|
CLTX SHLDR DIS W/ANTM NECKFX(T
|
Facility
|
OP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 23675
|
| Hospital Charge Code |
761T0490
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$725.97 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$1,625.47
|
| Rate for Payer: Anthem Medicaid |
$725.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,646.58
|
| 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 |
$1,055.50
|
| 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: Humana KY Medicaid |
$725.97
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$733.36
|
| 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 |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$740.54
|
| 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
|
|
|
CLTX SHLDR DIS W/ANTM NECKFX(T
|
Facility
|
IP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 23675
|
| Hospital Charge Code |
761T0490
|
|
Hospital Revenue Code
|
761
|
| 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
|
|
|
CLTX SPRCND/TRNCND HUMFX WWO M
|
Facility
|
OP
|
$1,815.00
|
|
|
Service Code
|
HCPCS 24530
|
| Hospital Charge Code |
76100536
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$1,742.40 |
| Rate for Payer: Aetna Commercial |
$1,397.55
|
| Rate for Payer: Anthem Medicaid |
$624.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,415.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$907.50
|
| Rate for Payer: Cash Price |
$907.50
|
| Rate for Payer: Cigna Commercial |
$1,506.45
|
| Rate for Payer: First Health Commercial |
$1,724.25
|
| Rate for Payer: Humana Commercial |
$1,542.75
|
| Rate for Payer: Humana KY Medicaid |
$624.18
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$630.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,488.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,339.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$636.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,597.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,361.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,452.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,579.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,252.35
|
| Rate for Payer: PHCS Commercial |
$1,742.40
|
| Rate for Payer: United Healthcare All Payer |
$1,597.20
|
|
|
CLTX SPRCND/TRNCND HUMFX WWO M
|
Professional
|
Both
|
$1,815.00
|
|
|
Service Code
|
HCPCS 24530
|
| Hospital Charge Code |
76100536
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$180.26 |
| Max. Negotiated Rate |
$1,089.00 |
| Rate for Payer: Aetna Commercial |
$462.35
|
| Rate for Payer: Ambetter Exchange |
$339.97
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$182.72
|
| Rate for Payer: Anthem Medicaid |
$180.26
|
| Rate for Payer: Buckeye Individual/Medicaid |
$339.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$339.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$407.96
|
| Rate for Payer: Cash Price |
$907.50
|
| Rate for Payer: Cash Price |
$907.50
|
| Rate for Payer: Cigna Commercial |
$567.41
|
| Rate for Payer: Healthspan PPO |
$458.55
|
| Rate for Payer: Humana Medicaid |
$180.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$407.97
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$339.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$339.97
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$183.87
|
| Rate for Payer: Molina Healthcare Passport |
$180.26
|
| Rate for Payer: Multiplan PHCS |
$1,089.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$441.96
|
| Rate for Payer: UHCCP Medicaid |
$191.86
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$182.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$339.97
|
|
|
CLTX SPRCND/TRNCND HUMFX WWO M
|
Facility
|
IP
|
$1,815.00
|
|
|
Service Code
|
HCPCS 24530
|
| Hospital Charge Code |
76100536
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$544.50 |
| Max. Negotiated Rate |
$1,742.40 |
| Rate for Payer: Aetna Commercial |
$1,397.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,415.70
|
| Rate for Payer: Cash Price |
$907.50
|
| Rate for Payer: Cigna Commercial |
$1,506.45
|
| Rate for Payer: First Health Commercial |
$1,724.25
|
| Rate for Payer: Humana Commercial |
$1,542.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,488.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,339.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$544.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,597.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,361.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,452.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,579.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,252.35
|
| Rate for Payer: PHCS Commercial |
$1,742.40
|
| Rate for Payer: United Healthcare All Payer |
$1,597.20
|
|
|
CLTX SPRCND/TRNCND HUMFX WWO M
|
Facility
