|
CLTX FX W8 BRG ARTCLR DSTTIB
|
Facility
|
OP
|
$720.00
|
|
|
Service Code
|
HCPCS 27824
|
| Hospital Charge Code |
76100946
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$93.60 |
| Max. Negotiated Rate |
$691.20 |
| Rate for Payer: Aetna Commercial |
$554.40
|
| Rate for Payer: Anthem Medicaid |
$247.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$561.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cigna Commercial |
$597.60
|
| Rate for Payer: First Health Commercial |
$684.00
|
| Rate for Payer: Humana Commercial |
$612.00
|
| Rate for Payer: Humana KY Medicaid |
$247.61
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$250.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$590.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$531.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$252.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$633.60
|
| Rate for Payer: Ohio Health Group HMO |
$540.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$144.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$93.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$223.20
|
| Rate for Payer: PHCS Commercial |
$691.20
|
| Rate for Payer: United Healthcare All Payer |
$633.60
|
|
|
CLTX FX W8 BRG ARTCLR DSTTIB(P
|
Professional
|
Both
|
$720.00
|
|
|
Service Code
|
HCPCS 27824
|
| Hospital Charge Code |
761P0946
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$185.96 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$406.77
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$197.04
|
| Rate for Payer: Anthem Medicaid |
$185.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$720.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cigna Commercial |
$469.14
|
| Rate for Payer: Healthspan PPO |
$381.54
|
| Rate for Payer: Humana Medicaid |
$185.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$361.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$189.68
|
| Rate for Payer: Molina Healthcare Passport |
$185.96
|
| Rate for Payer: Multiplan PHCS |
$432.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$504.00
|
| Rate for Payer: UHCCP Medicaid |
$206.89
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$187.82
|
|
|
CLTX GREATER HUM TUB FX W/OMAN
|
Facility
|
IP
|
$900.00
|
|
|
Service Code
|
HCPCS 23620
|
| Hospital Charge Code |
761T0482
|
|
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 GREATER HUM TUB FX W/OMAN
|
Professional
|
Both
|
$1,485.00
|
|
|
Service Code
|
HCPCS 23620
|
| Hospital Charge Code |
76100482
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$115.82 |
| Max. Negotiated Rate |
$1,485.00 |
| Rate for Payer: Aetna Commercial |
$336.94
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$161.07
|
| Rate for Payer: Anthem Medicaid |
$115.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,485.00
|
| Rate for Payer: Cash Price |
$742.50
|
| Rate for Payer: Cash Price |
$742.50
|
| Rate for Payer: Cigna Commercial |
$395.04
|
| Rate for Payer: Healthspan PPO |
$322.16
|
| Rate for Payer: Humana Medicaid |
$115.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$300.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$118.14
|
| Rate for Payer: Molina Healthcare Passport |
$115.82
|
| Rate for Payer: Multiplan PHCS |
$891.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,039.50
|
| Rate for Payer: UHCCP Medicaid |
$169.12
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$116.98
|
|
|
CLTX GREATER HUM TUB FX W/OMAN
|
Facility
|
OP
|
$1,485.00
|
|
|
Service Code
|
HCPCS 23620
|
| Hospital Charge Code |
76100482
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$193.05 |
| Max. Negotiated Rate |
$1,425.60 |
| Rate for Payer: Aetna Commercial |
$1,143.45
|
| Rate for Payer: Anthem Medicaid |
$510.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,158.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$742.50
|
| Rate for Payer: Cash Price |
$742.50
|
| Rate for Payer: Cigna Commercial |
$1,232.55
|
| Rate for Payer: First Health Commercial |
$1,410.75
|
| Rate for Payer: Humana Commercial |
$1,262.25
|
| Rate for Payer: Humana KY Medicaid |
$510.69
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$515.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,217.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,095.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$520.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,306.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,113.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$297.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$193.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$460.35
|
| Rate for Payer: PHCS Commercial |
$1,425.60
|
| Rate for Payer: United Healthcare All Payer |
$1,306.80
|
|
|
CLTX GREATER HUM TUB FX W/OMAN
|
Facility
|
OP
|
$900.00
|
|
|
Service Code
|
HCPCS 23620
