|
RCNST TNDN PULLEY WLOC TISS (P
|
Professional
|
Both
|
$1,300.00
|
|
|
Service Code
|
HCPCS 26500
|
| Hospital Charge Code |
761P0709
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$274.57 |
| Max. Negotiated Rate |
$1,300.00 |
| Rate for Payer: Aetna Commercial |
$876.69
|
| Rate for Payer: Anthem Medicaid |
$274.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,300.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$1,075.74
|
| Rate for Payer: Healthspan PPO |
$794.09
|
| Rate for Payer: Humana Medicaid |
$274.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$757.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$280.06
|
| Rate for Payer: Molina Healthcare Passport |
$274.57
|
| Rate for Payer: Multiplan PHCS |
$780.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$910.00
|
| Rate for Payer: UHCCP Medicaid |
$455.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$277.32
|
|
|
RCS COCR CABLE/SWAGE 1.6
|
Facility
|
IP
|
$3,381.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$439.54 |
| Max. Negotiated Rate |
$3,245.83 |
| Rate for Payer: Aetna Commercial |
$2,603.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,637.23
|
| Rate for Payer: Cash Price |
$1,690.54
|
| Rate for Payer: Cigna Commercial |
$2,806.29
|
| Rate for Payer: First Health Commercial |
$3,212.02
|
| Rate for Payer: Humana Commercial |
$2,873.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,772.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,495.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,014.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,975.34
|
| Rate for Payer: Ohio Health Group HMO |
$2,535.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$676.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$439.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,048.13
|
| Rate for Payer: PHCS Commercial |
$3,245.83
|
| Rate for Payer: United Healthcare All Payer |
$2,975.34
|
|
|
RCS COCR CABLE/SWAGE 1.6
|
Facility
|
OP
|
$3,381.07
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$439.54 |
| Max. Negotiated Rate |
$3,245.83 |
| Rate for Payer: Aetna Commercial |
$2,603.42
|
| Rate for Payer: Anthem Medicaid |
$1,162.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,637.23
|
| Rate for Payer: Cash Price |
$1,690.54
|
| Rate for Payer: Cigna Commercial |
$2,806.29
|
| Rate for Payer: First Health Commercial |
$3,212.02
|
| Rate for Payer: Humana Commercial |
$2,873.91
|
| Rate for Payer: Humana KY Medicaid |
$1,162.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,174.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,772.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,495.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,014.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,186.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,975.34
|
| Rate for Payer: Ohio Health Group HMO |
$2,535.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$676.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$439.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,048.13
|
| Rate for Payer: PHCS Commercial |
$3,245.83
|
| Rate for Payer: United Healthcare All Payer |
$2,975.34
|
|
|
READI-CAT 2 450ML
|
Facility
|
OP
|
$12.04
|
|
|
Service Code
|
NDC 32909071103
|
| Hospital Charge Code |
25003925
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$11.56 |
| Rate for Payer: Aetna Commercial |
$9.27
|
| Rate for Payer: Anthem Medicaid |
$4.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.39
|
| Rate for Payer: Cash Price |
$6.02
|
| Rate for Payer: Cigna Commercial |
$9.99
|
| Rate for Payer: First Health Commercial |
$11.44
|
| Rate for Payer: Humana Commercial |
$10.23
|
| Rate for Payer: Humana KY Medicaid |
$4.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$10.60
|
| Rate for Payer: Ohio Health Group HMO |
$9.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.73
|
| Rate for Payer: PHCS Commercial |
$11.56
|
| Rate for Payer: United Healthcare All Payer |
$10.60
|
|
|
READI-CAT 2 450ML
|
Facility
|
IP
|
$12.04
|
|
|
Service Code
|
NDC 32909071103
|
| Hospital Charge Code |
25003925
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$11.56 |
| Rate for Payer: Aetna Commercial |
$9.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.39
|
| Rate for Payer: Cash Price |
$6.02
|
| Rate for Payer: Cigna Commercial |
$9.99
|
| Rate for Payer: First Health Commercial |
$11.44
|
| Rate for Payer: Humana Commercial |
$10.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$10.60
|
| Rate for Payer: Ohio Health Group HMO |
$9.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.73
|
| Rate for Payer: PHCS Commercial |
$11.56
|
| Rate for Payer: United Healthcare All Payer |
$10.60
|
|
|
REALIGNMENT OF LOWER LEG
|
Facility
|
IP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 27712
|
| Hospital Charge Code |
76100919
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$2,400.00 |
| Rate for Payer: Aetna Commercial |
$1,925.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,950.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$2,075.00
|
| Rate for Payer: First Health Commercial |
$2,375.00
|
| Rate for Payer: Humana Commercial |
