|
OPTI-FIX XLPE 28 20 DEG 56-62
|
Facility
|
OP
|
$9,478.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,232.22 |
| Max. Negotiated Rate |
$9,099.45 |
| Rate for Payer: Aetna Commercial |
$7,298.51
|
| Rate for Payer: Anthem Medicaid |
$3,259.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,393.30
|
| Rate for Payer: Cash Price |
$4,739.29
|
| Rate for Payer: Cigna Commercial |
$7,867.23
|
| Rate for Payer: First Health Commercial |
$9,004.66
|
| Rate for Payer: Humana Commercial |
$8,056.80
|
| Rate for Payer: Humana KY Medicaid |
$3,259.69
|
| Rate for Payer: Kentucky WC Medicaid |
$3,292.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,772.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,995.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,843.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,325.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,341.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,108.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,895.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,232.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,938.36
|
| Rate for Payer: PHCS Commercial |
$9,099.45
|
| Rate for Payer: United Healthcare All Payer |
$8,341.16
|
|
|
OPTI-FIX XLPE 28 20 DEG 63-74
|
Facility
|
OP
|
$9,478.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,232.22 |
| Max. Negotiated Rate |
$9,099.45 |
| Rate for Payer: Aetna Commercial |
$7,298.51
|
| Rate for Payer: Anthem Medicaid |
$3,259.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,393.30
|
| Rate for Payer: Cash Price |
$4,739.29
|
| Rate for Payer: Cigna Commercial |
$7,867.23
|
| Rate for Payer: First Health Commercial |
$9,004.66
|
| Rate for Payer: Humana Commercial |
$8,056.80
|
| Rate for Payer: Humana KY Medicaid |
$3,259.69
|
| Rate for Payer: Kentucky WC Medicaid |
$3,292.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,772.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,995.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,843.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,325.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,341.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,108.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,895.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,232.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,938.36
|
| Rate for Payer: PHCS Commercial |
$9,099.45
|
| Rate for Payer: United Healthcare All Payer |
$8,341.16
|
|
|
OPTI-FIX XLPE 28 20 DEG 63-74
|
Facility
|
IP
|
$9,478.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,232.22 |
| Max. Negotiated Rate |
$9,099.45 |
| Rate for Payer: Aetna Commercial |
$7,298.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,393.30
|
| Rate for Payer: Cash Price |
$4,739.29
|
| Rate for Payer: Cigna Commercial |
$7,867.23
|
| Rate for Payer: First Health Commercial |
$9,004.66
|
| Rate for Payer: Humana Commercial |
$8,056.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,772.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,995.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,843.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,341.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,108.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,895.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,232.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,938.36
|
| Rate for Payer: PHCS Commercial |
$9,099.45
|
| Rate for Payer: United Healthcare All Payer |
$8,341.16
|
|
|
OPTI-FIX XLPE 32 20 DEG 56-62
|
Facility
|
IP
|
$9,478.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,232.22 |
| Max. Negotiated Rate |
$9,099.45 |
| Rate for Payer: Aetna Commercial |
$7,298.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,393.30
|
| Rate for Payer: Cash Price |
$4,739.29
|
| Rate for Payer: Cigna Commercial |
$7,867.23
|
| Rate for Payer: First Health Commercial |
$9,004.66
|
| Rate for Payer: Humana Commercial |
$8,056.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,772.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,995.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,843.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,341.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,108.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,895.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,232.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,938.36
|
| Rate for Payer: PHCS Commercial |
$9,099.45
|
| Rate for Payer: United Healthcare All Payer |
$8,341.16
|
|
|
OPTI-FIX XLPE 32 20 DEG 56-62
|
Facility
|
OP
|
$9,478.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,232.22 |
| Max. Negotiated Rate |
$9,099.45 |
| Rate for Payer: Aetna Commercial |
$7,298.51
|
| Rate for Payer: Anthem Medicaid |
$3,259.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,393.30
|
| Rate for Payer: Cash Price |
$4,739.29
|
| Rate for Payer: Cigna Commercial |
$7,867.23
|
| Rate for Payer: First Health Commercial |
$9,004.66
|
| Rate for Payer: Humana Commercial |
$8,056.80
|
| Rate for Payer: Humana KY Medicaid |
$3,259.69
|
