|
OPTX DIS PHLNG FX EACH
|
Facility
|
IP
|
$2,636.00
|
|
|
Service Code
|
HCPCS 26765
|
| Hospital Charge Code |
76100746
|
|
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
|
|
|
OPTX DIS PHLNG FX EACH
|
Facility
|
OP
|
$2,636.00
|
|
|
Service Code
|
HCPCS 26765
|
| Hospital Charge Code |
76100746
|
|
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
|
Professional
|
Both
|
$2,636.00
|
|
|
Service Code
|
HCPCS 26765
|
| Hospital Charge Code |
76100747
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$200.83 |
| Max. Negotiated Rate |
$1,581.60 |
| Rate for Payer: Aetna Commercial |
$656.50
|
| Rate for Payer: Ambetter Exchange |
$481.54
|
| Rate for Payer: Anthem Medicaid |
$200.83
|
| Rate for Payer: Buckeye Individual/Medicaid |
$481.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$481.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$577.85
|
| Rate for Payer: Cash Price |
$1,318.00
|
| Rate for Payer: Cash Price |
$1,318.00
|
| Rate for Payer: Cigna Commercial |
$563.27
|
| Rate for Payer: Healthspan PPO |
$594.64
|
| Rate for Payer: Humana Medicaid |
$200.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$597.04
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$481.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$481.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$204.85
|
| Rate for Payer: Molina Healthcare Passport |
$200.83
|
| Rate for Payer: Multiplan PHCS |
$1,581.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$626.00
|
| Rate for Payer: UHCCP Medicaid |
$922.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$202.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$481.54
|
|
|
OPTX DIS PHLNG FX EACH
|
Professional
|
Both
|
$2,636.00
|
|
|
Service Code
|
HCPCS 26765
|
| Hospital Charge Code |
76100746
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$200.83 |
| Max. Negotiated Rate |
$1,581.60 |
| Rate for Payer: Aetna Commercial |
$656.50
|
| Rate for Payer: Ambetter Exchange |
$481.54
|
| Rate for Payer: Anthem Medicaid |
$200.83
|
| Rate for Payer: Buckeye Individual/Medicaid |
$481.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$481.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$577.85
|
| Rate for Payer: Cash Price |
$1,318.00
|
| Rate for Payer: Cash Price |
$1,318.00
|
| Rate for Payer: Cigna Commercial |
$563.27
|
| Rate for Payer: Healthspan PPO |
$594.64
|
| Rate for Payer: Humana Medicaid |
$200.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$597.04
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$481.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$481.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$204.85
|
| Rate for Payer: Molina Healthcare Passport |
$200.83
|
| Rate for Payer: Multiplan PHCS |
$1,581.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$626.00
|
| Rate for Payer: UHCCP Medicaid |
$922.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$202.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$481.54
|
|
|
OPTX DIS PHLNG FX EACH(P
|
Professional
|
Both
|
$2,636.00
|
|
|
Service Code
|
HCPCS 26765
|
| Hospital Charge Code |
761P0747
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$200.83 |
| Max. Negotiated Rate |
$1,581.60 |
| Rate for Payer: Aetna Commercial |
$656.50
|
| Rate for Payer: Ambetter Exchange |
$481.54
|
| Rate for Payer: Anthem Medicaid |
$200.83
|
| Rate for Payer: Buckeye Individual/Medicaid |
$481.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$481.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$577.85
|
| Rate for Payer: Cash Price |
$1,318.00
|
| Rate for Payer: Cash Price |
$1,318.00
|
| Rate for Payer: Cigna Commercial |
$563.27
|
| Rate for Payer: Healthspan PPO |
$594.64
|
| Rate for Payer: Humana Medicaid |
$200.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$597.04
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$481.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$481.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$204.85
|
| Rate for Payer: Molina Healthcare Passport |
$200.83
|
| Rate for Payer: Multiplan PHCS |
$1,581.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$626.00
|
| Rate for Payer: UHCCP Medicaid |
$922.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$202.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$481.54
|
|
|
OPTX DIS PHLNG FX EACH(P
|
Professional
|
Both
|
$2,636.00
|
|
|
Service Code
|
HCPCS 26765
|
| Hospital Charge Code |
761P0746
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$200.83 |
| Max. Negotiated Rate |
$1,581.60 |
| Rate for Payer: Aetna Commercial |
$656.50
|
| Rate for Payer: Ambetter Exchange |
$481.54
|
| Rate for Payer: Anthem Medicaid |
$200.83
|
| Rate for Payer: Buckeye Individual/Medicaid |
$481.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$481.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$577.85
|
| Rate for Payer: Cash Price |
$1,318.00
|
| Rate for Payer: Cash Price |
$1,318.00
|
| Rate for Payer: Cigna Commercial |
$563.27
|
| Rate for Payer: Healthspan PPO |
$594.64
|
| Rate for Payer: Humana Medicaid |
$200.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$597.04
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$481.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$481.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$204.85
|
