|
TREAT ANKLE DISLOCATION
|
Professional
|
Both
|
$519.00
|
|
|
Service Code
|
HCPCS 27842
|
| Hospital Charge Code |
76102741
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$181.65 |
| Max. Negotiated Rate |
$760.52 |
| Rate for Payer: Aetna Commercial |
$704.25
|
| Rate for Payer: Ambetter Exchange |
$472.32
|
| Rate for Payer: Anthem Medicaid |
$235.65
|
| Rate for Payer: Buckeye Individual/Medicaid |
$472.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$472.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$566.78
|
| Rate for Payer: Cash Price |
$259.50
|
| Rate for Payer: Cash Price |
$259.50
|
| Rate for Payer: Cigna Commercial |
$760.52
|
| Rate for Payer: Healthspan PPO |
$637.90
|
| Rate for Payer: Humana Medicaid |
$235.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$605.11
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$472.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$472.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$240.36
|
| Rate for Payer: Molina Healthcare Passport |
$235.65
|
| Rate for Payer: Multiplan PHCS |
$311.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$614.02
|
| Rate for Payer: UHCCP Medicaid |
$181.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$238.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$472.32
|
|
|
TREAT ANKLE DISLOCATION
|
Facility
|
OP
|
$1,775.00
|
|
|
Service Code
|
HCPCS 27846
|
| Hospital Charge Code |
76102955
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$610.42 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,366.75
|
| Rate for Payer: Anthem Medicaid |
$610.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,384.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cigna Commercial |
$1,473.25
|
| Rate for Payer: First Health Commercial |
$1,686.25
|
| Rate for Payer: Humana Commercial |
$1,508.75
|
| Rate for Payer: Humana KY Medicaid |
$610.42
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$616.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,455.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,309.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$622.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,562.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,331.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,544.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.75
|
| Rate for Payer: PHCS Commercial |
$1,704.00
|
| Rate for Payer: United Healthcare All Payer |
$1,562.00
|
|
|
TREAT ANKLE DISLOCATION
|
Professional
|
Both
|
$1,775.00
|
|
|
Service Code
|
HCPCS 27846
|
| Hospital Charge Code |
76102955
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$528.96 |
| Max. Negotiated Rate |
$1,197.69 |
| Rate for Payer: Aetna Commercial |
$1,096.26
|
| Rate for Payer: Ambetter Exchange |
$689.17
|
| Rate for Payer: Anthem Medicaid |
$528.96
|
| Rate for Payer: Buckeye Individual/Medicaid |
$689.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$689.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$827.00
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cigna Commercial |
$1,197.69
|
| Rate for Payer: Healthspan PPO |
$992.97
|
| Rate for Payer: Humana Medicaid |
$528.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$914.87
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$689.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$689.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$539.54
|
| Rate for Payer: Molina Healthcare Passport |
$528.96
|
| Rate for Payer: Multiplan PHCS |
$1,065.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$895.92
|
| Rate for Payer: UHCCP Medicaid |
$621.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$534.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$689.17
|
|
|
TREAT CLAVICLE DISLOCATION
|
Facility
|
OP
|
$770.00
|
|
|
Service Code
|
HCPCS 23550
|
| Hospital Charge Code |
76102599
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$264.80 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$592.90
|
| Rate for Payer: Anthem Medicaid |
$264.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$600.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: Cigna Commercial |
$639.10
|
| Rate for Payer: First Health Commercial |
$731.50
|
| Rate for Payer: Humana Commercial |
$654.50
|
| Rate for Payer: Humana KY Medicaid |
$264.80
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$267.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$631.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$568.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$270.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$677.60
|
| Rate for Payer: Ohio Health Group HMO |
$577.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$616.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$669.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$531.30
|
| Rate for Payer: PHCS Commercial |
$739.20
|
| Rate for Payer: United Healthcare All Payer |
$677.60
|
|
|
TREAT CLAVICLE DISLOCATION
|
Professional
|
Both
|
$545.00
|
|
|
Service Code
|
HCPCS 23545
|
| Hospital Charge Code |
76102716
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$150.24 |
| Max. Negotiated Rate |
$476.30 |
| Rate for Payer: Aetna Commercial |
$393.19
|
| Rate for Payer: Ambetter Exchange |
$314.46
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$164.38
|
| Rate for Payer: Anthem Medicaid |
$150.24
|
