|
HIP HINGE RAIL MOD UPPER
|
Facility
|
OP
|
$4,655.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,396.50 |
| Max. Negotiated Rate |
$4,468.80 |
| Rate for Payer: Aetna Commercial |
$3,584.35
|
| Rate for Payer: Anthem Medicaid |
$1,600.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,630.90
|
| Rate for Payer: Cash Price |
$2,327.50
|
| Rate for Payer: Cigna Commercial |
$3,863.65
|
| Rate for Payer: First Health Commercial |
$4,422.25
|
| Rate for Payer: Humana Commercial |
$3,956.75
|
| Rate for Payer: Humana KY Medicaid |
$1,600.85
|
| Rate for Payer: Kentucky WC Medicaid |
$1,617.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,817.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,435.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,396.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,632.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,096.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,491.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,724.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,049.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,211.95
|
| Rate for Payer: PHCS Commercial |
$4,468.80
|
| Rate for Payer: United Healthcare All Payer |
$4,096.40
|
|
|
HIP HINGE SM RAIL MOD UPPER
|
Facility
|
IP
|
$4,088.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,226.40 |
| Max. Negotiated Rate |
$3,924.48 |
| Rate for Payer: Aetna Commercial |
$3,147.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,188.64
|
| Rate for Payer: Cash Price |
$2,044.00
|
| Rate for Payer: Cigna Commercial |
$3,393.04
|
| Rate for Payer: First Health Commercial |
$3,883.60
|
| Rate for Payer: Humana Commercial |
$3,474.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,352.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,016.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,226.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,597.44
|
| Rate for Payer: Ohio Health Group HMO |
$3,066.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,270.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,556.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,820.72
|
| Rate for Payer: PHCS Commercial |
$3,924.48
|
| Rate for Payer: United Healthcare All Payer |
$3,597.44
|
|
|
HIP HINGE SM RAIL MOD UPPER
|
Facility
|
OP
|
$4,088.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,226.40 |
| Max. Negotiated Rate |
$3,924.48 |
| Rate for Payer: Aetna Commercial |
$3,147.76
|
| Rate for Payer: Anthem Medicaid |
$1,405.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,188.64
|
| Rate for Payer: Cash Price |
$2,044.00
|
| Rate for Payer: Cigna Commercial |
$3,393.04
|
| Rate for Payer: First Health Commercial |
$3,883.60
|
| Rate for Payer: Humana Commercial |
$3,474.80
|
| Rate for Payer: Humana KY Medicaid |
$1,405.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,420.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,352.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,016.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,226.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,434.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,597.44
|
| Rate for Payer: Ohio Health Group HMO |
$3,066.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,270.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,556.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,820.72
|
| Rate for Payer: PHCS Commercial |
$3,924.48
|
| Rate for Payer: United Healthcare All Payer |
$3,597.44
|
|
|
HIP REVISION KIT
|
Facility
|
IP
|
$11,169.57
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,350.87 |
| Max. Negotiated Rate |
$10,722.79 |
| Rate for Payer: Aetna Commercial |
$8,600.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,712.26
|
| Rate for Payer: Cash Price |
$5,584.78
|
| Rate for Payer: Cigna Commercial |
$9,270.74
|
| Rate for Payer: First Health Commercial |
$10,611.09
|
| Rate for Payer: Humana Commercial |
$9,494.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,159.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,243.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,350.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,829.22
|
| Rate for Payer: Ohio Health Group HMO |
$8,377.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,935.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,717.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,707.00
|
| Rate for Payer: PHCS Commercial |
$10,722.79
|
| Rate for Payer: United Healthcare All Payer |
$9,829.22
|
|
|
HIP REVISION KIT
|
Facility
|
OP
|
$11,169.57
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,350.87 |
| Max. Negotiated Rate |
$10,722.79 |
| Rate for Payer: Aetna Commercial |
$8,600.57
|
| Rate for Payer: Anthem Medicaid |
$3,841.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,712.26
|
