|
CLTX INTR/PERI/SBTRCHTC FEMFX
|
Professional
|
Both
|
$2,390.00
|
|
|
Service Code
|
HCPCS 27240
|
| Hospital Charge Code |
76100793
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$616.02 |
| Max. Negotiated Rate |
$2,390.00 |
| Rate for Payer: Aetna Commercial |
$1,415.62
|
| Rate for Payer: Anthem Medicaid |
$616.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,390.00
|
| Rate for Payer: Cash Price |
$1,195.00
|
| Rate for Payer: Cash Price |
$1,195.00
|
| Rate for Payer: Cigna Commercial |
$1,528.38
|
| Rate for Payer: Healthspan PPO |
$1,282.25
|
| Rate for Payer: Humana Medicaid |
$616.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,190.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$628.34
|
| Rate for Payer: Molina Healthcare Passport |
$616.02
|
| Rate for Payer: Multiplan PHCS |
$1,434.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,673.00
|
| Rate for Payer: UHCCP Medicaid |
$836.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$622.18
|
|
|
CLTX INTR/PERI/SBTRCHTC FEMFX
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
CLTX INTR/PERI/SBTRCHTC FEMFX
|
Professional
|
Both
|
$2,390.00
|
|
|
Service Code
|
HCPCS 27240
|
| Hospital Charge Code |
761P0793
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$616.02 |
| Max. Negotiated Rate |
$2,390.00 |
| Rate for Payer: Aetna Commercial |
$1,415.62
|
| Rate for Payer: Anthem Medicaid |
$616.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,390.00
|
| Rate for Payer: Cash Price |
$1,195.00
|
| Rate for Payer: Cash Price |
$1,195.00
|
| Rate for Payer: Cigna Commercial |
$1,528.38
|
| Rate for Payer: Healthspan PPO |
$1,282.25
|
| Rate for Payer: Humana Medicaid |
$616.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,190.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$628.34
|
| Rate for Payer: Molina Healthcare Passport |
$616.02
|
| Rate for Payer: Multiplan PHCS |
$1,434.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,673.00
|
| Rate for Payer: UHCCP Medicaid |
$836.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$622.18
|
|
|
CLTX IPHAL JT DISLC W/O ANES
|
Facility
|
OP
|
$810.00
|
|
|
Service Code
|
HCPCS 26770
|
| Hospital Charge Code |
76100748
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$105.30 |
| Max. Negotiated Rate |
$777.60 |
| Rate for Payer: Aetna Commercial |
$623.70
|
| Rate for Payer: Anthem Medicaid |
$278.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$631.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna Commercial |
$672.30
|
| Rate for Payer: First Health Commercial |
$769.50
|
| Rate for Payer: Humana Commercial |
$688.50
|
| Rate for Payer: Humana KY Medicaid |
$278.56
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$281.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$664.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$597.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$284.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$712.80
|
| Rate for Payer: Ohio Health Group HMO |
$607.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$162.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$251.10
|
| Rate for Payer: PHCS Commercial |
$777.60
|
| Rate for Payer: United Healthcare All Payer |
$712.80
|
|
|
CLTX IPHAL JT DISLC W/O ANES
|
Facility
|
IP
|
$810.00
|
|
|
Service Code
|
HCPCS 26770
|
| Hospital Charge Code |
76100748
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$105.30 |
| Max. Negotiated Rate |
$777.60 |
| Rate for Payer: Aetna Commercial |
$623.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$631.80
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna Commercial |
$672.30
|
| Rate for Payer: First Health Commercial |
$769.50
|
| Rate for Payer: Humana Commercial |
$688.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$664.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$597.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$243.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$712.80
|
| Rate for Payer: Ohio Health Group HMO |
$607.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$162.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$251.10
|
| Rate for Payer: PHCS Commercial |
$777.60
|
| Rate for Payer: United Healthcare All Payer |
$712.80
|
|
|
CLTX IPHAL JT DISLC W/O ANES
|
Facility
|
IP
|
$368.00
|
|
|
Service Code
|
HCPCS 26770
|
| Hospital Charge Code |
45000147
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$47.84 |
| Max. Negotiated Rate |
$353.28 |
| Rate for Payer: Aetna Commercial |
$283.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$287.04
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cigna Commercial |
$305.44
|
| Rate for Payer: First Health Commercial |
$349.60
|
| Rate for Payer: Humana Commercial |
$312.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$301.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$271.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$110.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$323.84
|
| Rate for Payer: Ohio Health Group HMO |
$276.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$73.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$47.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$114.08
|
| Rate for Payer: PHCS Commercial |
$353.28
|
| Rate for Payer: United Healthcare All Payer |
$323.84
|
|
|
CLTX IPHAL JT DISLC W/O ANES
|
Facility
|
OP
|
$368.00
|
|
|
Service Code
|
HCPCS 26770
|
| Hospital Charge Code |
45000147
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$47.84 |
| Max. Negotiated Rate |
$353.28 |
| Rate for Payer: Aetna Commercial |
$283.36
|
| Rate for Payer: Anthem Medicaid |