|
OP
|
$1,065.00
|
|
|
Service Code
|
HCPCS 24530
|
| Hospital Charge Code |
761T0536
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$1,022.40 |
| Rate for Payer: Aetna Commercial |
$820.05
|
| Rate for Payer: Anthem Medicaid |
$366.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$830.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$883.95
|
| Rate for Payer: First Health Commercial |
$1,011.75
|
| Rate for Payer: Humana Commercial |
$905.25
|
| Rate for Payer: Humana KY Medicaid |
$366.25
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$369.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$873.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$785.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$373.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$937.20
|
| Rate for Payer: Ohio Health Group HMO |
$798.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$852.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$926.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$734.85
|
| Rate for Payer: PHCS Commercial |
$1,022.40
|
| Rate for Payer: United Healthcare All Payer |
$937.20
|
|
|
CLTX SPRCND/TRNCND HUMFX WWO M
|
Facility
|
IP
|
$1,065.00
|
|
|
Service Code
|
HCPCS 24530
|
| Hospital Charge Code |
761T0536
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$319.50 |
| Max. Negotiated Rate |
$1,022.40 |
| Rate for Payer: Aetna Commercial |
$820.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$830.70
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$883.95
|
| Rate for Payer: First Health Commercial |
$1,011.75
|
| Rate for Payer: Humana Commercial |
$905.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$873.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$785.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$319.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$937.20
|
| Rate for Payer: Ohio Health Group HMO |
$798.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$852.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$926.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$734.85
|
| Rate for Payer: PHCS Commercial |
$1,022.40
|
| Rate for Payer: United Healthcare All Payer |
$937.20
|
|
|
CLTX SPRCND/TRNCND HUMFX WWO M
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 24530
|
| Hospital Charge Code |
761P0536
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$180.26 |
| Max. Negotiated Rate |
$567.41 |
| Rate for Payer: Aetna Commercial |
$462.35
|
| Rate for Payer: Ambetter Exchange |
$339.97
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$182.72
|
| Rate for Payer: Anthem Medicaid |
$180.26
|
| Rate for Payer: Buckeye Individual/Medicaid |
$339.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$339.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$407.96
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$567.41
|
| Rate for Payer: Healthspan PPO |
$458.55
|
| Rate for Payer: Humana Medicaid |
$180.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$407.97
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$339.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$339.97
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$183.87
|
| Rate for Payer: Molina Healthcare Passport |
$180.26
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$441.96
|
| Rate for Payer: UHCCP Medicaid |
$191.86
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$182.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$339.97
|
|
|
CLTX SPRCNDYLR/TRNSCNDYR FEMFX
|
Professional
|
Both
|
$1,933.75
|
|
|
Service Code
|
HCPCS 27501
|
| Hospital Charge Code |
76100857
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$320.26 |
| Max. Negotiated Rate |
$1,160.25 |
| Rate for Payer: Aetna Commercial |
$713.87
|
| Rate for Payer: Ambetter Exchange |
$477.25
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$350.94
|
| Rate for Payer: Anthem Medicaid |
$320.26
|
| Rate for Payer: Buckeye Individual/Medicaid |
$477.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$477.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$572.70
|
| Rate for Payer: Cash Price |
$966.88
|
| Rate for Payer: Cash Price |
$966.88
|
| Rate for Payer: Cigna Commercial |
$796.12
|
| Rate for Payer: Healthspan PPO |
$654.86
|
| Rate for Payer: Humana Medicaid |
$320.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$611.89
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$477.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$477.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$326.67
|
| Rate for Payer: Molina Healthcare Passport |
$320.26
|
| Rate for Payer: Multiplan PHCS |
$1,160.25
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$620.42
|
| Rate for Payer: UHCCP Medicaid |
$368.49
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$323.46
|
| Rate for Payer: Wellcare Medicare Advantage |
