|
RETACRIT 4000 UNIT/ML VL
|
Facility
|
IP
|
$240.45
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
25002731
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.26 |
| Max. Negotiated Rate |
$230.83 |
| Rate for Payer: Aetna Commercial |
$185.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$187.55
|
| Rate for Payer: Cash Price |
$120.22
|
| Rate for Payer: Cigna Commercial |
$199.57
|
| Rate for Payer: First Health Commercial |
$228.43
|
| Rate for Payer: Humana Commercial |
$204.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$197.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$177.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$72.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$211.60
|
| Rate for Payer: Ohio Health Group HMO |
$180.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$74.54
|
| Rate for Payer: PHCS Commercial |
$230.83
|
| Rate for Payer: United Healthcare All Payer |
$211.60
|
|
|
RETICULOCYTE COUNT
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
HCPCS 85045
|
| Hospital Charge Code |
30000572
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.81 |
| Max. Negotiated Rate |
$35.52 |
| Rate for Payer: Aetna Commercial |
$28.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29.71
|
| Rate for Payer: Cash Price |
$18.50
|
| Rate for Payer: Cigna Commercial |
$30.71
|
| Rate for Payer: First Health Commercial |
$35.15
|
| Rate for Payer: Humana Commercial |
$31.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$32.56
|
| Rate for Payer: Ohio Health Group HMO |
$27.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11.47
|
| Rate for Payer: PHCS Commercial |
$35.52
|
| Rate for Payer: United Healthcare All Payer |
$32.56
|
|
|
RETICULOCYTE COUNT
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
HCPCS 85045
|
| Hospital Charge Code |
30000572
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.99 |
| Max. Negotiated Rate |
$35.52 |
| Rate for Payer: Aetna Commercial |
$28.49
|
| Rate for Payer: Anthem Medicaid |
$12.72
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$29.71
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$5.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.99
|
| Rate for Payer: Cash Price |
$18.50
|
| Rate for Payer: Cash Price |
$18.50
|
| Rate for Payer: Cigna Commercial |
$30.71
|
| Rate for Payer: First Health Commercial |
$35.15
|
| Rate for Payer: Humana Commercial |
$31.45
|
| Rate for Payer: Humana KY Medicaid |
$12.72
|
| Rate for Payer: Humana Medicare Advantage |
$3.99
|
| Rate for Payer: Kentucky WC Medicaid |
$12.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$30.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$27.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$32.56
|
| Rate for Payer: Ohio Health Group HMO |
$27.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11.47
|
| Rate for Payer: PHCS Commercial |
$35.52
|
| Rate for Payer: United Healthcare All Payer |
$32.56
|
|
|
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC
|
Facility
|
IP
|
$11,630.35
|
|
|
Service Code
|
MSDRG 815
|
| Min. Negotiated Rate |
$7,892.02 |
| Max. Negotiated Rate |
$11,630.35 |
| Rate for Payer: Anthem Medicaid |
$7,892.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8,307.39
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$11,630.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$11,214.98
|
| Rate for Payer: Humana KY Medicaid |
$7,892.02
|
| Rate for Payer: Humana Medicare Advantage |
$8,307.39
|
| Rate for Payer: Kentucky WC Medicaid |
$7,970.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,968.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,049.86
|
|
|
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC
|
Facility
|
IP
|
$24,894.98
|
|
|
Service Code
|
MSDRG 814
|
| Min. Negotiated Rate |
$16,893.02 |
| Max. Negotiated Rate |
$24,894.98 |
| Rate for Payer: Anthem Medicaid |
$16,893.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17,782.13
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24,894.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$24,005.88
|
| Rate for Payer: Humana KY Medicaid |
$16,893.02
|
| Rate for Payer: Humana Medicare Advantage |
$17,782.13
|
| Rate for Payer: Kentucky WC Medicaid |
$17,061.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,338.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$17,230.88
|
|
|
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$8,308.08
|
|
|
Service Code
|
MSDRG 816
|
| Min. Negotiated Rate |
$5,637.62 |
| Max. Negotiated Rate |
$8,308.08 |
| Rate for Payer: Anthem Medicaid |
$5,637.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,934.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,308.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,011.36
|
| Rate for Payer: Humana KY Medicaid |
$5,637.62
|
| Rate for Payer: Humana Medicare Advantage |
$5,934.34
|
| Rate for Payer: Kentucky WC Medicaid |
$5,694.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,121.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,750.38
|
|
|
RETROBUTTON LONG 15MM
|
Facility
|
IP
|
$2,172.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$282.42 |
| Max. Negotiated Rate |
