|
TREAT FRACTURE OF RADIUS
|
Facility
|
IP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 25505
|
| Hospital Charge Code |
45000128
|
|
Hospital Revenue Code
|
450
|
| 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 FRACTURE OF RADIUS
|
Professional
|
Both
|
$2,981.00
|
|
|
Service Code
|
HCPCS 25505
|
| Hospital Charge Code |
76100618
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$253.69 |
| Max. Negotiated Rate |
$2,981.00 |
| Rate for Payer: Aetna Commercial |
$645.11
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$255.50
|
| Rate for Payer: Anthem Medicaid |
$253.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,981.00
|
| Rate for Payer: Cash Price |
$1,490.50
|
| Rate for Payer: Cash Price |
$1,490.50
|
| Rate for Payer: Cigna Commercial |
$773.08
|
| Rate for Payer: Healthspan PPO |
$627.97
|
| Rate for Payer: Humana Medicaid |
$253.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$555.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$258.76
|
| Rate for Payer: Molina Healthcare Passport |
$253.69
|
| Rate for Payer: Multiplan PHCS |
$1,788.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,086.70
|
| Rate for Payer: UHCCP Medicaid |
$268.28
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$256.23
|
|
|
TREAT FRACTURE OF RADIUS
|
Facility
|
IP
|
$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 POS/PPO/Traditional |
$1,170.00
|
| 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: 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 |
$450.00
|
| 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
|
|
|
TREAT FRACTURE OF RADIUS
|
Facility
|
OP
|
$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 Medicaid |
$1,025.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,325.18
|
| 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 |
$1,490.50
|
| 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: Humana KY Medicaid |
$1,025.17
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$1,035.60
|
| 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 |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,045.73
|
| 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
|
$2,111.00
|
|
|
Service Code
|
HCPCS 25505
|
| Hospital Charge Code |
45000128
|
|
Hospital Revenue Code
|
450
|
| 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 FRACTURE OF RADIUS(P
|
Professional
|
Both
|
$870.00
|
|
|
Service Code
|
HCPCS 25505
|
| Hospital Charge Code |
761P0618
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$253.69 |
| Max. Negotiated Rate |
$870.00 |
| Rate for Payer: Aetna Commercial |
$645.11
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$255.50
|
| Rate for Payer: Anthem Medicaid |
$253.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$870.00
|
| Rate for Payer: Cash Price |
$435.00
|
| Rate for Payer: Cash Price |
$435.00
|
| Rate for Payer: Cigna Commercial |
$773.08
|
| Rate for Payer: Healthspan PPO |
$627.97
|
| Rate for Payer: Humana Medicaid |
$253.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$555.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$258.76
|
| Rate for Payer: Molina Healthcare Passport |
$253.69
|
| Rate for Payer: Multiplan PHCS |
$522.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$609.00
|
| Rate for Payer: UHCCP Medicaid |
$268.28
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$256.23
|
|
|
TREAT FRACTURE OF RADIUS(P
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 25500
|
| Hospital Charge Code |
761P0617
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$105.78 |
| Max. Negotiated Rate |
$600.00 |
| 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 |
$600.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| 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 |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$420.00
|
| Rate for Payer: UHCCP Medicaid |
$144.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$106.84
|
|
|
TREAT FRACTURE OF RADIUS(T
|
Facility
|
OP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 25505
|
| Hospital Charge Code |
761T0618
|
|
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 FRACTURE OF RADIUS(T
|
Facility
|
IP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 25505
|
| Hospital Charge Code |
761T0618
|
|
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 FRACTURE OF RADIUS(T
|
Facility
|
IP
|
$900.00
|
|
|
Service Code
|
HCPCS 25500
|
| Hospital Charge Code |
761T0617
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$864.00 |
| Rate for Payer: Aetna Commercial |
$693.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$702.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$747.00
|
| Rate for Payer: First Health Commercial |
$855.00
|
| Rate for Payer: Humana Commercial |
$765.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$738.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$664.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$270.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$792.00
|
| Rate for Payer: Ohio Health Group HMO |
$675.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$117.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$279.00
|
| Rate for Payer: PHCS Commercial |
$864.00
|
| Rate for Payer: United Healthcare All Payer |
$792.00
|
|
|
TREAT FRACTURE OF RADIUS(T
|
Facility
|
OP
|
$900.00
|
|
|
Service Code
|
HCPCS 25500
|
| Hospital Charge Code |
761T0617
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$864.00 |
| Rate for Payer: Aetna Commercial |
$693.00
|
| Rate for Payer: Anthem Medicaid |
$309.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$702.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$747.00
|
| Rate for Payer: First Health Commercial |
$855.00
|
| Rate for Payer: Humana Commercial |
$765.00
|
| Rate for Payer: Humana KY Medicaid |
$309.51
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$312.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$738.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$664.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$315.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$792.00
|
| Rate for Payer: Ohio Health Group HMO |
$675.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$117.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$279.00
|
| Rate for Payer: PHCS Commercial |
$864.00
|
| Rate for Payer: United Healthcare All Payer |
