|
INFLUENZA B AG IF
|
Professional
|
Both
|
$73.00
|
|
|
Service Code
|
HCPCS 87275
|
| Hospital Charge Code |
30001576
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.35 |
| Max. Negotiated Rate |
$73.00 |
| Rate for Payer: Aetna Commercial |
$20.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$73.00
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cigna Commercial |
$10.56
|
| Rate for Payer: Healthspan PPO |
$12.57
|
| Rate for Payer: Multiplan PHCS |
$43.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$51.10
|
| Rate for Payer: UHCCP Medicaid |
$25.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$7.35
|
|
|
INFLUENZA B AG IF
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
HCPCS 87275
|
| Hospital Charge Code |
30001576
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.49 |
| Max. Negotiated Rate |
$70.08 |
| Rate for Payer: Aetna Commercial |
$56.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58.62
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cigna Commercial |
$60.59
|
| Rate for Payer: First Health Commercial |
$69.35
|
| Rate for Payer: Humana Commercial |
$62.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$64.24
|
| Rate for Payer: Ohio Health Group HMO |
$54.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.63
|
| Rate for Payer: PHCS Commercial |
$70.08
|
| Rate for Payer: United Healthcare All Payer |
$64.24
|
|
|
INFLUENZA B AG IF
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
HCPCS 87275
|
| Hospital Charge Code |
30001576
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.49 |
| Max. Negotiated Rate |
$70.08 |
| Rate for Payer: Aetna Commercial |
$56.21
|
| Rate for Payer: Anthem Medicaid |
$12.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.25
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cigna Commercial |
$60.59
|
| Rate for Payer: First Health Commercial |
$69.35
|
| Rate for Payer: Humana Commercial |
$62.05
|
| Rate for Payer: Humana KY Medicaid |
$12.25
|
| Rate for Payer: Humana Medicare Advantage |
$12.25
|
| Rate for Payer: Kentucky WC Medicaid |
$12.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$64.24
|
| Rate for Payer: Ohio Health Group HMO |
$54.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.63
|
| Rate for Payer: PHCS Commercial |
$70.08
|
| Rate for Payer: United Healthcare All Payer |
$64.24
|
|
|
INFLUENZA DNA AMP 1+ POC
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
HCPCS 87501
|
| Hospital Charge Code |
30002021
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.79 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna Commercial |
$115.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$120.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$51.08
|
| Rate for Payer: Healthspan PPO |
$54.17
|
| Rate for Payer: Multiplan PHCS |
$72.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$84.00
|
| Rate for Payer: UHCCP Medicaid |
$42.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$30.79
|
|
|
INFLUENZA DNA AMP 1+ POC
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
HCPCS 87501
|
| Hospital Charge Code |
30002021
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: Aetna Commercial |
$92.40
|
| Rate for Payer: Anthem Medicaid |
$51.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$51.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$96.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$71.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$51.31
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$99.60
|
| Rate for Payer: First Health Commercial |
$114.00
|
| Rate for Payer: Humana Commercial |
$102.00
|
| Rate for Payer: Humana KY Medicaid |
$51.31
|
| Rate for Payer: Humana Medicare Advantage |
$51.31
|
| Rate for Payer: Kentucky WC Medicaid |
$51.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$98.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$88.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$52.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$105.60
|
| Rate for Payer: Ohio Health Group HMO |
$90.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.20
|
| Rate for Payer: PHCS Commercial |
$115.20
|
| Rate for Payer: United Healthcare All Payer |
$105.60
|
|
|
INFLUENZA DNA AMP 1+ POC
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
HCPCS 87501
|
| Hospital Charge Code |
30002021
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: Aetna Commercial |
$92.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$96.36
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$99.60
|
| Rate for Payer: First Health Commercial |
$114.00
|
| Rate for Payer: Humana Commercial |
$102.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$98.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$88.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$105.60
|
| Rate for Payer: Ohio Health Group HMO |
$90.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.20
|
| Rate for Payer: PHCS Commercial |
$115.20
|
| Rate for Payer: United Healthcare All Payer |
$105.60
|
|
|
INFLUENZA VACCINE 6-35 MONTHS
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
HCPCS 90657
|
| Hospital Charge Code |
77000021
