|
CLTX TARSL DIS W/O TALOTARSAL
|
Facility
|
OP
|
$1,450.00
|
|
|
Service Code
|
HCPCS 28540
|
| Hospital Charge Code |
76101029
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$1,392.00 |
| Rate for Payer: Aetna Commercial |
$1,116.50
|
| Rate for Payer: Anthem Medicaid |
$498.65
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,131.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cigna Commercial |
$1,203.50
|
| Rate for Payer: First Health Commercial |
$1,377.50
|
| Rate for Payer: Humana Commercial |
$1,232.50
|
| Rate for Payer: Humana KY Medicaid |
$498.65
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$503.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,189.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,070.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$508.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,276.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,087.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,261.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,000.50
|
| Rate for Payer: PHCS Commercial |
$1,392.00
|
| Rate for Payer: United Healthcare All Payer |
$1,276.00
|
|
|
CLTX TARSL DIS W/O TALOTARSAL
|
Facility
|
IP
|
$1,450.00
|
|
|
Service Code
|
HCPCS 28540
|
| Hospital Charge Code |
76101029
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$435.00 |
| Max. Negotiated Rate |
$1,392.00 |
| Rate for Payer: Aetna Commercial |
$1,116.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,131.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cigna Commercial |
$1,203.50
|
| Rate for Payer: First Health Commercial |
$1,377.50
|
| Rate for Payer: Humana Commercial |
$1,232.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,189.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,070.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$435.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,276.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,087.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,261.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,000.50
|
| Rate for Payer: PHCS Commercial |
$1,392.00
|
| Rate for Payer: United Healthcare All Payer |
$1,276.00
|
|
|
CLTX TARSL DIS W/O TALOTARSAL
|
Professional
|
Both
|
$1,450.00
|
|
|
Service Code
|
HCPCS 28540
|
| Hospital Charge Code |
76101029
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$73.01 |
| Max. Negotiated Rate |
$870.00 |
| 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 |
$725.00
|
| Rate for Payer: Cash Price |
$725.00
|
| 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 |
$870.00
|
| 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
|
|
|
CLTX THIGH FX
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 27267
|
| Hospital Charge Code |
76100804
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$378.29 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem Medicaid |
$378.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$913.00
|
| Rate for Payer: First Health Commercial |
$1,045.00
|
| Rate for Payer: Humana Commercial |
$935.00
|
| Rate for Payer: Humana KY Medicaid |
$378.29
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$382.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$902.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$385.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$968.00
|
| Rate for Payer: Ohio Health Group HMO |
$825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$759.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
CLTX THIGH FX
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 27267
|
| Hospital Charge Code |
76100804
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$330.00 |
| Max. Negotiated Rate |
$1,056.00 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$913.00
|
| Rate for Payer: First Health Commercial |
$1,045.00
|
| Rate for Payer: Humana Commercial |
$935.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$902.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$330.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$968.00
|
| Rate for Payer: Ohio Health Group HMO |
$825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$759.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
CLTX THIGH FX
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 27267
|
| Hospital Charge Code |
76100804
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$316.58 |
| Max. Negotiated Rate |
$660.00 |
| Rate for Payer: Aetna Commercial |
$603.00
|
| Rate for Payer: Ambetter Exchange |
$421.23
|
| Rate for Payer: Anthem Medicaid |
$316.58
|
| Rate for Payer: Buckeye Individual/Medicaid |
$421.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$421.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$505.48
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$647.63
|
| Rate for Payer: Healthspan PPO |
$546.19
|
| Rate for Payer: Humana Medicaid |
$316.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$523.91
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$421.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$421.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$322.91
|
| Rate for Payer: Molina Healthcare Passport |
$316.58
|
| Rate for Payer: Multiplan PHCS |
$660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$547.60
|
| Rate for Payer: UHCCP Medicaid |
$385.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$319.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$421.23
|
|
|
CLTX THIGH FX(P
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 27267
|
| Hospital Charge Code |
761P0804
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$316.58 |
