|
TREAT METACARPAL FRACTURE
|
Professional
|
Both
|
$1,055.00
|
|
|
Service Code
|
HCPCS 26600
|
| Hospital Charge Code |
76100721
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$99.76 |
| Max. Negotiated Rate |
$633.00 |
| Rate for Payer: Aetna Commercial |
$340.08
|
| Rate for Payer: Ambetter Exchange |
$279.09
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$149.16
|
| Rate for Payer: Anthem Medicaid |
$99.76
|
| Rate for Payer: Buckeye Individual/Medicaid |
$279.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$279.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$334.91
|
| Rate for Payer: Cash Price |
$527.50
|
| Rate for Payer: Cash Price |
$527.50
|
| Rate for Payer: Cigna Commercial |
$396.82
|
| Rate for Payer: Healthspan PPO |
$331.79
|
| Rate for Payer: Humana Medicaid |
$99.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$316.99
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$279.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$279.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$101.76
|
| Rate for Payer: Molina Healthcare Passport |
$99.76
|
| Rate for Payer: Multiplan PHCS |
$633.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$362.82
|
| Rate for Payer: UHCCP Medicaid |
$156.62
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$100.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$279.09
|
|
|
TREAT METACARPAL FRACTURE
|
Facility
|
OP
|
$1,055.00
|
|
|
Service Code
|
HCPCS 26600
|
| Hospital Charge Code |
76100721
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$1,012.80 |
| Rate for Payer: Aetna Commercial |
$812.35
|
| Rate for Payer: Anthem Medicaid |
$362.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$822.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$527.50
|
| Rate for Payer: Cash Price |
$527.50
|
| Rate for Payer: Cigna Commercial |
$875.65
|
| Rate for Payer: First Health Commercial |
$1,002.25
|
| Rate for Payer: Humana Commercial |
$896.75
|
| Rate for Payer: Humana KY Medicaid |
$362.81
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$366.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$865.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$778.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$370.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$928.40
|
| Rate for Payer: Ohio Health Group HMO |
$791.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$844.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$917.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$727.95
|
| Rate for Payer: PHCS Commercial |
$1,012.80
|
| Rate for Payer: United Healthcare All Payer |
$928.40
|
|
|
TREAT METACARPAL FRACTURE
|
Professional
|
Both
|
$1,150.00
|
|
|
Service Code
|
HCPCS 26607
|
| Hospital Charge Code |
76100723
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$259.31 |
| Max. Negotiated Rate |
$749.74 |
| Rate for Payer: Aetna Commercial |
$625.22
|
| Rate for Payer: Ambetter Exchange |
$479.64
|
| Rate for Payer: Anthem Medicaid |
$259.31
|
| Rate for Payer: Buckeye Individual/Medicaid |
$479.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$479.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$575.57
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cigna Commercial |
$749.74
|
| Rate for Payer: Healthspan PPO |
$566.31
|
| Rate for Payer: Humana Medicaid |
$259.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$546.36
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$479.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$479.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$264.50
|
| Rate for Payer: Molina Healthcare Passport |
$259.31
|
| Rate for Payer: Multiplan PHCS |
$690.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$623.53
|
| Rate for Payer: UHCCP Medicaid |
$402.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$261.90
|
| Rate for Payer: Wellcare Medicare Advantage |
$479.64
|
|
|
TREAT METACARPAL FRACTURE
|
Facility
|
IP
|
$1,150.00
|
|
|
Service Code
|
HCPCS 26607
|
| Hospital Charge Code |
76100723
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$345.00 |
| Max. Negotiated Rate |
$1,104.00 |
| Rate for Payer: Aetna Commercial |
$885.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$897.00
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cigna Commercial |
$954.50
|
| Rate for Payer: First Health Commercial |
$1,092.50
|
| Rate for Payer: Humana Commercial |
$977.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$943.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$848.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,012.00
|
| Rate for Payer: Ohio Health Group HMO |
$862.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,000.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$793.50
|
| Rate for Payer: PHCS Commercial |
$1,104.00
|
| Rate for Payer: United Healthcare All Payer |
$1,012.00
|
|
|
TREAT METACARPAL FRACTURE
|
Facility
|
OP
|
$1,150.00
|
|
|
Service Code
|
HCPCS 26607
|
| Hospital Charge Code |
76100723
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$395.49 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$885.50
|
| Rate for Payer: Anthem Medicaid |
$395.49
