|
OP TX TALUS FX W INTERN FIXATI
|
Professional
|
Both
|
$1,250.00
|
|
|
Service Code
|
HCPCS 28445
|
| Hospital Charge Code |
76102570
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$437.50 |
| Max. Negotiated Rate |
$1,858.63 |
| Rate for Payer: Aetna Commercial |
$1,612.34
|
| Rate for Payer: Anthem Medicaid |
$527.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,250.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cigna Commercial |
$1,858.63
|
| Rate for Payer: Healthspan PPO |
$1,460.44
|
| Rate for Payer: Humana Medicaid |
$527.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,327.42
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$538.24
|
| Rate for Payer: Molina Healthcare Passport |
$527.69
|
| Rate for Payer: Multiplan PHCS |
$750.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$875.00
|
| Rate for Payer: UHCCP Medicaid |
$437.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$532.97
|
|
|
OP TX TALUS FX W INTERN FIXATI
|
Facility
|
OP
|
$8,933.00
|
|
|
Service Code
|
HCPCS 28445
|
| Hospital Charge Code |
45000176
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,161.29 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$6,878.41
|
| Rate for Payer: Anthem Medicaid |
$3,072.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,967.74
|
| 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 |
$4,466.50
|
| Rate for Payer: Cash Price |
$4,466.50
|
| Rate for Payer: Cigna Commercial |
$7,414.39
|
| Rate for Payer: First Health Commercial |
$8,486.35
|
| Rate for Payer: Humana Commercial |
$7,593.05
|
| Rate for Payer: Humana KY Medicaid |
$3,072.06
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$3,103.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,325.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,592.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,133.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,861.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,699.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,786.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,769.23
|
| Rate for Payer: PHCS Commercial |
$8,575.68
|
| Rate for Payer: United Healthcare All Payer |
$7,861.04
|
|
|
OP TX TALUS FX W INTERN FIXATI
|
Facility
|
IP
|
$8,933.00
|
|
|
Service Code
|
HCPCS 28445
|
| Hospital Charge Code |
45000176
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,161.29 |
| Max. Negotiated Rate |
$8,575.68 |
| Rate for Payer: Aetna Commercial |
$6,878.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,967.74
|
| Rate for Payer: Cash Price |
$4,466.50
|
| Rate for Payer: Cigna Commercial |
$7,414.39
|
| Rate for Payer: First Health Commercial |
$8,486.35
|
| Rate for Payer: Humana Commercial |
$7,593.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,325.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,592.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,861.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,699.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,786.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,769.23
|
| Rate for Payer: PHCS Commercial |
$8,575.68
|
| Rate for Payer: United Healthcare All Payer |
$7,861.04
|
|
|
OPTX THIGH FX
|
Facility
|
IP
|
$1,735.00
|
|
|
Service Code
|
HCPCS 27269
|
| Hospital Charge Code |
76100806
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$225.55 |
| Max. Negotiated Rate |
$1,665.60 |
| Rate for Payer: Aetna Commercial |
$1,335.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,353.30
|
| Rate for Payer: Cash Price |
$867.50
|
| Rate for Payer: Cigna Commercial |
$1,440.05
|
| Rate for Payer: First Health Commercial |
$1,648.25
|
| Rate for Payer: Humana Commercial |
$1,474.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,422.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,280.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$520.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,526.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,301.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$347.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$225.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$537.85
|
| Rate for Payer: PHCS Commercial |
$1,665.60
|
| Rate for Payer: United Healthcare All Payer |
$1,526.80
|
|
|
OPTX THIGH FX
|
Facility
|
OP
|
$1,735.00
|
|
|
Service Code
|
HCPCS 27269
|
| Hospital Charge Code |
76100806
