|
CLTX CARP/SCAPHOID FX W/O MA(T
|
Facility
|
IP
|
$595.00
|
|
|
Service Code
|
HCPCS 25622
|
| Hospital Charge Code |
761T0636
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$178.50 |
| Max. Negotiated Rate |
$571.20 |
| Rate for Payer: Aetna Commercial |
$458.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$464.10
|
| Rate for Payer: Cash Price |
$297.50
|
| Rate for Payer: Cigna Commercial |
$493.85
|
| Rate for Payer: First Health Commercial |
$565.25
|
| Rate for Payer: Humana Commercial |
$505.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$487.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$439.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$178.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$523.60
|
| Rate for Payer: Ohio Health Group HMO |
$446.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$476.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$517.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$410.55
|
| Rate for Payer: PHCS Commercial |
$571.20
|
| Rate for Payer: United Healthcare All Payer |
$523.60
|
|
|
CLTX CARP/SCAPHOID FX W/O MA(T
|
Facility
|
OP
|
$595.00
|
|
|
Service Code
|
HCPCS 25622
|
| Hospital Charge Code |
761T0636
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$204.62 |
| Max. Negotiated Rate |
$571.20 |
| Rate for Payer: Aetna Commercial |
$458.15
|
| Rate for Payer: Anthem Medicaid |
$204.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$464.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$297.50
|
| Rate for Payer: Cash Price |
$297.50
|
| Rate for Payer: Cigna Commercial |
$493.85
|
| Rate for Payer: First Health Commercial |
$565.25
|
| Rate for Payer: Humana Commercial |
$505.75
|
| Rate for Payer: Humana KY Medicaid |
$204.62
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$206.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$487.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$439.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$208.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$523.60
|
| Rate for Payer: Ohio Health Group HMO |
$446.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$476.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$517.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$410.55
|
| Rate for Payer: PHCS Commercial |
$571.20
|
| Rate for Payer: United Healthcare All Payer |
$523.60
|
|
|
CL TX DIS RADIOULNAR DIS W/MAN
|
Facility
|
IP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 25675
|
| Hospital Charge Code |
45000132
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$480.00 |
| Max. Negotiated Rate |
$1,536.00 |
| Rate for Payer: Aetna Commercial |
$1,232.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,248.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,328.00
|
| Rate for Payer: First Health Commercial |
$1,520.00
|
| Rate for Payer: Humana Commercial |
$1,360.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,312.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,180.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$480.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,408.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,392.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,104.00
|
| Rate for Payer: PHCS Commercial |
$1,536.00
|
| Rate for Payer: United Healthcare All Payer |
$1,408.00
|
|
|
CL TX DIS RADIOULNAR DIS W/MAN
|
Facility
|
OP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 25675
|
| Hospital Charge Code |
45000132
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$1,536.00 |
| Rate for Payer: Aetna Commercial |
$1,232.00
|
| Rate for Payer: Anthem Medicaid |
$550.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,248.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,328.00
|
| Rate for Payer: First Health Commercial |
$1,520.00
|
| Rate for Payer: Humana Commercial |
$1,360.00
|
| Rate for Payer: Humana KY Medicaid |
$550.24
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$555.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,312.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,180.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$561.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,408.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,392.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,104.00
|
| Rate for Payer: PHCS Commercial |
$1,536.00
|
| Rate for Payer: United Healthcare All Payer |
$1,408.00
|
|
|
CL TX DIS RADIOULNAR DIS W/MAN
|
Facility
|
OP
|
$2,640.00
|
|
|
Service Code
|
HCPCS 25675
|
| Hospital Charge Code |
76100643
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$2,534.40 |
| Rate for Payer: Aetna Commercial |
$2,032.80
|
| Rate for Payer: Anthem Medicaid |
$907.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,059.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$1,320.00
|
| Rate for Payer: Cash Price |
$1,320.00
|
| Rate for Payer: Cigna Commercial |
$2,191.20
|
| Rate for Payer: First Health Commercial |
