|
CLSD TRTMNT FEM FX DIS/MED/LAT
|
Facility
|
OP
|
$1,550.00
|
|
|
Service Code
|
HCPCS 27510
|
| Hospital Charge Code |
76100862
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$533.04 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$1,193.50
|
| Rate for Payer: Anthem Medicaid |
$533.04
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,209.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Cigna Commercial |
$1,286.50
|
| Rate for Payer: First Health Commercial |
$1,472.50
|
| Rate for Payer: Humana Commercial |
$1,317.50
|
| Rate for Payer: Humana KY Medicaid |
$533.04
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$538.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,271.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,143.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$543.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,364.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,162.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,348.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,069.50
|
| Rate for Payer: PHCS Commercial |
$1,488.00
|
| Rate for Payer: United Healthcare All Payer |
$1,364.00
|
|
|
CLSD TRTMNT FEM FX DIS/MED/LAT
|
Professional
|
Both
|
$1,550.00
|
|
|
Service Code
|
HCPCS 27510
|
| Hospital Charge Code |
761P0862
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$449.73 |
| Max. Negotiated Rate |
$1,121.28 |
| Rate for Payer: Aetna Commercial |
$1,026.30
|
| Rate for Payer: Ambetter Exchange |
$650.58
|
| Rate for Payer: Anthem Medicaid |
$449.73
|
| Rate for Payer: Buckeye Individual/Medicaid |
$650.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$650.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$780.70
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Cigna Commercial |
$1,121.28
|
| Rate for Payer: Healthspan PPO |
$929.61
|
| Rate for Payer: Humana Medicaid |
$449.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$860.31
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$650.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$650.58
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$458.72
|
| Rate for Payer: Molina Healthcare Passport |
$449.73
|
| Rate for Payer: Multiplan PHCS |
$930.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$845.75
|
| Rate for Payer: UHCCP Medicaid |
$542.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$454.23
|
| Rate for Payer: Wellcare Medicare Advantage |
$650.58
|
|
|
CLSD TRTMNT FEM FX DIS/MED/LAT
|
Facility
|
IP
|
$2,185.00
|
|
|
Service Code
|
HCPCS 27510
|
| Hospital Charge Code |
45000158
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$655.50 |
| Max. Negotiated Rate |
$2,097.60 |
| Rate for Payer: Aetna Commercial |
$1,682.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,704.30
|
| Rate for Payer: Cash Price |
$1,092.50
|
| Rate for Payer: Cigna Commercial |
$1,813.55
|
| Rate for Payer: First Health Commercial |
$2,075.75
|
| Rate for Payer: Humana Commercial |
$1,857.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,791.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,612.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$655.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,922.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,638.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,748.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,900.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,507.65
|
| Rate for Payer: PHCS Commercial |
$2,097.60
|
| Rate for Payer: United Healthcare All Payer |
$1,922.80
|
|
|
CLSD TRTMNT FEM FX DIS/MED/LAT
|
Facility
|
OP
|
$2,185.00
|
|
|
Service Code
|
HCPCS 27510
|
| Hospital Charge Code |
45000158
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$751.42 |
| Max. Negotiated Rate |
$2,097.60 |
| Rate for Payer: Aetna Commercial |
$1,682.45
|
| Rate for Payer: Anthem Medicaid |
$751.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,704.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| Rate for Payer: Cash Price |
$1,092.50
|
| Rate for Payer: Cash Price |
$1,092.50
|
| Rate for Payer: Cigna Commercial |
$1,813.55
|
| Rate for Payer: First Health Commercial |
$2,075.75
|
| Rate for Payer: Humana Commercial |
$1,857.25
|
| Rate for Payer: Humana KY Medicaid |
$751.42
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$759.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,791.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,612.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$766.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,922.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,638.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,748.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,900.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,507.65
|
| Rate for Payer: PHCS Commercial |
$2,097.60
|
| Rate for Payer: United Healthcare All Payer |
$1,922.80
|
|
|
CLSD TRTMNT FEM FX DIS/MED/LAT
|
Facility
|
IP
|
$1,550.00
|
|
|
Service Code
|
HCPCS 27510
|
| Hospital Charge Code |
76100862
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$465.00 |
| Max. Negotiated Rate |
$1,488.00 |
| Rate for Payer: Aetna Commercial |
$1,193.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,209.00
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Cigna Commercial |
$1,286.50
|
| Rate for Payer: First Health Commercial |
$1,472.50
|
| Rate for Payer: Humana Commercial |
