|
CLSD RDUC W/PERC PIN DIST ULNA
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 25999
|
| Hospital Charge Code |
76102994
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$840.00
|
| Rate for Payer: UHCCP Medicaid |
$420.00
|
|
|
CLSD SHOULD DISLC W/MAN W/O AN
|
Facility
|
OP
|
$744.00
|
|
|
Service Code
|
HCPCS 23650
|
| Hospital Charge Code |
45000112
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$714.24 |
| Rate for Payer: Aetna Commercial |
$572.88
|
| Rate for Payer: Anthem Medicaid |
$255.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$580.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cigna Commercial |
$617.52
|
| Rate for Payer: First Health Commercial |
$706.80
|
| Rate for Payer: Humana Commercial |
$632.40
|
| Rate for Payer: Humana KY Medicaid |
$255.86
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$258.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$610.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$549.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$261.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$654.72
|
| Rate for Payer: Ohio Health Group HMO |
$558.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$595.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$513.36
|
| Rate for Payer: PHCS Commercial |
$714.24
|
| Rate for Payer: United Healthcare All Payer |
$654.72
|
|
|
CLSD SHOULD DISLC W/MAN W/O AN
|
Facility
|
IP
|
$744.00
|
|
|
Service Code
|
HCPCS 23650
|
| Hospital Charge Code |
45000112
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$223.20 |
| Max. Negotiated Rate |
$714.24 |
| Rate for Payer: Aetna Commercial |
$572.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$580.32
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cigna Commercial |
$617.52
|
| Rate for Payer: First Health Commercial |
$706.80
|
| Rate for Payer: Humana Commercial |
$632.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$610.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$549.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$223.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$654.72
|
| Rate for Payer: Ohio Health Group HMO |
$558.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$595.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$513.36
|
| Rate for Payer: PHCS Commercial |
$714.24
|
| Rate for Payer: United Healthcare All Payer |
$654.72
|
|
|
CLSD SHOULD DISLC W/MAN W/O AN
|
Facility
|
OP
|
$744.00
|
|
|
Service Code
|
HCPCS 23650
|
| Hospital Charge Code |
761T0485
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$714.24 |
| Rate for Payer: Aetna Commercial |
$572.88
|
| Rate for Payer: Anthem Medicaid |
$255.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$580.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cigna Commercial |
$617.52
|
| Rate for Payer: First Health Commercial |
$706.80
|
| Rate for Payer: Humana Commercial |
$632.40
|
| Rate for Payer: Humana KY Medicaid |
$255.86
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$258.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$610.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$549.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$261.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$654.72
|
| Rate for Payer: Ohio Health Group HMO |
$558.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$595.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$513.36
|
| Rate for Payer: PHCS Commercial |
$714.24
|
| Rate for Payer: United Healthcare All Payer |
$654.72
|
|
|
CLSD SHOULD DISLC W/MAN W/O AN
|
Professional
|
Both
|
$644.00
|
|
|
Service Code
|
HCPCS 23650
|
| Hospital Charge Code |
761P0485
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$157.23 |
| Max. Negotiated Rate |
$398.12 |
| Rate for Payer: Aetna Commercial |
$367.68
|
| Rate for Payer: Ambetter Exchange |
$293.24
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$157.80
|
| Rate for Payer: Anthem Medicaid |
$157.23
|
| Rate for Payer: Buckeye Individual/Medicaid |
$293.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$293.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$351.89
|
| Rate for Payer: Cash Price |
$322.00
|
| Rate for Payer: Cash Price |
$322.00
|
| Rate for Payer: Cigna Commercial |
$398.12
|
| Rate for Payer: Healthspan PPO |
$361.63
|
| Rate for Payer: Humana Medicaid |
$157.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$330.20
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$293.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$293.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$160.37
|
| Rate for Payer: Molina Healthcare Passport |
$157.23
|
| Rate for Payer: Multiplan PHCS |
$386.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$381.21
|
| Rate for Payer: UHCCP Medicaid |
$165.69
