|
REAMER LOW PROFILE 9MM
|
Facility
|
OP
|
$2,041.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.30 |
| Max. Negotiated Rate |
$1,959.36 |
| Rate for Payer: Aetna Commercial |
$1,571.57
|
| Rate for Payer: Anthem Medicaid |
$701.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,591.98
|
| Rate for Payer: Cash Price |
$1,020.50
|
| Rate for Payer: Cigna Commercial |
$1,694.03
|
| Rate for Payer: First Health Commercial |
$1,938.95
|
| Rate for Payer: Humana Commercial |
$1,734.85
|
| Rate for Payer: Humana KY Medicaid |
$701.90
|
| Rate for Payer: Kentucky WC Medicaid |
$709.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,673.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,506.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$715.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,796.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,530.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,632.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,775.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,408.29
|
| Rate for Payer: PHCS Commercial |
$1,959.36
|
| Rate for Payer: United Healthcare All Payer |
$1,796.08
|
|
|
REAMER LOW PROFILE 9MM
|
Facility
|
IP
|
$2,041.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.30 |
| Max. Negotiated Rate |
$1,959.36 |
| Rate for Payer: Aetna Commercial |
$1,571.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,591.98
|
| Rate for Payer: Cash Price |
$1,020.50
|
| Rate for Payer: Cigna Commercial |
$1,694.03
|
| Rate for Payer: First Health Commercial |
$1,938.95
|
| Rate for Payer: Humana Commercial |
$1,734.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,673.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,506.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,796.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,530.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,632.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,775.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,408.29
|
| Rate for Payer: PHCS Commercial |
$1,959.36
|
| Rate for Payer: United Healthcare All Payer |
$1,796.08
|
|
|
REAMER TRINKLE SHAFT 8*510MM
|
Facility
|
OP
|
$3,410.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,023.00 |
| Max. Negotiated Rate |
$3,273.60 |
| Rate for Payer: Aetna Commercial |
$2,625.70
|
| Rate for Payer: Anthem Medicaid |
$1,172.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,659.80
|
| Rate for Payer: Cash Price |
$1,705.00
|
| Rate for Payer: Cigna Commercial |
$2,830.30
|
| Rate for Payer: First Health Commercial |
$3,239.50
|
| Rate for Payer: Humana Commercial |
$2,898.50
|
| Rate for Payer: Humana KY Medicaid |
$1,172.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,184.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,796.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,516.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,023.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,196.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,000.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,557.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,966.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,352.90
|
| Rate for Payer: PHCS Commercial |
$3,273.60
|
| Rate for Payer: United Healthcare All Payer |
$3,000.80
|
|
|
REAMER TRINKLE SHAFT 8*510MM
|
Facility
|
IP
|
$3,410.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,023.00 |
| Max. Negotiated Rate |
$3,273.60 |
| Rate for Payer: Aetna Commercial |
$2,625.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,659.80
|
| Rate for Payer: Cash Price |
$1,705.00
|
| Rate for Payer: Cigna Commercial |
$2,830.30
|
| Rate for Payer: First Health Commercial |
$3,239.50
|
| Rate for Payer: Humana Commercial |
$2,898.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,796.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,516.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,023.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,000.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,557.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,966.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,352.90
|
| Rate for Payer: PHCS Commercial |
$3,273.60
|
| Rate for Payer: United Healthcare All Payer |
$3,000.80
|
|
|
REAMNG ROD W/BALL TIP 2.5*1150
|
Facility
|
IP
|
$1,846.93
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$554.08 |
| Max. Negotiated Rate |
$1,773.05 |
| Rate for Payer: Aetna Commercial |
$1,422.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,440.61
|
| Rate for Payer: Cash Price |
$923.47
|
| Rate for Payer: Cigna Commercial |
$1,532.95
|
| Rate for Payer: First Health Commercial |
$1,754.58
|
| Rate for Payer: Humana Commercial |
$1,569.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,514.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,363.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$554.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,625.30
|
| Rate for Payer: Ohio Health Group HMO |
