|
CLTX MONTEGGIA FX DIS ELB WMAN
|
Professional
|
Both
|
$2,891.00
|
|
|
Service Code
|
HCPCS 24620
|
| Hospital Charge Code |
76100554
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$309.49 |
| Max. Negotiated Rate |
$2,891.00 |
| Rate for Payer: Aetna Commercial |
$790.98
|
| Rate for Payer: Anthem Medicaid |
$309.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,891.00
|
| Rate for Payer: Cash Price |
$1,445.50
|
| Rate for Payer: Cash Price |
$1,445.50
|
| Rate for Payer: Cigna Commercial |
$870.79
|
| Rate for Payer: Healthspan PPO |
$716.46
|
| Rate for Payer: Humana Medicaid |
$309.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$678.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$315.68
|
| Rate for Payer: Molina Healthcare Passport |
$309.49
|
| Rate for Payer: Multiplan PHCS |
$1,734.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,023.70
|
| Rate for Payer: UHCCP Medicaid |
$1,011.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$312.58
|
|
|
CLTX MONTEGGIA FX DIS ELB WMAN
|
Facility
|
IP
|
$2,891.00
|
|
|
Service Code
|
HCPCS 24620
|
| Hospital Charge Code |
76100554
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$375.83 |
| Max. Negotiated Rate |
$2,775.36 |
| Rate for Payer: Aetna Commercial |
$2,226.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,254.98
|
| Rate for Payer: Cash Price |
$1,445.50
|
| Rate for Payer: Cigna Commercial |
$2,399.53
|
| Rate for Payer: First Health Commercial |
$2,746.45
|
| Rate for Payer: Humana Commercial |
$2,457.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,370.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,133.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$867.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,544.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,168.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$578.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$375.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$896.21
|
| Rate for Payer: PHCS Commercial |
$2,775.36
|
| Rate for Payer: United Healthcare All Payer |
$2,544.08
|
|
|
CLTX MONTEGGIA FX DIS ELB WMAN
|
Facility
|
IP
|
$1,941.00
|
|
|
Service Code
|
HCPCS 24620
|
| Hospital Charge Code |
761T0554
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$252.33 |
| Max. Negotiated Rate |
$1,863.36 |
| Rate for Payer: Aetna Commercial |
$1,494.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,513.98
|
| Rate for Payer: Cash Price |
$970.50
|
| Rate for Payer: Cigna Commercial |
$1,611.03
|
| Rate for Payer: First Health Commercial |
$1,843.95
|
| Rate for Payer: Humana Commercial |
$1,649.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,591.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,432.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$582.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,708.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,455.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$388.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$252.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$601.71
|
| Rate for Payer: PHCS Commercial |
$1,863.36
|
| Rate for Payer: United Healthcare All Payer |
$1,708.08
|
|
|
CLTX MONTEGGIA FX DIS ELB WMAN
|
Facility
|
OP
|
$2,891.00
|
|
|
Service Code
|
HCPCS 24620
|
| Hospital Charge Code |
76100554
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$375.83 |
| Max. Negotiated Rate |
$2,775.36 |
| Rate for Payer: Aetna Commercial |
$2,226.07
|
| Rate for Payer: Anthem Medicaid |
$994.21
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,254.98
|
| 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 |
$1,445.50
|
| Rate for Payer: Cash Price |
$1,445.50
|
| Rate for Payer: Cigna Commercial |
$2,399.53
|
| Rate for Payer: First Health Commercial |
$2,746.45
|
| Rate for Payer: Humana Commercial |
$2,457.35
|
| Rate for Payer: Humana KY Medicaid |
$994.21
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$1,004.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,370.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,133.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,014.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,544.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,168.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$578.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$375.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$896.21
|
| Rate for Payer: PHCS Commercial |
$2,775.36
|
| Rate for Payer: United Healthcare All Payer |
$2,544.08
|
|
|
CLTX MONTEGGIA FX DIS ELB WMAN
|
Professional
|
Both
|
$950.00
|
|
|
Service Code
|
HCPCS 24620
|
| Hospital Charge Code |
761P0554
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$309.49 |
| Max. Negotiated Rate |
$950.00 |
| Rate for Payer: Aetna Commercial |
$790.98
|
| Rate for Payer: Anthem Medicaid |
$309.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$950.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cigna Commercial |
$870.79
|
