|
OPTILUME BPH 40MM
|
Facility
|
OP
|
$27,125.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27000057
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$8,137.50 |
| Max. Negotiated Rate |
$26,040.00 |
| Rate for Payer: Aetna Commercial |
$20,886.25
|
| Rate for Payer: Anthem Medicaid |
$9,328.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,157.50
|
| Rate for Payer: Cash Price |
$13,562.50
|
| Rate for Payer: Cigna Commercial |
$22,513.75
|
| Rate for Payer: First Health Commercial |
$25,768.75
|
| Rate for Payer: Humana Commercial |
$23,056.25
|
| Rate for Payer: Humana KY Medicaid |
$9,328.29
|
| Rate for Payer: Kentucky WC Medicaid |
$9,423.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,242.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,018.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,137.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,515.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,870.00
|
| Rate for Payer: Ohio Health Group HMO |
$20,343.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,598.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,716.25
|
| Rate for Payer: PHCS Commercial |
$26,040.00
|
| Rate for Payer: United Healthcare All Payer |
$23,870.00
|
|
|
OPTILUME BPH 45MM
|
Facility
|
OP
|
$27,125.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27000057
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$8,137.50 |
| Max. Negotiated Rate |
$26,040.00 |
| Rate for Payer: Aetna Commercial |
$20,886.25
|
| Rate for Payer: Anthem Medicaid |
$9,328.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,157.50
|
| Rate for Payer: Cash Price |
$13,562.50
|
| Rate for Payer: Cigna Commercial |
$22,513.75
|
| Rate for Payer: First Health Commercial |
$25,768.75
|
| Rate for Payer: Humana Commercial |
$23,056.25
|
| Rate for Payer: Humana KY Medicaid |
$9,328.29
|
| Rate for Payer: Kentucky WC Medicaid |
$9,423.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,242.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,018.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,137.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,515.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,870.00
|
| Rate for Payer: Ohio Health Group HMO |
$20,343.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,598.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,716.25
|
| Rate for Payer: PHCS Commercial |
$26,040.00
|
| Rate for Payer: United Healthcare All Payer |
$23,870.00
|
|
|
OPTILUME BPH 45MM
|
Facility
|
IP
|
$27,125.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27000057
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$8,137.50 |
| Max. Negotiated Rate |
$26,040.00 |
| Rate for Payer: Aetna Commercial |
$20,886.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,157.50
|
| Rate for Payer: Cash Price |
$13,562.50
|
| Rate for Payer: Cigna Commercial |
$22,513.75
|
| Rate for Payer: First Health Commercial |
$25,768.75
|
| Rate for Payer: Humana Commercial |
$23,056.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,242.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,018.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,137.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,870.00
|
| Rate for Payer: Ohio Health Group HMO |
$20,343.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,598.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,716.25
|
| Rate for Payer: PHCS Commercial |
$26,040.00
|
| Rate for Payer: United Healthcare All Payer |
$23,870.00
|
|
|
OP TISSUE ABLATION
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS 33257
|
| Hospital Charge Code |
76101271
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem Medicaid |
$275.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Humana KY Medicaid |
$275.12
|
| Rate for Payer: Kentucky WC Medicaid |
$277.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$280.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
OP TISSUE ABLATION
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 33257
|
| Hospital Charge Code |
76101271
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$280.00 |
| Max. Negotiated Rate |
$960.85 |
| Rate for Payer: Aetna Commercial |
$960.85
|
| Rate for Payer: Ambetter Exchange |
$548.28
|
| Rate for Payer: Anthem Medicaid |
$474.42
|
| Rate for Payer: Buckeye Individual/Medicaid |
$548.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$548.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$657.94
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$926.87
|
| Rate for Payer: Healthspan PPO |
$944.71
|
| Rate for Payer: Humana Medicaid |
$474.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$817.19
