|
CLSD TXSPONDISLOHIPWMANIPWANES
|
Facility
|
IP
|
$2,172.00
|
|
|
Service Code
|
HCPCS 27257
|
| Hospital Charge Code |
45000153
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$651.60 |
| Max. Negotiated Rate |
$2,085.12 |
| Rate for Payer: Aetna Commercial |
$1,672.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,694.16
|
| Rate for Payer: Cash Price |
$1,086.00
|
| Rate for Payer: Cigna Commercial |
$1,802.76
|
| Rate for Payer: First Health Commercial |
$2,063.40
|
| Rate for Payer: Humana Commercial |
$1,846.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,781.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,602.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,911.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,629.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,737.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,889.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,498.68
|
| Rate for Payer: PHCS Commercial |
$2,085.12
|
| Rate for Payer: United Healthcare All Payer |
$1,911.36
|
|
|
CLSD TXSPONDISLOHIPWMANIPWANES
|
Facility
|
OP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 27257
|
| Hospital Charge Code |
76100801
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$725.97 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$1,625.47
|
| Rate for Payer: Anthem Medicaid |
$725.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,646.58
|
| 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 |
$1,055.50
|
| 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 |
$1,478.75
|
| 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 |
$1,774.50
|
| 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 |
$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
|
|
|
CLSD TXSPONDISLOHIPWMANIPWANES
|
Facility
|
OP
|
$2,172.00
|
|
|
Service Code
|
HCPCS 27257
|
| Hospital Charge Code |
45000153
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$746.95 |
| Max. Negotiated Rate |
$2,085.12 |
| Rate for Payer: Aetna Commercial |
$1,672.44
|
| Rate for Payer: Anthem Medicaid |
$746.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,694.16
|
| 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 |
$1,086.00
|
| Rate for Payer: Cash Price |
$1,086.00
|
| Rate for Payer: Cigna Commercial |
$1,802.76
|
| Rate for Payer: First Health Commercial |
$2,063.40
|
| Rate for Payer: Humana Commercial |
$1,846.20
|
| Rate for Payer: Humana KY Medicaid |
$746.95
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$754.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,781.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,602.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$761.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,911.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,629.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,737.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,889.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,498.68
|
| Rate for Payer: PHCS Commercial |
$2,085.12
|
| Rate for Payer: United Healthcare All Payer |
$1,911.36
|
|
|
CLSD TX TALOJNTDISL W/OANES
|
Facility
|
IP
|
$309.00
|
|
|
Service Code
|
HCPCS 28570
|
| Hospital Charge Code |
45000180
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$92.70 |
| Max. Negotiated Rate |
$296.64 |
| Rate for Payer: Aetna Commercial |
$237.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$241.02
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cigna Commercial |
$256.47
|
| Rate for Payer: First Health Commercial |
$293.55
|
| Rate for Payer: Humana Commercial |
$262.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$253.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$228.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$92.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$271.92
|
| Rate for Payer: Ohio Health Group HMO |
$231.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$247.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$268.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$213.21
|
| Rate for Payer: PHCS Commercial |
$296.64
|
| Rate for Payer: United Healthcare All Payer |
$271.92
|
|
|
CLSD TX TALOJNTDISL W/OANES
|
Facility
|
IP
|
$309.00
|
|
|
Service Code
|
HCPCS 28570
|
| Hospital Charge Code |
76101030
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$92.70 |
| Max. Negotiated Rate |
$296.64 |
| Rate for Payer: Aetna Commercial |
$237.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$241.02
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cigna Commercial |
$256.47
|
| Rate for Payer: First Health Commercial |
$293.55
|
| Rate for Payer: Humana Commercial |
$262.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$253.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$228.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$92.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$271.92
|
| Rate for Payer: Ohio Health Group HMO |
$231.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$247.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$268.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$213.21
|
| Rate for Payer: PHCS Commercial |
$296.64
|
| Rate for Payer: United Healthcare All Payer |
$271.92
|
|
|
CLSD TX TALOJNTDISL W/OANES
|
Facility
|
OP
|
$309.00
|
|
|
Service Code
|
HCPCS 28570
|
| Hospital Charge Code |