$2,125.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,050.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,845.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$750.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,875.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$325.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$775.00
|
| Rate for Payer: PHCS Commercial |
$2,400.00
|
| Rate for Payer: United Healthcare All Payer |
$2,200.00
|
|
|
REALIGNMENT OF LOWER LEG
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 27712
|
| Hospital Charge Code |
76100919
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$680.93 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Aetna Commercial |
$1,628.11
|
| Rate for Payer: Anthem Medicaid |
$680.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,500.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$1,745.06
|
| Rate for Payer: Healthspan PPO |
$1,474.72
|
| Rate for Payer: Humana Medicaid |
$680.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,378.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$694.55
|
| Rate for Payer: Molina Healthcare Passport |
$680.93
|
| Rate for Payer: Multiplan PHCS |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,750.00
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$687.74
|
|
|
REALIGNMENT OF LOWER LEG
|
Facility
|
OP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 27712
|
| Hospital Charge Code |
76100919
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$2,400.00 |
| Rate for Payer: Aetna Commercial |
$1,925.00
|
| Rate for Payer: Anthem Medicaid |
$859.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,950.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$2,075.00
|
| Rate for Payer: First Health Commercial |
$2,375.00
|
| Rate for Payer: Humana Commercial |
$2,125.00
|
| Rate for Payer: Humana KY Medicaid |
$859.75
|
| Rate for Payer: Kentucky WC Medicaid |
$868.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,050.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,845.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$750.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$877.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,875.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$325.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$775.00
|
| Rate for Payer: PHCS Commercial |
$2,400.00
|
| Rate for Payer: United Healthcare All Payer |
$2,200.00
|
|
|
REALIGNMENT OF LOWER LEG(P
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 27712
|
| Hospital Charge Code |
761P0919
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$680.93 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Aetna Commercial |
$1,628.11
|
| Rate for Payer: Anthem Medicaid |
$680.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,500.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$1,745.06
|
| Rate for Payer: Healthspan PPO |
$1,474.72
|
| Rate for Payer: Humana Medicaid |
$680.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,378.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$694.55
|
| Rate for Payer: Molina Healthcare Passport |
$680.93
|
| Rate for Payer: Multiplan PHCS |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,750.00
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$687.74
|
|
|
REALIGNMENT OF TENDONS
|
Facility
|
OP
|
$1,190.00
|
|
|
Service Code
|
HCPCS 26437
|
| Hospital Charge Code |
76100699
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$154.70 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$916.30
|
| Rate for Payer: Anthem Medicaid |
$409.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$928.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$595.00
|
| Rate for Payer: Cash Price |
$595.00
|
| Rate for Payer: Cigna Commercial |
$987.70
|
| Rate for Payer: First Health Commercial |
$1,130.50
|
| Rate for Payer: Humana Commercial |
$1,011.50
|
| Rate for Payer: Humana KY Medicaid |
$409.24
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$413.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$975.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$878.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$417.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,047.20
|
| Rate for Payer: Ohio Health Group HMO |
$892.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$238.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$154.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$368.90
|
| Rate for Payer: PHCS Commercial |
$1,142.40
|
| Rate for Payer: United Healthcare All Payer |
$1,047.20
|
|
|
REALIGNMENT OF TENDONS
|
Facility
|
IP
|
$1,190.00
|
|
|
Service Code
|
HCPCS 26437
|
| Hospital Charge Code |
76100699
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$154.70 |
| Max. Negotiated Rate |
$1,142.40 |
| Rate for Payer: Aetna Commercial |
$916.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$928.20
|
| Rate for Payer: Cash Price |
$595.00
|
| Rate for Payer: Cigna Commercial |
$987.70
|
| Rate for Payer: First Health Commercial |
$1,130.50
|
| Rate for Payer: Humana Commercial |
$1,011.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$975.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$878.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$357.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,047.20
|
