|
HYPERRAB 150 IU (1500 U VIAL)
|
Facility
|
OP
|
$18,543.46
|
|
|
Service Code
|
HCPCS 90375
|
| Hospital Charge Code |
25000007
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$289.98 |
| Max. Negotiated Rate |
$17,801.72 |
| Rate for Payer: Aetna Commercial |
$14,278.46
|
| Rate for Payer: Anthem Medicaid |
$6,377.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$289.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,463.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$405.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$391.47
|
| Rate for Payer: Cash Price |
$9,271.73
|
| Rate for Payer: Cash Price |
$9,271.73
|
| Rate for Payer: Cigna Commercial |
$15,391.07
|
| Rate for Payer: First Health Commercial |
$17,616.29
|
| Rate for Payer: Humana Commercial |
$15,761.94
|
| Rate for Payer: Humana KY Medicaid |
$6,377.10
|
| Rate for Payer: Humana Medicare Advantage |
$289.98
|
| Rate for Payer: Kentucky WC Medicaid |
$6,442.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,205.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,685.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$347.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,505.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,318.24
|
| Rate for Payer: Ohio Health Group HMO |
$13,907.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,708.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,410.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,748.47
|
| Rate for Payer: PHCS Commercial |
$17,801.72
|
| Rate for Payer: United Healthcare All Payer |
$16,318.24
|
|
|
HYPERRAB 150 IU (300 U VIAL)
|
Facility
|
IP
|
$3,708.73
|
|
|
Service Code
|
HCPCS 90375
|
| Hospital Charge Code |
25000006
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$482.13 |
| Max. Negotiated Rate |
$3,560.38 |
| Rate for Payer: Aetna Commercial |
$2,855.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,892.81
|
| Rate for Payer: Cash Price |
$1,854.37
|
| Rate for Payer: Cigna Commercial |
$3,078.25
|
| Rate for Payer: First Health Commercial |
$3,523.29
|
| Rate for Payer: Humana Commercial |
$3,152.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,041.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,737.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,112.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,263.68
|
| Rate for Payer: Ohio Health Group HMO |
$2,781.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$741.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$482.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,149.71
|
| Rate for Payer: PHCS Commercial |
$3,560.38
|
| Rate for Payer: United Healthcare All Payer |
$3,263.68
|
|
|
HYPERRAB 150 IU (300 U VIAL)
|
Facility
|
OP
|
$3,708.73
|
|
|
Service Code
|
HCPCS 90375
|
| Hospital Charge Code |
25000006
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$289.98 |
| Max. Negotiated Rate |
$3,560.38 |
| Rate for Payer: Aetna Commercial |
$2,855.72
|
| Rate for Payer: Anthem Medicaid |
$1,275.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$289.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,892.81
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$405.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$391.47
|
| Rate for Payer: Cash Price |
$1,854.37
|
| Rate for Payer: Cash Price |
$1,854.37
|
| Rate for Payer: Cigna Commercial |
$3,078.25
|
| Rate for Payer: First Health Commercial |
$3,523.29
|
| Rate for Payer: Humana Commercial |
$3,152.42
|
| Rate for Payer: Humana KY Medicaid |
$1,275.43
|
| Rate for Payer: Humana Medicare Advantage |
$289.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,288.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,041.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,737.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$347.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,301.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,263.68
|
| Rate for Payer: Ohio Health Group HMO |
$2,781.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$741.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$482.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,149.71
|
| Rate for Payer: PHCS Commercial |
$3,560.38
|
| Rate for Payer: United Healthcare All Payer |
$3,263.68
|
|
|
HYPERRAB 150 IU (900 U VIAL)
|
Facility
|
OP
|
$11,126.12
|
|
|
Service Code
|
HCPCS 90375
|
| Hospital Charge Code |
25004087
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$289.98 |
| Max. Negotiated Rate |
$10,681.08 |
| Rate for Payer: Aetna Commercial |
$8,567.11
|
| Rate for Payer: Anthem Medicaid |
