|
TREAT KNEE DISLOCATIN WANESTH
|
Facility
|
OP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 27552
|
| Hospital Charge Code |
45000161
|
|
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 KNEE DISLOCATIN WANESTH
|
Professional
|
Both
|
$1,020.00
|
|
|
Service Code
|
HCPCS 27552
|
| Hospital Charge Code |
76100875
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$321.73 |
| Max. Negotiated Rate |
$1,020.00 |
| Rate for Payer: Aetna Commercial |
$904.54
|
| Rate for Payer: Anthem Medicaid |
$321.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,020.00
|
| Rate for Payer: Cash Price |
$510.00
|
| Rate for Payer: Cash Price |
$510.00
|
| Rate for Payer: Cigna Commercial |
$990.44
|
| Rate for Payer: Healthspan PPO |
$819.32
|
| Rate for Payer: Humana Medicaid |
$321.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$770.21
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$328.16
|
| Rate for Payer: Molina Healthcare Passport |
$321.73
|
| Rate for Payer: Multiplan PHCS |
$612.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$714.00
|
| Rate for Payer: UHCCP Medicaid |
$357.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$324.95
|
|
|
TREAT KNEE DISLOCATIN WANESTH
|
Facility
|
IP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 27552
|
| Hospital Charge Code |
45000161
|
|
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 KNEE DISLOCATIN WANESTH
|
Facility
|
IP
|
$1,020.00
|
|
|
Service Code
|
HCPCS 27552
|
| Hospital Charge Code |
76100875
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$132.60 |
| Max. Negotiated Rate |
$979.20 |
| Rate for Payer: Aetna Commercial |
$785.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$795.60
|
| 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: 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 |
$306.00
|
| 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
|
|
|
TREAT KNEE DISLOCATIN WANESTH
|
Professional
|
Both
|
$1,020.00
|
|
|
Service Code
|
HCPCS 27552
|
| Hospital Charge Code |
761P0875
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$321.73 |
| Max. Negotiated Rate |
$1,020.00 |
| Rate for Payer: Aetna Commercial |
$904.54
|
| Rate for Payer: Anthem Medicaid |
$321.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,020.00
|
| Rate for Payer: Cash Price |
$510.00
|
| Rate for Payer: Cash Price |
$510.00
|
| Rate for Payer: Cigna Commercial |
$990.44
|
| Rate for Payer: Healthspan PPO |
$819.32
|
| Rate for Payer: Humana Medicaid |
$321.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$770.21
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$328.16
|
| Rate for Payer: Molina Healthcare Passport |
$321.73
|
| Rate for Payer: Multiplan PHCS |
$612.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$714.00
|
| Rate for Payer: UHCCP Medicaid |
$357.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$324.95
|
|
|
TREAT KNUCKLE DISLOCATION
|
Facility
|
OP
|
$925.00
|
|
|
Service Code
|
HCPCS 26715
|
| Hospital Charge Code |
76100735
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$120.25 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$712.25
|
| Rate for Payer: Anthem Medicaid |
$318.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$721.50
|
| 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 |
$462.50
|
| Rate for Payer: Cash Price |
$462.50
|
| Rate for Payer: Cigna Commercial |
$767.75
|
| Rate for Payer: First Health Commercial |
$878.75
|
| Rate for Payer: Humana Commercial |
$786.25
|
| Rate for Payer: Humana KY Medicaid |
$318.11
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$321.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$758.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$682.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$324.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$814.00
|
| Rate for Payer: Ohio Health Group HMO |
$693.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$185.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$120.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$286.75
|
| Rate for Payer: PHCS Commercial |
$888.00
|
| Rate for Payer: United Healthcare All Payer |
$814.00
|
|
|
TREAT KNUCKLE DISLOCATION
|
Professional
|
Both
|
$925.00
|
|
|
Service Code
|
HCPCS 26715
|
| Hospital Charge Code |
76100735
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$287.61 |
| Max. Negotiated Rate |
$925.00 |
| Rate for Payer: Aetna Commercial |
$780.37
|
| Rate for Payer: Anthem Medicaid |
$287.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$925.00
|
| Rate for Payer: Cash Price |
$462.50
|
| Rate for Payer: Cash Price |
$462.50
|
| Rate for Payer: Cigna Commercial |
$740.77
|
| Rate for Payer: Healthspan PPO |
$706.85
|
| Rate for Payer: Humana Medicaid |
$287.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$690.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$293.36
|
| Rate for Payer: Molina Healthcare Passport |
$287.61
|
| Rate for Payer: Multiplan PHCS |
$555.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$647.50
|
| Rate for Payer: UHCCP Medicaid |
$323.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$290.49
|
|
|
TREAT KNUCKLE DISLOCATION
|
Facility
|
IP
|
$925.00
|
|
|
Service Code
|
HCPCS 26715
|
| Hospital Charge Code |
76100735
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$120.25 |
| Max. Negotiated Rate |
$888.00 |
| Rate for Payer: Aetna Commercial |
$712.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$721.50
|
| Rate for Payer: Cash Price |
$462.50
|
| Rate for Payer: Cigna Commercial |
$767.75
|
| Rate for Payer: First Health Commercial |
$878.75
|
