|
TREAT FRACTURE OF ULNA
|
Facility
|
IP
|
$3,009.00
|
|
|
Service Code
|
HCPCS 25535
|
| Hospital Charge Code |
76100624
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$902.70 |
| Max. Negotiated Rate |
$2,888.64 |
| Rate for Payer: Aetna Commercial |
$2,316.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,347.02
|
| Rate for Payer: Cash Price |
$1,504.50
|
| Rate for Payer: Cigna Commercial |
$2,497.47
|
| Rate for Payer: First Health Commercial |
$2,858.55
|
| Rate for Payer: Humana Commercial |
$2,557.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,467.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,220.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$902.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,647.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,256.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,407.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,617.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,076.21
|
| Rate for Payer: PHCS Commercial |
$2,888.64
|
| Rate for Payer: United Healthcare All Payer |
$2,647.92
|
|
|
TREAT FRACTURE OF ULNA(P
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 25535
|
| Hospital Charge Code |
761P0624
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$251.28 |
| Max. Negotiated Rate |
$694.80 |
| Rate for Payer: Aetna Commercial |
$634.44
|
| Rate for Payer: Ambetter Exchange |
$440.63
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$251.28
|
| Rate for Payer: Anthem Medicaid |
$252.95
|
| Rate for Payer: Buckeye Individual/Medicaid |
$440.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$440.63
|
| Rate for Payer: CareSource Just4Me Medicare |
$528.76
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$694.80
|
| Rate for Payer: Healthspan PPO |
$609.57
|
| Rate for Payer: Humana Medicaid |
$252.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$546.93
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$440.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$440.63
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$258.01
|
| Rate for Payer: Molina Healthcare Passport |
$252.95
|
| Rate for Payer: Multiplan PHCS |
$540.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$572.82
|
| Rate for Payer: UHCCP Medicaid |
$263.84
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$255.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$440.63
|
|
|
TREAT FRACTURE OF ULNA(P
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 25530
|
| Hospital Charge Code |
761P0623
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.84 |
| Max. Negotiated Rate |
$380.62 |
| Rate for Payer: Aetna Commercial |
$306.20
|
| Rate for Payer: Ambetter Exchange |
$237.44
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$130.84
|
| Rate for Payer: Anthem Medicaid |
$130.88
|
| Rate for Payer: Buckeye Individual/Medicaid |
$237.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$237.44
|
| Rate for Payer: CareSource Just4Me Medicare |
$284.93
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$380.62
|
| Rate for Payer: Healthspan PPO |
$306.44
|
| Rate for Payer: Humana Medicaid |
$130.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$275.26
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$237.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$237.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$133.50
|
| Rate for Payer: Molina Healthcare Passport |
$130.88
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$308.67
|
| Rate for Payer: UHCCP Medicaid |
$137.38
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$132.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$237.44
|
|
|
TREAT FRACTURE OF ULNA(T
|
Facility
|
IP
|
$669.00
|
|
|
Service Code
|
HCPCS 25530
|
| Hospital Charge Code |
761T0623
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$200.70 |
| Max. Negotiated Rate |
$642.24 |
| Rate for Payer: Aetna Commercial |
$515.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$521.82
|
| Rate for Payer: Cash Price |
$334.50
|
| Rate for Payer: Cigna Commercial |
$555.27
|
| Rate for Payer: First Health Commercial |
$635.55
|
| Rate for Payer: Humana Commercial |
$568.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$548.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$493.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$200.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$588.72
|
| Rate for Payer: Ohio Health Group HMO |
$501.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$535.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$582.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$461.61
|
| Rate for Payer: PHCS Commercial |
$642.24
|
| Rate for Payer: United Healthcare All Payer |
$588.72
|
|
|
TREAT FRACTURE OF ULNA(T
|
Facility
|
OP
|
$2,109.00
|
|
|
Service Code
|
HCPCS 25535
|
| Hospital Charge Code |
761T0624
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$2,024.64 |
| Rate for Payer: Aetna Commercial |
$1,623.93
|
| Rate for Payer: Anthem Medicaid |
$725.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,645.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$1,054.50
|
| Rate for Payer: Cash Price |
$1,054.50
|
| Rate for Payer: Cigna Commercial |
$1,750.47
|
| Rate for Payer: First Health Commercial |
$2,003.55
|
| Rate for Payer: Humana Commercial |
$1,792.65
|
| Rate for Payer: Humana KY Medicaid |
$725.29
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$732.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,729.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,556.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$739.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,855.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,581.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,687.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,834.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,455.21
