|
TREAT ELBOW DISLOCATION
|
Facility
|
IP
|
$1,215.00
|
|
|
Service Code
|
HCPCS 24640
|
| Hospital Charge Code |
76100556
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$364.50 |
| Max. Negotiated Rate |
$1,166.40 |
| Rate for Payer: Aetna Commercial |
$935.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$947.70
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Cigna Commercial |
$1,008.45
|
| Rate for Payer: First Health Commercial |
$1,154.25
|
| Rate for Payer: Humana Commercial |
$1,032.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$996.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$896.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$364.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,069.20
|
| Rate for Payer: Ohio Health Group HMO |
$911.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$972.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,057.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$838.35
|
| Rate for Payer: PHCS Commercial |
$1,166.40
|
| Rate for Payer: United Healthcare All Payer |
$1,069.20
|
|
|
TREAT ELBOW DISLOCATION
|
Professional
|
Both
|
$1,590.00
|
|
|
Service Code
|
HCPCS 24615
|
| Hospital Charge Code |
76100553
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$542.19 |
| Max. Negotiated Rate |
$1,154.59 |
| Rate for Payer: Aetna Commercial |
$1,051.80
|
| Rate for Payer: Ambetter Exchange |
$681.34
|
| Rate for Payer: Anthem Medicaid |
$542.19
|
| Rate for Payer: Buckeye Individual/Medicaid |
$681.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$681.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$817.61
|
| Rate for Payer: Cash Price |
$795.00
|
| Rate for Payer: Cash Price |
$795.00
|
| Rate for Payer: Cigna Commercial |
$1,154.59
|
| Rate for Payer: Healthspan PPO |
$952.71
|
| Rate for Payer: Humana Medicaid |
$542.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$882.31
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$681.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$681.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$553.03
|
| Rate for Payer: Molina Healthcare Passport |
$542.19
|
| Rate for Payer: Multiplan PHCS |
$954.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$885.74
|
| Rate for Payer: UHCCP Medicaid |
$556.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$547.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$681.34
|
|
|
TREAT ELBOW DISLOCATION
|
Professional
|
Both
|
$2,927.00
|
|
|
Service Code
|
HCPCS 24605
|
| Hospital Charge Code |
76100552
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$219.48 |
| Max. Negotiated Rate |
$1,756.20 |
| Rate for Payer: Aetna Commercial |
$653.28
|
| Rate for Payer: Ambetter Exchange |
$457.19
|
| Rate for Payer: Anthem Medicaid |
$219.48
|
| Rate for Payer: Buckeye Individual/Medicaid |
$457.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$457.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$548.63
|
| Rate for Payer: Cash Price |
$1,463.50
|
| Rate for Payer: Cash Price |
$1,463.50
|
| Rate for Payer: Cigna Commercial |
$715.27
|
| Rate for Payer: Healthspan PPO |
$591.73
|
| Rate for Payer: Humana Medicaid |
$219.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$566.13
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$457.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$457.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$223.87
|
| Rate for Payer: Molina Healthcare Passport |
$219.48
|
| Rate for Payer: Multiplan PHCS |
$1,756.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$594.35
|
| Rate for Payer: UHCCP Medicaid |
$1,024.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$221.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$457.19
|
|
|
TREAT ELBOW DISLOCATION
|
Facility
|
IP
|
$1,590.00
|
|
|
Service Code
|
HCPCS 24615
|
| Hospital Charge Code |
76100553
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$477.00 |
| Max. Negotiated Rate |
$1,526.40 |
| Rate for Payer: Aetna Commercial |
$1,224.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,240.20
|
| 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: 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 |
$477.00
|
| 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
|
|
|
TREAT ELBOW DISLOCATION
|
Facility
|
OP
|
$2,927.00
|
|
|
Service Code
|
HCPCS 24605
|
| Hospital Charge Code |
76100552
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,006.60 |
| Max. Negotiated Rate |
$2,809.92 |
| Rate for Payer: Aetna Commercial |
$2,253.79
|
| Rate for Payer: Anthem Medicaid |
$1,006.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,283.06
|
| 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 |
$1,463.50
|
| Rate for Payer: Cash Price |
$1,463.50
|
| Rate for Payer: Cigna Commercial |
$2,429.41
|
| Rate for Payer: First Health Commercial |
$2,780.65
|
| Rate for Payer: Humana Commercial |
$2,487.95
|
| Rate for Payer: Humana KY Medicaid |
$1,006.60