| Rate for Payer: Healthspan PPO |
$716.46
|
| Rate for Payer: Humana Medicaid |
$309.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$678.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$315.68
|
| Rate for Payer: Molina Healthcare Passport |
$309.49
|
| Rate for Payer: Multiplan PHCS |
$570.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$665.00
|
| Rate for Payer: UHCCP Medicaid |
$332.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$312.58
|
|
|
CLTX MONTEGGIA FX DIS ELB WMAN
|
Facility
|
OP
|
$1,941.00
|
|
|
Service Code
|
HCPCS 24620
|
| Hospital Charge Code |
761T0554
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$252.33 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Aetna Commercial |
$1,494.57
|
| Rate for Payer: Anthem Medicaid |
$667.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,513.98
|
| 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 |
$970.50
|
| Rate for Payer: Cash Price |
$970.50
|
| Rate for Payer: Cigna Commercial |
$1,611.03
|
| Rate for Payer: First Health Commercial |
$1,843.95
|
| Rate for Payer: Humana Commercial |
$1,649.85
|
| Rate for Payer: Humana KY Medicaid |
$667.51
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$674.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,591.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,432.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$680.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,708.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,455.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$388.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$252.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$601.71
|
| Rate for Payer: PHCS Commercial |
$1,863.36
|
| Rate for Payer: United Healthcare All Payer |
$1,708.08
|
|
|
CLTX OF POST MALEOLS FX W/MANP
|
Facility
|
IP
|
$640.00
|
|
|
Service Code
|
HCPCS 27768
|
| Hospital Charge Code |
76100932
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$83.20 |
| Max. Negotiated Rate |
$614.40 |
| Rate for Payer: Aetna Commercial |
$492.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$499.20
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cigna Commercial |
$531.20
|
| Rate for Payer: First Health Commercial |
$608.00
|
| Rate for Payer: Humana Commercial |
$544.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$524.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$472.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$192.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$563.20
|
| Rate for Payer: Ohio Health Group HMO |
$480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$128.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$83.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$198.40
|
| Rate for Payer: PHCS Commercial |
$614.40
|
| Rate for Payer: United Healthcare All Payer |
$563.20
|
|
|
CLTX OF POST MALEOLS FX W/MANP
|
Professional
|
Both
|
$640.00
|
|
|
Service Code
|
HCPCS 27768
|
| Hospital Charge Code |
76100932
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$224.00 |
| Max. Negotiated Rate |
$640.00 |
| Rate for Payer: Aetna Commercial |
$580.91
|
| Rate for Payer: Anthem Medicaid |
$299.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$640.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cigna Commercial |
$612.32
|
| Rate for Payer: Healthspan PPO |
$526.18
|
| Rate for Payer: Humana Medicaid |
$299.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$519.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$305.36
|
| Rate for Payer: Molina Healthcare Passport |
$299.37
|
| Rate for Payer: Multiplan PHCS |
$384.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$448.00
|
| Rate for Payer: UHCCP Medicaid |
$224.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$302.36
|
|
|
CLTX OF POST MALEOLS FX W/MANP
|
Facility
|
OP
|
$640.00
|
|
|
Service Code
|
HCPCS 27768
|
| Hospital Charge Code |
76100932
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$83.20 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Aetna Commercial |
$492.80
|
| Rate for Payer: Anthem Medicaid |
$220.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$499.20
|
| 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 |
$320.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cigna Commercial |
$531.20
|
| Rate for Payer: First Health Commercial |
$608.00
|
| Rate for Payer: Humana Commercial |
$544.00
|
| Rate for Payer: Humana KY Medicaid |
$220.10
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$222.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$524.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$472.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$224.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$563.20
|
| Rate for Payer: Ohio Health Group HMO |
$480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$128.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$83.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$198.40
|
| Rate for Payer: PHCS Commercial |
$614.40
|