$792.00
|
|
|
TREAT FRACTURE OF ULNA
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 25530
|
| Hospital Charge Code |
76100623
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$98.15 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$306.20
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$130.84
|
| Rate for Payer: Anthem Medicaid |
$98.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$600.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$380.62
|
| Rate for Payer: Healthspan PPO |
$306.44
|
| Rate for Payer: Humana Medicaid |
$98.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$275.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$100.11
|
| Rate for Payer: Molina Healthcare Passport |
$98.15
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$420.00
|
| Rate for Payer: UHCCP Medicaid |
$137.38
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$99.13
|
|
|
TREAT FRACTURE OF ULNA
|
Facility
|
OP
|
$3,008.62
|
|
|
Service Code
|
HCPCS 25535
|
| Hospital Charge Code |
76100624
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$203.93 |
| Max. Negotiated Rate |
$2,888.28 |
| Rate for Payer: Aetna Commercial |
$2,316.64
|
| Rate for Payer: Anthem Medicaid |
$1,034.66
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,346.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$1,504.31
|
| Rate for Payer: Cash Price |
$1,504.31
|
| Rate for Payer: Cigna Commercial |
$2,497.15
|
| Rate for Payer: First Health Commercial |
$2,858.19
|
| Rate for Payer: Humana Commercial |
$2,557.33
|
| Rate for Payer: Humana KY Medicaid |
$1,034.66
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$1,045.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,467.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,220.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,055.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,647.59
|
| Rate for Payer: Ohio Health Group HMO |
$2,256.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$601.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$391.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$932.67
|
| Rate for Payer: PHCS Commercial |
$2,888.28
|
| Rate for Payer: United Healthcare All Payer |
$2,647.59
|
|
|
TREAT FRACTURE OF ULNA
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS 25530
|
| Hospital Charge Code |
76100623
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$576.00 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Anthem Medicaid |
$206.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$468.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$498.00
|
| Rate for Payer: First Health Commercial |
$570.00
|
| Rate for Payer: Humana Commercial |
$510.00
|
| Rate for Payer: Humana KY Medicaid |
$206.34
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$208.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$492.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$210.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$528.00
|
| Rate for Payer: Ohio Health Group HMO |
$450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$186.00
|
| Rate for Payer: PHCS Commercial |
$576.00
|
| Rate for Payer: United Healthcare All Payer |
$528.00
|
|
|
TREAT FRACTURE OF ULNA
|
Professional
|
Both
|
$3,008.62
|
|
|
Service Code
|
HCPCS 25535
|
| Hospital Charge Code |
76100624
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$251.28 |
| Max. Negotiated Rate |
$3,008.62 |
| Rate for Payer: Aetna Commercial |
$634.44
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$251.28
|
| Rate for Payer: Anthem Medicaid |
$252.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,008.62
|
| Rate for Payer: Cash Price |
$1,504.31
|
| Rate for Payer: Cash Price |
$1,504.31
|
| Rate for Payer: Cigna Commercial |
$694.80
|
| Rate for Payer: Healthspan PPO |
$609.57
|
| Rate for Payer: Humana Medicaid |
$252.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$546.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$258.01
|
| Rate for Payer: Molina Healthcare Passport |
$252.95
|
| Rate for Payer: Multiplan PHCS |
$1,805.17
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,106.03
|
| Rate for Payer: UHCCP Medicaid |
$263.84
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$255.48
|
|
|
TREAT FRACTURE OF ULNA
|
Facility
|
OP
|
$322.00
|
|
|
Service Code
|
HCPCS 25535
|
| Hospital Charge Code |
45000129
|
|
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 FRACTURE OF ULNA
|
Facility
|
IP
|
$3,008.62
|
|
|
Service Code
|
HCPCS 25535
|
| Hospital Charge Code |
76100624
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$391.12 |
| Max. Negotiated Rate |
$2,888.28 |
| Rate for Payer: Aetna Commercial |
$2,316.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,346.72
|
| Rate for Payer: Cash Price |
$1,504.31
|
| Rate for Payer: Cigna Commercial |
$2,497.15
|
| Rate for Payer: First Health Commercial |
$2,858.19
|
| Rate for Payer: Humana Commercial |
$2,557.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,467.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,220.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$902.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,647.59
|
| Rate for Payer: Ohio Health Group HMO |
$2,256.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$601.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$391.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$932.67
|
| Rate for Payer: PHCS Commercial |
$2,888.28
|
| Rate for Payer: United Healthcare All Payer |
$2,647.59
|
|
|
TREAT FRACTURE OF ULNA
|
Facility
|
IP
|
$322.00
|
|
|
Service Code
|
HCPCS 25535
|
| Hospital Charge Code |
45000129
|
|
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 FRACTURE OF ULNA
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
HCPCS 25530
|
| Hospital Charge Code |
76100623
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$576.00 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$468.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$498.00
|
| Rate for Payer: First Health Commercial |
$570.00
|
| Rate for Payer: Humana Commercial |
$510.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$492.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$180.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$528.00
|
| Rate for Payer: Ohio Health Group HMO |
$450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$186.00
