|
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 |
$1,560.00 |
| Rate for Payer: Aetna Commercial |
$1,525.04
|
| Rate for Payer: Ambetter Exchange |
$1,026.14
|
| Rate for Payer: Anthem Medicaid |
$600.92
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,026.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,026.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,231.37
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,026.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,026.14
|
| 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 |
$1,333.98
|
| Rate for Payer: UHCCP Medicaid |
$910.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$606.93
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,026.14
|
|
|
REBUILD OUTER EAR CANAL
|
Facility
|
OP
|
$2,600.00
|
|
|
Service Code
|
HCPCS 69310
|
| Hospital Charge Code |
76102416
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$894.14 |
| Max. Negotiated Rate |
$7,652.33 |
| Rate for Payer: Aetna Commercial |
$2,002.00
|
| Rate for Payer: Anthem Medicaid |
$894.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,465.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,028.00
|
| 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 |
$1,300.00
|
| 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 |
$5,465.95
|
| 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 |
$6,559.14
|
| 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 |
$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
|
|
|
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 |
$1,560.00 |
| Rate for Payer: Aetna Commercial |
$1,525.04
|
| Rate for Payer: Ambetter Exchange |
$1,026.14
|
| Rate for Payer: Anthem Medicaid |
$600.92
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,026.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,026.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,231.37
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,026.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,026.14
|
| 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 |
$1,333.98
|
| Rate for Payer: UHCCP Medicaid |
$910.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$606.93
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,026.14
|
|
|
RECARBRIO 1.25 GM/20 ML VIAL
|
Facility
|
IP
|
$847.50
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003950
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$254.25 |
| 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 |
$678.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$737.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$584.77
|
| 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
|
890
|
| Min. Negotiated Rate |
$254.25 |
| 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 |
$678.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$737.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$584.77
|
| Rate for Payer: PHCS Commercial |
$813.60
|
| Rate for Payer: United Healthcare All Payer |
$745.80
|
|
|
RECHANNELING ARTERY ENDAR.
|
Facility
|
OP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 35371
|
| Hospital Charge Code |
76101388
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$750.00 |
| 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 |
$2,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,175.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,725.00
|
| Rate for Payer: PHCS Commercial |
$2,400.00
|
| Rate for Payer: United Healthcare All Payer |
$2,200.00
|
|
|
RECHANNELING ARTERY ENDAR.
|
Facility
|
IP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 35371
|
| Hospital Charge Code |
76101388
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$750.00 |
| 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 |
$2,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,175.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,725.00
|
| Rate for Payer: PHCS Commercial |
$2,400.00
|
| Rate for Payer: United Healthcare All Payer |
$2,200.00
|
|
|
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 |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$1,456.40
|
| Rate for Payer: Ambetter Exchange |
$762.90
|
| Rate for Payer: Anthem Medicaid |
$704.10
|
| Rate for Payer: Buckeye Individual/Medicaid |
$762.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$762.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$915.48
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$762.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$762.90
|
| 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 |
$991.77
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$711.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$762.90
|
|
|
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 |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$1,456.40
|
| Rate for Payer: Ambetter Exchange |
$762.90
|
| Rate for Payer: Anthem Medicaid |
$704.10
|
| Rate for Payer: Buckeye Individual/Medicaid |
$762.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$762.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$915.48
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$762.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$762.90
|
| 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 |
$991.77
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$711.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$762.90
|
|
|
RECHANNELING OF ARTERY
|
Professional
|
Both
|
$3,690.00
|
|
|
Service Code
|
HCPCS 35361
|
| Hospital Charge Code |
76102995
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,263.78 |
| Max. Negotiated Rate |
$2,805.25 |
| Rate for Payer: Aetna Commercial |
$2,805.25
|
| Rate for Payer: Ambetter Exchange |
$1,433.03
|
| Rate for Payer: Anthem Medicaid |
$1,263.78
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,433.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,433.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,719.64
|
| Rate for Payer: Cash Price |
$1,845.00
|
| Rate for Payer: Cash Price |
$1,845.00
|
| Rate for Payer: Cigna Commercial |
$2,664.79
|
| Rate for Payer: Healthspan PPO |
$2,758.11
|
| Rate for Payer: Humana Medicaid |
$1,263.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,141.61