| Rate for Payer: Ohio Health Group HMO |
$892.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$238.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$154.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$368.90
|
| Rate for Payer: PHCS Commercial |
$1,142.40
|
| Rate for Payer: United Healthcare All Payer |
$1,047.20
|
|
|
REALIGNMENT OF TENDONS
|
Professional
|
Both
|
$1,190.00
|
|
|
Service Code
|
HCPCS 26437
|
| Hospital Charge Code |
76100699
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$287.42 |
| Max. Negotiated Rate |
$1,190.00 |
| Rate for Payer: Aetna Commercial |
$871.10
|
| Rate for Payer: Anthem Medicaid |
$287.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,190.00
|
| Rate for Payer: Cash Price |
$595.00
|
| Rate for Payer: Cash Price |
$595.00
|
| Rate for Payer: Cigna Commercial |
$1,071.46
|
| Rate for Payer: Healthspan PPO |
$789.03
|
| Rate for Payer: Humana Medicaid |
$287.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$748.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$293.17
|
| Rate for Payer: Molina Healthcare Passport |
$287.42
|
| Rate for Payer: Multiplan PHCS |
$714.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$833.00
|
| Rate for Payer: UHCCP Medicaid |
$416.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$290.29
|
|
|
REALIGNMENT OF TENDONS(P
|
Professional
|
Both
|
$1,190.00
|
|
|
Service Code
|
HCPCS 26437
|
| Hospital Charge Code |
761P0699
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$287.42 |
| Max. Negotiated Rate |
$1,190.00 |
| Rate for Payer: Aetna Commercial |
$871.10
|
| Rate for Payer: Anthem Medicaid |
$287.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,190.00
|
| Rate for Payer: Cash Price |
$595.00
|
| Rate for Payer: Cash Price |
$595.00
|
| Rate for Payer: Cigna Commercial |
$1,071.46
|
| Rate for Payer: Healthspan PPO |
$789.03
|
| Rate for Payer: Humana Medicaid |
$287.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$748.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$293.17
|
| Rate for Payer: Molina Healthcare Passport |
$287.42
|
| Rate for Payer: Multiplan PHCS |
$714.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$833.00
|
| Rate for Payer: UHCCP Medicaid |
$416.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$290.29
|
|
|
REAMER FOR CROSS-PLATES
|
Facility
|
OP
|
$4,811.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$625.53 |
| Max. Negotiated Rate |
$4,619.30 |
| Rate for Payer: Aetna Commercial |
$3,705.06
|
| Rate for Payer: Anthem Medicaid |
$1,654.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,753.18
|
| Rate for Payer: Cash Price |
$2,405.89
|
| Rate for Payer: Cigna Commercial |
$3,993.77
|
| Rate for Payer: First Health Commercial |
$4,571.18
|
| Rate for Payer: Humana Commercial |
$4,090.00
|
| Rate for Payer: Humana KY Medicaid |
$1,654.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,671.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,945.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,551.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,443.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,687.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,234.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,608.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$962.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$625.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,491.65
|
| Rate for Payer: PHCS Commercial |
$4,619.30
|
| Rate for Payer: United Healthcare All Payer |
$4,234.36
|
|
|
REAMER FOR CROSS-PLATES
|
Facility
|
IP
|
$4,811.77
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$625.53 |
| Max. Negotiated Rate |
$4,619.30 |
| Rate for Payer: Aetna Commercial |
$3,705.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,753.18
|
| Rate for Payer: Cash Price |
$2,405.89
|
| Rate for Payer: Cigna Commercial |
$3,993.77
|
| Rate for Payer: First Health Commercial |
$4,571.18
|
| Rate for Payer: Humana Commercial |
$4,090.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,945.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,551.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,443.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,234.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,608.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$962.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$625.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,491.65
|
| Rate for Payer: PHCS Commercial |
$4,619.30
|
| Rate for Payer: United Healthcare All Payer |
$4,234.36
|
|
|
REAMER LOW PROFILE 10.5MM
|
Facility
|
IP
|
$2,032.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.22 |
| Max. Negotiated Rate |
$1,951.20 |
| Rate for Payer: Aetna Commercial |
$1,565.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,585.35
|
| Rate for Payer: Cash Price |
$1,016.25
|
| Rate for Payer: Cigna Commercial |
$1,686.98
|
| Rate for Payer: First Health Commercial |
$1,930.88
|
| Rate for Payer: Humana Commercial |
$1,727.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,666.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,499.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$609.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,788.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,524.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$406.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$264.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$630.08