$126.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$287.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cigna Commercial |
$305.44
|
| Rate for Payer: First Health Commercial |
$349.60
|
| Rate for Payer: Humana Commercial |
$312.80
|
| Rate for Payer: Humana KY Medicaid |
$126.56
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$127.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$301.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$271.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$129.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$323.84
|
| Rate for Payer: Ohio Health Group HMO |
$276.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$73.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$47.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$114.08
|
| Rate for Payer: PHCS Commercial |
$353.28
|
| Rate for Payer: United Healthcare All Payer |
$323.84
|
|
|
CLTX IPHAL JT DISLC W/O ANES
|
Professional
|
Both
|
$810.00
|
|
|
Service Code
|
HCPCS 26770
|
| Hospital Charge Code |
76100748
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$107.13 |
| Max. Negotiated Rate |
$810.00 |
| Rate for Payer: Aetna Commercial |
$328.65
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$135.31
|
| Rate for Payer: Anthem Medicaid |
$107.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$810.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna Commercial |
$353.59
|
| Rate for Payer: Healthspan PPO |
$323.38
|
| Rate for Payer: Humana Medicaid |
$107.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$296.58
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$109.27
|
| Rate for Payer: Molina Healthcare Passport |
$107.13
|
| Rate for Payer: Multiplan PHCS |
$486.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$567.00
|
| Rate for Payer: UHCCP Medicaid |
$142.08
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$108.20
|
|
|
CLTX IPHAL JT DISLC W/O ANES(P
|
Professional
|
Both
|
$810.00
|
|
|
Service Code
|
HCPCS 26770
|
| Hospital Charge Code |
761P0748
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$107.13 |
| Max. Negotiated Rate |
$810.00 |
| Rate for Payer: Aetna Commercial |
$328.65
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$135.31
|
| Rate for Payer: Anthem Medicaid |
$107.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$810.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna Commercial |
$353.59
|
| Rate for Payer: Healthspan PPO |
$323.38
|
| Rate for Payer: Humana Medicaid |
$107.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$296.58
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$109.27
|
| Rate for Payer: Molina Healthcare Passport |
$107.13
|
| Rate for Payer: Multiplan PHCS |
$486.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$567.00
|
| Rate for Payer: UHCCP Medicaid |
$142.08
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$108.20
|
|
|
CLTX MED ANKLE FX W/MNPJ
|
Facility
|
OP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 27762
|
| Hospital Charge Code |
45000166
|
|
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 MED ANKLE FX W/MNPJ
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 27762
|
| Hospital Charge Code |
76100929
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$243.12 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$628.31
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$246.63
|
| Rate for Payer: Anthem Medicaid |
$243.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,200.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$694.54
|
| Rate for Payer: Healthspan PPO |
$611.29
|
| Rate for Payer: Humana Medicaid |
$243.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$537.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$247.98
|
| Rate for Payer: Molina Healthcare Passport |
$243.12
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$840.00
|
| Rate for Payer: UHCCP Medicaid |
$258.96
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$245.55
|
|
|
CLTX MED ANKLE FX W/MNPJ
|
Facility
|
IP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 27762
|
| Hospital Charge Code |
45000166
|
|
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 MED ANKLE FX W/MNPJ
|
Facility
|
OP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 27762
|
| Hospital Charge Code |
76100929
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem Medicaid |
$412.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Humana KY Medicaid |
$412.68
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$416.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$420.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$372.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
CLTX MED ANKLE FX W/MNPJ
|
Facility
|
IP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 27762
|
| Hospital Charge Code |
76100929
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$360.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$372.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
CLTX MED ANKLE FX W/MNPJ(P
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 27762
|
| Hospital Charge Code |
761P0929
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$243.12 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$628.31
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$246.63
|
| Rate for Payer: Anthem Medicaid |
$243.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,200.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$694.54
|
| Rate for Payer: Healthspan PPO |
$611.29
|
| Rate for Payer: Humana Medicaid |