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$225.55 |
| Max. Negotiated Rate |
$1,665.60 |
| Rate for Payer: Aetna Commercial |
$1,335.95
|
| Rate for Payer: Anthem Medicaid |
$596.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,353.30
|
| Rate for Payer: Cash Price |
$867.50
|
| Rate for Payer: Cigna Commercial |
$1,440.05
|
| Rate for Payer: First Health Commercial |
$1,648.25
|
| Rate for Payer: Humana Commercial |
$1,474.75
|
| Rate for Payer: Humana KY Medicaid |
$596.67
|
| Rate for Payer: Kentucky WC Medicaid |
$602.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,422.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,280.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$520.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$608.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,526.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,301.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$347.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$225.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$537.85
|
| Rate for Payer: PHCS Commercial |
$1,665.60
|
| Rate for Payer: United Healthcare All Payer |
$1,526.80
|
|
|
OPTX THIGH FX
|
Professional
|
Both
|
$1,735.00
|
|
|
Service Code
|
HCPCS 27269
|
| Hospital Charge Code |
76100806
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$607.25 |
| Max. Negotiated Rate |
$1,906.10 |
| Rate for Payer: Aetna Commercial |
$1,820.29
|
| Rate for Payer: Anthem Medicaid |
$936.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,735.00
|
| Rate for Payer: Cash Price |
$867.50
|
| Rate for Payer: Cash Price |
$867.50
|
| Rate for Payer: Cigna Commercial |
$1,906.10
|
| Rate for Payer: Healthspan PPO |
$1,648.80
|
| Rate for Payer: Humana Medicaid |
$936.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,537.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$955.41
|
| Rate for Payer: Molina Healthcare Passport |
$936.68
|
| Rate for Payer: Multiplan PHCS |
$1,041.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,214.50
|
| Rate for Payer: UHCCP Medicaid |
$607.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$946.05
|
|
|
OPTX THIGH FX(P
|
Professional
|
Both
|
$1,735.00
|
|
|
Service Code
|
HCPCS 27269
|
| Hospital Charge Code |
761P0806
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$607.25 |
| Max. Negotiated Rate |
$1,906.10 |
| Rate for Payer: Aetna Commercial |
$1,820.29
|
| Rate for Payer: Anthem Medicaid |
$936.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,735.00
|
| Rate for Payer: Cash Price |
$867.50
|
| Rate for Payer: Cash Price |
$867.50
|
| Rate for Payer: Cigna Commercial |
$1,906.10
|
| Rate for Payer: Healthspan PPO |
$1,648.80
|
| Rate for Payer: Humana Medicaid |
$936.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,537.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$955.41
|
| Rate for Payer: Molina Healthcare Passport |
$936.68
|
| Rate for Payer: Multiplan PHCS |
$1,041.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,214.50
|
| Rate for Payer: UHCCP Medicaid |
$607.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$946.05
|
|
|
OPTX TIBIAL SHFT FX W/WO CERC
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 27758
|
| Hospital Charge Code |
76100926
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$700.00 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna Commercial |
$1,317.04
|
| Rate for Payer: Anthem Medicaid |
$723.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,430.27
|
| Rate for Payer: Healthspan PPO |
$1,192.96
|
| Rate for Payer: Humana Medicaid |
$723.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,108.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$737.84
|
| Rate for Payer: Molina Healthcare Passport |
$723.37
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,400.00
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$730.60
|
|
|
OPTX TIBIAL SHFT FX W/WO CERC
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 27758
|
| Hospital Charge Code |
76100926
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$15,933.60 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem Medicaid |
$687.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,381.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15,933.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$15,364.54
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Humana KY Medicaid |
$687.80
|
