|
OPTX FEM SHFT FX WINS IMED IMP
|
Facility
|
IP
|
$2,950.00
|
|
|
Service Code
|
HCPCS 27506
|
| Hospital Charge Code |
76100859
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$885.00 |
| Max. Negotiated Rate |
$2,832.00 |
| Rate for Payer: Aetna Commercial |
$2,271.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,301.00
|
| Rate for Payer: Cash Price |
$1,475.00
|
| Rate for Payer: Cigna Commercial |
$2,448.50
|
| Rate for Payer: First Health Commercial |
$2,802.50
|
| Rate for Payer: Humana Commercial |
$2,507.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,419.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,177.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$885.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,596.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,212.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,566.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,035.50
|
| Rate for Payer: PHCS Commercial |
$2,832.00
|
| Rate for Payer: United Healthcare All Payer |
$2,596.00
|
|
|
OPTX FEM SHFT FX W/WO CERCL
|
Facility
|
IP
|
$2,429.00
|
|
|
Service Code
|
HCPCS 27507
|
| Hospital Charge Code |
76100860
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$728.70 |
| Max. Negotiated Rate |
$2,331.84 |
| Rate for Payer: Aetna Commercial |
$1,870.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,894.62
|
| Rate for Payer: Cash Price |
$1,214.50
|
| Rate for Payer: Cigna Commercial |
$2,016.07
|
| Rate for Payer: First Health Commercial |
$2,307.55
|
| Rate for Payer: Humana Commercial |
$2,064.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,991.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,792.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$728.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,137.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,821.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,943.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,113.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,676.01
|
| Rate for Payer: PHCS Commercial |
$2,331.84
|
| Rate for Payer: United Healthcare All Payer |
$2,137.52
|
|
|
OPTX FEM SHFT FX W/WO CERCL
|
Professional
|
Both
|
$2,429.00
|
|
|
Service Code
|
HCPCS 27507
|
| Hospital Charge Code |
76100860
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$850.15 |
| Max. Negotiated Rate |
$1,607.74 |
| Rate for Payer: Aetna Commercial |
$1,476.80
|
| Rate for Payer: Ambetter Exchange |
$920.23
|
| Rate for Payer: Anthem Medicaid |
$868.96
|
| Rate for Payer: Buckeye Individual/Medicaid |
$920.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$920.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,104.28
|
| Rate for Payer: Cash Price |
$1,214.50
|
| Rate for Payer: Cash Price |
$1,214.50
|
| Rate for Payer: Cigna Commercial |
$1,607.74
|
| Rate for Payer: Healthspan PPO |
$1,337.67
|
| Rate for Payer: Humana Medicaid |
$868.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,225.16
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$920.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$920.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$886.34
|
| Rate for Payer: Molina Healthcare Passport |
$868.96
|
| Rate for Payer: Multiplan PHCS |
$1,457.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,196.30
|
| Rate for Payer: UHCCP Medicaid |
$850.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$877.65
|
| Rate for Payer: Wellcare Medicare Advantage |
$920.23
|
|
|
OPTX FEM SHFT FX W/WO CERCL
|
Facility
|
OP
|
$2,429.00
|
|
|
Service Code
|
HCPCS 27507
|
| Hospital Charge Code |
76100860
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$728.70 |
| Max. Negotiated Rate |
$2,331.84 |
| Rate for Payer: Aetna Commercial |
$1,870.33
|
| Rate for Payer: Anthem Medicaid |
$835.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,894.62
|
| Rate for Payer: Cash Price |
$1,214.50
|
| Rate for Payer: Cigna Commercial |
$2,016.07
|
| Rate for Payer: First Health Commercial |
$2,307.55
|
| Rate for Payer: Humana Commercial |
$2,064.65
|
| Rate for Payer: Humana KY Medicaid |
$835.33
|
| Rate for Payer: Kentucky WC Medicaid |
$843.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,991.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,792.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$728.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$852.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,137.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,821.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,943.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,113.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,676.01
