|
CLOSED TRMT ULNAR FX PROX
|
Professional
|
Both
|
$1,503.00
|
|
|
Service Code
|
HCPCS 24670
|
| Hospital Charge Code |
76100561
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.99 |
| Max. Negotiated Rate |
$1,503.00 |
| Rate for Payer: Aetna Commercial |
$347.87
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$140.02
|
| Rate for Payer: Anthem Medicaid |
$128.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,503.00
|
| Rate for Payer: Cash Price |
$751.50
|
| Rate for Payer: Cash Price |
$751.50
|
| Rate for Payer: Cigna Commercial |
$433.03
|
| Rate for Payer: Healthspan PPO |
$348.06
|
| Rate for Payer: Humana Medicaid |
$128.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$308.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$131.57
|
| Rate for Payer: Molina Healthcare Passport |
$128.99
|
| Rate for Payer: Multiplan PHCS |
$901.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,052.10
|
| Rate for Payer: UHCCP Medicaid |
$147.02
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$130.28
|
|
|
CLOSED TRMT ULNAR FX PROX
|
Facility
|
IP
|
$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 POS/PPO/Traditional |
$1,172.34
|
| 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: 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 |
$450.90
|
| 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
|
|
|
CLOSED TRMT ULNAR FX PROX(P
|
Professional
|
Both
|
$603.00
|
|
|
Service Code
|
HCPCS 24670
|
| Hospital Charge Code |
761P0561
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.99 |
| Max. Negotiated Rate |
$603.00 |
| Rate for Payer: Aetna Commercial |
$347.87
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$140.02
|
| Rate for Payer: Anthem Medicaid |
$128.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$603.00
|
| Rate for Payer: Cash Price |
$301.50
|
| Rate for Payer: Cash Price |
$301.50
|
| Rate for Payer: Cigna Commercial |
$433.03
|
| Rate for Payer: Healthspan PPO |
$348.06
|
| Rate for Payer: Humana Medicaid |
$128.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$308.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$131.57
|
| Rate for Payer: Molina Healthcare Passport |
$128.99
|
| Rate for Payer: Multiplan PHCS |
$361.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$422.10
|
| Rate for Payer: UHCCP Medicaid |
$147.02
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$130.28
|
|
|
CLOSED TRMT ULNAR FX PROX(T
|
Facility
|
IP
|
$900.00
|
|
|
Service Code
|
HCPCS 24670
|
| Hospital Charge Code |
761T0561
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$117.00 |
| 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 |
$180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$117.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$279.00
|
| Rate for Payer: PHCS Commercial |
$864.00
|
| Rate for Payer: United Healthcare All Payer |
$792.00
|
|
|
CLOSED TRMT ULNAR FX PROX(T
|
Facility
|
OP
|
$900.00
|
|
|
Service Code
|
HCPCS 24670
|
| Hospital Charge Code |
761T0561
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$117.00 |
| 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 |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$702.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| 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 |
$203.93
|
| 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 |
$244.72
|
| 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 |
$180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$117.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$279.00
|
| Rate for Payer: PHCS Commercial |
$864.00
|
| Rate for Payer: United Healthcare All Payer |
$792.00
|
|
|
CLOSED TX FEMORAL SHAFT FX
|
Professional
|
Both
|
$1,170.00
|
|
|
Service Code
|
HCPCS 27500
|
| Hospital Charge Code |
76100856
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$320.26 |
| Max. Negotiated Rate |
$1,170.00 |
| Rate for Payer: Aetna Commercial |
$687.46
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$325.86
|
| Rate for Payer: Anthem Medicaid |
$320.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,170.00
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cigna Commercial |
$809.33
|
| Rate for Payer: Healthspan PPO |
$664.39
|
| Rate for Payer: Humana Medicaid |
$320.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$586.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$326.67
|
| Rate for Payer: Molina Healthcare Passport |
$320.26
|
| Rate for Payer: Multiplan PHCS |
$702.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$819.00
|
| Rate for Payer: UHCCP Medicaid |
$342.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$323.46
|
|
|
CLOSED TX FEMORAL SHAFT FX
|
Facility
|
OP
|
$1,170.00
|
|
|
Service Code
|
HCPCS 27500
|
| Hospital Charge Code |
76100856
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$152.10 |
| Max. Negotiated Rate |
$1,123.20 |
| Rate for Payer: Aetna Commercial |
$900.90
|
| Rate for Payer: Anthem Medicaid |
$402.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$912.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cigna Commercial |
$971.10
|
| Rate for Payer: First Health Commercial |
$1,111.50