| Rate for Payer: Humana Medicare Advantage |
$11,381.14
|
| Rate for Payer: Kentucky WC Medicaid |
$694.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13,657.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$701.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$620.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
OPTX TIBIAL SHFT FX W/WO CERC
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 27758
|
| Hospital Charge Code |
76100926
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$620.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
OPTX TIBIAL SHFT FX W/WO CER(P
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 27758
|
| Hospital Charge Code |
761P0926
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$700.00 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna Commercial |
$1,317.04
|
| Rate for Payer: Anthem Medicaid |
$723.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,430.27
|
| Rate for Payer: Healthspan PPO |
$1,192.96
|
| Rate for Payer: Humana Medicaid |
$723.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,108.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$737.84
|
| Rate for Payer: Molina Healthcare Passport |
$723.37
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,400.00
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$730.60
|
|
|
OPTX TIBI X PRX BCNDYLR
|
Facility
|
IP
|
$2,400.00
|
|
|
Service Code
|
HCPCS 27536
|
| Hospital Charge Code |
76100871
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$312.00 |
| Max. Negotiated Rate |
$2,304.00 |
| Rate for Payer: Aetna Commercial |
$1,848.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,872.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cigna Commercial |
$1,992.00
|
| Rate for Payer: First Health Commercial |
$2,280.00
|
| Rate for Payer: Humana Commercial |
$2,040.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,968.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,771.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$720.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,112.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,800.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$480.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$312.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$744.00
|
| Rate for Payer: PHCS Commercial |
$2,304.00
|
| Rate for Payer: United Healthcare All Payer |
$2,112.00
|
|
|
OPTX TIBI X PRX BCNDYLR
|
Professional
|
Both
|
$2,400.00
|
|
|
Service Code
|
HCPCS 27536
|
| Hospital Charge Code |
76100871
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$785.01 |
| Max. Negotiated Rate |
$2,400.00 |
| Rate for Payer: Aetna Commercial |
$1,769.16
|
| Rate for Payer: Anthem Medicaid |
$785.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,400.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cigna Commercial |
$1,911.14
|
| Rate for Payer: Healthspan PPO |
$1,602.48
|
| Rate for Payer: Humana Medicaid |
$785.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,490.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$800.71
|
| Rate for Payer: Molina Healthcare Passport |
$785.01
|
| Rate for Payer: Multiplan PHCS |
$1,440.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,680.00
|
| Rate for Payer: UHCCP Medicaid |
$840.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$792.86
|
|
|
OPTX TIBI X PRX BCNDYLR
|
Facility
|
OP
|
$2,400.00
|
|
|
Service Code
|
HCPCS 27536
|
| Hospital Charge Code |
76100871
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$312.00 |
| Max. Negotiated Rate |
$2,304.00 |
| Rate for Payer: Aetna Commercial |
$1,848.00
|
| Rate for Payer: Anthem Medicaid |
$825.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,872.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cigna Commercial |
$1,992.00
|
| Rate for Payer: First Health Commercial |
$2,280.00
|
| Rate for Payer: Humana Commercial |
$2,040.00
|
| Rate for Payer: Humana KY Medicaid |
$825.36
|
| Rate for Payer: Kentucky WC Medicaid |
$833.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,968.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,771.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$720.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$841.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,112.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,800.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$480.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$312.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$744.00
