|
CLTX HUM SHAFT FX W/O MANIP
|
Professional
|
Both
|
$1,612.00
|
|
|
Service Code
|
HCPCS 24500
|
| Hospital Charge Code |
76100532
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$165.20 |
| Max. Negotiated Rate |
$967.20 |
| Rate for Payer: Aetna Commercial |
$428.36
|
| Rate for Payer: Ambetter Exchange |
$323.93
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$173.90
|
| Rate for Payer: Anthem Medicaid |
$165.20
|
| Rate for Payer: Buckeye Individual/Medicaid |
$323.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$323.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$388.72
|
| Rate for Payer: Cash Price |
$806.00
|
| Rate for Payer: Cash Price |
$806.00
|
| Rate for Payer: Cigna Commercial |
$525.66
|
| Rate for Payer: Healthspan PPO |
$424.85
|
| Rate for Payer: Humana Medicaid |
$165.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$381.68
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$323.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$323.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$168.50
|
| Rate for Payer: Molina Healthcare Passport |
$165.20
|
| Rate for Payer: Multiplan PHCS |
$967.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$421.11
|
| Rate for Payer: UHCCP Medicaid |
$182.59
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$166.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$323.93
|
|
|
CLTX HUM SHAFT FX W/O MANIP
|
Facility
|
OP
|
$1,612.00
|
|
|
Service Code
|
HCPCS 24500
|
| Hospital Charge Code |
76100532
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$1,547.52 |
| Rate for Payer: Aetna Commercial |
$1,241.24
|
| Rate for Payer: Anthem Medicaid |
$554.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,257.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$806.00
|
| 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: Humana KY Medicaid |
$554.37
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$560.01
|
| 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 |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$565.49
|
| 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
|
|
|
CLTX HUM SHAFT FX W/O MANIP(P
|
Professional
|
Both
|
$680.00
|
|
|
Service Code
|
HCPCS 24500
|
| Hospital Charge Code |
761P0532
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$165.20 |
| Max. Negotiated Rate |
$525.66 |
| Rate for Payer: Aetna Commercial |
$428.36
|
| Rate for Payer: Ambetter Exchange |
$323.93
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$173.90
|
| Rate for Payer: Anthem Medicaid |
$165.20
|
| Rate for Payer: Buckeye Individual/Medicaid |
$323.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$323.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$388.72
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cigna Commercial |
$525.66
|
| Rate for Payer: Healthspan PPO |
$424.85
|
| Rate for Payer: Humana Medicaid |
$165.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$381.68
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$323.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$323.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$168.50
|
| Rate for Payer: Molina Healthcare Passport |
$165.20
|
| Rate for Payer: Multiplan PHCS |
$408.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$421.11
|
| Rate for Payer: UHCCP Medicaid |
$182.59
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$166.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$323.93
|
|
|
CLTX HUM SHAFT FX W/O MANIP(T
|
Facility
|
OP
|
$932.00
|
|
|
Service Code
|
HCPCS 24500
|
| Hospital Charge Code |
761T0532
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$894.72 |
| Rate for Payer: Aetna Commercial |
$717.64
|
| Rate for Payer: Anthem Medicaid |
$320.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$726.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$466.00
|
| Rate for Payer: Cash Price |
$466.00
|
| Rate for Payer: Cigna Commercial |
$773.56
|
| Rate for Payer: First Health Commercial |
$885.40
|
| Rate for Payer: Humana Commercial |
$792.20
|
| Rate for Payer: Humana KY Medicaid |
$320.51
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$323.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$764.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$687.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$326.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$820.16
|
| Rate for Payer: Ohio Health Group HMO |
$699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$745.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$810.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$643.08
|
| Rate for Payer: PHCS Commercial |
$894.72
|
| Rate for Payer: United Healthcare All Payer |
$820.16
|
|
|
CLTX HUM SHAFT FX W/O MANIP(T
|
Facility
|
IP
|
$932.00
|
|
|
Service Code
|
HCPCS 24500
|
| Hospital Charge Code |
761T0532
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$279.60 |