$2,085.60 |
| Rate for Payer: Aetna Commercial |
$1,672.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,694.55
|
| Rate for Payer: Cash Price |
$1,086.25
|
| Rate for Payer: Cigna Commercial |
$1,803.18
|
| Rate for Payer: First Health Commercial |
$2,063.88
|
| Rate for Payer: Humana Commercial |
$1,846.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,781.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,603.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,911.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,629.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$434.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$282.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$673.48
|
| Rate for Payer: PHCS Commercial |
$2,085.60
|
| Rate for Payer: United Healthcare All Payer |
$1,911.80
|
|
|
RETROBUTTON LONG 15MM
|
Facility
|
OP
|
$2,172.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$282.42 |
| Max. Negotiated Rate |
$2,085.60 |
| Rate for Payer: Aetna Commercial |
$1,672.82
|
| Rate for Payer: Anthem Medicaid |
$747.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,694.55
|
| Rate for Payer: Cash Price |
$1,086.25
|
| Rate for Payer: Cigna Commercial |
$1,803.18
|
| Rate for Payer: First Health Commercial |
$2,063.88
|
| Rate for Payer: Humana Commercial |
$1,846.62
|
| Rate for Payer: Humana KY Medicaid |
$747.12
|
| Rate for Payer: Kentucky WC Medicaid |
$754.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,781.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,603.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$762.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,911.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,629.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$434.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$282.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$673.48
|
| Rate for Payer: PHCS Commercial |
$2,085.60
|
| Rate for Payer: United Healthcare All Payer |
$1,911.80
|
|
|
RETROBUTTON LONG 20MM
|
Facility
|
OP
|
$2,172.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$282.42 |
| Max. Negotiated Rate |
$2,085.60 |
| Rate for Payer: Aetna Commercial |
$1,672.82
|
| Rate for Payer: Anthem Medicaid |
$747.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,694.55
|
| Rate for Payer: Cash Price |
$1,086.25
|
| Rate for Payer: Cigna Commercial |
$1,803.18
|
| Rate for Payer: First Health Commercial |
$2,063.88
|
| Rate for Payer: Humana Commercial |
$1,846.62
|
| Rate for Payer: Humana KY Medicaid |
$747.12
|
| Rate for Payer: Kentucky WC Medicaid |
$754.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,781.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,603.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$762.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,911.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,629.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$434.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$282.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$673.48
|
| Rate for Payer: PHCS Commercial |
$2,085.60
|
| Rate for Payer: United Healthcare All Payer |
$1,911.80
|
|
|
RETROBUTTON LONG 20MM
|
Facility
|
IP
|
$2,172.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$282.42 |
| Max. Negotiated Rate |
$2,085.60 |
| Rate for Payer: Aetna Commercial |
$1,672.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,694.55
|
| Rate for Payer: Cash Price |
$1,086.25
|
| Rate for Payer: Cigna Commercial |
$1,803.18
|
| Rate for Payer: First Health Commercial |
$2,063.88
|
| Rate for Payer: Humana Commercial |
$1,846.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,781.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,603.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,911.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,629.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$434.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$282.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$673.48
|
| Rate for Payer: PHCS Commercial |
$2,085.60
|
| Rate for Payer: United Healthcare All Payer |
$1,911.80
|
|
|
RETROBUTTON LONG 25MM
|
Facility
|
IP
|
$2,172.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$282.42 |
| Max. Negotiated Rate |
$2,085.60 |
| Rate for Payer: Aetna Commercial |
$1,672.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,694.55
|
| Rate for Payer: Cash Price |
$1,086.25
|
| Rate for Payer: Cigna Commercial |
$1,803.18
|
| Rate for Payer: First Health Commercial |
$2,063.88
|
| Rate for Payer: Humana Commercial |
$1,846.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,781.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,603.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,911.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,629.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$434.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$282.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$673.48
|
| Rate for Payer: PHCS Commercial |
$2,085.60
|
| Rate for Payer: United Healthcare All Payer |
$1,911.80
|
|
|
RETROBUTTON LONG 25MM
|
Facility
|
OP
|
