|
OPTX PROXIMAL HUMERAL FX(P
|
Professional
|
Both
|
$3,276.00
|
|
|
Service Code
|
HCPCS 23615
|
| Hospital Charge Code |
761P0480
|
|
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 RAD&ULN SHFT FX W/FIX R/U
|
Professional
|
Both
|
$1,420.00
|
|
|
Service Code
|
HCPCS 25574
|
| Hospital Charge Code |
761P0628
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$426.04 |
| Max. Negotiated Rate |
$966.10 |
| Rate for Payer: Aetna Commercial |
$951.53
|
| Rate for Payer: Ambetter Exchange |
$646.64
|
| Rate for Payer: Anthem Medicaid |
$426.04
|
| Rate for Payer: Buckeye Individual/Medicaid |
$646.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$646.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$775.97
|
| Rate for Payer: Cash Price |
$710.00
|
| Rate for Payer: Cash Price |
$710.00
|
| Rate for Payer: Cigna Commercial |
$966.10
|
| Rate for Payer: Healthspan PPO |
$861.88
|
| Rate for Payer: Humana Medicaid |
$426.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$824.41
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$646.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$646.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$434.56
|
| Rate for Payer: Molina Healthcare Passport |
$426.04
|
| Rate for Payer: Multiplan PHCS |
$852.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$840.63
|
| Rate for Payer: UHCCP Medicaid |
$497.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$430.30
|
| Rate for Payer: Wellcare Medicare Advantage |
$646.64
|
|
|
OPTX RAD&ULN SHFT FX W/FIX R/U
|
Facility
|
IP
|
$1,420.00
|
|
|
Service Code
|
HCPCS 25574
|
| Hospital Charge Code |
76100628
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$426.00 |
| Max. Negotiated Rate |
$1,363.20 |
| Rate for Payer: Aetna Commercial |
$1,093.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,107.60
|
| Rate for Payer: Cash Price |
$710.00
|
| Rate for Payer: Cigna Commercial |
$1,178.60
|
| Rate for Payer: First Health Commercial |
$1,349.00
|
| Rate for Payer: Humana Commercial |
$1,207.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,164.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,047.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$426.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,249.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,065.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,136.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,235.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$979.80
|
| Rate for Payer: PHCS Commercial |
$1,363.20
|
| Rate for Payer: United Healthcare All Payer |
$1,249.60
|
|
|
OPTX RAD&ULN SHFT FX W/FIX R/U
|
Professional
|
Both
|
$1,420.00
|
|
|
Service Code
|
HCPCS 25574
|
| Hospital Charge Code |
76100628
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$426.04 |
| Max. Negotiated Rate |
$966.10 |
| Rate for Payer: Aetna Commercial |
$951.53
|
| Rate for Payer: Ambetter Exchange |
$646.64
|
| Rate for Payer: Anthem Medicaid |
$426.04
|
| Rate for Payer: Buckeye Individual/Medicaid |
$646.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$646.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$775.97
|
| Rate for Payer: Cash Price |
$710.00
|
| Rate for Payer: Cash Price |
$710.00
|
| Rate for Payer: Cigna Commercial |
$966.10
|
| Rate for Payer: Healthspan PPO |
$861.88
|
| Rate for Payer: Humana Medicaid |
$426.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$824.41
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$646.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$646.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$434.56
|
| Rate for Payer: Molina Healthcare Passport |
$426.04
|
| Rate for Payer: Multiplan PHCS |
$852.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$840.63
|
| Rate for Payer: UHCCP Medicaid |
$497.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$430.30
|
| Rate for Payer: Wellcare Medicare Advantage |
$646.64
|
|
|
OPTX RAD&ULN SHFT FX W/FIX R/U
|
Facility
|
OP
|
$1,420.00
|
|
|
Service Code
|
HCPCS 25574
|
| Hospital Charge Code |
76100628
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$488.34 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,093.40
|
| Rate for Payer: Anthem Medicaid |
$488.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,107.60
|
| 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 |
$710.00
|
| Rate for Payer: Cash Price |
$710.00
|
| Rate for Payer: Cigna Commercial |
$1,178.60
|
| Rate for Payer: First Health Commercial |
$1,349.00
|
| Rate for Payer: Humana Commercial |
$1,207.00
|
| Rate for Payer: Humana KY Medicaid |
$488.34
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$493.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,164.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,047.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$498.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,249.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,065.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,136.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,235.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$979.80
|
| Rate for Payer: PHCS Commercial |
$1,363.20
|
| Rate for Payer: United Healthcare All Payer |
$1,249.60
|
|
|
OP TX SHLDR DISLC W/HUM TUB FX
|
Professional
|
Both
|
$2,025.00
|
|
|
Service Code
|
HCPCS 23670
|
| Hospital Charge Code |
76100489
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$518.61 |
| Max. Negotiated Rate |
$1,217.71 |
| Rate for Payer: Aetna Commercial |
$1,217.71
|
| Rate for Payer: Ambetter Exchange |
$832.36
|
| Rate for Payer: Anthem Medicaid |