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$897.00
|
| 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 |
$575.00
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cigna Commercial |
$954.50
|
| Rate for Payer: First Health Commercial |
$1,092.50
|
| Rate for Payer: Humana Commercial |
$977.50
|
| Rate for Payer: Humana KY Medicaid |
$395.49
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$399.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$943.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$848.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$403.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,012.00
|
| Rate for Payer: Ohio Health Group HMO |
$862.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,000.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$793.50
|
| Rate for Payer: PHCS Commercial |
$1,104.00
|
| Rate for Payer: United Healthcare All Payer |
$1,012.00
|
|
|
TREAT METACARPAL FRACTURE
|
Facility
|
IP
|
$1,055.00
|
|
|
Service Code
|
HCPCS 26600
|
| Hospital Charge Code |
76100721
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$316.50 |
| Max. Negotiated Rate |
$1,012.80 |
| Rate for Payer: Aetna Commercial |
$812.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$822.90
|
| Rate for Payer: Cash Price |
$527.50
|
| Rate for Payer: Cigna Commercial |
$875.65
|
| Rate for Payer: First Health Commercial |
$1,002.25
|
| Rate for Payer: Humana Commercial |
$896.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$865.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$778.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$316.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$928.40
|
| Rate for Payer: Ohio Health Group HMO |
$791.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$844.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$917.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$727.95
|
| Rate for Payer: PHCS Commercial |
$1,012.80
|
| Rate for Payer: United Healthcare All Payer |
$928.40
|
|
|
TREAT METACARPAL FRACTURE(P
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 26600
|
| Hospital Charge Code |
761P0721
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$99.76 |
| Max. Negotiated Rate |
$396.82 |
| Rate for Payer: Aetna Commercial |
$340.08
|
| Rate for Payer: Ambetter Exchange |
$279.09
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$149.16
|
| Rate for Payer: Anthem Medicaid |
$99.76
|
| Rate for Payer: Buckeye Individual/Medicaid |
$279.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$279.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$334.91
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$396.82
|
| Rate for Payer: Healthspan PPO |
$331.79
|
| Rate for Payer: Humana Medicaid |
$99.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$316.99
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$279.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$279.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$101.76
|
| Rate for Payer: Molina Healthcare Passport |
$99.76
|
| Rate for Payer: Multiplan PHCS |
$330.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$362.82
|
| Rate for Payer: UHCCP Medicaid |
$156.62
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$100.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$279.09
|
|
|
TREAT METACARPAL FRACTURE(P
|
Professional
|
Both
|
$1,150.00
|
|
|
Service Code
|
HCPCS 26607
|
| Hospital Charge Code |
761P0723
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$259.31 |
| Max. Negotiated Rate |
$749.74 |
| Rate for Payer: Aetna Commercial |
$625.22
|
| Rate for Payer: Ambetter Exchange |
$479.64
|
| Rate for Payer: Anthem Medicaid |
$259.31
|
| Rate for Payer: Buckeye Individual/Medicaid |
$479.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$479.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$575.57
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cigna Commercial |
$749.74
|
| Rate for Payer: Healthspan PPO |
$566.31
|
| Rate for Payer: Humana Medicaid |
$259.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$546.36
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$479.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$479.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$264.50
|
| Rate for Payer: Molina Healthcare Passport |
$259.31
|
| Rate for Payer: Multiplan PHCS |
$690.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$623.53
|
| Rate for Payer: UHCCP Medicaid |
$402.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$261.90
|
| Rate for Payer: Wellcare Medicare Advantage |
$479.64
|
|
|
TREAT METACARPAL FRACTURE(T
|
Facility
|
IP
|
$505.00
|
|
|
Service Code
|
HCPCS 26600
|
| Hospital Charge Code |
761T0721
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$151.50 |
| Max. Negotiated Rate |
$484.80 |
| Rate for Payer: Aetna Commercial |
$388.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$393.90
|
| Rate for Payer: Cash Price |
$252.50
|
| Rate for Payer: Cigna Commercial |
$419.15
|
| Rate for Payer: First Health Commercial |
$479.75
|
| Rate for Payer: Humana Commercial |