|
| Rate for Payer: PHCS Commercial |
$2,024.64
|
| Rate for Payer: United Healthcare All Payer |
$1,855.92
|
|
|
TREAT FRACTURE OF ULNA(T
|
Facility
|
IP
|
$2,109.00
|
|
|
Service Code
|
HCPCS 25535
|
| Hospital Charge Code |
761T0624
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$632.70 |
| Max. Negotiated Rate |
$2,024.64 |
| Rate for Payer: Aetna Commercial |
$1,623.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,645.02
|
| Rate for Payer: Cash Price |
$1,054.50
|
| Rate for Payer: Cigna Commercial |
$1,750.47
|
| Rate for Payer: First Health Commercial |
$2,003.55
|
| Rate for Payer: Humana Commercial |
$1,792.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,729.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,556.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$632.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,855.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,581.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,687.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,834.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,455.21
|
| Rate for Payer: PHCS Commercial |
$2,024.64
|
| Rate for Payer: United Healthcare All Payer |
$1,855.92
|
|
|
TREAT FRACTURE OF ULNA(T
|
Facility
|
OP
|
$669.00
|
|
|
Service Code
|
HCPCS 25530
|
| Hospital Charge Code |
761T0623
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$642.24 |
| Rate for Payer: Aetna Commercial |
$515.13
|
| Rate for Payer: Anthem Medicaid |
$230.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$521.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$334.50
|
| Rate for Payer: Cash Price |
$334.50
|
| Rate for Payer: Cigna Commercial |
$555.27
|
| Rate for Payer: First Health Commercial |
$635.55
|
| Rate for Payer: Humana Commercial |
$568.65
|
| Rate for Payer: Humana KY Medicaid |
$230.07
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$232.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$548.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$493.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$234.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$588.72
|
| Rate for Payer: Ohio Health Group HMO |
$501.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$535.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$582.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$461.61
|
| Rate for Payer: PHCS Commercial |
$642.24
|
| Rate for Payer: United Healthcare All Payer |
$588.72
|
|
|
TREAT FRACTURE RADIUS/ULNA
|
Professional
|
Both
|
$3,058.00
|
|
|
Service Code
|
HCPCS 25605
|
| Hospital Charge Code |
76100631
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$275.93 |
| Max. Negotiated Rate |
$1,834.80 |
| Rate for Payer: Aetna Commercial |
$809.34
|
| Rate for Payer: Ambetter Exchange |
$492.42
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$275.93
|
| Rate for Payer: Anthem Medicaid |
$385.15
|
| Rate for Payer: Buckeye Individual/Medicaid |
$492.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$492.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$590.90
|
| Rate for Payer: Cash Price |
$1,529.00
|
| Rate for Payer: Cash Price |
$1,529.00
|
| Rate for Payer: Cigna Commercial |
$872.32
|
| Rate for Payer: Healthspan PPO |
$770.91
|
| Rate for Payer: Humana Medicaid |
$385.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$711.55
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$492.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$492.42
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$392.85
|
| Rate for Payer: Molina Healthcare Passport |
$385.15
|
| Rate for Payer: Multiplan PHCS |
$1,834.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$640.15
|
| Rate for Payer: UHCCP Medicaid |
$289.73
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$389.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$492.42
|
|
|
TREAT FRACTURE RADIUS/ULNA
|
Facility
|
IP
|
$3,058.00
|
|
|
Service Code
|
HCPCS 25605
|
| Hospital Charge Code |
76100631
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$917.40 |
| Max. Negotiated Rate |
$2,935.68 |
| Rate for Payer: Aetna Commercial |
$2,354.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,385.24
|
| Rate for Payer: Cash Price |
$1,529.00
|
| Rate for Payer: Cigna Commercial |
$2,538.14
|
| Rate for Payer: First Health Commercial |
$2,905.10
|
| Rate for Payer: Humana Commercial |
$2,599.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,507.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,256.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$917.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,691.04
|
| Rate for Payer: Ohio Health Group HMO |
$2,293.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,446.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,660.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,110.02
|
| Rate for Payer: PHCS Commercial |
$2,935.68
|
| Rate for Payer: United Healthcare All Payer |
$2,691.04
|
|
|
TREAT FRACTURE RADIUS/ULNA
|
Professional
|
Both
|
$1,599.00
|
|
|
Service Code
|
HCPCS 25600
|
| Hospital Charge Code |
76100630
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$171.56 |
| Max. Negotiated Rate |
$959.40 |
| Rate for Payer: Aetna Commercial |
$352.71
|
| Rate for Payer: Ambetter Exchange |
$314.54
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$171.56
|
| Rate for Payer: Anthem Medicaid |
$194.55
|
| Rate for Payer: Buckeye Individual/Medicaid |
$314.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$314.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$377.45
|
| Rate for Payer: Cash Price |
$799.50
|
| Rate for Payer: Cash Price |
$799.50
|
| Rate for Payer: Cigna Commercial |
$437.13
|
| Rate for Payer: Healthspan PPO |
$350.99
|
| Rate for Payer: Humana Medicaid |
$194.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$313.67