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,433.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,433.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,289.06
|
| Rate for Payer: Molina Healthcare Passport |
$1,263.78
|
| Rate for Payer: Multiplan PHCS |
$2,214.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,862.94
|
| Rate for Payer: UHCCP Medicaid |
$1,291.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,276.42
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,433.03
|
|
|
RECLAST 5MG(ZOLEDRONICACID)INJ
|
Facility
|
OP
|
$1,635.00
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
25002455
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$490.50 |
| 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 |
$1,308.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,422.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,128.15
|
| Rate for Payer: PHCS Commercial |
$1,569.60
|
| Rate for Payer: United Healthcare All Payer |
$1,438.80
|
|
|
RECLAST 5MG(ZOLEDRONICACID)INJ
|
Facility
|
IP
|
$1,635.00
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
25002455
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$490.50 |
| 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 |
$1,308.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,422.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,128.15
|
| Rate for Payer: PHCS Commercial |
$1,569.60
|
| Rate for Payer: United Healthcare All Payer |
$1,438.80
|
|
|
RECOMBIVAX HB 5mcg/0.5mL SDV
|
Facility
|
IP
|
$183.16
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
770T0141
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.95 |
| 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 |
$146.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$159.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$126.38
|
| Rate for Payer: PHCS Commercial |
$175.83
|
| Rate for Payer: United Healthcare All Payer |
$161.18
|
|
|
RECOMBIVAX HB 5mcg/0.5mL SDV
|
Facility
|
IP
|
$183.16
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
77000141
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.95 |
| 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 |
$146.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$159.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$126.38
|
| Rate for Payer: PHCS Commercial |
$175.83
|
| Rate for Payer: United Healthcare All Payer |
$161.18
|
|
|
RECOMBIVAX HB 5mcg/0.5mL SDV
|
Professional
|
Both
|
$183.16
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
77000141
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.22 |
| Max. Negotiated Rate |
$109.90 |
| Rate for Payer: Ambetter Exchange |
$31.67
|
| Rate for Payer: Anthem Medicaid |
$24.22
|
| Rate for Payer: Buckeye Individual/Medicaid |
$31.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$31.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$38.00
|
| Rate for Payer: Cash Price |
$91.58
|
| Rate for Payer: Cash Price |
$91.58
|
| Rate for Payer: Healthspan PPO |
$32.89
|
| Rate for Payer: Humana Medicaid |
$24.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$41.88
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$31.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$31.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$24.70
|
| Rate for Payer: Molina Healthcare Passport |
$24.22
|
| Rate for Payer: Multiplan PHCS |
$109.90
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$41.17
|
| Rate for Payer: UHCCP Medicaid |
$64.11
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$24.46
|
| Rate for Payer: Wellcare Medicare Advantage |
$31.67
|
|
|
RECOMBIVAX HB 5mcg/0.5mL SDV
|
Facility
|
OP
|
$183.16
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
770T0141
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.95 |
| Max. Negotiated Rate |
$175.83 |
| Rate for Payer: Aetna Commercial |
$141.03
|
| 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: 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 |
$146.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$159.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$126.38
|
| Rate for Payer: PHCS Commercial |
$175.83
|
| Rate for Payer: United Healthcare All Payer |
$161.18
|
|
|
RECOMBIVAX HB 5mcg/0.5mL SDV
|
Facility
|
OP
|
$183.16
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
77000141
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.95 |
| Max. Negotiated Rate |
$175.83 |
| Rate for Payer: Aetna Commercial |
$141.03
|
| 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: 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 |
$146.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$159.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$126.38
|
| 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 |
$54.95 |
| Max. Negotiated Rate |
$175.83 |
| Rate for Payer: Aetna Commercial |
$141.03
|
| 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: 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 |
$146.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$159.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$126.38
|
| Rate for Payer: PHCS Commercial |
$175.83
|
| Rate for Payer: United Healthcare All Payer |
$161.18
|
|
|
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 |
$54.95 |
| 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 |
$146.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$159.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$126.38
|
| Rate for Payer: PHCS Commercial |
$175.83
|
| Rate for Payer: United Healthcare All Payer |
$161.18
|
|
|
RECON CONT ACT HA RG 46MM L
|
Facility
|
IP
|
$13,137.42
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,941.23 |
| Max. Negotiated Rate |
$12,611.92 |
| Rate for Payer: Aetna Commercial |
$10,115.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,247.19
|
| Rate for Payer: Cash Price |
$6,568.71
|
| Rate for Payer: Cigna Commercial |
$10,904.06
|
| Rate for Payer: First Health Commercial |
$12,480.55
|
| Rate for Payer: Humana Commercial |
$11,166.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,772.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,695.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,941.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,560.93
