|
TREAT HAND BONE LESION
|
Facility
|
OP
|
$1,300.00
|
|
|
Service Code
|
HCPCS 26034
|
| Hospital Charge Code |
76100656
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$447.07 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$1,001.00
|
| Rate for Payer: Anthem Medicaid |
$447.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,014.00
|
| 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 |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$1,079.00
|
| Rate for Payer: First Health Commercial |
$1,235.00
|
| Rate for Payer: Humana Commercial |
$1,105.00
|
| Rate for Payer: Humana KY Medicaid |
$447.07
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$451.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,066.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$959.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$456.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,144.00
|
| Rate for Payer: Ohio Health Group HMO |
$975.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,040.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,131.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$897.00
|
| Rate for Payer: PHCS Commercial |
$1,248.00
|
| Rate for Payer: United Healthcare All Payer |
$1,144.00
|
|
|
TREAT HAND BONE LESION
|
Professional
|
Both
|
$1,300.00
|
|
|
Service Code
|
HCPCS 26034
|
| Hospital Charge Code |
76100656
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$294.74 |
| Max. Negotiated Rate |
$838.45 |
| Rate for Payer: Aetna Commercial |
$760.18
|
| Rate for Payer: Ambetter Exchange |
$527.37
|
| Rate for Payer: Anthem Medicaid |
$294.74
|
| Rate for Payer: Buckeye Individual/Medicaid |
$527.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$527.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$632.84
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$838.45
|
| Rate for Payer: Healthspan PPO |
$688.56
|
| Rate for Payer: Humana Medicaid |
$294.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$654.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$527.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$527.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$300.63
|
| Rate for Payer: Molina Healthcare Passport |
$294.74
|
| Rate for Payer: Multiplan PHCS |
$780.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$685.58
|
| Rate for Payer: UHCCP Medicaid |
$455.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$297.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$527.37
|
|
|
TREAT HAND BONE LESION
|
Facility
|
IP
|
$1,300.00
|
|
|
Service Code
|
HCPCS 26034
|
| Hospital Charge Code |
76100656
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$390.00 |
| Max. Negotiated Rate |
$1,248.00 |
| Rate for Payer: Aetna Commercial |
$1,001.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,014.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$1,079.00
|
| Rate for Payer: First Health Commercial |
$1,235.00
|
| Rate for Payer: Humana Commercial |
$1,105.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,066.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$959.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$390.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,144.00
|
| Rate for Payer: Ohio Health Group HMO |
$975.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,040.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,131.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$897.00
|
| Rate for Payer: PHCS Commercial |
$1,248.00
|
| Rate for Payer: United Healthcare All Payer |
$1,144.00
|
|
|
TREAT HAND BONE LESION(P
|
Professional
|
Both
|
$1,300.00
|
|
|
Service Code
|
HCPCS 26034
|
| Hospital Charge Code |
761P0656
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$294.74 |
| Max. Negotiated Rate |
$838.45 |
| Rate for Payer: Aetna Commercial |
$760.18
|
| Rate for Payer: Ambetter Exchange |
$527.37
|
| Rate for Payer: Anthem Medicaid |
$294.74
|
| Rate for Payer: Buckeye Individual/Medicaid |
$527.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$527.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$632.84
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$838.45
|
| Rate for Payer: Healthspan PPO |
$688.56
|
| Rate for Payer: Humana Medicaid |
$294.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$654.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$527.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$527.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$300.63
|
| Rate for Payer: Molina Healthcare Passport |
$294.74
|
| Rate for Payer: Multiplan PHCS |
$780.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$685.58
|
| Rate for Payer: UHCCP Medicaid |
$455.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$297.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$527.37
|
|
|
TREAT HAND DISLOCATION
|
Facility
|
IP
|
$865.00
|
|
|
Service Code
|
HCPCS 26675
|
| Hospital Charge Code |
76100730
