|
CL TX RAD&ULN SHAFT FX W/MAN
|
Facility
|
IP
|
$1,030.00
|
|
|
Service Code
|
HCPCS 25565
|
| Hospital Charge Code |
76100627
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$133.90 |
| Max. Negotiated Rate |
$988.80 |
| Rate for Payer: Aetna Commercial |
$793.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$803.40
|
| 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: 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 |
$309.00
|
| 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(P
|
Professional
|
Both
|
$1,030.00
|
|
|
Service Code
|
HCPCS 25565
|
| Hospital Charge Code |
761P0627
|
|
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
|
|
|
CLTX RAD&ULN SHAFT FX W/O MAN
|
Facility
|
OP
|
$1,530.00
|
|
|
Service Code
|
HCPCS 25560
|
| Hospital Charge Code |
76100626
|
|
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 RAD&ULN SHAFT FX W/O MAN
|
Facility
|
IP
|
$1,530.00
|
|
|
Service Code
|
HCPCS 25560
|
| Hospital Charge Code |
76100626
|
|
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 RAD&ULN SHAFT FX W/O MAN
|
Professional
|
Both
|
$1,530.00
|
|
|
Service Code
|
HCPCS 25560
|
| Hospital Charge Code |
76100626
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$134.64 |
| Max. Negotiated Rate |
$1,530.00 |
| Rate for Payer: Aetna Commercial |
$319.64
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$136.84
|
| Rate for Payer: Anthem Medicaid |
$134.64
|
| 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 |
$397.61
|
| Rate for Payer: Healthspan PPO |
$321.03
|
| Rate for Payer: Humana Medicaid |
$134.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$288.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$137.33
|
| Rate for Payer: Molina Healthcare Passport |
$134.64
|
| Rate for Payer: Multiplan PHCS |
$918.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,071.00
|
| Rate for Payer: UHCCP Medicaid |
$143.68
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$135.99
|
|
|
CLTX RAD&ULN SHAFT FX W/O MA(P
|
Professional
|
Both
|
$630.00
|
|
|
Service Code
|
HCPCS 25560
|
| Hospital Charge Code |
761P0626
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$134.64 |
| Max. Negotiated Rate |
$630.00 |
| Rate for Payer: Aetna Commercial |
$319.64
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$136.84
|
| Rate for Payer: Anthem Medicaid |
$134.64
|
| 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 |
$397.61
|
| Rate for Payer: Healthspan PPO |
$321.03
|
| Rate for Payer: Humana Medicaid |
$134.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$288.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$137.33
|
| Rate for Payer: Molina Healthcare Passport |
$134.64
|
| Rate for Payer: Multiplan PHCS |
$378.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$441.00
|
| Rate for Payer: UHCCP Medicaid |
$143.68
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$135.99
|
|
|
CLTX RAD&ULN SHAFT FX W/O MA(T
|
Facility
|
IP
|
$900.00
|
|
|
Service Code
|
HCPCS 25560
|
| Hospital Charge Code |
761T0626
|
|
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&ULN SHAFT FX W/O MA(T
|
Facility
|
OP
|
$900.00
|
|
|
Service Code
|
HCPCS 25560
|
| Hospital Charge Code |
761T0626
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$864.00 |
| Rate for Payer: Aetna Commercial |
$693.00
|
| Rate for Payer: Anthem Medicaid |
$309.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$702.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$747.00
|
| Rate for Payer: First Health Commercial |
$855.00
|
| Rate for Payer: Humana Commercial |
$765.00
|
| Rate for Payer: Humana KY Medicaid |
$309.51
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$312.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$738.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$664.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$315.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$792.00
|
| Rate for Payer: Ohio Health Group HMO |
$675.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$117.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$279.00
|
| Rate for Payer: PHCS Commercial |
$864.00
|
| Rate for Payer: United Healthcare All Payer |
$792.00
|
|
|
CLTX RDLSHF FX DIS DIST R/U JT
|
Facility
|
IP
|
$1,280.00
|
|
|
Service Code
|
HCPCS 25520
|
| Hospital Charge Code |
76100620
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$166.40 |
| Max. Negotiated Rate |
$1,228.80 |
| Rate for Payer: Aetna Commercial |
$985.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$998.40
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cigna Commercial |
$1,062.40
|
| Rate for Payer: First Health Commercial |
$1,216.00
|
| Rate for Payer: Humana Commercial |
$1,088.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,049.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$944.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$384.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,126.40
|
| Rate for Payer: Ohio Health Group HMO |
$960.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$256.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$166.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$396.80
|
| Rate for Payer: PHCS Commercial |
$1,228.80
|
| Rate for Payer: United Healthcare All Payer |
$1,126.40
|
|
|
CLTX RDLSHF FX DIS DIST R/U JT
|
Facility
|
OP
|
$1,280.00
|
|
|
Service Code
|
HCPCS 25520
|
| Hospital Charge Code |
76100620
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$166.40 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Aetna Commercial |
$985.60
|
| Rate for Payer: Anthem Medicaid |
$440.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$998.40
|
| 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 |
$640.00
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cigna Commercial |
$1,062.40
|
| Rate for Payer: First Health Commercial |
$1,216.00
|
| Rate for Payer: Humana Commercial |
$1,088.00
|
| Rate for Payer: Humana KY Medicaid |
