|
TREAT SHOULDER DISLOCATION
|
Facility
|
OP
|
$2,905.00
|
|
|
Service Code
|
HCPCS 23655
|
| Hospital Charge Code |
76100486
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$377.65 |
| Max. Negotiated Rate |
$2,788.80 |
| Rate for Payer: Aetna Commercial |
$2,236.85
|
| Rate for Payer: Anthem Medicaid |
$999.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,265.90
|
| 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 |
$1,452.50
|
| Rate for Payer: Cash Price |
$1,452.50
|
| Rate for Payer: Cigna Commercial |
$2,411.15
|
| Rate for Payer: First Health Commercial |
$2,759.75
|
| Rate for Payer: Humana Commercial |
$2,469.25
|
| Rate for Payer: Humana KY Medicaid |
$999.03
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$1,009.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,382.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,143.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,019.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,556.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,178.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$581.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$377.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$900.55
|
| Rate for Payer: PHCS Commercial |
$2,788.80
|
| Rate for Payer: United Healthcare All Payer |
$2,556.40
|
|
|
TREAT SHOULDER DISLOCATION
|
Professional
|
Both
|
$1,855.00
|
|
|
Service Code
|
HCPCS 23660
|
| Hospital Charge Code |
76100487
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$485.34 |
| Max. Negotiated Rate |
$1,855.00 |
| Rate for Payer: Aetna Commercial |
$847.19
|
| Rate for Payer: Anthem Medicaid |
$485.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,855.00
|
| Rate for Payer: Cash Price |
$927.50
|
| Rate for Payer: Cash Price |
$927.50
|
| Rate for Payer: Cigna Commercial |
$922.31
|
| Rate for Payer: Healthspan PPO |
$767.37
|
| Rate for Payer: Humana Medicaid |
$485.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$717.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$495.05
|
| Rate for Payer: Molina Healthcare Passport |
$485.34
|
| Rate for Payer: Multiplan PHCS |
$1,113.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,298.50
|
| Rate for Payer: UHCCP Medicaid |
$649.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$490.19
|
|
|
TREAT SHOULDER DISLOCATION
|
Facility
|
IP
|
$1,855.00
|
|
|
Service Code
|
HCPCS 23660
|
| Hospital Charge Code |
76100487
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$241.15 |
| Max. Negotiated Rate |
$1,780.80 |
| Rate for Payer: Aetna Commercial |
$1,428.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,446.90
|
| Rate for Payer: Cash Price |
$927.50
|
| Rate for Payer: Cigna Commercial |
$1,539.65
|
| Rate for Payer: First Health Commercial |
$1,762.25
|
| Rate for Payer: Humana Commercial |
$1,576.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,521.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,368.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$556.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,632.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,391.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$371.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$241.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$575.05
|
| Rate for Payer: PHCS Commercial |
$1,780.80
|
| Rate for Payer: United Healthcare All Payer |
$1,632.40
|
|
|
TREAT SHOULDER DISLOCATION
|
Facility
|
OP
|
$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 Medicaid |
$751.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,704.30
|
| 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 |
$1,092.50
|
| 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: Humana KY Medicaid |
$751.42
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$759.07
|
| 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 |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$766.50
|
| 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
|
|
|
TREAT SHOULDER DISLOCATION
|
Facility
|
OP
|
$1,855.00
|
|
|
Service Code
|
HCPCS 23660
|
| Hospital Charge Code |
76100487
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$241.15 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$1,428.35
|
| Rate for Payer: Anthem Medicaid |
$637.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,446.90
|
| 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 |
$927.50
|
| Rate for Payer: Cash Price |
$927.50
|
| Rate for Payer: Cigna Commercial |
$1,539.65
|
| Rate for Payer: First Health Commercial |
$1,762.25
|
| Rate for Payer: Humana Commercial |
$1,576.75
|
| Rate for Payer: Humana KY Medicaid |
$637.93
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$644.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,521.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,368.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$650.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,632.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,391.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$371.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$241.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$575.05
|
| Rate for Payer: PHCS Commercial |
$1,780.80
|
| Rate for Payer: United Healthcare All Payer |
$1,632.40
|
|
|
TREAT SHOULDER DISLOCATION
|
Facility
|
IP
|
$2,905.00
|
|
|
Service Code
|
HCPCS 23655
|
| Hospital Charge Code |
76100486
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$377.65 |
| Max. Negotiated Rate |
$2,788.80 |
| Rate for Payer: Aetna Commercial |
$2,236.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,265.90
|
| Rate for Payer: Cash Price |
$1,452.50
|
| Rate for Payer: Cigna Commercial |
$2,411.15
|
| Rate for Payer: First Health Commercial |
$2,759.75
|
| Rate for Payer: Humana Commercial |
$2,469.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,382.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,143.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$871.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,556.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,178.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$581.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$377.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$900.55
|
| Rate for Payer: PHCS Commercial |
$2,788.80
|
| Rate for Payer: United Healthcare All Payer |
$2,556.40
|
|
|
TREAT SHOULDER DISLOCATION(P
|
Professional
|
Both
|
$1,855.00
|
|
|
Service Code
|
HCPCS 23660
|
| Hospital Charge Code |
761P0487
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$485.34 |
| Max. Negotiated Rate |
$1,855.00 |
| Rate for Payer: Aetna Commercial |
$847.19
|
| Rate for Payer: Anthem Medicaid |
$485.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,855.00
|
| Rate for Payer: Cash Price |
$927.50
