|
CLOSED REDUCT TEMPOROMANDIB
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 21480
|
| Hospital Charge Code |
45000103
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem Medicaid |
$257.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| 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 |
$257.93
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| 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 |
$265.97
|
| 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 |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$652.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$517.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
|
CLOSED REDUCT TEMPOROMANDIB
|
Facility
|
OP
|
$1,065.00
|
|
|
Service Code
|
HCPCS 21480
|
| Hospital Charge Code |
76100389
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$1,022.40 |
| Rate for Payer: Aetna Commercial |
$820.05
|
| Rate for Payer: Anthem Medicaid |
$366.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$830.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$883.95
|
| Rate for Payer: First Health Commercial |
$1,011.75
|
| Rate for Payer: Humana Commercial |
$905.25
|
| Rate for Payer: Humana KY Medicaid |
$366.25
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$369.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$873.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$785.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$373.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$937.20
|
| Rate for Payer: Ohio Health Group HMO |
$798.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$852.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$926.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$734.85
|
| Rate for Payer: PHCS Commercial |
$1,022.40
|
| Rate for Payer: United Healthcare All Payer |
$937.20
|
|
|
CLOSED REDUCT TEMPOROMANDIB
|
Professional
|
Both
|
$1,065.00
|
|
|
Service Code
|
HCPCS 21480
|
| Hospital Charge Code |
76100389
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$20.50 |
| Max. Negotiated Rate |
$639.00 |
| Rate for Payer: Aetna Commercial |
$49.11
|
| Rate for Payer: Ambetter Exchange |
$30.26
|
| 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 Individual/Medicaid |
$30.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$30.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$36.31
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cash Price |
$532.50
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$30.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$41.83
|
| Rate for Payer: Molina Healthcare Passport |
$41.01
|
| Rate for Payer: Multiplan PHCS |
$639.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$39.34
|
| Rate for Payer: UHCCP Medicaid |
$21.52
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$41.42
|
| Rate for Payer: Wellcare Medicare Advantage |
$30.26
|
|
|
CLOSED REDUCT TEMPOROMANDIB
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 21480
|
| Hospital Charge Code |
45000103
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$225.00 |
| 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 |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$652.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$517.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
|
CLOSED REDUCT TEMPOROMANDIB(P
|
Professional
|
Both
|
$315.00
|
|
|
Service Code
|
HCPCS 21480
|
| Hospital Charge Code |
761P0389
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$20.50 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Aetna Commercial |
$49.11
|
| Rate for Payer: Ambetter Exchange |
$30.26
|
| 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 Individual/Medicaid |
$30.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$30.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$36.31
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$30.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$41.83
|
| Rate for Payer: Molina Healthcare Passport |
$41.01
|
| Rate for Payer: Multiplan PHCS |
$189.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$39.34
|
| Rate for Payer: UHCCP Medicaid |
$21.52
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$41.42
|
| Rate for Payer: Wellcare Medicare Advantage |
$30.26
|
|
|
CLOSED REDUCT TEMPOROMANDIB(T
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 21480
|
| Hospital Charge Code |
761T0389
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$225.00 |
| 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 |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$652.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$517.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
|
CLOSED REDUCT TEMPOROMANDIB(T
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 21480
|
| Hospital Charge Code |
761T0389
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem Medicaid |
$257.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| 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 |
$257.93
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| 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 |
$265.97
|
| 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 |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$652.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$517.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
|
CLOSED TREATMENT OF CARPOMETACARPAL FRACTURE DISLOCATION, THUMB (BENNETT FRACTURE), WITH MANIPULATION
