|
TREAT CLAVICLE DISLOCATION
|
Professional
|
Both
|
$770.00
|
|
|
Service Code
|
HCPCS 23550
|
| Hospital Charge Code |
76102599
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$269.50 |
| Max. Negotiated Rate |
$913.26 |
| Rate for Payer: Aetna Commercial |
$834.96
|
| Rate for Payer: Anthem Medicaid |
$458.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$770.00
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: Cigna Commercial |
$913.26
|
| Rate for Payer: Healthspan PPO |
$756.29
|
| Rate for Payer: Humana Medicaid |
$458.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$704.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$468.05
|
| Rate for Payer: Molina Healthcare Passport |
$458.87
|
| Rate for Payer: Multiplan PHCS |
$462.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$539.00
|
| Rate for Payer: UHCCP Medicaid |
$269.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$463.46
|
|
|
TREAT CLAVICLE FRACTURE
|
Professional
|
Both
|
$2,710.00
|
|
|
Service Code
|
HCPCS 23505
|
| Hospital Charge Code |
76100472
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.04 |
| Max. Negotiated Rate |
$2,710.00 |
| Rate for Payer: Aetna Commercial |
$457.35
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$184.37
|
| Rate for Payer: Anthem Medicaid |
$182.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,710.00
|
| Rate for Payer: Cash Price |
$1,355.00
|
| Rate for Payer: Cash Price |
$1,355.00
|
| Rate for Payer: Cigna Commercial |
$531.99
|
| Rate for Payer: Healthspan PPO |
$435.12
|
| Rate for Payer: Humana Medicaid |
$182.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$396.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$185.68
|
| Rate for Payer: Molina Healthcare Passport |
$182.04
|
| Rate for Payer: Multiplan PHCS |
$1,626.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,897.00
|
| Rate for Payer: UHCCP Medicaid |
$193.59
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$183.86
|
|
|
TREAT CLAVICLE FRACTURE
|
Facility
|
OP
|
$822.00
|
|
|
Service Code
|
HCPCS 23500
|
| Hospital Charge Code |
76100471
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$106.86 |
| Max. Negotiated Rate |
$789.12 |
| Rate for Payer: Aetna Commercial |
$632.94
|
| Rate for Payer: Anthem Medicaid |
$282.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$641.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cigna Commercial |
$682.26
|
| Rate for Payer: First Health Commercial |
$780.90
|
| Rate for Payer: Humana Commercial |
$698.70
|
| Rate for Payer: Humana KY Medicaid |
$282.69
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$285.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$674.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$606.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$288.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$723.36
|
| Rate for Payer: Ohio Health Group HMO |
$616.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$164.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$106.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$254.82
|
| Rate for Payer: PHCS Commercial |
$789.12
|
| Rate for Payer: United Healthcare All Payer |
$723.36
|
|
|
TREAT CLAVICLE FRACTURE
|
Facility
|
OP
|
$2,710.00
|
|
|
Service Code
|
HCPCS 23505
|
| Hospital Charge Code |
76100472
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$352.30 |
| Max. Negotiated Rate |
$2,601.60 |
| Rate for Payer: Aetna Commercial |
$2,086.70
|
| Rate for Payer: Anthem Medicaid |
$931.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,113.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| Rate for Payer: Cash Price |
$1,355.00
|
| Rate for Payer: Cash Price |
$1,355.00
|
| Rate for Payer: Cigna Commercial |
$2,249.30
|
| Rate for Payer: First Health Commercial |
$2,574.50
|
| Rate for Payer: Humana Commercial |
$2,303.50
|
| Rate for Payer: Humana KY Medicaid |
$931.97
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$941.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,222.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,999.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$950.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,384.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,032.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$542.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$352.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$840.10
|
| Rate for Payer: PHCS Commercial |
$2,601.60
|
| Rate for Payer: United Healthcare All Payer |
$2,384.80
|
|
|
TREAT CLAVICLE FRACTURE
|
Facility
|
IP
|
$822.00
|
|
|
Service Code
|
HCPCS 23500
|
| Hospital Charge Code |
76100471