$477.25
|
|
|
CLTX SPRCNDYLR/TRNSCNDYR FEMFX
|
Facility
|
OP
|
$768.75
|
|
|
Service Code
|
HCPCS 27501
|
| Hospital Charge Code |
761T0857
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$738.00 |
| Rate for Payer: Aetna Commercial |
$591.94
|
| Rate for Payer: Anthem Medicaid |
$264.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$599.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$384.38
|
| Rate for Payer: Cash Price |
$384.38
|
| Rate for Payer: Cigna Commercial |
$638.06
|
| Rate for Payer: First Health Commercial |
$730.31
|
| Rate for Payer: Humana Commercial |
$653.44
|
| Rate for Payer: Humana KY Medicaid |
$264.37
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$267.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$630.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$567.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$269.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$676.50
|
| Rate for Payer: Ohio Health Group HMO |
$576.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$615.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$668.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$530.44
|
| Rate for Payer: PHCS Commercial |
$738.00
|
| Rate for Payer: United Healthcare All Payer |
$676.50
|
|
|
CLTX SPRCNDYLR/TRNSCNDYR FEMFX
|
Facility
|
OP
|
$1,933.75
|
|
|
Service Code
|
HCPCS 27501
|
| Hospital Charge Code |
76100857
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$1,856.40 |
| Rate for Payer: Aetna Commercial |
$1,488.99
|
| Rate for Payer: Anthem Medicaid |
$665.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.33
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$966.88
|
| Rate for Payer: Cash Price |
$966.88
|
| Rate for Payer: Cigna Commercial |
$1,605.01
|
| Rate for Payer: First Health Commercial |
$1,837.06
|
| Rate for Payer: Humana Commercial |
$1,643.69
|
| Rate for Payer: Humana KY Medicaid |
$665.02
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$671.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,585.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$678.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,701.70
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,547.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,682.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,334.29
|
| Rate for Payer: PHCS Commercial |
$1,856.40
|
| Rate for Payer: United Healthcare All Payer |
$1,701.70
|
|
|
CLTX SPRCNDYLR/TRNSCNDYR FEMFX
|
Professional
|
Both
|
$1,165.00
|
|
|
Service Code
|
HCPCS 27501
|
| Hospital Charge Code |
761P0857
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$320.26 |
| Max. Negotiated Rate |
$796.12 |
| Rate for Payer: Aetna Commercial |
$713.87
|
| Rate for Payer: Ambetter Exchange |
$477.25
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$350.94
|
| Rate for Payer: Anthem Medicaid |
$320.26
|
| Rate for Payer: Buckeye Individual/Medicaid |
$477.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$477.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$572.70
|
| Rate for Payer: Cash Price |
$582.50
|
| Rate for Payer: Cash Price |
$582.50
|
| Rate for Payer: Cigna Commercial |
$796.12
|
| Rate for Payer: Healthspan PPO |
$654.86
|
| Rate for Payer: Humana Medicaid |
$320.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$611.89
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$477.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$477.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$326.67
|
| Rate for Payer: Molina Healthcare Passport |
$320.26
|
| Rate for Payer: Multiplan PHCS |
$699.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$620.42
|
| Rate for Payer: UHCCP Medicaid |
$368.49
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$323.46
|
| Rate for Payer: Wellcare Medicare Advantage |
$477.25
|
|
|
CLTX SPRCNDYLR/TRNSCNDYR FEMFX
|
Facility
|
IP
|
$1,933.75
|
|
|
Service Code
|
HCPCS 27501
|
| Hospital Charge Code |
76100857
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$580.12 |
| Max. Negotiated Rate |
$1,856.40 |
| Rate for Payer: Aetna Commercial |
$1,488.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.33
|
| Rate for Payer: Cash Price |
$966.88
|
| Rate for Payer: Cigna Commercial |
$1,605.01
|
| Rate for Payer: First Health Commercial |
$1,837.06
|
| Rate for Payer: Humana Commercial |
$1,643.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,585.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,701.70
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,547.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,682.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,334.29
|
| Rate for Payer: PHCS Commercial |
$1,856.40
|
| Rate for Payer: United Healthcare All Payer |
$1,701.70
|
|
|
CLTX SPRCNDYLR/TRNSCNDYR FEMFX
|
Facility
|
IP
|
