|
ORAPRED(PRED SOD)5MG (15MG/5ML
|
Facility
|
OP
|
$5.04
|
|
|
Service Code
|
HCPCS J7510
|
| Hospital Charge Code |
25002497
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$4.84 |
| Rate for Payer: Aetna Commercial |
$3.88
|
| Rate for Payer: Anthem Medicaid |
$1.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.93
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cigna Commercial |
$4.18
|
| Rate for Payer: First Health Commercial |
$4.79
|
| Rate for Payer: Humana Commercial |
$4.28
|
| Rate for Payer: Humana KY Medicaid |
$1.73
|
| Rate for Payer: Kentucky WC Medicaid |
$1.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.44
|
| Rate for Payer: Ohio Health Group HMO |
$3.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.56
|
| Rate for Payer: PHCS Commercial |
$4.84
|
| Rate for Payer: United Healthcare All Payer |
$4.44
|
|
|
ORAPRED(PRED SOD)5MG (15MG/5ML
|
Facility
|
IP
|
$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 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
|
IP
|
$5.04
|
|
|
Service Code
|
HCPCS J7510
|
| Hospital Charge Code |
25002497
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$4.84 |
| Rate for Payer: Aetna Commercial |
$3.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.93
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cigna Commercial |
$4.18
|
| Rate for Payer: First Health Commercial |
$4.79
|
| Rate for Payer: Humana Commercial |
$4.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.44
|
| Rate for Payer: Ohio Health Group HMO |
$3.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.56
|
| Rate for Payer: PHCS Commercial |
$4.84
|
| Rate for Payer: United Healthcare All Payer |
$4.44
|
|
|
ORBACTIV 400MG VIAL
|
Facility
|
IP
|
$6,142.15
|
|
|
Service Code
|
HCPCS J2407
|
| Hospital Charge Code |
25002287
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$798.48 |
| Max. Negotiated Rate |
$5,896.46 |
| Rate for Payer: Aetna Commercial |
$4,729.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,790.88
|
| Rate for Payer: Cash Price |
$3,071.07
|
| Rate for Payer: Cigna Commercial |
$5,097.98
|
| Rate for Payer: First Health Commercial |
$5,835.04
|
| Rate for Payer: Humana Commercial |
$5,220.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,036.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,532.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,842.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,405.09
|
| Rate for Payer: Ohio Health Group HMO |
$4,606.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,228.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$798.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,904.07
|
| Rate for Payer: PHCS Commercial |
$5,896.46
|
| Rate for Payer: United Healthcare All Payer |
$5,405.09
|
|
|
ORBACTIV 400MG VIAL
|
Facility
|
OP
|
$6,142.15
|
|
|
Service Code
|
HCPCS J2407
|
| Hospital Charge Code |
25002287
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$5,896.46 |
| Rate for Payer: Aetna Commercial |
$4,729.46
|
| Rate for Payer: Anthem Medicaid |
$2,112.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$27.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,790.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$38.63
|
| Rate for Payer: CareSource Just4Me Medicare |
$37.25
|
| Rate for Payer: Cash Price |
$3,071.07
|
| Rate for Payer: Cash Price |
$3,071.07
|
| Rate for Payer: Cigna Commercial |
$5,097.98
|
| Rate for Payer: First Health Commercial |
$5,835.04
|
| Rate for Payer: Humana Commercial |
$5,220.83
|
| Rate for Payer: Humana KY Medicaid |
$2,112.29
|
| Rate for Payer: Humana Medicare Advantage |
$27.60
|
| Rate for Payer: Kentucky WC Medicaid |
$2,133.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,036.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,532.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,154.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,405.09
|
| Rate for Payer: Ohio Health Group HMO |
$4,606.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,228.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$798.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,904.07
|
| Rate for Payer: PHCS Commercial |
$5,896.46
|
| Rate for Payer: United Healthcare All Payer |
$5,405.09
|
|
|
ORBICULARIS OCULI (BLINK) REFL
|
Facility
|
OP
|
$414.00
|
|
|
Service Code
|
HCPCS 95933
|
| Hospital Charge Code |
51000040
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$52.89 |
| Max. Negotiated Rate |
$397.44 |
| Rate for Payer: Aetna Commercial |
$318.78
|
| Rate for Payer: Anthem Medicaid |
$142.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$52.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$322.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$74.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$71.40
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cigna Commercial |
$343.62
|
