|
CLTX HUM EPICOND FX M/L WO MAN
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 24560
|
| Hospital Charge Code |
761T0541
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem Medicaid |
$343.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Humana KY Medicaid |
$343.90
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$347.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$350.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
CLTX HUM EPICOND FX M/L WO MAN
|
Facility
|
IP
|
$1,700.00
|
|
|
Service Code
|
HCPCS 24560
|
| Hospital Charge Code |
76100541
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.00 |
| Max. Negotiated Rate |
$1,632.00 |
| Rate for Payer: Aetna Commercial |
$1,309.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,326.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,411.00
|
| Rate for Payer: First Health Commercial |
$1,615.00
|
| Rate for Payer: Humana Commercial |
$1,445.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,394.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,254.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$527.00
|
| Rate for Payer: PHCS Commercial |
$1,632.00
|
| Rate for Payer: United Healthcare All Payer |
$1,496.00
|
|
|
CLTX HUM EPICOND FX M/L WO MAN
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 24560
|
| Hospital Charge Code |
761T0541
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
CLTX HUM EPICOND FX M/L WO MAN
|
Facility
|
OP
|
$1,700.00
|
|
|
Service Code
|
HCPCS 24560
|
| Hospital Charge Code |
76100541
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$203.93 |
| Max. Negotiated Rate |
$1,632.00 |
| Rate for Payer: Aetna Commercial |
$1,309.00
|
| Rate for Payer: Anthem Medicaid |
$584.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,326.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,411.00
|
| Rate for Payer: First Health Commercial |
$1,615.00
|
| Rate for Payer: Humana Commercial |
$1,445.00
|
| Rate for Payer: Humana KY Medicaid |
$584.63
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$590.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,394.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,254.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$596.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$527.00
|
| Rate for Payer: PHCS Commercial |
$1,632.00
|
| Rate for Payer: United Healthcare All Payer |
$1,496.00
|
|
|
CLTX HUMEPICON FX MED/LAT WMAN
|
Facility
|
IP
|
$680.00
|
|
|
Service Code
|
HCPCS 24565
|
| Hospital Charge Code |
76100542
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$88.40 |
| Max. Negotiated Rate |
$652.80 |
| Rate for Payer: Aetna Commercial |
$523.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$530.40
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cigna Commercial |
$564.40
|
| Rate for Payer: First Health Commercial |
$646.00
|
| Rate for Payer: Humana Commercial |
$578.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$557.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$501.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$204.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$598.40
|
| Rate for Payer: Ohio Health Group HMO |
$510.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$136.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$88.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$210.80
|
| Rate for Payer: PHCS Commercial |
$652.80
|
| Rate for Payer: United Healthcare All Payer |
$598.40
|
|
|
CLTX HUMEPICON FX MED/LAT WMAN
|
Professional
|
Both
|
$680.00
|
|
|
Service Code
|
HCPCS 24565
|
| Hospital Charge Code |
76100542
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$258.83 |
| Max. Negotiated Rate |
$733.95 |
| Rate for Payer: Aetna Commercial |
$663.14
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$260.26
|
| Rate for Payer: Anthem Medicaid |
$258.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$680.00
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cigna Commercial |
$733.95
|
| Rate for Payer: Healthspan PPO |
$644.29
|
| Rate for Payer: Humana Medicaid |
$258.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$582.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$264.01
|
| Rate for Payer: Molina Healthcare Passport |
$258.83
|
| Rate for Payer: Multiplan PHCS |
$408.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$476.00
|
| Rate for Payer: UHCCP Medicaid |
$273.27
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$261.42
|
|
|
CLTX HUMEPICON FX MED/LAT WMAN
|
Professional
|
Both
|
$680.00
|
|
|
Service Code
|
HCPCS 24565
|
| Hospital Charge Code |
761P0542
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$258.83 |
| Max. Negotiated Rate |
$733.95 |
| Rate for Payer: Aetna Commercial |
$663.14
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$260.26
|
| Rate for Payer: Anthem Medicaid |
$258.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$680.00
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cigna Commercial |
$733.95
|
| Rate for Payer: Healthspan PPO |
$644.29
|
| Rate for Payer: Humana Medicaid |
$258.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$582.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$264.01
|
| Rate for Payer: Molina Healthcare Passport |
$258.83
|
| Rate for Payer: Multiplan PHCS |
$408.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$476.00
|
| Rate for Payer: UHCCP Medicaid |