| Rate for Payer: Buckeye Individual/Medicaid |
$314.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$314.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$377.35
|
| Rate for Payer: Cash Price |
$272.50
|
| Rate for Payer: Cash Price |
$272.50
|
| Rate for Payer: Cigna Commercial |
$476.30
|
| Rate for Payer: Healthspan PPO |
$384.28
|
| Rate for Payer: Humana Medicaid |
$150.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$352.32
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$314.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$314.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$153.24
|
| Rate for Payer: Molina Healthcare Passport |
$150.24
|
| Rate for Payer: Multiplan PHCS |
$327.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$408.80
|
| Rate for Payer: UHCCP Medicaid |
$172.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$151.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$314.46
|
|
|
TREAT CLAVICLE DISLOCATION
|
Professional
|
Both
|
$770.00
|
|
|
Service Code
|
HCPCS 23550
|
| Hospital Charge Code |
76102599
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$269.50 |
| Max. Negotiated Rate |
$913.26 |
| Rate for Payer: Aetna Commercial |
$834.96
|
| Rate for Payer: Ambetter Exchange |
$545.99
|
| Rate for Payer: Anthem Medicaid |
$458.87
|
| Rate for Payer: Buckeye Individual/Medicaid |
$545.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$545.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$655.19
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: Cigna Commercial |
$913.26
|
| Rate for Payer: Healthspan PPO |
$756.29
|
| Rate for Payer: Humana Medicaid |
$458.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$704.87
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$545.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$545.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$468.05
|
| Rate for Payer: Molina Healthcare Passport |
$458.87
|
| Rate for Payer: Multiplan PHCS |
$462.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$709.79
|
| Rate for Payer: UHCCP Medicaid |
$269.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$463.46
|
| Rate for Payer: Wellcare Medicare Advantage |
$545.99
|
|
|
TREAT CLAVICLE DISLOCATION
|
Facility
|
IP
|
$770.00
|
|
|
Service Code
|
HCPCS 23550
|
| Hospital Charge Code |
76102599
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$231.00 |
| Max. Negotiated Rate |
$739.20 |
| Rate for Payer: Aetna Commercial |
$592.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$600.60
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: Cigna Commercial |
$639.10
|
| Rate for Payer: First Health Commercial |
$731.50
|
| Rate for Payer: Humana Commercial |
$654.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$631.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$568.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$231.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$677.60
|
| Rate for Payer: Ohio Health Group HMO |
$577.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$616.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$669.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$531.30
|
| Rate for Payer: PHCS Commercial |
$739.20
|
| Rate for Payer: United Healthcare All Payer |
$677.60
|
|
|
TREAT CLAVICLE DISLOCATION
|
Professional
|
Both
|
$770.00
|
|
|
Service Code
|
HCPCS 23550
|
| Hospital Charge Code |
761P2599
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$269.50 |
| Max. Negotiated Rate |
$913.26 |
| Rate for Payer: Aetna Commercial |
$834.96
|
| Rate for Payer: Ambetter Exchange |
$545.99
|
| Rate for Payer: Anthem Medicaid |
$458.87
|
| Rate for Payer: Buckeye Individual/Medicaid |
$545.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$545.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$655.19
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: Cigna Commercial |
$913.26
|
| Rate for Payer: Healthspan PPO |
$756.29
|
| Rate for Payer: Humana Medicaid |
$458.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$704.87
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$545.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$545.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$468.05
|
| Rate for Payer: Molina Healthcare Passport |
$458.87
|
| Rate for Payer: Multiplan PHCS |
$462.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$709.79
|
| Rate for Payer: UHCCP Medicaid |
$269.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$463.46
|
| Rate for Payer: Wellcare Medicare Advantage |
$545.99
|
|
|
TREAT CLAVICLE FRACTURE
|
Facility
|
OP
|
$2,710.00
|
|
|
Service Code
|
HCPCS 23505
|
| Hospital Charge Code |
76100472
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$931.97 |
| Max. Negotiated Rate |
$2,601.60 |
| Rate for Payer: Aetna Commercial |
$2,086.70
|
| Rate for Payer: Anthem Medicaid |
$931.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,113.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| Rate for Payer: Cash Price |
$1,355.00
|
| Rate for Payer: Cash Price |
$1,355.00
|
| Rate for Payer: Cigna Commercial |
$2,249.30
|
| Rate for Payer: First Health Commercial |
$2,574.50
|
| Rate for Payer: Humana Commercial |
$2,303.50
|
| Rate for Payer: Humana KY Medicaid |
$931.97
