|
CLSD MTCARPOPHLGLDISLOSNGLWMAN
|
Facility
|
OP
|
$335.00
|
|
|
Service Code
|
HCPCS 26700
|
| Hospital Charge Code |
45000142
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$43.55 |
| Max. Negotiated Rate |
$321.60 |
| Rate for Payer: Aetna Commercial |
$257.95
|
| Rate for Payer: Anthem Medicaid |
$115.21
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$261.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cigna Commercial |
$278.05
|
| Rate for Payer: First Health Commercial |
$318.25
|
| Rate for Payer: Humana Commercial |
$284.75
|
| Rate for Payer: Humana KY Medicaid |
$115.21
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$116.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$274.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$247.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$117.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$294.80
|
| Rate for Payer: Ohio Health Group HMO |
$251.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$103.85
|
| Rate for Payer: PHCS Commercial |
$321.60
|
| Rate for Payer: United Healthcare All Payer |
$294.80
|
|
|
CLSD MTCRPOPHLGLDISLOSNGLWANES
|
Facility
|
IP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 26705
|
| Hospital Charge Code |
45000143
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$274.43 |
| 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 |
$422.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$654.41
|
| Rate for Payer: PHCS Commercial |
$2,026.56
|
| Rate for Payer: United Healthcare All Payer |
$1,857.68
|
|
|
CLSD MTCRPOPHLGLDISLOSNGLWANES
|
Facility
|
OP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 26705
|
| Hospital Charge Code |
45000143
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$274.43 |
| Max. Negotiated Rate |
$2,026.56 |
| Rate for Payer: Aetna Commercial |
$1,625.47
|
| Rate for Payer: Anthem Medicaid |
$725.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,646.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| 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 |
$1,389.84
|
| 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 |
$1,667.81
|
| 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 |
$422.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$654.41
|
| Rate for Payer: PHCS Commercial |
$2,026.56
|
| Rate for Payer: United Healthcare All Payer |
$1,857.68
|
|
|
CLSD MTCRPOPHLGLDISLOSNGLWANES
|
Facility
|
OP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 26705
|
| Hospital Charge Code |
76100734
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$274.43 |
| Max. Negotiated Rate |
$2,026.56 |
| Rate for Payer: Aetna Commercial |
$1,625.47
|
| Rate for Payer: Anthem Medicaid |
$725.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,646.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| 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 |
$1,389.84
|
| 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 |
$1,667.81
|
| 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 |
$422.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$654.41
|
| Rate for Payer: PHCS Commercial |
$2,026.56
|
| Rate for Payer: United Healthcare All Payer |
$1,857.68
|
|
|
CLSD MTCRPOPHLGLDISLOSNGLWANES
|
Professional
|
Both
|
$2,111.00
|
|
|
Service Code
|
HCPCS 26705
|
| Hospital Charge Code |
76100734
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$171.38 |
| Max. Negotiated Rate |
$2,111.00 |
| Rate for Payer: Aetna Commercial |
$511.80
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$200.03
|
| Rate for Payer: Anthem Medicaid |
$171.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,111.00
|
| Rate for Payer: Cash Price |
$1,055.50
|
| Rate for Payer: Cash Price |
$1,055.50
|
| Rate for Payer: Cigna Commercial |
$562.83
|
| Rate for Payer: Healthspan PPO |
$500.92
|
| Rate for Payer: Humana Medicaid |
$171.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$453.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$174.81
|
| Rate for Payer: Molina Healthcare Passport |
$171.38
|
| Rate for Payer: Multiplan PHCS |
$1,266.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,477.70
|
| Rate for Payer: UHCCP Medicaid |
$210.03
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$173.09
|
|
|
CLSD MTCRPOPHLGLDISLOSNGLWANES
|
Facility
|
IP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 26705
|
| Hospital Charge Code |
76100734
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$274.43 |
| 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 |
$422.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$654.41
|
| Rate for Payer: PHCS Commercial |
$2,026.56
|
| Rate for Payer: United Healthcare All Payer |
$1,857.68
|
|
|
CLSD SHOULD DISLC W/MAN W/O AN
|
Facility
|
IP
|
$744.00
|
|
|
Service Code
|
HCPCS 23650
|
| Hospital Charge Code |
45000112
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$96.72 |
| Max. Negotiated Rate |
$714.24 |
| Rate for Payer: Aetna Commercial |
$572.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$580.32
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cigna Commercial |
$617.52
|
