|
REAMER LOW PROFILE 9.5MM
|
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 9.5MM
|
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 9MM
|
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 9MM
|
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 TRINKLE SHAFT 8*510MM
|
Facility
|
OP
|
$3,374.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$438.71 |
| Max. Negotiated Rate |
$3,239.68 |
| Rate for Payer: Aetna Commercial |
$2,598.50
|
| Rate for Payer: Anthem Medicaid |
$1,160.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,632.24
|
| Rate for Payer: Cash Price |
$1,687.34
|
| Rate for Payer: Cigna Commercial |
$2,800.98
|
| Rate for Payer: First Health Commercial |
$3,205.94
|
| Rate for Payer: Humana Commercial |
$2,868.47
|
| Rate for Payer: Humana KY Medicaid |
$1,160.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,172.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,767.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,490.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,012.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,183.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,969.71
|
| Rate for Payer: Ohio Health Group HMO |
$2,531.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$674.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$438.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,046.15
|
| Rate for Payer: PHCS Commercial |
$3,239.68
|
| Rate for Payer: United Healthcare All Payer |
$2,969.71
|
|
|
REAMER TRINKLE SHAFT 8*510MM
|
Facility
|
IP
|
$3,374.67
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$438.71 |
| Max. Negotiated Rate |
$3,239.68 |
| Rate for Payer: Aetna Commercial |
$2,598.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,632.24
|
| Rate for Payer: Cash Price |
$1,687.34
|
| Rate for Payer: Cigna Commercial |
$2,800.98
|
| Rate for Payer: First Health Commercial |
$3,205.94
|
| Rate for Payer: Humana Commercial |
$2,868.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,767.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,490.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,012.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,969.71
|
| Rate for Payer: Ohio Health Group HMO |
$2,531.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$674.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$438.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,046.15
|
| Rate for Payer: PHCS Commercial |
$3,239.68
|
| Rate for Payer: United Healthcare All Payer |
$2,969.71
|
|
|
REAMNG ROD W/BALL TIP 2.5*1150
|
Facility
|
OP
|
$1,853.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$240.99 |
| Max. Negotiated Rate |
$1,779.61 |
| Rate for Payer: Aetna Commercial |
$1,427.40
|
| Rate for Payer: Anthem Medicaid |
$637.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,445.93
|
| Rate for Payer: Cash Price |
$926.88
|
| Rate for Payer: Cigna Commercial |
$1,538.62
|
| Rate for Payer: First Health Commercial |
$1,761.07
|
| Rate for Payer: Humana Commercial |
$1,575.70
|
| Rate for Payer: Humana KY Medicaid |
$637.51
|
| Rate for Payer: Kentucky WC Medicaid |
$644.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,520.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,368.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$556.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$650.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,631.31
|
| Rate for Payer: Ohio Health Group HMO |
$1,390.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$370.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$574.67
|
| Rate for Payer: PHCS Commercial |
$1,779.61
|
| Rate for Payer: United Healthcare All Payer |
$1,631.31
|
|
|
REAMNG ROD W/BALL TIP 2.5*1150
|
Facility
|
IP
|
$1,853.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$240.99 |
| Max. Negotiated Rate |
$1,779.61 |
| Rate for Payer: Aetna Commercial |
$1,427.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,445.93
|
| Rate for Payer: Cash Price |
$926.88
|
| Rate for Payer: Cigna Commercial |
$1,538.62
|
| Rate for Payer: First Health Commercial |
$1,761.07
|
| Rate for Payer: Humana Commercial |
$1,575.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,520.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,368.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$556.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,631.31
|
| Rate for Payer: Ohio Health Group HMO |
$1,390.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$370.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$574.67
|
| Rate for Payer: PHCS Commercial |
$1,779.61
|
| Rate for Payer: United Healthcare All Payer |
