|
CLTX THIGH FX
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 27267
|
| Hospital Charge Code |
76100804
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$143.00 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem Medicaid |
$378.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$913.00
|
| Rate for Payer: First Health Commercial |
$1,045.00
|
| Rate for Payer: Humana Commercial |
$935.00
|
| Rate for Payer: Humana KY Medicaid |
$378.29
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$382.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$902.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$385.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$968.00
|
| Rate for Payer: Ohio Health Group HMO |
$825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$143.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$341.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
CLTX THIGH FX
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 27267
|
| Hospital Charge Code |
76100804
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$316.58 |
| Max. Negotiated Rate |
$1,100.00 |
| Rate for Payer: Aetna Commercial |
$603.00
|
| Rate for Payer: Anthem Medicaid |
$316.58
|
| 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 |
$647.63
|
| Rate for Payer: Healthspan PPO |
$546.19
|
| Rate for Payer: Humana Medicaid |
$316.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$523.91
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$322.91
|
| Rate for Payer: Molina Healthcare Passport |
$316.58
|
| Rate for Payer: Multiplan PHCS |
$660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$770.00
|
| Rate for Payer: UHCCP Medicaid |
$385.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$319.75
|
|
|
CLTX THIGH FX
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 27267
|
| Hospital Charge Code |
76100804
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$143.00 |
| Max. Negotiated Rate |
$1,056.00 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$913.00
|
| Rate for Payer: First Health Commercial |
$1,045.00
|
| Rate for Payer: Humana Commercial |
$935.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$902.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$330.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$968.00
|
| Rate for Payer: Ohio Health Group HMO |
$825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$143.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$341.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
CLTX THIGH FX(P
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 27267
|
| Hospital Charge Code |
761P0804
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$316.58 |
| Max. Negotiated Rate |
$1,100.00 |
| Rate for Payer: Aetna Commercial |
$603.00
|
| Rate for Payer: Anthem Medicaid |
$316.58
|
| 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 |
$647.63
|
| Rate for Payer: Healthspan PPO |
$546.19
|
| Rate for Payer: Humana Medicaid |
$316.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$523.91
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$322.91
|
| Rate for Payer: Molina Healthcare Passport |
$316.58
|
| Rate for Payer: Multiplan PHCS |
$660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$770.00
|
| Rate for Payer: UHCCP Medicaid |
$385.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$319.75
|
|
|
CLTX THIGH FX W/MNPJ
|
Facility
|
IP
|
$725.00
|
|
|
Service Code
|
HCPCS 27268
|
| Hospital Charge Code |
76100805
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$94.25 |
| Max. Negotiated Rate |
$696.00 |
| Rate for Payer: Aetna Commercial |
$558.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$565.50
|
| Rate for Payer: Cash Price |
$362.50
|
| Rate for Payer: Cigna Commercial |
$601.75
|
| Rate for Payer: First Health Commercial |
$688.75
|
| Rate for Payer: Humana Commercial |
$616.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$594.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$535.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$217.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$638.00
|
| Rate for Payer: Ohio Health Group HMO |
$543.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$145.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$94.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$224.75
|
| Rate for Payer: PHCS Commercial |
$696.00
|
| Rate for Payer: United Healthcare All Payer |
$638.00
|
|
|
CLTX THIGH FX W/MNPJ
|
Professional
|
Both
|
$725.00
|
|
|
Service Code
|
HCPCS 27268
|
| Hospital Charge Code |
76100805
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$253.75 |
| Max. Negotiated Rate |
$798.35 |
| Rate for Payer: Aetna Commercial |
$750.53
|
| Rate for Payer: Anthem Medicaid |
$391.05
|
| 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 |
$798.35
|
| Rate for Payer: Healthspan PPO |
$679.82
|
| Rate for Payer: Humana Medicaid |
$391.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$649.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$398.87
|
| Rate for Payer: Molina Healthcare Passport |
$391.05
|
| Rate for Payer: Multiplan PHCS |
$435.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$507.50
|
| Rate for Payer: UHCCP Medicaid |
$253.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$394.96
|
|
|
CLTX THIGH FX W/MNPJ
|
Facility
|
OP
|
$725.00
|
|
|
Service Code
|
HCPCS 27268
|
| Hospital Charge Code |
76100805
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$94.25 |
| Max. Negotiated Rate |
$696.00 |
| Rate for Payer: Aetna Commercial |
$558.25
|
| Rate for Payer: Anthem Medicaid |
$249.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$565.50
|
| Rate for Payer: Cash Price |
$362.50
|
| Rate for Payer: Cigna Commercial |
$601.75
|
| Rate for Payer: First Health Commercial |
$688.75
|
| Rate for Payer: Humana Commercial |
