|
CL TX DIS RADIOULNAR DIS W/MAN
|
Facility
|
OP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 25675
|
| Hospital Charge Code |
761T0643
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$203.93 |
| Max. Negotiated Rate |
$1,536.00 |
| Rate for Payer: Aetna Commercial |
$1,232.00
|
| Rate for Payer: Anthem Medicaid |
$550.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,248.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,328.00
|
| Rate for Payer: First Health Commercial |
$1,520.00
|
| Rate for Payer: Humana Commercial |
$1,360.00
|
| Rate for Payer: Humana KY Medicaid |
$550.24
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$555.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,312.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,180.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$561.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,408.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$208.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$496.00
|
| Rate for Payer: PHCS Commercial |
$1,536.00
|
| Rate for Payer: United Healthcare All Payer |
$1,408.00
|
|
|
CL TX DIS RADIOULNAR DIS W/MAN
|
Facility
|
OP
|
$2,640.00
|
|
|
Service Code
|
HCPCS 25675
|
| Hospital Charge Code |
76100643
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$203.93 |
| Max. Negotiated Rate |
$2,534.40 |
| Rate for Payer: Aetna Commercial |
$2,032.80
|
| Rate for Payer: Anthem Medicaid |
$907.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,059.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$1,320.00
|
| Rate for Payer: Cash Price |
$1,320.00
|
| Rate for Payer: Cigna Commercial |
$2,191.20
|
| Rate for Payer: First Health Commercial |
$2,508.00
|
| Rate for Payer: Humana Commercial |
$2,244.00
|
| Rate for Payer: Humana KY Medicaid |
$907.90
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$917.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,164.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,948.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$926.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,323.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,980.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$528.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$343.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$818.40
|
| Rate for Payer: PHCS Commercial |
$2,534.40
|
| Rate for Payer: United Healthcare All Payer |
$2,323.20
|
|
|
CL TX DIS RADIOULNAR DIS W/MAN
|
Facility
|
OP
|
$368.00
|
|
|
Service Code
|
HCPCS 25675
|
| Hospital Charge Code |
45000132
|
|
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
|
|
|
CL TX DIS RADIOULNAR DIS W/MAN
|
Professional
|
Both
|
$1,040.00
|
|
|
Service Code
|
HCPCS 25675
|
| Hospital Charge Code |
761P0643
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$199.70 |
| Max. Negotiated Rate |
$1,040.00 |
| Rate for Payer: Aetna Commercial |
$545.82
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$211.27
|
| Rate for Payer: Anthem Medicaid |
$199.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,040.00
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cigna Commercial |
$665.06
|
| Rate for Payer: Healthspan PPO |
$532.69
|
| Rate for Payer: Humana Medicaid |
$199.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$477.21
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$203.69
|
| Rate for Payer: Molina Healthcare Passport |
$199.70
|
| Rate for Payer: Multiplan PHCS |
$624.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$728.00
|
| Rate for Payer: UHCCP Medicaid |
$221.83
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$201.70
|
|
|
CL TX DIS RADIOULNAR DIS W/MAN
|
Facility
|
IP
|
$2,640.00
|
|
|
Service Code
|
HCPCS 25675
|
| Hospital Charge Code |
76100643
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$343.20 |
| Max. Negotiated Rate |
$2,534.40 |
| Rate for Payer: Aetna Commercial |
$2,032.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,059.20
|
| Rate for Payer: Cash Price |
$1,320.00
|
| Rate for Payer: Cigna Commercial |
$2,191.20
|
| Rate for Payer: First Health Commercial |
$2,508.00
|
| Rate for Payer: Humana Commercial |
$2,244.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,164.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,948.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$792.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,323.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,980.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$528.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$343.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$818.40
|
