REBUILD EARDRUM STRUCTURES(P
|
Professional
|
Both
|
$3,400.00
|
|
Service Code
|
HCPCS 69637
|
Hospital Charge Code |
761P2432
|
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 OUTER EAR CANAL
|
Professional
|
Both
|
$2,600.00
|
|
Service Code
|
HCPCS 69310
|
Hospital Charge Code |
76102416
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$600.92 |
Max. Negotiated Rate |
$2,600.00 |
Rate for Payer: Aetna Commercial |
$1,525.04
|
Rate for Payer: Anthem Medicaid |
$600.92
|
Rate for Payer: Buckeye Medicare Advantage |
$2,600.00
|
Rate for Payer: Cash Price |
$1,300.00
|
Rate for Payer: Cash Price |
$1,300.00
|
Rate for Payer: Cigna Commercial |
$1,534.11
|
Rate for Payer: Healthspan PPO |
$1,352.78
|
Rate for Payer: Humana Medicaid |
$600.92
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,378.86
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$612.94
|
Rate for Payer: Molina Healthcare Passport |
$600.92
|
Rate for Payer: Multiplan PHCS |
$1,560.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,820.00
|
Rate for Payer: UHCCP Medicaid |
$910.00
|
Rate for Payer: Wellcare CHIP/Medicaid |
$606.93
|
|
REBUILD OUTER EAR CANAL
|
Facility
|
IP
|
$2,600.00
|
|
Service Code
|
HCPCS 69310
|
Hospital Charge Code |
76102416
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$338.00 |
Max. Negotiated Rate |
$2,496.00 |
Rate for Payer: Aetna Commercial |
$2,002.00
|
Rate for Payer: Anthem POS/PPO/Traditional |
$2,028.00
|
Rate for Payer: Cash Price |
$1,300.00
|
Rate for Payer: Cigna Commercial |
$2,158.00
|
Rate for Payer: First Health Commercial |
$2,470.00
|
Rate for Payer: Humana Commercial |
$2,210.00
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$2,132.00
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,918.80
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$780.00
|
Rate for Payer: Ohio Health Choice Commercial |
$2,288.00
|
Rate for Payer: Ohio Health Group HMO |
$1,950.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$520.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$338.00
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$806.00
|
Rate for Payer: PHCS Commercial |
$2,496.00
|
Rate for Payer: United Healthcare All Payer |
$2,288.00
|
|
REBUILD OUTER EAR CANAL
|
Facility
|
OP
|
$2,600.00
|
|
Service Code
|
HCPCS 69310
|
Hospital Charge Code |
76102416
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$338.00 |
Max. Negotiated Rate |
$7,089.80 |
Rate for Payer: Aetna Commercial |
$2,002.00
|
Rate for Payer: Anthem Medicaid |
$894.14
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$5,064.14
|
Rate for Payer: Anthem POS/PPO/Traditional |
$2,028.00
|
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 |
$1,300.00
|
Rate for Payer: Cash Price |
$1,300.00
|
Rate for Payer: Cigna Commercial |
$2,158.00
|
Rate for Payer: First Health Commercial |
$2,470.00
|
Rate for Payer: Humana Commercial |
$2,210.00
|
Rate for Payer: Humana KY Medicaid |
$894.14
|
Rate for Payer: Humana Medicare Advantage |
$5,064.14
|
Rate for Payer: Kentucky WC Medicaid |
$903.24
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$2,132.00
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,918.80
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$6,076.97
|
Rate for Payer: Molina Healthcare Medicaid |
$912.08
|
Rate for Payer: Ohio Health Choice Commercial |
$2,288.00
|
Rate for Payer: Ohio Health Group HMO |
$1,950.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$520.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$338.00
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$806.00
|
Rate for Payer: PHCS Commercial |
$2,496.00
|
Rate for Payer: United Healthcare All Payer |
$2,288.00
|
|
REBUILD OUTER EAR CANAL(P
|
Professional
|
Both
|
$2,600.00
|
|
Service Code
|
HCPCS 69310
|
Hospital Charge Code |
761P2416
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$600.92 |
Max. Negotiated Rate |
$2,600.00 |
Rate for Payer: Aetna Commercial |
$1,525.04
|
