|
TREAT ELBOW DISLOCATION
|
Facility
|
OP
|
$1,590.00
|
|
|
Service Code
|
HCPCS 24615
|
| Hospital Charge Code |
76100553
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$206.70 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$1,224.30
|
| Rate for Payer: Anthem Medicaid |
$546.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,240.20
|
| 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 |
$795.00
|
| 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: Humana KY Medicaid |
$546.80
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$552.37
|
| 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 |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$557.77
|
| 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(P
|
Professional
|
Both
|
$755.00
|
|
|
Service Code
|
HCPCS 24605
|
| Hospital Charge Code |
761P0552
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$219.48 |
| Max. Negotiated Rate |
$755.00 |
| Rate for Payer: Aetna Commercial |
$653.28
|
| Rate for Payer: Anthem Medicaid |
$219.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$755.00
|
| Rate for Payer: Cash Price |
$377.50
|
| Rate for Payer: Cash Price |
$377.50
|
| 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 |
$453.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$528.50
|
| Rate for Payer: UHCCP Medicaid |
$264.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$221.67
|
|
|
TREAT ELBOW DISLOCATION(P
|
Professional
|
Both
|
$1,590.00
|
|
|
Service Code
|
HCPCS 24615
|
| Hospital Charge Code |
761P0553
|
|
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(P
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 24640
|
| Hospital Charge Code |
761P0556
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$45.39 |
| Max. Negotiated Rate |
$400.00 |
| 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 |
$400.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| 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 |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$280.00
|
| Rate for Payer: UHCCP Medicaid |
$47.66
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$63.41
|
|
|
TREAT ELBOW DISLOCATION(T
|
Facility
|
OP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 24605
|
| Hospital Charge Code |
761T0552
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$274.43 |
| Max. Negotiated Rate |
$2,026.56 |
| Rate for Payer: Aetna Commercial |
$1,625.47
|
| Rate for Payer: Anthem Medicaid |
$725.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,646.58
|
| 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 |
$1,055.50
|
| Rate for Payer: Cash Price |
$1,055.50
|
| Rate for Payer: Cigna Commercial |
$1,752.13
|
| Rate for Payer: First Health Commercial |
$2,005.45
|
| Rate for Payer: Humana Commercial |
$1,794.35
|
| Rate for Payer: Humana KY Medicaid |
$725.97
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$733.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,731.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,557.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$740.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,857.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,583.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$422.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$654.41
|
| Rate for Payer: PHCS Commercial |
$2,026.56
|
| Rate for Payer: United Healthcare All Payer |
$1,857.68
|
|
|
TREAT ELBOW DISLOCATION(T
|
Facility
|
IP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 24605
|
| Hospital Charge Code |
761T0552
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$274.43 |
| Max. Negotiated Rate |
$2,026.56 |
| Rate for Payer: Aetna Commercial |
$1,625.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,646.58
|
| Rate for Payer: Cash Price |
$1,055.50
|
| Rate for Payer: Cigna Commercial |
$1,752.13
|
| Rate for Payer: First Health Commercial |
$2,005.45
|
| Rate for Payer: Humana Commercial |
$1,794.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,731.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,557.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$633.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,857.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,583.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$422.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$654.41
|
| Rate for Payer: PHCS Commercial |
$2,026.56
|
| Rate for Payer: United Healthcare All Payer |
$1,857.68
|
|
|
TREAT ELBOW DISLOCATION(T
|
Facility
|
IP
|
$765.00
|
|
|
Service Code
|
HCPCS 24640
|
| Hospital Charge Code |
761T0556
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$99.45 |
| Max. Negotiated Rate |
$734.40 |
| Rate for Payer: Aetna Commercial |
$589.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$596.70
|
| Rate for Payer: Cash Price |
$382.50
|
| Rate for Payer: Cigna Commercial |
$634.95
|
| Rate for Payer: First Health Commercial |
$726.75
|
| Rate for Payer: Humana Commercial |