| Max. Negotiated Rate |
$660.00 |
| Rate for Payer: Aetna Commercial |
$603.00
|
| Rate for Payer: Ambetter Exchange |
$421.23
|
| Rate for Payer: Anthem Medicaid |
$316.58
|
| Rate for Payer: Buckeye Individual/Medicaid |
$421.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$421.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$505.48
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$647.63
|
| Rate for Payer: Healthspan PPO |
$546.19
|
| Rate for Payer: Humana Medicaid |
$316.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$523.91
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$421.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$421.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$322.91
|
| Rate for Payer: Molina Healthcare Passport |
$316.58
|
| Rate for Payer: Multiplan PHCS |
$660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$547.60
|
| Rate for Payer: UHCCP Medicaid |
$385.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$319.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$421.23
|
|
|
CLTX THIGH FX W/MNPJ
|
Professional
|
Both
|
$725.00
|
|
|
Service Code
|
HCPCS 27268
|
| Hospital Charge Code |
76100805
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$253.75 |
| Max. Negotiated Rate |
$798.35 |
| Rate for Payer: Aetna Commercial |
$750.53
|
| Rate for Payer: Ambetter Exchange |
$521.94
|
| Rate for Payer: Anthem Medicaid |
$391.05
|
| Rate for Payer: Buckeye Individual/Medicaid |
$521.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$521.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$626.33
|
| Rate for Payer: Cash Price |
$362.50
|
| Rate for Payer: Cash Price |
$362.50
|
| Rate for Payer: Cigna Commercial |
$798.35
|
| Rate for Payer: Healthspan PPO |
$679.82
|
| Rate for Payer: Humana Medicaid |
$391.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$649.94
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$521.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$521.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$398.87
|
| Rate for Payer: Molina Healthcare Passport |
$391.05
|
| Rate for Payer: Multiplan PHCS |
$435.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$678.52
|
| Rate for Payer: UHCCP Medicaid |
$253.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$394.96
|
| Rate for Payer: Wellcare Medicare Advantage |
$521.94
|
|
|
CLTX THIGH FX W/MNPJ
|
Facility
|
IP
|
$725.00
|
|
|
Service Code
|
HCPCS 27268
|
| Hospital Charge Code |
76100805
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$217.50 |
| Max. Negotiated Rate |
$696.00 |
| Rate for Payer: Aetna Commercial |
$558.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$565.50
|
| Rate for Payer: Cash Price |
$362.50
|
| Rate for Payer: Cigna Commercial |
$601.75
|
| Rate for Payer: First Health Commercial |
$688.75
|
| Rate for Payer: Humana Commercial |
$616.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$594.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$535.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$217.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$638.00
|
| Rate for Payer: Ohio Health Group HMO |
$543.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$580.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$630.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$500.25
|
| Rate for Payer: PHCS Commercial |
$696.00
|
| Rate for Payer: United Healthcare All Payer |
$638.00
|
|
|
CLTX THIGH FX W/MNPJ
|
Facility
|
OP
|
$725.00
|
|
|
Service Code
|
HCPCS 27268
|
| Hospital Charge Code |
76100805
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$217.50 |
| Max. Negotiated Rate |
$696.00 |
| Rate for Payer: Aetna Commercial |
$558.25
|
| Rate for Payer: Anthem Medicaid |
$249.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$565.50
|
| Rate for Payer: Cash Price |
$362.50
|
| Rate for Payer: Cigna Commercial |
$601.75
|
| Rate for Payer: First Health Commercial |
$688.75
|
| Rate for Payer: Humana Commercial |
$616.25
|
| Rate for Payer: Humana KY Medicaid |
$249.33
|
| Rate for Payer: Kentucky WC Medicaid |
$251.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$594.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$535.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$217.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$254.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$638.00
|
| Rate for Payer: Ohio Health Group HMO |
$543.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$580.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$630.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$500.25
|
| Rate for Payer: PHCS Commercial |
$696.00
|
| Rate for Payer: United Healthcare All Payer |
$638.00
|
|
|
CLTX THIGH FX W/MNPJ(P
|
Professional
|
Both
|
$725.00
|
|
|
Service Code
|
HCPCS 27268
|
| Hospital Charge Code |
761P0805
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$253.75 |
| Max. Negotiated Rate |
$798.35 |
| Rate for Payer: Aetna Commercial |
$750.53
|
| Rate for Payer: Ambetter Exchange |
$521.94
|
| Rate for Payer: Anthem Medicaid |
$391.05
|
| Rate for Payer: Buckeye Individual/Medicaid |
$521.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$521.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$626.33
|
| Rate for Payer: Cash Price |
$362.50
|
| Rate for Payer: Cash Price |
$362.50
|
| Rate for Payer: Cigna Commercial |
$798.35
|
| Rate for Payer: Healthspan PPO |
$679.82
|
| Rate for Payer: Humana Medicaid |
$391.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$649.94