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.15 |
| Max. Negotiated Rate |
$52.80 |
| Rate for Payer: Aetna Commercial |
$42.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$42.90
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cigna Commercial |
$45.65
|
| Rate for Payer: First Health Commercial |
$52.25
|
| Rate for Payer: Humana Commercial |
$46.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$45.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$40.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$48.40
|
| Rate for Payer: Ohio Health Group HMO |
$41.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.05
|
| Rate for Payer: PHCS Commercial |
$52.80
|
| Rate for Payer: United Healthcare All Payer |
$48.40
|
|
|
INFLUENZA VACCINE 6-35 MONTHS
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
HCPCS 90657
|
| Hospital Charge Code |
77000021
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.15 |
| Max. Negotiated Rate |
$52.80 |
| Rate for Payer: Aetna Commercial |
$42.35
|
| Rate for Payer: Anthem Medicaid |
$18.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$42.90
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cigna Commercial |
$45.65
|
| Rate for Payer: First Health Commercial |
$52.25
|
| Rate for Payer: Humana Commercial |
$46.75
|
| Rate for Payer: Humana KY Medicaid |
$18.91
|
| Rate for Payer: Kentucky WC Medicaid |
$19.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$45.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$40.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$19.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$48.40
|
| Rate for Payer: Ohio Health Group HMO |
$41.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.05
|
| Rate for Payer: PHCS Commercial |
$52.80
|
| Rate for Payer: United Healthcare All Payer |
$48.40
|
|
|
INFLUENZA VACCINE 6-35 MONTHS
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
HCPCS 90657
|
| Hospital Charge Code |
77000021
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.25 |
| Max. Negotiated Rate |
$55.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$55.00
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$26.40
|
| Rate for Payer: Multiplan PHCS |
$33.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$38.50
|
| Rate for Payer: UHCCP Medicaid |
$19.25
|
|
|
INFLUENZA VACCINE 6-35 MONTH(T
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
HCPCS 90657
|
| Hospital Charge Code |
770T0021
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.15 |
| Max. Negotiated Rate |
$52.80 |
| Rate for Payer: Aetna Commercial |
$42.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$42.90
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cigna Commercial |
$45.65
|
| Rate for Payer: First Health Commercial |
$52.25
|
| Rate for Payer: Humana Commercial |
$46.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$45.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$40.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$48.40
|
| Rate for Payer: Ohio Health Group HMO |
$41.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.05
|
| Rate for Payer: PHCS Commercial |
$52.80
|
| Rate for Payer: United Healthcare All Payer |
$48.40
|
|
|
INFLUENZA VACCINE 6-35 MONTH(T
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
HCPCS 90657
|
| Hospital Charge Code |
770T0021
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.15 |
| Max. Negotiated Rate |
$52.80 |
| Rate for Payer: Aetna Commercial |
$42.35
|
| Rate for Payer: Anthem Medicaid |
$18.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$42.90
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cigna Commercial |
$45.65
|
| Rate for Payer: First Health Commercial |
$52.25
|
| Rate for Payer: Humana Commercial |
$46.75
|
| Rate for Payer: Humana KY Medicaid |
$18.91
|
| Rate for Payer: Kentucky WC Medicaid |
$19.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$45.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$40.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$19.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$48.40
|
| Rate for Payer: Ohio Health Group HMO |
$41.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.05
|
| Rate for Payer: PHCS Commercial |
$52.80
|
| Rate for Payer: United Healthcare All Payer |
$48.40
|
|
|
INFLUX SPARC - 10CC
|
Facility
|
IP
|
$22,502.50
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
27000051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,925.32 |
| Max. Negotiated Rate |
$21,602.40 |
| Rate for Payer: Aetna Commercial |
$17,326.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,551.95
|
| Rate for Payer: Cash Price |
$11,251.25
|
| Rate for Payer: Cigna Commercial |
$18,677.08
|
| Rate for Payer: First Health Commercial |
$21,377.38
|
| Rate for Payer: Humana Commercial |
$19,127.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,452.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,606.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,750.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,802.20
|
| Rate for Payer: Ohio Health Group HMO |
$16,876.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,500.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,925.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,975.78
