|
CLSD TX NSL FX MNPJ WO STBLJ(T
|
Facility
|
OP
|
$2,015.00
|
|
|
Service Code
|
HCPCS 21315
|
| Hospital Charge Code |
761T0379
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$692.96 |
| Max. Negotiated Rate |
$1,934.40 |
| Rate for Payer: Aetna Commercial |
$1,551.55
|
| Rate for Payer: Anthem Medicaid |
$692.96
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,368.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,571.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,916.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,847.70
|
| Rate for Payer: Cash Price |
$1,007.50
|
| Rate for Payer: Cash Price |
$1,007.50
|
| Rate for Payer: Cigna Commercial |
$1,672.45
|
| Rate for Payer: First Health Commercial |
$1,914.25
|
| Rate for Payer: Humana Commercial |
$1,712.75
|
| Rate for Payer: Humana KY Medicaid |
$692.96
|
| Rate for Payer: Humana Medicare Advantage |
$1,368.67
|
| Rate for Payer: Kentucky WC Medicaid |
$700.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,652.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,487.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,642.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$706.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,773.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,511.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,612.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,753.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,390.35
|
| Rate for Payer: PHCS Commercial |
$1,934.40
|
| Rate for Payer: United Healthcare All Payer |
$1,773.20
|
|
|
CLSD TX NSL FX MNPJ WO STBLJ(T
|
Facility
|
IP
|
$2,015.00
|
|
|
Service Code
|
HCPCS 21315
|
| Hospital Charge Code |
761T0379
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$604.50 |
| Max. Negotiated Rate |
$1,934.40 |
| Rate for Payer: Aetna Commercial |
$1,551.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,571.70
|
| Rate for Payer: Cash Price |
$1,007.50
|
| Rate for Payer: Cigna Commercial |
$1,672.45
|
| Rate for Payer: First Health Commercial |
$1,914.25
|
| Rate for Payer: Humana Commercial |
$1,712.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,652.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,487.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$604.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,773.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,511.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,612.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,753.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,390.35
|
| Rate for Payer: PHCS Commercial |
$1,934.40
|
| Rate for Payer: United Healthcare All Payer |
$1,773.20
|
|
|
CLSD TX NSL FX W/MNPJ&STABLJ
|
Facility
|
OP
|
$3,912.00
|
|
|
Service Code
|
HCPCS 21320
|
| Hospital Charge Code |
45000101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,345.34 |
| Max. Negotiated Rate |
$4,195.14 |
| Rate for Payer: Aetna Commercial |
$3,012.24
|
| Rate for Payer: Anthem Medicaid |
$1,345.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,051.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,195.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,045.32
|
| Rate for Payer: Cash Price |
$1,956.00
|
| Rate for Payer: Cash Price |
$1,956.00
|
| Rate for Payer: Cigna Commercial |
$3,246.96
|
| Rate for Payer: First Health Commercial |
$3,716.40
|
| Rate for Payer: Humana Commercial |
$3,325.20
|
| Rate for Payer: Humana KY Medicaid |
$1,345.34
|
| Rate for Payer: Humana Medicare Advantage |
$2,996.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,359.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,207.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,887.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,595.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,372.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,442.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,934.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,129.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,403.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,699.28
|
| Rate for Payer: PHCS Commercial |
$3,755.52
|
| Rate for Payer: United Healthcare All Payer |
$3,442.56
|
|
|
CLSD TX NSL FX W/MNPJ&STABLJ
|
Facility
|
IP
|
$4,562.00
|
|
|
Service Code
|
HCPCS 21320
|
| Hospital Charge Code |
76100380
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,368.60 |
| Max. Negotiated Rate |
$4,379.52 |
| Rate for Payer: Aetna Commercial |
$3,512.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,558.36
|
| Rate for Payer: Cash Price |
$2,281.00
|
| Rate for Payer: Cigna Commercial |
$3,786.46
|
| Rate for Payer: First Health Commercial |
$4,333.90
|
| Rate for Payer: Humana Commercial |
$3,877.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,740.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,366.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,368.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,014.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,421.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,649.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,968.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,147.78