$1,317.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,271.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,143.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$465.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,364.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,162.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,348.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,069.50
|
| Rate for Payer: PHCS Commercial |
$1,488.00
|
| Rate for Payer: United Healthcare All Payer |
$1,364.00
|
|
|
CLSD TRTMNT FEM FX DIS/MED/LAT
|
Professional
|
Both
|
$1,550.00
|
|
|
Service Code
|
HCPCS 27510
|
| Hospital Charge Code |
76100862
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$449.73 |
| Max. Negotiated Rate |
$1,121.28 |
| Rate for Payer: Aetna Commercial |
$1,026.30
|
| Rate for Payer: Ambetter Exchange |
$650.58
|
| Rate for Payer: Anthem Medicaid |
$449.73
|
| Rate for Payer: Buckeye Individual/Medicaid |
$650.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$650.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$780.70
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Cigna Commercial |
$1,121.28
|
| Rate for Payer: Healthspan PPO |
$929.61
|
| Rate for Payer: Humana Medicaid |
$449.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$860.31
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$650.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$650.58
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$458.72
|
| Rate for Payer: Molina Healthcare Passport |
$449.73
|
| Rate for Payer: Multiplan PHCS |
$930.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$845.75
|
| Rate for Payer: UHCCP Medicaid |
$542.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$454.23
|
| Rate for Payer: Wellcare Medicare Advantage |
$650.58
|
|
|
CLSD TRTMNT FEM SHAFT FX W/MAN
|
Facility
|
OP
|
$2,172.00
|
|
|
Service Code
|
HCPCS 27502
|
| Hospital Charge Code |
45000157
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$746.95 |
| Max. Negotiated Rate |
$2,085.12 |
| Rate for Payer: Aetna Commercial |
$1,672.44
|
| Rate for Payer: Anthem Medicaid |
$746.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,694.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| Rate for Payer: Cash Price |
$1,086.00
|
| Rate for Payer: Cash Price |
$1,086.00
|
| Rate for Payer: Cigna Commercial |
$1,802.76
|
| Rate for Payer: First Health Commercial |
$2,063.40
|
| Rate for Payer: Humana Commercial |
$1,846.20
|
| Rate for Payer: Humana KY Medicaid |
$746.95
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$754.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,781.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,602.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$761.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,911.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,629.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,737.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,889.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,498.68
|
| Rate for Payer: PHCS Commercial |
$2,085.12
|
| Rate for Payer: United Healthcare All Payer |
$1,911.36
|
|
|
CLSD TRTMNT FEM SHAFT FX W/MAN
|
Facility
|
IP
|
$2,172.00
|
|
|
Service Code
|
HCPCS 27502
|
| Hospital Charge Code |
45000157
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$651.60 |
| Max. Negotiated Rate |
$2,085.12 |
| Rate for Payer: Aetna Commercial |
$1,672.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,694.16
|
| Rate for Payer: Cash Price |
$1,086.00
|
| Rate for Payer: Cigna Commercial |
$1,802.76
|
| Rate for Payer: First Health Commercial |
$2,063.40
|
| Rate for Payer: Humana Commercial |
$1,846.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,781.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,602.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,911.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,629.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,737.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,889.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,498.68
|
| Rate for Payer: PHCS Commercial |
$2,085.12
|
| Rate for Payer: United Healthcare All Payer |
$1,911.36
|
|
|
CLSD TRTMNT FEM SHAFT FX W/MAN
|
Professional
|
Both
|
$1,950.00
|
|
|
Service Code
|
HCPCS 27502
|
| Hospital Charge Code |
76100858
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$514.18 |
| Max. Negotiated Rate |
$1,276.89 |
| Rate for Payer: Aetna Commercial |
$1,164.84
|
| Rate for Payer: Ambetter Exchange |
$720.54
|
| Rate for Payer: Anthem Medicaid |
$514.18
|
| Rate for Payer: Buckeye Individual/Medicaid |
$720.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$720.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$864.65
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cigna Commercial |
$1,276.89
|
| Rate for Payer: Healthspan PPO |
$1,055.09
|
| Rate for Payer: Humana Medicaid |
$514.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$973.57
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$720.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$720.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$524.46
|
| Rate for Payer: Molina Healthcare Passport |
$514.18
|
| Rate for Payer: Multiplan PHCS |
$1,170.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$936.70
|
| Rate for Payer: UHCCP Medicaid |
$682.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$519.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$720.54