|
| Hospital Charge Code |
761T0482
|
|
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 GREATER HUM TUB FX W/OMAN
|
Facility
|
IP
|
$1,485.00
|
|
|
Service Code
|
HCPCS 23620
|
| Hospital Charge Code |
76100482
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$193.05 |
| Max. Negotiated Rate |
$1,425.60 |
| Rate for Payer: Aetna Commercial |
$1,143.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,158.30
|
| Rate for Payer: Cash Price |
$742.50
|
| Rate for Payer: Cigna Commercial |
$1,232.55
|
| Rate for Payer: First Health Commercial |
$1,410.75
|
| Rate for Payer: Humana Commercial |
$1,262.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,217.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,095.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$445.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,306.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,113.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$297.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$193.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$460.35
|
| Rate for Payer: PHCS Commercial |
$1,425.60
|
| Rate for Payer: United Healthcare All Payer |
$1,306.80
|
|
|
CLTX GREATER HUM TUB FX W/OMAN
|
Professional
|
Both
|
$585.00
|
|
|
Service Code
|
HCPCS 23620
|
| Hospital Charge Code |
761P0482
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$115.82 |
| Max. Negotiated Rate |
$585.00 |
| Rate for Payer: Aetna Commercial |
$336.94
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$161.07
|
| Rate for Payer: Anthem Medicaid |
$115.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$585.00
|
| Rate for Payer: Cash Price |
$292.50
|
| Rate for Payer: Cash Price |
$292.50
|
| Rate for Payer: Cigna Commercial |
$395.04
|
| Rate for Payer: Healthspan PPO |
$322.16
|
| Rate for Payer: Humana Medicaid |
$115.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$300.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$118.14
|
| Rate for Payer: Molina Healthcare Passport |
$115.82
|
| Rate for Payer: Multiplan PHCS |
$351.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$409.50
|
| Rate for Payer: UHCCP Medicaid |
$169.12
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$116.98
|
|
|
CLTX GRTER HUM TBRSTY FX W/MAN
|
Facility
|
IP
|
$3,377.50
|
|
|
Service Code
|
HCPCS 23625
|
| Hospital Charge Code |
76100483
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$439.08 |
| Max. Negotiated Rate |
$3,242.40 |
| Rate for Payer: Aetna Commercial |
$2,600.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,634.45
|
| Rate for Payer: Cash Price |
$1,688.75
|
| Rate for Payer: Cigna Commercial |
$2,803.32
|
| Rate for Payer: First Health Commercial |
$3,208.62
|
| Rate for Payer: Humana Commercial |
$2,870.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,769.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,492.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,013.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,972.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,533.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$675.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$439.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,047.02
|
| Rate for Payer: PHCS Commercial |
$3,242.40
|
| Rate for Payer: United Healthcare All Payer |
$2,972.20
|
|
|
CLTX GRTER HUM TBRSTY FX W/MAN
|
Facility
|
OP
|
$2,577.50
|
|
|
Service Code
|
HCPCS 23625
|
| Hospital Charge Code |
761T0483
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$335.08 |
| Max. Negotiated Rate |
$2,474.40 |
| Rate for Payer: Aetna Commercial |
$1,984.68
|
| Rate for Payer: Anthem Medicaid |
$886.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,010.45
|
| 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 |
$1,288.75
|
| Rate for Payer: Cash Price |
$1,288.75
|
| Rate for Payer: Cigna Commercial |
$2,139.32
|
| Rate for Payer: First Health Commercial |
$2,448.62
|
| Rate for Payer: Humana Commercial |
$2,190.88
|
| Rate for Payer: Humana KY Medicaid |
$886.40
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$895.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,113.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,902.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$904.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,268.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,933.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$515.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$335.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$799.02
|
| Rate for Payer: PHCS Commercial |
$2,474.40
|
| Rate for Payer: United Healthcare All Payer |
$2,268.20
|
|
|
CLTX GRTER HUM TBRSTY FX W/MAN
|
Facility
|
OP
|
$3,377.50
|
|
|
Service Code
|
HCPCS 23625
|
| Hospital Charge Code |
76100483
