|
TREATOF FRACTURE W REDUCTIO
|
Facility
|
OP
|
$290.00
|
|
| Hospital Charge Code |
45000326
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$87.00 |
| Max. Negotiated Rate |
$278.40 |
| Rate for Payer: Aetna Commercial |
$223.30
|
| Rate for Payer: Anthem Medicaid |
$99.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$226.20
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: Cigna Commercial |
$240.70
|
| Rate for Payer: First Health Commercial |
$275.50
|
| Rate for Payer: Humana Commercial |
$246.50
|
| Rate for Payer: Humana KY Medicaid |
$99.73
|
| Rate for Payer: Kentucky WC Medicaid |
$100.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$237.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$214.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$101.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$255.20
|
| Rate for Payer: Ohio Health Group HMO |
$217.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$232.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$252.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$200.10
|
| Rate for Payer: PHCS Commercial |
$278.40
|
| Rate for Payer: United Healthcare All Payer |
$255.20
|
|
|
TREATOF FRACTURE W REDUCTIO
|
Facility
|
OP
|
$278.00
|
|
| Hospital Charge Code |
76102553
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$83.40 |
| Max. Negotiated Rate |
$266.88 |
| Rate for Payer: Aetna Commercial |
$214.06
|
| Rate for Payer: Anthem Medicaid |
$95.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$216.84
|
| Rate for Payer: Cash Price |
$139.00
|
| Rate for Payer: Cigna Commercial |
$230.74
|
| Rate for Payer: First Health Commercial |
$264.10
|
| Rate for Payer: Humana Commercial |
$236.30
|
| Rate for Payer: Humana KY Medicaid |
$95.60
|
| Rate for Payer: Kentucky WC Medicaid |
$96.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$227.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$205.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$83.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$97.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$244.64
|
| Rate for Payer: Ohio Health Group HMO |
$208.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$222.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$241.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$191.82
|
| Rate for Payer: PHCS Commercial |
$266.88
|
| Rate for Payer: United Healthcare All Payer |
$244.64
|
|
|
TREATOF FRACTURE W REDUCTIO
|
Facility
|
IP
|
$290.00
|
|
| Hospital Charge Code |
45000326
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$87.00 |
| Max. Negotiated Rate |
$278.40 |
| Rate for Payer: Aetna Commercial |
$223.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$226.20
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: Cigna Commercial |
$240.70
|
| Rate for Payer: First Health Commercial |
$275.50
|
| Rate for Payer: Humana Commercial |
$246.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$237.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$214.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$255.20
|
| Rate for Payer: Ohio Health Group HMO |
$217.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$232.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$252.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$200.10
|
| Rate for Payer: PHCS Commercial |
$278.40
|
| Rate for Payer: United Healthcare All Payer |
$255.20
|
|
|
TREATOF FRACTURE W REDUCTIO
|
Facility
|
IP
|
$278.00
|
|
| Hospital Charge Code |
76102553
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$83.40 |
| Max. Negotiated Rate |
$266.88 |
| Rate for Payer: Aetna Commercial |
$214.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$216.84
|
| Rate for Payer: Cash Price |
$139.00
|
| Rate for Payer: Cigna Commercial |
$230.74
|
| Rate for Payer: First Health Commercial |
$264.10
|
| Rate for Payer: Humana Commercial |
$236.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$227.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$205.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$83.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$244.64
|
| Rate for Payer: Ohio Health Group HMO |
$208.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$222.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$241.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$191.82
|
| Rate for Payer: PHCS Commercial |
$266.88
|
| Rate for Payer: United Healthcare All Payer |
$244.64
|
|
|
TREAT ORBIT FRACTURE
|
Professional
|
Both
|
$13,317.00
|
|
|
Service Code
|
HCPCS 21365
|
| Hospital Charge Code |
76100387
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$780.79 |
| Max. Negotiated Rate |
$7,990.20 |
| Rate for Payer: Aetna Commercial |
$1,600.83
|
| Rate for Payer: Ambetter Exchange |
$1,024.19
|
| Rate for Payer: Anthem Medicaid |
$780.79
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,024.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,024.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,229.03
|
| Rate for Payer: Cash Price |
$6,658.50
|
| Rate for Payer: Cash Price |
$6,658.50
|
| Rate for Payer: Cigna Commercial |
$1,748.94
|
| Rate for Payer: Healthspan PPO |
$1,450.01
|
| Rate for Payer: Humana Medicaid |
$780.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,400.62