$768.75
|
|
|
Service Code
|
HCPCS 27501
|
| Hospital Charge Code |
761T0857
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$230.62 |
| Max. Negotiated Rate |
$738.00 |
| Rate for Payer: Aetna Commercial |
$591.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$599.62
|
| Rate for Payer: Cash Price |
$384.38
|
| Rate for Payer: Cigna Commercial |
$638.06
|
| Rate for Payer: First Health Commercial |
$730.31
|
| Rate for Payer: Humana Commercial |
$653.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$630.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$567.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$230.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$676.50
|
| Rate for Payer: Ohio Health Group HMO |
$576.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$615.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$668.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$530.44
|
| Rate for Payer: PHCS Commercial |
$738.00
|
| Rate for Payer: United Healthcare All Payer |
$676.50
|
|
|
CLTX SPRCNDY/TRANSCND HUM FX
|
Professional
|
Both
|
$3,474.00
|
|
|
Service Code
|
HCPCS 24535
|
| Hospital Charge Code |
76100537
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$294.67 |
| Max. Negotiated Rate |
$2,084.40 |
| Rate for Payer: Aetna Commercial |
$813.33
|
| Rate for Payer: Ambetter Exchange |
$551.64
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$294.67
|
| Rate for Payer: Anthem Medicaid |
$340.07
|
| Rate for Payer: Buckeye Individual/Medicaid |
$551.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$551.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$661.97
|
| Rate for Payer: Cash Price |
$1,737.00
|
| Rate for Payer: Cash Price |
$1,737.00
|
| Rate for Payer: Cigna Commercial |
$894.84
|
| Rate for Payer: Healthspan PPO |
$785.67
|
| Rate for Payer: Humana Medicaid |
$340.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$694.79
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$551.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$551.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$346.87
|
| Rate for Payer: Molina Healthcare Passport |
$340.07
|
| Rate for Payer: Multiplan PHCS |
$2,084.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$717.13
|
| Rate for Payer: UHCCP Medicaid |
$309.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$343.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$551.64
|
|
|
CLTX SPRCNDY/TRANSCND HUM FX
|
Facility
|
IP
|
$2,024.00
|
|
|
Service Code
|
HCPCS 24535
|
| Hospital Charge Code |
45000119
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$607.20 |
| Max. Negotiated Rate |
$1,943.04 |
| Rate for Payer: Aetna Commercial |
$1,558.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,578.72
|
| Rate for Payer: Cash Price |
$1,012.00
|
| Rate for Payer: Cigna Commercial |
$1,679.92
|
| Rate for Payer: First Health Commercial |
$1,922.80
|
| Rate for Payer: Humana Commercial |
$1,720.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,659.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,493.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$607.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,781.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,518.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,619.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,760.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,396.56
|
| Rate for Payer: PHCS Commercial |
$1,943.04
|
| Rate for Payer: United Healthcare All Payer |
$1,781.12
|
|
|
CLTX SPRCNDY/TRANSCND HUM FX
|
Facility
|
IP
|
$3,474.00
|
|
|
Service Code
|
HCPCS 24535
|
| Hospital Charge Code |
76100537
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,042.20 |
| Max. Negotiated Rate |
$3,335.04 |
| Rate for Payer: Aetna Commercial |
$2,674.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,709.72
|
| Rate for Payer: Cash Price |
$1,737.00
|
| Rate for Payer: Cigna Commercial |
$2,883.42
|
| Rate for Payer: First Health Commercial |
$3,300.30
|
| Rate for Payer: Humana Commercial |
$2,952.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,848.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,563.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,042.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,057.12
|
| Rate for Payer: Ohio Health Group HMO |
$2,605.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,779.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,022.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,397.06
|
| Rate for Payer: PHCS Commercial |
$3,335.04
|
| Rate for Payer: United Healthcare All Payer |
$3,057.12
|
|
|
CLTX SPRCNDY/TRANSCND HUM FX
|
Facility
|
OP
|
$3,474.00
|
|
|
Service Code
|
HCPCS 24535
|
| Hospital Charge Code |
76100537
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,194.71 |
| Max. Negotiated Rate |
