|
FEXOFENADINE HCL 180 MG TABLET
|
Facility
|
IP
|
$4.54
|
|
|
Service Code
|
NDC 41167041290
|
| Hospital Charge Code |
25003947
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$4.36 |
| Rate for Payer: Aetna Commercial |
$3.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.54
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Cigna Commercial |
$3.77
|
| Rate for Payer: First Health Commercial |
$4.31
|
| Rate for Payer: Humana Commercial |
$3.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.00
|
| Rate for Payer: Ohio Health Group HMO |
$3.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.13
|
| Rate for Payer: PHCS Commercial |
$4.36
|
| Rate for Payer: United Healthcare All Payer |
$4.00
|
|
|
FEXOFENADINE HCL 180 MG TABLET
|
Facility
|
OP
|
$4.54
|
|
|
Service Code
|
NDC 41167041290
|
| Hospital Charge Code |
25003947
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$4.36 |
| Rate for Payer: Aetna Commercial |
$3.50
|
| Rate for Payer: Anthem Medicaid |
$1.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.54
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Cigna Commercial |
$3.77
|
| Rate for Payer: First Health Commercial |
$4.31
|
| Rate for Payer: Humana Commercial |
$3.86
|
| Rate for Payer: Humana KY Medicaid |
$1.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.00
|
| Rate for Payer: Ohio Health Group HMO |
$3.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.13
|
| Rate for Payer: PHCS Commercial |
$4.36
|
| Rate for Payer: United Healthcare All Payer |
$4.00
|
|
|
FFP/CRYO THAWING; EACH UNIT
|
Facility
|
OP
|
$401.00
|
|
|
Service Code
|
HCPCS 86927
|
| Hospital Charge Code |
30001240
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$158.33 |
| Max. Negotiated Rate |
$384.96 |
| Rate for Payer: Aetna Commercial |
$308.77
|
| Rate for Payer: Anthem Medicaid |
$158.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$158.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$322.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$221.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$158.33
|
| Rate for Payer: Cash Price |
$200.50
|
| Rate for Payer: Cash Price |
$200.50
|
| Rate for Payer: Cigna Commercial |
$332.83
|
| Rate for Payer: First Health Commercial |
$380.95
|
| Rate for Payer: Humana Commercial |
$340.85
|
| Rate for Payer: Humana KY Medicaid |
$158.33
|
| Rate for Payer: Humana Medicare Advantage |
$158.33
|
| Rate for Payer: Kentucky WC Medicaid |
$159.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$328.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$295.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$161.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$352.88
|
| Rate for Payer: Ohio Health Group HMO |
$300.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$320.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$348.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$276.69
|
| Rate for Payer: PHCS Commercial |
$384.96
|
| Rate for Payer: United Healthcare All Payer |
$352.88
|
|
|
FFP/CRYO THAWING; EACH UNIT
|
Facility
|
IP
|
$401.00
|
|
|
Service Code
|
HCPCS 86927
|
| Hospital Charge Code |
30001240
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$120.30 |
| Max. Negotiated Rate |
$384.96 |
| Rate for Payer: Aetna Commercial |
$308.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$322.00
|
| Rate for Payer: Cash Price |
$200.50
|
| Rate for Payer: Cigna Commercial |
$332.83
|
| Rate for Payer: First Health Commercial |
$380.95
|
| Rate for Payer: Humana Commercial |
$340.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$328.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$295.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$120.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$352.88
|
| Rate for Payer: Ohio Health Group HMO |
$300.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$320.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$348.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$276.69
|
| Rate for Payer: PHCS Commercial |
$384.96
|
| Rate for Payer: United Healthcare All Payer |
$352.88
|
|
|
FFR NAVUUS II CATH.
|
Facility
|
IP
|
$4,812.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,443.75 |
| Max. Negotiated Rate |
$4,620.00 |
| Rate for Payer: Aetna Commercial |
$3,705.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,753.75
|
| Rate for Payer: Cash Price |
$2,406.25
|
| Rate for Payer: Cigna Commercial |
$3,994.38
|
| Rate for Payer: First Health Commercial |
$4,571.88
|
| Rate for Payer: Humana Commercial |
$4,090.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,946.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,551.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,443.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,235.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,609.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,850.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,186.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,320.62
|
| Rate for Payer: PHCS Commercial |
$4,620.00
|
| Rate for Payer: United Healthcare All Payer |
$4,235.00
|
|
|
FFR NAVUUS II CATH.