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$158.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$293.24
|
|
|
CLSD SHOULD DISLC W/MAN W/O AN
|
Facility
|
IP
|
$744.00
|
|
|
Service Code
|
HCPCS 23650
|
| Hospital Charge Code |
761T0485
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$223.20 |
| Max. Negotiated Rate |
$714.24 |
| Rate for Payer: Aetna Commercial |
$572.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$580.32
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cigna Commercial |
$617.52
|
| Rate for Payer: First Health Commercial |
$706.80
|
| Rate for Payer: Humana Commercial |
$632.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$610.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$549.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$223.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$654.72
|
| Rate for Payer: Ohio Health Group HMO |
$558.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$595.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$513.36
|
| Rate for Payer: PHCS Commercial |
$714.24
|
| Rate for Payer: United Healthcare All Payer |
$654.72
|
|
|
CLSD SHOULD DISLC W/MAN W/O AN
|
Facility
|
IP
|
$1,388.00
|
|
|
Service Code
|
HCPCS 23650
|
| Hospital Charge Code |
76100485
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$416.40 |
| Max. Negotiated Rate |
$1,332.48 |
| Rate for Payer: Aetna Commercial |
$1,068.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,082.64
|
| Rate for Payer: Cash Price |
$694.00
|
| Rate for Payer: Cigna Commercial |
$1,152.04
|
| Rate for Payer: First Health Commercial |
$1,318.60
|
| Rate for Payer: Humana Commercial |
$1,179.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,138.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,024.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$416.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,221.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,041.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,110.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,207.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$957.72
|
| Rate for Payer: PHCS Commercial |
$1,332.48
|
| Rate for Payer: United Healthcare All Payer |
$1,221.44
|
|
|
CLSD SHOULD DISLC W/MAN W/O AN
|
Professional
|
Both
|
$1,388.00
|
|
|
Service Code
|
HCPCS 23650
|
| Hospital Charge Code |
76100485
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$157.23 |
| Max. Negotiated Rate |
$832.80 |
| Rate for Payer: Aetna Commercial |
$367.68
|
| Rate for Payer: Ambetter Exchange |
$293.24
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$157.80
|
| Rate for Payer: Anthem Medicaid |
$157.23
|
| Rate for Payer: Buckeye Individual/Medicaid |
$293.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$293.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$351.89
|
| Rate for Payer: Cash Price |
$694.00
|
| Rate for Payer: Cash Price |
$694.00
|
| Rate for Payer: Cigna Commercial |
$398.12
|
| Rate for Payer: Healthspan PPO |
$361.63
|
| Rate for Payer: Humana Medicaid |
$157.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$330.20
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$293.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$293.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$160.37
|
| Rate for Payer: Molina Healthcare Passport |
$157.23
|
| Rate for Payer: Multiplan PHCS |
$832.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$381.21
|
| Rate for Payer: UHCCP Medicaid |
$165.69
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$158.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$293.24
|
|
|
CLSD SHOULD DISLC W/MAN W/O AN
|
Facility
|
OP
|
$1,388.00
|
|
|
Service Code
|
HCPCS 23650
|
| Hospital Charge Code |
76100485
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$1,332.48 |
| Rate for Payer: Aetna Commercial |
$1,068.76
|
| Rate for Payer: Anthem Medicaid |
$477.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,082.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$694.00
|
| Rate for Payer: Cash Price |
$694.00
|
| Rate for Payer: Cigna Commercial |
$1,152.04
|
| Rate for Payer: First Health Commercial |
$1,318.60
|
| Rate for Payer: Humana Commercial |
$1,179.80
|
| Rate for Payer: Humana KY Medicaid |
$477.33
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$482.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,138.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,024.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$486.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,221.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,041.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,110.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,207.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$957.72
