|
CLTX OF POST MALEOLS FX W/MANP
|
Facility
|
IP
|
$2,637.00
|
|
|
Service Code
|
HCPCS 27768
|
| Hospital Charge Code |
76100932
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$791.10 |
| Max. Negotiated Rate |
$2,531.52 |
| Rate for Payer: Aetna Commercial |
$2,030.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,056.86
|
| Rate for Payer: Cash Price |
$1,318.50
|
| Rate for Payer: Cigna Commercial |
$2,188.71
|
| Rate for Payer: First Health Commercial |
$2,505.15
|
| Rate for Payer: Humana Commercial |
$2,241.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,162.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,946.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$791.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,320.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,977.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,109.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,294.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,819.53
|
| Rate for Payer: PHCS Commercial |
$2,531.52
|
| Rate for Payer: United Healthcare All Payer |
$2,320.56
|
|
|
CLTX OF POST MALEOLS FX W/MANP
|
Professional
|
Both
|
$640.00
|
|
|
Service Code
|
HCPCS 27768
|
| Hospital Charge Code |
761P0932
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$224.00 |
| Max. Negotiated Rate |
$612.32 |
| Rate for Payer: Aetna Commercial |
$580.91
|
| Rate for Payer: Ambetter Exchange |
$431.74
|
| Rate for Payer: Anthem Medicaid |
$299.37
|
| Rate for Payer: Buckeye Individual/Medicaid |
$431.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$431.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$518.09
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cigna Commercial |
$612.32
|
| Rate for Payer: Healthspan PPO |
$526.18
|
| Rate for Payer: Humana Medicaid |
$299.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$519.67
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$431.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$431.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$305.36
|
| Rate for Payer: Molina Healthcare Passport |
$299.37
|
| Rate for Payer: Multiplan PHCS |
$384.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$561.26
|
| Rate for Payer: UHCCP Medicaid |
$224.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$302.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$431.74
|
|
|
CLTX OF POST MALEOLS FX W/MANP
|
Professional
|
Both
|
$2,637.00
|
|
|
Service Code
|
HCPCS 27768
|
| Hospital Charge Code |
76100932
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$299.37 |
| Max. Negotiated Rate |
$1,582.20 |
| Rate for Payer: Aetna Commercial |
$580.91
|
| Rate for Payer: Ambetter Exchange |
$431.74
|
| Rate for Payer: Anthem Medicaid |
$299.37
|
| Rate for Payer: Buckeye Individual/Medicaid |
$431.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$431.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$518.09
|
| Rate for Payer: Cash Price |
$1,318.50
|
| Rate for Payer: Cash Price |
$1,318.50
|
| Rate for Payer: Cigna Commercial |
$612.32
|
| Rate for Payer: Healthspan PPO |
$526.18
|
| Rate for Payer: Humana Medicaid |
$299.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$519.67
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$431.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$431.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$305.36
|
| Rate for Payer: Molina Healthcare Passport |
$299.37
|
| Rate for Payer: Multiplan PHCS |
$1,582.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$561.26
|
| Rate for Payer: UHCCP Medicaid |
$922.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$302.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$431.74
|
|
|
CLTX PHLNGL FX PRXMID PX/F/T
|
Facility
|
OP
|
$969.00
|
|
|
Service Code
|
HCPCS 26720
|
| Hospital Charge Code |
76100736
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$930.24 |
| Rate for Payer: Aetna Commercial |
$746.13
|
| Rate for Payer: Anthem Medicaid |
$333.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$755.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$484.50
|
| Rate for Payer: Cash Price |
$484.50
|
| Rate for Payer: Cigna Commercial |
$804.27
|
| Rate for Payer: First Health Commercial |
$920.55
|
| Rate for Payer: Humana Commercial |
$823.65
|
| Rate for Payer: Humana KY Medicaid |
$333.24
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$336.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$794.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$715.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$339.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$852.72
|
| Rate for Payer: Ohio Health Group HMO |
$726.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$775.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$843.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$668.61
|
| Rate for Payer: PHCS Commercial |
$930.24
|
| Rate for Payer: United Healthcare All Payer |
$852.72
|
|
|
CLTX PHLNGL FX PRXMID PX/F/T
|
Facility
|
IP
|
$969.00
|
|
|
Service Code
|
HCPCS 26720
