|
OS TAPENTADOL
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
HCPCS 80372
|
| Hospital Charge Code |
30000170
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.88
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cigna Commercial |
$21.58
|
| Rate for Payer: First Health Commercial |
$24.70
|
| Rate for Payer: Humana Commercial |
$22.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.88
|
| Rate for Payer: Ohio Health Group HMO |
$19.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.94
|
| Rate for Payer: PHCS Commercial |
$24.96
|
| Rate for Payer: United Healthcare All Payer |
$22.88
|
|
|
OS TAPENTADOL
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
HCPCS 80372
|
| Hospital Charge Code |
30000170
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Anthem Medicaid |
$8.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.88
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cigna Commercial |
$21.58
|
| Rate for Payer: First Health Commercial |
$24.70
|
| Rate for Payer: Humana Commercial |
$22.10
|
| Rate for Payer: Humana KY Medicaid |
$8.94
|
| Rate for Payer: Kentucky WC Medicaid |
$9.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.88
|
| Rate for Payer: Ohio Health Group HMO |
$19.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.94
|
| Rate for Payer: PHCS Commercial |
$24.96
|
| Rate for Payer: United Healthcare All Payer |
$22.88
|
|
|
OS TAPENTADOL
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000170
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.88
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cigna Commercial |
$21.58
|
| Rate for Payer: First Health Commercial |
$24.70
|
| Rate for Payer: Humana Commercial |
$22.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.88
|
| Rate for Payer: Ohio Health Group HMO |
$19.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.94
|
| Rate for Payer: PHCS Commercial |
$24.96
|
| Rate for Payer: United Healthcare All Payer |
$22.88
|
|
|
OS TAPENTADOL MH
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
HCPCS 80372
|
| Hospital Charge Code |
30000169
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Anthem Medicaid |
$8.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.88
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cigna Commercial |
$21.58
|
| Rate for Payer: First Health Commercial |
$24.70
|
| Rate for Payer: Humana Commercial |
$22.10
|
| Rate for Payer: Humana KY Medicaid |
$8.94
|
| Rate for Payer: Kentucky WC Medicaid |
$9.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.88
|
| Rate for Payer: Ohio Health Group HMO |
$19.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.94
|
| Rate for Payer: PHCS Commercial |
$24.96
|
| Rate for Payer: United Healthcare All Payer |
$22.88
|
|
|
OS TAPENTADOL MH
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000169
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.88
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cigna Commercial |
$21.58
|
| Rate for Payer: First Health Commercial |
$24.70
|
| Rate for Payer: Humana Commercial |
$22.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.88
|
| Rate for Payer: Ohio Health Group HMO |
$19.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.94
|
| Rate for Payer: PHCS Commercial |
$24.96
|
| Rate for Payer: United Healthcare All Payer |
$22.88
|
|
|
OS TAPENTADOL MH
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
HCPCS 80372
|
| Hospital Charge Code |
30000169
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.88
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cigna Commercial |
$21.58
|
| Rate for Payer: First Health Commercial |
$24.70
|
| Rate for Payer: Humana Commercial |
$22.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.88
|
| Rate for Payer: Ohio Health Group HMO |
$19.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.94
|
| Rate for Payer: PHCS Commercial |
$24.96
|
| Rate for Payer: United Healthcare All Payer |
$22.88
|
|
|
OS TAPENTADOL MH
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
30000169
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.94 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Anthem Medicaid |
$114.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.43
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cigna Commercial |
$21.58
|
| Rate for Payer: First Health Commercial |
$24.70
|
| Rate for Payer: Humana Commercial |
$22.10
|
| Rate for Payer: Humana KY Medicaid |
$114.43
|
| Rate for Payer: Humana Medicare Advantage |
$114.43
|
| Rate for Payer: Kentucky WC Medicaid |
$115.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.88
|
| Rate for Payer: Ohio Health Group HMO |
$19.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.94
|
| Rate for Payer: PHCS Commercial |
$24.96
|
| Rate for Payer: United Healthcare All Payer |
$22.88
|
|
|
OS TAU PHOSPHORYLATED EA
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 84393
|
| Hospital Charge Code |
30002079
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$602.25
