|
CLTX GRTER HUM TBRSTY FX W/MAN
|
Professional
|
Both
|
$3,378.00
|
|
|
Service Code
|
HCPCS 23625
|
| Hospital Charge Code |
76100483
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$203.75 |
| Max. Negotiated Rate |
$2,026.80 |
| Rate for Payer: Aetna Commercial |
$493.18
|
| Rate for Payer: Ambetter Exchange |
$338.55
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$203.75
|
| Rate for Payer: Anthem Medicaid |
$223.85
|
| Rate for Payer: Buckeye Individual/Medicaid |
$338.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$338.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$406.26
|
| Rate for Payer: Cash Price |
$1,689.00
|
| Rate for Payer: Cash Price |
$1,689.00
|
| Rate for Payer: Cigna Commercial |
$582.97
|
| Rate for Payer: Healthspan PPO |
$472.89
|
| Rate for Payer: Humana Medicaid |
$223.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$426.39
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$338.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$338.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$228.33
|
| Rate for Payer: Molina Healthcare Passport |
$223.85
|
| Rate for Payer: Multiplan PHCS |
$2,026.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$440.12
|
| Rate for Payer: UHCCP Medicaid |
$213.94
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$226.09
|
| Rate for Payer: Wellcare Medicare Advantage |
$338.55
|
|
|
CLTX GRTR TROCHANTERIC FX
|
Professional
|
Both
|
$809.00
|
|
|
Service Code
|
HCPCS 27246
|
| Hospital Charge Code |
76100796
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$246.32 |
| Max. Negotiated Rate |
$606.79 |
| Rate for Payer: Aetna Commercial |
$552.91
|
| Rate for Payer: Ambetter Exchange |
$372.56
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$253.80
|
| Rate for Payer: Anthem Medicaid |
$246.32
|
| Rate for Payer: Buckeye Individual/Medicaid |
$372.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$372.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$447.07
|
| Rate for Payer: Cash Price |
$404.50
|
| Rate for Payer: Cash Price |
$404.50
|
| Rate for Payer: Cigna Commercial |
$606.79
|
| Rate for Payer: Healthspan PPO |
$499.84
|
| Rate for Payer: Humana Medicaid |
$246.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$470.88
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$372.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$372.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$251.25
|
| Rate for Payer: Molina Healthcare Passport |
$246.32
|
| Rate for Payer: Multiplan PHCS |
$485.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$484.33
|
| Rate for Payer: UHCCP Medicaid |
$266.49
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$248.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$372.56
|
|
|
CLTX GRTR TROCHANTERIC FX
|
Facility
|
OP
|
$809.00
|
|
|
Service Code
|
HCPCS 27246
|
| Hospital Charge Code |
76100796
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$776.64 |
| Rate for Payer: Aetna Commercial |
$622.93
|
| Rate for Payer: Anthem Medicaid |
$278.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$631.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$404.50
|
| Rate for Payer: Cash Price |
$404.50
|
| Rate for Payer: Cigna Commercial |
$671.47
|
| Rate for Payer: First Health Commercial |
$768.55
|
| Rate for Payer: Humana Commercial |
$687.65
|
| Rate for Payer: Humana KY Medicaid |
$278.22
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$281.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$663.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$597.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$283.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$711.92
|
| Rate for Payer: Ohio Health Group HMO |
$606.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$647.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$703.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$558.21
|
| Rate for Payer: PHCS Commercial |
$776.64
|
| Rate for Payer: United Healthcare All Payer |
$711.92
|
|
|
CLTX GRTR TROCHANTERIC FX
|
Facility
|
IP
|
$809.00
|
|
|
Service Code
|
HCPCS 27246
|
| Hospital Charge Code |
76100796
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$242.70 |
| Max. Negotiated Rate |
$776.64 |
| Rate for Payer: Aetna Commercial |
$622.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$631.02
|
| Rate for Payer: Cash Price |
$404.50
|
| Rate for Payer: Cigna Commercial |
$671.47
|
| Rate for Payer: First Health Commercial |
$768.55
|
| Rate for Payer: Humana Commercial |
$687.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$663.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$597.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$242.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$711.92
|
| Rate for Payer: Ohio Health Group HMO |
