|
OPEN TX OF PHALANGEAL FRAC.
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS 26735
|
| Hospital Charge Code |
76100739
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$275.12 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem Medicaid |
$275.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| 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 |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Humana KY Medicaid |
$275.12
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$277.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$280.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
OPEN TX OF PHALANGEAL FRAC.
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS 26735
|
| Hospital Charge Code |
76100739
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
OPEN TX OF PHALANGEAL FRAC.(P
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 26735
|
| Hospital Charge Code |
761P0739
|
|
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
|
|
|
OPEN TX PATELLAR DISLOC
|
Facility
|
OP
|
$8,568.00
|
|
|
Service Code
|
HCPCS 27566
|
| Hospital Charge Code |
76100877
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,946.54 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$6,597.36
|
| Rate for Payer: Anthem Medicaid |
$2,946.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,683.04
|
| 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 |
$4,284.00
|
| Rate for Payer: Cash Price |
$4,284.00
|
| Rate for Payer: Cigna Commercial |
$7,111.44
|
| Rate for Payer: First Health Commercial |
$8,139.60
|
| Rate for Payer: Humana Commercial |
$7,282.80
|
| Rate for Payer: Humana KY Medicaid |
$2,946.54
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$2,976.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,025.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,323.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,005.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,539.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,426.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,854.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,454.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,911.92
|
| Rate for Payer: PHCS Commercial |
$8,225.28
|
| Rate for Payer: United Healthcare All Payer |
$7,539.84
|
|
|
OPEN TX PATELLAR DISLOC
|
Facility
|
IP
|
$8,568.00
|
|
|
Service Code
|
HCPCS 27566
|
| Hospital Charge Code |
45000163
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,570.40 |
| Max. Negotiated Rate |
$8,225.28 |
| Rate for Payer: Aetna Commercial |
$6,597.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,683.04
|
| Rate for Payer: Cash Price |
$4,284.00
|
| Rate for Payer: Cigna Commercial |
$7,111.44
|
| Rate for Payer: First Health Commercial |
$8,139.60
|
| Rate for Payer: Humana Commercial |
$7,282.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,025.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,323.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,570.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,539.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,426.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,854.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,454.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,911.92
|
| Rate for Payer: PHCS Commercial |
$8,225.28
|
| Rate for Payer: United Healthcare All Payer |
$7,539.84
|
|
|
OPEN TX PATELLAR DISLOC
|
Facility
|
IP
|
$8,568.00
|
|
|
Service Code
|
HCPCS 27566
|
| Hospital Charge Code |
76100877
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,570.40 |
| Max. Negotiated Rate |
$8,225.28 |
| Rate for Payer: Aetna Commercial |
$6,597.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,683.04
|
| Rate for Payer: Cash Price |
$4,284.00
|
| Rate for Payer: Cigna Commercial |
$7,111.44
|
| Rate for Payer: First Health Commercial |
$8,139.60
|
| Rate for Payer: Humana Commercial |
$7,282.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,025.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,323.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,570.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,539.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,426.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,854.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,454.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,911.92
|
| Rate for Payer: PHCS Commercial |
$8,225.28
|
| Rate for Payer: United Healthcare All Payer |
$7,539.84
|
|
|
OPEN TX PATELLAR DISLOC
|
Facility
|
OP
|
$8,568.00
|
|
|
Service Code
|
HCPCS 27566
|
| Hospital Charge Code |
45000163
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,946.54 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$6,597.36
|
| Rate for Payer: Anthem Medicaid |
$2,946.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,683.04
|
| 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 |
$4,284.00
|
| Rate for Payer: Cash Price |
$4,284.00
|
| Rate for Payer: Cigna Commercial |
$7,111.44
|
| Rate for Payer: First Health Commercial |
$8,139.60
|
| Rate for Payer: Humana Commercial |
$7,282.80
|
| Rate for Payer: Humana KY Medicaid |
$2,946.54
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$2,976.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,025.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,323.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,005.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,539.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,426.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,854.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,454.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,911.92