$650.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$627.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$564.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$229.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$673.20
|
| Rate for Payer: Ohio Health Group HMO |
$573.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$153.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$237.15
|
| Rate for Payer: PHCS Commercial |
$734.40
|
| Rate for Payer: United Healthcare All Payer |
$673.20
|
|
|
TREAT ELBOW DISLOCATION(T
|
Facility
|
OP
|
$765.00
|
|
|
Service Code
|
HCPCS 24640
|
| Hospital Charge Code |
761T0556
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$99.45 |
| Max. Negotiated Rate |
$734.40 |
| Rate for Payer: Aetna Commercial |
$589.05
|
| Rate for Payer: Anthem Medicaid |
$263.08
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$596.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$382.50
|
| Rate for Payer: Cash Price |
$382.50
|
| Rate for Payer: Cigna Commercial |
$634.95
|
| Rate for Payer: First Health Commercial |
$726.75
|
| Rate for Payer: Humana Commercial |
$650.25
|
| Rate for Payer: Humana KY Medicaid |
$263.08
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$265.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$627.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$564.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$268.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$673.20
|
| Rate for Payer: Ohio Health Group HMO |
$573.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$153.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$237.15
|
| Rate for Payer: PHCS Commercial |
$734.40
|
| Rate for Payer: United Healthcare All Payer |
$673.20
|
|
|
TREAT FOOT DISLOCATION
|
Professional
|
Both
|
$530.00
|
|
|
Service Code
|
HCPCS 28575
|
| Hospital Charge Code |
76102607
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$169.89 |
| Max. Negotiated Rate |
$530.00 |
| Rate for Payer: Aetna Commercial |
$434.62
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$175.63
|
| Rate for Payer: Anthem Medicaid |
$169.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$530.00
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cigna Commercial |
$470.03
|
| Rate for Payer: Healthspan PPO |
$418.40
|
| Rate for Payer: Humana Medicaid |
$169.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$388.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$173.29
|
| Rate for Payer: Molina Healthcare Passport |
$169.89
|
| Rate for Payer: Multiplan PHCS |
$318.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$371.00
|
| Rate for Payer: UHCCP Medicaid |
$184.41
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$171.59
|
|
|
TREAT FOOT DISLOCATION
|
Facility
|
IP
|
$530.00
|
|
|
Service Code
|
HCPCS 28575
|
| Hospital Charge Code |
76102607
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$68.90 |
| Max. Negotiated Rate |
$508.80 |
| Rate for Payer: Aetna Commercial |
$408.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$413.40
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cigna Commercial |
$439.90
|
| Rate for Payer: First Health Commercial |
$503.50
|
| Rate for Payer: Humana Commercial |
$450.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$434.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$391.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$159.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$466.40
|
| Rate for Payer: Ohio Health Group HMO |
$397.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$106.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$164.30
|
| Rate for Payer: PHCS Commercial |
$508.80
|
| Rate for Payer: United Healthcare All Payer |
$466.40
|
|
|
TREAT FOOT DISLOCATION
|
Professional
|
Both
|
$590.00
|
|
|
Service Code
|
HCPCS 28606
|
| Hospital Charge Code |
761P2608
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$206.50 |
| Max. Negotiated Rate |
$637.61 |
| Rate for Payer: Aetna Commercial |
$570.07
|
| Rate for Payer: Anthem Medicaid |
$238.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$590.00
|
| Rate for Payer: Cash Price |
$295.00
|
| Rate for Payer: Cash Price |
$295.00
|
| Rate for Payer: Cigna Commercial |
$637.61
|
| Rate for Payer: Healthspan PPO |
$516.36
|
| Rate for Payer: Humana Medicaid |
$238.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$480.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$243.20
|
| Rate for Payer: Molina Healthcare Passport |
$238.43
|
| Rate for Payer: Multiplan PHCS |
$354.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$413.00
|
| Rate for Payer: UHCCP Medicaid |
$206.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$240.81
|
|
|
TREAT FOOT DISLOCATION
|
Professional
|
Both
|
$590.00
|
|
|
Service Code
|
HCPCS 28606
|
| Hospital Charge Code |
76102608
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$206.50 |
| Max. Negotiated Rate |
$637.61 |
