|
PRIM ART M-THRMBC 1ST VSL
|
Facility
|
OP
|
$3,100.00
|
|
|
Service Code
|
HCPCS 37184
|
| Hospital Charge Code |
76101525
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,066.09 |
| Max. Negotiated Rate |
$23,228.31 |
| Rate for Payer: Aetna Commercial |
$2,387.00
|
| Rate for Payer: Anthem Medicaid |
$1,066.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16,591.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,418.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$23,228.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$22,398.73
|
| Rate for Payer: Cash Price |
$1,550.00
|
| Rate for Payer: Cash Price |
$1,550.00
|
| Rate for Payer: Cigna Commercial |
$2,573.00
|
| Rate for Payer: First Health Commercial |
$2,945.00
|
| Rate for Payer: Humana Commercial |
$2,635.00
|
| Rate for Payer: Humana KY Medicaid |
$1,066.09
|
| Rate for Payer: Humana Medicare Advantage |
$16,591.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,076.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,542.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,287.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19,909.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,087.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,728.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,325.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,480.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,697.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,139.00
|
| Rate for Payer: PHCS Commercial |
$2,976.00
|
| Rate for Payer: United Healthcare All Payer |
$2,728.00
|
|
|
PRIM ART M-THRMBC 1ST VSL
|
Facility
|
IP
|
$3,100.00
|
|
|
Service Code
|
HCPCS 37184
|
| Hospital Charge Code |
76101525
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$930.00 |
| Max. Negotiated Rate |
$2,976.00 |
| Rate for Payer: Aetna Commercial |
$2,387.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,418.00
|
| Rate for Payer: Cash Price |
$1,550.00
|
| Rate for Payer: Cigna Commercial |
$2,573.00
|
| Rate for Payer: First Health Commercial |
$2,945.00
|
| Rate for Payer: Humana Commercial |
$2,635.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,542.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,287.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$930.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,728.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,325.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,480.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,697.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,139.00
|
| Rate for Payer: PHCS Commercial |
$2,976.00
|
| Rate for Payer: United Healthcare All Payer |
$2,728.00
|
|
|
PRIM ART M-THRMBC 1ST VSL(P
|
Professional
|
Both
|
$3,100.00
|
|
|
Service Code
|
HCPCS 37184
|
| Hospital Charge Code |
761P1525
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$332.20 |
| Max. Negotiated Rate |
$2,801.50 |
| Rate for Payer: Aetna Commercial |
$725.36
|
| Rate for Payer: Ambetter Exchange |
$402.09
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$332.20
|
| Rate for Payer: Anthem Medicaid |
$2,105.80
|
| Rate for Payer: Buckeye Individual/Medicaid |
$402.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$402.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$482.51
|
| Rate for Payer: Cash Price |
$1,550.00
|
| Rate for Payer: Cash Price |
$1,550.00
|
| Rate for Payer: Cigna Commercial |
$668.09
|
| Rate for Payer: Healthspan PPO |
$2,801.50
|
| Rate for Payer: Humana Medicaid |
$2,105.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$604.83
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$402.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$402.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$2,147.92
|
| Rate for Payer: Molina Healthcare Passport |
$2,105.80
|
| Rate for Payer: Multiplan PHCS |
$1,860.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$522.72
|
| Rate for Payer: UHCCP Medicaid |
$348.81
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$2,126.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$402.09
|
|
|
PRIM ART M-THRMBC SBSQ VSL
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 37185
|
| Hospital Charge Code |
76101526
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem Medicaid |
$343.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Humana KY Medicaid |
$343.90
|
| Rate for Payer: Kentucky WC Medicaid |
$347.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$350.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$690.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
PRIM ART M-THRMBC SBSQ VSL
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 37185
|
| Hospital Charge Code |
76101526
