|
CLTX PRX HUM FX W/O MANIP
|
Facility
|
IP
|
$1,530.00
|
|
|
Service Code
|
HCPCS 23600
|
| Hospital Charge Code |
76100478
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$198.90 |
| Max. Negotiated Rate |
$1,468.80 |
| Rate for Payer: Aetna Commercial |
$1,178.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,193.40
|
| Rate for Payer: Cash Price |
$765.00
|
| Rate for Payer: Cigna Commercial |
$1,269.90
|
| Rate for Payer: First Health Commercial |
$1,453.50
|
| Rate for Payer: Humana Commercial |
$1,300.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,254.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,129.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$459.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,346.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,147.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$306.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$198.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$474.30
|
| Rate for Payer: PHCS Commercial |
$1,468.80
|
| Rate for Payer: United Healthcare All Payer |
$1,346.40
|
|
|
CLTX PRX HUM FX W/O MANIP
|
Professional
|
Both
|
$1,530.00
|
|
|
Service Code
|
HCPCS 23600
|
| Hospital Charge Code |
76100478
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$168.93 |
| Max. Negotiated Rate |
$1,530.00 |
| Rate for Payer: Aetna Commercial |
$401.63
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$173.86
|
| Rate for Payer: Anthem Medicaid |
$168.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,530.00
|
| Rate for Payer: Cash Price |
$765.00
|
| Rate for Payer: Cash Price |
$765.00
|
| Rate for Payer: Cigna Commercial |
$487.10
|
| Rate for Payer: Healthspan PPO |
$390.95
|
| Rate for Payer: Humana Medicaid |
$168.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$357.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$172.31
|
| Rate for Payer: Molina Healthcare Passport |
$168.93
|
| Rate for Payer: Multiplan PHCS |
$918.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,071.00
|
| Rate for Payer: UHCCP Medicaid |
$182.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$170.62
|
|
|
CLTX PRX HUM FX W/O MANIP
|
Facility
|
OP
|
$1,530.00
|
|
|
Service Code
|
HCPCS 23600
|
| Hospital Charge Code |
76100478
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$198.90 |
| Max. Negotiated Rate |
$1,468.80 |
| Rate for Payer: Aetna Commercial |
$1,178.10
|
| Rate for Payer: Anthem Medicaid |
$526.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,193.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$765.00
|
| Rate for Payer: Cash Price |
$765.00
|
| Rate for Payer: Cigna Commercial |
$1,269.90
|
| Rate for Payer: First Health Commercial |
$1,453.50
|
| Rate for Payer: Humana Commercial |
$1,300.50
|
| Rate for Payer: Humana KY Medicaid |
$526.17
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$531.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,254.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,129.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$536.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,346.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,147.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$306.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$198.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$474.30
|
| Rate for Payer: PHCS Commercial |
$1,468.80
|
| Rate for Payer: United Healthcare All Payer |
$1,346.40
|
|
|
CLTX PRX HUM FX W/O MANIP
|
Facility
|
OP
|
$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 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 PRX HUM FX W/O MANIP(P
|
Professional
|
Both
|
$630.00
|
|
|
Service Code
|
HCPCS 23600
|
| Hospital Charge Code |
761P0478
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$168.93 |
| Max. Negotiated Rate |
$630.00 |
| Rate for Payer: Aetna Commercial |
$401.63
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$173.86
|
| Rate for Payer: Anthem Medicaid |
$168.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$630.00
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cigna Commercial |
$487.10
|
| Rate for Payer: Healthspan PPO |
$390.95
|
| Rate for Payer: Humana Medicaid |
$168.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$357.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$172.31
|
| Rate for Payer: Molina Healthcare Passport |
$168.93
|
| Rate for Payer: Multiplan PHCS |
$378.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$441.00
|
