|
CLTX ARTCLR FX INVG MTCRPHLNGL
|
Facility
|
OP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 26742
|
| Hospital Charge Code |
45000145
|
|
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
|
|
|
CLTX ARTCLR FX INVG MTCRPHLNGL
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 26742
|
| Hospital Charge Code |
761P0741
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$169.45 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna Commercial |
$463.39
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$180.60
|
| Rate for Payer: Anthem Medicaid |
$169.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$750.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$572.51
|
| Rate for Payer: Healthspan PPO |
$458.03
|
| Rate for Payer: Humana Medicaid |
$169.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$400.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$172.84
|
| Rate for Payer: Molina Healthcare Passport |
$169.45
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$525.00
|
| Rate for Payer: UHCCP Medicaid |
$189.63
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$171.14
|
|
|
CLTX ARTCLR FX INVG MTCRPHLNGL
|
Facility
|
IP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 26742
|
| Hospital Charge Code |
45000145
|
|
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
|
|
|
CLTX ARTCLR FX INVG MTCRPHLNGL
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 26742
|
| Hospital Charge Code |
76100741
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.50 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem Medicaid |
$257.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| 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 |
$375.00
|
| 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: Humana KY Medicaid |
$257.92
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$260.55
|
| 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 |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$263.10
|
| 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
|
|
|
CLTX ARTCLR FX INVG MTCRPHLNGL
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 26742
|
| Hospital Charge Code |
76100741
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$169.45 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna Commercial |
$463.39
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$180.60
|
| Rate for Payer: Anthem Medicaid |
$169.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$750.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$572.51
|
| Rate for Payer: Healthspan PPO |
$458.03
|
| Rate for Payer: Humana Medicaid |
$169.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$400.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$172.84
|
| Rate for Payer: Molina Healthcare Passport |
$169.45
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$525.00
|
| Rate for Payer: UHCCP Medicaid |
$189.63
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$171.14
|
|
|
CLTX CARPAL BONE FX W/MAN
|
Facility
|
OP
|
$838.00
|
|
|
Service Code
|
HCPCS 25635
|
| Hospital Charge Code |
76100640
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$108.94 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Aetna Commercial |
$645.26
|
| Rate for Payer: Anthem Medicaid |
$288.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$653.64
|
| 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 |
$419.00
|
| Rate for Payer: Cash Price |
$419.00
|
| Rate for Payer: Cigna Commercial |
$695.54
|
| Rate for Payer: First Health Commercial |
$796.10
|
| Rate for Payer: Humana Commercial |
$712.30
|
| Rate for Payer: Humana KY Medicaid |
$288.19
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$291.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$687.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$618.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$293.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$737.44
|
| Rate for Payer: Ohio Health Group HMO |
$628.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$167.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$108.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$259.78
|
| Rate for Payer: PHCS Commercial |
$804.48
|
| Rate for Payer: United Healthcare All Payer |
$737.44
|
|
|
CLTX CARPAL BONE FX W/MAN
|
Facility
|
IP
|
$838.00
|
|
|
Service Code
|
HCPCS 25635
|
| Hospital Charge Code |
76100640
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$108.94 |
| Max. Negotiated Rate |
$804.48 |
| Rate for Payer: Aetna Commercial |
$645.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$653.64
|
| Rate for Payer: Cash Price |
$419.00
|
| Rate for Payer: Cigna Commercial |
$695.54
|
| Rate for Payer: First Health Commercial |
$796.10
|
| Rate for Payer: Humana Commercial |
$712.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$687.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$618.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$251.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$737.44