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$439.08 |
| Max. Negotiated Rate |
$3,242.40 |
| Rate for Payer: Aetna Commercial |
$2,600.68
|
| Rate for Payer: Anthem Medicaid |
$1,161.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,634.45
|
| 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 |
$1,688.75
|
| Rate for Payer: Cash Price |
$1,688.75
|
| Rate for Payer: Cigna Commercial |
$2,803.32
|
| Rate for Payer: First Health Commercial |
$3,208.62
|
| Rate for Payer: Humana Commercial |
$2,870.88
|
| Rate for Payer: Humana KY Medicaid |
$1,161.52
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$1,173.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,769.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,492.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,184.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,972.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,533.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$675.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$439.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,047.02
|
| Rate for Payer: PHCS Commercial |
$3,242.40
|
| Rate for Payer: United Healthcare All Payer |
$2,972.20
|
|
|
CLTX GRTER HUM TBRSTY FX W/MAN
|
Professional
|
Both
|
$3,377.50
|
|
|
Service Code
|
HCPCS 23625
|
| Hospital Charge Code |
76100483
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$203.75 |
| Max. Negotiated Rate |
$3,377.50 |
| Rate for Payer: Aetna Commercial |
$493.18
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$203.75
|
| Rate for Payer: Anthem Medicaid |
$223.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,377.50
|
| Rate for Payer: Cash Price |
$1,688.75
|
| Rate for Payer: Cash Price |
$1,688.75
|
| Rate for Payer: Cigna Commercial |
$582.97
|
| Rate for Payer: Healthspan PPO |
$472.89
|
| Rate for Payer: Humana Medicaid |
$223.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$426.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$228.33
|
| Rate for Payer: Molina Healthcare Passport |
$223.85
|
| Rate for Payer: Multiplan PHCS |
$2,026.50
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,364.25
|
| Rate for Payer: UHCCP Medicaid |
$213.94
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$226.09
|
|
|
CLTX GRTER HUM TBRSTY FX W/MAN
|
Facility
|
IP
|
$2,577.50
|
|
|
Service Code
|
HCPCS 23625
|
| Hospital Charge Code |
761T0483
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$335.08 |
| Max. Negotiated Rate |
$2,474.40 |
| Rate for Payer: Aetna Commercial |
$1,984.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,010.45
|
| Rate for Payer: Cash Price |
$1,288.75
|
| Rate for Payer: Cigna Commercial |
$2,139.32
|
| Rate for Payer: First Health Commercial |
$2,448.62
|
| Rate for Payer: Humana Commercial |
$2,190.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,113.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,902.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$773.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,268.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,933.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$515.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$335.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$799.02
|
| Rate for Payer: PHCS Commercial |
$2,474.40
|
| Rate for Payer: United Healthcare All Payer |
$2,268.20
|
|
|
CLTX GRTER HUM TBRSTY FX W/MAN
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 23625
|
| Hospital Charge Code |
761P0483
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$203.75 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Aetna Commercial |
$493.18
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$203.75
|
| Rate for Payer: Anthem Medicaid |
$223.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$800.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$582.97
|
| Rate for Payer: Healthspan PPO |
$472.89
|
| Rate for Payer: Humana Medicaid |
$223.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$426.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$228.33
|
| Rate for Payer: Molina Healthcare Passport |
$223.85
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$560.00
|
| Rate for Payer: UHCCP Medicaid |
$213.94
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$226.09
|
|
|
CLTX GRTR TROCHANTERIC FX
|
Facility
|
OP
|
$809.00
|
|
|
Service Code
|
HCPCS 27246
|
| Hospital Charge Code |
76100796
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$105.17 |
| Max. Negotiated Rate |
$776.64 |
| Rate for Payer: Aetna Commercial |
$622.93
|
| Rate for Payer: Anthem Medicaid |
$278.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$631.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$404.50
|
| Rate for Payer: Cash Price |
$404.50
|
| Rate for Payer: Cigna Commercial |
$671.47
|
| Rate for Payer: First Health Commercial |
$768.55