$616.25
|
| Rate for Payer: Humana KY Medicaid |
$249.33
|
| Rate for Payer: Kentucky WC Medicaid |
$251.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$594.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$535.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$217.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$254.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$638.00
|
| Rate for Payer: Ohio Health Group HMO |
$543.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$145.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$94.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$224.75
|
| Rate for Payer: PHCS Commercial |
$696.00
|
| Rate for Payer: United Healthcare All Payer |
$638.00
|
|
|
CLTX THIGH FX W/MNPJ(P
|
Professional
|
Both
|
$725.00
|
|
|
Service Code
|
HCPCS 27268
|
| Hospital Charge Code |
761P0805
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$253.75 |
| Max. Negotiated Rate |
$798.35 |
| Rate for Payer: Aetna Commercial |
$750.53
|
| Rate for Payer: Anthem Medicaid |
$391.05
|
| 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 |
$798.35
|
| Rate for Payer: Healthspan PPO |
$679.82
|
| Rate for Payer: Humana Medicaid |
$391.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$649.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$398.87
|
| Rate for Payer: Molina Healthcare Passport |
$391.05
|
| Rate for Payer: Multiplan PHCS |
$435.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$507.50
|
| Rate for Payer: UHCCP Medicaid |
$253.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$394.96
|
|
|
CLTX TIBIAL FX PROXIMAL
|
Professional
|
Both
|
$770.00
|
|
|
Service Code
|
HCPCS 27530
|
| Hospital Charge Code |
76100868
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$198.37 |
| Max. Negotiated Rate |
$770.00 |
| Rate for Payer: Aetna Commercial |
$506.66
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$205.18
|
| Rate for Payer: Anthem Medicaid |
$198.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$770.00
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: Cigna Commercial |
$603.42
|
| Rate for Payer: Healthspan PPO |
$489.96
|
| Rate for Payer: Humana Medicaid |
$198.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$443.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$202.34
|
| Rate for Payer: Molina Healthcare Passport |
$198.37
|
| Rate for Payer: Multiplan PHCS |
$462.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$539.00
|
| Rate for Payer: UHCCP Medicaid |
$215.44
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$200.35
|
|
|
CLTX TIBIAL FX PROXIMAL
|
Facility
|
OP
|
$770.00
|
|
|
Service Code
|
HCPCS 27530
|
| Hospital Charge Code |
76100868
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$100.10 |
| Max. Negotiated Rate |
$739.20 |
| Rate for Payer: Aetna Commercial |
$592.90
|
| Rate for Payer: Anthem Medicaid |
$264.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$600.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: Cigna Commercial |
$639.10
|
| Rate for Payer: First Health Commercial |
$731.50
|
| Rate for Payer: Humana Commercial |
$654.50
|
| Rate for Payer: Humana KY Medicaid |
$264.80
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$267.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$631.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$568.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$270.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$677.60
|
| Rate for Payer: Ohio Health Group HMO |
$577.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$154.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$238.70
|
| Rate for Payer: PHCS Commercial |
$739.20
|
| Rate for Payer: United Healthcare All Payer |
$677.60
|
|
|
CLTX TIBIAL FX PROXIMAL
|
Facility
|
IP
|
$770.00
|
|
|
Service Code
|
HCPCS 27530
|
| Hospital Charge Code |
76100868
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$100.10 |
| Max. Negotiated Rate |
$739.20 |
| Rate for Payer: Aetna Commercial |
$592.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$600.60
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: Cigna Commercial |
$639.10
|
| Rate for Payer: First Health Commercial |
$731.50
|
| Rate for Payer: Humana Commercial |
$654.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$631.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$568.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$231.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$677.60
|
| Rate for Payer: Ohio Health Group HMO |
$577.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$154.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$238.70
|
| Rate for Payer: PHCS Commercial |
$739.20
|
| Rate for Payer: United Healthcare All Payer |
$677.60
|
|
|
CLTX TIBIAL FX PROXIMAL(P
|
Professional
|
Both
|
$770.00
|
|
|
Service Code
|
HCPCS 27530
|
| Hospital Charge Code |
761P0868
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$198.37 |
| Max. Negotiated Rate |
$770.00 |
| Rate for Payer: Aetna Commercial |
$506.66
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$205.18
|
| Rate for Payer: Anthem Medicaid |
$198.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$770.00
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: Cigna Commercial |
$603.42
|
| Rate for Payer: Healthspan PPO |
$489.96
|
| Rate for Payer: Humana Medicaid |
$198.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$443.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$202.34
|
| Rate for Payer: Molina Healthcare Passport |
$198.37
|
| Rate for Payer: Multiplan PHCS |
$462.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$539.00
|
| Rate for Payer: UHCCP Medicaid |
$215.44
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$200.35
|
|
|
CLTX TIBIAL SHAFT FX
|
Facility
|
OP
|
$971.00
|
|
|
Service Code