$2,508.00
|
| Rate for Payer: Humana Commercial |
$2,244.00
|
| Rate for Payer: Humana KY Medicaid |
$907.90
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$917.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,164.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,948.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$926.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,323.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,980.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,296.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,821.60
|
| Rate for Payer: PHCS Commercial |
$2,534.40
|
| Rate for Payer: United Healthcare All Payer |
$2,323.20
|
|
|
CL TX DIS RADIOULNAR DIS W/MAN
|
Professional
|
Both
|
$2,640.00
|
|
|
Service Code
|
HCPCS 25675
|
| Hospital Charge Code |
76100643
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$199.70 |
| Max. Negotiated Rate |
$1,584.00 |
| Rate for Payer: Aetna Commercial |
$545.82
|
| Rate for Payer: Ambetter Exchange |
$401.48
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$211.27
|
| Rate for Payer: Anthem Medicaid |
$199.70
|
| Rate for Payer: Buckeye Individual/Medicaid |
$401.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$401.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$481.78
|
| Rate for Payer: Cash Price |
$1,320.00
|
| Rate for Payer: Cash Price |
$1,320.00
|
| Rate for Payer: Cigna Commercial |
$665.06
|
| Rate for Payer: Healthspan PPO |
$532.69
|
| Rate for Payer: Humana Medicaid |
$199.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$477.21
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$401.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$401.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$203.69
|
| Rate for Payer: Molina Healthcare Passport |
$199.70
|
| Rate for Payer: Multiplan PHCS |
$1,584.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$521.92
|
| Rate for Payer: UHCCP Medicaid |
$221.83
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$201.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$401.48
|
|
|
CL TX DIS RADIOULNAR DIS W/MAN
|
Facility
|
IP
|
$2,640.00
|
|
|
Service Code
|
HCPCS 25675
|
| Hospital Charge Code |
76100643
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$792.00 |
| Max. Negotiated Rate |
$2,534.40 |
| Rate for Payer: Aetna Commercial |
$2,032.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,059.20
|
| Rate for Payer: Cash Price |
$1,320.00
|
| Rate for Payer: Cigna Commercial |
$2,191.20
|
| Rate for Payer: First Health Commercial |
$2,508.00
|
| Rate for Payer: Humana Commercial |
$2,244.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,164.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,948.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$792.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,323.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,980.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,296.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,821.60
|
| Rate for Payer: PHCS Commercial |
$2,534.40
|
| Rate for Payer: United Healthcare All Payer |
$2,323.20
|
|
|
CL TX DIS RADIOULNAR DIS W/MAN
|
Professional
|
Both
|
$1,040.00
|
|
|
Service Code
|
HCPCS 25675
|
| Hospital Charge Code |
761P0643
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$199.70 |
| Max. Negotiated Rate |
$665.06 |
| Rate for Payer: Aetna Commercial |
$545.82
|
| Rate for Payer: Ambetter Exchange |
$401.48
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$211.27
|
| Rate for Payer: Anthem Medicaid |
$199.70
|
| Rate for Payer: Buckeye Individual/Medicaid |
$401.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$401.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$481.78
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cigna Commercial |
$665.06
|
| Rate for Payer: Healthspan PPO |
$532.69
|
| Rate for Payer: Humana Medicaid |
$199.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$477.21
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$401.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$401.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$203.69
|
| Rate for Payer: Molina Healthcare Passport |
$199.70
|
| Rate for Payer: Multiplan PHCS |
$624.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$521.92
|
| Rate for Payer: UHCCP Medicaid |
$221.83
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$201.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$401.48
|
|
|
CL TX DIS RADIOULNAR DIS W/MAN
|
Facility
|
IP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 25675
|
| Hospital Charge Code |
761T0643
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$480.00 |
| Max. Negotiated Rate |
$1,536.00 |
| Rate for Payer: Aetna Commercial |
$1,232.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,248.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,328.00
|
| Rate for Payer: First Health Commercial |
$1,520.00
|