|
| Rate for Payer: PHCS Commercial |
$2,304.00
|
| Rate for Payer: United Healthcare All Payer |
$2,112.00
|
|
|
OPTX TIBI X PRX BCNDYLR(P
|
Professional
|
Both
|
$2,400.00
|
|
|
Service Code
|
HCPCS 27536
|
| Hospital Charge Code |
761P0871
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$785.01 |
| Max. Negotiated Rate |
$2,400.00 |
| Rate for Payer: Aetna Commercial |
$1,769.16
|
| Rate for Payer: Anthem Medicaid |
$785.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,400.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cigna Commercial |
$1,911.14
|
| Rate for Payer: Healthspan PPO |
$1,602.48
|
| Rate for Payer: Humana Medicaid |
$785.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,490.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$800.71
|
| Rate for Payer: Molina Healthcare Passport |
$785.01
|
| Rate for Payer: Multiplan PHCS |
$1,440.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,680.00
|
| Rate for Payer: UHCCP Medicaid |
$840.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$792.86
|
|
|
ORAJEL 20% GEL (7GM)
|
Facility
|
OP
|
$0.60
|
|
|
Service Code
|
NDC 10310028340
|
| Hospital Charge Code |
25004371
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.58 |
| Rate for Payer: Aetna Commercial |
$0.46
|
| Rate for Payer: Anthem Medicaid |
$0.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.47
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.50
|
| Rate for Payer: First Health Commercial |
$0.57
|
| Rate for Payer: Humana Commercial |
$0.51
|
| Rate for Payer: Humana KY Medicaid |
$0.21
|
| Rate for Payer: Kentucky WC Medicaid |
$0.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.53
|
| Rate for Payer: Ohio Health Group HMO |
$0.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.19
|
| Rate for Payer: PHCS Commercial |
$0.58
|
| Rate for Payer: United Healthcare All Payer |
$0.53
|
|
|
ORAJEL 20% GEL (7GM)
|
Facility
|
IP
|
$0.60
|
|
|
Service Code
|
NDC 10310028340
|
| Hospital Charge Code |
25004371
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.58 |
| Rate for Payer: Aetna Commercial |
$0.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.47
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.50
|
| Rate for Payer: First Health Commercial |
$0.57
|
| Rate for Payer: Humana Commercial |
$0.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.53
|
| Rate for Payer: Ohio Health Group HMO |
$0.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.19
|
| Rate for Payer: PHCS Commercial |
$0.58
|
| Rate for Payer: United Healthcare All Payer |
$0.53
|
|
|
ORAP 1MG TABLET
|
Facility
|
IP
|
$9.36
|
|
|
Service Code
|
NDC 49884034701
|
| Hospital Charge Code |
25001138
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$8.99 |
| Rate for Payer: Aetna Commercial |
$7.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.30
|
| Rate for Payer: Cash Price |
$4.68
|
| Rate for Payer: Cigna Commercial |
$7.77
|
| Rate for Payer: First Health Commercial |
$8.89
|
| Rate for Payer: Humana Commercial |
$7.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.24
|
| Rate for Payer: Ohio Health Group HMO |
$7.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.90
|
| Rate for Payer: PHCS Commercial |
$8.99
|
| Rate for Payer: United Healthcare All Payer |
$8.24
|
|
|
ORAP 1MG TABLET
|
Facility
|
OP
|
$9.36
|
|
|
Service Code
|
NDC 49884034701
|
| Hospital Charge Code |
25001138
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$8.99 |
| Rate for Payer: Aetna Commercial |
$7.21
|
| Rate for Payer: Anthem Medicaid |
$3.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.30
|
| Rate for Payer: Cash Price |
$4.68
|
| Rate for Payer: Cigna Commercial |
$7.77
|
| Rate for Payer: First Health Commercial |
$8.89
|
| Rate for Payer: Humana Commercial |
$7.96
|
| Rate for Payer: Humana KY Medicaid |
$3.22
|
| Rate for Payer: Kentucky WC Medicaid |
$3.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.24
|
| Rate for Payer: Ohio Health Group HMO |
$7.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.90
|
| Rate for Payer: PHCS Commercial |
$8.99
|
| Rate for Payer: United Healthcare All Payer |
$8.24
|
|
|
ORAP 2MG TABLET
|
Facility
|
OP
|
$9.81
|
|
|
Service Code
|
NDC 49884034801
|
| Hospital Charge Code |
25001139
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$9.42 |
