|
OPTX DIS RAD IARTIC FX/EPIPH(P
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 25609
|
| Hospital Charge Code |
761P0635
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$1,609.11 |
| Rate for Payer: Aetna Commercial |
$1,517.59
|
| Rate for Payer: Anthem Medicaid |
$714.87
|
| 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 |
$1,609.11
|
| Rate for Payer: Healthspan PPO |
$1,374.61
|
| Rate for Payer: Humana Medicaid |
$714.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,287.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$729.17
|
| Rate for Payer: Molina Healthcare Passport |
$714.87
|
| 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 |
$722.02
|
|
|
OPTX DIS RAD XARTIC FX/EPIPH
|
Facility
|
IP
|
$1,075.00
|
|
|
Service Code
|
HCPCS 25607
|
| Hospital Charge Code |
76100633
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$139.75 |
| Max. Negotiated Rate |
$1,032.00 |
| Rate for Payer: Aetna Commercial |
$827.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$838.50
|
| Rate for Payer: Cash Price |
$537.50
|
| Rate for Payer: Cigna Commercial |
$892.25
|
| Rate for Payer: First Health Commercial |
$1,021.25
|
| Rate for Payer: Humana Commercial |
$913.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$881.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$793.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$322.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$946.00
|
| Rate for Payer: Ohio Health Group HMO |
$806.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$215.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$139.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$333.25
|
| Rate for Payer: PHCS Commercial |
$1,032.00
|
| Rate for Payer: United Healthcare All Payer |
$946.00
|
|
|
OPTX DIS RAD XARTIC FX/EPIPH
|
Facility
|
OP
|
$1,075.00
|
|
|
Service Code
|
HCPCS 25607
|
| Hospital Charge Code |
76100633
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$139.75 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$827.75
|
| Rate for Payer: Anthem Medicaid |
$369.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$838.50
|
| 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 |
$537.50
|
| Rate for Payer: Cash Price |
$537.50
|
| Rate for Payer: Cigna Commercial |
$892.25
|
| Rate for Payer: First Health Commercial |
$1,021.25
|
| Rate for Payer: Humana Commercial |
$913.75
|
| Rate for Payer: Humana KY Medicaid |
$369.69
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$373.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$881.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$793.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$377.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$946.00
|
| Rate for Payer: Ohio Health Group HMO |
$806.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$215.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$139.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$333.25
|
| Rate for Payer: PHCS Commercial |
$1,032.00
|
| Rate for Payer: United Healthcare All Payer |
$946.00
|
|
|
OPTX DIS RAD XARTIC FX/EPIPH
|
Professional
|
Both
|
$1,075.00
|
|
|
Service Code
|
HCPCS 25607
|
| Hospital Charge Code |
76100633
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$376.25 |
| Max. Negotiated Rate |
$1,100.97 |
| Rate for Payer: Aetna Commercial |
$1,031.02
|
| Rate for Payer: Anthem Medicaid |
$487.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,075.00
|
| Rate for Payer: Cash Price |
$537.50
|
| Rate for Payer: Cash Price |
$537.50
|
| Rate for Payer: Cigna Commercial |
$1,100.97
|
| Rate for Payer: Healthspan PPO |
$933.89
|
| Rate for Payer: Humana Medicaid |
$487.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$896.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$497.68
|
| Rate for Payer: Molina Healthcare Passport |
$487.92
|
| Rate for Payer: Multiplan PHCS |
$645.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$752.50
|
| Rate for Payer: UHCCP Medicaid |
$376.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$492.80
|
|
|
OPTX DIS RAD XARTIC FX/EPIPH(P
|
Professional
|
Both
|
$1,075.00
|
|
|
Service Code
|
HCPCS 25607
|
| Hospital Charge Code |
761P0633
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$376.25 |
| Max. Negotiated Rate |
$1,100.97 |
| Rate for Payer: Aetna Commercial |
$1,031.02
|
| Rate for Payer: Anthem Medicaid |
$487.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,075.00
|
| Rate for Payer: Cash Price |
$537.50
|
| Rate for Payer: Cash Price |
$537.50
|
| Rate for Payer: Cigna Commercial |
$1,100.97
|
| Rate for Payer: Healthspan PPO |
$933.89
|
| Rate for Payer: Humana Medicaid |
$487.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$896.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$497.68
|
| Rate for Payer: Molina Healthcare Passport |
$487.92
|
| Rate for Payer: Multiplan PHCS |
$645.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$752.50
|
| Rate for Payer: UHCCP Medicaid |
$376.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$492.80
|
|
|