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$941.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,222.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,999.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$950.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,384.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,032.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,168.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,357.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,869.90
|
| Rate for Payer: PHCS Commercial |
$2,601.60
|
| Rate for Payer: United Healthcare All Payer |
$2,384.80
|
|
|
TREAT CLAVICLE FRACTURE
|
Facility
|
OP
|
$2,024.00
|
|
|
Service Code
|
HCPCS 23505
|
| Hospital Charge Code |
45000108
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$696.05 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$1,558.48
|
| Rate for Payer: Anthem Medicaid |
$696.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,578.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| 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 |
$1,478.75
|
| 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 |
$1,774.50
|
| 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 |
$1,619.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,760.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,396.56
|
| Rate for Payer: PHCS Commercial |
$1,943.04
|
| Rate for Payer: United Healthcare All Payer |
$1,781.12
|
|
|
TREAT CLAVICLE FRACTURE
|
Facility
|
OP
|
$1,150.00
|
|
|
Service Code
|
HCPCS 23500
|
| Hospital Charge Code |
76100471
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$1,104.00 |
| Rate for Payer: Aetna Commercial |
$885.50
|
| Rate for Payer: Anthem Medicaid |
$395.49
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$897.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cigna Commercial |
$954.50
|
| Rate for Payer: First Health Commercial |
$1,092.50
|
| Rate for Payer: Humana Commercial |
$977.50
|
| Rate for Payer: Humana KY Medicaid |
$395.49
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$399.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$943.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$848.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$403.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,012.00
|
| Rate for Payer: Ohio Health Group HMO |
$862.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,000.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$793.50
|
| Rate for Payer: PHCS Commercial |
$1,104.00
|
| Rate for Payer: United Healthcare All Payer |
$1,012.00
|
|
|
TREAT CLAVICLE FRACTURE
|
Professional
|
Both
|
$1,150.00
|
|
|
Service Code
|
HCPCS 23500
|
| Hospital Charge Code |
76100471
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$106.58 |
| Max. Negotiated Rate |
$690.00 |
| Rate for Payer: Aetna Commercial |
$286.69
|
| Rate for Payer: Ambetter Exchange |
$223.33
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$108.18
|
| Rate for Payer: Anthem Medicaid |
$106.58
|
| Rate for Payer: Buckeye Individual/Medicaid |
$223.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$223.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$268.00
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cigna Commercial |
$322.51
|
| Rate for Payer: Healthspan PPO |
$261.13
|
| Rate for Payer: Humana Medicaid |
$106.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$258.11
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$223.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$223.33
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$108.71
|
| Rate for Payer: Molina Healthcare Passport |
$106.58
|
| Rate for Payer: Multiplan PHCS |
$690.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$290.33
|
| Rate for Payer: UHCCP Medicaid |
$113.59
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$107.65
|
| Rate for Payer: Wellcare Medicare Advantage |
$223.33
|
|
|
TREAT CLAVICLE FRACTURE
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
HCPCS 23500
|
| Hospital Charge Code |
45000107
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$180.00 |
| 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 |
$480.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$522.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$414.00
|
| Rate for Payer: PHCS Commercial |
$576.00
|
| Rate for Payer: United Healthcare All Payer |
$528.00
|
|
|
TREAT CLAVICLE FRACTURE
|
Professional
|
Both
|
$2,710.00
|
|
|
Service Code
|
HCPCS 23505
|
| Hospital Charge Code |
76100472
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.04 |
| Max. Negotiated Rate |
$1,626.00 |
| Rate for Payer: Aetna Commercial |
$457.35
|
| Rate for Payer: Ambetter Exchange |
$325.32
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$184.37
|
| Rate for Payer: Anthem Medicaid |
$182.04
|
| Rate for Payer: Buckeye Individual/Medicaid |
$325.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$325.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$390.38
|
| Rate for Payer: Cash Price |
$1,355.00
|
| Rate for Payer: Cash Price |
$1,355.00
|
| Rate for Payer: Cigna Commercial |
$531.99
|
| Rate for Payer: Healthspan PPO |
$435.12
|
| Rate for Payer: Humana Medicaid |
$182.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$396.72
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$325.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$185.68
|
| Rate for Payer: Molina Healthcare Passport |
$182.04
|
| Rate for Payer: Multiplan PHCS |