| Rate for Payer: United Healthcare All Payer |
$563.20
|
|
|
CLTX OF POST MALEOLS FX W/MANP
|
Professional
|
Both
|
$640.00
|
|
|
Service Code
|
HCPCS 27768
|
| Hospital Charge Code |
761P0932
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$224.00 |
| Max. Negotiated Rate |
$640.00 |
| Rate for Payer: Aetna Commercial |
$580.91
|
| Rate for Payer: Anthem Medicaid |
$299.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$640.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cigna Commercial |
$612.32
|
| Rate for Payer: Healthspan PPO |
$526.18
|
| Rate for Payer: Humana Medicaid |
$299.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$519.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$305.36
|
| Rate for Payer: Molina Healthcare Passport |
$299.37
|
| Rate for Payer: Multiplan PHCS |
$384.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$448.00
|
| Rate for Payer: UHCCP Medicaid |
$224.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$302.36
|
|
|
CLTX PHLNGL FX PRXMID PX/F/T
|
Facility
|
IP
|
$936.00
|
|
|
Service Code
|
HCPCS 26720
|
| Hospital Charge Code |
76100736
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$898.56 |
| Rate for Payer: Aetna Commercial |
$720.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$730.08
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Cigna Commercial |
$776.88
|
| Rate for Payer: First Health Commercial |
$889.20
|
| Rate for Payer: Humana Commercial |
$795.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$767.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$690.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$280.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$823.68
|
| Rate for Payer: Ohio Health Group HMO |
$702.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$187.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$121.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$290.16
|
| Rate for Payer: PHCS Commercial |
$898.56
|
| Rate for Payer: United Healthcare All Payer |
$823.68
|
|
|
CLTX PHLNGL FX PRXMID PX/F/T
|
Professional
|
Both
|
$936.00
|
|
|
Service Code
|
HCPCS 26720
|
| Hospital Charge Code |
76100736
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.17 |
| Max. Negotiated Rate |
$936.00 |
| Rate for Payer: Aetna Commercial |
$234.57
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$97.94
|
| Rate for Payer: Anthem Medicaid |
$64.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$936.00
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Cigna Commercial |
$287.65
|
| Rate for Payer: Healthspan PPO |
$230.90
|
| Rate for Payer: Humana Medicaid |
$64.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$212.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$65.45
|
| Rate for Payer: Molina Healthcare Passport |
$64.17
|
| Rate for Payer: Multiplan PHCS |
$561.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$655.20
|
| Rate for Payer: UHCCP Medicaid |
$102.84
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$64.81
|
|
|
CLTX PHLNGL FX PRXMID PX/F/T
|
Facility
|
OP
|
$936.00
|
|
|
Service Code
|
HCPCS 26720
|
| Hospital Charge Code |
76100736
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$898.56 |
| Rate for Payer: Aetna Commercial |
$720.72
|
| Rate for Payer: Anthem Medicaid |
$321.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$730.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Cigna Commercial |
$776.88
|
| Rate for Payer: First Health Commercial |
$889.20
|
| Rate for Payer: Humana Commercial |
$795.60
|
| Rate for Payer: Humana KY Medicaid |
$321.89
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$325.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$767.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$690.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$328.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$823.68
|
| Rate for Payer: Ohio Health Group HMO |
$702.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$187.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$121.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$290.16
|
| Rate for Payer: PHCS Commercial |
$898.56
|
| Rate for Payer: United Healthcare All Payer |
$823.68
|
|
|
CLTX PHLNGL FX PRXMID PX/F/T(P
|
Professional
|
Both
|
$435.00
|
|
|
Service Code
|
HCPCS 26720
|
| Hospital Charge Code |
761P0736
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.17 |
| Max. Negotiated Rate |
$435.00 |
| Rate for Payer: Aetna Commercial |
$234.57
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$97.94
|
| Rate for Payer: Anthem Medicaid |
$64.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$435.00
|
| Rate for Payer: Cash Price |
$217.50
|
| Rate for Payer: Cash Price |
$217.50
|
| Rate for Payer: Cigna Commercial |
$287.65
|
| Rate for Payer: Healthspan PPO |
$230.90
|
| Rate for Payer: Humana Medicaid |
$64.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$212.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$65.45
|
| Rate for Payer: Molina Healthcare Passport |