|
| Rate for Payer: Ohio Health Group HMO |
$628.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$167.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$108.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$259.78
|
| Rate for Payer: PHCS Commercial |
$804.48
|
| Rate for Payer: United Healthcare All Payer |
$737.44
|
|
|
CLTX CARPAL BONE FX W/MAN
|
Professional
|
Both
|
$838.00
|
|
|
Service Code
|
HCPCS 25635
|
| Hospital Charge Code |
76100640
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$179.28 |
| Max. Negotiated Rate |
$838.00 |
| Rate for Payer: Aetna Commercial |
$540.85
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$220.10
|
| Rate for Payer: Anthem Medicaid |
$179.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$838.00
|
| Rate for Payer: Cash Price |
$419.00
|
| Rate for Payer: Cash Price |
$419.00
|
| Rate for Payer: Cigna Commercial |
$569.41
|
| Rate for Payer: Healthspan PPO |
$543.23
|
| Rate for Payer: Humana Medicaid |
$179.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$485.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$182.87
|
| Rate for Payer: Molina Healthcare Passport |
$179.28
|
| Rate for Payer: Multiplan PHCS |
$502.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$586.60
|
| Rate for Payer: UHCCP Medicaid |
$231.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$181.07
|
|
|
CLTX CARPAL BONE FX W/MAN(P
|
Professional
|
Both
|
$838.00
|
|
|
Service Code
|
HCPCS 25635
|
| Hospital Charge Code |
761P0640
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$179.28 |
| Max. Negotiated Rate |
$838.00 |
| Rate for Payer: Aetna Commercial |
$540.85
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$220.10
|
| Rate for Payer: Anthem Medicaid |
$179.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$838.00
|
| Rate for Payer: Cash Price |
$419.00
|
| Rate for Payer: Cash Price |
$419.00
|
| Rate for Payer: Cigna Commercial |
$569.41
|
| Rate for Payer: Healthspan PPO |
$543.23
|
| Rate for Payer: Humana Medicaid |
$179.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$485.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$182.87
|
| Rate for Payer: Molina Healthcare Passport |
$179.28
|
| Rate for Payer: Multiplan PHCS |
$502.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$586.60
|
| Rate for Payer: UHCCP Medicaid |
$231.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$181.07
|
|
|
CLTX CARPAL BONE FX W/O MAN
|
Professional
|
Both
|
$1,538.00
|
|
|
Service Code
|
HCPCS 25630
|
| Hospital Charge Code |
76100639
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$116.77 |
| Max. Negotiated Rate |
$1,538.00 |
| Rate for Payer: Aetna Commercial |
$371.42
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$149.26
|
| Rate for Payer: Anthem Medicaid |
$116.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,538.00
|
| Rate for Payer: Cash Price |
$769.00
|
| Rate for Payer: Cash Price |
$769.00
|
| Rate for Payer: Cigna Commercial |
$459.36
|
| Rate for Payer: Healthspan PPO |
$369.39
|
| Rate for Payer: Humana Medicaid |
$116.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$330.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$119.11
|
| Rate for Payer: Molina Healthcare Passport |
$116.77
|
| Rate for Payer: Multiplan PHCS |
$922.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,076.60
|
| Rate for Payer: UHCCP Medicaid |
$156.72
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$117.94
|
|
|
CLTX CARPAL BONE FX W/O MAN
|
Facility
|
OP
|
$1,538.00
|
|
|
Service Code
|
HCPCS 25630
|
| Hospital Charge Code |
76100639
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$199.94 |
| Max. Negotiated Rate |
$1,476.48 |
| Rate for Payer: Aetna Commercial |
$1,184.26
|
| Rate for Payer: Anthem Medicaid |
$528.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,199.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$769.00
|
| Rate for Payer: Cash Price |
$769.00
|
| Rate for Payer: Cigna Commercial |
$1,276.54
|
| Rate for Payer: First Health Commercial |
$1,461.10
|
| Rate for Payer: Humana Commercial |
$1,307.30
|
| Rate for Payer: Humana KY Medicaid |
$528.92
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$534.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,261.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,135.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$539.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,353.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,153.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$307.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$199.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$476.78
|
| Rate for Payer: PHCS Commercial |
$1,476.48
|
| Rate for Payer: United Healthcare All Payer |
$1,353.44
|
|
|
CLTX CARPAL BONE FX W/O MAN
|
Facility
|
IP
|
$1,538.00
|
|
|
Service Code
|
HCPCS 25630
|
| Hospital Charge Code |
76100639
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$199.94 |
| Max. Negotiated Rate |