| Rate for Payer: PHCS Commercial |
$2,534.40
|
| Rate for Payer: United Healthcare All Payer |
$2,323.20
|
|
|
CL TX DIS RADIOULNAR DIS W/MAN
|
Professional
|
Both
|
$2,640.00
|
|
|
Service Code
|
HCPCS 25675
|
| Hospital Charge Code |
76100643
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$199.70 |
| Max. Negotiated Rate |
$2,640.00 |
| Rate for Payer: Aetna Commercial |
$545.82
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$211.27
|
| Rate for Payer: Anthem Medicaid |
$199.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,640.00
|
| Rate for Payer: Cash Price |
$1,320.00
|
| Rate for Payer: Cash Price |
$1,320.00
|
| Rate for Payer: Cigna Commercial |
$665.06
|
| Rate for Payer: Healthspan PPO |
$532.69
|
| Rate for Payer: Humana Medicaid |
$199.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$477.21
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$203.69
|
| Rate for Payer: Molina Healthcare Passport |
$199.70
|
| Rate for Payer: Multiplan PHCS |
$1,584.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,848.00
|
| Rate for Payer: UHCCP Medicaid |
$221.83
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$201.70
|
|
|
CL TX DIS RADIOULNAR DIS W/MAN
|
Facility
|
IP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 25675
|
| Hospital Charge Code |
761T0643
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$1,536.00 |
| Rate for Payer: Aetna Commercial |
$1,232.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,248.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,328.00
|
| Rate for Payer: First Health Commercial |
$1,520.00
|
| Rate for Payer: Humana Commercial |
$1,360.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,312.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,180.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$480.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,408.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$208.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$496.00
|
| Rate for Payer: PHCS Commercial |
$1,536.00
|
| Rate for Payer: United Healthcare All Payer |
$1,408.00
|
|
|
CL TX DIS RADIOULNAR DIS W/MAN
|
Facility
|
IP
|
$368.00
|
|
|
Service Code
|
HCPCS 25675
|
| Hospital Charge Code |
45000132
|
|
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
|
|
|
CLTX DIS XTNSRTDNINSWWOPERCPIN
|
Professional
|
Both
|
$675.00
|
|
|
Service Code
|
HCPCS 26432
|
| Hospital Charge Code |
76100697
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$168.20 |
| Max. Negotiated Rate |
$869.38 |
| Rate for Payer: Aetna Commercial |
$689.41
|
| Rate for Payer: Anthem Medicaid |
$168.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$675.00
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cigna Commercial |
$869.38
|
| Rate for Payer: Healthspan PPO |
$624.46
|
| Rate for Payer: Humana Medicaid |
$168.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$595.84
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$171.56
|
| Rate for Payer: Molina Healthcare Passport |
$168.20
|
| Rate for Payer: Multiplan PHCS |
$405.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$472.50
|
| Rate for Payer: UHCCP Medicaid |
$236.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$169.88
|
|
|
CLTX DIS XTNSRTDNINSWWOPERCPIN
|
Facility
|
OP
|
$675.00
|
|
|
Service Code
|
HCPCS 26432
|
| Hospital Charge Code |
76100697
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$87.75 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Aetna Commercial |
$519.75
|
| Rate for Payer: Anthem Medicaid |
$232.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$526.50
|
| 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 |
$337.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cigna Commercial |
$560.25
|
| Rate for Payer: First Health Commercial |
$641.25
|
| Rate for Payer: Humana Commercial |
$573.75
|
| Rate for Payer: Humana KY Medicaid |
$232.13
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$234.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$553.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$498.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$236.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$594.00
|
| Rate for Payer: Ohio Health Group HMO |
$506.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$135.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$87.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$209.25
|
| Rate for Payer: PHCS Commercial |
$648.00
|
| Rate for Payer: United Healthcare All Payer |
$594.00
|
|
|
CLTX DIS XTNSRTDNINSWWOPERCPIN
|
Professional
|
Both
|
$675.00
|
|
|
Service Code
|
HCPCS 26432
|
| Hospital Charge Code |
761P0697
