|
CLOSED REDUC INTRPHLANG JNT
|
Facility
|
IP
|
$322.00
|
|
|
Service Code
|
HCPCS 28660
|
| Hospital Charge Code |
45000182
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$41.86 |
| Max. Negotiated Rate |
$309.12 |
| Rate for Payer: Aetna Commercial |
$247.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$251.16
|
| Rate for Payer: Cash Price |
$161.00
|
| Rate for Payer: Cigna Commercial |
$267.26
|
| Rate for Payer: First Health Commercial |
$305.90
|
| Rate for Payer: Humana Commercial |
$273.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$264.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$237.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$96.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$283.36
|
| Rate for Payer: Ohio Health Group HMO |
$241.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$41.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$99.82
|
| Rate for Payer: PHCS Commercial |
$309.12
|
| Rate for Payer: United Healthcare All Payer |
$283.36
|
|
|
CLOSED REDUC INTRPHLANG JNT
|
Facility
|
IP
|
$878.00
|
|
|
Service Code
|
HCPCS 28660
|
| Hospital Charge Code |
76101035
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$114.14 |
| Max. Negotiated Rate |
$842.88 |
| Rate for Payer: First Health Commercial |
$834.10
|
| Rate for Payer: Humana Commercial |
$746.30
|
| Rate for Payer: Aetna Commercial |
$676.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$684.84
|
| Rate for Payer: Cash Price |
$439.00
|
| Rate for Payer: Cigna Commercial |
$728.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$719.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$647.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$263.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$772.64
|
| Rate for Payer: Ohio Health Group HMO |
$658.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$175.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$114.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$272.18
|
| Rate for Payer: PHCS Commercial |
$842.88
|
| Rate for Payer: United Healthcare All Payer |
$772.64
|
|
|
CLOSED REDUC INTRPHLANG JNT
|
Facility
|
OP
|
$878.00
|
|
|
Service Code
|
HCPCS 28660
|
| Hospital Charge Code |
76101035
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$114.14 |
| Max. Negotiated Rate |
$842.88 |
| Rate for Payer: Aetna Commercial |
$676.06
|
| Rate for Payer: Anthem Medicaid |
$301.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$684.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$439.00
|
| Rate for Payer: Cash Price |
$439.00
|
| Rate for Payer: Cigna Commercial |
$728.74
|
| Rate for Payer: First Health Commercial |
$834.10
|
| Rate for Payer: Humana Commercial |
$746.30
|
| Rate for Payer: Humana KY Medicaid |
$301.94
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$305.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$719.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$647.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$308.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$772.64
|
| Rate for Payer: Ohio Health Group HMO |
$658.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$175.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$114.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$272.18
|
| Rate for Payer: PHCS Commercial |
$842.88
|
| Rate for Payer: United Healthcare All Payer |
$772.64
|
|
|
CLOSED REDUC INTRPHLANG JNT
|
Facility
|
OP
|
$322.00
|
|
|
Service Code
|
HCPCS 28660
|
| Hospital Charge Code |
45000182
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$41.86 |
| Max. Negotiated Rate |
$309.12 |
| Rate for Payer: Aetna Commercial |
$247.94
|
| Rate for Payer: Anthem Medicaid |
$110.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$251.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$161.00
|
| Rate for Payer: Cash Price |
$161.00
|
| Rate for Payer: Cigna Commercial |
$267.26
|
| Rate for Payer: First Health Commercial |
$305.90
|
| Rate for Payer: Humana Commercial |
$273.70
|
| Rate for Payer: Humana KY Medicaid |
$110.74
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$111.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$264.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$237.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$112.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$283.36
|
| Rate for Payer: Ohio Health Group HMO |
$241.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$41.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$99.82
|
| Rate for Payer: PHCS Commercial |
$309.12
|
| Rate for Payer: United Healthcare All Payer |
$283.36
|
|
|
CLOSED REDUC INTRPHLANG JNT(P
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 28660
|
| Hospital Charge Code |
761P1035
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$47.59 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna Commercial |
$123.70
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$47.59
|
| Rate for Payer: Anthem Medicaid |
$52.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$350.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$162.25