|
| Rate for Payer: PHCS Commercial |
$21,602.40
|
| Rate for Payer: United Healthcare All Payer |
$19,802.20
|
|
|
INFLUX SPARC - 10CC
|
Facility
|
OP
|
$22,502.50
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
27000051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,925.32 |
| Max. Negotiated Rate |
$21,602.40 |
| Rate for Payer: Aetna Commercial |
$17,326.92
|
| Rate for Payer: Anthem Medicaid |
$7,738.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,551.95
|
| Rate for Payer: Cash Price |
$11,251.25
|
| Rate for Payer: Cigna Commercial |
$18,677.08
|
| Rate for Payer: First Health Commercial |
$21,377.38
|
| Rate for Payer: Humana Commercial |
$19,127.12
|
| Rate for Payer: Humana KY Medicaid |
$7,738.61
|
| Rate for Payer: Kentucky WC Medicaid |
$7,817.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,452.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,606.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,750.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,893.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,802.20
|
| Rate for Payer: Ohio Health Group HMO |
$16,876.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,500.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,925.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,975.78
|
| Rate for Payer: PHCS Commercial |
$21,602.40
|
| Rate for Payer: United Healthcare All Payer |
$19,802.20
|
|
|
INFLUX SPARC - 1CC
|
Facility
|
IP
|
$4,825.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
27000051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$627.25 |
| Max. Negotiated Rate |
$4,632.00 |
| Rate for Payer: Aetna Commercial |
$3,715.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,763.50
|
| Rate for Payer: Cash Price |
$2,412.50
|
| Rate for Payer: Cigna Commercial |
$4,004.75
|
| Rate for Payer: First Health Commercial |
$4,583.75
|
| Rate for Payer: Humana Commercial |
$4,101.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,956.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,560.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,447.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,246.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,618.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$965.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$627.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,495.75
|
| Rate for Payer: PHCS Commercial |
$4,632.00
|
| Rate for Payer: United Healthcare All Payer |
$4,246.00
|
|
|
INFLUX SPARC - 1CC
|
Facility
|
OP
|
$4,825.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
27000051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$627.25 |
| Max. Negotiated Rate |
$4,632.00 |
| Rate for Payer: Aetna Commercial |
$3,715.25
|
| Rate for Payer: Anthem Medicaid |
$1,659.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,763.50
|
| Rate for Payer: Cash Price |
$2,412.50
|
| Rate for Payer: Cigna Commercial |
$4,004.75
|
| Rate for Payer: First Health Commercial |
$4,583.75
|
| Rate for Payer: Humana Commercial |
$4,101.25
|
| Rate for Payer: Humana KY Medicaid |
$1,659.32
|
| Rate for Payer: Kentucky WC Medicaid |
$1,676.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,956.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,560.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,447.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,692.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,246.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,618.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$965.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$627.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,495.75
|
| Rate for Payer: PHCS Commercial |
$4,632.00
|
| Rate for Payer: United Healthcare All Payer |
$4,246.00
|
|
|
INFUSE BONE GRAFT LARGE
|
Facility
|
IP
|
$23,415.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,043.95 |
| Max. Negotiated Rate |
$22,478.40 |
| Rate for Payer: Aetna Commercial |
$18,029.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,263.70
|
| Rate for Payer: Cash Price |
$11,707.50
|
| Rate for Payer: Cigna Commercial |
$19,434.45
|
| Rate for Payer: First Health Commercial |
$22,244.25
|
| Rate for Payer: Humana Commercial |
$19,902.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,200.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,280.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,024.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,605.20
|
| Rate for Payer: Ohio Health Group HMO |
$17,561.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,683.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,043.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,258.65
|
| Rate for Payer: PHCS Commercial |
$22,478.40
|
| Rate for Payer: United Healthcare All Payer |
$20,605.20
|
|
|
INFUSE BONE GRAFT LARGE
|
Facility
|
OP
|
$23,415.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,043.95 |
| Max. Negotiated Rate |
$22,478.40 |
| Rate for Payer: Aetna Commercial |
$18,029.55
|
| Rate for Payer: Anthem Medicaid |
