|
TREAT HIP DISLOCATION(P
|
Professional
|
Both
|
$2,560.00
|
|
|
Service Code
|
HCPCS 27253
|
| Hospital Charge Code |
761P0800
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$755.25 |
| Max. Negotiated Rate |
$2,560.00 |
| Rate for Payer: Aetna Commercial |
$1,409.23
|
| Rate for Payer: Anthem Medicaid |
$755.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,560.00
|
| Rate for Payer: Cash Price |
$1,280.00
|
| Rate for Payer: Cash Price |
$1,280.00
|
| Rate for Payer: Cigna Commercial |
$1,538.96
|
| Rate for Payer: Healthspan PPO |
$1,276.46
|
| Rate for Payer: Humana Medicaid |
$755.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,177.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$770.36
|
| Rate for Payer: Molina Healthcare Passport |
$755.25
|
| Rate for Payer: Multiplan PHCS |
$1,536.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,792.00
|
| Rate for Payer: UHCCP Medicaid |
$896.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$762.80
|
|
|
TREAT HIP SOCKET FRACTURE
|
Professional
|
Both
|
$932.00
|
|
|
Service Code
|
HCPCS 27220
|
| Hospital Charge Code |
76100787
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$284.16 |
| Max. Negotiated Rate |
$932.00 |
| Rate for Payer: Aetna Commercial |
$752.05
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$303.03
|
| Rate for Payer: Anthem Medicaid |
$284.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$932.00
|
| Rate for Payer: Cash Price |
$466.00
|
| Rate for Payer: Cash Price |
$466.00
|
| Rate for Payer: Cigna Commercial |
$815.75
|
| Rate for Payer: Healthspan PPO |
$685.55
|
| Rate for Payer: Humana Medicaid |
$284.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$643.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$289.84
|
| Rate for Payer: Molina Healthcare Passport |
$284.16
|
| Rate for Payer: Multiplan PHCS |
$559.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$652.40
|
| Rate for Payer: UHCCP Medicaid |
$318.18
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$287.00
|
|
|
TREAT HIP SOCKET FRACTURE
|
Facility
|
IP
|
$932.00
|
|
|
Service Code
|
HCPCS 27220
|
| Hospital Charge Code |
76100787
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$121.16 |
| Max. Negotiated Rate |
$894.72 |
| Rate for Payer: Aetna Commercial |
$717.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$726.96
|
| Rate for Payer: Cash Price |
$466.00
|
| Rate for Payer: Cigna Commercial |
$773.56
|
| Rate for Payer: First Health Commercial |
$885.40
|
| Rate for Payer: Humana Commercial |
$792.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$764.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$687.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$279.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$820.16
|
| Rate for Payer: Ohio Health Group HMO |
$699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$186.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$121.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$288.92
|
| Rate for Payer: PHCS Commercial |
$894.72
|
| Rate for Payer: United Healthcare All Payer |
$820.16
|
|
|
TREAT HIP SOCKET FRACTURE
|
Facility
|
OP
|
$932.00
|
|
|
Service Code
|
HCPCS 27220
|
| Hospital Charge Code |
76100787
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$121.16 |
| Max. Negotiated Rate |
$894.72 |
| Rate for Payer: Aetna Commercial |
$717.64
|
| Rate for Payer: Anthem Medicaid |
$320.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$726.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$466.00
|
| Rate for Payer: Cash Price |
$466.00
|
| Rate for Payer: Cigna Commercial |
$773.56
|
| Rate for Payer: First Health Commercial |
$885.40
|
| Rate for Payer: Humana Commercial |
$792.20
|
| Rate for Payer: Humana KY Medicaid |
$320.51
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$323.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$764.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$687.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$326.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$820.16
|
| Rate for Payer: Ohio Health Group HMO |
$699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$186.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$121.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$288.92
|
| Rate for Payer: PHCS Commercial |
$894.72
|
| Rate for Payer: United Healthcare All Payer |
$820.16
|
|
|
TREAT HIP SOCKET FRACTURE(P
|
Professional
|
Both
|
$932.00
|
|
|
Service Code
|
HCPCS 27220
|
| Hospital Charge Code |
761P0787
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$284.16 |
| Max. Negotiated Rate |
$932.00 |
| Rate for Payer: Aetna Commercial |
$752.05
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$303.03
|
| Rate for Payer: Anthem Medicaid |
$284.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$932.00
|
| Rate for Payer: Cash Price |
$466.00
|
| Rate for Payer: Cash Price |
$466.00
|
| Rate for Payer: Cigna Commercial |
$815.75
|
| Rate for Payer: Healthspan PPO |
$685.55
|
| Rate for Payer: Humana Medicaid |
$284.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$643.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$289.84
|
| Rate for Payer: Molina Healthcare Passport |
$284.16
|
| Rate for Payer: Multiplan PHCS |
$559.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$652.40
|
| Rate for Payer: UHCCP Medicaid |
$318.18
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$287.00
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