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$521.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$521.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$398.87
|
| Rate for Payer: Molina Healthcare Passport |
$391.05
|
| Rate for Payer: Multiplan PHCS |
$435.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$678.52
|
| Rate for Payer: UHCCP Medicaid |
$253.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$394.96
|
| Rate for Payer: Wellcare Medicare Advantage |
$521.94
|
|
|
CLTX TIBIAL FX PROXIMAL
|
Facility
|
OP
|
$1,372.00
|
|
|
Service Code
|
HCPCS 27530
|
| Hospital Charge Code |
76100868
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$1,317.12 |
| Rate for Payer: Aetna Commercial |
$1,056.44
|
| Rate for Payer: Anthem Medicaid |
$471.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,070.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$686.00
|
| Rate for Payer: Cash Price |
$686.00
|
| Rate for Payer: Cigna Commercial |
$1,138.76
|
| Rate for Payer: First Health Commercial |
$1,303.40
|
| Rate for Payer: Humana Commercial |
$1,166.20
|
| Rate for Payer: Humana KY Medicaid |
$471.83
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$476.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,125.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,012.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$481.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,207.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,029.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,097.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,193.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$946.68
|
| Rate for Payer: PHCS Commercial |
$1,317.12
|
| Rate for Payer: United Healthcare All Payer |
$1,207.36
|
|
|
CLTX TIBIAL FX PROXIMAL
|
Facility
|
IP
|
$1,372.00
|
|
|
Service Code
|
HCPCS 27530
|
| Hospital Charge Code |
76100868
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$411.60 |
| Max. Negotiated Rate |
$1,317.12 |
| Rate for Payer: Aetna Commercial |
$1,056.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,070.16
|
| Rate for Payer: Cash Price |
$686.00
|
| Rate for Payer: Cigna Commercial |
$1,138.76
|
| Rate for Payer: First Health Commercial |
$1,303.40
|
| Rate for Payer: Humana Commercial |
$1,166.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,125.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,012.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$411.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,207.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,029.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,097.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,193.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$946.68
|
| Rate for Payer: PHCS Commercial |
$1,317.12
|
| Rate for Payer: United Healthcare All Payer |
$1,207.36
|
|
|
CLTX TIBIAL FX PROXIMAL
|
Professional
|
Both
|
$1,372.00
|
|
|
Service Code
|
HCPCS 27530
|
| Hospital Charge Code |
76100868
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$198.37 |
| Max. Negotiated Rate |
$823.20 |
| Rate for Payer: Aetna Commercial |
$506.66
|
| Rate for Payer: Ambetter Exchange |
$279.60
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$205.18
|
| Rate for Payer: Anthem Medicaid |
$198.37
|
| Rate for Payer: Buckeye Individual/Medicaid |
$279.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$279.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$335.52
|
| Rate for Payer: Cash Price |
$686.00
|
| Rate for Payer: Cash Price |
$686.00
|
| Rate for Payer: Cigna Commercial |
$603.42
|
| Rate for Payer: Healthspan PPO |
$489.95
|
| Rate for Payer: Humana Medicaid |
$198.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$443.89
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$279.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$279.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$202.34
|
| Rate for Payer: Molina Healthcare Passport |
$198.37
|
| Rate for Payer: Multiplan PHCS |
$823.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$363.48
|
| Rate for Payer: UHCCP Medicaid |
$215.44
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$200.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$279.60
|
|
|
CLTX TIBIAL FX PROXIMAL(P
|
Professional
|
Both
|
$770.00
|
|
|
Service Code
|
HCPCS 27530
|
| Hospital Charge Code |
761P0868
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$198.37 |
| Max. Negotiated Rate |
$603.42 |
| Rate for Payer: Aetna Commercial |
$506.66
|
| Rate for Payer: Ambetter Exchange |
$279.60
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$205.18
|
| Rate for Payer: Anthem Medicaid |
$198.37
|
| Rate for Payer: Buckeye Individual/Medicaid |
$279.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$279.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$335.52
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: Cigna Commercial |
$603.42
|
| Rate for Payer: Healthspan PPO |
$489.95
|
| Rate for Payer: Humana Medicaid |
$198.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$443.89
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$279.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$279.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$202.34
|
| Rate for Payer: Molina Healthcare Passport |
$198.37
|
| Rate for Payer: Multiplan PHCS |
$462.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$363.48
|
| Rate for Payer: UHCCP Medicaid |
$215.44
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$200.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$279.60
|
|
|
CLTX TIBIAL FX PROXIMAL(T
|
Facility
|
IP
|
$602.00
|
|
|