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,016.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,400.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,160.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,026.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,575.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,195.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,341.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,546.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,019.63
|
| Rate for Payer: PHCS Commercial |
$2,809.92
|
| Rate for Payer: United Healthcare All Payer |
$2,575.76
|
|
|
TREAT ELBOW DISLOCATION
|
Professional
|
Both
|
$1,215.00
|
|
|
Service Code
|
HCPCS 24640
|
| Hospital Charge Code |
76100556
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$45.39 |
| Max. Negotiated Rate |
$729.00 |
| Rate for Payer: Aetna Commercial |
$121.26
|
| Rate for Payer: Ambetter Exchange |
$74.34
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$45.39
|
| Rate for Payer: Anthem Medicaid |
$62.78
|
| Rate for Payer: Buckeye Individual/Medicaid |
$74.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$74.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$89.21
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Cigna Commercial |
$190.18
|
| Rate for Payer: Healthspan PPO |
$146.68
|
| Rate for Payer: Humana Medicaid |
$62.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$108.58
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$74.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$74.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$64.04
|
| Rate for Payer: Molina Healthcare Passport |
$62.78
|
| Rate for Payer: Multiplan PHCS |
$729.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$96.64
|
| Rate for Payer: UHCCP Medicaid |
$47.66
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$63.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$74.34
|
|
|
TREAT ELBOW DISLOCATION
|
Facility
|
IP
|
$2,927.00
|
|
|
Service Code
|
HCPCS 24605
|
| Hospital Charge Code |
76100552
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$878.10 |
| Max. Negotiated Rate |
$2,809.92 |
| Rate for Payer: Aetna Commercial |
$2,253.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,283.06
|
| Rate for Payer: Cash Price |
$1,463.50
|
| Rate for Payer: Cigna Commercial |
$2,429.41
|
| Rate for Payer: First Health Commercial |
$2,780.65
|
| Rate for Payer: Humana Commercial |
$2,487.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,400.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,160.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$878.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,575.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,195.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,341.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,546.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,019.63
|
| Rate for Payer: PHCS Commercial |
$2,809.92
|
| Rate for Payer: United Healthcare All Payer |
$2,575.76
|
|
|
TREAT ELBOW DISLOCATION
|
Facility
|
OP
|
$1,215.00
|
|
|
Service Code
|
HCPCS 24640
|
| Hospital Charge Code |
76100556
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$1,166.40 |
| Rate for Payer: Aetna Commercial |
$935.55
|
| Rate for Payer: Anthem Medicaid |
$417.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$947.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Cigna Commercial |
$1,008.45
|
| Rate for Payer: First Health Commercial |
$1,154.25
|
| Rate for Payer: Humana Commercial |
$1,032.75
|
| Rate for Payer: Humana KY Medicaid |
$417.84
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$422.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$996.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$896.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$426.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,069.20
|
| Rate for Payer: Ohio Health Group HMO |
$911.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$972.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,057.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$838.35
|
| Rate for Payer: PHCS Commercial |
$1,166.40
|
| Rate for Payer: United Healthcare All Payer |
$1,069.20
|
|
|
TREAT ELBOW DISLOCATION(P
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 24640
|
| Hospital Charge Code |
761P0556
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$45.39 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna Commercial |
$121.26
|
| Rate for Payer: Ambetter Exchange |
$74.34
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$45.39
|
| Rate for Payer: Anthem Medicaid |
$62.78
|
| Rate for Payer: Buckeye Individual/Medicaid |
$74.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$74.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$89.21
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$190.18
|
| Rate for Payer: Healthspan PPO |
$146.68
|
| Rate for Payer: Humana Medicaid |
$62.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$108.58