$429.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$414.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$372.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$151.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$444.40
|
| Rate for Payer: Ohio Health Group HMO |
$378.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$404.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$439.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$348.45
|
| Rate for Payer: PHCS Commercial |
$484.80
|
| Rate for Payer: United Healthcare All Payer |
$444.40
|
|
|
TREAT METACARPAL FRACTURE(T
|
Facility
|
OP
|
$505.00
|
|
|
Service Code
|
HCPCS 26600
|
| Hospital Charge Code |
761T0721
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$173.67 |
| Max. Negotiated Rate |
$484.80 |
| Rate for Payer: Aetna Commercial |
$388.85
|
| Rate for Payer: Anthem Medicaid |
$173.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$393.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$252.50
|
| Rate for Payer: Cash Price |
$252.50
|
| Rate for Payer: Cigna Commercial |
$419.15
|
| Rate for Payer: First Health Commercial |
$479.75
|
| Rate for Payer: Humana Commercial |
$429.25
|
| Rate for Payer: Humana KY Medicaid |
$173.67
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$175.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$414.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$372.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$177.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$444.40
|
| Rate for Payer: Ohio Health Group HMO |
$378.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$404.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$439.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$348.45
|
| Rate for Payer: PHCS Commercial |
$484.80
|
| Rate for Payer: United Healthcare All Payer |
$444.40
|
|
|
TREAT MIDFOOT FRACTURE EACH
|
Facility
|
OP
|
$1,137.00
|
|
|
Service Code
|
HCPCS 28450
|
| Hospital Charge Code |
76101016
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$1,091.52 |
| Rate for Payer: Aetna Commercial |
$875.49
|
| Rate for Payer: Anthem Medicaid |
$391.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$886.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$568.50
|
| Rate for Payer: Cash Price |
$568.50
|
| Rate for Payer: Cigna Commercial |
$943.71
|
| Rate for Payer: First Health Commercial |
$1,080.15
|
| Rate for Payer: Humana Commercial |
$966.45
|
| Rate for Payer: Humana KY Medicaid |
$391.01
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$394.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$932.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$839.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$398.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,000.56
|
| Rate for Payer: Ohio Health Group HMO |
$852.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$909.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$989.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$784.53
|
| Rate for Payer: PHCS Commercial |
$1,091.52
|
| Rate for Payer: United Healthcare All Payer |
$1,000.56
|
|
|
TREAT MIDFOOT FRACTURE EACH
|
Professional
|
Both
|
$1,137.00
|
|
|
Service Code
|
HCPCS 28450
|
| Hospital Charge Code |
76101016
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.73 |
| Max. Negotiated Rate |
$682.20 |
| Rate for Payer: Aetna Commercial |
$260.95
|
| Rate for Payer: Ambetter Exchange |
$183.75
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$104.73
|
| Rate for Payer: Anthem Medicaid |
$108.17
|
| Rate for Payer: Buckeye Individual/Medicaid |
$183.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$183.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$220.50
|
| Rate for Payer: Cash Price |
$568.50
|
| Rate for Payer: Cash Price |
$568.50
|
| Rate for Payer: Cigna Commercial |
$326.11
|
| Rate for Payer: Healthspan PPO |
$261.58
|
| Rate for Payer: Humana Medicaid |
$108.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$228.03
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$183.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$183.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$110.33
|
| Rate for Payer: Molina Healthcare Passport |
$108.17
|
| Rate for Payer: Multiplan PHCS |
$682.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$238.88
|
| Rate for Payer: UHCCP Medicaid |
$109.97
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$109.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$183.75
|
|
|
TREAT MIDFOOT FRACTURE EACH
|
Facility
|
OP
|
$1,240.00
|
|
|
Service Code
|
HCPCS 28465
|
| Hospital Charge Code |
76101018
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$426.44 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$954.80
|
| Rate for Payer: Anthem Medicaid |
$426.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$967.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| Rate for Payer: Cash Price |
$620.00
|
| Rate for Payer: Cash Price |
$620.00
|
| Rate for Payer: Cigna Commercial |
$1,029.20
|
| Rate for Payer: First Health Commercial |
$1,178.00
|
| Rate for Payer: Humana Commercial |
$1,054.00
|
| Rate for Payer: Humana KY Medicaid |
$426.44