$1,631.31
|
|
|
REAMP LEG TIBIA FIBULA
|
Professional
|
Both
|
$1,900.00
|
|
|
Service Code
|
HCPCS 27886
|
| Hospital Charge Code |
76100960
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$469.89 |
| Max. Negotiated Rate |
$1,900.00 |
| Rate for Payer: Aetna Commercial |
$993.82
|
| Rate for Payer: Anthem Medicaid |
$469.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,900.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cigna Commercial |
$1,076.97
|
| Rate for Payer: Healthspan PPO |
$900.19
|
| Rate for Payer: Humana Medicaid |
$469.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$848.57
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$479.29
|
| Rate for Payer: Molina Healthcare Passport |
$469.89
|
| Rate for Payer: Multiplan PHCS |
$1,140.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,330.00
|
| Rate for Payer: UHCCP Medicaid |
$665.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$474.59
|
|
|
REAMP LEG TIBIA FIBULA
|
Facility
|
OP
|
$1,900.00
|
|
|
Service Code
|
HCPCS 27886
|
| Hospital Charge Code |
76100960
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$247.00 |
| Max. Negotiated Rate |
$1,824.00 |
| Rate for Payer: Aetna Commercial |
$1,463.00
|
| Rate for Payer: Anthem Medicaid |
$653.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,482.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cigna Commercial |
$1,577.00
|
| Rate for Payer: First Health Commercial |
$1,805.00
|
| Rate for Payer: Humana Commercial |
$1,615.00
|
| Rate for Payer: Humana KY Medicaid |
$653.41
|
| Rate for Payer: Kentucky WC Medicaid |
$660.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,558.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,402.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$666.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,672.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,425.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$380.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$589.00
|
| Rate for Payer: PHCS Commercial |
$1,824.00
|
| Rate for Payer: United Healthcare All Payer |
$1,672.00
|
|
|
REAMP LEG TIBIA FIBULA
|
Facility
|
IP
|
$1,900.00
|
|
|
Service Code
|
HCPCS 27886
|
| Hospital Charge Code |
76100960
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$247.00 |
| Max. Negotiated Rate |
$1,824.00 |
| Rate for Payer: Aetna Commercial |
$1,463.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,482.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cigna Commercial |
$1,577.00
|
| Rate for Payer: First Health Commercial |
$1,805.00
|
| Rate for Payer: Humana Commercial |
$1,615.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,558.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,402.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,672.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,425.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$380.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$589.00
|
| Rate for Payer: PHCS Commercial |
$1,824.00
|
| Rate for Payer: United Healthcare All Payer |
$1,672.00
|
|
|
REAMP LEG TIBIA FIBULA(P
|
Professional
|
Both
|
$1,900.00
|
|
|
Service Code
|
HCPCS 27886
|
| Hospital Charge Code |
761P0960
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$469.89 |
| Max. Negotiated Rate |
$1,900.00 |
| Rate for Payer: Aetna Commercial |
$993.82
|
| Rate for Payer: Anthem Medicaid |
$469.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,900.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cigna Commercial |
$1,076.97
|
| Rate for Payer: Healthspan PPO |
$900.19
|
| Rate for Payer: Humana Medicaid |
$469.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$848.57
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$479.29
|
| Rate for Payer: Molina Healthcare Passport |
$469.89
|
| Rate for Payer: Multiplan PHCS |
$1,140.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,330.00
|
| Rate for Payer: UHCCP Medicaid |
$665.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$474.59
|
|
|
REASSESSMENT EA 15 MIN
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
HCPCS 97803
|
| Hospital Charge Code |
51000052
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$13.26 |
| Max. Negotiated Rate |
$97.92 |
| Rate for Payer: Aetna Commercial |
$78.54
|
| Rate for Payer: Anthem Medicaid |
$35.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$79.56
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cigna Commercial |
$84.66
|
| Rate for Payer: First Health Commercial |
$96.90
|
| Rate for Payer: Humana Commercial |
$86.70
|
| Rate for Payer: Humana KY Medicaid |
$35.08
|