|
Facility
|
OP
|
$4,812.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,443.75 |
| Max. Negotiated Rate |
$4,620.00 |
| Rate for Payer: Aetna Commercial |
$3,705.62
|
| Rate for Payer: Anthem Medicaid |
$1,655.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,753.75
|
| Rate for Payer: Cash Price |
$2,406.25
|
| Rate for Payer: Cigna Commercial |
$3,994.38
|
| Rate for Payer: First Health Commercial |
$4,571.88
|
| Rate for Payer: Humana Commercial |
$4,090.62
|
| Rate for Payer: Humana KY Medicaid |
$1,655.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,671.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,946.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,551.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,443.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,688.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,235.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,609.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,850.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,186.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,320.62
|
| Rate for Payer: PHCS Commercial |
$4,620.00
|
| Rate for Payer: United Healthcare All Payer |
$4,235.00
|
|
|
FIBERCON (POLYCARBOPHIL) 1TAB
|
Facility
|
OP
|
$4.89
|
|
|
Service Code
|
NDC 77333012050
|
| Hospital Charge Code |
25000676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$4.69 |
| Rate for Payer: Aetna Commercial |
$3.77
|
| Rate for Payer: Anthem Medicaid |
$1.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.81
|
| Rate for Payer: Cash Price |
$2.44
|
| Rate for Payer: Cigna Commercial |
$4.06
|
| Rate for Payer: First Health Commercial |
$4.65
|
| Rate for Payer: Humana Commercial |
$4.16
|
| Rate for Payer: Humana KY Medicaid |
$1.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.30
|
| Rate for Payer: Ohio Health Group HMO |
$3.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.37
|
| Rate for Payer: PHCS Commercial |
$4.69
|
| Rate for Payer: United Healthcare All Payer |
$4.30
|
|
|
FIBERCON (POLYCARBOPHIL) 1TAB
|
Facility
|
IP
|
$4.89
|
|
|
Service Code
|
NDC 77333012050
|
| Hospital Charge Code |
25000676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$4.69 |
| Rate for Payer: Aetna Commercial |
$3.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.81
|
| Rate for Payer: Cash Price |
$2.44
|
| Rate for Payer: Cigna Commercial |
$4.06
|
| Rate for Payer: First Health Commercial |
$4.65
|
| Rate for Payer: Humana Commercial |
$4.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.30
|
| Rate for Payer: Ohio Health Group HMO |
$3.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.37
|
| Rate for Payer: PHCS Commercial |
$4.69
|
| Rate for Payer: United Healthcare All Payer |
$4.30
|
|
|
FIBERLOOP #2 BLUE CVD AR-7234C
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$330.00 |
| Max. Negotiated Rate |
$1,056.00 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem Medicaid |
$378.29
|
| 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: Humana KY Medicaid |
$378.29
|
| 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 |
$330.00
|
| 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
|
|
|
FIBERLOOP #2 BLUE CVD AR-7234C
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| 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
|
|
|
FIBERSTITCH IMPLANT 24 DEGREE
|
Facility
|
OP
|
$3,856.25
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,156.88 |
| Max. Negotiated Rate |
$3,702.00 |
| Rate for Payer: Aetna Commercial |
$2,969.31
|
| Rate for Payer: Anthem Medicaid |
$1,326.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,007.88
|
| Rate for Payer: Cash Price |
$1,928.12
|
| Rate for Payer: Cigna Commercial |
$3,200.69
|
| Rate for Payer: First Health Commercial |
$3,663.44
|
| Rate for Payer: Humana Commercial |
$3,277.81
|
| Rate for Payer: Humana KY Medicaid |
$1,326.16
|
| Rate for Payer: Kentucky WC Medicaid |
$1,339.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,162.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,845.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,156.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,352.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,393.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,892.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,085.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,354.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,660.81
|
| Rate for Payer: PHCS Commercial |
$3,702.00
|
| Rate for Payer: United Healthcare All Payer |
$3,393.50
|
|
|
FIBERSTITCH IMPLANT 24 DEGREE
|
Facility
|
IP
|
$3,856.25
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,156.88 |
| Max. Negotiated Rate |
$3,702.00 |
| Rate for Payer: Aetna Commercial |
$2,969.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,007.88
|
| Rate for Payer: Cash Price |
$1,928.12
|
| Rate for Payer: Cigna Commercial |
$3,200.69
|
| Rate for Payer: First Health Commercial |
$3,663.44
|
| Rate for Payer: Humana Commercial |