45000180
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$106.27 |
| Max. Negotiated Rate |
$310.30 |
| Rate for Payer: Aetna Commercial |
$237.93
|
| Rate for Payer: Anthem Medicaid |
$106.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$241.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cigna Commercial |
$256.47
|
| Rate for Payer: First Health Commercial |
$293.55
|
| Rate for Payer: Humana Commercial |
$262.65
|
| Rate for Payer: Humana KY Medicaid |
$106.27
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$107.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$253.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$228.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$108.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$271.92
|
| Rate for Payer: Ohio Health Group HMO |
$231.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$247.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$268.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$213.21
|
| Rate for Payer: PHCS Commercial |
$296.64
|
| Rate for Payer: United Healthcare All Payer |
$271.92
|
|
|
CLSD TX TALOJNTDISL W/OANES
|
Facility
|
OP
|
$309.00
|
|
|
Service Code
|
HCPCS 28570
|
| Hospital Charge Code |
76101030
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$106.27 |
| Max. Negotiated Rate |
$310.30 |
| Rate for Payer: Aetna Commercial |
$237.93
|
| Rate for Payer: Anthem Medicaid |
$106.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$241.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cigna Commercial |
$256.47
|
| Rate for Payer: First Health Commercial |
$293.55
|
| Rate for Payer: Humana Commercial |
$262.65
|
| Rate for Payer: Humana KY Medicaid |
$106.27
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$107.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$253.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$228.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$108.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$271.92
|
| Rate for Payer: Ohio Health Group HMO |
$231.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$247.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$268.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$213.21
|
| Rate for Payer: PHCS Commercial |
$296.64
|
| Rate for Payer: United Healthcare All Payer |
$271.92
|
|
|
CLSD TX TALUS FRACTURE W MANIP
|
Facility
|
IP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 28435
|
| Hospital Charge Code |
45000175
|
|
Hospital Revenue Code
|
450
|
| 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
|
|
|
CLSD TX TALUS FRACTURE W MANIP
|
Facility
|
OP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 28435
|
| Hospital Charge Code |
76101015
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$725.97 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$1,625.47
|
| Rate for Payer: Anthem Medicaid |
$725.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,646.58
|
| 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 |
$1,055.50
|
| 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 |
$1,478.75
|
| 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 |
$1,774.50
|
| 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 |
$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
|
|
|
CLSD TX TALUS FRACTURE W MANIP
|
Facility
|
OP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 28435
|
| Hospital Charge Code |
45000175
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$725.97 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$1,625.47
|
| Rate for Payer: Anthem Medicaid |
$725.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,646.58
|
| 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 |
$1,055.50
|
| 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 |
$1,478.75
|
| 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 |
$1,774.50
|
| 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 |
$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
|
|
|
CLSD TX TALUS FRACTURE W MANIP
|
Facility
|
IP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 28435
|
| Hospital Charge Code |
76101015
|
|
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
|
|
|
CLSD TXTRAMATICDISLOHIPW/OANES
|
Facility
|
IP
|
$392.00
|
|
|
Service Code
|
HCPCS 27250
|
| Hospital Charge Code |
45000151
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$117.60 |
| Max. Negotiated Rate |
$376.32 |
| Rate for Payer: Aetna Commercial |
$301.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$305.76
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cigna Commercial |
$325.36
|
| Rate for Payer: First Health Commercial |
$372.40
|
| Rate for Payer: Humana Commercial |
$333.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$321.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$289.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$344.96
|
| Rate for Payer: Ohio Health Group HMO |
$294.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$313.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$341.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$270.48
|
| Rate for Payer: PHCS Commercial |
$376.32
|
| Rate for Payer: United Healthcare All Payer |
$344.96
|
|
|
CLSD TXTRAMATICDISLOHIPW/OANES
|
Facility
|
OP
|
$392.00
|
|
|
Service Code
|
HCPCS 27250
|
| Hospital Charge Code |
45000151