$3,826.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$289.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,678.37
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$405.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$391.47
|
| Rate for Payer: Cash Price |
$5,563.06
|
| Rate for Payer: Cash Price |
$5,563.06
|
| Rate for Payer: Cigna Commercial |
$9,234.68
|
| Rate for Payer: First Health Commercial |
$10,569.81
|
| Rate for Payer: Humana Commercial |
$9,457.20
|
| Rate for Payer: Humana KY Medicaid |
$3,826.27
|
| Rate for Payer: Humana Medicare Advantage |
$289.98
|
| Rate for Payer: Kentucky WC Medicaid |
$3,865.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,123.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,211.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$347.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,903.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,790.99
|
| Rate for Payer: Ohio Health Group HMO |
$8,344.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,225.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,446.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,449.10
|
| Rate for Payer: PHCS Commercial |
$10,681.08
|
| Rate for Payer: United Healthcare All Payer |
$9,790.99
|
|
|
HYPERRAB 150 IU (900 U VIAL)
|
Facility
|
IP
|
$11,126.12
|
|
|
Service Code
|
HCPCS 90375
|
| Hospital Charge Code |
25004087
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,446.40 |
| Max. Negotiated Rate |
$10,681.08 |
| Rate for Payer: Aetna Commercial |
$8,567.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,678.37
|
| Rate for Payer: Cash Price |
$5,563.06
|
| Rate for Payer: Cigna Commercial |
$9,234.68
|
| Rate for Payer: First Health Commercial |
$10,569.81
|
| Rate for Payer: Humana Commercial |
$9,457.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,123.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,211.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,337.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,790.99
|
| Rate for Payer: Ohio Health Group HMO |
$8,344.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,225.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,446.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,449.10
|
| Rate for Payer: PHCS Commercial |
$10,681.08
|
| Rate for Payer: United Healthcare All Payer |
$9,790.99
|
|
|
HYPERTENSION WITH MCC
|
Facility
|
IP
|
$13,441.25
|
|
|
Service Code
|
MSDRG 304
|
| Min. Negotiated Rate |
$9,120.85 |
| Max. Negotiated Rate |
$13,441.25 |
| Rate for Payer: Anthem Medicaid |
$9,120.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,600.89
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13,441.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$12,961.20
|
| Rate for Payer: Humana KY Medicaid |
$9,120.85
|
| Rate for Payer: Humana Medicare Advantage |
$9,600.89
|
| Rate for Payer: Kentucky WC Medicaid |
$9,212.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,521.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,303.26
|
|
|
HYPERTENSION WITHOUT MCC
|
Facility
|
IP
|
$8,814.61
|
|
|
Service Code
|
MSDRG 305
|
| Min. Negotiated Rate |
$5,981.34 |
| Max. Negotiated Rate |
$8,814.61 |
| Rate for Payer: Anthem Medicaid |
$5,981.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,296.15
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,814.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,499.80
|
| Rate for Payer: Humana KY Medicaid |
$5,981.34
|
| Rate for Payer: Humana Medicare Advantage |
$6,296.15
|
| Rate for Payer: Kentucky WC Medicaid |
$6,041.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,555.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,100.97
|
|
|
HYPERTENSIVE ENCEPHALOPATHY WITH CC
|
Facility
|
IP
|
$11,895.90
|
|
|
Service Code
|
MSDRG 078
|
| Min. Negotiated Rate |
$8,072.22 |
| Max. Negotiated Rate |
$11,895.90 |
| Rate for Payer: Anthem Medicaid |
$8,072.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8,497.07
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$11,895.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$11,471.04
|
| Rate for Payer: Humana KY Medicaid |
$8,072.22
|
| Rate for Payer: Humana Medicare Advantage |
$8,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$8,152.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,196.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,233.66
|
|
|
HYPERTENSIVE ENCEPHALOPATHY WITH MCC
|
Facility
|
IP
|
$17,674.83
|
|
|
Service Code
|
MSDRG 077
|
| Min. Negotiated Rate |
$11,993.64 |
| Max. Negotiated Rate |
$17,674.83 |