|
| Rate for Payer: PHCS Commercial |
$576.00
|
| Rate for Payer: United Healthcare All Payer |
$528.00
|
|
|
TREAT FRACTURE OF ULNA(P
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 25535
|
| Hospital Charge Code |
761P0624
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$251.28 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Aetna Commercial |
$634.44
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$251.28
|
| Rate for Payer: Anthem Medicaid |
$252.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$900.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$694.80
|
| Rate for Payer: Healthspan PPO |
$609.57
|
| Rate for Payer: Humana Medicaid |
$252.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$546.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$258.01
|
| Rate for Payer: Molina Healthcare Passport |
$252.95
|
| Rate for Payer: Multiplan PHCS |
$540.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$630.00
|
| Rate for Payer: UHCCP Medicaid |
$263.84
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$255.48
|
|
|
TREAT FRACTURE OF ULNA(P
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 25530
|
| Hospital Charge Code |
761P0623
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$98.15 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$306.20
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$130.84
|
| Rate for Payer: Anthem Medicaid |
$98.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$600.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$380.62
|
| Rate for Payer: Healthspan PPO |
$306.44
|
| Rate for Payer: Humana Medicaid |
$98.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$275.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$100.11
|
| Rate for Payer: Molina Healthcare Passport |
$98.15
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$420.00
|
| Rate for Payer: UHCCP Medicaid |
$137.38
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$99.13
|
|
|
TREAT FRACTURE OF ULNA(T
|
Facility
|
OP
|
$2,108.62
|
|
|
Service Code
|
HCPCS 25535
|
| Hospital Charge Code |
761T0624
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$203.93 |
| Max. Negotiated Rate |
$2,024.28 |
| Rate for Payer: Aetna Commercial |
$1,623.64
|
| Rate for Payer: Anthem Medicaid |
$725.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,644.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$1,054.31
|
| Rate for Payer: Cash Price |
$1,054.31
|
| Rate for Payer: Cigna Commercial |
$1,750.15
|
| Rate for Payer: First Health Commercial |
$2,003.19
|
| Rate for Payer: Humana Commercial |
$1,792.33
|
| Rate for Payer: Humana KY Medicaid |
$725.15
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$732.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,729.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,556.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$739.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,855.59
|
| Rate for Payer: Ohio Health Group HMO |
$1,581.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$421.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$653.67
|
| Rate for Payer: PHCS Commercial |
$2,024.28
|
| Rate for Payer: United Healthcare All Payer |
$1,855.59
|
|
|
TREAT FRACTURE OF ULNA(T
|
Facility
|
IP
|
$2,108.62
|
|
|
Service Code
|
HCPCS 25535
|
| Hospital Charge Code |
761T0624
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$274.12 |
| Max. Negotiated Rate |
$2,024.28 |
| Rate for Payer: Aetna Commercial |
$1,623.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,644.72
|
| Rate for Payer: Cash Price |
$1,054.31
|
| Rate for Payer: Cigna Commercial |
$1,750.15
|
| Rate for Payer: First Health Commercial |
$2,003.19
|
| Rate for Payer: Humana Commercial |
$1,792.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,729.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,556.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$632.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,855.59
|
| Rate for Payer: Ohio Health Group HMO |
$1,581.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$421.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$653.67
|
| Rate for Payer: PHCS Commercial |
$2,024.28
|
| Rate for Payer: United Healthcare All Payer |
$1,855.59
|
|
|
TREAT FRACTURE RADIUS/ULNA
|
Professional
|
Both
|
$975.00
|
|
|
Service Code
|
HCPCS 25605
|
| Hospital Charge Code |
76100631
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$275.93 |
| Max. Negotiated Rate |
$975.00 |
| Rate for Payer: Aetna Commercial |
$809.34
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$275.93
|
| Rate for Payer: Anthem Medicaid |
$385.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$975.00
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cigna Commercial |
$872.32
|
| Rate for Payer: Healthspan PPO |
$770.91
|
| Rate for Payer: Humana Medicaid |
$385.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$711.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$392.85
|
| Rate for Payer: Molina Healthcare Passport |
$385.15
|
| Rate for Payer: Multiplan PHCS |
$585.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$682.50
|
| Rate for Payer: UHCCP Medicaid |
$289.73
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$389.00
|
|
|
TREAT FRACTURE RADIUS/ULNA
|
Facility
|
IP
|
$2,185.00
|
|
|
Service Code
|
HCPCS 25605
|
| Hospital Charge Code |
45000131
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$284.05 |
| Max. Negotiated Rate |
$2,097.60 |
| Rate for Payer: Aetna Commercial |
$1,682.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,704.30
|
| Rate for Payer: Cash Price |
$1,092.50
|
| Rate for Payer: Cigna Commercial |
$1,813.55
|
| Rate for Payer: First Health Commercial |
$2,075.75
|
| Rate for Payer: Humana Commercial |
$1,857.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,791.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,612.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$655.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,922.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,638.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$437.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$284.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$677.35
|
| Rate for Payer: PHCS Commercial |
$2,097.60
|
| Rate for Payer: United Healthcare All Payer |
$1,922.80
|
|
