|
SKELETAL FIX TIBIAL SHAFT FX
|
Facility
|
OP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 27756
|
| Hospital Charge Code |
76100925
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$1,232.00
|
| Rate for Payer: Anthem Medicaid |
$550.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,248.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,661.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,351.78
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,328.00
|
| Rate for Payer: First Health Commercial |
$1,520.00
|
| Rate for Payer: Humana Commercial |
$1,360.00
|
| Rate for Payer: Humana KY Medicaid |
$550.24
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$555.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,312.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,180.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$561.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,408.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$208.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$496.00
|
| Rate for Payer: PHCS Commercial |
$1,536.00
|
| Rate for Payer: United Healthcare All Payer |
$1,408.00
|
|
|
SKELETAL FIX TIBIAL SHAFT FX
|
Facility
|
IP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 27756
|
| Hospital Charge Code |
76100925
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$1,536.00 |
| Rate for Payer: Aetna Commercial |
$1,232.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,248.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,328.00
|
| Rate for Payer: First Health Commercial |
$1,520.00
|
| Rate for Payer: Humana Commercial |
$1,360.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,312.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,180.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$480.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,408.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$208.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$496.00
|
| Rate for Payer: PHCS Commercial |
$1,536.00
|
| Rate for Payer: United Healthcare All Payer |
$1,408.00
|
|
|
SKELETAL FIX TIBIAL SHAFT FX
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 27756
|
| Hospital Charge Code |
76100925
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$413.30 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: Aetna Commercial |
$827.02
|
| Rate for Payer: Anthem Medicaid |
$413.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,600.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$906.87
|
| Rate for Payer: Healthspan PPO |
$749.10
|
| Rate for Payer: Humana Medicaid |
$413.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$706.97
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$421.57
|
| Rate for Payer: Molina Healthcare Passport |
$413.30
|
| Rate for Payer: Multiplan PHCS |
$960.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,120.00
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$417.43
|
|
|
SKELETAL FIX TIBIAL SHAFT FX(P
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 27756
|
| Hospital Charge Code |
761P0925
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$413.30 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: Aetna Commercial |
$827.02
|
| Rate for Payer: Anthem Medicaid |
$413.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,600.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$906.87
|
| Rate for Payer: Healthspan PPO |
$749.10
|
| Rate for Payer: Humana Medicaid |
$413.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$706.97
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$421.57
|
| Rate for Payer: Molina Healthcare Passport |
$413.30
|
| Rate for Payer: Multiplan PHCS |
$960.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,120.00
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$417.43
|
|
|
SKEL FIX DSTL PHLN FX FNG/THB
|
Professional
|
Both
|
$610.00
|
|
|
Service Code
|
HCPCS 26756
|
| Hospital Charge Code |
76100745
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$181.93 |
| Max. Negotiated Rate |
$656.57 |
| Rate for Payer: Aetna Commercial |
$580.42
|
| Rate for Payer: Anthem Medicaid |
$181.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$610.00
|
| Rate for Payer: Cash Price |
$305.00
|
| Rate for Payer: Cash Price |
$305.00
|
| Rate for Payer: Cigna Commercial |
$656.57
|
| Rate for Payer: Healthspan PPO |
$525.74
|
| Rate for Payer: Humana Medicaid |
$181.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$504.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$185.57
|
| Rate for Payer: Molina Healthcare Passport |
$181.93
|
| Rate for Payer: Multiplan PHCS |
$366.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$427.00
|
| Rate for Payer: UHCCP Medicaid |
$213.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$183.75
|
|
|
SKEL FIX DSTL PHLN FX FNG/THB
|
Facility
|
IP
|
$610.00
|
|
|
Service Code
|
HCPCS 26756
|
| Hospital Charge Code |
76100745
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$79.30 |
