|
CLTX DSTL PHLNGL FX FNGR/THMB
|
Professional
|
Both
|
$575.00
|
|
|
Service Code
|
HCPCS 26755
|
| Hospital Charge Code |
76100744
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$119.76 |
| Max. Negotiated Rate |
$481.95 |
| Rate for Payer: Aetna Commercial |
$370.70
|
| Rate for Payer: Ambetter Exchange |
$269.08
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$143.10
|
| Rate for Payer: Anthem Medicaid |
$119.76
|
| Rate for Payer: Buckeye Individual/Medicaid |
$269.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$269.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$322.90
|
| Rate for Payer: Cash Price |
$287.50
|
| Rate for Payer: Cash Price |
$287.50
|
| Rate for Payer: Cigna Commercial |
$481.95
|
| Rate for Payer: Healthspan PPO |
$381.35
|
| Rate for Payer: Humana Medicaid |
$119.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$325.81
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$269.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$269.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$122.16
|
| Rate for Payer: Molina Healthcare Passport |
$119.76
|
| Rate for Payer: Multiplan PHCS |
$345.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$349.80
|
| Rate for Payer: UHCCP Medicaid |
$150.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$120.96
|
| Rate for Payer: Wellcare Medicare Advantage |
$269.08
|
|
|
CLTX DSTL PHLNGL FX FNGR/THMB
|
Facility
|
OP
|
$368.00
|
|
|
Service Code
|
HCPCS 26755
|
| Hospital Charge Code |
45000146
|
|
Hospital Revenue Code
|
450
|
| 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
|
|
|
CLTX DSTL PHLNGL FX FNGR/THMB
|
Facility
|
IP
|
$368.00
|
|
|
Service Code
|
HCPCS 26755
|
| Hospital Charge Code |
45000146
|
|
Hospital Revenue Code
|
450
|
| 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
|
|
|
CLTX DSTL PHLNGL FX FNGR/THM(P
|
Professional
|
Both
|
$575.00
|
|
|
Service Code
|
HCPCS 26755
|
| Hospital Charge Code |
761P0744
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$119.76 |
| Max. Negotiated Rate |
$481.95 |
| Rate for Payer: Aetna Commercial |
$370.70
|
| Rate for Payer: Ambetter Exchange |
$269.08
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$143.10
|
| Rate for Payer: Anthem Medicaid |
$119.76
|
| Rate for Payer: Buckeye Individual/Medicaid |
$269.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$269.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$322.90
|
| Rate for Payer: Cash Price |
$287.50
|
| Rate for Payer: Cash Price |
$287.50
|
| Rate for Payer: Cigna Commercial |
$481.95
|
| Rate for Payer: Healthspan PPO |
$381.35
|
| Rate for Payer: Humana Medicaid |
$119.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$325.81
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$269.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$269.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$122.16
|
| Rate for Payer: Molina Healthcare Passport |
$119.76
|
| Rate for Payer: Multiplan PHCS |
$345.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$349.80
|
| Rate for Payer: UHCCP Medicaid |
$150.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$120.96
|
| Rate for Payer: Wellcare Medicare Advantage |
$269.08
|
|
|
CLTX DSTL PHLNGL FX FNGR/THM(P
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 26750
|
| Hospital Charge Code |
761P0743
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$71.64 |
| Max. Negotiated Rate |
$269.08 |
| 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 |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| 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 |
$240.00
|
| 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/THM(T
|
Facility
|
OP
|
$484.00
|
|
|
Service Code
|
HCPCS 26750
|
| Hospital Charge Code |
761T0743
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$166.45 |
| Max. Negotiated Rate |
$464.64 |
| Rate for Payer: Aetna Commercial |
$372.68
|
| Rate for Payer: Anthem Medicaid |
$166.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$377.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$242.00
|
| Rate for Payer: Cash Price |
$242.00
|
| Rate for Payer: Cigna Commercial |
$401.72
|
| Rate for Payer: First Health Commercial |
$459.80
|
| Rate for Payer: Humana Commercial |
$411.40
|
| Rate for Payer: Humana KY Medicaid |
$166.45
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$168.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$396.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$357.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$169.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$425.92
|
| Rate for Payer: Ohio Health Group HMO |
$363.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$387.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$421.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$333.96
|
| Rate for Payer: PHCS Commercial |
$464.64
|
| Rate for Payer: United Healthcare All Payer |
$425.92
|
|
|
CLTX DSTL PHLNGL FX FNGR/THM(T
|
Facility
|
IP
|
$484.00
|
|
|
Service Code
|
HCPCS 26750
|
| Hospital Charge Code |
761T0743
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$145.20 |
| Max. Negotiated Rate |
$464.64 |
| Rate for Payer: Aetna Commercial |
$372.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$377.52
|
| Rate for Payer: Cash Price |
$242.00
|