| Max. Negotiated Rate |
$894.72 |
| Rate for Payer: Aetna Commercial |
$717.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$726.96
|
| Rate for Payer: Cash Price |
$466.00
|
| Rate for Payer: Cigna Commercial |
$773.56
|
| Rate for Payer: First Health Commercial |
$885.40
|
| Rate for Payer: Humana Commercial |
$792.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$764.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$687.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$279.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$820.16
|
| Rate for Payer: Ohio Health Group HMO |
$699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$745.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$810.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$643.08
|
| Rate for Payer: PHCS Commercial |
$894.72
|
| Rate for Payer: United Healthcare All Payer |
$820.16
|
|
|
CLTX INTERCONDYLAR SPI&/TUBR(P
|
Professional
|
Both
|
$978.00
|
|
|
Service Code
|
HCPCS 27538
|
| Hospital Charge Code |
761P0872
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$238.94 |
| Max. Negotiated Rate |
$723.59 |
| Rate for Payer: Aetna Commercial |
$613.69
|
| Rate for Payer: Ambetter Exchange |
$433.25
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$245.99
|
| Rate for Payer: Anthem Medicaid |
$238.94
|
| Rate for Payer: Buckeye Individual/Medicaid |
$433.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$433.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$519.90
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$723.59
|
| Rate for Payer: Healthspan PPO |
$589.32
|
| Rate for Payer: Humana Medicaid |
$238.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$533.51
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$433.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$433.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$243.72
|
| Rate for Payer: Molina Healthcare Passport |
$238.94
|
| Rate for Payer: Multiplan PHCS |
$586.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$563.23
|
| Rate for Payer: UHCCP Medicaid |
$258.29
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$241.33
|
| Rate for Payer: Wellcare Medicare Advantage |
$433.25
|
|
|
CLTX INTERCONDYLAR SPI&/TUBRS
|
Professional
|
Both
|
$978.00
|
|
|
Service Code
|
HCPCS 27538
|
| Hospital Charge Code |
76100872
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$238.94 |
| Max. Negotiated Rate |
$723.59 |
| Rate for Payer: Aetna Commercial |
$613.69
|
| Rate for Payer: Ambetter Exchange |
$433.25
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$245.99
|
| Rate for Payer: Anthem Medicaid |
$238.94
|
| Rate for Payer: Buckeye Individual/Medicaid |
$433.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$433.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$519.90
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$723.59
|
| Rate for Payer: Healthspan PPO |
$589.32
|
| Rate for Payer: Humana Medicaid |
$238.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$533.51
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$433.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$433.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$243.72
|
| Rate for Payer: Molina Healthcare Passport |
$238.94
|
| Rate for Payer: Multiplan PHCS |
$586.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$563.23
|
| Rate for Payer: UHCCP Medicaid |
$258.29
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$241.33
|
| Rate for Payer: Wellcare Medicare Advantage |
$433.25
|
|
|
CLTX INTERCONDYLAR SPI&/TUBRS
|
Facility
|
IP
|
$978.00
|
|
|
Service Code
|
HCPCS 27538
|
| Hospital Charge Code |
76100872
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$293.40 |
| Max. Negotiated Rate |
$938.88 |
| Rate for Payer: Aetna Commercial |
$753.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$762.84
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$811.74
|
| Rate for Payer: First Health Commercial |
$929.10
|
| Rate for Payer: Humana Commercial |
$831.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$801.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$721.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$293.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$860.64
|
| Rate for Payer: Ohio Health Group HMO |
$733.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$782.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$850.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$674.82
|
| Rate for Payer: PHCS Commercial |
$938.88
|
| Rate for Payer: United Healthcare All Payer |
$860.64
|
|
|
CLTX INTERCONDYLAR SPI&/TUBRS
|
Facility
|
OP
|
$978.00
|
|
|
Service Code
|
HCPCS 27538
|
| Hospital Charge Code |
76100872
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$938.88 |
| Rate for Payer: Aetna Commercial |
$753.06
|
| Rate for Payer: Anthem Medicaid |