$273.27
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$261.42
|
|
|
CLTX HUMEPICON FX MED/LAT WMAN
|
Facility
|
OP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 24565
|
| Hospital Charge Code |
45000120
|
|
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 HUMEPICON FX MED/LAT WMAN
|
Facility
|
IP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 24565
|
| Hospital Charge Code |
45000120
|
|
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 HUMEPICON FX MED/LAT WMAN
|
Facility
|
OP
|
$680.00
|
|
|
Service Code
|
HCPCS 24565
|
| Hospital Charge Code |
76100542
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$88.40 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Aetna Commercial |
$523.60
|
| Rate for Payer: Anthem Medicaid |
$233.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$530.40
|
| 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 |
$340.00
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cigna Commercial |
$564.40
|
| Rate for Payer: First Health Commercial |
$646.00
|
| Rate for Payer: Humana Commercial |
$578.00
|
| Rate for Payer: Humana KY Medicaid |
$233.85
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$236.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$557.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$501.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$238.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$598.40
|
| Rate for Payer: Ohio Health Group HMO |
$510.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$136.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$88.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$210.80
|
| Rate for Payer: PHCS Commercial |
$652.80
|
| Rate for Payer: United Healthcare All Payer |
$598.40
|
|
|
CLTX HUM SHAFT FX W/O MANIP
|
Facility
|
IP
|
$1,580.00
|
|
|
Service Code
|
HCPCS 24500
|
| Hospital Charge Code |
76100532
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$205.40 |
| Max. Negotiated Rate |
$1,516.80 |
| Rate for Payer: Aetna Commercial |
$1,216.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,232.40
|
| Rate for Payer: Cash Price |
$790.00
|
| Rate for Payer: Cigna Commercial |
$1,311.40
|
| Rate for Payer: First Health Commercial |
$1,501.00
|
| Rate for Payer: Humana Commercial |
$1,343.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,295.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,166.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$474.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,390.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,185.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$316.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$489.80
|
| Rate for Payer: PHCS Commercial |
$1,516.80
|
| Rate for Payer: United Healthcare All Payer |
$1,390.40
|
|
|
CLTX HUM SHAFT FX W/O MANIP
|
Facility
|
OP
|
$1,580.00
|
|
|
Service Code
|
HCPCS 24500
|
| Hospital Charge Code |
76100532
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$203.93 |
| Max. Negotiated Rate |
$1,516.80 |
| Rate for Payer: Aetna Commercial |
$1,216.60
|
| Rate for Payer: Anthem Medicaid |
$543.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,232.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$790.00
|
| Rate for Payer: Cash Price |
$790.00
|
| Rate for Payer: Cigna Commercial |
$1,311.40
|
| Rate for Payer: First Health Commercial |
$1,501.00
|
| Rate for Payer: Humana Commercial |
$1,343.00
|
| Rate for Payer: Humana KY Medicaid |
$543.36
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$548.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,295.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,166.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$554.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,390.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,185.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$316.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$489.80
|
| Rate for Payer: PHCS Commercial |
$1,516.80
|
| Rate for Payer: United Healthcare All Payer |
$1,390.40
|
|
|
CLTX HUM SHAFT FX W/O MANIP
|
Professional
|
Both
|
$1,580.00
|
|
|
Service Code
|
HCPCS 24500
|
| Hospital Charge Code |
76100532
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$165.20 |
| Max. Negotiated Rate |
$1,580.00 |
| Rate for Payer: Aetna Commercial |
$428.36
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$173.90
|
| Rate for Payer: Anthem Medicaid |
$165.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,580.00
|
| Rate for Payer: Cash Price |
$790.00
|
| Rate for Payer: Cash Price |
$790.00
|
| Rate for Payer: Cigna Commercial |
$525.66
|
| Rate for Payer: Healthspan PPO |
$424.85
|
| Rate for Payer: Humana Medicaid |
$165.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$381.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$168.50
|
| Rate for Payer: Molina Healthcare Passport |
$165.20
|
| Rate for Payer: Multiplan PHCS |
$948.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,106.00
|
| Rate for Payer: UHCCP Medicaid |
$182.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$166.85
|
|
|
CLTX HUM SHAFT FX W/O MANIP(P
|
Professional
|
Both
|
$680.00
|
|
|
Service Code
|
HCPCS 24500
|
| Hospital Charge Code |
761P0532
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$165.20 |
| Max. Negotiated Rate |
$680.00 |
| Rate for Payer: Aetna Commercial |
$428.36