$243.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$537.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$247.98
|
| Rate for Payer: Molina Healthcare Passport |
$243.12
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$840.00
|
| Rate for Payer: UHCCP Medicaid |
$258.96
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$245.55
|
|
|
CLTX MEDIAL ANKLE FX
|
Professional
|
Both
|
$675.00
|
|
|
Service Code
|
HCPCS 27760
|
| Hospital Charge Code |
76100928
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$126.05 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Aetna Commercial |
$407.36
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$159.88
|
| Rate for Payer: Anthem Medicaid |
$126.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$675.00
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cigna Commercial |
$501.77
|
| Rate for Payer: Healthspan PPO |
$403.40
|
| Rate for Payer: Humana Medicaid |
$126.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$361.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$128.57
|
| Rate for Payer: Molina Healthcare Passport |
$126.05
|
| Rate for Payer: Multiplan PHCS |
$405.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$472.50
|
| Rate for Payer: UHCCP Medicaid |
$167.87
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$127.31
|
|
|
CLTX MEDIAL ANKLE FX
|
Facility
|
OP
|
$675.00
|
|
|
Service Code
|
HCPCS 27760
|
| Hospital Charge Code |
76100928
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$87.75 |
| Max. Negotiated Rate |
$648.00 |
| Rate for Payer: Aetna Commercial |
$519.75
|
| Rate for Payer: Anthem Medicaid |
$232.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$526.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cigna Commercial |
$560.25
|
| Rate for Payer: First Health Commercial |
$641.25
|
| Rate for Payer: Humana Commercial |
$573.75
|
| Rate for Payer: Humana KY Medicaid |
$232.13
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$234.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$553.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$498.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$236.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$594.00
|
| Rate for Payer: Ohio Health Group HMO |
$506.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$135.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$87.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$209.25
|
| Rate for Payer: PHCS Commercial |
$648.00
|
| Rate for Payer: United Healthcare All Payer |
$594.00
|
|
|
CLTX MEDIAL ANKLE FX
|
Facility
|
IP
|
$675.00
|
|
|
Service Code
|
HCPCS 27760
|
| Hospital Charge Code |
76100928
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$87.75 |
| Max. Negotiated Rate |
$648.00 |
| Rate for Payer: Aetna Commercial |
$519.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$526.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cigna Commercial |
$560.25
|
| Rate for Payer: First Health Commercial |
$641.25
|
| Rate for Payer: Humana Commercial |
$573.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$553.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$498.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$202.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$594.00
|
| Rate for Payer: Ohio Health Group HMO |
$506.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$135.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$87.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$209.25
|
| Rate for Payer: PHCS Commercial |
$648.00
|
| Rate for Payer: United Healthcare All Payer |
$594.00
|
|
|
CLTX MEDIAL ANKLE FX(P
|
Professional
|
Both
|
$675.00
|
|
|
Service Code
|
HCPCS 27760
|
| Hospital Charge Code |
761P0928
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$126.05 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Aetna Commercial |
$407.36
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$159.88
|
| Rate for Payer: Anthem Medicaid |
$126.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$675.00
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cigna Commercial |
$501.77
|
| Rate for Payer: Healthspan PPO |
$403.40
|
| Rate for Payer: Humana Medicaid |
$126.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$361.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$128.57
|
| Rate for Payer: Molina Healthcare Passport |
$126.05
|
| Rate for Payer: Multiplan PHCS |
$405.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$472.50
|
| Rate for Payer: UHCCP Medicaid |
$167.87
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$127.31
|
|
|
CLTX METACARPAL FX W/MANIP
|
Facility
|
OP
|
$670.00
|
|
|
Service Code
|
HCPCS 26605
|
| Hospital Charge Code |
76100722
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$87.10 |
| Max. Negotiated Rate |
$643.20 |
| Rate for Payer: Aetna Commercial |
$515.90
|
| Rate for Payer: Anthem Medicaid |
$230.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$522.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$335.00
|
| Rate for Payer: Cash Price |
$335.00
|
| Rate for Payer: Cigna Commercial |
$556.10
|
| Rate for Payer: First Health Commercial |
$636.50
|
| Rate for Payer: Humana Commercial |
$569.50
|
| Rate for Payer: Humana KY Medicaid |
$230.41
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$232.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$549.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$494.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$235.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$589.60
|
| Rate for Payer: Ohio Health Group HMO |