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$430.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,016.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$915.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$434.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,091.20
|
| Rate for Payer: Ohio Health Group HMO |
$930.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$992.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,078.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$855.60
|
| Rate for Payer: PHCS Commercial |
$1,190.40
|
| Rate for Payer: United Healthcare All Payer |
$1,091.20
|
|
|
TREAT MIDFOOT FRACTURE EACH
|
Professional
|
Both
|
$1,240.00
|
|
|
Service Code
|
HCPCS 28465
|
| Hospital Charge Code |
76101018
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$360.48 |
| Max. Negotiated Rate |
$903.02 |
| Rate for Payer: Aetna Commercial |
$903.02
|
| Rate for Payer: Ambetter Exchange |
$610.39
|
| Rate for Payer: Anthem Medicaid |
$360.48
|
| Rate for Payer: Buckeye Individual/Medicaid |
$610.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$610.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$732.47
|
| Rate for Payer: Cash Price |
$620.00
|
| Rate for Payer: Cash Price |
$620.00
|
| Rate for Payer: Cigna Commercial |
$872.93
|
| Rate for Payer: Healthspan PPO |
$817.95
|
| Rate for Payer: Humana Medicaid |
$360.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$755.12
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$610.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$610.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$367.69
|
| Rate for Payer: Molina Healthcare Passport |
$360.48
|
| Rate for Payer: Multiplan PHCS |
$744.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$793.51
|
| Rate for Payer: UHCCP Medicaid |
$434.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$364.08
|
| Rate for Payer: Wellcare Medicare Advantage |
$610.39
|
|
|
TREAT MIDFOOT FRACTURE EACH
|
Facility
|
IP
|
$1,137.00
|
|
|
Service Code
|
HCPCS 28450
|
| Hospital Charge Code |
76101016
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$341.10 |
| Max. Negotiated Rate |
$1,091.52 |
| Rate for Payer: Aetna Commercial |
$875.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$886.86
|
| Rate for Payer: Cash Price |
$568.50
|
| Rate for Payer: Cigna Commercial |
$943.71
|
| Rate for Payer: First Health Commercial |
$1,080.15
|
| Rate for Payer: Humana Commercial |
$966.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$932.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$839.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$341.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,000.56
|
| Rate for Payer: Ohio Health Group HMO |
$852.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$909.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$989.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$784.53
|
| Rate for Payer: PHCS Commercial |
$1,091.52
|
| Rate for Payer: United Healthcare All Payer |
$1,000.56
|
|
|
TREAT MIDFOOT FRACTURE EACH
|
Facility
|
IP
|
$1,240.00
|
|
|
Service Code
|
HCPCS 28465
|
| Hospital Charge Code |
76101018
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$372.00 |
| Max. Negotiated Rate |
$1,190.40 |
| Rate for Payer: Aetna Commercial |
$954.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$967.20
|
| Rate for Payer: Cash Price |
$620.00
|
| Rate for Payer: Cigna Commercial |
$1,029.20
|
| Rate for Payer: First Health Commercial |
$1,178.00
|
| Rate for Payer: Humana Commercial |
$1,054.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,016.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$915.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$372.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,091.20
|
| Rate for Payer: Ohio Health Group HMO |
$930.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$992.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,078.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$855.60
|
| Rate for Payer: PHCS Commercial |
$1,190.40
|
| Rate for Payer: United Healthcare All Payer |
$1,091.20
|
|
|
TREAT MIDFOOT FRACTURE EACH(P
|
Professional
|
Both
|
$610.00
|
|
|
Service Code
|
HCPCS 28450
|
| Hospital Charge Code |
761P1016
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.73 |
| Max. Negotiated Rate |
$366.00 |
| Rate for Payer: Aetna Commercial |
$260.95
|
| Rate for Payer: Ambetter Exchange |
$183.75
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$104.73
|
| Rate for Payer: Anthem Medicaid |
$108.17
|
| Rate for Payer: Buckeye Individual/Medicaid |
$183.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$183.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$220.50
|
| Rate for Payer: Cash Price |
$305.00
|
| Rate for Payer: Cash Price |
$305.00
|
| Rate for Payer: Cigna Commercial |
$326.11
|
| Rate for Payer: Healthspan PPO |
$261.58
|
| Rate for Payer: Humana Medicaid |
$108.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$228.03
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$183.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$183.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$110.33
|
| Rate for Payer: Molina Healthcare Passport |