|
| Rate for Payer: PHCS Commercial |
$1,951.20
|
| Rate for Payer: United Healthcare All Payer |
$1,788.60
|
|
|
REAMER LOW PROFILE 10.5MM
|
Facility
|
OP
|
$2,032.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.22 |
| Max. Negotiated Rate |
$1,951.20 |
| Rate for Payer: Aetna Commercial |
$1,565.02
|
| Rate for Payer: Anthem Medicaid |
$698.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,585.35
|
| Rate for Payer: Cash Price |
$1,016.25
|
| Rate for Payer: Cigna Commercial |
$1,686.98
|
| Rate for Payer: First Health Commercial |
$1,930.88
|
| Rate for Payer: Humana Commercial |
$1,727.62
|
| Rate for Payer: Humana KY Medicaid |
$698.98
|
| Rate for Payer: Kentucky WC Medicaid |
$706.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,666.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,499.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$609.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$713.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,788.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,524.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$406.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$264.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$630.08
|
| Rate for Payer: PHCS Commercial |
$1,951.20
|
| Rate for Payer: United Healthcare All Payer |
$1,788.60
|
|
|
REAMER LOW PROFILE 10MM
|
Facility
|
OP
|
$2,032.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.22 |
| Max. Negotiated Rate |
$1,951.20 |
| Rate for Payer: Aetna Commercial |
$1,565.02
|
| Rate for Payer: Anthem Medicaid |
$698.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,585.35
|
| Rate for Payer: Cash Price |
$1,016.25
|
| Rate for Payer: Cigna Commercial |
$1,686.98
|
| Rate for Payer: First Health Commercial |
$1,930.88
|
| Rate for Payer: Humana Commercial |
$1,727.62
|
| Rate for Payer: Humana KY Medicaid |
$698.98
|
| Rate for Payer: Kentucky WC Medicaid |
$706.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,666.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,499.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$609.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$713.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,788.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,524.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$406.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$264.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$630.08
|
| Rate for Payer: PHCS Commercial |
$1,951.20
|
| Rate for Payer: United Healthcare All Payer |
$1,788.60
|
|
|
REAMER LOW PROFILE 10MM
|
Facility
|
IP
|
$2,032.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.22 |
| Max. Negotiated Rate |
$1,951.20 |
| Rate for Payer: Aetna Commercial |
$1,565.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,585.35
|
| Rate for Payer: Cash Price |
$1,016.25
|
| Rate for Payer: Cigna Commercial |
$1,686.98
|
| Rate for Payer: First Health Commercial |
$1,930.88
|
| Rate for Payer: Humana Commercial |
$1,727.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,666.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,499.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$609.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,788.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,524.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$406.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$264.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$630.08
|
| Rate for Payer: PHCS Commercial |
$1,951.20
|
| Rate for Payer: United Healthcare All Payer |
$1,788.60
|
|
|
REAMER LOW PROFILE 11.5MM
|
Facility
|
IP
|
$2,032.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.22 |
| Max. Negotiated Rate |
$1,951.20 |
| Rate for Payer: Aetna Commercial |
$1,565.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,585.35
|
| Rate for Payer: Cash Price |
$1,016.25
|
| Rate for Payer: Cigna Commercial |
$1,686.98
|
| Rate for Payer: First Health Commercial |
$1,930.88
|
| Rate for Payer: Humana Commercial |
$1,727.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,666.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,499.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$609.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,788.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,524.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$406.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$264.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$630.08
|
| Rate for Payer: PHCS Commercial |
$1,951.20
|
| Rate for Payer: United Healthcare All Payer |
$1,788.60
|
|
|
REAMER LOW PROFILE 11.5MM
|
Facility
|
OP
|
$2,032.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.22 |
| Max. Negotiated Rate |
$1,951.20 |
| Rate for Payer: Aetna Commercial |
$1,565.02
|
| Rate for Payer: Anthem Medicaid |
$698.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,585.35
|
| Rate for Payer: Cash Price |
$1,016.25
|
| Rate for Payer: Cigna Commercial |
$1,686.98
|
| Rate for Payer: First Health Commercial |
$1,930.88
|