| Rate for Payer: Cash Price |
$5,584.78
|
| Rate for Payer: Cigna Commercial |
$9,270.74
|
| Rate for Payer: First Health Commercial |
$10,611.09
|
| Rate for Payer: Humana Commercial |
$9,494.13
|
| Rate for Payer: Humana KY Medicaid |
$3,841.22
|
| Rate for Payer: Kentucky WC Medicaid |
$3,880.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,159.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,243.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,350.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,918.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,829.22
|
| Rate for Payer: Ohio Health Group HMO |
$8,377.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,935.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,717.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,707.00
|
| Rate for Payer: PHCS Commercial |
$10,722.79
|
| Rate for Payer: United Healthcare All Payer |
$9,829.22
|
|
|
HI TORQUE PILOT 200 10CM
|
Facility
|
IP
|
$1,492.60
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$447.78 |
| Max. Negotiated Rate |
$1,432.90 |
| Rate for Payer: Aetna Commercial |
$1,149.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,164.23
|
| Rate for Payer: Cash Price |
$746.30
|
| Rate for Payer: Cigna Commercial |
$1,238.86
|
| Rate for Payer: First Health Commercial |
$1,417.97
|
| Rate for Payer: Humana Commercial |
$1,268.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,223.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,101.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$447.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,313.49
|
| Rate for Payer: Ohio Health Group HMO |
$1,119.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,194.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,298.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,029.89
|
| Rate for Payer: PHCS Commercial |
$1,432.90
|
| Rate for Payer: United Healthcare All Payer |
$1,313.49
|
|
|
HI TORQUE PILOT 200 10CM
|
Facility
|
OP
|
$1,492.60
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$447.78 |
| Max. Negotiated Rate |
$1,432.90 |
| Rate for Payer: Aetna Commercial |
$1,149.30
|
| Rate for Payer: Anthem Medicaid |
$513.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,164.23
|
| Rate for Payer: Cash Price |
$746.30
|
| Rate for Payer: Cigna Commercial |
$1,238.86
|
| Rate for Payer: First Health Commercial |
$1,417.97
|
| Rate for Payer: Humana Commercial |
$1,268.71
|
| Rate for Payer: Humana KY Medicaid |
$513.31
|
| Rate for Payer: Kentucky WC Medicaid |
$518.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,223.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,101.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$447.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$523.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,313.49
|
| Rate for Payer: Ohio Health Group HMO |
$1,119.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,194.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,298.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,029.89
|
| Rate for Payer: PHCS Commercial |
$1,432.90
|
| Rate for Payer: United Healthcare All Payer |
$1,313.49
|
|
|
HI TORQUE PILOT 200 300CM
|
Facility
|
OP
|
$1,205.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$361.50 |
| Max. Negotiated Rate |
$1,156.80 |
| Rate for Payer: Aetna Commercial |
$927.85
|
| Rate for Payer: Anthem Medicaid |
$414.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$939.90
|
| Rate for Payer: Cash Price |
$602.50
|
| Rate for Payer: Cigna Commercial |
$1,000.15
|
| Rate for Payer: First Health Commercial |
$1,144.75
|
| Rate for Payer: Humana Commercial |
$1,024.25
|
| Rate for Payer: Humana KY Medicaid |
$414.40
|
| Rate for Payer: Kentucky WC Medicaid |
$418.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$988.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$889.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$361.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$422.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,060.40
|
| Rate for Payer: Ohio Health Group HMO |
$903.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$964.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,048.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$831.45
|
| Rate for Payer: PHCS Commercial |
$1,156.80
|
| Rate for Payer: United Healthcare All Payer |
$1,060.40
|
|
|
HI TORQUE PILOT 200 300CM
|
Facility
|
IP
|
$1,205.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$361.50 |
| Max. Negotiated Rate |
$1,156.80 |
| Rate for Payer: Aetna Commercial |
$927.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$939.90
|
| Rate for Payer: Cash Price |
$602.50
|
| Rate for Payer: Cigna Commercial |
$1,000.15
|
| Rate for Payer: First Health Commercial |
$1,144.75
|
| Rate for Payer: Humana Commercial |