| Rate for Payer: UHCCP Medicaid |
$182.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$170.62
|
|
|
CLTX PRX HUM FX W/O MANIP(T
|
Facility
|
IP
|
$900.00
|
|
|
Service Code
|
HCPCS 23600
|
| Hospital Charge Code |
761T0478
|
|
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 PRX HUM FX W/O MANIP(T
|
Facility
|
OP
|
$900.00
|
|
|
Service Code
|
HCPCS 23600
|
| Hospital Charge Code |
761T0478
|
|
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
|
|
|
CL TX RAD HD/NECK FX W/MANIP
|
Professional
|
Both
|
$2,941.00
|
|
|
Service Code
|
HCPCS 24655
|
| Hospital Charge Code |
76100558
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$214.03 |
| Max. Negotiated Rate |
$2,941.00 |
| Rate for Payer: Aetna Commercial |
$549.83
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$217.22
|
| Rate for Payer: Anthem Medicaid |
$214.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,941.00
|
| Rate for Payer: Cash Price |
$1,470.50
|
| Rate for Payer: Cash Price |
$1,470.50
|
| Rate for Payer: Cigna Commercial |
$606.79
|
| Rate for Payer: Healthspan PPO |
$539.24
|
| Rate for Payer: Humana Medicaid |
$214.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$477.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$218.31
|
| Rate for Payer: Molina Healthcare Passport |
$214.03
|
| Rate for Payer: Multiplan PHCS |
$1,764.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,058.70
|
| Rate for Payer: UHCCP Medicaid |
$228.08
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$216.17
|
|
|
CL TX RAD HD/NECK FX W/MANIP
|
Facility
|
OP
|
$2,941.00
|
|
|
Service Code
|
HCPCS 24655
|
| Hospital Charge Code |
76100558
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$382.33 |
| Max. Negotiated Rate |
$2,823.36 |
| Rate for Payer: Aetna Commercial |
$2,264.57
|
| Rate for Payer: Anthem Medicaid |
$1,011.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,293.98
|
| 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 |
$1,470.50
|
| Rate for Payer: Cash Price |
$1,470.50
|
| Rate for Payer: Cigna Commercial |
$2,441.03
|
| Rate for Payer: First Health Commercial |
$2,793.95
|
| Rate for Payer: Humana Commercial |
$2,499.85
|
| Rate for Payer: Humana KY Medicaid |
$1,011.41
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$1,021.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,411.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,170.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,031.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,588.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,205.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$588.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$382.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$911.71
|
| Rate for Payer: PHCS Commercial |
$2,823.36
|
| Rate for Payer: United Healthcare All Payer |
$2,588.08
|
|
|
CL TX RAD HD/NECK FX W/MANIP
|
Facility
|
OP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 24655
|
| Hospital Charge Code |
45000126
|
|
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
|
|
|
CL TX RAD HD/NECK FX W/MANIP
|
Facility
|
IP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 24655
|
| Hospital Charge Code |
45000126
|
|
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
|
|
|
CL TX RAD HD/NECK FX W/MANIP
|
Facility
|
IP
|
$2,941.00
|
|
|
Service Code
|
HCPCS 24655
|
| Hospital Charge Code |
76100558
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$382.33 |
| Max. Negotiated Rate |
$2,823.36 |
| Rate for Payer: Aetna Commercial |
$2,264.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,293.98
|
| Rate for Payer: Cash Price |
$1,470.50
|
| Rate for Payer: Cigna Commercial |
$2,441.03
|
| Rate for Payer: First Health Commercial |
$2,793.95
|
| Rate for Payer: Humana Commercial |
$2,499.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,411.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,170.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$882.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,588.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,205.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$588.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$382.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$911.71
|
| Rate for Payer: PHCS Commercial |
$2,823.36
|
| Rate for Payer: United Healthcare All Payer |
$2,588.08
|
|
|
CL TX RAD HD/NECK FX W/MANIP(P
|
Professional
|
Both
|
$830.00
|
|
|
Service Code
|
HCPCS 24655
|
| Hospital Charge Code |
761P0558