|
| Rate for Payer: PHCS Commercial |
$8,225.28
|
| Rate for Payer: United Healthcare All Payer |
$7,539.84
|
|
|
OPEN TX PRX FIBULA/SHAFT FX
|
Facility
|
IP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 27784
|
| Hospital Charge Code |
76100935
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$480.00 |
| Max. Negotiated Rate |
$1,536.00 |
| Rate for Payer: Aetna Commercial |
$1,232.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,248.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,328.00
|
| Rate for Payer: First Health Commercial |
$1,520.00
|
| Rate for Payer: Humana Commercial |
$1,360.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,312.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,180.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$480.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,408.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,392.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,104.00
|
| Rate for Payer: PHCS Commercial |
$1,536.00
|
| Rate for Payer: United Healthcare All Payer |
$1,408.00
|
|
|
OPEN TX PRX FIBULA/SHAFT FX
|
Facility
|
OP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 27784
|
| Hospital Charge Code |
76100935
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$550.24 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,232.00
|
| Rate for Payer: Anthem Medicaid |
$550.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,248.00
|
| 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 |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,328.00
|
| Rate for Payer: First Health Commercial |
$1,520.00
|
| Rate for Payer: Humana Commercial |
$1,360.00
|
| Rate for Payer: Humana KY Medicaid |
$550.24
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$555.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,312.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,180.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$561.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,408.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,392.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,104.00
|
| Rate for Payer: PHCS Commercial |
$1,536.00
|
| Rate for Payer: United Healthcare All Payer |
$1,408.00
|
|
|
OPEN TX PRX FIBULA/SHAFT FX
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 27784
|
| Hospital Charge Code |
76100935
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$360.34 |
| Max. Negotiated Rate |
$1,005.33 |
| Rate for Payer: Aetna Commercial |
$1,005.33
|
| Rate for Payer: Ambetter Exchange |
$676.43
|
| Rate for Payer: Anthem Medicaid |
$360.34
|
| Rate for Payer: Buckeye Individual/Medicaid |
$676.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$676.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$811.72
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$913.52
|
| Rate for Payer: Healthspan PPO |
$910.61
|
| Rate for Payer: Humana Medicaid |
$360.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$880.87
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$676.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$676.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$367.55
|
| Rate for Payer: Molina Healthcare Passport |
$360.34
|
| Rate for Payer: Multiplan PHCS |
$960.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$879.36
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$363.94
|
| Rate for Payer: Wellcare Medicare Advantage |
$676.43
|
|
|
OPEN TX PRX FIBULA/SHAFT FX(P
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 27784
|
| Hospital Charge Code |
761P0935
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$360.34 |
| Max. Negotiated Rate |
$1,005.33 |
| Rate for Payer: Aetna Commercial |
$1,005.33
|
| Rate for Payer: Ambetter Exchange |
$676.43
|
| Rate for Payer: Anthem Medicaid |
$360.34
|
| Rate for Payer: Buckeye Individual/Medicaid |
$676.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$676.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$811.72
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$913.52
|
| Rate for Payer: Healthspan PPO |
$910.61
|
| Rate for Payer: Humana Medicaid |
$360.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$880.87
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$676.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$676.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$367.55
|
| Rate for Payer: Molina Healthcare Passport |
$360.34
|
| Rate for Payer: Multiplan PHCS |
$960.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$879.36
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$363.94
|
| Rate for Payer: Wellcare Medicare Advantage |
$676.43
|
|
|
OPEN TX RAD HEAD/NECK FX
|
Facility
|
IP
|
$1,285.00
|
|
|
Service Code
|
HCPCS 24665
|
| Hospital Charge Code |
76100559
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$385.50 |
| Max. Negotiated Rate |
$1,233.60 |
| Rate for Payer: Aetna Commercial |
$989.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,002.30
|
| Rate for Payer: Cash Price |
$642.50
|
| Rate for Payer: Cigna Commercial |
$1,066.55
|
| Rate for Payer: First Health Commercial |
$1,220.75
|
| Rate for Payer: Humana Commercial |
$1,092.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,053.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$948.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$385.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,130.80
|
| Rate for Payer: Ohio Health Group HMO |