| Rate for Payer: First Health Commercial |
$706.80
|
| Rate for Payer: Humana Commercial |
$632.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$610.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$549.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$223.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$654.72
|
| Rate for Payer: Ohio Health Group HMO |
$558.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$148.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$96.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$230.64
|
| Rate for Payer: PHCS Commercial |
$714.24
|
| Rate for Payer: United Healthcare All Payer |
$654.72
|
|
|
CLSD SHOULD DISLC W/MAN W/O AN
|
Facility
|
IP
|
$1,388.00
|
|
|
Service Code
|
HCPCS 23650
|
| Hospital Charge Code |
76100485
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$180.44 |
| Max. Negotiated Rate |
$1,332.48 |
| Rate for Payer: Aetna Commercial |
$1,068.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,082.64
|
| Rate for Payer: Cash Price |
$694.00
|
| Rate for Payer: Cigna Commercial |
$1,152.04
|
| Rate for Payer: First Health Commercial |
$1,318.60
|
| Rate for Payer: Humana Commercial |
$1,179.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,138.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,024.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$416.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,221.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,041.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$277.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$180.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$430.28
|
| Rate for Payer: PHCS Commercial |
$1,332.48
|
| Rate for Payer: United Healthcare All Payer |
$1,221.44
|
|
|
CLSD SHOULD DISLC W/MAN W/O AN
|
Facility
|
OP
|
$1,388.00
|
|
|
Service Code
|
HCPCS 23650
|
| Hospital Charge Code |
76100485
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$180.44 |
| Max. Negotiated Rate |
$1,332.48 |
| Rate for Payer: Aetna Commercial |
$1,068.76
|
| Rate for Payer: Anthem Medicaid |
$477.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,082.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$694.00
|
| Rate for Payer: Cash Price |
$694.00
|
| Rate for Payer: Cigna Commercial |
$1,152.04
|
| Rate for Payer: First Health Commercial |
$1,318.60
|
| Rate for Payer: Humana Commercial |
$1,179.80
|
| Rate for Payer: Humana KY Medicaid |
$477.33
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$482.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,138.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,024.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$486.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,221.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,041.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$277.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$180.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$430.28
|
| Rate for Payer: PHCS Commercial |
$1,332.48
|
| Rate for Payer: United Healthcare All Payer |
$1,221.44
|
|
|
CLSD SHOULD DISLC W/MAN W/O AN
|
Professional
|
Both
|
$644.00
|
|
|
Service Code
|
HCPCS 23650
|
| Hospital Charge Code |
761P0485
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$157.23 |
| Max. Negotiated Rate |
$644.00 |
| Rate for Payer: Aetna Commercial |
$367.68
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$157.80
|
| Rate for Payer: Anthem Medicaid |
$157.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$644.00
|
| Rate for Payer: Cash Price |
$322.00
|
| Rate for Payer: Cash Price |
$322.00
|
| Rate for Payer: Cigna Commercial |
$398.12
|
| Rate for Payer: Healthspan PPO |
$361.63
|
| Rate for Payer: Humana Medicaid |
$157.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$330.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$160.37
|
| Rate for Payer: Molina Healthcare Passport |
$157.23
|
| Rate for Payer: Multiplan PHCS |
$386.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$450.80
|
| Rate for Payer: UHCCP Medicaid |
$165.69
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$158.80
|
|
|
CLSD SHOULD DISLC W/MAN W/O AN
|
Professional
|
Both
|
$1,388.00
|
|
|
Service Code
|
HCPCS 23650
|
| Hospital Charge Code |
76100485
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$157.23 |
| Max. Negotiated Rate |
$1,388.00 |
| Rate for Payer: Aetna Commercial |
$367.68
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$157.80
|
| Rate for Payer: Anthem Medicaid |
$157.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,388.00
|
| Rate for Payer: Cash Price |
$694.00
|
| Rate for Payer: Cash Price |
$694.00
|
| Rate for Payer: Cigna Commercial |
$398.12
|
| Rate for Payer: Healthspan PPO |
$361.63
|
| Rate for Payer: Humana Medicaid |
$157.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$330.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$160.37
|
| Rate for Payer: Molina Healthcare Passport |
$157.23
|
| Rate for Payer: Multiplan PHCS |
$832.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$971.60
|
| Rate for Payer: UHCCP Medicaid |
