|
CLSD TX NSL FX MNPJ WO STBLJ
|
Professional
|
Both
|
$2,365.00
|
|
|
Service Code
|
HCPCS 21315
|
| Hospital Charge Code |
76100379
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$60.21 |
| Max. Negotiated Rate |
$2,365.00 |
| Rate for Payer: Aetna Commercial |
$208.54
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$60.21
|
| Rate for Payer: Anthem Medicaid |
$95.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,365.00
|
| Rate for Payer: Cash Price |
$1,182.50
|
| Rate for Payer: Cash Price |
$1,182.50
|
| Rate for Payer: Cigna Commercial |
$229.84
|
| Rate for Payer: Healthspan PPO |
$320.75
|
| Rate for Payer: Humana Medicaid |
$95.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$187.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$96.92
|
| Rate for Payer: Molina Healthcare Passport |
$95.02
|
| Rate for Payer: Multiplan PHCS |
$1,419.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,655.50
|
| Rate for Payer: UHCCP Medicaid |
$63.22
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$95.97
|
|
|
CLSD TX NSL FX MNPJ WO STBLJ
|
Facility
|
OP
|
$2,365.00
|
|
|
Service Code
|
HCPCS 21315
|
| Hospital Charge Code |
76100379
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$307.45 |
| Max. Negotiated Rate |
$2,270.40 |
| Rate for Payer: Aetna Commercial |
$1,821.05
|
| Rate for Payer: Anthem Medicaid |
$813.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,318.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,844.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,846.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,780.37
|
| Rate for Payer: Cash Price |
$1,182.50
|
| Rate for Payer: Cash Price |
$1,182.50
|
| Rate for Payer: Cigna Commercial |
$1,962.95
|
| Rate for Payer: First Health Commercial |
$2,246.75
|
| Rate for Payer: Humana Commercial |
$2,010.25
|
| Rate for Payer: Humana KY Medicaid |
$813.32
|
| Rate for Payer: Humana Medicare Advantage |
$1,318.79
|
| Rate for Payer: Kentucky WC Medicaid |
$821.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,939.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,745.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,582.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$829.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,081.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,773.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$473.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$307.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$733.15
|
| Rate for Payer: PHCS Commercial |
$2,270.40
|
| Rate for Payer: United Healthcare All Payer |
$2,081.20
|
|
|
CLSD TX NSL FX MNPJ WO STBLJ(P
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 21315
|
| Hospital Charge Code |
761P0379
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$60.21 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna Commercial |
$208.54
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$60.21
|
| Rate for Payer: Anthem Medicaid |
$95.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$350.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$229.84
|
| Rate for Payer: Healthspan PPO |
$320.75
|
| Rate for Payer: Humana Medicaid |
$95.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$187.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$96.92
|
| Rate for Payer: Molina Healthcare Passport |
$95.02
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$245.00
|
| Rate for Payer: UHCCP Medicaid |
$63.22
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$95.97
|
|
|
CLSD TX NSL FX MNPJ WO STBLJ(T
|
Facility
|
OP
|
$2,015.00
|
|
|
Service Code
|
HCPCS 21315
|
| Hospital Charge Code |
761T0379
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$261.95 |
| Max. Negotiated Rate |
$1,934.40 |
| Rate for Payer: Aetna Commercial |
$1,551.55
|
| Rate for Payer: Anthem Medicaid |
$692.96
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,318.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,571.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,846.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,780.37
|
| Rate for Payer: Cash Price |
$1,007.50
|
| Rate for Payer: Cash Price |
$1,007.50
|
| Rate for Payer: Cigna Commercial |
$1,672.45
|
| Rate for Payer: First Health Commercial |
$1,914.25
|
| Rate for Payer: Humana Commercial |
$1,712.75
|
| Rate for Payer: Humana KY Medicaid |
$692.96
|
| Rate for Payer: Humana Medicare Advantage |
$1,318.79
|
| Rate for Payer: Kentucky WC Medicaid |
