|
CLSD TXSPONDISLOHIPWMANIPWANES
|
Facility
|
IP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 27257
|
| Hospital Charge Code |
76100801
|
|
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 TXSPONDISLOHIPWMANIPWANES
|
Facility
|
IP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 27257
|
| Hospital Charge Code |
45000153
|
|
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 TXSPONDISLOHIPWMANIPWANES
|
Facility
|
OP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 27257
|
| Hospital Charge Code |
45000153
|
|
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 TXSPONDISLOHIPWMANIPWANES
|
Facility
|
OP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 27257
|
| Hospital Charge Code |
76100801
|
|
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 TX TALOJNTDISL W/OANES
|
Facility
|
IP
|
$309.00
|
|
|
Service Code
|
HCPCS 28570
|
| Hospital Charge Code |
76101030
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$40.17 |
| Max. Negotiated Rate |
$296.64 |
| Rate for Payer: Ohio Health Group HMO |
$231.75
|
| 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 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 TX TALOJNTDISL W/OANES
|
Facility
|
IP
|
$309.00
|
|
|
Service Code
|
HCPCS 28570
|
| Hospital Charge Code |
45000180
|
|
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 TX TALOJNTDISL W/OANES
|
Facility
|
OP
|
$309.00
|
|
|
Service Code
|
HCPCS 28570
|
| Hospital Charge Code |
45000180
|
|
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
|
|
|
CLSD TX TALOJNTDISL W/OANES
|
Facility
|
OP
|
$309.00
|
|
|
Service Code
|
HCPCS 28570
|
| Hospital Charge Code |
76101030
|
|
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 TX TALUS FRACTURE W MANIP
|
Facility
|
OP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 28435
|
| Hospital Charge Code |
76101015
|
|
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 TX TALUS FRACTURE W MANIP
|
Facility
|
IP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 28435
|
| Hospital Charge Code |
45000175
|
|
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 TX TALUS FRACTURE W MANIP
|
Facility
|
OP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 28435
|
| Hospital Charge Code |
45000175
|
|
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 TX TALUS FRACTURE W MANIP
|
Facility
|
IP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 28435
|
| Hospital Charge Code |
76101015
|
|
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 TXTRAMATICDISLOHIPW/OANES
|
Facility
|
OP
|
$368.00
|
|
|
Service Code
|
HCPCS 27250
|
| Hospital Charge Code |
45000151
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$47.84 |
| Max. Negotiated Rate |
$353.28 |
| Rate for Payer: Aetna Commercial |
$283.36
|
| Rate for Payer: Anthem Medicaid |
$126.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$287.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cigna Commercial |
$305.44
|
| Rate for Payer: First Health Commercial |
$349.60
|
| Rate for Payer: Humana Commercial |
$312.80
|
| Rate for Payer: Humana KY Medicaid |
$126.56
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$127.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$301.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$271.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$129.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$323.84
|
| Rate for Payer: Ohio Health Group HMO |
$276.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$73.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$47.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$114.08
|
| Rate for Payer: PHCS Commercial |
$353.28
|
| Rate for Payer: United Healthcare All Payer |
$323.84
|
|
|
CLSD TXTRAMATICDISLOHIPW/OANES
|
Facility
|
OP
|
$368.00
|
|
|
Service Code
|
HCPCS 27250
|
| Hospital Charge Code |
76100798
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$47.84 |
| Max. Negotiated Rate |
$353.28 |
| Rate for Payer: Aetna Commercial |
$283.36
|
| Rate for Payer: Anthem Medicaid |
$126.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$287.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cigna Commercial |
$305.44
|
| Rate for Payer: First Health Commercial |
$349.60
|
| Rate for Payer: Humana Commercial |
$312.80
|
| Rate for Payer: Humana KY Medicaid |
$126.56
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$127.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$301.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$271.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$129.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$323.84
|
| Rate for Payer: Ohio Health Group HMO |
$276.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$73.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$47.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$114.08
|
| Rate for Payer: PHCS Commercial |
$353.28
|
| Rate for Payer: United Healthcare All Payer |
$323.84
|
|
|
CLSD TXTRAMATICDISLOHIPW/OANES
|
Facility
|
IP
|
$368.00
|
|
|
Service Code
|
HCPCS 27250
|
| Hospital Charge Code |
45000151
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$47.84 |
| Max. Negotiated Rate |
$353.28 |
| Rate for Payer: Aetna Commercial |
$283.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$287.04
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cigna Commercial |
$305.44
|
| Rate for Payer: First Health Commercial |
$349.60
|
