|
TREAT TOE DISLOCATION
|
Professional
|
Both
|
$425.00
|
|
|
Service Code
|
HCPCS 28666
|
| Hospital Charge Code |
76102984
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$148.75 |
| Max. Negotiated Rate |
$337.92 |
| Rate for Payer: Aetna Commercial |
$291.20
|
| Rate for Payer: Ambetter Exchange |
$164.08
|
| Rate for Payer: Anthem Medicaid |
$150.28
|
| Rate for Payer: Buckeye Individual/Medicaid |
$164.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$164.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$196.90
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cigna Commercial |
$337.92
|
| Rate for Payer: Healthspan PPO |
$263.77
|
| Rate for Payer: Humana Medicaid |
$150.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$252.76
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$164.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$164.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$153.29
|
| Rate for Payer: Molina Healthcare Passport |
$150.28
|
| Rate for Payer: Multiplan PHCS |
$255.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$213.30
|
| Rate for Payer: UHCCP Medicaid |
$148.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$151.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$164.08
|
|
|
TREAT TOE DISLOCATION(P
|
Professional
|
Both
|
$405.00
|
|
|
Service Code
|
HCPCS 28636
|
| Hospital Charge Code |
761P1034
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.92 |
| Max. Negotiated Rate |
$367.44 |
| 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 |
$202.50
|
| Rate for Payer: Cash Price |
$202.50
|
| 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 |
$243.00
|
| 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
|
|
|
TREAT TOE DISLOCATION(T
|
Facility
|
IP
|
$5,388.50
|
|
|
Service Code
|
HCPCS 28636
|
| Hospital Charge Code |
761T1034
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,616.55 |
| Max. Negotiated Rate |
$5,172.96 |
| Rate for Payer: Aetna Commercial |
$4,149.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,203.03
|
| Rate for Payer: Cash Price |
$2,694.25
|
| Rate for Payer: Cigna Commercial |
$4,472.45
|
| Rate for Payer: First Health Commercial |
$5,119.07
|
| Rate for Payer: Humana Commercial |
$4,580.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,418.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,976.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,616.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,741.88
|
| Rate for Payer: Ohio Health Group HMO |
$4,041.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,310.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,687.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,718.07
|
| Rate for Payer: PHCS Commercial |
$5,172.96
|
| Rate for Payer: United Healthcare All Payer |
$4,741.88
|
|
|
TREAT TOE DISLOCATION(T
|
Facility
|
OP
|
$5,388.50
|
|
|
Service Code
|
HCPCS 28636
|
| Hospital Charge Code |
761T1034
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,853.11 |
| Max. Negotiated Rate |
$5,172.96 |
| Rate for Payer: Aetna Commercial |
$4,149.15
|
| Rate for Payer: Anthem Medicaid |
$1,853.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,203.03
|
| 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 |
$2,694.25
|
| Rate for Payer: Cash Price |
$2,694.25
|
| Rate for Payer: Cigna Commercial |
$4,472.45
|
| Rate for Payer: First Health Commercial |
$5,119.07
|
| Rate for Payer: Humana Commercial |
$4,580.23
|
| Rate for Payer: Humana KY Medicaid |
$1,853.11
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,871.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,418.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,976.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,890.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,741.88
|
| Rate for Payer: Ohio Health Group HMO |
$4,041.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,310.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,687.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,718.07
|
| Rate for Payer: PHCS Commercial |
$5,172.96
|
| Rate for Payer: United Healthcare All Payer |
$4,741.88
|
|
|
TREAT TOE FRACTURE
|
Professional
|
Both
|
$585.00
|
|
|
Service Code
|
HCPCS 28525
|
| Hospital Charge Code |
76102735
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$152.68 |
| Max. Negotiated Rate |
$687.01 |
| Rate for Payer: Aetna Commercial |
$562.03
|
| Rate for Payer: Ambetter Exchange |
$381.83
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$206.95
|
| Rate for Payer: Anthem Medicaid |
$152.68
|
| Rate for Payer: Buckeye Individual/Medicaid |
$381.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$381.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$458.20
|
| Rate for Payer: Cash Price |
$292.50
|
| Rate for Payer: Cash Price |
$292.50
|
| Rate for Payer: Cigna Commercial |
$439.95
|
| Rate for Payer: Healthspan PPO |
$687.01
|
| Rate for Payer: Humana Medicaid |
$152.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$487.60