$1,626.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$422.92
|
| Rate for Payer: UHCCP Medicaid |
$193.59
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$183.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$325.32
|
|
|
TREAT CLAVICLE FRACTURE
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS 23500
|
| Hospital Charge Code |
45000107
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$206.34 |
| Max. Negotiated Rate |
$576.00 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Anthem Medicaid |
$206.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$468.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$498.00
|
| Rate for Payer: First Health Commercial |
$570.00
|
| Rate for Payer: Humana Commercial |
$510.00
|
| Rate for Payer: Humana KY Medicaid |
$206.34
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$208.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$492.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$210.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$528.00
|
| Rate for Payer: Ohio Health Group HMO |
$450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$480.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$522.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$414.00
|
| Rate for Payer: PHCS Commercial |
$576.00
|
| Rate for Payer: United Healthcare All Payer |
$528.00
|
|
|
TREAT CLAVICLE FRACTURE
|
Facility
|
IP
|
$1,150.00
|
|
|
Service Code
|
HCPCS 23500
|
| Hospital Charge Code |
76100471
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$345.00 |
| Max. Negotiated Rate |
$1,104.00 |
| Rate for Payer: Aetna Commercial |
$885.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$897.00
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cigna Commercial |
$954.50
|
| Rate for Payer: First Health Commercial |
$1,092.50
|
| Rate for Payer: Humana Commercial |
$977.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$943.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$848.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,012.00
|
| Rate for Payer: Ohio Health Group HMO |
$862.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,000.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$793.50
|
| Rate for Payer: PHCS Commercial |
$1,104.00
|
| Rate for Payer: United Healthcare All Payer |
$1,012.00
|
|
|
TREAT CLAVICLE FRACTURE
|
Facility
|
IP
|
$2,024.00
|
|
|
Service Code
|
HCPCS 23505
|
| Hospital Charge Code |
45000108
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$607.20 |
| 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 |
$1,619.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,760.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,396.56
|
| Rate for Payer: PHCS Commercial |
$1,943.04
|
| Rate for Payer: United Healthcare All Payer |
$1,781.12
|
|
|
TREAT CLAVICLE FRACTURE
|
Facility
|
IP
|
$2,710.00
|
|
|
Service Code
|
HCPCS 23505
|
| Hospital Charge Code |
76100472
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$813.00 |
| Max. Negotiated Rate |
$2,601.60 |
| Rate for Payer: Aetna Commercial |
$2,086.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,113.80
|
| Rate for Payer: Cash Price |
$1,355.00
|
| Rate for Payer: Cigna Commercial |
$2,249.30
|
| Rate for Payer: First Health Commercial |
$2,574.50
|
| Rate for Payer: Humana Commercial |
$2,303.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,222.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,999.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$813.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,384.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,032.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,168.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,357.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,869.90
|
| Rate for Payer: PHCS Commercial |
$2,601.60
|
| Rate for Payer: United Healthcare All Payer |
$2,384.80
|
|
|
TREAT CLAVICLE FRACTURE(P
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 23500
|
| Hospital Charge Code |
761P0471
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$106.58 |
| Max. Negotiated Rate |
$330.00 |
| Rate for Payer: Aetna Commercial |
$286.69
|
| Rate for Payer: Ambetter Exchange |
$223.33
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$108.18
|
| Rate for Payer: Anthem Medicaid |
$106.58
|
| Rate for Payer: Buckeye Individual/Medicaid |
$223.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$223.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$268.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$322.51
|
| Rate for Payer: Healthspan PPO |
$261.13
|
| Rate for Payer: Humana Medicaid |
$106.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$258.11
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$223.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$223.33
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$108.71
|
| Rate for Payer: Molina Healthcare Passport |
$106.58
|
| Rate for Payer: Multiplan PHCS |
$330.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$290.33
|
| Rate for Payer: UHCCP Medicaid |
$113.59
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$107.65
|
| Rate for Payer: Wellcare Medicare Advantage |
$223.33
|
|
|
TREAT CLAVICLE FRACTURE(P
|
Professional
|
Both
|
$686.00
|
|
|
Service Code
|
HCPCS 23505
|
| Hospital Charge Code |
761P0472
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.04 |