| Rate for Payer: Cigna Commercial |
$401.72
|
| Rate for Payer: First Health Commercial |
$459.80
|
| Rate for Payer: Humana Commercial |
$411.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$396.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$357.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$145.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$425.92
|
| Rate for Payer: Ohio Health Group HMO |
$363.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$387.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$421.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$333.96
|
| Rate for Payer: PHCS Commercial |
$464.64
|
| Rate for Payer: United Healthcare All Payer |
$425.92
|
|
|
CLTX FEM FX DST MED/LAT COND
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 27508
|
| Hospital Charge Code |
76100861
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$281.86 |
| Max. Negotiated Rate |
$818.04 |
| Rate for Payer: Aetna Commercial |
$699.41
|
| Rate for Payer: Ambetter Exchange |
$478.65
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$295.86
|
| Rate for Payer: Anthem Medicaid |
$281.86
|
| Rate for Payer: Buckeye Individual/Medicaid |
$478.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$478.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$574.38
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$818.04
|
| Rate for Payer: Healthspan PPO |
$667.45
|
| Rate for Payer: Humana Medicaid |
$281.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$601.30
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$478.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$478.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$287.50
|
| Rate for Payer: Molina Healthcare Passport |
$281.86
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$622.25
|
| Rate for Payer: UHCCP Medicaid |
$310.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$284.68
|
| Rate for Payer: Wellcare Medicare Advantage |
$478.65
|
|
|
CLTX FEM FX DST MED/LAT COND
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 27508
|
| Hospital Charge Code |
76100861
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem Medicaid |
$343.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Humana KY Medicaid |
$343.90
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$347.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$350.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$690.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
CLTX FEM FX DST MED/LAT COND
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 27508
|
| Hospital Charge Code |
76100861
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$690.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
CLTX FEM FX DST MED/LAT COND(P
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 27508
|
| Hospital Charge Code |
761P0861
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$281.86 |
| Max. Negotiated Rate |
$818.04 |
| Rate for Payer: Aetna Commercial |
$699.41
|
| Rate for Payer: Ambetter Exchange |
$478.65
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$295.86
|
| Rate for Payer: Anthem Medicaid |
$281.86
|
| Rate for Payer: Buckeye Individual/Medicaid |
$478.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$478.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$574.38
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$818.04
|
| Rate for Payer: Healthspan PPO |
$667.45
|
| Rate for Payer: Humana Medicaid |
$281.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$601.30
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$478.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$478.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$287.50
|
| Rate for Payer: Molina Healthcare Passport |
$281.86
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$622.25
|
| Rate for Payer: UHCCP Medicaid |
$310.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$284.68
|
| Rate for Payer: Wellcare Medicare Advantage |
$478.65
|
|
|
CLTX FEM FX PROX NCK WO MAN
|
Professional
|
Both
|
$1,358.50
|
|
|
Service Code
|
HCPCS 27230
|
| Hospital Charge Code |
76100788
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$243.73 |
| Max. Negotiated Rate |
$815.10 |
| Rate for Payer: Aetna Commercial |
$664.23
|
| Rate for Payer: Ambetter Exchange |
$458.05
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$262.44
|
| Rate for Payer: Anthem Medicaid |
$243.73
|
| Rate for Payer: Buckeye Individual/Medicaid |
$458.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$458.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$549.66
|
| Rate for Payer: Cash Price |
$679.25
|
| Rate for Payer: Cash Price |
$679.25
|
| Rate for Payer: Cigna Commercial |
$737.93
|
| Rate for Payer: Healthspan PPO |
$608.93
|
| Rate for Payer: Humana Medicaid |
$243.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$571.86
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$458.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$458.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$248.60
|
| Rate for Payer: Molina Healthcare Passport |
$243.73
|
| Rate for Payer: Multiplan PHCS |
$815.10
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$595.47
|
| Rate for Payer: UHCCP Medicaid |
$275.56
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$246.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$458.05