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$74.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$74.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$64.04
|
| Rate for Payer: Molina Healthcare Passport |
$62.78
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$96.64
|
| Rate for Payer: UHCCP Medicaid |
$47.66
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$63.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$74.34
|
|
|
TREAT ELBOW DISLOCATION(P
|
Professional
|
Both
|
$1,590.00
|
|
|
Service Code
|
HCPCS 24615
|
| Hospital Charge Code |
761P0553
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$542.19 |
| Max. Negotiated Rate |
$1,154.59 |
| Rate for Payer: Aetna Commercial |
$1,051.80
|
| Rate for Payer: Ambetter Exchange |
$681.34
|
| Rate for Payer: Anthem Medicaid |
$542.19
|
| Rate for Payer: Buckeye Individual/Medicaid |
$681.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$681.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$817.61
|
| Rate for Payer: Cash Price |
$795.00
|
| Rate for Payer: Cash Price |
$795.00
|
| Rate for Payer: Cigna Commercial |
$1,154.59
|
| Rate for Payer: Healthspan PPO |
$952.71
|
| Rate for Payer: Humana Medicaid |
$542.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$882.31
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$681.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$681.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$553.03
|
| Rate for Payer: Molina Healthcare Passport |
$542.19
|
| Rate for Payer: Multiplan PHCS |
$954.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$885.74
|
| Rate for Payer: UHCCP Medicaid |
$556.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$547.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$681.34
|
|
|
TREAT ELBOW DISLOCATION(P
|
Professional
|
Both
|
$755.00
|
|
|
Service Code
|
HCPCS 24605
|
| Hospital Charge Code |
761P0552
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$219.48 |
| Max. Negotiated Rate |
$715.27 |
| Rate for Payer: Aetna Commercial |
$653.28
|
| Rate for Payer: Ambetter Exchange |
$457.19
|
| Rate for Payer: Anthem Medicaid |
$219.48
|
| Rate for Payer: Buckeye Individual/Medicaid |
$457.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$457.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$548.63
|
| Rate for Payer: Cash Price |
$377.50
|
| Rate for Payer: Cash Price |
$377.50
|
| Rate for Payer: Cigna Commercial |
$715.27
|
| Rate for Payer: Healthspan PPO |
$591.73
|
| Rate for Payer: Humana Medicaid |
$219.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$566.13
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$457.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$457.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$223.87
|
| Rate for Payer: Molina Healthcare Passport |
$219.48
|
| Rate for Payer: Multiplan PHCS |
$453.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$594.35
|
| Rate for Payer: UHCCP Medicaid |
$264.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$221.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$457.19
|
|
|
TREAT ELBOW DISLOCATION(T
|
Facility
|
IP
|
$815.00
|
|
|
Service Code
|
HCPCS 24640
|
| Hospital Charge Code |
761T0556
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$244.50 |
| Max. Negotiated Rate |
$782.40 |
| Rate for Payer: Aetna Commercial |
$627.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$635.70
|
| Rate for Payer: Cash Price |
$407.50
|
| Rate for Payer: Cigna Commercial |
$676.45
|
| Rate for Payer: First Health Commercial |
$774.25
|
| Rate for Payer: Humana Commercial |
$692.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$668.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$601.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$717.20
|
| Rate for Payer: Ohio Health Group HMO |
$611.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$652.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$709.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$562.35
|
| Rate for Payer: PHCS Commercial |
$782.40
|
| Rate for Payer: United Healthcare All Payer |
$717.20
|
|
|
TREAT ELBOW DISLOCATION(T
|
Facility
|
OP
|
$815.00
|
|
|
Service Code
|
HCPCS 24640
|
| Hospital Charge Code |
761T0556
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$782.40 |
| Rate for Payer: Aetna Commercial |
$627.55
|
| Rate for Payer: Anthem Medicaid |
$280.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$635.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$407.50
|
| Rate for Payer: Cash Price |
$407.50
|
| Rate for Payer: Cigna Commercial |
$676.45
|
| Rate for Payer: First Health Commercial |
$774.25
|
| Rate for Payer: Humana Commercial |
$692.75
|
| Rate for Payer: Humana KY Medicaid |
$280.28
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$283.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$668.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$601.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$285.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$717.20
|
| Rate for Payer: Ohio Health Group HMO |