OPTX DST RAD IARTIC FX/EPIPH
|
Facility
|
IP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 25608
|
| Hospital Charge Code |
76100634
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$360.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$372.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
OPTX DST RAD IARTIC FX/EPIPH
|
Facility
|
OP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 25608
|
| Hospital Charge Code |
76100634
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem Medicaid |
$412.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| 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 |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Humana KY Medicaid |
$412.68
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$416.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$420.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$372.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
OPTX DST RAD IARTIC FX/EPIPH
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 25608
|
| Hospital Charge Code |
76100634
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$1,261.14 |
| Rate for Payer: Aetna Commercial |
$1,187.14
|
| Rate for Payer: Anthem Medicaid |
$559.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,200.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$1,261.14
|
| Rate for Payer: Healthspan PPO |
$1,075.29
|
| Rate for Payer: Humana Medicaid |
$559.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,008.42
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$570.53
|
| Rate for Payer: Molina Healthcare Passport |
$559.34
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$840.00
|
| Rate for Payer: UHCCP Medicaid |
$420.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$564.93
|
|
|
OPTX DST RAD IARTIC FX/EPIPH(P
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 25608
|
| Hospital Charge Code |
761P0634
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$1,261.14 |
| Rate for Payer: Aetna Commercial |
$1,187.14
|
| Rate for Payer: Anthem Medicaid |
$559.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,200.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$1,261.14
|
| Rate for Payer: Healthspan PPO |
$1,075.29
|
| Rate for Payer: Humana Medicaid |
$559.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,008.42
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$570.53
|
| Rate for Payer: Molina Healthcare Passport |
$559.34
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$840.00
|
| Rate for Payer: UHCCP Medicaid |
$420.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$564.93
|
|
|
OPTX FEM PROX NCKINTFIXPROSRPL
|
Professional
|
Both
|
$3,190.00
|
|
|
Service Code
|
HCPCS 27236
|
| Hospital Charge Code |
761P0791
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$934.33 |
| Max. Negotiated Rate |
$3,190.00 |
| Rate for Payer: Aetna Commercial |
$1,772.49
|
| Rate for Payer: Anthem Medicaid |
$934.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,190.00
|
| Rate for Payer: Cash Price |
$1,595.00
|
| Rate for Payer: Cash Price |
$1,595.00
|
| Rate for Payer: Cigna Commercial |
$1,897.08
|
| Rate for Payer: Healthspan PPO |
$1,605.50
|
| Rate for Payer: Humana Medicaid |
$934.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,496.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$953.02
|
| Rate for Payer: Molina Healthcare Passport |
$934.33
|
| Rate for Payer: Multiplan PHCS |
$1,914.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,233.00
|
| Rate for Payer: UHCCP Medicaid |
$1,116.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$943.67
|
|
|
OPTX FEM PROX NCKINTFIXPROSRPL
|
Facility
|
OP
|
$3,190.00
|
|
|
Service Code
|
HCPCS 27236
|
| Hospital Charge Code |
76100791
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$414.70 |
| Max. Negotiated Rate |
$3,062.40 |
| Rate for Payer: Aetna Commercial |
$2,456.30
|
| Rate for Payer: Anthem Medicaid |
$1,097.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,488.20
|
| Rate for Payer: Cash Price |
$1,595.00
|
| Rate for Payer: Cigna Commercial |
$2,647.70
|
| Rate for Payer: First Health Commercial |
$3,030.50
|
| Rate for Payer: Humana Commercial |
$2,711.50
|
| Rate for Payer: Humana KY Medicaid |
$1,097.04
|
| Rate for Payer: Kentucky WC Medicaid |
$1,108.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,615.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,354.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$957.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,119.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,807.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,392.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$638.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$414.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$988.90
|
| Rate for Payer: PHCS Commercial |
$3,062.40
|
| Rate for Payer: United Healthcare All Payer |
$2,807.20
|
|
|
OPTX FEM PROX NCKINTFIXPROSRPL
|
Facility
|
IP
|
$3,190.00
|
|
|
Service Code
|
HCPCS 27236
|
| Hospital Charge Code |
76100791