|
| Hospital Charge Code |
76100736
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$290.70 |
| Max. Negotiated Rate |
$930.24 |
| Rate for Payer: Aetna Commercial |
$746.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$755.82
|
| Rate for Payer: Cash Price |
$484.50
|
| Rate for Payer: Cigna Commercial |
$804.27
|
| Rate for Payer: First Health Commercial |
$920.55
|
| Rate for Payer: Humana Commercial |
$823.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$794.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$715.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$290.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$852.72
|
| Rate for Payer: Ohio Health Group HMO |
$726.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$775.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$843.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$668.61
|
| Rate for Payer: PHCS Commercial |
$930.24
|
| Rate for Payer: United Healthcare All Payer |
$852.72
|
|
|
CLTX PHLNGL FX PRXMID PX/F/T
|
Professional
|
Both
|
$969.00
|
|
|
Service Code
|
HCPCS 26720
|
| Hospital Charge Code |
76100736
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.92 |
| Max. Negotiated Rate |
$581.40 |
| Rate for Payer: Aetna Commercial |
$234.57
|
| Rate for Payer: Ambetter Exchange |
$184.73
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$97.94
|
| Rate for Payer: Anthem Medicaid |
$78.92
|
| Rate for Payer: Buckeye Individual/Medicaid |
$184.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$184.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$221.68
|
| Rate for Payer: Cash Price |
$484.50
|
| Rate for Payer: Cash Price |
$484.50
|
| Rate for Payer: Cigna Commercial |
$287.65
|
| Rate for Payer: Healthspan PPO |
$230.90
|
| Rate for Payer: Humana Medicaid |
$78.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$212.44
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$184.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$184.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$80.50
|
| Rate for Payer: Molina Healthcare Passport |
$78.92
|
| Rate for Payer: Multiplan PHCS |
$581.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$240.15
|
| Rate for Payer: UHCCP Medicaid |
$102.84
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$79.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$184.73
|
|
|
CLTX PHLNGL FX PRXMID PX/F/T(P
|
Professional
|
Both
|
$435.00
|
|
|
Service Code
|
HCPCS 26720
|
| Hospital Charge Code |
761P0736
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.92 |
| Max. Negotiated Rate |
$287.65 |
| Rate for Payer: Aetna Commercial |
$234.57
|
| Rate for Payer: Ambetter Exchange |
$184.73
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$97.94
|
| Rate for Payer: Anthem Medicaid |
$78.92
|
| Rate for Payer: Buckeye Individual/Medicaid |
$184.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$184.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$221.68
|
| Rate for Payer: Cash Price |
$217.50
|
| Rate for Payer: Cash Price |
$217.50
|
| Rate for Payer: Cigna Commercial |
$287.65
|
| Rate for Payer: Healthspan PPO |
$230.90
|
| Rate for Payer: Humana Medicaid |
$78.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$212.44
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$184.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$184.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$80.50
|
| Rate for Payer: Molina Healthcare Passport |
$78.92
|
| Rate for Payer: Multiplan PHCS |
$261.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$240.15
|
| Rate for Payer: UHCCP Medicaid |
$102.84
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$79.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$184.73
|
|
|
CLTX PHLNGL FX PRXMID PX/F/T(T
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 26720
|
| Hospital Charge Code |
761T0736
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$183.64 |
| Max. Negotiated Rate |
$512.64 |
| Rate for Payer: Aetna Commercial |
$411.18
|
| Rate for Payer: Anthem Medicaid |
$183.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$416.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Cigna Commercial |
$443.22
|
| Rate for Payer: First Health Commercial |
$507.30
|
| Rate for Payer: Humana Commercial |
$453.90
|
| Rate for Payer: Humana KY Medicaid |
$183.64
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$185.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$437.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$394.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$187.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$469.92
|
| Rate for Payer: Ohio Health Group HMO |
$400.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$427.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$464.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$368.46
|
| Rate for Payer: PHCS Commercial |
$512.64
|
| Rate for Payer: United Healthcare All Payer |
$469.92
|
|
|
CLTX PHLNGL FX PRXMID PX/F/T(T
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 26720