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$622.50
|
| Rate for Payer: First Health Commercial |
$712.50
|
| Rate for Payer: Humana Commercial |
$637.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$553.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.00
|
| Rate for Payer: Ohio Health Group HMO |
$562.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$652.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$517.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
|
OS TAU PHOSPHORYLATED EA
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 84393
|
| Hospital Charge Code |
30002079
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem Medicaid |
$257.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$602.25
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$622.50
|
| Rate for Payer: First Health Commercial |
$712.50
|
| Rate for Payer: Humana Commercial |
$637.50
|
| Rate for Payer: Humana KY Medicaid |
$257.93
|
| Rate for Payer: Kentucky WC Medicaid |
$260.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$553.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$263.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.00
|
| Rate for Payer: Ohio Health Group HMO |
$562.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$652.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$517.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
|
OS T CELLS TOTAL COUNT
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 86359
|
| Hospital Charge Code |
30001086
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$153.60 |
| Rate for Payer: Aetna Commercial |
$123.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$128.48
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cigna Commercial |
$132.80
|
| Rate for Payer: First Health Commercial |
$152.00
|
| Rate for Payer: Humana Commercial |
$136.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$131.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$140.80
|
| Rate for Payer: Ohio Health Group HMO |
$120.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$128.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$139.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$110.40
|
| Rate for Payer: PHCS Commercial |
$153.60
|
| Rate for Payer: United Healthcare All Payer |
$140.80
|
|
|
OS T CELLS TOTAL COUNT
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 86359
|
| Hospital Charge Code |
30001086
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.73 |
| Max. Negotiated Rate |
$153.60 |
| Rate for Payer: Aetna Commercial |
$123.20
|
| Rate for Payer: Anthem Medicaid |
$37.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$37.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$128.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$52.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$37.73
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cigna Commercial |
$132.80
|
| Rate for Payer: First Health Commercial |
$152.00
|
| Rate for Payer: Humana Commercial |
$136.00
|
| Rate for Payer: Humana KY Medicaid |
$37.73
|
| Rate for Payer: Humana Medicare Advantage |
$37.73
|
| Rate for Payer: Kentucky WC Medicaid |
$38.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$131.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$38.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$140.80
|
| Rate for Payer: Ohio Health Group HMO |
$120.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$128.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$139.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$110.40
|
| Rate for Payer: PHCS Commercial |
$153.60
|
| Rate for Payer: United Healthcare All Payer |
$140.80
|
|
|
OST CHOND FLAP MULTI SHOT
|
Facility
|
OP
|
$4,047.50
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,214.25 |
| Max. Negotiated Rate |
$3,885.60 |
| Rate for Payer: Aetna Commercial |
$3,116.57
|
| Rate for Payer: Anthem Medicaid |
$1,391.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,157.05
|
| Rate for Payer: Cash Price |
$2,023.75
|
| Rate for Payer: Cigna Commercial |
$3,359.43
|
| Rate for Payer: First Health Commercial |
$3,845.12
|
| Rate for Payer: Humana Commercial |
$3,440.38
|
| Rate for Payer: Humana KY Medicaid |
$1,391.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,406.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,318.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,987.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,214.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,419.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,561.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,035.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,238.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,521.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,792.78
|
| Rate for Payer: PHCS Commercial |
$3,885.60
|
| Rate for Payer: United Healthcare All Payer |
$3,561.80
|
|
|
OST CHOND FLAP MULTI SHOT
|
Facility
|
IP
|
$4,047.50
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,214.25 |