| Rate for Payer: First Health Commercial |
$393.30
|
| Rate for Payer: Humana Commercial |
$351.90
|
| Rate for Payer: Humana KY Medicaid |
$142.37
|
| Rate for Payer: Humana Medicare Advantage |
$52.89
|
| Rate for Payer: Kentucky WC Medicaid |
$143.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$339.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$305.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$145.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$364.32
|
| Rate for Payer: Ohio Health Group HMO |
$310.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$82.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$128.34
|
| Rate for Payer: PHCS Commercial |
$397.44
|
| Rate for Payer: United Healthcare All Payer |
$364.32
|
|
|
ORBICULARIS OCULI (BLINK) REFL
|
Facility
|
IP
|
$414.00
|
|
|
Service Code
|
HCPCS 95933
|
| Hospital Charge Code |
51000040
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$53.82 |
| Max. Negotiated Rate |
$397.44 |
| Rate for Payer: Aetna Commercial |
$318.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$322.92
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cigna Commercial |
$343.62
|
| Rate for Payer: First Health Commercial |
$393.30
|
| Rate for Payer: Humana Commercial |
$351.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$339.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$305.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$124.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$364.32
|
| Rate for Payer: Ohio Health Group HMO |
$310.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$82.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$128.34
|
| Rate for Payer: PHCS Commercial |
$397.44
|
| Rate for Payer: United Healthcare All Payer |
$364.32
|
|
|
ORBICULARIS OCULI (BLINK) REFL
|
Professional
|
Both
|
$414.00
|
|
|
Service Code
|
HCPCS 95933
|
| Hospital Charge Code |
51000040
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$36.30 |
| Max. Negotiated Rate |
$414.00 |
| Rate for Payer: Aetna Commercial |
$98.45
|
| Rate for Payer: Anthem Medicaid |
$53.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$414.00
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cigna Commercial |
$96.78
|
| Rate for Payer: Healthspan PPO |
$86.72
|
| Rate for Payer: Humana Medicaid |
$53.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$36.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$54.34
|
| Rate for Payer: Molina Healthcare Passport |
$53.27
|
| Rate for Payer: Multiplan PHCS |
$248.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$289.80
|
| Rate for Payer: UHCCP Medicaid |
$144.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$53.80
|
|
|
ORBICULARIS OCULI BLINK REFL(P
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 95933
|
| Hospital Charge Code |
510P0040
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna Commercial |
$98.45
|
| Rate for Payer: Anthem Medicaid |
$53.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$100.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$96.78
|
| Rate for Payer: Healthspan PPO |
$86.72
|
| Rate for Payer: Humana Medicaid |
$53.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$36.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$54.34
|
| Rate for Payer: Molina Healthcare Passport |
$53.27
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.00
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$53.80
|
|
|
ORBICULARIS OCULI BLINK REF(T
|
Facility
|
IP
|
$314.00
|
|
|
Service Code
|
HCPCS 95933
|
| Hospital Charge Code |
510T0040
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$40.82 |
| Max. Negotiated Rate |
$301.44 |
| Rate for Payer: Aetna Commercial |
$241.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$244.92
|
| Rate for Payer: Cash Price |
$157.00
|
| Rate for Payer: Cigna Commercial |
$260.62
|
| Rate for Payer: First Health Commercial |
$298.30
|
| Rate for Payer: Humana Commercial |
$266.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$257.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$231.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$276.32
|
| Rate for Payer: Ohio Health Group HMO |
$235.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$97.34
|
| Rate for Payer: PHCS Commercial |
$301.44
|
| Rate for Payer: United Healthcare All Payer |
$276.32
|
|
|
ORBICULARIS OCULI BLINK REF(T
|
Facility
|
OP
|
$314.00
|
|
|
Service Code
|
HCPCS 95933
|
| Hospital Charge Code |
510T0040
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$40.82 |
| Max. Negotiated Rate |
$301.44 |
| Rate for Payer: Aetna Commercial |
$241.78
|
| Rate for Payer: Anthem Medicaid |
$107.98
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$52.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$244.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$74.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$71.40
