|
RELISTOR (12MG/0.6ML V)0.1 MG
|
Facility
|
IP
|
$597.93
|
|
|
Service Code
|
HCPCS J2212
|
| Hospital Charge Code |
25002230
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$179.38 |
| Max. Negotiated Rate |
$574.01 |
| Rate for Payer: Aetna Commercial |
$460.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$466.39
|
| Rate for Payer: Cash Price |
$298.96
|
| Rate for Payer: Cigna Commercial |
$496.28
|
| Rate for Payer: First Health Commercial |
$568.03
|
| Rate for Payer: Humana Commercial |
$508.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$490.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$441.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$179.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$526.18
|
| Rate for Payer: Ohio Health Group HMO |
$448.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$478.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$520.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$412.57
|
| Rate for Payer: PHCS Commercial |
$574.01
|
| Rate for Payer: United Healthcare All Payer |
$526.18
|
|
|
RELOCATE POCKET FOR DEFIB
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 33223
|
| Hospital Charge Code |
76101255
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$515.85 |
| Max. Negotiated Rate |
$2,366.24 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem Medicaid |
$515.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,690.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,366.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,281.73
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Humana KY Medicaid |
$515.85
|
| Rate for Payer: Humana Medicare Advantage |
$1,690.17
|
| Rate for Payer: Kentucky WC Medicaid |
$521.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,028.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$526.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,305.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,035.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
RELOCATE POCKET FOR DEFIB
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 33223
|
| Hospital Charge Code |
76101255
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$450.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,305.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,035.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
RELOCATE POCKET FOR DEFIB
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 33223
|
| Hospital Charge Code |
76101255
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$357.60 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Aetna Commercial |
$716.78
|
| Rate for Payer: Ambetter Exchange |
$380.93
|
| Rate for Payer: Anthem Medicaid |
$357.60
|
| Rate for Payer: Buckeye Individual/Medicaid |
$380.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$380.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$457.12
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$684.19
|
| Rate for Payer: Healthspan PPO |
$704.74
|
| Rate for Payer: Humana Medicaid |
$357.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$585.81
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$380.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$380.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$364.75
|
| Rate for Payer: Molina Healthcare Passport |
$357.60
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$495.21
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$361.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$380.93
|
|
|
RELOCATE POCKET FOR DEFIB(P
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 33223
|
| Hospital Charge Code |
761P1255
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$357.60 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Aetna Commercial |
$716.78
|
| Rate for Payer: Ambetter Exchange |
$380.93
|
| Rate for Payer: Anthem Medicaid |
$357.60
|
| Rate for Payer: Buckeye Individual/Medicaid |
$380.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$380.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$457.12
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$684.19
|
| Rate for Payer: Healthspan PPO |
$704.74
|
| Rate for Payer: Humana Medicaid |
$357.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$585.81
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$380.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$380.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$364.75
|
| Rate for Payer: Molina Healthcare Passport |
$357.60
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$495.21
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$361.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$380.93
|
|
|
RELOCATE POCKET FOR PACEMAKE(P
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 33222
|
| Hospital Charge Code |
761P1254
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$312.11 |
| Max. Negotiated Rate |
$660.00 |
| Rate for Payer: Aetna Commercial |
$592.70
|
| Rate for Payer: Ambetter Exchange |
$319.50
|
| Rate for Payer: Anthem Medicaid |
$312.11
|
| Rate for Payer: Buckeye Individual/Medicaid |
$319.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$319.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$383.40
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$573.64
|
| Rate for Payer: Healthspan PPO |
$582.74
|
| Rate for Payer: Humana Medicaid |