| Rate for Payer: Anthem Medicaid |
$11,993.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12,624.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17,674.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$17,043.59
|
| Rate for Payer: Humana KY Medicaid |
$11,993.64
|
| Rate for Payer: Humana Medicare Advantage |
$12,624.88
|
| Rate for Payer: Kentucky WC Medicaid |
$12,113.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15,149.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,233.51
|
|
|
HYPERTENSIVE ENCEPHALOPATHY WITHOUT CC/MCC
|
Facility
|
IP
|
$8,666.04
|
|
|
Service Code
|
MSDRG 079
|
| Min. Negotiated Rate |
$5,880.53 |
| Max. Negotiated Rate |
$8,666.04 |
| Rate for Payer: Anthem Medicaid |
$5,880.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,190.03
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,666.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,356.54
|
| Rate for Payer: Humana KY Medicaid |
$5,880.53
|
| Rate for Payer: Humana Medicare Advantage |
$6,190.03
|
| Rate for Payer: Kentucky WC Medicaid |
$5,939.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,428.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,998.14
|
|
|
HYPER-TET(TET IMM GLO 250U/1ML
|
Facility
|
OP
|
$1,572.26
|
|
|
Service Code
|
HCPCS J1670
|
| Hospital Charge Code |
25002154
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$204.39 |
| Max. Negotiated Rate |
$1,509.37 |
| Rate for Payer: Aetna Commercial |
$1,210.64
|
| Rate for Payer: Anthem Medicaid |
$540.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$578.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,226.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$810.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$781.13
|
| Rate for Payer: Cash Price |
$786.13
|
| Rate for Payer: Cash Price |
$786.13
|
| Rate for Payer: Cigna Commercial |
$1,304.98
|
| Rate for Payer: First Health Commercial |
$1,493.65
|
| Rate for Payer: Humana Commercial |
$1,336.42
|
| Rate for Payer: Humana KY Medicaid |
$540.70
|
| Rate for Payer: Humana Medicare Advantage |
$578.61
|
| Rate for Payer: Kentucky WC Medicaid |
$546.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,289.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,160.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$694.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$551.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,383.59
|
| Rate for Payer: Ohio Health Group HMO |
$1,179.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$314.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$204.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$487.40
|
| Rate for Payer: PHCS Commercial |
$1,509.37
|
| Rate for Payer: United Healthcare All Payer |
$1,383.59
|
|
|
HYPER-TET(TET IMM GLO 250U/1ML
|
Facility
|
IP
|
$1,572.26
|
|
|
Service Code
|
HCPCS J1670
|
| Hospital Charge Code |
25002154
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$204.39 |
| Max. Negotiated Rate |
$1,509.37 |
| Rate for Payer: Aetna Commercial |
$1,210.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,226.36
|
| Rate for Payer: Cash Price |
$786.13
|
| Rate for Payer: Cigna Commercial |
$1,304.98
|
| Rate for Payer: First Health Commercial |
$1,493.65
|
| Rate for Payer: Humana Commercial |
$1,336.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,289.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,160.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$471.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,383.59
|
| Rate for Payer: Ohio Health Group HMO |
$1,179.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$314.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$204.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$487.40
|
| Rate for Payer: PHCS Commercial |
$1,509.37
|
| Rate for Payer: United Healthcare All Payer |
$1,383.59
|
|
|
HYPOCURE SINUS TARSI IMP SZ 10
|
Facility
|
IP
|
$8,567.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,113.71 |
| Max. Negotiated Rate |
$8,224.32 |
| Rate for Payer: Aetna Commercial |
$6,596.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,682.26
|
| Rate for Payer: Cash Price |
$4,283.50
|
| Rate for Payer: Cigna Commercial |
$7,110.61
|
| Rate for Payer: First Health Commercial |
$8,138.65
|
| Rate for Payer: Humana Commercial |
$7,281.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,024.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,322.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,570.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,538.96
|
| Rate for Payer: Ohio Health Group HMO |