$963.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,028.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,117.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$886.65
|
| Rate for Payer: PHCS Commercial |
$1,233.60
|
| Rate for Payer: United Healthcare All Payer |
$1,130.80
|
|
|
OPEN TX RAD HEAD/NECK FX
|
Facility
|
OP
|
$1,285.00
|
|
|
Service Code
|
HCPCS 24665
|
| Hospital Charge Code |
76100559
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$441.91 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$989.45
|
| Rate for Payer: Anthem Medicaid |
$441.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,002.30
|
| 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 |
$642.50
|
| Rate for Payer: Cash Price |
$642.50
|
| Rate for Payer: Cigna Commercial |
$1,066.55
|
| Rate for Payer: First Health Commercial |
$1,220.75
|
| Rate for Payer: Humana Commercial |
$1,092.25
|
| Rate for Payer: Humana KY Medicaid |
$441.91
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$446.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,053.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$948.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$450.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,130.80
|
| Rate for Payer: Ohio Health Group HMO |
$963.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,028.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,117.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$886.65
|
| Rate for Payer: PHCS Commercial |
$1,233.60
|
| Rate for Payer: United Healthcare All Payer |
$1,130.80
|
|
|
OPEN TX RAD HEAD/NECK FX
|
Professional
|
Both
|
$1,285.00
|
|
|
Service Code
|
HCPCS 24665
|
| Hospital Charge Code |
76100559
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$444.59 |
| Max. Negotiated Rate |
$1,036.74 |
| Rate for Payer: Aetna Commercial |
$943.11
|
| Rate for Payer: Ambetter Exchange |
$628.73
|
| Rate for Payer: Anthem Medicaid |
$444.59
|
| Rate for Payer: Buckeye Individual/Medicaid |
$628.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$628.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$754.48
|
| Rate for Payer: Cash Price |
$642.50
|
| Rate for Payer: Cash Price |
$642.50
|
| Rate for Payer: Cigna Commercial |
$1,036.74
|
| Rate for Payer: Healthspan PPO |
$854.25
|
| Rate for Payer: Humana Medicaid |
$444.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$800.01
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$628.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$628.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$453.48
|
| Rate for Payer: Molina Healthcare Passport |
$444.59
|
| Rate for Payer: Multiplan PHCS |
$771.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$817.35
|
| Rate for Payer: UHCCP Medicaid |
$449.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$449.04
|
| Rate for Payer: Wellcare Medicare Advantage |
$628.73
|
|
|
OPEN TX RAD HEAD/NECK FX(P
|
Professional
|
Both
|
$1,285.00
|
|
|
Service Code
|
HCPCS 24665
|
| Hospital Charge Code |
761P0559
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$444.59 |
| Max. Negotiated Rate |
$1,036.74 |
| Rate for Payer: Aetna Commercial |
$943.11
|
| Rate for Payer: Ambetter Exchange |
$628.73
|
| Rate for Payer: Anthem Medicaid |
$444.59
|
| Rate for Payer: Buckeye Individual/Medicaid |
$628.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$628.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$754.48
|
| Rate for Payer: Cash Price |
$642.50
|
| Rate for Payer: Cash Price |
$642.50
|
| Rate for Payer: Cigna Commercial |
$1,036.74
|
| Rate for Payer: Healthspan PPO |
$854.25
|
| Rate for Payer: Humana Medicaid |
$444.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$800.01
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$628.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$628.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$453.48
|
| Rate for Payer: Molina Healthcare Passport |
$444.59
|
| Rate for Payer: Multiplan PHCS |
$771.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$817.35
|
| Rate for Payer: UHCCP Medicaid |
$449.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$449.04
|
| Rate for Payer: Wellcare Medicare Advantage |
$628.73
|
|
|
OPEN TX RAD HEAD/NECK FX PROST
|
Facility
|
IP
|
$1,525.00
|
|
|
Service Code
|
HCPCS 24666
|
| Hospital Charge Code |
76100560
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$457.50 |
| Max. Negotiated Rate |
$1,464.00 |
| Rate for Payer: Aetna Commercial |
$1,174.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,189.50
|
| Rate for Payer: Cash Price |
$762.50
|
| Rate for Payer: Cigna Commercial |
$1,265.75
|
| Rate for Payer: First Health Commercial |
$1,448.75
|
| Rate for Payer: Humana Commercial |
$1,296.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,250.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,125.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$457.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,342.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,326.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,052.25
|
| Rate for Payer: PHCS Commercial |
$1,464.00
|
| Rate for Payer: United Healthcare All Payer |
$1,342.00
|
|
|
OPEN TX RAD HEAD/NECK FX PROST
|
Professional
|
Both
|
$1,525.00
|
|
|
Service Code
|
HCPCS 24666
|
| Hospital Charge Code |
761P0560
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$533.75 |
| Max. Negotiated Rate |
$1,175.27 |
| Rate for Payer: Aetna Commercial |
$1,073.64
|
| Rate for Payer: Ambetter Exchange |
$699.10
|
| Rate for Payer: Anthem Medicaid |
$574.62
|