$611.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$652.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$709.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$562.35
|
| Rate for Payer: PHCS Commercial |
$782.40
|
| Rate for Payer: United Healthcare All Payer |
$717.20
|
|
|
TREAT ELBOW DISLOCATION(T
|
Facility
|
OP
|
$2,172.00
|
|
|
Service Code
|
HCPCS 24605
|
| Hospital Charge Code |
761T0552
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$746.95 |
| Max. Negotiated Rate |
$2,085.12 |
| Rate for Payer: Aetna Commercial |
$1,672.44
|
| Rate for Payer: Anthem Medicaid |
$746.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,694.16
|
| 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 |
$1,086.00
|
| Rate for Payer: Cash Price |
$1,086.00
|
| Rate for Payer: Cigna Commercial |
$1,802.76
|
| Rate for Payer: First Health Commercial |
$2,063.40
|
| Rate for Payer: Humana Commercial |
$1,846.20
|
| Rate for Payer: Humana KY Medicaid |
$746.95
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$754.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,781.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,602.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$761.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,911.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,629.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,737.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,889.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,498.68
|
| Rate for Payer: PHCS Commercial |
$2,085.12
|
| Rate for Payer: United Healthcare All Payer |
$1,911.36
|
|
|
TREAT ELBOW DISLOCATION(T
|
Facility
|
IP
|
$2,172.00
|
|
|
Service Code
|
HCPCS 24605
|
| Hospital Charge Code |
761T0552
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$651.60 |
| Max. Negotiated Rate |
$2,085.12 |
| Rate for Payer: Aetna Commercial |
$1,672.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,694.16
|
| Rate for Payer: Cash Price |
$1,086.00
|
| Rate for Payer: Cigna Commercial |
$1,802.76
|
| Rate for Payer: First Health Commercial |
$2,063.40
|
| Rate for Payer: Humana Commercial |
$1,846.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,781.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,602.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,911.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,629.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,737.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,889.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,498.68
|
| Rate for Payer: PHCS Commercial |
$2,085.12
|
| Rate for Payer: United Healthcare All Payer |
$1,911.36
|
|
|
TREAT FOOT DISLOCATION
|
Professional
|
Both
|
$530.00
|
|
|
Service Code
|
HCPCS 28575
|
| Hospital Charge Code |
76102607
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$169.89 |
| Max. Negotiated Rate |
$470.03 |
| Rate for Payer: Aetna Commercial |
$434.62
|
| Rate for Payer: Ambetter Exchange |
$327.27
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$175.63
|
| Rate for Payer: Anthem Medicaid |
$169.89
|
| Rate for Payer: Buckeye Individual/Medicaid |
$327.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$327.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$392.72
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cigna Commercial |
$470.03
|
| Rate for Payer: Healthspan PPO |
$418.40
|
| Rate for Payer: Humana Medicaid |
$169.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$388.39
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$327.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$173.29
|
| Rate for Payer: Molina Healthcare Passport |
$169.89
|
| Rate for Payer: Multiplan PHCS |
$318.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$425.45
|
| Rate for Payer: UHCCP Medicaid |
$184.41
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$171.59
|
| Rate for Payer: Wellcare Medicare Advantage |
$327.27
|
|
|
TREAT FOOT DISLOCATION
|
Facility
|
OP
|
$530.00
|
|
|
Service Code
|
HCPCS 28575
|
| Hospital Charge Code |
76102607
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.27 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$408.10
|
| Rate for Payer: Anthem Medicaid |
$182.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$413.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cigna Commercial |
$439.90
|
| Rate for Payer: First Health Commercial |
$503.50
|
| Rate for Payer: Humana Commercial |
$450.50
|
| Rate for Payer: Humana KY Medicaid |
$182.27
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$184.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$434.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$391.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$185.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$466.40
|
| Rate for Payer: Ohio Health Group HMO |
$397.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$424.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$461.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$365.70
|
