|
OPHORECTOMY(P
|
Professional
|
Both
|
$2,700.00
|
|
|
Service Code
|
HCPCS 58940
|
| Hospital Charge Code |
761P2263
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$398.30 |
| Max. Negotiated Rate |
$1,620.00 |
| Rate for Payer: Aetna Commercial |
$755.67
|
| Rate for Payer: Ambetter Exchange |
$524.80
|
| Rate for Payer: Anthem Medicaid |
$398.30
|
| Rate for Payer: Buckeye Individual/Medicaid |
$524.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$524.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$629.76
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$726.58
|
| Rate for Payer: Healthspan PPO |
$731.68
|
| Rate for Payer: Humana Medicaid |
$398.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$666.53
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$524.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$524.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$406.27
|
| Rate for Payer: Molina Healthcare Passport |
$398.30
|
| Rate for Payer: Multiplan PHCS |
$1,620.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$682.24
|
| Rate for Payer: UHCCP Medicaid |
$945.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$402.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$524.80
|
|
|
OPIUM & BELADONA 30MG SUPPRECT
|
Facility
|
OP
|
$82.01
|
|
|
Service Code
|
NDC 574704512
|
| Hospital Charge Code |
25001134
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.60 |
| Max. Negotiated Rate |
$78.73 |
| Rate for Payer: Aetna Commercial |
$63.15
|
| Rate for Payer: Anthem Medicaid |
$28.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63.97
|
| Rate for Payer: Cash Price |
$41.01
|
| Rate for Payer: Cigna Commercial |
$68.07
|
| Rate for Payer: First Health Commercial |
$77.91
|
| Rate for Payer: Humana Commercial |
$69.71
|
| Rate for Payer: Humana KY Medicaid |
$28.20
|
| Rate for Payer: Kentucky WC Medicaid |
$28.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$28.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$72.17
|
| Rate for Payer: Ohio Health Group HMO |
$61.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56.59
|
| Rate for Payer: PHCS Commercial |
$78.73
|
| Rate for Payer: United Healthcare All Payer |
$72.17
|
|
|
OPIUM & BELADONA 30MG SUPPRECT
|
Facility
|
IP
|
$82.01
|
|
|
Service Code
|
NDC 574704512
|
| Hospital Charge Code |
25001134
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.60 |
| Max. Negotiated Rate |
$78.73 |
| Rate for Payer: Aetna Commercial |
$63.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63.97
|
| Rate for Payer: Cash Price |
$41.01
|
| Rate for Payer: Cigna Commercial |
$68.07
|
| Rate for Payer: First Health Commercial |
$77.91
|
| Rate for Payer: Humana Commercial |
$69.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$72.17
|
| Rate for Payer: Ohio Health Group HMO |
$61.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56.59
|
| Rate for Payer: PHCS Commercial |
$78.73
|
| Rate for Payer: United Healthcare All Payer |
$72.17
|
|
|
OPN EXC/DST NTRA-ABD 10.1-20
|
Professional
|
Both
|
$4,715.00
|
|
|
Service Code
|
HCPCS 49188
|
| Hospital Charge Code |
76103002
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,650.25 |
| Max. Negotiated Rate |
$2,829.00 |
| Rate for Payer: Ambetter Exchange |
$1,904.81
|
| Rate for Payer: Anthem Medicaid |
$1,662.27
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,904.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,904.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,285.77
|
| Rate for Payer: Cash Price |
$2,357.50
|
| Rate for Payer: Cash Price |
$2,357.50
|
| Rate for Payer: Humana Medicaid |
$1,662.27
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,904.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,904.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,695.52
|
| Rate for Payer: Molina Healthcare Passport |
$1,662.27
|
| Rate for Payer: Multiplan PHCS |
$2,829.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,476.25
|
| Rate for Payer: UHCCP Medicaid |
$1,650.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,678.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,904.81
|
|
|
OPN EXC/DST NTRA-ABD 20.1-30
|
Professional
|
Both
|
$5,490.00
|
|
|
Service Code
|
HCPCS 49189
|
| Hospital Charge Code |
76103003
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,921.50 |
| Max. Negotiated Rate |
$3,294.00 |
| Rate for Payer: Ambetter Exchange |
$2,217.63
|
| Rate for Payer: Anthem Medicaid |
$1,934.96
|
| Rate for Payer: Buckeye Individual/Medicaid |
$2,217.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,217.63
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,661.16
|
| Rate for Payer: Cash Price |
$2,745.00
|
| Rate for Payer: Cash Price |
$2,745.00
|
| Rate for Payer: Humana Medicaid |
$1,934.96
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$2,217.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,217.63
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,973.66
|
| Rate for Payer: Molina Healthcare Passport |
$1,934.96
|
| Rate for Payer: Multiplan PHCS |
$3,294.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,882.92
|
| Rate for Payer: UHCCP Medicaid |
$1,921.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,954.31
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,217.63
|
|
|
OPN EXC/DSTR NTRA-ABD >30 CM
|
Professional
|
Both
|
$6,775.00
|
|
|
Service Code
|
HCPCS 49190
|
| Hospital Charge Code |
76103004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,371.25 |
| Max. Negotiated Rate |
$4,065.00 |
| Rate for Payer: Ambetter Exchange |