|
| Rate for Payer: Humana Commercial |
$687.65
|
| Rate for Payer: Humana KY Medicaid |
$278.22
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$281.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$663.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$597.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$283.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$711.92
|
| Rate for Payer: Ohio Health Group HMO |
$606.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$161.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$250.79
|
| Rate for Payer: PHCS Commercial |
$776.64
|
| Rate for Payer: United Healthcare All Payer |
$711.92
|
|
|
CLTX GRTR TROCHANTERIC FX
|
Facility
|
IP
|
$809.00
|
|
|
Service Code
|
HCPCS 27246
|
| Hospital Charge Code |
76100796
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$105.17 |
| Max. Negotiated Rate |
$776.64 |
| Rate for Payer: Aetna Commercial |
$622.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$631.02
|
| Rate for Payer: Cash Price |
$404.50
|
| Rate for Payer: Cigna Commercial |
$671.47
|
| Rate for Payer: First Health Commercial |
$768.55
|
| Rate for Payer: Humana Commercial |
$687.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$663.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$597.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$242.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$711.92
|
| Rate for Payer: Ohio Health Group HMO |
$606.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$161.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$250.79
|
| Rate for Payer: PHCS Commercial |
$776.64
|
| Rate for Payer: United Healthcare All Payer |
$711.92
|
|
|
CLTX GRTR TROCHANTERIC FX
|
Professional
|
Both
|
$809.00
|
|
|
Service Code
|
HCPCS 27246
|
| Hospital Charge Code |
76100796
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$246.32 |
| Max. Negotiated Rate |
$809.00 |
| Rate for Payer: Aetna Commercial |
$552.91
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$253.80
|
| Rate for Payer: Anthem Medicaid |
$246.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$809.00
|
| Rate for Payer: Cash Price |
$404.50
|
| Rate for Payer: Cash Price |
$404.50
|
| Rate for Payer: Cigna Commercial |
$606.79
|
| Rate for Payer: Healthspan PPO |
$499.84
|
| Rate for Payer: Humana Medicaid |
$246.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$470.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$251.25
|
| Rate for Payer: Molina Healthcare Passport |
$246.32
|
| Rate for Payer: Multiplan PHCS |
$485.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$566.30
|
| Rate for Payer: UHCCP Medicaid |
$266.49
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$248.78
|
|
|
CLTX GRTR TROCHANTERIC FX(P
|
Professional
|
Both
|
$809.00
|
|
|
Service Code
|
HCPCS 27246
|
| Hospital Charge Code |
761P0796
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$246.32 |
| Max. Negotiated Rate |
$809.00 |
| Rate for Payer: Aetna Commercial |
$552.91
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$253.80
|
| Rate for Payer: Anthem Medicaid |
$246.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$809.00
|
| Rate for Payer: Cash Price |
$404.50
|
| Rate for Payer: Cash Price |
$404.50
|
| Rate for Payer: Cigna Commercial |
$606.79
|
| Rate for Payer: Healthspan PPO |
$499.84
|
| Rate for Payer: Humana Medicaid |
$246.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$470.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$251.25
|
| Rate for Payer: Molina Healthcare Passport |
$246.32
|
| Rate for Payer: Multiplan PHCS |
$485.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$566.30
|
| Rate for Payer: UHCCP Medicaid |
$266.49
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$248.78
|
|
|
CLTX HIP ARTHRP DISLC WANES
|
Facility
|
OP
|
$1,031.00
|
|
|
Service Code
|
HCPCS 27266
|
| Hospital Charge Code |
76100803
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$134.03 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Aetna Commercial |
$793.87
|
| Rate for Payer: Anthem Medicaid |
$354.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$804.18
|
| 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 |
$515.50
|
| Rate for Payer: Cash Price |
$515.50
|
| Rate for Payer: Cigna Commercial |
$855.73
|
| Rate for Payer: First Health Commercial |
$979.45
|
| Rate for Payer: Humana Commercial |
$876.35
|
| Rate for Payer: Humana KY Medicaid |
$354.56
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$358.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$845.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$760.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$361.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$907.28
|
| Rate for Payer: Ohio Health Group HMO |
