|
OPEN TX MONTEGGIA FX DIS ELB
|
Professional
|
Both
|
$1,965.00
|
|
|
Service Code
|
HCPCS 24635
|
| Hospital Charge Code |
76100555
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$647.82 |
| Max. Negotiated Rate |
$1,777.55 |
| Rate for Payer: Aetna Commercial |
$1,120.94
|
| Rate for Payer: Ambetter Exchange |
$647.82
|
| Rate for Payer: Anthem Medicaid |
$704.35
|
| Rate for Payer: Buckeye Individual/Medicaid |
$647.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$647.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$777.38
|
| Rate for Payer: Cash Price |
$982.50
|
| Rate for Payer: Cash Price |
$982.50
|
| Rate for Payer: Cigna Commercial |
$1,777.55
|
| Rate for Payer: Healthspan PPO |
$1,015.33
|
| Rate for Payer: Humana Medicaid |
$704.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$866.85
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$647.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$647.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$718.44
|
| Rate for Payer: Molina Healthcare Passport |
$704.35
|
| Rate for Payer: Multiplan PHCS |
$1,179.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$842.17
|
| Rate for Payer: UHCCP Medicaid |
$687.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$711.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$647.82
|
|
|
OPEN TX MONTEGGIA FX DIS ELB(P
|
Professional
|
Both
|
$1,965.00
|
|
|
Service Code
|
HCPCS 24635
|
| Hospital Charge Code |
761P0555
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$647.82 |
| Max. Negotiated Rate |
$1,777.55 |
| Rate for Payer: Aetna Commercial |
$1,120.94
|
| Rate for Payer: Ambetter Exchange |
$647.82
|
| Rate for Payer: Anthem Medicaid |
$704.35
|
| Rate for Payer: Buckeye Individual/Medicaid |
$647.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$647.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$777.38
|
| Rate for Payer: Cash Price |
$982.50
|
| Rate for Payer: Cash Price |
$982.50
|
| Rate for Payer: Cigna Commercial |
$1,777.55
|
| Rate for Payer: Healthspan PPO |
$1,015.33
|
| Rate for Payer: Humana Medicaid |
$704.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$866.85
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$647.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$647.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$718.44
|
| Rate for Payer: Molina Healthcare Passport |
$704.35
|
| Rate for Payer: Multiplan PHCS |
$1,179.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$842.17
|
| Rate for Payer: UHCCP Medicaid |
$687.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$711.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$647.82
|
|
|
OPEN TX NOSE FX UNCOMPLICATD
|
Facility
|
OP
|
$5,977.00
|
|
|
Service Code
|
HCPCS 21325
|
| Hospital Charge Code |
76100381
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,055.49 |
| Max. Negotiated Rate |
$5,737.92 |
| Rate for Payer: Aetna Commercial |
$4,602.29
|
| Rate for Payer: Anthem Medicaid |
$2,055.49
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,662.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,195.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,045.32
|
| Rate for Payer: Cash Price |
$2,988.50
|
| Rate for Payer: Cash Price |
$2,988.50
|
| Rate for Payer: Cigna Commercial |
$4,960.91
|
| Rate for Payer: First Health Commercial |
$5,678.15
|
| Rate for Payer: Humana Commercial |
$5,080.45
|
| Rate for Payer: Humana KY Medicaid |
$2,055.49
|
| Rate for Payer: Humana Medicare Advantage |
$2,996.53
|
| Rate for Payer: Kentucky WC Medicaid |
$2,076.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,901.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,411.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,595.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,096.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,259.76
|
| Rate for Payer: Ohio Health Group HMO |
$4,482.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,781.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,199.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,124.13
|
| Rate for Payer: PHCS Commercial |
$5,737.92
|
| Rate for Payer: United Healthcare All Payer |
$5,259.76
|
|
|
OPEN TX NOSE FX UNCOMPLICATD
|
Professional
|
Both
|
$5,977.00
|
|
|
Service Code
|
HCPCS 21325
|
| Hospital Charge Code |
76100381
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$225.63 |
| Max. Negotiated Rate |
$3,586.20 |
| Rate for Payer: Aetna Commercial |
$647.21
|
| Rate for Payer: Ambetter Exchange |
$409.86
|
| Rate for Payer: Anthem Medicaid |
$225.63
|
| Rate for Payer: Buckeye Individual/Medicaid |
$409.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$409.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$491.83
|
| Rate for Payer: Cash Price |
$2,988.50
|
| Rate for Payer: Cash Price |
$2,988.50
|
| Rate for Payer: Cigna Commercial |
$772.79
|
| Rate for Payer: Healthspan PPO |
$586.24
|
| Rate for Payer: Humana Medicaid |
$225.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$579.70
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$409.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$409.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$230.14
|
| Rate for Payer: Molina Healthcare Passport |
$225.63
|
| Rate for Payer: Multiplan PHCS |
$3,586.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$532.82
|
