|
TREAT SHOULDER BLADE FX(T
|
Facility
|
OP
|
$900.00
|
|
|
Service Code
|
HCPCS 23570
|
| Hospital Charge Code |
761T0476
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$864.00 |
| Rate for Payer: Aetna Commercial |
$693.00
|
| Rate for Payer: Anthem Medicaid |
$309.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$702.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$747.00
|
| Rate for Payer: First Health Commercial |
$855.00
|
| Rate for Payer: Humana Commercial |
$765.00
|
| Rate for Payer: Humana KY Medicaid |
$309.51
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$312.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$738.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$664.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$315.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$792.00
|
| Rate for Payer: Ohio Health Group HMO |
$675.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$720.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$783.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$621.00
|
| Rate for Payer: PHCS Commercial |
$864.00
|
| Rate for Payer: United Healthcare All Payer |
$792.00
|
|
|
TREAT SHOULDER BLADE FX(T
|
Facility
|
IP
|
$900.00
|
|
|
Service Code
|
HCPCS 23570
|
| Hospital Charge Code |
761T0476
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$864.00 |
| Rate for Payer: Aetna Commercial |
$693.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$702.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$747.00
|
| Rate for Payer: First Health Commercial |
$855.00
|
| Rate for Payer: Humana Commercial |
$765.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$738.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$664.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$270.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$792.00
|
| Rate for Payer: Ohio Health Group HMO |
$675.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$720.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$783.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$621.00
|
| Rate for Payer: PHCS Commercial |
$864.00
|
| Rate for Payer: United Healthcare All Payer |
$792.00
|
|
|
TREAT SHOULDER DISLOCATION
|
Facility
|
IP
|
$2,185.00
|
|
|
Service Code
|
HCPCS 23655
|
| Hospital Charge Code |
45000113
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$655.50 |
| Max. Negotiated Rate |
$2,097.60 |
| Rate for Payer: Aetna Commercial |
$1,682.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,704.30
|
| Rate for Payer: Cash Price |
$1,092.50
|
| Rate for Payer: Cigna Commercial |
$1,813.55
|
| Rate for Payer: First Health Commercial |
$2,075.75
|
| Rate for Payer: Humana Commercial |
$1,857.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,791.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,612.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$655.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,922.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,638.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,748.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,900.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,507.65
|
| Rate for Payer: PHCS Commercial |
$2,097.60
|
| Rate for Payer: United Healthcare All Payer |
$1,922.80
|
|
|
TREAT SHOULDER DISLOCATION
|
Facility
|
OP
|
$2,905.00
|
|
|
Service Code
|
HCPCS 23655
|
| Hospital Charge Code |
76100486
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$999.03 |
| Max. Negotiated Rate |
$2,788.80 |
| Rate for Payer: Aetna Commercial |
$2,236.85
|
| Rate for Payer: Anthem Medicaid |
$999.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,265.90
|
| 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 |
$1,452.50
|
| Rate for Payer: Cash Price |
$1,452.50
|
| Rate for Payer: Cigna Commercial |
$2,411.15
|
| Rate for Payer: First Health Commercial |
$2,759.75
|
| Rate for Payer: Humana Commercial |
$2,469.25
|
| Rate for Payer: Humana KY Medicaid |
$999.03
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,009.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,382.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,143.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,019.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,556.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,178.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,324.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,527.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,004.45
|
| Rate for Payer: PHCS Commercial |
$2,788.80
|
| Rate for Payer: United Healthcare All Payer |
$2,556.40
|
|
|
TREAT SHOULDER DISLOCATION
|
Facility
|
OP
|
$1,855.00
|
|
|
Service Code
|
HCPCS 23660
|
| Hospital Charge Code |
76100487
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$637.93 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,428.35
|
| Rate for Payer: Anthem Medicaid |
$637.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,446.90
|
| 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 |
$927.50
|
| Rate for Payer: Cash Price |
$927.50
|
| Rate for Payer: Cigna Commercial |
$1,539.65
|
| Rate for Payer: First Health Commercial |
$1,762.25
|
| Rate for Payer: Humana Commercial |
$1,576.75
|
| Rate for Payer: Humana KY Medicaid |
$637.93