|
| Rate for Payer: PHCS Commercial |
$4,379.52
|
| Rate for Payer: United Healthcare All Payer |
$4,014.56
|
|
|
CLSD TX NSL FX W/MNPJ&STABLJ
|
Facility
|
IP
|
$3,912.00
|
|
|
Service Code
|
HCPCS 21320
|
| Hospital Charge Code |
45000101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,173.60 |
| Max. Negotiated Rate |
$3,755.52 |
| Rate for Payer: Aetna Commercial |
$3,012.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,051.36
|
| Rate for Payer: Cash Price |
$1,956.00
|
| Rate for Payer: Cigna Commercial |
$3,246.96
|
| Rate for Payer: First Health Commercial |
$3,716.40
|
| Rate for Payer: Humana Commercial |
$3,325.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,207.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,887.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,173.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,442.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,934.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,129.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,403.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,699.28
|
| Rate for Payer: PHCS Commercial |
$3,755.52
|
| Rate for Payer: United Healthcare All Payer |
$3,442.56
|
|
|
CLSD TX NSL FX W/MNPJ&STABLJ
|
Professional
|
Both
|
$4,562.00
|
|
|
Service Code
|
HCPCS 21320
|
| Hospital Charge Code |
76100380
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$55.52 |
| Max. Negotiated Rate |
$2,737.20 |
| Rate for Payer: Aetna Commercial |
$197.27
|
| Rate for Payer: Ambetter Exchange |
$89.76
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$55.52
|
| Rate for Payer: Anthem Medicaid |
$124.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$89.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$89.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$107.71
|
| Rate for Payer: Cash Price |
$2,281.00
|
| Rate for Payer: Cash Price |
$2,281.00
|
| Rate for Payer: Cigna Commercial |
$218.36
|
| Rate for Payer: Healthspan PPO |
$310.55
|
| Rate for Payer: Humana Medicaid |
$124.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$170.38
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$89.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$89.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$126.64
|
| Rate for Payer: Molina Healthcare Passport |
$124.16
|
| Rate for Payer: Multiplan PHCS |
$2,737.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$116.69
|
| Rate for Payer: UHCCP Medicaid |
$58.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$125.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$89.76
|
|
|
CLSD TX NSL FX W/MNPJ&STABLJ
|
Facility
|
OP
|
$4,562.00
|
|
|
Service Code
|
HCPCS 21320
|
| Hospital Charge Code |
76100380
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,568.87 |
| Max. Negotiated Rate |
$4,379.52 |
| Rate for Payer: Aetna Commercial |
$3,512.74
|
| Rate for Payer: Anthem Medicaid |
$1,568.87
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,558.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,195.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,045.32
|
| Rate for Payer: Cash Price |
$2,281.00
|
| Rate for Payer: Cash Price |
$2,281.00
|
| Rate for Payer: Cigna Commercial |
$3,786.46
|
| Rate for Payer: First Health Commercial |
$4,333.90
|
| Rate for Payer: Humana Commercial |
$3,877.70
|
| Rate for Payer: Humana KY Medicaid |
$1,568.87
|
| Rate for Payer: Humana Medicare Advantage |
$2,996.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,584.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,740.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,366.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,595.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,600.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,014.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,421.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,649.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,968.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,147.78
|
| Rate for Payer: PHCS Commercial |
$4,379.52
|
| Rate for Payer: United Healthcare All Payer |
$4,014.56
|
|
|
CLSD TX NSL FX W/MNPJ&STABLJ(P
|
Professional
|
Both
|
$650.00
|
|
|
Service Code
|
HCPCS 21320
|
| Hospital Charge Code |
761P0380
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$55.52 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Aetna Commercial |
$197.27
|
| Rate for Payer: Ambetter Exchange |
$89.76
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$55.52
|
| Rate for Payer: Anthem Medicaid |
$124.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$89.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$89.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$107.71
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cigna Commercial |
$218.36