Rate for Payer: Anthem Medicaid |
$600.92
|
Rate for Payer: Buckeye Medicare Advantage |
$2,600.00
|
Rate for Payer: Cash Price |
$1,300.00
|
Rate for Payer: Cash Price |
$1,300.00
|
Rate for Payer: Cigna Commercial |
$1,534.11
|
Rate for Payer: Healthspan PPO |
$1,352.78
|
Rate for Payer: Humana Medicaid |
$600.92
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,378.86
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$612.94
|
Rate for Payer: Molina Healthcare Passport |
$600.92
|
Rate for Payer: Multiplan PHCS |
$1,560.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,820.00
|
Rate for Payer: UHCCP Medicaid |
$910.00
|
Rate for Payer: Wellcare CHIP/Medicaid |
$606.93
|
|
RECARBRIO 1.25 GM/20 ML VIAL
|
Facility
|
IP
|
$847.50
|
|
Service Code
|
HCPCS J3490
|
Hospital Charge Code |
25003950
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$110.18 |
Max. Negotiated Rate |
$813.60 |
Rate for Payer: Aetna Commercial |
$652.58
|
Rate for Payer: Anthem POS/PPO/Traditional |
$661.05
|
Rate for Payer: Cash Price |
$423.75
|
Rate for Payer: Cigna Commercial |
$703.42
|
Rate for Payer: First Health Commercial |
$805.12
|
Rate for Payer: Humana Commercial |
$720.38
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$694.95
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$625.46
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$254.25
|
Rate for Payer: Ohio Health Choice Commercial |
$745.80
|
Rate for Payer: Ohio Health Group HMO |
$635.62
|
Rate for Payer: Ohio Health Group PPO Differential |
$169.50
|
Rate for Payer: Ohio Health Group PPO No Differential |
$110.18
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$262.72
|
Rate for Payer: PHCS Commercial |
$813.60
|
Rate for Payer: United Healthcare All Payer |
$745.80
|
|
RECARBRIO 1.25 GM/20 ML VIAL
|
Facility
|
OP
|
$847.50
|
|
Service Code
|
HCPCS J3490
|
Hospital Charge Code |
25003950
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$110.18 |
Max. Negotiated Rate |
$813.60 |
Rate for Payer: Aetna Commercial |
$652.58
|
Rate for Payer: Anthem Medicaid |
$291.46
|
Rate for Payer: Anthem POS/PPO/Traditional |
$661.05
|
Rate for Payer: Cash Price |
$423.75
|
Rate for Payer: Cigna Commercial |
$703.42
|
Rate for Payer: First Health Commercial |
$805.12
|
Rate for Payer: Humana Commercial |
$720.38
|
Rate for Payer: Humana KY Medicaid |
$291.46
|
Rate for Payer: Kentucky WC Medicaid |
$294.42
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$694.95
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$625.46
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$254.25
|
Rate for Payer: Molina Healthcare Medicaid |
$297.30
|
Rate for Payer: Ohio Health Choice Commercial |
$745.80
|
Rate for Payer: Ohio Health Group HMO |
$635.62
|
Rate for Payer: Ohio Health Group PPO Differential |
$169.50
|
Rate for Payer: Ohio Health Group PPO No Differential |
$110.18
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$262.72
|
Rate for Payer: PHCS Commercial |
$813.60
|
Rate for Payer: United Healthcare All Payer |
$745.80
|
|
RECHANNELING ARTERY ENDAR.
|
Professional
|
Both
|
$2,500.00
|
|
Service Code
|
HCPCS 35371
|
Hospital Charge Code |
76101388
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$704.10 |
Max. Negotiated Rate |
$2,500.00 |
Rate for Payer: Aetna Commercial |
$1,456.40
|
Rate for Payer: Anthem Medicaid |
$704.10
|
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 |
$1,405.40
|
Rate for Payer: Healthspan PPO |
$1,431.93
|
Rate for Payer: Humana Medicaid |
$704.10
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,127.71
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$718.18
|
Rate for Payer: Molina Healthcare Passport |
$704.10
|
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 |
$711.14
|
|
RECHANNELING ARTERY ENDAR.
|
Facility
|
IP
|
$2,500.00
|
|
Service Code
|
HCPCS 35371
|
Hospital Charge Code |
76101388
|
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
|
|
RECHANNELING ARTERY ENDAR.