| Rate for Payer: Humana Commercial |
$786.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$758.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$682.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$277.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$814.00
|
| Rate for Payer: Ohio Health Group HMO |
$693.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$185.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$120.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$286.75
|
| Rate for Payer: PHCS Commercial |
$888.00
|
| Rate for Payer: United Healthcare All Payer |
$814.00
|
|
|
TREAT KNUCKLE DISLOCATION(P
|
Professional
|
Both
|
$925.00
|
|
|
Service Code
|
HCPCS 26715
|
| Hospital Charge Code |
761P0735
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$287.61 |
| Max. Negotiated Rate |
$925.00 |
| Rate for Payer: Aetna Commercial |
$780.37
|
| Rate for Payer: Anthem Medicaid |
$287.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$925.00
|
| Rate for Payer: Cash Price |
$462.50
|
| Rate for Payer: Cash Price |
$462.50
|
| Rate for Payer: Cigna Commercial |
$740.77
|
| Rate for Payer: Healthspan PPO |
$706.85
|
| Rate for Payer: Humana Medicaid |
$287.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$690.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$293.36
|
| Rate for Payer: Molina Healthcare Passport |
$287.61
|
| Rate for Payer: Multiplan PHCS |
$555.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$647.50
|
| Rate for Payer: UHCCP Medicaid |
$323.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$290.49
|
|
|
TREAT LOWER LEG JOINT
|
Professional
|
Both
|
$1,330.00
|
|
|
Service Code
|
HCPCS 27829
|
| Hospital Charge Code |
76100951
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$343.29 |
| Max. Negotiated Rate |
$1,330.00 |
| Rate for Payer: Aetna Commercial |
$943.20
|
| Rate for Payer: Anthem Medicaid |
$343.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,330.00
|
| Rate for Payer: Cash Price |
$665.00
|
| Rate for Payer: Cash Price |
$665.00
|
| Rate for Payer: Cigna Commercial |
$805.21
|
| Rate for Payer: Healthspan PPO |
$854.34
|
| Rate for Payer: Humana Medicaid |
$343.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$837.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$350.16
|
| Rate for Payer: Molina Healthcare Passport |
$343.29
|
| Rate for Payer: Multiplan PHCS |
$798.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$931.00
|
| Rate for Payer: UHCCP Medicaid |
$465.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$346.72
|
|
|
TREAT LOWER LEG JOINT
|
Facility
|
OP
|
$1,330.00
|
|
|
Service Code
|
HCPCS 27829
|
| Hospital Charge Code |
76100951
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$172.90 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$1,024.10
|
| Rate for Payer: Anthem Medicaid |
$457.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,037.40
|
| 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 |
$665.00
|
| Rate for Payer: Cash Price |
$665.00
|
| Rate for Payer: Cigna Commercial |
$1,103.90
|
| Rate for Payer: First Health Commercial |
$1,263.50
|
| Rate for Payer: Humana Commercial |
$1,130.50
|
| Rate for Payer: Humana KY Medicaid |
$457.39
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$462.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,090.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$981.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$466.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,170.40
|
| Rate for Payer: Ohio Health Group HMO |
$997.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$266.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$172.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$412.30
|
| Rate for Payer: PHCS Commercial |
$1,276.80
|
| Rate for Payer: United Healthcare All Payer |
$1,170.40
|
|
|
TREAT LOWER LEG JOINT
|
Facility
|
IP
|
$1,330.00
|
|
|
Service Code
|
HCPCS 27829
|
| Hospital Charge Code |
76100951
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$172.90 |
| Max. Negotiated Rate |
$1,276.80 |
| Rate for Payer: Aetna Commercial |
$1,024.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,037.40
|
| Rate for Payer: Cash Price |
$665.00
|
| Rate for Payer: Cigna Commercial |
$1,103.90
|
| Rate for Payer: First Health Commercial |
$1,263.50
|
| Rate for Payer: Humana Commercial |
$1,130.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,090.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$981.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,170.40
|
| Rate for Payer: Ohio Health Group HMO |
$997.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$266.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$172.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$412.30
|
| Rate for Payer: PHCS Commercial |
$1,276.80
|
| Rate for Payer: United Healthcare All Payer |
$1,170.40
|
|
|
TREAT LOWER LEG JOINT(P
|
Professional
|
Both
|
$1,330.00
|
|
|
Service Code
|
HCPCS 27829
|
| Hospital Charge Code |
761P0951
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$343.29 |
| Max. Negotiated Rate |
$1,330.00 |
| Rate for Payer: Aetna Commercial |
$943.20
|
| Rate for Payer: Anthem Medicaid |
$343.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,330.00
|
| Rate for Payer: Cash Price |
$665.00
|
| Rate for Payer: Cash Price |
$665.00
|
| Rate for Payer: Cigna Commercial |
$805.21
|
| Rate for Payer: Healthspan PPO |
$854.34
|
| Rate for Payer: Humana Medicaid |
$343.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$837.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$350.16
|
| Rate for Payer: Molina Healthcare Passport |
