|
OPEN TX FX DIS TIB
|
Facility
|
IP
|
$2,550.00
|
|
|
Service Code
|
HCPCS 27827
|
| Hospital Charge Code |
76100949
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$331.50 |
| Max. Negotiated Rate |
$2,448.00 |
| Rate for Payer: Aetna Commercial |
$1,963.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,989.00
|
| Rate for Payer: Cash Price |
$1,275.00
|
| Rate for Payer: Cigna Commercial |
$2,116.50
|
| Rate for Payer: First Health Commercial |
$2,422.50
|
| Rate for Payer: Humana Commercial |
$2,167.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,091.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,881.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$765.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,244.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,912.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$510.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$331.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$790.50
|
| Rate for Payer: PHCS Commercial |
$2,448.00
|
| Rate for Payer: United Healthcare All Payer |
$2,244.00
|
|
|
OPEN TX FX DIS TIB
|
Facility
|
OP
|
$2,550.00
|
|
|
Service Code
|
HCPCS 27827
|
| Hospital Charge Code |
76100949
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$331.50 |
| Max. Negotiated Rate |
$15,933.60 |
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,989.00
|
| Rate for Payer: Aetna Commercial |
$1,963.50
|
| Rate for Payer: Anthem Medicaid |
$876.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,381.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15,933.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$15,364.54
|
| Rate for Payer: Cash Price |
$1,275.00
|
| Rate for Payer: Cash Price |
$1,275.00
|
| Rate for Payer: Cigna Commercial |
$2,116.50
|
| Rate for Payer: First Health Commercial |
$2,422.50
|
| Rate for Payer: Humana Commercial |
$2,167.50
|
| Rate for Payer: Humana KY Medicaid |
$876.94
|
| Rate for Payer: Humana Medicare Advantage |
$11,381.14
|
| Rate for Payer: Kentucky WC Medicaid |
$885.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,091.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,881.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13,657.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$894.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,244.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,912.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$510.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$331.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$790.50
|
| Rate for Payer: PHCS Commercial |
$2,448.00
|
| Rate for Payer: United Healthcare All Payer |
$2,244.00
|
|
|
OPEN TX FX DIS TIB&FIB
|
Facility
|
OP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 27828
|
| Hospital Charge Code |
76100950
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$364.00 |
| Max. Negotiated Rate |
$15,933.60 |
| Rate for Payer: Aetna Commercial |
$2,156.00
|
| Rate for Payer: Anthem Medicaid |
$962.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,381.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,184.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15,933.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$15,364.54
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cigna Commercial |
$2,324.00
|
| Rate for Payer: First Health Commercial |
$2,660.00
|
| Rate for Payer: Humana Commercial |
$2,380.00
|
| Rate for Payer: Humana KY Medicaid |
$962.92
|
| Rate for Payer: Humana Medicare Advantage |
$11,381.14
|
| Rate for Payer: Kentucky WC Medicaid |
$972.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,296.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,066.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13,657.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$982.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,464.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,100.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$364.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$868.00
|
| Rate for Payer: PHCS Commercial |
$2,688.00
|
| Rate for Payer: United Healthcare All Payer |
$2,464.00
|
|
|
OPEN TX FX DIS TIB&FIB
|
Professional
|
Both
|
$2,800.00
|
|
|
Service Code
|
HCPCS 27828
|
| Hospital Charge Code |
76100950
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$754.67 |
| Max. Negotiated Rate |
$2,800.00 |
| Rate for Payer: Aetna Commercial |
$1,919.86
|
| Rate for Payer: Anthem Medicaid |
$754.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,800.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cigna Commercial |
$2,117.19
|
| Rate for Payer: Healthspan PPO |
$1,738.98
|
| Rate for Payer: Humana Medicaid |
$754.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,623.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$769.76
|
| Rate for Payer: Molina Healthcare Passport |
$754.67
|
| Rate for Payer: Multiplan PHCS |
$1,680.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,960.00
|
| Rate for Payer: UHCCP Medicaid |
$980.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$762.22
|
|
|
OPEN TX FX DIS TIB&FIB
|
Facility
|
IP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 27828
|
| Hospital Charge Code |
76100950
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$364.00 |
| Max. Negotiated Rate |
$2,688.00 |
| Rate for Payer: Aetna Commercial |
$2,156.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,184.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cigna Commercial |
$2,324.00
|
| Rate for Payer: First Health Commercial |
$2,660.00
|
| Rate for Payer: Humana Commercial |