| Max. Negotiated Rate |
$531.99 |
| Rate for Payer: Aetna Commercial |
$457.35
|
| Rate for Payer: Ambetter Exchange |
$325.32
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$184.37
|
| Rate for Payer: Anthem Medicaid |
$182.04
|
| Rate for Payer: Buckeye Individual/Medicaid |
$325.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$325.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$390.38
|
| Rate for Payer: Cash Price |
$343.00
|
| Rate for Payer: Cash Price |
$343.00
|
| Rate for Payer: Cigna Commercial |
$531.99
|
| Rate for Payer: Healthspan PPO |
$435.12
|
| Rate for Payer: Humana Medicaid |
$182.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$396.72
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$325.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$185.68
|
| Rate for Payer: Molina Healthcare Passport |
$182.04
|
| Rate for Payer: Multiplan PHCS |
$411.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$422.92
|
| Rate for Payer: UHCCP Medicaid |
$193.59
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$183.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$325.32
|
|
|
TREAT CLAVICLE FRACTURE(T
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS 23500
|
| Hospital Charge Code |
761T0471
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$206.34 |
| Max. Negotiated Rate |
$576.00 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Anthem Medicaid |
$206.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$468.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$498.00
|
| Rate for Payer: First Health Commercial |
$570.00
|
| Rate for Payer: Humana Commercial |
$510.00
|
| Rate for Payer: Humana KY Medicaid |
$206.34
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$208.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$492.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$210.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$528.00
|
| Rate for Payer: Ohio Health Group HMO |
$450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$480.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$522.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$414.00
|
| Rate for Payer: PHCS Commercial |
$576.00
|
| Rate for Payer: United Healthcare All Payer |
$528.00
|
|
|
TREAT CLAVICLE FRACTURE(T
|
Facility
|
IP
|
$2,024.00
|
|
|
Service Code
|
HCPCS 23505
|
| Hospital Charge Code |
761T0472
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$607.20 |
| 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 |
$1,619.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,760.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,396.56
|
| Rate for Payer: PHCS Commercial |
$1,943.04
|
| Rate for Payer: United Healthcare All Payer |
$1,781.12
|
|
|
TREAT CLAVICLE FRACTURE(T
|
Facility
|
OP
|
$2,024.00
|
|
|
Service Code
|
HCPCS 23505
|
| Hospital Charge Code |
761T0472
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$696.05 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$1,558.48
|
| Rate for Payer: Anthem Medicaid |
$696.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,578.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| 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 |
$1,478.75
|
| 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 |
$1,774.50
|
| 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 |
$1,619.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,760.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,396.56
|
| Rate for Payer: PHCS Commercial |
$1,943.04
|
| Rate for Payer: United Healthcare All Payer |
$1,781.12
|
|
|
TREAT CLAVICLE FRACTURE(T
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
HCPCS 23500
|
| Hospital Charge Code |
761T0471
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$180.00 |
| 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 |
$480.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$522.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$414.00
|
| Rate for Payer: PHCS Commercial |
$576.00
|
| Rate for Payer: United Healthcare All Payer |
$528.00
|
|
|
TREAT ELBOW DISLOCATION
|
Facility
|
OP
|
$1,590.00
|
|
|
Service Code
|
HCPCS 24615
|
| Hospital Charge Code |
76100553
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$546.80 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,224.30
|
| Rate for Payer: Anthem Medicaid |
$546.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,240.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| Rate for Payer: Cash Price |
$795.00
|
| Rate for Payer: Cash Price |
$795.00
|
| Rate for Payer: Cigna Commercial |
$1,319.70
|
| Rate for Payer: First Health Commercial |
$1,510.50
|
| Rate for Payer: Humana Commercial |
$1,351.50
|
| Rate for Payer: Humana KY Medicaid |
$546.80
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$552.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,303.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,173.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$557.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,399.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,192.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,272.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,383.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,097.10
|
| Rate for Payer: PHCS Commercial |
$1,526.40
|
| Rate for Payer: United Healthcare All Payer |
$1,399.20
|
|