|
|
|
CLSD TRTMNT FEM SHAFT FX W/MAN
|
Facility
|
IP
|
$1,950.00
|
|
|
Service Code
|
HCPCS 27502
|
| Hospital Charge Code |
76100858
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$585.00 |
| Max. Negotiated Rate |
$1,872.00 |
| Rate for Payer: Aetna Commercial |
$1,501.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,521.00
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cigna Commercial |
$1,618.50
|
| Rate for Payer: First Health Commercial |
$1,852.50
|
| Rate for Payer: Humana Commercial |
$1,657.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,599.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,439.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$585.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,716.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,462.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,696.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,345.50
|
| Rate for Payer: PHCS Commercial |
$1,872.00
|
| Rate for Payer: United Healthcare All Payer |
$1,716.00
|
|
|
CLSD TRTMNT FEM SHAFT FX W/MAN
|
Facility
|
OP
|
$1,950.00
|
|
|
Service Code
|
HCPCS 27502
|
| Hospital Charge Code |
76100858
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$670.61 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$1,501.50
|
| Rate for Payer: Anthem Medicaid |
$670.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,521.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cigna Commercial |
$1,618.50
|
| Rate for Payer: First Health Commercial |
$1,852.50
|
| Rate for Payer: Humana Commercial |
$1,657.50
|
| Rate for Payer: Humana KY Medicaid |
$670.61
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$677.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,599.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,439.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$684.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,716.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,462.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,696.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,345.50
|
| Rate for Payer: PHCS Commercial |
$1,872.00
|
| Rate for Payer: United Healthcare All Payer |
$1,716.00
|
|
|
CLSD TRTMNT FEM SHAFT FX W/MAN
|
Professional
|
Both
|
$1,950.00
|
|
|
Service Code
|
HCPCS 27502
|
| Hospital Charge Code |
761P0858
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$514.18 |
| Max. Negotiated Rate |
$1,276.89 |
| Rate for Payer: Aetna Commercial |
$1,164.84
|
| Rate for Payer: Ambetter Exchange |
$720.54
|
| Rate for Payer: Anthem Medicaid |
$514.18
|
| Rate for Payer: Buckeye Individual/Medicaid |
$720.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$720.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$864.65
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cigna Commercial |
$1,276.89
|
| Rate for Payer: Healthspan PPO |
$1,055.09
|
| Rate for Payer: Humana Medicaid |
$514.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$973.57
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$720.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$720.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$524.46
|
| Rate for Payer: Molina Healthcare Passport |
$514.18
|
| Rate for Payer: Multiplan PHCS |
$1,170.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$936.70
|
| Rate for Payer: UHCCP Medicaid |
$682.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$519.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$720.54
|
|
|
CLSD TRTMNT FX PHALANX/PHALANG
|
Professional
|
Both
|
$1,140.00
|
|
|
Service Code
|
HCPCS 28515
|
| Hospital Charge Code |
76101027
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$72.62 |
| Max. Negotiated Rate |
$684.00 |
| Rate for Payer: Aetna Commercial |
$196.28
|
| Rate for Payer: Ambetter Exchange |
$137.14
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$73.02
|
| Rate for Payer: Anthem Medicaid |
$72.62
|
| Rate for Payer: Buckeye Individual/Medicaid |
$137.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$137.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$164.57
|
| Rate for Payer: Cash Price |
$570.00
|
| Rate for Payer: Cash Price |
$570.00
|
| Rate for Payer: Cigna Commercial |
$225.05
|
| Rate for Payer: Healthspan PPO |
$191.85
|
| Rate for Payer: Humana Medicaid |
$72.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$169.65
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$137.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$74.07
|
| Rate for Payer: Molina Healthcare Passport |
$72.62
|
| Rate for Payer: Multiplan PHCS |
$684.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$178.28
|
| Rate for Payer: UHCCP Medicaid |
$76.67
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$73.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$137.14
|
|
|
CLSD TRTMNT FX PHALANX/PHALANG
|
Facility
|
IP
|
$1,140.00
|
|
|
Service Code
|
HCPCS 28515
|
| Hospital Charge Code |
76101027
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$342.00 |
| Max. Negotiated Rate |
$1,094.40 |
| Rate for Payer: Aetna Commercial |
$877.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$889.20
|
| Rate for Payer: Cash Price |
$570.00
|
| Rate for Payer: Cigna Commercial |
$946.20
|
| Rate for Payer: First Health Commercial |
$1,083.00
|
| Rate for Payer: Humana Commercial |