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$381.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$381.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$155.73
|
| Rate for Payer: Molina Healthcare Passport |
$152.68
|
| Rate for Payer: Multiplan PHCS |
$351.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$496.38
|
| Rate for Payer: UHCCP Medicaid |
$217.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$154.21
|
| Rate for Payer: Wellcare Medicare Advantage |
$381.83
|
|
|
TREAT ULNAR FRACTURE
|
Facility
|
OP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 24675
|
| Hospital Charge Code |
45000127
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$725.97 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$1,625.47
|
| Rate for Payer: Anthem Medicaid |
$725.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,646.58
|
| 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 |
$1,055.50
|
| Rate for Payer: Cash Price |
$1,055.50
|
| Rate for Payer: Cigna Commercial |
$1,752.13
|
| Rate for Payer: First Health Commercial |
$2,005.45
|
| Rate for Payer: Humana Commercial |
$1,794.35
|
| Rate for Payer: Humana KY Medicaid |
$725.97
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$733.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,731.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,557.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$740.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,857.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,583.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,688.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,836.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,456.59
|
| Rate for Payer: PHCS Commercial |
$2,026.56
|
| Rate for Payer: United Healthcare All Payer |
$1,857.68
|
|
|
TREAT ULNAR FRACTURE
|
Facility
|
OP
|
$2,721.00
|
|
|
Service Code
|
HCPCS 24675
|
| Hospital Charge Code |
76100562
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$935.75 |
| Max. Negotiated Rate |
$2,612.16 |
| Rate for Payer: Aetna Commercial |
$2,095.17
|
| Rate for Payer: Anthem Medicaid |
$935.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,122.38
|
| 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 |
$1,360.50
|
| Rate for Payer: Cash Price |
$1,360.50
|
| Rate for Payer: Cigna Commercial |
$2,258.43
|
| Rate for Payer: First Health Commercial |
$2,584.95
|
| Rate for Payer: Humana Commercial |
$2,312.85
|
| Rate for Payer: Humana KY Medicaid |
$935.75
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$945.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,231.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,008.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$954.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,394.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,040.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,176.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,367.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,877.49
|
| Rate for Payer: PHCS Commercial |
$2,612.16
|
| Rate for Payer: United Healthcare All Payer |
$2,394.48
|
|
|
TREAT ULNAR FRACTURE
|
Facility
|
IP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 24675
|
| Hospital Charge Code |
45000127
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$633.30 |
| Max. Negotiated Rate |
$2,026.56 |
| Rate for Payer: Aetna Commercial |
$1,625.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,646.58
|
| Rate for Payer: Cash Price |
$1,055.50
|
| Rate for Payer: Cigna Commercial |
$1,752.13
|
| Rate for Payer: First Health Commercial |
$2,005.45
|
| Rate for Payer: Humana Commercial |
$1,794.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,731.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,557.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$633.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,857.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,583.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,688.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,836.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,456.59
|
| Rate for Payer: PHCS Commercial |
$2,026.56
|
| Rate for Payer: United Healthcare All Payer |
$1,857.68
|
|
|
TREAT ULNAR FRACTURE
|
Professional
|
Both
|
$2,721.00
|
|
|
Service Code
|
HCPCS 24675
|
| Hospital Charge Code |
76100562
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$239.90 |
| Max. Negotiated Rate |
$1,632.60 |
| Rate for Payer: Aetna Commercial |
$586.25
|
| Rate for Payer: Ambetter Exchange |
$402.56
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$243.88
|
| Rate for Payer: Anthem Medicaid |
$239.90
|
| Rate for Payer: Buckeye Individual/Medicaid |
$402.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$402.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$483.07
|
| Rate for Payer: Cash Price |
$1,360.50
|
| Rate for Payer: Cash Price |
$1,360.50
|
| Rate for Payer: Cigna Commercial |
$702.97
|
| Rate for Payer: Healthspan PPO |
$572.23
|
| Rate for Payer: Humana Medicaid |
$239.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$504.41