|
Facility
|
OP
|
$2,070.25
|
|
|
Service Code
|
CPT 26645
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,478.75 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
|
|
CLOSED TREATMENT OF DISTAL EXTENSOR TENDON INSERTION, WITH OR WITHOUT PERCUTANEOUS PINNING (EG, MALLET FINGER)
|
Facility
|
OP
|
$2,070.25
|
|
|
Service Code
|
CPT 26432
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,478.75 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
|
|
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
|
$2,070.25
|
|
|
Service Code
|
CPT 25605
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,478.75 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
|
|
CLOSED TREATMENT OF NASAL BONE FRACTURE WITH MANIPULATION; WITH STABILIZATION
|
Facility
|
OP
|
$4,195.14
|
|
|
Service Code
|
CPT 21320
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,996.53 |
| Max. Negotiated Rate |
$4,195.14 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,195.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,045.32
|
| Rate for Payer: Humana Medicare Advantage |
$2,996.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,595.84
|
|
|
CLOSED TREATMENT OF NASAL SEPTAL FRACTURE, WITH OR WITHOUT STABILIZATION
|
Facility
|
OP
|
$4,195.14
|
|
|
Service Code
|
CPT 21337
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,996.53 |
| Max. Negotiated Rate |
$4,195.14 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,195.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,045.32
|
| Rate for Payer: Humana Medicare Advantage |
$2,996.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,595.84
|
|
|
CLOSED TREATMENT OF POST HIP ARTHROPLASTY DISLOCATION; REQUIRING REGIONAL OR GENERAL ANESTHESIA
|
Facility
|
OP
|
$2,070.25
|
|
|
Service Code
|
CPT 27266
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,478.75 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
|
|
CLOSED TREATMENT OF RADIAL AND ULNAR SHAFT FRACTURES; WITH MANIPULATION
|
Facility
|
OP
|
$2,070.25
|
|
|
Service Code
|
CPT 25565
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,478.75 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
|
|
CLOSED TREATMENT OF SHOULDER DISLOCATION, WITH MANIPULATION; REQUIRING ANESTHESIA
|
Facility
|
OP
|
$2,070.25
|
|
|
Service Code
|
CPT 23655
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,478.75 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
|
|
CLOSED TREATMENT OF ULNAR SHAFT FRACTURE; WITH MANIPULATION
|
Facility
|
OP
|
$310.30
|
|
|
Service Code
|
CPT 25535
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$310.30 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
|
|
CLOSED TRMT ULNAR FX PROX
|
Facility
|
IP
|
$1,562.00
|
|
|
Service Code
|
HCPCS 24670
|
| Hospital Charge Code |
76100561
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$468.60 |
| Max. Negotiated Rate |
$1,499.52 |
| Rate for Payer: Aetna Commercial |
$1,202.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,218.36
|
| Rate for Payer: Cash Price |
$781.00
|
| Rate for Payer: Cigna Commercial |
$1,296.46
|
| Rate for Payer: First Health Commercial |
$1,483.90
|
| Rate for Payer: Humana Commercial |
$1,327.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,280.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,152.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$468.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,374.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,171.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,249.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,358.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,077.78
|
| Rate for Payer: PHCS Commercial |
$1,499.52
|
| Rate for Payer: United Healthcare All Payer |
$1,374.56
|
|
|
CLOSED TRMT ULNAR FX PROX
|
Facility
|
OP
|
$1,562.00
|
|
|
Service Code
|
HCPCS 24670
|
| Hospital Charge Code |
76100561
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$1,499.52 |
| Rate for Payer: Aetna Commercial |
$1,202.74
|
| Rate for Payer: Anthem Medicaid |
$537.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,218.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$781.00
|
| Rate for Payer: Cash Price |
$781.00
|
| Rate for Payer: Cigna Commercial |
$1,296.46
|
| Rate for Payer: First Health Commercial |
$1,483.90
|
| Rate for Payer: Humana Commercial |
$1,327.70
|
| Rate for Payer: Humana KY Medicaid |
$537.17
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$542.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,280.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,152.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$547.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,374.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,171.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,249.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,358.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,077.78
|
| Rate for Payer: PHCS Commercial |
$1,499.52
|
| Rate for Payer: United Healthcare All Payer |
$1,374.56
|
|
|
CLOSED TRMT ULNAR FX PROX
|
Professional
|
Both
|
$1,562.00
|
|
|
Service Code
|
HCPCS 24670
|
| Hospital Charge Code |
76100561
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.99 |
| Max. Negotiated Rate |
$937.20 |
| Rate for Payer: Aetna Commercial |
$347.87
|
| Rate for Payer: Ambetter Exchange |
$260.31
|
| 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 Individual/Medicaid |