|
|
|
CLTX FEM FX PROX NCK WO MAN
|
Facility
|
IP
|
$1,358.50
|
|
|
Service Code
|
HCPCS 27230
|
| Hospital Charge Code |
76100788
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$407.55 |
| Max. Negotiated Rate |
$1,304.16 |
| Rate for Payer: Aetna Commercial |
$1,046.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,059.63
|
| Rate for Payer: Cash Price |
$679.25
|
| Rate for Payer: Cigna Commercial |
$1,127.56
|
| Rate for Payer: First Health Commercial |
$1,290.58
|
| Rate for Payer: Humana Commercial |
$1,154.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,113.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,002.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$407.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,195.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,018.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,086.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,181.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$937.37
|
| Rate for Payer: PHCS Commercial |
$1,304.16
|
| Rate for Payer: United Healthcare All Payer |
$1,195.48
|
|
|
CLTX FEM FX PROX NCK WO MAN
|
Facility
|
OP
|
$1,358.50
|
|
|
Service Code
|
HCPCS 27230
|
| Hospital Charge Code |
76100788
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$1,304.16 |
| Rate for Payer: Aetna Commercial |
$1,046.05
|
| Rate for Payer: Anthem Medicaid |
$467.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,059.63
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$679.25
|
| Rate for Payer: Cash Price |
$679.25
|
| Rate for Payer: Cigna Commercial |
$1,127.56
|
| Rate for Payer: First Health Commercial |
$1,290.58
|
| Rate for Payer: Humana Commercial |
$1,154.72
|
| Rate for Payer: Humana KY Medicaid |
$467.19
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$471.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,113.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,002.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$476.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,195.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,018.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,086.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,181.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$937.37
|
| Rate for Payer: PHCS Commercial |
$1,304.16
|
| Rate for Payer: United Healthcare All Payer |
$1,195.48
|
|
|
CLTX FEM FX PROX NCK WO MAN(P
|
Professional
|
Both
|
$860.00
|
|
|
Service Code
|
HCPCS 27230
|
| Hospital Charge Code |
761P0788
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$243.73 |
| Max. Negotiated Rate |
$737.93 |
| Rate for Payer: Aetna Commercial |
$664.23
|
| Rate for Payer: Ambetter Exchange |
$458.05
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$262.44
|
| Rate for Payer: Anthem Medicaid |
$243.73
|
| Rate for Payer: Buckeye Individual/Medicaid |
$458.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$458.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$549.66
|
| Rate for Payer: Cash Price |
$430.00
|
| Rate for Payer: Cash Price |
$430.00
|
| Rate for Payer: Cigna Commercial |
$737.93
|
| Rate for Payer: Healthspan PPO |
$608.93
|
| Rate for Payer: Humana Medicaid |
$243.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$571.86
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$458.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$458.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$248.60
|
| Rate for Payer: Molina Healthcare Passport |
$243.73
|
| Rate for Payer: Multiplan PHCS |
$516.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$595.47
|
| Rate for Payer: UHCCP Medicaid |
$275.56
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$246.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$458.05
|
|
|
CLTX FEM FX PROX NCK WO MAN(T
|
Facility
|
OP
|
$498.50
|
|
|
Service Code
|
HCPCS 27230
|
| Hospital Charge Code |
761T0788
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$171.43 |
| Max. Negotiated Rate |
$478.56 |
| Rate for Payer: Aetna Commercial |
$383.85
|
| Rate for Payer: Anthem Medicaid |
$171.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$388.83
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$249.25
|
| Rate for Payer: Cash Price |
$249.25
|
| Rate for Payer: Cigna Commercial |
$413.75
|
| Rate for Payer: First Health Commercial |
$473.57
|
| Rate for Payer: Humana Commercial |
$423.73
|
| Rate for Payer: Humana KY Medicaid |
$171.43
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$173.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$408.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$367.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$174.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$438.68
|
| Rate for Payer: Ohio Health Group HMO |
$373.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$398.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$433.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$343.96
|
| Rate for Payer: PHCS Commercial |
$478.56
|
| Rate for Payer: United Healthcare All Payer |
$438.68
|
|
|
CLTX FEM FX PROX NCK WO MAN(T
|
Facility
|
IP
|
$498.50
|
|
|
Service Code
|
HCPCS 27230
|
| Hospital Charge Code |
761T0788
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$149.55 |
| Max. Negotiated Rate |