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$106.86 |
| Max. Negotiated Rate |
$789.12 |
| Rate for Payer: Aetna Commercial |
$632.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$641.16
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cigna Commercial |
$682.26
|
| Rate for Payer: First Health Commercial |
$780.90
|
| Rate for Payer: Humana Commercial |
$698.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$674.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$606.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$246.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$723.36
|
| Rate for Payer: Ohio Health Group HMO |
$616.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$164.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$106.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$254.82
|
| Rate for Payer: PHCS Commercial |
$789.12
|
| Rate for Payer: United Healthcare All Payer |
$723.36
|
|
|
TREAT CLAVICLE FRACTURE
|
Facility
|
IP
|
$2,710.00
|
|
|
Service Code
|
HCPCS 23505
|
| Hospital Charge Code |
76100472
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$352.30 |
| Max. Negotiated Rate |
$2,601.60 |
| Rate for Payer: Aetna Commercial |
$2,086.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,113.80
|
| Rate for Payer: Cash Price |
$1,355.00
|
| Rate for Payer: Cigna Commercial |
$2,249.30
|
| Rate for Payer: First Health Commercial |
$2,574.50
|
| Rate for Payer: Humana Commercial |
$2,303.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,222.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,999.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$813.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,384.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,032.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$542.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$352.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$840.10
|
| Rate for Payer: PHCS Commercial |
$2,601.60
|
| Rate for Payer: United Healthcare All Payer |
$2,384.80
|
|
|
TREAT CLAVICLE FRACTURE
|
Facility
|
OP
|
$322.00
|
|
|
Service Code
|
HCPCS 23500
|
| Hospital Charge Code |
45000107
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$41.86 |
| Max. Negotiated Rate |
$309.12 |
| Rate for Payer: Aetna Commercial |
$247.94
|
| Rate for Payer: Anthem Medicaid |
$110.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$251.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$161.00
|
| Rate for Payer: Cash Price |
$161.00
|
| Rate for Payer: Cigna Commercial |
$267.26
|
| Rate for Payer: First Health Commercial |
$305.90
|
| Rate for Payer: Humana Commercial |
$273.70
|
| Rate for Payer: Humana KY Medicaid |
$110.74
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$111.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$264.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$237.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$112.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$283.36
|
| Rate for Payer: Ohio Health Group HMO |
$241.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$41.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$99.82
|
| Rate for Payer: PHCS Commercial |
$309.12
|
| Rate for Payer: United Healthcare All Payer |
$283.36
|
|
|
TREAT CLAVICLE FRACTURE
|
Facility
|
OP
|
$2,024.00
|
|
|
Service Code
|
HCPCS 23505
|
| Hospital Charge Code |
45000108
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$263.12 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Aetna Commercial |
$1,558.48
|
| Rate for Payer: Anthem Medicaid |
$696.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,578.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| Rate for Payer: Cash Price |
$1,012.00
|
| Rate for Payer: Cash Price |
$1,012.00
|
| Rate for Payer: Cigna Commercial |
$1,679.92
|
| Rate for Payer: First Health Commercial |
$1,922.80
|
| Rate for Payer: Humana Commercial |
$1,720.40
|
| Rate for Payer: Humana KY Medicaid |
$696.05
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$703.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,659.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,493.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$710.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,781.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,518.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$404.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$263.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$627.44
|
| Rate for Payer: PHCS Commercial |
$1,943.04
|
| Rate for Payer: United Healthcare All Payer |
$1,781.12
|
|
|
TREAT CLAVICLE FRACTURE
|
Professional
|
Both
|
$822.00