$606.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$647.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$703.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$558.21
|
| Rate for Payer: PHCS Commercial |
$776.64
|
| Rate for Payer: United Healthcare All Payer |
$711.92
|
|
|
CLTX GRTR TROCHANTERIC FX(P
|
Professional
|
Both
|
$809.00
|
|
|
Service Code
|
HCPCS 27246
|
| Hospital Charge Code |
761P0796
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$246.32 |
| Max. Negotiated Rate |
$606.79 |
| Rate for Payer: Aetna Commercial |
$552.91
|
| Rate for Payer: Ambetter Exchange |
$372.56
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$253.80
|
| Rate for Payer: Anthem Medicaid |
$246.32
|
| Rate for Payer: Buckeye Individual/Medicaid |
$372.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$372.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$447.07
|
| Rate for Payer: Cash Price |
$404.50
|
| Rate for Payer: Cash Price |
$404.50
|
| Rate for Payer: Cigna Commercial |
$606.79
|
| Rate for Payer: Healthspan PPO |
$499.84
|
| Rate for Payer: Humana Medicaid |
$246.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$470.88
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$372.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$372.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$251.25
|
| Rate for Payer: Molina Healthcare Passport |
$246.32
|
| Rate for Payer: Multiplan PHCS |
$485.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$484.33
|
| Rate for Payer: UHCCP Medicaid |
$266.49
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$248.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$372.56
|
|
|
CLTX HIP ARTHRP DISLC WANES
|
Facility
|
OP
|
$1,031.00
|
|
|
Service Code
|
HCPCS 27266
|
| Hospital Charge Code |
76100803
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$354.56 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$793.87
|
| Rate for Payer: Anthem Medicaid |
$354.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$804.18
|
| 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 |
$515.50
|
| Rate for Payer: Cash Price |
$515.50
|
| Rate for Payer: Cigna Commercial |
$855.73
|
| Rate for Payer: First Health Commercial |
$979.45
|
| Rate for Payer: Humana Commercial |
$876.35
|
| Rate for Payer: Humana KY Medicaid |
$354.56
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$358.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$845.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$760.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$361.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$907.28
|
| Rate for Payer: Ohio Health Group HMO |
$773.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$824.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$896.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$711.39
|
| Rate for Payer: PHCS Commercial |
$989.76
|
| Rate for Payer: United Healthcare All Payer |
$907.28
|
|
|
CLTX HIP ARTHRP DISLC WANES
|
Facility
|
IP
|
$1,031.00
|
|
|
Service Code
|
HCPCS 27266
|
| Hospital Charge Code |
76100803
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$309.30 |
| Max. Negotiated Rate |
$989.76 |
| Rate for Payer: Aetna Commercial |
$793.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$804.18
|
| Rate for Payer: Cash Price |
$515.50
|
| Rate for Payer: Cigna Commercial |
$855.73
|
| Rate for Payer: First Health Commercial |
$979.45
|
| Rate for Payer: Humana Commercial |
$876.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$845.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$760.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$309.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$907.28
|
| Rate for Payer: Ohio Health Group HMO |
$773.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$824.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$896.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$711.39
|
| Rate for Payer: PHCS Commercial |
$989.76
|
| Rate for Payer: United Healthcare All Payer |
$907.28
|
|
|
CLTX HIP ARTHRP DISLC WANES
|
Facility
|
OP
|
$2,172.00
|
|
|
Service Code
|
HCPCS 27266
|
| Hospital Charge Code |
45000155
|
|
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
|
|
|
CLTX HIP ARTHRP DISLC WANES
|
Professional
|
Both
|
$1,031.00
|
|
|
Service Code
|
HCPCS 27266
|
| Hospital Charge Code |
76100803
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$360.85 |
| Max. Negotiated Rate |
$926.53 |
| Rate for Payer: Aetna Commercial |
$847.15
|
| Rate for Payer: Ambetter Exchange |
$555.18
|
| Rate for Payer: Anthem Medicaid |
$363.44
|
| Rate for Payer: Buckeye Individual/Medicaid |
$555.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$555.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$666.22
|
| Rate for Payer: Cash Price |