| Rate for Payer: Humana Commercial |
$1,360.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,312.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,180.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$480.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,408.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,392.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,104.00
|
| Rate for Payer: PHCS Commercial |
$1,536.00
|
| Rate for Payer: United Healthcare All Payer |
$1,408.00
|
|
|
CL TX DIS RADIOULNAR DIS W/MAN
|
Facility
|
OP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 25675
|
| Hospital Charge Code |
761T0643
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$1,536.00 |
| Rate for Payer: Aetna Commercial |
$1,232.00
|
| Rate for Payer: Anthem Medicaid |
$550.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,248.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,328.00
|
| Rate for Payer: First Health Commercial |
$1,520.00
|
| Rate for Payer: Humana Commercial |
$1,360.00
|
| Rate for Payer: Humana KY Medicaid |
$550.24
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$555.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,312.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,180.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$561.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,408.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,392.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,104.00
|
| Rate for Payer: PHCS Commercial |
$1,536.00
|
| Rate for Payer: United Healthcare All Payer |
$1,408.00
|
|
|
CLTX DIS XTNSRTDNINSWWOPERCPIN
|
Facility
|
IP
|
$675.00
|
|
|
Service Code
|
HCPCS 26432
|
| Hospital Charge Code |
76100697
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$202.50 |
| Max. Negotiated Rate |
$648.00 |
| Rate for Payer: Aetna Commercial |
$519.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$526.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cigna Commercial |
$560.25
|
| Rate for Payer: First Health Commercial |
$641.25
|
| Rate for Payer: Humana Commercial |
$573.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$553.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$498.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$202.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$594.00
|
| Rate for Payer: Ohio Health Group HMO |
$506.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$587.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$465.75
|
| Rate for Payer: PHCS Commercial |
$648.00
|
| Rate for Payer: United Healthcare All Payer |
$594.00
|
|
|
CLTX DIS XTNSRTDNINSWWOPERCPIN
|
Professional
|
Both
|
$675.00
|
|
|
Service Code
|
HCPCS 26432
|
| Hospital Charge Code |
761P0697
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$210.44 |
| Max. Negotiated Rate |
$869.38 |
| Rate for Payer: Aetna Commercial |
$689.41
|
| Rate for Payer: Ambetter Exchange |
$501.94
|
| Rate for Payer: Anthem Medicaid |
$210.44
|
| Rate for Payer: Buckeye Individual/Medicaid |
$501.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$501.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$602.33
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cigna Commercial |
$869.38
|
| Rate for Payer: Healthspan PPO |
$624.46
|
| Rate for Payer: Humana Medicaid |
$210.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$595.84
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$501.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$501.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$214.65
|
| Rate for Payer: Molina Healthcare Passport |
$210.44
|
| Rate for Payer: Multiplan PHCS |
$405.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$652.52
|
| Rate for Payer: UHCCP Medicaid |
$236.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$212.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$501.94
|
|
|
CLTX DIS XTNSRTDNINSWWOPERCPIN
|
Professional
|
Both
|
$675.00
|
|
|
Service Code
|
HCPCS 26432
|
| Hospital Charge Code |
76100697
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$210.44 |
| Max. Negotiated Rate |
$869.38 |
| Rate for Payer: Aetna Commercial |
$689.41
|
| Rate for Payer: Ambetter Exchange |
$501.94
|
| Rate for Payer: Anthem Medicaid |
$210.44
|
| Rate for Payer: Buckeye Individual/Medicaid |
$501.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$501.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$602.33
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cigna Commercial |
$869.38
|
| Rate for Payer: Healthspan PPO |
$624.46
|
| Rate for Payer: Humana Medicaid |
$210.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$595.84
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$501.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$501.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$214.65
|
| Rate for Payer: Molina Healthcare Passport |
$210.44
|
| Rate for Payer: Multiplan PHCS |
$405.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$652.52