|
| Rate for Payer: Humana Commercial |
$994.50
|
| Rate for Payer: Humana KY Medicaid |
$402.36
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$406.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$959.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$863.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$410.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,029.60
|
| Rate for Payer: Ohio Health Group HMO |
$877.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$152.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$362.70
|
| Rate for Payer: PHCS Commercial |
$1,123.20
|
| Rate for Payer: United Healthcare All Payer |
$1,029.60
|
|
|
CLOSED TX FEMORAL SHAFT FX
|
Facility
|
IP
|
$1,170.00
|
|
|
Service Code
|
HCPCS 27500
|
| Hospital Charge Code |
76100856
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$152.10 |
| Max. Negotiated Rate |
$1,123.20 |
| Rate for Payer: Aetna Commercial |
$900.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$912.60
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cigna Commercial |
$971.10
|
| Rate for Payer: First Health Commercial |
$1,111.50
|
| Rate for Payer: Humana Commercial |
$994.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$959.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$863.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$351.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,029.60
|
| Rate for Payer: Ohio Health Group HMO |
$877.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$152.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$362.70
|
| Rate for Payer: PHCS Commercial |
$1,123.20
|
| Rate for Payer: United Healthcare All Payer |
$1,029.60
|
|
|
CLOSED TX FEMORAL SHAFT FX(P
|
Professional
|
Both
|
$1,170.00
|
|
|
Service Code
|
HCPCS 27500
|
| Hospital Charge Code |
761P0856
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$320.26 |
| Max. Negotiated Rate |
$1,170.00 |
| Rate for Payer: Aetna Commercial |
$687.46
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$325.86
|
| Rate for Payer: Anthem Medicaid |
$320.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,170.00
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cigna Commercial |
$809.33
|
| Rate for Payer: Healthspan PPO |
$664.39
|
| Rate for Payer: Humana Medicaid |
$320.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$586.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$326.67
|
| Rate for Payer: Molina Healthcare Passport |
$320.26
|
| Rate for Payer: Multiplan PHCS |
$702.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$819.00
|
| Rate for Payer: UHCCP Medicaid |
$342.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$323.46
|
|
|
CLOSED TX KNEE DISLO W/O ANEST
|
Professional
|
Both
|
$725.00
|
|
|
Service Code
|
HCPCS 27550
|
| Hospital Charge Code |
76102676
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$239.95 |
| Max. Negotiated Rate |
$725.00 |
| Rate for Payer: Aetna Commercial |
$643.32
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$245.71
|
| Rate for Payer: Anthem Medicaid |
$239.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$725.00
|
| Rate for Payer: Cash Price |
$362.50
|
| Rate for Payer: Cash Price |
$362.50
|
| Rate for Payer: Cigna Commercial |
$701.42
|
| Rate for Payer: Healthspan PPO |
$621.50
|
| Rate for Payer: Humana Medicaid |
$239.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$560.29
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$244.75
|
| Rate for Payer: Molina Healthcare Passport |
$239.95
|
| Rate for Payer: Multiplan PHCS |
$435.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$507.50
|
| Rate for Payer: UHCCP Medicaid |
$258.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$242.35
|
|
|
CLOSED TX METATARSAL FX
|
Facility
|
OP
|
$550.00
|
|
|
Service Code
|
HCPCS 28470
|
| Hospital Charge Code |
76101019
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$71.50 |
| Max. Negotiated Rate |
$528.00 |
| Rate for Payer: Aetna Commercial |
$423.50
|
| Rate for Payer: Anthem Medicaid |
$189.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$429.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$456.50
|
| Rate for Payer: First Health Commercial |
$522.50
|
| Rate for Payer: Humana Commercial |
$467.50
|
| Rate for Payer: Humana KY Medicaid |
$189.14
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$191.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$451.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$405.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$192.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$484.00
|
| Rate for Payer: Ohio Health Group HMO |
$412.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$110.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$170.50
|
| Rate for Payer: PHCS Commercial |
$528.00
|
| Rate for Payer: United Healthcare All Payer |
$484.00
|
|
|
CLOSED TX METATARSAL FX
|
Facility
|
IP
|
$550.00
|
|
|
Service Code
|
HCPCS 28470
|
| Hospital Charge Code |
76101019
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$71.50 |
| Max. Negotiated Rate |
$528.00 |
| Rate for Payer: Aetna Commercial |
