|
OPTX OF RIB FX W/FIXJ SCOPE
|
Facility
|
OP
|
$10,708.00
|
|
|
Service Code
|
HCPCS 21811
|
| Hospital Charge Code |
76100407
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,682.48 |
| Max. Negotiated Rate |
$10,279.68 |
| Rate for Payer: Aetna Commercial |
$8,245.16
|
| Rate for Payer: Anthem Medicaid |
$3,682.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,352.24
|
| 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 |
$5,354.00
|
| Rate for Payer: Cash Price |
$5,354.00
|
| Rate for Payer: Cigna Commercial |
$8,887.64
|
| Rate for Payer: First Health Commercial |
$10,172.60
|
| Rate for Payer: Humana Commercial |
$9,101.80
|
| Rate for Payer: Humana KY Medicaid |
$3,682.48
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$3,719.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,780.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,902.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,756.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,423.04
|
| Rate for Payer: Ohio Health Group HMO |
$8,031.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,566.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,315.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,388.52
|
| Rate for Payer: PHCS Commercial |
$10,279.68
|
| Rate for Payer: United Healthcare All Payer |
$9,423.04
|
|
|
OPTX OF RIB FX W/FIXJ SCOPE
|
Facility
|
IP
|
$10,708.00
|
|
|
Service Code
|
HCPCS 21811
|
| Hospital Charge Code |
76100407
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,212.40 |
| Max. Negotiated Rate |
$10,279.68 |
| Rate for Payer: Aetna Commercial |
$8,245.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,352.24
|
| Rate for Payer: Cash Price |
$5,354.00
|
| Rate for Payer: Cigna Commercial |
$8,887.64
|
| Rate for Payer: First Health Commercial |
$10,172.60
|
| Rate for Payer: Humana Commercial |
$9,101.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,780.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,902.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,212.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,423.04
|
| Rate for Payer: Ohio Health Group HMO |
$8,031.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,566.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,315.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,388.52
|
| Rate for Payer: PHCS Commercial |
$10,279.68
|
| Rate for Payer: United Healthcare All Payer |
$9,423.04
|
|
|
OPTX OF RIB FX W/FIXJ SCOPE
|
Professional
|
Both
|
$10,708.00
|
|
|
Service Code
|
HCPCS 21811
|
| Hospital Charge Code |
76100407
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$448.68 |
| Max. Negotiated Rate |
$6,424.80 |
| Rate for Payer: Ambetter Exchange |
$562.70
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$448.68
|
| Rate for Payer: Anthem Medicaid |
$488.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$562.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$562.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$675.24
|
| Rate for Payer: Cash Price |
$5,354.00
|
| Rate for Payer: Cash Price |
$5,354.00
|
| Rate for Payer: Cigna Commercial |
$1,145.43
|
| Rate for Payer: Humana Medicaid |
$488.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$797.25
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$562.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$497.92
|
| Rate for Payer: Molina Healthcare Passport |
$488.16
|
| Rate for Payer: Multiplan PHCS |
$6,424.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$731.51
|
| Rate for Payer: UHCCP Medicaid |
$471.11
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$493.04
|
| Rate for Payer: Wellcare Medicare Advantage |
$562.70
|
|
|
OPTX OF RIB FX W/FIXJ SCOPE(P
|
Professional
|
Both
|
$1,175.00
|
|
|
Service Code
|
HCPCS 21811
|
| Hospital Charge Code |
761P0407
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$448.68 |
| Max. Negotiated Rate |
$1,145.43 |
| Rate for Payer: Ambetter Exchange |
$562.70
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$448.68
|
| Rate for Payer: Anthem Medicaid |
$488.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$562.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$562.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$675.24
|
| Rate for Payer: Cash Price |
$587.50
|
| Rate for Payer: Cash Price |
$587.50
|
| Rate for Payer: Cigna Commercial |
$1,145.43
|
| Rate for Payer: Humana Medicaid |
$488.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$797.25
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$562.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$497.92
|
| Rate for Payer: Molina Healthcare Passport |
$488.16
|
| Rate for Payer: Multiplan PHCS |
$705.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$731.51
|
| Rate for Payer: UHCCP Medicaid |
$471.11
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$493.04
|
| Rate for Payer: Wellcare Medicare Advantage |
$562.70
|
|
|
OPTX OF RIB FX W/FIXJ SCOPE(T
|
Facility
|
IP
|
$9,533.00
|
|
|
Service Code
|
HCPCS 21811
|
| Hospital Charge Code |
761T0407
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,859.90 |
| Max. Negotiated Rate |
$9,151.68 |
| Rate for Payer: Aetna Commercial |