$108.17
|
| Rate for Payer: Multiplan PHCS |
$366.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$238.88
|
| Rate for Payer: UHCCP Medicaid |
$109.97
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$109.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$183.75
|
|
|
TREAT MIDFOOT FRACTURE EACH(P
|
Professional
|
Both
|
$1,240.00
|
|
|
Service Code
|
HCPCS 28465
|
| Hospital Charge Code |
761P1018
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$360.48 |
| Max. Negotiated Rate |
$903.02 |
| Rate for Payer: Aetna Commercial |
$903.02
|
| Rate for Payer: Ambetter Exchange |
$610.39
|
| Rate for Payer: Anthem Medicaid |
$360.48
|
| Rate for Payer: Buckeye Individual/Medicaid |
$610.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$610.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$732.47
|
| Rate for Payer: Cash Price |
$620.00
|
| Rate for Payer: Cash Price |
$620.00
|
| Rate for Payer: Cigna Commercial |
$872.93
|
| Rate for Payer: Healthspan PPO |
$817.95
|
| Rate for Payer: Humana Medicaid |
$360.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$755.12
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$610.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$610.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$367.69
|
| Rate for Payer: Molina Healthcare Passport |
$360.48
|
| Rate for Payer: Multiplan PHCS |
$744.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$793.51
|
| Rate for Payer: UHCCP Medicaid |
$434.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$364.08
|
| Rate for Payer: Wellcare Medicare Advantage |
$610.39
|
|
|
TREAT MIDFOOT FRACTURE EACH(T
|
Facility
|
IP
|
$527.00
|
|
|
Service Code
|
HCPCS 28450
|
| Hospital Charge Code |
761T1016
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$158.10 |
| Max. Negotiated Rate |
$505.92 |
| Rate for Payer: Aetna Commercial |
$405.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$411.06
|
| Rate for Payer: Cash Price |
$263.50
|
| Rate for Payer: Cigna Commercial |
$437.41
|
| Rate for Payer: First Health Commercial |
$500.65
|
| Rate for Payer: Humana Commercial |
$447.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$432.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$388.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$158.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$463.76
|
| Rate for Payer: Ohio Health Group HMO |
$395.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$421.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$458.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$363.63
|
| Rate for Payer: PHCS Commercial |
$505.92
|
| Rate for Payer: United Healthcare All Payer |
$463.76
|
|
|
TREAT MIDFOOT FRACTURE EACH(T
|
Facility
|
OP
|
$527.00
|
|
|
Service Code
|
HCPCS 28450
|
| Hospital Charge Code |
761T1016
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$181.24 |
| Max. Negotiated Rate |
$505.92 |
| Rate for Payer: Aetna Commercial |
$405.79
|
| Rate for Payer: Anthem Medicaid |
$181.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$411.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$263.50
|
| Rate for Payer: Cash Price |
$263.50
|
| Rate for Payer: Cigna Commercial |
$437.41
|
| Rate for Payer: First Health Commercial |
$500.65
|
| Rate for Payer: Humana Commercial |
$447.95
|
| Rate for Payer: Humana KY Medicaid |
$181.24
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$183.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$432.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$388.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$184.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$463.76
|
| Rate for Payer: Ohio Health Group HMO |
$395.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$421.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$458.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$363.63
|
| Rate for Payer: PHCS Commercial |
$505.92
|
| Rate for Payer: United Healthcare All Payer |
$463.76
|
|
|
TREAT MOUTH ROOF FRACTURE
|
Professional
|
Both
|
$1,775.00
|
|
|
Service Code
|
HCPCS 21422
|
| Hospital Charge Code |
76100388
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$520.06 |
| Max. Negotiated Rate |
$1,065.64 |
| Rate for Payer: Aetna Commercial |
$960.96
|
| Rate for Payer: Ambetter Exchange |
$595.00
|
| Rate for Payer: Anthem Medicaid |
$520.06
|
| Rate for Payer: Buckeye Individual/Medicaid |
$595.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$595.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$714.00
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cigna Commercial |
$1,065.64
|
| Rate for Payer: Healthspan PPO |
$870.42
|
| Rate for Payer: Humana Medicaid |
$520.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$821.46
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$595.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$595.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$530.46
|
| Rate for Payer: Molina Healthcare Passport |
$520.06
|
| Rate for Payer: Multiplan PHCS |
$1,065.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$773.50
|
| Rate for Payer: UHCCP Medicaid |
$621.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$525.26