$3,277.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,162.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,845.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,156.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,393.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,892.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,085.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,354.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,660.81
|
| Rate for Payer: PHCS Commercial |
$3,702.00
|
| Rate for Payer: United Healthcare All Payer |
$3,393.50
|
|
|
FIBERSTITCH IMPLANT REVRS CVD
|
Facility
|
IP
|
$3,949.06
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,184.72 |
| Max. Negotiated Rate |
$3,791.10 |
| Rate for Payer: Aetna Commercial |
$3,040.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,080.27
|
| Rate for Payer: Cash Price |
$1,974.53
|
| Rate for Payer: Cigna Commercial |
$3,277.72
|
| Rate for Payer: First Health Commercial |
$3,751.61
|
| Rate for Payer: Humana Commercial |
$3,356.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,238.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,914.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,184.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,475.17
|
| Rate for Payer: Ohio Health Group HMO |
$2,961.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,159.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,435.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,724.85
|
| Rate for Payer: PHCS Commercial |
$3,791.10
|
| Rate for Payer: United Healthcare All Payer |
$3,475.17
|
|
|
FIBERSTITCH IMPLANT REVRS CVD
|
Facility
|
OP
|
$3,949.06
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,184.72 |
| Max. Negotiated Rate |
$3,791.10 |
| Rate for Payer: Aetna Commercial |
$3,040.78
|
| Rate for Payer: Anthem Medicaid |
$1,358.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,080.27
|
| Rate for Payer: Cash Price |
$1,974.53
|
| Rate for Payer: Cigna Commercial |
$3,277.72
|
| Rate for Payer: First Health Commercial |
$3,751.61
|
| Rate for Payer: Humana Commercial |
$3,356.70
|
| Rate for Payer: Humana KY Medicaid |
$1,358.08
|
| Rate for Payer: Kentucky WC Medicaid |
$1,371.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,238.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,914.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,184.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,385.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,475.17
|
| Rate for Payer: Ohio Health Group HMO |
$2,961.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,159.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,435.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,724.85
|
| Rate for Payer: PHCS Commercial |
$3,791.10
|
| Rate for Payer: United Healthcare All Payer |
$3,475.17
|
|
|
FIBERSTITCH IMPLANT STRAIGHT
|
Facility
|
IP
|
$3,856.25
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,156.88 |
| Max. Negotiated Rate |
$3,702.00 |
| Rate for Payer: Aetna Commercial |
$2,969.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,007.88
|
| Rate for Payer: Cash Price |
$1,928.12
|
| Rate for Payer: Cigna Commercial |
$3,200.69
|
| Rate for Payer: First Health Commercial |
$3,663.44
|
| Rate for Payer: Humana Commercial |
$3,277.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,162.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,845.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,156.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,393.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,892.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,085.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,354.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,660.81
|
| Rate for Payer: PHCS Commercial |
$3,702.00
|
| Rate for Payer: United Healthcare All Payer |
$3,393.50
|
|
|
FIBERSTITCH IMPLANT STRAIGHT
|
Facility
|
OP
|
$3,856.25
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,156.88 |
| Max. Negotiated Rate |
$3,702.00 |
| Rate for Payer: Aetna Commercial |
$2,969.31
|
| Rate for Payer: Anthem Medicaid |
$1,326.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,007.88
|
| Rate for Payer: Cash Price |
$1,928.12
|
| Rate for Payer: Cigna Commercial |
$3,200.69
|
| Rate for Payer: First Health Commercial |
$3,663.44
|
| Rate for Payer: Humana Commercial |
$3,277.81
|
| Rate for Payer: Humana KY Medicaid |
$1,326.16
|
| Rate for Payer: Kentucky WC Medicaid |
$1,339.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,162.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,845.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,156.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,352.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,393.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,892.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,085.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,354.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,660.81
|
| Rate for Payer: PHCS Commercial |
$3,702.00
|
| Rate for Payer: United Healthcare All Payer |
$3,393.50
|
|
|
FIBERSTITCH RC STRAIGHT
|
Facility
|
IP
|
$4,062.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,218.75 |