| Max. Negotiated Rate |
$585.60 |
| Rate for Payer: Aetna Commercial |
$469.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$475.80
|
| Rate for Payer: Cash Price |
$305.00
|
| Rate for Payer: Cigna Commercial |
$506.30
|
| Rate for Payer: First Health Commercial |
$579.50
|
| Rate for Payer: Humana Commercial |
$518.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$500.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$450.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$183.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$536.80
|
| Rate for Payer: Ohio Health Group HMO |
$457.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$122.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$79.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$189.10
|
| Rate for Payer: PHCS Commercial |
$585.60
|
| Rate for Payer: United Healthcare All Payer |
$536.80
|
|
|
SKEL FIX DSTL PHLN FX FNG/THB
|
Facility
|
OP
|
$610.00
|
|
|
Service Code
|
HCPCS 26756
|
| Hospital Charge Code |
76100745
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$79.30 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$469.70
|
| Rate for Payer: Anthem Medicaid |
$209.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$475.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$305.00
|
| Rate for Payer: Cash Price |
$305.00
|
| Rate for Payer: Cigna Commercial |
$506.30
|
| Rate for Payer: First Health Commercial |
$579.50
|
| Rate for Payer: Humana Commercial |
$518.50
|
| Rate for Payer: Humana KY Medicaid |
$209.78
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$211.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$500.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$450.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$213.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$536.80
|
| Rate for Payer: Ohio Health Group HMO |
$457.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$122.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$79.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$189.10
|
| Rate for Payer: PHCS Commercial |
$585.60
|
| Rate for Payer: United Healthcare All Payer |
$536.80
|
|
|
SKEL FIX DSTL PHLN FX FNG/TH(P
|
Professional
|
Both
|
$610.00
|
|
|
Service Code
|
HCPCS 26756
|
| Hospital Charge Code |
761P0745
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$181.93 |
| Max. Negotiated Rate |
$656.57 |
| Rate for Payer: Aetna Commercial |
$580.42
|
| Rate for Payer: Anthem Medicaid |
$181.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$610.00
|
| Rate for Payer: Cash Price |
$305.00
|
| Rate for Payer: Cash Price |
$305.00
|
| Rate for Payer: Cigna Commercial |
$656.57
|
| Rate for Payer: Healthspan PPO |
$525.74
|
| Rate for Payer: Humana Medicaid |
$181.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$504.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$185.57
|
| Rate for Payer: Molina Healthcare Passport |
$181.93
|
| Rate for Payer: Multiplan PHCS |
$366.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$427.00
|
| Rate for Payer: UHCCP Medicaid |
$213.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$183.75
|
|
|
SKEL FIX FEM FX PROX NECK
|
Facility
|
IP
|
$2,700.00
|
|
|
Service Code
|
HCPCS 27235
|
| Hospital Charge Code |
76100790
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$351.00 |
| Max. Negotiated Rate |
$2,592.00 |
| Rate for Payer: Aetna Commercial |
$2,079.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,106.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$2,241.00
|
| Rate for Payer: First Health Commercial |
$2,565.00
|
| Rate for Payer: Humana Commercial |
$2,295.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,214.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,992.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$810.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,376.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,025.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$351.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$837.00
|
| Rate for Payer: PHCS Commercial |
$2,592.00
|
| Rate for Payer: United Healthcare All Payer |
$2,376.00
|
|
|
SKEL FIX FEM FX PROX NECK
|
Facility
|
OP
|
$2,700.00
|
|
|
Service Code
|
HCPCS 27235
|
| Hospital Charge Code |
76100790
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$351.00 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$2,079.00
|
| Rate for Payer: Anthem Medicaid |
$928.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,106.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,661.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,351.78
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$2,241.00
|
| Rate for Payer: First Health Commercial |
$2,565.00
|
| Rate for Payer: Humana Commercial |
$2,295.00
|
| Rate for Payer: Humana KY Medicaid |
$928.53