$1,024.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$988.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$889.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$361.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,060.40
|
| Rate for Payer: Ohio Health Group HMO |
$903.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$964.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,048.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$831.45
|
| Rate for Payer: PHCS Commercial |
$1,156.80
|
| Rate for Payer: United Healthcare All Payer |
$1,060.40
|
|
|
HI TORQUE PILOT 50 300CM ST
|
Facility
|
IP
|
$1,205.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$361.50 |
| Max. Negotiated Rate |
$1,156.80 |
| Rate for Payer: Aetna Commercial |
$927.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$939.90
|
| Rate for Payer: Cash Price |
$602.50
|
| Rate for Payer: Cigna Commercial |
$1,000.15
|
| Rate for Payer: First Health Commercial |
$1,144.75
|
| Rate for Payer: Humana Commercial |
$1,024.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$988.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$889.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$361.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,060.40
|
| Rate for Payer: Ohio Health Group HMO |
$903.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$964.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,048.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$831.45
|
| Rate for Payer: PHCS Commercial |
$1,156.80
|
| Rate for Payer: United Healthcare All Payer |
$1,060.40
|
|
|
HI TORQUE PILOT 50 300CM ST
|
Facility
|
OP
|
$1,205.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$361.50 |
| Max. Negotiated Rate |
$1,156.80 |
| Rate for Payer: Aetna Commercial |
$927.85
|
| Rate for Payer: Anthem Medicaid |
$414.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$939.90
|
| Rate for Payer: Cash Price |
$602.50
|
| Rate for Payer: Cigna Commercial |
$1,000.15
|
| Rate for Payer: First Health Commercial |
$1,144.75
|
| Rate for Payer: Humana Commercial |
$1,024.25
|
| Rate for Payer: Humana KY Medicaid |
$414.40
|
| Rate for Payer: Kentucky WC Medicaid |
$418.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$988.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$889.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$361.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$422.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,060.40
|
| Rate for Payer: Ohio Health Group HMO |
$903.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$964.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,048.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$831.45
|
| Rate for Payer: PHCS Commercial |
$1,156.80
|
| Rate for Payer: United Healthcare All Payer |
$1,060.40
|
|
|
HI TORQUE WHISPER MS 300CM ST
|
Facility
|
OP
|
$1,205.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$361.50 |
| Max. Negotiated Rate |
$1,156.80 |
| Rate for Payer: Aetna Commercial |
$927.85
|
| Rate for Payer: Anthem Medicaid |
$414.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$939.90
|
| Rate for Payer: Cash Price |
$602.50
|
| Rate for Payer: Cigna Commercial |
$1,000.15
|
| Rate for Payer: First Health Commercial |
$1,144.75
|
| Rate for Payer: Humana Commercial |
$1,024.25
|
| Rate for Payer: Humana KY Medicaid |
$414.40
|
| Rate for Payer: Kentucky WC Medicaid |
$418.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$988.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$889.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$361.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$422.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,060.40
|
| Rate for Payer: Ohio Health Group HMO |
$903.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$964.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,048.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$831.45
|
| Rate for Payer: PHCS Commercial |
$1,156.80
|
| Rate for Payer: United Healthcare All Payer |
$1,060.40
|
|
|
HI TORQUE WHISPER MS 300CM ST
|
Facility
|
IP
|
$1,205.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$361.50 |
| Max. Negotiated Rate |
$1,156.80 |
| Rate for Payer: Aetna Commercial |
$927.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$939.90
|
| Rate for Payer: Cash Price |
$602.50
|
| Rate for Payer: Cigna Commercial |
$1,000.15
|
| Rate for Payer: First Health Commercial |
$1,144.75
|
| Rate for Payer: Humana Commercial |
$1,024.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$988.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$889.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$361.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,060.40
|
| Rate for Payer: Ohio Health Group HMO |