$2,380.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,296.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,066.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$840.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,464.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,100.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$364.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$868.00
|
| Rate for Payer: PHCS Commercial |
$2,688.00
|
| Rate for Payer: United Healthcare All Payer |
$2,464.00
|
|
|
OPEN TX FX DIS TIBFIB
|
Professional
|
Both
|
$1,900.00
|
|
|
Service Code
|
HCPCS 27826
|
| Hospital Charge Code |
76100948
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$518.51 |
| Max. Negotiated Rate |
$1,900.00 |
| Rate for Payer: Aetna Commercial |
$1,191.04
|
| Rate for Payer: Anthem Medicaid |
$518.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,900.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cigna Commercial |
$1,154.53
|
| Rate for Payer: Healthspan PPO |
$1,078.83
|
| Rate for Payer: Humana Medicaid |
$518.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,033.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$528.88
|
| Rate for Payer: Molina Healthcare Passport |
$518.51
|
| Rate for Payer: Multiplan PHCS |
$1,140.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,330.00
|
| Rate for Payer: UHCCP Medicaid |
$665.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$523.70
|
|
|
OPEN TX FX DIS TIBFIB
|
Facility
|
IP
|
$1,900.00
|
|
|
Service Code
|
HCPCS 27826
|
| Hospital Charge Code |
76100948
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$247.00 |
| Max. Negotiated Rate |
$1,824.00 |
| Rate for Payer: Aetna Commercial |
$1,463.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,482.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cigna Commercial |
$1,577.00
|
| Rate for Payer: First Health Commercial |
$1,805.00
|
| Rate for Payer: Humana Commercial |
$1,615.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,558.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,402.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,672.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,425.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$380.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$589.00
|
| Rate for Payer: PHCS Commercial |
$1,824.00
|
| Rate for Payer: United Healthcare All Payer |
$1,672.00
|
|
|
OPEN TX FX DIS TIBFIB
|
Facility
|
OP
|
$1,900.00
|
|
|
Service Code
|
HCPCS 27826
|
| Hospital Charge Code |
76100948
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$247.00 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$1,463.00
|
| Rate for Payer: Anthem Medicaid |
$653.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,482.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,661.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,351.78
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cigna Commercial |
$1,577.00
|
| Rate for Payer: First Health Commercial |
$1,805.00
|
| Rate for Payer: Humana Commercial |
$1,615.00
|
| Rate for Payer: Humana KY Medicaid |
$653.41
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$660.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,558.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,402.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$666.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,672.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,425.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$380.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$589.00
|
| Rate for Payer: PHCS Commercial |
$1,824.00
|
| Rate for Payer: United Healthcare All Payer |
$1,672.00
|
|
|
OPEN TX FX DIS TIB&FIB(P
|
Professional
|
Both
|
$2,800.00
|
|
|
Service Code
|
HCPCS 27828
|
| Hospital Charge Code |
761P0950
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$754.67 |
| Max. Negotiated Rate |
$2,800.00 |
| Rate for Payer: Aetna Commercial |
$1,919.86
|
| Rate for Payer: Anthem Medicaid |
$754.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,800.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cigna Commercial |
$2,117.19
|
| Rate for Payer: Healthspan PPO |
$1,738.98
|
| Rate for Payer: Humana Medicaid |
$754.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,623.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$769.76
|
| Rate for Payer: Molina Healthcare Passport |
$754.67
|
| Rate for Payer: Multiplan PHCS |
$1,680.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,960.00
|
| Rate for Payer: UHCCP Medicaid |
$980.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$762.22
|
|
|
OPEN TX FX DIS TIBFIB(P
|
Professional
|
Both
|
$1,900.00
|
|
|
Service Code
|
HCPCS 27826
|
| Hospital Charge Code |
761P0948
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$518.51 |
| Max. Negotiated Rate |
$1,900.00 |
| Rate for Payer: Aetna Commercial |
$1,191.04
|
| Rate for Payer: Anthem Medicaid |
$518.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,900.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cigna Commercial |
$1,154.53
|
| Rate for Payer: Healthspan PPO |
$1,078.83
|
| Rate for Payer: Humana Medicaid |
$518.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,033.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$528.88
|
| Rate for Payer: Molina Healthcare Passport |
$518.51
|
| Rate for Payer: Multiplan PHCS |
$1,140.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,330.00
|
| Rate for Payer: UHCCP Medicaid |
$665.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$523.70
|
|
|
OPEN TX FX DIS TIB(P
|
Professional
|
Both
|
$2,550.00
|
|
|
Service Code
|
HCPCS 27827
|
| Hospital Charge Code |
761P0949
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$650.27 |
| Max. Negotiated Rate |
$2,550.00 |
| Rate for Payer: Aetna Commercial |
$1,605.61
|
| Rate for Payer: Anthem Medicaid |