| Rate for Payer: Aetna Commercial |
$570.07
|
| Rate for Payer: Anthem Medicaid |
$238.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$590.00
|
| Rate for Payer: Cash Price |
$295.00
|
| Rate for Payer: Cash Price |
$295.00
|
| Rate for Payer: Cigna Commercial |
$637.61
|
| Rate for Payer: Healthspan PPO |
$516.36
|
| Rate for Payer: Humana Medicaid |
$238.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$480.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$243.20
|
| Rate for Payer: Molina Healthcare Passport |
$238.43
|
| Rate for Payer: Multiplan PHCS |
$354.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$413.00
|
| Rate for Payer: UHCCP Medicaid |
$206.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$240.81
|
|
|
TREAT FOOT DISLOCATION
|
Facility
|
OP
|
$590.00
|
|
|
Service Code
|
HCPCS 28606
|
| Hospital Charge Code |
76102608
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$76.70 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$454.30
|
| Rate for Payer: Anthem Medicaid |
$202.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$460.20
|
| 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 |
$295.00
|
| Rate for Payer: Cash Price |
$295.00
|
| Rate for Payer: Cigna Commercial |
$489.70
|
| Rate for Payer: First Health Commercial |
$560.50
|
| Rate for Payer: Humana Commercial |
$501.50
|
| Rate for Payer: Humana KY Medicaid |
$202.90
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$204.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$483.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$435.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$206.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$519.20
|
| Rate for Payer: Ohio Health Group HMO |
$442.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$118.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$76.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$182.90
|
| Rate for Payer: PHCS Commercial |
$566.40
|
| Rate for Payer: United Healthcare All Payer |
$519.20
|
|
|
TREAT FOOT DISLOCATION
|
Facility
|
IP
|
$590.00
|
|
|
Service Code
|
HCPCS 28606
|
| Hospital Charge Code |
76102608
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$76.70 |
| Max. Negotiated Rate |
$566.40 |
| Rate for Payer: Aetna Commercial |
$454.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$460.20
|
| Rate for Payer: Cash Price |
$295.00
|
| Rate for Payer: Cigna Commercial |
$489.70
|
| Rate for Payer: First Health Commercial |
$560.50
|
| Rate for Payer: Humana Commercial |
$501.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$483.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$435.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$177.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$519.20
|
| Rate for Payer: Ohio Health Group HMO |
$442.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$118.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$76.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$182.90
|
| Rate for Payer: PHCS Commercial |
$566.40
|
| Rate for Payer: United Healthcare All Payer |
$519.20
|
|
|
TREAT FOOT DISLOCATION
|
Professional
|
Both
|
$530.00
|
|
|
Service Code
|
HCPCS 28575
|
| Hospital Charge Code |
761P2607
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$169.89 |
| Max. Negotiated Rate |
$530.00 |
| Rate for Payer: Aetna Commercial |
$434.62
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$175.63
|
| Rate for Payer: Anthem Medicaid |
$169.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$530.00
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cigna Commercial |
$470.03
|
| Rate for Payer: Healthspan PPO |
$418.40
|
| Rate for Payer: Humana Medicaid |
$169.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$388.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$173.29
|
| Rate for Payer: Molina Healthcare Passport |
$169.89
|
| Rate for Payer: Multiplan PHCS |
$318.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$371.00
|
| Rate for Payer: UHCCP Medicaid |
$184.41
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$171.59
|
|
|
TREAT FOOT DISLOCATION
|
Facility
|
OP
|
$530.00
|
|
|
Service Code
|
HCPCS 28575
|
| Hospital Charge Code |
76102607
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$68.90 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$408.10
|
| Rate for Payer: Anthem Medicaid |
$182.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$413.40
|
| 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 |
$265.00
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cigna Commercial |
$439.90
|
| Rate for Payer: First Health Commercial |
$503.50
|
| Rate for Payer: Humana Commercial |
$450.50
|
| Rate for Payer: Humana KY Medicaid |
$182.27
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$184.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$434.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$391.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$185.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$466.40