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$548.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$548.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$483.91
|
| Rate for Payer: Molina Healthcare Passport |
$474.42
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$712.76
|
| Rate for Payer: UHCCP Medicaid |
$280.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$479.16
|
| Rate for Payer: Wellcare Medicare Advantage |
$548.28
|
|
|
OP TISSUE ABLATION
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS 33257
|
| Hospital Charge Code |
76101271
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
OP TISSUE ABLATION(P
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 33257
|
| Hospital Charge Code |
761P1271
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$280.00 |
| Max. Negotiated Rate |
$960.85 |
| Rate for Payer: Aetna Commercial |
$960.85
|
| Rate for Payer: Ambetter Exchange |
$548.28
|
| Rate for Payer: Anthem Medicaid |
$474.42
|
| Rate for Payer: Buckeye Individual/Medicaid |
$548.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$548.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$657.94
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$926.87
|
| Rate for Payer: Healthspan PPO |
$944.71
|
| Rate for Payer: Humana Medicaid |
$474.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$817.19
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$548.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$548.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$483.91
|
| Rate for Payer: Molina Healthcare Passport |
$474.42
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$712.76
|
| Rate for Payer: UHCCP Medicaid |
$280.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$479.16
|
| Rate for Payer: Wellcare Medicare Advantage |
$548.28
|
|
|
OPTIVAR(AZELASTINE)0.05%SOL6ML
|
Facility
|
IP
|
$1.55
|
|
|
Service Code
|
NDC 70069009101
|
| Hospital Charge Code |
25001135
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$1.49 |
| Rate for Payer: Aetna Commercial |
$1.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.21
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Cigna Commercial |
$1.29
|
| Rate for Payer: First Health Commercial |
$1.47
|
| Rate for Payer: Humana Commercial |
$1.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.36
|
| Rate for Payer: Ohio Health Group HMO |
$1.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.07
|
| Rate for Payer: PHCS Commercial |
$1.49
|
| Rate for Payer: United Healthcare All Payer |
$1.36
|
|
|
OPTIVAR(AZELASTINE)0.05%SOL6ML
|
Facility
|
OP
|
$1.55
|
|
|
Service Code
|
NDC 70069009101
|
| Hospital Charge Code |
25001135
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$1.49 |
| Rate for Payer: Aetna Commercial |
$1.19
|
| Rate for Payer: Anthem Medicaid |
$0.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.21
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Cigna Commercial |
$1.29
|
| Rate for Payer: First Health Commercial |
$1.47
|
| Rate for Payer: Humana Commercial |
$1.32
|
| Rate for Payer: Humana KY Medicaid |
$0.53
|
| Rate for Payer: Kentucky WC Medicaid |
$0.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.36
|
| Rate for Payer: Ohio Health Group HMO |
$1.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.07
|
| Rate for Payer: PHCS Commercial |
$1.49
|
| Rate for Payer: United Healthcare All Payer |
$1.36
|
|
|
OPTX ACRO DIS ACT/CHR WFAS GRF
|
Facility
|
IP
|
$9,920.00
|
|
|
Service Code
|
HCPCS 23552
|
| Hospital Charge Code |
76100475
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,976.00 |
| Max. Negotiated Rate |
$9,523.20 |
| Rate for Payer: Aetna Commercial |
$7,638.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,737.60
|
| Rate for Payer: Cash Price |
$4,960.00
|
| Rate for Payer: Cigna Commercial |
$8,233.60
|
| Rate for Payer: First Health Commercial |
$9,424.00
|
| Rate for Payer: Humana Commercial |
$8,432.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,134.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,320.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,976.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,729.60
|
| Rate for Payer: Ohio Health Group HMO |
$7,440.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,936.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,630.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,844.80
|
| Rate for Payer: PHCS Commercial |
$9,523.20
|
| Rate for Payer: United Healthcare All Payer |
$8,729.60
|
|
|
OPTX ACRO DIS ACT/CHR WFAS GRF
|
Facility
|
OP
|
$9,070.00
|
|
|
Service Code
|
HCPCS 23552
|
| Hospital Charge Code |
761T0475
