|
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 |
$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
|
|
|
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 |
$701.42 |
| Rate for Payer: Aetna Commercial |
$643.32
|
| Rate for Payer: Ambetter Exchange |
$453.48
|
| 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 Individual/Medicaid |
$453.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$453.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$544.18
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$453.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$453.48
|
| 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 |
$589.52
|
| Rate for Payer: UHCCP Medicaid |
$258.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$242.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$453.48
|
|
|
CLOSED TX METATARSAL FX
|
Facility
|
OP
|
$1,065.00
|
|
|
Service Code
|
HCPCS 28470
|
| Hospital Charge Code |
76101019
|
|
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 TX METATARSAL FX
|
Facility
|
IP
|
$1,065.00
|
|
|
Service Code
|
HCPCS 28470
|
| Hospital Charge Code |
76101019
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$319.50 |
| Max. Negotiated Rate |
$1,022.40 |
| Rate for Payer: Aetna Commercial |
$820.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$830.70
|
| 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: 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 |
$319.50
|
| 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 TX METATARSAL FX
|
Professional
|
Both
|
$1,065.00
|
|
|
Service Code
|
HCPCS 28470
|
| Hospital Charge Code |
76101019
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$105.51 |
| Max. Negotiated Rate |
$639.00 |
| Rate for Payer: Aetna Commercial |
$263.08
|
| Rate for Payer: Ambetter Exchange |
$196.43
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$116.62
|
| Rate for Payer: Anthem Medicaid |
$105.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$196.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$196.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$235.72
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$328.80
|
| Rate for Payer: Healthspan PPO |
$262.04
|
| Rate for Payer: Humana Medicaid |
$105.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$227.96
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$196.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$196.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$107.62
|
| Rate for Payer: Molina Healthcare Passport |
$105.51
|
| Rate for Payer: Multiplan PHCS |
$639.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$255.36
|
| Rate for Payer: UHCCP Medicaid |
$122.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$106.57
|
| Rate for Payer: Wellcare Medicare Advantage |
$196.43
|
|
|
CLOSED TX METATARSAL FX(P
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 28470
|
| Hospital Charge Code |
761P1019
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$105.51 |
| Max. Negotiated Rate |
$330.00 |
| Rate for Payer: Aetna Commercial |
$263.08
|
| Rate for Payer: Ambetter Exchange |
$196.43
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$116.62
|
| Rate for Payer: Anthem Medicaid |
$105.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$196.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$196.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$235.72
|
| 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 |
$105.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$227.96
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$196.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$196.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$107.62
|
| Rate for Payer: Molina Healthcare Passport |
$105.51
|
| Rate for Payer: Multiplan PHCS |
$330.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$255.36
|
| Rate for Payer: UHCCP Medicaid |
$122.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$106.57
|
| Rate for Payer: Wellcare Medicare Advantage |
$196.43
|
|
|
CLOSED TX METATARSAL FX(T
|
Facility
|
IP
|
$515.00
|
|
|
Service Code
|
HCPCS 28470
|
| Hospital Charge Code |
761T1019
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$154.50 |
| Max. Negotiated Rate |
$494.40 |
| Rate for Payer: Aetna Commercial |
$396.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$401.70
|
| Rate for Payer: Cash Price |
$257.50
|
| Rate for Payer: Cigna Commercial |
$427.45
|
| Rate for Payer: First Health Commercial |
$489.25
|
| Rate for Payer: Humana Commercial |
$437.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$422.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$380.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$154.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$453.20
|
| Rate for Payer: Ohio Health Group HMO |
$386.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$412.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$448.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$355.35
|
| Rate for Payer: PHCS Commercial |
$494.40
|
| Rate for Payer: United Healthcare All Payer |
$453.20
|
|
|
CLOSED TX METATARSAL FX(T
|
Facility
|
OP
|
$515.00
|
|
|
Service Code
|
HCPCS 28470
|
| Hospital Charge Code |
761T1019
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$177.11 |
| Max. Negotiated Rate |
$494.40 |
| Rate for Payer: Aetna Commercial |
$396.55
|
| Rate for Payer: Anthem Medicaid |
$177.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$401.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$257.50
|
| Rate for Payer: Cash Price |
$257.50
|
| Rate for Payer: Cigna Commercial |
$427.45
|
| Rate for Payer: First Health Commercial |
$489.25
|
| Rate for Payer: Humana Commercial |
$437.75
|
| Rate for Payer: Humana KY Medicaid |
$177.11
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$178.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$422.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$380.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$180.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$453.20
|
| Rate for Payer: Ohio Health Group HMO |
$386.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$412.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$448.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$355.35
|
| Rate for Payer: PHCS Commercial |
$494.40
|
| Rate for Payer: United Healthcare All Payer |
$453.20
|
|
|
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 |
$1,173.60 |
| 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 |
$3,129.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,403.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,699.28
|
| Rate for Payer: PHCS Commercial |
$3,755.52
|
| Rate for Payer: United Healthcare All Payer |
$3,442.56
|
|
|
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 |
$3,007.20 |
| Rate for Payer: Aetna Commercial |
$399.74
|
| Rate for Payer: Ambetter Exchange |
$283.80
|
| 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 Individual/Medicaid |