$650.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,550.00
|
| Rate for Payer: Cash Price |
$1,275.00
|
| Rate for Payer: Cash Price |
$1,275.00
|
| Rate for Payer: Cigna Commercial |
$1,867.50
|
| Rate for Payer: Healthspan PPO |
$1,454.34
|
| Rate for Payer: Humana Medicaid |
$650.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,353.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$663.28
|
| Rate for Payer: Molina Healthcare Passport |
$650.27
|
| Rate for Payer: Multiplan PHCS |
$1,530.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,785.00
|
| Rate for Payer: UHCCP Medicaid |
$892.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$656.77
|
|
|
OPEN TX FX GRT TOE/PHLNX/PHLNG
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 28505
|
| Hospital Charge Code |
76101025
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
OPEN TX FX GRT TOE/PHLNX/PHLNG
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 28505
|
| Hospital Charge Code |
76101025
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$194.82 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$706.35
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$254.70
|
| Rate for Payer: Anthem Medicaid |
$194.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,000.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$501.23
|
| Rate for Payer: Healthspan PPO |
$818.21
|
| Rate for Payer: Humana Medicaid |
$194.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$611.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$198.72
|
| Rate for Payer: Molina Healthcare Passport |
$194.82
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$267.44
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$196.77
|
|
|
OPEN TX FX GRT TOE/PHLNX/PHLNG
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 28505
|
| Hospital Charge Code |
761P1025
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$194.82 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$706.35
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$254.70
|
| Rate for Payer: Anthem Medicaid |
$194.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,000.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$501.23
|
| Rate for Payer: Healthspan PPO |
$818.21
|
| Rate for Payer: Humana Medicaid |
$194.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$611.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$198.72
|
| Rate for Payer: Molina Healthcare Passport |
$194.82
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$267.44
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$196.77
|
|
|
OPEN TX FX GRT TOE/PHLNX/PHLNG
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 28505
|
| Hospital Charge Code |
76101025
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem Medicaid |
$343.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Humana KY Medicaid |
$343.90
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$347.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$350.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
OPEN TX HUM EPICONDYLAR FX
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 24575
|
| Hospital Charge Code |
76100545
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$15,933.60 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem Medicaid |
$481.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,381.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15,933.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$15,364.54
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Humana KY Medicaid |
$481.46
|
| Rate for Payer: Humana Medicare Advantage |
$11,381.14
|
| Rate for Payer: Kentucky WC Medicaid |
$486.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13,657.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$491.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$182.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$434.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
OPEN TX HUM EPICONDYLAR FX
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 24575
|
| Hospital Charge Code |
76100544
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$490.00 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Aetna Commercial |
$1,087.32
|
| Rate for Payer: Anthem Medicaid |
$529.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,400.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,288.00
|
| Rate for Payer: Healthspan PPO |
$984.88
|
| Rate for Payer: Humana Medicaid |
$529.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$904.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$540.47
|
| Rate for Payer: Molina Healthcare Passport |
$529.87
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$980.00
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$535.17
|
|
|
OPEN TX HUM EPICONDYLAR FX
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 24575
|
| Hospital Charge Code |
76100545
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$1,344.00 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$420.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$182.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$434.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
OPEN TX HUM EPICONDYLAR FX
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 24575
|
| Hospital Charge Code |
76100544
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$15,933.60 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem Medicaid |
$481.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,381.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15,933.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$15,364.54
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Humana KY Medicaid |
$481.46
|
| Rate for Payer: Humana Medicare Advantage |
$11,381.14
|