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,024.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,024.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$796.41
|
| Rate for Payer: Molina Healthcare Passport |
$780.79
|
| Rate for Payer: Multiplan PHCS |
$7,990.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,331.45
|
| Rate for Payer: UHCCP Medicaid |
$4,660.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$788.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,024.19
|
|
|
TREAT ORBIT FRACTURE
|
Facility
|
OP
|
$13,317.00
|
|
|
Service Code
|
HCPCS 21365
|
| Hospital Charge Code |
76100387
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,579.72 |
| Max. Negotiated Rate |
$12,784.32 |
| Rate for Payer: Aetna Commercial |
$10,254.09
|
| Rate for Payer: Anthem Medicaid |
$4,579.72
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,465.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,387.26
|
| 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 |
$6,658.50
|
| Rate for Payer: Cash Price |
$6,658.50
|
| Rate for Payer: Cigna Commercial |
$11,053.11
|
| Rate for Payer: First Health Commercial |
$12,651.15
|
| Rate for Payer: Humana Commercial |
$11,319.45
|
| Rate for Payer: Humana KY Medicaid |
$4,579.72
|
| Rate for Payer: Humana Medicare Advantage |
$5,465.95
|
| Rate for Payer: Kentucky WC Medicaid |
$4,626.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,919.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,827.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,559.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,671.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,718.96
|
| Rate for Payer: Ohio Health Group HMO |
$9,987.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,653.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,585.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,188.73
|
| Rate for Payer: PHCS Commercial |
$12,784.32
|
| Rate for Payer: United Healthcare All Payer |
$11,718.96
|
|
|
TREAT ORBIT FRACTURE
|
Facility
|
IP
|
$13,317.00
|
|
|
Service Code
|
HCPCS 21365
|
| Hospital Charge Code |
76100387
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,995.10 |
| Max. Negotiated Rate |
$12,784.32 |
| Rate for Payer: Aetna Commercial |
$10,254.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,387.26
|
| Rate for Payer: Cash Price |
$6,658.50
|
| Rate for Payer: Cigna Commercial |
$11,053.11
|
| Rate for Payer: First Health Commercial |
$12,651.15
|
| Rate for Payer: Humana Commercial |
$11,319.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,919.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,827.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,995.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,718.96
|
| Rate for Payer: Ohio Health Group HMO |
$9,987.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,653.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,585.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,188.73
|
| Rate for Payer: PHCS Commercial |
$12,784.32
|
| Rate for Payer: United Healthcare All Payer |
$11,718.96
|
|
|
TREAT ORBIT FRACTURE(P
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 21365
|
| Hospital Charge Code |
761P0387
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$700.00 |
| Max. Negotiated Rate |
$1,748.94 |
| Rate for Payer: Aetna Commercial |
$1,600.83
|
| Rate for Payer: Ambetter Exchange |
$1,024.19
|
| Rate for Payer: Anthem Medicaid |
$780.79
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,024.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,024.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,229.03
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,748.94
|
| Rate for Payer: Healthspan PPO |
$1,450.01
|
| Rate for Payer: Humana Medicaid |
$780.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,400.62
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,024.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,024.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$796.41
|
| Rate for Payer: Molina Healthcare Passport |
$780.79
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,331.45
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$788.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,024.19
|
|
|
TREAT ORBIT FRACTURE(T
|
Facility
|
OP
|
$11,317.00
|
|
|
Service Code
|
HCPCS 21365
|
| Hospital Charge Code |
761T0387
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,891.92 |
| Max. Negotiated Rate |
$10,864.32 |
| Rate for Payer: Aetna Commercial |
$8,714.09
|
| Rate for Payer: Anthem Medicaid |
$3,891.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,465.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,827.26
|
| 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 |
$5,658.50
|
| Rate for Payer: Cash Price |
$5,658.50
|
| Rate for Payer: Cigna Commercial |
$9,393.11
|
| Rate for Payer: First Health Commercial |
$10,751.15
|
| Rate for Payer: Humana Commercial |
$9,619.45
|
| Rate for Payer: Humana KY Medicaid |
$3,891.92
|
| Rate for Payer: Humana Medicare Advantage |
$5,465.95
|
| Rate for Payer: Kentucky WC Medicaid |
