|
OPEN TX SHOULDER DIS W/NECK FX
|
Facility
|
OP
|
$1,130.00
|
|
|
Service Code
|
HCPCS 23680
|
| Hospital Charge Code |
76100491
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$388.61 |
| Max. Negotiated Rate |
$16,644.15 |
| Rate for Payer: Aetna Commercial |
$870.10
|
| Rate for Payer: Anthem Medicaid |
$388.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,888.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$881.40
|
| 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 |
$565.00
|
| 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: Humana KY Medicaid |
$388.61
|
| Rate for Payer: Humana Medicare Advantage |
$11,888.68
|
| Rate for Payer: Kentucky WC Medicaid |
$392.56
|
| 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 |
$14,266.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$396.40
|
| 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 |
76100491
|
|
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
|
|
|
OPEN TX TIB FX PRX UNICONDYLAR
|
Facility
|
IP
|
$1,720.00
|
|
|
Service Code
|
HCPCS 27535
|
| Hospital Charge Code |
76100870
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$516.00 |
| Max. Negotiated Rate |
$1,651.20 |
| Rate for Payer: Aetna Commercial |
$1,324.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,341.60
|
| Rate for Payer: Cash Price |
$860.00
|
| Rate for Payer: Cigna Commercial |
$1,427.60
|
| Rate for Payer: First Health Commercial |
$1,634.00
|
| Rate for Payer: Humana Commercial |
$1,462.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,410.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,269.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$516.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,513.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,376.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,496.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,186.80
|
| Rate for Payer: PHCS Commercial |
$1,651.20
|
| Rate for Payer: United Healthcare All Payer |
$1,513.60
|
|
|
OPEN TX TIB FX PRX UNICONDYLAR
|
Facility
|
OP
|
$1,720.00
|
|
|
Service Code
|
HCPCS 27535
|
| Hospital Charge Code |
76100870
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$516.00 |
| Max. Negotiated Rate |
$1,651.20 |
| Rate for Payer: Aetna Commercial |
$1,324.40
|
| Rate for Payer: Anthem Medicaid |
$591.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,341.60
|
| Rate for Payer: Cash Price |
$860.00
|
| Rate for Payer: Cigna Commercial |
$1,427.60
|
| Rate for Payer: First Health Commercial |
$1,634.00
|
| Rate for Payer: Humana Commercial |
$1,462.00
|
| Rate for Payer: Humana KY Medicaid |
$591.51
|
| Rate for Payer: Kentucky WC Medicaid |
$597.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,410.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,269.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$516.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$603.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,513.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,376.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,496.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,186.80
|
| Rate for Payer: PHCS Commercial |
$1,651.20
|
| Rate for Payer: United Healthcare All Payer |
$1,513.60
|
|
|
OPEN TX TIB FX PRX UNICONDYLAR
|
Professional
|
Both
|
$1,720.00
|
|
|
Service Code
|
HCPCS 27535
|
| Hospital Charge Code |
76100870
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$602.00 |
| Max. Negotiated Rate |
$1,438.43 |
| Rate for Payer: Aetna Commercial |
$1,356.57
|
| Rate for Payer: Ambetter Exchange |
$852.08
|
| Rate for Payer: Anthem Medicaid |
$663.23
|
| Rate for Payer: Buckeye Individual/Medicaid |
$852.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$852.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,022.50
|
| Rate for Payer: Cash Price |
$860.00
|
| Rate for Payer: Cash Price |
$860.00
|
| Rate for Payer: Cigna Commercial |
$1,438.43
|
| Rate for Payer: Healthspan PPO |
$1,228.76
|
| Rate for Payer: Humana Medicaid |
$663.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,136.43
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$852.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$852.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$676.49
|
| Rate for Payer: Molina Healthcare Passport |
$663.23
|
| Rate for Payer: Multiplan PHCS |
$1,032.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,107.70
|
| Rate for Payer: UHCCP Medicaid |
$602.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$669.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$852.08
|
|
|
OPEN TX TIB FX PRX UNICONDYLAR
|
Professional
|
Both
|
$1,720.00
|
|
|
Service Code
|
HCPCS 27535
|
| Hospital Charge Code |
761P0870
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$602.00 |
| Max. Negotiated Rate |
$1,438.43 |
| Rate for Payer: Aetna Commercial |
$1,356.57
|
| Rate for Payer: Ambetter Exchange |
$852.08
|
| Rate for Payer: Anthem Medicaid |
$663.23
|
| Rate for Payer: Buckeye Individual/Medicaid |
$852.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$852.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,022.50