$6,425.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,713.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,113.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,655.77
|
| Rate for Payer: PHCS Commercial |
$8,224.32
|
| Rate for Payer: United Healthcare All Payer |
$7,538.96
|
|
|
HYPOCURE SINUS TARSI IMP SZ 10
|
Facility
|
OP
|
$8,567.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,113.71 |
| Max. Negotiated Rate |
$8,224.32 |
| Rate for Payer: Aetna Commercial |
$6,596.59
|
| Rate for Payer: Anthem Medicaid |
$2,946.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,682.26
|
| Rate for Payer: Cash Price |
$4,283.50
|
| Rate for Payer: Cigna Commercial |
$7,110.61
|
| Rate for Payer: First Health Commercial |
$8,138.65
|
| Rate for Payer: Humana Commercial |
$7,281.95
|
| Rate for Payer: Humana KY Medicaid |
$2,946.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,976.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,024.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,322.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,570.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,005.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,538.96
|
| Rate for Payer: Ohio Health Group HMO |
$6,425.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,713.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,113.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,655.77
|
| Rate for Payer: PHCS Commercial |
$8,224.32
|
| Rate for Payer: United Healthcare All Payer |
$7,538.96
|
|
|
HYPOCURE SINUS TARSI IMP SZ 5
|
Facility
|
OP
|
$8,567.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,113.71 |
| Max. Negotiated Rate |
$8,224.32 |
| Rate for Payer: Aetna Commercial |
$6,596.59
|
| Rate for Payer: Anthem Medicaid |
$2,946.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,682.26
|
| Rate for Payer: Cash Price |
$4,283.50
|
| Rate for Payer: Cigna Commercial |
$7,110.61
|
| Rate for Payer: First Health Commercial |
$8,138.65
|
| Rate for Payer: Humana Commercial |
$7,281.95
|
| Rate for Payer: Humana KY Medicaid |
$2,946.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,976.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,024.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,322.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,570.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,005.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,538.96
|
| Rate for Payer: Ohio Health Group HMO |
$6,425.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,713.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,113.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,655.77
|
| Rate for Payer: PHCS Commercial |
$8,224.32
|
| Rate for Payer: United Healthcare All Payer |
$7,538.96
|
|
|
HYPOCURE SINUS TARSI IMP SZ 5
|
Facility
|
IP
|
$8,567.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,113.71 |
| Max. Negotiated Rate |
$8,224.32 |
| Rate for Payer: Aetna Commercial |
$6,596.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,682.26
|
| Rate for Payer: Cash Price |
$4,283.50
|
| Rate for Payer: Cigna Commercial |
$7,110.61
|
| Rate for Payer: First Health Commercial |
$8,138.65
|
| Rate for Payer: Humana Commercial |
$7,281.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,024.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,322.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,570.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,538.96
|
| Rate for Payer: Ohio Health Group HMO |
$6,425.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,713.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,113.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,655.77
|
| Rate for Payer: PHCS Commercial |
$8,224.32
|
| Rate for Payer: United Healthcare All Payer |
$7,538.96
|
|
|
HYPOCURE SINUS TARSI IMP SZ 6
|
Facility
|
IP
|
$8,567.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,113.71 |
| Max. Negotiated Rate |
$8,224.32 |
| Rate for Payer: Aetna Commercial |
$6,596.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,682.26
|
| Rate for Payer: Cash Price |
$4,283.50
|
| Rate for Payer: Cigna Commercial |
$7,110.61
|
| Rate for Payer: First Health Commercial |
$8,138.65
|
| Rate for Payer: Humana Commercial |
$7,281.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,024.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,322.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,570.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,538.96
|
| Rate for Payer: Ohio Health Group HMO |