|
| Rate for Payer: Healthspan PPO |
$135.79
|
| Rate for Payer: Humana Medicaid |
$52.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$107.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$54.04
|
| Rate for Payer: Molina Healthcare Passport |
$52.98
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$245.00
|
| Rate for Payer: UHCCP Medicaid |
$49.97
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$53.51
|
|
|
CLOSED REDUC INTRPHLANG JNT(T
|
Facility
|
OP
|
$528.00
|
|
|
Service Code
|
HCPCS 28660
|
| Hospital Charge Code |
761T1035
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$68.64 |
| Max. Negotiated Rate |
$506.88 |
| Rate for Payer: Aetna Commercial |
$406.56
|
| Rate for Payer: Anthem Medicaid |
$181.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$411.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cigna Commercial |
$438.24
|
| Rate for Payer: First Health Commercial |
$501.60
|
| Rate for Payer: Humana Commercial |
$448.80
|
| Rate for Payer: Humana KY Medicaid |
$181.58
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$183.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$432.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$389.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$185.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$464.64
|
| Rate for Payer: Ohio Health Group HMO |
$396.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$105.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$163.68
|
| Rate for Payer: PHCS Commercial |
$506.88
|
| Rate for Payer: United Healthcare All Payer |
$464.64
|
|
|
CLOSED REDUC INTRPHLANG JNT(T
|
Facility
|
IP
|
$528.00
|
|
|
Service Code
|
HCPCS 28660
|
| Hospital Charge Code |
761T1035
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$68.64 |
| Max. Negotiated Rate |
$506.88 |
| Rate for Payer: Aetna Commercial |
$406.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$411.84
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cigna Commercial |
$438.24
|
| Rate for Payer: First Health Commercial |
$501.60
|
| Rate for Payer: Humana Commercial |
$448.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$432.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$389.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$158.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$464.64
|
| Rate for Payer: Ohio Health Group HMO |
$396.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$105.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$163.68
|
| Rate for Payer: PHCS Commercial |
$506.88
|
| Rate for Payer: United Healthcare All Payer |
$464.64
|
|
|
CLOSED REDUCT TEMPOROMANDIB
|
Facility
|
OP
|
$338.00
|
|
|
Service Code
|
HCPCS 21480
|
| Hospital Charge Code |
45000103
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$43.94 |
| Max. Negotiated Rate |
$324.48 |
| Rate for Payer: Aetna Commercial |
$260.26
|
| Rate for Payer: Anthem Medicaid |
$116.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$263.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Cigna Commercial |
$280.54
|
| Rate for Payer: First Health Commercial |
$321.10
|
| Rate for Payer: Humana Commercial |
$287.30
|
| Rate for Payer: Humana KY Medicaid |
$116.24
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$117.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$277.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$249.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$118.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$297.44
|
| Rate for Payer: Ohio Health Group HMO |
$253.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$104.78
|
| Rate for Payer: PHCS Commercial |
$324.48
|
| Rate for Payer: United Healthcare All Payer |
$297.44
|
|
|
CLOSED REDUCT TEMPOROMANDIB
|
Facility
|
IP
|
$888.00
|
|
|
Service Code
|
HCPCS 21480
|
| Hospital Charge Code |
76100389
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$115.44 |
| Max. Negotiated Rate |
$852.48 |
| Rate for Payer: Aetna Commercial |
$683.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$692.64
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cigna Commercial |
$737.04
|
| Rate for Payer: First Health Commercial |
$843.60
|
| Rate for Payer: Humana Commercial |
$754.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$728.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$655.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$266.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$781.44
|
| Rate for Payer: Ohio Health Group HMO |
$666.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$177.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$115.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$275.28
|
| Rate for Payer: PHCS Commercial |
$852.48
|
| Rate for Payer: United Healthcare All Payer |
$781.44
|
|
|
CLOSED REDUCT TEMPOROMANDIB
|
Facility
|
OP
|
$888.00
|
|
|
Service Code
|
HCPCS 21480
|
| Hospital Charge Code |
76100389
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$115.44 |
| Max. Negotiated Rate |