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$134.81 |
| Max. Negotiated Rate |
$376.32 |
| Rate for Payer: Aetna Commercial |
$301.84
|
| Rate for Payer: Anthem Medicaid |
$134.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$305.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cigna Commercial |
$325.36
|
| Rate for Payer: First Health Commercial |
$372.40
|
| Rate for Payer: Humana Commercial |
$333.20
|
| Rate for Payer: Humana KY Medicaid |
$134.81
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$136.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$321.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$289.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$137.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$344.96
|
| Rate for Payer: Ohio Health Group HMO |
$294.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$313.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$341.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$270.48
|
| Rate for Payer: PHCS Commercial |
$376.32
|
| Rate for Payer: United Healthcare All Payer |
$344.96
|
|
|
CLSD TXTRAMATICDISLOHIPW/OANES
|
Facility
|
OP
|
$368.00
|
|
|
Service Code
|
HCPCS 27250
|
| Hospital Charge Code |
76100798
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$126.56 |
| Max. Negotiated Rate |
$353.28 |
| Rate for Payer: Aetna Commercial |
$283.36
|
| Rate for Payer: Anthem Medicaid |
$126.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$287.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cigna Commercial |
$305.44
|
| Rate for Payer: First Health Commercial |
$349.60
|
| Rate for Payer: Humana Commercial |
$312.80
|
| Rate for Payer: Humana KY Medicaid |
$126.56
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$127.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$301.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$271.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$129.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$323.84
|
| Rate for Payer: Ohio Health Group HMO |
$276.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$294.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$320.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$253.92
|
| Rate for Payer: PHCS Commercial |
$353.28
|
| Rate for Payer: United Healthcare All Payer |
$323.84
|
|
|
CLSD TXTRAMATICDISLOHIPW/OANES
|
Facility
|
IP
|
$368.00
|
|
|
Service Code
|
HCPCS 27250
|
| Hospital Charge Code |
76100798
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$110.40 |
| Max. Negotiated Rate |
$353.28 |
| Rate for Payer: Aetna Commercial |
$283.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$287.04
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cigna Commercial |
$305.44
|
| Rate for Payer: First Health Commercial |
$349.60
|
| Rate for Payer: Humana Commercial |
$312.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$301.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$271.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$110.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$323.84
|
| Rate for Payer: Ohio Health Group HMO |
$276.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$294.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$320.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$253.92
|
| Rate for Payer: PHCS Commercial |
$353.28
|
| Rate for Payer: United Healthcare All Payer |
$323.84
|
|
|
CLSRE LAC VESTIBULEMOUTH 2.5 <
|
Facility
|
OP
|
$304.00
|
|
|
Service Code
|
HCPCS 40830
|
| Hospital Charge Code |
45000249
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$104.55 |
| Max. Negotiated Rate |
$300.40 |
| Rate for Payer: Aetna Commercial |
$234.08
|
| Rate for Payer: Anthem Medicaid |
$104.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$214.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$237.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$300.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$289.67
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cigna Commercial |
$252.32
|
| Rate for Payer: First Health Commercial |
$288.80
|
| Rate for Payer: Humana Commercial |
$258.40
|
| Rate for Payer: Humana KY Medicaid |
$104.55
|
| Rate for Payer: Humana Medicare Advantage |
$214.57
|
| Rate for Payer: Kentucky WC Medicaid |
$105.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$249.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$224.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$257.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$106.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$267.52
|
| Rate for Payer: Ohio Health Group HMO |
$228.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$243.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$264.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$209.76
|
| Rate for Payer: PHCS Commercial |
$291.84
|
| Rate for Payer: United Healthcare All Payer |
$267.52
|
|
|
CLSRE LAC VESTIBULEMOUTH 2.5 <
|
Facility
|
IP
|
$292.00
|
|
|
Service Code
|
HCPCS 40830
|
| Hospital Charge Code |
76101641
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$87.60 |
| Max. Negotiated Rate |
$280.32 |
| Rate for Payer: Aetna Commercial |
$224.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$227.76
|
| Rate for Payer: Cash Price |
$146.00
|
| Rate for Payer: Cigna Commercial |
$242.36
|
| Rate for Payer: First Health Commercial |