|
| Rate for Payer: UHCCP Medicaid |
$236.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$212.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$501.94
|
|
|
CLTX DIS XTNSRTDNINSWWOPERCPIN
|
Facility
|
OP
|
$675.00
|
|
|
Service Code
|
HCPCS 26432
|
| Hospital Charge Code |
76100697
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$232.13 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$519.75
|
| Rate for Payer: Anthem Medicaid |
$232.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$526.50
|
| 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 |
$337.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cigna Commercial |
$560.25
|
| Rate for Payer: First Health Commercial |
$641.25
|
| Rate for Payer: Humana Commercial |
$573.75
|
| Rate for Payer: Humana KY Medicaid |
$232.13
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$234.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$553.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$498.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$236.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$594.00
|
| Rate for Payer: Ohio Health Group HMO |
$506.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$587.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$465.75
|
| Rate for Payer: PHCS Commercial |
$648.00
|
| Rate for Payer: United Healthcare All Payer |
$594.00
|
|
|
CLTX DSTL FIB FX LAT MALL
|
Facility
|
IP
|
$1,345.00
|
|
|
Service Code
|
HCPCS 27786
|
| Hospital Charge Code |
76100936
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$403.50 |
| Max. Negotiated Rate |
$1,291.20 |
| Rate for Payer: Aetna Commercial |
$1,035.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,049.10
|
| Rate for Payer: Cash Price |
$672.50
|
| Rate for Payer: Cigna Commercial |
$1,116.35
|
| Rate for Payer: First Health Commercial |
$1,277.75
|
| Rate for Payer: Humana Commercial |
$1,143.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,102.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$992.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$403.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,183.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,008.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,076.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,170.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$928.05
|
| Rate for Payer: PHCS Commercial |
$1,291.20
|
| Rate for Payer: United Healthcare All Payer |
$1,183.60
|
|
|
CLTX DSTL FIB FX LAT MALL
|
Professional
|
Both
|
$1,345.00
|
|
|
Service Code
|
HCPCS 27786
|
| Hospital Charge Code |
76100936
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$150.19 |
| Max. Negotiated Rate |
$807.00 |
| Rate for Payer: Aetna Commercial |
$383.24
|
| Rate for Payer: Ambetter Exchange |
$276.88
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$150.19
|
| Rate for Payer: Anthem Medicaid |
$154.88
|
| Rate for Payer: Buckeye Individual/Medicaid |
$276.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$276.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$332.26
|
| Rate for Payer: Cash Price |
$672.50
|
| Rate for Payer: Cash Price |
$672.50
|
| Rate for Payer: Cigna Commercial |
$476.11
|
| Rate for Payer: Healthspan PPO |
$382.52
|
| Rate for Payer: Humana Medicaid |
$154.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$338.74
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$276.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$276.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$157.98
|
| Rate for Payer: Molina Healthcare Passport |
$154.88
|
| Rate for Payer: Multiplan PHCS |
$807.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$359.94
|
| Rate for Payer: UHCCP Medicaid |
$157.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$156.43
|
| Rate for Payer: Wellcare Medicare Advantage |
$276.88
|
|
|
CLTX DSTL FIB FX LAT MALL
|
Facility
|
OP
|
$1,345.00
|
|
|
Service Code
|
HCPCS 27786
|
| Hospital Charge Code |
76100936
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$1,291.20 |
| Rate for Payer: Aetna Commercial |
$1,035.65
|
| Rate for Payer: Anthem Medicaid |
$462.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,049.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$672.50
|
| Rate for Payer: Cash Price |
$672.50
|
| Rate for Payer: Cigna Commercial |
$1,116.35
|
| Rate for Payer: First Health Commercial |
$1,277.75
|
| Rate for Payer: Humana Commercial |
$1,143.25
|
| Rate for Payer: Humana KY Medicaid |
$462.55
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$467.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,102.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$992.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$471.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,183.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,008.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,076.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,170.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$928.05