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$402.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$402.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$244.70
|
| Rate for Payer: Molina Healthcare Passport |
$239.90
|
| Rate for Payer: Multiplan PHCS |
$1,632.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$523.33
|
| Rate for Payer: UHCCP Medicaid |
$256.07
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$242.30
|
| Rate for Payer: Wellcare Medicare Advantage |
$402.56
|
|
|
TREAT ULNAR FRACTURE
|
Facility
|
IP
|
$2,721.00
|
|
|
Service Code
|
HCPCS 24675
|
| Hospital Charge Code |
76100562
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$816.30 |
| Max. Negotiated Rate |
$2,612.16 |
| Rate for Payer: Aetna Commercial |
$2,095.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,122.38
|
| Rate for Payer: Cash Price |
$1,360.50
|
| Rate for Payer: Cigna Commercial |
$2,258.43
|
| Rate for Payer: First Health Commercial |
$2,584.95
|
| Rate for Payer: Humana Commercial |
$2,312.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,231.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,008.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$816.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,394.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,040.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,176.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,367.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,877.49
|
| Rate for Payer: PHCS Commercial |
$2,612.16
|
| Rate for Payer: United Healthcare All Payer |
$2,394.48
|
|
|
TREAT ULNAR FRACTURE(P
|
Professional
|
Both
|
$610.00
|
|
|
Service Code
|
HCPCS 24675
|
| Hospital Charge Code |
761P0562
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$239.90 |
| Max. Negotiated Rate |
$702.97 |
| Rate for Payer: Aetna Commercial |
$586.25
|
| Rate for Payer: Ambetter Exchange |
$402.56
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$243.88
|
| Rate for Payer: Anthem Medicaid |
$239.90
|
| Rate for Payer: Buckeye Individual/Medicaid |
$402.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$402.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$483.07
|
| Rate for Payer: Cash Price |
$305.00
|
| Rate for Payer: Cash Price |
$305.00
|
| Rate for Payer: Cigna Commercial |
$702.97
|
| Rate for Payer: Healthspan PPO |
$572.23
|
| Rate for Payer: Humana Medicaid |
$239.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$504.41
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$402.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$402.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$244.70
|
| Rate for Payer: Molina Healthcare Passport |
$239.90
|
| Rate for Payer: Multiplan PHCS |
$366.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$523.33
|
| Rate for Payer: UHCCP Medicaid |
$256.07
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$242.30
|
| Rate for Payer: Wellcare Medicare Advantage |
$402.56
|
|
|
TREAT ULNAR FRACTURE(T
|
Facility
|
OP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 24675
|
| Hospital Charge Code |
761T0562
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$725.97 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$1,625.47
|
| Rate for Payer: Anthem Medicaid |
$725.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,646.58
|
| 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 |
$1,055.50
|
| Rate for Payer: Cash Price |
$1,055.50
|
| Rate for Payer: Cigna Commercial |
$1,752.13
|
| Rate for Payer: First Health Commercial |
$2,005.45
|
| Rate for Payer: Humana Commercial |
$1,794.35
|
| Rate for Payer: Humana KY Medicaid |
$725.97
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$733.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,731.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,557.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$740.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,857.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,583.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,688.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,836.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,456.59
|
| Rate for Payer: PHCS Commercial |
$2,026.56
|
| Rate for Payer: United Healthcare All Payer |
$1,857.68
|
|
|
TREAT ULNAR FRACTURE(T
|
Facility
|
IP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 24675
|
| Hospital Charge Code |
761T0562
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$633.30 |
| Max. Negotiated Rate |
$2,026.56 |
| Rate for Payer: Aetna Commercial |
$1,625.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,646.58
|
| Rate for Payer: Cash Price |
$1,055.50
|
| Rate for Payer: Cigna Commercial |
$1,752.13
|
| Rate for Payer: First Health Commercial |
$2,005.45
|
| Rate for Payer: Humana Commercial |
$1,794.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,731.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,557.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$633.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,857.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,583.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,688.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,836.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,456.59