|
HCPCS 27750
|
| Hospital Charge Code |
76100923
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$126.23 |
| Max. Negotiated Rate |
$932.16 |
| Rate for Payer: Aetna Commercial |
$747.67
|
| Rate for Payer: Anthem Medicaid |
$333.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$757.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$485.50
|
| Rate for Payer: Cash Price |
$485.50
|
| Rate for Payer: Cigna Commercial |
$805.93
|
| Rate for Payer: First Health Commercial |
$922.45
|
| Rate for Payer: Humana Commercial |
$825.35
|
| Rate for Payer: Humana KY Medicaid |
$333.93
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$337.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$796.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$716.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$340.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$854.48
|
| Rate for Payer: Ohio Health Group HMO |
$728.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$194.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$126.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$301.01
|
| Rate for Payer: PHCS Commercial |
$932.16
|
| Rate for Payer: United Healthcare All Payer |
$854.48
|
|
|
CLTX TIBIAL SHAFT FX
|
Professional
|
Both
|
$971.00
|
|
|
Service Code
|
HCPCS 27750
|
| Hospital Charge Code |
76100923
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$186.41 |
| Max. Negotiated Rate |
$971.00 |
| Rate for Payer: Aetna Commercial |
$429.12
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$186.41
|
| Rate for Payer: Anthem Medicaid |
$189.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$971.00
|
| Rate for Payer: Cash Price |
$485.50
|
| Rate for Payer: Cash Price |
$485.50
|
| Rate for Payer: Cigna Commercial |
$520.64
|
| Rate for Payer: Healthspan PPO |
$420.69
|
| Rate for Payer: Humana Medicaid |
$189.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$377.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$193.58
|
| Rate for Payer: Molina Healthcare Passport |
$189.78
|
| Rate for Payer: Multiplan PHCS |
$582.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$679.70
|
| Rate for Payer: UHCCP Medicaid |
$195.73
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$191.68
|
|
|
CLTX TIBIAL SHAFT FX
|
Facility
|
IP
|
$971.00
|
|
|
Service Code
|
HCPCS 27750
|
| Hospital Charge Code |
76100923
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$126.23 |
| Max. Negotiated Rate |
$932.16 |
| Rate for Payer: Aetna Commercial |
$747.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$757.38
|
| Rate for Payer: Cash Price |
$485.50
|
| Rate for Payer: Cigna Commercial |
$805.93
|
| Rate for Payer: First Health Commercial |
$922.45
|
| Rate for Payer: Humana Commercial |
$825.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$796.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$716.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$291.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$854.48
|
| Rate for Payer: Ohio Health Group HMO |
$728.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$194.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$126.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$301.01
|
| Rate for Payer: PHCS Commercial |
$932.16
|
| Rate for Payer: United Healthcare All Payer |
$854.48
|
|
|
CLTX TIBIAL SHAFT FX(P
|
Professional
|
Both
|
$971.00
|
|
|
Service Code
|
HCPCS 27750
|
| Hospital Charge Code |
761P0923
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$186.41 |
| Max. Negotiated Rate |
$971.00 |
| Rate for Payer: Aetna Commercial |
$429.12
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$186.41
|
| Rate for Payer: Anthem Medicaid |
$189.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$971.00
|
| Rate for Payer: Cash Price |
$485.50
|
| Rate for Payer: Cash Price |
$485.50
|
| Rate for Payer: Cigna Commercial |
$520.64
|
| Rate for Payer: Healthspan PPO |
$420.69
|
| Rate for Payer: Humana Medicaid |
$189.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$377.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$193.58
|
| Rate for Payer: Molina Healthcare Passport |
$189.78
|
| Rate for Payer: Multiplan PHCS |
$582.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$679.70
|
| Rate for Payer: UHCCP Medicaid |
$195.73
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$191.68
|
|
|
CLTX TRANSSCPHPRLNR TYP FX DIS
|
Facility
|
OP
|
$1,570.00
|
|
|
Service Code
|
HCPCS 25680
|
| Hospital Charge Code |
76100644
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$203.93 |
| Max. Negotiated Rate |
$1,507.20 |
| Rate for Payer: Aetna Commercial |
$1,208.90
|
| Rate for Payer: Anthem Medicaid |
$539.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,224.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$785.00
|
| Rate for Payer: Cash Price |
$785.00
|
| Rate for Payer: Cigna Commercial |
$1,303.10
|
| Rate for Payer: First Health Commercial |
$1,491.50
|
| Rate for Payer: Humana Commercial |
$1,334.50
|
| Rate for Payer: Humana KY Medicaid |
$539.92
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$545.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,287.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,158.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$550.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,381.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,177.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$314.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$204.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$486.70
|
| Rate for Payer: PHCS Commercial |
$1,507.20
|
| Rate for Payer: United Healthcare All Payer |
$1,381.60
|
|
|
CLTX TRANSSCPHPRLNR TYP FX DIS
|
Facility
|
IP
|
$1,570.00
|
|
|
Service Code
|
HCPCS 25680
|
| Hospital Charge Code |
76100644