| Rate for Payer: Kentucky WC Medicaid |
$3,292.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,772.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,995.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,843.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,325.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,341.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,108.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,895.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,232.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,938.36
|
| Rate for Payer: PHCS Commercial |
$9,099.45
|
| Rate for Payer: United Healthcare All Payer |
$8,341.16
|
|
|
OPTI-FIX XLPE 32 20 DEG 63-74
|
Facility
|
OP
|
$9,478.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,232.22 |
| Max. Negotiated Rate |
$9,099.45 |
| Rate for Payer: Aetna Commercial |
$7,298.51
|
| Rate for Payer: Anthem Medicaid |
$3,259.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,393.30
|
| Rate for Payer: Cash Price |
$4,739.29
|
| Rate for Payer: Cigna Commercial |
$7,867.23
|
| Rate for Payer: First Health Commercial |
$9,004.66
|
| Rate for Payer: Humana Commercial |
$8,056.80
|
| Rate for Payer: Humana KY Medicaid |
$3,259.69
|
| Rate for Payer: Kentucky WC Medicaid |
$3,292.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,772.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,995.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,843.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,325.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,341.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,108.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,895.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,232.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,938.36
|
| Rate for Payer: PHCS Commercial |
$9,099.45
|
| Rate for Payer: United Healthcare All Payer |
$8,341.16
|
|
|
OPTI-FIX XLPE 32 20 DEG 63-74
|
Facility
|
IP
|
$9,478.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,232.22 |
| Max. Negotiated Rate |
$9,099.45 |
| Rate for Payer: Aetna Commercial |
$7,298.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,393.30
|
| Rate for Payer: Cash Price |
$4,739.29
|
| Rate for Payer: Cigna Commercial |
$7,867.23
|
| Rate for Payer: First Health Commercial |
$9,004.66
|
| Rate for Payer: Humana Commercial |
$8,056.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,772.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,995.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,843.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,341.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,108.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,895.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,232.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,938.36
|
| Rate for Payer: PHCS Commercial |
$9,099.45
|
| Rate for Payer: United Healthcare All Payer |
$8,341.16
|
|
|
OPTIFIX XLPE ANVTD 26 +4 46-48
|
Facility
|
OP
|
$9,288.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,207.54 |
| Max. Negotiated Rate |
$8,917.24 |
| Rate for Payer: Aetna Commercial |
$7,152.37
|
| Rate for Payer: Anthem Medicaid |
$3,194.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,245.26
|
| Rate for Payer: Cash Price |
$4,644.39
|
| Rate for Payer: Cigna Commercial |
$7,709.70
|
| Rate for Payer: First Health Commercial |
$8,824.35
|
| Rate for Payer: Humana Commercial |
$7,895.47
|
| Rate for Payer: Humana KY Medicaid |
$3,194.41
|
| Rate for Payer: Kentucky WC Medicaid |
$3,226.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,616.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,855.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,786.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,258.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,174.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,966.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,857.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,207.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,879.52
|
| Rate for Payer: PHCS Commercial |
$8,917.24
|
| Rate for Payer: United Healthcare All Payer |
$8,174.14
|
|
|
OPTIFIX XLPE ANVTD 26 +4 46-48
|
Facility
|
IP
|
$9,288.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,207.54 |
| Max. Negotiated Rate |
$8,917.24 |
| Rate for Payer: Aetna Commercial |
$7,152.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,245.26
|
| Rate for Payer: Cash Price |
$4,644.39
|
| Rate for Payer: Cigna Commercial |
$7,709.70
|
| Rate for Payer: First Health Commercial |
$8,824.35
|
| Rate for Payer: Humana Commercial |
$7,895.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,616.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,855.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,786.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,174.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,966.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,857.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,207.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,879.52
|