$1,476.48 |
| Rate for Payer: Aetna Commercial |
$1,184.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,199.64
|
| Rate for Payer: Cash Price |
$769.00
|
| Rate for Payer: Cigna Commercial |
$1,276.54
|
| Rate for Payer: First Health Commercial |
$1,461.10
|
| Rate for Payer: Humana Commercial |
$1,307.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,261.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,135.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$461.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,353.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,153.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$307.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$199.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$476.78
|
| Rate for Payer: PHCS Commercial |
$1,476.48
|
| Rate for Payer: United Healthcare All Payer |
$1,353.44
|
|
|
CLTX CARPAL BONE FX W/O MAN(P
|
Professional
|
Both
|
$638.00
|
|
|
Service Code
|
HCPCS 25630
|
| Hospital Charge Code |
761P0639
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$116.77 |
| Max. Negotiated Rate |
$638.00 |
| Rate for Payer: Aetna Commercial |
$371.42
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$149.26
|
| Rate for Payer: Anthem Medicaid |
$116.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$638.00
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Cigna Commercial |
$459.36
|
| Rate for Payer: Healthspan PPO |
$369.39
|
| Rate for Payer: Humana Medicaid |
$116.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$330.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$119.11
|
| Rate for Payer: Molina Healthcare Passport |
$116.77
|
| Rate for Payer: Multiplan PHCS |
$382.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$446.60
|
| Rate for Payer: UHCCP Medicaid |
$156.72
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$117.94
|
|
|
CLTX CARPAL BONE FX W/O MAN(T
|
Facility
|
OP
|
$900.00
|
|
|
Service Code
|
HCPCS 25630
|
| Hospital Charge Code |
761T0639
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$864.00 |
| Rate for Payer: Aetna Commercial |
$693.00
|
| Rate for Payer: Anthem Medicaid |
$309.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$702.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$747.00
|
| Rate for Payer: First Health Commercial |
$855.00
|
| Rate for Payer: Humana Commercial |
$765.00
|
| Rate for Payer: Humana KY Medicaid |
$309.51
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$312.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$738.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$664.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$315.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$792.00
|
| Rate for Payer: Ohio Health Group HMO |
$675.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$117.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$279.00
|
| Rate for Payer: PHCS Commercial |
$864.00
|
| Rate for Payer: United Healthcare All Payer |
$792.00
|
|
|
CLTX CARPAL BONE FX W/O MAN(T
|
Facility
|
IP
|
$900.00
|
|
|
Service Code
|
HCPCS 25630
|
| Hospital Charge Code |
761T0639
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$864.00 |
| Rate for Payer: Aetna Commercial |
$693.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$702.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$747.00
|
| Rate for Payer: First Health Commercial |
$855.00
|
| Rate for Payer: Humana Commercial |
$765.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$738.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$664.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$270.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$792.00
|
| Rate for Payer: Ohio Health Group HMO |
$675.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$117.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$279.00
|
| Rate for Payer: PHCS Commercial |
$864.00
|
| Rate for Payer: United Healthcare All Payer |
$792.00
|
|
|
CLTX CARP/SCAPHOID FX W/MAN
|
Facility
|
OP
|
$862.00
|
|
|
Service Code
|
HCPCS 25624
|
| Hospital Charge Code |
76100637
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$112.06 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Aetna Commercial |
$663.74
|
| Rate for Payer: Anthem Medicaid |
$296.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$672.36
|
| 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 |
$431.00
|
| Rate for Payer: Cash Price |
$431.00
|
| Rate for Payer: Cigna Commercial |
$715.46
|
| Rate for Payer: First Health Commercial |
$818.90
|
| Rate for Payer: Humana Commercial |
$732.70
|
| Rate for Payer: Humana KY Medicaid |
$296.44
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$299.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$706.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$636.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$302.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$758.56
|
| Rate for Payer: Ohio Health Group HMO |