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$168.20 |
| Max. Negotiated Rate |
$869.38 |
| Rate for Payer: Aetna Commercial |
$689.41
|
| Rate for Payer: Anthem Medicaid |
$168.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$675.00
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cigna Commercial |
$869.38
|
| Rate for Payer: Healthspan PPO |
$624.46
|
| Rate for Payer: Humana Medicaid |
$168.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$595.84
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$171.56
|
| Rate for Payer: Molina Healthcare Passport |
$168.20
|
| Rate for Payer: Multiplan PHCS |
$405.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$472.50
|
| Rate for Payer: UHCCP Medicaid |
$236.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$169.88
|
|
|
CLTX DIS XTNSRTDNINSWWOPERCPIN
|
Facility
|
IP
|
$675.00
|
|
|
Service Code
|
HCPCS 26432
|
| Hospital Charge Code |
76100697
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$87.75 |
| Max. Negotiated Rate |
$648.00 |
| Rate for Payer: Aetna Commercial |
$519.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$526.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cigna Commercial |
$560.25
|
| Rate for Payer: First Health Commercial |
$641.25
|
| Rate for Payer: Humana Commercial |
$573.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$553.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$498.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$202.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$594.00
|
| Rate for Payer: Ohio Health Group HMO |
$506.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$135.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$87.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$209.25
|
| Rate for Payer: PHCS Commercial |
$648.00
|
| Rate for Payer: United Healthcare All Payer |
$594.00
|
|
|
CLTX DSTL FIB FX LAT MALL
|
Professional
|
Both
|
$663.00
|
|
|
Service Code
|
HCPCS 27786
|
| Hospital Charge Code |
76100936
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$121.08 |
| Max. Negotiated Rate |
$663.00 |
| Rate for Payer: Aetna Commercial |
$383.24
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$150.19
|
| Rate for Payer: Anthem Medicaid |
$121.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$663.00
|
| Rate for Payer: Cash Price |
$331.50
|
| Rate for Payer: Cash Price |
$331.50
|
| Rate for Payer: Cigna Commercial |
$476.11
|
| Rate for Payer: Healthspan PPO |
$382.52
|
| Rate for Payer: Humana Medicaid |
$121.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$338.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$123.50
|
| Rate for Payer: Molina Healthcare Passport |
$121.08
|
| Rate for Payer: Multiplan PHCS |
$397.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$464.10
|
| Rate for Payer: UHCCP Medicaid |
$157.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$122.29
|
|
|
CLTX DSTL FIB FX LAT MALL
|
Facility
|
IP
|
$663.00
|
|
|
Service Code
|
HCPCS 27786
|
| Hospital Charge Code |
76100936
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$86.19 |
| Max. Negotiated Rate |
$636.48 |
| Rate for Payer: Aetna Commercial |
$510.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$517.14
|
| Rate for Payer: Cash Price |
$331.50
|
| Rate for Payer: Cigna Commercial |
$550.29
|
| Rate for Payer: First Health Commercial |
$629.85
|
| Rate for Payer: Humana Commercial |
$563.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$543.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$489.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$198.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$583.44
|
| Rate for Payer: Ohio Health Group HMO |
$497.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$132.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$86.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$205.53
|
| Rate for Payer: PHCS Commercial |
$636.48
|
| Rate for Payer: United Healthcare All Payer |
$583.44
|
|
|
CLTX DSTL FIB FX LAT MALL
|
Facility
|
OP
|
$663.00
|
|
|
Service Code
|
HCPCS 27786
|
| Hospital Charge Code |
76100936
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$86.19 |
| Max. Negotiated Rate |
$636.48 |
| Rate for Payer: Aetna Commercial |
$510.51
|
| Rate for Payer: Anthem Medicaid |
$228.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$517.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$331.50
|
| Rate for Payer: Cash Price |
$331.50
|
| Rate for Payer: Cigna Commercial |
$550.29
|
| Rate for Payer: First Health Commercial |
$629.85
|
| Rate for Payer: Humana Commercial |
$563.55
|
| Rate for Payer: Humana KY Medicaid |
$228.01