| Rate for Payer: Molina Healthcare Passport |
$200.83
|
| Rate for Payer: Multiplan PHCS |
$1,581.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$626.00
|
| Rate for Payer: UHCCP Medicaid |
$922.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$202.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$481.54
|
|
|
OPTX DIS RAD IARTIC FX/EPIPH
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 25609
|
| Hospital Charge Code |
76100635
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$515.85 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem Medicaid |
$515.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| 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 |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Humana KY Medicaid |
$515.85
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$521.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$526.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,305.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,035.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
OPTX DIS RAD IARTIC FX/EPIPH
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 25609
|
| Hospital Charge Code |
76100635
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$450.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,305.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,035.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
OPTX DIS RAD IARTIC FX/EPIPH
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 25609
|
| Hospital Charge Code |
76100635
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$1,609.11 |
| Rate for Payer: Aetna Commercial |
$1,517.59
|
| Rate for Payer: Ambetter Exchange |
$1,003.51
|
| Rate for Payer: Anthem Medicaid |
$714.87
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,003.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,003.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,204.21
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,609.11
|
| Rate for Payer: Healthspan PPO |
$1,374.61
|
| Rate for Payer: Humana Medicaid |
$714.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,287.01
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,003.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,003.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$729.17
|
| Rate for Payer: Molina Healthcare Passport |
$714.87
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,304.56
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$722.02
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,003.51
|
|
|
OPTX DIS RAD IARTIC FX/EPIPH(P
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 25609
|
| Hospital Charge Code |
761P0635
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$1,609.11 |
| Rate for Payer: Aetna Commercial |
$1,517.59
|
| Rate for Payer: Ambetter Exchange |
$1,003.51
|
| Rate for Payer: Anthem Medicaid |
$714.87
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,003.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,003.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,204.21
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,609.11
|
| Rate for Payer: Healthspan PPO |
$1,374.61
|
| Rate for Payer: Humana Medicaid |
$714.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,287.01
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,003.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,003.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$729.17
|
| Rate for Payer: Molina Healthcare Passport |
$714.87
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,304.56
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$722.02
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,003.51
|
|
|
OPTX DIS RAD XARTIC FX/EPIPH
|
Facility
|
IP
|
$1,075.00
|
|
|
Service Code
|
HCPCS 25607
|
| Hospital Charge Code |
76100633
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$322.50 |
| Max. Negotiated Rate |
$1,032.00 |
| Rate for Payer: Aetna Commercial |
$827.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$838.50
|
| Rate for Payer: Cash Price |
$537.50
|
| Rate for Payer: Cigna Commercial |
$892.25
|
| Rate for Payer: First Health Commercial |
$1,021.25
|
| Rate for Payer: Humana Commercial |
$913.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$881.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$793.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$322.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$946.00
|
| Rate for Payer: Ohio Health Group HMO |
$806.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$935.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$741.75
|
| Rate for Payer: PHCS Commercial |
$1,032.00
|
| Rate for Payer: United Healthcare All Payer |
$946.00
|
|
|
OPTX DIS RAD XARTIC FX/EPIPH
|
Facility
|
OP
|
$1,075.00
|
|
|
Service Code
|
HCPCS 25607
|
| Hospital Charge Code |
76100633
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$369.69 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$827.75
|
| Rate for Payer: Anthem Medicaid |
$369.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$838.50
|
| 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 |
$537.50
|
| Rate for Payer: Cash Price |
$537.50
|
| Rate for Payer: Cigna Commercial |
$892.25
|
| Rate for Payer: First Health Commercial |
$1,021.25
|
| Rate for Payer: Humana Commercial |
$913.75
|