| Rate for Payer: Humana Commercial |
$1,727.62
|
| Rate for Payer: Humana KY Medicaid |
$698.98
|
| Rate for Payer: Kentucky WC Medicaid |
$706.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,666.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,499.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$609.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$713.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,788.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,524.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$406.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$264.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$630.08
|
| Rate for Payer: PHCS Commercial |
$1,951.20
|
| Rate for Payer: United Healthcare All Payer |
$1,788.60
|
|
|
REAMER LOW PROFILE 11MM
|
Facility
|
OP
|
$2,032.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.22 |
| Max. Negotiated Rate |
$1,951.20 |
| Rate for Payer: Aetna Commercial |
$1,565.02
|
| Rate for Payer: Anthem Medicaid |
$698.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,585.35
|
| Rate for Payer: Cash Price |
$1,016.25
|
| Rate for Payer: Cigna Commercial |
$1,686.98
|
| Rate for Payer: First Health Commercial |
$1,930.88
|
| Rate for Payer: Humana Commercial |
$1,727.62
|
| Rate for Payer: Humana KY Medicaid |
$698.98
|
| Rate for Payer: Kentucky WC Medicaid |
$706.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,666.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,499.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$609.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$713.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,788.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,524.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$406.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$264.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$630.08
|
| Rate for Payer: PHCS Commercial |
$1,951.20
|
| Rate for Payer: United Healthcare All Payer |
$1,788.60
|
|
|
REAMER LOW PROFILE 11MM
|
Facility
|
IP
|
$2,032.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.22 |
| Max. Negotiated Rate |
$1,951.20 |
| Rate for Payer: Aetna Commercial |
$1,565.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,585.35
|
| Rate for Payer: Cash Price |
$1,016.25
|
| Rate for Payer: Cigna Commercial |
$1,686.98
|
| Rate for Payer: First Health Commercial |
$1,930.88
|
| Rate for Payer: Humana Commercial |
$1,727.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,666.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,499.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$609.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,788.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,524.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$406.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$264.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$630.08
|
| Rate for Payer: PHCS Commercial |
$1,951.20
|
| Rate for Payer: United Healthcare All Payer |
$1,788.60
|
|
|
REAMER LOW PROFILE 8.5MM
|
Facility
|
OP
|
$2,032.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.22 |
| Max. Negotiated Rate |
$1,951.20 |
| Rate for Payer: Aetna Commercial |
$1,565.02
|
| Rate for Payer: Anthem Medicaid |
$698.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,585.35
|
| Rate for Payer: Cash Price |
$1,016.25
|
| Rate for Payer: Cigna Commercial |
$1,686.98
|
| Rate for Payer: First Health Commercial |
$1,930.88
|
| Rate for Payer: Humana Commercial |
$1,727.62
|
| Rate for Payer: Humana KY Medicaid |
$698.98
|
| Rate for Payer: Kentucky WC Medicaid |
$706.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,666.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,499.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$609.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$713.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,788.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,524.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$406.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$264.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$630.08
|
| Rate for Payer: PHCS Commercial |
$1,951.20
|
| Rate for Payer: United Healthcare All Payer |
$1,788.60
|
|
|
REAMER LOW PROFILE 8.5MM
|
Facility
|
IP
|
$2,032.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.22 |
| Max. Negotiated Rate |
$1,951.20 |
| Rate for Payer: Aetna Commercial |
$1,565.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,585.35
|
| Rate for Payer: Cash Price |
$1,016.25
|
| Rate for Payer: Cigna Commercial |
$1,686.98
|
| Rate for Payer: First Health Commercial |
$1,930.88
|
| Rate for Payer: Humana Commercial |
$1,727.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,666.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,499.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$609.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,788.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,524.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$406.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$264.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$630.08
|
| Rate for Payer: PHCS Commercial |
$1,951.20
|
| Rate for Payer: United Healthcare All Payer |
$1,788.60
|
|