$312.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$486.42
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$319.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$319.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$318.35
|
| Rate for Payer: Molina Healthcare Passport |
$312.11
|
| Rate for Payer: Multiplan PHCS |
$660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$415.35
|
| Rate for Payer: UHCCP Medicaid |
$385.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$315.23
|
| Rate for Payer: Wellcare Medicare Advantage |
$319.50
|
|
|
RELOCATE POCKET FOR PACEMAKER
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 33222
|
| Hospital Charge Code |
76101254
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$312.11 |
| Max. Negotiated Rate |
$660.00 |
| Rate for Payer: Aetna Commercial |
$592.70
|
| Rate for Payer: Ambetter Exchange |
$319.50
|
| Rate for Payer: Anthem Medicaid |
$312.11
|
| Rate for Payer: Buckeye Individual/Medicaid |
$319.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$319.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$383.40
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$573.64
|
| Rate for Payer: Healthspan PPO |
$582.74
|
| Rate for Payer: Humana Medicaid |
$312.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$486.42
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$319.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$319.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$318.35
|
| Rate for Payer: Molina Healthcare Passport |
$312.11
|
| Rate for Payer: Multiplan PHCS |
$660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$415.35
|
| Rate for Payer: UHCCP Medicaid |
$385.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$315.23
|
| Rate for Payer: Wellcare Medicare Advantage |
$319.50
|
|
|
RELOCATE POCKET FOR PACEMAKER
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 33222
|
| Hospital Charge Code |
76101254
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$330.00 |
| Max. Negotiated Rate |
$1,056.00 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$913.00
|
| Rate for Payer: First Health Commercial |
$1,045.00
|
| Rate for Payer: Humana Commercial |
$935.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$902.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$330.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$968.00
|
| Rate for Payer: Ohio Health Group HMO |
$825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$759.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
RELOCATE POCKET FOR PACEMAKER
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 33222
|
| Hospital Charge Code |
76101254
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$378.29 |
| Max. Negotiated Rate |
$2,366.24 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem Medicaid |
$378.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,690.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,366.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,281.73
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$913.00
|
| Rate for Payer: First Health Commercial |
$1,045.00
|
| Rate for Payer: Humana Commercial |
$935.00
|
| Rate for Payer: Humana KY Medicaid |
$378.29
|
| Rate for Payer: Humana Medicare Advantage |
$1,690.17
|
| Rate for Payer: Kentucky WC Medicaid |
$382.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$902.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,028.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$385.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$968.00
|
| Rate for Payer: Ohio Health Group HMO |
$825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$759.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
RELOCATION OF SKIN POCKET FOR IMPLANTABLE DEFIBRILLATOR
|
Facility
|
OP
|
$2,366.24
|
|
|
Service Code
|
CPT 33223
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,690.17 |
| Max. Negotiated Rate |
$2,366.24 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,690.17
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,366.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,281.73
|
| Rate for Payer: Humana Medicare Advantage |
$1,690.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,028.20
|
|
|
REM CERCLAGE SUTURE UNDER ANES
|
Facility
|
OP
|
$325.00
|
|
|
Service Code
|
HCPCS 59871
|
| Hospital Charge Code |
76102734
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$111.77 |
| Max. Negotiated Rate |
$4,112.95 |
| Rate for Payer: Aetna Commercial |
$250.25
|
| Rate for Payer: Anthem Medicaid |
$111.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,937.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$253.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,112.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,966.06
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cigna Commercial |
$269.75
|
| Rate for Payer: First Health Commercial |
$308.75
|
| Rate for Payer: Humana Commercial |
$276.25
|
| Rate for Payer: Humana KY Medicaid |
$111.77
|
| Rate for Payer: Humana Medicare Advantage |
$2,937.82
|
| Rate for Payer: Kentucky WC Medicaid |
$112.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$266.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$239.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,525.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$114.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$286.00