|
| Rate for Payer: Ohio Health Group HMO |
$9,853.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,509.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,429.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,064.82
|
| Rate for Payer: PHCS Commercial |
$12,611.92
|
| Rate for Payer: United Healthcare All Payer |
$11,560.93
|
|
|
RECON CONT ACT HA RG 46MM L
|
Facility
|
OP
|
$13,137.42
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,941.23 |
| Max. Negotiated Rate |
$12,611.92 |
| Rate for Payer: Aetna Commercial |
$10,115.81
|
| Rate for Payer: Anthem Medicaid |
$4,517.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,247.19
|
| Rate for Payer: Cash Price |
$6,568.71
|
| Rate for Payer: Cigna Commercial |
$10,904.06
|
| Rate for Payer: First Health Commercial |
$12,480.55
|
| Rate for Payer: Humana Commercial |
$11,166.81
|
| Rate for Payer: Humana KY Medicaid |
$4,517.96
|
| Rate for Payer: Kentucky WC Medicaid |
$4,563.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,772.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,695.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,941.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,608.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,560.93
|
| Rate for Payer: Ohio Health Group HMO |
$9,853.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,509.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,429.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,064.82
|
| Rate for Payer: PHCS Commercial |
$12,611.92
|
| Rate for Payer: United Healthcare All Payer |
$11,560.93
|
|
|
RECON CONT ACT HA RG 46MM R
|
Facility
|
IP
|
$13,137.42
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,941.23 |
| Max. Negotiated Rate |
$12,611.92 |
| Rate for Payer: Aetna Commercial |
$10,115.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,247.19
|
| Rate for Payer: Cash Price |
$6,568.71
|
| Rate for Payer: Cigna Commercial |
$10,904.06
|
| Rate for Payer: First Health Commercial |
$12,480.55
|
| Rate for Payer: Humana Commercial |
$11,166.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,772.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,695.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,941.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,560.93
|
| Rate for Payer: Ohio Health Group HMO |
$9,853.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,509.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,429.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,064.82
|
| Rate for Payer: PHCS Commercial |
$12,611.92
|
| Rate for Payer: United Healthcare All Payer |
$11,560.93
|
|
|
RECON CONT ACT HA RG 46MM R
|
Facility
|
OP
|
$13,137.42
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,941.23 |
| Max. Negotiated Rate |
$12,611.92 |
| Rate for Payer: Aetna Commercial |
$10,115.81
|
| Rate for Payer: Anthem Medicaid |
$4,517.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,247.19
|
| Rate for Payer: Cash Price |
$6,568.71
|
| Rate for Payer: Cigna Commercial |
$10,904.06
|
| Rate for Payer: First Health Commercial |
$12,480.55
|
| Rate for Payer: Humana Commercial |
$11,166.81
|
| Rate for Payer: Humana KY Medicaid |
$4,517.96
|
| Rate for Payer: Kentucky WC Medicaid |
$4,563.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,772.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,695.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,941.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,608.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,560.93
|
| Rate for Payer: Ohio Health Group HMO |
$9,853.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,509.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,429.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,064.82
|
| Rate for Payer: PHCS Commercial |
$12,611.92
|
| Rate for Payer: United Healthcare All Payer |
$11,560.93
|
|
|
RECON CONT ACT HA RG 52MM L
|
Facility
|
OP
|
$13,137.42
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,941.23 |
| Max. Negotiated Rate |
$12,611.92 |
| Rate for Payer: Aetna Commercial |
$10,115.81
|
| Rate for Payer: Anthem Medicaid |
$4,517.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,247.19
|
| Rate for Payer: Cash Price |
$6,568.71
|
| Rate for Payer: Cigna Commercial |
$10,904.06
|
| Rate for Payer: First Health Commercial |
$12,480.55
|
| Rate for Payer: Humana Commercial |
$11,166.81
|
| Rate for Payer: Humana KY Medicaid |
$4,517.96
|
| Rate for Payer: Kentucky WC Medicaid |
$4,563.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,772.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,695.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,941.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,608.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,560.93
|
| Rate for Payer: Ohio Health Group HMO |
$9,853.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,509.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,429.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,064.82
|
| Rate for Payer: PHCS Commercial |
$12,611.92
|
| Rate for Payer: United Healthcare All Payer |
$11,560.93
|
|
|
RECON CONT ACT HA RG 52MM L
|
Facility
|
IP
|
$13,137.42
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,941.23 |
| Max. Negotiated Rate |
$12,611.92 |
| Rate for Payer: Aetna Commercial |
$10,115.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,247.19
|
| Rate for Payer: Cash Price |
$6,568.71
|
| Rate for Payer: Cigna Commercial |
$10,904.06
|
| Rate for Payer: First Health Commercial |
$12,480.55
|
| Rate for Payer: Humana Commercial |
$11,166.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,772.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,695.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,941.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,560.93
|
| Rate for Payer: Ohio Health Group HMO |
$9,853.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,509.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,429.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,064.82
|
| Rate for Payer: PHCS Commercial |
$12,611.92
|
| Rate for Payer: United Healthcare All Payer |
$11,560.93
|
|