|
| Rate for Payer: Cash Price |
$860.00
|
| Rate for Payer: Cash Price |
$860.00
|
| Rate for Payer: Cigna Commercial |
$1,438.43
|
| Rate for Payer: Healthspan PPO |
$1,228.76
|
| Rate for Payer: Humana Medicaid |
$663.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,136.43
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$852.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$852.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$676.49
|
| Rate for Payer: Molina Healthcare Passport |
$663.23
|
| Rate for Payer: Multiplan PHCS |
$1,032.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,107.70
|
| Rate for Payer: UHCCP Medicaid |
$602.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$669.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$852.08
|
|
|
OPEN TX TRIMALLEOLAR ANKLE F(P
|
Professional
|
Both
|
$2,475.00
|
|
|
Service Code
|
HCPCS 27823
|
| Hospital Charge Code |
761P0945
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$712.71 |
| Max. Negotiated Rate |
$1,686.14 |
| Rate for Payer: Aetna Commercial |
$1,433.07
|
| Rate for Payer: Ambetter Exchange |
$928.50
|
| Rate for Payer: Anthem Medicaid |
$712.71
|
| Rate for Payer: Buckeye Individual/Medicaid |
$928.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$928.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,114.20
|
| Rate for Payer: Cash Price |
$1,237.50
|
| Rate for Payer: Cash Price |
$1,237.50
|
| Rate for Payer: Cigna Commercial |
$1,686.14
|
| Rate for Payer: Healthspan PPO |
$1,298.05
|
| Rate for Payer: Humana Medicaid |
$712.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,197.04
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$928.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$928.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$726.96
|
| Rate for Payer: Molina Healthcare Passport |
$712.71
|
| Rate for Payer: Multiplan PHCS |
$1,485.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,207.05
|
| Rate for Payer: UHCCP Medicaid |
$866.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$719.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$928.50
|
|
|
OPEN TX TRIMALLEOLAR ANKLE FX
|
Facility
|
OP
|
$2,475.00
|
|
|
Service Code
|
HCPCS 27823
|
| Hospital Charge Code |
76100945
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$851.15 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,905.75
|
| Rate for Payer: Anthem Medicaid |
$851.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,930.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| Rate for Payer: Cash Price |
$1,237.50
|
| Rate for Payer: Cash Price |
$1,237.50
|
| Rate for Payer: Cigna Commercial |
$2,054.25
|
| Rate for Payer: First Health Commercial |
$2,351.25
|
| Rate for Payer: Humana Commercial |
$2,103.75
|
| Rate for Payer: Humana KY Medicaid |
$851.15
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$859.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,029.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,826.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$868.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,178.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,856.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,980.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,153.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,707.75
|
| Rate for Payer: PHCS Commercial |
$2,376.00
|
| Rate for Payer: United Healthcare All Payer |
$2,178.00
|
|
|
OPEN TX TRIMALLEOLAR ANKLE FX
|
Facility
|
IP
|
$2,475.00
|
|
|
Service Code
|
HCPCS 27823
|
| Hospital Charge Code |
76100945
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$742.50 |
| Max. Negotiated Rate |
$2,376.00 |
| Rate for Payer: Aetna Commercial |
$1,905.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,930.50
|
| Rate for Payer: Cash Price |
$1,237.50
|
| Rate for Payer: Cigna Commercial |
$2,054.25
|
| Rate for Payer: First Health Commercial |
$2,351.25
|
| Rate for Payer: Humana Commercial |
$2,103.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,029.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,826.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$742.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,178.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,856.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,980.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,153.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,707.75
|
| Rate for Payer: PHCS Commercial |
$2,376.00
|
| Rate for Payer: United Healthcare All Payer |
$2,178.00
|
|
|
OPEN TX TRIMALLEOLAR ANKLE FX
|
Professional
|
Both
|
$2,475.00
|
|
|
Service Code
|
HCPCS 27823
|
| Hospital Charge Code |
76100945
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$712.71 |
| Max. Negotiated Rate |
$1,686.14 |
| Rate for Payer: Aetna Commercial |
$1,433.07
|
| Rate for Payer: Ambetter Exchange |
$928.50
|
| Rate for Payer: Anthem Medicaid |
$712.71
|
| Rate for Payer: Buckeye Individual/Medicaid |
$928.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$928.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,114.20