$277.40
|
| Rate for Payer: Humana Commercial |
$248.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$239.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$215.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$256.96
|
| Rate for Payer: Ohio Health Group HMO |
$219.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$233.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$254.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$201.48
|
| Rate for Payer: PHCS Commercial |
$280.32
|
| Rate for Payer: United Healthcare All Payer |
$256.96
|
|
|
CLSRE LAC VESTIBULEMOUTH 2.5 <
|
Professional
|
Both
|
$292.00
|
|
|
Service Code
|
HCPCS 40830
|
| Hospital Charge Code |
76101641
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$69.85 |
| Max. Negotiated Rate |
$276.35 |
| Rate for Payer: Aetna Commercial |
$224.40
|
| Rate for Payer: Ambetter Exchange |
$137.20
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$88.71
|
| Rate for Payer: Anthem Medicaid |
$69.85
|
| Rate for Payer: Buckeye Individual/Medicaid |
$137.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$137.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$164.64
|
| Rate for Payer: Cash Price |
$146.00
|
| Rate for Payer: Cash Price |
$146.00
|
| Rate for Payer: Cigna Commercial |
$225.10
|
| Rate for Payer: Healthspan PPO |
$276.35
|
| Rate for Payer: Humana Medicaid |
$69.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$203.38
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$137.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$71.25
|
| Rate for Payer: Molina Healthcare Passport |
$69.85
|
| Rate for Payer: Multiplan PHCS |
$175.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$178.36
|
| Rate for Payer: UHCCP Medicaid |
$93.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$70.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$137.20
|
|
|
CLSRE LAC VESTIBULEMOUTH 2.5 <
|
Facility
|
OP
|
$292.00
|
|
|
Service Code
|
HCPCS 40830
|
| Hospital Charge Code |
76101641
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$100.42 |
| Max. Negotiated Rate |
$300.40 |
| Rate for Payer: Aetna Commercial |
$224.84
|
| Rate for Payer: Anthem Medicaid |
$100.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$214.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$227.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$300.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$289.67
|
| Rate for Payer: Cash Price |
$146.00
|
| Rate for Payer: Cash Price |
$146.00
|
| Rate for Payer: Cigna Commercial |
$242.36
|
| Rate for Payer: First Health Commercial |
$277.40
|
| Rate for Payer: Humana Commercial |
$248.20
|
| Rate for Payer: Humana KY Medicaid |
$100.42
|
| Rate for Payer: Humana Medicare Advantage |
$214.57
|
| Rate for Payer: Kentucky WC Medicaid |
$101.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$239.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$215.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$257.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$102.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$256.96
|
| Rate for Payer: Ohio Health Group HMO |
$219.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$233.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$254.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$201.48
|
| Rate for Payer: PHCS Commercial |
$280.32
|
| Rate for Payer: United Healthcare All Payer |
$256.96
|
|
|
CLSRE LAC VESTIBULEMOUTH 2.5 <
|
Facility
|
IP
|
$304.00
|
|
|
Service Code
|
HCPCS 40830
|
| Hospital Charge Code |
45000249
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$91.20 |
| Max. Negotiated Rate |
$291.84 |
| Rate for Payer: Aetna Commercial |
$234.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$237.12
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cigna Commercial |
$252.32
|
| Rate for Payer: First Health Commercial |
$288.80
|
| Rate for Payer: Humana Commercial |
$258.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$249.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$224.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$91.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$267.52
|
| Rate for Payer: Ohio Health Group HMO |
$228.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$243.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$264.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$209.76
|
| Rate for Payer: PHCS Commercial |
$291.84
|
| Rate for Payer: United Healthcare All Payer |
$267.52
|
|
|
CLTX ARTC FX MTCRPHL/IPH JT
|
Facility
|
OP
|
$1,265.00
|
|
|
Service Code
|
HCPCS 26740
|
| Hospital Charge Code |
76100740
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$1,214.40 |
| Rate for Payer: Aetna Commercial |
$974.05
|
| Rate for Payer: Anthem Medicaid |
$435.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$986.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$632.50
|
| Rate for Payer: Cash Price |
$632.50
|
| Rate for Payer: Cigna Commercial |
$1,049.95
|
| Rate for Payer: First Health Commercial |
$1,201.75
|
| Rate for Payer: Humana Commercial |
$1,075.25
|
| Rate for Payer: Humana KY Medicaid |
$435.03
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$439.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,037.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$933.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$443.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,113.20