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$204.10 |
| Max. Negotiated Rate |
$1,507.20 |
| Rate for Payer: Aetna Commercial |
$1,208.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,224.60
|
| Rate for Payer: Cash Price |
$785.00
|
| Rate for Payer: Cigna Commercial |
$1,303.10
|
| Rate for Payer: First Health Commercial |
$1,491.50
|
| Rate for Payer: Humana Commercial |
$1,334.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,287.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,158.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$471.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,381.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,177.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$314.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$204.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$486.70
|
| Rate for Payer: PHCS Commercial |
$1,507.20
|
| Rate for Payer: United Healthcare All Payer |
$1,381.60
|
|
|
CLTX TRANSSCPHPRLNR TYP FX DIS
|
Professional
|
Both
|
$1,570.00
|
|
|
Service Code
|
HCPCS 25680
|
| Hospital Charge Code |
76100644
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$239.40 |
| Max. Negotiated Rate |
$1,570.00 |
| Rate for Payer: Aetna Commercial |
$650.04
|
| Rate for Payer: Anthem Medicaid |
$239.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,570.00
|
| Rate for Payer: Cash Price |
$785.00
|
| Rate for Payer: Cash Price |
$785.00
|
| Rate for Payer: Cigna Commercial |
$705.52
|
| Rate for Payer: Healthspan PPO |
$588.80
|
| Rate for Payer: Humana Medicaid |
$239.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$563.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$244.19
|
| Rate for Payer: Molina Healthcare Passport |
$239.40
|
| Rate for Payer: Multiplan PHCS |
$942.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,099.00
|
| Rate for Payer: UHCCP Medicaid |
$549.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$241.79
|
|
|
CLTX TRANSSCPHPRLNR TYP FX DIS
|
Facility
|
OP
|
$900.00
|
|
|
Service Code
|
HCPCS 25680
|
| Hospital Charge Code |
761T0644
|
|
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
|
|
|
CLTX TRANSSCPHPRLNR TYP FX DIS
|
Professional
|
Both
|
$670.00
|
|
|
Service Code
|
HCPCS 25680
|
| Hospital Charge Code |
761P0644
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$234.50 |
| Max. Negotiated Rate |
$705.52 |
| Rate for Payer: Aetna Commercial |
$650.04
|
| Rate for Payer: Anthem Medicaid |
$239.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$670.00
|
| Rate for Payer: Cash Price |
$335.00
|
| Rate for Payer: Cash Price |
$335.00
|
| Rate for Payer: Cigna Commercial |
$705.52
|
| Rate for Payer: Healthspan PPO |
$588.80
|
| Rate for Payer: Humana Medicaid |
$239.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$563.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$244.19
|
| Rate for Payer: Molina Healthcare Passport |
$239.40
|
| Rate for Payer: Multiplan PHCS |
$402.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$469.00
|
| Rate for Payer: UHCCP Medicaid |
$234.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$241.79
|
|
|
CLTX TRANSSCPHPRLNR TYP FX DIS
|
Facility
|
IP
|
$900.00
|
|
|
Service Code
|
HCPCS 25680
|
| Hospital Charge Code |
761T0644
|
|
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
|
|
|
CLTX TRIMALLEOLAR ANKLE FX
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 27816
|
| Hospital Charge Code |
76100942
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.50 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$622.50
|
| Rate for Payer: First Health Commercial |
$712.50
|
| Rate for Payer: Humana Commercial |
$637.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$553.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.00
|
| Rate for Payer: Ohio Health Group HMO |
$562.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$150.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$232.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
|
CLTX TRIMALLEOLAR ANKLE FX
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 27816
|
| Hospital Charge Code |
76100942
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.50 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem Medicaid |
$257.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$622.50
|
| Rate for Payer: First Health Commercial |
$712.50
|
| Rate for Payer: Humana Commercial |
$637.50
|
| Rate for Payer: Humana KY Medicaid |
$257.92
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$260.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$553.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$263.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.00
|
| Rate for Payer: Ohio Health Group HMO |
$562.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$150.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$232.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
|
CLTX TRIMALLEOLAR ANKLE FX
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 27816
|
| Hospital Charge Code |
76100942
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$185.96 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna Commercial |
$379.17
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$191.26
|
| Rate for Payer: Anthem Medicaid |
$185.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$750.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$472.50
|
| Rate for Payer: Healthspan PPO |
$378.36
|
| Rate for Payer: Humana Medicaid |
$185.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$337.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$189.68
|
| Rate for Payer: Molina Healthcare Passport |
$185.96
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$525.00
|
| Rate for Payer: UHCCP Medicaid |
$200.82
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$187.82
|
|