|
| Rate for Payer: Cash Price |
$157.00
|
| Rate for Payer: Cash Price |
$157.00
|
| Rate for Payer: Cigna Commercial |
$260.62
|
| Rate for Payer: First Health Commercial |
$298.30
|
| Rate for Payer: Humana Commercial |
$266.90
|
| Rate for Payer: Humana KY Medicaid |
$107.98
|
| Rate for Payer: Humana Medicare Advantage |
$52.89
|
| Rate for Payer: Kentucky WC Medicaid |
$109.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$257.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$231.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$110.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$276.32
|
| Rate for Payer: Ohio Health Group HMO |
$235.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$97.34
|
| Rate for Payer: PHCS Commercial |
$301.44
|
| Rate for Payer: United Healthcare All Payer |
$276.32
|
|
|
ORBITAL PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$29,330.92
|
|
|
Service Code
|
MSDRG 113
|
| Min. Negotiated Rate |
$19,903.13 |
| Max. Negotiated Rate |
$29,330.92 |
| Rate for Payer: Anthem Medicaid |
$19,903.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$20,950.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$29,330.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$28,283.39
|
| Rate for Payer: Humana KY Medicaid |
$19,903.13
|
| Rate for Payer: Humana Medicare Advantage |
$20,950.66
|
| Rate for Payer: Kentucky WC Medicaid |
$20,102.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,140.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$20,301.19
|
|
|
ORBITAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$14,409.84
|
|
|
Service Code
|
MSDRG 114
|
| Min. Negotiated Rate |
$9,778.10 |
| Max. Negotiated Rate |
$14,409.84 |
| Rate for Payer: Anthem Medicaid |
$9,778.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10,292.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$14,409.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$13,895.20
|
| Rate for Payer: Humana KY Medicaid |
$9,778.10
|
| Rate for Payer: Humana Medicare Advantage |
$10,292.74
|
| Rate for Payer: Kentucky WC Medicaid |
$9,875.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,351.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,973.67
|
|
|
ORBITS COMPLETE 4 VIEWS
|
Facility
|
OP
|
$569.00
|
|
|
Service Code
|
HCPCS 70200
|
| Hospital Charge Code |
32000014
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$73.97 |
| Max. Negotiated Rate |
$546.24 |
| Rate for Payer: Aetna Commercial |
$438.13
|
| Rate for Payer: Anthem Medicaid |
$195.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$443.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$284.50
|
| Rate for Payer: Cash Price |
$284.50
|
| Rate for Payer: Cigna Commercial |
$472.27
|
| Rate for Payer: First Health Commercial |
$540.55
|
| Rate for Payer: Humana Commercial |
$483.65
|
| Rate for Payer: Humana KY Medicaid |
$195.68
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$197.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$466.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$419.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$199.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$500.72
|
| Rate for Payer: Ohio Health Group HMO |
$426.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$113.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$176.39
|
| Rate for Payer: PHCS Commercial |
$546.24
|
| Rate for Payer: United Healthcare All Payer |
$500.72
|
|
|
ORBITS COMPLETE 4 VIEWS
|
Facility
|
IP
|
$569.00
|
|
|
Service Code
|
HCPCS 70200
|
| Hospital Charge Code |
32000014
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$73.97 |
| Max. Negotiated Rate |
$546.24 |
| Rate for Payer: Aetna Commercial |
$438.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$443.82
|
| Rate for Payer: Cash Price |
$284.50
|
| Rate for Payer: Cigna Commercial |
$472.27
|
| Rate for Payer: First Health Commercial |
$540.55
|
| Rate for Payer: Humana Commercial |
$483.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$466.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$419.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$170.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$500.72
|
| Rate for Payer: Ohio Health Group HMO |
$426.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$113.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$176.39
|
| Rate for Payer: PHCS Commercial |
$546.24
|
| Rate for Payer: United Healthcare All Payer |
$500.72
|
|
|
ORBITS COMPLETE 4 VIEWS
|
Professional
|
Both
|
$569.00
|
|
|
Service Code
|
HCPCS 70200
|
| Hospital Charge Code |
32000014
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.67 |
| Max. Negotiated Rate |
$569.00 |
| Rate for Payer: Aetna Commercial |
$66.99
|
| Rate for Payer: Anthem Medicaid |
$33.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$569.00
|
| Rate for Payer: Cash Price |
$284.50
|