|
| Rate for Payer: PHCS Commercial |
$2,331.84
|
| Rate for Payer: United Healthcare All Payer |
$2,137.52
|
|
|
OPTX FEM SHFT FX W/WO CERCL(P
|
Professional
|
Both
|
$2,429.00
|
|
|
Service Code
|
HCPCS 27507
|
| Hospital Charge Code |
761P0860
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$850.15 |
| Max. Negotiated Rate |
$1,607.74 |
| Rate for Payer: Aetna Commercial |
$1,476.80
|
| Rate for Payer: Ambetter Exchange |
$920.23
|
| Rate for Payer: Anthem Medicaid |
$868.96
|
| Rate for Payer: Buckeye Individual/Medicaid |
$920.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$920.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,104.28
|
| Rate for Payer: Cash Price |
$1,214.50
|
| Rate for Payer: Cash Price |
$1,214.50
|
| Rate for Payer: Cigna Commercial |
$1,607.74
|
| Rate for Payer: Healthspan PPO |
$1,337.67
|
| Rate for Payer: Humana Medicaid |
$868.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,225.16
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$920.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$920.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$886.34
|
| Rate for Payer: Molina Healthcare Passport |
$868.96
|
| Rate for Payer: Multiplan PHCS |
$1,457.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,196.30
|
| Rate for Payer: UHCCP Medicaid |
$850.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$877.65
|
| Rate for Payer: Wellcare Medicare Advantage |
$920.23
|
|
|
OPTX FEM SUPRACONDYLAR FX
|
Facility
|
OP
|
$2,369.00
|
|
|
Service Code
|
HCPCS 27511
|
| Hospital Charge Code |
76100863
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$710.70 |
| Max. Negotiated Rate |
$2,274.24 |
| Rate for Payer: Aetna Commercial |
$1,824.13
|
| Rate for Payer: Anthem Medicaid |
$814.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,847.82
|
| Rate for Payer: Cash Price |
$1,184.50
|
| Rate for Payer: Cigna Commercial |
$1,966.27
|
| Rate for Payer: First Health Commercial |
$2,250.55
|
| Rate for Payer: Humana Commercial |
$2,013.65
|
| Rate for Payer: Humana KY Medicaid |
$814.70
|
| Rate for Payer: Kentucky WC Medicaid |
$822.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,942.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,748.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$710.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$831.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,084.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,776.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,895.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,061.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,634.61
|
| Rate for Payer: PHCS Commercial |
$2,274.24
|
| Rate for Payer: United Healthcare All Payer |
$2,084.72
|
|
|
OPTX FEM SUPRACONDYLAR FX
|
Facility
|
IP
|
$2,369.00
|
|
|
Service Code
|
HCPCS 27511
|
| Hospital Charge Code |
76100863
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$710.70 |
| Max. Negotiated Rate |
$2,274.24 |
| Rate for Payer: Aetna Commercial |
$1,824.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,847.82
|
| Rate for Payer: Cash Price |
$1,184.50
|
| Rate for Payer: Cigna Commercial |
$1,966.27
|
| Rate for Payer: First Health Commercial |
$2,250.55
|
| Rate for Payer: Humana Commercial |
$2,013.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,942.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,748.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$710.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,084.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,776.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,895.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,061.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,634.61
|
| Rate for Payer: PHCS Commercial |
$2,274.24
|
| Rate for Payer: United Healthcare All Payer |
$2,084.72
|
|
|
OPTX FEM SUPRACONDYLAR FX
|
Professional
|
Both
|
$2,369.00
|
|
|
Service Code
|
HCPCS 27511
|
| Hospital Charge Code |
76100863
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$829.15 |
| Max. Negotiated Rate |
$1,655.16 |
| Rate for Payer: Aetna Commercial |
$1,524.92
|
| Rate for Payer: Ambetter Exchange |
$944.57
|
| Rate for Payer: Anthem Medicaid |
$858.15
|
| Rate for Payer: Buckeye Individual/Medicaid |