$343.29
|
| Rate for Payer: Multiplan PHCS |
$798.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$931.00
|
| Rate for Payer: UHCCP Medicaid |
$465.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$346.72
|
|
|
TREATMENT KNEE CAP DISLOCATION
|
Facility
|
OP
|
$451.00
|
|
|
Service Code
|
HCPCS 27550
|
| Hospital Charge Code |
45000160
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$58.63 |
| Max. Negotiated Rate |
$432.96 |
| Rate for Payer: Aetna Commercial |
$347.27
|
| Rate for Payer: Anthem Medicaid |
$155.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$351.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$225.50
|
| Rate for Payer: Cash Price |
$225.50
|
| Rate for Payer: Cigna Commercial |
$374.33
|
| Rate for Payer: First Health Commercial |
$428.45
|
| Rate for Payer: Humana Commercial |
$383.35
|
| Rate for Payer: Humana KY Medicaid |
$155.10
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$156.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$369.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$332.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$158.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$396.88
|
| Rate for Payer: Ohio Health Group HMO |
$338.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$139.81
|
| Rate for Payer: PHCS Commercial |
$432.96
|
| Rate for Payer: United Healthcare All Payer |
$396.88
|
|
|
TREATMENT KNEE CAP DISLOCATION
|
Facility
|
IP
|
$451.00
|
|
|
Service Code
|
HCPCS 27550
|
| Hospital Charge Code |
76100874
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$58.63 |
| Max. Negotiated Rate |
$432.96 |
| Rate for Payer: Aetna Commercial |
$347.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$351.78
|
| Rate for Payer: Cash Price |
$225.50
|
| Rate for Payer: Cigna Commercial |
$374.33
|
| Rate for Payer: First Health Commercial |
$428.45
|
| Rate for Payer: Humana Commercial |
$383.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$369.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$332.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$135.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$396.88
|
| Rate for Payer: Ohio Health Group HMO |
$338.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$139.81
|
| Rate for Payer: PHCS Commercial |
$432.96
|
| Rate for Payer: United Healthcare All Payer |
$396.88
|
|
|
TREATMENT KNEE CAP DISLOCATION
|
Facility
|
IP
|
$451.00
|
|
|
Service Code
|
HCPCS 27550
|
| Hospital Charge Code |
45000160
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$58.63 |
| Max. Negotiated Rate |
$432.96 |
| Rate for Payer: Aetna Commercial |
$347.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$351.78
|
| Rate for Payer: Cash Price |
$225.50
|
| Rate for Payer: Cigna Commercial |
$374.33
|
| Rate for Payer: First Health Commercial |
$428.45
|
| Rate for Payer: Humana Commercial |
$383.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$369.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$332.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$135.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$396.88
|
| Rate for Payer: Ohio Health Group HMO |
$338.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$139.81
|
| Rate for Payer: PHCS Commercial |
$432.96
|
| Rate for Payer: United Healthcare All Payer |
$396.88
|
|
|
TREATMENT KNEE CAP DISLOCATION
|
Facility
|
OP
|
$451.00
|
|
|
Service Code
|
HCPCS 27550
|
| Hospital Charge Code |
76100874
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$58.63 |
| Max. Negotiated Rate |
$432.96 |
| Rate for Payer: Aetna Commercial |
$347.27
|
| Rate for Payer: Anthem Medicaid |
$155.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$351.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$225.50
|
| Rate for Payer: Cash Price |
$225.50
|
| Rate for Payer: Cigna Commercial |
$374.33
|
| Rate for Payer: First Health Commercial |
$428.45
|
| Rate for Payer: Humana Commercial |
$383.35
|
| Rate for Payer: Humana KY Medicaid |
$155.10
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$156.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$369.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$332.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$158.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$396.88
|
| Rate for Payer: Ohio Health Group HMO |
$338.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$139.81
|
| Rate for Payer: PHCS Commercial |
$432.96
|
| Rate for Payer: United Healthcare All Payer |
$396.88
|
|
|
TREATMENT OF ANKLE FRACTURE
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 28430
|
| Hospital Charge Code |
76101014
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$98.87 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$281.01
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$131.80
|
| Rate for Payer: Anthem Medicaid |
$98.87
|
| 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 |
$355.57
|
| Rate for Payer: Healthspan PPO |
$283.14
|
| Rate for Payer: Humana Medicaid |
$98.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$247.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$100.85
|
| Rate for Payer: Molina Healthcare Passport |
$98.87
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$420.00
|
| Rate for Payer: UHCCP Medicaid |
$138.39
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$99.86
|
|
|
TREATMENT OF ANKLE FRACTURE
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 27808
|
| Hospital Charge Code |
76100939
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.36 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Commercial |