|
|
|
Service Code
|
HCPCS 23500
|
| Hospital Charge Code |
76100471
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$106.58 |
| Max. Negotiated Rate |
$822.00 |
| Rate for Payer: Aetna Commercial |
$286.69
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$108.18
|
| Rate for Payer: Anthem Medicaid |
$106.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$822.00
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cigna Commercial |
$322.51
|
| Rate for Payer: Healthspan PPO |
$261.13
|
| Rate for Payer: Humana Medicaid |
$106.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$258.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$108.71
|
| Rate for Payer: Molina Healthcare Passport |
$106.58
|
| Rate for Payer: Multiplan PHCS |
$493.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$575.40
|
| Rate for Payer: UHCCP Medicaid |
$113.59
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$107.65
|
|
|
TREAT CLAVICLE FRACTURE
|
Facility
|
IP
|
$2,024.00
|
|
|
Service Code
|
HCPCS 23505
|
| Hospital Charge Code |
45000108
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$263.12 |
| Max. Negotiated Rate |
$1,943.04 |
| Rate for Payer: Aetna Commercial |
$1,558.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,578.72
|
| Rate for Payer: Cash Price |
$1,012.00
|
| Rate for Payer: Cigna Commercial |
$1,679.92
|
| Rate for Payer: First Health Commercial |
$1,922.80
|
| Rate for Payer: Humana Commercial |
$1,720.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,659.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,493.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$607.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,781.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,518.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$404.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$263.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$627.44
|
| Rate for Payer: PHCS Commercial |
$1,943.04
|
| Rate for Payer: United Healthcare All Payer |
$1,781.12
|
|
|
TREAT CLAVICLE FRACTURE
|
Facility
|
IP
|
$322.00
|
|
|
Service Code
|
HCPCS 23500
|
| Hospital Charge Code |
45000107
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$41.86 |
| Max. Negotiated Rate |
$309.12 |
| Rate for Payer: Aetna Commercial |
$247.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$251.16
|
| Rate for Payer: Cash Price |
$161.00
|
| Rate for Payer: Cigna Commercial |
$267.26
|
| Rate for Payer: First Health Commercial |
$305.90
|
| Rate for Payer: Humana Commercial |
$273.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$264.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$237.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$96.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$283.36
|
| Rate for Payer: Ohio Health Group HMO |
$241.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$41.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$99.82
|
| Rate for Payer: PHCS Commercial |
$309.12
|
| Rate for Payer: United Healthcare All Payer |
$283.36
|
|
|
TREAT CLAVICLE FRACTURE(P
|
Professional
|
Both
|
$686.00
|
|
|
Service Code
|
HCPCS 23505
|
| Hospital Charge Code |
761P0472
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.04 |
| Max. Negotiated Rate |
$686.00 |
| Rate for Payer: Aetna Commercial |
$457.35
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$184.37
|
| Rate for Payer: Anthem Medicaid |
$182.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$686.00
|
| Rate for Payer: Cash Price |
$343.00
|
| Rate for Payer: Cash Price |
$343.00
|
| Rate for Payer: Cigna Commercial |
$531.99
|
| Rate for Payer: Healthspan PPO |
$435.12
|
| Rate for Payer: Humana Medicaid |
$182.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$396.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$185.68
|
| Rate for Payer: Molina Healthcare Passport |
$182.04
|
| Rate for Payer: Multiplan PHCS |
$411.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$480.20
|
| Rate for Payer: UHCCP Medicaid |
$193.59
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$183.86
|
|
|
TREAT CLAVICLE FRACTURE(P
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 23500
|
| Hospital Charge Code |
761P0471
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$106.58 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna Commercial |
$286.69
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$108.18
|
| Rate for Payer: Anthem Medicaid |
$106.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$500.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$322.51
|
| Rate for Payer: Healthspan PPO |
$261.13
|
| Rate for Payer: Humana Medicaid |