$773.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$206.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$134.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$319.61
|
| Rate for Payer: PHCS Commercial |
$989.76
|
| Rate for Payer: United Healthcare All Payer |
$907.28
|
|
|
CLTX HIP ARTHRP DISLC WANES
|
Facility
|
IP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 27266
|
| Hospital Charge Code |
45000155
|
|
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 HIP ARTHRP DISLC WANES
|
Facility
|
IP
|
$1,031.00
|
|
|
Service Code
|
HCPCS 27266
|
| Hospital Charge Code |
76100803
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$134.03 |
| Max. Negotiated Rate |
$989.76 |
| Rate for Payer: Aetna Commercial |
$793.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$804.18
|
| Rate for Payer: Cash Price |
$515.50
|
| Rate for Payer: Cigna Commercial |
$855.73
|
| Rate for Payer: First Health Commercial |
$979.45
|
| Rate for Payer: Humana Commercial |
$876.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$845.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$760.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$309.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$907.28
|
| Rate for Payer: Ohio Health Group HMO |
$773.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$206.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$134.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$319.61
|
| Rate for Payer: PHCS Commercial |
$989.76
|
| Rate for Payer: United Healthcare All Payer |
$907.28
|
|
|
CLTX HIP ARTHRP DISLC WANES
|
Professional
|
Both
|
$1,031.00
|
|
|
Service Code
|
HCPCS 27266
|
| Hospital Charge Code |
76100803
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$360.85 |
| Max. Negotiated Rate |
$1,031.00 |
| Rate for Payer: Aetna Commercial |
$847.15
|
| Rate for Payer: Anthem Medicaid |
$363.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,031.00
|
| Rate for Payer: Cash Price |
$515.50
|
| Rate for Payer: Cash Price |
$515.50
|
| Rate for Payer: Cigna Commercial |
$926.53
|
| Rate for Payer: Healthspan PPO |
$767.34
|
| Rate for Payer: Humana Medicaid |
$363.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$717.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$370.71
|
| Rate for Payer: Molina Healthcare Passport |
$363.44
|
| Rate for Payer: Multiplan PHCS |
$618.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$721.70
|
| Rate for Payer: UHCCP Medicaid |
$360.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$367.07
|
|
|
CLTX HIP ARTHRP DISLC WANES
|
Facility
|
OP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 27266
|
| Hospital Charge Code |
45000155
|
|
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 HIP ARTHRP DISLC WANES(P
|
Professional
|
Both
|
$1,031.00
|
|
|
Service Code
|
HCPCS 27266
|
| Hospital Charge Code |
761P0803
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$360.85 |
| Max. Negotiated Rate |
$1,031.00 |
| Rate for Payer: Aetna Commercial |
$847.15
|
| Rate for Payer: Anthem Medicaid |
$363.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,031.00
|
| Rate for Payer: Cash Price |
$515.50
|
| Rate for Payer: Cash Price |
$515.50
|
| Rate for Payer: Cigna Commercial |
$926.53
|
| Rate for Payer: Healthspan PPO |
$767.34
|
| Rate for Payer: Humana Medicaid |
$363.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$717.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$370.71
|
| Rate for Payer: Molina Healthcare Passport |
$363.44
|
| Rate for Payer: Multiplan PHCS |
$618.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$721.70
|
| Rate for Payer: UHCCP Medicaid |
$360.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$367.07
|
|
|
CLTX HIP ARTHRP DISLC WOANES
|
Facility
|
OP
|
$440.00
|
|
|
Service Code
|
HCPCS 27265
|
| Hospital Charge Code |
45000154
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$57.20 |
| Max. Negotiated Rate |
$422.40 |
| Rate for Payer: Aetna Commercial |
$338.80
|
| Rate for Payer: Anthem Medicaid |
$151.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$343.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cigna Commercial |
$365.20
|
| Rate for Payer: First Health Commercial |
$418.00
|
| Rate for Payer: Humana Commercial |
$374.00
|
| Rate for Payer: Humana KY Medicaid |
$151.32
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$152.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$360.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$324.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$154.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$387.20
|
| Rate for Payer: Ohio Health Group HMO |
$330.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$88.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$136.40
|
| Rate for Payer: PHCS Commercial |
$422.40
|
| Rate for Payer: United Healthcare All Payer |
$387.20
|
|
