|
TREAT ORBIT FRACTURE
|
Professional
|
Both
|
$13,316.33
|
|
|
Service Code
|
HCPCS 21365
|
| Hospital Charge Code |
76100387
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$780.79 |
| Max. Negotiated Rate |
$13,316.33 |
| Rate for Payer: Aetna Commercial |
$1,600.83
|
| Rate for Payer: Anthem Medicaid |
$780.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$13,316.33
|
| Rate for Payer: Cash Price |
$6,658.16
|
| Rate for Payer: Cash Price |
$6,658.16
|
| Rate for Payer: Cigna Commercial |
$1,748.94
|
| Rate for Payer: Healthspan PPO |
$1,450.01
|
| Rate for Payer: Humana Medicaid |
$780.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,400.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$796.41
|
| Rate for Payer: Molina Healthcare Passport |
$780.79
|
| Rate for Payer: Multiplan PHCS |
$7,989.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$9,321.43
|
| Rate for Payer: UHCCP Medicaid |
$4,660.72
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$788.60
|
|
|
TREAT ORBIT FRACTURE
|
Facility
|
OP
|
$13,316.33
|
|
|
Service Code
|
HCPCS 21365
|
| Hospital Charge Code |
76100387
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,731.12 |
| Max. Negotiated Rate |
$12,783.68 |
| Rate for Payer: Aetna Commercial |
$10,253.57
|
| Rate for Payer: Anthem Medicaid |
$4,579.49
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,064.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,386.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,089.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,836.59
|
| Rate for Payer: Cash Price |
$6,658.16
|
| Rate for Payer: Cash Price |
$6,658.16
|
| Rate for Payer: Cigna Commercial |
$11,052.55
|
| Rate for Payer: First Health Commercial |
$12,650.51
|
| Rate for Payer: Humana Commercial |
$11,318.88
|
| Rate for Payer: Humana KY Medicaid |
$4,579.49
|
| Rate for Payer: Humana Medicare Advantage |
$5,064.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,626.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,919.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,827.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,076.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,671.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,718.37
|
| Rate for Payer: Ohio Health Group HMO |
$9,987.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,663.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,731.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,128.06
|
| Rate for Payer: PHCS Commercial |
$12,783.68
|
| Rate for Payer: United Healthcare All Payer |
$11,718.37
|
|
|
TREAT ORBIT FRACTURE
|
Facility
|
IP
|
$13,316.33
|
|
|
Service Code
|
HCPCS 21365
|
| Hospital Charge Code |
76100387
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,731.12 |
| Max. Negotiated Rate |
$12,783.68 |
| Rate for Payer: Aetna Commercial |
$10,253.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,386.74
|
| Rate for Payer: Cash Price |
$6,658.16
|
| Rate for Payer: Cigna Commercial |
$11,052.55
|
| Rate for Payer: First Health Commercial |
$12,650.51
|
| Rate for Payer: Humana Commercial |
$11,318.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,919.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,827.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,994.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,718.37
|
| Rate for Payer: Ohio Health Group HMO |
$9,987.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,663.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,731.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,128.06
|
| Rate for Payer: PHCS Commercial |
$12,783.68
|
| Rate for Payer: United Healthcare All Payer |
$11,718.37
|
|
|
TREAT ORBIT FRACTURE(P
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 21365
|
| Hospital Charge Code |
761P0387
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$700.00 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna Commercial |
$1,600.83
|
| Rate for Payer: Anthem Medicaid |
$780.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,748.94
|
| Rate for Payer: Healthspan PPO |
$1,450.01
|
| Rate for Payer: Humana Medicaid |
$780.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,400.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$796.41
|
| Rate for Payer: Molina Healthcare Passport |
$780.79
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,400.00
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$788.60
|
|
|
TREAT ORBIT FRACTURE(T
|
Facility
|
OP
|
$11,316.33
|
|
|
Service Code
|
HCPCS 21365
|
| Hospital Charge Code |
761T0387