$903.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$964.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,048.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$831.45
|
| Rate for Payer: PHCS Commercial |
$1,156.80
|
| Rate for Payer: United Healthcare All Payer |
$1,060.40
|
|
|
HI TORQUE X-S'PORT 190CM
|
Facility
|
OP
|
$1,542.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$462.60 |
| Max. Negotiated Rate |
$1,480.32 |
| Rate for Payer: Aetna Commercial |
$1,187.34
|
| Rate for Payer: Anthem Medicaid |
$530.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,202.76
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cigna Commercial |
$1,279.86
|
| Rate for Payer: First Health Commercial |
$1,464.90
|
| Rate for Payer: Humana Commercial |
$1,310.70
|
| Rate for Payer: Humana KY Medicaid |
$530.29
|
| Rate for Payer: Kentucky WC Medicaid |
$535.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,264.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,138.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$462.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$540.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,356.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,156.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,233.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,341.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,063.98
|
| Rate for Payer: PHCS Commercial |
$1,480.32
|
| Rate for Payer: United Healthcare All Payer |
$1,356.96
|
|
|
HI TORQUE X-S'PORT 190CM
|
Facility
|
IP
|
$1,542.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$462.60 |
| Max. Negotiated Rate |
$1,480.32 |
| Rate for Payer: Aetna Commercial |
$1,187.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,202.76
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cigna Commercial |
$1,279.86
|
| Rate for Payer: First Health Commercial |
$1,464.90
|
| Rate for Payer: Humana Commercial |
$1,310.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,264.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,138.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$462.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,356.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,156.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,233.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,341.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,063.98
|
| Rate for Payer: PHCS Commercial |
$1,480.32
|
| Rate for Payer: United Healthcare All Payer |
$1,356.96
|
|
|
HI-TORQU SUPRA CORE WIRE 300CM
|
Facility
|
IP
|
$1,515.40
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$454.62 |
| Max. Negotiated Rate |
$1,454.78 |
| Rate for Payer: Aetna Commercial |
$1,166.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,182.01
|
| Rate for Payer: Cash Price |
$757.70
|
| Rate for Payer: Cigna Commercial |
$1,257.78
|
| Rate for Payer: First Health Commercial |
$1,439.63
|
| Rate for Payer: Humana Commercial |
$1,288.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,242.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,118.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$454.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,333.55
|
| Rate for Payer: Ohio Health Group HMO |
$1,136.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,212.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,318.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,045.63
|
| Rate for Payer: PHCS Commercial |
$1,454.78
|
| Rate for Payer: United Healthcare All Payer |
$1,333.55
|
|
|
HI-TORQU SUPRA CORE WIRE 300CM
|
Facility
|
OP
|
$1,515.40
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$454.62 |
| Max. Negotiated Rate |
$1,454.78 |
| Rate for Payer: Aetna Commercial |
$1,166.86
|
| Rate for Payer: Anthem Medicaid |
$521.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,182.01
|
| Rate for Payer: Cash Price |
$757.70
|
| Rate for Payer: Cigna Commercial |
$1,257.78
|
| Rate for Payer: First Health Commercial |
$1,439.63
|
| Rate for Payer: Humana Commercial |
$1,288.09
|
| Rate for Payer: Humana KY Medicaid |
$521.15
|
| Rate for Payer: Kentucky WC Medicaid |
$526.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,242.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,118.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$454.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$531.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,333.55
|
| Rate for Payer: Ohio Health Group HMO |
$1,136.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,212.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,318.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,045.63
|
| Rate for Payer: PHCS Commercial |
$1,454.78
|
| Rate for Payer: United Healthcare All Payer |
$1,333.55
|
|
|
HIV 1/2 AG/AB COMBO
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
HCPCS 87806
|