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$937.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,214.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,992.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$947.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,376.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,025.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$351.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$837.00
|
| Rate for Payer: PHCS Commercial |
$2,592.00
|
| Rate for Payer: United Healthcare All Payer |
$2,376.00
|
|
|
SKEL FIX FEM FX PROX NECK
|
Professional
|
Both
|
$2,700.00
|
|
|
Service Code
|
HCPCS 27235
|
| Hospital Charge Code |
76100790
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$764.73 |
| Max. Negotiated Rate |
$2,700.00 |
| Rate for Payer: Aetna Commercial |
$1,354.18
|
| Rate for Payer: Anthem Medicaid |
$764.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,700.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$1,476.56
|
| Rate for Payer: Healthspan PPO |
$1,226.60
|
| Rate for Payer: Humana Medicaid |
$764.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,136.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$780.02
|
| Rate for Payer: Molina Healthcare Passport |
$764.73
|
| Rate for Payer: Multiplan PHCS |
$1,620.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,890.00
|
| Rate for Payer: UHCCP Medicaid |
$945.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$772.38
|
|
|
SKEL FIX FEM FX PROX NECK(P
|
Professional
|
Both
|
$2,700.00
|
|
|
Service Code
|
HCPCS 27235
|
| Hospital Charge Code |
761P0790
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$764.73 |
| Max. Negotiated Rate |
$2,700.00 |
| Rate for Payer: Aetna Commercial |
$1,354.18
|
| Rate for Payer: Anthem Medicaid |
$764.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,700.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$1,476.56
|
| Rate for Payer: Healthspan PPO |
$1,226.60
|
| Rate for Payer: Humana Medicaid |
$764.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,136.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$780.02
|
| Rate for Payer: Molina Healthcare Passport |
$764.73
|
| Rate for Payer: Multiplan PHCS |
$1,620.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,890.00
|
| Rate for Payer: UHCCP Medicaid |
$945.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$772.38
|
|
|
SKEL FIXJ DISTAL RAD FX/EPIPH
|
Professional
|
Both
|
$1,005.00
|
|
|
Service Code
|
HCPCS 25606
|
| Hospital Charge Code |
761P0632
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$351.75 |
| Max. Negotiated Rate |
$1,091.51 |
| Rate for Payer: Aetna Commercial |
$952.28
|
| Rate for Payer: Anthem Medicaid |
$478.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,005.00
|
| Rate for Payer: Cash Price |
$502.50
|
| Rate for Payer: Cash Price |
$502.50
|
| Rate for Payer: Cigna Commercial |
$1,091.51
|
| Rate for Payer: Healthspan PPO |
$862.56
|
| Rate for Payer: Humana Medicaid |
$478.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$817.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$488.14
|
| Rate for Payer: Molina Healthcare Passport |
$478.57
|
| Rate for Payer: Multiplan PHCS |
$603.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$703.50
|
| Rate for Payer: UHCCP Medicaid |
$351.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$483.36
|
|
|
SKEL FIXJ DISTAL RAD FX/EPIPH
|
Facility
|
OP
|
$1,005.00
|
|
|
Service Code
|
HCPCS 25606
|
| Hospital Charge Code |
76100632
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.65 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$773.85
|
| Rate for Payer: Anthem Medicaid |
$345.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$783.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$502.50
|
| Rate for Payer: Cash Price |
$502.50
|
| Rate for Payer: Cigna Commercial |
$834.15
|
| Rate for Payer: First Health Commercial |
$954.75
|
| Rate for Payer: Humana Commercial |
$854.25
|
| Rate for Payer: Humana KY Medicaid |
$345.62
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$349.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$824.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$741.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$352.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$884.40
|
| Rate for Payer: Ohio Health Group HMO |
$753.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$201.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$311.55
|
| Rate for Payer: PHCS Commercial |
$964.80
|
| Rate for Payer: United Healthcare All Payer |
$884.40
|
|
|
SKEL FIXJ DISTAL RAD FX/EPIPH
|
Professional
|
Both
|
$1,005.00
|
|
|
Service Code
|
HCPCS 25606
|
| Hospital Charge Code |
76100632
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$351.75 |
| Max. Negotiated Rate |
$1,091.51 |
| Rate for Payer: Aetna Commercial |
$952.28
|
| Rate for Payer: Anthem Medicaid |
$478.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,005.00
|
| Rate for Payer: Cash Price |
$502.50
|
| Rate for Payer: Cash Price |
$502.50
|
| Rate for Payer: Cigna Commercial |
$1,091.51
|
| Rate for Payer: Healthspan PPO |