|
| Rate for Payer: PHCS Commercial |
$2,026.56
|
| Rate for Payer: United Healthcare All Payer |
$1,857.68
|
|
|
TREAT VAGINA INFECTION
|
Facility
|
IP
|
$288.00
|
|
|
Service Code
|
HCPCS 57150
|
| Hospital Charge Code |
76102174
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$86.40 |
| Max. Negotiated Rate |
$276.48 |
| Rate for Payer: Aetna Commercial |
$221.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$224.64
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$239.04
|
| Rate for Payer: First Health Commercial |
$273.60
|
| Rate for Payer: Humana Commercial |
$244.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$236.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$212.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$86.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$253.44
|
| Rate for Payer: Ohio Health Group HMO |
$216.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$230.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$250.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$198.72
|
| Rate for Payer: PHCS Commercial |
$276.48
|
| Rate for Payer: United Healthcare All Payer |
$253.44
|
|
|
TREAT VAGINA INFECTION
|
Professional
|
Both
|
$288.00
|
|
|
Service Code
|
HCPCS 57150
|
| Hospital Charge Code |
76102174
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$24.11 |
| Max. Negotiated Rate |
$172.80 |
| Rate for Payer: Aetna Commercial |
$46.38
|
| Rate for Payer: Ambetter Exchange |
$24.11
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$24.94
|
| Rate for Payer: Anthem Medicaid |
$33.65
|
| Rate for Payer: Buckeye Individual/Medicaid |
$24.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$24.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$28.93
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$88.64
|
| Rate for Payer: Healthspan PPO |
$72.88
|
| Rate for Payer: Humana Medicaid |
$33.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$38.12
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$24.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$34.32
|
| Rate for Payer: Molina Healthcare Passport |
$33.65
|
| Rate for Payer: Multiplan PHCS |
$172.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$31.34
|
| Rate for Payer: UHCCP Medicaid |
$26.19
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$33.99
|
| Rate for Payer: Wellcare Medicare Advantage |
$24.11
|
|
|
TREAT VAGINA INFECTION
|
Facility
|
OP
|
$288.00
|
|
|
Service Code
|
HCPCS 57150
|
| Hospital Charge Code |
76102174
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$54.88 |
| Max. Negotiated Rate |
$276.48 |
| Rate for Payer: Aetna Commercial |
$221.76
|
| Rate for Payer: Anthem Medicaid |
$99.04
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$54.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$224.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$76.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$74.09
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$239.04
|
| Rate for Payer: First Health Commercial |
$273.60
|
| Rate for Payer: Humana Commercial |
$244.80
|
| Rate for Payer: Humana KY Medicaid |
$99.04
|
| Rate for Payer: Humana Medicare Advantage |
$54.88
|
| Rate for Payer: Kentucky WC Medicaid |
$100.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$236.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$212.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$101.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$253.44
|
| Rate for Payer: Ohio Health Group HMO |
$216.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$230.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$250.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$198.72
|
| Rate for Payer: PHCS Commercial |
$276.48
|
| Rate for Payer: United Healthcare All Payer |
$253.44
|
|
|
TREAT VAGINA INFECTION(P
|
Professional
|
Both
|
$74.00
|
|
|
Service Code
|
HCPCS 57150
|
| Hospital Charge Code |
761P2174
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$24.11 |
| Max. Negotiated Rate |
$88.64 |
| Rate for Payer: Aetna Commercial |
$46.38
|
| Rate for Payer: Ambetter Exchange |
$24.11
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$24.94
|
| Rate for Payer: Anthem Medicaid |
$33.65
|
| Rate for Payer: Buckeye Individual/Medicaid |
$24.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$24.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$28.93
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Cigna Commercial |
$88.64
|
| Rate for Payer: Healthspan PPO |
$72.88
|
| Rate for Payer: Humana Medicaid |
$33.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$38.12
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$24.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$34.32
|
| Rate for Payer: Molina Healthcare Passport |
$33.65
|
| Rate for Payer: Multiplan PHCS |
$44.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$31.34
|