$852.48 |
| Rate for Payer: Aetna Commercial |
$683.76
|
| Rate for Payer: Anthem Medicaid |
$305.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$692.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cigna Commercial |
$737.04
|
| Rate for Payer: First Health Commercial |
$843.60
|
| Rate for Payer: Humana Commercial |
$754.80
|
| Rate for Payer: Humana KY Medicaid |
$305.38
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$308.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$728.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$655.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$311.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$781.44
|
| Rate for Payer: Ohio Health Group HMO |
$666.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$177.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$115.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$275.28
|
| Rate for Payer: PHCS Commercial |
$852.48
|
| Rate for Payer: United Healthcare All Payer |
$781.44
|
|
|
CLOSED REDUCT TEMPOROMANDIB
|
Facility
|
IP
|
$338.00
|
|
|
Service Code
|
HCPCS 21480
|
| Hospital Charge Code |
45000103
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$43.94 |
| Max. Negotiated Rate |
$324.48 |
| Rate for Payer: Aetna Commercial |
$260.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$263.64
|
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Cigna Commercial |
$280.54
|
| Rate for Payer: First Health Commercial |
$321.10
|
| Rate for Payer: Humana Commercial |
$287.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$277.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$249.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$101.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$297.44
|
| Rate for Payer: Ohio Health Group HMO |
$253.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$104.78
|
| Rate for Payer: PHCS Commercial |
$324.48
|
| Rate for Payer: United Healthcare All Payer |
$297.44
|
|
|
CLOSED REDUCT TEMPOROMANDIB
|
Professional
|
Both
|
$888.00
|
|
|
Service Code
|
HCPCS 21480
|
| Hospital Charge Code |
76100389
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$20.50 |
| Max. Negotiated Rate |
$888.00 |
| Rate for Payer: Aetna Commercial |
$49.11
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$20.50
|
| Rate for Payer: Anthem Medicaid |
$41.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$888.00
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cigna Commercial |
$146.52
|
| Rate for Payer: Healthspan PPO |
$111.88
|
| Rate for Payer: Humana Medicaid |
$41.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$40.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$41.83
|
| Rate for Payer: Molina Healthcare Passport |
$41.01
|
| Rate for Payer: Multiplan PHCS |
$532.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$621.60
|
| Rate for Payer: UHCCP Medicaid |
$21.52
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$41.42
|
|
|
CLOSED REDUCT TEMPOROMANDIB(P
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 21480
|
| Hospital Charge Code |
761P0389
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$20.50 |
| Max. Negotiated Rate |
$550.00 |
| Rate for Payer: Aetna Commercial |
$49.11
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$20.50
|
| Rate for Payer: Anthem Medicaid |
$41.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$550.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$146.52
|
| Rate for Payer: Healthspan PPO |
$111.88
|
| Rate for Payer: Humana Medicaid |
$41.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$40.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$41.83
|
| Rate for Payer: Molina Healthcare Passport |
$41.01
|
| Rate for Payer: Multiplan PHCS |
$330.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$385.00
|
| Rate for Payer: UHCCP Medicaid |
$21.52
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$41.42
|
|
|
CLOSED REDUCT TEMPOROMANDIB(T
|
Facility
|
IP
|
$338.00
|
|
|
Service Code
|
HCPCS 21480
|
| Hospital Charge Code |
761T0389
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$43.94 |
| Max. Negotiated Rate |
$324.48 |
| Rate for Payer: Aetna Commercial |
$260.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$263.64
|
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Cigna Commercial |
$280.54
|
| Rate for Payer: First Health Commercial |
$321.10
|
| Rate for Payer: Humana Commercial |
$287.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$277.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$249.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$101.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$297.44
|
| Rate for Payer: Ohio Health Group HMO |
$253.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$104.78
|
| Rate for Payer: PHCS Commercial |
$324.48
|
| Rate for Payer: United Healthcare All Payer |
$297.44
|
|
|
CLOSED REDUCT TEMPOROMANDIB(T
|
Facility
|
OP
|
$338.00
|
|
|
Service Code
|
HCPCS 21480
|
| Hospital Charge Code |
761T0389
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$43.94 |