| Rate for Payer: Kentucky WC Medicaid |
$35.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$83.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$75.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$89.76
|
| Rate for Payer: Ohio Health Group HMO |
$76.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31.62
|
| Rate for Payer: PHCS Commercial |
$97.92
|
| Rate for Payer: United Healthcare All Payer |
$89.76
|
|
|
REASSESSMENT EA 15 MIN
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
HCPCS 97803
|
| Hospital Charge Code |
51000052
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$13.26 |
| Max. Negotiated Rate |
$97.92 |
| Rate for Payer: Aetna Commercial |
$78.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$79.56
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cigna Commercial |
$84.66
|
| Rate for Payer: First Health Commercial |
$96.90
|
| Rate for Payer: Humana Commercial |
$86.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$83.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$75.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$89.76
|
| Rate for Payer: Ohio Health Group HMO |
$76.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31.62
|
| Rate for Payer: PHCS Commercial |
$97.92
|
| Rate for Payer: United Healthcare All Payer |
$89.76
|
|
|
REASSESSMENT EA 15 MIN
|
Professional
|
Both
|
$102.00
|
|
|
Service Code
|
HCPCS 97803
|
| Hospital Charge Code |
51000052
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$11.87 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Aetna Commercial |
$37.40
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$16.06
|
| Rate for Payer: Anthem Medicaid |
$11.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$102.00
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cigna Commercial |
$35.64
|
| Rate for Payer: Humana Medicaid |
$11.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$33.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$12.11
|
| Rate for Payer: Molina Healthcare Passport |
$11.87
|
| Rate for Payer: Multiplan PHCS |
$61.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$71.40
|
| Rate for Payer: UHCCP Medicaid |
$16.86
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$11.99
|
|
|
REASSESSMENT EA 15 MIN(P
|
Professional
|
Both
|
$39.00
|
|
|
Service Code
|
HCPCS 97803
|
| Hospital Charge Code |
510P0052
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$11.87 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: Aetna Commercial |
$37.40
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$16.06
|
| Rate for Payer: Anthem Medicaid |
$11.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$39.00
|
| Rate for Payer: Cash Price |
$19.50
|
| Rate for Payer: Cash Price |
$19.50
|
| Rate for Payer: Cigna Commercial |
$35.64
|
| Rate for Payer: Humana Medicaid |
$11.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$33.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$12.11
|
| Rate for Payer: Molina Healthcare Passport |
$11.87
|
| Rate for Payer: Multiplan PHCS |
$23.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$27.30
|
| Rate for Payer: UHCCP Medicaid |
$16.86
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$11.99
|
|
|
REASSESSMENT EA 15 MIN(T
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
HCPCS 97803
|
| Hospital Charge Code |
510T0052
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.19 |
| Max. Negotiated Rate |
$60.48 |
| Rate for Payer: Aetna Commercial |
$48.51
|
| Rate for Payer: Anthem Medicaid |
$21.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.14
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$52.29
|
| Rate for Payer: First Health Commercial |
$59.85
|
| Rate for Payer: Humana Commercial |
$53.55
|
| Rate for Payer: Humana KY Medicaid |
$21.67
|
| Rate for Payer: Kentucky WC Medicaid |
$21.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$51.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$46.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$55.44
|
| Rate for Payer: Ohio Health Group HMO |
$47.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.53
|
| Rate for Payer: PHCS Commercial |
$60.48
|
| Rate for Payer: United Healthcare All Payer |
$55.44
|
|
|
REASSESSMENT EA 15 MIN(T
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
HCPCS 97803
|
| Hospital Charge Code |
510T0052
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.19 |
| Max. Negotiated Rate |
$60.48 |
| Rate for Payer: Aetna Commercial |
$48.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.14
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$52.29
|
| Rate for Payer: First Health Commercial |
$59.85
|