$423.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$429.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$456.50
|
| Rate for Payer: First Health Commercial |
$522.50
|
| Rate for Payer: Humana Commercial |
$467.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$451.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$405.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$484.00
|
| Rate for Payer: Ohio Health Group HMO |
$412.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$110.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$170.50
|
| Rate for Payer: PHCS Commercial |
$528.00
|
| Rate for Payer: United Healthcare All Payer |
$484.00
|
|
|
CLOSED TX METATARSAL FX
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 28470
|
| Hospital Charge Code |
76101019
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$81.37 |
| Max. Negotiated Rate |
$550.00 |
| Rate for Payer: Aetna Commercial |
$263.08
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$116.62
|
| Rate for Payer: Anthem Medicaid |
$81.37
|
| 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 |
$328.80
|
| Rate for Payer: Healthspan PPO |
$262.04
|
| Rate for Payer: Humana Medicaid |
$81.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$227.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$83.00
|
| Rate for Payer: Molina Healthcare Passport |
$81.37
|
| Rate for Payer: Multiplan PHCS |
$330.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$385.00
|
| Rate for Payer: UHCCP Medicaid |
$122.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$82.18
|
|
|
CLOSED TX METATARSAL FX(P
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 28470
|
| Hospital Charge Code |
761P1019
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$81.37 |
| Max. Negotiated Rate |
$550.00 |
| Rate for Payer: Aetna Commercial |
$263.08
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$116.62
|
| Rate for Payer: Anthem Medicaid |
$81.37
|
| 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 |
$328.80
|
| Rate for Payer: Healthspan PPO |
$262.04
|
| Rate for Payer: Humana Medicaid |
$81.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$227.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$83.00
|
| Rate for Payer: Molina Healthcare Passport |
$81.37
|
| Rate for Payer: Multiplan PHCS |
$330.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$385.00
|
| Rate for Payer: UHCCP Medicaid |
$122.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$82.18
|
|
|
CLOSED TX SEPTAL&NOSE FX
|
Facility
|
OP
|
$3,912.00
|
|
|
Service Code
|
HCPCS 21337
|
| Hospital Charge Code |
45000102
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$508.56 |
| Max. Negotiated Rate |
$3,897.84 |
| Rate for Payer: Aetna Commercial |
$3,012.24
|
| Rate for Payer: Anthem Medicaid |
$1,345.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,051.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,897.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,758.63
|
| Rate for Payer: Cash Price |
$1,956.00
|
| Rate for Payer: Cash Price |
$1,956.00
|
| Rate for Payer: Cigna Commercial |
$3,246.96
|
| Rate for Payer: First Health Commercial |
$3,716.40
|
| Rate for Payer: Humana Commercial |
$3,325.20
|
| Rate for Payer: Humana KY Medicaid |
$1,345.34
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,359.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,207.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,887.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,372.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,442.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,934.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$782.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$508.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,212.72
|
| Rate for Payer: PHCS Commercial |
$3,755.52
|
| Rate for Payer: United Healthcare All Payer |
$3,442.56
|
|
|
CLOSED TX SEPTAL&NOSE FX
|
Facility
|
IP
|
$5,012.00
|
|
|
Service Code
|
HCPCS 21337
|
| Hospital Charge Code |
76100384
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$651.56 |
| Max. Negotiated Rate |
$4,811.52 |
| Rate for Payer: Aetna Commercial |
$3,859.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,909.36
|
| Rate for Payer: Cash Price |
$2,506.00
|
| Rate for Payer: Cigna Commercial |
$4,159.96
|
| Rate for Payer: First Health Commercial |
$4,761.40
|
| Rate for Payer: Humana Commercial |
$4,260.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,109.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,698.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,503.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,410.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,759.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,002.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$651.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,553.72
|
| Rate for Payer: PHCS Commercial |
$4,811.52
|
| Rate for Payer: United Healthcare All Payer |
$4,410.56
|
|
|
CLOSED TX SEPTAL&NOSE FX
|
Professional
|
Both
|
$5,012.00
|
|
|
Service Code
|
HCPCS 21337
|
| Hospital Charge Code |
76100384