|
| Rate for Payer: PHCS Commercial |
$1,291.20
|
| Rate for Payer: United Healthcare All Payer |
$1,183.60
|
|
|
CLTX DSTL FIB FX LAT MALL(P
|
Professional
|
Both
|
$663.00
|
|
|
Service Code
|
HCPCS 27786
|
| Hospital Charge Code |
761P0936
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$150.19 |
| Max. Negotiated Rate |
$476.11 |
| Rate for Payer: Aetna Commercial |
$383.24
|
| Rate for Payer: Ambetter Exchange |
$276.88
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$150.19
|
| Rate for Payer: Anthem Medicaid |
$154.88
|
| Rate for Payer: Buckeye Individual/Medicaid |
$276.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$276.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$332.26
|
| Rate for Payer: Cash Price |
$331.50
|
| Rate for Payer: Cash Price |
$331.50
|
| Rate for Payer: Cigna Commercial |
$476.11
|
| Rate for Payer: Healthspan PPO |
$382.52
|
| Rate for Payer: Humana Medicaid |
$154.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$338.74
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$276.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$276.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$157.98
|
| Rate for Payer: Molina Healthcare Passport |
$154.88
|
| Rate for Payer: Multiplan PHCS |
$397.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$359.94
|
| Rate for Payer: UHCCP Medicaid |
$157.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$156.43
|
| Rate for Payer: Wellcare Medicare Advantage |
$276.88
|
|
|
CLTX DSTL FIB FX LAT MALL(T
|
Facility
|
OP
|
$682.00
|
|
|
Service Code
|
HCPCS 27786
|
| Hospital Charge Code |
761T0936
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$654.72 |
| Rate for Payer: Aetna Commercial |
$525.14
|
| Rate for Payer: Anthem Medicaid |
$234.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$531.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$341.00
|
| Rate for Payer: Cash Price |
$341.00
|
| Rate for Payer: Cigna Commercial |
$566.06
|
| Rate for Payer: First Health Commercial |
$647.90
|
| Rate for Payer: Humana Commercial |
$579.70
|
| Rate for Payer: Humana KY Medicaid |
$234.54
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$236.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$559.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$503.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$239.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$600.16
|
| Rate for Payer: Ohio Health Group HMO |
$511.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$545.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$593.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$470.58
|
| Rate for Payer: PHCS Commercial |
$654.72
|
| Rate for Payer: United Healthcare All Payer |
$600.16
|
|
|
CLTX DSTL FIB FX LAT MALL(T
|
Facility
|
IP
|
$682.00
|
|
|
Service Code
|
HCPCS 27786
|
| Hospital Charge Code |
761T0936
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$204.60 |
| Max. Negotiated Rate |
$654.72 |
| Rate for Payer: Aetna Commercial |
$525.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$531.96
|
| Rate for Payer: Cash Price |
$341.00
|
| Rate for Payer: Cigna Commercial |
$566.06
|
| Rate for Payer: First Health Commercial |
$647.90
|
| Rate for Payer: Humana Commercial |
$579.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$559.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$503.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$204.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$600.16
|
| Rate for Payer: Ohio Health Group HMO |
$511.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$545.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$593.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$470.58
|
| Rate for Payer: PHCS Commercial |
$654.72
|
| Rate for Payer: United Healthcare All Payer |
$600.16
|
|
|
CLTX DSTL PHLNGL FX FNGR/THMB
|
Facility
|
IP
|
$575.00
|
|
|
Service Code
|
HCPCS 26755
|
| Hospital Charge Code |
76100744
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$172.50 |
| Max. Negotiated Rate |
$552.00 |
| Rate for Payer: Aetna Commercial |
$442.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$448.50
|
| Rate for Payer: Cash Price |
$287.50
|
| Rate for Payer: Cigna Commercial |
$477.25
|
| Rate for Payer: First Health Commercial |
$546.25
|
| Rate for Payer: Humana Commercial |
$488.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$471.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$424.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$172.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$506.00
|
| Rate for Payer: Ohio Health Group HMO |
$431.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$460.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$500.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$396.75
|
| Rate for Payer: PHCS Commercial |
$552.00
|
| Rate for Payer: United Healthcare All Payer |