$646.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$172.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$112.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$267.22
|
| Rate for Payer: PHCS Commercial |
$827.52
|
| Rate for Payer: United Healthcare All Payer |
$758.56
|
|
|
CLTX CARP/SCAPHOID FX W/MAN
|
Facility
|
IP
|
$862.00
|
|
|
Service Code
|
HCPCS 25624
|
| Hospital Charge Code |
76100637
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$112.06 |
| Max. Negotiated Rate |
$827.52 |
| Rate for Payer: Aetna Commercial |
$663.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$672.36
|
| Rate for Payer: Cash Price |
$431.00
|
| Rate for Payer: Cigna Commercial |
$715.46
|
| Rate for Payer: First Health Commercial |
$818.90
|
| Rate for Payer: Humana Commercial |
$732.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$706.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$636.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$258.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$758.56
|
| Rate for Payer: Ohio Health Group HMO |
$646.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$172.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$112.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$267.22
|
| Rate for Payer: PHCS Commercial |
$827.52
|
| Rate for Payer: United Healthcare All Payer |
$758.56
|
|
|
CLTX CARP/SCAPHOID FX W/MAN
|
Professional
|
Both
|
$862.00
|
|
|
Service Code
|
HCPCS 25624
|
| Hospital Charge Code |
76100637
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$188.66 |
| Max. Negotiated Rate |
$862.00 |
| Rate for Payer: Aetna Commercial |
$582.52
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$239.27
|
| Rate for Payer: Anthem Medicaid |
$188.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$862.00
|
| Rate for Payer: Cash Price |
$431.00
|
| Rate for Payer: Cash Price |
$431.00
|
| Rate for Payer: Cigna Commercial |
$637.39
|
| Rate for Payer: Healthspan PPO |
$573.21
|
| Rate for Payer: Humana Medicaid |
$188.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$504.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$192.43
|
| Rate for Payer: Molina Healthcare Passport |
$188.66
|
| Rate for Payer: Multiplan PHCS |
$517.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$603.40
|
| Rate for Payer: UHCCP Medicaid |
$251.23
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$190.55
|
|
|
CLTX CARP/SCAPHOID FX W/MAN(P
|
Professional
|
Both
|
$862.00
|
|
|
Service Code
|
HCPCS 25624
|
| Hospital Charge Code |
761P0637
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$188.66 |
| Max. Negotiated Rate |
$862.00 |
| Rate for Payer: Aetna Commercial |
$582.52
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$239.27
|
| Rate for Payer: Anthem Medicaid |
$188.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$862.00
|
| Rate for Payer: Cash Price |
$431.00
|
| Rate for Payer: Cash Price |
$431.00
|
| Rate for Payer: Cigna Commercial |
$637.39
|
| Rate for Payer: Healthspan PPO |
$573.21
|
| Rate for Payer: Humana Medicaid |
$188.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$504.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$192.43
|
| Rate for Payer: Molina Healthcare Passport |
$188.66
|
| Rate for Payer: Multiplan PHCS |
$517.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$603.40
|
| Rate for Payer: UHCCP Medicaid |
$251.23
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$190.55
|
|
|
CLTX CARP/SCAPHOID FX W/O MAN
|
Professional
|
Both
|
$1,058.00
|
|
|
Service Code
|
HCPCS 25622
|
| Hospital Charge Code |
76100636
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$109.90 |
| Max. Negotiated Rate |
$1,058.00 |
| Rate for Payer: Aetna Commercial |
$359.45
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$147.94
|
| Rate for Payer: Anthem Medicaid |
$109.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,058.00
|
| Rate for Payer: Cash Price |
$529.00
|
| Rate for Payer: Cash Price |
$529.00
|
| Rate for Payer: Cigna Commercial |
$447.68
|
| Rate for Payer: Healthspan PPO |
$359.03
|
| Rate for Payer: Humana Medicaid |
$109.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$323.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$112.10
|
| Rate for Payer: Molina Healthcare Passport |
$109.90
|
| Rate for Payer: Multiplan PHCS |
$634.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$740.60
|
| Rate for Payer: UHCCP Medicaid |
$155.34
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$111.00
|
|
|
CLTX CARP/SCAPHOID FX W/O MAN
|
Facility
|
IP
|
$1,058.00
|
|
|
Service Code
|
HCPCS 25622
|
| Hospital Charge Code |
76100636
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$137.54 |
| Max. Negotiated Rate |
$1,015.68 |
| Rate for Payer: Aetna Commercial |
$814.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$825.24
|
| Rate for Payer: Cash Price |
$529.00
|
| Rate for Payer: Cigna Commercial |
$878.14
|
| Rate for Payer: First Health Commercial |
$1,005.10
|
| Rate for Payer: Humana Commercial |