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$259.50 |
| Max. Negotiated Rate |
$830.40 |
| Rate for Payer: Aetna Commercial |
$666.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$674.70
|
| Rate for Payer: Cash Price |
$432.50
|
| Rate for Payer: Cigna Commercial |
$717.95
|
| Rate for Payer: First Health Commercial |
$821.75
|
| Rate for Payer: Humana Commercial |
$735.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$709.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$638.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$259.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$761.20
|
| Rate for Payer: Ohio Health Group HMO |
$648.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$692.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$752.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$596.85
|
| Rate for Payer: PHCS Commercial |
$830.40
|
| Rate for Payer: United Healthcare All Payer |
$761.20
|
|
|
TREAT HAND DISLOCATION
|
Professional
|
Both
|
$775.00
|
|
|
Service Code
|
HCPCS 26685
|
| Hospital Charge Code |
360P1268
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$271.25 |
| Max. Negotiated Rate |
$867.79 |
| Rate for Payer: Aetna Commercial |
$804.57
|
| Rate for Payer: Ambetter Exchange |
$552.09
|
| Rate for Payer: Anthem Medicaid |
$368.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$552.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$552.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$662.51
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cigna Commercial |
$867.79
|
| Rate for Payer: Healthspan PPO |
$728.77
|
| Rate for Payer: Humana Medicaid |
$368.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$701.07
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$552.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$552.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$375.88
|
| Rate for Payer: Molina Healthcare Passport |
$368.51
|
| Rate for Payer: Multiplan PHCS |
$465.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$717.72
|
| Rate for Payer: UHCCP Medicaid |
$271.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$372.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$552.09
|
|
|
TREAT HAND DISLOCATION
|
Professional
|
Both
|
$775.00
|
|
|
Service Code
|
HCPCS 26685
|
| Hospital Charge Code |
36001268
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$271.25 |
| Max. Negotiated Rate |
$867.79 |
| Rate for Payer: Aetna Commercial |
$804.57
|
| Rate for Payer: Ambetter Exchange |
$552.09
|
| Rate for Payer: Anthem Medicaid |
$368.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$552.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$552.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$662.51
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cigna Commercial |
$867.79
|
| Rate for Payer: Healthspan PPO |
$728.77
|
| Rate for Payer: Humana Medicaid |
$368.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$701.07
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$552.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$552.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$375.88
|
| Rate for Payer: Molina Healthcare Passport |
$368.51
|
| Rate for Payer: Multiplan PHCS |
$465.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$717.72
|
| Rate for Payer: UHCCP Medicaid |
$271.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$372.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$552.09
|
|
|
TREAT HAND DISLOCATION
|
Professional
|
Both
|
$865.00
|
|
|
Service Code
|
HCPCS 26675
|
| Hospital Charge Code |
76100730
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$219.58 |
| Max. Negotiated Rate |
$606.58 |
| Rate for Payer: Aetna Commercial |
$563.28
|
| Rate for Payer: Ambetter Exchange |
$408.85
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$219.58
|
| Rate for Payer: Anthem Medicaid |
$261.27
|
| Rate for Payer: Buckeye Individual/Medicaid |
$408.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$408.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$490.62
|
| Rate for Payer: Cash Price |
$432.50
|
| Rate for Payer: Cash Price |
$432.50
|
| Rate for Payer: Cigna Commercial |
$606.58
|
| Rate for Payer: Healthspan PPO |
$548.01
|
| Rate for Payer: Humana Medicaid |
$261.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$496.36
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$408.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$408.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$266.50
|
| Rate for Payer: Molina Healthcare Passport |
$261.27
|
| Rate for Payer: Multiplan PHCS |
$519.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$531.50
|
| Rate for Payer: UHCCP Medicaid |
$230.56
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$263.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$408.85
|
|
|
TREAT HAND DISLOCATION
|
Facility
|
OP
|
$865.00
|
|
|
Service Code
|
HCPCS 26675
|
| Hospital Charge Code |