$518.61
|
| Rate for Payer: Buckeye Individual/Medicaid |
$832.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$832.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$998.83
|
| Rate for Payer: Cash Price |
$1,012.50
|
| Rate for Payer: Cash Price |
$1,012.50
|
| Rate for Payer: Cigna Commercial |
$979.76
|
| Rate for Payer: Healthspan PPO |
$1,102.99
|
| Rate for Payer: Humana Medicaid |
$518.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,074.88
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$832.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$832.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$528.98
|
| Rate for Payer: Molina Healthcare Passport |
$518.61
|
| Rate for Payer: Multiplan PHCS |
$1,215.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,082.07
|
| Rate for Payer: UHCCP Medicaid |
$708.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$523.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$832.36
|
|
|
OP TX SHLDR DISLC W/HUM TUB FX
|
Facility
|
OP
|
$2,025.00
|
|
|
Service Code
|
HCPCS 23670
|
| Hospital Charge Code |
76100489
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$696.40 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,559.25
|
| Rate for Payer: Anthem Medicaid |
$696.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,579.50
|
| 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 |
$1,012.50
|
| Rate for Payer: Cash Price |
$1,012.50
|
| Rate for Payer: Cigna Commercial |
$1,680.75
|
| Rate for Payer: First Health Commercial |
$1,923.75
|
| Rate for Payer: Humana Commercial |
$1,721.25
|
| Rate for Payer: Humana KY Medicaid |
$696.40
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$703.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,660.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,494.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$710.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,782.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,518.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,620.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,761.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,397.25
|
| Rate for Payer: PHCS Commercial |
$1,944.00
|
| Rate for Payer: United Healthcare All Payer |
$1,782.00
|
|
|
OP TX SHLDR DISLC W/HUM TUB FX
|
Facility
|
IP
|
$2,025.00
|
|
|
Service Code
|
HCPCS 23670
|
| Hospital Charge Code |
76100489
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$607.50 |
| Max. Negotiated Rate |
$1,944.00 |
| Rate for Payer: Aetna Commercial |
$1,559.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,579.50
|
| Rate for Payer: Cash Price |
$1,012.50
|
| Rate for Payer: Cigna Commercial |
$1,680.75
|
| Rate for Payer: First Health Commercial |
$1,923.75
|
| Rate for Payer: Humana Commercial |
$1,721.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,660.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,494.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$607.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,782.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,518.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,620.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,761.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,397.25
|
| Rate for Payer: PHCS Commercial |
$1,944.00
|
| Rate for Payer: United Healthcare All Payer |
$1,782.00
|
|
|
OP TX SHLDR DISLC W/HUM TUB FX
|
Professional
|
Both
|
$2,025.00
|
|
|
Service Code
|
HCPCS 23670
|
| Hospital Charge Code |
761P0489
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$518.61 |
| Max. Negotiated Rate |
$1,217.71 |
| Rate for Payer: Aetna Commercial |
$1,217.71
|
| Rate for Payer: Ambetter Exchange |
$832.36
|
| Rate for Payer: Anthem Medicaid |
$518.61
|
| Rate for Payer: Buckeye Individual/Medicaid |
$832.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$832.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$998.83
|
| Rate for Payer: Cash Price |
$1,012.50
|
| Rate for Payer: Cash Price |
$1,012.50
|
| Rate for Payer: Cigna Commercial |
$979.76
|
| Rate for Payer: Healthspan PPO |
$1,102.99
|
| Rate for Payer: Humana Medicaid |
$518.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,074.88
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$832.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$832.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$528.98
|
| Rate for Payer: Molina Healthcare Passport |
$518.61
|
| Rate for Payer: Multiplan PHCS |
$1,215.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,082.07
|
| Rate for Payer: UHCCP Medicaid |
$708.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$523.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$832.36
|
|
|
OP TX TALUS FX W INTERN FIXATI
|
Professional
|
Both
|
$1,250.00
|
|
|
Service Code
|
HCPCS 28445
|
| Hospital Charge Code |
76102570
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$437.50 |
| Max. Negotiated Rate |
$1,858.63 |
| Rate for Payer: Aetna Commercial |
$1,612.34
|
| Rate for Payer: Ambetter Exchange |
$993.27
|
| Rate for Payer: Anthem Medicaid |
$527.69
|
| Rate for Payer: Buckeye Individual/Medicaid |
$993.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$993.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,191.92
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cigna Commercial |
$1,858.63
|
| Rate for Payer: Healthspan PPO |
$1,460.44
|
| Rate for Payer: Humana Medicaid |
$527.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,327.42
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$993.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$993.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$538.24