|
| Rate for Payer: Healthspan PPO |
$310.55
|
| Rate for Payer: Humana Medicaid |
$124.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$170.38
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$89.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$89.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$126.64
|
| Rate for Payer: Molina Healthcare Passport |
$124.16
|
| Rate for Payer: Multiplan PHCS |
$390.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$116.69
|
| Rate for Payer: UHCCP Medicaid |
$58.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$125.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$89.76
|
|
|
CLSD TX NSL FX W/MNPJ&STABLJ(T
|
Facility
|
OP
|
$3,912.00
|
|
|
Service Code
|
HCPCS 21320
|
| Hospital Charge Code |
761T0380
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,345.34 |
| Max. Negotiated Rate |
$4,195.14 |
| Rate for Payer: Aetna Commercial |
$3,012.24
|
| Rate for Payer: Anthem Medicaid |
$1,345.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,051.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,195.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,045.32
|
| Rate for Payer: Cash Price |
$1,956.00
|
| Rate for Payer: Cash Price |
$1,956.00
|
| Rate for Payer: Cigna Commercial |
$3,246.96
|
| Rate for Payer: First Health Commercial |
$3,716.40
|
| Rate for Payer: Humana Commercial |
$3,325.20
|
| Rate for Payer: Humana KY Medicaid |
$1,345.34
|
| Rate for Payer: Humana Medicare Advantage |
$2,996.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,359.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,207.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,887.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,595.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,372.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,442.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,934.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,129.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,403.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,699.28
|
| Rate for Payer: PHCS Commercial |
$3,755.52
|
| Rate for Payer: United Healthcare All Payer |
$3,442.56
|
|
|
CLSD TX NSL FX W/MNPJ&STABLJ(T
|
Facility
|
IP
|
$3,912.00
|
|
|
Service Code
|
HCPCS 21320
|
| Hospital Charge Code |
761T0380
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,173.60 |
| Max. Negotiated Rate |
$3,755.52 |
| Rate for Payer: Aetna Commercial |
$3,012.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,051.36
|
| Rate for Payer: Cash Price |
$1,956.00
|
| Rate for Payer: Cigna Commercial |
$3,246.96
|
| Rate for Payer: First Health Commercial |
$3,716.40
|
| Rate for Payer: Humana Commercial |
$3,325.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,207.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,887.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,173.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,442.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,934.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,129.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,403.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,699.28
|
| Rate for Payer: PHCS Commercial |
$3,755.52
|
| Rate for Payer: United Healthcare All Payer |
$3,442.56
|
|
|
CLSD TXPATARDISLOCATIONW/OANES
|
Facility
|
OP
|
$528.00
|
|
|
Service Code
|
HCPCS 27560
|
| Hospital Charge Code |
45000162
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$181.58 |
| Max. Negotiated Rate |
$506.88 |
| Rate for Payer: Aetna Commercial |
$406.56
|
| Rate for Payer: Anthem Medicaid |
$181.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$411.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cigna Commercial |
$438.24
|
| Rate for Payer: First Health Commercial |
$501.60
|
| Rate for Payer: Humana Commercial |
$448.80
|
| Rate for Payer: Humana KY Medicaid |
$181.58
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$183.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$432.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$389.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$185.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$464.64
|
| Rate for Payer: Ohio Health Group HMO |
$396.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$422.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$459.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$364.32
|
| Rate for Payer: PHCS Commercial |
$506.88
|
| Rate for Payer: United Healthcare All Payer |
$464.64
|
|
|
CLSD TXPATARDISLOCATIONW/OANES
|
Facility
|
OP
|
$496.00
|
|
|
Service Code
|
HCPCS 27560
|
| Hospital Charge Code |
76100876
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$170.57 |
| Max. Negotiated Rate |
$476.16 |
| Rate for Payer: Aetna Commercial |
$381.92
|
| Rate for Payer: Anthem Medicaid |
$170.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$386.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cigna Commercial |
$411.68
|
| Rate for Payer: First Health Commercial |
