|
CLTX HIP ARTHRP DISLC WOANES
|
Professional
|
Both
|
$975.00
|
|
|
Service Code
|
HCPCS 27265
|
| Hospital Charge Code |
76100802
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$269.66 |
| Max. Negotiated Rate |
$975.00 |
| Rate for Payer: Aetna Commercial |
$558.78
|
| Rate for Payer: Anthem Medicaid |
$269.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$975.00
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cigna Commercial |
$633.49
|
| Rate for Payer: Healthspan PPO |
$506.14
|
| Rate for Payer: Humana Medicaid |
$269.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$480.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$275.05
|
| Rate for Payer: Molina Healthcare Passport |
$269.66
|
| Rate for Payer: Multiplan PHCS |
$585.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$682.50
|
| Rate for Payer: UHCCP Medicaid |
$341.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$272.36
|
|
|
CLTX HIP ARTHRP DISLC WOANES
|
Facility
|
IP
|
$975.00
|
|
|
Service Code
|
HCPCS 27265
|
| Hospital Charge Code |
76100802
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$126.75 |
| Max. Negotiated Rate |
$936.00 |
| Rate for Payer: Aetna Commercial |
$750.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$760.50
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cigna Commercial |
$809.25
|
| Rate for Payer: First Health Commercial |
$926.25
|
| Rate for Payer: Humana Commercial |
$828.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$799.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$719.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$292.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$858.00
|
| Rate for Payer: Ohio Health Group HMO |
$731.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$195.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$126.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$302.25
|
| Rate for Payer: PHCS Commercial |
$936.00
|
| Rate for Payer: United Healthcare All Payer |
$858.00
|
|
|
CLTX HIP ARTHRP DISLC WOANES
|
Facility
|
OP
|
$975.00
|
|
|
Service Code
|
HCPCS 27265
|
| Hospital Charge Code |
76100802
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$126.75 |
| Max. Negotiated Rate |
$936.00 |
| Rate for Payer: Aetna Commercial |
$750.75
|
| Rate for Payer: Anthem Medicaid |
$335.30
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$760.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cigna Commercial |
$809.25
|
| Rate for Payer: First Health Commercial |
$926.25
|
| Rate for Payer: Humana Commercial |
$828.75
|
| Rate for Payer: Humana KY Medicaid |
$335.30
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$338.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$799.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$719.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$342.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$858.00
|
| Rate for Payer: Ohio Health Group HMO |
$731.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$195.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$126.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$302.25
|
| Rate for Payer: PHCS Commercial |
$936.00
|
| Rate for Payer: United Healthcare All Payer |
$858.00
|
|
|
CLTX HIP ARTHRP DISLC WOANES
|
Facility
|
IP
|
$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 POS/PPO/Traditional |
$343.20
|
| 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: 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 |
$132.00
|
| 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
|
|
|
CLTX HIP ARTHRP DISLC WOANES(P
|
Professional
|
Both
|
$975.00
|
|
|
Service Code
|
HCPCS 27265
|
| Hospital Charge Code |
761P0802
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$269.66 |
| Max. Negotiated Rate |
$975.00 |
| Rate for Payer: Aetna Commercial |
$558.78
|
| Rate for Payer: Anthem Medicaid |
$269.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$975.00
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cigna Commercial |
$633.49
|
| Rate for Payer: Healthspan PPO |
$506.14
|
| Rate for Payer: Humana Medicaid |
$269.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$480.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$275.05
|
| Rate for Payer: Molina Healthcare Passport |
$269.66
|
| Rate for Payer: Multiplan PHCS |
$585.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$682.50
|
| Rate for Payer: UHCCP Medicaid |
$341.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$272.36
|
|
|
CLTX HIP DISL TRAUM W/ANES
|
Facility
|
OP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 27252
|
| Hospital Charge Code |
45000152
|
|
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 DISL TRAUM W/ANES
|
Professional
|
Both
|
$1,240.00
|
|
|
Service Code
|
HCPCS 27252
|
| Hospital Charge Code |
76100799
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$410.81 |
| Max. Negotiated Rate |
$1,240.00 |
| Rate for Payer: Aetna Commercial |
$1,116.78
|