|
| Rate for Payer: Molina Healthcare Passport |
$527.69
|
| Rate for Payer: Multiplan PHCS |
$750.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,291.25
|
| Rate for Payer: UHCCP Medicaid |
$437.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$532.97
|
| Rate for Payer: Wellcare Medicare Advantage |
$993.27
|
|
|
OP TX TALUS FX W INTERN FIXATI
|
Facility
|
IP
|
$8,933.00
|
|
|
Service Code
|
HCPCS 28445
|
| Hospital Charge Code |
45000176
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,679.90 |
| Max. Negotiated Rate |
$8,575.68 |
| Rate for Payer: Aetna Commercial |
$6,878.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,967.74
|
| Rate for Payer: Cash Price |
$4,466.50
|
| Rate for Payer: Cigna Commercial |
$7,414.39
|
| Rate for Payer: First Health Commercial |
$8,486.35
|
| Rate for Payer: Humana Commercial |
$7,593.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,325.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,592.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,861.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,699.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,146.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,771.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,163.77
|
| Rate for Payer: PHCS Commercial |
$8,575.68
|
| Rate for Payer: United Healthcare All Payer |
$7,861.04
|
|
|
OP TX TALUS FX W INTERN FIXATI
|
Facility
|
OP
|
$8,933.00
|
|
|
Service Code
|
HCPCS 28445
|
| Hospital Charge Code |
45000176
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,072.06 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$6,878.41
|
| Rate for Payer: Anthem Medicaid |
$3,072.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,967.74
|
| 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 |
$4,466.50
|
| Rate for Payer: Cash Price |
$4,466.50
|
| Rate for Payer: Cigna Commercial |
$7,414.39
|
| Rate for Payer: First Health Commercial |
$8,486.35
|
| Rate for Payer: Humana Commercial |
$7,593.05
|
| Rate for Payer: Humana KY Medicaid |
$3,072.06
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$3,103.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,325.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,592.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,133.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,861.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,699.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,146.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,771.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,163.77
|
| Rate for Payer: PHCS Commercial |
$8,575.68
|
| Rate for Payer: United Healthcare All Payer |
$7,861.04
|
|
|
OPTX THIGH FX
|
Facility
|
OP
|
$1,735.00
|
|
|
Service Code
|
HCPCS 27269
|
| Hospital Charge Code |
76100806
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$520.50 |
| Max. Negotiated Rate |
$1,665.60 |
| Rate for Payer: Aetna Commercial |
$1,335.95
|
| Rate for Payer: Anthem Medicaid |
$596.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,353.30
|
| Rate for Payer: Cash Price |
$867.50
|
| Rate for Payer: Cigna Commercial |
$1,440.05
|
| Rate for Payer: First Health Commercial |
$1,648.25
|
| Rate for Payer: Humana Commercial |
$1,474.75
|
| Rate for Payer: Humana KY Medicaid |
$596.67
|
| Rate for Payer: Kentucky WC Medicaid |
$602.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,422.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,280.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$520.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$608.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,526.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,301.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,388.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,509.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,197.15
|
| Rate for Payer: PHCS Commercial |
$1,665.60
|
| Rate for Payer: United Healthcare All Payer |
$1,526.80
|
|
|
OPTX THIGH FX
|
Professional
|
Both
|
$1,735.00
|
|
|
Service Code
|
HCPCS 27269
|
| Hospital Charge Code |
76100806
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$607.25 |
| Max. Negotiated Rate |
$1,906.10 |
| Rate for Payer: Aetna Commercial |
$1,820.29
|
| Rate for Payer: Ambetter Exchange |
$1,178.48
|
| Rate for Payer: Anthem Medicaid |
$936.68
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,178.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,178.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,414.18
|
| Rate for Payer: Cash Price |
$867.50
|
| Rate for Payer: Cash Price |
$867.50
|
| Rate for Payer: Cigna Commercial |
$1,906.10
|
| Rate for Payer: Healthspan PPO |
$1,648.80
|
| Rate for Payer: Humana Medicaid |
$936.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,537.43
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,178.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,178.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$955.41
|
| Rate for Payer: Molina Healthcare Passport |
$936.68
|
| Rate for Payer: Multiplan PHCS |
$1,041.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,532.02
|
| Rate for Payer: UHCCP Medicaid |
$607.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$946.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,178.48
|
|
|
OPTX THIGH FX
|
Facility
|
IP
|
$1,735.00
|
|
|
Service Code
|
HCPCS 27269
|
| Hospital Charge Code |
76100806
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$520.50 |
| Max. Negotiated Rate |
$1,665.60 |
| Rate for Payer: Aetna Commercial |
