|
OPEN WEDGE/BX LUNG INFILTR(P
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 32096
|
| Hospital Charge Code |
761P1172
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$490.00 |
| Max. Negotiated Rate |
$1,522.82 |
| Rate for Payer: Anthem Medicaid |
$656.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,400.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,522.82
|
| Rate for Payer: Healthspan PPO |
$814.79
|
| Rate for Payer: Humana Medicaid |
$656.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,099.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$669.23
|
| Rate for Payer: Molina Healthcare Passport |
$656.11
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$980.00
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$662.67
|
|
|
OPERATIVE TISSUE ABLATION
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 33259
|
| Hospital Charge Code |
76101272
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$1,433.61
|
| Rate for Payer: Anthem Medicaid |
$703.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,500.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,376.13
|
| Rate for Payer: Healthspan PPO |
$1,409.52
|
| Rate for Payer: Humana Medicaid |
$703.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,188.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$717.85
|
| Rate for Payer: Molina Healthcare Passport |
$703.77
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,050.00
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$710.81
|
|
|
OPERATIVE TISSUE ABLATION
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 33259
|
| Hospital Charge Code |
76101272
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem Medicaid |
$515.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Humana KY Medicaid |
$515.85
|
| Rate for Payer: Kentucky WC Medicaid |
$521.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$450.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$526.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$195.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$465.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
OPERATIVE TISSUE ABLATION
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 33259
|
| Hospital Charge Code |
76101272
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$450.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$195.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$465.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
OPERATIVE TISSUE ABLATION(P
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 33259
|
| Hospital Charge Code |
761P1272
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$1,433.61
|
| Rate for Payer: Anthem Medicaid |
$703.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,500.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,376.13
|
| Rate for Payer: Healthspan PPO |
$1,409.52
|
| Rate for Payer: Humana Medicaid |
$703.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,188.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$717.85
|
| Rate for Payer: Molina Healthcare Passport |
$703.77
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,050.00
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$710.81
|
|
|
OPHORECTOMY
|
Professional
|
Both
|
$2,700.00
|
|
|
Service Code
|
HCPCS 58940
|
| Hospital Charge Code |
76102263
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$398.30 |
| Max. Negotiated Rate |
$2,700.00 |
| Rate for Payer: Aetna Commercial |
$755.67
|
| Rate for Payer: Anthem Medicaid |
$398.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,700.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$726.58
|
| Rate for Payer: Healthspan PPO |
$731.68
|
| Rate for Payer: Humana Medicaid |
$398.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$666.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$406.27
|
| Rate for Payer: Molina Healthcare Passport |
$398.30
|
| Rate for Payer: Multiplan PHCS |
$1,620.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,890.00
|
| Rate for Payer: UHCCP Medicaid |
$945.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$402.28
|
|
|
OPHORECTOMY
|
Facility
|
IP
|
$2,700.00
|
|
|
Service Code
|
HCPCS 58940
|
| Hospital Charge Code |
76102263
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$351.00 |
| Max. Negotiated Rate |
$2,592.00 |
| Rate for Payer: Aetna Commercial |
$2,079.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,106.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$2,241.00
|
| Rate for Payer: First Health Commercial |
$2,565.00
|
| Rate for Payer: Humana Commercial |
$2,295.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,214.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,992.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$810.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,376.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,025.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$351.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$837.00
|
| Rate for Payer: PHCS Commercial |
$2,592.00
|
| Rate for Payer: United Healthcare All Payer |
$2,376.00
|
|
|
OPHORECTOMY
|
Facility
|
OP
|
$2,700.00
|
|
|
Service Code
|
HCPCS 58940
|
| Hospital Charge Code |
76102263
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$351.00 |
| Max. Negotiated Rate |
$2,592.00 |
| Rate for Payer: Aetna Commercial |
$2,079.00
|
| Rate for Payer: Anthem Medicaid |
$928.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,106.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$2,241.00
|
| Rate for Payer: First Health Commercial |
$2,565.00
|
| Rate for Payer: Humana Commercial |
$2,295.00
|