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$230.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$543.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$489.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$232.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$583.44
|
| Rate for Payer: Ohio Health Group HMO |
$497.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$132.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$86.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$205.53
|
| Rate for Payer: PHCS Commercial |
$636.48
|
| Rate for Payer: United Healthcare All Payer |
$583.44
|
|
|
CLTX DSTL FIB FX LAT MALL(P
|
Professional
|
Both
|
$663.00
|
|
|
Service Code
|
HCPCS 27786
|
| Hospital Charge Code |
761P0936
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$121.08 |
| Max. Negotiated Rate |
$663.00 |
| Rate for Payer: Aetna Commercial |
$383.24
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$150.19
|
| Rate for Payer: Anthem Medicaid |
$121.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$663.00
|
| Rate for Payer: Cash Price |
$331.50
|
| Rate for Payer: Cash Price |
$331.50
|
| Rate for Payer: Cigna Commercial |
$476.11
|
| Rate for Payer: Healthspan PPO |
$382.52
|
| Rate for Payer: Humana Medicaid |
$121.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$338.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$123.50
|
| Rate for Payer: Molina Healthcare Passport |
$121.08
|
| Rate for Payer: Multiplan PHCS |
$397.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$464.10
|
| Rate for Payer: UHCCP Medicaid |
$157.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$122.29
|
|
|
CLTX DSTL PHLNGL FX FNGR/THMB
|
Facility
|
IP
|
$575.00
|
|
|
Service Code
|
HCPCS 26755
|
| Hospital Charge Code |
76100744
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$74.75 |
| Max. Negotiated Rate |
$552.00 |
| Rate for Payer: Aetna Commercial |
$442.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$448.50
|
| Rate for Payer: Cash Price |
$287.50
|
| Rate for Payer: Cigna Commercial |
$477.25
|
| Rate for Payer: First Health Commercial |
$546.25
|
| Rate for Payer: Humana Commercial |
$488.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$471.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$424.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$172.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$506.00
|
| Rate for Payer: Ohio Health Group HMO |
$431.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$115.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$74.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$178.25
|
| Rate for Payer: PHCS Commercial |
$552.00
|
| Rate for Payer: United Healthcare All Payer |
$506.00
|
|
|
CLTX DSTL PHLNGL FX FNGR/THMB
|
Facility
|
OP
|
$368.00
|
|
|
Service Code
|
HCPCS 26755
|
| Hospital Charge Code |
45000146
|
|
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
|
|
|
CLTX DSTL PHLNGL FX FNGR/THMB
|
Facility
|
OP
|
$575.00
|
|
|
Service Code
|
HCPCS 26755
|
| Hospital Charge Code |
76100744
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$74.75 |
| Max. Negotiated Rate |
$552.00 |
| Rate for Payer: Aetna Commercial |
$442.75
|
| Rate for Payer: Anthem Medicaid |
$197.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$448.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$287.50
|
| Rate for Payer: Cash Price |
$287.50
|
| Rate for Payer: Cigna Commercial |
$477.25
|
| Rate for Payer: First Health Commercial |
$546.25
|
| Rate for Payer: Humana Commercial |
$488.75
|
| Rate for Payer: Humana KY Medicaid |
$197.74
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$199.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$471.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$424.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$201.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$506.00
|
| Rate for Payer: Ohio Health Group HMO |
$431.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$115.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$74.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$178.25
|
| Rate for Payer: PHCS Commercial |
$552.00
|
| Rate for Payer: United Healthcare All Payer |
$506.00
|
|
|
CLTX DSTL PHLNGL FX FNGR/THMB
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 26750
|
| Hospital Charge Code |
76100743
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$71.64 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna Commercial |
$232.79
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$97.42
|
| Rate for Payer: Anthem Medicaid |
$71.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$400.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$269.08