$969.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$934.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$841.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$342.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,003.20
|
| Rate for Payer: Ohio Health Group HMO |
$855.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$912.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$991.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$786.60
|
| Rate for Payer: PHCS Commercial |
$1,094.40
|
| Rate for Payer: United Healthcare All Payer |
$1,003.20
|
|
|
CLSD TRTMNT FX PHALANX/PHALANG
|
Facility
|
OP
|
$1,140.00
|
|
|
Service Code
|
HCPCS 28515
|
| Hospital Charge Code |
76101027
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$1,094.40 |
| Rate for Payer: Aetna Commercial |
$877.80
|
| Rate for Payer: Anthem Medicaid |
$392.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$889.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$570.00
|
| Rate for Payer: Cash Price |
$570.00
|
| Rate for Payer: Cigna Commercial |
$946.20
|
| Rate for Payer: First Health Commercial |
$1,083.00
|
| Rate for Payer: Humana Commercial |
$969.00
|
| Rate for Payer: Humana KY Medicaid |
$392.05
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$396.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$934.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$841.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$399.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,003.20
|
| Rate for Payer: Ohio Health Group HMO |
$855.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$912.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$991.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$786.60
|
| Rate for Payer: PHCS Commercial |
$1,094.40
|
| Rate for Payer: United Healthcare All Payer |
$1,003.20
|
|
|
CLSD TRTMNT FX PHALANX/PHALANG
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS 28515
|
| Hospital Charge Code |
45000179
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem Medicaid |
$275.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Humana KY Medicaid |
$275.12
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$277.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$280.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
CLSD TRTMNT FX PHALANX/PHALANG
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS 28515
|
| Hospital Charge Code |
45000179
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
CLSD TRTMNT FX PHALANX/PHALANG
|
Professional
|
Both
|
$340.00
|
|
|
Service Code
|
HCPCS 28515
|
| Hospital Charge Code |
761P1027
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$72.62 |
| Max. Negotiated Rate |
$225.05 |
| Rate for Payer: Aetna Commercial |
$196.28
|
| Rate for Payer: Ambetter Exchange |
$137.14
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$73.02
|
| Rate for Payer: Anthem Medicaid |
$72.62
|
| Rate for Payer: Buckeye Individual/Medicaid |
$137.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$137.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$164.57
|
| Rate for Payer: Cash Price |
$170.00
|
| Rate for Payer: Cash Price |
$170.00
|
| Rate for Payer: Cigna Commercial |
$225.05
|
| Rate for Payer: Healthspan PPO |
$191.85
|
| Rate for Payer: Humana Medicaid |
$72.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$169.65
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$137.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$74.07
|
| Rate for Payer: Molina Healthcare Passport |
$72.62
|
| Rate for Payer: Multiplan PHCS |
$204.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$178.28
|
| Rate for Payer: UHCCP Medicaid |
$76.67
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$73.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$137.14
|
|
|
CLSD TRTMNT FX PHALANX/PHALANG
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS 28515
|
| Hospital Charge Code |
761T1027
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
CLSD TRTMNT FX PHALANX/PHALANG
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS 28515
|
| Hospital Charge Code |
761T1027
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem Medicaid |
$275.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Humana KY Medicaid |
$275.12
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$277.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$280.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
CLSD TRTMNT FX WT BRNG ART PTN
|
Facility
|
OP
|
$1,130.00
|
|
|
Service Code
|
HCPCS 27825
|
| Hospital Charge Code |
76100947
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$388.61 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$870.10
|
| Rate for Payer: Anthem Medicaid |
$388.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$881.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| Rate for Payer: Cash Price |
$565.00
|
| Rate for Payer: Cash Price |
$565.00
|
| Rate for Payer: Cigna Commercial |
$937.90
|
| Rate for Payer: First Health Commercial |
$1,073.50
|
| Rate for Payer: Humana Commercial |
$960.50
|
| Rate for Payer: Humana KY Medicaid |
$388.61
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$392.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$926.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$833.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$396.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$994.40
|
| Rate for Payer: Ohio Health Group HMO |