| Rate for Payer: Anthem Medicaid |
$410.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,240.00
|
| Rate for Payer: Cash Price |
$620.00
|
| Rate for Payer: Cash Price |
$620.00
|
| Rate for Payer: Cigna Commercial |
$1,211.16
|
| Rate for Payer: Healthspan PPO |
$1,011.56
|
| Rate for Payer: Humana Medicaid |
$410.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$941.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$419.03
|
| Rate for Payer: Molina Healthcare Passport |
$410.81
|
| Rate for Payer: Multiplan PHCS |
$744.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$868.00
|
| Rate for Payer: UHCCP Medicaid |
$434.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$414.92
|
|
|
CLTX HIP DISL TRAUM W/ANES
|
Facility
|
IP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 27252
|
| Hospital Charge Code |
45000152
|
|
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 DISL TRAUM W/ANES
|
Facility
|
OP
|
$1,240.00
|
|
|
Service Code
|
HCPCS 27252
|
| Hospital Charge Code |
76100799
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$161.20 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Aetna Commercial |
$954.80
|
| Rate for Payer: Anthem Medicaid |
$426.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$967.20
|
| 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 |
$620.00
|
| Rate for Payer: Cash Price |
$620.00
|
| Rate for Payer: Cigna Commercial |
$1,029.20
|
| Rate for Payer: First Health Commercial |
$1,178.00
|
| Rate for Payer: Humana Commercial |
$1,054.00
|
| Rate for Payer: Humana KY Medicaid |
$426.44
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$430.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,016.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$915.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$434.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,091.20
|
| Rate for Payer: Ohio Health Group HMO |
$930.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$248.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$161.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$384.40
|
| Rate for Payer: PHCS Commercial |
$1,190.40
|
| Rate for Payer: United Healthcare All Payer |
$1,091.20
|
|
|
CLTX HIP DISL TRAUM W/ANES
|
Facility
|
IP
|
$1,240.00
|
|
|
Service Code
|
HCPCS 27252
|
| Hospital Charge Code |
76100799
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$161.20 |
| Max. Negotiated Rate |
$1,190.40 |
| Rate for Payer: Aetna Commercial |
$954.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$967.20
|
| Rate for Payer: Cash Price |
$620.00
|
| Rate for Payer: Cigna Commercial |
$1,029.20
|
| Rate for Payer: First Health Commercial |
$1,178.00
|
| Rate for Payer: Humana Commercial |
$1,054.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,016.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$915.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$372.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,091.20
|
| Rate for Payer: Ohio Health Group HMO |
$930.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$248.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$161.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$384.40
|
| Rate for Payer: PHCS Commercial |
$1,190.40
|
| Rate for Payer: United Healthcare All Payer |
$1,091.20
|
|
|
CLTX HIP DISL TRAUM W/ANES(P
|
Professional
|
Both
|
$1,240.00
|
|
|
Service Code
|
HCPCS 27252
|
| Hospital Charge Code |
761P0799
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$410.81 |
| Max. Negotiated Rate |
$1,240.00 |
| Rate for Payer: Aetna Commercial |
$1,116.78
|
| Rate for Payer: Anthem Medicaid |
$410.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,240.00
|
| Rate for Payer: Cash Price |
$620.00
|
| Rate for Payer: Cash Price |
$620.00
|
| Rate for Payer: Cigna Commercial |
$1,211.16
|
| Rate for Payer: Healthspan PPO |
$1,011.56
|
| Rate for Payer: Humana Medicaid |
$410.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$941.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$419.03
|
| Rate for Payer: Molina Healthcare Passport |
$410.81
|
| Rate for Payer: Multiplan PHCS |
$744.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$868.00
|
| Rate for Payer: UHCCP Medicaid |
$434.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$414.92
|
|
|
CLTX HUM CONDYLR FX M/L WO MAN
|
Facility
|
IP
|
$1,050.00
|
|
|
Service Code
|
HCPCS 24576
|
| Hospital Charge Code |
761T0547
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$136.50 |
| Max. Negotiated Rate |
$1,008.00 |
| Rate for Payer: Aetna Commercial |
$808.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$819.00
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$871.50
|
| Rate for Payer: First Health Commercial |
$997.50
|
| Rate for Payer: Humana Commercial |
$892.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$861.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$774.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$315.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$924.00
