|
CLTX HUM CONDYLR FX M/L WO MAN
|
Facility
|
IP
|
$1,050.00
|
|
|
Service Code
|
HCPCS 24576
|
| Hospital Charge Code |
761T0547
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$315.00 |
| Max. Negotiated Rate |
$1,008.00 |
| Rate for Payer: Aetna Commercial |
$808.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$819.00
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$871.50
|
| Rate for Payer: First Health Commercial |
$997.50
|
| Rate for Payer: Humana Commercial |
$892.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$861.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$774.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$315.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$924.00
|
| Rate for Payer: Ohio Health Group HMO |
$787.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$840.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$913.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$724.50
|
| Rate for Payer: PHCS Commercial |
$1,008.00
|
| Rate for Payer: United Healthcare All Payer |
$924.00
|
|
|
CLTX HUM CONDYLR FX M/L WO MAN
|
Facility
|
OP
|
$1,050.00
|
|
|
Service Code
|
HCPCS 24576
|
| Hospital Charge Code |
761T0547
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$1,008.00 |
| Rate for Payer: Aetna Commercial |
$808.50
|
| Rate for Payer: Anthem Medicaid |
$361.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$819.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$871.50
|
| Rate for Payer: First Health Commercial |
$997.50
|
| Rate for Payer: Humana Commercial |
$892.50
|
| Rate for Payer: Humana KY Medicaid |
$361.10
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$364.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$861.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$774.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$368.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$924.00
|
| Rate for Payer: Ohio Health Group HMO |
$787.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$840.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$913.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$724.50
|
| Rate for Payer: PHCS Commercial |
$1,008.00
|
| Rate for Payer: United Healthcare All Payer |
$924.00
|
|
|
CLTX HUM CONDYLR FX M/L WO MAN
|
Facility
|
IP
|
$553.98
|
|
|
Service Code
|
HCPCS 24576
|
| Hospital Charge Code |
761T0546
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$166.19 |
| Max. Negotiated Rate |
$531.82 |
| Rate for Payer: Aetna Commercial |
$426.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$432.10
|
| 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: 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 |
$166.19
|
| 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
|
Professional
|
Both
|
$1,844.00
|
|
|
Service Code
|
HCPCS 24576
|
| Hospital Charge Code |
76100547
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$144.01 |
| Max. Negotiated Rate |
$1,106.40 |
| Rate for Payer: Aetna Commercial |
$400.49
|
| Rate for Payer: Ambetter Exchange |
$304.13
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$163.17
|
| Rate for Payer: Anthem Medicaid |
$144.01
|
| Rate for Payer: Buckeye Individual/Medicaid |
$304.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$304.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$364.96
|
| Rate for Payer: Cash Price |
$922.00
|
| Rate for Payer: Cash Price |
$922.00
|
| Rate for Payer: Cigna Commercial |
$497.38
|
| Rate for Payer: Healthspan PPO |
$400.58
|
| Rate for Payer: Humana Medicaid |
$144.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$359.34
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$304.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$304.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$146.89
|
| Rate for Payer: Molina Healthcare Passport |
$144.01
|
| Rate for Payer: Multiplan PHCS |
$1,106.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$395.37
|
| Rate for Payer: UHCCP Medicaid |
$171.33
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$145.45
|
| Rate for Payer: Wellcare Medicare Advantage |
$304.13
|
|
|
CLTX HUM CONDYLR FX M/L WO MAN
|
Professional
|
Both
|
$794.00
|
|
|
Service Code
|
HCPCS 24576
|
| Hospital Charge Code |
761P0546
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$144.01 |
| Max. Negotiated Rate |
$497.38 |
| Rate for Payer: Aetna Commercial |
$400.49
|
| Rate for Payer: Ambetter Exchange |
$304.13
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$163.17
|
| Rate for Payer: Anthem Medicaid |
$144.01
|
| Rate for Payer: Buckeye Individual/Medicaid |
$304.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$304.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$364.96
|
| Rate for Payer: Cash Price |
$397.00
|
| Rate for Payer: Cash Price |
$397.00
|
| Rate for Payer: Cigna Commercial |
$497.38
|
| Rate for Payer: Healthspan PPO |
$400.58
|
| Rate for Payer: Humana Medicaid |
$144.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$359.34