$944.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$944.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,133.48
|
| Rate for Payer: Cash Price |
$1,184.50
|
| Rate for Payer: Cash Price |
$1,184.50
|
| Rate for Payer: Cigna Commercial |
$1,655.16
|
| Rate for Payer: Healthspan PPO |
$1,381.26
|
| Rate for Payer: Humana Medicaid |
$858.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,267.50
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$944.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$944.57
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$875.31
|
| Rate for Payer: Molina Healthcare Passport |
$858.15
|
| Rate for Payer: Multiplan PHCS |
$1,421.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,227.94
|
| Rate for Payer: UHCCP Medicaid |
$829.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$866.73
|
| Rate for Payer: Wellcare Medicare Advantage |
$944.57
|
|
|
OPTX FEM SUPRACONDYLAR FX(P
|
Professional
|
Both
|
$2,369.00
|
|
|
Service Code
|
HCPCS 27511
|
| Hospital Charge Code |
761P0863
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$829.15 |
| Max. Negotiated Rate |
$1,655.16 |
| Rate for Payer: Aetna Commercial |
$1,524.92
|
| Rate for Payer: Ambetter Exchange |
$944.57
|
| Rate for Payer: Anthem Medicaid |
$858.15
|
| Rate for Payer: Buckeye Individual/Medicaid |
$944.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$944.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,133.48
|
| Rate for Payer: Cash Price |
$1,184.50
|
| Rate for Payer: Cash Price |
$1,184.50
|
| Rate for Payer: Cigna Commercial |
$1,655.16
|
| Rate for Payer: Healthspan PPO |
$1,381.26
|
| Rate for Payer: Humana Medicaid |
$858.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,267.50
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$944.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$944.57
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$875.31
|
| Rate for Payer: Molina Healthcare Passport |
$858.15
|
| Rate for Payer: Multiplan PHCS |
$1,421.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,227.94
|
| Rate for Payer: UHCCP Medicaid |
$829.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$866.73
|
| Rate for Payer: Wellcare Medicare Advantage |
$944.57
|
|
|
OPTX GREATER TROCHANTERIC FX
|
Professional
|
Both
|
$1,565.00
|
|
|
Service Code
|
HCPCS 27248
|
| Hospital Charge Code |
76100797
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$547.75 |
| Max. Negotiated Rate |
$1,258.35 |
| Rate for Payer: Aetna Commercial |
$1,121.10
|
| Rate for Payer: Ambetter Exchange |
$709.14
|
| Rate for Payer: Anthem Medicaid |
$670.98
|
| Rate for Payer: Buckeye Individual/Medicaid |
$709.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$709.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$850.97
|
| Rate for Payer: Cash Price |
$782.50
|
| Rate for Payer: Cash Price |
$782.50
|
| Rate for Payer: Cigna Commercial |
$1,258.35
|
| Rate for Payer: Healthspan PPO |
$1,015.48
|
| Rate for Payer: Humana Medicaid |
$670.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$933.12
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$709.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$709.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$684.40
|
| Rate for Payer: Molina Healthcare Passport |
$670.98
|
| Rate for Payer: Multiplan PHCS |
$939.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$921.88
|
| Rate for Payer: UHCCP Medicaid |
$547.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$677.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$709.14
|
|
|
OPTX GREATER TROCHANTERIC FX
|
Facility
|
IP
|
$1,565.00
|
|
|
Service Code
|
HCPCS 27248
|
| Hospital Charge Code |
76100797
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$469.50 |
| Max. Negotiated Rate |
$1,502.40 |
| Rate for Payer: Aetna Commercial |
$1,205.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,220.70
|
| Rate for Payer: Cash Price |
$782.50
|
| Rate for Payer: Cigna Commercial |
$1,298.95
|
| Rate for Payer: First Health Commercial |
$1,486.75
|
| Rate for Payer: Humana Commercial |
$1,330.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,283.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,154.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$469.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,377.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,173.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,252.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,361.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,079.85