Service Code
|
HCPCS 27530
|
| Hospital Charge Code |
761T0868
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$180.60 |
| Max. Negotiated Rate |
$577.92 |
| Rate for Payer: Aetna Commercial |
$463.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$469.56
|
| Rate for Payer: Cash Price |
$301.00
|
| Rate for Payer: Cigna Commercial |
$499.66
|
| Rate for Payer: First Health Commercial |
$571.90
|
| Rate for Payer: Humana Commercial |
$511.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$493.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$444.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$180.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$529.76
|
| Rate for Payer: Ohio Health Group HMO |
$451.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$481.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$523.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$415.38
|
| Rate for Payer: PHCS Commercial |
$577.92
|
| Rate for Payer: United Healthcare All Payer |
$529.76
|
|
|
CLTX TIBIAL FX PROXIMAL(T
|
Facility
|
OP
|
$602.00
|
|
|
Service Code
|
HCPCS 27530
|
| Hospital Charge Code |
761T0868
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$207.03 |
| Max. Negotiated Rate |
$577.92 |
| Rate for Payer: Aetna Commercial |
$463.54
|
| Rate for Payer: Anthem Medicaid |
$207.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$469.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$301.00
|
| Rate for Payer: Cash Price |
$301.00
|
| Rate for Payer: Cigna Commercial |
$499.66
|
| Rate for Payer: First Health Commercial |
$571.90
|
| Rate for Payer: Humana Commercial |
$511.70
|
| Rate for Payer: Humana KY Medicaid |
$207.03
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$209.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$493.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$444.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$211.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$529.76
|
| Rate for Payer: Ohio Health Group HMO |
$451.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$481.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$523.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$415.38
|
| Rate for Payer: PHCS Commercial |
$577.92
|
| Rate for Payer: United Healthcare All Payer |
$529.76
|
|
|
CLTX TIBIAL SHAFT FX
|
Facility
|
OP
|
$1,970.00
|
|
|
Service Code
|
HCPCS 27750
|
| Hospital Charge Code |
76100923
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$1,891.20 |
| Rate for Payer: Aetna Commercial |
$1,516.90
|
| Rate for Payer: Anthem Medicaid |
$677.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,536.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$985.00
|
| Rate for Payer: Cash Price |
$985.00
|
| Rate for Payer: Cigna Commercial |
$1,635.10
|
| Rate for Payer: First Health Commercial |
$1,871.50
|
| Rate for Payer: Humana Commercial |
$1,674.50
|
| Rate for Payer: Humana KY Medicaid |
$677.48
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$684.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,615.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,453.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$691.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,733.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,477.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,576.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,713.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,359.30
|
| Rate for Payer: PHCS Commercial |
$1,891.20
|
| Rate for Payer: United Healthcare All Payer |
$1,733.60
|
|
|
CLTX TIBIAL SHAFT FX
|
Professional
|
Both
|
$1,970.00
|
|
|
Service Code
|
HCPCS 27750
|
| Hospital Charge Code |
76100923
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$186.41 |
| Max. Negotiated Rate |
$1,182.00 |
| Rate for Payer: Aetna Commercial |
$429.12
|
| Rate for Payer: Ambetter Exchange |
$312.25
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$186.41
|
| Rate for Payer: Anthem Medicaid |
$189.78
|
| Rate for Payer: Buckeye Individual/Medicaid |
$312.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$312.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$374.70
|
| Rate for Payer: Cash Price |
$985.00
|
| Rate for Payer: Cash Price |
$985.00
|
| Rate for Payer: Cigna Commercial |
$520.64
|
| Rate for Payer: Healthspan PPO |
$420.69
|
| Rate for Payer: Humana Medicaid |
$189.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$377.14
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$312.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$312.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$193.58
|
| Rate for Payer: Molina Healthcare Passport |
$189.78
|
| Rate for Payer: Multiplan PHCS |
$1,182.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$405.93
|
| Rate for Payer: UHCCP Medicaid |
$195.73
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$191.68
|
| Rate for Payer: Wellcare Medicare Advantage |
$312.25
|
|
|
CLTX TIBIAL SHAFT FX
|
Facility
|
IP
|
$1,970.00
|
|
|
Service Code
|
HCPCS 27750
|
| Hospital Charge Code |
76100923
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$591.00 |
| Max. Negotiated Rate |
$1,891.20 |
| Rate for Payer: Aetna Commercial |
$1,516.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,536.60
|
| Rate for Payer: Cash Price |
$985.00
|
| Rate for Payer: Cigna Commercial |
$1,635.10
|
| Rate for Payer: First Health Commercial |
$1,871.50
|
| Rate for Payer: Humana Commercial |