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$122.38 |
| Max. Negotiated Rate |
$928.12 |
| Rate for Payer: Aetna Commercial |
$267.46
|
| Rate for Payer: Ambetter Exchange |
$152.08
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$122.38
|
| Rate for Payer: Anthem Medicaid |
$688.35
|
| Rate for Payer: Buckeye Individual/Medicaid |
$152.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$152.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$182.50
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$245.07
|
| Rate for Payer: Healthspan PPO |
$928.12
|
| Rate for Payer: Humana Medicaid |
$688.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$224.65
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$152.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$152.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$702.12
|
| Rate for Payer: Molina Healthcare Passport |
$688.35
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$197.70
|
| Rate for Payer: UHCCP Medicaid |
$128.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$695.23
|
| Rate for Payer: Wellcare Medicare Advantage |
$152.08
|
|
|
PRIM ART M-THRMBC SBSQ VSL
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 37185
|
| Hospital Charge Code |
76101526
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$690.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
PRIM ART M-THRMBC SBSQ VSL(P
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 37185
|
| Hospital Charge Code |
761P1526
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$122.38 |
| Max. Negotiated Rate |
$928.12 |
| Rate for Payer: Aetna Commercial |
$267.46
|
| Rate for Payer: Ambetter Exchange |
$152.08
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$122.38
|
| Rate for Payer: Anthem Medicaid |
$688.35
|
| Rate for Payer: Buckeye Individual/Medicaid |
$152.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$152.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$182.50
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$245.07
|
| Rate for Payer: Healthspan PPO |
$928.12
|
| Rate for Payer: Humana Medicaid |
$688.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$224.65
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$152.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$152.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$702.12
|
| Rate for Payer: Molina Healthcare Passport |
$688.35
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$197.70
|
| Rate for Payer: UHCCP Medicaid |
$128.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$695.23
|
| Rate for Payer: Wellcare Medicare Advantage |
$152.08
|
|
|
PRIMARY HEMI MAND PLATE RIGH
|
Facility
|
IP
|
$4,430.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,329.00 |
| Max. Negotiated Rate |
$4,252.80 |
| Rate for Payer: Aetna Commercial |
$3,411.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,455.40
|
| Rate for Payer: Cash Price |
$2,215.00
|
| Rate for Payer: Cigna Commercial |
$3,676.90
|
| Rate for Payer: First Health Commercial |
$4,208.50
|
| Rate for Payer: Humana Commercial |
$3,765.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,632.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,269.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,329.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,898.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,322.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,544.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,854.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,056.70
|
| Rate for Payer: PHCS Commercial |
$4,252.80
|
| Rate for Payer: United Healthcare All Payer |
$3,898.40
|
|
|
PRIMARY HEMI MAND PLATE RIGH
|
Facility
|
OP
|
$4,430.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,329.00 |
| Max. Negotiated Rate |
$4,252.80 |
| Rate for Payer: Aetna Commercial |
$3,411.10
|
| Rate for Payer: Anthem Medicaid |
$1,523.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,455.40
|
| Rate for Payer: Cash Price |
$2,215.00
|
| Rate for Payer: Cigna Commercial |
$3,676.90
|
| Rate for Payer: First Health Commercial |
$4,208.50
|
| Rate for Payer: Humana Commercial |
$3,765.50
|
| Rate for Payer: Humana KY Medicaid |
$1,523.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,538.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,632.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,269.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,329.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,554.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,898.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,322.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,544.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,854.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,056.70