$3,335.04 |
| Rate for Payer: Aetna Commercial |
$2,674.98
|
| Rate for Payer: Anthem Medicaid |
$1,194.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,709.72
|
| 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 |
$1,737.00
|
| Rate for Payer: Cash Price |
$1,737.00
|
| Rate for Payer: Cigna Commercial |
$2,883.42
|
| Rate for Payer: First Health Commercial |
$3,300.30
|
| Rate for Payer: Humana Commercial |
$2,952.90
|
| Rate for Payer: Humana KY Medicaid |
$1,194.71
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,206.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,848.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,563.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,218.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,057.12
|
| Rate for Payer: Ohio Health Group HMO |
$2,605.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,779.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,022.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,397.06
|
| Rate for Payer: PHCS Commercial |
$3,335.04
|
| Rate for Payer: United Healthcare All Payer |
$3,057.12
|
|
|
CLTX SPRCNDY/TRANSCND HUM FX
|
Facility
|
OP
|
$2,024.00
|
|
|
Service Code
|
HCPCS 24535
|
| Hospital Charge Code |
45000119
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$696.05 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$1,558.48
|
| Rate for Payer: Anthem Medicaid |
$696.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,578.72
|
| 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 |
$1,012.00
|
| Rate for Payer: Cash Price |
$1,012.00
|
| Rate for Payer: Cigna Commercial |
$1,679.92
|
| Rate for Payer: First Health Commercial |
$1,922.80
|
| Rate for Payer: Humana Commercial |
$1,720.40
|
| Rate for Payer: Humana KY Medicaid |
$696.05
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$703.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,659.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,493.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$710.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,781.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,518.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,619.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,760.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,396.56
|
| Rate for Payer: PHCS Commercial |
$1,943.04
|
| Rate for Payer: United Healthcare All Payer |
$1,781.12
|
|
|
CLTX SPRCNDY/TRANSCND HUM FX(P
|
Professional
|
Both
|
$1,450.00
|
|
|
Service Code
|
HCPCS 24535
|
| Hospital Charge Code |
761P0537
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$294.67 |
| Max. Negotiated Rate |
$894.84 |
| Rate for Payer: Aetna Commercial |
$813.33
|
| Rate for Payer: Ambetter Exchange |
$551.64
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$294.67
|
| Rate for Payer: Anthem Medicaid |
$340.07
|
| Rate for Payer: Buckeye Individual/Medicaid |
$551.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$551.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$661.97
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cigna Commercial |
$894.84
|
| Rate for Payer: Healthspan PPO |
$785.67
|
| Rate for Payer: Humana Medicaid |
$340.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$694.79
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$551.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$551.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$346.87
|
| Rate for Payer: Molina Healthcare Passport |
$340.07
|
| Rate for Payer: Multiplan PHCS |
$870.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$717.13
|
| Rate for Payer: UHCCP Medicaid |
$309.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$343.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$551.64
|
|
|
CLTX SPRCNDY/TRANSCND HUM FX(T
|
Facility
|
OP
|
$2,024.00
|
|
|
Service Code
|
HCPCS 24535
|
| Hospital Charge Code |
761T0537
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$696.05 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$1,558.48
|
| Rate for Payer: Anthem Medicaid |
$696.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,578.72
|
| 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 |
$1,012.00
|
| Rate for Payer: Cash Price |
$1,012.00
|
| Rate for Payer: Cigna Commercial |
$1,679.92
|
| Rate for Payer: First Health Commercial |
$1,922.80
|
| Rate for Payer: Humana Commercial |
$1,720.40
|
| Rate for Payer: Humana KY Medicaid |
$696.05
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$703.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,659.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,493.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$710.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,781.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,518.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,619.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,760.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,396.56