| Rate for Payer: UHCCP Medicaid |
$2,091.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$227.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$409.86
|
|
|
OPEN TX NOSE FX UNCOMPLICATD
|
Facility
|
IP
|
$5,977.00
|
|
|
Service Code
|
HCPCS 21325
|
| Hospital Charge Code |
76100381
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,793.10 |
| Max. Negotiated Rate |
$5,737.92 |
| Rate for Payer: Aetna Commercial |
$4,602.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,662.06
|
| Rate for Payer: Cash Price |
$2,988.50
|
| Rate for Payer: Cigna Commercial |
$4,960.91
|
| Rate for Payer: First Health Commercial |
$5,678.15
|
| Rate for Payer: Humana Commercial |
$5,080.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,901.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,411.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,793.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,259.76
|
| Rate for Payer: Ohio Health Group HMO |
$4,482.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,781.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,199.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,124.13
|
| Rate for Payer: PHCS Commercial |
$5,737.92
|
| Rate for Payer: United Healthcare All Payer |
$5,259.76
|
|
|
OPEN TX NOSE FX UNCOMPLICAT(P
|
Professional
|
Both
|
$675.00
|
|
|
Service Code
|
HCPCS 21325
|
| Hospital Charge Code |
761P0381
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$225.63 |
| Max. Negotiated Rate |
$772.79 |
| Rate for Payer: Aetna Commercial |
$647.21
|
| Rate for Payer: Ambetter Exchange |
$409.86
|
| Rate for Payer: Anthem Medicaid |
$225.63
|
| Rate for Payer: Buckeye Individual/Medicaid |
$409.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$409.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$491.83
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cigna Commercial |
$772.79
|
| Rate for Payer: Healthspan PPO |
$586.24
|
| Rate for Payer: Humana Medicaid |
$225.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$579.70
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$409.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$409.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$230.14
|
| Rate for Payer: Molina Healthcare Passport |
$225.63
|
| Rate for Payer: Multiplan PHCS |
$405.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$532.82
|
| Rate for Payer: UHCCP Medicaid |
$236.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$227.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$409.86
|
|
|
OPEN TX NOSE FX UNCOMPLICAT(T
|
Facility
|
IP
|
$5,302.00
|
|
|
Service Code
|
HCPCS 21325
|
| Hospital Charge Code |
761T0381
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,590.60 |
| Max. Negotiated Rate |
$5,089.92 |
| Rate for Payer: Aetna Commercial |
$4,082.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,135.56
|
| Rate for Payer: Cash Price |
$2,651.00
|
| Rate for Payer: Cigna Commercial |
$4,400.66
|
| Rate for Payer: First Health Commercial |
$5,036.90
|
| Rate for Payer: Humana Commercial |
$4,506.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,347.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,912.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,590.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,665.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,976.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,241.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,612.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,658.38
|
| Rate for Payer: PHCS Commercial |
$5,089.92
|
| Rate for Payer: United Healthcare All Payer |
$4,665.76
|
|
|
OPEN TX NOSE FX UNCOMPLICAT(T
|
Facility
|
OP
|
$5,302.00
|
|
|
Service Code
|
HCPCS 21325
|
| Hospital Charge Code |
761T0381
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,823.36 |
| Max. Negotiated Rate |
$5,089.92 |
| Rate for Payer: Aetna Commercial |
$4,082.54
|
| Rate for Payer: Anthem Medicaid |
$1,823.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,135.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,195.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,045.32
|
| Rate for Payer: Cash Price |
$2,651.00
|
| Rate for Payer: Cash Price |
$2,651.00
|
| Rate for Payer: Cigna Commercial |
$4,400.66
|
| Rate for Payer: First Health Commercial |
$5,036.90
|
| Rate for Payer: Humana Commercial |
$4,506.70
|
| Rate for Payer: Humana KY Medicaid |
$1,823.36
|
| Rate for Payer: Humana Medicare Advantage |
$2,996.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,841.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,347.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,912.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,595.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,859.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,665.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,976.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,241.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,612.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,658.38
|
| Rate for Payer: PHCS Commercial |
$5,089.92
|
| Rate for Payer: United Healthcare All Payer |
$4,665.76
|
|
|
OPEN TX NOSE FX W/SKELE FIXJ
|
Facility
|
IP
|
$9,082.00
|
|
|
Service Code
|
HCPCS 21330
|
| Hospital Charge Code |
76100382
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,724.60 |