$336.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$762.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$811.74
|
| Rate for Payer: First Health Commercial |
$929.10
|
| Rate for Payer: Humana Commercial |
$831.30
|
| Rate for Payer: Humana KY Medicaid |
$336.33
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$339.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$801.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$721.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$343.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$860.64
|
| Rate for Payer: Ohio Health Group HMO |
$733.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$782.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$850.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$674.82
|
| Rate for Payer: PHCS Commercial |
$938.88
|
| Rate for Payer: United Healthcare All Payer |
$860.64
|
|
|
CLTX INT/PER/SUBTROCH FEM FX
|
Facility
|
OP
|
$870.00
|
|
|
Service Code
|
HCPCS 27238
|
| Hospital Charge Code |
76100792
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$299.19 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$669.90
|
| Rate for Payer: Anthem Medicaid |
$299.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$678.60
|
| 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 |
$435.00
|
| Rate for Payer: Cash Price |
$435.00
|
| Rate for Payer: Cigna Commercial |
$722.10
|
| Rate for Payer: First Health Commercial |
$826.50
|
| Rate for Payer: Humana Commercial |
$739.50
|
| Rate for Payer: Humana KY Medicaid |
$299.19
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$302.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$713.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$642.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$305.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$765.60
|
| Rate for Payer: Ohio Health Group HMO |
$652.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$756.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$600.30
|
| Rate for Payer: PHCS Commercial |
$835.20
|
| Rate for Payer: United Healthcare All Payer |
$765.60
|
|
|
CLTX INT/PER/SUBTROCH FEM FX
|
Facility
|
IP
|
$870.00
|
|
|
Service Code
|
HCPCS 27238
|
| Hospital Charge Code |
76100792
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$261.00 |
| Max. Negotiated Rate |
$835.20 |
| Rate for Payer: Aetna Commercial |
$669.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$678.60
|
| Rate for Payer: Cash Price |
$435.00
|
| Rate for Payer: Cigna Commercial |
$722.10
|
| Rate for Payer: First Health Commercial |
$826.50
|
| Rate for Payer: Humana Commercial |
$739.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$713.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$642.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$261.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$765.60
|
| Rate for Payer: Ohio Health Group HMO |
$652.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$756.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$600.30
|
| Rate for Payer: PHCS Commercial |
$835.20
|
| Rate for Payer: United Healthcare All Payer |
$765.60
|
|
|
CLTX INT/PER/SUBTROCH FEM FX
|
Professional
|
Both
|
$870.00
|
|
|
Service Code
|
HCPCS 27238
|
| Hospital Charge Code |
76100792
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$297.43 |
| Max. Negotiated Rate |
$708.94 |
| Rate for Payer: Aetna Commercial |
$649.58
|
| Rate for Payer: Ambetter Exchange |
$448.71
|
| Rate for Payer: Anthem Medicaid |
$297.43
|
| Rate for Payer: Buckeye Individual/Medicaid |
$448.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$448.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$538.45
|
| Rate for Payer: Cash Price |
$435.00
|
| Rate for Payer: Cash Price |
$435.00
|
| Rate for Payer: Cigna Commercial |
$708.94
|
| Rate for Payer: Healthspan PPO |
$588.38
|
| Rate for Payer: Humana Medicaid |
$297.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$559.42
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$448.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$448.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$303.38
|
| Rate for Payer: Molina Healthcare Passport |
$297.43
|
| Rate for Payer: Multiplan PHCS |
$522.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$583.32
|
| Rate for Payer: UHCCP Medicaid |
$304.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$300.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$448.71
|
|
|
CLTX INT/PER/SUBTROCH FEM FX(P
|
Professional
|
Both
|
$870.00
|
|
|
Service Code
|
HCPCS 27238
|
| Hospital Charge Code |
761P0792
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$297.43 |
| Max. Negotiated Rate |
$708.94 |
| Rate for Payer: Aetna Commercial |
$649.58
|
| Rate for Payer: Ambetter Exchange |
$448.71
|
| Rate for Payer: Anthem Medicaid |
$297.43
|
| Rate for Payer: Buckeye Individual/Medicaid |