|
Facility
|
OP
|
$2,500.00
|
|
Service Code
|
HCPCS 35371
|
Hospital Charge Code |
76101388
|
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
|
|
RECHANNELING ARTERY ENDAR.(P
|
Professional
|
Both
|
$2,500.00
|
|
Service Code
|
HCPCS 35371
|
Hospital Charge Code |
761P1388
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$704.10 |
Max. Negotiated Rate |
$2,500.00 |
Rate for Payer: Aetna Commercial |
$1,456.40
|
Rate for Payer: Anthem Medicaid |
$704.10
|
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 |
$1,405.40
|
Rate for Payer: Healthspan PPO |
$1,431.93
|
Rate for Payer: Humana Medicaid |
$704.10
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,127.71
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$718.18
|
Rate for Payer: Molina Healthcare Passport |
$704.10
|
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 |
$711.14
|
|
RECLAST 5MG(ZOLEDRONICACID)INJ
|
Facility
|
IP
|
$1,635.00
|
|
Service Code
|
HCPCS J3489
|
Hospital Charge Code |
25002455
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$212.55 |
Max. Negotiated Rate |
$1,569.60 |
Rate for Payer: Aetna Commercial |
$1,258.95
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,275.30
|
Rate for Payer: Cash Price |
$817.50
|
Rate for Payer: Cigna Commercial |
$1,357.05
|
Rate for Payer: First Health Commercial |
$1,553.25
|
Rate for Payer: Humana Commercial |
$1,389.75
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,340.70
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,206.63
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$490.50
|
Rate for Payer: Ohio Health Choice Commercial |
$1,438.80
|
Rate for Payer: Ohio Health Group HMO |
$1,226.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$327.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$212.55
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$506.85
|
Rate for Payer: PHCS Commercial |
$1,569.60
|
Rate for Payer: United Healthcare All Payer |
$1,438.80
|
|
RECLAST 5MG(ZOLEDRONICACID)INJ
|
Facility
|
OP
|
$1,635.00
|
|
Service Code
|
HCPCS J3489
|
Hospital Charge Code |
25002455
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$212.55 |
Max. Negotiated Rate |
$1,569.60 |
Rate for Payer: Aetna Commercial |
$1,258.95
|
Rate for Payer: Anthem Medicaid |
$562.28
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,275.30
|
Rate for Payer: Cash Price |
$817.50
|
Rate for Payer: Cigna Commercial |
$1,357.05
|
Rate for Payer: First Health Commercial |
$1,553.25
|
Rate for Payer: Humana Commercial |
$1,389.75
|
Rate for Payer: Humana KY Medicaid |
$562.28
|
Rate for Payer: Kentucky WC Medicaid |
$568.00
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,340.70
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,206.63
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$490.50
|
Rate for Payer: Molina Healthcare Medicaid |
$573.56
|
Rate for Payer: Ohio Health Choice Commercial |
$1,438.80
|
Rate for Payer: Ohio Health Group HMO |
$1,226.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$327.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$212.55
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$506.85
|
Rate for Payer: PHCS Commercial |
$1,569.60
|
Rate for Payer: United Healthcare All Payer |
$1,438.80
|
|
RECOMBIVAX HB 5MCG/0.5ML VIAL
|
Facility
|
IP
|
$183.16
|
|
Service Code
|
HCPCS 90746
|
Hospital Charge Code |
25000047
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$23.81 |
Max. Negotiated Rate |
$175.83 |
Rate for Payer: Aetna Commercial |
$141.03
|
Rate for Payer: Anthem POS/PPO/Traditional |
$142.86
|
Rate for Payer: Cash Price |
$91.58
|
Rate for Payer: Cigna Commercial |
$152.02
|
Rate for Payer: First Health Commercial |
$174.00
|
Rate for Payer: Humana Commercial |
$155.69
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$150.19
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$135.17
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$54.95
|
Rate for Payer: Ohio Health Choice Commercial |
$161.18
|
Rate for Payer: Ohio Health Group HMO |
$137.37
|
Rate for Payer: Ohio Health Group PPO Differential |
$36.63
|
Rate for Payer: Ohio Health Group PPO No Differential |
$23.81