| Rate for Payer: Buckeye Individual/Medicaid |
$699.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$699.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$838.92
|
| Rate for Payer: Cash Price |
$762.50
|
| Rate for Payer: Cash Price |
$762.50
|
| Rate for Payer: Cigna Commercial |
$1,175.27
|
| Rate for Payer: Healthspan PPO |
$972.49
|
| Rate for Payer: Humana Medicaid |
$574.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$904.60
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$699.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$699.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$586.11
|
| Rate for Payer: Molina Healthcare Passport |
$574.62
|
| Rate for Payer: Multiplan PHCS |
$915.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$908.83
|
| Rate for Payer: UHCCP Medicaid |
$533.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$580.37
|
| Rate for Payer: Wellcare Medicare Advantage |
$699.10
|
|
|
OPEN TX RAD HEAD/NECK FX PROST
|
Facility
|
OP
|
$1,525.00
|
|
|
Service Code
|
HCPCS 24666
|
| Hospital Charge Code |
76100560
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$524.45 |
| Max. Negotiated Rate |
$16,644.15 |
| Rate for Payer: Aetna Commercial |
$1,174.25
|
| Rate for Payer: Anthem Medicaid |
$524.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,888.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,189.50
|
| 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 |
$762.50
|
| Rate for Payer: Cash Price |
$762.50
|
| Rate for Payer: Cigna Commercial |
$1,265.75
|
| Rate for Payer: First Health Commercial |
$1,448.75
|
| Rate for Payer: Humana Commercial |
$1,296.25
|
| Rate for Payer: Humana KY Medicaid |
$524.45
|
| Rate for Payer: Humana Medicare Advantage |
$11,888.68
|
| Rate for Payer: Kentucky WC Medicaid |
$529.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,250.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,125.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14,266.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$534.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,342.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,326.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,052.25
|
| Rate for Payer: PHCS Commercial |
$1,464.00
|
| Rate for Payer: United Healthcare All Payer |
$1,342.00
|
|
|
OPEN TX RAD HEAD/NECK FX PROST
|
Professional
|
Both
|
$1,525.00
|
|
|
Service Code
|
HCPCS 24666
|
| Hospital Charge Code |
76100560
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$533.75 |
| Max. Negotiated Rate |
$1,175.27 |
| Rate for Payer: Aetna Commercial |
$1,073.64
|
| Rate for Payer: Ambetter Exchange |
$699.10
|
| Rate for Payer: Anthem Medicaid |
$574.62
|
| Rate for Payer: Buckeye Individual/Medicaid |
$699.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$699.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$838.92
|
| Rate for Payer: Cash Price |
$762.50
|
| Rate for Payer: Cash Price |
$762.50
|
| Rate for Payer: Cigna Commercial |
$1,175.27
|
| Rate for Payer: Healthspan PPO |
$972.49
|
| Rate for Payer: Humana Medicaid |
$574.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$904.60
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$699.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$699.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$586.11
|
| Rate for Payer: Molina Healthcare Passport |
$574.62
|
| Rate for Payer: Multiplan PHCS |
$915.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$908.83
|
| Rate for Payer: UHCCP Medicaid |
$533.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$580.37
|
| Rate for Payer: Wellcare Medicare Advantage |
$699.10
|
|
|
OPEN TX RAD&ULN SHFT FX W/FI(P
|
Professional
|
Both
|
$1,915.00
|
|
|
Service Code
|
HCPCS 25575
|
| Hospital Charge Code |
761P0629
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$606.91 |
| Max. Negotiated Rate |
$1,423.39 |
| Rate for Payer: Aetna Commercial |
$1,302.27
|
| Rate for Payer: Ambetter Exchange |
$862.44
|
| Rate for Payer: Anthem Medicaid |
$606.91
|
| Rate for Payer: Buckeye Individual/Medicaid |
$862.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$862.44
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,034.93
|
| Rate for Payer: Cash Price |
$957.50
|
| Rate for Payer: Cash Price |
$957.50
|
| Rate for Payer: Cigna Commercial |
$1,423.39
|
| Rate for Payer: Healthspan PPO |
$1,179.58
|
| Rate for Payer: Humana Medicaid |
$606.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,110.48
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$862.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$862.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$619.05
|
| Rate for Payer: Molina Healthcare Passport |
$606.91
|
| Rate for Payer: Multiplan PHCS |
$1,149.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,121.17
|
| Rate for Payer: UHCCP Medicaid |
$670.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$612.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$862.44
|
|
|
OPEN TX RAD&ULN SHFT FX W/FIX
|
Facility
|
OP
|
$1,915.00
|
|
|
Service Code
|
HCPCS 25575
|
| Hospital Charge Code |
76100629
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$658.57 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,474.55
|
| Rate for Payer: Anthem Medicaid |
$658.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,493.70
|
| 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 |
$957.50
|
| Rate for Payer: Cash Price |
$957.50
|
| Rate for Payer: Cigna Commercial |
$1,589.45
|
| Rate for Payer: First Health Commercial |
$1,819.25
|