|
| Rate for Payer: Ohio Health Group HMO |
$243.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$282.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$224.25
|
| Rate for Payer: PHCS Commercial |
$312.00
|
| Rate for Payer: United Healthcare All Payer |
$286.00
|
|
|
REM CERCLAGE SUTURE UNDER ANES
|
Facility
|
IP
|
$325.00
|
|
|
Service Code
|
HCPCS 59871
|
| Hospital Charge Code |
76102734
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.50 |
| Max. Negotiated Rate |
$312.00 |
| Rate for Payer: Aetna Commercial |
$250.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$253.50
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cigna Commercial |
$269.75
|
| Rate for Payer: First Health Commercial |
$308.75
|
| Rate for Payer: Humana Commercial |
$276.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$266.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$239.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$286.00
|
| Rate for Payer: Ohio Health Group HMO |
$243.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$282.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$224.25
|
| Rate for Payer: PHCS Commercial |
$312.00
|
| Rate for Payer: United Healthcare All Payer |
$286.00
|
|
|
REM CERCLAGE SUTURE UNDER ANES
|
Professional
|
Both
|
$325.00
|
|
|
Service Code
|
HCPCS 59871
|
| Hospital Charge Code |
76102734
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$113.75 |
| Max. Negotiated Rate |
$222.67 |
| Rate for Payer: Aetna Commercial |
$222.67
|
| Rate for Payer: Ambetter Exchange |
$126.82
|
| Rate for Payer: Anthem Medicaid |
$117.25
|
| Rate for Payer: Buckeye Individual/Medicaid |
$126.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$126.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$152.18
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cigna Commercial |
$206.50
|
| Rate for Payer: Healthspan PPO |
$161.61
|
| Rate for Payer: Humana Medicaid |
$117.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$178.24
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$126.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$126.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$119.59
|
| Rate for Payer: Molina Healthcare Passport |
$117.25
|
| Rate for Payer: Multiplan PHCS |
$195.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$164.87
|
| Rate for Payer: UHCCP Medicaid |
$113.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$118.42
|
| Rate for Payer: Wellcare Medicare Advantage |
$126.82
|
|
|
REM CERCLAGE SUTURE W/O ANES
|
Professional
|
Both
|
$325.00
|
|
|
Service Code
|
HCPCS 59899
|
| Hospital Charge Code |
76102905
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$227.50 |
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$195.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$227.50
|
| Rate for Payer: UHCCP Medicaid |
$113.75
|
|
|
REM CERCLAGE SUTURE W/O ANES
|
Facility
|
IP
|
$325.00
|
|
|
Service Code
|
HCPCS 59899
|
| Hospital Charge Code |
76102905
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$97.50 |
| Max. Negotiated Rate |
$312.00 |
| Rate for Payer: Aetna Commercial |
$250.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$253.50
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cigna Commercial |
$269.75
|
| Rate for Payer: First Health Commercial |
$308.75
|
| Rate for Payer: Humana Commercial |
$276.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$266.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$239.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$286.00
|
| Rate for Payer: Ohio Health Group HMO |
$243.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$282.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$224.25
|
| Rate for Payer: PHCS Commercial |
$312.00
|
| Rate for Payer: United Healthcare All Payer |
$286.00
|
|
|
REM CERCLAGE SUTURE W/O ANES
|
Facility
|
OP
|
$325.00
|
|
|
Service Code
|
HCPCS 59899
|
| Hospital Charge Code |
76102905
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$111.77 |
| Max. Negotiated Rate |
$312.00 |
| Rate for Payer: Aetna Commercial |
$250.25
|
| Rate for Payer: Anthem Medicaid |
$111.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$185.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$253.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$260.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$250.94
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cigna Commercial |
$269.75
|
| Rate for Payer: First Health Commercial |
$308.75
|
| Rate for Payer: Humana Commercial |
$276.25
|
| Rate for Payer: Humana KY Medicaid |
$111.77
|
| Rate for Payer: Humana Medicare Advantage |
$185.88
|
| Rate for Payer: Kentucky WC Medicaid |
$112.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$266.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$239.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$223.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$114.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$286.00
|
| Rate for Payer: Ohio Health Group HMO |
$243.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$282.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$224.25
|
| Rate for Payer: PHCS Commercial |
$312.00
|
| Rate for Payer: United Healthcare All Payer |
$286.00
|
|
|
REMDESIVIR 100 MG/20 ML VIAL
|
Facility
|
OP
|
$3,459.93
|
|