|
| Rate for Payer: PHCS Commercial |
$4,252.80
|
| Rate for Payer: United Healthcare All Payer |
$3,898.40
|
|
|
PRIMARY PERCUTANEOUS TRANSLUMINAL MECHANICAL THROMBECTOMY, NONCORONARY, NON-INTRACRANIAL, ARTERIAL OR ARTERIAL BYPASS GRAFT, INCLUDING FLUOROSCOPIC GUIDANCE AND INTRAPROCEDURAL PHARMACOLOGICAL THROMBOLYTIC INJECTION(S); INITIAL VESSEL
|
Facility
|
OP
|
$23,228.31
|
|
|
Service Code
|
CPT 37184
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$16,591.65 |
| Max. Negotiated Rate |
$23,228.31 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16,591.65
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$23,228.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$22,398.73
|
| Rate for Payer: Humana Medicare Advantage |
$16,591.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19,909.98
|
|
|
PRIMATRIX 0.2*26.5
|
Facility
|
IP
|
$2,186.67
|
|
|
Service Code
|
HCPCS Q4110
|
| Hospital Charge Code |
27000119
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$656.00 |
| Max. Negotiated Rate |
$2,099.20 |
| Rate for Payer: Aetna Commercial |
$1,683.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,705.60
|
| Rate for Payer: Cash Price |
$1,093.33
|
| Rate for Payer: Cigna Commercial |
$1,814.94
|
| Rate for Payer: First Health Commercial |
$2,077.34
|
| Rate for Payer: Humana Commercial |
$1,858.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,793.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,613.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$656.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,924.27
|
| Rate for Payer: Ohio Health Group HMO |
$1,640.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,749.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,902.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,508.80
|
| Rate for Payer: PHCS Commercial |
$2,099.20
|
| Rate for Payer: United Healthcare All Payer |
$1,924.27
|
|
|
PRIMATRIX 0.2*26.5
|
Facility
|
OP
|
$2,186.67
|
|
|
Service Code
|
HCPCS Q4110
|
| Hospital Charge Code |
27000119
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$656.00 |
| Max. Negotiated Rate |
$2,099.20 |
| Rate for Payer: Aetna Commercial |
$1,683.74
|
| Rate for Payer: Anthem Medicaid |
$752.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,705.60
|
| Rate for Payer: Cash Price |
$1,093.33
|
| Rate for Payer: Cigna Commercial |
$1,814.94
|
| Rate for Payer: First Health Commercial |
$2,077.34
|
| Rate for Payer: Humana Commercial |
$1,858.67
|
| Rate for Payer: Humana KY Medicaid |
$752.00
|
| Rate for Payer: Kentucky WC Medicaid |
$759.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,793.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,613.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$656.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$767.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,924.27
|
| Rate for Payer: Ohio Health Group HMO |
$1,640.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,749.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,902.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,508.80
|
| Rate for Payer: PHCS Commercial |
$2,099.20
|
| Rate for Payer: United Healthcare All Payer |
$1,924.27
|
|
|
PRIMATRIX 3*3
|
Facility
|
IP
|
$4,118.75
|
|
|
Service Code
|
HCPCS Q4110
|
| Hospital Charge Code |
27000119
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,235.62 |
| Max. Negotiated Rate |
$3,954.00 |
| Rate for Payer: Aetna Commercial |
$3,171.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,212.62
|
| Rate for Payer: Cash Price |
$2,059.38
|
| Rate for Payer: Cigna Commercial |
$3,418.56
|
| Rate for Payer: First Health Commercial |
$3,912.81
|
| Rate for Payer: Humana Commercial |
$3,500.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,377.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,039.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,235.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,624.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,089.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,295.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,583.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,841.94
|
| Rate for Payer: PHCS Commercial |
$3,954.00
|
| Rate for Payer: United Healthcare All Payer |
$3,624.50
|
|
|
PRIMATRIX 3*3
|
Facility
|
OP
|
$4,118.75
|
|
|
Service Code
|
HCPCS Q4110
|
| Hospital Charge Code |
27000119
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,235.62 |
| Max. Negotiated Rate |
$3,954.00 |
| Rate for Payer: Aetna Commercial |
$3,171.44
|
| Rate for Payer: Anthem Medicaid |
$1,416.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,212.62
|
| Rate for Payer: Cash Price |
$2,059.38
|