$106.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$258.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$108.71
|
| Rate for Payer: Molina Healthcare Passport |
$106.58
|
| Rate for Payer: Multiplan PHCS |
$300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$350.00
|
| Rate for Payer: UHCCP Medicaid |
$113.59
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$107.65
|
|
|
TREAT CLAVICLE FRACTURE(T
|
Facility
|
OP
|
$322.00
|
|
|
Service Code
|
HCPCS 23500
|
| Hospital Charge Code |
761T0471
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$41.86 |
| Max. Negotiated Rate |
$309.12 |
| Rate for Payer: Aetna Commercial |
$247.94
|
| Rate for Payer: Anthem Medicaid |
$110.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$251.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$161.00
|
| Rate for Payer: Cash Price |
$161.00
|
| Rate for Payer: Cigna Commercial |
$267.26
|
| Rate for Payer: First Health Commercial |
$305.90
|
| Rate for Payer: Humana Commercial |
$273.70
|
| Rate for Payer: Humana KY Medicaid |
$110.74
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$111.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$264.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$237.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$112.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$283.36
|
| Rate for Payer: Ohio Health Group HMO |
$241.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$41.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$99.82
|
| Rate for Payer: PHCS Commercial |
$309.12
|
| Rate for Payer: United Healthcare All Payer |
$283.36
|
|
|
TREAT CLAVICLE FRACTURE(T
|
Facility
|
OP
|
$2,024.00
|
|
|
Service Code
|
HCPCS 23505
|
| Hospital Charge Code |
761T0472
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$263.12 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Aetna Commercial |
$1,558.48
|
| Rate for Payer: Anthem Medicaid |
$696.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,578.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| Rate for Payer: Cash Price |
$1,012.00
|
| Rate for Payer: Cash Price |
$1,012.00
|
| Rate for Payer: Cigna Commercial |
$1,679.92
|
| Rate for Payer: First Health Commercial |
$1,922.80
|
| Rate for Payer: Humana Commercial |
$1,720.40
|
| Rate for Payer: Humana KY Medicaid |
$696.05
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$703.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,659.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,493.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$710.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,781.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,518.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$404.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$263.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$627.44
|
| Rate for Payer: PHCS Commercial |
$1,943.04
|
| Rate for Payer: United Healthcare All Payer |
$1,781.12
|
|
|
TREAT CLAVICLE FRACTURE(T
|
Facility
|
IP
|
$322.00
|
|
|
Service Code
|
HCPCS 23500
|
| Hospital Charge Code |
761T0471
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$41.86 |
| Max. Negotiated Rate |
$309.12 |
| Rate for Payer: Aetna Commercial |
$247.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$251.16
|
| Rate for Payer: Cash Price |
$161.00
|
| Rate for Payer: Cigna Commercial |
$267.26
|
| Rate for Payer: First Health Commercial |
$305.90
|
| Rate for Payer: Humana Commercial |
$273.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$264.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$237.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$96.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$283.36
|
| Rate for Payer: Ohio Health Group HMO |
$241.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$41.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$99.82
|
| Rate for Payer: PHCS Commercial |
$309.12
|
| Rate for Payer: United Healthcare All Payer |
$283.36
|
|
|
TREAT CLAVICLE FRACTURE(T
|
Facility
|
IP
|
$2,024.00
|
|
|
Service Code
|
HCPCS 23505
|
| Hospital Charge Code |
761T0472
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$263.12 |
| Max. Negotiated Rate |
$1,943.04 |
| Rate for Payer: Aetna Commercial |
$1,558.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,578.72
|
| Rate for Payer: Cash Price |
$1,012.00
|
| Rate for Payer: Cigna Commercial |
$1,679.92
|
| Rate for Payer: First Health Commercial |
$1,922.80
|
| Rate for Payer: Humana Commercial |