| Max. Negotiated Rate |
$3,900.00 |
| Rate for Payer: Aetna Commercial |
$3,128.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,168.75
|
| Rate for Payer: Cash Price |
$2,031.25
|
| Rate for Payer: Cigna Commercial |
$3,371.88
|
| Rate for Payer: First Health Commercial |
$3,859.38
|
| Rate for Payer: Humana Commercial |
$3,453.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,331.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,998.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,218.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,575.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,046.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,250.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,534.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,803.12
|
| Rate for Payer: PHCS Commercial |
$3,900.00
|
| Rate for Payer: United Healthcare All Payer |
$3,575.00
|
|
|
FIBERSTITCH RC STRAIGHT
|
Facility
|
OP
|
$4,062.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,218.75 |
| Max. Negotiated Rate |
$3,900.00 |
| Rate for Payer: Aetna Commercial |
$3,128.12
|
| Rate for Payer: Anthem Medicaid |
$1,397.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,168.75
|
| Rate for Payer: Cash Price |
$2,031.25
|
| Rate for Payer: Cigna Commercial |
$3,371.88
|
| Rate for Payer: First Health Commercial |
$3,859.38
|
| Rate for Payer: Humana Commercial |
$3,453.12
|
| Rate for Payer: Humana KY Medicaid |
$1,397.09
|
| Rate for Payer: Kentucky WC Medicaid |
$1,411.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,331.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,998.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,218.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,425.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,575.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,046.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,250.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,534.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,803.12
|
| Rate for Payer: PHCS Commercial |
$3,900.00
|
| Rate for Payer: United Healthcare All Payer |
$3,575.00
|
|
|
FIBERTAG TIGHTROPE 2 ABS
|
Facility
|
OP
|
$3,518.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,055.62 |
| Max. Negotiated Rate |
$3,378.00 |
| Rate for Payer: Aetna Commercial |
$2,709.44
|
| Rate for Payer: Anthem Medicaid |
$1,210.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,744.62
|
| Rate for Payer: Cash Price |
$1,759.38
|
| Rate for Payer: Cigna Commercial |
$2,920.56
|
| Rate for Payer: First Health Commercial |
$3,342.81
|
| Rate for Payer: Humana Commercial |
$2,990.94
|
| Rate for Payer: Humana KY Medicaid |
$1,210.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,222.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,885.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,596.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,055.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,234.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,096.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,639.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,815.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,061.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,427.94
|
| Rate for Payer: PHCS Commercial |
$3,378.00
|
| Rate for Payer: United Healthcare All Payer |
$3,096.50
|
|
|
FIBERTAG TIGHTROPE 2 ABS
|
Facility
|
IP
|
$3,518.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,055.62 |
| Max. Negotiated Rate |
$3,378.00 |
| Rate for Payer: Aetna Commercial |
$2,709.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,744.62
|
| Rate for Payer: Cash Price |
$1,759.38
|
| Rate for Payer: Cigna Commercial |
$2,920.56
|
| Rate for Payer: First Health Commercial |
$3,342.81
|
| Rate for Payer: Humana Commercial |
$2,990.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,885.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,596.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,055.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,096.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,639.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,815.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,061.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,427.94
|
| Rate for Payer: PHCS Commercial |
$3,378.00
|
| Rate for Payer: United Healthcare All Payer |
$3,096.50
|
|
|
FIBERTAG TIGHTROPE 2 W/BRACE
|
Facility
|
IP
|
$4,718.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,415.62 |
| Max. Negotiated Rate |
$4,530.00 |
| Rate for Payer: Aetna Commercial |
$3,633.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,680.62
|
| Rate for Payer: Cash Price |
$2,359.38
|
| Rate for Payer: Cigna Commercial |
$3,916.56
|
| Rate for Payer: First Health Commercial |
$4,482.81
|
| Rate for Payer: Humana Commercial |