$700.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,652.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,487.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,582.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$706.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,773.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,511.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$403.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$261.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$624.65
|
| Rate for Payer: PHCS Commercial |
$1,934.40
|
| Rate for Payer: United Healthcare All Payer |
$1,773.20
|
|
|
CLSD TX NSL FX MNPJ WO STBLJ(T
|
Facility
|
IP
|
$2,015.00
|
|
|
Service Code
|
HCPCS 21315
|
| Hospital Charge Code |
761T0379
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$261.95 |
| Max. Negotiated Rate |
$1,934.40 |
| Rate for Payer: Aetna Commercial |
$1,551.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,571.70
|
| Rate for Payer: Cash Price |
$1,007.50
|
| Rate for Payer: Cigna Commercial |
$1,672.45
|
| Rate for Payer: First Health Commercial |
$1,914.25
|
| Rate for Payer: Humana Commercial |
$1,712.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,652.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,487.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$604.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,773.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,511.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$403.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$261.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$624.65
|
| Rate for Payer: PHCS Commercial |
$1,934.40
|
| Rate for Payer: United Healthcare All Payer |
$1,773.20
|
|
|
CLSD TX NSL FX W/MNPJ&STABLJ
|
Facility
|
IP
|
$3,912.00
|
|
|
Service Code
|
HCPCS 21320
|
| Hospital Charge Code |
45000101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$508.56 |
| Max. Negotiated Rate |
$3,755.52 |
| Rate for Payer: Aetna Commercial |
$3,012.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,051.36
|
| Rate for Payer: Cash Price |
$1,956.00
|
| Rate for Payer: Cigna Commercial |
$3,246.96
|
| Rate for Payer: First Health Commercial |
$3,716.40
|
| Rate for Payer: Humana Commercial |
$3,325.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,207.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,887.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,173.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,442.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,934.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$782.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$508.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,212.72
|
| Rate for Payer: PHCS Commercial |
$3,755.52
|
| Rate for Payer: United Healthcare All Payer |
$3,442.56
|
|
|
CLSD TX NSL FX W/MNPJ&STABLJ
|
Facility
|
IP
|
$4,562.00
|
|
|
Service Code
|
HCPCS 21320
|
| Hospital Charge Code |
76100380
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$593.06 |
| Max. Negotiated Rate |
$4,379.52 |
| Rate for Payer: Aetna Commercial |
$3,512.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,558.36
|
| Rate for Payer: Cash Price |
$2,281.00
|
| Rate for Payer: Cigna Commercial |
$3,786.46
|
| Rate for Payer: First Health Commercial |
$4,333.90
|
| Rate for Payer: Humana Commercial |
$3,877.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,740.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,366.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,368.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,014.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,421.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$912.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$593.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,414.22
|
| Rate for Payer: PHCS Commercial |
$4,379.52
|
| Rate for Payer: United Healthcare All Payer |
$4,014.56
|
|
|
CLSD TX NSL FX W/MNPJ&STABLJ
|
Facility
|
OP
|
$3,912.00
|
|
|
Service Code
|
HCPCS 21320
|
| Hospital Charge Code |
45000101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$508.56 |
| Max. Negotiated Rate |
$3,897.84 |
| Rate for Payer: Aetna Commercial |
$3,012.24
|
| Rate for Payer: Anthem Medicaid |
$1,345.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,051.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,897.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,758.63
|
| Rate for Payer: Cash Price |
$1,956.00
|
| Rate for Payer: Cash Price |
$1,956.00
|
| Rate for Payer: Cigna Commercial |
$3,246.96
|
| Rate for Payer: First Health Commercial |
$3,716.40
|
| Rate for Payer: Humana Commercial |
$3,325.20
|
| Rate for Payer: Humana KY Medicaid |
$1,345.34