$2,172.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$282.42 |
| Max. Negotiated Rate |
$2,085.60 |
| Rate for Payer: Aetna Commercial |
$1,672.82
|
| Rate for Payer: Anthem Medicaid |
$747.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,694.55
|
| Rate for Payer: Cash Price |
$1,086.25
|
| Rate for Payer: Cigna Commercial |
$1,803.18
|
| Rate for Payer: First Health Commercial |
$2,063.88
|
| Rate for Payer: Humana Commercial |
$1,846.62
|
| Rate for Payer: Humana KY Medicaid |
$747.12
|
| Rate for Payer: Kentucky WC Medicaid |
$754.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,781.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,603.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$762.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,911.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,629.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$434.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$282.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$673.48
|
| Rate for Payer: PHCS Commercial |
$2,085.60
|
| Rate for Payer: United Healthcare All Payer |
$1,911.80
|
|
|
RETROBUTTON XL
|
Facility
|
IP
|
$3,127.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$406.58 |
| Max. Negotiated Rate |
$3,002.40 |
| Rate for Payer: Aetna Commercial |
$2,408.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,439.45
|
| Rate for Payer: Cash Price |
$1,563.75
|
| Rate for Payer: Cigna Commercial |
$2,595.82
|
| Rate for Payer: First Health Commercial |
$2,971.12
|
| Rate for Payer: Humana Commercial |
$2,658.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,564.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,308.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$938.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,752.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,345.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$625.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$406.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$969.52
|
| Rate for Payer: PHCS Commercial |
$3,002.40
|
| Rate for Payer: United Healthcare All Payer |
$2,752.20
|
|
|
RETROBUTTON XL
|
Facility
|
OP
|
$3,127.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$406.58 |
| Max. Negotiated Rate |
$3,002.40 |
| Rate for Payer: Aetna Commercial |
$2,408.18
|
| Rate for Payer: Anthem Medicaid |
$1,075.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,439.45
|
| Rate for Payer: Cash Price |
$1,563.75
|
| Rate for Payer: Cigna Commercial |
$2,595.82
|
| Rate for Payer: First Health Commercial |
$2,971.12
|
| Rate for Payer: Humana Commercial |
$2,658.38
|
| Rate for Payer: Humana KY Medicaid |
$1,075.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,086.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,564.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,308.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$938.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,097.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,752.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,345.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$625.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$406.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$969.52
|
| Rate for Payer: PHCS Commercial |
$3,002.40
|
| Rate for Payer: United Healthcare All Payer |
$2,752.20
|
|
|
RETROCUTTER 10.5MM
|
Facility
|
IP
|
$2,032.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.22 |
| Max. Negotiated Rate |
$1,951.20 |
| Rate for Payer: Aetna Commercial |
$1,565.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,585.35
|
| Rate for Payer: Cash Price |
$1,016.25
|
| Rate for Payer: Cigna Commercial |
$1,686.98
|
| Rate for Payer: First Health Commercial |
$1,930.88
|
| Rate for Payer: Humana Commercial |
$1,727.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,666.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,499.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$609.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,788.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,524.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$406.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$264.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$630.08
|
| Rate for Payer: PHCS Commercial |
$1,951.20
|
| Rate for Payer: United Healthcare All Payer |
$1,788.60
|
|
|
RETROCUTTER 10.5MM
|
Facility
|
OP
|
$2,032.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.22 |
| Max. Negotiated Rate |
$1,951.20 |
| Rate for Payer: Aetna Commercial |
$1,565.02
|
| Rate for Payer: Anthem Medicaid |
$698.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,585.35
|
| Rate for Payer: Cash Price |
$1,016.25
|
| Rate for Payer: Cigna Commercial |
$1,686.98
|
| Rate for Payer: First Health Commercial |
$1,930.88
|
| Rate for Payer: Humana Commercial |
$1,727.62
|
| Rate for Payer: Humana KY Medicaid |
$698.98
|
| Rate for Payer: Kentucky WC Medicaid |