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$304.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$304.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$146.89
|
| Rate for Payer: Molina Healthcare Passport |
$144.01
|
| Rate for Payer: Multiplan PHCS |
$476.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$395.37
|
| Rate for Payer: UHCCP Medicaid |
$171.33
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$145.45
|
| Rate for Payer: Wellcare Medicare Advantage |
$304.13
|
|
|
CLTX HUM CONDYLR FX M/L WO MAN
|
Facility
|
OP
|
$1,844.00
|
|
|
Service Code
|
HCPCS 24576
|
| Hospital Charge Code |
76100547
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$1,770.24 |
| Rate for Payer: Aetna Commercial |
$1,419.88
|
| Rate for Payer: Anthem Medicaid |
$634.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,438.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$922.00
|
| 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: Humana KY Medicaid |
$634.15
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$640.61
|
| 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 |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$646.88
|
| 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
|
|
|
CLTX HUM CONDYLR FX M/L WO MAN
|
Facility
|
OP
|
$1,347.98
|
|
|
Service Code
|
HCPCS 24576
|
| Hospital Charge Code |
76100546
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$1,294.06 |
| Rate for Payer: Aetna Commercial |
$1,037.94
|
| Rate for Payer: Anthem Medicaid |
$463.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,051.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$673.99
|
| Rate for Payer: Cash Price |
$673.99
|
| Rate for Payer: Cigna Commercial |
$1,118.82
|
| Rate for Payer: First Health Commercial |
$1,280.58
|
| Rate for Payer: Humana Commercial |
$1,145.78
|
| Rate for Payer: Humana KY Medicaid |
$463.57
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$468.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,105.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$994.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$472.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,186.22
|
| Rate for Payer: Ohio Health Group HMO |
$1,010.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,078.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,172.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$930.11
|
| Rate for Payer: PHCS Commercial |
$1,294.06
|
| Rate for Payer: United Healthcare All Payer |
$1,186.22
|
|
|
CLTX HUM CONDYLR FX M/L WO MAN
|
Professional
|
Both
|
$1,347.98
|
|
|
Service Code
|
HCPCS 24576
|
| Hospital Charge Code |
76100546
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$144.01 |
| Max. Negotiated Rate |
$808.79 |
| Rate for Payer: Aetna Commercial |
$400.49
|
| Rate for Payer: Ambetter Exchange |
$304.13
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$163.17
|
| Rate for Payer: Anthem Medicaid |
$144.01
|
| Rate for Payer: Buckeye Individual/Medicaid |
$304.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$304.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$364.96
|
| Rate for Payer: Cash Price |
$673.99
|
| Rate for Payer: Cash Price |
$673.99
|
| Rate for Payer: Cigna Commercial |
$497.38
|
| Rate for Payer: Healthspan PPO |
$400.58
|
| Rate for Payer: Humana Medicaid |
$144.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$359.34
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$304.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$304.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$146.89
|
| Rate for Payer: Molina Healthcare Passport |
$144.01
|
| Rate for Payer: Multiplan PHCS |
$808.79
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$395.37
|
| Rate for Payer: UHCCP Medicaid |
$171.33
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$145.45
|
| Rate for Payer: Wellcare Medicare Advantage |
$304.13
|
|
|
CLTX HUM CONDYLR FX M/L WO MAN
|
Professional
|
Both
|
$794.00
|
|
|
Service Code
|
HCPCS 24576
|
| Hospital Charge Code |
761P0547
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$144.01 |
| Max. Negotiated Rate |
$497.38 |
| Rate for Payer: Aetna Commercial |
$400.49
|
| Rate for Payer: Ambetter Exchange |
$304.13
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$163.17
|
| Rate for Payer: Anthem Medicaid |
$144.01
|
| Rate for Payer: Buckeye Individual/Medicaid |
$304.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$304.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$364.96
|
| Rate for Payer: Cash Price |
$397.00
|
| Rate for Payer: Cash Price |
$397.00
|
| Rate for Payer: Cigna Commercial |
$497.38
|
| Rate for Payer: Healthspan PPO |
$400.58
|
| Rate for Payer: Humana Medicaid |
$144.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$359.34
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$304.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$304.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$146.89
|
| Rate for Payer: Molina Healthcare Passport |