| Rate for Payer: Cigna Commercial |
$3,418.56
|
| Rate for Payer: First Health Commercial |
$3,912.81
|
| Rate for Payer: Humana Commercial |
$3,500.94
|
| Rate for Payer: Humana KY Medicaid |
$1,416.44
|
| Rate for Payer: Kentucky WC Medicaid |
$1,430.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,377.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,039.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,235.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,444.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,624.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,089.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,295.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,583.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,841.94
|
| Rate for Payer: PHCS Commercial |
$3,954.00
|
| Rate for Payer: United Healthcare All Payer |
$3,624.50
|
|
|
PRIMATRIX 4*4CM FENESTRATED
|
Facility
|
IP
|
$4,456.25
|
|
|
Service Code
|
HCPCS Q4110
|
| Hospital Charge Code |
27000119
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,336.88 |
| Max. Negotiated Rate |
$4,278.00 |
| Rate for Payer: Aetna Commercial |
$3,431.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,475.88
|
| Rate for Payer: Cash Price |
$2,228.12
|
| Rate for Payer: Cigna Commercial |
$3,698.69
|
| Rate for Payer: First Health Commercial |
$4,233.44
|
| Rate for Payer: Humana Commercial |
$3,787.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,654.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,288.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,336.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,921.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,342.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,565.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,876.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,074.81
|
| Rate for Payer: PHCS Commercial |
$4,278.00
|
| Rate for Payer: United Healthcare All Payer |
$3,921.50
|
|
|
PRIMATRIX 4*4CM FENESTRATED
|
Facility
|
OP
|
$4,456.25
|
|
|
Service Code
|
HCPCS Q4110
|
| Hospital Charge Code |
27000119
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,336.88 |
| Max. Negotiated Rate |
$4,278.00 |
| Rate for Payer: Aetna Commercial |
$3,431.31
|
| Rate for Payer: Anthem Medicaid |
$1,532.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,475.88
|
| Rate for Payer: Cash Price |
$2,228.12
|
| Rate for Payer: Cigna Commercial |
$3,698.69
|
| Rate for Payer: First Health Commercial |
$4,233.44
|
| Rate for Payer: Humana Commercial |
$3,787.81
|
| Rate for Payer: Humana KY Medicaid |
$1,532.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,548.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,654.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,288.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,336.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,563.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,921.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,342.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,565.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,876.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,074.81
|
| Rate for Payer: PHCS Commercial |
$4,278.00
|
| Rate for Payer: United Healthcare All Payer |
$3,921.50
|
|
|
PRIMATRIX 4*4CM MESHED
|
Facility
|
OP
|
$4,978.25
|
|
|
Service Code
|
HCPCS Q4110
|
| Hospital Charge Code |
27000119
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,493.47 |
| Max. Negotiated Rate |
$4,779.12 |
| Rate for Payer: Aetna Commercial |
$3,833.25
|
| Rate for Payer: Anthem Medicaid |
$1,712.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,883.03
|
| Rate for Payer: Cash Price |
$2,489.12
|
| Rate for Payer: Cigna Commercial |
$4,131.95
|
| Rate for Payer: First Health Commercial |
$4,729.34
|
| Rate for Payer: Humana Commercial |
$4,231.51
|
| Rate for Payer: Humana KY Medicaid |
$1,712.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,729.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,082.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,673.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,493.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,746.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,380.86
|
| Rate for Payer: Ohio Health Group HMO |
$3,733.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,982.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,331.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,434.99
|
| Rate for Payer: PHCS Commercial |
$4,779.12
|
| Rate for Payer: United Healthcare All Payer |
$4,380.86
|
|
|
PRIMATRIX 4*4CM MESHED
|
Facility
|
IP
|
$4,978.25
|
|
|
Service Code
|
HCPCS Q4110
|
| Hospital Charge Code |
27000119