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,359.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,207.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,887.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,372.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,442.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,934.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$782.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$508.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,212.72
|
| Rate for Payer: PHCS Commercial |
$3,755.52
|
| Rate for Payer: United Healthcare All Payer |
$3,442.56
|
|
|
CLSD TX NSL FX W/MNPJ&STABLJ
|
Facility
|
OP
|
$4,562.00
|
|
|
Service Code
|
HCPCS 21320
|
| Hospital Charge Code |
76100380
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$593.06 |
| Max. Negotiated Rate |
$4,379.52 |
| Rate for Payer: Aetna Commercial |
$3,512.74
|
| Rate for Payer: Anthem Medicaid |
$1,568.87
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,558.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,897.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,758.63
|
| Rate for Payer: Cash Price |
$2,281.00
|
| Rate for Payer: Cash Price |
$2,281.00
|
| Rate for Payer: Cigna Commercial |
$3,786.46
|
| Rate for Payer: First Health Commercial |
$4,333.90
|
| Rate for Payer: Humana Commercial |
$3,877.70
|
| Rate for Payer: Humana KY Medicaid |
$1,568.87
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,584.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,740.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,366.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,600.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,014.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,421.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$912.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$593.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,414.22
|
| Rate for Payer: PHCS Commercial |
$4,379.52
|
| Rate for Payer: United Healthcare All Payer |
$4,014.56
|
|
|
CLSD TX NSL FX W/MNPJ&STABLJ
|
Professional
|
Both
|
$4,562.00
|
|
|
Service Code
|
HCPCS 21320
|
| Hospital Charge Code |
76100380
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$55.52 |
| Max. Negotiated Rate |
$4,562.00 |
| Rate for Payer: Aetna Commercial |
$197.27
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$55.52
|
| Rate for Payer: Anthem Medicaid |
$124.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,562.00
|
| Rate for Payer: Cash Price |
$2,281.00
|
| Rate for Payer: Cash Price |
$2,281.00
|
| Rate for Payer: Cigna Commercial |
$218.36
|
| Rate for Payer: Healthspan PPO |
$310.55
|
| Rate for Payer: Humana Medicaid |
$124.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$170.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$126.64
|
| Rate for Payer: Molina Healthcare Passport |
$124.16
|
| Rate for Payer: Multiplan PHCS |
$2,737.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,193.40
|
| Rate for Payer: UHCCP Medicaid |
$58.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$125.40
|
|
|
CLSD TX NSL FX W/MNPJ&STABLJ(P
|
Professional
|
Both
|
$650.00
|
|
|
Service Code
|
HCPCS 21320
|
| Hospital Charge Code |
761P0380
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$55.52 |
| Max. Negotiated Rate |
$650.00 |
| Rate for Payer: Aetna Commercial |
$197.27
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$55.52
|
| Rate for Payer: Anthem Medicaid |
$124.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$650.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cigna Commercial |
$218.36
|
| Rate for Payer: Healthspan PPO |
$310.55
|
| Rate for Payer: Humana Medicaid |
$124.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$170.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$126.64
|
| Rate for Payer: Molina Healthcare Passport |
$124.16
|
| Rate for Payer: Multiplan PHCS |
$390.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$455.00
|
| Rate for Payer: UHCCP Medicaid |
$58.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$125.40
|
|
|
CLSD TX NSL FX W/MNPJ&STABLJ(T
|
Facility
|
IP
|
$3,912.00
|
|
|
Service Code
|
HCPCS 21320
|
| Hospital Charge Code |
761T0380
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$508.56 |
| Max. Negotiated Rate |
$3,755.52 |
| Rate for Payer: Aetna Commercial |
$3,012.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,051.36
|
| Rate for Payer: Cash Price |
$1,956.00
|
| Rate for Payer: Cigna Commercial |
$3,246.96
|
| Rate for Payer: First Health Commercial |
$3,716.40
|
| Rate for Payer: Humana Commercial |
$3,325.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,207.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,887.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,173.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,442.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,934.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$782.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$508.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,212.72