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$153.65 |
| Max. Negotiated Rate |
$5,012.00 |
| Rate for Payer: Aetna Commercial |
$399.74
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$153.65
|
| Rate for Payer: Anthem Medicaid |
$158.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,012.00
|
| Rate for Payer: Cash Price |
$2,506.00
|
| Rate for Payer: Cash Price |
$2,506.00
|
| Rate for Payer: Cigna Commercial |
$433.54
|
| Rate for Payer: Healthspan PPO |
$484.24
|
| Rate for Payer: Humana Medicaid |
$158.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$361.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$162.00
|
| Rate for Payer: Molina Healthcare Passport |
$158.82
|
| Rate for Payer: Multiplan PHCS |
$3,007.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,508.40
|
| Rate for Payer: UHCCP Medicaid |
$161.33
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$160.41
|
|
|
CLOSED TX SEPTAL&NOSE FX
|
Facility
|
OP
|
$5,012.00
|
|
|
Service Code
|
HCPCS 21337
|
| Hospital Charge Code |
76100384
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$651.56 |
| Max. Negotiated Rate |
$4,811.52 |
| Rate for Payer: Aetna Commercial |
$3,859.24
|
| Rate for Payer: Anthem Medicaid |
$1,723.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,909.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,897.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,758.63
|
| Rate for Payer: Cash Price |
$2,506.00
|
| Rate for Payer: Cash Price |
$2,506.00
|
| Rate for Payer: Cigna Commercial |
$4,159.96
|
| Rate for Payer: First Health Commercial |
$4,761.40
|
| Rate for Payer: Humana Commercial |
$4,260.20
|
| Rate for Payer: Humana KY Medicaid |
$1,723.63
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,741.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,109.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,698.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,758.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,410.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,759.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,002.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$651.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,553.72
|
| Rate for Payer: PHCS Commercial |
$4,811.52
|
| Rate for Payer: United Healthcare All Payer |
$4,410.56
|
|
|
CLOSED TX SEPTAL&NOSE FX
|
Facility
|
IP
|
$3,912.00
|
|
|
Service Code
|
HCPCS 21337
|
| Hospital Charge Code |
45000102
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$508.56 |
| Max. Negotiated Rate |
$3,755.52 |
| Rate for Payer: Aetna Commercial |
$3,012.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,051.36
|
| Rate for Payer: Cash Price |
$1,956.00
|
| Rate for Payer: Cigna Commercial |
$3,246.96
|
| Rate for Payer: First Health Commercial |
$3,716.40
|
| Rate for Payer: Humana Commercial |
$3,325.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,207.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,887.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,173.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,442.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,934.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$782.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$508.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,212.72
|
| Rate for Payer: PHCS Commercial |
$3,755.52
|
| Rate for Payer: United Healthcare All Payer |
$3,442.56
|
|
|
CLOSED TX SEPTAL&NOSE FX(P
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 21337
|
| Hospital Charge Code |
761P0384
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$153.65 |
| Max. Negotiated Rate |
$1,100.00 |
| Rate for Payer: Aetna Commercial |
$399.74
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$153.65
|
| Rate for Payer: Anthem Medicaid |
$158.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,100.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$433.54
|
| Rate for Payer: Healthspan PPO |
$484.24
|
| Rate for Payer: Humana Medicaid |
$158.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$361.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$162.00
|
| Rate for Payer: Molina Healthcare Passport |
$158.82
|
| Rate for Payer: Multiplan PHCS |
$660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$770.00
|
| Rate for Payer: UHCCP Medicaid |
$161.33
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$160.41
|
|
|
CLOSED TX SEPTAL&NOSE FX(T
|
Facility
|
IP
|
$3,912.00
|
|
|
Service Code
|
HCPCS 21337
|
| Hospital Charge Code |
761T0384
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$508.56 |
| Max. Negotiated Rate |
$3,755.52 |
| Rate for Payer: Aetna Commercial |
$3,012.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,051.36
|
| Rate for Payer: Cash Price |
$1,956.00
|
| Rate for Payer: Cigna Commercial |
$3,246.96
|
| Rate for Payer: First Health Commercial |
$3,716.40
|
| Rate for Payer: Humana Commercial |
$3,325.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,207.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,887.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,173.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,442.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,934.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$782.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$508.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,212.72