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$214.03 |
| Max. Negotiated Rate |
$830.00 |
| Rate for Payer: Aetna Commercial |
$549.83
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$217.22
|
| Rate for Payer: Anthem Medicaid |
$214.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$830.00
|
| Rate for Payer: Cash Price |
$415.00
|
| Rate for Payer: Cash Price |
$415.00
|
| Rate for Payer: Cigna Commercial |
$606.79
|
| Rate for Payer: Healthspan PPO |
$539.24
|
| Rate for Payer: Humana Medicaid |
$214.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$477.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$218.31
|
| Rate for Payer: Molina Healthcare Passport |
$214.03
|
| Rate for Payer: Multiplan PHCS |
$498.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$581.00
|
| Rate for Payer: UHCCP Medicaid |
$228.08
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$216.17
|
|
|
CL TX RAD HD/NECK FX W/MANIP(T
|
Facility
|
IP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 24655
|
| Hospital Charge Code |
761T0558
|
|
Hospital Revenue Code
|
761
|
| 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
|
|
|
CL TX RAD HD/NECK FX W/MANIP(T
|
Facility
|
OP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 24655
|
| Hospital Charge Code |
761T0558
|
|
Hospital Revenue Code
|
761
|
| 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 RAD HEAD/NECK FX WO MANIP
|
Facility
|
IP
|
$900.00
|
|
|
Service Code
|
HCPCS 24650
|
| Hospital Charge Code |
761T0557
|
|
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 RAD HEAD/NECK FX WO MANIP
|
Professional
|
Both
|
$1,489.00
|
|
|
Service Code
|
HCPCS 24650
|
| Hospital Charge Code |
76100557
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.17 |
| Max. Negotiated Rate |
$1,489.00 |
| Rate for Payer: Aetna Commercial |
$310.43
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$130.25
|
| Rate for Payer: Anthem Medicaid |
$97.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,489.00
|
| Rate for Payer: Cash Price |
$744.50
|
| Rate for Payer: Cash Price |
$744.50
|
| Rate for Payer: Cigna Commercial |
$385.92
|
| Rate for Payer: Healthspan PPO |
$308.81
|
| Rate for Payer: Humana Medicaid |
$97.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$278.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$99.11
|
| Rate for Payer: Molina Healthcare Passport |
$97.17
|
| Rate for Payer: Multiplan PHCS |
$893.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,042.30
|
| Rate for Payer: UHCCP Medicaid |
$136.76
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$98.14
|
|
|
CLTX RAD HEAD/NECK FX WO MANIP
|
Professional
|
Both
|
$589.00
|
|
|
Service Code
|
HCPCS 24650
|
| Hospital Charge Code |
761P0557
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.17 |
| Max. Negotiated Rate |
$589.00 |
| Rate for Payer: Aetna Commercial |
$310.43
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$130.25
|
| Rate for Payer: Anthem Medicaid |
$97.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$589.00
|
| Rate for Payer: Cash Price |
$294.50
|
| Rate for Payer: Cash Price |
$294.50
|
| Rate for Payer: Cigna Commercial |
$385.92
|
| Rate for Payer: Healthspan PPO |
$308.81
|
| Rate for Payer: Humana Medicaid |
$97.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$278.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$99.11
|
| Rate for Payer: Molina Healthcare Passport |
$97.17
|
| Rate for Payer: Multiplan PHCS |
$353.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$412.30
|
| Rate for Payer: UHCCP Medicaid |
$136.76
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$98.14
|
|
|
CLTX RAD HEAD/NECK FX WO MANIP
|
Facility
|
OP
|
$1,489.00
|
|
|
Service Code
|
HCPCS 24650
|
| Hospital Charge Code |
76100557
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$193.57 |
| Max. Negotiated Rate |
$1,429.44 |
| Rate for Payer: Aetna Commercial |
$1,146.53
|
| Rate for Payer: Anthem Medicaid |
$512.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,161.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$744.50
|
| Rate for Payer: Cash Price |
$744.50
|
| Rate for Payer: Cigna Commercial |
$1,235.87
|
| Rate for Payer: First Health Commercial |
$1,414.55
|
| Rate for Payer: Humana Commercial |
$1,265.65
|
| Rate for Payer: Humana KY Medicaid |
$512.07