$440.19
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$444.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,049.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$944.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$449.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,126.40
|
| Rate for Payer: Ohio Health Group HMO |
$960.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$256.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$166.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$396.80
|
| Rate for Payer: PHCS Commercial |
$1,228.80
|
| Rate for Payer: United Healthcare All Payer |
$1,126.40
|
|
|
CLTX RDLSHF FX DIS DIST R/U JT
|
Professional
|
Both
|
$1,280.00
|
|
|
Service Code
|
HCPCS 25520
|
| Hospital Charge Code |
76100620
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$353.15 |
| Max. Negotiated Rate |
$1,280.00 |
| Rate for Payer: Aetna Commercial |
$737.27
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$353.92
|
| Rate for Payer: Anthem Medicaid |
$353.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,280.00
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cigna Commercial |
$864.80
|
| Rate for Payer: Healthspan PPO |
$697.39
|
| Rate for Payer: Humana Medicaid |
$353.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$643.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$360.21
|
| Rate for Payer: Molina Healthcare Passport |
$353.15
|
| Rate for Payer: Multiplan PHCS |
$768.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$896.00
|
| Rate for Payer: UHCCP Medicaid |
$371.62
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$356.68
|
|
|
CLTX RDLSHF FX DIS DIST R/U JT
|
Professional
|
Both
|
$1,280.00
|
|
|
Service Code
|
HCPCS 25520
|
| Hospital Charge Code |
761P0620
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$353.15 |
| Max. Negotiated Rate |
$1,280.00 |
| Rate for Payer: Aetna Commercial |
$737.27
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$353.92
|
| Rate for Payer: Anthem Medicaid |
$353.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,280.00
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cigna Commercial |
$864.80
|
| Rate for Payer: Healthspan PPO |
$697.39
|
| Rate for Payer: Humana Medicaid |
$353.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$643.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$360.21
|
| Rate for Payer: Molina Healthcare Passport |
$353.15
|
| Rate for Payer: Multiplan PHCS |
$768.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$896.00
|
| Rate for Payer: UHCCP Medicaid |
$371.62
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$356.68
|
|
|
CLTX SHLDR DISLC WFX HUM TUBRT
|
Facility
|
IP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 23665
|
| Hospital Charge Code |
45000114
|
|
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 SHLDR DISLC WFX HUM TUBRT
|
Facility
|
OP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 23665
|
| Hospital Charge Code |
45000114
|
|
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 SHLDR DISLC WFX HUM TUBRT
|
Facility
|
IP
|
$3,031.00
|
|
|
Service Code
|
HCPCS 23665
|
| Hospital Charge Code |
76100488
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$394.03 |
| Max. Negotiated Rate |
$2,909.76 |
| Rate for Payer: Aetna Commercial |
$2,333.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,364.18
|
| Rate for Payer: Cash Price |
$1,515.50
|
| Rate for Payer: Cigna Commercial |
$2,515.73
|
| Rate for Payer: First Health Commercial |
$2,879.45
|
| Rate for Payer: Humana Commercial |
$2,576.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,485.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,236.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$909.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,667.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,273.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$606.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$394.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$939.61
|
| Rate for Payer: PHCS Commercial |
$2,909.76
|
| Rate for Payer: United Healthcare All Payer |
$2,667.28
|
|
|
CLTX SHLDR DISLC WFX HUM TUBRT
|
Facility
|
IP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 23665
|
| Hospital Charge Code |
761T0488
|
|
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
|
|
|
CLTX SHLDR DISLC WFX HUM TUBRT
|
Professional
|
Both
|
$3,031.00
|
|
|
Service Code
|
HCPCS 23665
|
| Hospital Charge Code |
76100488
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$224.31 |
| Max. Negotiated Rate |
$3,031.00 |
| Rate for Payer: Aetna Commercial |
$549.19
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$227.75
|
| Rate for Payer: Anthem Medicaid |
$224.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,031.00
|
| Rate for Payer: Cash Price |
$1,515.50
|
| Rate for Payer: Cash Price |
$1,515.50
|
| Rate for Payer: Cigna Commercial |
$642.55
|
| Rate for Payer: Healthspan PPO |
$525.57
|
| Rate for Payer: Humana Medicaid |
$224.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$476.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$228.80
|
| Rate for Payer: Molina Healthcare Passport |
$224.31
|
| Rate for Payer: Multiplan PHCS |
$1,818.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,121.70
|
| Rate for Payer: UHCCP Medicaid |
$239.14
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$226.55
|
|
|
CLTX SHLDR DISLC WFX HUM TUBRT
|
Professional
|
Both
|
$920.00
|
|
|
Service Code
|
HCPCS 23665
|
| Hospital Charge Code |
761P0488
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$224.31 |
| Max. Negotiated Rate |
$920.00 |
| Rate for Payer: Aetna Commercial |
$549.19
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$227.75
|
| Rate for Payer: Anthem Medicaid |
$224.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$920.00
|
| Rate for Payer: Cash Price |
$460.00
|
| Rate for Payer: Cash Price |
$460.00
|