| Max. Negotiated Rate |
$3,885.60 |
| Rate for Payer: Aetna Commercial |
$3,116.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,157.05
|
| Rate for Payer: Cash Price |
$2,023.75
|
| Rate for Payer: Cigna Commercial |
$3,359.43
|
| Rate for Payer: First Health Commercial |
$3,845.12
|
| Rate for Payer: Humana Commercial |
$3,440.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,318.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,987.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,214.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,561.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,035.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,238.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,521.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,792.78
|
| Rate for Payer: PHCS Commercial |
$3,885.60
|
| Rate for Payer: United Healthcare All Payer |
$3,561.80
|
|
|
OST CHOND FLAP SNGLE SHOT
|
Facility
|
IP
|
$6,928.31
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,078.49 |
| Max. Negotiated Rate |
$6,651.18 |
| Rate for Payer: Aetna Commercial |
$5,334.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,404.08
|
| Rate for Payer: Cash Price |
$3,464.16
|
| Rate for Payer: Cigna Commercial |
$5,750.50
|
| Rate for Payer: First Health Commercial |
$6,581.89
|
| Rate for Payer: Humana Commercial |
$5,889.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,681.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,113.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,078.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,096.91
|
| Rate for Payer: Ohio Health Group HMO |
$5,196.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,542.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,027.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,780.53
|
| Rate for Payer: PHCS Commercial |
$6,651.18
|
| Rate for Payer: United Healthcare All Payer |
$6,096.91
|
|
|
OST CHOND FLAP SNGLE SHOT
|
Facility
|
OP
|
$6,928.31
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,078.49 |
| Max. Negotiated Rate |
$6,651.18 |
| Rate for Payer: Aetna Commercial |
$5,334.80
|
| Rate for Payer: Anthem Medicaid |
$2,382.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,404.08
|
| Rate for Payer: Cash Price |
$3,464.16
|
| Rate for Payer: Cigna Commercial |
$5,750.50
|
| Rate for Payer: First Health Commercial |
$6,581.89
|
| Rate for Payer: Humana Commercial |
$5,889.06
|
| Rate for Payer: Humana KY Medicaid |
$2,382.65
|
| Rate for Payer: Kentucky WC Medicaid |
$2,406.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,681.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,113.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,078.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,430.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,096.91
|
| Rate for Payer: Ohio Health Group HMO |
$5,196.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,542.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,027.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,780.53
|
| Rate for Payer: PHCS Commercial |
$6,651.18
|
| Rate for Payer: United Healthcare All Payer |
$6,096.91
|
|
|
OS TEA IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000883
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Humana KY Medicaid |
$5.22
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Kentucky WC Medicaid |
$5.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
OS TEA IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000883
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.70 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
OSTECTOMY, CALCANEUS
|
Professional
|
Both
|
$1,375.00
|
|
|
Service Code
|
HCPCS 28118
|
| Hospital Charge Code |
76100984
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$214.91 |
| Max. Negotiated Rate |
$825.00 |
| Rate for Payer: Aetna Commercial |
$629.44
|
| Rate for Payer: Ambetter Exchange |
$403.37
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$214.91
|
| Rate for Payer: Anthem Medicaid |
$332.34
|
| Rate for Payer: Buckeye Individual/Medicaid |
$403.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$403.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$484.04
|
| Rate for Payer: Cash Price |
$687.50
|
| Rate for Payer: Cash Price |
$687.50
|
| Rate for Payer: Cigna Commercial |
$681.68
|
| Rate for Payer: Healthspan PPO |
$731.57
|
| Rate for Payer: Humana Medicaid |
$332.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$511.31
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$403.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$403.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$338.99
|
| Rate for Payer: Molina Healthcare Passport |
$332.34
|
| Rate for Payer: Multiplan PHCS |
$825.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$524.38
|
| Rate for Payer: UHCCP Medicaid |
$225.66
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$335.66
|
| Rate for Payer: Wellcare Medicare Advantage |