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$517.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,220.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,098.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$522.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,310.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,116.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$297.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$193.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$461.59
|
| Rate for Payer: PHCS Commercial |
$1,429.44
|
| Rate for Payer: United Healthcare All Payer |
$1,310.32
|
|
|
CLTX RAD HEAD/NECK FX WO MANIP
|
Facility
|
IP
|
$1,489.00
|
|
|
Service Code
|
HCPCS 24650
|
| Hospital Charge Code |
76100557
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$193.57 |
| Max. Negotiated Rate |
$1,429.44 |
| Rate for Payer: Aetna Commercial |
$1,146.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,161.42
|
| Rate for Payer: Cash Price |
$744.50
|
| Rate for Payer: Cigna Commercial |
$1,235.87
|
| Rate for Payer: First Health Commercial |
$1,414.55
|
| Rate for Payer: Humana Commercial |
$1,265.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,220.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,098.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$446.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,310.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,116.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$297.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$193.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$461.59
|
| Rate for Payer: PHCS Commercial |
$1,429.44
|
| Rate for Payer: United Healthcare All Payer |
$1,310.32
|
|
|
CLTX RAD HEAD/NECK FX WO MANIP
|
Facility
|
OP
|
$900.00
|
|
|
Service Code
|
HCPCS 24650
|
| Hospital Charge Code |
761T0557
|
|
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
|
|
|
CL TX RAD&ULN SHAFT FX W/MAN
|
Facility
|
OP
|
$1,030.00
|
|
|
Service Code
|
HCPCS 25565
|
| Hospital Charge Code |
76100627
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$133.90 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Aetna Commercial |
$793.10
|
| Rate for Payer: Anthem Medicaid |
$354.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$803.40
|
| 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 |
$515.00
|
| Rate for Payer: Cash Price |
$515.00
|
| Rate for Payer: Cigna Commercial |
$854.90
|
| Rate for Payer: First Health Commercial |
$978.50
|
| Rate for Payer: Humana Commercial |
$875.50
|
| Rate for Payer: Humana KY Medicaid |
$354.22
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$357.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$844.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$760.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$361.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$906.40
|
| Rate for Payer: Ohio Health Group HMO |
$772.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$206.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$133.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$319.30
|
| Rate for Payer: PHCS Commercial |
$988.80
|
| Rate for Payer: United Healthcare All Payer |
$906.40
|
|
|
CL TX RAD&ULN SHAFT FX W/MAN
|
Professional
|
Both
|
$1,030.00
|
|
|
Service Code
|
HCPCS 25565
|
| Hospital Charge Code |
76100627
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$287.20 |
| Max. Negotiated Rate |
$1,030.00 |
| Rate for Payer: Aetna Commercial |
$670.39
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$287.20
|
| Rate for Payer: Anthem Medicaid |
$297.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,030.00
|
| Rate for Payer: Cash Price |
$515.00
|
| Rate for Payer: Cash Price |
$515.00
|
| Rate for Payer: Cigna Commercial |
$734.25
|
| Rate for Payer: Healthspan PPO |
$657.65
|
| Rate for Payer: Humana Medicaid |
$297.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$575.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$303.17
|
| Rate for Payer: Molina Healthcare Passport |
$297.23
|
| Rate for Payer: Multiplan PHCS |
$618.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$721.00
|
| Rate for Payer: UHCCP Medicaid |
$301.56
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$300.20
|
|
|
CL TX RAD&ULN SHAFT FX W/MAN
|
Facility
|
IP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 25565
|
| Hospital Charge Code |
45000130
|
|
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
|
|
|
CL TX RAD&ULN SHAFT FX W/MAN
|
Facility
|
OP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 25565
|
| Hospital Charge Code |
45000130
|
|
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
|
|