|
| Rate for Payer: PHCS Commercial |
$3,755.52
|
| Rate for Payer: United Healthcare All Payer |
$3,442.56
|
|
|
CLOSED TX SEPTAL&NOSE FX(T
|
Facility
|
OP
|
$3,912.00
|
|
|
Service Code
|
HCPCS 21337
|
| Hospital Charge Code |
761T0384
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$508.56 |
| Max. Negotiated Rate |
$3,897.84 |
| Rate for Payer: Aetna Commercial |
$3,012.24
|
| Rate for Payer: Anthem Medicaid |
$1,345.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,051.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,897.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,758.63
|
| Rate for Payer: Cash Price |
$1,956.00
|
| Rate for Payer: Cash Price |
$1,956.00
|
| Rate for Payer: Cigna Commercial |
$3,246.96
|
| Rate for Payer: First Health Commercial |
$3,716.40
|
| Rate for Payer: Humana Commercial |
$3,325.20
|
| Rate for Payer: Humana KY Medicaid |
$1,345.34
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,359.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,207.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,887.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,372.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,442.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,934.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$782.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$508.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,212.72
|
| Rate for Payer: PHCS Commercial |
$3,755.52
|
| Rate for Payer: United Healthcare All Payer |
$3,442.56
|
|
|
CLOSED TX TARSOMETATARSAL DI(P
|
Professional
|
Both
|
$575.00
|
|
|
Service Code
|
HCPCS 28600
|
| Hospital Charge Code |
761P1031
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$62.71 |
| Max. Negotiated Rate |
$575.00 |
| Rate for Payer: Aetna Commercial |
$260.74
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$94.82
|
| Rate for Payer: Anthem Medicaid |
$62.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$575.00
|
| Rate for Payer: Cash Price |
$287.50
|
| Rate for Payer: Cash Price |
$287.50
|
| Rate for Payer: Cigna Commercial |
$312.33
|
| Rate for Payer: Healthspan PPO |
$260.41
|
| Rate for Payer: Humana Medicaid |
$62.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$227.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$63.96
|
| Rate for Payer: Molina Healthcare Passport |
$62.71
|
| Rate for Payer: Multiplan PHCS |
$345.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$402.50
|
| Rate for Payer: UHCCP Medicaid |
$99.56
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$63.34
|
|
|
CLOSED TX TARSOMETATARSAL DIS
|
Professional
|
Both
|
$1,261.00
|
|
|
Service Code
|
HCPCS 28600
|
| Hospital Charge Code |
76101031
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$62.71 |
| Max. Negotiated Rate |
$1,261.00 |
| Rate for Payer: Aetna Commercial |
$260.74
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$94.82
|
| Rate for Payer: Anthem Medicaid |
$62.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,261.00
|
| Rate for Payer: Cash Price |
$630.50
|
| Rate for Payer: Cash Price |
$630.50
|
| Rate for Payer: Cigna Commercial |
$312.33
|
| Rate for Payer: Healthspan PPO |
$260.41
|
| Rate for Payer: Humana Medicaid |
$62.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$227.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$63.96
|
| Rate for Payer: Molina Healthcare Passport |
$62.71
|
| Rate for Payer: Multiplan PHCS |
$756.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$882.70
|
| Rate for Payer: UHCCP Medicaid |
$99.56
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$63.34
|
|
|
CLOSED TX TARSOMETATARSAL DIS
|
Facility
|
OP
|
$1,261.00
|
|
|
Service Code
|
HCPCS 28600
|
| Hospital Charge Code |
76101031
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$163.93 |
| Max. Negotiated Rate |
$1,210.56 |
| Rate for Payer: Aetna Commercial |
$970.97
|
| Rate for Payer: Anthem Medicaid |
$433.66
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$983.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$630.50
|
| Rate for Payer: Cash Price |
$630.50
|
| Rate for Payer: Cigna Commercial |
$1,046.63
|
| Rate for Payer: First Health Commercial |
$1,197.95
|
| Rate for Payer: Humana Commercial |
$1,071.85
|
| Rate for Payer: Humana KY Medicaid |
$433.66
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$438.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,034.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$930.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$442.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,109.68
|
| Rate for Payer: Ohio Health Group HMO |
$945.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$252.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$163.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$390.91
|
| Rate for Payer: PHCS Commercial |
$1,210.56
|
| Rate for Payer: United Healthcare All Payer |
$1,109.68
|
|