$165.69
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$158.80
|
|
|
CLSD SHOULD DISLC W/MAN W/O AN
|
Facility
|
OP
|
$744.00
|
|
|
Service Code
|
HCPCS 23650
|
| Hospital Charge Code |
45000112
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$96.72 |
| Max. Negotiated Rate |
$714.24 |
| Rate for Payer: Aetna Commercial |
$572.88
|
| Rate for Payer: Anthem Medicaid |
$255.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$580.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cigna Commercial |
$617.52
|
| Rate for Payer: First Health Commercial |
$706.80
|
| Rate for Payer: Humana Commercial |
$632.40
|
| Rate for Payer: Humana KY Medicaid |
$255.86
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$258.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$610.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$549.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$261.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$654.72
|
| Rate for Payer: Ohio Health Group HMO |
$558.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$148.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$96.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$230.64
|
| Rate for Payer: PHCS Commercial |
$714.24
|
| Rate for Payer: United Healthcare All Payer |
$654.72
|
|
|
CLSD SHOULD DISLC W/MAN W/O AN
|
Facility
|
IP
|
$744.00
|
|
|
Service Code
|
HCPCS 23650
|
| Hospital Charge Code |
761T0485
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$96.72 |
| Max. Negotiated Rate |
$714.24 |
| Rate for Payer: Aetna Commercial |
$572.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$580.32
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cigna Commercial |
$617.52
|
| Rate for Payer: First Health Commercial |
$706.80
|
| Rate for Payer: Humana Commercial |
$632.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$610.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$549.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$223.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$654.72
|
| Rate for Payer: Ohio Health Group HMO |
$558.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$148.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$96.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$230.64
|
| Rate for Payer: PHCS Commercial |
$714.24
|
| Rate for Payer: United Healthcare All Payer |
$654.72
|
|
|
CLSD SHOULD DISLC W/MAN W/O AN
|
Facility
|
OP
|
$744.00
|
|
|
Service Code
|
HCPCS 23650
|
| Hospital Charge Code |
761T0485
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$96.72 |
| Max. Negotiated Rate |
$714.24 |
| Rate for Payer: Aetna Commercial |
$572.88
|
| Rate for Payer: Anthem Medicaid |
$255.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$580.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cigna Commercial |
$617.52
|
| Rate for Payer: First Health Commercial |
$706.80
|
| Rate for Payer: Humana Commercial |
$632.40
|
| Rate for Payer: Humana KY Medicaid |
$255.86
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$258.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$610.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$549.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$261.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$654.72
|
| Rate for Payer: Ohio Health Group HMO |
$558.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$148.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$96.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$230.64
|
| Rate for Payer: PHCS Commercial |
$714.24
|
| Rate for Payer: United Healthcare All Payer |
$654.72
|
|
|
CLSD TIBFXPROXW/SKELTRACTION
|
Facility
|
OP
|
$3,921.00
|
|
|
Service Code
|
HCPCS 27532
|
| Hospital Charge Code |
45000159
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$509.73 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$3,019.17
|
| Rate for Payer: Anthem Medicaid |
$1,348.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,058.38
|
| 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 |
$1,960.50
|
| Rate for Payer: Cash Price |
$1,960.50
|
| Rate for Payer: Cigna Commercial |
$3,254.43
|
| Rate for Payer: First Health Commercial |
$3,724.95
|
| Rate for Payer: Humana Commercial |
$3,332.85
|
| Rate for Payer: Humana KY Medicaid |
$1,348.43
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,362.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,215.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,893.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,375.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,450.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,940.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$784.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$509.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,215.51
|
| Rate for Payer: PHCS Commercial |
$3,764.16
|
| Rate for Payer: United Healthcare All Payer |
$3,450.48
|
|
|
CLSD TIBFXPROXW/SKELTRACTION
|
Facility
|
IP
|
$3,921.00
|
|
|
Service Code
|
HCPCS 27532
|
| Hospital Charge Code |
76100869
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$509.73 |