$1,385.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,477.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,606.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,274.38
|
| Rate for Payer: PHCS Commercial |
$1,773.05
|
| Rate for Payer: United Healthcare All Payer |
$1,625.30
|
|
|
REAMNG ROD W/BALL TIP 2.5*1150
|
Facility
|
OP
|
$1,846.93
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$554.08 |
| Max. Negotiated Rate |
$1,773.05 |
| Rate for Payer: Aetna Commercial |
$1,422.14
|
| Rate for Payer: Anthem Medicaid |
$635.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,440.61
|
| Rate for Payer: Cash Price |
$923.47
|
| Rate for Payer: Cigna Commercial |
$1,532.95
|
| Rate for Payer: First Health Commercial |
$1,754.58
|
| Rate for Payer: Humana Commercial |
$1,569.89
|
| Rate for Payer: Humana KY Medicaid |
$635.16
|
| Rate for Payer: Kentucky WC Medicaid |
$641.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,514.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,363.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$554.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$647.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,625.30
|
| Rate for Payer: Ohio Health Group HMO |
$1,385.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,477.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,606.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,274.38
|
| Rate for Payer: PHCS Commercial |
$1,773.05
|
| Rate for Payer: United Healthcare All Payer |
$1,625.30
|
|
|
REAMP LEG TIBIA FIBULA
|
Facility
|
OP
|
$1,900.00
|
|
|
Service Code
|
HCPCS 27886
|
| Hospital Charge Code |
76100960
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$570.00 |
| 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 |
$1,520.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,653.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,311.00
|
| 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 |
$570.00 |
| 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 |
$1,520.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,653.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,311.00
|
| Rate for Payer: PHCS Commercial |
$1,824.00
|
| Rate for Payer: United Healthcare All Payer |
$1,672.00
|
|
|
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 |
$1,140.00 |
| Rate for Payer: Aetna Commercial |
$993.82
|
| Rate for Payer: Ambetter Exchange |
$614.43
|
| Rate for Payer: Anthem Medicaid |
$469.89
|
| Rate for Payer: Buckeye Individual/Medicaid |
$614.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$614.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$737.32
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$614.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$614.43
|
| 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 |
$798.76
|
| Rate for Payer: UHCCP Medicaid |
$665.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$474.59
|
| Rate for Payer: Wellcare Medicare Advantage |
$614.43
|
|
|
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 |
$1,140.00 |
| Rate for Payer: Aetna Commercial |
$993.82
|
| Rate for Payer: Ambetter Exchange |
$614.43
|
| Rate for Payer: Anthem Medicaid |
$469.89
|
| Rate for Payer: Buckeye Individual/Medicaid |
$614.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$614.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$737.32
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$614.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$614.43
|
| 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 |
$798.76
|
| Rate for Payer: UHCCP Medicaid |
$665.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$474.59
|
| Rate for Payer: Wellcare Medicare Advantage |
$614.43
|
|
|
REASSESSMENT EA 15 MIN
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
HCPCS 97803
|
| Hospital Charge Code |
51000052
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.60 |
| 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 |
$81.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$88.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$70.38
|
| 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 |
$61.20 |
| Rate for Payer: Aetna Commercial |
$37.40
|
| Rate for Payer: Ambetter Exchange |
$25.50
|
| 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 Individual/Medicaid |
$25.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$25.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$30.60
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$25.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.50
|
| 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 |
$33.15
|
| Rate for Payer: UHCCP Medicaid |
$16.86
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$11.99
|
| Rate for Payer: Wellcare Medicare Advantage |
$25.50
|
|
|
REASSESSMENT EA 15 MIN
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
HCPCS 97803
|
| Hospital Charge Code |
51000052
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.60 |
| 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 |
$81.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$88.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$70.38
|
| Rate for Payer: PHCS Commercial |
$97.92
|