$515.50
|
| Rate for Payer: Cash Price |
$515.50
|
| Rate for Payer: Cigna Commercial |
$926.53
|
| Rate for Payer: Healthspan PPO |
$767.34
|
| Rate for Payer: Humana Medicaid |
$363.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$717.17
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$555.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$555.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$370.71
|
| Rate for Payer: Molina Healthcare Passport |
$363.44
|
| Rate for Payer: Multiplan PHCS |
$618.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$721.73
|
| Rate for Payer: UHCCP Medicaid |
$360.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$367.07
|
| Rate for Payer: Wellcare Medicare Advantage |
$555.18
|
|
|
CLTX HIP ARTHRP DISLC WANES
|
Facility
|
IP
|
$2,172.00
|
|
|
Service Code
|
HCPCS 27266
|
| Hospital Charge Code |
45000155
|
|
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
|
|
|
CLTX HIP ARTHRP DISLC WANES(P
|
Professional
|
Both
|
$1,031.00
|
|
|
Service Code
|
HCPCS 27266
|
| Hospital Charge Code |
761P0803
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$360.85 |
| Max. Negotiated Rate |
$926.53 |
| Rate for Payer: Aetna Commercial |
$847.15
|
| Rate for Payer: Ambetter Exchange |
$555.18
|
| Rate for Payer: Anthem Medicaid |
$363.44
|
| Rate for Payer: Buckeye Individual/Medicaid |
$555.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$555.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$666.22
|
| Rate for Payer: Cash Price |
$515.50
|
| Rate for Payer: Cash Price |
$515.50
|
| Rate for Payer: Cigna Commercial |
$926.53
|
| Rate for Payer: Healthspan PPO |
$767.34
|
| Rate for Payer: Humana Medicaid |
$363.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$717.17
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$555.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$555.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$370.71
|
| Rate for Payer: Molina Healthcare Passport |
$363.44
|
| Rate for Payer: Multiplan PHCS |
$618.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$721.73
|
| Rate for Payer: UHCCP Medicaid |
$360.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$367.07
|
| Rate for Payer: Wellcare Medicare Advantage |
$555.18
|
|
|
CLTX HIP ARTHRP DISLC WOANES
|
Facility
|
OP
|
$455.00
|
|
|
Service Code
|
HCPCS 27265
|
| Hospital Charge Code |
45000154
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$156.47 |
| Max. Negotiated Rate |
$436.80 |
| Rate for Payer: Aetna Commercial |
$350.35
|
| Rate for Payer: Anthem Medicaid |
$156.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$354.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$227.50
|
| Rate for Payer: Cash Price |
$227.50
|
| Rate for Payer: Cigna Commercial |
$377.65
|
| Rate for Payer: First Health Commercial |
$432.25
|
| Rate for Payer: Humana Commercial |
$386.75
|
| Rate for Payer: Humana KY Medicaid |
$156.47
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$158.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$373.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$335.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$159.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$400.40
|
| Rate for Payer: Ohio Health Group HMO |
$341.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$364.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$395.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$313.95
|
| Rate for Payer: PHCS Commercial |
$436.80
|
| Rate for Payer: United Healthcare All Payer |
$400.40
|
|
|
CLTX HIP ARTHRP DISLC WOANES
|
Professional
|
Both
|
$975.00
|
|
|
Service Code
|
HCPCS 27265
|
| Hospital Charge Code |
76100802
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$269.66 |
| Max. Negotiated Rate |
$633.49 |
| Rate for Payer: Aetna Commercial |
$558.78
|
| Rate for Payer: Ambetter Exchange |
$402.80
|
| Rate for Payer: Anthem Medicaid |
$269.66
|
| Rate for Payer: Buckeye Individual/Medicaid |
$402.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$402.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$483.36
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cigna Commercial |
$633.49
|
| Rate for Payer: Healthspan PPO |
$506.14
|
| Rate for Payer: Humana Medicaid |
$269.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$480.11
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$402.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$402.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$275.05
|
| Rate for Payer: Molina Healthcare Passport |
$269.66
|
| Rate for Payer: Multiplan PHCS |
$585.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$523.64
|
| Rate for Payer: UHCCP Medicaid |
$341.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$272.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$402.80