76100730
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$297.47 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$666.05
|
| Rate for Payer: Anthem Medicaid |
$297.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$674.70
|
| 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 |
$432.50
|
| Rate for Payer: Cash Price |
$432.50
|
| Rate for Payer: Cigna Commercial |
$717.95
|
| Rate for Payer: First Health Commercial |
$821.75
|
| Rate for Payer: Humana Commercial |
$735.25
|
| Rate for Payer: Humana KY Medicaid |
$297.47
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$300.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$709.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$638.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$303.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$761.20
|
| Rate for Payer: Ohio Health Group HMO |
$648.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$692.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$752.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$596.85
|
| Rate for Payer: PHCS Commercial |
$830.40
|
| Rate for Payer: United Healthcare All Payer |
$761.20
|
|
|
TREAT HAND DISLOCATION(P
|
Professional
|
Both
|
$865.00
|
|
|
Service Code
|
HCPCS 26675
|
| Hospital Charge Code |
761P0730
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$219.58 |
| Max. Negotiated Rate |
$606.58 |
| Rate for Payer: Aetna Commercial |
$563.28
|
| Rate for Payer: Ambetter Exchange |
$408.85
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$219.58
|
| Rate for Payer: Anthem Medicaid |
$261.27
|
| Rate for Payer: Buckeye Individual/Medicaid |
$408.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$408.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$490.62
|
| Rate for Payer: Cash Price |
$432.50
|
| Rate for Payer: Cash Price |
$432.50
|
| Rate for Payer: Cigna Commercial |
$606.58
|
| Rate for Payer: Healthspan PPO |
$548.01
|
| Rate for Payer: Humana Medicaid |
$261.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$496.36
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$408.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$408.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$266.50
|
| Rate for Payer: Molina Healthcare Passport |
$261.27
|
| Rate for Payer: Multiplan PHCS |
$519.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$531.50
|
| Rate for Payer: UHCCP Medicaid |
$230.56
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$263.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$408.85
|
|
|
TREAT HIP DISLOCATION
|
Professional
|
Both
|
$4,480.00
|
|
|
Service Code
|
HCPCS 27253
|
| Hospital Charge Code |
76100800
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$755.25 |
| Max. Negotiated Rate |
$2,688.00 |
| Rate for Payer: Aetna Commercial |
$1,409.23
|
| Rate for Payer: Ambetter Exchange |
$893.72
|
| Rate for Payer: Anthem Medicaid |
$755.25
|
| Rate for Payer: Buckeye Individual/Medicaid |
$893.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$893.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,072.46
|
| Rate for Payer: Cash Price |
$2,240.00
|
| Rate for Payer: Cash Price |
$2,240.00
|
| Rate for Payer: Cigna Commercial |
$1,538.96
|
| Rate for Payer: Healthspan PPO |
$1,276.46
|
| Rate for Payer: Humana Medicaid |
$755.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,177.10
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$893.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$893.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$770.36
|
| Rate for Payer: Molina Healthcare Passport |
$755.25
|
| Rate for Payer: Multiplan PHCS |
$2,688.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,161.84
|
| Rate for Payer: UHCCP Medicaid |
$1,568.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$762.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$893.72
|
|
|
TREAT HIP DISLOCATION
|
Facility
|
OP
|
$4,480.00
|
|
|
Service Code
|
HCPCS 27253
|
| Hospital Charge Code |
76100800
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,344.00 |
| Max. Negotiated Rate |
$4,300.80 |
| Rate for Payer: Aetna Commercial |
$3,449.60
|
| Rate for Payer: Anthem Medicaid |
$1,540.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,494.40
|
| Rate for Payer: Cash Price |
$2,240.00
|
| Rate for Payer: Cigna Commercial |
$3,718.40
|
| Rate for Payer: First Health Commercial |
$4,256.00
|
| Rate for Payer: Humana Commercial |
$3,808.00
|
| Rate for Payer: Humana KY Medicaid |
$1,540.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1,556.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,673.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,306.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,344.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,571.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,942.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,360.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,584.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,897.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,091.20