$398.76
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$159.36
|
| Rate for Payer: Anthem Medicaid |
$161.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$700.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$497.32
|
| Rate for Payer: Healthspan PPO |
$399.01
|
| Rate for Payer: Humana Medicaid |
$161.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$354.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$164.71
|
| Rate for Payer: Molina Healthcare Passport |
$161.48
|
| Rate for Payer: Multiplan PHCS |
$420.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$490.00
|
| Rate for Payer: UHCCP Medicaid |
$167.33
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$163.09
|
|
|
TREATMENT OF ANKLE FRACTURE
|
Professional
|
Both
|
$625.00
|
|
|
Service Code
|
HCPCS 27788
|
| Hospital Charge Code |
76102717
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$180.71 |
| Max. Negotiated Rate |
$660.64 |
| Rate for Payer: Aetna Commercial |
$546.95
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$226.79
|
| Rate for Payer: Anthem Medicaid |
$180.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$625.00
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Cigna Commercial |
$660.64
|
| Rate for Payer: Healthspan PPO |
$533.24
|
| Rate for Payer: Humana Medicaid |
$180.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$469.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$184.32
|
| Rate for Payer: Molina Healthcare Passport |
$180.71
|
| Rate for Payer: Multiplan PHCS |
$375.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$437.50
|
| Rate for Payer: UHCCP Medicaid |
$238.13
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$182.52
|
|
|
TREATMENT OF ANKLE FRACTURE
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
HCPCS 28430
|
| Hospital Charge Code |
76101014
|
|
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
|
|
|
TREATMENT OF ANKLE FRACTURE
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
HCPCS 27808
|
| Hospital Charge Code |
76100939
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$672.00 |
| Rate for Payer: Aetna Commercial |
$539.00
|
| Rate for Payer: Anthem Medicaid |
$240.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$546.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$581.00
|
| Rate for Payer: First Health Commercial |
$665.00
|
| Rate for Payer: Humana Commercial |
$595.00
|
| Rate for Payer: Humana KY Medicaid |
$240.73
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$243.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$574.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$516.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$245.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$616.00
|
| Rate for Payer: Ohio Health Group HMO |
$525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$91.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$217.00
|
| Rate for Payer: PHCS Commercial |
$672.00
|
| Rate for Payer: United Healthcare All Payer |
$616.00
|
|
|
TREATMENT OF ANKLE FRACTURE
|
Facility
|
OP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 27810
|
| Hospital Charge Code |
45000168
|
|
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
|
|
|
TREATMENT OF ANKLE FRACTURE
|
Facility
|
OP
|
$1,056.00
|
|
|
Service Code
|
HCPCS 27810
|
| Hospital Charge Code |
76100940
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$137.28 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Aetna Commercial |
$813.12
|
| Rate for Payer: Anthem Medicaid |
$363.16
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$823.68
|
| 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 |
$528.00
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cigna Commercial |
$876.48
|
| Rate for Payer: First Health Commercial |
$1,003.20
|
| Rate for Payer: Humana Commercial |
$897.60
|
| Rate for Payer: Humana KY Medicaid |
$363.16
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$366.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$865.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$779.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$370.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$929.28
|
| Rate for Payer: Ohio Health Group HMO |
$792.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$211.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$137.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$327.36
|
| Rate for Payer: PHCS Commercial |
$1,013.76
|
| Rate for Payer: United Healthcare All Payer |
$929.28
|
|
|
TREATMENT OF ANKLE FRACTURE
|
Facility
|
IP
|
$1,056.00
|
|
|
Service Code
|
HCPCS 27810
|
| Hospital Charge Code |
76100940
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$137.28 |
| Max. Negotiated Rate |
$1,013.76 |
| Rate for Payer: Aetna Commercial |
$813.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$823.68
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cigna Commercial |
$876.48
|
| Rate for Payer: First Health Commercial |
$1,003.20
|
| Rate for Payer: Humana Commercial |
$897.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$865.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$779.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$316.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$929.28
|
| Rate for Payer: Ohio Health Group HMO |
$792.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$211.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$137.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$327.36
|
| Rate for Payer: PHCS Commercial |
$1,013.76
|
| Rate for Payer: United Healthcare All Payer |
$929.28
|
|