|
|
|
CLTX HIP ARTHRP DISLC WOANES
|
Facility
|
OP
|
$975.00
|
|
|
Service Code
|
HCPCS 27265
|
| Hospital Charge Code |
76100802
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$936.00 |
| Rate for Payer: Aetna Commercial |
$750.75
|
| Rate for Payer: Anthem Medicaid |
$335.30
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$760.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cigna Commercial |
$809.25
|
| Rate for Payer: First Health Commercial |
$926.25
|
| Rate for Payer: Humana Commercial |
$828.75
|
| Rate for Payer: Humana KY Medicaid |
$335.30
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$338.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$799.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$719.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$342.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$858.00
|
| Rate for Payer: Ohio Health Group HMO |
$731.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$848.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$672.75
|
| Rate for Payer: PHCS Commercial |
$936.00
|
| Rate for Payer: United Healthcare All Payer |
$858.00
|
|
|
CLTX HIP ARTHRP DISLC WOANES
|
Facility
|
IP
|
$975.00
|
|
|
Service Code
|
HCPCS 27265
|
| Hospital Charge Code |
76100802
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$292.50 |
| Max. Negotiated Rate |
$936.00 |
| Rate for Payer: Aetna Commercial |
$750.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$760.50
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cigna Commercial |
$809.25
|
| Rate for Payer: First Health Commercial |
$926.25
|
| Rate for Payer: Humana Commercial |
$828.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$799.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$719.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$292.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$858.00
|
| Rate for Payer: Ohio Health Group HMO |
$731.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$848.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$672.75
|
| Rate for Payer: PHCS Commercial |
$936.00
|
| Rate for Payer: United Healthcare All Payer |
$858.00
|
|
|
CLTX HIP ARTHRP DISLC WOANES
|
Facility
|
IP
|
$455.00
|
|
|
Service Code
|
HCPCS 27265
|
| Hospital Charge Code |
45000154
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$136.50 |
| Max. Negotiated Rate |
$436.80 |
| Rate for Payer: Aetna Commercial |
$350.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$354.90
|
| Rate for Payer: Cash Price |
$227.50
|
| Rate for Payer: Cigna Commercial |
$377.65
|
| Rate for Payer: First Health Commercial |
$432.25
|
| Rate for Payer: Humana Commercial |
$386.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$373.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$335.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$136.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$400.40
|
| Rate for Payer: Ohio Health Group HMO |
$341.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$364.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$395.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$313.95
|
| Rate for Payer: PHCS Commercial |
$436.80
|
| Rate for Payer: United Healthcare All Payer |
$400.40
|
|
|
CLTX HIP ARTHRP DISLC WOANES(P
|
Professional
|
Both
|
$975.00
|
|
|
Service Code
|
HCPCS 27265
|
| Hospital Charge Code |
761P0802
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$269.66 |
| Max. Negotiated Rate |
$633.49 |
| Rate for Payer: Aetna Commercial |
$558.78
|
| Rate for Payer: Ambetter Exchange |
$402.80
|
| Rate for Payer: Anthem Medicaid |
$269.66
|
| Rate for Payer: Buckeye Individual/Medicaid |
$402.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$402.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$483.36
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cigna Commercial |
$633.49
|
| Rate for Payer: Healthspan PPO |
$506.14
|
| Rate for Payer: Humana Medicaid |
$269.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$480.11
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$402.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$402.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$275.05
|
| Rate for Payer: Molina Healthcare Passport |
$269.66
|
| Rate for Payer: Multiplan PHCS |
$585.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$523.64
|
| Rate for Payer: UHCCP Medicaid |
$341.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$272.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$402.80
|
|
|
CLTX HIP DISL TRAUM W/ANES
|
Facility
|
IP
|
$1,240.00
|
|
|
Service Code
|
HCPCS 27252
|
| Hospital Charge Code |
76100799
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$372.00 |
| Max. Negotiated Rate |
$1,190.40 |
| Rate for Payer: Aetna Commercial |