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,471.12 |
| Max. Negotiated Rate |
$10,863.68 |
| Rate for Payer: Aetna Commercial |
$8,713.57
|
| Rate for Payer: Anthem Medicaid |
$3,891.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,064.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,826.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,089.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,836.59
|
| Rate for Payer: Cash Price |
$5,658.16
|
| Rate for Payer: Cash Price |
$5,658.16
|
| Rate for Payer: Cigna Commercial |
$9,392.55
|
| Rate for Payer: First Health Commercial |
$10,750.51
|
| Rate for Payer: Humana Commercial |
$9,618.88
|
| Rate for Payer: Humana KY Medicaid |
$3,891.69
|
| Rate for Payer: Humana Medicare Advantage |
$5,064.14
|
| Rate for Payer: Kentucky WC Medicaid |
$3,931.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,279.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,351.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,076.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,969.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,958.37
|
| Rate for Payer: Ohio Health Group HMO |
$8,487.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,263.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,471.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,508.06
|
| Rate for Payer: PHCS Commercial |
$10,863.68
|
| Rate for Payer: United Healthcare All Payer |
$9,958.37
|
|
|
TREAT ORBIT FRACTURE(T
|
Facility
|
IP
|
$11,316.33
|
|
|
Service Code
|
HCPCS 21365
|
| Hospital Charge Code |
761T0387
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,471.12 |
| Max. Negotiated Rate |
$10,863.68 |
| Rate for Payer: Aetna Commercial |
$8,713.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,826.74
|
| Rate for Payer: Cash Price |
$5,658.16
|
| Rate for Payer: Cigna Commercial |
$9,392.55
|
| Rate for Payer: First Health Commercial |
$10,750.51
|
| Rate for Payer: Humana Commercial |
$9,618.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,279.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,351.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,394.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,958.37
|
| Rate for Payer: Ohio Health Group HMO |
$8,487.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,263.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,471.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,508.06
|
| Rate for Payer: PHCS Commercial |
$10,863.68
|
| Rate for Payer: United Healthcare All Payer |
$9,958.37
|
|
|
TREAT SCAPULA FRACTURE
|
Professional
|
Both
|
$1,180.00
|
|
|
Service Code
|
HCPCS 23585
|
| Hospital Charge Code |
76102723
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$413.00 |
| Max. Negotiated Rate |
$1,380.03 |
| Rate for Payer: Aetna Commercial |
$1,380.03
|
| Rate for Payer: Anthem Medicaid |
$484.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,180.00
|
| Rate for Payer: Cash Price |
$590.00
|
| Rate for Payer: Cash Price |
$590.00
|
| Rate for Payer: Cigna Commercial |
$1,107.36
|
| Rate for Payer: Healthspan PPO |
$1,250.02
|
| Rate for Payer: Humana Medicaid |
$484.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,213.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$494.34
|
| Rate for Payer: Molina Healthcare Passport |
$484.65
|
| Rate for Payer: Multiplan PHCS |
$708.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$826.00
|
| Rate for Payer: UHCCP Medicaid |
$413.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$489.50
|
|
|
TREAT SESAMOID BONE FRACTURE
|
Facility
|
IP
|
$1,165.00
|
|
|
Service Code
|
HCPCS 28530
|
| Hospital Charge Code |
76101028
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$151.45 |
| Max. Negotiated Rate |
$1,118.40 |
| Rate for Payer: Aetna Commercial |
$897.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$908.70
|
| Rate for Payer: Cash Price |
$582.50
|
| Rate for Payer: Cigna Commercial |
$966.95
|
| Rate for Payer: First Health Commercial |
$1,106.75
|
| Rate for Payer: Humana Commercial |
$990.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$955.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$859.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$349.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,025.20
|
| Rate for Payer: Ohio Health Group HMO |
$873.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$233.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$151.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$361.15
|
| Rate for Payer: PHCS Commercial |
$1,118.40
|
| Rate for Payer: United Healthcare All Payer |