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$644.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,521.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,368.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$650.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,632.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,391.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,484.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,613.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,279.95
|
| Rate for Payer: PHCS Commercial |
$1,780.80
|
| Rate for Payer: United Healthcare All Payer |
$1,632.40
|
|
|
TREAT SHOULDER DISLOCATION
|
Facility
|
IP
|
$1,855.00
|
|
|
Service Code
|
HCPCS 23660
|
| Hospital Charge Code |
76100487
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$556.50 |
| Max. Negotiated Rate |
$1,780.80 |
| Rate for Payer: Aetna Commercial |
$1,428.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,446.90
|
| Rate for Payer: Cash Price |
$927.50
|
| Rate for Payer: Cigna Commercial |
$1,539.65
|
| Rate for Payer: First Health Commercial |
$1,762.25
|
| Rate for Payer: Humana Commercial |
$1,576.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,521.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,368.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$556.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,632.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,391.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,484.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,613.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,279.95
|
| Rate for Payer: PHCS Commercial |
$1,780.80
|
| Rate for Payer: United Healthcare All Payer |
$1,632.40
|
|
|
TREAT SHOULDER DISLOCATION
|
Facility
|
IP
|
$2,905.00
|
|
|
Service Code
|
HCPCS 23655
|
| Hospital Charge Code |
76100486
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$871.50 |
| Max. Negotiated Rate |
$2,788.80 |
| Rate for Payer: Aetna Commercial |
$2,236.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,265.90
|
| Rate for Payer: Cash Price |
$1,452.50
|
| Rate for Payer: Cigna Commercial |
$2,411.15
|
| Rate for Payer: First Health Commercial |
$2,759.75
|
| Rate for Payer: Humana Commercial |
$2,469.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,382.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,143.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$871.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,556.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,178.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,324.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,527.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,004.45
|
| Rate for Payer: PHCS Commercial |
$2,788.80
|
| Rate for Payer: United Healthcare All Payer |
$2,556.40
|
|
|
TREAT SHOULDER DISLOCATION
|
Facility
|
OP
|
$2,185.00
|
|
|
Service Code
|
HCPCS 23655
|
| Hospital Charge Code |
45000113
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$751.42 |
| Max. Negotiated Rate |
$2,097.60 |
| Rate for Payer: Aetna Commercial |
$1,682.45
|
| Rate for Payer: Anthem Medicaid |
$751.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,704.30
|
| 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 |
$1,092.50
|
| Rate for Payer: Cash Price |
$1,092.50
|
| Rate for Payer: Cigna Commercial |
$1,813.55
|
| Rate for Payer: First Health Commercial |
$2,075.75
|
| Rate for Payer: Humana Commercial |
$1,857.25
|
| Rate for Payer: Humana KY Medicaid |
$751.42
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$759.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,791.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,612.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$766.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,922.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,638.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,748.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,900.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,507.65
|
| Rate for Payer: PHCS Commercial |
$2,097.60
|
| Rate for Payer: United Healthcare All Payer |
$1,922.80
|
|
|
TREAT SHOULDER DISLOCATION
|
Professional
|
Both
|
$2,905.00
|
|
|
Service Code
|
HCPCS 23655
|
| Hospital Charge Code |
76100486
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$214.28 |
| Max. Negotiated Rate |
$1,743.00 |
| Rate for Payer: Aetna Commercial |
$541.77
|
| Rate for Payer: Ambetter Exchange |
$391.48
|
| Rate for Payer: Anthem Medicaid |
$214.28
|
| Rate for Payer: Buckeye Individual/Medicaid |
$391.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$391.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$469.78
|
| Rate for Payer: Cash Price |
$1,452.50
|
| Rate for Payer: Cash Price |
$1,452.50
|
| Rate for Payer: Cigna Commercial |
$582.46
|
| Rate for Payer: Healthspan PPO |
$490.72
|
| Rate for Payer: Humana Medicaid |
$214.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$474.66
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$391.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$391.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$218.57
|
| Rate for Payer: Molina Healthcare Passport |
$214.28
|
| Rate for Payer: Multiplan PHCS |
$1,743.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$508.92
|
| Rate for Payer: UHCCP Medicaid |
$1,016.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$216.42
|
| Rate for Payer: Wellcare Medicare Advantage |
$391.48
|
|
|
TREAT SHOULDER DISLOCATION
|
Professional
|
Both
|
$1,855.00
|
|
|
Service Code
|
HCPCS 23660
|
| Hospital Charge Code |
76100487
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$485.34 |
| Max. Negotiated Rate |
$1,113.00 |