|
| Hospital Charge Code |
761T0736
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$160.20 |
| Max. Negotiated Rate |
$512.64 |
| Rate for Payer: Aetna Commercial |
$411.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$416.52
|
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Cigna Commercial |
$443.22
|
| Rate for Payer: First Health Commercial |
$507.30
|
| Rate for Payer: Humana Commercial |
$453.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$437.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$394.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$160.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$469.92
|
| Rate for Payer: Ohio Health Group HMO |
$400.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$427.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$464.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$368.46
|
| Rate for Payer: PHCS Commercial |
$512.64
|
| Rate for Payer: United Healthcare All Payer |
$469.92
|
|
|
CLTX POST ANKLE FX
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 27767
|
| Hospital Charge Code |
76100931
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$150.71 |
| Max. Negotiated Rate |
$391.70 |
| Rate for Payer: Aetna Commercial |
$352.47
|
| Rate for Payer: Ambetter Exchange |
$281.85
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$150.71
|
| Rate for Payer: Anthem Medicaid |
$190.48
|
| Rate for Payer: Buckeye Individual/Medicaid |
$281.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$281.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$338.22
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$391.70
|
| Rate for Payer: Healthspan PPO |
$317.81
|
| Rate for Payer: Humana Medicaid |
$190.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$329.11
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$281.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$281.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$194.29
|
| Rate for Payer: Molina Healthcare Passport |
$190.48
|
| Rate for Payer: Multiplan PHCS |
$300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$366.40
|
| Rate for Payer: UHCCP Medicaid |
$158.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$192.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$281.85
|
|
|
CLTX POST ANKLE FX
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
HCPCS 27767
|
| Hospital Charge Code |
76100931
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: Aetna Commercial |
$385.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$390.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$415.00
|
| Rate for Payer: First Health Commercial |
$475.00
|
| Rate for Payer: Humana Commercial |
$425.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$410.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$369.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$150.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$440.00
|
| Rate for Payer: Ohio Health Group HMO |
$375.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$435.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$345.00
|
| Rate for Payer: PHCS Commercial |
$480.00
|
| Rate for Payer: United Healthcare All Payer |
$440.00
|
|
|
CLTX POST ANKLE FX
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
HCPCS 27767
|
| Hospital Charge Code |
76100931
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$171.95 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: Aetna Commercial |
$385.00
|
| Rate for Payer: Anthem Medicaid |
$171.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$390.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$415.00
|
| Rate for Payer: First Health Commercial |
$475.00
|
| Rate for Payer: Humana Commercial |
$425.00
|
| Rate for Payer: Humana KY Medicaid |
$171.95
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$173.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$410.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$369.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$175.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$440.00
|
| Rate for Payer: Ohio Health Group HMO |
$375.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$435.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$345.00
|
| Rate for Payer: PHCS Commercial |
$480.00
|
| Rate for Payer: United Healthcare All Payer |
$440.00
|
|
|
CLTX POST ANKLE FX(P
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 27767
|
| Hospital Charge Code |
761P0931
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$150.71 |
| Max. Negotiated Rate |
$391.70 |
| Rate for Payer: Aetna Commercial |
$352.47
|
| Rate for Payer: Ambetter Exchange |
$281.85
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$150.71
|
| Rate for Payer: Anthem Medicaid |
$190.48
|
| Rate for Payer: Buckeye Individual/Medicaid |
$281.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$281.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$338.22
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$391.70
|
| Rate for Payer: Healthspan PPO |
$317.81
|