$8,052.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,263.70
|
| Rate for Payer: Cash Price |
$11,707.50
|
| Rate for Payer: Cigna Commercial |
$19,434.45
|
| Rate for Payer: First Health Commercial |
$22,244.25
|
| Rate for Payer: Humana Commercial |
$19,902.75
|
| Rate for Payer: Humana KY Medicaid |
$8,052.42
|
| Rate for Payer: Kentucky WC Medicaid |
$8,134.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,200.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,280.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,024.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,213.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,605.20
|
| Rate for Payer: Ohio Health Group HMO |
$17,561.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,683.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,043.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,258.65
|
| Rate for Payer: PHCS Commercial |
$22,478.40
|
| Rate for Payer: United Healthcare All Payer |
$20,605.20
|
|
|
INFUSE BONE GRAFT LARGE II
|
Facility
|
OP
|
$23,415.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,043.95 |
| Max. Negotiated Rate |
$22,478.40 |
| Rate for Payer: Aetna Commercial |
$18,029.55
|
| Rate for Payer: Anthem Medicaid |
$8,052.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,263.70
|
| Rate for Payer: Cash Price |
$11,707.50
|
| Rate for Payer: Cigna Commercial |
$19,434.45
|
| Rate for Payer: First Health Commercial |
$22,244.25
|
| Rate for Payer: Humana Commercial |
$19,902.75
|
| Rate for Payer: Humana KY Medicaid |
$8,052.42
|
| Rate for Payer: Kentucky WC Medicaid |
$8,134.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,200.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,280.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,024.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,213.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,605.20
|
| Rate for Payer: Ohio Health Group HMO |
$17,561.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,683.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,043.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,258.65
|
| Rate for Payer: PHCS Commercial |
$22,478.40
|
| Rate for Payer: United Healthcare All Payer |
$20,605.20
|
|
|
INFUSE BONE GRAFT LARGE II
|
Facility
|
IP
|
$23,415.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,043.95 |
| Max. Negotiated Rate |
$22,478.40 |
| Rate for Payer: Aetna Commercial |
$18,029.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,263.70
|
| Rate for Payer: Cash Price |
$11,707.50
|
| Rate for Payer: Cigna Commercial |
$19,434.45
|
| Rate for Payer: First Health Commercial |
$22,244.25
|
| Rate for Payer: Humana Commercial |
$19,902.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,200.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,280.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,024.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,605.20
|
| Rate for Payer: Ohio Health Group HMO |
$17,561.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,683.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,043.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,258.65
|
| Rate for Payer: PHCS Commercial |
$22,478.40
|
| Rate for Payer: United Healthcare All Payer |
$20,605.20
|
|
|
INFUSE BONE GRAFT MEDIUM
|
Facility
|
OP
|
$21,590.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,806.70 |
| Max. Negotiated Rate |
$20,726.40 |
| Rate for Payer: Aetna Commercial |
$16,624.30
|
| Rate for Payer: Anthem Medicaid |
$7,424.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,840.20
|
| Rate for Payer: Cash Price |
$10,795.00
|
| Rate for Payer: Cigna Commercial |
$17,919.70
|
| Rate for Payer: First Health Commercial |
$20,510.50
|
| Rate for Payer: Humana Commercial |
$18,351.50
|
| Rate for Payer: Humana KY Medicaid |
$7,424.80
|
| Rate for Payer: Kentucky WC Medicaid |
$7,500.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,703.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,933.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,477.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,573.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,999.20
|
| Rate for Payer: Ohio Health Group HMO |
$16,192.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,318.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,806.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,692.90
|
| Rate for Payer: PHCS Commercial |
$20,726.40
|
| Rate for Payer: United Healthcare All Payer |
$18,999.20
|
|
|
INFUSE BONE GRAFT MEDIUM
|
Facility
|
IP
|
$21,590.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,806.70 |
| Max. Negotiated Rate |
$20,726.40 |
| Rate for Payer: Aetna Commercial |
$16,624.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,840.20
|
| Rate for Payer: Cash Price |
$10,795.00
|
| Rate for Payer: Cigna Commercial |
$17,919.70
|
| Rate for Payer: First Health Commercial |
$20,510.50
|
| Rate for Payer: Humana Commercial |
$18,351.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,703.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,933.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,477.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,999.20