$478.56 |
| Rate for Payer: Aetna Commercial |
$383.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$388.83
|
| Rate for Payer: Cash Price |
$249.25
|
| Rate for Payer: Cigna Commercial |
$413.75
|
| Rate for Payer: First Health Commercial |
$473.57
|
| Rate for Payer: Humana Commercial |
$423.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$408.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$367.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$149.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$438.68
|
| Rate for Payer: Ohio Health Group HMO |
$373.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$398.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$433.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$343.96
|
| Rate for Payer: PHCS Commercial |
$478.56
|
| Rate for Payer: United Healthcare All Payer |
$438.68
|
|
|
CLTX FEM FX PRX END NCK W/WO
|
Facility
|
IP
|
$950.00
|
|
|
Service Code
|
HCPCS 27232
|
| Hospital Charge Code |
76100789
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$285.00 |
| Max. Negotiated Rate |
$912.00 |
| Rate for Payer: Aetna Commercial |
$731.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$741.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cigna Commercial |
$788.50
|
| Rate for Payer: First Health Commercial |
$902.50
|
| Rate for Payer: Humana Commercial |
$807.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$779.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$701.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$285.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$836.00
|
| Rate for Payer: Ohio Health Group HMO |
$712.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$826.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$655.50
|
| Rate for Payer: PHCS Commercial |
$912.00
|
| Rate for Payer: United Healthcare All Payer |
$836.00
|
|
|
CLTX FEM FX PRX END NCK W/WO
|
Professional
|
Both
|
$950.00
|
|
|
Service Code
|
HCPCS 27232
|
| Hospital Charge Code |
76100789
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$332.50 |
| Max. Negotiated Rate |
$1,248.14 |
| Rate for Payer: Aetna Commercial |
$1,157.68
|
| Rate for Payer: Ambetter Exchange |
$698.32
|
| Rate for Payer: Anthem Medicaid |
$549.82
|
| Rate for Payer: Buckeye Individual/Medicaid |
$698.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$698.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$837.98
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cigna Commercial |
$1,248.14
|
| Rate for Payer: Healthspan PPO |
$1,048.61
|
| Rate for Payer: Humana Medicaid |
$549.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$958.97
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$698.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$698.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$560.82
|
| Rate for Payer: Molina Healthcare Passport |
$549.82
|
| Rate for Payer: Multiplan PHCS |
$570.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$907.82
|
| Rate for Payer: UHCCP Medicaid |
$332.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$555.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$698.32
|
|
|
CLTX FEM FX PRX END NCK W/WO
|
Facility
|
OP
|
$950.00
|
|
|
Service Code
|
HCPCS 27232
|
| Hospital Charge Code |
76100789
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$285.00 |
| Max. Negotiated Rate |
$912.00 |
| Rate for Payer: Aetna Commercial |
$731.50
|
| Rate for Payer: Anthem Medicaid |
$326.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$741.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cigna Commercial |
$788.50
|
| Rate for Payer: First Health Commercial |
$902.50
|
| Rate for Payer: Humana Commercial |
$807.50
|
| Rate for Payer: Humana KY Medicaid |
$326.70
|
| Rate for Payer: Kentucky WC Medicaid |
$330.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$779.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$701.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$285.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$333.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$836.00
|
| Rate for Payer: Ohio Health Group HMO |
$712.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$826.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$655.50
|
| Rate for Payer: PHCS Commercial |
$912.00
|
| Rate for Payer: United Healthcare All Payer |
$836.00
|
|
|
CLTX FEM FX PRX END NCK W/WO(P
|
Professional
|
Both
|
$950.00
|
|
|
Service Code
|
HCPCS 27232
|
| Hospital Charge Code |
761P0789
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$332.50 |
| Max. Negotiated Rate |
$1,248.14 |
| Rate for Payer: Aetna Commercial |
$1,157.68
|
| Rate for Payer: Ambetter Exchange |
$698.32
|
| Rate for Payer: Anthem Medicaid |
$549.82
|
| Rate for Payer: Buckeye Individual/Medicaid |
$698.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$698.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$837.98
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cigna Commercial |
$1,248.14
|
| Rate for Payer: Healthspan PPO |
$1,048.61
|
| Rate for Payer: Humana Medicaid |
$549.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$958.97
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$698.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$698.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$560.82