| Rate for Payer: Humana Medicaid |
$190.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$329.11
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$281.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$281.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$194.29
|
| Rate for Payer: Molina Healthcare Passport |
$190.48
|
| Rate for Payer: Multiplan PHCS |
$300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$366.40
|
| Rate for Payer: UHCCP Medicaid |
$158.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$192.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$281.85
|
|
|
CLTX PROX FIBULA/SHFT
|
Facility
|
OP
|
$1,134.00
|
|
|
Service Code
|
HCPCS 27780
|
| Hospital Charge Code |
76100934
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$1,088.64 |
| Rate for Payer: Aetna Commercial |
$873.18
|
| Rate for Payer: Anthem Medicaid |
$389.98
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$884.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cigna Commercial |
$941.22
|
| Rate for Payer: First Health Commercial |
$1,077.30
|
| Rate for Payer: Humana Commercial |
$963.90
|
| Rate for Payer: Humana KY Medicaid |
$389.98
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$393.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$929.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$836.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$397.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$997.92
|
| Rate for Payer: Ohio Health Group HMO |
$850.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$907.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$986.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$782.46
|
| Rate for Payer: PHCS Commercial |
$1,088.64
|
| Rate for Payer: United Healthcare All Payer |
$997.92
|
|
|
CLTX PROX FIBULA/SHFT
|
Facility
|
IP
|
$1,134.00
|
|
|
Service Code
|
HCPCS 27780
|
| Hospital Charge Code |
76100934
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$340.20 |
| Max. Negotiated Rate |
$1,088.64 |
| Rate for Payer: Aetna Commercial |
$873.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$884.52
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cigna Commercial |
$941.22
|
| Rate for Payer: First Health Commercial |
$1,077.30
|
| Rate for Payer: Humana Commercial |
$963.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$929.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$836.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$340.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$997.92
|
| Rate for Payer: Ohio Health Group HMO |
$850.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$907.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$986.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$782.46
|
| Rate for Payer: PHCS Commercial |
$1,088.64
|
| Rate for Payer: United Healthcare All Payer |
$997.92
|
|
|
CLTX PROX FIBULA/SHFT
|
Professional
|
Both
|
$1,134.00
|
|
|
Service Code
|
HCPCS 27780
|
| Hospital Charge Code |
76100934
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$131.64 |
| Max. Negotiated Rate |
$680.40 |
| Rate for Payer: Aetna Commercial |
$362.83
|
| Rate for Payer: Ambetter Exchange |
$276.41
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$148.64
|
| Rate for Payer: Anthem Medicaid |
$131.64
|
| Rate for Payer: Buckeye Individual/Medicaid |
$276.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$276.41
|
| Rate for Payer: CareSource Just4Me Medicare |
$331.69
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cigna Commercial |
$445.97
|
| Rate for Payer: Healthspan PPO |
$360.15
|
| Rate for Payer: Humana Medicaid |
$131.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$326.10
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$276.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$276.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$134.27
|
| Rate for Payer: Molina Healthcare Passport |
$131.64
|
| Rate for Payer: Multiplan PHCS |
$680.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$359.33
|
| Rate for Payer: UHCCP Medicaid |
$156.07
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$132.96
|
| Rate for Payer: Wellcare Medicare Advantage |
$276.41
|
|
|
CLTX PROX FIBULA/SHFT(P
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 27780
|
| Hospital Charge Code |
761P0934
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$131.64 |
| Max. Negotiated Rate |
$445.97 |
| Rate for Payer: Aetna Commercial |
$362.83
|
| Rate for Payer: Ambetter Exchange |
$276.41
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$148.64
|
| Rate for Payer: Anthem Medicaid |
$131.64
|
| Rate for Payer: Buckeye Individual/Medicaid |
$276.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$276.41
|
| Rate for Payer: CareSource Just4Me Medicare |
$331.69
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$445.97
|
| Rate for Payer: Healthspan PPO |
$360.15
|
| Rate for Payer: Humana Medicaid |
$131.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$326.10