$3,931.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,279.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,351.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,559.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,970.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,958.96
|
| Rate for Payer: Ohio Health Group HMO |
$8,487.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,053.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,845.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,808.73
|
| Rate for Payer: PHCS Commercial |
$10,864.32
|
| Rate for Payer: United Healthcare All Payer |
$9,958.96
|
|
|
TREAT ORBIT FRACTURE(T
|
Facility
|
IP
|
$11,317.00
|
|
|
Service Code
|
HCPCS 21365
|
| Hospital Charge Code |
761T0387
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,395.10 |
| Max. Negotiated Rate |
$10,864.32 |
| Rate for Payer: Aetna Commercial |
$8,714.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,827.26
|
| Rate for Payer: Cash Price |
$5,658.50
|
| Rate for Payer: Cigna Commercial |
$9,393.11
|
| Rate for Payer: First Health Commercial |
$10,751.15
|
| Rate for Payer: Humana Commercial |
$9,619.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,279.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,351.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,395.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,958.96
|
| Rate for Payer: Ohio Health Group HMO |
$8,487.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,053.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,845.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,808.73
|
| Rate for Payer: PHCS Commercial |
$10,864.32
|
| Rate for Payer: United Healthcare All Payer |
$9,958.96
|
|
|
TREAT SCAPULA FRACTURE
|
Professional
|
Both
|
$1,180.00
|
|
|
Service Code
|
HCPCS 23585
|
| Hospital Charge Code |
76102723
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$413.00 |
| Max. Negotiated Rate |
$1,380.03 |
| Rate for Payer: Aetna Commercial |
$1,380.03
|
| Rate for Payer: Ambetter Exchange |
$928.01
|
| Rate for Payer: Anthem Medicaid |
$484.65
|
| Rate for Payer: Buckeye Individual/Medicaid |
$928.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$928.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,113.61
|
| Rate for Payer: Cash Price |
$590.00
|
| Rate for Payer: Cash Price |
$590.00
|
| Rate for Payer: Cigna Commercial |
$1,107.36
|
| Rate for Payer: Healthspan PPO |
$1,250.02
|
| Rate for Payer: Humana Medicaid |
$484.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,213.00
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$928.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$928.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$494.34
|
| Rate for Payer: Molina Healthcare Passport |
$484.65
|
| Rate for Payer: Multiplan PHCS |
$708.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,206.41
|
| Rate for Payer: UHCCP Medicaid |
$413.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$489.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$928.01
|
|
|
TREAT SESAMOID BONE FRACTURE
|
Facility
|
OP
|
$1,165.00
|
|
|
Service Code
|
HCPCS 28530
|
| Hospital Charge Code |
76101028
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$1,118.40 |
| Rate for Payer: Aetna Commercial |
$897.05
|
| Rate for Payer: Anthem Medicaid |
$400.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$908.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$582.50
|
| Rate for Payer: Cash Price |
$582.50
|
| Rate for Payer: Cigna Commercial |
$966.95
|
| Rate for Payer: First Health Commercial |
$1,106.75
|
| Rate for Payer: Humana Commercial |
$990.25
|
| Rate for Payer: Humana KY Medicaid |
$400.64
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$404.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$955.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$859.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$408.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,025.20
|
| Rate for Payer: Ohio Health Group HMO |
$873.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$932.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,013.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$803.85
|
| Rate for Payer: PHCS Commercial |
$1,118.40
|
| Rate for Payer: United Healthcare All Payer |
$1,025.20
|
|
|
TREAT SESAMOID BONE FRACTURE
|
Professional
|
Both
|
$1,165.00
|
|
|
Service Code
|
HCPCS 28530
|
| Hospital Charge Code |
76101028
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$56.07 |
| Max. Negotiated Rate |
$699.00 |
| Rate for Payer: Aetna Commercial |
$144.57
|
| Rate for Payer: Ambetter Exchange |
$99.48
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$56.07
|
| Rate for Payer: Anthem Medicaid |
$58.89
|
| Rate for Payer: Buckeye Individual/Medicaid |
$99.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$99.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$119.38
|
| Rate for Payer: Cash Price |
$582.50
|
| Rate for Payer: Cash Price |
$582.50
|
| Rate for Payer: Cigna Commercial |
$166.60
|
| Rate for Payer: Healthspan PPO |
$140.64
|
| Rate for Payer: Humana Medicaid |
$58.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$122.88
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$99.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$99.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$60.07
|