| Rate for Payer: UHCCP Medicaid |
$26.19
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$33.99
|
| Rate for Payer: Wellcare Medicare Advantage |
$24.11
|
|
|
TREAT VAGINA INFECTION(T
|
Facility
|
OP
|
$214.00
|
|
|
Service Code
|
HCPCS 57150
|
| Hospital Charge Code |
761T2174
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$54.88 |
| Max. Negotiated Rate |
$205.44 |
| Rate for Payer: Aetna Commercial |
$164.78
|
| Rate for Payer: Anthem Medicaid |
$73.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$54.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$166.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$76.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$74.09
|
| Rate for Payer: Cash Price |
$107.00
|
| Rate for Payer: Cash Price |
$107.00
|
| Rate for Payer: Cigna Commercial |
$177.62
|
| Rate for Payer: First Health Commercial |
$203.30
|
| Rate for Payer: Humana Commercial |
$181.90
|
| Rate for Payer: Humana KY Medicaid |
$73.59
|
| Rate for Payer: Humana Medicare Advantage |
$54.88
|
| Rate for Payer: Kentucky WC Medicaid |
$74.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$175.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$157.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$75.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$188.32
|
| Rate for Payer: Ohio Health Group HMO |
$160.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$171.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$186.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$147.66
|
| Rate for Payer: PHCS Commercial |
$205.44
|
| Rate for Payer: United Healthcare All Payer |
$188.32
|
|
|
TREAT VAGINA INFECTION(T
|
Facility
|
IP
|
$214.00
|
|
|
Service Code
|
HCPCS 57150
|
| Hospital Charge Code |
761T2174
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.20 |
| Max. Negotiated Rate |
$205.44 |
| Rate for Payer: Aetna Commercial |
$164.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$166.92
|
| Rate for Payer: Cash Price |
$107.00
|
| Rate for Payer: Cigna Commercial |
$177.62
|
| Rate for Payer: First Health Commercial |
$203.30
|
| Rate for Payer: Humana Commercial |
$181.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$175.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$157.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$64.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$188.32
|
| Rate for Payer: Ohio Health Group HMO |
$160.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$171.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$186.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$147.66
|
| Rate for Payer: PHCS Commercial |
$205.44
|
| Rate for Payer: United Healthcare All Payer |
$188.32
|
|
|
TREAT WRIST BONE FRACTURE
|
Professional
|
Both
|
$2,769.00
|
|
|
Service Code
|
HCPCS 25650
|
| Hospital Charge Code |
76100641
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$164.31 |
| Max. Negotiated Rate |
$1,661.40 |
| Rate for Payer: Aetna Commercial |
$393.58
|
| Rate for Payer: Ambetter Exchange |
$297.33
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$172.80
|
| Rate for Payer: Anthem Medicaid |
$164.31
|
| Rate for Payer: Buckeye Individual/Medicaid |
$297.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$297.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$356.80
|
| Rate for Payer: Cash Price |
$1,384.50
|
| Rate for Payer: Cash Price |
$1,384.50
|
| Rate for Payer: Cigna Commercial |
$478.18
|
| Rate for Payer: Healthspan PPO |
$384.63
|
| Rate for Payer: Humana Medicaid |
$164.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$352.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$297.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$297.33
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$167.60
|
| Rate for Payer: Molina Healthcare Passport |
$164.31
|
| Rate for Payer: Multiplan PHCS |
$1,661.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$386.53
|
| Rate for Payer: UHCCP Medicaid |
$181.44
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$165.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$297.33
|
|
|
TREAT WRIST BONE FRACTURE
|
Facility
|
IP
|
$2,769.00
|
|
|
Service Code
|
HCPCS 25650
|
| Hospital Charge Code |
76100641
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$830.70 |
| Max. Negotiated Rate |
$2,658.24 |
| Rate for Payer: Aetna Commercial |
$2,132.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,159.82
|
| Rate for Payer: Cash Price |
$1,384.50
|
| Rate for Payer: Cigna Commercial |
$2,298.27
|
| Rate for Payer: First Health Commercial |
$2,630.55
|
| Rate for Payer: Humana Commercial |
$2,353.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,270.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,043.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$830.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,436.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,076.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,215.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,409.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,910.61
|
