|
|
Service Code
|
HCPCS 24546
|
| Hospital Charge Code |
76100540
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$435.75 |
| Max. Negotiated Rate |
$1,813.48 |
| Rate for Payer: Aetna Commercial |
$1,576.28
|
| Rate for Payer: Ambetter Exchange |
$988.22
|
| Rate for Payer: Anthem Medicaid |
$736.23
|
| Rate for Payer: Buckeye Individual/Medicaid |
$988.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$988.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,185.86
|
| Rate for Payer: Cash Price |
$622.50
|
| Rate for Payer: Cash Price |
$622.50
|
| Rate for Payer: Cigna Commercial |
$1,813.48
|
| Rate for Payer: Healthspan PPO |
$1,427.77
|
| Rate for Payer: Humana Medicaid |
$736.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,301.71
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$988.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$988.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$750.95
|
| Rate for Payer: Molina Healthcare Passport |
$736.23
|
| Rate for Payer: Multiplan PHCS |
$747.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,284.69
|
| Rate for Payer: UHCCP Medicaid |
$435.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$743.59
|
| Rate for Payer: Wellcare Medicare Advantage |
$988.22
|
|
|
OPEN TX HUMRL SUPR/TRNSCDLR FX
|
Facility
|
IP
|
$1,245.00
|
|
|
Service Code
|
HCPCS 24546
|
| Hospital Charge Code |
76100540
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$373.50 |
| Max. Negotiated Rate |
$1,195.20 |
| Rate for Payer: Aetna Commercial |
$958.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$971.10
|
| Rate for Payer: Cash Price |
$622.50
|
| Rate for Payer: Cigna Commercial |
$1,033.35
|
| Rate for Payer: First Health Commercial |
$1,182.75
|
| Rate for Payer: Humana Commercial |
$1,058.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,020.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$918.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$373.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,095.60
|
| Rate for Payer: Ohio Health Group HMO |
$933.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,083.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$859.05
|
| Rate for Payer: PHCS Commercial |
$1,195.20
|
| Rate for Payer: United Healthcare All Payer |
$1,095.60
|
|
|
OPENTX INTCONDYLAR SPINE/TUBRS
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 27540
|
| Hospital Charge Code |
76100873
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$699.25 |
| Max. Negotiated Rate |
$1,524.00 |
| Rate for Payer: Aetna Commercial |
$1,243.24
|
| Rate for Payer: Ambetter Exchange |
$776.83
|
| Rate for Payer: Anthem Medicaid |
$699.25
|
| Rate for Payer: Buckeye Individual/Medicaid |
$776.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$776.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$932.20
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,524.00
|
| Rate for Payer: Healthspan PPO |
$1,126.11
|
| Rate for Payer: Humana Medicaid |
$699.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,017.02
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$776.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$776.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$713.24
|
| Rate for Payer: Molina Healthcare Passport |
$699.25
|
| Rate for Payer: Multiplan PHCS |
$1,260.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,009.88
|
| Rate for Payer: UHCCP Medicaid |
$735.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$706.24
|
| Rate for Payer: Wellcare Medicare Advantage |
$776.83
|
|
|
OPENTX INTCONDYLAR SPINE/TUBRS
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 27540
|
| Hospital Charge Code |
761P0873
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$699.25 |
| Max. Negotiated Rate |
$1,524.00 |
| Rate for Payer: Aetna Commercial |
$1,243.24
|
| Rate for Payer: Ambetter Exchange |
$776.83
|
| Rate for Payer: Anthem Medicaid |
$699.25
|
| Rate for Payer: Buckeye Individual/Medicaid |
$776.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$776.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$932.20
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,524.00
|
| Rate for Payer: Healthspan PPO |
$1,126.11
|
| Rate for Payer: Humana Medicaid |
$699.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,017.02
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$776.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$776.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$713.24
|
| Rate for Payer: Molina Healthcare Passport |
$699.25
|
| Rate for Payer: Multiplan PHCS |
$1,260.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,009.88
|
| Rate for Payer: UHCCP Medicaid |
$735.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$706.24
|
| Rate for Payer: Wellcare Medicare Advantage |
$776.83
|
|
|
OPENTX INTCONDYLAR SPINE/TUBRS
|
Facility
|
OP
|
$2,100.00
|
|
|
Service Code
|
HCPCS 27540
|
| Hospital Charge Code |
76100873
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$630.00 |
| Max. Negotiated Rate |
$2,016.00 |
| Rate for Payer: Aetna Commercial |
$1,617.00
|
| Rate for Payer: Anthem Medicaid |
$722.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,638.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,743.00
|
| Rate for Payer: First Health Commercial |
$1,995.00
|
| Rate for Payer: Humana Commercial |
$1,785.00
|
| Rate for Payer: Humana KY Medicaid |
$722.19
|
| Rate for Payer: Kentucky WC Medicaid |
$729.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,722.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,549.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$736.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,848.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,827.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,449.00
|
| Rate for Payer: PHCS Commercial |
$2,016.00
|
| Rate for Payer: United Healthcare All Payer |
$1,848.00
|
|
|
OPENTX INTCONDYLAR SPINE/TUBRS
|
Facility
|
IP
|
$2,100.00
|
|
|
Service Code
|
HCPCS 27540
|
| Hospital Charge Code |
76100873
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$630.00 |
| Max. Negotiated Rate |
$2,016.00 |
| Rate for Payer: Aetna Commercial |
$1,617.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,638.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,743.00
|
| Rate for Payer: First Health Commercial |
$1,995.00
|
| Rate for Payer: Humana Commercial |
$1,785.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,722.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,549.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,848.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,827.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,449.00
|
| Rate for Payer: PHCS Commercial |
$2,016.00
|
| Rate for Payer: United Healthcare All Payer |
$1,848.00
|
|
|
OPEN TX MONTEGGIA FX DIS ELB
|
Facility
|
IP
|
$1,965.00
|
|
|
Service Code
|
HCPCS 24635
|
| Hospital Charge Code |
76100555
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$589.50 |
| Max. Negotiated Rate |
$1,886.40 |
| Rate for Payer: Aetna Commercial |
$1,513.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,532.70
|
| Rate for Payer: Cash Price |
$982.50
|
| Rate for Payer: Cigna Commercial |
$1,630.95
|
| Rate for Payer: First Health Commercial |
$1,866.75
|
| Rate for Payer: Humana Commercial |
$1,670.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,611.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,450.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$589.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,729.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,473.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,572.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,709.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,355.85
|
| Rate for Payer: PHCS Commercial |
$1,886.40
|
| Rate for Payer: United Healthcare All Payer |
$1,729.20
|
|
|
OPEN TX MONTEGGIA FX DIS ELB
|
Facility
|
OP
|
$1,965.00
|
|
|
Service Code
|
HCPCS 24635
|
| Hospital Charge Code |
76100555
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$675.76 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,513.05
|
| Rate for Payer: Anthem Medicaid |
$675.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,532.70
|
| 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 |
$982.50
|
| Rate for Payer: Cash Price |
$982.50
|
| Rate for Payer: Cigna Commercial |
$1,630.95
|
| Rate for Payer: First Health Commercial |
$1,866.75
|
| Rate for Payer: Humana Commercial |
$1,670.25
|
| Rate for Payer: Humana KY Medicaid |
$675.76
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$682.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,611.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,450.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$689.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,729.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,473.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,572.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,709.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,355.85
|
| Rate for Payer: PHCS Commercial |
$1,886.40
|
| Rate for Payer: United Healthcare All Payer |
$1,729.20
|
|