$1,335.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,353.30
|
| Rate for Payer: Cash Price |
$867.50
|
| Rate for Payer: Cigna Commercial |
$1,440.05
|
| Rate for Payer: First Health Commercial |
$1,648.25
|
| Rate for Payer: Humana Commercial |
$1,474.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,422.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,280.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$520.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,526.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,301.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,388.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,509.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,197.15
|
| Rate for Payer: PHCS Commercial |
$1,665.60
|
| Rate for Payer: United Healthcare All Payer |
$1,526.80
|
|
|
OPTX THIGH FX(P
|
Professional
|
Both
|
$1,735.00
|
|
|
Service Code
|
HCPCS 27269
|
| Hospital Charge Code |
761P0806
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$607.25 |
| Max. Negotiated Rate |
$1,906.10 |
| Rate for Payer: Aetna Commercial |
$1,820.29
|
| Rate for Payer: Ambetter Exchange |
$1,178.48
|
| Rate for Payer: Anthem Medicaid |
$936.68
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,178.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,178.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,414.18
|
| Rate for Payer: Cash Price |
$867.50
|
| Rate for Payer: Cash Price |
$867.50
|
| Rate for Payer: Cigna Commercial |
$1,906.10
|
| Rate for Payer: Healthspan PPO |
$1,648.80
|
| Rate for Payer: Humana Medicaid |
$936.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,537.43
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,178.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,178.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$955.41
|
| Rate for Payer: Molina Healthcare Passport |
$936.68
|
| Rate for Payer: Multiplan PHCS |
$1,041.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,532.02
|
| Rate for Payer: UHCCP Medicaid |
$607.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$946.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,178.48
|
|
|
OPTX TIBIAL SHFT FX W/WO CERC
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 27758
|
| Hospital Charge Code |
76100926
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
OPTX TIBIAL SHFT FX W/WO CERC
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 27758
|
| Hospital Charge Code |
76100926
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$700.00 |
| Max. Negotiated Rate |
$1,430.27 |
| Rate for Payer: Aetna Commercial |
$1,317.04
|
| Rate for Payer: Ambetter Exchange |
$852.83
|
| Rate for Payer: Anthem Medicaid |
$723.37
|
| Rate for Payer: Buckeye Individual/Medicaid |
$852.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$852.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,023.40
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,430.27
|
| Rate for Payer: Healthspan PPO |
$1,192.96
|
| Rate for Payer: Humana Medicaid |
$723.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,108.89
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$852.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$852.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$737.84
|
| Rate for Payer: Molina Healthcare Passport |
$723.37
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,108.68
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$730.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$852.83
|
|
|
OPTX TIBIAL SHFT FX W/WO CERC
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 27758
|
| Hospital Charge Code |
76100926
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$687.80 |
| Max. Negotiated Rate |
$16,644.15 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem Medicaid |
$687.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,888.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| 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 |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Humana KY Medicaid |
$687.80
|
| Rate for Payer: Humana Medicare Advantage |
$11,888.68
|
| Rate for Payer: Kentucky WC Medicaid |
$694.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14,266.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$701.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
OPTX TIBIAL SHFT FX W/WO CER(P
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 27758
|
| Hospital Charge Code |
761P0926
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$700.00 |
| Max. Negotiated Rate |
$1,430.27 |
| Rate for Payer: Aetna Commercial |
$1,317.04
|
| Rate for Payer: Ambetter Exchange |
$852.83
|
| Rate for Payer: Anthem Medicaid |
$723.37
|
| Rate for Payer: Buckeye Individual/Medicaid |
$852.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$852.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,023.40
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,430.27
|
| Rate for Payer: Healthspan PPO |
$1,192.96
|
| Rate for Payer: Humana Medicaid |
$723.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,108.89
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$852.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$852.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$737.84
|
| Rate for Payer: Molina Healthcare Passport |
$723.37
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,108.68
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$730.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$852.83
|
|
|
OPTX TIBI X PRX BCNDYLR
|
Facility
|
IP
|
$2,400.00
|
|
|
Service Code
|
HCPCS 27536