| Rate for Payer: Humana KY Medicaid |
$928.53
|
| Rate for Payer: Kentucky WC Medicaid |
$937.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,214.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,992.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$810.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$947.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,376.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,025.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$351.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$837.00
|
| Rate for Payer: PHCS Commercial |
$2,592.00
|
| Rate for Payer: United Healthcare All Payer |
$2,376.00
|
|
|
OPHORECTOMY(P
|
Professional
|
Both
|
$2,700.00
|
|
|
Service Code
|
HCPCS 58940
|
| Hospital Charge Code |
761P2263
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$398.30 |
| Max. Negotiated Rate |
$2,700.00 |
| Rate for Payer: Aetna Commercial |
$755.67
|
| Rate for Payer: Anthem Medicaid |
$398.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,700.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$726.58
|
| Rate for Payer: Healthspan PPO |
$731.68
|
| Rate for Payer: Humana Medicaid |
$398.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$666.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$406.27
|
| Rate for Payer: Molina Healthcare Passport |
$398.30
|
| Rate for Payer: Multiplan PHCS |
$1,620.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,890.00
|
| Rate for Payer: UHCCP Medicaid |
$945.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$402.28
|
|
|
OPIUM & BELADONA 30MG SUPPRECT
|
Facility
|
OP
|
$82.01
|
|
|
Service Code
|
NDC 574704512
|
| Hospital Charge Code |
25001134
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.66 |
| Max. Negotiated Rate |
$78.73 |
| Rate for Payer: Aetna Commercial |
$63.15
|
| Rate for Payer: Anthem Medicaid |
$28.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63.97
|
| Rate for Payer: Cash Price |
$41.01
|
| Rate for Payer: Cigna Commercial |
$68.07
|
| Rate for Payer: First Health Commercial |
$77.91
|
| Rate for Payer: Humana Commercial |
$69.71
|
| Rate for Payer: Humana KY Medicaid |
$28.20
|
| Rate for Payer: Kentucky WC Medicaid |
$28.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$28.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$72.17
|
| Rate for Payer: Ohio Health Group HMO |
$61.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25.42
|
| Rate for Payer: PHCS Commercial |
$78.73
|
| Rate for Payer: United Healthcare All Payer |
$72.17
|
|
|
OPIUM & BELADONA 30MG SUPPRECT
|
Facility
|
IP
|
$82.01
|
|
|
Service Code
|
NDC 574704512
|
| Hospital Charge Code |
25001134
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.66 |
| Max. Negotiated Rate |
$78.73 |
| Rate for Payer: Aetna Commercial |
$63.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63.97
|
| Rate for Payer: Cash Price |
$41.01
|
| Rate for Payer: Cigna Commercial |
$68.07
|
| Rate for Payer: First Health Commercial |
$77.91
|
| Rate for Payer: Humana Commercial |
$69.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$72.17
|
| Rate for Payer: Ohio Health Group HMO |
$61.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25.42
|
| Rate for Payer: PHCS Commercial |
$78.73
|
| Rate for Payer: United Healthcare All Payer |
$72.17
|
|
|
OPN IMPLTJ NEA SACRAL NERVE
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 64581
|
| Hospital Charge Code |
76102337
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$1,344.00 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$420.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$182.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$434.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
OPN IMPLTJ NEA SACRAL NERVE
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 64581
|
| Hospital Charge Code |
76102337
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$8,279.85 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem Medicaid |
$481.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,914.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,279.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,984.14
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Humana KY Medicaid |
$481.46
|
| Rate for Payer: Humana Medicare Advantage |
$5,914.18
|
| Rate for Payer: Kentucky WC Medicaid |
$486.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,097.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$491.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$182.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$434.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
OPN IMPLTJ NEA SACRAL NERVE
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 64581
|
| Hospital Charge Code |
76102337
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$490.00 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Aetna Commercial |
$1,344.05
|
| Rate for Payer: Anthem Medicaid |
$571.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,400.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,176.06
|
| Rate for Payer: Healthspan PPO |
$1,049.40
|
| Rate for Payer: Humana Medicaid |
$571.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$905.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$582.65
|
| Rate for Payer: Molina Healthcare Passport |
$571.23
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$980.00
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$576.94
|
|
|
OPN IMPLTJ NEA SACRAL NERVE (P
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 64581
|
| Hospital Charge Code |
761P2337
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$490.00 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$1,400.00