$403.37
|
|
|
OSTECTOMY, CALCANEUS
|
Facility
|
OP
|
$1,375.00
|
|
|
Service Code
|
HCPCS 28118
|
| Hospital Charge Code |
76100984
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$472.86 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$1,058.75
|
| Rate for Payer: Anthem Medicaid |
$472.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,072.50
|
| 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 |
$687.50
|
| Rate for Payer: Cash Price |
$687.50
|
| Rate for Payer: Cigna Commercial |
$1,141.25
|
| Rate for Payer: First Health Commercial |
$1,306.25
|
| Rate for Payer: Humana Commercial |
$1,168.75
|
| Rate for Payer: Humana KY Medicaid |
$472.86
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$477.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,127.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,014.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$482.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,210.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,031.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,196.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$948.75
|
| Rate for Payer: PHCS Commercial |
$1,320.00
|
| Rate for Payer: United Healthcare All Payer |
$1,210.00
|
|
|
OSTECTOMY, CALCANEUS
|
Facility
|
IP
|
$1,375.00
|
|
|
Service Code
|
HCPCS 28118
|
| Hospital Charge Code |
76100984
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$412.50 |
| Max. Negotiated Rate |
$1,320.00 |
| Rate for Payer: Aetna Commercial |
$1,058.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,072.50
|
| Rate for Payer: Cash Price |
$687.50
|
| Rate for Payer: Cigna Commercial |
$1,141.25
|
| Rate for Payer: First Health Commercial |
$1,306.25
|
| Rate for Payer: Humana Commercial |
$1,168.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,127.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,014.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$412.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,210.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,031.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,196.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$948.75
|
| Rate for Payer: PHCS Commercial |
$1,320.00
|
| Rate for Payer: United Healthcare All Payer |
$1,210.00
|
|
|
OSTECTOMY, CALCANEUS;
|
Facility
|
OP
|
$4,197.13
|
|
|
Service Code
|
CPT 28118
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,997.95 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
|
|
OSTECTOMY, CALCANEUS; FOR SPUR, WITH OR WITHOUT PLANTAR FASCIAL RELEASE
|
Facility
|
OP
|
$4,197.13
|
|
|
Service Code
|
CPT 28119
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,997.95 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
|
|
OSTECTOMY, CALCANEUS;(P
|
Professional
|
Both
|
$1,375.00
|
|
|
Service Code
|
HCPCS 28118
|
| Hospital Charge Code |
761P0984
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$214.91 |
| Max. Negotiated Rate |
$825.00 |
| Rate for Payer: Aetna Commercial |
$629.44
|
| Rate for Payer: Ambetter Exchange |
$403.37
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$214.91
|
| Rate for Payer: Anthem Medicaid |
$332.34
|
| Rate for Payer: Buckeye Individual/Medicaid |
$403.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$403.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$484.04
|
| Rate for Payer: Cash Price |
$687.50
|
| Rate for Payer: Cash Price |
$687.50
|
| Rate for Payer: Cigna Commercial |
$681.68
|
| Rate for Payer: Healthspan PPO |
$731.57
|
| Rate for Payer: Humana Medicaid |
$332.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$511.31
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$403.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$403.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$338.99
|
| Rate for Payer: Molina Healthcare Passport |
$332.34
|
| Rate for Payer: Multiplan PHCS |
$825.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$524.38
|
| Rate for Payer: UHCCP Medicaid |
$225.66
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$335.66
|
| Rate for Payer: Wellcare Medicare Advantage |
$403.37
|
|
|
OSTECTOMY - COMPLETE EXCISION
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 28111
|
| Hospital Charge Code |
76100980
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$343.90 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem Medicaid |
$343.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| 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 |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Humana KY Medicaid |
$343.90
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$347.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$350.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$690.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
OSTECTOMY - COMPLETE EXCISION
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 28111
|
| Hospital Charge Code |
76100980
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$690.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