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,119.17 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$6,983.90
|
| Rate for Payer: Anthem Medicaid |
$3,119.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,074.60
|
| 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 |
$4,535.00
|
| Rate for Payer: Cash Price |
$4,535.00
|
| Rate for Payer: Cigna Commercial |
$7,528.10
|
| Rate for Payer: First Health Commercial |
$8,616.50
|
| Rate for Payer: Humana Commercial |
$7,709.50
|
| Rate for Payer: Humana KY Medicaid |
$3,119.17
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$3,150.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,437.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,693.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,181.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,981.60
|
| Rate for Payer: Ohio Health Group HMO |
$6,802.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,256.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,890.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,258.30
|
| Rate for Payer: PHCS Commercial |
$8,707.20
|
| Rate for Payer: United Healthcare All Payer |
$7,981.60
|
|
|
OPTX ACRO DIS ACT/CHR WFAS GRF
|
Facility
|
OP
|
$9,920.00
|
|
|
Service Code
|
HCPCS 23552
|
| Hospital Charge Code |
76100475
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,411.49 |
| Max. Negotiated Rate |
$9,523.20 |
| Rate for Payer: Aetna Commercial |
$7,638.40
|
| Rate for Payer: Anthem Medicaid |
$3,411.49
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,737.60
|
| 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 |
$4,960.00
|
| Rate for Payer: Cash Price |
$4,960.00
|
| Rate for Payer: Cigna Commercial |
$8,233.60
|
| Rate for Payer: First Health Commercial |
$9,424.00
|
| Rate for Payer: Humana Commercial |
$8,432.00
|
| Rate for Payer: Humana KY Medicaid |
$3,411.49
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$3,446.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,134.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,320.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,479.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,729.60
|
| Rate for Payer: Ohio Health Group HMO |
$7,440.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,936.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,630.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,844.80
|
| Rate for Payer: PHCS Commercial |
$9,523.20
|
| Rate for Payer: United Healthcare All Payer |
$8,729.60
|
|
|
OPTX ACRO DIS ACT/CHR WFAS GRF
|
Professional
|
Both
|
$9,920.00
|
|
|
Service Code
|
HCPCS 23552
|
| Hospital Charge Code |
76100475
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$453.72 |
| Max. Negotiated Rate |
$5,952.00 |
| Rate for Payer: Aetna Commercial |
$962.60
|
| Rate for Payer: Ambetter Exchange |
$616.50
|
| Rate for Payer: Anthem Medicaid |
$453.72
|
| Rate for Payer: Buckeye Individual/Medicaid |
$616.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$616.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$739.80
|
| Rate for Payer: Cash Price |
$4,960.00
|
| Rate for Payer: Cash Price |
$4,960.00
|
| Rate for Payer: Cigna Commercial |
$1,055.54
|
| Rate for Payer: Healthspan PPO |
$871.91
|
| Rate for Payer: Humana Medicaid |
$453.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$812.62
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$616.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$616.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$462.79
|
| Rate for Payer: Molina Healthcare Passport |
$453.72
|
| Rate for Payer: Multiplan PHCS |
$5,952.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$801.45
|
| Rate for Payer: UHCCP Medicaid |
$3,472.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$458.26
|
| Rate for Payer: Wellcare Medicare Advantage |
$616.50
|
|
|
OPTX ACRO DIS ACT/CHR WFAS GRF
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 23552
|
| Hospital Charge Code |
761P0475
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$297.50 |
| Max. Negotiated Rate |
$1,055.54 |
| Rate for Payer: Aetna Commercial |
$962.60
|
| Rate for Payer: Ambetter Exchange |
$616.50
|
| Rate for Payer: Anthem Medicaid |
$453.72
|
| Rate for Payer: Buckeye Individual/Medicaid |
$616.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$616.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$739.80
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$1,055.54
|
| Rate for Payer: Healthspan PPO |
$871.91
|
| Rate for Payer: Humana Medicaid |
$453.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$812.62