|
| Rate for Payer: Ohio Health Group HMO |
$787.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$210.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$136.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$325.50
|
| Rate for Payer: PHCS Commercial |
$1,008.00
|
| Rate for Payer: United Healthcare All Payer |
$924.00
|
|
|
CLTX HUM CONDYLR FX M/L WO MAN
|
Facility
|
OP
|
$1,347.98
|
|
|
Service Code
|
HCPCS 24576
|
| Hospital Charge Code |
76100546
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$175.24 |
| Max. Negotiated Rate |
$1,294.06 |
| Rate for Payer: Aetna Commercial |
$1,037.94
|
| Rate for Payer: Anthem Medicaid |
$463.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,051.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$673.99
|
| Rate for Payer: Cash Price |
$673.99
|
| Rate for Payer: Cigna Commercial |
$1,118.82
|
| Rate for Payer: First Health Commercial |
$1,280.58
|
| Rate for Payer: Humana Commercial |
$1,145.78
|
| Rate for Payer: Humana KY Medicaid |
$463.57
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$468.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,105.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$994.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$472.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,186.22
|
| Rate for Payer: Ohio Health Group HMO |
$1,010.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$269.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$175.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$417.87
|
| Rate for Payer: PHCS Commercial |
$1,294.06
|
| Rate for Payer: United Healthcare All Payer |
$1,186.22
|
|
|
CLTX HUM CONDYLR FX M/L WO MAN
|
Facility
|
OP
|
$553.98
|
|
|
Service Code
|
HCPCS 24576
|
| Hospital Charge Code |
761T0546
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$72.02 |
| Max. Negotiated Rate |
$531.82 |
| Rate for Payer: Aetna Commercial |
$426.56
|
| Rate for Payer: Anthem Medicaid |
$190.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$432.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$276.99
|
| Rate for Payer: Cash Price |
$276.99
|
| Rate for Payer: Cigna Commercial |
$459.80
|
| Rate for Payer: First Health Commercial |
$526.28
|
| Rate for Payer: Humana Commercial |
$470.88
|
| Rate for Payer: Humana KY Medicaid |
$190.51
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$192.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$454.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$408.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$194.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$487.50
|
| Rate for Payer: Ohio Health Group HMO |
$415.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$110.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$171.73
|
| Rate for Payer: PHCS Commercial |
$531.82
|
| Rate for Payer: United Healthcare All Payer |
$487.50
|
|
|
CLTX HUM CONDYLR FX M/L WO MAN
|
Professional
|
Both
|
$1,844.00
|
|
|
Service Code
|
HCPCS 24576
|
| Hospital Charge Code |
76100547
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$144.01 |
| Max. Negotiated Rate |
$1,844.00 |
| Rate for Payer: Aetna Commercial |
$400.49
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$163.17
|
| Rate for Payer: Anthem Medicaid |
$144.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,844.00
|
| Rate for Payer: Cash Price |
$922.00
|
| Rate for Payer: Cash Price |
$922.00
|
| Rate for Payer: Cigna Commercial |
$497.38
|
| Rate for Payer: Healthspan PPO |
$400.58
|
| Rate for Payer: Humana Medicaid |
$144.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$359.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$146.89
|
| Rate for Payer: Molina Healthcare Passport |
$144.01
|
| Rate for Payer: Multiplan PHCS |
$1,106.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,290.80
|
| Rate for Payer: UHCCP Medicaid |
$171.33
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$145.45
|
|
|
CLTX HUM CONDYLR FX M/L WO MAN
|
Facility
|
OP
|
$1,050.00
|
|
|
Service Code
|
HCPCS 24576
|
| Hospital Charge Code |
761T0547
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$136.50 |
| Max. Negotiated Rate |
$1,008.00 |
| Rate for Payer: Aetna Commercial |
$808.50
|
| Rate for Payer: Anthem Medicaid |
$361.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$819.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$871.50
|
| Rate for Payer: First Health Commercial |
$997.50
|
| Rate for Payer: Humana Commercial |
$892.50
|
| Rate for Payer: Humana KY Medicaid |
$361.10
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$364.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$861.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$774.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$368.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$924.00
|
| Rate for Payer: Ohio Health Group HMO |