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$314.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$314.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$198.44
|
| Rate for Payer: Molina Healthcare Passport |
$194.55
|
| Rate for Payer: Multiplan PHCS |
$959.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$408.90
|
| Rate for Payer: UHCCP Medicaid |
$180.14
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$196.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$314.54
|
|
|
TREAT FRACTURE RADIUS/ULNA
|
Facility
|
IP
|
$1,599.00
|
|
|
Service Code
|
HCPCS 25600
|
| Hospital Charge Code |
76100630
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$479.70 |
| Max. Negotiated Rate |
$1,535.04 |
| Rate for Payer: Aetna Commercial |
$1,231.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,247.22
|
| Rate for Payer: Cash Price |
$799.50
|
| Rate for Payer: Cigna Commercial |
$1,327.17
|
| Rate for Payer: First Health Commercial |
$1,519.05
|
| Rate for Payer: Humana Commercial |
$1,359.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,311.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,180.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$479.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,407.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,199.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,279.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,391.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,103.31
|
| Rate for Payer: PHCS Commercial |
$1,535.04
|
| Rate for Payer: United Healthcare All Payer |
$1,407.12
|
|
|
TREAT FRACTURE RADIUS/ULNA
|
Facility
|
IP
|
$2,083.00
|
|
|
Service Code
|
HCPCS 25605
|
| Hospital Charge Code |
45000131
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$624.90 |
| Max. Negotiated Rate |
$1,999.68 |
| Rate for Payer: Aetna Commercial |
$1,603.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,624.74
|
| Rate for Payer: Cash Price |
$1,041.50
|
| Rate for Payer: Cigna Commercial |
$1,728.89
|
| Rate for Payer: First Health Commercial |
$1,978.85
|
| Rate for Payer: Humana Commercial |
$1,770.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,708.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,537.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$624.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,833.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,562.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,666.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,812.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,437.27
|
| Rate for Payer: PHCS Commercial |
$1,999.68
|
| Rate for Payer: United Healthcare All Payer |
$1,833.04
|
|
|
TREAT FRACTURE RADIUS/ULNA
|
Facility
|
OP
|
$1,599.00
|
|
|
Service Code
|
HCPCS 25600
|
| Hospital Charge Code |
76100630
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$1,535.04 |
| Rate for Payer: Aetna Commercial |
$1,231.23
|
| Rate for Payer: Anthem Medicaid |
$549.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,247.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$799.50
|
| Rate for Payer: Cash Price |
$799.50
|
| Rate for Payer: Cigna Commercial |
$1,327.17
|
| Rate for Payer: First Health Commercial |
$1,519.05
|
| Rate for Payer: Humana Commercial |
$1,359.15
|
| Rate for Payer: Humana KY Medicaid |
$549.90
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$555.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,311.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,180.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$560.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,407.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,199.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,279.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,391.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,103.31
|
| Rate for Payer: PHCS Commercial |
$1,535.04
|
| Rate for Payer: United Healthcare All Payer |
$1,407.12
|
|
|
TREAT FRACTURE RADIUS/ULNA
|
Facility
|
OP
|
$2,083.00
|
|
|
Service Code
|
HCPCS 25605
|
| Hospital Charge Code |
45000131
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$716.34 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$1,603.91
|
| Rate for Payer: Anthem Medicaid |
$716.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,624.74
|
| 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 |
$1,041.50
|
| Rate for Payer: Cash Price |
$1,041.50
|
| Rate for Payer: Cigna Commercial |
$1,728.89
|
| Rate for Payer: First Health Commercial |
$1,978.85
|
| Rate for Payer: Humana Commercial |
$1,770.55
|
| Rate for Payer: Humana KY Medicaid |
$716.34
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$723.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,708.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,537.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$730.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,833.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,562.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,666.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,812.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,437.27
|
| Rate for Payer: PHCS Commercial |
$1,999.68
|
| Rate for Payer: United Healthcare All Payer |
$1,833.04
|
|
|
TREAT FRACTURE RADIUS/ULNA
|
Facility
|
OP
|
$3,058.00
|
|
|
Service Code
|
HCPCS 25605
|
| Hospital Charge Code |
76100631
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,051.65 |
| Max. Negotiated Rate |
$2,935.68 |
| Rate for Payer: Aetna Commercial |
$2,354.66
|
| Rate for Payer: Anthem Medicaid |
$1,051.65
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,385.24
|
| 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 |
$1,529.00
|
| Rate for Payer: Cash Price |
$1,529.00
|
| Rate for Payer: Cigna Commercial |
$2,538.14
|
| Rate for Payer: First Health Commercial |
$2,905.10