$2,735.36
|
| Rate for Payer: Anthem Medicaid |
$2,386.89
|
| Rate for Payer: Buckeye Individual/Medicaid |
$2,735.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,735.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,282.43
|
| Rate for Payer: Cash Price |
$3,387.50
|
| Rate for Payer: Cash Price |
$3,387.50
|
| Rate for Payer: Humana Medicaid |
$2,386.89
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$2,735.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,735.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$2,434.63
|
| Rate for Payer: Molina Healthcare Passport |
$2,386.89
|
| Rate for Payer: Multiplan PHCS |
$4,065.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,555.97
|
| Rate for Payer: UHCCP Medicaid |
$2,371.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$2,410.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,735.36
|
|
|
OPN EXC/DSTR NTRA-ABD 5.1-10
|
Professional
|
Both
|
$3,950.00
|
|
|
Service Code
|
HCPCS 49187
|
| Hospital Charge Code |
76103001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,382.50 |
| Max. Negotiated Rate |
$2,370.00 |
| Rate for Payer: Ambetter Exchange |
$1,594.79
|
| Rate for Payer: Anthem Medicaid |
$1,391.63
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,594.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,594.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,913.75
|
| Rate for Payer: Cash Price |
$1,975.00
|
| Rate for Payer: Cash Price |
$1,975.00
|
| Rate for Payer: Humana Medicaid |
$1,391.63
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,594.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,594.79
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,419.46
|
| Rate for Payer: Molina Healthcare Passport |
$1,391.63
|
| Rate for Payer: Multiplan PHCS |
$2,370.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,073.23
|
| Rate for Payer: UHCCP Medicaid |
$1,382.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,405.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,594.79
|
|
|
OPN EXC/DSTR NTRA-ABD 5 CM/<
|
Professional
|
Both
|
$3,090.00
|
|
|
Service Code
|
HCPCS 49186
|
| Hospital Charge Code |
76103000
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,081.50 |
| Max. Negotiated Rate |
$1,854.00 |
| Rate for Payer: Ambetter Exchange |
$1,244.67
|
| Rate for Payer: Anthem Medicaid |
$1,087.34
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,244.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,244.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,493.60
|
| Rate for Payer: Cash Price |
$1,545.00
|
| Rate for Payer: Cash Price |
$1,545.00
|
| Rate for Payer: Humana Medicaid |
$1,087.34
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,244.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,244.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,109.09
|
| Rate for Payer: Molina Healthcare Passport |
$1,087.34
|
| Rate for Payer: Multiplan PHCS |
$1,854.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,618.07
|
| Rate for Payer: UHCCP Medicaid |
$1,081.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,098.21
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,244.67
|
|
|
OPN IMPLTJ NEA SACRAL NERVE
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 64581
|
| Hospital Charge Code |
76102337
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$490.00 |
| Max. Negotiated Rate |
$1,344.05 |
| Rate for Payer: Aetna Commercial |
$1,344.05
|
| Rate for Payer: Ambetter Exchange |
$622.85
|
| Rate for Payer: Anthem Medicaid |
$571.23
|
| Rate for Payer: Buckeye Individual/Medicaid |
$622.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$622.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$747.42
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,176.06
|
| Rate for Payer: Healthspan PPO |
$1,049.40
|
| Rate for Payer: Humana Medicaid |
$571.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$905.83
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$622.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$622.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$582.65
|
| Rate for Payer: Molina Healthcare Passport |
$571.23
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$809.71
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$576.94
|
| Rate for Payer: Wellcare Medicare Advantage |
$622.85
|
|
|
OPN IMPLTJ NEA SACRAL NERVE
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 64581
|
| Hospital Charge Code |
76102337
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$481.46 |
| Max. Negotiated Rate |
$8,489.59 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem Medicaid |
$481.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,063.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,489.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,186.39
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Humana KY Medicaid |
$481.46
|
| Rate for Payer: Humana Medicare Advantage |
$6,063.99
|
| Rate for Payer: Kentucky WC Medicaid |
$486.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,276.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$491.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,218.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$966.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
OPN IMPLTJ NEA SACRAL NERVE
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 64581
|
| Hospital Charge Code |
76102337