| Rate for Payer: Aetna Commercial |
$847.19
|
| Rate for Payer: Ambetter Exchange |
$559.35
|
| Rate for Payer: Anthem Medicaid |
$485.34
|
| Rate for Payer: Buckeye Individual/Medicaid |
$559.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$559.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$671.22
|
| Rate for Payer: Cash Price |
$927.50
|
| Rate for Payer: Cash Price |
$927.50
|
| Rate for Payer: Cigna Commercial |
$922.31
|
| Rate for Payer: Healthspan PPO |
$767.37
|
| Rate for Payer: Humana Medicaid |
$485.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$717.55
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$559.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$559.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$495.05
|
| Rate for Payer: Molina Healthcare Passport |
$485.34
|
| Rate for Payer: Multiplan PHCS |
$1,113.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$727.15
|
| Rate for Payer: UHCCP Medicaid |
$649.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$490.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$559.35
|
|
|
TREAT SHOULDER DISLOCATION(P
|
Professional
|
Both
|
$720.00
|
|
|
Service Code
|
HCPCS 23655
|
| Hospital Charge Code |
761P0486
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$214.28 |
| Max. Negotiated Rate |
$582.46 |
| Rate for Payer: Aetna Commercial |
$541.77
|
| Rate for Payer: Ambetter Exchange |
$391.48
|
| Rate for Payer: Anthem Medicaid |
$214.28
|
| Rate for Payer: Buckeye Individual/Medicaid |
$391.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$391.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$469.78
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cigna Commercial |
$582.46
|
| Rate for Payer: Healthspan PPO |
$490.72
|
| Rate for Payer: Humana Medicaid |
$214.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$474.66
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$391.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$391.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$218.57
|
| Rate for Payer: Molina Healthcare Passport |
$214.28
|
| Rate for Payer: Multiplan PHCS |
$432.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$508.92
|
| Rate for Payer: UHCCP Medicaid |
$252.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$216.42
|
| Rate for Payer: Wellcare Medicare Advantage |
$391.48
|
|
|
TREAT SHOULDER DISLOCATION(P
|
Professional
|
Both
|
$1,855.00
|
|
|
Service Code
|
HCPCS 23660
|
| Hospital Charge Code |
761P0487
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$485.34 |
| Max. Negotiated Rate |
$1,113.00 |
| Rate for Payer: Aetna Commercial |
$847.19
|
| Rate for Payer: Ambetter Exchange |
$559.35
|
| Rate for Payer: Anthem Medicaid |
$485.34
|
| Rate for Payer: Buckeye Individual/Medicaid |
$559.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$559.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$671.22
|
| Rate for Payer: Cash Price |
$927.50
|
| Rate for Payer: Cash Price |
$927.50
|
| Rate for Payer: Cigna Commercial |
$922.31
|
| Rate for Payer: Healthspan PPO |
$767.37
|
| Rate for Payer: Humana Medicaid |
$485.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$717.55
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$559.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$559.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$495.05
|
| Rate for Payer: Molina Healthcare Passport |
$485.34
|
| Rate for Payer: Multiplan PHCS |
$1,113.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$727.15
|
| Rate for Payer: UHCCP Medicaid |
$649.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$490.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$559.35
|
|
|
TREAT SHOULDER DISLOCATION(T
|
Facility
|
OP
|
$2,185.00
|
|
|
Service Code
|
HCPCS 23655
|
| Hospital Charge Code |
761T0486
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$751.42 |
| Max. Negotiated Rate |
$2,097.60 |
| Rate for Payer: Aetna Commercial |
$1,682.45
|
| Rate for Payer: Anthem Medicaid |
$751.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,704.30
|
| 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 |
$1,092.50
|
| Rate for Payer: Cash Price |
$1,092.50
|
| Rate for Payer: Cigna Commercial |
$1,813.55
|
| Rate for Payer: First Health Commercial |
$2,075.75
|
| Rate for Payer: Humana Commercial |
$1,857.25
|
| Rate for Payer: Humana KY Medicaid |
$751.42
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$759.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,791.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,612.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$766.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,922.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,638.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,748.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,900.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,507.65
|
| Rate for Payer: PHCS Commercial |
$2,097.60
|
| Rate for Payer: United Healthcare All Payer |
$1,922.80
|
|
|
TREAT SHOULDER DISLOCATION(T
|
Facility
|
IP
|
$2,185.00
|
|
|
Service Code
|
HCPCS 23655
|
| Hospital Charge Code |
761T0486
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$655.50 |
| Max. Negotiated Rate |
$2,097.60 |
| Rate for Payer: Aetna Commercial |
$1,682.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,704.30
|
| Rate for Payer: Cash Price |
$1,092.50
|
| Rate for Payer: Cigna Commercial |
$1,813.55
|
| Rate for Payer: First Health Commercial |
$2,075.75