$144.01
|
| Rate for Payer: Multiplan PHCS |
$476.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$395.37
|
| Rate for Payer: UHCCP Medicaid |
$171.33
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$145.45
|
| Rate for Payer: Wellcare Medicare Advantage |
$304.13
|
|
|
CLTX HUM CONDYLR FX M/L WO MAN
|
Facility
|
IP
|
$1,347.98
|
|
|
Service Code
|
HCPCS 24576
|
| Hospital Charge Code |
76100546
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$404.39 |
| Max. Negotiated Rate |
$1,294.06 |
| Rate for Payer: Aetna Commercial |
$1,037.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,051.42
|
| Rate for Payer: Cash Price |
$673.99
|
| Rate for Payer: Cigna Commercial |
$1,118.82
|
| Rate for Payer: First Health Commercial |
$1,280.58
|
| Rate for Payer: Humana Commercial |
$1,145.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,105.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$994.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$404.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,186.22
|
| Rate for Payer: Ohio Health Group HMO |
$1,010.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,078.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,172.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$930.11
|
| Rate for Payer: PHCS Commercial |
$1,294.06
|
| Rate for Payer: United Healthcare All Payer |
$1,186.22
|
|
|
CLTX HUM EPICOND FX M/L WO MAN
|
Facility
|
IP
|
$1,029.00
|
|
|
Service Code
|
HCPCS 24560
|
| Hospital Charge Code |
761T0541
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$308.70 |
| Max. Negotiated Rate |
$987.84 |
| Rate for Payer: Aetna Commercial |
$792.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$802.62
|
| Rate for Payer: Cash Price |
$514.50
|
| Rate for Payer: Cigna Commercial |
$854.07
|
| Rate for Payer: First Health Commercial |
$977.55
|
| Rate for Payer: Humana Commercial |
$874.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$843.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$759.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$308.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$905.52
|
| Rate for Payer: Ohio Health Group HMO |
$771.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$823.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$895.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$710.01
|
| Rate for Payer: PHCS Commercial |
$987.84
|
| Rate for Payer: United Healthcare All Payer |
$905.52
|
|
|
CLTX HUM EPICOND FX M/L WO MAN
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 24560
|
| Hospital Charge Code |
761P0541
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$142.11 |
| Max. Negotiated Rate |
$472.79 |
| Rate for Payer: Aetna Commercial |
$376.83
|
| Rate for Payer: Ambetter Exchange |
$286.17
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$153.65
|
| Rate for Payer: Anthem Medicaid |
$142.11
|
| Rate for Payer: Buckeye Individual/Medicaid |
$286.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$286.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$343.40
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$472.79
|
| Rate for Payer: Healthspan PPO |
$381.09
|
| Rate for Payer: Humana Medicaid |
$142.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$336.46
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$286.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$286.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$144.95
|
| Rate for Payer: Molina Healthcare Passport |
$142.11
|
| Rate for Payer: Multiplan PHCS |
$420.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$372.02
|
| Rate for Payer: UHCCP Medicaid |
$161.33
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$143.53
|
| Rate for Payer: Wellcare Medicare Advantage |
$286.17
|
|
|
CLTX HUM EPICOND FX M/L WO MAN
|
Facility
|
OP
|
$1,029.00
|
|
|
Service Code
|
HCPCS 24560
|
| Hospital Charge Code |
761T0541
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$987.84 |
| Rate for Payer: Aetna Commercial |
$792.33
|
| Rate for Payer: Anthem Medicaid |
$353.87
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$802.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$514.50
|
| Rate for Payer: Cash Price |
$514.50
|
| Rate for Payer: Cigna Commercial |
$854.07
|
| Rate for Payer: First Health Commercial |
$977.55
|
| Rate for Payer: Humana Commercial |
$874.65
|
| Rate for Payer: Humana KY Medicaid |
$353.87
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$357.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$843.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$759.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$360.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$905.52
|
| Rate for Payer: Ohio Health Group HMO |
$771.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$823.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$895.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$710.01
|
| Rate for Payer: PHCS Commercial |
$987.84
|