| Max. Negotiated Rate |
$3,764.16 |
| Rate for Payer: Aetna Commercial |
$3,019.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,058.38
|
| Rate for Payer: Cash Price |
$1,960.50
|
| Rate for Payer: Cigna Commercial |
$3,254.43
|
| Rate for Payer: First Health Commercial |
$3,724.95
|
| Rate for Payer: Humana Commercial |
$3,332.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,215.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,893.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,176.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,450.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,940.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$784.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$509.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,215.51
|
| Rate for Payer: PHCS Commercial |
$3,764.16
|
| Rate for Payer: United Healthcare All Payer |
$3,450.48
|
|
|
CLSD TIBFXPROXW/SKELTRACTION
|
Facility
|
OP
|
$3,921.00
|
|
|
Service Code
|
HCPCS 27532
|
| Hospital Charge Code |
76100869
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$509.73 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$3,019.17
|
| Rate for Payer: Anthem Medicaid |
$1,348.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,058.38
|
| 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 |
$1,960.50
|
| Rate for Payer: Cash Price |
$1,960.50
|
| Rate for Payer: Cigna Commercial |
$3,254.43
|
| Rate for Payer: First Health Commercial |
$3,724.95
|
| Rate for Payer: Humana Commercial |
$3,332.85
|
| Rate for Payer: Humana KY Medicaid |
$1,348.43
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,362.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,215.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,893.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,375.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,450.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,940.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$784.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$509.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,215.51
|
| Rate for Payer: PHCS Commercial |
$3,764.16
|
| Rate for Payer: United Healthcare All Payer |
$3,450.48
|
|
|
CLSD TIBFXPROXW/SKELTRACTION
|
Facility
|
IP
|
$3,921.00
|
|
|
Service Code
|
HCPCS 27532
|
| Hospital Charge Code |
45000159
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$509.73 |
| Max. Negotiated Rate |
$3,764.16 |
| Rate for Payer: Aetna Commercial |
$3,019.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,058.38
|
| Rate for Payer: Cash Price |
$1,960.50
|
| Rate for Payer: Cigna Commercial |
$3,254.43
|
| Rate for Payer: First Health Commercial |
$3,724.95
|
| Rate for Payer: Humana Commercial |
$3,332.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,215.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,893.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,176.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,450.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,940.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$784.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$509.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,215.51
|
| Rate for Payer: PHCS Commercial |
$3,764.16
|
| Rate for Payer: United Healthcare All Payer |
$3,450.48
|
|
|
CLSD TRMNT TRMLLLR ANK FX WMAN
|
Professional
|
Both
|
$1,070.00
|
|
|
Service Code
|
HCPCS 27818
|
| Hospital Charge Code |
76100943
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$320.89 |
| Max. Negotiated Rate |
$1,070.00 |
| Rate for Payer: Aetna Commercial |
$626.11
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$320.89
|
| Rate for Payer: Anthem Medicaid |
$349.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,070.00
|
| Rate for Payer: Cash Price |
$535.00
|
| Rate for Payer: Cash Price |
$535.00
|
| Rate for Payer: Cigna Commercial |
$698.57
|
| Rate for Payer: Healthspan PPO |
$616.09
|
| Rate for Payer: Humana Medicaid |
$349.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$533.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$356.42
|
| Rate for Payer: Molina Healthcare Passport |
$349.43
|
| Rate for Payer: Multiplan PHCS |
$642.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$749.00
|
| Rate for Payer: UHCCP Medicaid |
$336.93
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$352.92
|
|
|
CLSD TRMNT TRMLLLR ANK FX WMAN
|
Facility
|
OP
|
$1,070.00
|
|
|
Service Code
|
HCPCS 27818
|
| Hospital Charge Code |
76100943
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$139.10 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Aetna Commercial |
$823.90
|
| Rate for Payer: Anthem Medicaid |
$367.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$834.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| Rate for Payer: Cash Price |
$535.00
|
| Rate for Payer: Cash Price |
$535.00
|
| Rate for Payer: Cigna Commercial |
$888.10
|
| Rate for Payer: First Health Commercial |
$1,016.50
|
| Rate for Payer: Humana Commercial |
$909.50
|
| Rate for Payer: Humana KY Medicaid |
$367.97