$954.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$967.20
|
| Rate for Payer: Cash Price |
$620.00
|
| Rate for Payer: Cigna Commercial |
$1,029.20
|
| Rate for Payer: First Health Commercial |
$1,178.00
|
| Rate for Payer: Humana Commercial |
$1,054.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,016.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$915.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$372.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,091.20
|
| Rate for Payer: Ohio Health Group HMO |
$930.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$992.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,078.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$855.60
|
| Rate for Payer: PHCS Commercial |
$1,190.40
|
| Rate for Payer: United Healthcare All Payer |
$1,091.20
|
|
|
CLTX HIP DISL TRAUM W/ANES
|
Facility
|
OP
|
$1,240.00
|
|
|
Service Code
|
HCPCS 27252
|
| Hospital Charge Code |
76100799
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$426.44 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$954.80
|
| Rate for Payer: Anthem Medicaid |
$426.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$967.20
|
| 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 |
$620.00
|
| Rate for Payer: Cash Price |
$620.00
|
| Rate for Payer: Cigna Commercial |
$1,029.20
|
| Rate for Payer: First Health Commercial |
$1,178.00
|
| Rate for Payer: Humana Commercial |
$1,054.00
|
| Rate for Payer: Humana KY Medicaid |
$426.44
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$430.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,016.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$915.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$434.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,091.20
|
| Rate for Payer: Ohio Health Group HMO |
$930.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$992.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,078.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$855.60
|
| Rate for Payer: PHCS Commercial |
$1,190.40
|
| Rate for Payer: United Healthcare All Payer |
$1,091.20
|
|
|
CLTX HIP DISL TRAUM W/ANES
|
Professional
|
Both
|
$1,240.00
|
|
|
Service Code
|
HCPCS 27252
|
| Hospital Charge Code |
76100799
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$410.81 |
| Max. Negotiated Rate |
$1,211.16 |
| Rate for Payer: Aetna Commercial |
$1,116.78
|
| Rate for Payer: Ambetter Exchange |
$711.87
|
| Rate for Payer: Anthem Medicaid |
$410.81
|
| Rate for Payer: Buckeye Individual/Medicaid |
$711.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$711.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$854.24
|
| Rate for Payer: Cash Price |
$620.00
|
| Rate for Payer: Cash Price |
$620.00
|
| Rate for Payer: Cigna Commercial |
$1,211.16
|
| Rate for Payer: Healthspan PPO |
$1,011.56
|
| Rate for Payer: Humana Medicaid |
$410.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$941.10
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$711.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$711.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$419.03
|
| Rate for Payer: Molina Healthcare Passport |
$410.81
|
| Rate for Payer: Multiplan PHCS |
$744.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$925.43
|
| Rate for Payer: UHCCP Medicaid |
$434.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$414.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$711.87
|
|
|
CLTX HIP DISL TRAUM W/ANES
|
Facility
|
OP
|
$2,248.00
|
|
|
Service Code
|
HCPCS 27252
|
| Hospital Charge Code |
45000152
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$773.09 |
| Max. Negotiated Rate |
$2,158.08 |
| Rate for Payer: Aetna Commercial |
$1,730.96
|
| Rate for Payer: Anthem Medicaid |
$773.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,753.44
|
| 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 |
$1,124.00
|
| Rate for Payer: Cash Price |
$1,124.00
|
| Rate for Payer: Cigna Commercial |
$1,865.84
|
| Rate for Payer: First Health Commercial |
$2,135.60
|
| Rate for Payer: Humana Commercial |
$1,910.80
|
| Rate for Payer: Humana KY Medicaid |
$773.09
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$780.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,843.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,659.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$788.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,978.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,686.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,798.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,955.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,551.12
|
| Rate for Payer: PHCS Commercial |
$2,158.08
|
| Rate for Payer: United Healthcare All Payer |
$1,978.24
|
|
|
CLTX HIP DISL TRAUM W/ANES