|
| Rate for Payer: PHCS Commercial |
$1,502.40
|
| Rate for Payer: United Healthcare All Payer |
$1,377.20
|
|
|
OPTX GREATER TROCHANTERIC FX
|
Facility
|
OP
|
$1,565.00
|
|
|
Service Code
|
HCPCS 27248
|
| Hospital Charge Code |
76100797
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$469.50 |
| Max. Negotiated Rate |
$1,502.40 |
| Rate for Payer: Aetna Commercial |
$1,205.05
|
| Rate for Payer: Anthem Medicaid |
$538.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,220.70
|
| Rate for Payer: Cash Price |
$782.50
|
| Rate for Payer: Cigna Commercial |
$1,298.95
|
| Rate for Payer: First Health Commercial |
$1,486.75
|
| Rate for Payer: Humana Commercial |
$1,330.25
|
| Rate for Payer: Humana KY Medicaid |
$538.20
|
| Rate for Payer: Kentucky WC Medicaid |
$543.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,283.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,154.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$469.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$549.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,377.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,173.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,252.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,361.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,079.85
|
| Rate for Payer: PHCS Commercial |
$1,502.40
|
| Rate for Payer: United Healthcare All Payer |
$1,377.20
|
|
|
OPTX GREATER TROCHANTERIC FX(P
|
Professional
|
Both
|
$1,565.00
|
|
|
Service Code
|
HCPCS 27248
|
| Hospital Charge Code |
761P0797
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$547.75 |
| Max. Negotiated Rate |
$1,258.35 |
| Rate for Payer: Aetna Commercial |
$1,121.10
|
| Rate for Payer: Ambetter Exchange |
$709.14
|
| Rate for Payer: Anthem Medicaid |
$670.98
|
| Rate for Payer: Buckeye Individual/Medicaid |
$709.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$709.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$850.97
|
| Rate for Payer: Cash Price |
$782.50
|
| Rate for Payer: Cash Price |
$782.50
|
| Rate for Payer: Cigna Commercial |
$1,258.35
|
| Rate for Payer: Healthspan PPO |
$1,015.48
|
| Rate for Payer: Humana Medicaid |
$670.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$933.12
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$709.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$709.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$684.40
|
| Rate for Payer: Molina Healthcare Passport |
$670.98
|
| Rate for Payer: Multiplan PHCS |
$939.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$921.88
|
| Rate for Payer: UHCCP Medicaid |
$547.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$677.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$709.14
|
|
|
OPTX HUM SHFT FX WP/S W/WOCERC
|
Facility
|
IP
|
$2,100.00
|
|
|
Service Code
|
HCPCS 24515
|
| Hospital Charge Code |
76100534
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$630.00 |
| Max. Negotiated Rate |
$2,016.00 |
| Rate for Payer: Aetna Commercial |
$1,617.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,638.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,743.00
|
| Rate for Payer: First Health Commercial |
$1,995.00
|
| Rate for Payer: Humana Commercial |
$1,785.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,722.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,549.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,848.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,827.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,449.00
|
| Rate for Payer: PHCS Commercial |
$2,016.00
|
| Rate for Payer: United Healthcare All Payer |
$1,848.00
|
|
|
OPTX HUM SHFT FX WP/S W/WOCERC
|
Facility
|
OP
|
$2,100.00
|
|
|
Service Code
|
HCPCS 24515
|
| Hospital Charge Code |
76100534
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$722.19 |
| Max. Negotiated Rate |
$16,644.15 |
| Rate for Payer: Aetna Commercial |
$1,617.00
|
| Rate for Payer: Anthem Medicaid |
$722.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,888.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,638.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16,644.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$16,049.72
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,743.00
|
| Rate for Payer: First Health Commercial |
$1,995.00
|
| Rate for Payer: Humana Commercial |
$1,785.00
|