$283.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$283.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$340.56
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$283.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$283.80
|
| 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 |
$368.94
|
| Rate for Payer: UHCCP Medicaid |
$161.33
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$160.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$283.80
|
|
|
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 |
$1,503.60 |
| 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 |
$4,009.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,360.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,458.28
|
| Rate for Payer: PHCS Commercial |
$4,811.52
|
| Rate for Payer: United Healthcare All Payer |
$4,410.56
|
|
|
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 |
$1,723.63 |
| 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 |
$2,996.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,909.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,195.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,045.32
|
| 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 |
$2,996.53
|
| 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 |
$3,595.84
|
| 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 |
$4,009.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,360.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,458.28
|
| Rate for Payer: PHCS Commercial |
$4,811.52
|
| Rate for Payer: United Healthcare All Payer |
$4,410.56
|
|
|
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 |
$1,345.34 |
| Max. Negotiated Rate |
$4,195.14 |
| Rate for Payer: Aetna Commercial |
$3,012.24
|
| Rate for Payer: Anthem Medicaid |
$1,345.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,051.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,195.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,045.32
|
| 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 |
$2,996.53
|
| 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 |
$3,595.84
|
| 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 |
$3,129.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,403.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,699.28
|
| 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 |
$660.00 |
| Rate for Payer: Aetna Commercial |
$399.74
|
| Rate for Payer: Ambetter Exchange |
$283.80
|
| 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 Individual/Medicaid |
$283.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$283.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$340.56
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$283.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$283.80
|
| 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 |
$368.94
|
| Rate for Payer: UHCCP Medicaid |
$161.33
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$160.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$283.80
|
|
|
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 |
$1,173.60 |
| 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 |
$3,129.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,403.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,699.28
|
| 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 |
$1,345.34 |
| Max. Negotiated Rate |
$4,195.14 |
| Rate for Payer: Aetna Commercial |
$3,012.24
|
| Rate for Payer: Anthem Medicaid |
$1,345.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,051.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,195.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,045.32
|
| 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 |
$2,996.53
|
| 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 |
$3,595.84
|
| 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 |
$3,129.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,403.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,699.28
|
| 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 |
$71.83 |
| Max. Negotiated Rate |
$345.00 |
| Rate for Payer: Aetna Commercial |
$260.74
|
| Rate for Payer: Ambetter Exchange |
$178.97
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$94.82
|
| Rate for Payer: Anthem Medicaid |
$71.83
|
| Rate for Payer: Buckeye Individual/Medicaid |
$178.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$178.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$214.76
|
| 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 |
$71.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$227.08
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$178.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$178.97
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$73.27
|
| Rate for Payer: Molina Healthcare Passport |
$71.83
|
| Rate for Payer: Multiplan PHCS |
$345.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$232.66
|
| Rate for Payer: UHCCP Medicaid |
$99.56
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$72.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$178.97
|
|
|
CLOSED TX TARSOMETATARSAL DIS
|
Professional
|
Both
|
$1,261.00
|
|
|
Service Code
|
HCPCS 28600
|
| Hospital Charge Code |
76101031
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$71.83 |
| Max. Negotiated Rate |
$756.60 |
| Rate for Payer: Aetna Commercial |
$260.74
|
| Rate for Payer: Ambetter Exchange |
$178.97
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$94.82
|
| Rate for Payer: Anthem Medicaid |
$71.83
|
| Rate for Payer: Buckeye Individual/Medicaid |
$178.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$178.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$214.76
|
| 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 |
$71.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$227.08
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$178.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$178.97
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$73.27
|
| Rate for Payer: Molina Healthcare Passport |
$71.83
|
| Rate for Payer: Multiplan PHCS |
$756.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$232.66
|
| Rate for Payer: UHCCP Medicaid |
$99.56
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$72.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$178.97
|
|
|
CLOSED TX TARSOMETATARSAL DIS
|
Facility
|
OP
|
$1,261.00
|
|
|
Service Code
|
HCPCS 28600
|
| Hospital Charge Code |
76101031
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| 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 |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$983.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| 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 |
$221.64
|
| 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 |
$265.97
|
| 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 |
$1,008.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,097.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$870.09
|