|
| Rate for Payer: PHCS Commercial |
$1,943.04
|
| Rate for Payer: United Healthcare All Payer |
$1,781.12
|
|
|
CLTX SPRCNDY/TRANSCND HUM FX(T
|
Facility
|
IP
|
$2,024.00
|
|
|
Service Code
|
HCPCS 24535
|
| Hospital Charge Code |
761T0537
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$607.20 |
| Max. Negotiated Rate |
$1,943.04 |
| Rate for Payer: Aetna Commercial |
$1,558.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,578.72
|
| Rate for Payer: Cash Price |
$1,012.00
|
| Rate for Payer: Cigna Commercial |
$1,679.92
|
| Rate for Payer: First Health Commercial |
$1,922.80
|
| Rate for Payer: Humana Commercial |
$1,720.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,659.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,493.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$607.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,781.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,518.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,619.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,760.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,396.56
|
| Rate for Payer: PHCS Commercial |
$1,943.04
|
| Rate for Payer: United Healthcare All Payer |
$1,781.12
|
|
|
CLTX TARSL DIS W/O TALOTARSAL
|
Facility
|
IP
|
$900.00
|
|
|
Service Code
|
HCPCS 28540
|
| Hospital Charge Code |
761T1029
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$864.00 |
| Rate for Payer: Aetna Commercial |
$693.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$702.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$747.00
|
| Rate for Payer: First Health Commercial |
$855.00
|
| Rate for Payer: Humana Commercial |
$765.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$738.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$664.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$270.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$792.00
|
| Rate for Payer: Ohio Health Group HMO |
$675.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$720.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$783.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$621.00
|
| Rate for Payer: PHCS Commercial |
$864.00
|
| Rate for Payer: United Healthcare All Payer |
$792.00
|
|
|
CLTX TARSL DIS W/O TALOTARSAL
|
Facility
|
OP
|
$900.00
|
|
|
Service Code
|
HCPCS 28540
|
| Hospital Charge Code |
761T1029
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$864.00 |
| Rate for Payer: Aetna Commercial |
$693.00
|
| Rate for Payer: Anthem Medicaid |
$309.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$702.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$747.00
|
| Rate for Payer: First Health Commercial |
$855.00
|
| Rate for Payer: Humana Commercial |
$765.00
|
| Rate for Payer: Humana KY Medicaid |
$309.51
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$312.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$738.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$664.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$315.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$792.00
|
| Rate for Payer: Ohio Health Group HMO |
$675.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$720.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$783.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$621.00
|
| Rate for Payer: PHCS Commercial |
$864.00
|
| Rate for Payer: United Healthcare All Payer |
$792.00
|
|
|
CLTX TARSL DIS W/O TALOTARSAL
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 28540
|
| Hospital Charge Code |
761P1029
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$73.01 |
| Max. Negotiated Rate |
$330.00 |
| Rate for Payer: Aetna Commercial |
$260.17
|
| Rate for Payer: Ambetter Exchange |
$168.42
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$89.63
|
| Rate for Payer: Anthem Medicaid |
$73.01
|
| Rate for Payer: Buckeye Individual/Medicaid |
$168.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$168.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$202.10
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$298.65
|
| Rate for Payer: Healthspan PPO |
$250.68
|
| Rate for Payer: Humana Medicaid |
$73.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$220.46
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$168.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$168.42
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$74.47
|
| Rate for Payer: Molina Healthcare Passport |
$73.01
|
| Rate for Payer: Multiplan PHCS |
$330.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$218.95
|
| Rate for Payer: UHCCP Medicaid |
$94.11
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$73.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$168.42
|
|