| Rate for Payer: Cash Price |
$284.50
|
| Rate for Payer: Cigna Commercial |
$65.58
|
| Rate for Payer: Healthspan PPO |
$62.78
|
| Rate for Payer: Humana Medicaid |
$33.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$17.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$34.19
|
| Rate for Payer: Molina Healthcare Passport |
$33.52
|
| Rate for Payer: Multiplan PHCS |
$341.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$398.30
|
| Rate for Payer: UHCCP Medicaid |
$199.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$33.86
|
|
|
ORBITS COMPLETE 4 VIEWS(P
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 70200
|
| Hospital Charge Code |
320P0014
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.67 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna Commercial |
$66.99
|
| Rate for Payer: Anthem Medicaid |
$33.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$75.00
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$65.58
|
| Rate for Payer: Healthspan PPO |
$62.78
|
| Rate for Payer: Humana Medicaid |
$33.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$17.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$34.19
|
| Rate for Payer: Molina Healthcare Passport |
$33.52
|
| Rate for Payer: Multiplan PHCS |
$45.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$52.50
|
| Rate for Payer: UHCCP Medicaid |
$26.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$33.86
|
|
|
ORBITS COMPLETE 4 VIEWS(T
|
Facility
|
OP
|
$494.00
|
|
|
Service Code
|
HCPCS 70200
|
| Hospital Charge Code |
320T0014
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$64.22 |
| Max. Negotiated Rate |
$474.24 |
| Rate for Payer: Aetna Commercial |
$380.38
|
| Rate for Payer: Anthem Medicaid |
$169.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$385.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$247.00
|
| Rate for Payer: Cash Price |
$247.00
|
| Rate for Payer: Cigna Commercial |
$410.02
|
| Rate for Payer: First Health Commercial |
$469.30
|
| Rate for Payer: Humana Commercial |
$419.90
|
| Rate for Payer: Humana KY Medicaid |
$169.89
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$171.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$405.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$364.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$173.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$434.72
|
| Rate for Payer: Ohio Health Group HMO |
$370.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$98.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$153.14
|
| Rate for Payer: PHCS Commercial |
$474.24
|
| Rate for Payer: United Healthcare All Payer |
$434.72
|
|
|
ORBITS COMPLETE 4 VIEWS(T
|
Facility
|
IP
|
$494.00
|
|
|
Service Code
|
HCPCS 70200
|
| Hospital Charge Code |
320T0014
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$64.22 |
| Max. Negotiated Rate |
$474.24 |
| Rate for Payer: Aetna Commercial |
$380.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$385.32
|
| Rate for Payer: Cash Price |
$247.00
|
| Rate for Payer: Cigna Commercial |
$410.02
|
| Rate for Payer: First Health Commercial |
$469.30
|
| Rate for Payer: Humana Commercial |
$419.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$405.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$364.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$148.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$434.72
|
| Rate for Payer: Ohio Health Group HMO |
$370.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$98.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$153.14
|
| Rate for Payer: PHCS Commercial |
$474.24
|
| Rate for Payer: United Healthcare All Payer |
$434.72
|
|
|
ORCHIECTOMY, RADICAL, FOR TUMOR; INGUINAL APPROACH
|
Facility
|
OP
|
$4,188.46
|
|
|
Service Code
|
CPT 54530
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,991.76 |
| Max. Negotiated Rate |
$4,188.46 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,991.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,188.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,038.88
|
| Rate for Payer: Humana Medicare Advantage |
$2,991.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,590.11
|
|
|
ORCHIECTOMY, SIMPLE (INCLUDING SUBCAPSULAR), WITH OR WITHOUT TESTICULAR PROSTHESIS, SCROTAL OR INGUINAL APPROACH
|
Facility
|
OP
|
$4,220.54
|
|
|
Service Code
|
CPT 54520
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,014.67 |
| Max. Negotiated Rate |
$4,220.54 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,014.67
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,220.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,069.80
|
| Rate for Payer: Humana Medicare Advantage |
$3,014.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.60
|
|
|
ORCHIOPEXY INGUN/SCROT APPR
|
Facility
|
OP
|
$640.00
|
|
|
Service Code
|
HCPCS 54640
|
| Hospital Charge Code |
36001274