$862.56
|
| Rate for Payer: Humana Medicaid |
$478.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$817.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$488.14
|
| Rate for Payer: Molina Healthcare Passport |
$478.57
|
| Rate for Payer: Multiplan PHCS |
$603.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$703.50
|
| Rate for Payer: UHCCP Medicaid |
$351.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$483.36
|
|
|
SKEL FIXJ DISTAL RAD FX/EPIPH
|
Facility
|
IP
|
$1,005.00
|
|
|
Service Code
|
HCPCS 25606
|
| Hospital Charge Code |
76100632
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.65 |
| Max. Negotiated Rate |
$964.80 |
| Rate for Payer: Aetna Commercial |
$773.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$783.90
|
| Rate for Payer: Cash Price |
$502.50
|
| Rate for Payer: Cigna Commercial |
$834.15
|
| Rate for Payer: First Health Commercial |
$954.75
|
| Rate for Payer: Humana Commercial |
$854.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$824.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$741.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$301.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$884.40
|
| Rate for Payer: Ohio Health Group HMO |
$753.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$201.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$311.55
|
| Rate for Payer: PHCS Commercial |
$964.80
|
| Rate for Payer: United Healthcare All Payer |
$884.40
|
|
|
SKEL FIXJ FX GRT TOE PHLX/PHLG
|
Facility
|
IP
|
$440.00
|
|
|
Service Code
|
HCPCS 28496
|
| Hospital Charge Code |
76101024
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$57.20 |
| Max. Negotiated Rate |
$422.40 |
| Rate for Payer: Aetna Commercial |
$338.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$343.20
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cigna Commercial |
$365.20
|
| Rate for Payer: First Health Commercial |
$418.00
|
| Rate for Payer: Humana Commercial |
$374.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$360.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$324.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$387.20
|
| Rate for Payer: Ohio Health Group HMO |
$330.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$88.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$136.40
|
| Rate for Payer: PHCS Commercial |
$422.40
|
| Rate for Payer: United Healthcare All Payer |
$387.20
|
|
|
SKEL FIXJ FX GRT TOE PHLX/PHLG
|
Facility
|
OP
|
$440.00
|
|
|
Service Code
|
HCPCS 28496
|
| Hospital Charge Code |
76101024
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$57.20 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$338.80
|
| Rate for Payer: Anthem Medicaid |
$151.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$343.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cigna Commercial |
$365.20
|
| Rate for Payer: First Health Commercial |
$418.00
|
| Rate for Payer: Humana Commercial |
$374.00
|
| Rate for Payer: Humana KY Medicaid |
$151.32
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$152.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$360.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$324.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$154.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$387.20
|
| Rate for Payer: Ohio Health Group HMO |
$330.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$88.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$136.40
|
| Rate for Payer: PHCS Commercial |
$422.40
|
| Rate for Payer: United Healthcare All Payer |
$387.20
|
|
|
SKEL FIXJ FX GRT TOE PHLX/PHLG
|
Professional
|
Both
|
$440.00
|
|
|
Service Code
|
HCPCS 28496
|
| Hospital Charge Code |
761P1024
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$127.02 |
| Max. Negotiated Rate |
$504.99 |
| Rate for Payer: Aetna Commercial |
$322.55
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$140.94
|
| Rate for Payer: Anthem Medicaid |
$127.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$440.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cigna Commercial |
$361.05
|
| Rate for Payer: Healthspan PPO |
$504.99
|
| Rate for Payer: Humana Medicaid |
$127.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$279.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$129.56
|
| Rate for Payer: Molina Healthcare Passport |
$127.02
|
| Rate for Payer: Multiplan PHCS |
$264.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$308.00
|
| Rate for Payer: UHCCP Medicaid |
$147.99
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$128.29
|
|
|
SKEL FIXJ FX GRT TOE PHLX/PHLG
|
Professional
|
Both
|
$440.00
|
|
|
Service Code
|
HCPCS 28496
|
| Hospital Charge Code |
76101024
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$127.02 |
| Max. Negotiated Rate |
$504.99 |
| Rate for Payer: Aetna Commercial |
$322.55
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$140.94
|
| Rate for Payer: Anthem Medicaid |