$787.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$210.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$136.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$325.50
|
| Rate for Payer: PHCS Commercial |
$1,008.00
|
| Rate for Payer: United Healthcare All Payer |
$924.00
|
|
|
CLTX HUM CONDYLR FX M/L WO MAN
|
Facility
|
OP
|
$1,844.00
|
|
|
Service Code
|
HCPCS 24576
|
| Hospital Charge Code |
76100547
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$203.93 |
| Max. Negotiated Rate |
$1,770.24 |
| Rate for Payer: Aetna Commercial |
$1,419.88
|
| Rate for Payer: Anthem Medicaid |
$634.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,438.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$922.00
|
| Rate for Payer: Cash Price |
$922.00
|
| Rate for Payer: Cigna Commercial |
$1,530.52
|
| Rate for Payer: First Health Commercial |
$1,751.80
|
| Rate for Payer: Humana Commercial |
$1,567.40
|
| Rate for Payer: Humana KY Medicaid |
$634.15
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$640.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,512.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,360.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$646.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,622.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,383.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$368.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$239.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$571.64
|
| Rate for Payer: PHCS Commercial |
$1,770.24
|
| Rate for Payer: United Healthcare All Payer |
$1,622.72
|
|
|
CLTX HUM CONDYLR FX M/L WO MAN
|
Professional
|
Both
|
$794.00
|
|
|
Service Code
|
HCPCS 24576
|
| Hospital Charge Code |
761P0547
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$144.01 |
| Max. Negotiated Rate |
$794.00 |
| Rate for Payer: Aetna Commercial |
$400.49
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$163.17
|
| Rate for Payer: Anthem Medicaid |
$144.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$794.00
|
| Rate for Payer: Cash Price |
$397.00
|
| Rate for Payer: Cash Price |
$397.00
|
| Rate for Payer: Cigna Commercial |
$497.38
|
| Rate for Payer: Healthspan PPO |
$400.58
|
| Rate for Payer: Humana Medicaid |
$144.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$359.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$146.89
|
| Rate for Payer: Molina Healthcare Passport |
$144.01
|
| Rate for Payer: Multiplan PHCS |
$476.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$555.80
|
| Rate for Payer: UHCCP Medicaid |
$171.33
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$145.45
|
|
|
CLTX HUM CONDYLR FX M/L WO MAN
|
Professional
|
Both
|
$1,347.98
|
|
|
Service Code
|
HCPCS 24576
|
| Hospital Charge Code |
76100546
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$144.01 |
| Max. Negotiated Rate |
$1,347.98 |
| Rate for Payer: Aetna Commercial |
$400.49
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$163.17
|
| Rate for Payer: Anthem Medicaid |
$144.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,347.98
|
| Rate for Payer: Cash Price |
$673.99
|
| Rate for Payer: Cash Price |
$673.99
|
| Rate for Payer: Cigna Commercial |
$497.38
|
| Rate for Payer: Healthspan PPO |
$400.58
|
| Rate for Payer: Humana Medicaid |
$144.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$359.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$146.89
|
| Rate for Payer: Molina Healthcare Passport |
$144.01
|
| Rate for Payer: Multiplan PHCS |
$808.79
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$943.59
|
| Rate for Payer: UHCCP Medicaid |
$171.33
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$145.45
|
|
|
CLTX HUM CONDYLR FX M/L WO MAN
|
Facility
|
IP
|
$1,844.00
|
|
|
Service Code
|
HCPCS 24576
|
| Hospital Charge Code |
76100547
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$239.72 |
| Max. Negotiated Rate |
$1,770.24 |
| Rate for Payer: Aetna Commercial |
$1,419.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,438.32
|
| Rate for Payer: Cash Price |
$922.00
|
| Rate for Payer: Cigna Commercial |
$1,530.52
|
| Rate for Payer: First Health Commercial |
$1,751.80
|
| Rate for Payer: Humana Commercial |
$1,567.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,512.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,360.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$553.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,622.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,383.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$368.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$239.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$571.64
|
| Rate for Payer: PHCS Commercial |
$1,770.24
|
| Rate for Payer: United Healthcare All Payer |
$1,622.72
|
|
|
CLTX HUM CONDYLR FX M/L WO MAN
|
Facility
|
IP
|
$553.98
|
|
|
Service Code
|
HCPCS 24576
|
| Hospital Charge Code |
761T0546
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$72.02 |