|
| Rate for Payer: Cash Price |
$927.50
|
| Rate for Payer: Cigna Commercial |
$922.31
|
| Rate for Payer: Healthspan PPO |
$767.37
|
| Rate for Payer: Humana Medicaid |
$485.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$717.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$495.05
|
| Rate for Payer: Molina Healthcare Passport |
$485.34
|
| Rate for Payer: Multiplan PHCS |
$1,113.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,298.50
|
| Rate for Payer: UHCCP Medicaid |
$649.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$490.19
|
|
|
TREAT SHOULDER DISLOCATION(P
|
Professional
|
Both
|
$720.00
|
|
|
Service Code
|
HCPCS 23655
|
| Hospital Charge Code |
761P0486
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$214.28 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$541.77
|
| Rate for Payer: Anthem Medicaid |
$214.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$720.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cash Price |
$360.00
|
| 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 |
$432.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$504.00
|
| Rate for Payer: UHCCP Medicaid |
$252.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$216.42
|
|
|
TREAT SHOULDER DISLOCATION(T
|
Facility
|
OP
|
$2,185.00
|
|
|
Service Code
|
HCPCS 23655
|
| Hospital Charge Code |
761T0486
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$284.05 |
| Max. Negotiated Rate |
$2,097.60 |
| Rate for Payer: Aetna Commercial |
$1,682.45
|
| Rate for Payer: Anthem Medicaid |
$751.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,704.30
|
| 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 |
$1,092.50
|
| 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: Humana KY Medicaid |
$751.42
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$759.07
|
| 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 |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$766.50
|
| 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
|
|
|
TREAT SHOULDER DISLOCATION(T
|
Facility
|
IP
|
$2,185.00
|
|
|
Service Code
|
HCPCS 23655
|
| Hospital Charge Code |
761T0486
|
|
Hospital Revenue Code
|
761
|
| 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
|
|
|
TREAT STERNUM FRACTURE
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 21825
|
| Hospital Charge Code |
76100408
|
|
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 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: Humana KY Medicaid |
$481.46
|
| 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 |
$420.00
|
| 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 STERNUM FRACTURE
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 21825
|
| Hospital Charge Code |
76100408
|
|
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 STERNUM FRACTURE
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 21825
|
| Hospital Charge Code |
76100408
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$412.41 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Aetna Commercial |
$828.39
|
| Rate for Payer: Anthem Medicaid |
$412.41
|
| 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 |
$914.28
|
| Rate for Payer: Healthspan PPO |
$750.35
|
| Rate for Payer: Humana Medicaid |
$412.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$712.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$420.66
|
| Rate for Payer: Molina Healthcare Passport |
$412.41
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$980.00
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$416.53
|
|
|
TREAT STERNUM FRACTURE(P
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 21825
|
| Hospital Charge Code |
761P0408
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$412.41 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Aetna Commercial |
$828.39
|
| Rate for Payer: Anthem Medicaid |
$412.41
|
| 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 |
$914.28
|
| Rate for Payer: Healthspan PPO |
$750.35
|
| Rate for Payer: Humana Medicaid |
$412.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$712.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$420.66
|
| Rate for Payer: Molina Healthcare Passport |
$412.41
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$980.00
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$416.53
|
|
|
TREAT THUMB FRACTURE
|
Facility
|
OP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 26650
|
| Hospital Charge Code |
76100728
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem Medicaid |
$412.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| 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 |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Humana KY Medicaid |
$412.68
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$416.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$420.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$372.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
TREAT THUMB FRACTURE
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 26650
|
| Hospital Charge Code |
76100728
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$284.20 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$674.79
|
| Rate for Payer: Anthem Medicaid |
$284.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,200.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$809.42
|
| Rate for Payer: Healthspan PPO |
$611.22
|
| Rate for Payer: Humana Medicaid |
$284.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$580.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$289.88
|
| Rate for Payer: Molina Healthcare Passport |
$284.20
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$840.00
|
| Rate for Payer: UHCCP Medicaid |
$420.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$287.04
|
|
|
TREAT THUMB FRACTURE
|
Facility
|
IP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 26650
|
| Hospital Charge Code |
76100728
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$360.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$372.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
TREAT THUMB FRACTURE(P
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 26650
|
| Hospital Charge Code |
761P0728
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$284.20 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$674.79
|
| Rate for Payer: Anthem Medicaid |
$284.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,200.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$809.42
|
| Rate for Payer: Healthspan PPO |
$611.22
|
| Rate for Payer: Humana Medicaid |
$284.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$580.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$289.88
|
| Rate for Payer: Molina Healthcare Passport |
$284.20
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$840.00
|
| Rate for Payer: UHCCP Medicaid |