| Rate for Payer: PHCS Commercial |
$1,210.56
|
| Rate for Payer: United Healthcare All Payer |
$1,109.68
|
|
|
CLOSED TX TARSOMETATARSAL DIS
|
Facility
|
IP
|
$1,261.00
|
|
|
Service Code
|
HCPCS 28600
|
| Hospital Charge Code |
76101031
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$378.30 |
| Max. Negotiated Rate |
$1,210.56 |
| Rate for Payer: Aetna Commercial |
$970.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$983.58
|
| 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: 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 |
$378.30
|
| 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 |
$1,008.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,097.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$870.09
|
| Rate for Payer: PHCS Commercial |
$1,210.56
|
| Rate for Payer: United Healthcare All Payer |
$1,109.68
|
|
|
CLOSED TX TARSOMETATARSAL DI(T
|
Facility
|
IP
|
$686.00
|
|
|
Service Code
|
HCPCS 28600
|
| Hospital Charge Code |
761T1031
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$205.80 |
| Max. Negotiated Rate |
$658.56 |
| Rate for Payer: Aetna Commercial |
$528.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$535.08
|
| Rate for Payer: Cash Price |
$343.00
|
| Rate for Payer: Cigna Commercial |
$569.38
|
| Rate for Payer: First Health Commercial |
$651.70
|
| Rate for Payer: Humana Commercial |
$583.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$562.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$506.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$205.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$603.68
|
| Rate for Payer: Ohio Health Group HMO |
$514.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$548.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$596.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$473.34
|
| Rate for Payer: PHCS Commercial |
$658.56
|
| Rate for Payer: United Healthcare All Payer |
$603.68
|
|
|
CLOSED TX TARSOMETATARSAL DI(T
|
Facility
|
OP
|
$686.00
|
|
|
Service Code
|
HCPCS 28600
|
| Hospital Charge Code |
761T1031
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$658.56 |
| Rate for Payer: Aetna Commercial |
$528.22
|
| Rate for Payer: Anthem Medicaid |
$235.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$535.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$343.00
|
| Rate for Payer: Cash Price |
$343.00
|
| Rate for Payer: Cigna Commercial |
$569.38
|
| Rate for Payer: First Health Commercial |
$651.70
|
| Rate for Payer: Humana Commercial |
$583.10
|
| Rate for Payer: Humana KY Medicaid |
$235.92
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$238.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$562.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$506.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$240.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$603.68
|
| Rate for Payer: Ohio Health Group HMO |
$514.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$548.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$596.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$473.34
|
| Rate for Payer: PHCS Commercial |
$658.56
|
| Rate for Payer: United Healthcare All Payer |
$603.68
|
|
|
CLOSED TX VERT FX W/MANJ
|
Facility
|
OP
|
$5,321.00
|
|
|
Service Code
|
HCPCS 22315
|
| Hospital Charge Code |
76100420
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,829.89 |
| Max. Negotiated Rate |
$5,108.16 |
| Rate for Payer: Aetna Commercial |
$4,097.17
|
| Rate for Payer: Anthem Medicaid |
$1,829.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,150.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$2,660.50
|
| Rate for Payer: Cash Price |
$2,660.50
|
| Rate for Payer: Cigna Commercial |
$4,416.43
|
| Rate for Payer: First Health Commercial |
$5,054.95
|
| Rate for Payer: Humana Commercial |
$4,522.85
|
| Rate for Payer: Humana KY Medicaid |
$1,829.89
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,848.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,363.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,926.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,866.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,682.48
|
| Rate for Payer: Ohio Health Group HMO |
$3,990.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,256.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,629.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,671.49
|
| Rate for Payer: PHCS Commercial |
$5,108.16
|
| Rate for Payer: United Healthcare All Payer |
$4,682.48
|
|
|
CLOSED TX VERT FX W/MANJ
|
Facility
|
IP
|
$5,321.00
|
|
|
Service Code
|
HCPCS 22315
|
| Hospital Charge Code |
76100420
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,596.30 |
| Max. Negotiated Rate |
$5,108.16 |
| Rate for Payer: Aetna Commercial |
$4,097.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,150.38
|
| Rate for Payer: Cash Price |
$2,660.50
|
| Rate for Payer: Cigna Commercial |
$4,416.43
|
| Rate for Payer: First Health Commercial |
$5,054.95
|
| Rate for Payer: Humana Commercial |
$4,522.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,363.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,926.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,596.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,682.48
|
| Rate for Payer: Ohio Health Group HMO |
$3,990.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,256.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,629.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,671.49
|
| Rate for Payer: PHCS Commercial |
$5,108.16
|
| Rate for Payer: United Healthcare All Payer |
$4,682.48
|
|
|
CLOSED TX VERT FX W/MANJ
|
Professional
|
Both
|
$5,321.00
|
|
|
Service Code
|
HCPCS 22315
|
| Hospital Charge Code |
76100420
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$395.90 |
| Max. Negotiated Rate |
$3,192.60 |
| Rate for Payer: Aetna Commercial |
$1,104.28
|
| Rate for Payer: Ambetter Exchange |
$746.74
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$395.90
|
| Rate for Payer: Anthem Medicaid |
$414.00
|
| Rate for Payer: Buckeye Individual/Medicaid |
$746.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$746.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$896.09
|
| Rate for Payer: Cash Price |
$2,660.50
|
| Rate for Payer: Cash Price |
$2,660.50
|
| Rate for Payer: Cigna Commercial |
$1,172.62
|
| Rate for Payer: Healthspan PPO |
$1,112.70
|
| Rate for Payer: Humana Medicaid |
$414.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$960.54
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$746.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$746.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$422.28
|
| Rate for Payer: Molina Healthcare Passport |
$414.00
|
| Rate for Payer: Multiplan PHCS |
$3,192.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$970.76
|
| Rate for Payer: UHCCP Medicaid |
$415.69
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$418.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$746.74
|
|