| Rate for Payer: United Healthcare All Payer |
$89.76
|
|
|
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 |
$37.40 |
| Rate for Payer: Aetna Commercial |
$37.40
|
| Rate for Payer: Ambetter Exchange |
$25.50
|
| 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 Individual/Medicaid |
$25.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$25.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$30.60
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$25.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.50
|
| 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 |
$33.15
|
| Rate for Payer: UHCCP Medicaid |
$16.86
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$11.99
|
| Rate for Payer: Wellcare Medicare Advantage |
$25.50
|
|
|
REASSESSMENT EA 15 MIN(T
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
HCPCS 97803
|
| Hospital Charge Code |
510T0052
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$18.90 |
| 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 |
$50.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$54.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$43.47
|
| Rate for Payer: PHCS Commercial |
$60.48
|
| Rate for Payer: United Healthcare All Payer |
$55.44
|
|
|
REASSESSMENT EA 15 MIN(T
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
HCPCS 97803
|
| Hospital Charge Code |
510T0052
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$18.90 |
| 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 |
$50.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$54.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$43.47
|
| Rate for Payer: PHCS Commercial |
$60.48
|
| Rate for Payer: United Healthcare All Payer |
$55.44
|
|
|
REBLOZYL 0.25mg (25mg SDV)
|
Facility
|
IP
|
$21,977.07
|
|
|
Service Code
|
HCPCS J0896
|
| Hospital Charge Code |
25004303
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,593.12 |
| Max. Negotiated Rate |
$21,097.99 |
| Rate for Payer: Aetna Commercial |
$16,922.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,142.11
|
| Rate for Payer: Cash Price |
$10,988.53
|
| Rate for Payer: Cigna Commercial |
$18,240.97
|
| Rate for Payer: First Health Commercial |
$20,878.22
|
| Rate for Payer: Humana Commercial |
$18,680.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,021.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,219.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,593.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,339.82
|
| Rate for Payer: Ohio Health Group HMO |
$16,482.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,581.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,120.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,164.18
|
| Rate for Payer: PHCS Commercial |
$21,097.99
|
| Rate for Payer: United Healthcare All Payer |
$19,339.82
|
|
|
REBLOZYL 0.25mg (25mg SDV)
|
Facility
|
OP
|
$21,977.07
|
|
|
Service Code
|
HCPCS J0896
|
| Hospital Charge Code |
25004303
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.96 |
| Max. Negotiated Rate |
$21,097.99 |
| Rate for Payer: Aetna Commercial |
$16,922.34
|
| Rate for Payer: Anthem Medicaid |
$7,557.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$41.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,142.11
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$58.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$56.65
|
| Rate for Payer: Cash Price |
$10,988.53
|
| Rate for Payer: Cash Price |
$10,988.53
|
| Rate for Payer: Cigna Commercial |
$18,240.97
|
| Rate for Payer: First Health Commercial |
$20,878.22
|
| Rate for Payer: Humana Commercial |
$18,680.51
|
| Rate for Payer: Humana KY Medicaid |
$7,557.91
|
| Rate for Payer: Humana Medicare Advantage |
$41.96
|
| Rate for Payer: Kentucky WC Medicaid |
$7,634.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,021.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,219.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,709.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,339.82
|
| Rate for Payer: Ohio Health Group HMO |
$16,482.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,581.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,120.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,164.18
|
| Rate for Payer: PHCS Commercial |
$21,097.99
|
| Rate for Payer: United Healthcare All Payer |
$19,339.82
|
|
|
REBLOZYL 0.25mg (75mg SDV)
|
Facility
|
IP
|
$65,930.94
|
|
|
Service Code
|
HCPCS J0896
|
| Hospital Charge Code |
25004304
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19,779.28 |
| Max. Negotiated Rate |
$63,293.70 |
| Rate for Payer: Aetna Commercial |
$50,766.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$51,426.13
|
| Rate for Payer: Cash Price |
$32,965.47
|
| Rate for Payer: Cigna Commercial |
$54,722.68
|
| Rate for Payer: First Health Commercial |
$62,634.39
|
| Rate for Payer: Humana Commercial |
$56,041.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54,063.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48,657.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19,779.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$58,019.23