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$173.90
|
| Rate for Payer: Anthem Medicaid |
$165.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$680.00
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cigna Commercial |
$525.66
|
| Rate for Payer: Healthspan PPO |
$424.85
|
| Rate for Payer: Humana Medicaid |
$165.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$381.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$168.50
|
| Rate for Payer: Molina Healthcare Passport |
$165.20
|
| Rate for Payer: Multiplan PHCS |
$408.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$476.00
|
| Rate for Payer: UHCCP Medicaid |
$182.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$166.85
|
|
|
CLTX HUM SHAFT FX W/O MANIP(T
|
Facility
|
IP
|
$900.00
|
|
|
Service Code
|
HCPCS 24500
|
| Hospital Charge Code |
761T0532
|
|
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 HUM SHAFT FX W/O MANIP(T
|
Facility
|
OP
|
$900.00
|
|
|
Service Code
|
HCPCS 24500
|
| Hospital Charge Code |
761T0532
|
|
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 INTERCONDYLAR SPI&/TUBR(P
|
Professional
|
Both
|
$978.00
|
|
|
Service Code
|
HCPCS 27538
|
| Hospital Charge Code |
761P0872
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$238.94 |
| Max. Negotiated Rate |
$978.00 |
| Rate for Payer: Aetna Commercial |
$613.69
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$245.99
|
| Rate for Payer: Anthem Medicaid |
$238.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$978.00
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$723.59
|
| Rate for Payer: Healthspan PPO |
$589.32
|
| Rate for Payer: Humana Medicaid |
$238.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$533.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$243.72
|
| Rate for Payer: Molina Healthcare Passport |
$238.94
|
| Rate for Payer: Multiplan PHCS |
$586.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$684.60
|
| Rate for Payer: UHCCP Medicaid |
$258.29
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$241.33
|
|
|
CLTX INTERCONDYLAR SPI&/TUBRS
|
Facility
|
OP
|
$978.00
|
|
|
Service Code
|
HCPCS 27538
|
| Hospital Charge Code |
76100872
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$127.14 |
| Max. Negotiated Rate |
$938.88 |
| Rate for Payer: Aetna Commercial |
$753.06
|
| Rate for Payer: Anthem Medicaid |
$336.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$762.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$811.74
|
| Rate for Payer: First Health Commercial |
$929.10
|
| Rate for Payer: Humana Commercial |
$831.30
|
| Rate for Payer: Humana KY Medicaid |
$336.33
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$339.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$801.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$721.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$343.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$860.64
|
| Rate for Payer: Ohio Health Group HMO |
$733.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$195.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$127.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$303.18
|
| Rate for Payer: PHCS Commercial |
$938.88
|
| Rate for Payer: United Healthcare All Payer |
$860.64
|
|
|
CLTX INTERCONDYLAR SPI&/TUBRS
|
Facility
|
IP
|
$978.00
|
|
|
Service Code
|
HCPCS 27538
|
| Hospital Charge Code |
76100872
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$127.14 |
| Max. Negotiated Rate |
$938.88 |
| Rate for Payer: Aetna Commercial |
$753.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$762.84
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$811.74
|
| Rate for Payer: First Health Commercial |
$929.10
|
| Rate for Payer: Humana Commercial |
$831.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$801.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$721.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$293.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$860.64
|
| Rate for Payer: Ohio Health Group HMO |
$733.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$195.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$127.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$303.18
|
| Rate for Payer: PHCS Commercial |
$938.88
|
| Rate for Payer: United Healthcare All Payer |
$860.64
|
|
|
CLTX INTERCONDYLAR SPI&/TUBRS
|
Professional
|
Both
|
$978.00
|
|
|
Service Code
|
HCPCS 27538
|
| Hospital Charge Code |
76100872
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$238.94 |
| Max. Negotiated Rate |
$978.00 |
| Rate for Payer: Aetna Commercial |
$613.69
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$245.99
|
| Rate for Payer: Anthem Medicaid |
$238.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$978.00
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$723.59
|
| Rate for Payer: Healthspan PPO |
$589.32
|
| Rate for Payer: Humana Medicaid |
$238.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$533.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$243.72
|
| Rate for Payer: Molina Healthcare Passport |
$238.94
|
| Rate for Payer: Multiplan PHCS |
$586.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$684.60
|
| Rate for Payer: UHCCP Medicaid |
$258.29
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$241.33
|
|
|
CLTX INT/PER/SUBTROCH FEM FX
|
Professional
|
Both
|
$870.00
|
|
|
Service Code
|
HCPCS 27238
|
| Hospital Charge Code |
76100792