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$414.70 |
| Max. Negotiated Rate |
$3,062.40 |
| Rate for Payer: Aetna Commercial |
$2,456.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,488.20
|
| Rate for Payer: Cash Price |
$1,595.00
|
| Rate for Payer: Cigna Commercial |
$2,647.70
|
| Rate for Payer: First Health Commercial |
$3,030.50
|
| Rate for Payer: Humana Commercial |
$2,711.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,615.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,354.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$957.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,807.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,392.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$638.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$414.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$988.90
|
| Rate for Payer: PHCS Commercial |
$3,062.40
|
| Rate for Payer: United Healthcare All Payer |
$2,807.20
|
|
|
OPTX FEM PROX NCKINTFIXPROSRPL
|
Professional
|
Both
|
$3,190.00
|
|
|
Service Code
|
HCPCS 27236
|
| Hospital Charge Code |
76100791
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$934.33 |
| Max. Negotiated Rate |
$3,190.00 |
| Rate for Payer: Aetna Commercial |
$1,772.49
|
| Rate for Payer: Anthem Medicaid |
$934.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,190.00
|
| Rate for Payer: Cash Price |
$1,595.00
|
| Rate for Payer: Cash Price |
$1,595.00
|
| Rate for Payer: Cigna Commercial |
$1,897.08
|
| Rate for Payer: Healthspan PPO |
$1,605.50
|
| Rate for Payer: Humana Medicaid |
$934.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,496.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$953.02
|
| Rate for Payer: Molina Healthcare Passport |
$934.33
|
| Rate for Payer: Multiplan PHCS |
$1,914.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,233.00
|
| Rate for Payer: UHCCP Medicaid |
$1,116.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$943.67
|
|
|
OPTX FEM SHFT FX WINS IMED IMP
|
Professional
|
Both
|
$2,950.00
|
|
|
Service Code
|
HCPCS 27506
|
| Hospital Charge Code |
76100859
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$959.33 |
| Max. Negotiated Rate |
$2,950.00 |
| Rate for Payer: Aetna Commercial |
$1,984.55
|
| Rate for Payer: Anthem Medicaid |
$959.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,950.00
|
| Rate for Payer: Cash Price |
$1,475.00
|
| Rate for Payer: Cash Price |
$1,475.00
|
| Rate for Payer: Cigna Commercial |
$2,133.68
|
| Rate for Payer: Healthspan PPO |
$1,797.58
|
| Rate for Payer: Humana Medicaid |
$959.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,675.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$978.52
|
| Rate for Payer: Molina Healthcare Passport |
$959.33
|
| Rate for Payer: Multiplan PHCS |
$1,770.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,065.00
|
| Rate for Payer: UHCCP Medicaid |
$1,032.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$968.92
|
|
|
OPTX FEM SHFT FX WINS IMED IMP
|
Professional
|
Both
|
$2,950.00
|
|
|
Service Code
|
HCPCS 27506
|
| Hospital Charge Code |
761P0859
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$959.33 |
| Max. Negotiated Rate |
$2,950.00 |
| Rate for Payer: Aetna Commercial |
$1,984.55
|
| Rate for Payer: Anthem Medicaid |
$959.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,950.00
|
| Rate for Payer: Cash Price |
$1,475.00
|
| Rate for Payer: Cash Price |
$1,475.00
|
| Rate for Payer: Cigna Commercial |
$2,133.68
|
| Rate for Payer: Healthspan PPO |
$1,797.58
|
| Rate for Payer: Humana Medicaid |
$959.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,675.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$978.52
|
| Rate for Payer: Molina Healthcare Passport |
$959.33
|
| Rate for Payer: Multiplan PHCS |
$1,770.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,065.00
|
| Rate for Payer: UHCCP Medicaid |
$1,032.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$968.92
|
|
|
OPTX FEM SHFT FX WINS IMED IMP
|
Facility
|
IP
|
$2,950.00
|
|
|
Service Code
|
HCPCS 27506
|
| Hospital Charge Code |
76100859
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$383.50 |
| Max. Negotiated Rate |
$2,832.00 |
| Rate for Payer: Aetna Commercial |
$2,271.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,301.00
|
| Rate for Payer: Cash Price |
$1,475.00
|
| Rate for Payer: Cigna Commercial |
$2,448.50
|
| Rate for Payer: First Health Commercial |
$2,802.50
|
| Rate for Payer: Humana Commercial |
$2,507.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,419.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,177.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$885.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,596.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,212.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$590.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$383.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$914.50
|
| Rate for Payer: PHCS Commercial |
$2,832.00
|
| Rate for Payer: United Healthcare All Payer |
$2,596.00