|
Facility
|
IP
|
$2,248.00
|
|
|
Service Code
|
HCPCS 27252
|
| Hospital Charge Code |
45000152
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$674.40 |
| Max. Negotiated Rate |
$2,158.08 |
| Rate for Payer: Aetna Commercial |
$1,730.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,753.44
|
| Rate for Payer: Cash Price |
$1,124.00
|
| Rate for Payer: Cigna Commercial |
$1,865.84
|
| Rate for Payer: First Health Commercial |
$2,135.60
|
| Rate for Payer: Humana Commercial |
$1,910.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,843.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,659.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$674.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,978.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,686.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,798.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,955.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,551.12
|
| Rate for Payer: PHCS Commercial |
$2,158.08
|
| Rate for Payer: United Healthcare All Payer |
$1,978.24
|
|
|
CLTX HIP DISL TRAUM W/ANES(P
|
Professional
|
Both
|
$1,240.00
|
|
|
Service Code
|
HCPCS 27252
|
| Hospital Charge Code |
761P0799
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$410.81 |
| Max. Negotiated Rate |
$1,211.16 |
| Rate for Payer: Aetna Commercial |
$1,116.78
|
| Rate for Payer: Ambetter Exchange |
$711.87
|
| Rate for Payer: Anthem Medicaid |
$410.81
|
| Rate for Payer: Buckeye Individual/Medicaid |
$711.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$711.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$854.24
|
| Rate for Payer: Cash Price |
$620.00
|
| Rate for Payer: Cash Price |
$620.00
|
| Rate for Payer: Cigna Commercial |
$1,211.16
|
| Rate for Payer: Healthspan PPO |
$1,011.56
|
| Rate for Payer: Humana Medicaid |
$410.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$941.10
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$711.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$711.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$419.03
|
| Rate for Payer: Molina Healthcare Passport |
$410.81
|
| Rate for Payer: Multiplan PHCS |
$744.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$925.43
|
| Rate for Payer: UHCCP Medicaid |
$434.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$414.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$711.87
|
|
|
CLTX HUM CONDYLR FX M/L WO MAN
|
Facility
|
OP
|
$553.98
|
|
|
Service Code
|
HCPCS 24576
|
| Hospital Charge Code |
761T0546
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$190.51 |
| Max. Negotiated Rate |
$531.82 |
| Rate for Payer: Aetna Commercial |
$426.56
|
| Rate for Payer: Anthem Medicaid |
$190.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$432.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$276.99
|
| Rate for Payer: Cash Price |
$276.99
|
| Rate for Payer: Cigna Commercial |
$459.80
|
| Rate for Payer: First Health Commercial |
$526.28
|
| Rate for Payer: Humana Commercial |
$470.88
|
| Rate for Payer: Humana KY Medicaid |
$190.51
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$192.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$454.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$408.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$194.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$487.50
|
| Rate for Payer: Ohio Health Group HMO |
$415.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$443.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$481.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$382.25
|
| Rate for Payer: PHCS Commercial |
$531.82
|
| Rate for Payer: United Healthcare All Payer |
$487.50
|
|
|
CLTX HUM CONDYLR FX M/L WO MAN
|
Facility
|
IP
|
$1,844.00
|
|
|
Service Code
|
HCPCS 24576
|
| Hospital Charge Code |
76100547
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$553.20 |
| Max. Negotiated Rate |
$1,770.24 |
| Rate for Payer: Aetna Commercial |
$1,419.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,438.32
|
| Rate for Payer: Cash Price |
$922.00
|
| Rate for Payer: Cigna Commercial |
$1,530.52
|
| Rate for Payer: First Health Commercial |
$1,751.80
|
| Rate for Payer: Humana Commercial |
$1,567.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,512.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,360.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$553.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,622.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,383.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,475.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,604.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,272.36
|
| Rate for Payer: PHCS Commercial |
$1,770.24
|
| Rate for Payer: United Healthcare All Payer |
$1,622.72
|
|