|
| Rate for Payer: Cash Price |
$1,237.50
|
| Rate for Payer: Cash Price |
$1,237.50
|
| Rate for Payer: Cigna Commercial |
$1,686.14
|
| Rate for Payer: Healthspan PPO |
$1,298.05
|
| Rate for Payer: Humana Medicaid |
$712.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,197.04
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$928.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$928.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$726.96
|
| Rate for Payer: Molina Healthcare Passport |
$712.71
|
| Rate for Payer: Multiplan PHCS |
$1,485.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,207.05
|
| Rate for Payer: UHCCP Medicaid |
$866.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$719.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$928.50
|
|
|
OPENTX TRIMALLEOLAR ANKLE FX
|
Professional
|
Both
|
$2,135.00
|
|
|
Service Code
|
HCPCS 27822
|
| Hospital Charge Code |
76100944
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$579.67 |
| Max. Negotiated Rate |
$1,486.93 |
| Rate for Payer: Aetna Commercial |
$1,254.02
|
| Rate for Payer: Ambetter Exchange |
$822.71
|
| Rate for Payer: Anthem Medicaid |
$579.67
|
| Rate for Payer: Buckeye Individual/Medicaid |
$822.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$822.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$987.25
|
| Rate for Payer: Cash Price |
$1,067.50
|
| Rate for Payer: Cash Price |
$1,067.50
|
| Rate for Payer: Cigna Commercial |
$1,486.93
|
| Rate for Payer: Healthspan PPO |
$1,135.87
|
| Rate for Payer: Humana Medicaid |
$579.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,050.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$822.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$822.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$591.26
|
| Rate for Payer: Molina Healthcare Passport |
$579.67
|
| Rate for Payer: Multiplan PHCS |
$1,281.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,069.52
|
| Rate for Payer: UHCCP Medicaid |
$747.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$585.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$822.71
|
|
|
OPENTX TRIMALLEOLAR ANKLE FX
|
Facility
|
OP
|
$2,135.00
|
|
|
Service Code
|
HCPCS 27822
|
| Hospital Charge Code |
76100944
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$734.23 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,643.95
|
| Rate for Payer: Anthem Medicaid |
$734.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,665.30
|
| 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 |
$1,067.50
|
| Rate for Payer: Cash Price |
$1,067.50
|
| Rate for Payer: Cigna Commercial |
$1,772.05
|
| Rate for Payer: First Health Commercial |
$2,028.25
|
| Rate for Payer: Humana Commercial |
$1,814.75
|
| Rate for Payer: Humana KY Medicaid |
$734.23
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$741.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,750.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,575.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$748.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,878.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,601.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,708.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,857.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,473.15
|
| Rate for Payer: PHCS Commercial |
$2,049.60
|
| Rate for Payer: United Healthcare All Payer |
$1,878.80
|
|
|
OPENTX TRIMALLEOLAR ANKLE FX
|
Facility
|
IP
|
$2,135.00
|
|
|
Service Code
|
HCPCS 27822
|
| Hospital Charge Code |
76100944
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$640.50 |
| Max. Negotiated Rate |
$2,049.60 |
| Rate for Payer: Aetna Commercial |
$1,643.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,665.30
|
| Rate for Payer: Cash Price |
$1,067.50
|
| Rate for Payer: Cigna Commercial |
$1,772.05
|
| Rate for Payer: First Health Commercial |
$2,028.25
|
| Rate for Payer: Humana Commercial |
$1,814.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,750.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,575.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$640.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,878.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,601.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,708.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,857.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,473.15
|
| Rate for Payer: PHCS Commercial |
$2,049.60
|
| Rate for Payer: United Healthcare All Payer |
$1,878.80
|
|
|
OPENTX TRIMALLEOLAR ANKLE FX(P
|
Professional
|
Both
|
$2,135.00
|
|
|
Service Code
|
HCPCS 27822
|
| Hospital Charge Code |
761P0944
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$579.67 |
| Max. Negotiated Rate |
$1,486.93 |
| Rate for Payer: Aetna Commercial |
$1,254.02
|
| Rate for Payer: Ambetter Exchange |
$822.71
|
| Rate for Payer: Anthem Medicaid |
$579.67
|
| Rate for Payer: Buckeye Individual/Medicaid |
$822.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$822.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$987.25
|
| Rate for Payer: Cash Price |