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,493.47 |
| Max. Negotiated Rate |
$4,779.12 |
| Rate for Payer: Aetna Commercial |
$3,833.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,883.03
|
| Rate for Payer: Cash Price |
$2,489.12
|
| Rate for Payer: Cigna Commercial |
$4,131.95
|
| Rate for Payer: First Health Commercial |
$4,729.34
|
| Rate for Payer: Humana Commercial |
$4,231.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,082.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,673.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,493.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,380.86
|
| Rate for Payer: Ohio Health Group HMO |
$3,733.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,982.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,331.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,434.99
|
| Rate for Payer: PHCS Commercial |
$4,779.12
|
| Rate for Payer: United Healthcare All Payer |
$4,380.86
|
|
|
PRIMATRIX 6*6CM FENESTRATED
|
Facility
|
OP
|
$8,116.35
|
|
|
Service Code
|
HCPCS Q4110
|
| Hospital Charge Code |
27000119
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,434.91 |
| Max. Negotiated Rate |
$7,791.70 |
| Rate for Payer: Aetna Commercial |
$6,249.59
|
| Rate for Payer: Anthem Medicaid |
$2,791.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,330.75
|
| Rate for Payer: Cash Price |
$4,058.18
|
| Rate for Payer: Cigna Commercial |
$6,736.57
|
| Rate for Payer: First Health Commercial |
$7,710.53
|
| Rate for Payer: Humana Commercial |
$6,898.90
|
| Rate for Payer: Humana KY Medicaid |
$2,791.21
|
| Rate for Payer: Kentucky WC Medicaid |
$2,819.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,655.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,989.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,434.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,847.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,142.39
|
| Rate for Payer: Ohio Health Group HMO |
$6,087.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,493.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,061.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,600.28
|
| Rate for Payer: PHCS Commercial |
$7,791.70
|
| Rate for Payer: United Healthcare All Payer |
$7,142.39
|
|
|
PRIMATRIX 6*6CM FENESTRATED
|
Facility
|
IP
|
$8,116.35
|
|
|
Service Code
|
HCPCS Q4110
|
| Hospital Charge Code |
27000119
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,434.91 |
| Max. Negotiated Rate |
$7,791.70 |
| Rate for Payer: Aetna Commercial |
$6,249.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,330.75
|
| Rate for Payer: Cash Price |
$4,058.18
|
| Rate for Payer: Cigna Commercial |
$6,736.57
|
| Rate for Payer: First Health Commercial |
$7,710.53
|
| Rate for Payer: Humana Commercial |
$6,898.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,655.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,989.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,434.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,142.39
|
| Rate for Payer: Ohio Health Group HMO |
$6,087.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,493.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,061.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,600.28
|
| Rate for Payer: PHCS Commercial |
$7,791.70
|
| Rate for Payer: United Healthcare All Payer |
$7,142.39
|
|
|
PRIMATRIX 6*6CM MESHED
|
Facility
|
OP
|
$11,207.00
|
|
|
Service Code
|
HCPCS Q4110
|
| Hospital Charge Code |
27000119
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,362.10 |
| Max. Negotiated Rate |
$10,758.72 |
| Rate for Payer: Aetna Commercial |
$8,629.39
|
| Rate for Payer: Anthem Medicaid |
$3,854.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,741.46
|
| Rate for Payer: Cash Price |
$5,603.50
|
| Rate for Payer: Cigna Commercial |
$9,301.81
|
| Rate for Payer: First Health Commercial |
$10,646.65
|
| Rate for Payer: Humana Commercial |
$9,525.95
|
| Rate for Payer: Humana KY Medicaid |
$3,854.09
|
| Rate for Payer: Kentucky WC Medicaid |
$3,893.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,189.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,270.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,362.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,931.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,862.16
|
| Rate for Payer: Ohio Health Group HMO |
$8,405.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,965.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,750.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,732.83
|
| Rate for Payer: PHCS Commercial |
$10,758.72
|
| Rate for Payer: United Healthcare All Payer |
$9,862.16
|
|
|
PRIMATRIX 6*6CM MESHED
|
Facility
|
IP
|
$11,207.00
|
|
|
Service Code
|
HCPCS Q4110