IP
|
$965.00
|
|
|
Service Code
|
HCPCS 24505
|
| Hospital Charge Code |
76100533
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$125.45 |
| Max. Negotiated Rate |
$926.40 |
| Rate for Payer: Aetna Commercial |
$743.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$752.70
|
| Rate for Payer: Cash Price |
$482.50
|
| Rate for Payer: Cigna Commercial |
$800.95
|
| Rate for Payer: First Health Commercial |
$916.75
|
| Rate for Payer: Humana Commercial |
$820.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$791.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$712.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$289.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$849.20
|
| Rate for Payer: Ohio Health Group HMO |
$723.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$193.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$125.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$299.15
|
| Rate for Payer: PHCS Commercial |
$926.40
|
| Rate for Payer: United Healthcare All Payer |
$849.20
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
IP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 24505
|
| Hospital Charge Code |
45000118
|
|
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 HUMERUS FRACTURE
|
Facility
|
OP
|
$965.00
|
|
|
Service Code
|
HCPCS 24505
|
| Hospital Charge Code |
76100533
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$125.45 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Aetna Commercial |
$743.05
|
| Rate for Payer: Anthem Medicaid |
$331.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$752.70
|
| 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 |
$482.50
|
| Rate for Payer: Cash Price |
$482.50
|
| Rate for Payer: Cigna Commercial |
$800.95
|
| Rate for Payer: First Health Commercial |
$916.75
|
| Rate for Payer: Humana Commercial |
$820.25
|
| Rate for Payer: Humana KY Medicaid |
$331.86
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$335.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$791.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$712.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$338.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$849.20
|
| Rate for Payer: Ohio Health Group HMO |
$723.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$193.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$125.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$299.15
|
| Rate for Payer: PHCS Commercial |
$926.40
|
| Rate for Payer: United Healthcare All Payer |
$849.20
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
OP
|
$2,024.00
|
|
|
Service Code
|
HCPCS 23605
|
| Hospital Charge Code |
45000111
|
|
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 HUMERUS FRACTURE
|
Facility
|
IP
|
$2,024.00
|
|
|
Service Code
|
HCPCS 23605
|
| Hospital Charge Code |
45000111
|
|
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 HUMERUS FRACTURE
|
Professional
|
Both
|
$2,924.00
|
|
|
Service Code
|
HCPCS 23605
|
| Hospital Charge Code |
76100479
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$267.44 |
| Max. Negotiated Rate |
$2,924.00 |
| Rate for Payer: Aetna Commercial |
$599.73
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$267.44
|
| Rate for Payer: Anthem Medicaid |
$279.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,924.00
|
| Rate for Payer: Cash Price |
$1,462.00
|
| Rate for Payer: Cash Price |
$1,462.00
|
| Rate for Payer: Cigna Commercial |
$661.21
|
| Rate for Payer: Healthspan PPO |
$583.94
|
| Rate for Payer: Humana Medicaid |
$279.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$516.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$285.55
|
| Rate for Payer: Molina Healthcare Passport |
$279.95
|
| Rate for Payer: Multiplan PHCS |
$1,754.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,046.80
|
| Rate for Payer: UHCCP Medicaid |
$280.81
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$282.75
|
|
|
TREAT HUMERUS FRACTURE
|
Professional
|
Both
|
$965.00
|
|
|
Service Code
|
HCPCS 24505
|
| Hospital Charge Code |
76100533
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$279.68 |
| Max. Negotiated Rate |
$965.00 |
| Rate for Payer: Aetna Commercial |
$636.17
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$284.52
|
| Rate for Payer: Anthem Medicaid |
$279.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$965.00
|
| Rate for Payer: Cash Price |
$482.50
|
| Rate for Payer: Cash Price |
$482.50
|
| Rate for Payer: Cigna Commercial |
$700.55
|
| Rate for Payer: Healthspan PPO |
$624.72
|
| Rate for Payer: Humana Medicaid |
$279.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$548.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$285.27
|
| Rate for Payer: Molina Healthcare Passport |
$279.68
|
| Rate for Payer: Multiplan PHCS |
$579.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$675.50
|
| Rate for Payer: UHCCP Medicaid |
$298.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$282.48
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
IP
|
$2,924.00
|
|
|
Service Code
|
HCPCS 23605
|
| Hospital Charge Code |
76100479
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$2,807.04 |
| Rate for Payer: Aetna Commercial |
$2,251.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,280.72
|
| Rate for Payer: Cash Price |
$1,462.00
|
| Rate for Payer: Cigna Commercial |
$2,426.92
|
| Rate for Payer: First Health Commercial |
$2,777.80
|
| Rate for Payer: Humana Commercial |