| Rate for Payer: Humana Commercial |
$312.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$301.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$271.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$110.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$323.84
|
| Rate for Payer: Ohio Health Group HMO |
$276.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$73.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$47.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$114.08
|
| Rate for Payer: PHCS Commercial |
$353.28
|
| Rate for Payer: United Healthcare All Payer |
$323.84
|
|
|
CLSD TXTRAMATICDISLOHIPW/OANES
|
Facility
|
IP
|
$368.00
|
|
|
Service Code
|
HCPCS 27250
|
| Hospital Charge Code |
76100798
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$47.84 |
| Max. Negotiated Rate |
$353.28 |
| Rate for Payer: Aetna Commercial |
$283.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$287.04
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cigna Commercial |
$305.44
|
| Rate for Payer: First Health Commercial |
$349.60
|
| Rate for Payer: Humana Commercial |
$312.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$301.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$271.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$110.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$323.84
|
| Rate for Payer: Ohio Health Group HMO |
$276.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$73.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$47.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$114.08
|
| Rate for Payer: PHCS Commercial |
$353.28
|
| Rate for Payer: United Healthcare All Payer |
$323.84
|
|
|
CLSRE LAC VESTIBULEMOUTH 2.5 <
|
Facility
|
IP
|
$292.00
|
|
|
Service Code
|
HCPCS 40830
|
| Hospital Charge Code |
76101641
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$37.96 |
| Max. Negotiated Rate |
$280.32 |
| Rate for Payer: Aetna Commercial |
$224.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$227.76
|
| Rate for Payer: Cash Price |
$146.00
|
| Rate for Payer: Cigna Commercial |
$242.36
|
| Rate for Payer: First Health Commercial |
$277.40
|
| Rate for Payer: Humana Commercial |
$248.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$239.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$215.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$256.96
|
| Rate for Payer: Ohio Health Group HMO |
$219.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$90.52
|
| Rate for Payer: PHCS Commercial |
$280.32
|
| Rate for Payer: United Healthcare All Payer |
$256.96
|
|
|
CLSRE LAC VESTIBULEMOUTH 2.5 <
|
Facility
|
IP
|
$304.00
|
|
|
Service Code
|
HCPCS 40830
|
| Hospital Charge Code |
45000249
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$39.52 |
| Max. Negotiated Rate |
$291.84 |
| Rate for Payer: Aetna Commercial |
$234.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$237.12
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cigna Commercial |
$252.32
|
| Rate for Payer: First Health Commercial |
$288.80
|
| Rate for Payer: Humana Commercial |
$258.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$249.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$224.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$91.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$267.52
|
| Rate for Payer: Ohio Health Group HMO |
$228.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$94.24
|
| Rate for Payer: PHCS Commercial |
$291.84
|
| Rate for Payer: United Healthcare All Payer |
$267.52
|
|
|
CLSRE LAC VESTIBULEMOUTH 2.5 <
|
Facility
|
OP
|
$292.00
|
|
|
Service Code
|
HCPCS 40830
|
| Hospital Charge Code |
76101641
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$37.96 |
| Max. Negotiated Rate |
$295.72 |
| Rate for Payer: Aetna Commercial |
$224.84
|
| Rate for Payer: Anthem Medicaid |
$100.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$227.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$295.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$285.16
|
| Rate for Payer: Cash Price |
$146.00
|
| Rate for Payer: Cash Price |
$146.00
|
| Rate for Payer: Cigna Commercial |
$242.36
|
| Rate for Payer: First Health Commercial |
$277.40
|
| Rate for Payer: Humana Commercial |
$248.20
|
| Rate for Payer: Humana KY Medicaid |
$100.42
|
| Rate for Payer: Humana Medicare Advantage |
$211.23
|
| Rate for Payer: Kentucky WC Medicaid |
$101.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$239.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$215.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$253.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$102.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$256.96
|
| Rate for Payer: Ohio Health Group HMO |
$219.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$90.52
|
| Rate for Payer: PHCS Commercial |
$280.32
|
| Rate for Payer: United Healthcare All Payer |
$256.96
|
|
|
CLSRE LAC VESTIBULEMOUTH 2.5 <
|
Facility
|
OP
|
$304.00
|
|
|
Service Code
|
HCPCS 40830
|
| Hospital Charge Code |
45000249
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$39.52 |
| Max. Negotiated Rate |
$295.72 |
| Rate for Payer: Aetna Commercial |
$234.08
|
| Rate for Payer: Anthem Medicaid |
$104.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$237.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$295.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$285.16