|
| Rate for Payer: Ohio Health Group HMO |
$397.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$106.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$164.30
|
| Rate for Payer: PHCS Commercial |
$508.80
|
| Rate for Payer: United Healthcare All Payer |
$466.40
|
|
|
TREAT FRACTURE OF MALAR AREA
|
Facility
|
IP
|
$4,502.00
|
|
|
Service Code
|
HCPCS 21355
|
| Hospital Charge Code |
76100385
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$585.26 |
| Max. Negotiated Rate |
$4,321.92 |
| Rate for Payer: Aetna Commercial |
$3,466.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,511.56
|
| Rate for Payer: Cash Price |
$2,251.00
|
| Rate for Payer: Cigna Commercial |
$3,736.66
|
| Rate for Payer: First Health Commercial |
$4,276.90
|
| Rate for Payer: Humana Commercial |
$3,826.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,691.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,322.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,350.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,961.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,376.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$900.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$585.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,395.62
|
| Rate for Payer: PHCS Commercial |
$4,321.92
|
| Rate for Payer: United Healthcare All Payer |
$3,961.76
|
|
|
TREAT FRACTURE OF MALAR AREA
|
Professional
|
Both
|
$4,502.00
|
|
|
Service Code
|
HCPCS 21355
|
| Hospital Charge Code |
76100385
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$149.26 |
| Max. Negotiated Rate |
$4,502.00 |
| Rate for Payer: Aetna Commercial |
$460.40
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$167.84
|
| Rate for Payer: Anthem Medicaid |
$149.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,502.00
|
| Rate for Payer: Cash Price |
$2,251.00
|
| Rate for Payer: Cash Price |
$2,251.00
|
| Rate for Payer: Cigna Commercial |
$491.47
|
| Rate for Payer: Healthspan PPO |
$546.94
|
| Rate for Payer: Humana Medicaid |
$149.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$409.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$152.25
|
| Rate for Payer: Molina Healthcare Passport |
$149.26
|
| Rate for Payer: Multiplan PHCS |
$2,701.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,151.40
|
| Rate for Payer: UHCCP Medicaid |
$176.23
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$150.75
|
|
|
TREAT FRACTURE OF MALAR AREA
|
Facility
|
OP
|
$4,502.00
|
|
|
Service Code
|
HCPCS 21355
|
| Hospital Charge Code |
76100385
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$585.26 |
| Max. Negotiated Rate |
$4,321.92 |
| Rate for Payer: Aetna Commercial |
$3,466.54
|
| Rate for Payer: Anthem Medicaid |
$1,548.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,511.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,897.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,758.63
|
| Rate for Payer: Cash Price |
$2,251.00
|
| Rate for Payer: Cash Price |
$2,251.00
|
| Rate for Payer: Cigna Commercial |
$3,736.66
|
| Rate for Payer: First Health Commercial |
$4,276.90
|
| Rate for Payer: Humana Commercial |
$3,826.70
|
| Rate for Payer: Humana KY Medicaid |
$1,548.24
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,563.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,691.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,322.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,579.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,961.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,376.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$900.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$585.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,395.62
|
| Rate for Payer: PHCS Commercial |
$4,321.92
|
| Rate for Payer: United Healthcare All Payer |
$3,961.76
|
|
|
TREAT FRACTURE OF MALAR AREA(P
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 21355
|
| Hospital Charge Code |
761P0385
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$149.26 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna Commercial |
$460.40
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$167.84
|
| Rate for Payer: Anthem Medicaid |
$149.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$750.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$491.47
|
| Rate for Payer: Healthspan PPO |
$546.94
|
| Rate for Payer: Humana Medicaid |
$149.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$409.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$152.25
|
| Rate for Payer: Molina Healthcare Passport |
$149.26
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$525.00
|
| Rate for Payer: UHCCP Medicaid |
$176.23
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$150.75
|
|
|
TREAT FRACTURE OF MALAR AREA(T
|
Facility
|
OP
|
$3,752.00
|
|
|
Service Code
|
HCPCS 21355
|
| Hospital Charge Code |
761T0385