$2,485.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,397.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,157.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$877.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,573.12
|
| Rate for Payer: Ohio Health Group HMO |
$2,193.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$584.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$380.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$906.44
|
| Rate for Payer: PHCS Commercial |
$2,807.04
|
| Rate for Payer: United Healthcare All Payer |
$2,573.12
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
OP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 24505
|
| Hospital Charge Code |
45000118
|
|
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 HUMERUS FRACTURE
|
Facility
|
OP
|
$2,924.00
|
|
|
Service Code
|
HCPCS 23605
|
| Hospital Charge Code |
76100479
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$2,807.04 |
| Rate for Payer: Aetna Commercial |
$2,251.48
|
| Rate for Payer: Anthem Medicaid |
$1,005.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,280.72
|
| 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 |
$1,462.00
|
| Rate for Payer: Cash Price |
$1,462.00
|
| Rate for Payer: Cigna Commercial |
$2,426.92
|
| Rate for Payer: First Health Commercial |
$2,777.80
|
| Rate for Payer: Humana Commercial |
$2,485.40
|
| Rate for Payer: Humana KY Medicaid |
$1,005.56
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$1,015.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,397.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,157.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,025.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,573.12
|
| Rate for Payer: Ohio Health Group HMO |
$2,193.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$584.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$380.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$906.44
|
| Rate for Payer: PHCS Commercial |
$2,807.04
|
| Rate for Payer: United Healthcare All Payer |
$2,573.12
|
|
|
TREAT HUMERUS FRACTURE(P
|
Professional
|
Both
|
$965.00
|
|
|
Service Code
|
HCPCS 24505
|
| Hospital Charge Code |
761P0533
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$279.68 |
| Max. Negotiated Rate |
$965.00 |
| Rate for Payer: Aetna Commercial |
$636.17
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$284.52
|
| Rate for Payer: Anthem Medicaid |
$279.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$965.00
|
| Rate for Payer: Cash Price |
$482.50
|
| Rate for Payer: Cash Price |
$482.50
|
| Rate for Payer: Cigna Commercial |
$700.55
|
| Rate for Payer: Healthspan PPO |
$624.72
|
| Rate for Payer: Humana Medicaid |
$279.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$548.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$285.27
|
| Rate for Payer: Molina Healthcare Passport |
$279.68
|
| Rate for Payer: Multiplan PHCS |
$579.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$675.50
|
| Rate for Payer: UHCCP Medicaid |
$298.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$282.48
|
|
|
TREAT HUMERUS FRACTURE(P
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 23605
|
| Hospital Charge Code |
761P0479
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$267.44 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Aetna Commercial |
$599.73
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$267.44
|
| Rate for Payer: Anthem Medicaid |
$279.95
|
| 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 |
$661.21
|
| Rate for Payer: Healthspan PPO |
$583.94
|
| Rate for Payer: Humana Medicaid |
$279.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$516.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$285.55
|
| Rate for Payer: Molina Healthcare Passport |
$279.95
|
| Rate for Payer: Multiplan PHCS |
$540.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$630.00
|
| Rate for Payer: UHCCP Medicaid |
$280.81
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$282.75
|
|
|
TREAT HUMERUS FRACTURE(T
|
Facility
|
OP
|
$2,024.00
|
|
|
Service Code
|
HCPCS 23605
|
| Hospital Charge Code |
761T0479
|
|
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 HUMERUS FRACTURE(T
|
Facility
|
IP
|
$2,024.00
|
|
|
Service Code
|
HCPCS 23605
|
| Hospital Charge Code |
761T0479
|
|
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 KNEECAP DISLOCATION
|
Professional
|
Both
|
$515.00
|
|
|
Service Code
|
HCPCS 27562
|
| Hospital Charge Code |
76102756
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$180.25 |
| Max. Negotiated Rate |
$704.31 |
| Rate for Payer: Aetna Commercial |
$664.77
|
| Rate for Payer: Anthem Medicaid |
$318.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$515.00
|
| Rate for Payer: Cash Price |
$257.50
|
| Rate for Payer: Cash Price |
$257.50
|
| Rate for Payer: Cigna Commercial |
$704.31
|
| Rate for Payer: Healthspan PPO |
$602.14
|
| Rate for Payer: Humana Medicaid |
$318.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$581.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$324.57
|
| Rate for Payer: Molina Healthcare Passport |
$318.21
|
| Rate for Payer: Multiplan PHCS |
$309.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$360.50
|
| Rate for Payer: UHCCP Medicaid |
$180.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$321.39
|
|
|
TREAT KNEECAP FRACTURE
|
Facility
|
OP
|
$684.00
|
|
|
Service Code
|
HCPCS 27520
|
| Hospital Charge Code |
76100866