|
| Rate for Payer: Molina Healthcare Passport |
$549.82
|
| Rate for Payer: Multiplan PHCS |
$570.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$907.82
|
| Rate for Payer: UHCCP Medicaid |
$332.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$555.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$698.32
|
|
|
CLTX FX GRT TOE PHLX/PHLG
|
Facility
|
IP
|
$887.00
|
|
|
Service Code
|
HCPCS 28490
|
| Hospital Charge Code |
76101023
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$266.10 |
| Max. Negotiated Rate |
$851.52 |
| Rate for Payer: Aetna Commercial |
$682.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$691.86
|
| Rate for Payer: Cash Price |
$443.50
|
| Rate for Payer: Cigna Commercial |
$736.21
|
| Rate for Payer: First Health Commercial |
$842.65
|
| Rate for Payer: Humana Commercial |
$753.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$727.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$654.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$266.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$780.56
|
| Rate for Payer: Ohio Health Group HMO |
$665.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$709.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$771.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$612.03
|
| Rate for Payer: PHCS Commercial |
$851.52
|
| Rate for Payer: United Healthcare All Payer |
$780.56
|
|
|
CLTX FX GRT TOE PHLX/PHLG
|
Facility
|
OP
|
$887.00
|
|
|
Service Code
|
HCPCS 28490
|
| Hospital Charge Code |
76101023
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$851.52 |
| Rate for Payer: Aetna Commercial |
$682.99
|
| Rate for Payer: Anthem Medicaid |
$305.04
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$691.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$443.50
|
| Rate for Payer: Cash Price |
$443.50
|
| Rate for Payer: Cigna Commercial |
$736.21
|
| Rate for Payer: First Health Commercial |
$842.65
|
| Rate for Payer: Humana Commercial |
$753.95
|
| Rate for Payer: Humana KY Medicaid |
$305.04
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$308.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$727.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$654.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$311.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$780.56
|
| Rate for Payer: Ohio Health Group HMO |
$665.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$709.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$771.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$612.03
|
| Rate for Payer: PHCS Commercial |
$851.52
|
| Rate for Payer: United Healthcare All Payer |
$780.56
|
|
|
CLTX FX GRT TOE PHLX/PHLG
|
Professional
|
Both
|
$887.00
|
|
|
Service Code
|
HCPCS 28490
|
| Hospital Charge Code |
76101023
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$56.21 |
| Max. Negotiated Rate |
$532.20 |
| Rate for Payer: Aetna Commercial |
$162.40
|
| Rate for Payer: Ambetter Exchange |
$119.81
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$63.85
|
| Rate for Payer: Anthem Medicaid |
$56.21
|
| Rate for Payer: Buckeye Individual/Medicaid |
$119.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$119.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$143.77
|
| Rate for Payer: Cash Price |
$443.50
|
| Rate for Payer: Cash Price |
$443.50
|
| Rate for Payer: Cigna Commercial |
$203.54
|
| Rate for Payer: Healthspan PPO |
$166.49
|
| Rate for Payer: Humana Medicaid |
$56.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$145.14
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$119.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$119.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$57.33
|
| Rate for Payer: Molina Healthcare Passport |
$56.21
|
| Rate for Payer: Multiplan PHCS |
$532.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$155.75
|
| Rate for Payer: UHCCP Medicaid |
$67.04
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$56.77
|
| Rate for Payer: Wellcare Medicare Advantage |
$119.81
|
|
|
CLTX FX GRT TOE PHLX/PHLG(P
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 28490
|
| Hospital Charge Code |
761P1023
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$56.21 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$162.40
|
| Rate for Payer: Ambetter Exchange |
$119.81
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$63.85
|
| Rate for Payer: Anthem Medicaid |
$56.21
|
| Rate for Payer: Buckeye Individual/Medicaid |
$119.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$119.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$143.77
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$203.54
|
| Rate for Payer: Healthspan PPO |
$166.49
|
| Rate for Payer: Humana Medicaid |
$56.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$145.14
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$119.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$119.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$57.33
|
| Rate for Payer: Molina Healthcare Passport |
$56.21
|
| Rate for Payer: Multiplan PHCS |
$300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$155.75
|
| Rate for Payer: UHCCP Medicaid |
$67.04
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$56.77
|
| Rate for Payer: Wellcare Medicare Advantage |
$119.81
|
|