| Rate for Payer: United Healthcare All Payer |
$905.52
|
|
|
CLTX HUM EPICOND FX M/L WO MAN
|
Facility
|
IP
|
$1,729.00
|
|
|
Service Code
|
HCPCS 24560
|
| Hospital Charge Code |
76100541
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$518.70 |
| Max. Negotiated Rate |
$1,659.84 |
| Rate for Payer: Aetna Commercial |
$1,331.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,348.62
|
| Rate for Payer: Cash Price |
$864.50
|
| Rate for Payer: Cigna Commercial |
$1,435.07
|
| Rate for Payer: First Health Commercial |
$1,642.55
|
| Rate for Payer: Humana Commercial |
$1,469.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,417.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,276.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$518.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,521.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,296.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,383.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,504.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,193.01
|
| Rate for Payer: PHCS Commercial |
$1,659.84
|
| Rate for Payer: United Healthcare All Payer |
$1,521.52
|
|
|
CLTX HUM EPICOND FX M/L WO MAN
|
Professional
|
Both
|
$1,729.00
|
|
|
Service Code
|
HCPCS 24560
|
| Hospital Charge Code |
76100541
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$142.11 |
| Max. Negotiated Rate |
$1,037.40 |
| Rate for Payer: Aetna Commercial |
$376.83
|
| Rate for Payer: Ambetter Exchange |
$286.17
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$153.65
|
| Rate for Payer: Anthem Medicaid |
$142.11
|
| Rate for Payer: Buckeye Individual/Medicaid |
$286.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$286.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$343.40
|
| Rate for Payer: Cash Price |
$864.50
|
| Rate for Payer: Cash Price |
$864.50
|
| Rate for Payer: Cigna Commercial |
$472.79
|
| Rate for Payer: Healthspan PPO |
$381.09
|
| Rate for Payer: Humana Medicaid |
$142.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$336.46
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$286.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$286.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$144.95
|
| Rate for Payer: Molina Healthcare Passport |
$142.11
|
| Rate for Payer: Multiplan PHCS |
$1,037.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$372.02
|
| Rate for Payer: UHCCP Medicaid |
$161.33
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$143.53
|
| Rate for Payer: Wellcare Medicare Advantage |
$286.17
|
|
|
CLTX HUM EPICOND FX M/L WO MAN
|
Facility
|
OP
|
$1,729.00
|
|
|
Service Code
|
HCPCS 24560
|
| Hospital Charge Code |
76100541
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$1,659.84 |
| Rate for Payer: Aetna Commercial |
$1,331.33
|
| Rate for Payer: Anthem Medicaid |
$594.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,348.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$864.50
|
| Rate for Payer: Cash Price |
$864.50
|
| Rate for Payer: Cigna Commercial |
$1,435.07
|
| Rate for Payer: First Health Commercial |
$1,642.55
|
| Rate for Payer: Humana Commercial |
$1,469.65
|
| Rate for Payer: Humana KY Medicaid |
$594.60
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$600.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,417.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,276.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$606.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,521.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,296.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,383.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,504.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,193.01
|
| Rate for Payer: PHCS Commercial |
$1,659.84
|
| Rate for Payer: United Healthcare All Payer |
$1,521.52
|
|
|
CLTX HUMEPICON FX MED/LAT WMAN
|
Facility
|
OP
|
$3,160.00
|
|
|
Service Code
|
HCPCS 24565
|
| Hospital Charge Code |
45000120
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,086.72 |
| Max. Negotiated Rate |
$3,033.60 |
| Rate for Payer: Aetna Commercial |
$2,433.20
|
| Rate for Payer: Anthem Medicaid |
$1,086.72
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,464.80
|
| 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 |
$1,580.00
|
| Rate for Payer: Cash Price |
$1,580.00
|
| Rate for Payer: Cigna Commercial |
$2,622.80
|
| Rate for Payer: First Health Commercial |
$3,002.00
|
| Rate for Payer: Humana Commercial |
$2,686.00
|
| Rate for Payer: Humana KY Medicaid |
$1,086.72
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,097.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,591.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,332.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,108.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,780.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,370.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,528.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,749.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,180.40