| Rate for Payer: PHCS Commercial |
$508.80
|
| Rate for Payer: United Healthcare All Payer |
$466.40
|
|
|
TREAT FOOT DISLOCATION
|
Facility
|
IP
|
$590.00
|
|
|
Service Code
|
HCPCS 28606
|
| Hospital Charge Code |
76102608
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$177.00 |
| Max. Negotiated Rate |
$566.40 |
| Rate for Payer: Aetna Commercial |
$454.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$460.20
|
| Rate for Payer: Cash Price |
$295.00
|
| Rate for Payer: Cigna Commercial |
$489.70
|
| Rate for Payer: First Health Commercial |
$560.50
|
| Rate for Payer: Humana Commercial |
$501.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$483.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$435.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$177.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$519.20
|
| Rate for Payer: Ohio Health Group HMO |
$442.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$472.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$513.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$407.10
|
| Rate for Payer: PHCS Commercial |
$566.40
|
| Rate for Payer: United Healthcare All Payer |
$519.20
|
|
|
TREAT FOOT DISLOCATION
|
Professional
|
Both
|
$530.00
|
|
|
Service Code
|
HCPCS 28575
|
| Hospital Charge Code |
761P2607
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$169.89 |
| Max. Negotiated Rate |
$470.03 |
| Rate for Payer: Aetna Commercial |
$434.62
|
| Rate for Payer: Ambetter Exchange |
$327.27
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$175.63
|
| Rate for Payer: Anthem Medicaid |
$169.89
|
| Rate for Payer: Buckeye Individual/Medicaid |
$327.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$327.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$392.72
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cigna Commercial |
$470.03
|
| Rate for Payer: Healthspan PPO |
$418.40
|
| Rate for Payer: Humana Medicaid |
$169.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$388.39
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$327.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$173.29
|
| Rate for Payer: Molina Healthcare Passport |
$169.89
|
| Rate for Payer: Multiplan PHCS |
$318.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$425.45
|
| Rate for Payer: UHCCP Medicaid |
$184.41
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$171.59
|
| Rate for Payer: Wellcare Medicare Advantage |
$327.27
|
|
|
TREAT FOOT DISLOCATION
|
Professional
|
Both
|
$590.00
|
|
|
Service Code
|
HCPCS 28606
|
| Hospital Charge Code |
761P2608
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$206.50 |
| Max. Negotiated Rate |
$637.61 |
| Rate for Payer: Aetna Commercial |
$570.07
|
| Rate for Payer: Ambetter Exchange |
$380.58
|
| Rate for Payer: Anthem Medicaid |
$238.43
|
| Rate for Payer: Buckeye Individual/Medicaid |
$380.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$380.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$456.70
|
| Rate for Payer: Cash Price |
$295.00
|
| Rate for Payer: Cash Price |
$295.00
|
| Rate for Payer: Cigna Commercial |
$637.61
|
| Rate for Payer: Healthspan PPO |
$516.36
|
| Rate for Payer: Humana Medicaid |
$238.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$480.45
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$380.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$380.58
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$243.20
|
| Rate for Payer: Molina Healthcare Passport |
$238.43
|
| Rate for Payer: Multiplan PHCS |
$354.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$494.75
|
| Rate for Payer: UHCCP Medicaid |
$206.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$240.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$380.58
|
|
|
TREAT FOOT DISLOCATION
|
Facility
|
OP
|
$590.00
|
|
|
Service Code
|
HCPCS 28606
|
| Hospital Charge Code |
76102608
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$202.90 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$454.30
|
| Rate for Payer: Anthem Medicaid |
$202.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$460.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$295.00
|
| Rate for Payer: Cash Price |
$295.00
|
| Rate for Payer: Cigna Commercial |
$489.70
|
| Rate for Payer: First Health Commercial |
$560.50
|
| Rate for Payer: Humana Commercial |
$501.50
|
| Rate for Payer: Humana KY Medicaid |
$202.90
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$204.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$483.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$435.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$206.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$519.20
|
| Rate for Payer: Ohio Health Group HMO |
$442.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$472.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$513.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$407.10
|
| Rate for Payer: PHCS Commercial |
$566.40
|
| Rate for Payer: United Healthcare All Payer |
$519.20