|
| Rate for Payer: PHCS Commercial |
$1,332.48
|
| Rate for Payer: United Healthcare All Payer |
$1,221.44
|
|
|
CLSD TIBFXPROXW/SKELTRACTION
|
Facility
|
IP
|
$3,921.00
|
|
|
Service Code
|
HCPCS 27532
|
| Hospital Charge Code |
76100869
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,176.30 |
| Max. Negotiated Rate |
$3,764.16 |
| Rate for Payer: Aetna Commercial |
$3,019.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,058.38
|
| Rate for Payer: Cash Price |
$1,960.50
|
| Rate for Payer: Cigna Commercial |
$3,254.43
|
| Rate for Payer: First Health Commercial |
$3,724.95
|
| Rate for Payer: Humana Commercial |
$3,332.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,215.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,893.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,176.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,450.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,940.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,136.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,411.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,705.49
|
| Rate for Payer: PHCS Commercial |
$3,764.16
|
| Rate for Payer: United Healthcare All Payer |
$3,450.48
|
|
|
CLSD TIBFXPROXW/SKELTRACTION
|
Facility
|
OP
|
$3,921.00
|
|
|
Service Code
|
HCPCS 27532
|
| Hospital Charge Code |
76100869
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,348.43 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$3,019.17
|
| Rate for Payer: Anthem Medicaid |
$1,348.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,058.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$1,960.50
|
| Rate for Payer: Cash Price |
$1,960.50
|
| Rate for Payer: Cigna Commercial |
$3,254.43
|
| Rate for Payer: First Health Commercial |
$3,724.95
|
| Rate for Payer: Humana Commercial |
$3,332.85
|
| Rate for Payer: Humana KY Medicaid |
$1,348.43
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,362.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,215.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,893.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,375.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,450.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,940.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,136.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,411.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,705.49
|
| Rate for Payer: PHCS Commercial |
$3,764.16
|
| Rate for Payer: United Healthcare All Payer |
$3,450.48
|
|
|
CLSD TIBFXPROXW/SKELTRACTION
|
Facility
|
OP
|
$3,921.00
|
|
|
Service Code
|
HCPCS 27532
|
| Hospital Charge Code |
45000159
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,348.43 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$3,019.17
|
| Rate for Payer: Anthem Medicaid |
$1,348.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,058.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$1,960.50
|
| Rate for Payer: Cash Price |
$1,960.50
|
| Rate for Payer: Cigna Commercial |
$3,254.43
|
| Rate for Payer: First Health Commercial |
$3,724.95
|
| Rate for Payer: Humana Commercial |
$3,332.85
|
| Rate for Payer: Humana KY Medicaid |
$1,348.43
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,362.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,215.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,893.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,375.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,450.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,940.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,136.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,411.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,705.49
|
| Rate for Payer: PHCS Commercial |
$3,764.16
|
| Rate for Payer: United Healthcare All Payer |
$3,450.48
|
|
|
CLSD TIBFXPROXW/SKELTRACTION
|
Facility
|
IP
|
$3,921.00
|
|
|
Service Code
|
HCPCS 27532
|
| Hospital Charge Code |
45000159
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,176.30 |
| Max. Negotiated Rate |
$3,764.16 |
| Rate for Payer: Aetna Commercial |
$3,019.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,058.38
|
| Rate for Payer: Cash Price |
$1,960.50
|
| Rate for Payer: Cigna Commercial |
$3,254.43
|
| Rate for Payer: First Health Commercial |
$3,724.95
|
| Rate for Payer: Humana Commercial |
$3,332.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,215.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,893.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,176.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,450.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,940.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,136.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,411.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,705.49