| Max. Negotiated Rate |
$8,718.72 |
| Rate for Payer: Aetna Commercial |
$6,993.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,083.96
|
| Rate for Payer: Cash Price |
$4,541.00
|
| Rate for Payer: Cigna Commercial |
$7,538.06
|
| Rate for Payer: First Health Commercial |
$8,627.90
|
| Rate for Payer: Humana Commercial |
$7,719.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,447.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,702.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,724.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,992.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,811.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,265.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,901.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,266.58
|
| Rate for Payer: PHCS Commercial |
$8,718.72
|
| Rate for Payer: United Healthcare All Payer |
$7,992.16
|
|
|
OPEN TX NOSE FX W/SKELE FIXJ
|
Professional
|
Both
|
$9,082.00
|
|
|
Service Code
|
HCPCS 21330
|
| Hospital Charge Code |
76100382
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$341.50 |
| Max. Negotiated Rate |
$5,449.20 |
| Rate for Payer: Aetna Commercial |
$802.36
|
| Rate for Payer: Ambetter Exchange |
$495.26
|
| Rate for Payer: Anthem Medicaid |
$341.50
|
| Rate for Payer: Buckeye Individual/Medicaid |
$495.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$495.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$594.31
|
| Rate for Payer: Cash Price |
$4,541.00
|
| Rate for Payer: Cash Price |
$4,541.00
|
| Rate for Payer: Cigna Commercial |
$947.91
|
| Rate for Payer: Healthspan PPO |
$726.77
|
| Rate for Payer: Humana Medicaid |
$341.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$699.98
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$495.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$495.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$348.33
|
| Rate for Payer: Molina Healthcare Passport |
$341.50
|
| Rate for Payer: Multiplan PHCS |
$5,449.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$643.84
|
| Rate for Payer: UHCCP Medicaid |
$3,178.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$344.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$495.26
|
|
|
OPEN TX NOSE FX W/SKELE FIXJ
|
Facility
|
OP
|
$9,082.00
|
|
|
Service Code
|
HCPCS 21330
|
| Hospital Charge Code |
76100382
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,123.30 |
| Max. Negotiated Rate |
$8,718.72 |
| Rate for Payer: Aetna Commercial |
$6,993.14
|
| Rate for Payer: Anthem Medicaid |
$3,123.30
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,465.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,083.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,652.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,379.03
|
| Rate for Payer: Cash Price |
$4,541.00
|
| Rate for Payer: Cash Price |
$4,541.00
|
| Rate for Payer: Cigna Commercial |
$7,538.06
|
| Rate for Payer: First Health Commercial |
$8,627.90
|
| Rate for Payer: Humana Commercial |
$7,719.70
|
| Rate for Payer: Humana KY Medicaid |
$3,123.30
|
| Rate for Payer: Humana Medicare Advantage |
$5,465.95
|
| Rate for Payer: Kentucky WC Medicaid |
$3,155.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,447.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,702.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,559.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,185.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,992.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,811.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,265.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,901.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,266.58
|
| Rate for Payer: PHCS Commercial |
$8,718.72
|
| Rate for Payer: United Healthcare All Payer |
$7,992.16
|
|
|
OPEN TX NOSE FX W/SKELE FIX(P
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 21330
|
| Hospital Charge Code |
761P0382
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$341.50 |
| Max. Negotiated Rate |
$947.91 |
| Rate for Payer: Aetna Commercial |
$802.36
|
| Rate for Payer: Ambetter Exchange |
$495.26
|
| Rate for Payer: Anthem Medicaid |
$341.50
|
| Rate for Payer: Buckeye Individual/Medicaid |
$495.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$495.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$594.31
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$947.91
|
| Rate for Payer: Healthspan PPO |
$726.77
|
| Rate for Payer: Humana Medicaid |
$341.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$699.98
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$495.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$495.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$348.33
|
| Rate for Payer: Molina Healthcare Passport |
$341.50
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$643.84
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$344.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$495.26
|
|
|
OPEN TX NOSE FX W/SKELE FIX(T
|
Facility
|
IP
|
$7,682.00
|
|
|
Service Code
|
HCPCS 21330
|
| Hospital Charge Code |
761T0382
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,304.60 |
| Max. Negotiated Rate |
$7,374.72 |
| Rate for Payer: Aetna Commercial |
$5,915.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,991.96
|
| Rate for Payer: Cash Price |