$1,720.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,659.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,493.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$607.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,781.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,518.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$404.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$263.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$627.44
|
| Rate for Payer: PHCS Commercial |
$1,943.04
|
| Rate for Payer: United Healthcare All Payer |
$1,781.12
|
|
|
TREAT ELBOW DISLOCATION
|
Facility
|
OP
|
$1,165.00
|
|
|
Service Code
|
HCPCS 24640
|
| Hospital Charge Code |
76100556
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$151.45 |
| Max. Negotiated Rate |
$1,118.40 |
| Rate for Payer: Aetna Commercial |
$897.05
|
| Rate for Payer: Anthem Medicaid |
$400.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$908.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$582.50
|
| Rate for Payer: Cash Price |
$582.50
|
| Rate for Payer: Cigna Commercial |
$966.95
|
| Rate for Payer: First Health Commercial |
$1,106.75
|
| Rate for Payer: Humana Commercial |
$990.25
|
| Rate for Payer: Humana KY Medicaid |
$400.64
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$404.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$955.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$859.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$408.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,025.20
|
| Rate for Payer: Ohio Health Group HMO |
$873.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$233.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$151.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$361.15
|
| Rate for Payer: PHCS Commercial |
$1,118.40
|
| Rate for Payer: United Healthcare All Payer |
$1,025.20
|
|
|
TREAT ELBOW DISLOCATION
|
Professional
|
Both
|
$1,165.00
|
|
|
Service Code
|
HCPCS 24640
|
| Hospital Charge Code |
76100556
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$45.39 |
| Max. Negotiated Rate |
$1,165.00 |
| Rate for Payer: Aetna Commercial |
$121.26
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$45.39
|
| Rate for Payer: Anthem Medicaid |
$62.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,165.00
|
| Rate for Payer: Cash Price |
$582.50
|
| Rate for Payer: Cash Price |
$582.50
|
| Rate for Payer: Cigna Commercial |
$190.18
|
| Rate for Payer: Healthspan PPO |
$146.68
|
| Rate for Payer: Humana Medicaid |
$62.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$108.58
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$64.04
|
| Rate for Payer: Molina Healthcare Passport |
$62.78
|
| Rate for Payer: Multiplan PHCS |
$699.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$815.50
|
| Rate for Payer: UHCCP Medicaid |
$47.66
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$63.41
|
|
|
TREAT ELBOW DISLOCATION
|
Professional
|
Both
|
$2,866.00
|
|
|
Service Code
|
HCPCS 24605
|
| Hospital Charge Code |
76100552
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$219.48 |
| Max. Negotiated Rate |
$2,866.00 |
| Rate for Payer: Aetna Commercial |
$653.28
|
| Rate for Payer: Anthem Medicaid |
$219.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,866.00
|
| Rate for Payer: Cash Price |
$1,433.00
|
| Rate for Payer: Cash Price |
$1,433.00
|
| Rate for Payer: Cigna Commercial |
$715.27
|
| Rate for Payer: Healthspan PPO |
$591.73
|
| Rate for Payer: Humana Medicaid |
$219.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$566.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$223.87
|
| Rate for Payer: Molina Healthcare Passport |
$219.48
|
| Rate for Payer: Multiplan PHCS |
$1,719.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,006.20
|
| Rate for Payer: UHCCP Medicaid |
$1,003.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$221.67
|
|
|
TREAT ELBOW DISLOCATION
|
Facility
|
IP
|
$1,590.00
|
|
|
Service Code
|
HCPCS 24615
|
| Hospital Charge Code |
76100553
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$206.70 |
| Max. Negotiated Rate |
$1,526.40 |
| Rate for Payer: Aetna Commercial |
$1,224.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,240.20
|
| Rate for Payer: Cash Price |
$795.00
|
| Rate for Payer: Cigna Commercial |
$1,319.70
|
| Rate for Payer: First Health Commercial |
$1,510.50
|
| Rate for Payer: Humana Commercial |
$1,351.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,303.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,173.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$477.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,399.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,192.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$318.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$206.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$492.90