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$1,344.00 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$420.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,218.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$966.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
OPN IMPLTJ NEA SACRAL NERVE (P
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 64581
|
| Hospital Charge Code |
761P2337
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$490.00 |
| Max. Negotiated Rate |
$1,344.05 |
| Rate for Payer: Aetna Commercial |
$1,344.05
|
| Rate for Payer: Ambetter Exchange |
$622.85
|
| Rate for Payer: Anthem Medicaid |
$571.23
|
| Rate for Payer: Buckeye Individual/Medicaid |
$622.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$622.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$747.42
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,176.06
|
| Rate for Payer: Healthspan PPO |
$1,049.40
|
| Rate for Payer: Humana Medicaid |
$571.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$905.83
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$622.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$622.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$582.65
|
| Rate for Payer: Molina Healthcare Passport |
$571.23
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$809.71
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$576.94
|
| Rate for Payer: Wellcare Medicare Advantage |
$622.85
|
|
|
OP RDL SHFT FX CLSD R/U JT DIS
|
Professional
|
Both
|
$2,225.00
|
|
|
Service Code
|
HCPCS 25525
|
| Hospital Charge Code |
76100621
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$686.56 |
| Max. Negotiated Rate |
$1,502.00 |
| Rate for Payer: Aetna Commercial |
$1,191.25
|
| Rate for Payer: Ambetter Exchange |
$754.76
|
| Rate for Payer: Anthem Medicaid |
$686.56
|
| Rate for Payer: Buckeye Individual/Medicaid |
$754.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$754.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$905.71
|
| Rate for Payer: Cash Price |
$1,112.50
|
| Rate for Payer: Cash Price |
$1,112.50
|
| Rate for Payer: Cigna Commercial |
$1,502.00
|
| Rate for Payer: Healthspan PPO |
$1,079.02
|
| Rate for Payer: Humana Medicaid |
$686.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$976.30
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$754.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$754.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$700.29
|
| Rate for Payer: Molina Healthcare Passport |
$686.56
|
| Rate for Payer: Multiplan PHCS |
$1,335.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$981.19
|
| Rate for Payer: UHCCP Medicaid |
$778.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$693.43
|
| Rate for Payer: Wellcare Medicare Advantage |
$754.76
|
|
|
OP RDL SHFT FX CLSD R/U JT DIS
|
Facility
|
OP
|
$2,225.00
|
|
|
Service Code
|
HCPCS 25525
|
| Hospital Charge Code |
76100621
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$765.18 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,713.25
|
| Rate for Payer: Anthem Medicaid |
$765.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,735.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| Rate for Payer: Cash Price |
$1,112.50
|
| Rate for Payer: Cash Price |
$1,112.50
|
| Rate for Payer: Cigna Commercial |
$1,846.75
|
| Rate for Payer: First Health Commercial |
$2,113.75
|
| Rate for Payer: Humana Commercial |
$1,891.25
|
| Rate for Payer: Humana KY Medicaid |
$765.18
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$772.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,824.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,642.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$780.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,958.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,668.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,935.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,535.25
|
| Rate for Payer: PHCS Commercial |
$2,136.00
|
| Rate for Payer: United Healthcare All Payer |
$1,958.00
|
|
|
OP RDL SHFT FX CLSD R/U JT DIS
|
Professional
|
Both
|
$2,225.00
|
|
|
Service Code
|
HCPCS 25525
|
| Hospital Charge Code |
761P0621
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$686.56 |
| Max. Negotiated Rate |
$1,502.00 |
| Rate for Payer: Aetna Commercial |
$1,191.25
|
| Rate for Payer: Ambetter Exchange |
$754.76
|
| Rate for Payer: Anthem Medicaid |
$686.56
|
| Rate for Payer: Buckeye Individual/Medicaid |
$754.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$754.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$905.71
|
| Rate for Payer: Cash Price |
$1,112.50
|
| Rate for Payer: Cash Price |
$1,112.50
|
| Rate for Payer: Cigna Commercial |
$1,502.00
|
| Rate for Payer: Healthspan PPO |
$1,079.02
|
| Rate for Payer: Humana Medicaid |
$686.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$976.30
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$754.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$754.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$700.29
|
| Rate for Payer: Molina Healthcare Passport |
$686.56
|
| Rate for Payer: Multiplan PHCS |
$1,335.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$981.19
|
| Rate for Payer: UHCCP Medicaid |
$778.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$693.43
|
| Rate for Payer: Wellcare Medicare Advantage |
$754.76
|
|
|
OP RDL SHFT FX CLSD R/U JT DIS
|
Facility
|
IP
|
$2,225.00
|
|
|
Service Code
|
HCPCS 25525
|
| Hospital Charge Code |
76100621
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$667.50 |
| Max. Negotiated Rate |
$2,136.00 |
| Rate for Payer: Aetna Commercial |