$3,841.00
|
| Rate for Payer: Cigna Commercial |
$6,376.06
|
| Rate for Payer: First Health Commercial |
$7,297.90
|
| Rate for Payer: Humana Commercial |
$6,529.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,299.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,669.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,304.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,760.16
|
| Rate for Payer: Ohio Health Group HMO |
$5,761.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,145.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,683.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,300.58
|
| Rate for Payer: PHCS Commercial |
$7,374.72
|
| Rate for Payer: United Healthcare All Payer |
$6,760.16
|
|
|
OPEN TX NOSE FX W/SKELE FIX(T
|
Facility
|
OP
|
$7,682.00
|
|
|
Service Code
|
HCPCS 21330
|
| Hospital Charge Code |
761T0382
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,641.84 |
| Max. Negotiated Rate |
$7,652.33 |
| Rate for Payer: Aetna Commercial |
$5,915.14
|
| Rate for Payer: Anthem Medicaid |
$2,641.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,465.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,991.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,652.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,379.03
|
| Rate for Payer: Cash Price |
$3,841.00
|
| Rate for Payer: Cash Price |
$3,841.00
|
| Rate for Payer: Cigna Commercial |
$6,376.06
|
| Rate for Payer: First Health Commercial |
$7,297.90
|
| Rate for Payer: Humana Commercial |
$6,529.70
|
| Rate for Payer: Humana KY Medicaid |
$2,641.84
|
| Rate for Payer: Humana Medicare Advantage |
$5,465.95
|
| Rate for Payer: Kentucky WC Medicaid |
$2,668.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,299.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,669.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,559.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,694.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,760.16
|
| Rate for Payer: Ohio Health Group HMO |
$5,761.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,145.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,683.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,300.58
|
| Rate for Payer: PHCS Commercial |
$7,374.72
|
| Rate for Payer: United Healthcare All Payer |
$6,760.16
|
|
|
OPEN TX NOSE & SEPTAL FX
|
Facility
|
IP
|
$8,536.00
|
|
|
Service Code
|
HCPCS 21335
|
| Hospital Charge Code |
76100383
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,560.80 |
| Max. Negotiated Rate |
$8,194.56 |
| Rate for Payer: Aetna Commercial |
$6,572.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,658.08
|
| Rate for Payer: Cash Price |
$4,268.00
|
| Rate for Payer: Cigna Commercial |
$7,084.88
|
| Rate for Payer: First Health Commercial |
$8,109.20
|
| Rate for Payer: Humana Commercial |
$7,255.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,999.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,299.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,560.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,511.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,402.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,828.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,426.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,889.84
|
| Rate for Payer: PHCS Commercial |
$8,194.56
|
| Rate for Payer: United Healthcare All Payer |
$7,511.68
|
|
|
OPEN TX NOSE & SEPTAL FX
|
Professional
|
Both
|
$8,536.00
|
|
|
Service Code
|
HCPCS 21335
|
| Hospital Charge Code |
76100383
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$550.66 |
| Max. Negotiated Rate |
$5,121.60 |
| Rate for Payer: Aetna Commercial |
$1,041.80
|
| Rate for Payer: Ambetter Exchange |
$668.13
|
| Rate for Payer: Anthem Medicaid |
$550.66
|
| Rate for Payer: Buckeye Individual/Medicaid |
$668.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$668.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$801.76
|
| Rate for Payer: Cash Price |
$4,268.00
|
| Rate for Payer: Cash Price |
$4,268.00
|
| Rate for Payer: Cigna Commercial |
$1,154.23
|
| Rate for Payer: Healthspan PPO |
$943.65
|
| Rate for Payer: Humana Medicaid |
$550.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$908.13
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$668.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$668.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$561.67
|
| Rate for Payer: Molina Healthcare Passport |
$550.66
|
| Rate for Payer: Multiplan PHCS |
$5,121.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$868.57
|
| Rate for Payer: UHCCP Medicaid |
$2,987.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$556.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$668.13
|
|
|
OPEN TX NOSE & SEPTAL FX
|
Facility
|
OP
|
$8,536.00
|
|
|
Service Code
|
HCPCS 21335
|
| Hospital Charge Code |
76100383
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,935.53 |
| Max. Negotiated Rate |
$8,194.56 |
| Rate for Payer: Aetna Commercial |
$6,572.72
|
| Rate for Payer: Anthem Medicaid |
$2,935.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,658.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,195.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,045.32
|
| Rate for Payer: Cash Price |
$4,268.00
|
| Rate for Payer: Cash Price |
$4,268.00
|
| Rate for Payer: Cigna Commercial |