$706.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,666.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,499.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$609.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$713.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,788.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,524.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$406.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$264.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$630.08
|
| Rate for Payer: PHCS Commercial |
$1,951.20
|
| Rate for Payer: United Healthcare All Payer |
$1,788.60
|
|
|
RETROCUTTER 10MM
|
Facility
|
OP
|
$2,032.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.22 |
| Max. Negotiated Rate |
$1,951.20 |
| Rate for Payer: Aetna Commercial |
$1,565.02
|
| Rate for Payer: Anthem Medicaid |
$698.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,585.35
|
| Rate for Payer: Cash Price |
$1,016.25
|
| Rate for Payer: Cigna Commercial |
$1,686.98
|
| Rate for Payer: First Health Commercial |
$1,930.88
|
| Rate for Payer: Humana Commercial |
$1,727.62
|
| Rate for Payer: Humana KY Medicaid |
$698.98
|
| Rate for Payer: Kentucky WC Medicaid |
$706.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,666.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,499.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$609.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$713.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,788.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,524.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$406.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$264.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$630.08
|
| Rate for Payer: PHCS Commercial |
$1,951.20
|
| Rate for Payer: United Healthcare All Payer |
$1,788.60
|
|
|
RETROCUTTER 10MM
|
Facility
|
IP
|
$2,032.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.22 |
| Max. Negotiated Rate |
$1,951.20 |
| Rate for Payer: Aetna Commercial |
$1,565.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,585.35
|
| Rate for Payer: Cash Price |
$1,016.25
|
| Rate for Payer: Cigna Commercial |
$1,686.98
|
| Rate for Payer: First Health Commercial |
$1,930.88
|
| Rate for Payer: Humana Commercial |
$1,727.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,666.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,499.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$609.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,788.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,524.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$406.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$264.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$630.08
|
| Rate for Payer: PHCS Commercial |
$1,951.20
|
| Rate for Payer: United Healthcare All Payer |
$1,788.60
|
|
|
RETROCUTTER 11MM
|
Facility
|
OP
|
$2,032.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.22 |
| Max. Negotiated Rate |
$1,951.20 |
| Rate for Payer: Aetna Commercial |
$1,565.02
|
| Rate for Payer: Anthem Medicaid |
$698.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,585.35
|
| Rate for Payer: Cash Price |
$1,016.25
|
| Rate for Payer: Cigna Commercial |
$1,686.98
|
| Rate for Payer: First Health Commercial |
$1,930.88
|
| Rate for Payer: Humana Commercial |
$1,727.62
|
| Rate for Payer: Humana KY Medicaid |
$698.98
|
| Rate for Payer: Kentucky WC Medicaid |
$706.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,666.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,499.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$609.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$713.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,788.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,524.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$406.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$264.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$630.08
|
| Rate for Payer: PHCS Commercial |
$1,951.20
|
| Rate for Payer: United Healthcare All Payer |
$1,788.60
|
|
|
RETROCUTTER 11MM
|
Facility
|
IP
|
$2,032.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.22 |
| Max. Negotiated Rate |
$1,951.20 |
| Rate for Payer: Aetna Commercial |
$1,565.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,585.35
|
| Rate for Payer: Cash Price |
$1,016.25
|
| Rate for Payer: Cigna Commercial |
$1,686.98
|
| Rate for Payer: First Health Commercial |
$1,930.88
|
| Rate for Payer: Humana Commercial |
$1,727.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,666.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,499.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$609.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,788.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,524.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$406.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$264.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$630.08
|
| Rate for Payer: PHCS Commercial |
$1,951.20
|
| Rate for Payer: United Healthcare All Payer |
$1,788.60
|
|
|
RETROCUTTER 12MM
|
Facility
|
IP
|
$2,032.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.22 |
| Max. Negotiated Rate |
$1,951.20 |
| Rate for Payer: Aetna Commercial |
$1,565.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,585.35
|
| Rate for Payer: Cash Price |
$1,016.25
|