$420.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$287.04
|
|
|
TREAT TOE DISLOCATION
|
Professional
|
Both
|
$405.00
|
|
|
Service Code
|
HCPCS 28636
|
| Hospital Charge Code |
76101034
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.92 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Aetna Commercial |
$303.45
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$101.92
|
| Rate for Payer: Anthem Medicaid |
$157.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$405.00
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cigna Commercial |
$348.33
|
| Rate for Payer: Healthspan PPO |
$367.44
|
| Rate for Payer: Humana Medicaid |
$157.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$230.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$160.36
|
| Rate for Payer: Molina Healthcare Passport |
$157.22
|
| Rate for Payer: Multiplan PHCS |
$243.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$283.50
|
| Rate for Payer: UHCCP Medicaid |
$107.02
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$158.79
|
|
|
TREAT TOE DISLOCATION
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
HCPCS 28636
|
| Hospital Charge Code |
76101034
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$52.65 |
| Max. Negotiated Rate |
$388.80 |
| Rate for Payer: Aetna Commercial |
$311.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$315.90
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cigna Commercial |
$336.15
|
| Rate for Payer: First Health Commercial |
$384.75
|
| Rate for Payer: Humana Commercial |
$344.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$332.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$298.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$121.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$356.40
|
| Rate for Payer: Ohio Health Group HMO |
$303.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$81.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$125.55
|
| Rate for Payer: PHCS Commercial |
$388.80
|
| Rate for Payer: United Healthcare All Payer |
$356.40
|
|
|
TREAT TOE DISLOCATION
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
HCPCS 28636
|
| Hospital Charge Code |
76101034
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$52.65 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$311.85
|
| Rate for Payer: Anthem Medicaid |
$139.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$315.90
|
| 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 |
$202.50
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cigna Commercial |
$336.15
|
| Rate for Payer: First Health Commercial |
$384.75
|
| Rate for Payer: Humana Commercial |
$344.25
|
| Rate for Payer: Humana KY Medicaid |
$139.28
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$140.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$332.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$298.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$142.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$356.40
|
| Rate for Payer: Ohio Health Group HMO |
$303.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$81.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$125.55
|
| Rate for Payer: PHCS Commercial |
$388.80
|
| Rate for Payer: United Healthcare All Payer |
$356.40
|
|
|
TREAT TOE DISLOCATION(P
|
Professional
|
Both
|
$405.00
|
|
|
Service Code
|
HCPCS 28636
|
| Hospital Charge Code |
761P1034
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.92 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Aetna Commercial |
$303.45
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$101.92
|
| Rate for Payer: Anthem Medicaid |
$157.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$405.00
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cigna Commercial |
$348.33
|
| Rate for Payer: Healthspan PPO |
$367.44
|
| Rate for Payer: Humana Medicaid |
$157.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$230.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$160.36
|
| Rate for Payer: Molina Healthcare Passport |
$157.22
|
| Rate for Payer: Multiplan PHCS |
$243.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$283.50
|
| Rate for Payer: UHCCP Medicaid |
$107.02
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$158.79
|
|
|
TREAT TOE FRACTURE
|
Professional
|
Both
|
$585.00
|
|
|
Service Code
|
HCPCS 28525
|
| Hospital Charge Code |
76102735
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$152.68 |
| Max. Negotiated Rate |
$687.01 |
| Rate for Payer: Aetna Commercial |
$562.03
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$206.95
|
| Rate for Payer: Anthem Medicaid |
$152.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$585.00
|
| Rate for Payer: Cash Price |
$292.50
|
| Rate for Payer: Cash Price |
$292.50
|
| Rate for Payer: Cigna Commercial |
$439.95
|
| Rate for Payer: Healthspan PPO |
$687.01
|
| Rate for Payer: Humana Medicaid |
$152.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$487.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$155.73
|
| Rate for Payer: Molina Healthcare Passport |
$152.68
|
| Rate for Payer: Multiplan PHCS |
$351.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$409.50
|
| Rate for Payer: UHCCP Medicaid |
$217.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$154.21
|
|
|
TREAT ULNAR FRACTURE
|
Facility
|
OP
|
$2,721.00
|
|
|
Service Code
|
HCPCS 24675
|
| Hospital Charge Code |
76100562
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$353.73 |
| Max. Negotiated Rate |
$2,612.16 |
| Rate for Payer: Aetna Commercial |
$2,095.17
|
| Rate for Payer: Anthem Medicaid |
$935.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,122.38
|
| 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 |
$1,360.50
|
| Rate for Payer: Cash Price |
$1,360.50
|
| Rate for Payer: Cigna Commercial |
$2,258.43
|
| Rate for Payer: First Health Commercial |
$2,584.95
|
| Rate for Payer: Humana Commercial |
$2,312.85
|
| Rate for Payer: Humana KY Medicaid |
$935.75
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$945.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,231.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,008.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$954.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,394.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,040.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$544.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$353.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$843.51
|
| Rate for Payer: PHCS Commercial |
$2,612.16
|
| Rate for Payer: United Healthcare All Payer |
$2,394.48
|
|
|
TREAT ULNAR FRACTURE
|
Facility
|
OP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 24675
|
| Hospital Charge Code |
45000127
|
|
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
|
|