|
| Rate for Payer: PHCS Commercial |
$3,755.52
|
| Rate for Payer: United Healthcare All Payer |
$3,442.56
|
|
|
CLSD TX NSL FX W/MNPJ&STABLJ(T
|
Facility
|
OP
|
$3,912.00
|
|
|
Service Code
|
HCPCS 21320
|
| Hospital Charge Code |
761T0380
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$508.56 |
| Max. Negotiated Rate |
$3,897.84 |
| Rate for Payer: Aetna Commercial |
$3,012.24
|
| Rate for Payer: Anthem Medicaid |
$1,345.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,051.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,897.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,758.63
|
| Rate for Payer: Cash Price |
$1,956.00
|
| Rate for Payer: Cash Price |
$1,956.00
|
| Rate for Payer: Cigna Commercial |
$3,246.96
|
| Rate for Payer: First Health Commercial |
$3,716.40
|
| Rate for Payer: Humana Commercial |
$3,325.20
|
| Rate for Payer: Humana KY Medicaid |
$1,345.34
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,359.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,207.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,887.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,372.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,442.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,934.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$782.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$508.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,212.72
|
| Rate for Payer: PHCS Commercial |
$3,755.52
|
| Rate for Payer: United Healthcare All Payer |
$3,442.56
|
|
|
CLSD TXPATARDISLOCATIONW/OANES
|
Facility
|
OP
|
$496.00
|
|
|
Service Code
|
HCPCS 27560
|
| Hospital Charge Code |
76100876
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.48 |
| Max. Negotiated Rate |
$476.16 |
| Rate for Payer: Aetna Commercial |
$381.92
|
| Rate for Payer: Anthem Medicaid |
$170.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$386.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cigna Commercial |
$411.68
|
| Rate for Payer: First Health Commercial |
$471.20
|
| Rate for Payer: Humana Commercial |
$421.60
|
| Rate for Payer: Humana KY Medicaid |
$170.57
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$172.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$406.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$366.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$174.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$436.48
|
| Rate for Payer: Ohio Health Group HMO |
$372.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$153.76
|
| Rate for Payer: PHCS Commercial |
$476.16
|
| Rate for Payer: United Healthcare All Payer |
$436.48
|
|
|
CLSD TXPATARDISLOCATIONW/OANES
|
Facility
|
OP
|
$496.00
|
|
|
Service Code
|
HCPCS 27560
|
| Hospital Charge Code |
45000162
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$64.48 |
| Max. Negotiated Rate |
$476.16 |
| Rate for Payer: Aetna Commercial |
$381.92
|
| Rate for Payer: Anthem Medicaid |
$170.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$386.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cigna Commercial |
$411.68
|
| Rate for Payer: First Health Commercial |
$471.20
|
| Rate for Payer: Humana Commercial |
$421.60
|
| Rate for Payer: Humana KY Medicaid |
$170.57
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$172.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$406.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$366.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$174.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$436.48
|
| Rate for Payer: Ohio Health Group HMO |
$372.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$153.76
|
| Rate for Payer: PHCS Commercial |
$476.16
|
| Rate for Payer: United Healthcare All Payer |
$436.48
|
|
|
CLSD TXPATARDISLOCATIONW/OANES
|
Facility
|
IP
|
$496.00
|
|
|
Service Code
|
HCPCS 27560
|
| Hospital Charge Code |
76100876
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.48 |
| Max. Negotiated Rate |
$476.16 |
| Rate for Payer: Aetna Commercial |
$381.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$386.88
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cigna Commercial |
$411.68
|
| Rate for Payer: First Health Commercial |
$471.20
|
| Rate for Payer: Humana Commercial |
$421.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$406.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$366.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$148.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$436.48
|
| Rate for Payer: Ohio Health Group HMO |