$847.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$904.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$983.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$779.70
|
| Rate for Payer: PHCS Commercial |
$1,084.80
|
| Rate for Payer: United Healthcare All Payer |
$994.40
|
|
|
CLSD TRTMNT FX WT BRNG ART PTN
|
Facility
|
OP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 27825
|
| Hospital Charge Code |
45000170
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$725.97 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$1,625.47
|
| Rate for Payer: Anthem Medicaid |
$725.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,646.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| Rate for Payer: Cash Price |
$1,055.50
|
| Rate for Payer: Cash Price |
$1,055.50
|
| Rate for Payer: Cigna Commercial |
$1,752.13
|
| Rate for Payer: First Health Commercial |
$2,005.45
|
| Rate for Payer: Humana Commercial |
$1,794.35
|
| Rate for Payer: Humana KY Medicaid |
$725.97
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$733.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,731.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,557.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$740.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,857.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,583.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,688.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,836.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,456.59
|
| Rate for Payer: PHCS Commercial |
$2,026.56
|
| Rate for Payer: United Healthcare All Payer |
$1,857.68
|
|
|
CLSD TRTMNT FX WT BRNG ART PTN
|
Facility
|
IP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 27825
|
| Hospital Charge Code |
45000170
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$633.30 |
| Max. Negotiated Rate |
$2,026.56 |
| Rate for Payer: Aetna Commercial |
$1,625.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,646.58
|
| Rate for Payer: Cash Price |
$1,055.50
|
| Rate for Payer: Cigna Commercial |
$1,752.13
|
| Rate for Payer: First Health Commercial |
$2,005.45
|
| Rate for Payer: Humana Commercial |
$1,794.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,731.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,557.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$633.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,857.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,583.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,688.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,836.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,456.59
|
| Rate for Payer: PHCS Commercial |
$2,026.56
|
| Rate for Payer: United Healthcare All Payer |
$1,857.68
|
|
|
CLSD TRTMNT FX WT BRNG ART PTN
|
Professional
|
Both
|
$1,130.00
|
|
|
Service Code
|
HCPCS 27825
|
| Hospital Charge Code |
76100947
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$336.64 |
| Max. Negotiated Rate |
$789.06 |
| Rate for Payer: Aetna Commercial |
$722.29
|
| Rate for Payer: Ambetter Exchange |
$476.29
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$336.64
|
| Rate for Payer: Anthem Medicaid |
$349.43
|
| Rate for Payer: Buckeye Individual/Medicaid |
$476.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$476.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$571.55
|
| Rate for Payer: Cash Price |
$565.00
|
| Rate for Payer: Cash Price |
$565.00
|
| Rate for Payer: Cigna Commercial |
$789.06
|
| Rate for Payer: Healthspan PPO |
$705.63
|
| Rate for Payer: Humana Medicaid |
$349.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$613.22
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$476.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$476.29
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$356.42
|
| Rate for Payer: Molina Healthcare Passport |
$349.43
|
| Rate for Payer: Multiplan PHCS |
$678.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$619.18
|
| Rate for Payer: UHCCP Medicaid |
$353.47
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$352.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$476.29
|
|
|
CLSD TRTMNT FX WT BRNG ART PTN
|
Professional
|
Both
|
$1,130.00
|
|
|
Service Code
|
HCPCS 27825
|
| Hospital Charge Code |
761P0947
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$336.64 |
| Max. Negotiated Rate |
$789.06 |
| Rate for Payer: Aetna Commercial |
$722.29
|
| Rate for Payer: Ambetter Exchange |
$476.29
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$336.64
|
| Rate for Payer: Anthem Medicaid |
$349.43
|
| Rate for Payer: Buckeye Individual/Medicaid |
$476.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$476.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$571.55
|
| Rate for Payer: Cash Price |
$565.00
|
| Rate for Payer: Cash Price |
$565.00
|
| Rate for Payer: Cigna Commercial |
$789.06
|
| Rate for Payer: Healthspan PPO |
$705.63
|
| Rate for Payer: Humana Medicaid |
$349.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$613.22
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$476.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$476.29
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$356.42
|
| Rate for Payer: Molina Healthcare Passport |
$349.43
|
| Rate for Payer: Multiplan PHCS |
$678.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$619.18
|
| Rate for Payer: UHCCP Medicaid |
$353.47
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$352.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$476.29
|
|