$127.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$440.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cigna Commercial |
$361.05
|
| Rate for Payer: Healthspan PPO |
$504.99
|
| Rate for Payer: Humana Medicaid |
$127.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$279.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$129.56
|
| Rate for Payer: Molina Healthcare Passport |
$127.02
|
| Rate for Payer: Multiplan PHCS |
$264.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$308.00
|
| Rate for Payer: UHCCP Medicaid |
$147.99
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$128.29
|
|
|
SKEL FIX SPRCND/TRANSCND HUMFX
|
Facility
|
IP
|
$1,650.00
|
|
|
Service Code
|
HCPCS 24538
|
| Hospital Charge Code |
76100538
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$214.50 |
| 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 |
$330.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$214.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$511.50
|
| Rate for Payer: PHCS Commercial |
$1,584.00
|
| Rate for Payer: United Healthcare All Payer |
$1,452.00
|
|
|
SKEL FIX SPRCND/TRANSCND HUMFX
|
Professional
|
Both
|
$1,650.00
|
|
|
Service Code
|
HCPCS 24538
|
| Hospital Charge Code |
76100538
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$504.35 |
| Max. Negotiated Rate |
$1,650.00 |
| Rate for Payer: Aetna Commercial |
$1,086.91
|
| Rate for Payer: Anthem Medicaid |
$504.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,650.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cigna Commercial |
$1,202.94
|
| Rate for Payer: Healthspan PPO |
$984.51
|
| Rate for Payer: Humana Medicaid |
$504.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$918.57
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$514.44
|
| Rate for Payer: Molina Healthcare Passport |
$504.35
|
| Rate for Payer: Multiplan PHCS |
$990.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,155.00
|
| Rate for Payer: UHCCP Medicaid |
$577.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$509.39
|
|
|
SKEL FIX SPRCND/TRANSCND HUMFX
|
Facility
|
OP
|
$1,650.00
|
|
|
Service Code
|
HCPCS 24538
|
| Hospital Charge Code |
76100538
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$214.50 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$1,270.50
|
| Rate for Payer: Anthem Medicaid |
$567.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,287.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,661.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,351.78
|
| 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 |
$567.44
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| 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 |
$7,423.80
|
| 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 |
$330.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$214.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$511.50
|
| Rate for Payer: PHCS Commercial |
$1,584.00
|
| Rate for Payer: United Healthcare All Payer |
$1,452.00
|
|
|
SKEL FIX SPRCND/TRANSCND HUMFX
|
Professional
|
Both
|
$1,650.00
|
|
|
Service Code
|
HCPCS 24538
|
| Hospital Charge Code |
761P0538
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$504.35 |
| Max. Negotiated Rate |
$1,650.00 |
| Rate for Payer: Aetna Commercial |
$1,086.91
|
| Rate for Payer: Anthem Medicaid |
$504.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,650.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cigna Commercial |
$1,202.94
|
| Rate for Payer: Healthspan PPO |
$984.51
|
| Rate for Payer: Humana Medicaid |
$504.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$918.57
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$514.44
|
| Rate for Payer: Molina Healthcare Passport |
$504.35
|
| Rate for Payer: Multiplan PHCS |
$990.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,155.00
|
| Rate for Payer: UHCCP Medicaid |
$577.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$509.39
|
|
|
SKIN BRACHY LESION OR>2CM
|
Facility
|
IP
|
$4,677.00
|
|
|
Service Code
|
HCPCS 77768
|
| Hospital Charge Code |
33300031
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$608.01 |
| Max. Negotiated Rate |
$4,489.92 |
| Rate for Payer: Aetna Commercial |
$3,601.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,648.06
|
| Rate for Payer: Cash Price |
$2,338.50
|
| Rate for Payer: Cigna Commercial |
$3,881.91
|
| Rate for Payer: First Health Commercial |
$4,443.15
|
| Rate for Payer: Humana Commercial |
$3,975.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,835.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,451.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,403.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,115.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,507.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$935.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$608.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,449.87
|
| Rate for Payer: PHCS Commercial |
$4,489.92
|
| Rate for Payer: United Healthcare All Payer |
$4,115.76
|
|