|
| Rate for Payer: Aetna Commercial |
$1,344.05
|
| Rate for Payer: Anthem Medicaid |
$571.23
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,176.06
|
| Rate for Payer: Healthspan PPO |
$1,049.40
|
| Rate for Payer: Humana Medicaid |
$571.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$905.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$582.65
|
| Rate for Payer: Molina Healthcare Passport |
$571.23
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$980.00
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$576.94
|
|
|
OP RDL SHFT FX CLSD R/U JT DIS
|
Facility
|
OP
|
$2,225.00
|
|
|
Service Code
|
HCPCS 25525
|
| Hospital Charge Code |
76100621
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$289.25 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$1,713.25
|
| Rate for Payer: Anthem Medicaid |
$765.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,735.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,661.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,351.78
|
| Rate for Payer: Cash Price |
$1,112.50
|
| Rate for Payer: Cash Price |
$1,112.50
|
| Rate for Payer: Cigna Commercial |
$1,846.75
|
| Rate for Payer: First Health Commercial |
$2,113.75
|
| Rate for Payer: Humana Commercial |
$1,891.25
|
| Rate for Payer: Humana KY Medicaid |
$765.18
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$772.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,824.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,642.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$780.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,958.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,668.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$445.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$289.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$689.75
|
| Rate for Payer: PHCS Commercial |
$2,136.00
|
| Rate for Payer: United Healthcare All Payer |
$1,958.00
|
|
|
OP RDL SHFT FX CLSD R/U JT DIS
|
Professional
|
Both
|
$2,225.00
|
|
|
Service Code
|
HCPCS 25525
|
| Hospital Charge Code |
761P0621
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$686.56 |
| Max. Negotiated Rate |
$2,225.00 |
| Rate for Payer: Aetna Commercial |
$1,191.25
|
| Rate for Payer: Anthem Medicaid |
$686.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,225.00
|
| Rate for Payer: Cash Price |
$1,112.50
|
| Rate for Payer: Cash Price |
$1,112.50
|
| Rate for Payer: Cigna Commercial |
$1,502.00
|
| Rate for Payer: Healthspan PPO |
$1,079.02
|
| Rate for Payer: Humana Medicaid |
$686.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$976.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$700.29
|
| Rate for Payer: Molina Healthcare Passport |
$686.56
|
| Rate for Payer: Multiplan PHCS |
$1,335.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,557.50
|
| Rate for Payer: UHCCP Medicaid |
$778.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$693.43
|
|
|
OP RDL SHFT FX CLSD R/U JT DIS
|
Professional
|
Both
|
$2,225.00
|
|
|
Service Code
|
HCPCS 25525
|
| Hospital Charge Code |
76100621
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$686.56 |
| Max. Negotiated Rate |
$2,225.00 |
| Rate for Payer: Aetna Commercial |
$1,191.25
|
| Rate for Payer: Anthem Medicaid |
$686.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,225.00
|
| Rate for Payer: Cash Price |
$1,112.50
|
| Rate for Payer: Cash Price |
$1,112.50
|
| Rate for Payer: Cigna Commercial |
$1,502.00
|
| Rate for Payer: Healthspan PPO |
$1,079.02
|
| Rate for Payer: Humana Medicaid |
$686.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$976.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$700.29
|
| Rate for Payer: Molina Healthcare Passport |
$686.56
|
| Rate for Payer: Multiplan PHCS |
$1,335.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,557.50
|
| Rate for Payer: UHCCP Medicaid |
$778.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$693.43
|
|
|
OP RDL SHFT FX CLSD R/U JT DIS
|
Facility
|
IP
|
$2,225.00
|
|
|
Service Code
|
HCPCS 25525
|
| Hospital Charge Code |
76100621
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$289.25 |
| Max. Negotiated Rate |
$2,136.00 |
| Rate for Payer: Aetna Commercial |
$1,713.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,735.50
|
| Rate for Payer: Cash Price |
$1,112.50
|
| Rate for Payer: Cigna Commercial |
$1,846.75
|
| Rate for Payer: First Health Commercial |
$2,113.75
|
| Rate for Payer: Humana Commercial |
$1,891.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,824.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,642.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$667.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,958.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,668.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$445.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$289.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$689.75
|
| Rate for Payer: PHCS Commercial |
$2,136.00
|
| Rate for Payer: United Healthcare All Payer |
$1,958.00
|
|
|
OP RDL SHFT FX RAD/ULN JT DI(P
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 25526
|
| Hospital Charge Code |
761P0622
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$729.72 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Aetna Commercial |
$1,448.52
|
| Rate for Payer: Anthem Medicaid |
$729.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,500.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$1,738.21
|
| Rate for Payer: Healthspan PPO |
$1,312.05
|
| Rate for Payer: Humana Medicaid |