|
| Rate for Payer: Ohio Health Group HMO |
$49,448.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52,744.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57,359.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$45,492.35
|
| Rate for Payer: PHCS Commercial |
$63,293.70
|
| Rate for Payer: United Healthcare All Payer |
$58,019.23
|
|
|
REBLOZYL 0.25mg (75mg SDV)
|
Facility
|
OP
|
$65,930.94
|
|
|
Service Code
|
HCPCS J0896
|
| Hospital Charge Code |
25004304
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.96 |
| Max. Negotiated Rate |
$63,293.70 |
| Rate for Payer: Aetna Commercial |
$50,766.82
|
| Rate for Payer: Anthem Medicaid |
$22,673.65
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$41.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$51,426.13
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$58.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$56.65
|
| Rate for Payer: Cash Price |
$32,965.47
|
| Rate for Payer: Cash Price |
$32,965.47
|
| Rate for Payer: Cigna Commercial |
$54,722.68
|
| Rate for Payer: First Health Commercial |
$62,634.39
|
| Rate for Payer: Humana Commercial |
$56,041.30
|
| Rate for Payer: Humana KY Medicaid |
$22,673.65
|
| Rate for Payer: Humana Medicare Advantage |
$41.96
|
| Rate for Payer: Kentucky WC Medicaid |
$22,904.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54,063.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48,657.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$23,128.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$58,019.23
|
| Rate for Payer: Ohio Health Group HMO |
$49,448.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52,744.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57,359.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$45,492.35
|
| Rate for Payer: PHCS Commercial |
$63,293.70
|
| Rate for Payer: United Healthcare All Payer |
$58,019.23
|
|
|
REBUILD EARDRUM STRUCTURES
|
Facility
|
IP
|
$3,400.00
|
|
|
Service Code
|
HCPCS 69637
|
| Hospital Charge Code |
76102432
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,020.00 |
| 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 |
$2,720.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,958.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,346.00
|
| 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 |
$1,169.26 |
| Max. Negotiated Rate |
$7,652.33 |
| Rate for Payer: Aetna Commercial |
$2,618.00
|
| Rate for Payer: Anthem Medicaid |
$1,169.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,465.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,652.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,652.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,379.03
|
| 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 |
$5,465.95
|
| 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 |
$6,559.14
|
| 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 |
$2,720.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,958.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,346.00
|
| Rate for Payer: PHCS Commercial |
$3,264.00
|
| Rate for Payer: United Healthcare All Payer |
$2,992.00
|
|
|
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 |
$2,040.00 |
| Rate for Payer: Aetna Commercial |
$1,952.82
|
| Rate for Payer: Ambetter Exchange |
$1,293.75
|
| Rate for Payer: Anthem Medicaid |
$994.28
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,293.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,293.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,552.50
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,293.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,293.75
|
| 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 |
$1,681.88
|
| Rate for Payer: UHCCP Medicaid |
$1,190.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,004.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,293.75
|
|
|
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 |
$2,040.00 |
| Rate for Payer: Aetna Commercial |
$1,952.82
|
| Rate for Payer: Ambetter Exchange |
$1,293.75
|
| Rate for Payer: Anthem Medicaid |
$994.28
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,293.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,293.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,552.50
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,293.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,293.75
|
| 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 |
$1,681.88
|
| Rate for Payer: UHCCP Medicaid |
$1,190.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,004.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,293.75
|
|
|
REBUILD OUTER EAR CANAL
|
Facility
|
IP
|
$2,600.00
|
|
|
Service Code
|
HCPCS 69310
|
| Hospital Charge Code |
76102416
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$780.00 |
| 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 |
$2,080.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,262.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,794.00
|
| Rate for Payer: PHCS Commercial |
$2,496.00
|
| Rate for Payer: United Healthcare All Payer |
$2,288.00
|
|