| Rate for Payer: Humana KY Medicaid |
$722.19
|
| Rate for Payer: Humana Medicare Advantage |
$11,888.68
|
| Rate for Payer: Kentucky WC Medicaid |
$729.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,722.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,549.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14,266.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$736.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,848.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,827.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,449.00
|
| Rate for Payer: PHCS Commercial |
$2,016.00
|
| Rate for Payer: United Healthcare All Payer |
$1,848.00
|
|
|
OPTX HUM SHFT FX WP/S W/WOCERC
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 24515
|
| Hospital Charge Code |
761P0534
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$616.68 |
| Max. Negotiated Rate |
$1,414.22 |
| Rate for Payer: Aetna Commercial |
$1,294.18
|
| Rate for Payer: Ambetter Exchange |
$838.26
|
| Rate for Payer: Anthem Medicaid |
$616.68
|
| Rate for Payer: Buckeye Individual/Medicaid |
$838.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$838.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,005.91
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,414.22
|
| Rate for Payer: Healthspan PPO |
$1,172.25
|
| Rate for Payer: Humana Medicaid |
$616.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,086.96
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$838.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$838.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$629.01
|
| Rate for Payer: Molina Healthcare Passport |
$616.68
|
| Rate for Payer: Multiplan PHCS |
$1,260.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,089.74
|
| Rate for Payer: UHCCP Medicaid |
$735.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$622.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$838.26
|
|
|
OPTX HUM SHFT FX WP/S W/WOCERC
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 24515
|
| Hospital Charge Code |
76100534
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$616.68 |
| Max. Negotiated Rate |
$1,414.22 |
| Rate for Payer: Aetna Commercial |
$1,294.18
|
| Rate for Payer: Ambetter Exchange |
$838.26
|
| Rate for Payer: Anthem Medicaid |
$616.68
|
| Rate for Payer: Buckeye Individual/Medicaid |
$838.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$838.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,005.91
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,414.22
|
| Rate for Payer: Healthspan PPO |
$1,172.25
|
| Rate for Payer: Humana Medicaid |
$616.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,086.96
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$838.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$838.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$629.01
|
| Rate for Payer: Molina Healthcare Passport |
$616.68
|
| Rate for Payer: Multiplan PHCS |
$1,260.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,089.74
|
| Rate for Payer: UHCCP Medicaid |
$735.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$622.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$838.26
|
|
|
OPTX HUM SUPRACOND FX W/O XTN
|
Facility
|
OP
|
$1,865.00
|
|
|
Service Code
|
HCPCS 24545
|
| Hospital Charge Code |
76100539
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$641.37 |
| Max. Negotiated Rate |
$16,644.15 |
| Rate for Payer: Aetna Commercial |
$1,436.05
|
| Rate for Payer: Anthem Medicaid |
$641.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,888.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,454.70
|
| 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 |
$932.50
|
| Rate for Payer: Cash Price |
$932.50
|
| Rate for Payer: Cigna Commercial |
$1,547.95
|
| Rate for Payer: First Health Commercial |
$1,771.75
|
| Rate for Payer: Humana Commercial |
$1,585.25
|
| Rate for Payer: Humana KY Medicaid |
$641.37
|
| Rate for Payer: Humana Medicare Advantage |
$11,888.68
|
| Rate for Payer: Kentucky WC Medicaid |
$647.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,529.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,376.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14,266.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$654.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,641.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,398.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,492.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,622.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,286.85