| Rate for Payer: Molina Healthcare Passport |
$58.89
|
| Rate for Payer: Multiplan PHCS |
$699.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$129.32
|
| Rate for Payer: UHCCP Medicaid |
$58.87
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$59.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$99.48
|
|
|
TREAT SESAMOID BONE FRACTURE
|
Facility
|
IP
|
$1,165.00
|
|
|
Service Code
|
HCPCS 28530
|
| Hospital Charge Code |
76101028
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$349.50 |
| Max. Negotiated Rate |
$1,118.40 |
| Rate for Payer: Aetna Commercial |
$897.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$908.70
|
| Rate for Payer: Cash Price |
$582.50
|
| Rate for Payer: Cigna Commercial |
$966.95
|
| Rate for Payer: First Health Commercial |
$1,106.75
|
| Rate for Payer: Humana Commercial |
$990.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$955.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$859.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$349.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,025.20
|
| Rate for Payer: Ohio Health Group HMO |
$873.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$932.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,013.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$803.85
|
| Rate for Payer: PHCS Commercial |
$1,118.40
|
| Rate for Payer: United Healthcare All Payer |
$1,025.20
|
|
|
TREAT SESAMOID BONE FRACTUR(P
|
Professional
|
Both
|
$365.00
|
|
|
Service Code
|
HCPCS 28530
|
| Hospital Charge Code |
761P1028
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$56.07 |
| Max. Negotiated Rate |
$219.00 |
| Rate for Payer: Aetna Commercial |
$144.57
|
| Rate for Payer: Ambetter Exchange |
$99.48
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$56.07
|
| Rate for Payer: Anthem Medicaid |
$58.89
|
| Rate for Payer: Buckeye Individual/Medicaid |
$99.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$99.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$119.38
|
| Rate for Payer: Cash Price |
$182.50
|
| Rate for Payer: Cash Price |
$182.50
|
| Rate for Payer: Cigna Commercial |
$166.60
|
| Rate for Payer: Healthspan PPO |
$140.64
|
| Rate for Payer: Humana Medicaid |
$58.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$122.88
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$99.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$99.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$60.07
|
| Rate for Payer: Molina Healthcare Passport |
$58.89
|
| Rate for Payer: Multiplan PHCS |
$219.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$129.32
|
| Rate for Payer: UHCCP Medicaid |
$58.87
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$59.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$99.48
|
|
|
TREAT SESAMOID BONE FRACTUR(T
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS 28530
|
| Hospital Charge Code |
761T1028
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
TREAT SESAMOID BONE FRACTUR(T
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS 28530
|
| Hospital Charge Code |
761T1028
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem Medicaid |
$275.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Humana KY Medicaid |
$275.12
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$277.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$280.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
TREAT SHOULDER BLADE FX
|
Facility
|
IP
|
$2,024.00
|
|
|
Service Code
|
HCPCS 23575
|
| Hospital Charge Code |
76100477
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$607.20 |
| Max. Negotiated Rate |
$1,943.04 |
| Rate for Payer: Aetna Commercial |
$1,558.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,578.72
|
| Rate for Payer: Cash Price |
$1,012.00
|
| Rate for Payer: Cigna Commercial |
$1,679.92
|
| Rate for Payer: First Health Commercial |
$1,922.80
|
| Rate for Payer: Humana Commercial |
$1,720.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,659.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,493.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$607.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,781.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,518.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,619.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,760.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,396.56
|
| Rate for Payer: PHCS Commercial |
$1,943.04
|
| Rate for Payer: United Healthcare All Payer |
$1,781.12
|
|
|
TREAT SHOULDER BLADE FX
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 23570
|
| Hospital Charge Code |
76100476
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$1,344.00 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem Medicaid |
$481.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| 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 |
$221.64
|
| 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 |
$265.97
|
| 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 SHOULDER BLADE FX
|
Facility
|
OP
|
$2,024.00
|
|
|
Service Code
|
HCPCS 23575
|
| Hospital Charge Code |
45000109
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$696.05 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$1,558.48
|
| Rate for Payer: Anthem Medicaid |