$7,084.88
|
| Rate for Payer: First Health Commercial |
$8,109.20
|
| Rate for Payer: Humana Commercial |
$7,255.60
|
| Rate for Payer: Humana KY Medicaid |
$2,935.53
|
| Rate for Payer: Humana Medicare Advantage |
$2,996.53
|
| Rate for Payer: Kentucky WC Medicaid |
$2,965.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,999.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,299.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,595.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,994.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,511.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,402.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,828.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,426.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,889.84
|
| Rate for Payer: PHCS Commercial |
$8,194.56
|
| Rate for Payer: United Healthcare All Payer |
$7,511.68
|
|
|
OPEN TX NOSE & SEPTAL FX(P
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 21335
|
| Hospital Charge Code |
761P0383
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$550.66 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$1,041.80
|
| Rate for Payer: Ambetter Exchange |
$668.13
|
| Rate for Payer: Anthem Medicaid |
$550.66
|
| Rate for Payer: Buckeye Individual/Medicaid |
$668.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$668.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$801.76
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$1,154.23
|
| Rate for Payer: Healthspan PPO |
$943.65
|
| Rate for Payer: Humana Medicaid |
$550.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$908.13
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$668.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$668.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$561.67
|
| Rate for Payer: Molina Healthcare Passport |
$550.66
|
| Rate for Payer: Multiplan PHCS |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$868.57
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$556.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$668.13
|
|
|
OPEN TX NOSE & SEPTAL FX(T
|
Facility
|
OP
|
$6,036.00
|
|
|
Service Code
|
HCPCS 21335
|
| Hospital Charge Code |
761T0383
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,075.78 |
| Max. Negotiated Rate |
$5,794.56 |
| Rate for Payer: Aetna Commercial |
$4,647.72
|
| Rate for Payer: Anthem Medicaid |
$2,075.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,708.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,195.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,045.32
|
| Rate for Payer: Cash Price |
$3,018.00
|
| Rate for Payer: Cash Price |
$3,018.00
|
| Rate for Payer: Cigna Commercial |
$5,009.88
|
| Rate for Payer: First Health Commercial |
$5,734.20
|
| Rate for Payer: Humana Commercial |
$5,130.60
|
| Rate for Payer: Humana KY Medicaid |
$2,075.78
|
| Rate for Payer: Humana Medicare Advantage |
$2,996.53
|
| Rate for Payer: Kentucky WC Medicaid |
$2,096.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,949.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,454.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,595.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,117.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,311.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,527.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,828.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,251.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,164.84
|
| Rate for Payer: PHCS Commercial |
$5,794.56
|
| Rate for Payer: United Healthcare All Payer |
$5,311.68
|
|
|
OPEN TX NOSE & SEPTAL FX(T
|
Facility
|
IP
|
$6,036.00
|
|
|
Service Code
|
HCPCS 21335
|
| Hospital Charge Code |
761T0383
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,810.80 |
| Max. Negotiated Rate |
$5,794.56 |
| Rate for Payer: Aetna Commercial |
$4,647.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,708.08
|
| Rate for Payer: Cash Price |
$3,018.00
|
| Rate for Payer: Cigna Commercial |
$5,009.88
|
| Rate for Payer: First Health Commercial |
$5,734.20
|
| Rate for Payer: Humana Commercial |
$5,130.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,949.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,454.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,810.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,311.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,527.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,828.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,251.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,164.84
|
| Rate for Payer: PHCS Commercial |
$5,794.56
|
| Rate for Payer: United Healthcare All Payer |
$5,311.68
|
|
|
OPEN TX. OF INTERPHALAN. JOINT
|
Professional
|
Both
|
$684.00
|
|
|
Service Code
|
HCPCS 26785
|
| Hospital Charge Code |
76100750
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$211.05 |
| Max. Negotiated Rate |
$715.63 |
| Rate for Payer: Aetna Commercial |
$715.63
|
| Rate for Payer: Ambetter Exchange |
$525.51
|
| Rate for Payer: Anthem Medicaid |
$211.05
|
| Rate for Payer: Buckeye Individual/Medicaid |
$525.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$525.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$630.61
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Cigna Commercial |
$574.04