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$616.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$616.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$462.79
|
| Rate for Payer: Molina Healthcare Passport |
$453.72
|
| Rate for Payer: Multiplan PHCS |
$510.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$801.45
|
| Rate for Payer: UHCCP Medicaid |
$297.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$458.26
|
| Rate for Payer: Wellcare Medicare Advantage |
$616.50
|
|
|
OPTX ACRO DIS ACT/CHR WFAS GRF
|
Facility
|
IP
|
$9,070.00
|
|
|
Service Code
|
HCPCS 23552
|
| Hospital Charge Code |
761T0475
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,721.00 |
| Max. Negotiated Rate |
$8,707.20 |
| Rate for Payer: Aetna Commercial |
$6,983.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,074.60
|
| Rate for Payer: Cash Price |
$4,535.00
|
| Rate for Payer: Cigna Commercial |
$7,528.10
|
| Rate for Payer: First Health Commercial |
$8,616.50
|
| Rate for Payer: Humana Commercial |
$7,709.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,437.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,693.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,721.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,981.60
|
| Rate for Payer: Ohio Health Group HMO |
$6,802.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,256.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,890.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,258.30
|
| Rate for Payer: PHCS Commercial |
$8,707.20
|
| Rate for Payer: United Healthcare All Payer |
$7,981.60
|
|
|
OPTX CARP/SCAPHOID NAVICULR FX
|
Professional
|
Both
|
$1,235.00
|
|
|
Service Code
|
HCPCS 25628
|
| Hospital Charge Code |
761P0638
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$432.25 |
| Max. Negotiated Rate |
$1,138.34 |
| Rate for Payer: Aetna Commercial |
$1,036.16
|
| Rate for Payer: Ambetter Exchange |
$687.65
|
| Rate for Payer: Anthem Medicaid |
$448.60
|
| Rate for Payer: Buckeye Individual/Medicaid |
$687.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$687.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$825.18
|
| Rate for Payer: Cash Price |
$617.50
|
| Rate for Payer: Cash Price |
$617.50
|
| Rate for Payer: Cigna Commercial |
$1,138.34
|
| Rate for Payer: Healthspan PPO |
$938.54
|
| Rate for Payer: Humana Medicaid |
$448.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$886.21
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$687.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$687.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$457.57
|
| Rate for Payer: Molina Healthcare Passport |
$448.60
|
| Rate for Payer: Multiplan PHCS |
$741.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$893.95
|
| Rate for Payer: UHCCP Medicaid |
$432.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$453.09
|
| Rate for Payer: Wellcare Medicare Advantage |
$687.65
|
|
|
OPTX CARP/SCAPHOID NAVICULR FX
|
Professional
|
Both
|
$1,235.00
|
|
|
Service Code
|
HCPCS 25628
|
| Hospital Charge Code |
76100638
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$432.25 |
| Max. Negotiated Rate |
$1,138.34 |
| Rate for Payer: Aetna Commercial |
$1,036.16
|
| Rate for Payer: Ambetter Exchange |
$687.65
|
| Rate for Payer: Anthem Medicaid |
$448.60
|
| Rate for Payer: Buckeye Individual/Medicaid |
$687.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$687.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$825.18
|
| Rate for Payer: Cash Price |
$617.50
|
| Rate for Payer: Cash Price |
$617.50
|
| Rate for Payer: Cigna Commercial |
$1,138.34
|
| Rate for Payer: Healthspan PPO |
$938.54
|
| Rate for Payer: Humana Medicaid |
$448.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$886.21
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$687.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$687.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$457.57
|
| Rate for Payer: Molina Healthcare Passport |
$448.60
|
| Rate for Payer: Multiplan PHCS |
$741.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$893.95
|
| Rate for Payer: UHCCP Medicaid |
$432.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$453.09
|
| Rate for Payer: Wellcare Medicare Advantage |
$687.65
|
|
|
OPTX CARP/SCAPHOID NAVICULR FX
|
Facility
|
OP
|
$1,235.00
|
|
|
Service Code
|
HCPCS 25628
|
| Hospital Charge Code |
76100638
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$424.72 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$950.95
|
| Rate for Payer: Anthem Medicaid |
$424.72
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$963.30
|
| 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 |
$617.50
|
| Rate for Payer: Cash Price |
$617.50
|