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$297.43 |
| Max. Negotiated Rate |
$870.00 |
| Rate for Payer: Aetna Commercial |
$649.58
|
| Rate for Payer: Anthem Medicaid |
$297.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$870.00
|
| Rate for Payer: Cash Price |
$435.00
|
| Rate for Payer: Cash Price |
$435.00
|
| Rate for Payer: Cigna Commercial |
$708.94
|
| Rate for Payer: Healthspan PPO |
$588.38
|
| Rate for Payer: Humana Medicaid |
$297.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$559.42
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$303.38
|
| Rate for Payer: Molina Healthcare Passport |
$297.43
|
| Rate for Payer: Multiplan PHCS |
$522.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$609.00
|
| Rate for Payer: UHCCP Medicaid |
$304.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$300.40
|
|
|
CLTX INT/PER/SUBTROCH FEM FX
|
Facility
|
OP
|
$870.00
|
|
|
Service Code
|
HCPCS 27238
|
| Hospital Charge Code |
76100792
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$113.10 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Aetna Commercial |
$669.90
|
| Rate for Payer: Anthem Medicaid |
$299.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$678.60
|
| 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 |
$435.00
|
| Rate for Payer: Cash Price |
$435.00
|
| Rate for Payer: Cigna Commercial |
$722.10
|
| Rate for Payer: First Health Commercial |
$826.50
|
| Rate for Payer: Humana Commercial |
$739.50
|
| Rate for Payer: Humana KY Medicaid |
$299.19
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$302.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$713.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$642.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$305.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$765.60
|
| Rate for Payer: Ohio Health Group HMO |
$652.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$174.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$269.70
|
| Rate for Payer: PHCS Commercial |
$835.20
|
| Rate for Payer: United Healthcare All Payer |
$765.60
|
|
|
CLTX INT/PER/SUBTROCH FEM FX
|
Facility
|
IP
|
$870.00
|
|
|
Service Code
|
HCPCS 27238
|
| Hospital Charge Code |
76100792
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$113.10 |
| Max. Negotiated Rate |
$835.20 |
| Rate for Payer: Aetna Commercial |
$669.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$678.60
|
| Rate for Payer: Cash Price |
$435.00
|
| Rate for Payer: Cigna Commercial |
$722.10
|
| Rate for Payer: First Health Commercial |
$826.50
|
| Rate for Payer: Humana Commercial |
$739.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$713.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$642.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$261.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$765.60
|
| Rate for Payer: Ohio Health Group HMO |
$652.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$174.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$269.70
|
| Rate for Payer: PHCS Commercial |
$835.20
|
| Rate for Payer: United Healthcare All Payer |
$765.60
|
|
|
CLTX INT/PER/SUBTROCH FEM FX(P
|
Professional
|
Both
|
$870.00
|
|
|
Service Code
|
HCPCS 27238
|
| Hospital Charge Code |
761P0792
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$297.43 |
| Max. Negotiated Rate |
$870.00 |
| Rate for Payer: Aetna Commercial |
$649.58
|
| Rate for Payer: Anthem Medicaid |
$297.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$870.00
|
| Rate for Payer: Cash Price |
$435.00
|
| Rate for Payer: Cash Price |
$435.00
|
| Rate for Payer: Cigna Commercial |
$708.94
|
| Rate for Payer: Healthspan PPO |
$588.38
|
| Rate for Payer: Humana Medicaid |
$297.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$559.42
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$303.38
|
| Rate for Payer: Molina Healthcare Passport |
$297.43
|
| Rate for Payer: Multiplan PHCS |
$522.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$609.00
|
| Rate for Payer: UHCCP Medicaid |
$304.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$300.40
|
|
|
CLTX INTR/PERI/SBTRCHTC FEMFX
|
Facility
|
OP
|
$2,390.00
|
|
|
Service Code
|
HCPCS 27240
|
| Hospital Charge Code |
76100793
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$310.70 |
| Max. Negotiated Rate |
$2,294.40 |
| Rate for Payer: Aetna Commercial |
$1,840.30
|
| Rate for Payer: Anthem Medicaid |
$821.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,864.20
|
| Rate for Payer: Cash Price |
$1,195.00
|
| Rate for Payer: Cigna Commercial |
$1,983.70
|
| Rate for Payer: First Health Commercial |
$2,270.50
|
| Rate for Payer: Humana Commercial |
$2,031.50
|
| Rate for Payer: Humana KY Medicaid |
$821.92
|
| Rate for Payer: Kentucky WC Medicaid |
$830.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,959.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,763.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$717.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$838.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,103.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,792.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$478.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$310.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$740.90
|
| Rate for Payer: PHCS Commercial |
$2,294.40
|
| Rate for Payer: United Healthcare All Payer |
$2,103.20
|
|