| Rate for Payer: PHCS Commercial |
$8,917.24
|
| Rate for Payer: United Healthcare All Payer |
$8,174.14
|
|
|
OPTIFIX XLPE ANVTD 28 +4 50-54
|
Facility
|
IP
|
$9,288.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,207.54 |
| Max. Negotiated Rate |
$8,917.24 |
| Rate for Payer: Aetna Commercial |
$7,152.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,245.26
|
| Rate for Payer: Cash Price |
$4,644.39
|
| Rate for Payer: Cigna Commercial |
$7,709.70
|
| Rate for Payer: First Health Commercial |
$8,824.35
|
| Rate for Payer: Humana Commercial |
$7,895.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,616.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,855.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,786.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,174.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,966.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,857.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,207.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,879.52
|
| Rate for Payer: PHCS Commercial |
$8,917.24
|
| Rate for Payer: United Healthcare All Payer |
$8,174.14
|
|
|
OPTIFIX XLPE ANVTD 28 +4 50-54
|
Facility
|
OP
|
$9,288.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,207.54 |
| Max. Negotiated Rate |
$8,917.24 |
| Rate for Payer: Aetna Commercial |
$7,152.37
|
| Rate for Payer: Anthem Medicaid |
$3,194.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,245.26
|
| Rate for Payer: Cash Price |
$4,644.39
|
| Rate for Payer: Cigna Commercial |
$7,709.70
|
| Rate for Payer: First Health Commercial |
$8,824.35
|
| Rate for Payer: Humana Commercial |
$7,895.47
|
| Rate for Payer: Humana KY Medicaid |
$3,194.41
|
| Rate for Payer: Kentucky WC Medicaid |
$3,226.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,616.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,855.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,786.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,258.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,174.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,966.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,857.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,207.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,879.52
|
| Rate for Payer: PHCS Commercial |
$8,917.24
|
| Rate for Payer: United Healthcare All Payer |
$8,174.14
|
|
|
OPTIFIX XLPE ANVTD 28 +4 56-62
|
Facility
|
IP
|
$9,288.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,207.54 |
| Max. Negotiated Rate |
$8,917.24 |
| Rate for Payer: Aetna Commercial |
$7,152.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,245.26
|
| Rate for Payer: Cash Price |
$4,644.39
|
| Rate for Payer: Cigna Commercial |
$7,709.70
|
| Rate for Payer: First Health Commercial |
$8,824.35
|
| Rate for Payer: Humana Commercial |
$7,895.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,616.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,855.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,786.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,174.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,966.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,857.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,207.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,879.52
|
| Rate for Payer: PHCS Commercial |
$8,917.24
|
| Rate for Payer: United Healthcare All Payer |
$8,174.14
|
|
|
OPTIFIX XLPE ANVTD 28 +4 56-62
|
Facility
|
OP
|
$9,288.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,207.54 |
| Max. Negotiated Rate |
$8,917.24 |
| Rate for Payer: Aetna Commercial |
$7,152.37
|
| Rate for Payer: Anthem Medicaid |
$3,194.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,245.26
|
| Rate for Payer: Cash Price |
$4,644.39
|
| Rate for Payer: Cigna Commercial |
$7,709.70
|
| Rate for Payer: First Health Commercial |
$8,824.35
|
| Rate for Payer: Humana Commercial |
$7,895.47
|
| Rate for Payer: Humana KY Medicaid |
$3,194.41
|
| Rate for Payer: Kentucky WC Medicaid |
$3,226.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,616.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,855.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,786.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,258.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,174.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,966.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,857.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,207.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,879.52
|
| Rate for Payer: PHCS Commercial |
$8,917.24
|
| Rate for Payer: United Healthcare All Payer |
$8,174.14
|
|
|
OPTIFIX XLPE ANVTD 32 +4 56-62
|
Facility
|
OP
|
$12,279.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,596.39 |
| Max. Negotiated Rate |
$11,788.71 |
| Rate for Payer: Aetna Commercial |
$9,455.53
|
| Rate for Payer: Anthem Medicaid |
$4,223.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,578.33
|
| Rate for Payer: Cash Price |
$6,139.96
|
| Rate for Payer: Cigna Commercial |
$10,192.33
|
| Rate for Payer: First Health Commercial |
$11,665.91
|