|
| Rate for Payer: Ohio Health Group HMO |
$16,192.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,318.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,806.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,692.90
|
| Rate for Payer: PHCS Commercial |
$20,726.40
|
| Rate for Payer: United Healthcare All Payer |
$18,999.20
|
|
|
INFUSE BONE GRAFT SMALL
|
Facility
|
IP
|
$17,160.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,230.80 |
| Max. Negotiated Rate |
$16,473.60 |
| Rate for Payer: Aetna Commercial |
$13,213.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,384.80
|
| Rate for Payer: Cash Price |
$8,580.00
|
| Rate for Payer: Cigna Commercial |
$14,242.80
|
| Rate for Payer: First Health Commercial |
$16,302.00
|
| Rate for Payer: Humana Commercial |
$14,586.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,071.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,664.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,148.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,100.80
|
| Rate for Payer: Ohio Health Group HMO |
$12,870.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,432.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,230.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,319.60
|
| Rate for Payer: PHCS Commercial |
$16,473.60
|
| Rate for Payer: United Healthcare All Payer |
$15,100.80
|
|
|
INFUSE BONE GRAFT SMALL
|
Facility
|
OP
|
$17,160.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,230.80 |
| Max. Negotiated Rate |
$16,473.60 |
| Rate for Payer: Aetna Commercial |
$13,213.20
|
| Rate for Payer: Anthem Medicaid |
$5,901.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,384.80
|
| Rate for Payer: Cash Price |
$8,580.00
|
| Rate for Payer: Cigna Commercial |
$14,242.80
|
| Rate for Payer: First Health Commercial |
$16,302.00
|
| Rate for Payer: Humana Commercial |
$14,586.00
|
| Rate for Payer: Humana KY Medicaid |
$5,901.32
|
| Rate for Payer: Kentucky WC Medicaid |
$5,961.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,071.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,664.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,148.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,019.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,100.80
|
| Rate for Payer: Ohio Health Group HMO |
$12,870.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,432.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,230.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,319.60
|
| Rate for Payer: PHCS Commercial |
$16,473.60
|
| Rate for Payer: United Healthcare All Payer |
$15,100.80
|
|
|
INFUSE RADIOACTIVE MATERIAL
|
Professional
|
Both
|
$1,435.00
|
|
|
Service Code
|
HCPCS 77750
|
| Hospital Charge Code |
33300029
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$232.97 |
| Max. Negotiated Rate |
$1,435.00 |
| Rate for Payer: Aetna Commercial |
$529.55
|
| Rate for Payer: Anthem Medicaid |
$232.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,435.00
|
| Rate for Payer: Cash Price |
$717.50
|
| Rate for Payer: Cash Price |
$717.50
|
| Rate for Payer: Cigna Commercial |
$463.90
|
| Rate for Payer: Healthspan PPO |
$446.58
|
| Rate for Payer: Humana Medicaid |
$232.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$319.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$237.63
|
| Rate for Payer: Molina Healthcare Passport |
$232.97
|
| Rate for Payer: Multiplan PHCS |
$861.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,004.50
|
| Rate for Payer: UHCCP Medicaid |
$502.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$235.30
|
|
|
INFUSE RADIOACTIVE MATERIAL
|
Facility
|
OP
|
$1,435.00
|
|
|
Service Code
|
HCPCS 77750
|
| Hospital Charge Code |
33300029
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$186.55 |
| Max. Negotiated Rate |
$1,377.60 |
| Rate for Payer: Aetna Commercial |
$1,104.95
|
| Rate for Payer: Anthem Medicaid |
$493.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$232.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,119.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$325.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$313.74
|
| Rate for Payer: Cash Price |
$717.50
|
| Rate for Payer: Cash Price |
$717.50
|
| Rate for Payer: Cigna Commercial |
$1,191.05
|
| Rate for Payer: First Health Commercial |
$1,363.25
|
| Rate for Payer: Humana Commercial |
$1,219.75
|
| Rate for Payer: Humana KY Medicaid |
$493.50
|
| Rate for Payer: Humana Medicare Advantage |
$232.40
|
| Rate for Payer: Kentucky WC Medicaid |
$498.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,176.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,059.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$278.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$503.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,262.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,076.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$287.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$186.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$444.85
|
| Rate for Payer: PHCS Commercial |
$1,377.60
|
| Rate for Payer: United Healthcare All Payer |
$1,262.80
|
|