| Rate for Payer: Cigna Commercial |
$1,686.98
|
| Rate for Payer: First Health Commercial |
$1,930.88
|
| Rate for Payer: Humana Commercial |
$1,727.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,666.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,499.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$609.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,788.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,524.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$406.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$264.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$630.08
|
| Rate for Payer: PHCS Commercial |
$1,951.20
|
| Rate for Payer: United Healthcare All Payer |
$1,788.60
|
|
|
RETROCUTTER 12MM
|
Facility
|
OP
|
$2,032.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.22 |
| Max. Negotiated Rate |
$1,951.20 |
| Rate for Payer: Aetna Commercial |
$1,565.02
|
| Rate for Payer: Anthem Medicaid |
$698.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,585.35
|
| Rate for Payer: Cash Price |
$1,016.25
|
| Rate for Payer: Cigna Commercial |
$1,686.98
|
| Rate for Payer: First Health Commercial |
$1,930.88
|
| Rate for Payer: Humana Commercial |
$1,727.62
|
| Rate for Payer: Humana KY Medicaid |
$698.98
|
| Rate for Payer: Kentucky WC Medicaid |
$706.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,666.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,499.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$609.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$713.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,788.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,524.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$406.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$264.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$630.08
|
| Rate for Payer: PHCS Commercial |
$1,951.20
|
| Rate for Payer: United Healthcare All Payer |
$1,788.60
|
|
|
RETROCUTTER 5.5MM
|
Facility
|
OP
|
$2,032.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.22 |
| Max. Negotiated Rate |
$1,951.20 |
| Rate for Payer: Aetna Commercial |
$1,565.02
|
| Rate for Payer: Anthem Medicaid |
$698.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,585.35
|
| Rate for Payer: Cash Price |
$1,016.25
|
| Rate for Payer: Cigna Commercial |
$1,686.98
|
| Rate for Payer: First Health Commercial |
$1,930.88
|
| Rate for Payer: Humana Commercial |
$1,727.62
|
| Rate for Payer: Humana KY Medicaid |
$698.98
|
| Rate for Payer: Kentucky WC Medicaid |
$706.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,666.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,499.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$609.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$713.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,788.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,524.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$406.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$264.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$630.08
|
| Rate for Payer: PHCS Commercial |
$1,951.20
|
| Rate for Payer: United Healthcare All Payer |
$1,788.60
|
|
|
RETROCUTTER 5.5MM
|
Facility
|
IP
|
$2,032.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.22 |
| Max. Negotiated Rate |
$1,951.20 |
| Rate for Payer: Aetna Commercial |
$1,565.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,585.35
|
| Rate for Payer: Cash Price |
$1,016.25
|
| Rate for Payer: Cigna Commercial |
$1,686.98
|
| Rate for Payer: First Health Commercial |
$1,930.88
|
| Rate for Payer: Humana Commercial |
$1,727.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,666.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,499.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$609.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,788.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,524.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$406.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$264.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$630.08
|
| Rate for Payer: PHCS Commercial |
$1,951.20
|
| Rate for Payer: United Healthcare All Payer |
$1,788.60
|
|
|
RETROCUTTER 5MM
|
Facility
|
IP
|
$2,032.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.22 |
| Max. Negotiated Rate |
$1,951.20 |
| Rate for Payer: Aetna Commercial |
$1,565.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,585.35
|
| Rate for Payer: Cash Price |
$1,016.25
|
| Rate for Payer: Cigna Commercial |
$1,686.98
|
| Rate for Payer: First Health Commercial |
$1,930.88
|
| Rate for Payer: Humana Commercial |
$1,727.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,666.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,499.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$609.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,788.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,524.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$406.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$264.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$630.08
|
| Rate for Payer: PHCS Commercial |
$1,951.20
|
| Rate for Payer: United Healthcare All Payer |
$1,788.60
|
|