| Hospital Charge Code |
30001411
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.77 |
| Max. Negotiated Rate |
$145.92 |
| Rate for Payer: Aetna Commercial |
$117.04
|
| Rate for Payer: Anthem Medicaid |
$32.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$32.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$122.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$45.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$32.77
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cigna Commercial |
$126.16
|
| Rate for Payer: First Health Commercial |
$144.40
|
| Rate for Payer: Humana Commercial |
$129.20
|
| Rate for Payer: Humana KY Medicaid |
$32.77
|
| Rate for Payer: Humana Medicare Advantage |
$32.77
|
| Rate for Payer: Kentucky WC Medicaid |
$33.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$124.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$112.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$33.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$133.76
|
| Rate for Payer: Ohio Health Group HMO |
$114.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$121.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$132.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$104.88
|
| Rate for Payer: PHCS Commercial |
$145.92
|
| Rate for Payer: United Healthcare All Payer |
$133.76
|
|
|
HIV 1/2 AG/AB COMBO
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
HCPCS 87806
|
| Hospital Charge Code |
30001411
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.60 |
| Max. Negotiated Rate |
$145.92 |
| Rate for Payer: Aetna Commercial |
$117.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$122.06
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cigna Commercial |
$126.16
|
| Rate for Payer: First Health Commercial |
$144.40
|
| Rate for Payer: Humana Commercial |
$129.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$124.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$112.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$133.76
|
| Rate for Payer: Ohio Health Group HMO |
$114.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$121.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$132.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$104.88
|
| Rate for Payer: PHCS Commercial |
$145.92
|
| Rate for Payer: United Healthcare All Payer |
$133.76
|
|
|
HIV SCREEN 4TH GENERATION
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
HCPCS 87389
|
| Hospital Charge Code |
30001357
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.08 |
| Max. Negotiated Rate |
$165.12 |
| Rate for Payer: Aetna Commercial |
$132.44
|
| Rate for Payer: Anthem Medicaid |
$24.08
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$24.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$138.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$33.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$24.08
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Cigna Commercial |
$142.76
|
| Rate for Payer: First Health Commercial |
$163.40
|
| Rate for Payer: Humana Commercial |
$146.20
|
| Rate for Payer: Humana KY Medicaid |
$24.08
|
| Rate for Payer: Humana Medicare Advantage |
$24.08
|
| Rate for Payer: Kentucky WC Medicaid |
$24.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$141.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$151.36
|
| Rate for Payer: Ohio Health Group HMO |
$129.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$137.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$149.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$118.68
|
| Rate for Payer: PHCS Commercial |
$165.12
|
| Rate for Payer: United Healthcare All Payer |
$151.36
|
|
|
HIV SCREEN 4TH GENERATION
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
HCPCS 87389
|
| Hospital Charge Code |
30001357
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.60 |
| Max. Negotiated Rate |
$165.12 |
| Rate for Payer: Aetna Commercial |
$132.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$138.12
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Cigna Commercial |
$142.76
|
| Rate for Payer: First Health Commercial |
$163.40
|
| Rate for Payer: Humana Commercial |
$146.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$141.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$151.36
|
| Rate for Payer: Ohio Health Group HMO |
$129.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$137.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$149.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$118.68
|
| Rate for Payer: PHCS Commercial |
$165.12
|
| Rate for Payer: United Healthcare All Payer |
$151.36
|
|
|
HIZENTRA 100mg (10gm Vial)
|
Facility
|
OP
|
$13,134.50
|
|
|
Service Code
|
HCPCS J1559
|
| Hospital Charge Code |
25002082
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$12,609.12 |