| Rate for Payer: Aetna Commercial |
$7.55
|
| Rate for Payer: Anthem Medicaid |
$3.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.65
|
| Rate for Payer: Cash Price |
$4.90
|
| Rate for Payer: Cigna Commercial |
$8.14
|
| Rate for Payer: First Health Commercial |
$9.32
|
| Rate for Payer: Humana Commercial |
$8.34
|
| Rate for Payer: Humana KY Medicaid |
$3.37
|
| Rate for Payer: Kentucky WC Medicaid |
$3.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.63
|
| Rate for Payer: Ohio Health Group HMO |
$7.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.04
|
| Rate for Payer: PHCS Commercial |
$9.42
|
| Rate for Payer: United Healthcare All Payer |
$8.63
|
|
|
ORAP 2MG TABLET
|
Facility
|
IP
|
$9.81
|
|
|
Service Code
|
NDC 49884034801
|
| Hospital Charge Code |
25001139
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$9.42 |
| Rate for Payer: Aetna Commercial |
$7.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.65
|
| Rate for Payer: Cash Price |
$4.90
|
| Rate for Payer: Cigna Commercial |
$8.14
|
| Rate for Payer: First Health Commercial |
$9.32
|
| Rate for Payer: Humana Commercial |
$8.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.63
|
| Rate for Payer: Ohio Health Group HMO |
$7.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.04
|
| Rate for Payer: PHCS Commercial |
$9.42
|
| Rate for Payer: United Healthcare All Payer |
$8.63
|
|
|
ORAPRED(PRED SOD)5MG (15MG/5ML
|
Facility
|
IP
|
$4.73
|
|
|
Service Code
|
HCPCS J7510
|
| Hospital Charge Code |
636T0077
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$4.54 |
| Rate for Payer: Aetna Commercial |
$3.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.69
|
| Rate for Payer: Cash Price |
$2.37
|
| Rate for Payer: Cigna Commercial |
$3.93
|
| Rate for Payer: First Health Commercial |
$4.49
|
| Rate for Payer: Humana Commercial |
$4.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.16
|
| Rate for Payer: Ohio Health Group HMO |
$3.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.47
|
| Rate for Payer: PHCS Commercial |
$4.54
|
| Rate for Payer: United Healthcare All Payer |
$4.16
|
|
|
ORAPRED(PRED SOD)5MG (15MG/5ML
|
Facility
|
OP
|
$4.73
|
|
|
Service Code
|
HCPCS J7510
|
| Hospital Charge Code |
636T0077
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$4.54 |
| Rate for Payer: Aetna Commercial |
$3.64
|
| Rate for Payer: Anthem Medicaid |
$1.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.69
|
| Rate for Payer: Cash Price |
$2.37
|
| Rate for Payer: Cigna Commercial |
$3.93
|
| Rate for Payer: First Health Commercial |
$4.49
|
| Rate for Payer: Humana Commercial |
$4.02
|
| Rate for Payer: Humana KY Medicaid |
$1.63
|
| Rate for Payer: Kentucky WC Medicaid |
$1.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.16
|
| Rate for Payer: Ohio Health Group HMO |
$3.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.47
|
| Rate for Payer: PHCS Commercial |
$4.54
|
| Rate for Payer: United Healthcare All Payer |
$4.16
|
|
|
ORAPRED(PRED SOD)5MG (15MG/5ML
|
Professional
|
Both
|
$4.73
|
|
|
Service Code
|
HCPCS J7510
|
| Hospital Charge Code |
63600077
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$4.73 |
| Rate for Payer: Aetna Commercial |
$0.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$4.73
|
| Rate for Payer: Cash Price |
$2.37
|
| Rate for Payer: Cash Price |
$2.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$0.21
|
| Rate for Payer: Multiplan PHCS |
$2.84
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3.31
|
| Rate for Payer: UHCCP Medicaid |
$1.66
|
|
|
ORAPRED(PRED SOD)5MG (15MG/5ML
|
Facility
|
OP
|
$4.73
|
|
|
Service Code
|
HCPCS J7510
|
| Hospital Charge Code |
63600077
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$4.54 |
| Rate for Payer: Aetna Commercial |
$3.64
|
| Rate for Payer: Anthem Medicaid |
$1.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.69
|
| Rate for Payer: Cash Price |
$2.37
|
| Rate for Payer: Cigna Commercial |
$3.93
|
| Rate for Payer: First Health Commercial |
$4.49
|
| Rate for Payer: Humana Commercial |
$4.02
|
| Rate for Payer: Humana KY Medicaid |
$1.63
|
| Rate for Payer: Kentucky WC Medicaid |
$1.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.16
|
| Rate for Payer: Ohio Health Group HMO |
$3.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.47
|
| Rate for Payer: PHCS Commercial |
$4.54
|
| Rate for Payer: United Healthcare All Payer |
$4.16
|
|