$899.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$867.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$780.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$317.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$931.04
|
| Rate for Payer: Ohio Health Group HMO |
$793.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$211.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$137.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$327.98
|
| Rate for Payer: PHCS Commercial |
$1,015.68
|
| Rate for Payer: United Healthcare All Payer |
$931.04
|
|
|
CLTX CARP/SCAPHOID FX W/O MAN
|
Facility
|
OP
|
$1,058.00
|
|
|
Service Code
|
HCPCS 25622
|
| Hospital Charge Code |
76100636
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$137.54 |
| Max. Negotiated Rate |
$1,015.68 |
| Rate for Payer: Aetna Commercial |
$814.66
|
| Rate for Payer: Anthem Medicaid |
$363.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$825.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$529.00
|
| Rate for Payer: Cash Price |
$529.00
|
| Rate for Payer: Cigna Commercial |
$878.14
|
| Rate for Payer: First Health Commercial |
$1,005.10
|
| Rate for Payer: Humana Commercial |
$899.30
|
| Rate for Payer: Humana KY Medicaid |
$363.85
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$367.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$867.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$780.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$371.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$931.04
|
| Rate for Payer: Ohio Health Group HMO |
$793.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$211.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$137.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$327.98
|
| Rate for Payer: PHCS Commercial |
$1,015.68
|
| Rate for Payer: United Healthcare All Payer |
$931.04
|
|
|
CLTX CARP/SCAPHOID FX W/O MA(P
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 25622
|
| Hospital Charge Code |
761P0636
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$109.90 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna Commercial |
$359.45
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$147.94
|
| Rate for Payer: Anthem Medicaid |
$109.90
|
| 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 |
$447.68
|
| Rate for Payer: Healthspan PPO |
$359.03
|
| Rate for Payer: Humana Medicaid |
$109.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$323.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$112.10
|
| Rate for Payer: Molina Healthcare Passport |
$109.90
|
| Rate for Payer: Multiplan PHCS |
$300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$350.00
|
| Rate for Payer: UHCCP Medicaid |
$155.34
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$111.00
|
|
|
CLTX CARP/SCAPHOID FX W/O MA(T
|
Facility
|
IP
|
$558.00
|
|
|
Service Code
|
HCPCS 25622
|
| Hospital Charge Code |
761T0636
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$72.54 |
| Max. Negotiated Rate |
$535.68 |
| Rate for Payer: Aetna Commercial |
$429.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$435.24
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Cigna Commercial |
$463.14
|
| Rate for Payer: First Health Commercial |
$530.10
|
| Rate for Payer: Humana Commercial |
$474.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$457.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$411.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$167.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$491.04
|
| Rate for Payer: Ohio Health Group HMO |
$418.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$111.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$172.98
|
| Rate for Payer: PHCS Commercial |
$535.68
|
| Rate for Payer: United Healthcare All Payer |
$491.04
|
|
|
CLTX CARP/SCAPHOID FX W/O MA(T
|
Facility
|
OP
|
$558.00
|
|
|
Service Code
|
HCPCS 25622
|
| Hospital Charge Code |
761T0636
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$72.54 |
| Max. Negotiated Rate |
$535.68 |
| Rate for Payer: Aetna Commercial |
$429.66
|
| Rate for Payer: Anthem Medicaid |
$191.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$435.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Cigna Commercial |
$463.14
|
| Rate for Payer: First Health Commercial |
$530.10
|
| Rate for Payer: Humana Commercial |
$474.30
|
| Rate for Payer: Humana KY Medicaid |
$191.90
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$193.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$457.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$411.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$195.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$491.04
|
| Rate for Payer: Ohio Health Group HMO |
$418.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$111.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$172.98
|
| Rate for Payer: PHCS Commercial |
$535.68
|
| Rate for Payer: United Healthcare All Payer |
$491.04
|
|