$260.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$260.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$312.37
|
| Rate for Payer: Cash Price |
$781.00
|
| Rate for Payer: Cash Price |
$781.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$260.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$260.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$131.57
|
| Rate for Payer: Molina Healthcare Passport |
$128.99
|
| Rate for Payer: Multiplan PHCS |
$937.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$338.40
|
| Rate for Payer: UHCCP Medicaid |
$147.02
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$130.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$260.31
|
|
|
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 |
$433.03 |
| Rate for Payer: Aetna Commercial |
$347.87
|
| Rate for Payer: Ambetter Exchange |
$260.31
|
| 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 Individual/Medicaid |
$260.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$260.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$312.37
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$260.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$260.31
|
| 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 |
$338.40
|
| Rate for Payer: UHCCP Medicaid |
$147.02
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$130.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$260.31
|
|
|
CLOSED TRMT ULNAR FX PROX(T
|
Facility
|
OP
|
$959.00
|
|
|
Service Code
|
HCPCS 24670
|
| Hospital Charge Code |
761T0561
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$920.64 |
| Rate for Payer: Aetna Commercial |
$738.43
|
| Rate for Payer: Anthem Medicaid |
$329.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$748.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$479.50
|
| Rate for Payer: Cash Price |
$479.50
|
| Rate for Payer: Cigna Commercial |
$795.97
|
| Rate for Payer: First Health Commercial |
$911.05
|
| Rate for Payer: Humana Commercial |
$815.15
|
| Rate for Payer: Humana KY Medicaid |
$329.80
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$333.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$786.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$707.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$336.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$843.92
|
| Rate for Payer: Ohio Health Group HMO |
$719.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$767.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$834.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$661.71
|
| Rate for Payer: PHCS Commercial |
$920.64
|
| Rate for Payer: United Healthcare All Payer |
$843.92
|
|
|
CLOSED TRMT ULNAR FX PROX(T
|
Facility
|
IP
|
$959.00
|
|
|
Service Code
|
HCPCS 24670
|
| Hospital Charge Code |
761T0561
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$287.70 |
| Max. Negotiated Rate |
$920.64 |
| Rate for Payer: Aetna Commercial |
$738.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$748.02
|
| Rate for Payer: Cash Price |
$479.50
|
| Rate for Payer: Cigna Commercial |
$795.97
|
| Rate for Payer: First Health Commercial |
$911.05
|
| Rate for Payer: Humana Commercial |
$815.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$786.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$707.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$287.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$843.92
|
| Rate for Payer: Ohio Health Group HMO |
$719.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$767.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$834.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$661.71
|
| Rate for Payer: PHCS Commercial |
$920.64
|
| Rate for Payer: United Healthcare All Payer |
$843.92
|
|
|
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 |
$221.64 |
| 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 |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$912.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| 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 |
$221.64
|
| 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 |
$265.97
|
| 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 |
$936.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,017.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$807.30
|
| 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 |
$351.00 |
| 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 |
$936.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,017.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$807.30
|
| Rate for Payer: PHCS Commercial |
$1,123.20
|
| Rate for Payer: United Healthcare All Payer |
$1,029.60
|
|
|
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 |
$809.33 |
| Rate for Payer: Aetna Commercial |
$687.46
|
| Rate for Payer: Ambetter Exchange |
$460.45
|
| 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 Individual/Medicaid |
$460.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$460.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$552.54
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$460.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$460.45
|
| 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 |
$598.59
|
| Rate for Payer: UHCCP Medicaid |
$342.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$323.46
|
| Rate for Payer: Wellcare Medicare Advantage |
$460.45
|
|