|
Service Code
|
HCPCS J0248
|
| Hospital Charge Code |
25003942
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.73 |
| Max. Negotiated Rate |
$3,321.53 |
| Rate for Payer: Aetna Commercial |
$2,664.15
|
| Rate for Payer: Anthem Medicaid |
$1,189.87
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,698.75
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.09
|
| Rate for Payer: Cash Price |
$1,729.96
|
| Rate for Payer: Cash Price |
$1,729.96
|
| Rate for Payer: Cigna Commercial |
$2,871.74
|
| Rate for Payer: First Health Commercial |
$3,286.93
|
| Rate for Payer: Humana Commercial |
$2,940.94
|
| Rate for Payer: Humana KY Medicaid |
$1,189.87
|
| Rate for Payer: Humana Medicare Advantage |
$6.73
|
| Rate for Payer: Kentucky WC Medicaid |
$1,201.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,837.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,553.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,213.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,044.74
|
| Rate for Payer: Ohio Health Group HMO |
$2,594.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,767.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,010.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,387.35
|
| Rate for Payer: PHCS Commercial |
$3,321.53
|
| Rate for Payer: United Healthcare All Payer |
$3,044.74
|
|
|
REMDESIVIR 100 MG/20 ML VIAL
|
Facility
|
IP
|
$3,459.93
|
|
|
Service Code
|
HCPCS J0248
|
| Hospital Charge Code |
25003942
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,037.98 |
| Max. Negotiated Rate |
$3,321.53 |
| Rate for Payer: Aetna Commercial |
$2,664.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,698.75
|
| Rate for Payer: Cash Price |
$1,729.96
|
| Rate for Payer: Cigna Commercial |
$2,871.74
|
| Rate for Payer: First Health Commercial |
$3,286.93
|
| Rate for Payer: Humana Commercial |
$2,940.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,837.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,553.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,037.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,044.74
|
| Rate for Payer: Ohio Health Group HMO |
$2,594.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,767.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,010.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,387.35
|
| Rate for Payer: PHCS Commercial |
$3,321.53
|
| Rate for Payer: United Healthcare All Payer |
$3,044.74
|
|
|
REMDESIVIR 1mg(100mg Vial)
|
Facility
|
OP
|
$3,459.93
|
|
|
Service Code
|
HCPCS J0248
|
| Hospital Charge Code |
25004179
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.73 |
| Max. Negotiated Rate |
$3,321.53 |
| Rate for Payer: Aetna Commercial |
$2,664.15
|
| Rate for Payer: Anthem Medicaid |
$1,189.87
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,698.75
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.09
|
| Rate for Payer: Cash Price |
$1,729.96
|
| Rate for Payer: Cash Price |
$1,729.96
|
| Rate for Payer: Cigna Commercial |
$2,871.74
|
| Rate for Payer: First Health Commercial |
$3,286.93
|
| Rate for Payer: Humana Commercial |
$2,940.94
|
| Rate for Payer: Humana KY Medicaid |
$1,189.87
|
| Rate for Payer: Humana Medicare Advantage |
$6.73
|
| Rate for Payer: Kentucky WC Medicaid |
$1,201.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,837.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,553.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,213.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,044.74
|
| Rate for Payer: Ohio Health Group HMO |
$2,594.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,767.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,010.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,387.35
|
| Rate for Payer: PHCS Commercial |
$3,321.53
|
| Rate for Payer: United Healthcare All Payer |
$3,044.74
|
|
|
REMDESIVIR 1mg(100mg Vial)
|
Facility
|
IP
|
$3,459.93
|
|
|
Service Code
|
HCPCS J0248
|
| Hospital Charge Code |
25004179
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,037.98 |
| Max. Negotiated Rate |
$3,321.53 |
| Rate for Payer: Aetna Commercial |
$2,664.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,698.75
|
| Rate for Payer: Cash Price |
$1,729.96
|
| Rate for Payer: Cigna Commercial |
$2,871.74
|
| Rate for Payer: First Health Commercial |
$3,286.93
|
| Rate for Payer: Humana Commercial |
$2,940.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,837.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,553.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,037.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,044.74
|
| Rate for Payer: Ohio Health Group HMO |
$2,594.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,767.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,010.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,387.35
|
| Rate for Payer: PHCS Commercial |
$3,321.53
|
| Rate for Payer: United Healthcare All Payer |
$3,044.74
|
|
|
REMEDY ACET CUP 46MM ID/54MM O
|
Facility
|
IP
|
$8,201.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,460.38 |
| Max. Negotiated Rate |
$7,873.20 |
| Rate for Payer: Aetna Commercial |
$6,314.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,396.98
|
| Rate for Payer: Cash Price |
$4,100.62
|
| Rate for Payer: Cigna Commercial |
$6,807.04
|
| Rate for Payer: First Health Commercial |
$7,791.19
|