|
| Rate for Payer: PHCS Commercial |
$3,764.16
|
| Rate for Payer: United Healthcare All Payer |
$3,450.48
|
|
|
CLSD TRMNT TRMLLLR ANK FX WMAN
|
Facility
|
OP
|
$2,327.00
|
|
|
Service Code
|
HCPCS 27818
|
| Hospital Charge Code |
45000169
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$800.26 |
| Max. Negotiated Rate |
$2,233.92 |
| Rate for Payer: Aetna Commercial |
$1,791.79
|
| Rate for Payer: Anthem Medicaid |
$800.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,815.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| Rate for Payer: Cash Price |
$1,163.50
|
| Rate for Payer: Cash Price |
$1,163.50
|
| Rate for Payer: Cigna Commercial |
$1,931.41
|
| Rate for Payer: First Health Commercial |
$2,210.65
|
| Rate for Payer: Humana Commercial |
$1,977.95
|
| Rate for Payer: Humana KY Medicaid |
$800.26
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$808.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,908.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,717.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$816.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,047.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,745.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,861.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,024.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,605.63
|
| Rate for Payer: PHCS Commercial |
$2,233.92
|
| Rate for Payer: United Healthcare All Payer |
$2,047.76
|
|
|
CLSD TRMNT TRMLLLR ANK FX WMAN
|
Professional
|
Both
|
$1,070.00
|
|
|
Service Code
|
HCPCS 27818
|
| Hospital Charge Code |
76100943
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$320.89 |
| Max. Negotiated Rate |
$698.57 |
| Rate for Payer: Aetna Commercial |
$626.11
|
| Rate for Payer: Ambetter Exchange |
$425.80
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$320.89
|
| Rate for Payer: Anthem Medicaid |
$349.43
|
| Rate for Payer: Buckeye Individual/Medicaid |
$425.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$425.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$510.96
|
| Rate for Payer: Cash Price |
$535.00
|
| Rate for Payer: Cash Price |
$535.00
|
| Rate for Payer: Cigna Commercial |
$698.57
|
| Rate for Payer: Healthspan PPO |
$616.09
|
| Rate for Payer: Humana Medicaid |
$349.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$533.16
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$425.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$425.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$356.42
|
| Rate for Payer: Molina Healthcare Passport |
$349.43
|
| Rate for Payer: Multiplan PHCS |
$642.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$553.54
|
| Rate for Payer: UHCCP Medicaid |
$336.93
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$352.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$425.80
|
|
|
CLSD TRMNT TRMLLLR ANK FX WMAN
|
Professional
|
Both
|
$1,070.00
|
|
|
Service Code
|
HCPCS 27818
|
| Hospital Charge Code |
761P0943
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$320.89 |
| Max. Negotiated Rate |
$698.57 |
| Rate for Payer: Aetna Commercial |
$626.11
|
| Rate for Payer: Ambetter Exchange |
$425.80
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$320.89
|
| Rate for Payer: Anthem Medicaid |
$349.43
|
| Rate for Payer: Buckeye Individual/Medicaid |
$425.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$425.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$510.96
|
| Rate for Payer: Cash Price |
$535.00
|
| Rate for Payer: Cash Price |
$535.00
|
| Rate for Payer: Cigna Commercial |
$698.57
|
| Rate for Payer: Healthspan PPO |
$616.09
|
| Rate for Payer: Humana Medicaid |
$349.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$533.16
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$425.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$425.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$356.42
|
| Rate for Payer: Molina Healthcare Passport |
$349.43
|
| Rate for Payer: Multiplan PHCS |
$642.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$553.54
|
| Rate for Payer: UHCCP Medicaid |
$336.93
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$352.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$425.80
|
|
|
CLSD TRMNT TRMLLLR ANK FX WMAN
|
Facility
|
OP
|
$1,070.00
|
|
|
Service Code
|
HCPCS 27818
|
| Hospital Charge Code |
76100943
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$367.97 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$823.90
|
| Rate for Payer: Anthem Medicaid |
$367.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$834.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| Rate for Payer: Cash Price |
$535.00
|
| Rate for Payer: Cash Price |
$535.00
|