$7,340.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,435.74
|
| Rate for Payer: Cash Price |
$4,766.50
|
| Rate for Payer: Cigna Commercial |
$7,912.39
|
| Rate for Payer: First Health Commercial |
$9,056.35
|
| Rate for Payer: Humana Commercial |
$8,103.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,817.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,035.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,859.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,389.04
|
| Rate for Payer: Ohio Health Group HMO |
$7,149.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,626.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,293.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,577.77
|
| Rate for Payer: PHCS Commercial |
$9,151.68
|
| Rate for Payer: United Healthcare All Payer |
$8,389.04
|
|
|
OPTX OF RIB FX W/FIXJ SCOPE(T
|
Facility
|
OP
|
$9,533.00
|
|
|
Service Code
|
HCPCS 21811
|
| Hospital Charge Code |
761T0407
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,278.40 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$7,340.41
|
| Rate for Payer: Anthem Medicaid |
$3,278.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,435.74
|
| 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 |
$4,766.50
|
| Rate for Payer: Cash Price |
$4,766.50
|
| Rate for Payer: Cigna Commercial |
$7,912.39
|
| Rate for Payer: First Health Commercial |
$9,056.35
|
| Rate for Payer: Humana Commercial |
$8,103.05
|
| Rate for Payer: Humana KY Medicaid |
$3,278.40
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$3,311.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,817.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,035.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,344.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,389.04
|
| Rate for Payer: Ohio Health Group HMO |
$7,149.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,626.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,293.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,577.77
|
| Rate for Payer: PHCS Commercial |
$9,151.68
|
| Rate for Payer: United Healthcare All Payer |
$8,389.04
|
|
|
OPTX OF ULNAR SHAFT FX
|
Professional
|
Both
|
$1,300.00
|
|
|
Service Code
|
HCPCS 25545
|
| Hospital Charge Code |
76100625
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$455.00 |
| Max. Negotiated Rate |
$1,105.86 |
| Rate for Payer: Aetna Commercial |
$917.14
|
| Rate for Payer: Ambetter Exchange |
$598.29
|
| Rate for Payer: Anthem Medicaid |
$477.49
|
| Rate for Payer: Buckeye Individual/Medicaid |
$598.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$598.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$717.95
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$1,105.86
|
| Rate for Payer: Healthspan PPO |
$830.73
|
| Rate for Payer: Humana Medicaid |
$477.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$765.40
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$598.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$598.29
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$487.04
|
| Rate for Payer: Molina Healthcare Passport |
$477.49
|
| Rate for Payer: Multiplan PHCS |
$780.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$777.78
|
| Rate for Payer: UHCCP Medicaid |
$455.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$482.26
|
| Rate for Payer: Wellcare Medicare Advantage |
$598.29
|
|
|
OPTX OF ULNAR SHAFT FX
|
Facility
|
OP
|
$1,300.00
|
|
|
Service Code
|
HCPCS 25545
|
| Hospital Charge Code |
76100625
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$447.07 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,001.00
|
| Rate for Payer: Anthem Medicaid |
$447.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,014.00
|
| 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 |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$1,079.00
|
| Rate for Payer: First Health Commercial |
$1,235.00
|
| Rate for Payer: Humana Commercial |
$1,105.00
|
| Rate for Payer: Humana KY Medicaid |
$447.07
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$451.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,066.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$959.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$456.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,144.00
|
| Rate for Payer: Ohio Health Group HMO |
$975.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,040.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,131.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$897.00
|
| Rate for Payer: PHCS Commercial |
$1,248.00
|
| Rate for Payer: United Healthcare All Payer |
$1,144.00
|
|
|
OPTX OF ULNAR SHAFT FX
|
Facility
|
IP
|
$1,300.00
|
|
|
Service Code
|
HCPCS 25545
|
| Hospital Charge Code |
76100625
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$390.00 |
| Max. Negotiated Rate |
$1,248.00 |
| Rate for Payer: Aetna Commercial |
$1,001.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,014.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$1,079.00
|
| Rate for Payer: First Health Commercial |
$1,235.00
|
| Rate for Payer: Humana Commercial |