|
| Rate for Payer: PHCS Commercial |
$4,300.80
|
| Rate for Payer: United Healthcare All Payer |
$3,942.40
|
|
|
TREAT HIP DISLOCATION
|
Facility
|
IP
|
$4,480.00
|
|
|
Service Code
|
HCPCS 27253
|
| Hospital Charge Code |
76100800
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,344.00 |
| Max. Negotiated Rate |
$4,300.80 |
| Rate for Payer: Aetna Commercial |
$3,449.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,494.40
|
| Rate for Payer: Cash Price |
$2,240.00
|
| Rate for Payer: Cigna Commercial |
$3,718.40
|
| Rate for Payer: First Health Commercial |
$4,256.00
|
| Rate for Payer: Humana Commercial |
$3,808.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,673.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,306.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,344.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,942.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,360.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,584.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,897.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,091.20
|
| Rate for Payer: PHCS Commercial |
$4,300.80
|
| Rate for Payer: United Healthcare All Payer |
$3,942.40
|
|
|
TREAT HIP DISLOCATION(P
|
Professional
|
Both
|
$2,240.00
|
|
|
Service Code
|
HCPCS 27253
|
| Hospital Charge Code |
761P0800
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$755.25 |
| Max. Negotiated Rate |
$1,538.96 |
| Rate for Payer: Aetna Commercial |
$1,409.23
|
| Rate for Payer: Ambetter Exchange |
$893.72
|
| Rate for Payer: Anthem Medicaid |
$755.25
|
| Rate for Payer: Buckeye Individual/Medicaid |
$893.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$893.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,072.46
|
| Rate for Payer: Cash Price |
$1,120.00
|
| Rate for Payer: Cash Price |
$1,120.00
|
| Rate for Payer: Cigna Commercial |
$1,538.96
|
| Rate for Payer: Healthspan PPO |
$1,276.46
|
| Rate for Payer: Humana Medicaid |
$755.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,177.10
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$893.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$893.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$770.36
|
| Rate for Payer: Molina Healthcare Passport |
$755.25
|
| Rate for Payer: Multiplan PHCS |
$1,344.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,161.84
|
| Rate for Payer: UHCCP Medicaid |
$784.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$762.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$893.72
|
|
|
TREAT HIP DISLOCATION(T
|
Facility
|
IP
|
$2,240.00
|
|
|
Service Code
|
HCPCS 27253
|
| Hospital Charge Code |
761T0800
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$672.00 |
| Max. Negotiated Rate |
$2,150.40 |
| Rate for Payer: Aetna Commercial |
$1,724.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,747.20
|
| Rate for Payer: Cash Price |
$1,120.00
|
| Rate for Payer: Cigna Commercial |
$1,859.20
|
| Rate for Payer: First Health Commercial |
$2,128.00
|
| Rate for Payer: Humana Commercial |
$1,904.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,836.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,653.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$672.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,971.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,680.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,792.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,948.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,545.60
|
| Rate for Payer: PHCS Commercial |
$2,150.40
|
| Rate for Payer: United Healthcare All Payer |
$1,971.20
|
|
|
TREAT HIP DISLOCATION(T
|
Facility
|
OP
|
$2,240.00
|
|
|
Service Code
|
HCPCS 27253
|
| Hospital Charge Code |
761T0800
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$672.00 |
| Max. Negotiated Rate |
$2,150.40 |
| Rate for Payer: Aetna Commercial |
$1,724.80
|
| Rate for Payer: Anthem Medicaid |
$770.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,747.20
|
| Rate for Payer: Cash Price |
$1,120.00
|
| Rate for Payer: Cigna Commercial |
$1,859.20
|
| Rate for Payer: First Health Commercial |
$2,128.00
|
| Rate for Payer: Humana Commercial |
$1,904.00
|
| Rate for Payer: Humana KY Medicaid |
$770.34
|
| Rate for Payer: Kentucky WC Medicaid |
$778.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,836.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,653.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$672.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$785.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,971.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,680.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,792.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,948.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,545.60