$471.20
|
| Rate for Payer: Humana Commercial |
$421.60
|
| Rate for Payer: Humana KY Medicaid |
$170.57
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$172.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$406.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$366.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$174.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$436.48
|
| Rate for Payer: Ohio Health Group HMO |
$372.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$396.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$431.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$342.24
|
| Rate for Payer: PHCS Commercial |
$476.16
|
| Rate for Payer: United Healthcare All Payer |
$436.48
|
|
|
CLSD TXPATARDISLOCATIONW/OANES
|
Facility
|
IP
|
$528.00
|
|
|
Service Code
|
HCPCS 27560
|
| Hospital Charge Code |
45000162
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$158.40 |
| Max. Negotiated Rate |
$506.88 |
| Rate for Payer: Aetna Commercial |
$406.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$411.84
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cigna Commercial |
$438.24
|
| Rate for Payer: First Health Commercial |
$501.60
|
| Rate for Payer: Humana Commercial |
$448.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$432.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$389.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$158.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$464.64
|
| Rate for Payer: Ohio Health Group HMO |
$396.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$422.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$459.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$364.32
|
| Rate for Payer: PHCS Commercial |
$506.88
|
| Rate for Payer: United Healthcare All Payer |
$464.64
|
|
|
CLSD TXPATARDISLOCATIONW/OANES
|
Facility
|
IP
|
$496.00
|
|
|
Service Code
|
HCPCS 27560
|
| Hospital Charge Code |
76100876
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$148.80 |
| Max. Negotiated Rate |
$476.16 |
| Rate for Payer: Aetna Commercial |
$381.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$386.88
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cigna Commercial |
$411.68
|
| Rate for Payer: First Health Commercial |
$471.20
|
| Rate for Payer: Humana Commercial |
$421.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$406.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$366.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$148.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$436.48
|
| Rate for Payer: Ohio Health Group HMO |
$372.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$396.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$431.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$342.24
|
| Rate for Payer: PHCS Commercial |
$476.16
|
| Rate for Payer: United Healthcare All Payer |
$436.48
|
|
|
CLSD TX PELVIC RING FX
|
Facility
|
IP
|
$1,097.00
|
|
|
Service Code
|
HCPCS 27197
|
| Hospital Charge Code |
76100786
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$329.10 |
| Max. Negotiated Rate |
$1,053.12 |
| Rate for Payer: Aetna Commercial |
$844.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$855.66
|
| Rate for Payer: Cash Price |
$548.50
|
| Rate for Payer: Cigna Commercial |
$910.51
|
| Rate for Payer: First Health Commercial |
$1,042.15
|
| Rate for Payer: Humana Commercial |
$932.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$899.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$809.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$329.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$965.36
|
| Rate for Payer: Ohio Health Group HMO |
$822.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$877.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$954.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$756.93
|
| Rate for Payer: PHCS Commercial |
$1,053.12
|
| Rate for Payer: United Healthcare All Payer |
$965.36
|
|
|
CLSD TX PELVIC RING FX
|
Professional
|
Both
|
$1,097.00
|
|
|
Service Code
|
HCPCS 27197
|
| Hospital Charge Code |
76100786
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$92.27 |
| Max. Negotiated Rate |
$658.20 |
| Rate for Payer: Ambetter Exchange |
$124.30
|
| Rate for Payer: Anthem Medicaid |
$92.27
|
| Rate for Payer: Buckeye Individual/Medicaid |
$124.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$124.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$149.16
|
| Rate for Payer: Cash Price |
$548.50
|
| Rate for Payer: Cash Price |
$548.50
|
| Rate for Payer: Cigna Commercial |
$216.61
|
| Rate for Payer: Humana Medicaid |
$92.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$152.26
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$124.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$124.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$94.12
|
| Rate for Payer: Molina Healthcare Passport |
$92.27
|
| Rate for Payer: Multiplan PHCS |
$658.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$161.59
|