|
| Rate for Payer: PHCS Commercial |
$1,790.40
|
| Rate for Payer: United Healthcare All Payer |
$1,641.20
|
|
|
OPTX HUM SUPRACOND FX W/O XTN
|
Professional
|
Both
|
$1,865.00
|
|
|
Service Code
|
HCPCS 24545
|
| Hospital Charge Code |
76100539
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$589.21 |
| Max. Negotiated Rate |
$1,338.30 |
| Rate for Payer: Aetna Commercial |
$1,338.30
|
| Rate for Payer: Ambetter Exchange |
$885.12
|
| Rate for Payer: Anthem Medicaid |
$589.21
|
| Rate for Payer: Buckeye Individual/Medicaid |
$885.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$885.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,062.14
|
| Rate for Payer: Cash Price |
$932.50
|
| Rate for Payer: Cash Price |
$932.50
|
| Rate for Payer: Cigna Commercial |
$1,279.30
|
| Rate for Payer: Healthspan PPO |
$1,212.21
|
| Rate for Payer: Humana Medicaid |
$589.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,150.27
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$885.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$885.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$600.99
|
| Rate for Payer: Molina Healthcare Passport |
$589.21
|
| Rate for Payer: Multiplan PHCS |
$1,119.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,150.66
|
| Rate for Payer: UHCCP Medicaid |
$652.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$595.10
|
| Rate for Payer: Wellcare Medicare Advantage |
$885.12
|
|
|
OPTX HUM SUPRACOND FX W/O XTN
|
Facility
|
IP
|
$1,865.00
|
|
|
Service Code
|
HCPCS 24545
|
| Hospital Charge Code |
76100539
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$559.50 |
| Max. Negotiated Rate |
$1,790.40 |
| Rate for Payer: Aetna Commercial |
$1,436.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,454.70
|
| Rate for Payer: Cash Price |
$932.50
|
| Rate for Payer: Cigna Commercial |
$1,547.95
|
| Rate for Payer: First Health Commercial |
$1,771.75
|
| Rate for Payer: Humana Commercial |
$1,585.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,529.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,376.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$559.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,641.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,398.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,492.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,622.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,286.85
|
| Rate for Payer: PHCS Commercial |
$1,790.40
|
| Rate for Payer: United Healthcare All Payer |
$1,641.20
|
|
|
OPTX HUM SUPRACOND FX W/O XT(P
|
Professional
|
Both
|
$1,865.00
|
|
|
Service Code
|
HCPCS 24545
|
| Hospital Charge Code |
761P0539
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$589.21 |
| Max. Negotiated Rate |
$1,338.30 |
| Rate for Payer: Aetna Commercial |
$1,338.30
|
| Rate for Payer: Ambetter Exchange |
$885.12
|
| Rate for Payer: Anthem Medicaid |
$589.21
|
| Rate for Payer: Buckeye Individual/Medicaid |
$885.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$885.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,062.14
|
| Rate for Payer: Cash Price |
$932.50
|
| Rate for Payer: Cash Price |
$932.50
|
| Rate for Payer: Cigna Commercial |
$1,279.30
|
| Rate for Payer: Healthspan PPO |
$1,212.21
|
| Rate for Payer: Humana Medicaid |
$589.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,150.27
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$885.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$885.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$600.99
|
| Rate for Payer: Molina Healthcare Passport |
$589.21
|
| Rate for Payer: Multiplan PHCS |
$1,119.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,150.66
|
| Rate for Payer: UHCCP Medicaid |
$652.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$595.10
|
| Rate for Payer: Wellcare Medicare Advantage |
$885.12
|
|
|
OPTX MEDIAL ANKLE FX
|
Facility
|
OP
|
$1,330.00
|
|
|
Service Code
|
HCPCS 27766
|
| Hospital Charge Code |
76100930
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$457.39 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,024.10
|
| Rate for Payer: Anthem Medicaid |
$457.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,037.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| Rate for Payer: Cash Price |
$665.00
|
| Rate for Payer: Cash Price |
$665.00
|
| Rate for Payer: Cigna Commercial |