$1,713.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,735.50
|
| Rate for Payer: Cash Price |
$1,112.50
|
| Rate for Payer: Cigna Commercial |
$1,846.75
|
| Rate for Payer: First Health Commercial |
$2,113.75
|
| Rate for Payer: Humana Commercial |
$1,891.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,824.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,642.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$667.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,958.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,668.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,935.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,535.25
|
| Rate for Payer: PHCS Commercial |
$2,136.00
|
| Rate for Payer: United Healthcare All Payer |
$1,958.00
|
|
|
OP RDL SHFT FX RAD/ULN JT DI(P
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 25526
|
| Hospital Charge Code |
761P0622
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$729.72 |
| Max. Negotiated Rate |
$1,738.21 |
| Rate for Payer: Aetna Commercial |
$1,448.52
|
| Rate for Payer: Ambetter Exchange |
$911.50
|
| Rate for Payer: Anthem Medicaid |
$729.72
|
| Rate for Payer: Buckeye Individual/Medicaid |
$911.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$911.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,093.80
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$1,738.21
|
| Rate for Payer: Healthspan PPO |
$1,312.05
|
| Rate for Payer: Humana Medicaid |
$729.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,204.51
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$911.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$911.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$744.31
|
| Rate for Payer: Molina Healthcare Passport |
$729.72
|
| Rate for Payer: Multiplan PHCS |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,184.95
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$737.02
|
| Rate for Payer: Wellcare Medicare Advantage |
$911.50
|
|
|
OP RDL SHFT FX RAD/ULN JT DIS
|
Facility
|
IP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 25526
|
| Hospital Charge Code |
76100622
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$750.00 |
| Max. Negotiated Rate |
$2,400.00 |
| Rate for Payer: Aetna Commercial |
$1,925.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,950.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$2,075.00
|
| Rate for Payer: First Health Commercial |
$2,375.00
|
| Rate for Payer: Humana Commercial |
$2,125.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,050.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,845.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$750.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,875.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,175.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,725.00
|
| Rate for Payer: PHCS Commercial |
$2,400.00
|
| Rate for Payer: United Healthcare All Payer |
$2,200.00
|
|
|
OP RDL SHFT FX RAD/ULN JT DIS
|
Facility
|
OP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 25526
|
| Hospital Charge Code |
76100622
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$859.75 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,925.00
|
| Rate for Payer: Anthem Medicaid |
$859.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,950.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$2,075.00
|
| Rate for Payer: First Health Commercial |
$2,375.00
|
| Rate for Payer: Humana Commercial |
$2,125.00
|
| Rate for Payer: Humana KY Medicaid |
$859.75
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$868.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,050.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,845.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$877.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,875.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,175.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,725.00
|
| Rate for Payer: PHCS Commercial |
$2,400.00
|
| Rate for Payer: United Healthcare All Payer |
$2,200.00
|
|
|
OP RDL SHFT FX RAD/ULN JT DIS
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 25526
|
| Hospital Charge Code |
76100622
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$729.72 |
| Max. Negotiated Rate |
$1,738.21 |
| Rate for Payer: Aetna Commercial |
$1,448.52
|
| Rate for Payer: Ambetter Exchange |
$911.50
|
| Rate for Payer: Anthem Medicaid |
$729.72
|
| Rate for Payer: Buckeye Individual/Medicaid |
$911.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$911.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,093.80
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$1,738.21
|
| Rate for Payer: Healthspan PPO |
$1,312.05
|
| Rate for Payer: Humana Medicaid |
$729.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,204.51
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$911.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$911.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$744.31
|
| Rate for Payer: Molina Healthcare Passport |
$729.72
|
| Rate for Payer: Multiplan PHCS |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,184.95
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$737.02
|
| Rate for Payer: Wellcare Medicare Advantage |
$911.50
|
|
|
OPTEASE CAVA FILTER 55CM
|
Facility
|
IP
|
$9,186.75
|
|
|
Service Code
|
HCPCS C1880
|
| Hospital Charge Code |
27000050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,756.03 |
| Max. Negotiated Rate |
$8,819.28 |
| Rate for Payer: Aetna Commercial |