| Rate for Payer: UHCCP Medicaid |
$383.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$93.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.30
|
|
|
CLSD TX PELVIC RING FX
|
Facility
|
OP
|
$1,097.00
|
|
|
Service Code
|
HCPCS 27197
|
| Hospital Charge Code |
76100786
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$1,053.12 |
| Rate for Payer: Aetna Commercial |
$844.69
|
| Rate for Payer: Anthem Medicaid |
$377.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$855.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$548.50
|
| Rate for Payer: Cash Price |
$548.50
|
| Rate for Payer: Cigna Commercial |
$910.51
|
| Rate for Payer: First Health Commercial |
$1,042.15
|
| Rate for Payer: Humana Commercial |
$932.45
|
| Rate for Payer: Humana KY Medicaid |
$377.26
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$381.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$899.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$809.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$384.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$965.36
|
| Rate for Payer: Ohio Health Group HMO |
$822.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$877.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$954.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$756.93
|
| Rate for Payer: PHCS Commercial |
$1,053.12
|
| Rate for Payer: United Healthcare All Payer |
$965.36
|
|
|
CLSD TX PELVIC RING FX(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 27197
|
| Hospital Charge Code |
761P0786
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$92.27 |
| Max. Negotiated Rate |
$216.61 |
| Rate for Payer: Ambetter Exchange |
$124.30
|
| Rate for Payer: Anthem Medicaid |
$92.27
|
| Rate for Payer: Buckeye Individual/Medicaid |
$124.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$124.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$149.16
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$216.61
|
| Rate for Payer: Humana Medicaid |
$92.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$152.26
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$124.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$124.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$94.12
|
| Rate for Payer: Molina Healthcare Passport |
$92.27
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$161.59
|
| Rate for Payer: UHCCP Medicaid |
$105.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$93.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$124.30
|
|
|
CLSD TX PELVIC RING FX(T
|
Facility
|
IP
|
$797.00
|
|
|
Service Code
|
HCPCS 27197
|
| Hospital Charge Code |
761T0786
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$239.10 |
| Max. Negotiated Rate |
$765.12 |
| Rate for Payer: Aetna Commercial |
$613.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$621.66
|
| Rate for Payer: Cash Price |
$398.50
|
| Rate for Payer: Cigna Commercial |
$661.51
|
| Rate for Payer: First Health Commercial |
$757.15
|
| Rate for Payer: Humana Commercial |
$677.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$653.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$588.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$239.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$701.36
|
| Rate for Payer: Ohio Health Group HMO |
$597.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$637.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$693.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$549.93
|
| Rate for Payer: PHCS Commercial |
$765.12
|
| Rate for Payer: United Healthcare All Payer |
$701.36
|
|
|
CLSD TX PELVIC RING FX(T
|
Facility
|
OP
|
$797.00
|
|
|
Service Code
|
HCPCS 27197
|
| Hospital Charge Code |
761T0786
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$765.12 |
| Rate for Payer: Aetna Commercial |
$613.69
|
| Rate for Payer: Anthem Medicaid |
$274.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$621.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$398.50
|
| Rate for Payer: Cash Price |
$398.50
|
| Rate for Payer: Cigna Commercial |
$661.51
|
| Rate for Payer: First Health Commercial |
$757.15
|
| Rate for Payer: Humana Commercial |
$677.45
|
| Rate for Payer: Humana KY Medicaid |
$274.09
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$276.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$653.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$588.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$279.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$701.36
|
| Rate for Payer: Ohio Health Group HMO |
$597.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$637.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$693.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$549.93
|
| Rate for Payer: PHCS Commercial |
$765.12
|
| Rate for Payer: United Healthcare All Payer |
$701.36
|
|
|
CLSD TXPOSTRIORMALLEOLUSFXWMAN
|
Facility
|
IP
|
$318.00
|
|
|
Service Code
|
HCPCS 27788
|
| Hospital Charge Code |
45000167
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$95.40 |