$506.00
|
|
|
CLTX DSTL PHLNGL FX FNGR/THMB
|
Professional
|
Both
|
$884.00
|
|
|
Service Code
|
HCPCS 26750
|
| Hospital Charge Code |
76100743
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$71.64 |
| Max. Negotiated Rate |
$530.40 |
| Rate for Payer: Aetna Commercial |
$232.79
|
| Rate for Payer: Ambetter Exchange |
$186.36
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$97.42
|
| Rate for Payer: Anthem Medicaid |
$71.64
|
| Rate for Payer: Buckeye Individual/Medicaid |
$186.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$186.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$223.63
|
| Rate for Payer: Cash Price |
$442.00
|
| Rate for Payer: Cash Price |
$442.00
|
| Rate for Payer: Cigna Commercial |
$269.08
|
| Rate for Payer: Healthspan PPO |
$216.18
|
| Rate for Payer: Humana Medicaid |
$71.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$211.69
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$186.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$186.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$73.07
|
| Rate for Payer: Molina Healthcare Passport |
$71.64
|
| Rate for Payer: Multiplan PHCS |
$530.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$242.27
|
| Rate for Payer: UHCCP Medicaid |
$102.29
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$72.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$186.36
|
|
|
CLTX DSTL PHLNGL FX FNGR/THMB
|
Facility
|
IP
|
$884.00
|
|
|
Service Code
|
HCPCS 26750
|
| Hospital Charge Code |
76100743
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$265.20 |
| Max. Negotiated Rate |
$848.64 |
| Rate for Payer: Aetna Commercial |
$680.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$689.52
|
| Rate for Payer: Cash Price |
$442.00
|
| Rate for Payer: Cigna Commercial |
$733.72
|
| Rate for Payer: First Health Commercial |
$839.80
|
| Rate for Payer: Humana Commercial |
$751.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$724.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$652.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$777.92
|
| Rate for Payer: Ohio Health Group HMO |
$663.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$707.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$769.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$609.96
|
| Rate for Payer: PHCS Commercial |
$848.64
|
| Rate for Payer: United Healthcare All Payer |
$777.92
|
|
|
CLTX DSTL PHLNGL FX FNGR/THMB
|
Facility
|
OP
|
$575.00
|
|
|
Service Code
|
HCPCS 26755
|
| Hospital Charge Code |
76100744
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$197.74 |
| Max. Negotiated Rate |
$552.00 |
| Rate for Payer: Aetna Commercial |
$442.75
|
| Rate for Payer: Anthem Medicaid |
$197.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$448.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$287.50
|
| Rate for Payer: Cash Price |
$287.50
|
| Rate for Payer: Cigna Commercial |
$477.25
|
| Rate for Payer: First Health Commercial |
$546.25
|
| Rate for Payer: Humana Commercial |
$488.75
|
| Rate for Payer: Humana KY Medicaid |
$197.74
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$199.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$471.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$424.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$201.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$506.00
|
| Rate for Payer: Ohio Health Group HMO |
$431.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$460.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$500.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$396.75
|
| Rate for Payer: PHCS Commercial |
$552.00
|
| Rate for Payer: United Healthcare All Payer |
$506.00
|
|
|
CLTX DSTL PHLNGL FX FNGR/THMB
|
Facility
|
OP
|
$884.00
|
|
|
Service Code
|
HCPCS 26750
|
| Hospital Charge Code |
76100743
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$848.64 |
| Rate for Payer: Aetna Commercial |
$680.68
|
| Rate for Payer: Anthem Medicaid |
$304.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$689.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$442.00
|
| Rate for Payer: Cash Price |
$442.00
|
| Rate for Payer: Cigna Commercial |
$733.72
|
| Rate for Payer: First Health Commercial |
$839.80
|
| Rate for Payer: Humana Commercial |
$751.40
|
| Rate for Payer: Humana KY Medicaid |
$304.01
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$307.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$724.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$652.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$310.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$777.92
|
| Rate for Payer: Ohio Health Group HMO |
$663.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$707.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$769.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$609.96
|
| Rate for Payer: PHCS Commercial |
$848.64
|
| Rate for Payer: United Healthcare All Payer |
$777.92
|
|