| Rate for Payer: Cigna Commercial |
$888.10
|
| Rate for Payer: First Health Commercial |
$1,016.50
|
| Rate for Payer: Humana Commercial |
$909.50
|
| Rate for Payer: Humana KY Medicaid |
$367.97
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$371.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$877.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$789.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$375.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$941.60
|
| Rate for Payer: Ohio Health Group HMO |
$802.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$856.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$930.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$738.30
|
| Rate for Payer: PHCS Commercial |
$1,027.20
|
| Rate for Payer: United Healthcare All Payer |
$941.60
|
|
|
CLSD TRMNT TRMLLLR ANK FX WMAN
|
Facility
|
IP
|
$1,070.00
|
|
|
Service Code
|
HCPCS 27818
|
| Hospital Charge Code |
76100943
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$321.00 |
| Max. Negotiated Rate |
$1,027.20 |
| Rate for Payer: Aetna Commercial |
$823.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$834.60
|
| Rate for Payer: Cash Price |
$535.00
|
| Rate for Payer: Cigna Commercial |
$888.10
|
| Rate for Payer: First Health Commercial |
$1,016.50
|
| Rate for Payer: Humana Commercial |
$909.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$877.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$789.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$321.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$941.60
|
| Rate for Payer: Ohio Health Group HMO |
$802.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$856.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$930.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$738.30
|
| Rate for Payer: PHCS Commercial |
$1,027.20
|
| Rate for Payer: United Healthcare All Payer |
$941.60
|
|
|
CLSD TRMNT TRMLLLR ANK FX WMAN
|
Facility
|
IP
|
$2,327.00
|
|
|
Service Code
|
HCPCS 27818
|
| Hospital Charge Code |
45000169
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$698.10 |
| Max. Negotiated Rate |
$2,233.92 |
| Rate for Payer: Aetna Commercial |
$1,791.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,815.06
|
| Rate for Payer: Cash Price |
$1,163.50
|
| Rate for Payer: Cigna Commercial |
$1,931.41
|
| Rate for Payer: First Health Commercial |
$2,210.65
|
| Rate for Payer: Humana Commercial |
$1,977.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,908.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,717.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$698.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,047.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,745.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,861.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,024.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,605.63
|
| Rate for Payer: PHCS Commercial |
$2,233.92
|
| Rate for Payer: United Healthcare All Payer |
$2,047.76
|
|
|
CLSD TRMT CRPMTCRPLFX/DIS THMB
|
Professional
|
Both
|
$1,155.00
|
|
|
Service Code
|
HCPCS 26645
|
| Hospital Charge Code |
761P0727
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$191.15 |
| Max. Negotiated Rate |
$693.00 |
| Rate for Payer: Aetna Commercial |
$525.18
|
| Rate for Payer: Ambetter Exchange |
$382.51
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$205.74
|
| Rate for Payer: Anthem Medicaid |
$191.15
|
| Rate for Payer: Buckeye Individual/Medicaid |
$382.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$382.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$459.01
|
| Rate for Payer: Cash Price |
$577.50
|
| Rate for Payer: Cash Price |
$577.50
|
| Rate for Payer: Cigna Commercial |
$624.75
|
| Rate for Payer: Healthspan PPO |
$512.05
|
| Rate for Payer: Humana Medicaid |
$191.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$465.40
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$382.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$382.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$194.97
|
| Rate for Payer: Molina Healthcare Passport |
$191.15
|
| Rate for Payer: Multiplan PHCS |
$693.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$497.26
|
| Rate for Payer: UHCCP Medicaid |
$216.03
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$193.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$382.51
|
|
|
CLSD TRMT CRPMTCRPLFX/DIS THMB
|
Facility
|
IP
|
$3,096.00
|
|
|
Service Code
|
HCPCS 26645
|
| Hospital Charge Code |
76100727
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$928.80 |
| Max. Negotiated Rate |
$2,972.16 |
| Rate for Payer: Aetna Commercial |
$2,383.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,414.88
|
| Rate for Payer: Cash Price |
$1,548.00
|