| Rate for Payer: Humana Commercial |
$10,437.92
|
| Rate for Payer: Humana KY Medicaid |
$4,223.06
|
| Rate for Payer: Kentucky WC Medicaid |
$4,266.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,069.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,062.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,683.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,307.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,806.32
|
| Rate for Payer: Ohio Health Group HMO |
$9,209.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,455.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,596.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,806.77
|
| Rate for Payer: PHCS Commercial |
$11,788.71
|
| Rate for Payer: United Healthcare All Payer |
$10,806.32
|
|
|
OPTIFIX XLPE ANVTD 32 +4 56-62
|
Facility
|
IP
|
$12,279.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,596.39 |
| Max. Negotiated Rate |
$11,788.71 |
| Rate for Payer: Aetna Commercial |
$9,455.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,578.33
|
| Rate for Payer: Cash Price |
$6,139.96
|
| Rate for Payer: Cigna Commercial |
$10,192.33
|
| Rate for Payer: First Health Commercial |
$11,665.91
|
| Rate for Payer: Humana Commercial |
$10,437.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,069.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,062.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,683.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,806.32
|
| Rate for Payer: Ohio Health Group HMO |
$9,209.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,455.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,596.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,806.77
|
| Rate for Payer: PHCS Commercial |
$11,788.71
|
| Rate for Payer: United Healthcare All Payer |
$10,806.32
|
|
|
OPTIFIX XLPE ANVTD 32 +4 63-74
|
Facility
|
IP
|
$9,288.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,207.54 |
| Max. Negotiated Rate |
$8,917.24 |
| Rate for Payer: Aetna Commercial |
$7,152.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,245.26
|
| Rate for Payer: Cash Price |
$4,644.39
|
| Rate for Payer: Cigna Commercial |
$7,709.70
|
| Rate for Payer: First Health Commercial |
$8,824.35
|
| Rate for Payer: Humana Commercial |
$7,895.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,616.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,855.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,786.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,174.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,966.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,857.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,207.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,879.52
|
| Rate for Payer: PHCS Commercial |
$8,917.24
|
| Rate for Payer: United Healthcare All Payer |
$8,174.14
|
|
|
OPTIFIX XLPE ANVTD 32 +4 63-74
|
Facility
|
OP
|
$9,288.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,207.54 |
| Max. Negotiated Rate |
$8,917.24 |
| Rate for Payer: Aetna Commercial |
$7,152.37
|
| Rate for Payer: Anthem Medicaid |
$3,194.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,245.26
|
| Rate for Payer: Cash Price |
$4,644.39
|
| Rate for Payer: Cigna Commercial |
$7,709.70
|
| Rate for Payer: First Health Commercial |
$8,824.35
|
| Rate for Payer: Humana Commercial |
$7,895.47
|
| Rate for Payer: Humana KY Medicaid |
$3,194.41
|
| Rate for Payer: Kentucky WC Medicaid |
$3,226.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,616.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,855.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,786.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,258.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,174.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,966.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,857.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,207.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,879.52
|
| Rate for Payer: PHCS Commercial |
$8,917.24
|
| Rate for Payer: United Healthcare All Payer |
$8,174.14
|
|
|
OPTIFIX XLPE ANVTD 36 +4 63-74
|
Facility
|
OP
|
$9,288.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,207.54 |
| Max. Negotiated Rate |
$8,917.24 |
| Rate for Payer: Aetna Commercial |
$7,152.37
|
| Rate for Payer: Anthem Medicaid |
$3,194.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,245.26
|
| Rate for Payer: Cash Price |
$4,644.39
|
| Rate for Payer: Cigna Commercial |
$7,709.70
|
| Rate for Payer: First Health Commercial |
$8,824.35
|
| Rate for Payer: Humana Commercial |
$7,895.47
|
| Rate for Payer: Humana KY Medicaid |
$3,194.41
|
| Rate for Payer: Kentucky WC Medicaid |
$3,226.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,616.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,855.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,786.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,258.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,174.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,966.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,857.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,207.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,879.52