|
| Rate for Payer: PHCS Commercial |
$3,033.60
|
| Rate for Payer: United Healthcare All Payer |
$2,780.80
|
|
|
CLTX HUMEPICON FX MED/LAT WMAN
|
Facility
|
OP
|
$4,460.00
|
|
|
Service Code
|
HCPCS 24565
|
| Hospital Charge Code |
76100542
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,478.75 |
| Max. Negotiated Rate |
$4,281.60 |
| Rate for Payer: Aetna Commercial |
$3,434.20
|
| Rate for Payer: Anthem Medicaid |
$1,533.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,478.80
|
| 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 |
$2,230.00
|
| Rate for Payer: Cash Price |
$2,230.00
|
| Rate for Payer: Cigna Commercial |
$3,701.80
|
| Rate for Payer: First Health Commercial |
$4,237.00
|
| Rate for Payer: Humana Commercial |
$3,791.00
|
| Rate for Payer: Humana KY Medicaid |
$1,533.79
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,549.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,657.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,291.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,564.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,924.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,345.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,568.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,880.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,077.40
|
| Rate for Payer: PHCS Commercial |
$4,281.60
|
| Rate for Payer: United Healthcare All Payer |
$3,924.80
|
|
|
CLTX HUMEPICON FX MED/LAT WMAN
|
Professional
|
Both
|
$4,460.00
|
|
|
Service Code
|
HCPCS 24565
|
| Hospital Charge Code |
76100542
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$258.83 |
| Max. Negotiated Rate |
$2,676.00 |
| Rate for Payer: Aetna Commercial |
$663.14
|
| Rate for Payer: Ambetter Exchange |
$477.42
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$260.26
|
| Rate for Payer: Anthem Medicaid |
$258.83
|
| Rate for Payer: Buckeye Individual/Medicaid |
$477.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$477.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$572.90
|
| Rate for Payer: Cash Price |
$2,230.00
|
| Rate for Payer: Cash Price |
$2,230.00
|
| Rate for Payer: Cigna Commercial |
$733.95
|
| Rate for Payer: Healthspan PPO |
$644.29
|
| Rate for Payer: Humana Medicaid |
$258.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$582.81
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$477.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$477.42
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$264.01
|
| Rate for Payer: Molina Healthcare Passport |
$258.83
|
| Rate for Payer: Multiplan PHCS |
$2,676.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$620.65
|
| Rate for Payer: UHCCP Medicaid |
$273.27
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$261.42
|
| Rate for Payer: Wellcare Medicare Advantage |
$477.42
|
|
|
CLTX HUMEPICON FX MED/LAT WMAN
|
Facility
|
IP
|
$3,160.00
|
|
|
Service Code
|
HCPCS 24565
|
| Hospital Charge Code |
761T0542
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$948.00 |
| Max. Negotiated Rate |
$3,033.60 |
| Rate for Payer: Aetna Commercial |
$2,433.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,464.80
|
| Rate for Payer: Cash Price |
$1,580.00
|
| Rate for Payer: Cigna Commercial |
$2,622.80
|
| Rate for Payer: First Health Commercial |
$3,002.00
|
| Rate for Payer: Humana Commercial |
$2,686.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,591.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,332.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$948.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,780.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,370.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,528.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,749.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,180.40
|
| Rate for Payer: PHCS Commercial |
$3,033.60
|
| Rate for Payer: United Healthcare All Payer |
$2,780.80
|
|
|
CLTX HUMEPICON FX MED/LAT WMAN
|
Facility
|
OP
|
$3,160.00
|
|
|
Service Code
|
HCPCS 24565
|
| Hospital Charge Code |
761T0542
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,086.72 |
| Max. Negotiated Rate |
$3,033.60 |
| Rate for Payer: Aetna Commercial |
$2,433.20
|
| Rate for Payer: Anthem Medicaid |
$1,086.72
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,464.80
|
| 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 |
$1,580.00
|
| Rate for Payer: Cash Price |
$1,580.00
|
| Rate for Payer: Cigna Commercial |
$2,622.80
|
| Rate for Payer: First Health Commercial |
$3,002.00
|
| Rate for Payer: Humana Commercial |
$2,686.00
|
| Rate for Payer: Humana KY Medicaid |
$1,086.72
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,097.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,591.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,332.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,108.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,780.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,370.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,528.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,749.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,180.40