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56.78
|
Rate for Payer: PHCS Commercial |
$175.83
|
Rate for Payer: United Healthcare All Payer |
$161.18
|
|
RECOMBIVAX HB 5MCG/0.5ML VIAL
|
Facility
|
OP
|
$183.16
|
|
Service Code
|
HCPCS 90746
|
Hospital Charge Code |
25000047
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$23.81 |
Max. Negotiated Rate |
$175.83 |
Rate for Payer: Anthem Medicaid |
$62.99
|
Rate for Payer: Anthem POS/PPO/Traditional |
$142.86
|
Rate for Payer: Cash Price |
$91.58
|
Rate for Payer: Cigna Commercial |
$152.02
|
Rate for Payer: First Health Commercial |
$174.00
|
Rate for Payer: Humana Commercial |
$155.69
|
Rate for Payer: Humana KY Medicaid |
$62.99
|
Rate for Payer: Kentucky WC Medicaid |
$63.63
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$150.19
|
Rate for Payer: Aetna Commercial |
$141.03
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$135.17
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$54.95
|
Rate for Payer: Molina Healthcare Medicaid |
$64.25
|
Rate for Payer: Ohio Health Choice Commercial |
$161.18
|
Rate for Payer: Ohio Health Group HMO |
$137.37
|
Rate for Payer: Ohio Health Group PPO Differential |
$36.63
|
Rate for Payer: Ohio Health Group PPO No Differential |
$23.81
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56.78
|
Rate for Payer: PHCS Commercial |
$175.83
|
Rate for Payer: United Healthcare All Payer |
$161.18
|
|
RECON CONT ACT HA RG 46MM L
|
Facility
|
OP
|
$12,884.90
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,675.04 |
Max. Negotiated Rate |
$12,369.50 |
Rate for Payer: Aetna Commercial |
$9,921.37
|
Rate for Payer: Anthem Medicaid |
$4,431.12
|
Rate for Payer: Anthem POS/PPO/Traditional |
$10,050.22
|
Rate for Payer: Cash Price |
$6,442.45
|
Rate for Payer: Cigna Commercial |
$10,694.47
|
Rate for Payer: First Health Commercial |
$12,240.66
|
Rate for Payer: Humana Commercial |
$10,952.16
|
Rate for Payer: Humana KY Medicaid |
$4,431.12
|
Rate for Payer: Kentucky WC Medicaid |
$4,476.21
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$10,565.62
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,509.06
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$3,865.47
|
Rate for Payer: Molina Healthcare Medicaid |
$4,520.02
|
Rate for Payer: Ohio Health Choice Commercial |
$11,338.71
|
Rate for Payer: Ohio Health Group HMO |
$9,663.68
|
Rate for Payer: Ohio Health Group PPO Differential |
$2,576.98
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,675.04
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,994.32
|
Rate for Payer: PHCS Commercial |
$12,369.50
|
Rate for Payer: United Healthcare All Payer |
$11,338.71
|
|
RECON CONT ACT HA RG 46MM L
|
Facility
|
IP
|
$12,884.90
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,675.04 |
Max. Negotiated Rate |
$12,369.50 |
Rate for Payer: Aetna Commercial |
$9,921.37
|
Rate for Payer: Anthem POS/PPO/Traditional |
$10,050.22
|
Rate for Payer: Cash Price |
$6,442.45
|
Rate for Payer: Cigna Commercial |
$10,694.47
|
Rate for Payer: First Health Commercial |
$12,240.66
|
Rate for Payer: Humana Commercial |
$10,952.16
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$10,565.62
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,509.06
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$3,865.47
|
Rate for Payer: Ohio Health Choice Commercial |
$11,338.71
|
Rate for Payer: Ohio Health Group HMO |
$9,663.68
|
Rate for Payer: Ohio Health Group PPO Differential |
$2,576.98
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,675.04
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,994.32
|
Rate for Payer: PHCS Commercial |
$12,369.50
|
Rate for Payer: United Healthcare All Payer |
$11,338.71
|
|
RECON CONT ACT HA RG 46MM R
|
Facility
|
IP
|
$12,884.90
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,675.04 |
Max. Negotiated Rate |
$12,369.50 |
Rate for Payer: Aetna Commercial |
$9,921.37
|
Rate for Payer: Anthem POS/PPO/Traditional |
$10,050.22
|
Rate for Payer: Cash Price |
$6,442.45
|
Rate for Payer: Cigna Commercial |
$10,694.47
|
Rate for Payer: First Health Commercial |
$12,240.66
|
Rate for Payer: Humana Commercial |
$10,952.16