|
| Rate for Payer: Healthspan PPO |
$648.21
|
| Rate for Payer: Humana Medicaid |
$211.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$651.80
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$525.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$215.27
|
| Rate for Payer: Molina Healthcare Passport |
$211.05
|
| Rate for Payer: Multiplan PHCS |
$410.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$683.16
|
| Rate for Payer: UHCCP Medicaid |
$239.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$213.16
|
| Rate for Payer: Wellcare Medicare Advantage |
$525.51
|
|
|
OPEN TX. OF INTERPHALAN. JOINT
|
Facility
|
OP
|
$684.00
|
|
|
Service Code
|
HCPCS 26785
|
| Hospital Charge Code |
76100750
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$235.23 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$526.68
|
| Rate for Payer: Anthem Medicaid |
$235.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$533.52
|
| 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 |
$342.00
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Cigna Commercial |
$567.72
|
| Rate for Payer: First Health Commercial |
$649.80
|
| Rate for Payer: Humana Commercial |
$581.40
|
| Rate for Payer: Humana KY Medicaid |
$235.23
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$237.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$560.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$504.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$239.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$601.92
|
| Rate for Payer: Ohio Health Group HMO |
$513.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$547.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$595.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$471.96
|
| Rate for Payer: PHCS Commercial |
$656.64
|
| Rate for Payer: United Healthcare All Payer |
$601.92
|
|
|
OPEN TX. OF INTERPHALAN. JOINT
|
Facility
|
IP
|
$684.00
|
|
|
Service Code
|
HCPCS 26785
|
| Hospital Charge Code |
76100750
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$205.20 |
| Max. Negotiated Rate |
$656.64 |
| Rate for Payer: Aetna Commercial |
$526.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$533.52
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Cigna Commercial |
$567.72
|
| Rate for Payer: First Health Commercial |
$649.80
|
| Rate for Payer: Humana Commercial |
$581.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$560.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$504.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$205.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$601.92
|
| Rate for Payer: Ohio Health Group HMO |
$513.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$547.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$595.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$471.96
|
| Rate for Payer: PHCS Commercial |
$656.64
|
| Rate for Payer: United Healthcare All Payer |
$601.92
|
|
|
OPEN TX. OF INTERPHALAN. JOINT
|
Professional
|
Both
|
$684.00
|
|
|
Service Code
|
HCPCS 26785
|
| Hospital Charge Code |
761P0750
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$211.05 |
| Max. Negotiated Rate |
$715.63 |
| Rate for Payer: Aetna Commercial |
$715.63
|
| Rate for Payer: Ambetter Exchange |
$525.51
|
| Rate for Payer: Anthem Medicaid |
$211.05
|
| Rate for Payer: Buckeye Individual/Medicaid |
$525.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$525.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$630.61
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Cigna Commercial |
$574.04
|
| Rate for Payer: Healthspan PPO |
$648.21
|
| Rate for Payer: Humana Medicaid |
$211.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$651.80
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$525.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$215.27
|
| Rate for Payer: Molina Healthcare Passport |
$211.05
|
| Rate for Payer: Multiplan PHCS |
$410.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$683.16
|
| Rate for Payer: UHCCP Medicaid |
$239.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$213.16
|
| Rate for Payer: Wellcare Medicare Advantage |
$525.51
|
|
|
OPEN TX OF PHALANGEAL FRAC.
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 26735
|
| Hospital Charge Code |
76100739
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$280.00 |
| Max. Negotiated Rate |
$813.22 |
| Rate for Payer: Aetna Commercial |
$813.22
|
| Rate for Payer: Ambetter Exchange |
$569.13
|
| Rate for Payer: Anthem Medicaid |
$282.71
|
| Rate for Payer: Buckeye Individual/Medicaid |
$569.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$569.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$682.96
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$760.46
|
| Rate for Payer: Healthspan PPO |
$736.60
|
| Rate for Payer: Humana Medicaid |
$282.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$720.16
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$569.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$569.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$288.36
|
| Rate for Payer: Molina Healthcare Passport |
$282.71
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$739.87
|
| Rate for Payer: UHCCP Medicaid |
$280.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$285.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$569.13
|
|