|
|
|
TREAT FOOT DISLOCATION
|
Professional
|
Both
|
$590.00
|
|
|
Service Code
|
HCPCS 28606
|
| Hospital Charge Code |
76102608
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$206.50 |
| Max. Negotiated Rate |
$637.61 |
| Rate for Payer: Aetna Commercial |
$570.07
|
| Rate for Payer: Ambetter Exchange |
$380.58
|
| Rate for Payer: Anthem Medicaid |
$238.43
|
| Rate for Payer: Buckeye Individual/Medicaid |
$380.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$380.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$456.70
|
| Rate for Payer: Cash Price |
$295.00
|
| Rate for Payer: Cash Price |
$295.00
|
| Rate for Payer: Cigna Commercial |
$637.61
|
| Rate for Payer: Healthspan PPO |
$516.36
|
| Rate for Payer: Humana Medicaid |
$238.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$480.45
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$380.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$380.58
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$243.20
|
| Rate for Payer: Molina Healthcare Passport |
$238.43
|
| Rate for Payer: Multiplan PHCS |
$354.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$494.75
|
| Rate for Payer: UHCCP Medicaid |
$206.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$240.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$380.58
|
|
|
TREAT FOOT DISLOCATION
|
Facility
|
IP
|
$530.00
|
|
|
Service Code
|
HCPCS 28575
|
| Hospital Charge Code |
76102607
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.00 |
| Max. Negotiated Rate |
$508.80 |
| Rate for Payer: Aetna Commercial |
$408.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$413.40
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cigna Commercial |
$439.90
|
| Rate for Payer: First Health Commercial |
$503.50
|
| Rate for Payer: Humana Commercial |
$450.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$434.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$391.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$159.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$466.40
|
| Rate for Payer: Ohio Health Group HMO |
$397.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$424.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$461.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$365.70
|
| Rate for Payer: PHCS Commercial |
$508.80
|
| Rate for Payer: United Healthcare All Payer |
$466.40
|
|
|
TREAT FRACTURE OF MALAR AREA
|
Facility
|
IP
|
$4,502.00
|
|
|
Service Code
|
HCPCS 21355
|
| Hospital Charge Code |
76100385
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,350.60 |
| Max. Negotiated Rate |
$4,321.92 |
| Rate for Payer: Aetna Commercial |
$3,466.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,511.56
|
| Rate for Payer: Cash Price |
$2,251.00
|
| Rate for Payer: Cigna Commercial |
$3,736.66
|
| Rate for Payer: First Health Commercial |
$4,276.90
|
| Rate for Payer: Humana Commercial |
$3,826.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,691.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,322.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,350.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,961.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,376.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,601.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,916.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,106.38
|
| Rate for Payer: PHCS Commercial |
$4,321.92
|
| Rate for Payer: United Healthcare All Payer |
$3,961.76
|
|
|
TREAT FRACTURE OF MALAR AREA
|
Facility
|
OP
|
$4,502.00
|
|
|
Service Code
|
HCPCS 21355
|
| Hospital Charge Code |
76100385
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,548.24 |
| Max. Negotiated Rate |
$4,321.92 |
| Rate for Payer: Aetna Commercial |
$3,466.54
|
| Rate for Payer: Anthem Medicaid |
$1,548.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,511.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,195.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,045.32
|
| Rate for Payer: Cash Price |
$2,251.00
|
| Rate for Payer: Cash Price |
$2,251.00
|
| Rate for Payer: Cigna Commercial |
$3,736.66
|
| Rate for Payer: First Health Commercial |
$4,276.90
|
| Rate for Payer: Humana Commercial |
$3,826.70
|
| Rate for Payer: Humana KY Medicaid |
$1,548.24
|
| Rate for Payer: Humana Medicare Advantage |
$2,996.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,563.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,691.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,322.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,595.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,579.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,961.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,376.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,601.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,916.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,106.38
|
| Rate for Payer: PHCS Commercial |
$4,321.92
|
| Rate for Payer: United Healthcare All Payer |
$3,961.76
|
|