$1,067.50
|
| Rate for Payer: Cash Price |
$1,067.50
|
| Rate for Payer: Cigna Commercial |
$1,486.93
|
| Rate for Payer: Healthspan PPO |
$1,135.87
|
| Rate for Payer: Humana Medicaid |
$579.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,050.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$822.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$822.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$591.26
|
| Rate for Payer: Molina Healthcare Passport |
$579.67
|
| Rate for Payer: Multiplan PHCS |
$1,281.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,069.52
|
| Rate for Payer: UHCCP Medicaid |
$747.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$585.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$822.71
|
|
|
OPEN WEDGE/BX LUNG INFILTR
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 32096
|
| Hospital Charge Code |
76101172
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$490.00 |
| Max. Negotiated Rate |
$1,522.82 |
| Rate for Payer: Ambetter Exchange |
$757.57
|
| Rate for Payer: Anthem Medicaid |
$656.11
|
| Rate for Payer: Buckeye Individual/Medicaid |
$757.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$757.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$909.08
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,522.82
|
| Rate for Payer: Healthspan PPO |
$814.79
|
| Rate for Payer: Humana Medicaid |
$656.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,099.40
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$757.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$757.57
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$669.23
|
| Rate for Payer: Molina Healthcare Passport |
$656.11
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$984.84
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$662.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$757.57
|
|
|
OPEN WEDGE/BX LUNG INFILTR
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 32096
|
| Hospital Charge Code |
76101172
|
|
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 WEDGE/BX LUNG INFILTR
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 32096
|
| Hospital Charge Code |
76101172
|
|
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 Medicaid |
$481.46
|
| 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: Humana KY Medicaid |
$481.46
|
| 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 |
$420.00
|
| 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 WEDGE/BX LUNG INFILTR(P
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 32096
|
| Hospital Charge Code |
761P1172
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$490.00 |
| Max. Negotiated Rate |
$1,522.82 |
| Rate for Payer: Ambetter Exchange |
$757.57
|
| Rate for Payer: Anthem Medicaid |
$656.11
|
| Rate for Payer: Buckeye Individual/Medicaid |
$757.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$757.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$909.08
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,522.82
|
| Rate for Payer: Healthspan PPO |
$814.79
|
| Rate for Payer: Humana Medicaid |
$656.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,099.40
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$757.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$757.57
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$669.23
|
| Rate for Payer: Molina Healthcare Passport |
$656.11
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$984.84
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$662.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$757.57
|
|
|
OPERATIVE TISSUE ABLATION
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 33259
|
| Hospital Charge Code |
76101272
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$450.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,305.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,035.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
OPERATIVE TISSUE ABLATION
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 33259
|
| Hospital Charge Code |
76101272
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem Medicaid |
$515.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Humana KY Medicaid |
$515.85
|
| Rate for Payer: Kentucky WC Medicaid |
$521.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$450.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$526.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,305.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,035.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
OPERATIVE TISSUE ABLATION
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 33259
|
| Hospital Charge Code |
76101272
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$1,433.61 |
| Rate for Payer: Aetna Commercial |
$1,433.61
|
| Rate for Payer: Ambetter Exchange |
$796.35
|
| Rate for Payer: Anthem Medicaid |
$703.77
|
| Rate for Payer: Buckeye Individual/Medicaid |
$796.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$796.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$955.62
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,376.13
|
| Rate for Payer: Healthspan PPO |