$1,025.20
|
|
|
TREAT SESAMOID BONE FRACTURE
|
Facility
|
OP
|
$1,165.00
|
|
|
Service Code
|
HCPCS 28530
|
| Hospital Charge Code |
76101028
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$151.45 |
| Max. Negotiated Rate |
$1,118.40 |
| Rate for Payer: Aetna Commercial |
$897.05
|
| Rate for Payer: Anthem Medicaid |
$400.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$908.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$582.50
|
| Rate for Payer: Cash Price |
$582.50
|
| Rate for Payer: Cigna Commercial |
$966.95
|
| Rate for Payer: First Health Commercial |
$1,106.75
|
| Rate for Payer: Humana Commercial |
$990.25
|
| Rate for Payer: Humana KY Medicaid |
$400.64
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$404.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$955.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$859.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$408.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,025.20
|
| Rate for Payer: Ohio Health Group HMO |
$873.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$233.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$151.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$361.15
|
| Rate for Payer: PHCS Commercial |
$1,118.40
|
| Rate for Payer: United Healthcare All Payer |
$1,025.20
|
|
|
TREAT SESAMOID BONE FRACTURE
|
Professional
|
Both
|
$1,165.00
|
|
|
Service Code
|
HCPCS 28530
|
| Hospital Charge Code |
76101028
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$45.48 |
| Max. Negotiated Rate |
$1,165.00 |
| Rate for Payer: Aetna Commercial |
$144.57
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$56.07
|
| Rate for Payer: Anthem Medicaid |
$45.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,165.00
|
| Rate for Payer: Cash Price |
$582.50
|
| Rate for Payer: Cash Price |
$582.50
|
| Rate for Payer: Cigna Commercial |
$166.60
|
| Rate for Payer: Healthspan PPO |
$140.64
|
| Rate for Payer: Humana Medicaid |
$45.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$122.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$46.39
|
| Rate for Payer: Molina Healthcare Passport |
$45.48
|
| Rate for Payer: Multiplan PHCS |
$699.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$815.50
|
| Rate for Payer: UHCCP Medicaid |
$58.87
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$45.93
|
|
|
TREAT SESAMOID BONE FRACTUR(P
|
Professional
|
Both
|
$365.00
|
|
|
Service Code
|
HCPCS 28530
|
| Hospital Charge Code |
761P1028
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$45.48 |
| Max. Negotiated Rate |
$365.00 |
| Rate for Payer: Aetna Commercial |
$144.57
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$56.07
|
| Rate for Payer: Anthem Medicaid |
$45.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$365.00
|
| Rate for Payer: Cash Price |
$182.50
|
| Rate for Payer: Cash Price |
$182.50
|
| Rate for Payer: Cigna Commercial |
$166.60
|
| Rate for Payer: Healthspan PPO |
$140.64
|
| Rate for Payer: Humana Medicaid |
$45.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$122.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$46.39
|
| Rate for Payer: Molina Healthcare Passport |
$45.48
|
| Rate for Payer: Multiplan PHCS |
$219.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$255.50
|
| Rate for Payer: UHCCP Medicaid |
$58.87
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$45.93
|
|
|
TREAT SESAMOID BONE FRACTUR(T
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS 28530
|
| Hospital Charge Code |
761T1028
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem Medicaid |
$275.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Humana KY Medicaid |
$275.12
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$277.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$280.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
TREAT SESAMOID BONE FRACTUR(T
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS 28530
|
| Hospital Charge Code |
761T1028
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
TREAT SHOULDER BLADE FX
|
Facility
|
IP
|
$2,024.00
|
|
|
Service Code
|
HCPCS 23575
|
| Hospital Charge Code |
76100477
|
|
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 SHOULDER BLADE FX
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 23570
|
| Hospital Charge Code |
76100476
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$1,344.00 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem Medicaid |
$481.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Humana KY Medicaid |
$481.46