| Max. Negotiated Rate |
$305.28 |
| Rate for Payer: Aetna Commercial |
$244.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$248.04
|
| Rate for Payer: Cash Price |
$159.00
|
| Rate for Payer: Cigna Commercial |
$263.94
|
| Rate for Payer: First Health Commercial |
$302.10
|
| Rate for Payer: Humana Commercial |
$270.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$260.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$234.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$95.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$279.84
|
| Rate for Payer: Ohio Health Group HMO |
$238.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$254.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$276.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$219.42
|
| Rate for Payer: PHCS Commercial |
$305.28
|
| Rate for Payer: United Healthcare All Payer |
$279.84
|
|
|
CLSD TXPOSTRIORMALLEOLUSFXWMAN
|
Facility
|
OP
|
$318.00
|
|
|
Service Code
|
HCPCS 27788
|
| Hospital Charge Code |
45000167
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$109.36 |
| Max. Negotiated Rate |
$310.30 |
| Rate for Payer: Aetna Commercial |
$244.86
|
| Rate for Payer: Anthem Medicaid |
$109.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$248.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$159.00
|
| Rate for Payer: Cash Price |
$159.00
|
| Rate for Payer: Cigna Commercial |
$263.94
|
| Rate for Payer: First Health Commercial |
$302.10
|
| Rate for Payer: Humana Commercial |
$270.30
|
| Rate for Payer: Humana KY Medicaid |
$109.36
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$110.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$260.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$234.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$111.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$279.84
|
| Rate for Payer: Ohio Health Group HMO |
$238.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$254.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$276.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$219.42
|
| Rate for Payer: PHCS Commercial |
$305.28
|
| Rate for Payer: United Healthcare All Payer |
$279.84
|
|
|
CLSD TXPOSTRIORMALLEOLUSFXWMAN
|
Facility
|
OP
|
$320.00
|
|
|
Service Code
|
HCPCS 27788
|
| Hospital Charge Code |
76100937
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$110.05 |
| Max. Negotiated Rate |
$310.30 |
| Rate for Payer: Aetna Commercial |
$246.40
|
| Rate for Payer: Anthem Medicaid |
$110.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$249.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cigna Commercial |
$265.60
|
| Rate for Payer: First Health Commercial |
$304.00
|
| Rate for Payer: Humana Commercial |
$272.00
|
| Rate for Payer: Humana KY Medicaid |
$110.05
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$111.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$262.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$236.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$112.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$281.60
|
| Rate for Payer: Ohio Health Group HMO |
$240.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$256.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$278.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$220.80
|
| Rate for Payer: PHCS Commercial |
$307.20
|
| Rate for Payer: United Healthcare All Payer |
$281.60
|
|
|
CLSD TXPOSTRIORMALLEOLUSFXWMAN
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
HCPCS 27788
|
| Hospital Charge Code |
76100937
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$96.00 |
| Max. Negotiated Rate |
$307.20 |
| Rate for Payer: Aetna Commercial |
$246.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$249.60
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cigna Commercial |
$265.60
|
| Rate for Payer: First Health Commercial |
$304.00
|
| Rate for Payer: Humana Commercial |
$272.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$262.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$236.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$96.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$281.60
|
| Rate for Payer: Ohio Health Group HMO |
$240.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$256.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$278.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$220.80
|
| Rate for Payer: PHCS Commercial |
$307.20
|
| Rate for Payer: United Healthcare All Payer |
$281.60
|
|
|
CLSD TXSPONDISLOHIPWMANIPWANES
|
Facility
|
IP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 27257
|
| Hospital Charge Code |
76100801
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$633.30 |
| 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 |
$1,688.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,836.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,456.59
|
| Rate for Payer: PHCS Commercial |
$2,026.56
|
| Rate for Payer: United Healthcare All Payer |
$1,857.68
|
|