| Max. Negotiated Rate |
$531.82 |
| Rate for Payer: Aetna Commercial |
$426.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$432.10
|
| Rate for Payer: Cash Price |
$276.99
|
| Rate for Payer: Cigna Commercial |
$459.80
|
| Rate for Payer: First Health Commercial |
$526.28
|
| Rate for Payer: Humana Commercial |
$470.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$454.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$408.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$166.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$487.50
|
| Rate for Payer: Ohio Health Group HMO |
$415.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$110.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$171.73
|
| Rate for Payer: PHCS Commercial |
$531.82
|
| Rate for Payer: United Healthcare All Payer |
$487.50
|
|
|
CLTX HUM CONDYLR FX M/L WO MAN
|
Facility
|
IP
|
$1,347.98
|
|
|
Service Code
|
HCPCS 24576
|
| Hospital Charge Code |
76100546
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$175.24 |
| Max. Negotiated Rate |
$1,294.06 |
| Rate for Payer: Aetna Commercial |
$1,037.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,051.42
|
| Rate for Payer: Cash Price |
$673.99
|
| Rate for Payer: Cigna Commercial |
$1,118.82
|
| Rate for Payer: First Health Commercial |
$1,280.58
|
| Rate for Payer: Humana Commercial |
$1,145.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,105.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$994.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$404.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,186.22
|
| Rate for Payer: Ohio Health Group HMO |
$1,010.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$269.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$175.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$417.87
|
| Rate for Payer: PHCS Commercial |
$1,294.06
|
| Rate for Payer: United Healthcare All Payer |
$1,186.22
|
|
|
CLTX HUM CONDYLR FX M/L WO MAN
|
Professional
|
Both
|
$794.00
|
|
|
Service Code
|
HCPCS 24576
|
| Hospital Charge Code |
761P0546
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$144.01 |
| Max. Negotiated Rate |
$794.00 |
| Rate for Payer: Aetna Commercial |
$400.49
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$163.17
|
| Rate for Payer: Anthem Medicaid |
$144.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$794.00
|
| Rate for Payer: Cash Price |
$397.00
|
| Rate for Payer: Cash Price |
$397.00
|
| Rate for Payer: Cigna Commercial |
$497.38
|
| Rate for Payer: Healthspan PPO |
$400.58
|
| Rate for Payer: Humana Medicaid |
$144.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$359.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$146.89
|
| Rate for Payer: Molina Healthcare Passport |
$144.01
|
| Rate for Payer: Multiplan PHCS |
$476.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$555.80
|
| Rate for Payer: UHCCP Medicaid |
$171.33
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$145.45
|
|
|
CLTX HUM EPICOND FX M/L WO MAN
|
Professional
|
Both
|
$1,700.00
|
|
|
Service Code
|
HCPCS 24560
|
| Hospital Charge Code |
76100541
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$142.11 |
| Max. Negotiated Rate |
$1,700.00 |
| Rate for Payer: Aetna Commercial |
$376.83
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$153.65
|
| Rate for Payer: Anthem Medicaid |
$142.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,700.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$472.79
|
| Rate for Payer: Healthspan PPO |
$381.09
|
| Rate for Payer: Humana Medicaid |
$142.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$336.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$144.95
|
| Rate for Payer: Molina Healthcare Passport |
$142.11
|
| Rate for Payer: Multiplan PHCS |
$1,020.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,190.00
|
| Rate for Payer: UHCCP Medicaid |
$161.33
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$143.53
|
|
|
CLTX HUM EPICOND FX M/L WO MAN
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 24560
|
| Hospital Charge Code |
761P0541
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$142.11 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Commercial |
$376.83
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$153.65
|
| Rate for Payer: Anthem Medicaid |
$142.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$700.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$472.79
|
| Rate for Payer: Healthspan PPO |
$381.09
|
| Rate for Payer: Humana Medicaid |
$142.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$336.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$144.95
|
| Rate for Payer: Molina Healthcare Passport |
$142.11
|
| Rate for Payer: Multiplan PHCS |
$420.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$490.00
|
| Rate for Payer: UHCCP Medicaid |
$161.33
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$143.53
|
|