|
| Rate for Payer: PHCS Commercial |
$2,150.40
|
| Rate for Payer: United Healthcare All Payer |
$1,971.20
|
|
|
TREAT HIP SOCKET FRACTURE
|
Facility
|
OP
|
$932.00
|
|
|
Service Code
|
HCPCS 27220
|
| Hospital Charge Code |
76100787
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$894.72 |
| Rate for Payer: Aetna Commercial |
$717.64
|
| Rate for Payer: Anthem Medicaid |
$320.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$726.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$466.00
|
| Rate for Payer: Cash Price |
$466.00
|
| Rate for Payer: Cigna Commercial |
$773.56
|
| Rate for Payer: First Health Commercial |
$885.40
|
| Rate for Payer: Humana Commercial |
$792.20
|
| Rate for Payer: Humana KY Medicaid |
$320.51
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$323.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$764.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$687.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$326.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$820.16
|
| Rate for Payer: Ohio Health Group HMO |
$699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$745.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$810.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$643.08
|
| Rate for Payer: PHCS Commercial |
$894.72
|
| Rate for Payer: United Healthcare All Payer |
$820.16
|
|
|
TREAT HIP SOCKET FRACTURE
|
Professional
|
Both
|
$932.00
|
|
|
Service Code
|
HCPCS 27220
|
| Hospital Charge Code |
76100787
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$284.16 |
| Max. Negotiated Rate |
$815.75 |
| Rate for Payer: Aetna Commercial |
$752.05
|
| Rate for Payer: Ambetter Exchange |
$395.38
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$303.03
|
| Rate for Payer: Anthem Medicaid |
$284.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$395.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$395.38
|
| Rate for Payer: CareSource Just4Me Medicare |
$474.46
|
| Rate for Payer: Cash Price |
$466.00
|
| Rate for Payer: Cash Price |
$466.00
|
| Rate for Payer: Cigna Commercial |
$815.75
|
| Rate for Payer: Healthspan PPO |
$685.55
|
| Rate for Payer: Humana Medicaid |
$284.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$643.76
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$395.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$289.84
|
| Rate for Payer: Molina Healthcare Passport |
$284.16
|
| Rate for Payer: Multiplan PHCS |
$559.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$513.99
|
| Rate for Payer: UHCCP Medicaid |
$318.18
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$287.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$395.38
|
|
|
TREAT HIP SOCKET FRACTURE
|
Facility
|
IP
|
$932.00
|
|
|
Service Code
|
HCPCS 27220
|
| Hospital Charge Code |
76100787
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$279.60 |
| Max. Negotiated Rate |
$894.72 |
| Rate for Payer: Aetna Commercial |
$717.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$726.96
|
| Rate for Payer: Cash Price |
$466.00
|
| Rate for Payer: Cigna Commercial |
$773.56
|
| Rate for Payer: First Health Commercial |
$885.40
|
| Rate for Payer: Humana Commercial |
$792.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$764.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$687.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$279.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$820.16
|
| Rate for Payer: Ohio Health Group HMO |
$699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$745.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$810.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$643.08
|
| Rate for Payer: PHCS Commercial |
$894.72
|
| Rate for Payer: United Healthcare All Payer |
$820.16
|
|
|
TREAT HIP SOCKET FRACTURE(P
|
Professional
|
Both
|
$932.00
|
|
|
Service Code
|
HCPCS 27220
|
| Hospital Charge Code |
761P0787
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$284.16 |
| Max. Negotiated Rate |
$815.75 |
| Rate for Payer: Aetna Commercial |
$752.05
|
| Rate for Payer: Ambetter Exchange |
$395.38
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$303.03
|
| Rate for Payer: Anthem Medicaid |
$284.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$395.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$395.38
|
| Rate for Payer: CareSource Just4Me Medicare |
$474.46
|
| Rate for Payer: Cash Price |
$466.00
|
| Rate for Payer: Cash Price |
$466.00
|
| Rate for Payer: Cigna Commercial |
$815.75
|
| Rate for Payer: Healthspan PPO |
$685.55
|
| Rate for Payer: Humana Medicaid |
$284.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$643.76
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$395.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$289.84
|
| Rate for Payer: Molina Healthcare Passport |
$284.16
|
| Rate for Payer: Multiplan PHCS |
$559.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$513.99
|
| Rate for Payer: UHCCP Medicaid |