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$486.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$491.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$182.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$434.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
TREAT SHOULDER BLADE FX
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 23570
|
| Hospital Charge Code |
76100476
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$1,344.00 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$420.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$182.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$434.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
TREAT SHOULDER BLADE FX
|
Facility
|
OP
|
$2,024.00
|
|
|
Service Code
|
HCPCS 23575
|
| Hospital Charge Code |
76100477
|
|
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 SHOULDER BLADE FX
|
Facility
|
OP
|
$2,024.00
|
|
|
Service Code
|
HCPCS 23575
|
| Hospital Charge Code |
45000109
|
|
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 SHOULDER BLADE FX
|
Facility
|
IP
|
$2,024.00
|
|
|
Service Code
|
HCPCS 23575
|
| Hospital Charge Code |
45000109
|
|
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 SHOULDER BLADE FX
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 23570
|
| Hospital Charge Code |
76100476
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$113.29 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Aetna Commercial |
$313.52
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$122.34
|
| Rate for Payer: Anthem Medicaid |
$113.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,400.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$344.40
|
| Rate for Payer: Healthspan PPO |
$280.59
|
| Rate for Payer: Humana Medicaid |
$113.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$279.07
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$115.56
|
| Rate for Payer: Molina Healthcare Passport |
$113.29
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$980.00
|
| Rate for Payer: UHCCP Medicaid |
$128.46
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$114.42
|
|
|
TREAT SHOULDER BLADE FX(P
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 23570
|
| Hospital Charge Code |
761P0476
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$113.29 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna Commercial |
$313.52
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$122.34
|
| Rate for Payer: Anthem Medicaid |
$113.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$500.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$344.40
|
| Rate for Payer: Healthspan PPO |
$280.59
|
| Rate for Payer: Humana Medicaid |
$113.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$279.07
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$115.56
|
| Rate for Payer: Molina Healthcare Passport |
$113.29
|
| Rate for Payer: Multiplan PHCS |
$300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$350.00
|
| Rate for Payer: UHCCP Medicaid |
$128.46
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$114.42
|
|
|
TREAT SHOULDER BLADE FX(T
|
Facility
|
IP
|
$900.00
|
|
|
Service Code
|
HCPCS 23570
|
| Hospital Charge Code |
761T0476
|
|
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 SHOULDER BLADE FX(T
|
Facility
|
OP
|
$900.00
|
|
|
Service Code
|
HCPCS 23570
|
| Hospital Charge Code |
761T0476
|
|
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 SHOULDER DISLOCATION
|
Professional
|
Both
|
$2,905.00
|
|
|
Service Code
|
HCPCS 23655
|
| Hospital Charge Code |
76100486
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$214.28 |
| Max. Negotiated Rate |
$2,905.00 |
| Rate for Payer: Aetna Commercial |
$541.77
|
| Rate for Payer: Anthem Medicaid |
$214.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,905.00
|
| Rate for Payer: Cash Price |
$1,452.50
|
| Rate for Payer: Cash Price |
$1,452.50
|
| Rate for Payer: Cigna Commercial |
$582.46
|
| Rate for Payer: Healthspan PPO |
$490.72
|
| Rate for Payer: Humana Medicaid |
$214.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$474.66
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$218.57
|
| Rate for Payer: Molina Healthcare Passport |
$214.28
|
| Rate for Payer: Multiplan PHCS |
$1,743.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,033.50
|
| Rate for Payer: UHCCP Medicaid |
$1,016.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$216.42
|
|
|
TREAT SHOULDER DISLOCATION
|
Facility
|
IP
|
$2,185.00
|
|
|
Service Code
|
HCPCS 23655
|
| Hospital Charge Code |
45000113
|
|
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
|
|