$372.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$153.76
|
| Rate for Payer: PHCS Commercial |
$476.16
|
| Rate for Payer: United Healthcare All Payer |
$436.48
|
|
|
CLSD TXPATARDISLOCATIONW/OANES
|
Facility
|
IP
|
$496.00
|
|
|
Service Code
|
HCPCS 27560
|
| Hospital Charge Code |
45000162
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$64.48 |
| Max. Negotiated Rate |
$476.16 |
| Rate for Payer: Aetna Commercial |
$381.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$386.88
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cigna Commercial |
$411.68
|
| Rate for Payer: First Health Commercial |
$471.20
|
| Rate for Payer: Humana Commercial |
$421.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$406.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$366.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$148.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$436.48
|
| Rate for Payer: Ohio Health Group HMO |
$372.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$153.76
|
| Rate for Payer: PHCS Commercial |
$476.16
|
| Rate for Payer: United Healthcare All Payer |
$436.48
|
|
|
CLSD TX PELVIC RING FX
|
Professional
|
Both
|
$1,075.00
|
|
|
Service Code
|
HCPCS 27197
|
| Hospital Charge Code |
76100786
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$92.27 |
| Max. Negotiated Rate |
$1,075.00 |
| Rate for Payer: Anthem Medicaid |
$92.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,075.00
|
| Rate for Payer: Cash Price |
$537.50
|
| Rate for Payer: Cash Price |
$537.50
|
| Rate for Payer: Cigna Commercial |
$216.61
|
| Rate for Payer: Humana Medicaid |
$92.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$152.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$94.12
|
| Rate for Payer: Molina Healthcare Passport |
$92.27
|
| Rate for Payer: Multiplan PHCS |
$645.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$752.50
|
| Rate for Payer: UHCCP Medicaid |
$376.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$93.19
|
|
|
CLSD TX PELVIC RING FX
|
Facility
|
IP
|
$1,075.00
|
|
|
Service Code
|
HCPCS 27197
|
| Hospital Charge Code |
76100786
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$139.75 |
| Max. Negotiated Rate |
$1,032.00 |
| Rate for Payer: Aetna Commercial |
$827.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$838.50
|
| Rate for Payer: Cash Price |
$537.50
|
| Rate for Payer: Cigna Commercial |
$892.25
|
| Rate for Payer: First Health Commercial |
$1,021.25
|
| Rate for Payer: Humana Commercial |
$913.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$881.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$793.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$322.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$946.00
|
| Rate for Payer: Ohio Health Group HMO |
$806.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$215.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$139.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$333.25
|
| Rate for Payer: PHCS Commercial |
$1,032.00
|
| Rate for Payer: United Healthcare All Payer |
$946.00
|
|
|
CLSD TX PELVIC RING FX
|
Facility
|
OP
|
$1,075.00
|
|
|
Service Code
|
HCPCS 27197
|
| Hospital Charge Code |
76100786
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$139.75 |
| Max. Negotiated Rate |
$1,032.00 |
| Rate for Payer: Aetna Commercial |
$827.75
|
| Rate for Payer: Anthem Medicaid |
$369.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$838.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$537.50
|
| Rate for Payer: Cash Price |
$537.50
|
| Rate for Payer: Cigna Commercial |
$892.25
|
| Rate for Payer: First Health Commercial |
$1,021.25
|
| Rate for Payer: Humana Commercial |
$913.75
|
| Rate for Payer: Humana KY Medicaid |
$369.69
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$373.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$881.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$793.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$377.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$946.00
|
| Rate for Payer: Ohio Health Group HMO |
$806.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$215.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$139.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$333.25
|
| Rate for Payer: PHCS Commercial |
$1,032.00
|
| Rate for Payer: United Healthcare All Payer |
$946.00
|
|
|
CLSD TX PELVIC RING FX(P
|
Professional
|
Both
|
$1,075.00
|
|
|
Service Code
|
HCPCS 27197
|
| Hospital Charge Code |
761P0786
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$92.27 |
| Max. Negotiated Rate |
$1,075.00 |
| Rate for Payer: Anthem Medicaid |
$92.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,075.00