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$10,565.62
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,509.06
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$3,865.47
|
Rate for Payer: Ohio Health Choice Commercial |
$11,338.71
|
Rate for Payer: Ohio Health Group HMO |
$9,663.68
|
Rate for Payer: Ohio Health Group PPO Differential |
$2,576.98
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,675.04
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,994.32
|
Rate for Payer: PHCS Commercial |
$12,369.50
|
Rate for Payer: United Healthcare All Payer |
$11,338.71
|
|
RECON CONT ACT HA RG 46MM R
|
Facility
|
OP
|
$12,884.90
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,675.04 |
Max. Negotiated Rate |
$12,369.50 |
Rate for Payer: Aetna Commercial |
$9,921.37
|
Rate for Payer: Anthem Medicaid |
$4,431.12
|
Rate for Payer: Anthem POS/PPO/Traditional |
$10,050.22
|
Rate for Payer: Cash Price |
$6,442.45
|
Rate for Payer: Cigna Commercial |
$10,694.47
|
Rate for Payer: First Health Commercial |
$12,240.66
|
Rate for Payer: Humana Commercial |
$10,952.16
|
Rate for Payer: Humana KY Medicaid |
$4,431.12
|
Rate for Payer: Kentucky WC Medicaid |
$4,476.21
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$10,565.62
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,509.06
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$3,865.47
|
Rate for Payer: Molina Healthcare Medicaid |
$4,520.02
|
Rate for Payer: Ohio Health Choice Commercial |
$11,338.71
|
Rate for Payer: Ohio Health Group HMO |
$9,663.68
|
Rate for Payer: Ohio Health Group PPO Differential |
$2,576.98
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,675.04
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,994.32
|
Rate for Payer: PHCS Commercial |
$12,369.50
|
Rate for Payer: United Healthcare All Payer |
$11,338.71
|
|
RECON CONT ACT HA RG 52MM L
|
Facility
|
OP
|
$12,884.90
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,675.04 |
Max. Negotiated Rate |
$12,369.50 |
Rate for Payer: Aetna Commercial |
$9,921.37
|
Rate for Payer: Anthem Medicaid |
$4,431.12
|
Rate for Payer: Anthem POS/PPO/Traditional |
$10,050.22
|
Rate for Payer: Cash Price |
$6,442.45
|
Rate for Payer: Cigna Commercial |
$10,694.47
|
Rate for Payer: First Health Commercial |
$12,240.66
|
Rate for Payer: Humana Commercial |
$10,952.16
|
Rate for Payer: Humana KY Medicaid |
$4,431.12
|
Rate for Payer: Kentucky WC Medicaid |
$4,476.21
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$10,565.62
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,509.06
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$3,865.47
|
Rate for Payer: Molina Healthcare Medicaid |
$4,520.02
|
Rate for Payer: Ohio Health Choice Commercial |
$11,338.71
|
Rate for Payer: Ohio Health Group HMO |
$9,663.68
|
Rate for Payer: Ohio Health Group PPO Differential |
$2,576.98
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,675.04
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,994.32
|
Rate for Payer: PHCS Commercial |
$12,369.50
|
Rate for Payer: United Healthcare All Payer |
$11,338.71
|
|
RECON CONT ACT HA RG 52MM L
|
Facility
|
IP
|
$12,884.90
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,675.04 |
Max. Negotiated Rate |
$12,369.50 |
Rate for Payer: Aetna Commercial |
$9,921.37
|
Rate for Payer: Anthem POS/PPO/Traditional |
$10,050.22
|
Rate for Payer: Cash Price |
$6,442.45
|
Rate for Payer: Cigna Commercial |
$10,694.47
|
Rate for Payer: First Health Commercial |
$12,240.66
|
Rate for Payer: Humana Commercial |
$10,952.16
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$10,565.62
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,509.06
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$3,865.47
|
Rate for Payer: Ohio Health Choice Commercial |
$11,338.71
|
Rate for Payer: Ohio Health Group HMO |
$9,663.68
|
Rate for Payer: Ohio Health Group PPO Differential |
$2,576.98
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,675.04
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,994.32
|
Rate for Payer: PHCS Commercial |
$12,369.50
|
Rate for Payer: United Healthcare All Payer |
$11,338.71
|
|
RECON CONT ACT HA RG 52MM R
|
Facility
|
OP
|
$12,884.90