| Rate for Payer: Cigna Commercial |
$1,025.05
|
| Rate for Payer: First Health Commercial |
$1,173.25
|
| Rate for Payer: Humana Commercial |
$1,049.75
|
| Rate for Payer: Humana KY Medicaid |
$424.72
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$429.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,012.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$911.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$433.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,086.80
|
| Rate for Payer: Ohio Health Group HMO |
$926.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$988.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,074.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$852.15
|
| Rate for Payer: PHCS Commercial |
$1,185.60
|
| Rate for Payer: United Healthcare All Payer |
$1,086.80
|
|
|
OPTX CARP/SCAPHOID NAVICULR FX
|
Facility
|
IP
|
$1,235.00
|
|
|
Service Code
|
HCPCS 25628
|
| Hospital Charge Code |
76100638
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$370.50 |
| Max. Negotiated Rate |
$1,185.60 |
| Rate for Payer: Aetna Commercial |
$950.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$963.30
|
| Rate for Payer: Cash Price |
$617.50
|
| Rate for Payer: Cigna Commercial |
$1,025.05
|
| Rate for Payer: First Health Commercial |
$1,173.25
|
| Rate for Payer: Humana Commercial |
$1,049.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,012.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$911.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$370.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,086.80
|
| Rate for Payer: Ohio Health Group HMO |
$926.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$988.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,074.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$852.15
|
| Rate for Payer: PHCS Commercial |
$1,185.60
|
| Rate for Payer: United Healthcare All Payer |
$1,086.80
|
|
|
OP TX CLAV FX INTERNAL FIX
|
Professional
|
Both
|
$1,275.00
|
|
|
Service Code
|
HCPCS 23515
|
| Hospital Charge Code |
76100473
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$418.79 |
| Max. Negotiated Rate |
$1,019.13 |
| Rate for Payer: Aetna Commercial |
$1,019.13
|
| Rate for Payer: Ambetter Exchange |
$686.96
|
| Rate for Payer: Anthem Medicaid |
$418.79
|
| Rate for Payer: Buckeye Individual/Medicaid |
$686.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$686.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$824.35
|
| Rate for Payer: Cash Price |
$637.50
|
| Rate for Payer: Cash Price |
$637.50
|
| Rate for Payer: Cigna Commercial |
$924.47
|
| Rate for Payer: Healthspan PPO |
$923.11
|
| Rate for Payer: Humana Medicaid |
$418.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$890.80
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$686.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$686.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$427.17
|
| Rate for Payer: Molina Healthcare Passport |
$418.79
|
| Rate for Payer: Multiplan PHCS |
$765.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$893.05
|
| Rate for Payer: UHCCP Medicaid |
$446.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$422.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$686.96
|
|
|
OP TX CLAV FX INTERNAL FIX
|
Facility
|
OP
|
$1,275.00
|
|
|
Service Code
|
HCPCS 23515
|
| Hospital Charge Code |
76100473
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$438.47 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$981.75
|
| Rate for Payer: Anthem Medicaid |
$438.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$994.50
|
| 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 |
$637.50
|
| Rate for Payer: Cash Price |
$637.50
|
| Rate for Payer: Cigna Commercial |
$1,058.25
|
| Rate for Payer: First Health Commercial |
$1,211.25
|
| Rate for Payer: Humana Commercial |
$1,083.75
|
| Rate for Payer: Humana KY Medicaid |
$438.47
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$442.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,045.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$940.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$447.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,122.00
|
| Rate for Payer: Ohio Health Group HMO |
$956.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,020.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,109.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$879.75
|
| Rate for Payer: PHCS Commercial |
$1,224.00
|
| Rate for Payer: United Healthcare All Payer |
$1,122.00
|
|
|
OP TX CLAV FX INTERNAL FIX
|
Facility
|
IP
|
$1,275.00
|
|
|
Service Code
|
HCPCS 23515
|
| Hospital Charge Code |
76100473