| Rate for Payer: Humana KY Medicaid |
$369.69
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$373.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$881.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$793.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$377.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$946.00
|
| Rate for Payer: Ohio Health Group HMO |
$806.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$935.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$741.75
|
| Rate for Payer: PHCS Commercial |
$1,032.00
|
| Rate for Payer: United Healthcare All Payer |
$946.00
|
|
|
OPTX DIS RAD XARTIC FX/EPIPH
|
Professional
|
Both
|
$1,075.00
|
|
|
Service Code
|
HCPCS 25607
|
| Hospital Charge Code |
76100633
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$376.25 |
| Max. Negotiated Rate |
$1,100.97 |
| Rate for Payer: Aetna Commercial |
$1,031.02
|
| Rate for Payer: Ambetter Exchange |
$708.91
|
| Rate for Payer: Anthem Medicaid |
$487.92
|
| Rate for Payer: Buckeye Individual/Medicaid |
$708.91
|
| Rate for Payer: Buckeye Medicare Advantage |
$708.91
|
| Rate for Payer: CareSource Just4Me Medicare |
$850.69
|
| Rate for Payer: Cash Price |
$537.50
|
| Rate for Payer: Cash Price |
$537.50
|
| Rate for Payer: Cigna Commercial |
$1,100.97
|
| Rate for Payer: Healthspan PPO |
$933.89
|
| Rate for Payer: Humana Medicaid |
$487.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$896.71
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$708.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$708.91
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$497.68
|
| Rate for Payer: Molina Healthcare Passport |
$487.92
|
| Rate for Payer: Multiplan PHCS |
$645.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$921.58
|
| Rate for Payer: UHCCP Medicaid |
$376.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$492.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$708.91
|
|
|
OPTX DIS RAD XARTIC FX/EPIPH(P
|
Professional
|
Both
|
$1,075.00
|
|
|
Service Code
|
HCPCS 25607
|
| Hospital Charge Code |
761P0633
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$376.25 |
| Max. Negotiated Rate |
$1,100.97 |
| Rate for Payer: Aetna Commercial |
$1,031.02
|
| Rate for Payer: Ambetter Exchange |
$708.91
|
| Rate for Payer: Anthem Medicaid |
$487.92
|
| Rate for Payer: Buckeye Individual/Medicaid |
$708.91
|
| Rate for Payer: Buckeye Medicare Advantage |
$708.91
|
| Rate for Payer: CareSource Just4Me Medicare |
$850.69
|
| Rate for Payer: Cash Price |
$537.50
|
| Rate for Payer: Cash Price |
$537.50
|
| Rate for Payer: Cigna Commercial |
$1,100.97
|
| Rate for Payer: Healthspan PPO |
$933.89
|
| Rate for Payer: Humana Medicaid |
$487.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$896.71
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$708.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$708.91
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$497.68
|
| Rate for Payer: Molina Healthcare Passport |
$487.92
|
| Rate for Payer: Multiplan PHCS |
$645.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$921.58
|
| Rate for Payer: UHCCP Medicaid |
$376.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$492.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$708.91
|
|
|
OPTX DST RAD IARTIC FX/EPIPH
|
Facility
|
IP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 25608
|
| Hospital Charge Code |
76100634
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$360.00 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$360.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$960.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,044.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$828.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
OPTX DST RAD IARTIC FX/EPIPH
|
Facility
|
OP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 25608
|
| Hospital Charge Code |
76100634
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$412.68 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem Medicaid |
$412.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| 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 |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Humana KY Medicaid |
$412.68
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$416.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$420.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$960.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,044.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$828.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
OPTX DST RAD IARTIC FX/EPIPH
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 25608
|
| Hospital Charge Code |
76100634
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$1,261.14 |
| Rate for Payer: Aetna Commercial |
$1,187.14
|
| Rate for Payer: Ambetter Exchange |
$790.86
|
| Rate for Payer: Anthem Medicaid |
$559.34
|
| Rate for Payer: Buckeye Individual/Medicaid |
$790.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$790.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$949.03
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$1,261.14
|
| Rate for Payer: Healthspan PPO |
$1,075.29
|
| Rate for Payer: Humana Medicaid |
$559.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,008.42