|
| Rate for Payer: Humana Commercial |
$2,599.30
|
| Rate for Payer: Humana KY Medicaid |
$1,051.65
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,062.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,507.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,256.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,072.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,691.04
|
| Rate for Payer: Ohio Health Group HMO |
$2,293.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,446.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,660.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,110.02
|
| Rate for Payer: PHCS Commercial |
$2,935.68
|
| Rate for Payer: United Healthcare All Payer |
$2,691.04
|
|
|
TREAT FRACTURE RADIUS/ULNA(P
|
Professional
|
Both
|
$975.00
|
|
|
Service Code
|
HCPCS 25605
|
| Hospital Charge Code |
761P0631
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$275.93 |
| Max. Negotiated Rate |
$872.32 |
| Rate for Payer: Aetna Commercial |
$809.34
|
| Rate for Payer: Ambetter Exchange |
$492.42
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$275.93
|
| Rate for Payer: Anthem Medicaid |
$385.15
|
| Rate for Payer: Buckeye Individual/Medicaid |
$492.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$492.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$590.90
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cigna Commercial |
$872.32
|
| Rate for Payer: Healthspan PPO |
$770.91
|
| Rate for Payer: Humana Medicaid |
$385.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$711.55
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$492.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$492.42
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$392.85
|
| Rate for Payer: Molina Healthcare Passport |
$385.15
|
| Rate for Payer: Multiplan PHCS |
$585.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$640.15
|
| Rate for Payer: UHCCP Medicaid |
$289.73
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$389.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$492.42
|
|
|
TREAT FRACTURE RADIUS/ULNA(P
|
Professional
|
Both
|
$788.00
|
|
|
Service Code
|
HCPCS 25600
|
| Hospital Charge Code |
761P0630
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$171.56 |
| Max. Negotiated Rate |
$472.80 |
| Rate for Payer: Aetna Commercial |
$352.71
|
| Rate for Payer: Ambetter Exchange |
$314.54
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$171.56
|
| Rate for Payer: Anthem Medicaid |
$194.55
|
| Rate for Payer: Buckeye Individual/Medicaid |
$314.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$314.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$377.45
|
| Rate for Payer: Cash Price |
$394.00
|
| Rate for Payer: Cash Price |
$394.00
|
| Rate for Payer: Cigna Commercial |
$437.13
|
| Rate for Payer: Healthspan PPO |
$350.99
|
| Rate for Payer: Humana Medicaid |
$194.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$313.67
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$314.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$314.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$198.44
|
| Rate for Payer: Molina Healthcare Passport |
$194.55
|
| Rate for Payer: Multiplan PHCS |
$472.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$408.90
|
| Rate for Payer: UHCCP Medicaid |
$180.14
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$196.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$314.54
|
|
|
TREAT FRACTURE RADIUS/ULNA(T
|
Facility
|
IP
|
$2,083.00
|
|
|
Service Code
|
HCPCS 25605
|
| Hospital Charge Code |
761T0631
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$624.90 |
| Max. Negotiated Rate |
$1,999.68 |
| Rate for Payer: Aetna Commercial |
$1,603.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,624.74
|
| Rate for Payer: Cash Price |
$1,041.50
|
| Rate for Payer: Cigna Commercial |
$1,728.89
|
| Rate for Payer: First Health Commercial |
$1,978.85
|
| Rate for Payer: Humana Commercial |
$1,770.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,708.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,537.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$624.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,833.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,562.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,666.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,812.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,437.27
|
| Rate for Payer: PHCS Commercial |
$1,999.68
|
| Rate for Payer: United Healthcare All Payer |
$1,833.04
|
|
|
TREAT FRACTURE RADIUS/ULNA(T
|
Facility
|
OP
|
$811.00
|
|
|
Service Code
|
HCPCS 25600
|
| Hospital Charge Code |
761T0630
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$778.56 |
| Rate for Payer: Aetna Commercial |
$624.47
|
| Rate for Payer: Anthem Medicaid |
$278.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$632.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$405.50
|
| Rate for Payer: Cash Price |
$405.50
|
| Rate for Payer: Cigna Commercial |
$673.13
|
| Rate for Payer: First Health Commercial |
$770.45
|
| Rate for Payer: Humana Commercial |
$689.35
|
| Rate for Payer: Humana KY Medicaid |
$278.90
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$281.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$665.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$598.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$284.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$713.68
|
| Rate for Payer: Ohio Health Group HMO |
$608.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$648.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$705.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$559.59
|
| Rate for Payer: PHCS Commercial |
$778.56
|
| Rate for Payer: United Healthcare All Payer |
$713.68
|
|
|
TREAT FRACTURE RADIUS/ULNA(T
|
Facility
|
IP
|
$811.00
|
|