$1,105.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,066.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$959.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$390.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,144.00
|
| Rate for Payer: Ohio Health Group HMO |
$975.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,040.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,131.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$897.00
|
| Rate for Payer: PHCS Commercial |
$1,248.00
|
| Rate for Payer: United Healthcare All Payer |
$1,144.00
|
|
|
OPTX OF ULNAR SHAFT FX(P
|
Professional
|
Both
|
$1,300.00
|
|
|
Service Code
|
HCPCS 25545
|
| Hospital Charge Code |
761P0625
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$455.00 |
| Max. Negotiated Rate |
$1,105.86 |
| Rate for Payer: Aetna Commercial |
$917.14
|
| Rate for Payer: Ambetter Exchange |
$598.29
|
| Rate for Payer: Anthem Medicaid |
$477.49
|
| Rate for Payer: Buckeye Individual/Medicaid |
$598.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$598.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$717.95
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$1,105.86
|
| Rate for Payer: Healthspan PPO |
$830.73
|
| Rate for Payer: Humana Medicaid |
$477.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$765.40
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$598.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$598.29
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$487.04
|
| Rate for Payer: Molina Healthcare Passport |
$477.49
|
| Rate for Payer: Multiplan PHCS |
$780.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$777.78
|
| Rate for Payer: UHCCP Medicaid |
$455.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$482.26
|
| Rate for Payer: Wellcare Medicare Advantage |
$598.29
|
|
|
OPTX PATLLR FX PATLLC&SFTS RPR
|
Facility
|
IP
|
$1,650.00
|
|
|
Service Code
|
HCPCS 27524
|
| Hospital Charge Code |
76100867
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$495.00 |
| Max. Negotiated Rate |
$1,584.00 |
| Rate for Payer: Aetna Commercial |
$1,270.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,287.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cigna Commercial |
$1,369.50
|
| Rate for Payer: First Health Commercial |
$1,567.50
|
| Rate for Payer: Humana Commercial |
$1,402.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,353.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,217.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$495.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,452.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,237.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,435.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,138.50
|
| Rate for Payer: PHCS Commercial |
$1,584.00
|
| Rate for Payer: United Healthcare All Payer |
$1,452.00
|
|
|
OPTX PATLLR FX PATLLC&SFTS RPR
|
Professional
|
Both
|
$1,650.00
|
|
|
Service Code
|
HCPCS 27524
|
| Hospital Charge Code |
761P0867
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$577.50 |
| Max. Negotiated Rate |
$1,221.16 |
| Rate for Payer: Aetna Commercial |
$1,113.93
|
| Rate for Payer: Ambetter Exchange |
$718.55
|
| Rate for Payer: Anthem Medicaid |
$592.67
|
| Rate for Payer: Buckeye Individual/Medicaid |
$718.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$718.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$862.26
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cigna Commercial |
$1,221.16
|
| Rate for Payer: Healthspan PPO |
$1,008.98
|
| Rate for Payer: Humana Medicaid |
$592.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$934.68
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$718.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$718.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$604.52
|
| Rate for Payer: Molina Healthcare Passport |
$592.67
|
| Rate for Payer: Multiplan PHCS |
$990.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$934.12
|
| Rate for Payer: UHCCP Medicaid |
$577.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$598.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$718.55
|
|
|
OPTX PATLLR FX PATLLC&SFTS RPR
|
Facility
|
OP
|
$1,650.00
|
|
|
Service Code
|
HCPCS 27524
|
| Hospital Charge Code |
76100867
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$567.43 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,270.50
|
| Rate for Payer: Anthem Medicaid |
$567.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,287.00
|
| 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 |
$825.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cigna Commercial |
$1,369.50
|
| Rate for Payer: First Health Commercial |
$1,567.50
|
| Rate for Payer: Humana Commercial |
$1,402.50
|
| Rate for Payer: Humana KY Medicaid |
$567.43
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$573.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,353.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,217.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$578.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,452.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,237.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,435.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,138.50