$6,425.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,713.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,113.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,655.77
|
| Rate for Payer: PHCS Commercial |
$8,224.32
|
| Rate for Payer: United Healthcare All Payer |
$7,538.96
|
|
|
HYPOCURE SINUS TARSI IMP SZ 6
|
Facility
|
OP
|
$8,567.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,113.71 |
| Max. Negotiated Rate |
$8,224.32 |
| Rate for Payer: Aetna Commercial |
$6,596.59
|
| Rate for Payer: Anthem Medicaid |
$2,946.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,682.26
|
| Rate for Payer: Cash Price |
$4,283.50
|
| Rate for Payer: Cigna Commercial |
$7,110.61
|
| Rate for Payer: First Health Commercial |
$8,138.65
|
| Rate for Payer: Humana Commercial |
$7,281.95
|
| Rate for Payer: Humana KY Medicaid |
$2,946.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,976.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,024.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,322.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,570.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,005.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,538.96
|
| Rate for Payer: Ohio Health Group HMO |
$6,425.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,713.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,113.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,655.77
|
| Rate for Payer: PHCS Commercial |
$8,224.32
|
| Rate for Payer: United Healthcare All Payer |
$7,538.96
|
|
|
HYPOCURE SINUS TARSI IMP SZ 7
|
Facility
|
OP
|
$8,567.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,113.71 |
| Max. Negotiated Rate |
$8,224.32 |
| Rate for Payer: Aetna Commercial |
$6,596.59
|
| Rate for Payer: Anthem Medicaid |
$2,946.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,682.26
|
| Rate for Payer: Cash Price |
$4,283.50
|
| Rate for Payer: Cigna Commercial |
$7,110.61
|
| Rate for Payer: First Health Commercial |
$8,138.65
|
| Rate for Payer: Humana Commercial |
$7,281.95
|
| Rate for Payer: Humana KY Medicaid |
$2,946.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,976.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,024.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,322.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,570.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,005.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,538.96
|
| Rate for Payer: Ohio Health Group HMO |
$6,425.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,713.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,113.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,655.77
|
| Rate for Payer: PHCS Commercial |
$8,224.32
|
| Rate for Payer: United Healthcare All Payer |
$7,538.96
|
|
|
HYPOCURE SINUS TARSI IMP SZ 7
|
Facility
|
IP
|
$8,567.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,113.71 |
| Max. Negotiated Rate |
$8,224.32 |
| Rate for Payer: Aetna Commercial |
$6,596.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,682.26
|
| Rate for Payer: Cash Price |
$4,283.50
|
| Rate for Payer: Cigna Commercial |
$7,110.61
|
| Rate for Payer: First Health Commercial |
$8,138.65
|
| Rate for Payer: Humana Commercial |
$7,281.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,024.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,322.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,570.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,538.96
|
| Rate for Payer: Ohio Health Group HMO |
$6,425.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,713.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,113.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,655.77
|
| Rate for Payer: PHCS Commercial |
$8,224.32
|
| Rate for Payer: United Healthcare All Payer |
$7,538.96
|
|
|
HYPOCURE SINUS TARSI IMP SZ 8
|
Facility
|
OP
|
$8,567.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,113.71 |
| Max. Negotiated Rate |
$8,224.32 |
| Rate for Payer: Aetna Commercial |
$6,596.59
|
| Rate for Payer: Anthem Medicaid |
$2,946.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,682.26
|
| Rate for Payer: Cash Price |
$4,283.50
|
| Rate for Payer: Cigna Commercial |
$7,110.61
|
| Rate for Payer: First Health Commercial |
$8,138.65
|
| Rate for Payer: Humana Commercial |
$7,281.95
|
| Rate for Payer: Humana KY Medicaid |
$2,946.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,976.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,024.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,322.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,570.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,005.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,538.96