|
| Hospital Charge Code |
27000119
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,362.10 |
| Max. Negotiated Rate |
$10,758.72 |
| Rate for Payer: Aetna Commercial |
$8,629.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,741.46
|
| Rate for Payer: Cash Price |
$5,603.50
|
| Rate for Payer: Cigna Commercial |
$9,301.81
|
| Rate for Payer: First Health Commercial |
$10,646.65
|
| Rate for Payer: Humana Commercial |
$9,525.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,189.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,270.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,362.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,862.16
|
| Rate for Payer: Ohio Health Group HMO |
$8,405.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,965.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,750.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,732.83
|
| Rate for Payer: PHCS Commercial |
$10,758.72
|
| Rate for Payer: United Healthcare All Payer |
$9,862.16
|
|
|
PRIMATRIX 8*8CM FENESTRATED
|
Facility
|
OP
|
$11,485.92
|
|
|
Service Code
|
HCPCS Q4110
|
| Hospital Charge Code |
27000119
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,445.78 |
| Max. Negotiated Rate |
$11,026.48 |
| Rate for Payer: Aetna Commercial |
$8,844.16
|
| Rate for Payer: Anthem Medicaid |
$3,950.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,959.02
|
| Rate for Payer: Cash Price |
$5,742.96
|
| Rate for Payer: Cigna Commercial |
$9,533.31
|
| Rate for Payer: First Health Commercial |
$10,911.62
|
| Rate for Payer: Humana Commercial |
$9,763.03
|
| Rate for Payer: Humana KY Medicaid |
$3,950.01
|
| Rate for Payer: Kentucky WC Medicaid |
$3,990.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,418.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,476.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,445.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,029.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,107.61
|
| Rate for Payer: Ohio Health Group HMO |
$8,614.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,188.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,992.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,925.28
|
| Rate for Payer: PHCS Commercial |
$11,026.48
|
| Rate for Payer: United Healthcare All Payer |
$10,107.61
|
|
|
PRIMATRIX 8*8CM FENESTRATED
|
Facility
|
IP
|
$11,485.92
|
|
|
Service Code
|
HCPCS Q4110
|
| Hospital Charge Code |
27000119
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,445.78 |
| Max. Negotiated Rate |
$11,026.48 |
| Rate for Payer: Aetna Commercial |
$8,844.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,959.02
|
| Rate for Payer: Cash Price |
$5,742.96
|
| Rate for Payer: Cigna Commercial |
$9,533.31
|
| Rate for Payer: First Health Commercial |
$10,911.62
|
| Rate for Payer: Humana Commercial |
$9,763.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,418.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,476.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,445.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,107.61
|
| Rate for Payer: Ohio Health Group HMO |
$8,614.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,188.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,992.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,925.28
|
| Rate for Payer: PHCS Commercial |
$11,026.48
|
| Rate for Payer: United Healthcare All Payer |
$10,107.61
|
|
|
PRIMATRIX AG 4*4CM FENESTRATED
|
Facility
|
OP
|
$4,242.80
|
|
|
Service Code
|
HCPCS Q4110
|
| Hospital Charge Code |
27000119
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,272.84 |
| Max. Negotiated Rate |
$4,073.09 |
| Rate for Payer: Aetna Commercial |
$3,266.96
|
| Rate for Payer: Anthem Medicaid |
$1,459.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,309.38
|
| Rate for Payer: Cash Price |
$2,121.40
|
| Rate for Payer: Cigna Commercial |
$3,521.52
|
| Rate for Payer: First Health Commercial |
$4,030.66
|
| Rate for Payer: Humana Commercial |
$3,606.38
|
| Rate for Payer: Humana KY Medicaid |
$1,459.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,473.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,479.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,131.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,272.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,488.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,733.66
|
| Rate for Payer: Ohio Health Group HMO |
$3,182.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,394.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,691.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,927.53
|
| Rate for Payer: PHCS Commercial |
$4,073.09
|
| Rate for Payer: United Healthcare All Payer |
$3,733.66
|
|