$7,073.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,165.66
|
| Rate for Payer: Cash Price |
$4,593.38
|
| Rate for Payer: Cigna Commercial |
$7,625.00
|
| Rate for Payer: First Health Commercial |
$8,727.41
|
| Rate for Payer: Humana Commercial |
$7,808.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,533.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,779.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,756.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,084.34
|
| Rate for Payer: Ohio Health Group HMO |
$6,890.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,349.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,992.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,338.86
|
| Rate for Payer: PHCS Commercial |
$8,819.28
|
| Rate for Payer: United Healthcare All Payer |
$8,084.34
|
|
|
OPTEASE CAVA FILTER 55CM
|
Facility
|
OP
|
$9,186.75
|
|
|
Service Code
|
HCPCS C1880
|
| Hospital Charge Code |
27000050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,756.03 |
| Max. Negotiated Rate |
$8,819.28 |
| Rate for Payer: Aetna Commercial |
$7,073.80
|
| Rate for Payer: Anthem Medicaid |
$3,159.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,165.66
|
| Rate for Payer: Cash Price |
$4,593.38
|
| Rate for Payer: Cigna Commercial |
$7,625.00
|
| Rate for Payer: First Health Commercial |
$8,727.41
|
| Rate for Payer: Humana Commercial |
$7,808.74
|
| Rate for Payer: Humana KY Medicaid |
$3,159.32
|
| Rate for Payer: Kentucky WC Medicaid |
$3,191.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,533.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,779.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,756.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,222.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,084.34
|
| Rate for Payer: Ohio Health Group HMO |
$6,890.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,349.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,992.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,338.86
|
| Rate for Payer: PHCS Commercial |
$8,819.28
|
| Rate for Payer: United Healthcare All Payer |
$8,084.34
|
|
|
OPTEASE CAVA FILTER 90CM
|
Facility
|
IP
|
$9,551.75
|
|
|
Service Code
|
HCPCS C1880
|
| Hospital Charge Code |
27000050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,865.53 |
| Max. Negotiated Rate |
$9,169.68 |
| Rate for Payer: Aetna Commercial |
$7,354.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,450.36
|
| Rate for Payer: Cash Price |
$4,775.88
|
| Rate for Payer: Cigna Commercial |
$7,927.95
|
| Rate for Payer: First Health Commercial |
$9,074.16
|
| Rate for Payer: Humana Commercial |
$8,118.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,832.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,049.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,865.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,405.54
|
| Rate for Payer: Ohio Health Group HMO |
$7,163.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,641.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,310.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,590.71
|
| Rate for Payer: PHCS Commercial |
$9,169.68
|
| Rate for Payer: United Healthcare All Payer |
$8,405.54
|
|
|
OPTEASE CAVA FILTER 90CM
|
Facility
|
OP
|
$9,551.75
|
|
|
Service Code
|
HCPCS C1880
|
| Hospital Charge Code |
27000050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,865.53 |
| Max. Negotiated Rate |
$9,169.68 |
| Rate for Payer: Aetna Commercial |
$7,354.85
|
| Rate for Payer: Anthem Medicaid |
$3,284.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,450.36
|
| Rate for Payer: Cash Price |
$4,775.88
|
| Rate for Payer: Cigna Commercial |
$7,927.95
|
| Rate for Payer: First Health Commercial |
$9,074.16
|
| Rate for Payer: Humana Commercial |
$8,118.99
|
| Rate for Payer: Humana KY Medicaid |
$3,284.85
|
| Rate for Payer: Kentucky WC Medicaid |
$3,318.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,832.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,049.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,865.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,350.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,405.54
|
| Rate for Payer: Ohio Health Group HMO |
$7,163.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,641.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,310.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,590.71
|
| Rate for Payer: PHCS Commercial |
$9,169.68
|
| Rate for Payer: United Healthcare All Payer |
$8,405.54
|
|
|
OPTETRAK FEM COMP POST SZ2.5 R
|
Facility
|
IP
|
$16,306.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,891.98 |
| Max. Negotiated Rate |
$15,654.34 |
| Rate for Payer: Aetna Commercial |
$12,556.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,719.15
|
| Rate for Payer: Cash Price |
$8,153.30
|
| Rate for Payer: Cigna Commercial |
$13,534.48
|
| Rate for Payer: First Health Commercial |
$15,491.27
|
| Rate for Payer: Humana Commercial |
$13,860.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,371.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,034.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,891.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,349.81
|
| Rate for Payer: Ohio Health Group HMO |
$12,229.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,045.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,186.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,251.55
|
| Rate for Payer: PHCS Commercial |
$15,654.34
|
| Rate for Payer: United Healthcare All Payer |
$14,349.81
|
|