|
| Rate for Payer: Ohio Health Group HMO |
$948.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,012.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,100.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$872.85
|
| Rate for Payer: PHCS Commercial |
$1,214.40
|
| Rate for Payer: United Healthcare All Payer |
$1,113.20
|
|
|
CLTX ARTC FX MTCRPHL/IPH JT
|
Professional
|
Both
|
$1,265.00
|
|
|
Service Code
|
HCPCS 26740
|
| Hospital Charge Code |
76100740
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$88.11 |
| Max. Negotiated Rate |
$759.00 |
| Rate for Payer: Aetna Commercial |
$280.91
|
| Rate for Payer: Ambetter Exchange |
$215.25
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$114.72
|
| Rate for Payer: Anthem Medicaid |
$88.11
|
| Rate for Payer: Buckeye Individual/Medicaid |
$215.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$215.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$258.30
|
| Rate for Payer: Cash Price |
$632.50
|
| Rate for Payer: Cash Price |
$632.50
|
| Rate for Payer: Cigna Commercial |
$331.94
|
| Rate for Payer: Healthspan PPO |
$269.96
|
| Rate for Payer: Humana Medicaid |
$88.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$250.66
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$215.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$215.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$89.87
|
| Rate for Payer: Molina Healthcare Passport |
$88.11
|
| Rate for Payer: Multiplan PHCS |
$759.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$279.82
|
| Rate for Payer: UHCCP Medicaid |
$120.46
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$88.99
|
| Rate for Payer: Wellcare Medicare Advantage |
$215.25
|
|
|
CLTX ARTC FX MTCRPHL/IPH JT
|
Facility
|
IP
|
$1,265.00
|
|
|
Service Code
|
HCPCS 26740
|
| Hospital Charge Code |
76100740
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$379.50 |
| Max. Negotiated Rate |
$1,214.40 |
| Rate for Payer: Aetna Commercial |
$974.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$986.70
|
| Rate for Payer: Cash Price |
$632.50
|
| Rate for Payer: Cigna Commercial |
$1,049.95
|
| Rate for Payer: First Health Commercial |
$1,201.75
|
| Rate for Payer: Humana Commercial |
$1,075.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,037.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$933.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$379.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,113.20
|
| Rate for Payer: Ohio Health Group HMO |
$948.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,012.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,100.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$872.85
|
| Rate for Payer: PHCS Commercial |
$1,214.40
|
| Rate for Payer: United Healthcare All Payer |
$1,113.20
|
|
|
CLTX ARTC FX MTCRPHL/IPH JT(P
|
Professional
|
Both
|
$540.00
|
|
|
Service Code
|
HCPCS 26740
|
| Hospital Charge Code |
761P0740
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$88.11 |
| Max. Negotiated Rate |
$331.94 |
| Rate for Payer: Aetna Commercial |
$280.91
|
| Rate for Payer: Ambetter Exchange |
$215.25
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$114.72
|
| Rate for Payer: Anthem Medicaid |
$88.11
|
| Rate for Payer: Buckeye Individual/Medicaid |
$215.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$215.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$258.30
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Cigna Commercial |
$331.94
|
| Rate for Payer: Healthspan PPO |
$269.96
|
| Rate for Payer: Humana Medicaid |
$88.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$250.66
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$215.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$215.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$89.87
|
| Rate for Payer: Molina Healthcare Passport |
$88.11
|
| Rate for Payer: Multiplan PHCS |
$324.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$279.82
|
| Rate for Payer: UHCCP Medicaid |
$120.46
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$88.99
|
| Rate for Payer: Wellcare Medicare Advantage |
$215.25
|
|
|
CLTX ARTC FX MTCRPHL/IPH JT(T
|
Facility
|
IP
|
$725.00
|
|
|
Service Code
|
HCPCS 26740
|
| Hospital Charge Code |
761T0740
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$217.50 |
| Max. Negotiated Rate |
$696.00 |
| Rate for Payer: Aetna Commercial |
$558.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$565.50
|
| Rate for Payer: Cash Price |
$362.50
|
| Rate for Payer: Cigna Commercial |
$601.75
|
| Rate for Payer: First Health Commercial |
$688.75
|
| Rate for Payer: Humana Commercial |
$616.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$594.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$535.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$217.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$638.00
|
| Rate for Payer: Ohio Health Group HMO |
$543.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$580.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$630.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$500.25
|
| Rate for Payer: PHCS Commercial |
$696.00
|
| Rate for Payer: United Healthcare All Payer |
$638.00
|
|