$448.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$448.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$538.45
|
| Rate for Payer: Cash Price |
$435.00
|
| Rate for Payer: Cash Price |
$435.00
|
| Rate for Payer: Cigna Commercial |
$708.94
|
| Rate for Payer: Healthspan PPO |
$588.38
|
| Rate for Payer: Humana Medicaid |
$297.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$559.42
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$448.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$448.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$303.38
|
| Rate for Payer: Molina Healthcare Passport |
$297.43
|
| Rate for Payer: Multiplan PHCS |
$522.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$583.32
|
| Rate for Payer: UHCCP Medicaid |
$304.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$300.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$448.71
|
|
|
CLTX INTR/PERI/SBTRCHTC FEMFX
|
Facility
|
OP
|
$2,390.00
|
|
|
Service Code
|
HCPCS 27240
|
| Hospital Charge Code |
76100793
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$717.00 |
| Max. Negotiated Rate |
$2,294.40 |
| Rate for Payer: Aetna Commercial |
$1,840.30
|
| Rate for Payer: Anthem Medicaid |
$821.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,864.20
|
| Rate for Payer: Cash Price |
$1,195.00
|
| Rate for Payer: Cigna Commercial |
$1,983.70
|
| Rate for Payer: First Health Commercial |
$2,270.50
|
| Rate for Payer: Humana Commercial |
$2,031.50
|
| Rate for Payer: Humana KY Medicaid |
$821.92
|
| Rate for Payer: Kentucky WC Medicaid |
$830.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,959.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,763.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$717.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$838.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,103.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,792.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,912.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,079.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,649.10
|
| Rate for Payer: PHCS Commercial |
$2,294.40
|
| Rate for Payer: United Healthcare All Payer |
$2,103.20
|
|
|
CLTX INTR/PERI/SBTRCHTC FEMFX
|
Facility
|
IP
|
$2,390.00
|
|
|
Service Code
|
HCPCS 27240
|
| Hospital Charge Code |
76100793
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$717.00 |
| Max. Negotiated Rate |
$2,294.40 |
| Rate for Payer: Aetna Commercial |
$1,840.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,864.20
|
| Rate for Payer: Cash Price |
$1,195.00
|
| Rate for Payer: Cigna Commercial |
$1,983.70
|
| Rate for Payer: First Health Commercial |
$2,270.50
|
| Rate for Payer: Humana Commercial |
$2,031.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,959.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,763.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$717.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,103.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,792.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,912.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,079.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,649.10
|
| Rate for Payer: PHCS Commercial |
$2,294.40
|
| Rate for Payer: United Healthcare All Payer |
$2,103.20
|
|
|
CLTX INTR/PERI/SBTRCHTC FEMFX
|
Professional
|
Both
|
$2,390.00
|
|
|
Service Code
|
HCPCS 27240
|
| Hospital Charge Code |
76100793
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$616.02 |
| Max. Negotiated Rate |
$1,528.38 |
| Rate for Payer: Aetna Commercial |
$1,415.62
|
| Rate for Payer: Ambetter Exchange |
$909.99
|
| Rate for Payer: Anthem Medicaid |
$616.02
|
| Rate for Payer: Buckeye Individual/Medicaid |
$909.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$909.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,091.99
|
| Rate for Payer: Cash Price |
$1,195.00
|
| Rate for Payer: Cash Price |
$1,195.00
|
| Rate for Payer: Cigna Commercial |
$1,528.38
|
| Rate for Payer: Healthspan PPO |
$1,282.25
|
| Rate for Payer: Humana Medicaid |
$616.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,190.73
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$909.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$909.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$628.34
|
| Rate for Payer: Molina Healthcare Passport |
$616.02
|
| Rate for Payer: Multiplan PHCS |
$1,434.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,182.99
|
| Rate for Payer: UHCCP Medicaid |
$836.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$622.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$909.99
|
|
|
CLTX INTR/PERI/SBTRCHTC FEMFX
|
Professional
|
Both
|
$2,390.00
|
|
|
Service Code
|
HCPCS 27240
|
| Hospital Charge Code |
761P0793
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$616.02 |
| Max. Negotiated Rate |
$1,528.38 |
| Rate for Payer: Aetna Commercial |
$1,415.62
|