$696.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,578.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| Rate for Payer: Cash Price |
$1,012.00
|
| Rate for Payer: Cash Price |
$1,012.00
|
| Rate for Payer: Cigna Commercial |
$1,679.92
|
| Rate for Payer: First Health Commercial |
$1,922.80
|
| Rate for Payer: Humana Commercial |
$1,720.40
|
| Rate for Payer: Humana KY Medicaid |
$696.05
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$703.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,659.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,493.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$710.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,781.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,518.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,619.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,760.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,396.56
|
| Rate for Payer: PHCS Commercial |
$1,943.04
|
| Rate for Payer: United Healthcare All Payer |
$1,781.12
|
|
|
TREAT SHOULDER BLADE FX
|
Facility
|
IP
|
$2,024.00
|
|
|
Service Code
|
HCPCS 23575
|
| Hospital Charge Code |
45000109
|
|
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 SHOULDER BLADE FX
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 23570
|
| Hospital Charge Code |
76100476
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$113.29 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna Commercial |
$313.52
|
| Rate for Payer: Ambetter Exchange |
$236.81
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$122.34
|
| Rate for Payer: Anthem Medicaid |
$113.29
|
| Rate for Payer: Buckeye Individual/Medicaid |
$236.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$236.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$284.17
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$344.40
|
| Rate for Payer: Healthspan PPO |
$280.59
|
| Rate for Payer: Humana Medicaid |
$113.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$279.07
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$236.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$236.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$115.56
|
| Rate for Payer: Molina Healthcare Passport |
$113.29
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$307.85
|
| Rate for Payer: UHCCP Medicaid |
$128.46
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$114.42
|
| Rate for Payer: Wellcare Medicare Advantage |
$236.81
|
|
|
TREAT SHOULDER BLADE FX
|
Facility
|
OP
|
$2,024.00
|
|
|
Service Code
|
HCPCS 23575
|
| Hospital Charge Code |
76100477
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$696.05 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$1,558.48
|
| Rate for Payer: Anthem Medicaid |
$696.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,578.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| Rate for Payer: Cash Price |
$1,012.00
|
| Rate for Payer: Cash Price |
$1,012.00
|
| Rate for Payer: Cigna Commercial |
$1,679.92
|
| Rate for Payer: First Health Commercial |
$1,922.80
|
| Rate for Payer: Humana Commercial |
$1,720.40
|
| Rate for Payer: Humana KY Medicaid |
$696.05
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$703.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,659.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,493.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$710.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,781.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,518.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,619.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,760.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,396.56
|
| Rate for Payer: PHCS Commercial |
$1,943.04
|
| Rate for Payer: United Healthcare All Payer |
$1,781.12
|
|
|
TREAT SHOULDER BLADE FX
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 23570
|
| Hospital Charge Code |
76100476
|
|
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 SHOULDER BLADE FX(P
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 23570
|
| Hospital Charge Code |
761P0476
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$113.29 |
| Max. Negotiated Rate |
$344.40 |
| Rate for Payer: Aetna Commercial |
$313.52
|
| Rate for Payer: Ambetter Exchange |
$236.81
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$122.34
|
| Rate for Payer: Anthem Medicaid |
$113.29
|
| Rate for Payer: Buckeye Individual/Medicaid |
$236.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$236.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$284.17
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$344.40
|
| Rate for Payer: Healthspan PPO |
$280.59
|
| Rate for Payer: Humana Medicaid |
$113.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$279.07
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$236.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$236.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$115.56
|
| Rate for Payer: Molina Healthcare Passport |
$113.29
|
| Rate for Payer: Multiplan PHCS |
$300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$307.85
|
| Rate for Payer: UHCCP Medicaid |
$128.46
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$114.42
|
| Rate for Payer: Wellcare Medicare Advantage |
$236.81
|
|