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$88.92 |
| Max. Negotiated Rate |
$656.64 |
| Rate for Payer: Aetna Commercial |
$526.68
|
| Rate for Payer: Anthem Medicaid |
$235.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$533.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Cigna Commercial |
$567.72
|
| Rate for Payer: First Health Commercial |
$649.80
|
| Rate for Payer: Humana Commercial |
$581.40
|
| Rate for Payer: Humana KY Medicaid |
$235.23
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$237.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$560.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$504.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$239.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$601.92
|
| Rate for Payer: Ohio Health Group HMO |
$513.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$136.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$88.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$212.04
|
| Rate for Payer: PHCS Commercial |
$656.64
|
| Rate for Payer: United Healthcare All Payer |
$601.92
|
|
|
TREAT KNEECAP FRACTURE
|
Facility
|
IP
|
$684.00
|
|
|
Service Code
|
HCPCS 27520
|
| Hospital Charge Code |
76100866
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$88.92 |
| Max. Negotiated Rate |
$656.64 |
| Rate for Payer: Aetna Commercial |
$526.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$533.52
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Cigna Commercial |
$567.72
|
| Rate for Payer: First Health Commercial |
$649.80
|
| Rate for Payer: Humana Commercial |
$581.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$560.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$504.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$205.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$601.92
|
| Rate for Payer: Ohio Health Group HMO |
$513.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$136.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$88.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$212.04
|
| Rate for Payer: PHCS Commercial |
$656.64
|
| Rate for Payer: United Healthcare All Payer |
$601.92
|
|
|
TREAT KNEECAP FRACTURE
|
Professional
|
Both
|
$684.00
|
|
|
Service Code
|
HCPCS 27520
|
| Hospital Charge Code |
76100866
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.34 |
| Max. Negotiated Rate |
$684.00 |
| Rate for Payer: Aetna Commercial |
$390.46
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$173.38
|
| Rate for Payer: Anthem Medicaid |
$130.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$684.00
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Cigna Commercial |
$482.45
|
| Rate for Payer: Healthspan PPO |
$387.61
|
| Rate for Payer: Humana Medicaid |
$130.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$347.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$132.95
|
| Rate for Payer: Molina Healthcare Passport |
$130.34
|
| Rate for Payer: Multiplan PHCS |
$410.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$478.80
|
| Rate for Payer: UHCCP Medicaid |
$182.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$131.64
|
|
|
TREAT KNEECAP FRACTURE(P
|
Professional
|
Both
|
$684.00
|
|
|
Service Code
|
HCPCS 27520
|
| Hospital Charge Code |
761P0866
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.34 |
| Max. Negotiated Rate |
$684.00 |
| Rate for Payer: Aetna Commercial |
$390.46
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$173.38
|
| Rate for Payer: Anthem Medicaid |
$130.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$684.00
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Cash Price |
$342.00
|
| Rate for Payer: Cigna Commercial |
$482.45
|
| Rate for Payer: Healthspan PPO |
$387.61
|
| Rate for Payer: Humana Medicaid |
$130.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$347.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$132.95
|
| Rate for Payer: Molina Healthcare Passport |
$130.34
|
| Rate for Payer: Multiplan PHCS |
$410.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$478.80
|
| Rate for Payer: UHCCP Medicaid |
$182.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$131.64
|
|
|
TREAT KNEE DISLOCATIN WANESTH
|
Facility
|
OP
|
$1,020.00
|
|
|
Service Code
|
HCPCS 27552
|
| Hospital Charge Code |
76100875
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$132.60 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Aetna Commercial |
$785.40
|
| Rate for Payer: Anthem Medicaid |
$350.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$795.60
|
| 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 |
$510.00
|
| Rate for Payer: Cash Price |
$510.00
|
| Rate for Payer: Cigna Commercial |
$846.60
|
| Rate for Payer: First Health Commercial |
$969.00
|
| Rate for Payer: Humana Commercial |
$867.00
|
| Rate for Payer: Humana KY Medicaid |
$350.78
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$354.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$836.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$752.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$357.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$897.60
|
| Rate for Payer: Ohio Health Group HMO |
$765.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$204.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$132.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$316.20
|
| Rate for Payer: PHCS Commercial |
$979.20
|
| Rate for Payer: United Healthcare All Payer |
$897.60
|
|