| Rate for Payer: Cigna Commercial |
$642.55
|
| Rate for Payer: Healthspan PPO |
$525.57
|
| Rate for Payer: Humana Medicaid |
$224.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$476.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$228.80
|
| Rate for Payer: Molina Healthcare Passport |
$224.31
|
| Rate for Payer: Multiplan PHCS |
$552.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$644.00
|
| Rate for Payer: UHCCP Medicaid |
$239.14
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$226.55
|
|
|
CLTX SHLDR DISLC WFX HUM TUBRT
|
Facility
|
OP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 23665
|
| Hospital Charge Code |
761T0488
|
|
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 SHLDR DISLC WFX HUM TUBRT
|
Facility
|
OP
|
$3,031.00
|
|
|
Service Code
|
HCPCS 23665
|
| Hospital Charge Code |
76100488
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$394.03 |
| Max. Negotiated Rate |
$2,909.76 |
| Rate for Payer: Aetna Commercial |
$2,333.87
|
| Rate for Payer: Anthem Medicaid |
$1,042.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,364.18
|
| 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 |
$1,515.50
|
| Rate for Payer: Cash Price |
$1,515.50
|
| Rate for Payer: Cigna Commercial |
$2,515.73
|
| Rate for Payer: First Health Commercial |
$2,879.45
|
| Rate for Payer: Humana Commercial |
$2,576.35
|
| Rate for Payer: Humana KY Medicaid |
$1,042.36
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$1,052.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,485.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,236.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,063.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,667.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,273.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$606.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$394.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$939.61
|
| Rate for Payer: PHCS Commercial |
$2,909.76
|
| Rate for Payer: United Healthcare All Payer |
$2,667.28
|
|
|
CLTX SHLDR DIS W/ANTM NECKFX
|
Facility
|
IP
|
$3,551.00
|
|
|
Service Code
|
HCPCS 23675
|
| Hospital Charge Code |
76100490
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$461.63 |
| Max. Negotiated Rate |
$3,408.96 |
| Rate for Payer: Aetna Commercial |
$2,734.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,769.78
|
| Rate for Payer: Cash Price |
$1,775.50
|
| Rate for Payer: Cigna Commercial |
$2,947.33
|
| Rate for Payer: First Health Commercial |
$3,373.45
|
| Rate for Payer: Humana Commercial |
$3,018.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,911.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,620.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,065.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,124.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,663.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$710.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$461.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,100.81
|
| Rate for Payer: PHCS Commercial |
$3,408.96
|
| Rate for Payer: United Healthcare All Payer |
$3,124.88
|
|
|
CLTX SHLDR DIS W/ANTM NECKFX
|
Facility
|
IP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 23675
|
| Hospital Charge Code |
45000115
|
|
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 SHLDR DIS W/ANTM NECKFX
|
Facility
|
OP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 23675
|
| Hospital Charge Code |
45000115
|
|
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 SHLDR DIS W/ANTM NECKFX
|
Professional
|
Both
|
$3,551.00
|
|
|
Service Code
|
HCPCS 23675
|
| Hospital Charge Code |
76100490
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$259.55 |
| Max. Negotiated Rate |
$3,551.00 |
| Rate for Payer: Aetna Commercial |
$710.49
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$259.55
|
| Rate for Payer: Anthem Medicaid |
$284.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,551.00
|
| Rate for Payer: Cash Price |
$1,775.50
|
| Rate for Payer: Cash Price |
$1,775.50
|
| Rate for Payer: Cigna Commercial |
$847.61
|
| Rate for Payer: Healthspan PPO |
$690.10
|
| Rate for Payer: Humana Medicaid |
$284.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$609.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$290.25
|
| Rate for Payer: Molina Healthcare Passport |
$284.56
|
| Rate for Payer: Multiplan PHCS |
$2,130.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,485.70
|
| Rate for Payer: UHCCP Medicaid |
$272.53
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$287.41
|
|
|
CLTX SHLDR DIS W/ANTM NECKFX
|
Facility
|
OP
|
$3,551.00
|
|
|
Service Code
|
HCPCS 23675
|
| Hospital Charge Code |
76100490
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$461.63 |
| Max. Negotiated Rate |
$3,408.96 |
| Rate for Payer: Aetna Commercial |
$2,734.27
|
| Rate for Payer: Anthem Medicaid |
$1,221.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,769.78
|
| 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 |
$1,775.50
|
| Rate for Payer: Cash Price |
$1,775.50
|
| Rate for Payer: Cigna Commercial |
$2,947.33
|
| Rate for Payer: First Health Commercial |
$3,373.45
|
| Rate for Payer: Humana Commercial |
$3,018.35
|
| Rate for Payer: Humana KY Medicaid |
$1,221.19
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$1,233.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,911.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,620.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,245.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,124.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,663.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$710.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$461.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,100.81
|
| Rate for Payer: PHCS Commercial |
$3,408.96
|
| Rate for Payer: United Healthcare All Payer |
$3,124.88
|
|