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$276.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$276.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$134.27
|
| Rate for Payer: Molina Healthcare Passport |
$131.64
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$359.33
|
| Rate for Payer: UHCCP Medicaid |
$156.07
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$132.96
|
| Rate for Payer: Wellcare Medicare Advantage |
$276.41
|
|
|
CLTX PROX FIBULA/SHFT(T
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 27780
|
| Hospital Charge Code |
761T0934
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$160.20 |
| Max. Negotiated Rate |
$512.64 |
| Rate for Payer: Aetna Commercial |
$411.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$416.52
|
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Cigna Commercial |
$443.22
|
| Rate for Payer: First Health Commercial |
$507.30
|
| Rate for Payer: Humana Commercial |
$453.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$437.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$394.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$160.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$469.92
|
| Rate for Payer: Ohio Health Group HMO |
$400.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$427.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$464.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$368.46
|
| Rate for Payer: PHCS Commercial |
$512.64
|
| Rate for Payer: United Healthcare All Payer |
$469.92
|
|
|
CLTX PROX FIBULA/SHFT(T
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 27780
|
| Hospital Charge Code |
761T0934
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$183.64 |
| Max. Negotiated Rate |
$512.64 |
| Rate for Payer: Aetna Commercial |
$411.18
|
| Rate for Payer: Anthem Medicaid |
$183.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$416.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Cigna Commercial |
$443.22
|
| Rate for Payer: First Health Commercial |
$507.30
|
| Rate for Payer: Humana Commercial |
$453.90
|
| Rate for Payer: Humana KY Medicaid |
$183.64
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$185.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$437.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$394.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$187.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$469.92
|
| Rate for Payer: Ohio Health Group HMO |
$400.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$427.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$464.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$368.46
|
| Rate for Payer: PHCS Commercial |
$512.64
|
| Rate for Payer: United Healthcare All Payer |
$469.92
|
|
|
CLTX PRX HUM FX W/O MANIP
|
Professional
|
Both
|
$1,589.00
|
|
|
Service Code
|
HCPCS 23600
|
| Hospital Charge Code |
76100478
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$168.93 |
| Max. Negotiated Rate |
$953.40 |
| Rate for Payer: Aetna Commercial |
$401.63
|
| Rate for Payer: Ambetter Exchange |
$306.86
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$173.86
|
| Rate for Payer: Anthem Medicaid |
$168.93
|
| Rate for Payer: Buckeye Individual/Medicaid |
$306.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$306.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$368.23
|
| Rate for Payer: Cash Price |
$794.50
|
| Rate for Payer: Cash Price |
$794.50
|
| Rate for Payer: Cigna Commercial |
$487.10
|
| Rate for Payer: Healthspan PPO |
$390.95
|
| Rate for Payer: Humana Medicaid |
$168.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$357.51
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$306.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$306.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$172.31
|
| Rate for Payer: Molina Healthcare Passport |
$168.93
|
| Rate for Payer: Multiplan PHCS |
$953.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$398.92
|
| Rate for Payer: UHCCP Medicaid |
$182.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$170.62
|
| Rate for Payer: Wellcare Medicare Advantage |
$306.86
|
|
|
CLTX PRX HUM FX W/O MANIP
|
Facility
|
IP
|
$1,589.00
|
|
|
Service Code
|
HCPCS 23600
|
| Hospital Charge Code |
76100478
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$476.70 |
| Max. Negotiated Rate |
$1,525.44 |
| Rate for Payer: Aetna Commercial |
$1,223.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,239.42
|
| Rate for Payer: Cash Price |
$794.50
|
| Rate for Payer: Cigna Commercial |
$1,318.87
|
| Rate for Payer: First Health Commercial |
$1,509.55
|
| Rate for Payer: Humana Commercial |
$1,350.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,302.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,172.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$476.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,398.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,191.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,271.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,382.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,096.41