$64.17
|
| Rate for Payer: Multiplan PHCS |
$261.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$304.50
|
| Rate for Payer: UHCCP Medicaid |
$102.84
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$64.81
|
|
|
CLTX PHLNGL FX PRXMID PX/F/T(T
|
Facility
|
OP
|
$501.00
|
|
|
Service Code
|
HCPCS 26720
|
| Hospital Charge Code |
761T0736
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.13 |
| Max. Negotiated Rate |
$480.96 |
| Rate for Payer: Aetna Commercial |
$385.77
|
| Rate for Payer: Anthem Medicaid |
$172.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$390.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$250.50
|
| Rate for Payer: Cash Price |
$250.50
|
| Rate for Payer: Cigna Commercial |
$415.83
|
| Rate for Payer: First Health Commercial |
$475.95
|
| Rate for Payer: Humana Commercial |
$425.85
|
| Rate for Payer: Humana KY Medicaid |
$172.29
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$174.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$410.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$369.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$175.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$440.88
|
| Rate for Payer: Ohio Health Group HMO |
$375.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$100.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$155.31
|
| Rate for Payer: PHCS Commercial |
$480.96
|
| Rate for Payer: United Healthcare All Payer |
$440.88
|
|
|
CLTX PHLNGL FX PRXMID PX/F/T(T
|
Facility
|
IP
|
$501.00
|
|
|
Service Code
|
HCPCS 26720
|
| Hospital Charge Code |
761T0736
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.13 |
| Max. Negotiated Rate |
$480.96 |
| Rate for Payer: Aetna Commercial |
$385.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$390.78
|
| Rate for Payer: Cash Price |
$250.50
|
| Rate for Payer: Cigna Commercial |
$415.83
|
| Rate for Payer: First Health Commercial |
$475.95
|
| Rate for Payer: Humana Commercial |
$425.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$410.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$369.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$150.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$440.88
|
| Rate for Payer: Ohio Health Group HMO |
$375.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$100.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$155.31
|
| Rate for Payer: PHCS Commercial |
$480.96
|
| Rate for Payer: United Healthcare All Payer |
$440.88
|
|
|
CLTX POST ANKLE FX
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 27767
|
| Hospital Charge Code |
76100931
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$150.71 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna Commercial |
$352.47
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$150.71
|
| Rate for Payer: Anthem Medicaid |
$191.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$500.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$391.70
|
| Rate for Payer: Healthspan PPO |
$317.81
|
| Rate for Payer: Humana Medicaid |
$191.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$329.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$195.20
|
| Rate for Payer: Molina Healthcare Passport |
$191.37
|
| Rate for Payer: Multiplan PHCS |
$300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$350.00
|
| Rate for Payer: UHCCP Medicaid |
$158.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$193.28
|
|
|
CLTX POST ANKLE FX
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
HCPCS 27767
|
| Hospital Charge Code |
76100931
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: Aetna Commercial |
$385.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$390.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$415.00
|
| Rate for Payer: First Health Commercial |
$475.00
|
| Rate for Payer: Humana Commercial |
$425.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$410.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$369.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$150.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$440.00
|
| Rate for Payer: Ohio Health Group HMO |
$375.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$155.00
|
| Rate for Payer: PHCS Commercial |
$480.00
|
| Rate for Payer: United Healthcare All Payer |
$440.00
|
|
|
CLTX POST ANKLE FX
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
HCPCS 27767
|
| Hospital Charge Code |
76100931
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: Aetna Commercial |
$385.00
|
| Rate for Payer: Anthem Medicaid |
$171.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$390.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$415.00
|
| Rate for Payer: First Health Commercial |
$475.00
|
| Rate for Payer: Humana Commercial |
$425.00
|
| Rate for Payer: Humana KY Medicaid |
$171.95
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$173.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$410.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$369.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$175.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$440.00