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cigna Commercial |
$252.32
|
| Rate for Payer: First Health Commercial |
$288.80
|
| Rate for Payer: Humana Commercial |
$258.40
|
| Rate for Payer: Humana KY Medicaid |
$104.55
|
| Rate for Payer: Humana Medicare Advantage |
$211.23
|
| Rate for Payer: Kentucky WC Medicaid |
$105.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$249.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$224.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$253.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$106.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$267.52
|
| Rate for Payer: Ohio Health Group HMO |
$228.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$94.24
|
| Rate for Payer: PHCS Commercial |
$291.84
|
| Rate for Payer: United Healthcare All Payer |
$267.52
|
|
|
CLTX ARTC FX MTCRPHL/IPH JT
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
HCPCS 26740
|
| Hospital Charge Code |
76100740
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: Aetna Commercial |
$385.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$390.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$415.00
|
| Rate for Payer: First Health Commercial |
$475.00
|
| Rate for Payer: Humana Commercial |
$425.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$410.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$369.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$150.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$440.00
|
| Rate for Payer: Ohio Health Group HMO |
$375.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$155.00
|
| Rate for Payer: PHCS Commercial |
$480.00
|
| Rate for Payer: United Healthcare All Payer |
$440.00
|
|
|
CLTX ARTC FX MTCRPHL/IPH JT
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
HCPCS 26740
|
| Hospital Charge Code |
76100740
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: Aetna Commercial |
$385.00
|
| Rate for Payer: Anthem Medicaid |
$171.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$390.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$415.00
|
| Rate for Payer: First Health Commercial |
$475.00
|
| Rate for Payer: Humana Commercial |
$425.00
|
| Rate for Payer: Humana KY Medicaid |
$171.95
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$173.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$410.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$369.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$175.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$440.00
|
| Rate for Payer: Ohio Health Group HMO |
$375.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$155.00
|
| Rate for Payer: PHCS Commercial |
$480.00
|
| Rate for Payer: United Healthcare All Payer |
$440.00
|
|
|
CLTX ARTC FX MTCRPHL/IPH JT
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 26740
|
| Hospital Charge Code |
76100740
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$72.56 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna Commercial |
$280.91
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$114.72
|
| Rate for Payer: Anthem Medicaid |
$72.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$500.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$331.94
|
| Rate for Payer: Healthspan PPO |
$269.96
|
| Rate for Payer: Humana Medicaid |
$72.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$250.66
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$74.01
|
| Rate for Payer: Molina Healthcare Passport |
$72.56
|
| Rate for Payer: Multiplan PHCS |
$300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$350.00
|
| Rate for Payer: UHCCP Medicaid |
$120.46
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$73.29
|
|
|
CLTX ARTC FX MTCRPHL/IPH JT(P
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 26740
|
| Hospital Charge Code |
761P0740
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$72.56 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna Commercial |
$280.91
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$114.72
|
| Rate for Payer: Anthem Medicaid |
$72.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$500.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$331.94
|
| Rate for Payer: Healthspan PPO |
$269.96
|
| Rate for Payer: Humana Medicaid |
$72.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$250.66
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$74.01
|
| Rate for Payer: Molina Healthcare Passport |
$72.56
|
| Rate for Payer: Multiplan PHCS |
$300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$350.00
|
| Rate for Payer: UHCCP Medicaid |
$120.46
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$73.29
|
|
|
CLTX ARTCLR FX INVG MTCRPHLNGL
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 26742
|
| Hospital Charge Code |
76100741
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.50 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$622.50
|
| Rate for Payer: First Health Commercial |
$712.50
|
| Rate for Payer: Humana Commercial |
$637.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$553.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.00
|
| Rate for Payer: Ohio Health Group HMO |
$562.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$150.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$232.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