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$83.20 |
| Max. Negotiated Rate |
$4,188.46 |
| Rate for Payer: Aetna Commercial |
$492.80
|
| Rate for Payer: Anthem Medicaid |
$220.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,991.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$499.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,188.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,038.88
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cigna Commercial |
$531.20
|
| Rate for Payer: First Health Commercial |
$608.00
|
| Rate for Payer: Humana Commercial |
$544.00
|
| Rate for Payer: Humana KY Medicaid |
$220.10
|
| Rate for Payer: Humana Medicare Advantage |
$2,991.76
|
| Rate for Payer: Kentucky WC Medicaid |
$222.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$524.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$472.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,590.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$224.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$563.20
|
| Rate for Payer: Ohio Health Group HMO |
$480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$128.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$83.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$198.40
|
| Rate for Payer: PHCS Commercial |
$614.40
|
| Rate for Payer: United Healthcare All Payer |
$563.20
|
|
|
ORCHIOPEXY INGUN/SCROT APPR
|
Professional
|
Both
|
$640.00
|
|
|
Service Code
|
HCPCS 54640
|
| Hospital Charge Code |
36001274
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$224.00 |
| Max. Negotiated Rate |
$755.73 |
| Rate for Payer: Aetna Commercial |
$755.73
|
| Rate for Payer: Anthem Medicaid |
$349.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$640.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cigna Commercial |
$667.69
|
| Rate for Payer: Healthspan PPO |
$731.74
|
| Rate for Payer: Humana Medicaid |
$349.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$646.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$356.45
|
| Rate for Payer: Molina Healthcare Passport |
$349.46
|
| Rate for Payer: Multiplan PHCS |
$384.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$448.00
|
| Rate for Payer: UHCCP Medicaid |
$224.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$352.95
|
|
|
ORCHIOPEXY INGUN/SCROT APPR
|
Facility
|
IP
|
$640.00
|
|
|
Service Code
|
HCPCS 54640
|
| Hospital Charge Code |
36001274
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$83.20 |
| Max. Negotiated Rate |
$614.40 |
| Rate for Payer: Aetna Commercial |
$492.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$499.20
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cigna Commercial |
$531.20
|
| Rate for Payer: First Health Commercial |
$608.00
|
| Rate for Payer: Humana Commercial |
$544.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$524.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$472.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$192.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$563.20
|
| Rate for Payer: Ohio Health Group HMO |
$480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$128.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$83.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$198.40
|
| Rate for Payer: PHCS Commercial |
$614.40
|
| Rate for Payer: United Healthcare All Payer |
$563.20
|
|
|
ORENCIA 10MG(ABATACEPT)250MG V
|
Facility
|
OP
|
$7,970.52
|
|
|
Service Code
|
HCPCS J0129
|
| Hospital Charge Code |
25001820
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.16 |
| Max. Negotiated Rate |
$7,651.70 |
| Rate for Payer: Aetna Commercial |
$6,137.30
|
| Rate for Payer: Anthem Medicaid |
$2,741.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$43.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,217.01
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$60.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$58.27
|
| Rate for Payer: Cash Price |
$3,985.26
|
| Rate for Payer: Cash Price |
$3,985.26
|
| Rate for Payer: Cigna Commercial |
$6,615.53
|
| Rate for Payer: First Health Commercial |
$7,571.99
|
| Rate for Payer: Humana Commercial |
$6,774.94
|
| Rate for Payer: Humana KY Medicaid |
$2,741.06
|
| Rate for Payer: Humana Medicare Advantage |
$43.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,768.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,535.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,882.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,796.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,014.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,977.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,594.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,036.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,470.86
|
| Rate for Payer: PHCS Commercial |
$7,651.70
|
| Rate for Payer: United Healthcare All Payer |
$7,014.06
|
|