| Rate for Payer: Ambetter Exchange |
$909.99
|
| Rate for Payer: Anthem Medicaid |
$616.02
|
| Rate for Payer: Buckeye Individual/Medicaid |
$909.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$909.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,091.99
|
| Rate for Payer: Cash Price |
$1,195.00
|
| Rate for Payer: Cash Price |
$1,195.00
|
| Rate for Payer: Cigna Commercial |
$1,528.38
|
| Rate for Payer: Healthspan PPO |
$1,282.25
|
| Rate for Payer: Humana Medicaid |
$616.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,190.73
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$909.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$909.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$628.34
|
| Rate for Payer: Molina Healthcare Passport |
$616.02
|
| Rate for Payer: Multiplan PHCS |
$1,434.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,182.99
|
| Rate for Payer: UHCCP Medicaid |
$836.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$622.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$909.99
|
|
|
CLTX IPHAL JT DISLC W/O ANES
|
Professional
|
Both
|
$810.00
|
|
|
Service Code
|
HCPCS 26770
|
| Hospital Charge Code |
76100748
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$107.13 |
| Max. Negotiated Rate |
$486.00 |
| Rate for Payer: Aetna Commercial |
$328.65
|
| Rate for Payer: Ambetter Exchange |
$257.90
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$135.31
|
| Rate for Payer: Anthem Medicaid |
$107.13
|
| Rate for Payer: Buckeye Individual/Medicaid |
$257.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$257.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$309.48
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna Commercial |
$353.59
|
| Rate for Payer: Healthspan PPO |
$323.38
|
| Rate for Payer: Humana Medicaid |
$107.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$296.58
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$257.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$257.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$109.27
|
| Rate for Payer: Molina Healthcare Passport |
$107.13
|
| Rate for Payer: Multiplan PHCS |
$486.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$335.27
|
| Rate for Payer: UHCCP Medicaid |
$142.08
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$108.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$257.90
|
|
|
CLTX IPHAL JT DISLC W/O ANES
|
Facility
|
IP
|
$810.00
|
|
|
Service Code
|
HCPCS 26770
|
| Hospital Charge Code |
76100748
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$243.00 |
| Max. Negotiated Rate |
$777.60 |
| Rate for Payer: Aetna Commercial |
$623.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$631.80
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna Commercial |
$672.30
|
| Rate for Payer: First Health Commercial |
$769.50
|
| Rate for Payer: Humana Commercial |
$688.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$664.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$597.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$243.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$712.80
|
| Rate for Payer: Ohio Health Group HMO |
$607.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$648.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$704.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$558.90
|
| Rate for Payer: PHCS Commercial |
$777.60
|
| Rate for Payer: United Healthcare All Payer |
$712.80
|
|
|
CLTX IPHAL JT DISLC W/O ANES
|
Facility
|
IP
|
$392.00
|
|
|
Service Code
|
HCPCS 26770
|
| Hospital Charge Code |
45000147
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$117.60 |
| Max. Negotiated Rate |
$376.32 |
| Rate for Payer: Aetna Commercial |
$301.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$305.76
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cigna Commercial |
$325.36
|
| Rate for Payer: First Health Commercial |
$372.40
|
| Rate for Payer: Humana Commercial |
$333.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$321.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$289.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$344.96
|
| Rate for Payer: Ohio Health Group HMO |
$294.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$313.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$341.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$270.48
|
| Rate for Payer: PHCS Commercial |
$376.32
|
| Rate for Payer: United Healthcare All Payer |
$344.96
|
|
|
CLTX IPHAL JT DISLC W/O ANES
|
Facility
|
OP
|
$392.00
|
|
|
Service Code
|
HCPCS 26770
|
| Hospital Charge Code |
45000147
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$134.81 |
| Max. Negotiated Rate |
$376.32 |
| Rate for Payer: Aetna Commercial |
$301.84
|
| Rate for Payer: Anthem Medicaid |
$134.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$305.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cigna Commercial |