| Rate for Payer: Cigna Commercial |
$2,569.68
|
| Rate for Payer: First Health Commercial |
$2,941.20
|
| Rate for Payer: Humana Commercial |
$2,631.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,538.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,284.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$928.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,724.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,322.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,476.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,693.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,136.24
|
| Rate for Payer: PHCS Commercial |
$2,972.16
|
| Rate for Payer: United Healthcare All Payer |
$2,724.48
|
|
|
CLSD TRMT CRPMTCRPLFX/DIS THMB
|
Facility
|
OP
|
$1,941.00
|
|
|
Service Code
|
HCPCS 26645
|
| Hospital Charge Code |
761T0727
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$667.51 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$1,494.57
|
| Rate for Payer: Anthem Medicaid |
$667.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,513.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| 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 |
$1,478.75
|
| 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 |
$1,774.50
|
| 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 |
$1,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,688.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,339.29
|
| Rate for Payer: PHCS Commercial |
$1,863.36
|
| Rate for Payer: United Healthcare All Payer |
$1,708.08
|
|
|
CLSD TRMT CRPMTCRPLFX/DIS THMB
|
Facility
|
OP
|
$3,096.00
|
|
|
Service Code
|
HCPCS 26645
|
| Hospital Charge Code |
76100727
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,064.71 |
| Max. Negotiated Rate |
$2,972.16 |
| Rate for Payer: Aetna Commercial |
$2,383.92
|
| Rate for Payer: Anthem Medicaid |
$1,064.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,414.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| Rate for Payer: Cash Price |
$1,548.00
|
| Rate for Payer: Cash Price |
$1,548.00
|
| Rate for Payer: Cigna Commercial |
$2,569.68
|
| Rate for Payer: First Health Commercial |
$2,941.20
|
| Rate for Payer: Humana Commercial |
$2,631.60
|
| Rate for Payer: Humana KY Medicaid |
$1,064.71
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,075.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,538.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,284.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,086.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,724.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,322.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,476.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,693.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,136.24
|
| Rate for Payer: PHCS Commercial |
$2,972.16
|
| Rate for Payer: United Healthcare All Payer |
$2,724.48
|
|
|
CLSD TRMT CRPMTCRPLFX/DIS THMB
|
Facility
|
IP
|
$1,941.00
|
|
|
Service Code
|
HCPCS 26645
|
| Hospital Charge Code |
761T0727
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$582.30 |
| 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 |
$1,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,688.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,339.29
|
| Rate for Payer: PHCS Commercial |
$1,863.36
|
| Rate for Payer: United Healthcare All Payer |
$1,708.08
|
|
|
CLSD TRMT CRPMTCRPLFX/DIS THMB
|
Professional
|
Both
|
$3,096.00
|
|
|
Service Code
|
HCPCS 26645
|
| Hospital Charge Code |
76100727
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$191.15 |
| Max. Negotiated Rate |
$1,857.60 |
| Rate for Payer: Aetna Commercial |
$525.18
|
| Rate for Payer: Ambetter Exchange |
$382.51
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$205.74
|
| Rate for Payer: Anthem Medicaid |
$191.15
|
| Rate for Payer: Buckeye Individual/Medicaid |
$382.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$382.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$459.01
|
| Rate for Payer: Cash Price |
$1,548.00
|
| Rate for Payer: Cash Price |
$1,548.00
|
| Rate for Payer: Cigna Commercial |
$624.75
|
| Rate for Payer: Healthspan PPO |
$512.05
|
| Rate for Payer: Humana Medicaid |
$191.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$465.40
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$382.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$382.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$194.97
|
| Rate for Payer: Molina Healthcare Passport |
$191.15
|
| Rate for Payer: Multiplan PHCS |
$1,857.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$497.26
|
| Rate for Payer: UHCCP Medicaid |
$216.03
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$193.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$382.51
|
|