|
| Rate for Payer: Humana Commercial |
$1,857.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,791.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,612.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$655.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,922.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,638.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,748.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,900.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,507.65
|
| Rate for Payer: PHCS Commercial |
$2,097.60
|
| Rate for Payer: United Healthcare All Payer |
$1,922.80
|
|
|
TREAT STERNUM FRACTURE
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 21825
|
| Hospital Charge Code |
76100408
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$412.41 |
| Max. Negotiated Rate |
$914.28 |
| Rate for Payer: Aetna Commercial |
$828.39
|
| Rate for Payer: Ambetter Exchange |
$524.79
|
| Rate for Payer: Anthem Medicaid |
$412.41
|
| Rate for Payer: Buckeye Individual/Medicaid |
$524.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$524.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$629.75
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$914.28
|
| Rate for Payer: Healthspan PPO |
$750.35
|
| Rate for Payer: Humana Medicaid |
$412.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$712.01
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$524.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$524.79
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$420.66
|
| Rate for Payer: Molina Healthcare Passport |
$412.41
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$682.23
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$416.53
|
| Rate for Payer: Wellcare Medicare Advantage |
$524.79
|
|
|
TREAT STERNUM FRACTURE
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 21825
|
| Hospital Charge Code |
76100408
|
|
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 STERNUM FRACTURE
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 21825
|
| Hospital Charge Code |
76100408
|
|
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 Medicaid |
$481.46
|
| 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: Humana KY Medicaid |
$481.46
|
| 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 |
$420.00
|
| 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 STERNUM FRACTURE(P
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 21825
|
| Hospital Charge Code |
761P0408
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$412.41 |
| Max. Negotiated Rate |
$914.28 |
| Rate for Payer: Aetna Commercial |
$828.39
|
| Rate for Payer: Ambetter Exchange |
$524.79
|
| Rate for Payer: Anthem Medicaid |
$412.41
|
| Rate for Payer: Buckeye Individual/Medicaid |
$524.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$524.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$629.75
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$914.28
|
| Rate for Payer: Healthspan PPO |
$750.35
|
| Rate for Payer: Humana Medicaid |
$412.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$712.01
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$524.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$524.79
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$420.66
|
| Rate for Payer: Molina Healthcare Passport |
$412.41
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$682.23
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$416.53
|
| Rate for Payer: Wellcare Medicare Advantage |
$524.79
|
|
|
TREAT THUMB FRACTURE
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 26650
|
| Hospital Charge Code |
76100728
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$284.20 |
| Max. Negotiated Rate |
$809.42 |
| Rate for Payer: Aetna Commercial |
$674.79
|
| Rate for Payer: Ambetter Exchange |
$461.74
|
| Rate for Payer: Anthem Medicaid |
$284.20
|
| Rate for Payer: Buckeye Individual/Medicaid |
$461.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$461.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$554.09
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$809.42
|
| Rate for Payer: Healthspan PPO |
$611.22
|
| Rate for Payer: Humana Medicaid |
$284.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$580.32
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$461.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$461.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$289.88
|
| Rate for Payer: Molina Healthcare Passport |
$284.20
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$600.26
|
| Rate for Payer: UHCCP Medicaid |
$420.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$287.04
|
| Rate for Payer: Wellcare Medicare Advantage |
$461.74
|
|
|
TREAT THUMB FRACTURE
|
Facility
|
OP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 26650
|
| Hospital Charge Code |
76100728
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$412.68 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem Medicaid |
$412.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| 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 |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Humana KY Medicaid |
$412.68
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$416.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$420.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$960.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,044.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$828.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