|
| Rate for Payer: Wellcare Medicare Advantage |
$595.00
|
|
|
TREAT MOUTH ROOF FRACTURE
|
Facility
|
OP
|
$1,775.00
|
|
|
Service Code
|
HCPCS 21422
|
| Hospital Charge Code |
76100388
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$610.42 |
| Max. Negotiated Rate |
$7,652.33 |
| Rate for Payer: Aetna Commercial |
$1,366.75
|
| Rate for Payer: Anthem Medicaid |
$610.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,465.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,384.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,652.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,379.03
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cigna Commercial |
$1,473.25
|
| Rate for Payer: First Health Commercial |
$1,686.25
|
| Rate for Payer: Humana Commercial |
$1,508.75
|
| Rate for Payer: Humana KY Medicaid |
$610.42
|
| Rate for Payer: Humana Medicare Advantage |
$5,465.95
|
| Rate for Payer: Kentucky WC Medicaid |
$616.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,455.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,309.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,559.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$622.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,562.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,331.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,544.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.75
|
| Rate for Payer: PHCS Commercial |
$1,704.00
|
| Rate for Payer: United Healthcare All Payer |
$1,562.00
|
|
|
TREAT MOUTH ROOF FRACTURE
|
Facility
|
IP
|
$1,775.00
|
|
|
Service Code
|
HCPCS 21422
|
| Hospital Charge Code |
76100388
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$532.50 |
| Max. Negotiated Rate |
$1,704.00 |
| Rate for Payer: Aetna Commercial |
$1,366.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,384.50
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cigna Commercial |
$1,473.25
|
| Rate for Payer: First Health Commercial |
$1,686.25
|
| Rate for Payer: Humana Commercial |
$1,508.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,455.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,309.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$532.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,562.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,331.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,544.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.75
|
| Rate for Payer: PHCS Commercial |
$1,704.00
|
| Rate for Payer: United Healthcare All Payer |
$1,562.00
|
|
|
TREAT MOUTH ROOF FRACTURE
|
Professional
|
Both
|
$1,005.00
|
|
|
Service Code
|
HCPCS 21423
|
| Hospital Charge Code |
76102691
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$351.75 |
| Max. Negotiated Rate |
$1,275.13 |
| Rate for Payer: Aetna Commercial |
$1,146.49
|
| Rate for Payer: Ambetter Exchange |
$748.63
|
| Rate for Payer: Anthem Medicaid |
$576.99
|
| Rate for Payer: Buckeye Individual/Medicaid |
$748.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$748.63
|
| Rate for Payer: CareSource Just4Me Medicare |
$898.36
|
| Rate for Payer: Cash Price |
$502.50
|
| Rate for Payer: Cash Price |
$502.50
|
| Rate for Payer: Cigna Commercial |
$1,275.13
|
| Rate for Payer: Healthspan PPO |
$1,038.48
|
| Rate for Payer: Humana Medicaid |
$576.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,027.99
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$748.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$748.63
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$588.53
|
| Rate for Payer: Molina Healthcare Passport |
$576.99
|
| Rate for Payer: Multiplan PHCS |
$603.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$973.22
|
| Rate for Payer: UHCCP Medicaid |
$351.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$582.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$748.63
|
|
|
TREAT MOUTH ROOF FRACTURE(P
|
Professional
|
Both
|
$1,775.00
|
|
|
Service Code
|
HCPCS 21422
|
| Hospital Charge Code |
761P0388
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$520.06 |
| Max. Negotiated Rate |
$1,065.64 |
| Rate for Payer: Aetna Commercial |
$960.96
|
| Rate for Payer: Ambetter Exchange |
$595.00
|
| Rate for Payer: Anthem Medicaid |
$520.06
|
| Rate for Payer: Buckeye Individual/Medicaid |
$595.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$595.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$714.00
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cigna Commercial |
$1,065.64
|
| Rate for Payer: Healthspan PPO |
$870.42
|
| Rate for Payer: Humana Medicaid |
$520.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$821.46
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$595.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$595.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$530.46
|
| Rate for Payer: Molina Healthcare Passport |
$520.06
|
| Rate for Payer: Multiplan PHCS |
$1,065.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$773.50
|
| Rate for Payer: UHCCP Medicaid |
$621.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$525.26
|
| Rate for Payer: Wellcare Medicare Advantage |
$595.00
|
|