|
| Rate for Payer: PHCS Commercial |
$3,033.60
|
| Rate for Payer: United Healthcare All Payer |
$2,780.80
|
|
|
CLTX HUMEPICON FX MED/LAT WMAN
|
Facility
|
IP
|
$3,160.00
|
|
|
Service Code
|
HCPCS 24565
|
| Hospital Charge Code |
45000120
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$948.00 |
| Max. Negotiated Rate |
$3,033.60 |
| Rate for Payer: Aetna Commercial |
$2,433.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,464.80
|
| Rate for Payer: Cash Price |
$1,580.00
|
| Rate for Payer: Cigna Commercial |
$2,622.80
|
| Rate for Payer: First Health Commercial |
$3,002.00
|
| Rate for Payer: Humana Commercial |
$2,686.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,591.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,332.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$948.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,780.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,370.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,528.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,749.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,180.40
|
| Rate for Payer: PHCS Commercial |
$3,033.60
|
| Rate for Payer: United Healthcare All Payer |
$2,780.80
|
|
|
CLTX HUMEPICON FX MED/LAT WMAN
|
Facility
|
IP
|
$4,460.00
|
|
|
Service Code
|
HCPCS 24565
|
| Hospital Charge Code |
76100542
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,338.00 |
| Max. Negotiated Rate |
$4,281.60 |
| Rate for Payer: Aetna Commercial |
$3,434.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,478.80
|
| Rate for Payer: Cash Price |
$2,230.00
|
| Rate for Payer: Cigna Commercial |
$3,701.80
|
| Rate for Payer: First Health Commercial |
$4,237.00
|
| Rate for Payer: Humana Commercial |
$3,791.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,657.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,291.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,338.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,924.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,345.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,568.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,880.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,077.40
|
| Rate for Payer: PHCS Commercial |
$4,281.60
|
| Rate for Payer: United Healthcare All Payer |
$3,924.80
|
|
|
CLTX HUMEPICON FX MED/LAT WMAN
|
Professional
|
Both
|
$1,300.00
|
|
|
Service Code
|
HCPCS 24565
|
| Hospital Charge Code |
761P0542
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$258.83 |
| Max. Negotiated Rate |
$780.00 |
| Rate for Payer: Aetna Commercial |
$663.14
|
| Rate for Payer: Ambetter Exchange |
$477.42
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$260.26
|
| Rate for Payer: Anthem Medicaid |
$258.83
|
| Rate for Payer: Buckeye Individual/Medicaid |
$477.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$477.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$572.90
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$733.95
|
| Rate for Payer: Healthspan PPO |
$644.29
|
| Rate for Payer: Humana Medicaid |
$258.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$582.81
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$477.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$477.42
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$264.01
|
| Rate for Payer: Molina Healthcare Passport |
$258.83
|
| Rate for Payer: Multiplan PHCS |
$780.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$620.65
|
| Rate for Payer: UHCCP Medicaid |
$273.27
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$261.42
|
| Rate for Payer: Wellcare Medicare Advantage |
$477.42
|
|
|
CLTX HUM SHAFT FX W/O MANIP
|
Facility
|
IP
|
$1,612.00
|
|
|
Service Code
|
HCPCS 24500
|
| Hospital Charge Code |
76100532
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$483.60 |
| Max. Negotiated Rate |
$1,547.52 |
| Rate for Payer: Aetna Commercial |
$1,241.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,257.36
|
| Rate for Payer: Cash Price |
$806.00
|
| Rate for Payer: Cigna Commercial |
$1,337.96
|
| Rate for Payer: First Health Commercial |
$1,531.40
|
| Rate for Payer: Humana Commercial |
$1,370.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,321.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,189.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$483.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,418.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,209.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,289.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,402.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,112.28
|
| Rate for Payer: PHCS Commercial |
$1,547.52
|
| Rate for Payer: United Healthcare All Payer |
$1,418.56
|
|