$729.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,204.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$744.31
|
| Rate for Payer: Molina Healthcare Passport |
$729.72
|
| Rate for Payer: Multiplan PHCS |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,750.00
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$737.02
|
|
|
OP RDL SHFT FX RAD/ULN JT DIS
|
Facility
|
IP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 25526
|
| Hospital Charge Code |
76100622
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$2,400.00 |
| Rate for Payer: Aetna Commercial |
$1,925.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,950.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$2,075.00
|
| Rate for Payer: First Health Commercial |
$2,375.00
|
| Rate for Payer: Humana Commercial |
$2,125.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,050.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,845.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$750.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,875.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$325.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$775.00
|
| Rate for Payer: PHCS Commercial |
$2,400.00
|
| Rate for Payer: United Healthcare All Payer |
$2,200.00
|
|
|
OP RDL SHFT FX RAD/ULN JT DIS
|
Facility
|
OP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 25526
|
| Hospital Charge Code |
76100622
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$1,925.00
|
| Rate for Payer: Anthem Medicaid |
$859.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,950.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,661.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,351.78
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$2,075.00
|
| Rate for Payer: First Health Commercial |
$2,375.00
|
| Rate for Payer: Humana Commercial |
$2,125.00
|
| Rate for Payer: Humana KY Medicaid |
$859.75
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$868.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,050.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,845.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$877.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,875.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$325.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$775.00
|
| Rate for Payer: PHCS Commercial |
$2,400.00
|
| Rate for Payer: United Healthcare All Payer |
$2,200.00
|
|
|
OP RDL SHFT FX RAD/ULN JT DIS
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 25526
|
| Hospital Charge Code |
76100622
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$729.72 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Aetna Commercial |
$1,448.52
|
| Rate for Payer: Anthem Medicaid |
$729.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,500.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$1,738.21
|
| Rate for Payer: Healthspan PPO |
$1,312.05
|
| Rate for Payer: Humana Medicaid |
$729.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,204.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$744.31
|
| Rate for Payer: Molina Healthcare Passport |
$729.72
|
| Rate for Payer: Multiplan PHCS |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,750.00
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$737.02
|
|
|
OPTEASE CAVA FILTER 55CM
|
Facility
|
OP
|
$8,986.75
|
|
|
Service Code
|
HCPCS C1880
|
| Hospital Charge Code |
27000050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,168.28 |
| Max. Negotiated Rate |
$8,627.28 |
| Rate for Payer: Aetna Commercial |
$6,919.80
|
| Rate for Payer: Anthem Medicaid |
$3,090.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,009.66
|
| Rate for Payer: Cash Price |
$4,493.38
|
| Rate for Payer: Cigna Commercial |
$7,459.00
|
| Rate for Payer: First Health Commercial |
$8,537.41
|
| Rate for Payer: Humana Commercial |
$7,638.74
|
| Rate for Payer: Humana KY Medicaid |
$3,090.54
|
| Rate for Payer: Kentucky WC Medicaid |
$3,122.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,369.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,632.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,696.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,152.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,908.34
|
| Rate for Payer: Ohio Health Group HMO |
$6,740.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,797.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,168.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,785.89
|
| Rate for Payer: PHCS Commercial |
$8,627.28
|
| Rate for Payer: United Healthcare All Payer |
$7,908.34
|
|
|
OPTEASE CAVA FILTER 55CM
|
Facility
|
IP
|
$8,986.75
|
|
|
Service Code
|
HCPCS C1880
|
| Hospital Charge Code |
27000050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,168.28 |
| Max. Negotiated Rate |
$8,627.28 |
| Rate for Payer: Aetna Commercial |
$6,919.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,009.66
|
| Rate for Payer: Cash Price |
$4,493.38
|
| Rate for Payer: Cigna Commercial |
$7,459.00
|
| Rate for Payer: First Health Commercial |
$8,537.41
|
| Rate for Payer: Humana Commercial |
$7,638.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,369.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,632.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,696.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,908.34
|
| Rate for Payer: Ohio Health Group HMO |
$6,740.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,797.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,168.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,785.89
|
| Rate for Payer: PHCS Commercial |
$8,627.28
|
| Rate for Payer: United Healthcare All Payer |
$7,908.34
|
|