|
| Rate for Payer: PHCS Commercial |
$1,525.44
|
| Rate for Payer: United Healthcare All Payer |
$1,398.32
|
|
|
CLTX PRX HUM FX W/O MANIP
|
Facility
|
IP
|
$959.00
|
|
|
Service Code
|
HCPCS 23600
|
| Hospital Charge Code |
45000110
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$287.70 |
| Max. Negotiated Rate |
$920.64 |
| Rate for Payer: Aetna Commercial |
$738.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$748.02
|
| Rate for Payer: Cash Price |
$479.50
|
| Rate for Payer: Cigna Commercial |
$795.97
|
| Rate for Payer: First Health Commercial |
$911.05
|
| Rate for Payer: Humana Commercial |
$815.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$786.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$707.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$287.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$843.92
|
| Rate for Payer: Ohio Health Group HMO |
$719.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$767.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$834.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$661.71
|
| Rate for Payer: PHCS Commercial |
$920.64
|
| Rate for Payer: United Healthcare All Payer |
$843.92
|
|
|
CLTX PRX HUM FX W/O MANIP
|
Facility
|
OP
|
$959.00
|
|
|
Service Code
|
HCPCS 23600
|
| Hospital Charge Code |
45000110
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$920.64 |
| Rate for Payer: Aetna Commercial |
$738.43
|
| Rate for Payer: Anthem Medicaid |
$329.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$748.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$479.50
|
| Rate for Payer: Cash Price |
$479.50
|
| Rate for Payer: Cigna Commercial |
$795.97
|
| Rate for Payer: First Health Commercial |
$911.05
|
| Rate for Payer: Humana Commercial |
$815.15
|
| Rate for Payer: Humana KY Medicaid |
$329.80
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$333.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$786.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$707.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$336.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$843.92
|
| Rate for Payer: Ohio Health Group HMO |
$719.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$767.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$834.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$661.71
|
| Rate for Payer: PHCS Commercial |
$920.64
|
| Rate for Payer: United Healthcare All Payer |
$843.92
|
|
|
CLTX PRX HUM FX W/O MANIP
|
Facility
|
OP
|
$1,589.00
|
|
|
Service Code
|
HCPCS 23600
|
| Hospital Charge Code |
76100478
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$1,525.44 |
| Rate for Payer: Aetna Commercial |
$1,223.53
|
| Rate for Payer: Anthem Medicaid |
$546.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,239.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$794.50
|
| Rate for Payer: Cash Price |
$794.50
|
| Rate for Payer: Cigna Commercial |
$1,318.87
|
| Rate for Payer: First Health Commercial |
$1,509.55
|
| Rate for Payer: Humana Commercial |
$1,350.65
|
| Rate for Payer: Humana KY Medicaid |
$546.46
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$552.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,302.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,172.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$557.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,398.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,191.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,271.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,382.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,096.41
|
| Rate for Payer: PHCS Commercial |
$1,525.44
|
| Rate for Payer: United Healthcare All Payer |
$1,398.32
|
|
|
CLTX PRX HUM FX W/O MANIP(P
|
Professional
|
Both
|
$630.00
|
|
|
Service Code
|
HCPCS 23600
|
| Hospital Charge Code |
761P0478
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$168.93 |
| Max. Negotiated Rate |
$487.10 |
| Rate for Payer: Aetna Commercial |
$401.63
|
| Rate for Payer: Ambetter Exchange |
$306.86
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$173.86
|
| Rate for Payer: Anthem Medicaid |
$168.93
|
| Rate for Payer: Buckeye Individual/Medicaid |
$306.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$306.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$368.23
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cigna Commercial |
$487.10
|
| Rate for Payer: Healthspan PPO |
$390.95
|
| Rate for Payer: Humana Medicaid |
$168.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$357.51
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$306.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$306.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$172.31
|
| Rate for Payer: Molina Healthcare Passport |
$168.93
|
| Rate for Payer: Multiplan PHCS |
$378.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$398.92
|
| Rate for Payer: UHCCP Medicaid |
$182.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$170.62
|
| Rate for Payer: Wellcare Medicare Advantage |
$306.86
|
|