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$790.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$790.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$570.53
|
| Rate for Payer: Molina Healthcare Passport |
$559.34
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,028.12
|
| Rate for Payer: UHCCP Medicaid |
$420.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$564.93
|
| Rate for Payer: Wellcare Medicare Advantage |
$790.86
|
|
|
OPTX DST RAD IARTIC FX/EPIPH(P
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 25608
|
| Hospital Charge Code |
761P0634
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$1,261.14 |
| Rate for Payer: Aetna Commercial |
$1,187.14
|
| Rate for Payer: Ambetter Exchange |
$790.86
|
| Rate for Payer: Anthem Medicaid |
$559.34
|
| Rate for Payer: Buckeye Individual/Medicaid |
$790.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$790.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$949.03
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$1,261.14
|
| Rate for Payer: Healthspan PPO |
$1,075.29
|
| Rate for Payer: Humana Medicaid |
$559.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,008.42
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$790.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$790.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$570.53
|
| Rate for Payer: Molina Healthcare Passport |
$559.34
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,028.12
|
| Rate for Payer: UHCCP Medicaid |
$420.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$564.93
|
| Rate for Payer: Wellcare Medicare Advantage |
$790.86
|
|
|
OPTX FEM PROX NCKINTFIXPROSRPL
|
Facility
|
IP
|
$3,190.00
|
|
|
Service Code
|
HCPCS 27236
|
| Hospital Charge Code |
76100791
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$957.00 |
| Max. Negotiated Rate |
$3,062.40 |
| Rate for Payer: Aetna Commercial |
$2,456.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,488.20
|
| Rate for Payer: Cash Price |
$1,595.00
|
| Rate for Payer: Cigna Commercial |
$2,647.70
|
| Rate for Payer: First Health Commercial |
$3,030.50
|
| Rate for Payer: Humana Commercial |
$2,711.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,615.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,354.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$957.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,807.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,392.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,552.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,775.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,201.10
|
| Rate for Payer: PHCS Commercial |
$3,062.40
|
| Rate for Payer: United Healthcare All Payer |
$2,807.20
|
|
|
OPTX FEM PROX NCKINTFIXPROSRPL
|
Professional
|
Both
|
$3,190.00
|
|
|
Service Code
|
HCPCS 27236
|
| Hospital Charge Code |
76100791
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$934.33 |
| Max. Negotiated Rate |
$1,914.00 |
| Rate for Payer: Aetna Commercial |
$1,772.49
|
| Rate for Payer: Ambetter Exchange |
$1,132.87
|
| Rate for Payer: Anthem Medicaid |
$934.33
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,132.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,132.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,359.44
|
| Rate for Payer: Cash Price |
$1,595.00
|
| Rate for Payer: Cash Price |
$1,595.00
|
| Rate for Payer: Cigna Commercial |
$1,897.08
|
| Rate for Payer: Healthspan PPO |
$1,605.50
|
| Rate for Payer: Humana Medicaid |
$934.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,496.03
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,132.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,132.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$953.02
|
| Rate for Payer: Molina Healthcare Passport |
$934.33
|
| Rate for Payer: Multiplan PHCS |
$1,914.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,472.73
|
| Rate for Payer: UHCCP Medicaid |
$1,116.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$943.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,132.87
|
|
|
OPTX FEM PROX NCKINTFIXPROSRPL
|
Professional
|
Both
|
$3,190.00
|
|
|
Service Code
|
HCPCS 27236
|
| Hospital Charge Code |
761P0791
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$934.33 |
| Max. Negotiated Rate |
$1,914.00 |
| Rate for Payer: Aetna Commercial |
$1,772.49
|
| Rate for Payer: Ambetter Exchange |
$1,132.87
|
| Rate for Payer: Anthem Medicaid |
$934.33
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,132.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,132.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,359.44
|
| Rate for Payer: Cash Price |
$1,595.00
|
| Rate for Payer: Cash Price |
$1,595.00
|
| Rate for Payer: Cigna Commercial |
$1,897.08
|
| Rate for Payer: Healthspan PPO |
$1,605.50
|
| Rate for Payer: Humana Medicaid |
$934.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,496.03
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,132.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,132.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$953.02
|
| Rate for Payer: Molina Healthcare Passport |
$934.33
|
| Rate for Payer: Multiplan PHCS |
$1,914.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,472.73
|
| Rate for Payer: UHCCP Medicaid |
$1,116.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$943.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,132.87