|
| Rate for Payer: PHCS Commercial |
$1,584.00
|
| Rate for Payer: United Healthcare All Payer |
$1,452.00
|
|
|
OPTX PATLLR FX PATLLC&SFTS RPR
|
Professional
|
Both
|
$1,650.00
|
|
|
Service Code
|
HCPCS 27524
|
| Hospital Charge Code |
76100867
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$577.50 |
| Max. Negotiated Rate |
$1,221.16 |
| Rate for Payer: Aetna Commercial |
$1,113.93
|
| Rate for Payer: Ambetter Exchange |
$718.55
|
| Rate for Payer: Anthem Medicaid |
$592.67
|
| Rate for Payer: Buckeye Individual/Medicaid |
$718.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$718.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$862.26
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cigna Commercial |
$1,221.16
|
| Rate for Payer: Healthspan PPO |
$1,008.98
|
| Rate for Payer: Humana Medicaid |
$592.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$934.68
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$718.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$718.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$604.52
|
| Rate for Payer: Molina Healthcare Passport |
$592.67
|
| Rate for Payer: Multiplan PHCS |
$990.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$934.12
|
| Rate for Payer: UHCCP Medicaid |
$577.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$598.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$718.55
|
|
|
OPTX PERIARTICULAR FX&/DIS ELB
|
Professional
|
Both
|
$1,290.00
|
|
|
Service Code
|
HCPCS 24586
|
| Hospital Charge Code |
761P0550
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$451.50 |
| Max. Negotiated Rate |
$1,780.79 |
| Rate for Payer: Aetna Commercial |
$1,633.12
|
| Rate for Payer: Ambetter Exchange |
$1,029.72
|
| Rate for Payer: Anthem Medicaid |
$873.83
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,029.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,029.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,235.66
|
| Rate for Payer: Cash Price |
$645.00
|
| Rate for Payer: Cash Price |
$645.00
|
| Rate for Payer: Cigna Commercial |
$1,780.79
|
| Rate for Payer: Healthspan PPO |
$1,479.26
|
| Rate for Payer: Humana Medicaid |
$873.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,358.64
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,029.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,029.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$891.31
|
| Rate for Payer: Molina Healthcare Passport |
$873.83
|
| Rate for Payer: Multiplan PHCS |
$774.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,338.64
|
| Rate for Payer: UHCCP Medicaid |
$451.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$882.57
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,029.72
|
|
|
OPTX PERIARTICULAR FX&/DIS ELB
|
Professional
|
Both
|
$1,290.00
|
|
|
Service Code
|
HCPCS 24586
|
| Hospital Charge Code |
76100550
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$451.50 |
| Max. Negotiated Rate |
$1,780.79 |
| Rate for Payer: Aetna Commercial |
$1,633.12
|
| Rate for Payer: Ambetter Exchange |
$1,029.72
|
| Rate for Payer: Anthem Medicaid |
$873.83
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,029.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,029.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,235.66
|
| Rate for Payer: Cash Price |
$645.00
|
| Rate for Payer: Cash Price |
$645.00
|
| Rate for Payer: Cigna Commercial |
$1,780.79
|
| Rate for Payer: Healthspan PPO |
$1,479.26
|
| Rate for Payer: Humana Medicaid |
$873.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,358.64
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,029.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,029.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$891.31
|
| Rate for Payer: Molina Healthcare Passport |
$873.83
|
| Rate for Payer: Multiplan PHCS |
$774.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,338.64
|
| Rate for Payer: UHCCP Medicaid |
$451.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$882.57
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,029.72
|
|
|
OPTX PERIARTICULAR FX&/DIS ELB
|
Facility
|
IP
|
$1,290.00
|
|
|
Service Code
|
HCPCS 24586
|
| Hospital Charge Code |
76100550
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$387.00 |
| Max. Negotiated Rate |
$1,238.40 |
| Rate for Payer: Aetna Commercial |
$993.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,006.20
|
| Rate for Payer: Cash Price |
$645.00
|
| Rate for Payer: Cigna Commercial |
$1,070.70
|
| Rate for Payer: First Health Commercial |
$1,225.50
|
| Rate for Payer: Humana Commercial |
$1,096.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,057.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$952.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$387.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,135.20
|
| Rate for Payer: Ohio Health Group HMO |
$967.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,032.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,122.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$890.10
|
| Rate for Payer: PHCS Commercial |
$1,238.40
|
| Rate for Payer: United Healthcare All Payer |
$1,135.20
|
|
|
OPTX PERIARTICULAR FX&/DIS ELB