| Rate for Payer: PHCS Commercial |
$2,658.24
|
| Rate for Payer: United Healthcare All Payer |
$2,436.72
|
|
|
TREAT WRIST BONE FRACTURE
|
Facility
|
OP
|
$2,769.00
|
|
|
Service Code
|
HCPCS 25650
|
| Hospital Charge Code |
76100641
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$2,658.24 |
| Rate for Payer: Aetna Commercial |
$2,132.13
|
| Rate for Payer: Anthem Medicaid |
$952.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,159.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$1,384.50
|
| Rate for Payer: Cash Price |
$1,384.50
|
| Rate for Payer: Cigna Commercial |
$2,298.27
|
| Rate for Payer: First Health Commercial |
$2,630.55
|
| Rate for Payer: Humana Commercial |
$2,353.65
|
| Rate for Payer: Humana KY Medicaid |
$952.26
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$961.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,270.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,043.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$971.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,436.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,076.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,215.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,409.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,910.61
|
| Rate for Payer: PHCS Commercial |
$2,658.24
|
| Rate for Payer: United Healthcare All Payer |
$2,436.72
|
|
|
TREAT WRIST BONE FRACTURE(P
|
Professional
|
Both
|
$1,065.00
|
|
|
Service Code
|
HCPCS 25650
|
| Hospital Charge Code |
761P0641
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$164.31 |
| Max. Negotiated Rate |
$639.00 |
| Rate for Payer: Aetna Commercial |
$393.58
|
| Rate for Payer: Ambetter Exchange |
$297.33
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$172.80
|
| Rate for Payer: Anthem Medicaid |
$164.31
|
| Rate for Payer: Buckeye Individual/Medicaid |
$297.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$297.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$356.80
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$478.18
|
| Rate for Payer: Healthspan PPO |
$384.63
|
| Rate for Payer: Humana Medicaid |
$164.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$352.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$297.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$297.33
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$167.60
|
| Rate for Payer: Molina Healthcare Passport |
$164.31
|
| Rate for Payer: Multiplan PHCS |
$639.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$386.53
|
| Rate for Payer: UHCCP Medicaid |
$181.44
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$165.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$297.33
|
|
|
TREAT WRIST BONE FRACTURE(T
|
Facility
|
IP
|
$1,704.00
|
|
|
Service Code
|
HCPCS 25650
|
| Hospital Charge Code |
761T0641
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$511.20 |
| Max. Negotiated Rate |
$1,635.84 |
| Rate for Payer: Aetna Commercial |
$1,312.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,329.12
|
| Rate for Payer: Cash Price |
$852.00
|
| Rate for Payer: Cigna Commercial |
$1,414.32
|
| Rate for Payer: First Health Commercial |
$1,618.80
|
| Rate for Payer: Humana Commercial |
$1,448.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,397.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,257.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$511.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,499.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,278.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,363.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,482.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,175.76
|
| Rate for Payer: PHCS Commercial |
$1,635.84
|
| Rate for Payer: United Healthcare All Payer |
$1,499.52
|
|
|
TREAT WRIST BONE FRACTURE(T
|
Facility
|
OP
|
$1,704.00
|
|
|
Service Code
|
HCPCS 25650
|
| Hospital Charge Code |
761T0641
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$1,635.84 |
| Rate for Payer: Aetna Commercial |
$1,312.08
|
| Rate for Payer: Anthem Medicaid |
$586.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,329.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$852.00
|
| Rate for Payer: Cash Price |
$852.00
|
| Rate for Payer: Cigna Commercial |
$1,414.32
|
| Rate for Payer: First Health Commercial |
$1,618.80
|
| Rate for Payer: Humana Commercial |
$1,448.40
|
| Rate for Payer: Humana KY Medicaid |
$586.01
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$591.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,397.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,257.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$597.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,499.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,278.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,363.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,482.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,175.76
|
| Rate for Payer: PHCS Commercial |
$1,635.84
|
| Rate for Payer: United Healthcare All Payer |
$1,499.52
|
|