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$371.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$877.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$789.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$375.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$941.60
|
| Rate for Payer: Ohio Health Group HMO |
$802.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$214.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$139.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$331.70
|
| Rate for Payer: PHCS Commercial |
$1,027.20
|
| Rate for Payer: United Healthcare All Payer |
$941.60
|
|
|
CLSD TRMNT TRMLLLR ANK FX WMAN
|
Facility
|
IP
|
$2,185.00
|
|
|
Service Code
|
HCPCS 27818
|
| Hospital Charge Code |
45000169
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$284.05 |
| 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 |
$437.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$284.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$677.35
|
| Rate for Payer: PHCS Commercial |
$2,097.60
|
| Rate for Payer: United Healthcare All Payer |
$1,922.80
|
|
|
CLSD TRMNT TRMLLLR ANK FX WMAN
|
Facility
|
IP
|
$1,070.00
|
|
|
Service Code
|
HCPCS 27818
|
| Hospital Charge Code |
76100943
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$139.10 |
| Max. Negotiated Rate |
$1,027.20 |
| Rate for Payer: Aetna Commercial |
$823.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$834.60
|
| Rate for Payer: Cash Price |
$535.00
|
| Rate for Payer: Cigna Commercial |
$888.10
|
| Rate for Payer: First Health Commercial |
$1,016.50
|
| Rate for Payer: Humana Commercial |
$909.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$877.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$789.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$321.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$941.60
|
| Rate for Payer: Ohio Health Group HMO |
$802.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$214.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$139.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$331.70
|
| Rate for Payer: PHCS Commercial |
$1,027.20
|
| Rate for Payer: United Healthcare All Payer |
$941.60
|
|
|
CLSD TRMNT TRMLLLR ANK FX WMAN
|
Facility
|
OP
|
$2,185.00
|
|
|
Service Code
|
HCPCS 27818
|
| Hospital Charge Code |
45000169
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$284.05 |
| 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 |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,704.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| 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 |
$1,389.84
|
| 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 |
$1,667.81
|
| 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 |
$437.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$284.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$677.35
|
| Rate for Payer: PHCS Commercial |
$2,097.60
|
| Rate for Payer: United Healthcare All Payer |
$1,922.80
|
|
|
CLSD TRMNT TRMLLLR ANK FX WMAN
|
Professional
|
Both
|
$1,070.00
|
|
|
Service Code
|
HCPCS 27818
|
| Hospital Charge Code |
761P0943
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$320.89 |
| Max. Negotiated Rate |
$1,070.00 |
| Rate for Payer: Aetna Commercial |
$626.11
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$320.89
|
| Rate for Payer: Anthem Medicaid |
$349.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,070.00
|
| Rate for Payer: Cash Price |
$535.00
|
| Rate for Payer: Cash Price |
$535.00
|
| Rate for Payer: Cigna Commercial |
$698.57
|
| Rate for Payer: Healthspan PPO |
$616.09
|
| Rate for Payer: Humana Medicaid |
$349.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$533.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$356.42
|
| Rate for Payer: Molina Healthcare Passport |
$349.43
|
| Rate for Payer: Multiplan PHCS |
$642.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$749.00
|
| Rate for Payer: UHCCP Medicaid |
$336.93
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$352.92
|
|
|
CLSD TRMT CRPMTCRPLFX/DIS THMB
|
Facility
|
IP
|
$1,155.00
|
|
|
Service Code
|
HCPCS 26645
|
| Hospital Charge Code |
76100727
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$150.15 |
| Max. Negotiated Rate |
$1,108.80 |
| Rate for Payer: Aetna Commercial |
$889.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$900.90
|
| Rate for Payer: Cash Price |
$577.50
|
| Rate for Payer: Cigna Commercial |
$958.65
|
| Rate for Payer: First Health Commercial |
$1,097.25
|
| Rate for Payer: Humana Commercial |
$981.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$947.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$852.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$346.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,016.40
|
| Rate for Payer: Ohio Health Group HMO |
$866.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$231.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$150.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$358.05
|
| Rate for Payer: PHCS Commercial |
$1,108.80
|
| Rate for Payer: United Healthcare All Payer |
$1,016.40
|
|