|
Facility
|
OP
|
$1,290.00
|
|
|
Service Code
|
HCPCS 24586
|
| Hospital Charge Code |
76100550
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$443.63 |
| Max. Negotiated Rate |
$16,644.15 |
| Rate for Payer: Aetna Commercial |
$993.30
|
| Rate for Payer: Anthem Medicaid |
$443.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,888.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,006.20
|
| 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 |
$645.00
|
| Rate for Payer: Cash Price |
$645.00
|
| Rate for Payer: Cigna Commercial |
$1,070.70
|
| Rate for Payer: First Health Commercial |
$1,225.50
|
| Rate for Payer: Humana Commercial |
$1,096.50
|
| Rate for Payer: Humana KY Medicaid |
$443.63
|
| Rate for Payer: Humana Medicare Advantage |
$11,888.68
|
| Rate for Payer: Kentucky WC Medicaid |
$448.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,057.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$952.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14,266.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$452.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,135.20
|
| Rate for Payer: Ohio Health Group HMO |
$967.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,032.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,122.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$890.10
|
| Rate for Payer: PHCS Commercial |
$1,238.40
|
| Rate for Payer: United Healthcare All Payer |
$1,135.20
|
|
|
OPTX POST ANKLE FX
|
Facility
|
IP
|
$1,060.00
|
|
|
Service Code
|
HCPCS 27769
|
| Hospital Charge Code |
76100933
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$318.00 |
| Max. Negotiated Rate |
$1,017.60 |
| Rate for Payer: Aetna Commercial |
$816.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$826.80
|
| Rate for Payer: Cash Price |
$530.00
|
| Rate for Payer: Cigna Commercial |
$879.80
|
| Rate for Payer: First Health Commercial |
$1,007.00
|
| Rate for Payer: Humana Commercial |
$901.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$869.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$782.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$318.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$932.80
|
| Rate for Payer: Ohio Health Group HMO |
$795.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$848.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$922.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$731.40
|
| Rate for Payer: PHCS Commercial |
$1,017.60
|
| Rate for Payer: United Healthcare All Payer |
$932.80
|
|
|
OPTX POST ANKLE FX
|
Facility
|
OP
|
$1,060.00
|
|
|
Service Code
|
HCPCS 27769
|
| Hospital Charge Code |
76100933
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$364.53 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$816.20
|
| Rate for Payer: Anthem Medicaid |
$364.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$826.80
|
| 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 |
$530.00
|
| Rate for Payer: Cash Price |
$530.00
|
| Rate for Payer: Cigna Commercial |
$879.80
|
| Rate for Payer: First Health Commercial |
$1,007.00
|
| Rate for Payer: Humana Commercial |
$901.00
|
| Rate for Payer: Humana KY Medicaid |
$364.53
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$368.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$869.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$782.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$371.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$932.80
|
| Rate for Payer: Ohio Health Group HMO |
$795.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$848.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$922.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$731.40
|
| Rate for Payer: PHCS Commercial |
$1,017.60
|
| Rate for Payer: United Healthcare All Payer |
$932.80
|
|
|
OPTX POST ANKLE FX
|
Professional
|
Both
|
$1,060.00
|
|
|
Service Code
|
HCPCS 27769
|
| Hospital Charge Code |
76100933
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$371.00 |
| Max. Negotiated Rate |
$1,059.88 |
| Rate for Payer: Aetna Commercial |
$1,019.83
|
| Rate for Payer: Ambetter Exchange |
$691.99
|
| Rate for Payer: Anthem Medicaid |
$520.12
|
| Rate for Payer: Buckeye Individual/Medicaid |
$691.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$691.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$830.39
|
| Rate for Payer: Cash Price |
$530.00
|
| Rate for Payer: Cash Price |
$530.00
|
| Rate for Payer: Cigna Commercial |
$1,059.88
|
| Rate for Payer: Healthspan PPO |
$923.75
|
| Rate for Payer: Humana Medicaid |
$520.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$892.27
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$691.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$691.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$530.52
|
| Rate for Payer: Molina Healthcare Passport |
$520.12
|
| Rate for Payer: Multiplan PHCS |
$636.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$899.59
|
| Rate for Payer: UHCCP Medicaid |
$371.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$525.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$691.99
|
|
|
OPTX POST ANKLE FX(P
|
Professional
|
Both
|
$1,060.00
|
|