|
| Hospital Charge Code |
76100871
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$720.00 |
| Max. Negotiated Rate |
$2,304.00 |
| Rate for Payer: Aetna Commercial |
$1,848.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,872.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cigna Commercial |
$1,992.00
|
| Rate for Payer: First Health Commercial |
$2,280.00
|
| Rate for Payer: Humana Commercial |
$2,040.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,968.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,771.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$720.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,112.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,800.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,088.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,656.00
|
| Rate for Payer: PHCS Commercial |
$2,304.00
|
| Rate for Payer: United Healthcare All Payer |
$2,112.00
|
|
|
OPTX TIBI X PRX BCNDYLR
|
Facility
|
OP
|
$2,400.00
|
|
|
Service Code
|
HCPCS 27536
|
| Hospital Charge Code |
76100871
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$720.00 |
| Max. Negotiated Rate |
$2,304.00 |
| Rate for Payer: Aetna Commercial |
$1,848.00
|
| Rate for Payer: Anthem Medicaid |
$825.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,872.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cigna Commercial |
$1,992.00
|
| Rate for Payer: First Health Commercial |
$2,280.00
|
| Rate for Payer: Humana Commercial |
$2,040.00
|
| Rate for Payer: Humana KY Medicaid |
$825.36
|
| Rate for Payer: Kentucky WC Medicaid |
$833.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,968.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,771.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$720.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$841.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,112.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,800.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,088.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,656.00
|
| Rate for Payer: PHCS Commercial |
$2,304.00
|
| Rate for Payer: United Healthcare All Payer |
$2,112.00
|
|
|
OPTX TIBI X PRX BCNDYLR
|
Professional
|
Both
|
$2,400.00
|
|
|
Service Code
|
HCPCS 27536
|
| Hospital Charge Code |
76100871
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$785.01 |
| Max. Negotiated Rate |
$1,911.14 |
| Rate for Payer: Aetna Commercial |
$1,769.16
|
| Rate for Payer: Ambetter Exchange |
$1,128.62
|
| Rate for Payer: Anthem Medicaid |
$785.01
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,128.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,128.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,354.34
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cigna Commercial |
$1,911.14
|
| Rate for Payer: Healthspan PPO |
$1,602.48
|
| Rate for Payer: Humana Medicaid |
$785.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,490.74
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,128.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,128.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$800.71
|
| Rate for Payer: Molina Healthcare Passport |
$785.01
|
| Rate for Payer: Multiplan PHCS |
$1,440.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,467.21
|
| Rate for Payer: UHCCP Medicaid |
$840.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$792.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,128.62
|
|
|
OPTX TIBI X PRX BCNDYLR(P
|
Professional
|
Both
|
$2,400.00
|
|
|
Service Code
|
HCPCS 27536
|
| Hospital Charge Code |
761P0871
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$785.01 |
| Max. Negotiated Rate |
$1,911.14 |
| Rate for Payer: Aetna Commercial |
$1,769.16
|
| Rate for Payer: Ambetter Exchange |
$1,128.62
|
| Rate for Payer: Anthem Medicaid |
$785.01
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,128.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,128.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,354.34
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cigna Commercial |
$1,911.14
|
| Rate for Payer: Healthspan PPO |
$1,602.48
|
| Rate for Payer: Humana Medicaid |
$785.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,490.74
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,128.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,128.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$800.71
|
| Rate for Payer: Molina Healthcare Passport |
$785.01
|
| Rate for Payer: Multiplan PHCS |
$1,440.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,467.21
|
| Rate for Payer: UHCCP Medicaid |
$840.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$792.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,128.62
|
|
|
ORAJEL 20% GEL (7GM)
|
Facility
|
OP
|
$5.47
|
|
|
Service Code
|
NDC 10310028340
|
| Hospital Charge Code |
25004371
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$5.25 |
| Rate for Payer: Aetna Commercial |
$4.21
|
| Rate for Payer: Anthem Medicaid |
$1.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.27
|
| Rate for Payer: Cash Price |
$2.73
|
| Rate for Payer: Cigna Commercial |
$4.54
|
| Rate for Payer: First Health Commercial |
$5.20
|
| Rate for Payer: Humana Commercial |
$4.65
|
| Rate for Payer: Humana KY Medicaid |
$1.88
|
| Rate for Payer: Kentucky WC Medicaid |
$1.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.81
|
| Rate for Payer: Ohio Health Group HMO |
$4.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.77
|
| Rate for Payer: PHCS Commercial |
$5.25
|
| Rate for Payer: United Healthcare All Payer |
$4.81
|
|