| Rate for Payer: Aetna Commercial |
$10,113.57
|
| Rate for Payer: Anthem Medicaid |
$4,516.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,244.91
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$19.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$19.06
|
| Rate for Payer: Cash Price |
$6,567.25
|
| Rate for Payer: Cash Price |
$6,567.25
|
| Rate for Payer: Cigna Commercial |
$10,901.64
|
| Rate for Payer: First Health Commercial |
$12,477.77
|
| Rate for Payer: Humana Commercial |
$11,164.33
|
| Rate for Payer: Humana KY Medicaid |
$4,516.95
|
| Rate for Payer: Humana Medicare Advantage |
$14.12
|
| Rate for Payer: Kentucky WC Medicaid |
$4,562.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,770.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,693.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,607.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,558.36
|
| Rate for Payer: Ohio Health Group HMO |
$9,850.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,507.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,427.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,062.81
|
| Rate for Payer: PHCS Commercial |
$12,609.12
|
| Rate for Payer: United Healthcare All Payer |
$11,558.36
|
|
|
HIZENTRA 100mg (10gm Vial)
|
Facility
|
IP
|
$13,134.50
|
|
|
Service Code
|
HCPCS J1559
|
| Hospital Charge Code |
25002082
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,940.35 |
| Max. Negotiated Rate |
$12,609.12 |
| Rate for Payer: Aetna Commercial |
$10,113.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,244.91
|
| Rate for Payer: Cash Price |
$6,567.25
|
| Rate for Payer: Cigna Commercial |
$10,901.64
|
| Rate for Payer: First Health Commercial |
$12,477.77
|
| Rate for Payer: Humana Commercial |
$11,164.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,770.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,693.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,940.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,558.36
|
| Rate for Payer: Ohio Health Group HMO |
$9,850.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,507.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,427.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,062.81
|
| Rate for Payer: PHCS Commercial |
$12,609.12
|
| Rate for Payer: United Healthcare All Payer |
$11,558.36
|
|
|
HIZENTRA 1GM/5ML VIAL
|
Facility
|
IP
|
$1,313.45
|
|
|
Service Code
|
HCPCS J1559
|
| Hospital Charge Code |
25002083
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$394.04 |
| Max. Negotiated Rate |
$1,260.91 |
| Rate for Payer: Aetna Commercial |
$1,011.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,024.49
|
| Rate for Payer: Cash Price |
$656.72
|
| Rate for Payer: Cigna Commercial |
$1,090.16
|
| Rate for Payer: First Health Commercial |
$1,247.78
|
| Rate for Payer: Humana Commercial |
$1,116.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,077.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$969.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$394.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,155.84
|
| Rate for Payer: Ohio Health Group HMO |
$985.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,050.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,142.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$906.28
|
| Rate for Payer: PHCS Commercial |
$1,260.91
|
| Rate for Payer: United Healthcare All Payer |
$1,155.84
|
|
|
HIZENTRA 1GM/5ML VIAL
|
Facility
|
OP
|
$1,313.45
|
|
|
Service Code
|
HCPCS J1559
|
| Hospital Charge Code |
25002083
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$1,260.91 |
| Rate for Payer: Aetna Commercial |
$1,011.36
|
| Rate for Payer: Anthem Medicaid |
$451.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,024.49
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$19.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$19.06
|
| Rate for Payer: Cash Price |
$656.72
|
| Rate for Payer: Cash Price |
$656.72
|
| Rate for Payer: Cigna Commercial |
$1,090.16
|
| Rate for Payer: First Health Commercial |
$1,247.78
|
| Rate for Payer: Humana Commercial |
$1,116.43
|
| Rate for Payer: Humana KY Medicaid |
$451.70
|
| Rate for Payer: Humana Medicare Advantage |
$14.12
|
| Rate for Payer: Kentucky WC Medicaid |
$456.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,077.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$969.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$460.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,155.84
|
| Rate for Payer: Ohio Health Group HMO |
$985.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,050.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,142.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$906.28
|
| Rate for Payer: PHCS Commercial |
$1,260.91
|
| Rate for Payer: United Healthcare All Payer |
$1,155.84
|
|