| Max. Negotiated Rate |
$324.48 |
| Rate for Payer: Aetna Commercial |
$260.26
|
| Rate for Payer: Anthem Medicaid |
$116.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$263.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Cigna Commercial |
$280.54
|
| Rate for Payer: First Health Commercial |
$321.10
|
| Rate for Payer: Humana Commercial |
$287.30
|
| Rate for Payer: Humana KY Medicaid |
$116.24
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$117.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$277.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$249.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$118.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$297.44
|
| Rate for Payer: Ohio Health Group HMO |
$253.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$104.78
|
| Rate for Payer: PHCS Commercial |
$324.48
|
| Rate for Payer: United Healthcare All Payer |
$297.44
|
|
|
CLOSED TREATMENT OF CARPOMETACARPAL FRACTURE DISLOCATION, THUMB (BENNETT FRACTURE), WITH MANIPULATION
|
Facility
|
OP
|
$1,945.78
|
|
|
Service Code
|
CPT 26645
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,389.84 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
|
|
CLOSED TREATMENT OF DISTAL EXTENSOR TENDON INSERTION, WITH OR WITHOUT PERCUTANEOUS PINNING (EG, MALLET FINGER)
|
Facility
|
OP
|
$1,945.78
|
|
|
Service Code
|
CPT 26432
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,389.84 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
|
|
CLOSED TREATMENT OF DISTAL RADIAL FRACTURE (EG, COLLES OR SMITH TYPE) OR EPIPHYSEAL SEPARATION, INCLUDES CLOSED TREATMENT OF FRACTURE OF ULNAR STYLOID, WHEN PERFORMED; WITH MANIPULATION
|
Facility
|
OP
|
$1,945.78
|
|
|
Service Code
|
CPT 25605
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,389.84 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
|
|
CLOSED TREATMENT OF NASAL BONE FRACTURE WITH MANIPULATION; WITH STABILIZATION
|
Facility
|
OP
|
$3,897.84
|
|
|
Service Code
|
CPT 21320
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,784.17 |
| Max. Negotiated Rate |
$3,897.84 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,897.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,758.63
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
|
|
CLOSED TREATMENT OF NASAL SEPTAL FRACTURE, WITH OR WITHOUT STABILIZATION
|
Facility
|
OP
|
$3,897.84
|
|
|
Service Code
|
CPT 21337
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,784.17 |
| Max. Negotiated Rate |
$3,897.84 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,897.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,758.63
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
|
|
CLOSED TREATMENT OF POST HIP ARTHROPLASTY DISLOCATION; REQUIRING REGIONAL OR GENERAL ANESTHESIA
|
Facility
|
OP
|
$1,945.78
|
|
|
Service Code
|
CPT 27266
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,389.84 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
|
|
CLOSED TREATMENT OF RADIAL AND ULNAR SHAFT FRACTURES; WITH MANIPULATION
|
Facility
|
OP
|
$1,945.78
|
|
|
Service Code
|
CPT 25565
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,389.84 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
|
|
CLOSED TREATMENT OF SHOULDER DISLOCATION, WITH MANIPULATION; REQUIRING ANESTHESIA
|
Facility
|
OP
|
$1,945.78
|
|
|
Service Code
|
CPT 23655
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,389.84 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
|
|
CLOSED TREATMENT OF ULNAR SHAFT FRACTURE; WITH MANIPULATION
|
Facility
|
OP
|
$285.50
|
|
|
Service Code
|
CPT 25535
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$203.93 |
| Max. Negotiated Rate |
$285.50 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
|
|
CLOSED TRMT ULNAR FX PROX
|
Facility
|
OP
|
$1,503.00
|
|
|
Service Code
|
HCPCS 24670
|
| Hospital Charge Code |
76100561
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$195.39 |
| Max. Negotiated Rate |
$1,442.88 |
| Rate for Payer: Aetna Commercial |
$1,157.31
|
| Rate for Payer: Anthem Medicaid |
$516.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,172.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$751.50
|
| Rate for Payer: Cash Price |
$751.50
|
| Rate for Payer: Cigna Commercial |
$1,247.49
|
| Rate for Payer: First Health Commercial |
$1,427.85
|
| Rate for Payer: Humana Commercial |
$1,277.55
|
| Rate for Payer: Humana KY Medicaid |
$516.88
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$522.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,232.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,109.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$527.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,322.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,127.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$300.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$195.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$465.93
|
| Rate for Payer: PHCS Commercial |
$1,442.88
|
| Rate for Payer: United Healthcare All Payer |
$1,322.64
|
|