TREAT THUMB FRACTURE
|
Facility
|
IP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 26650
|
| Hospital Charge Code |
76100728
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$360.00 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$360.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$960.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,044.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$828.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
TREAT THUMB FRACTURE(P
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 26650
|
| Hospital Charge Code |
761P0728
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$284.20 |
| Max. Negotiated Rate |
$809.42 |
| Rate for Payer: Aetna Commercial |
$674.79
|
| Rate for Payer: Ambetter Exchange |
$461.74
|
| Rate for Payer: Anthem Medicaid |
$284.20
|
| Rate for Payer: Buckeye Individual/Medicaid |
$461.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$461.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$554.09
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$809.42
|
| Rate for Payer: Healthspan PPO |
$611.22
|
| Rate for Payer: Humana Medicaid |
$284.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$580.32
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$461.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$461.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$289.88
|
| Rate for Payer: Molina Healthcare Passport |
$284.20
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$600.26
|
| Rate for Payer: UHCCP Medicaid |
$420.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$287.04
|
| Rate for Payer: Wellcare Medicare Advantage |
$461.74
|
|
|
TREAT TOE DISLOCATION
|
Facility
|
IP
|
$5,793.50
|
|
|
Service Code
|
HCPCS 28636
|
| Hospital Charge Code |
76101034
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,738.05 |
| Max. Negotiated Rate |
$5,561.76 |
| Rate for Payer: Aetna Commercial |
$4,460.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,518.93
|
| Rate for Payer: Cash Price |
$2,896.75
|
| Rate for Payer: Cigna Commercial |
$4,808.60
|
| Rate for Payer: First Health Commercial |
$5,503.82
|
| Rate for Payer: Humana Commercial |
$4,924.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,750.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,275.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,738.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,098.28
|
| Rate for Payer: Ohio Health Group HMO |
$4,345.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,634.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,040.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,997.51
|
| Rate for Payer: PHCS Commercial |
$5,561.76
|
| Rate for Payer: United Healthcare All Payer |
$5,098.28
|
|
|
TREAT TOE DISLOCATION
|
Facility
|
OP
|
$5,793.50
|
|
|
Service Code
|
HCPCS 28636
|
| Hospital Charge Code |
76101034
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,992.38 |
| Max. Negotiated Rate |
$5,561.76 |
| Rate for Payer: Aetna Commercial |
$4,460.99
|
| Rate for Payer: Anthem Medicaid |
$1,992.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,518.93
|
| 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 |
$2,896.75
|
| Rate for Payer: Cash Price |
$2,896.75
|
| Rate for Payer: Cigna Commercial |
$4,808.60
|
| Rate for Payer: First Health Commercial |
$5,503.82
|
| Rate for Payer: Humana Commercial |
$4,924.48
|
| Rate for Payer: Humana KY Medicaid |
$1,992.38
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$2,012.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,750.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,275.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,032.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,098.28
|
| Rate for Payer: Ohio Health Group HMO |
$4,345.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,634.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,040.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,997.51
|
| Rate for Payer: PHCS Commercial |
$5,561.76
|
| Rate for Payer: United Healthcare All Payer |
$5,098.28
|
|
|
TREAT TOE DISLOCATION
|
Professional
|
Both
|
$5,793.50
|
|
|
Service Code
|
HCPCS 28636
|
| Hospital Charge Code |
76101034
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.92 |
| Max. Negotiated Rate |
$3,476.10 |
| Rate for Payer: Aetna Commercial |
$303.45
|
| Rate for Payer: Ambetter Exchange |
$213.30
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$101.92
|
| Rate for Payer: Anthem Medicaid |
$157.22
|
| Rate for Payer: Buckeye Individual/Medicaid |
$213.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$213.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$255.96
|
| Rate for Payer: Cash Price |
$2,896.75
|
| Rate for Payer: Cash Price |
$2,896.75
|
| Rate for Payer: Cigna Commercial |
$348.33
|
| Rate for Payer: Healthspan PPO |
$367.44
|
| Rate for Payer: Humana Medicaid |
$157.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$230.68
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$213.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$213.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$160.36
|
| Rate for Payer: Molina Healthcare Passport |
$157.22
|
| Rate for Payer: Multiplan PHCS |
$3,476.10
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$277.29
|
| Rate for Payer: UHCCP Medicaid |
$107.02
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$158.79
|
| Rate for Payer: Wellcare Medicare Advantage |
$213.30
|
|