| Rate for Payer: Humana Commercial |
$53.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$51.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$46.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$55.44
|
| Rate for Payer: Ohio Health Group HMO |
$47.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.53
|
| Rate for Payer: PHCS Commercial |
$60.48
|
| Rate for Payer: United Healthcare All Payer |
$55.44
|
|
|
REBLOZYL 0.25mg (25mg SDV)
|
Facility
|
IP
|
$21,546.14
|
|
|
Service Code
|
HCPCS J0896
|
| Hospital Charge Code |
25004303
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,801.00 |
| Max. Negotiated Rate |
$20,684.29 |
| Rate for Payer: Aetna Commercial |
$16,590.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,805.99
|
| Rate for Payer: Cash Price |
$10,773.07
|
| Rate for Payer: Cigna Commercial |
$17,883.30
|
| Rate for Payer: First Health Commercial |
$20,468.83
|
| Rate for Payer: Humana Commercial |
$18,314.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,667.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,901.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,463.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,960.60
|
| Rate for Payer: Ohio Health Group HMO |
$16,159.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,309.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,801.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,679.30
|
| Rate for Payer: PHCS Commercial |
$20,684.29
|
| Rate for Payer: United Healthcare All Payer |
$18,960.60
|
|
|
REBLOZYL 0.25mg (25mg SDV)
|
Facility
|
OP
|
$21,546.14
|
|
|
Service Code
|
HCPCS J0896
|
| Hospital Charge Code |
25004303
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.97 |
| Max. Negotiated Rate |
$20,684.29 |
| Rate for Payer: Aetna Commercial |
$16,590.53
|
| Rate for Payer: Anthem Medicaid |
$7,409.72
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$39.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,805.99
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$55.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$53.96
|
| Rate for Payer: Cash Price |
$10,773.07
|
| Rate for Payer: Cash Price |
$10,773.07
|
| Rate for Payer: Cigna Commercial |
$17,883.30
|
| Rate for Payer: First Health Commercial |
$20,468.83
|
| Rate for Payer: Humana Commercial |
$18,314.22
|
| Rate for Payer: Humana KY Medicaid |
$7,409.72
|
| Rate for Payer: Humana Medicare Advantage |
$39.97
|
| Rate for Payer: Kentucky WC Medicaid |
$7,485.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,667.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,901.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$47.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,558.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,960.60
|
| Rate for Payer: Ohio Health Group HMO |
$16,159.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,309.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,801.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,679.30
|
| Rate for Payer: PHCS Commercial |
$20,684.29
|
| Rate for Payer: United Healthcare All Payer |
$18,960.60
|
|
|
REBLOZYL 0.25mg (75mg SDV)
|
Facility
|
IP
|
$64,638.20
|
|
|
Service Code
|
HCPCS J0896
|
| Hospital Charge Code |
25004304
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8,402.97 |
| Max. Negotiated Rate |
$62,052.67 |
| Rate for Payer: Aetna Commercial |
$49,771.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$50,417.80
|
| Rate for Payer: Cash Price |
$32,319.10
|
| Rate for Payer: Cigna Commercial |
$53,649.71
|
| Rate for Payer: First Health Commercial |
$61,406.29
|
| Rate for Payer: Humana Commercial |
$54,942.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53,003.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47,702.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19,391.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$56,881.62
|
| Rate for Payer: Ohio Health Group HMO |
$48,478.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,927.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,402.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,037.84
|
| Rate for Payer: PHCS Commercial |
$62,052.67
|
| Rate for Payer: United Healthcare All Payer |
$56,881.62
|
|
|
REBLOZYL 0.25mg (75mg SDV)
|
Facility
|
OP
|
$64,638.20
|
|
|
Service Code
|
HCPCS J0896
|
| Hospital Charge Code |
25004304
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.97 |
| Max. Negotiated Rate |
$62,052.67 |
| Rate for Payer: Aetna Commercial |
$49,771.41
|
| Rate for Payer: Anthem Medicaid |
$22,229.08