|
| Rate for Payer: Ohio Health Group HMO |
$375.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$155.00
|
| Rate for Payer: PHCS Commercial |
$480.00
|
| Rate for Payer: United Healthcare All Payer |
$440.00
|
|
|
CLTX POST ANKLE FX(P
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 27767
|
| Hospital Charge Code |
761P0931
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$150.71 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna Commercial |
$352.47
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$150.71
|
| Rate for Payer: Anthem Medicaid |
$191.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$500.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$391.70
|
| Rate for Payer: Healthspan PPO |
$317.81
|
| Rate for Payer: Humana Medicaid |
$191.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$329.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$195.20
|
| Rate for Payer: Molina Healthcare Passport |
$191.37
|
| Rate for Payer: Multiplan PHCS |
$300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$350.00
|
| Rate for Payer: UHCCP Medicaid |
$158.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$193.28
|
|
|
CLTX PROX FIBULA/SHFT
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS 27780
|
| Hospital Charge Code |
76100934
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$576.00 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Anthem Medicaid |
$206.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$468.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$498.00
|
| Rate for Payer: First Health Commercial |
$570.00
|
| Rate for Payer: Humana Commercial |
$510.00
|
| Rate for Payer: Humana KY Medicaid |
$206.34
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$208.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$492.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$210.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$528.00
|
| Rate for Payer: Ohio Health Group HMO |
$450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$186.00
|
| Rate for Payer: PHCS Commercial |
$576.00
|
| Rate for Payer: United Healthcare All Payer |
$528.00
|
|
|
CLTX PROX FIBULA/SHFT
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
HCPCS 27780
|
| Hospital Charge Code |
76100934
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$576.00 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$468.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$498.00
|
| Rate for Payer: First Health Commercial |
$570.00
|
| Rate for Payer: Humana Commercial |
$510.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$492.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$180.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$528.00
|
| Rate for Payer: Ohio Health Group HMO |
$450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$186.00
|
| Rate for Payer: PHCS Commercial |
$576.00
|
| Rate for Payer: United Healthcare All Payer |
$528.00
|
|
|
CLTX PROX FIBULA/SHFT
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 27780
|
| Hospital Charge Code |
76100934
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$105.22 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$362.83
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$148.64
|
| Rate for Payer: Anthem Medicaid |
$105.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$600.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$445.97
|
| Rate for Payer: Healthspan PPO |
$360.15
|
| Rate for Payer: Humana Medicaid |
$105.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$326.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$107.32
|
| Rate for Payer: Molina Healthcare Passport |
$105.22
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$420.00
|
| Rate for Payer: UHCCP Medicaid |
$156.07
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$106.27
|
|
|
CLTX PROX FIBULA/SHFT(P
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 27780
|
| Hospital Charge Code |
761P0934
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$105.22 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$362.83
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$148.64
|
| Rate for Payer: Anthem Medicaid |
$105.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$600.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$445.97
|
| Rate for Payer: Healthspan PPO |
$360.15
|
| Rate for Payer: Humana Medicaid |
$105.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$326.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$107.32
|
| Rate for Payer: Molina Healthcare Passport |
$105.22
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$420.00
|
| Rate for Payer: UHCCP Medicaid |
$156.07
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$106.27
|
|
|
CLTX PRX HUM FX W/O MANIP
|
Facility
|
IP
|
$368.00
|
|
|
Service Code
|
HCPCS 23600
|
| Hospital Charge Code |
45000110
|
|
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
|
|