|
| Rate for Payer: PHCS Commercial |
$1,526.40
|
| Rate for Payer: United Healthcare All Payer |
$1,399.20
|
|
|
TREAT ELBOW DISLOCATION
|
Professional
|
Both
|
$1,590.00
|
|
|
Service Code
|
HCPCS 24615
|
| Hospital Charge Code |
76100553
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$542.19 |
| Max. Negotiated Rate |
$1,590.00 |
| Rate for Payer: Aetna Commercial |
$1,051.80
|
| Rate for Payer: Anthem Medicaid |
$542.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,590.00
|
| Rate for Payer: Cash Price |
$795.00
|
| Rate for Payer: Cash Price |
$795.00
|
| Rate for Payer: Cigna Commercial |
$1,154.59
|
| Rate for Payer: Healthspan PPO |
$952.71
|
| Rate for Payer: Humana Medicaid |
$542.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$882.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$553.03
|
| Rate for Payer: Molina Healthcare Passport |
$542.19
|
| Rate for Payer: Multiplan PHCS |
$954.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,113.00
|
| Rate for Payer: UHCCP Medicaid |
$556.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$547.61
|
|
|
TREAT ELBOW DISLOCATION
|
Facility
|
IP
|
$2,866.00
|
|
|
Service Code
|
HCPCS 24605
|
| Hospital Charge Code |
76100552
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$372.58 |
| Max. Negotiated Rate |
$2,751.36 |
| Rate for Payer: Aetna Commercial |
$2,206.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,235.48
|
| Rate for Payer: Cash Price |
$1,433.00
|
| Rate for Payer: Cigna Commercial |
$2,378.78
|
| Rate for Payer: First Health Commercial |
$2,722.70
|
| Rate for Payer: Humana Commercial |
$2,436.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,350.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,115.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$859.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,522.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,149.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$573.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$372.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$888.46
|
| Rate for Payer: PHCS Commercial |
$2,751.36
|
| Rate for Payer: United Healthcare All Payer |
$2,522.08
|
|
|
TREAT ELBOW DISLOCATION
|
Facility
|
IP
|
$1,165.00
|
|
|
Service Code
|
HCPCS 24640
|
| Hospital Charge Code |
76100556
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$151.45 |
| Max. Negotiated Rate |
$1,118.40 |
| Rate for Payer: Aetna Commercial |
$897.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$908.70
|
| Rate for Payer: Cash Price |
$582.50
|
| Rate for Payer: Cigna Commercial |
$966.95
|
| Rate for Payer: First Health Commercial |
$1,106.75
|
| Rate for Payer: Humana Commercial |
$990.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$955.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$859.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$349.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,025.20
|
| Rate for Payer: Ohio Health Group HMO |
$873.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$233.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$151.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$361.15
|
| Rate for Payer: PHCS Commercial |
$1,118.40
|
| Rate for Payer: United Healthcare All Payer |
$1,025.20
|
|
|
TREAT ELBOW DISLOCATION
|
Facility
|
OP
|
$2,866.00
|
|
|
Service Code
|
HCPCS 24605
|
| Hospital Charge Code |
76100552
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$372.58 |
| Max. Negotiated Rate |
$2,751.36 |
| Rate for Payer: Aetna Commercial |
$2,206.82
|
| Rate for Payer: Anthem Medicaid |
$985.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,235.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| Rate for Payer: Cash Price |
$1,433.00
|
| Rate for Payer: Cash Price |
$1,433.00
|
| Rate for Payer: Cigna Commercial |
$2,378.78
|
| Rate for Payer: First Health Commercial |
$2,722.70
|
| Rate for Payer: Humana Commercial |
$2,436.10
|
| Rate for Payer: Humana KY Medicaid |
$985.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$995.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,350.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,115.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,005.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,522.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,149.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$573.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$372.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$888.46
|
| Rate for Payer: PHCS Commercial |
$2,751.36
|
| Rate for Payer: United Healthcare All Payer |
$2,522.08
|
|