| Rate for Payer: Humana Commercial |
$6,971.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,725.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,052.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,460.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,217.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,150.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,561.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,135.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,658.86
|
| Rate for Payer: PHCS Commercial |
$7,873.20
|
| Rate for Payer: United Healthcare All Payer |
$7,217.10
|
|
|
REMEDY ACET CUP 46MM ID/54MM O
|
Facility
|
OP
|
$8,201.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,460.38 |
| Max. Negotiated Rate |
$7,873.20 |
| Rate for Payer: Aetna Commercial |
$6,314.96
|
| Rate for Payer: Anthem Medicaid |
$2,820.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,396.98
|
| Rate for Payer: Cash Price |
$4,100.62
|
| Rate for Payer: Cigna Commercial |
$6,807.04
|
| Rate for Payer: First Health Commercial |
$7,791.19
|
| Rate for Payer: Humana Commercial |
$6,971.06
|
| Rate for Payer: Humana KY Medicaid |
$2,820.41
|
| Rate for Payer: Kentucky WC Medicaid |
$2,849.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,725.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,052.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,460.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,877.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,217.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,150.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,561.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,135.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,658.86
|
| Rate for Payer: PHCS Commercial |
$7,873.20
|
| Rate for Payer: United Healthcare All Payer |
$7,217.10
|
|
|
REMEDY COMP STEMMED FEMORAL LG
|
Facility
|
IP
|
$9,570.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,871.00 |
| Max. Negotiated Rate |
$9,187.20 |
| Rate for Payer: Aetna Commercial |
$7,368.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,464.60
|
| Rate for Payer: Cash Price |
$4,785.00
|
| Rate for Payer: Cigna Commercial |
$7,943.10
|
| Rate for Payer: First Health Commercial |
$9,091.50
|
| Rate for Payer: Humana Commercial |
$8,134.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,847.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,062.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,871.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,421.60
|
| Rate for Payer: Ohio Health Group HMO |
$7,177.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,656.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,325.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,603.30
|
| Rate for Payer: PHCS Commercial |
$9,187.20
|
| Rate for Payer: United Healthcare All Payer |
$8,421.60
|
|
|
REMEDY COMP STEMMED FEMORAL LG
|
Facility
|
OP
|
$9,570.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,871.00 |
| Max. Negotiated Rate |
$9,187.20 |
| Rate for Payer: Aetna Commercial |
$7,368.90
|
| Rate for Payer: Anthem Medicaid |
$3,291.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,464.60
|
| Rate for Payer: Cash Price |
$4,785.00
|
| Rate for Payer: Cigna Commercial |
$7,943.10
|
| Rate for Payer: First Health Commercial |
$9,091.50
|
| Rate for Payer: Humana Commercial |
$8,134.50
|
| Rate for Payer: Humana KY Medicaid |
$3,291.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,324.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,847.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,062.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,871.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,357.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,421.60
|
| Rate for Payer: Ohio Health Group HMO |
$7,177.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,656.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,325.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,603.30
|
| Rate for Payer: PHCS Commercial |
$9,187.20
|
| Rate for Payer: United Healthcare All Payer |
$8,421.60
|
|
|
REMEDY COMP STEMMED FEMORAL SM
|
Facility
|
OP
|
$9,570.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,871.00 |
| Max. Negotiated Rate |
$9,187.20 |
| Rate for Payer: Aetna Commercial |
$7,368.90
|
| Rate for Payer: Anthem Medicaid |
$3,291.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,464.60
|
| Rate for Payer: Cash Price |
$4,785.00
|
| Rate for Payer: Cigna Commercial |
$7,943.10
|
| Rate for Payer: First Health Commercial |
$9,091.50
|
| Rate for Payer: Humana Commercial |
$8,134.50
|
| Rate for Payer: Humana KY Medicaid |
$3,291.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,324.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,847.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,062.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,871.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,357.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,421.60
|
| Rate for Payer: Ohio Health Group HMO |
$7,177.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,656.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,325.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,603.30
|
| Rate for Payer: PHCS Commercial |
$9,187.20
|
| Rate for Payer: United Healthcare All Payer |
$8,421.60
|
|