|
| Rate for Payer: Ohio Health Group HMO |
$6,425.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,713.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,113.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,655.77
|
| Rate for Payer: PHCS Commercial |
$8,224.32
|
| Rate for Payer: United Healthcare All Payer |
$7,538.96
|
|
|
HYPOCURE SINUS TARSI IMP SZ 8
|
Facility
|
IP
|
$8,567.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,113.71 |
| Max. Negotiated Rate |
$8,224.32 |
| Rate for Payer: Aetna Commercial |
$6,596.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,682.26
|
| Rate for Payer: Cash Price |
$4,283.50
|
| Rate for Payer: Cigna Commercial |
$7,110.61
|
| Rate for Payer: First Health Commercial |
$8,138.65
|
| Rate for Payer: Humana Commercial |
$7,281.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,024.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,322.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,570.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,538.96
|
| Rate for Payer: Ohio Health Group HMO |
$6,425.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,713.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,113.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,655.77
|
| Rate for Payer: PHCS Commercial |
$8,224.32
|
| Rate for Payer: United Healthcare All Payer |
$7,538.96
|
|
|
HYPOCURE SINUS TARSI IMP SZ 9
|
Facility
|
OP
|
$8,567.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,113.71 |
| Max. Negotiated Rate |
$8,224.32 |
| Rate for Payer: Aetna Commercial |
$6,596.59
|
| Rate for Payer: Anthem Medicaid |
$2,946.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,682.26
|
| Rate for Payer: Cash Price |
$4,283.50
|
| Rate for Payer: Cigna Commercial |
$7,110.61
|
| Rate for Payer: First Health Commercial |
$8,138.65
|
| Rate for Payer: Humana Commercial |
$7,281.95
|
| Rate for Payer: Humana KY Medicaid |
$2,946.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,976.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,024.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,322.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,570.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,005.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,538.96
|
| Rate for Payer: Ohio Health Group HMO |
$6,425.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,713.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,113.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,655.77
|
| Rate for Payer: PHCS Commercial |
$8,224.32
|
| Rate for Payer: United Healthcare All Payer |
$7,538.96
|
|
|
HYPOCURE SINUS TARSI IMP SZ 9
|
Facility
|
IP
|
$8,567.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,113.71 |
| Max. Negotiated Rate |
$8,224.32 |
| Rate for Payer: Aetna Commercial |
$6,596.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,682.26
|
| Rate for Payer: Cash Price |
$4,283.50
|
| Rate for Payer: Cigna Commercial |
$7,110.61
|
| Rate for Payer: First Health Commercial |
$8,138.65
|
| Rate for Payer: Humana Commercial |
$7,281.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,024.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,322.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,570.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,538.96
|
| Rate for Payer: Ohio Health Group HMO |
$6,425.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,713.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,113.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,655.77
|
| Rate for Payer: PHCS Commercial |
$8,224.32
|
| Rate for Payer: United Healthcare All Payer |
$7,538.96
|
|
|
HYSEPT 50 (DAKIN0.5%EQUIV) SOL
|
Facility
|
OP
|
$1.31
|
|
|
Service Code
|
NDC 39328006250
|
| Hospital Charge Code |
25003111
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$1.26 |
| Rate for Payer: Aetna Commercial |
$1.01
|
| Rate for Payer: Anthem Medicaid |
$0.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.02
|
| Rate for Payer: Cash Price |
$0.66
|
| Rate for Payer: Cigna Commercial |
$1.09
|
| Rate for Payer: First Health Commercial |
$1.24
|
| Rate for Payer: Humana Commercial |
$1.11
|
| Rate for Payer: Humana KY Medicaid |
$0.45
|
| Rate for Payer: Kentucky WC Medicaid |
$0.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.15
|
| Rate for Payer: Ohio Health Group HMO |
$0.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.41
|
| Rate for Payer: PHCS Commercial |
$1.26
|
| Rate for Payer: United Healthcare All Payer |
$1.15
|
|