|
|
|
OPTX FEM SHFT FX WINS IMED IMP
|
Facility
|
OP
|
$2,950.00
|
|
|
Service Code
|
HCPCS 27506
|
| Hospital Charge Code |
76100859
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$383.50 |
| Max. Negotiated Rate |
$2,832.00 |
| Rate for Payer: Aetna Commercial |
$2,271.50
|
| Rate for Payer: Anthem Medicaid |
$1,014.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,301.00
|
| Rate for Payer: Cash Price |
$1,475.00
|
| Rate for Payer: Cigna Commercial |
$2,448.50
|
| Rate for Payer: First Health Commercial |
$2,802.50
|
| Rate for Payer: Humana Commercial |
$2,507.50
|
| Rate for Payer: Humana KY Medicaid |
$1,014.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,024.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,419.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,177.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$885.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,034.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,596.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,212.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$590.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$383.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$914.50
|
| Rate for Payer: PHCS Commercial |
$2,832.00
|
| Rate for Payer: United Healthcare All Payer |
$2,596.00
|
|
|
OPTX FEM SHFT FX W/WO CERCL
|
Facility
|
IP
|
$2,429.00
|
|
|
Service Code
|
HCPCS 27507
|
| Hospital Charge Code |
76100860
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$315.77 |
| Max. Negotiated Rate |
$2,331.84 |
| Rate for Payer: Aetna Commercial |
$1,870.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,894.62
|
| Rate for Payer: Cash Price |
$1,214.50
|
| Rate for Payer: Cigna Commercial |
$2,016.07
|
| Rate for Payer: First Health Commercial |
$2,307.55
|
| Rate for Payer: Humana Commercial |
$2,064.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,991.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,792.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$728.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,137.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,821.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$485.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$315.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$752.99
|
| Rate for Payer: PHCS Commercial |
$2,331.84
|
| Rate for Payer: United Healthcare All Payer |
$2,137.52
|
|
|
OPTX FEM SHFT FX W/WO CERCL
|
Facility
|
OP
|
$2,429.00
|
|
|
Service Code
|
HCPCS 27507
|
| Hospital Charge Code |
76100860
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$315.77 |
| Max. Negotiated Rate |
$2,331.84 |
| Rate for Payer: Aetna Commercial |
$1,870.33
|
| Rate for Payer: Anthem Medicaid |
$835.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,894.62
|
| Rate for Payer: Cash Price |
$1,214.50
|
| Rate for Payer: Cigna Commercial |
$2,016.07
|
| Rate for Payer: First Health Commercial |
$2,307.55
|
| Rate for Payer: Humana Commercial |
$2,064.65
|
| Rate for Payer: Humana KY Medicaid |
$835.33
|
| Rate for Payer: Kentucky WC Medicaid |
$843.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,991.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,792.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$728.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$852.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,137.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,821.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$485.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$315.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$752.99
|
| Rate for Payer: PHCS Commercial |
$2,331.84
|
| Rate for Payer: United Healthcare All Payer |
$2,137.52
|
|
|
OPTX FEM SHFT FX W/WO CERCL
|
Professional
|
Both
|
$2,429.00
|
|
|
Service Code
|
HCPCS 27507
|
| Hospital Charge Code |
76100860
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$850.15 |
| Max. Negotiated Rate |
$2,429.00 |
| Rate for Payer: Aetna Commercial |
$1,476.80
|
| Rate for Payer: Anthem Medicaid |
$868.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,429.00
|
| Rate for Payer: Cash Price |
$1,214.50
|
| Rate for Payer: Cash Price |
$1,214.50
|
| Rate for Payer: Cigna Commercial |
$1,607.74
|
| Rate for Payer: Healthspan PPO |
$1,337.67
|
| Rate for Payer: Humana Medicaid |
$868.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,225.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$886.34
|
| Rate for Payer: Molina Healthcare Passport |
$868.96
|
| Rate for Payer: Multiplan PHCS |
$1,457.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,700.30
|
| Rate for Payer: UHCCP Medicaid |
$850.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$877.65
|
|
|
OPTX FEM SHFT FX W/WO CERCL(P
|
Professional
|
Both
|
$2,429.00
|
|
|
Service Code
|
HCPCS 27507
|
| Hospital Charge Code |
761P0860
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$850.15 |
| Max. Negotiated Rate |
$2,429.00 |
| Rate for Payer: Aetna Commercial |
$1,476.80
|
| Rate for Payer: Anthem Medicaid |