| Rate for Payer: Humana Commercial |
$1,627.75
|
| Rate for Payer: Humana KY Medicaid |
$658.57
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$665.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,570.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,413.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$671.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,685.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,436.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,532.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,666.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,321.35
|
| Rate for Payer: PHCS Commercial |
$1,838.40
|
| Rate for Payer: United Healthcare All Payer |
$1,685.20
|
|
|
OPEN TX RAD&ULN SHFT FX W/FIX
|
Facility
|
IP
|
$1,915.00
|
|
|
Service Code
|
HCPCS 25575
|
| Hospital Charge Code |
76100629
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$574.50 |
| Max. Negotiated Rate |
$1,838.40 |
| Rate for Payer: Aetna Commercial |
$1,474.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,493.70
|
| Rate for Payer: Cash Price |
$957.50
|
| Rate for Payer: Cigna Commercial |
$1,589.45
|
| Rate for Payer: First Health Commercial |
$1,819.25
|
| Rate for Payer: Humana Commercial |
$1,627.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,570.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,413.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$574.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,685.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,436.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,532.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,666.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,321.35
|
| Rate for Payer: PHCS Commercial |
$1,838.40
|
| Rate for Payer: United Healthcare All Payer |
$1,685.20
|
|
|
OPEN TX RAD&ULN SHFT FX W/FIX
|
Professional
|
Both
|
$1,915.00
|
|
|
Service Code
|
HCPCS 25575
|
| Hospital Charge Code |
76100629
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$606.91 |
| Max. Negotiated Rate |
$1,423.39 |
| Rate for Payer: Aetna Commercial |
$1,302.27
|
| Rate for Payer: Ambetter Exchange |
$862.44
|
| Rate for Payer: Anthem Medicaid |
$606.91
|
| Rate for Payer: Buckeye Individual/Medicaid |
$862.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$862.44
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,034.93
|
| Rate for Payer: Cash Price |
$957.50
|
| Rate for Payer: Cash Price |
$957.50
|
| Rate for Payer: Cigna Commercial |
$1,423.39
|
| Rate for Payer: Healthspan PPO |
$1,179.58
|
| Rate for Payer: Humana Medicaid |
$606.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,110.48
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$862.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$862.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$619.05
|
| Rate for Payer: Molina Healthcare Passport |
$606.91
|
| Rate for Payer: Multiplan PHCS |
$1,149.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,121.17
|
| Rate for Payer: UHCCP Medicaid |
$670.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$612.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$862.44
|
|
|
OPEN TX SHOULDER DIS W/NECK FX
|
Facility
|
IP
|
$1,130.00
|
|
|
Service Code
|
HCPCS 23680
|
| Hospital Charge Code |
76100491
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$339.00 |
| Max. Negotiated Rate |
$1,084.80 |
| Rate for Payer: Aetna Commercial |
$870.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$881.40
|
| Rate for Payer: Cash Price |
$565.00
|
| Rate for Payer: Cigna Commercial |
$937.90
|
| Rate for Payer: First Health Commercial |
$1,073.50
|
| Rate for Payer: Humana Commercial |
$960.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$926.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$833.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$339.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$994.40
|
| Rate for Payer: Ohio Health Group HMO |
$847.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$904.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$983.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$779.70
|
| Rate for Payer: PHCS Commercial |
$1,084.80
|
| Rate for Payer: United Healthcare All Payer |
$994.40
|
|
|
OPEN TX SHOULDER DIS W/NECK FX
|
Professional
|
Both
|
$1,130.00
|
|
|
Service Code
|
HCPCS 23680
|
| Hospital Charge Code |
761P0491
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$395.50 |
| Max. Negotiated Rate |
$1,328.50 |
| Rate for Payer: Aetna Commercial |
$1,328.50
|
| Rate for Payer: Ambetter Exchange |
$886.75
|
| Rate for Payer: Anthem Medicaid |
$653.04
|
| Rate for Payer: Buckeye Individual/Medicaid |
$886.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$886.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,064.10
|
| Rate for Payer: Cash Price |
$565.00
|
| Rate for Payer: Cash Price |
$565.00
|
| Rate for Payer: Cigna Commercial |
$1,219.49
|
| Rate for Payer: Healthspan PPO |
$1,203.34
|
| Rate for Payer: Humana Medicaid |
$653.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,147.12
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$886.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$886.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$666.10
|
| Rate for Payer: Molina Healthcare Passport |
$653.04
|
| Rate for Payer: Multiplan PHCS |
$678.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,152.78
|
| Rate for Payer: UHCCP Medicaid |
$395.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$659.57
|
| Rate for Payer: Wellcare Medicare Advantage |
$886.75
|
|