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,675.04 |
Max. Negotiated Rate |
$12,369.50 |
Rate for Payer: Aetna Commercial |
$9,921.37
|
Rate for Payer: Anthem Medicaid |
$4,431.12
|
Rate for Payer: Anthem POS/PPO/Traditional |
$10,050.22
|
Rate for Payer: Cash Price |
$6,442.45
|
Rate for Payer: Cigna Commercial |
$10,694.47
|
Rate for Payer: First Health Commercial |
$12,240.66
|
Rate for Payer: Humana Commercial |
$10,952.16
|
Rate for Payer: Humana KY Medicaid |
$4,431.12
|
Rate for Payer: Kentucky WC Medicaid |
$4,476.21
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$10,565.62
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,509.06
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$3,865.47
|
Rate for Payer: Molina Healthcare Medicaid |
$4,520.02
|
Rate for Payer: Ohio Health Choice Commercial |
$11,338.71
|
Rate for Payer: Ohio Health Group HMO |
$9,663.68
|
Rate for Payer: Ohio Health Group PPO Differential |
$2,576.98
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,675.04
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,994.32
|
Rate for Payer: PHCS Commercial |
$12,369.50
|
Rate for Payer: United Healthcare All Payer |
$11,338.71
|
|
RECON CONT ACT HA RG 52MM R
|
Facility
|
IP
|
$12,884.90
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,675.04 |
Max. Negotiated Rate |
$12,369.50 |
Rate for Payer: Aetna Commercial |
$9,921.37
|
Rate for Payer: Anthem POS/PPO/Traditional |
$10,050.22
|
Rate for Payer: Cash Price |
$6,442.45
|
Rate for Payer: Cigna Commercial |
$10,694.47
|
Rate for Payer: First Health Commercial |
$12,240.66
|
Rate for Payer: Humana Commercial |
$10,952.16
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$10,565.62
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,509.06
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$3,865.47
|
Rate for Payer: Ohio Health Choice Commercial |
$11,338.71
|
Rate for Payer: Ohio Health Group HMO |
$9,663.68
|
Rate for Payer: Ohio Health Group PPO Differential |
$2,576.98
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,675.04
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,994.32
|
Rate for Payer: PHCS Commercial |
$12,369.50
|
Rate for Payer: United Healthcare All Payer |
$11,338.71
|
|
RECON ROTAT CUFF AVULSION CH(P
|
Professional
|
Both
|
$2,475.00
|
|
Service Code
|
HCPCS 23420
|
Hospital Charge Code |
761P0459
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$820.33 |
Max. Negotiated Rate |
$2,475.00 |
Rate for Payer: Aetna Commercial |
$1,445.33
|
Rate for Payer: Anthem Medicaid |
$820.33
|
Rate for Payer: Buckeye Medicare Advantage |
$2,475.00
|
Rate for Payer: Cash Price |
$1,237.50
|
Rate for Payer: Cash Price |
$1,237.50
|
Rate for Payer: Cigna Commercial |
$1,694.43
|
Rate for Payer: Healthspan PPO |
$1,309.16
|
Rate for Payer: Humana Medicaid |
$820.33
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,208.17
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$836.74
|
Rate for Payer: Molina Healthcare Passport |
$820.33
|
Rate for Payer: Multiplan PHCS |
$1,485.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,732.50
|
Rate for Payer: UHCCP Medicaid |
$866.25
|
Rate for Payer: Wellcare CHIP/Medicaid |
$828.53
|
|
RECON ROTAT CUFF AVULSION CHR
|
Professional
|
Both
|
$2,475.00
|
|
Service Code
|
HCPCS 23420
|
Hospital Charge Code |
76100459
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$820.33 |
Max. Negotiated Rate |
$2,475.00 |
Rate for Payer: Aetna Commercial |
$1,445.33
|
Rate for Payer: Anthem Medicaid |
$820.33
|
Rate for Payer: Buckeye Medicare Advantage |
$2,475.00
|
Rate for Payer: Cash Price |
$1,237.50
|
Rate for Payer: Cash Price |
$1,237.50
|
Rate for Payer: Cigna Commercial |
$1,694.43
|
Rate for Payer: Healthspan PPO |
$1,309.16
|
Rate for Payer: Humana Medicaid |
$820.33
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,208.17
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$836.74
|
Rate for Payer: Molina Healthcare Passport |
$820.33
|
Rate for Payer: Multiplan PHCS |
$1,485.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,732.50
|
Rate for Payer: UHCCP Medicaid |
$866.25
|
Rate for Payer: Wellcare CHIP/Medicaid |
$828.53
|
|