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$487.76 |
| Max. Negotiated Rate |
$3,897.84 |
| Rate for Payer: Aetna Commercial |
$2,889.04
|
| Rate for Payer: Anthem Medicaid |
$1,290.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,926.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,897.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,758.63
|
| Rate for Payer: Cash Price |
$1,876.00
|
| Rate for Payer: Cash Price |
$1,876.00
|
| Rate for Payer: Cigna Commercial |
$3,114.16
|
| Rate for Payer: First Health Commercial |
$3,564.40
|
| Rate for Payer: Humana Commercial |
$3,189.20
|
| Rate for Payer: Humana KY Medicaid |
$1,290.31
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,303.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,076.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,768.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,316.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,301.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,814.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$750.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$487.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,163.12
|
| Rate for Payer: PHCS Commercial |
$3,601.92
|
| Rate for Payer: United Healthcare All Payer |
$3,301.76
|
|
|
TREAT FRACTURE OF MALAR AREA(T
|
Facility
|
IP
|
$3,752.00
|
|
|
Service Code
|
HCPCS 21355
|
| Hospital Charge Code |
761T0385
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$487.76 |
| Max. Negotiated Rate |
$3,601.92 |
| Rate for Payer: Aetna Commercial |
$2,889.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,926.56
|
| Rate for Payer: Cash Price |
$1,876.00
|
| Rate for Payer: Cigna Commercial |
$3,114.16
|
| Rate for Payer: First Health Commercial |
$3,564.40
|
| Rate for Payer: Humana Commercial |
$3,189.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,076.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,768.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,125.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,301.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,814.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$750.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$487.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,163.12
|
| Rate for Payer: PHCS Commercial |
$3,601.92
|
| Rate for Payer: United Healthcare All Payer |
$3,301.76
|
|
|
TREAT FRACTURE OF RADIUS
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 25500
|
| Hospital Charge Code |
76100617
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$105.78 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$321.28
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$137.90
|
| Rate for Payer: Anthem Medicaid |
$105.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,500.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$392.05
|
| Rate for Payer: Healthspan PPO |
$317.19
|
| Rate for Payer: Humana Medicaid |
$105.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$288.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$107.90
|
| Rate for Payer: Molina Healthcare Passport |
$105.78
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,050.00
|
| Rate for Payer: UHCCP Medicaid |
$144.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$106.84
|
|
|
TREAT FRACTURE OF RADIUS
|
Facility
|
IP
|
$2,981.00
|
|
|
Service Code
|
HCPCS 25505
|
| Hospital Charge Code |
76100618
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$387.53 |
| Max. Negotiated Rate |
$2,861.76 |
| Rate for Payer: Aetna Commercial |
$2,295.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,325.18
|
| Rate for Payer: Cash Price |
$1,490.50
|
| Rate for Payer: Cigna Commercial |
$2,474.23
|
| Rate for Payer: First Health Commercial |
$2,831.95
|
| Rate for Payer: Humana Commercial |
$2,533.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,444.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,199.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$894.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,623.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,235.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$596.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$387.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$924.11
|
| Rate for Payer: PHCS Commercial |
$2,861.76
|
| Rate for Payer: United Healthcare All Payer |
$2,623.28
|
|
|
TREAT FRACTURE OF RADIUS
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 25500
|
| Hospital Charge Code |
76100617
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem Medicaid |
$515.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Humana KY Medicaid |
$515.85
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$521.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$526.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$195.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$465.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