|
|
|
OPTX FEM PROX NCKINTFIXPROSRPL
|
Facility
|
OP
|
$3,190.00
|
|
|
Service Code
|
HCPCS 27236
|
| Hospital Charge Code |
76100791
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$957.00 |
| Max. Negotiated Rate |
$3,062.40 |
| Rate for Payer: Aetna Commercial |
$2,456.30
|
| Rate for Payer: Anthem Medicaid |
$1,097.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,488.20
|
| Rate for Payer: Cash Price |
$1,595.00
|
| Rate for Payer: Cigna Commercial |
$2,647.70
|
| Rate for Payer: First Health Commercial |
$3,030.50
|
| Rate for Payer: Humana Commercial |
$2,711.50
|
| Rate for Payer: Humana KY Medicaid |
$1,097.04
|
| Rate for Payer: Kentucky WC Medicaid |
$1,108.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,615.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,354.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$957.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,119.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,807.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,392.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,552.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,775.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,201.10
|
| Rate for Payer: PHCS Commercial |
$3,062.40
|
| Rate for Payer: United Healthcare All Payer |
$2,807.20
|
|
|
OPTX FEM SHFT FX WINS IMED IMP
|
Facility
|
OP
|
$2,950.00
|
|
|
Service Code
|
HCPCS 27506
|
| Hospital Charge Code |
76100859
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$885.00 |
| Max. Negotiated Rate |
$2,832.00 |
| Rate for Payer: Aetna Commercial |
$2,271.50
|
| Rate for Payer: Anthem Medicaid |
$1,014.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,301.00
|
| Rate for Payer: Cash Price |
$1,475.00
|
| Rate for Payer: Cigna Commercial |
$2,448.50
|
| Rate for Payer: First Health Commercial |
$2,802.50
|
| Rate for Payer: Humana Commercial |
$2,507.50
|
| Rate for Payer: Humana KY Medicaid |
$1,014.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,024.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,419.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,177.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$885.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,034.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,596.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,212.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,566.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,035.50
|
| Rate for Payer: PHCS Commercial |
$2,832.00
|
| Rate for Payer: United Healthcare All Payer |
$2,596.00
|
|
|
OPTX FEM SHFT FX WINS IMED IMP
|
Professional
|
Both
|
$2,950.00
|
|
|
Service Code
|
HCPCS 27506
|
| Hospital Charge Code |
761P0859
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$959.33 |
| Max. Negotiated Rate |
$2,133.68 |
| Rate for Payer: Aetna Commercial |
$1,984.55
|
| Rate for Payer: Ambetter Exchange |
$1,270.43
|
| Rate for Payer: Anthem Medicaid |
$959.33
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,270.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,270.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,524.52
|
| Rate for Payer: Cash Price |
$1,475.00
|
| Rate for Payer: Cash Price |
$1,475.00
|
| Rate for Payer: Cigna Commercial |
$2,133.68
|
| Rate for Payer: Healthspan PPO |
$1,797.58
|
| Rate for Payer: Humana Medicaid |
$959.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,675.10
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,270.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,270.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$978.52
|
| Rate for Payer: Molina Healthcare Passport |
$959.33
|
| Rate for Payer: Multiplan PHCS |
$1,770.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,651.56
|
| Rate for Payer: UHCCP Medicaid |
$1,032.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$968.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,270.43
|
|
|
OPTX FEM SHFT FX WINS IMED IMP
|
Professional
|
Both
|
$2,950.00
|
|
|
Service Code
|
HCPCS 27506
|
| Hospital Charge Code |
76100859
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$959.33 |
| Max. Negotiated Rate |
$2,133.68 |
| Rate for Payer: Aetna Commercial |
$1,984.55
|
| Rate for Payer: Ambetter Exchange |
$1,270.43
|
| Rate for Payer: Anthem Medicaid |
$959.33
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,270.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,270.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,524.52
|
| Rate for Payer: Cash Price |
$1,475.00
|
| Rate for Payer: Cash Price |
$1,475.00
|
| Rate for Payer: Cigna Commercial |
$2,133.68
|
| Rate for Payer: Healthspan PPO |
$1,797.58
|
| Rate for Payer: Humana Medicaid |
$959.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,675.10
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,270.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,270.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$978.52
|
| Rate for Payer: Molina Healthcare Passport |
$959.33
|
| Rate for Payer: Multiplan PHCS |
$1,770.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,651.56
|
| Rate for Payer: UHCCP Medicaid |
$1,032.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$968.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,270.43
|
|