|
Service Code
|
HCPCS 27769
|
| Hospital Charge Code |
761P0933
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$371.00 |
| Max. Negotiated Rate |
$1,059.88 |
| Rate for Payer: Aetna Commercial |
$1,019.83
|
| Rate for Payer: Ambetter Exchange |
$691.99
|
| Rate for Payer: Anthem Medicaid |
$520.12
|
| Rate for Payer: Buckeye Individual/Medicaid |
$691.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$691.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$830.39
|
| Rate for Payer: Cash Price |
$530.00
|
| Rate for Payer: Cash Price |
$530.00
|
| Rate for Payer: Cigna Commercial |
$1,059.88
|
| Rate for Payer: Healthspan PPO |
$923.75
|
| Rate for Payer: Humana Medicaid |
$520.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$892.27
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$691.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$691.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$530.52
|
| Rate for Payer: Molina Healthcare Passport |
$520.12
|
| Rate for Payer: Multiplan PHCS |
$636.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$899.59
|
| Rate for Payer: UHCCP Medicaid |
$371.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$525.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$691.99
|
|
|
OPTX PROXIMAL HUMERAL FX
|
Professional
|
Both
|
$3,276.00
|
|
|
Service Code
|
HCPCS 23615
|
| Hospital Charge Code |
76100480
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$576.68 |
| Max. Negotiated Rate |
$1,965.60 |
| Rate for Payer: Aetna Commercial |
$1,268.31
|
| Rate for Payer: Ambetter Exchange |
$841.25
|
| Rate for Payer: Anthem Medicaid |
$576.68
|
| Rate for Payer: Buckeye Individual/Medicaid |
$841.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$841.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,009.50
|
| Rate for Payer: Cash Price |
$1,638.00
|
| Rate for Payer: Cash Price |
$1,638.00
|
| Rate for Payer: Cigna Commercial |
$1,302.78
|
| Rate for Payer: Healthspan PPO |
$1,148.82
|
| Rate for Payer: Humana Medicaid |
$576.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,096.10
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$841.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$841.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$588.21
|
| Rate for Payer: Molina Healthcare Passport |
$576.68
|
| Rate for Payer: Multiplan PHCS |
$1,965.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,093.62
|
| Rate for Payer: UHCCP Medicaid |
$1,146.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$582.45
|
| Rate for Payer: Wellcare Medicare Advantage |
$841.25
|
|
|
OPTX PROXIMAL HUMERAL FX
|
Facility
|
IP
|
$3,276.00
|
|
|
Service Code
|
HCPCS 23615
|
| Hospital Charge Code |
76100480
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$982.80 |
| Max. Negotiated Rate |
$3,144.96 |
| Rate for Payer: Aetna Commercial |
$2,522.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,555.28
|
| Rate for Payer: Cash Price |
$1,638.00
|
| Rate for Payer: Cigna Commercial |
$2,719.08
|
| Rate for Payer: First Health Commercial |
$3,112.20
|
| Rate for Payer: Humana Commercial |
$2,784.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,686.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,417.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$982.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,882.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,457.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,620.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,850.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,260.44
|
| Rate for Payer: PHCS Commercial |
$3,144.96
|
| Rate for Payer: United Healthcare All Payer |
$2,882.88
|
|
|
OPTX PROXIMAL HUMERAL FX
|
Facility
|
OP
|
$3,276.00
|
|
|
Service Code
|
HCPCS 23615
|
| Hospital Charge Code |
76100480
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,126.62 |
| Max. Negotiated Rate |
$16,644.15 |
| Rate for Payer: Aetna Commercial |
$2,522.52
|
| Rate for Payer: Anthem Medicaid |
$1,126.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,888.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,555.28
|
| 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 |
$1,638.00
|
| Rate for Payer: Cash Price |
$1,638.00
|
| Rate for Payer: Cigna Commercial |
$2,719.08
|
| Rate for Payer: First Health Commercial |
$3,112.20
|
| Rate for Payer: Humana Commercial |
$2,784.60
|
| Rate for Payer: Humana KY Medicaid |
$1,126.62
|
| Rate for Payer: Humana Medicare Advantage |
$11,888.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1,138.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,686.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,417.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14,266.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,149.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,882.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,457.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,620.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,850.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,260.44
|
| Rate for Payer: PHCS Commercial |
$3,144.96
|
| Rate for Payer: United Healthcare All Payer |
$2,882.88
|
|