|
| Rate for Payer: PHCS Commercial |
$8,917.24
|
| Rate for Payer: United Healthcare All Payer |
$8,174.14
|
|
|
OPTIFIX XLPE ANVTD 36 +4 63-74
|
Facility
|
IP
|
$9,288.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,207.54 |
| Max. Negotiated Rate |
$8,917.24 |
| Rate for Payer: Aetna Commercial |
$7,152.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,245.26
|
| Rate for Payer: Cash Price |
$4,644.39
|
| Rate for Payer: Cigna Commercial |
$7,709.70
|
| Rate for Payer: First Health Commercial |
$8,824.35
|
| Rate for Payer: Humana Commercial |
$7,895.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,616.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,855.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,786.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,174.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,966.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,857.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,207.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,879.52
|
| Rate for Payer: PHCS Commercial |
$8,917.24
|
| Rate for Payer: United Healthcare All Payer |
$8,174.14
|
|
|
OP TISSUE ABLATION
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS 33257
|
| Hospital Charge Code |
76101271
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem Medicaid |
$275.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Humana KY Medicaid |
$275.12
|
| Rate for Payer: Kentucky WC Medicaid |
$277.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$280.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
OP TISSUE ABLATION
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS 33257
|
| Hospital Charge Code |
76101271
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
OP TISSUE ABLATION
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 33257
|
| Hospital Charge Code |
76101271
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$280.00 |
| Max. Negotiated Rate |
$960.85 |
| Rate for Payer: Aetna Commercial |
$960.85
|
| Rate for Payer: Anthem Medicaid |
$474.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$800.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$926.87
|
| Rate for Payer: Healthspan PPO |
$944.71
|
| Rate for Payer: Humana Medicaid |
$474.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$817.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$483.91
|
| Rate for Payer: Molina Healthcare Passport |
$474.42
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$560.00
|
| Rate for Payer: UHCCP Medicaid |
$280.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$479.16
|
|
|
OP TISSUE ABLATION(P
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 33257
|
| Hospital Charge Code |
761P1271
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$280.00 |
| Max. Negotiated Rate |
$960.85 |
| Rate for Payer: Aetna Commercial |
$960.85
|
| Rate for Payer: Anthem Medicaid |
$474.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$800.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$926.87
|
| Rate for Payer: Healthspan PPO |
$944.71
|
| Rate for Payer: Humana Medicaid |
$474.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$817.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$483.91
|
| Rate for Payer: Molina Healthcare Passport |
$474.42
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$560.00
|
| Rate for Payer: UHCCP Medicaid |
$280.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$479.16
|
|
|
OPTIVAR(AZELASTINE)0.05%SOL6ML
|
Facility
|
OP
|
$1.55
|
|
|
Service Code
|
NDC 70069009101
|
| Hospital Charge Code |
25001135
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$1.49 |
| Rate for Payer: Humana Commercial |
$1.32
|
| Rate for Payer: Humana KY Medicaid |
$0.53
|
| Rate for Payer: Kentucky WC Medicaid |
$0.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.36
|
| Rate for Payer: Ohio Health Group HMO |
$1.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.48
|
| Rate for Payer: PHCS Commercial |
$1.49
|
| Rate for Payer: United Healthcare All Payer |
$1.36
|
| Rate for Payer: Aetna Commercial |
$1.19
|
| Rate for Payer: Anthem Medicaid |
$0.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.21
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Cigna Commercial |
$1.29
|
| Rate for Payer: First Health Commercial |
$1.47
|
|
|
OPTIVAR(AZELASTINE)0.05%SOL6ML
|
Facility
|
IP
|
$1.55
|
|
|
Service Code
|
NDC 70069009101
|
| Hospital Charge Code |
25001135
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$1.49 |
| Rate for Payer: Aetna Commercial |
$1.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.21
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Cigna Commercial |
$1.29
|
| Rate for Payer: First Health Commercial |
$1.47
|
| Rate for Payer: Humana Commercial |
$1.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.36
|
| Rate for Payer: Ohio Health Group HMO |
$1.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.48
|
| Rate for Payer: PHCS Commercial |
$1.49
|
| Rate for Payer: United Healthcare All Payer |
$1.36
|
|