|
| Rate for Payer: Cash Price |
$537.50
|
| Rate for Payer: Cash Price |
$537.50
|
| Rate for Payer: Cigna Commercial |
$216.61
|
| Rate for Payer: Humana Medicaid |
$92.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$152.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$94.12
|
| Rate for Payer: Molina Healthcare Passport |
$92.27
|
| Rate for Payer: Multiplan PHCS |
$645.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$752.50
|
| Rate for Payer: UHCCP Medicaid |
$376.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$93.19
|
|
|
CLSD TXPOSTRIORMALLEOLUSFXWMAN
|
Facility
|
IP
|
$309.00
|
|
|
Service Code
|
HCPCS 27788
|
| Hospital Charge Code |
76100937
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$40.17 |
| Max. Negotiated Rate |
$296.64 |
| Rate for Payer: Aetna Commercial |
$237.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$241.02
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cigna Commercial |
$256.47
|
| Rate for Payer: First Health Commercial |
$293.55
|
| Rate for Payer: Humana Commercial |
$262.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$253.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$228.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$92.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$271.92
|
| Rate for Payer: Ohio Health Group HMO |
$231.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$95.79
|
| Rate for Payer: PHCS Commercial |
$296.64
|
| Rate for Payer: United Healthcare All Payer |
$271.92
|
|
|
CLSD TXPOSTRIORMALLEOLUSFXWMAN
|
Facility
|
IP
|
$309.00
|
|
|
Service Code
|
HCPCS 27788
|
| Hospital Charge Code |
45000167
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$40.17 |
| Max. Negotiated Rate |
$296.64 |
| Rate for Payer: Aetna Commercial |
$237.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$241.02
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cigna Commercial |
$256.47
|
| Rate for Payer: First Health Commercial |
$293.55
|
| Rate for Payer: Humana Commercial |
$262.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$253.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$228.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$92.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$271.92
|
| Rate for Payer: Ohio Health Group HMO |
$231.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$95.79
|
| Rate for Payer: PHCS Commercial |
$296.64
|
| Rate for Payer: United Healthcare All Payer |
$271.92
|
|
|
CLSD TXPOSTRIORMALLEOLUSFXWMAN
|
Facility
|
OP
|
$309.00
|
|
|
Service Code
|
HCPCS 27788
|
| Hospital Charge Code |
76100937
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$40.17 |
| Max. Negotiated Rate |
$296.64 |
| Rate for Payer: Aetna Commercial |
$237.93
|
| Rate for Payer: Anthem Medicaid |
$106.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$241.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cigna Commercial |
$256.47
|
| Rate for Payer: First Health Commercial |
$293.55
|
| Rate for Payer: Humana Commercial |
$262.65
|
| Rate for Payer: Humana KY Medicaid |
$106.27
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$107.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$253.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$228.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$108.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$271.92
|
| Rate for Payer: Ohio Health Group HMO |
$231.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$95.79
|
| Rate for Payer: PHCS Commercial |
$296.64
|
| Rate for Payer: United Healthcare All Payer |
$271.92
|
|
|
CLSD TXPOSTRIORMALLEOLUSFXWMAN
|
Facility
|
OP
|
$309.00
|
|
|
Service Code
|
HCPCS 27788
|
| Hospital Charge Code |
45000167
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$40.17 |
| Max. Negotiated Rate |
$296.64 |
| Rate for Payer: Aetna Commercial |
$237.93
|
| Rate for Payer: Anthem Medicaid |
$106.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$241.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cigna Commercial |
$256.47
|
| Rate for Payer: First Health Commercial |
$293.55
|
| Rate for Payer: Humana Commercial |
$262.65
|
| Rate for Payer: Humana KY Medicaid |
$106.27
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$107.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$253.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$228.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$108.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$271.92
|
| Rate for Payer: Ohio Health Group HMO |
$231.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$95.79
|
| Rate for Payer: PHCS Commercial |
$296.64
|
| Rate for Payer: United Healthcare All Payer |
$271.92
|
|