| Rate for Payer: Kentucky WC Medicaid |
$486.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13,657.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$491.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$182.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$434.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
OPEN TX HUM EPICONDYLAR FX
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 24575
|
| Hospital Charge Code |
76100544
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$1,344.00 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$420.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$182.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$434.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
OPEN TX HUM EPICONDYLAR FX
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 24575
|
| Hospital Charge Code |
76100545
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$490.00 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Aetna Commercial |
$1,087.32
|
| Rate for Payer: Anthem Medicaid |
$529.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,400.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,288.00
|
| Rate for Payer: Healthspan PPO |
$984.88
|
| Rate for Payer: Humana Medicaid |
$529.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$904.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$540.47
|
| Rate for Payer: Molina Healthcare Passport |
$529.87
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$980.00
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$535.17
|
|
|
OPEN TX HUM EPICONDYLAR FX(P
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 24575
|
| Hospital Charge Code |
761P0545
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$490.00 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Aetna Commercial |
$1,087.32
|
| Rate for Payer: Anthem Medicaid |
$529.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,400.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,288.00
|
| Rate for Payer: Healthspan PPO |
$984.88
|
| Rate for Payer: Humana Medicaid |
$529.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$904.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$540.47
|
| Rate for Payer: Molina Healthcare Passport |
$529.87
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$980.00
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$535.17
|
|
|
OPEN TX HUM EPICONDYLAR FX(P
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 24575
|
| Hospital Charge Code |
761P0544
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$490.00 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Aetna Commercial |
$1,087.32
|
| Rate for Payer: Anthem Medicaid |
$529.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,400.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,288.00
|
| Rate for Payer: Healthspan PPO |
$984.88
|
| Rate for Payer: Humana Medicaid |
$529.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$904.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$540.47
|
| Rate for Payer: Molina Healthcare Passport |
$529.87
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$980.00
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$535.17
|
|
|
OPEN TX HUMRL SUPR/TRNSCDLR FX
|
Facility
|
OP
|
$1,245.00
|
|
|
Service Code
|
HCPCS 24546
|
| Hospital Charge Code |
76100540
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$161.85 |
| Max. Negotiated Rate |
$15,933.60 |
| Rate for Payer: Aetna Commercial |
$958.65
|
| Rate for Payer: Anthem Medicaid |
$428.16
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,381.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$971.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15,933.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$15,364.54
|
| Rate for Payer: Cash Price |
$622.50
|
| Rate for Payer: Cash Price |
$622.50
|
| Rate for Payer: Cigna Commercial |
$1,033.35
|
| Rate for Payer: First Health Commercial |
$1,182.75
|
| Rate for Payer: Humana Commercial |
$1,058.25
|
| Rate for Payer: Humana KY Medicaid |
$428.16
|
| Rate for Payer: Humana Medicare Advantage |
$11,381.14
|
| Rate for Payer: Kentucky WC Medicaid |
$432.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,020.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$918.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13,657.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$436.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,095.60
|
| Rate for Payer: Ohio Health Group HMO |
$933.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$249.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$161.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$385.95
|
| Rate for Payer: PHCS Commercial |
$1,195.20
|
| Rate for Payer: United Healthcare All Payer |
$1,095.60
|
|
|
OPEN TX HUMRL SUPR/TRNSCDLR FX
|
Professional
|
Both
|
$1,245.00
|
|
|
Service Code
|
HCPCS 24546
|
| Hospital Charge Code |
761P0540
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$435.75 |
| Max. Negotiated Rate |
$1,813.48 |
| Rate for Payer: Aetna Commercial |
$1,576.28
|
| Rate for Payer: Anthem Medicaid |
$736.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,245.00
|
| Rate for Payer: Cash Price |
$622.50
|
| Rate for Payer: Cash Price |
$622.50
|
| Rate for Payer: Cigna Commercial |
$1,813.48
|
| Rate for Payer: Healthspan PPO |
$1,427.77
|
| Rate for Payer: Humana Medicaid |
$736.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,301.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$750.95
|
| Rate for Payer: Molina Healthcare Passport |
$736.23
|
| Rate for Payer: Multiplan PHCS |
$747.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$871.50
|
| Rate for Payer: UHCCP Medicaid |
$435.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$743.59
|
|