|
Service Code
|
HCPCS 25600
|
| Hospital Charge Code |
761T0630
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$243.30 |
| Max. Negotiated Rate |
$778.56 |
| Rate for Payer: Aetna Commercial |
$624.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$632.58
|
| Rate for Payer: Cash Price |
$405.50
|
| Rate for Payer: Cigna Commercial |
$673.13
|
| Rate for Payer: First Health Commercial |
$770.45
|
| Rate for Payer: Humana Commercial |
$689.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$665.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$598.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$243.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$713.68
|
| Rate for Payer: Ohio Health Group HMO |
$608.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$648.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$705.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$559.59
|
| Rate for Payer: PHCS Commercial |
$778.56
|
| Rate for Payer: United Healthcare All Payer |
$713.68
|
|
|
TREAT FRACTURE RADIUS/ULNA(T
|
Facility
|
OP
|
$2,083.00
|
|
|
Service Code
|
HCPCS 25605
|
| Hospital Charge Code |
761T0631
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$716.34 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$1,603.91
|
| Rate for Payer: Anthem Medicaid |
$716.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,624.74
|
| 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 |
$1,041.50
|
| Rate for Payer: Cash Price |
$1,041.50
|
| Rate for Payer: Cigna Commercial |
$1,728.89
|
| Rate for Payer: First Health Commercial |
$1,978.85
|
| Rate for Payer: Humana Commercial |
$1,770.55
|
| Rate for Payer: Humana KY Medicaid |
$716.34
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$723.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,708.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,537.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$730.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,833.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,562.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,666.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,812.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,437.27
|
| Rate for Payer: PHCS Commercial |
$1,999.68
|
| Rate for Payer: United Healthcare All Payer |
$1,833.04
|
|
|
TREAT FRACTURE ULNAR STYLOID
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 25652
|
| Hospital Charge Code |
76100642
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$481.46 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem Medicaid |
$481.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| 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 |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Humana KY Medicaid |
$481.46
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| 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 |
$7,920.79
|
| 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 |
$1,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,218.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$966.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
TREAT FRACTURE ULNAR STYLOID
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 25652
|
| Hospital Charge Code |
76100642
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$421.07 |
| Max. Negotiated Rate |
$977.21 |
| Rate for Payer: Aetna Commercial |
$891.22
|
| Rate for Payer: Ambetter Exchange |
$597.79
|
| Rate for Payer: Anthem Medicaid |
$421.07
|
| Rate for Payer: Buckeye Individual/Medicaid |
$597.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$597.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$717.35
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$977.21
|
| Rate for Payer: Healthspan PPO |
$807.26
|
| Rate for Payer: Humana Medicaid |
$421.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$762.70
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$597.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$597.79
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$429.49
|
| Rate for Payer: Molina Healthcare Passport |
$421.07
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$777.13
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$425.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$597.79
|
|
|
TREAT FRACTURE ULNAR STYLOID
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 25652
|
| Hospital Charge Code |
76100642
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$420.00 |
| 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 |
$1,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,218.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$966.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
TREAT FRACTURE ULNAR STYLOI(P
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 25652
|
| Hospital Charge Code |
761P0642
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$421.07 |
| Max. Negotiated Rate |
$977.21 |
| Rate for Payer: Aetna Commercial |
$891.22
|
| Rate for Payer: Ambetter Exchange |
$597.79
|
| Rate for Payer: Anthem Medicaid |
$421.07
|
| Rate for Payer: Buckeye Individual/Medicaid |
$597.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$597.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$717.35
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$977.21
|
| Rate for Payer: Healthspan PPO |
$807.26
|
| Rate for Payer: Humana Medicaid |
$421.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$762.70
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$597.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$597.79
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$429.49
|
| Rate for Payer: Molina Healthcare Passport |
$421.07
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$777.13
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$425.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$597.79
|
|