$325.36
|
| Rate for Payer: First Health Commercial |
$372.40
|
| Rate for Payer: Humana Commercial |
$333.20
|
| Rate for Payer: Humana KY Medicaid |
$134.81
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$136.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$321.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$289.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$137.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$344.96
|
| Rate for Payer: Ohio Health Group HMO |
$294.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$313.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$341.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$270.48
|
| Rate for Payer: PHCS Commercial |
$376.32
|
| Rate for Payer: United Healthcare All Payer |
$344.96
|
|
|
CLTX IPHAL JT DISLC W/O ANES
|
Facility
|
OP
|
$810.00
|
|
|
Service Code
|
HCPCS 26770
|
| Hospital Charge Code |
76100748
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$777.60 |
| Rate for Payer: Aetna Commercial |
$623.70
|
| Rate for Payer: Anthem Medicaid |
$278.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$631.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna Commercial |
$672.30
|
| Rate for Payer: First Health Commercial |
$769.50
|
| Rate for Payer: Humana Commercial |
$688.50
|
| Rate for Payer: Humana KY Medicaid |
$278.56
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$281.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$664.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$597.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$284.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$712.80
|
| Rate for Payer: Ohio Health Group HMO |
$607.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$648.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$704.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$558.90
|
| Rate for Payer: PHCS Commercial |
$777.60
|
| Rate for Payer: United Healthcare All Payer |
$712.80
|
|
|
CLTX IPHAL JT DISLC W/O ANES(P
|
Professional
|
Both
|
$810.00
|
|
|
Service Code
|
HCPCS 26770
|
| Hospital Charge Code |
761P0748
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$107.13 |
| Max. Negotiated Rate |
$486.00 |
| Rate for Payer: Aetna Commercial |
$328.65
|
| Rate for Payer: Ambetter Exchange |
$257.90
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$135.31
|
| Rate for Payer: Anthem Medicaid |
$107.13
|
| Rate for Payer: Buckeye Individual/Medicaid |
$257.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$257.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$309.48
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna Commercial |
$353.59
|
| Rate for Payer: Healthspan PPO |
$323.38
|
| Rate for Payer: Humana Medicaid |
$107.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$296.58
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$257.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$257.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$109.27
|
| Rate for Payer: Molina Healthcare Passport |
$107.13
|
| Rate for Payer: Multiplan PHCS |
$486.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$335.27
|
| Rate for Payer: UHCCP Medicaid |
$142.08
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$108.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$257.90
|
|
|
CLTX MED ANKLE FX W/MNPJ
|
Facility
|
IP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 27762
|
| Hospital Charge Code |
76100929
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$360.00 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$360.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$960.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,044.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$828.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
CLTX MED ANKLE FX W/MNPJ
|
Facility
|
IP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 27762
|
| Hospital Charge Code |
45000166
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$633.30 |
| Max. Negotiated Rate |
$2,026.56 |
| Rate for Payer: Aetna Commercial |
$1,625.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,646.58
|
| Rate for Payer: Cash Price |
$1,055.50
|
| Rate for Payer: Cigna Commercial |
$1,752.13
|
| Rate for Payer: First Health Commercial |
$2,005.45
|
| Rate for Payer: Humana Commercial |
$1,794.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,731.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,557.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$633.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,857.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,583.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,688.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,836.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,456.59
|
| Rate for Payer: PHCS Commercial |
$2,026.56
|
| Rate for Payer: United Healthcare All Payer |
$1,857.68
|
|