$502.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$134.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$87.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$207.70
|
| Rate for Payer: PHCS Commercial |
$643.20
|
| Rate for Payer: United Healthcare All Payer |
$589.60
|
|
|
CLTX METACARPAL FX W/MANIP
|
Facility
|
OP
|
$322.00
|
|
|
Service Code
|
HCPCS 26605
|
| Hospital Charge Code |
45000139
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$41.86 |
| Max. Negotiated Rate |
$309.12 |
| Rate for Payer: Aetna Commercial |
$247.94
|
| Rate for Payer: Anthem Medicaid |
$110.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$251.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$161.00
|
| Rate for Payer: Cash Price |
$161.00
|
| Rate for Payer: Cigna Commercial |
$267.26
|
| Rate for Payer: First Health Commercial |
$305.90
|
| Rate for Payer: Humana Commercial |
$273.70
|
| Rate for Payer: Humana KY Medicaid |
$110.74
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$111.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$264.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$237.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$112.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$283.36
|
| Rate for Payer: Ohio Health Group HMO |
$241.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$41.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$99.82
|
| Rate for Payer: PHCS Commercial |
$309.12
|
| Rate for Payer: United Healthcare All Payer |
$283.36
|
|
|
CLTX METACARPAL FX W/MANIP
|
Facility
|
IP
|
$322.00
|
|
|
Service Code
|
HCPCS 26605
|
| Hospital Charge Code |
45000139
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$41.86 |
| Max. Negotiated Rate |
$309.12 |
| Rate for Payer: Aetna Commercial |
$247.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$251.16
|
| Rate for Payer: Cash Price |
$161.00
|
| Rate for Payer: Cigna Commercial |
$267.26
|
| Rate for Payer: First Health Commercial |
$305.90
|
| Rate for Payer: Humana Commercial |
$273.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$264.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$237.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$96.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$283.36
|
| Rate for Payer: Ohio Health Group HMO |
$241.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$41.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$99.82
|
| Rate for Payer: PHCS Commercial |
$309.12
|
| Rate for Payer: United Healthcare All Payer |
$283.36
|
|
|
CLTX METACARPAL FX W/MANIP
|
Facility
|
IP
|
$670.00
|
|
|
Service Code
|
HCPCS 26605
|
| Hospital Charge Code |
76100722
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$87.10 |
| Max. Negotiated Rate |
$643.20 |
| Rate for Payer: Aetna Commercial |
$515.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$522.60
|
| Rate for Payer: Cash Price |
$335.00
|
| Rate for Payer: Cigna Commercial |
$556.10
|
| Rate for Payer: First Health Commercial |
$636.50
|
| Rate for Payer: Humana Commercial |
$569.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$549.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$494.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$201.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$589.60
|
| Rate for Payer: Ohio Health Group HMO |
$502.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$134.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$87.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$207.70
|
| Rate for Payer: PHCS Commercial |
$643.20
|
| Rate for Payer: United Healthcare All Payer |
$589.60
|
|
|
CLTX METACARPAL FX W/MANIP
|
Professional
|
Both
|
$670.00
|
|
|
Service Code
|
HCPCS 26605
|
| Hospital Charge Code |
76100722
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$117.81 |
| Max. Negotiated Rate |
$670.00 |
| Rate for Payer: Aetna Commercial |
$393.45
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$159.08
|
| Rate for Payer: Anthem Medicaid |
$117.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$670.00
|
| Rate for Payer: Cash Price |
$335.00
|
| Rate for Payer: Cash Price |
$335.00
|
| Rate for Payer: Cigna Commercial |
$483.68
|
| Rate for Payer: Healthspan PPO |
$387.89
|
| Rate for Payer: Humana Medicaid |
$117.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$346.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$120.17
|
| Rate for Payer: Molina Healthcare Passport |
$117.81
|
| Rate for Payer: Multiplan PHCS |
$402.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$469.00
|
| Rate for Payer: UHCCP Medicaid |
$167.03
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$118.99
|
|
|
CLTX METACARPAL FX W/MANIP(P
|
Professional
|
Both
|
$670.00
|
|
|
Service Code
|
HCPCS 26605
|
| Hospital Charge Code |
761P0722
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$117.81 |
| Max. Negotiated Rate |
$670.00 |
| Rate for Payer: Aetna Commercial |
$393.45
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$159.08
|
| Rate for Payer: Anthem Medicaid |
$117.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$670.00
|
| Rate for Payer: Cash Price |
$335.00
|
| Rate for Payer: Cash Price |
$335.00
|
| Rate for Payer: Cigna Commercial |
$483.68
|
| Rate for Payer: Healthspan PPO |
$387.89
|
| Rate for Payer: Humana Medicaid |
$117.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$346.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$120.17
|
| Rate for Payer: Molina Healthcare Passport |
$117.81
|
| Rate for Payer: Multiplan PHCS |
$402.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$469.00
|
| Rate for Payer: UHCCP Medicaid |
$167.03
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$118.99
|
|