$4,010.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,869.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,482.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,415.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,152.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,539.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,775.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,105.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,255.94
|
| Rate for Payer: PHCS Commercial |
$4,530.00
|
| Rate for Payer: United Healthcare All Payer |
$4,152.50
|
|
|
FIBERTAG TIGHTROPE 2 W/BRACE
|
Facility
|
OP
|
$4,718.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,415.62 |
| Max. Negotiated Rate |
$4,530.00 |
| Rate for Payer: Aetna Commercial |
$3,633.44
|
| Rate for Payer: Anthem Medicaid |
$1,622.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,680.62
|
| Rate for Payer: Cash Price |
$2,359.38
|
| Rate for Payer: Cigna Commercial |
$3,916.56
|
| Rate for Payer: First Health Commercial |
$4,482.81
|
| Rate for Payer: Humana Commercial |
$4,010.94
|
| Rate for Payer: Humana KY Medicaid |
$1,622.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,639.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,869.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,482.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,415.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,655.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,152.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,539.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,775.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,105.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,255.94
|
| Rate for Payer: PHCS Commercial |
$4,530.00
|
| Rate for Payer: United Healthcare All Payer |
$4,152.50
|
|
|
FIBERTAK DBL KNTLESS KNEE ANCH
|
Facility
|
OP
|
$13,133.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,940.12 |
| Max. Negotiated Rate |
$12,608.40 |
| Rate for Payer: Aetna Commercial |
$10,112.99
|
| Rate for Payer: Anthem Medicaid |
$4,516.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,244.33
|
| Rate for Payer: Cash Price |
$6,566.88
|
| Rate for Payer: Cigna Commercial |
$10,901.01
|
| Rate for Payer: First Health Commercial |
$12,477.06
|
| Rate for Payer: Humana Commercial |
$11,163.69
|
| Rate for Payer: Humana KY Medicaid |
$4,516.70
|
| Rate for Payer: Kentucky WC Medicaid |
$4,562.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,769.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,692.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,940.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,607.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,557.70
|
| Rate for Payer: Ohio Health Group HMO |
$9,850.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,507.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,426.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,062.29
|
| Rate for Payer: PHCS Commercial |
$12,608.40
|
| Rate for Payer: United Healthcare All Payer |
$11,557.70
|
|
|
FIBERTAK DBL KNTLESS KNEE ANCH
|
Facility
|
IP
|
$13,133.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,940.12 |
| Max. Negotiated Rate |
$12,608.40 |
| Rate for Payer: Aetna Commercial |
$10,112.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,244.33
|
| Rate for Payer: Cash Price |
$6,566.88
|
| Rate for Payer: Cigna Commercial |
$10,901.01
|
| Rate for Payer: First Health Commercial |
$12,477.06
|
| Rate for Payer: Humana Commercial |
$11,163.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,769.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,692.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,940.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,557.70
|
| Rate for Payer: Ohio Health Group HMO |
$9,850.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,507.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,426.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,062.29
|
| Rate for Payer: PHCS Commercial |
$12,608.40
|
| Rate for Payer: United Healthcare All Payer |
$11,557.70
|
|
|
FIBERTAK DBL LD W/ 1.3 SUT TPE
|
Facility
|
OP
|
$3,387.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,016.25 |
| Max. Negotiated Rate |
$3,252.00 |
| Rate for Payer: Aetna Commercial |
$2,608.38
|
| Rate for Payer: Anthem Medicaid |
$1,164.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,642.25
|
| Rate for Payer: Cash Price |
$1,693.75
|
| Rate for Payer: Cigna Commercial |
$2,811.62
|
| Rate for Payer: First Health Commercial |
$3,218.12
|
| Rate for Payer: Humana Commercial |
$2,879.38
|
| Rate for Payer: Humana KY Medicaid |
$1,164.96
|
| Rate for Payer: Kentucky WC Medicaid |
$1,176.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,777.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,499.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,016.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,188.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,981.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,540.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,710.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,947.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,337.38
|
| Rate for Payer: PHCS Commercial |
$3,252.00
|
| Rate for Payer: United Healthcare All Payer |
$2,981.00
|
|