$1,674.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,615.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,453.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$591.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,733.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,477.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,576.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,713.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,359.30
|
| Rate for Payer: PHCS Commercial |
$1,891.20
|
| Rate for Payer: United Healthcare All Payer |
$1,733.60
|
|
|
CLTX TIBIAL SHAFT FX(P
|
Professional
|
Both
|
$971.00
|
|
|
Service Code
|
HCPCS 27750
|
| Hospital Charge Code |
761P0923
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$186.41 |
| Max. Negotiated Rate |
$582.60 |
| Rate for Payer: Aetna Commercial |
$429.12
|
| Rate for Payer: Ambetter Exchange |
$312.25
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$186.41
|
| Rate for Payer: Anthem Medicaid |
$189.78
|
| Rate for Payer: Buckeye Individual/Medicaid |
$312.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$312.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$374.70
|
| Rate for Payer: Cash Price |
$485.50
|
| Rate for Payer: Cash Price |
$485.50
|
| Rate for Payer: Cigna Commercial |
$520.64
|
| Rate for Payer: Healthspan PPO |
$420.69
|
| Rate for Payer: Humana Medicaid |
$189.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$377.14
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$312.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$312.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$193.58
|
| Rate for Payer: Molina Healthcare Passport |
$189.78
|
| Rate for Payer: Multiplan PHCS |
$582.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$405.93
|
| Rate for Payer: UHCCP Medicaid |
$195.73
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$191.68
|
| Rate for Payer: Wellcare Medicare Advantage |
$312.25
|
|
|
CLTX TIBIAL SHAFT FX(T
|
Facility
|
OP
|
$999.00
|
|
|
Service Code
|
HCPCS 27750
|
| Hospital Charge Code |
761T0923
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$959.04 |
| Rate for Payer: Aetna Commercial |
$769.23
|
| Rate for Payer: Anthem Medicaid |
$343.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$779.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$499.50
|
| Rate for Payer: Cash Price |
$499.50
|
| Rate for Payer: Cigna Commercial |
$829.17
|
| Rate for Payer: First Health Commercial |
$949.05
|
| Rate for Payer: Humana Commercial |
$849.15
|
| Rate for Payer: Humana KY Medicaid |
$343.56
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$347.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$819.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$737.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$350.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$879.12
|
| Rate for Payer: Ohio Health Group HMO |
$749.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$799.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$869.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$689.31
|
| Rate for Payer: PHCS Commercial |
$959.04
|
| Rate for Payer: United Healthcare All Payer |
$879.12
|
|
|
CLTX TIBIAL SHAFT FX(T
|
Facility
|
IP
|
$999.00
|
|
|
Service Code
|
HCPCS 27750
|
| Hospital Charge Code |
761T0923
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$299.70 |
| Max. Negotiated Rate |
$959.04 |
| Rate for Payer: Aetna Commercial |
$769.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$779.22
|
| Rate for Payer: Cash Price |
$499.50
|
| Rate for Payer: Cigna Commercial |
$829.17
|
| Rate for Payer: First Health Commercial |
$949.05
|
| Rate for Payer: Humana Commercial |
$849.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$819.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$737.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$299.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$879.12
|
| Rate for Payer: Ohio Health Group HMO |
$749.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$799.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$869.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$689.31
|
| Rate for Payer: PHCS Commercial |
$959.04
|
| Rate for Payer: United Healthcare All Payer |
$879.12
|
|
|
CLTX TRANSSCPHPRLNR TYP FX DIS
|
Facility
|
IP
|
$900.00
|
|
|
Service Code
|
HCPCS 25680
|
| Hospital Charge Code |
761T0644
|
|
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 TRANSSCPHPRLNR TYP FX DIS
|
Professional
|
Both
|
$670.00
|
|
|
Service Code
|
HCPCS 25680
|
| Hospital Charge Code |
761P0644
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$234.50 |
| Max. Negotiated Rate |
$705.52 |
| Rate for Payer: Aetna Commercial |
$650.04
|
| Rate for Payer: Ambetter Exchange |
$510.68
|
| Rate for Payer: Anthem Medicaid |
$239.40
|
| Rate for Payer: Buckeye Individual/Medicaid |
$510.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$510.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$612.82
|
| Rate for Payer: Cash Price |
$335.00
|
| Rate for Payer: Cash Price |
$335.00
|
| Rate for Payer: Cigna Commercial |
$705.52
|
| Rate for Payer: Healthspan PPO |
$588.80
|
| Rate for Payer: Humana Medicaid |
$239.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$563.32
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$510.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$244.19
|
| Rate for Payer: Molina Healthcare Passport |
$239.40
|
| Rate for Payer: Multiplan PHCS |
$402.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$663.88
|
| Rate for Payer: UHCCP Medicaid |
$234.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$241.79
|
| Rate for Payer: Wellcare Medicare Advantage |
$510.68
|
|