$1,103.90
|
| Rate for Payer: First Health Commercial |
$1,263.50
|
| Rate for Payer: Humana Commercial |
$1,130.50
|
| Rate for Payer: Humana KY Medicaid |
$457.39
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$462.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,090.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$981.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$466.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,170.40
|
| Rate for Payer: Ohio Health Group HMO |
$997.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,064.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,157.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$917.70
|
| Rate for Payer: PHCS Commercial |
$1,276.80
|
| Rate for Payer: United Healthcare All Payer |
$1,170.40
|
|
|
OPTX MEDIAL ANKLE FX
|
Facility
|
IP
|
$1,330.00
|
|
|
Service Code
|
HCPCS 27766
|
| Hospital Charge Code |
76100930
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$399.00 |
| Max. Negotiated Rate |
$1,276.80 |
| Rate for Payer: Aetna Commercial |
$1,024.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,037.40
|
| Rate for Payer: Cash Price |
$665.00
|
| Rate for Payer: Cigna Commercial |
$1,103.90
|
| Rate for Payer: First Health Commercial |
$1,263.50
|
| Rate for Payer: Humana Commercial |
$1,130.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,090.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$981.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,170.40
|
| Rate for Payer: Ohio Health Group HMO |
$997.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,064.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,157.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$917.70
|
| Rate for Payer: PHCS Commercial |
$1,276.80
|
| Rate for Payer: United Healthcare All Payer |
$1,170.40
|
|
|
OPTX MEDIAL ANKLE FX
|
Professional
|
Both
|
$1,330.00
|
|
|
Service Code
|
HCPCS 27766
|
| Hospital Charge Code |
76100930
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$465.01 |
| Max. Negotiated Rate |
$1,051.91 |
| Rate for Payer: Aetna Commercial |
$896.07
|
| Rate for Payer: Ambetter Exchange |
$576.61
|
| Rate for Payer: Anthem Medicaid |
$465.01
|
| Rate for Payer: Buckeye Individual/Medicaid |
$576.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$576.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$691.93
|
| Rate for Payer: Cash Price |
$665.00
|
| Rate for Payer: Cash Price |
$665.00
|
| Rate for Payer: Cigna Commercial |
$1,051.91
|
| Rate for Payer: Healthspan PPO |
$811.65
|
| Rate for Payer: Humana Medicaid |
$465.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$753.52
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$576.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$576.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$474.31
|
| Rate for Payer: Molina Healthcare Passport |
$465.01
|
| Rate for Payer: Multiplan PHCS |
$798.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$749.59
|
| Rate for Payer: UHCCP Medicaid |
$465.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$469.66
|
| Rate for Payer: Wellcare Medicare Advantage |
$576.61
|
|
|
OPTX MEDIAL ANKLE FX(P
|
Professional
|
Both
|
$1,330.00
|
|
|
Service Code
|
HCPCS 27766
|
| Hospital Charge Code |
761P0930
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$465.01 |
| Max. Negotiated Rate |
$1,051.91 |
| Rate for Payer: Aetna Commercial |
$896.07
|
| Rate for Payer: Ambetter Exchange |
$576.61
|
| Rate for Payer: Anthem Medicaid |
$465.01
|
| Rate for Payer: Buckeye Individual/Medicaid |
$576.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$576.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$691.93
|
| Rate for Payer: Cash Price |
$665.00
|
| Rate for Payer: Cash Price |
$665.00
|
| Rate for Payer: Cigna Commercial |
$1,051.91
|
| Rate for Payer: Healthspan PPO |
$811.65
|
| Rate for Payer: Humana Medicaid |
$465.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$753.52
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$576.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$576.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$474.31
|
| Rate for Payer: Molina Healthcare Passport |
$465.01
|
| Rate for Payer: Multiplan PHCS |
$798.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$749.59
|
| Rate for Payer: UHCCP Medicaid |
$465.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$469.66
|
| Rate for Payer: Wellcare Medicare Advantage |
$576.61
|
|