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$39.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$50,417.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$55.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$53.96
|
| Rate for Payer: Cash Price |
$32,319.10
|
| Rate for Payer: Cash Price |
$32,319.10
|
| Rate for Payer: Cigna Commercial |
$53,649.71
|
| Rate for Payer: First Health Commercial |
$61,406.29
|
| Rate for Payer: Humana Commercial |
$54,942.47
|
| Rate for Payer: Humana KY Medicaid |
$22,229.08
|
| Rate for Payer: Humana Medicare Advantage |
$39.97
|
| Rate for Payer: Kentucky WC Medicaid |
$22,455.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53,003.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47,702.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$47.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$22,675.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$56,881.62
|
| Rate for Payer: Ohio Health Group HMO |
$48,478.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,927.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,402.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,037.84
|
| Rate for Payer: PHCS Commercial |
$62,052.67
|
| Rate for Payer: United Healthcare All Payer |
$56,881.62
|
|
|
REBUILD EARDRUM STRUCTURES
|
Professional
|
Both
|
$3,400.00
|
|
|
Service Code
|
HCPCS 69637
|
| Hospital Charge Code |
76102432
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$994.28 |
| Max. Negotiated Rate |
$3,400.00 |
| Rate for Payer: Aetna Commercial |
$1,952.82
|
| Rate for Payer: Anthem Medicaid |
$994.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,400.00
|
| Rate for Payer: Cash Price |
$1,700.00
|
| Rate for Payer: Cash Price |
$1,700.00
|
| Rate for Payer: Cigna Commercial |
$1,950.28
|
| Rate for Payer: Healthspan PPO |
$1,732.24
|
| Rate for Payer: Humana Medicaid |
$994.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,754.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,014.17
|
| Rate for Payer: Molina Healthcare Passport |
$994.28
|
| Rate for Payer: Multiplan PHCS |
$2,040.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,380.00
|
| Rate for Payer: UHCCP Medicaid |
$1,190.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,004.22
|
|
|
REBUILD EARDRUM STRUCTURES
|
Facility
|
IP
|
$3,400.00
|
|
|
Service Code
|
HCPCS 69637
|
| Hospital Charge Code |
76102432
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$442.00 |
| Max. Negotiated Rate |
$3,264.00 |
| Rate for Payer: Aetna Commercial |
$2,618.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,652.00
|
| Rate for Payer: Cash Price |
$1,700.00
|
| Rate for Payer: Cigna Commercial |
$2,822.00
|
| Rate for Payer: First Health Commercial |
$3,230.00
|
| Rate for Payer: Humana Commercial |
$2,890.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,788.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,509.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,020.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,992.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,550.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,054.00
|
| Rate for Payer: PHCS Commercial |
$3,264.00
|
| Rate for Payer: United Healthcare All Payer |
$2,992.00
|
|
|
REBUILD EARDRUM STRUCTURES
|
Facility
|
OP
|
$3,400.00
|
|
|
Service Code
|
HCPCS 69637
|
| Hospital Charge Code |
76102432
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$442.00 |
| Max. Negotiated Rate |
$7,089.80 |
| Rate for Payer: Aetna Commercial |
$2,618.00
|
| Rate for Payer: Anthem Medicaid |
$1,169.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,064.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,652.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,089.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,836.59
|
| Rate for Payer: Cash Price |
$1,700.00
|
| Rate for Payer: Cash Price |
$1,700.00
|
| Rate for Payer: Cigna Commercial |
$2,822.00
|
| Rate for Payer: First Health Commercial |
$3,230.00
|
| Rate for Payer: Humana Commercial |
$2,890.00
|
| Rate for Payer: Humana KY Medicaid |
$1,169.26
|
| Rate for Payer: Humana Medicare Advantage |
$5,064.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,181.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,788.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,509.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,076.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,192.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,992.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,550.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,054.00
|
| Rate for Payer: PHCS Commercial |
$3,264.00
|
| Rate for Payer: United Healthcare All Payer |
$2,992.00
|
|