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$382.50 |
| Max. Negotiated Rate |
$1,224.00 |
| Rate for Payer: Aetna Commercial |
$981.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$994.50
|
| Rate for Payer: Cash Price |
$637.50
|
| Rate for Payer: Cigna Commercial |
$1,058.25
|
| Rate for Payer: First Health Commercial |
$1,211.25
|
| Rate for Payer: Humana Commercial |
$1,083.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,045.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$940.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$382.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,122.00
|
| Rate for Payer: Ohio Health Group HMO |
$956.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,020.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,109.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$879.75
|
| Rate for Payer: PHCS Commercial |
$1,224.00
|
| Rate for Payer: United Healthcare All Payer |
$1,122.00
|
|
|
OP TX CLAV FX INTERNAL FIX(P
|
Professional
|
Both
|
$1,275.00
|
|
|
Service Code
|
HCPCS 23515
|
| Hospital Charge Code |
761P0473
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$418.79 |
| Max. Negotiated Rate |
$1,019.13 |
| Rate for Payer: Aetna Commercial |
$1,019.13
|
| Rate for Payer: Ambetter Exchange |
$686.96
|
| Rate for Payer: Anthem Medicaid |
$418.79
|
| Rate for Payer: Buckeye Individual/Medicaid |
$686.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$686.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$824.35
|
| Rate for Payer: Cash Price |
$637.50
|
| Rate for Payer: Cash Price |
$637.50
|
| Rate for Payer: Cigna Commercial |
$924.47
|
| Rate for Payer: Healthspan PPO |
$923.11
|
| Rate for Payer: Humana Medicaid |
$418.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$890.80
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$686.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$686.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$427.17
|
| Rate for Payer: Molina Healthcare Passport |
$418.79
|
| Rate for Payer: Multiplan PHCS |
$765.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$893.05
|
| Rate for Payer: UHCCP Medicaid |
$446.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$422.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$686.96
|
|
|
OPTX DIS PHLNG FX EACH
|
Facility
|
OP
|
$2,636.00
|
|
|
Service Code
|
HCPCS 26765
|
| Hospital Charge Code |
76100747
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$906.52 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$2,029.72
|
| Rate for Payer: Anthem Medicaid |
$906.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,056.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$1,318.00
|
| Rate for Payer: Cash Price |
$1,318.00
|
| Rate for Payer: Cigna Commercial |
$2,187.88
|
| Rate for Payer: First Health Commercial |
$2,504.20
|
| Rate for Payer: Humana Commercial |
$2,240.60
|
| Rate for Payer: Humana KY Medicaid |
$906.52
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$915.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,161.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,945.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$924.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,319.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,977.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,108.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,293.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,818.84
|
| Rate for Payer: PHCS Commercial |
$2,530.56
|
| Rate for Payer: United Healthcare All Payer |
$2,319.68
|
|
|
OPTX DIS PHLNG FX EACH
|
Facility
|
IP
|
$2,636.00
|
|
|
Service Code
|
HCPCS 26765
|
| Hospital Charge Code |
76100747
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$790.80 |
| Max. Negotiated Rate |
$2,530.56 |
| Rate for Payer: Aetna Commercial |
$2,029.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,056.08
|
| Rate for Payer: Cash Price |
$1,318.00
|
| Rate for Payer: Cigna Commercial |
$2,187.88
|
| Rate for Payer: First Health Commercial |
$2,504.20
|
| Rate for Payer: Humana Commercial |
$2,240.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,161.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,945.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$790.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,319.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,977.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,108.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,293.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,818.84
|
| Rate for Payer: PHCS Commercial |
$2,530.56
|
| Rate for Payer: United Healthcare All Payer |
$2,319.68
|
|