|
| Rate for Payer: Healthspan PPO |
$216.18
|
| Rate for Payer: Humana Medicaid |
$71.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$211.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$73.07
|
| Rate for Payer: Molina Healthcare Passport |
$71.64
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$280.00
|
| Rate for Payer: UHCCP Medicaid |
$102.29
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$72.36
|
|
|
CLTX DSTL PHLNGL FX FNGR/THMB
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
HCPCS 26750
|
| Hospital Charge Code |
76100743
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$52.00 |
| Max. Negotiated Rate |
$384.00 |
| Rate for Payer: Aetna Commercial |
$308.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$312.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$332.00
|
| Rate for Payer: First Health Commercial |
$380.00
|
| Rate for Payer: Humana Commercial |
$340.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$328.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$295.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$120.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$352.00
|
| Rate for Payer: Ohio Health Group HMO |
$300.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.00
|
| Rate for Payer: PHCS Commercial |
$384.00
|
| Rate for Payer: United Healthcare All Payer |
$352.00
|
|
|
CLTX DSTL PHLNGL FX FNGR/THMB
|
Facility
|
IP
|
$368.00
|
|
|
Service Code
|
HCPCS 26755
|
| Hospital Charge Code |
45000146
|
|
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
|
|
|
CLTX DSTL PHLNGL FX FNGR/THMB
|
Professional
|
Both
|
$575.00
|
|
|
Service Code
|
HCPCS 26755
|
| Hospital Charge Code |
76100744
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$119.76 |
| Max. Negotiated Rate |
$575.00 |
| Rate for Payer: Aetna Commercial |
$370.70
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$143.10
|
| Rate for Payer: Anthem Medicaid |
$119.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$575.00
|
| Rate for Payer: Cash Price |
$287.50
|
| Rate for Payer: Cash Price |
$287.50
|
| Rate for Payer: Cigna Commercial |
$481.95
|
| Rate for Payer: Healthspan PPO |
$381.35
|
| Rate for Payer: Humana Medicaid |
$119.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$325.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$122.16
|
| Rate for Payer: Molina Healthcare Passport |
$119.76
|
| Rate for Payer: Multiplan PHCS |
$345.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$402.50
|
| Rate for Payer: UHCCP Medicaid |
$150.26
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$120.96
|
|
|
CLTX DSTL PHLNGL FX FNGR/THMB
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
HCPCS 26750
|
| Hospital Charge Code |
76100743
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$52.00 |
| Max. Negotiated Rate |
$384.00 |
| Rate for Payer: Aetna Commercial |
$308.00
|
| Rate for Payer: Anthem Medicaid |
$137.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$312.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$332.00
|
| Rate for Payer: First Health Commercial |
$380.00
|
| Rate for Payer: Humana Commercial |
$340.00
|
| Rate for Payer: Humana KY Medicaid |
$137.56
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$138.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$328.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$295.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$140.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$352.00
|
| Rate for Payer: Ohio Health Group HMO |
$300.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.00
|
| Rate for Payer: PHCS Commercial |
$384.00
|
| Rate for Payer: United Healthcare All Payer |
$352.00
|
|
|
CLTX DSTL PHLNGL FX FNGR/THM(P
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 26750
|
| Hospital Charge Code |
761P0743
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$71.64 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna Commercial |
$232.79
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$97.42
|
| Rate for Payer: Anthem Medicaid |
$71.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$400.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$269.08
|
| Rate for Payer: Healthspan PPO |
$216.18
|
| Rate for Payer: Humana Medicaid |
$71.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$211.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$73.07
|
| Rate for Payer: Molina Healthcare Passport |
$71.64
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$280.00
|
| Rate for Payer: UHCCP Medicaid |
$102.29
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$72.36
|
|