$1,409.52
|
| Rate for Payer: Humana Medicaid |
$703.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,188.23
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$796.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$796.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$717.85
|
| Rate for Payer: Molina Healthcare Passport |
$703.77
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,035.26
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$710.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$796.35
|
|
|
OPERATIVE TISSUE ABLATION(P
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 33259
|
| Hospital Charge Code |
761P1272
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$1,433.61 |
| Rate for Payer: Aetna Commercial |
$1,433.61
|
| Rate for Payer: Ambetter Exchange |
$796.35
|
| Rate for Payer: Anthem Medicaid |
$703.77
|
| Rate for Payer: Buckeye Individual/Medicaid |
$796.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$796.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$955.62
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,376.13
|
| Rate for Payer: Healthspan PPO |
$1,409.52
|
| Rate for Payer: Humana Medicaid |
$703.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,188.23
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$796.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$796.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$717.85
|
| Rate for Payer: Molina Healthcare Passport |
$703.77
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,035.26
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$710.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$796.35
|
|
|
OPHORECTOMY
|
Facility
|
OP
|
$2,700.00
|
|
|
Service Code
|
HCPCS 58940
|
| Hospital Charge Code |
76102263
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$810.00 |
| Max. Negotiated Rate |
$2,592.00 |
| Rate for Payer: Aetna Commercial |
$2,079.00
|
| Rate for Payer: Anthem Medicaid |
$928.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,106.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$2,241.00
|
| Rate for Payer: First Health Commercial |
$2,565.00
|
| Rate for Payer: Humana Commercial |
$2,295.00
|
| Rate for Payer: Humana KY Medicaid |
$928.53
|
| Rate for Payer: Kentucky WC Medicaid |
$937.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,214.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,992.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$810.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$947.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,376.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,025.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,349.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,863.00
|
| Rate for Payer: PHCS Commercial |
$2,592.00
|
| Rate for Payer: United Healthcare All Payer |
$2,376.00
|
|
|
OPHORECTOMY
|
Professional
|
Both
|
$2,700.00
|
|
|
Service Code
|
HCPCS 58940
|
| Hospital Charge Code |
76102263
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$398.30 |
| Max. Negotiated Rate |
$1,620.00 |
| Rate for Payer: Aetna Commercial |
$755.67
|
| Rate for Payer: Ambetter Exchange |
$524.80
|
| Rate for Payer: Anthem Medicaid |
$398.30
|
| Rate for Payer: Buckeye Individual/Medicaid |
$524.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$524.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$629.76
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$726.58
|
| Rate for Payer: Healthspan PPO |
$731.68
|
| Rate for Payer: Humana Medicaid |
$398.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$666.53
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$524.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$524.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$406.27
|
| Rate for Payer: Molina Healthcare Passport |
$398.30
|
| Rate for Payer: Multiplan PHCS |
$1,620.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$682.24
|
| Rate for Payer: UHCCP Medicaid |
$945.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$402.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$524.80
|
|
|
OPHORECTOMY
|
Facility
|
IP
|
$2,700.00
|
|
|
Service Code
|
HCPCS 58940
|
| Hospital Charge Code |
76102263
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$810.00 |
| Max. Negotiated Rate |
$2,592.00 |
| Rate for Payer: Aetna Commercial |
$2,079.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,106.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$2,241.00
|
| Rate for Payer: First Health Commercial |
$2,565.00
|
| Rate for Payer: Humana Commercial |
$2,295.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,214.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,992.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$810.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,376.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,025.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,349.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,863.00
|
| Rate for Payer: PHCS Commercial |
$2,592.00
|
| Rate for Payer: United Healthcare All Payer |
$2,376.00
|
|