$318.18
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$287.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$395.38
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
IP
|
$2,024.00
|
|
|
Service Code
|
HCPCS 23605
|
| Hospital Charge Code |
45000111
|
|
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 HUMERUS FRACTURE
|
Facility
|
OP
|
$2,120.00
|
|
|
Service Code
|
HCPCS 24505
|
| Hospital Charge Code |
45000118
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$729.07 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$1,632.40
|
| Rate for Payer: Anthem Medicaid |
$729.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,653.60
|
| 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 |
$1,060.00
|
| Rate for Payer: Cash Price |
$1,060.00
|
| Rate for Payer: Cigna Commercial |
$1,759.60
|
| Rate for Payer: First Health Commercial |
$2,014.00
|
| Rate for Payer: Humana Commercial |
$1,802.00
|
| Rate for Payer: Humana KY Medicaid |
$729.07
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$736.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,738.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,564.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$743.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,865.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,590.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,696.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,844.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,462.80
|
| Rate for Payer: PHCS Commercial |
$2,035.20
|
| Rate for Payer: United Healthcare All Payer |
$1,865.60
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
IP
|
$2,120.00
|
|
|
Service Code
|
HCPCS 24505
|
| Hospital Charge Code |
45000118
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$636.00 |
| Max. Negotiated Rate |
$2,035.20 |
| Rate for Payer: Aetna Commercial |
$1,632.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,653.60
|
| Rate for Payer: Cash Price |
$1,060.00
|
| Rate for Payer: Cigna Commercial |
$1,759.60
|
| Rate for Payer: First Health Commercial |
$2,014.00
|
| Rate for Payer: Humana Commercial |
$1,802.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,738.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,564.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$636.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,865.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,590.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,696.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,844.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,462.80
|
| Rate for Payer: PHCS Commercial |
$2,035.20
|
| Rate for Payer: United Healthcare All Payer |
$1,865.60
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
IP
|
$3,335.00
|
|
|
Service Code
|
HCPCS 24505
|
| Hospital Charge Code |
76100533
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,000.50 |
| Max. Negotiated Rate |
$3,201.60 |
| Rate for Payer: Aetna Commercial |
$2,567.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,601.30
|
| Rate for Payer: Cash Price |
$1,667.50
|
| Rate for Payer: Cigna Commercial |
$2,768.05
|
| Rate for Payer: First Health Commercial |
$3,168.25
|
| Rate for Payer: Humana Commercial |
$2,834.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,734.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,461.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,000.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,934.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,501.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,668.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,901.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,301.15
|
| Rate for Payer: PHCS Commercial |
$3,201.60
|
| Rate for Payer: United Healthcare All Payer |
$2,934.80
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
IP
|
$2,924.00
|
|
|
Service Code
|
HCPCS 23605
|
| Hospital Charge Code |
76100479
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$877.20 |
| Max. Negotiated Rate |
$2,807.04 |
| Rate for Payer: Aetna Commercial |
$2,251.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,280.72
|
| Rate for Payer: Cash Price |
$1,462.00
|
| Rate for Payer: Cigna Commercial |
$2,426.92
|
| Rate for Payer: First Health Commercial |
$2,777.80
|
| Rate for Payer: Humana Commercial |
$2,485.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,397.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,157.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$877.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,573.12
|
| Rate for Payer: Ohio Health Group HMO |
$2,193.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,339.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,543.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,017.56
|
| Rate for Payer: PHCS Commercial |
$2,807.04
|
| Rate for Payer: United Healthcare All Payer |
$2,573.12
|
|