$868.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,429.00
|
| Rate for Payer: Cash Price |
$1,214.50
|
| Rate for Payer: Cash Price |
$1,214.50
|
| Rate for Payer: Cigna Commercial |
$1,607.74
|
| Rate for Payer: Healthspan PPO |
$1,337.67
|
| Rate for Payer: Humana Medicaid |
$868.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,225.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$886.34
|
| Rate for Payer: Molina Healthcare Passport |
$868.96
|
| Rate for Payer: Multiplan PHCS |
$1,457.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,700.30
|
| Rate for Payer: UHCCP Medicaid |
$850.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$877.65
|
|
|
OPTX FEM SUPRACONDYLAR FX
|
Facility
|
IP
|
$2,369.00
|
|
|
Service Code
|
HCPCS 27511
|
| Hospital Charge Code |
76100863
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$307.97 |
| Max. Negotiated Rate |
$2,274.24 |
| Rate for Payer: Aetna Commercial |
$1,824.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,847.82
|
| Rate for Payer: Cash Price |
$1,184.50
|
| Rate for Payer: Cigna Commercial |
$1,966.27
|
| Rate for Payer: First Health Commercial |
$2,250.55
|
| Rate for Payer: Humana Commercial |
$2,013.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,942.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,748.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$710.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,084.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,776.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$473.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$307.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$734.39
|
| Rate for Payer: PHCS Commercial |
$2,274.24
|
| Rate for Payer: United Healthcare All Payer |
$2,084.72
|
|
|
OPTX FEM SUPRACONDYLAR FX
|
Professional
|
Both
|
$2,369.00
|
|
|
Service Code
|
HCPCS 27511
|
| Hospital Charge Code |
76100863
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$829.15 |
| Max. Negotiated Rate |
$2,369.00 |
| Rate for Payer: Aetna Commercial |
$1,524.92
|
| Rate for Payer: Anthem Medicaid |
$858.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,369.00
|
| Rate for Payer: Cash Price |
$1,184.50
|
| Rate for Payer: Cash Price |
$1,184.50
|
| Rate for Payer: Cigna Commercial |
$1,655.16
|
| Rate for Payer: Healthspan PPO |
$1,381.26
|
| Rate for Payer: Humana Medicaid |
$858.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,267.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$875.31
|
| Rate for Payer: Molina Healthcare Passport |
$858.15
|
| Rate for Payer: Multiplan PHCS |
$1,421.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,658.30
|
| Rate for Payer: UHCCP Medicaid |
$829.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$866.73
|
|
|
OPTX FEM SUPRACONDYLAR FX
|
Facility
|
OP
|
$2,369.00
|
|
|
Service Code
|
HCPCS 27511
|
| Hospital Charge Code |
76100863
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$307.97 |
| Max. Negotiated Rate |
$2,274.24 |
| Rate for Payer: Aetna Commercial |
$1,824.13
|
| Rate for Payer: Anthem Medicaid |
$814.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,847.82
|
| Rate for Payer: Cash Price |
$1,184.50
|
| Rate for Payer: Cigna Commercial |
$1,966.27
|
| Rate for Payer: First Health Commercial |
$2,250.55
|
| Rate for Payer: Humana Commercial |
$2,013.65
|
| Rate for Payer: Humana KY Medicaid |
$814.70
|
| Rate for Payer: Kentucky WC Medicaid |
$822.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,942.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,748.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$710.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$831.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,084.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,776.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$473.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$307.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$734.39
|
| Rate for Payer: PHCS Commercial |
$2,274.24
|
| Rate for Payer: United Healthcare All Payer |
$2,084.72
|
|
|
OPTX FEM SUPRACONDYLAR FX(P
|
Professional
|
Both
|
$2,369.00
|
|
|
Service Code
|
HCPCS 27511
|
| Hospital Charge Code |
761P0863
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$829.15 |
| Max. Negotiated Rate |
$2,369.00 |
| Rate for Payer: Aetna Commercial |
$1,524.92
|
| Rate for Payer: Anthem Medicaid |
$858.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,369.00
|
| Rate for Payer: Cash Price |
$1,184.50
|
| Rate for Payer: Cash Price |
$1,184.50
|
| Rate for Payer: Cigna Commercial |
$1,655.16
|
| Rate for Payer: Healthspan PPO |
$1,381.26
|
| Rate for Payer: Humana Medicaid |
$858.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,267.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$875.31
|
| Rate for Payer: Molina Healthcare Passport |
$858.15
|
| Rate for Payer: Multiplan PHCS |
$1,421.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,658.30
|
| Rate for Payer: UHCCP Medicaid |
$829.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$866.73
|
|
