|
SILICONE TIP STRAIGHT I/A
|
Facility
|
OP
|
$1,555.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$202.20 |
| Max. Negotiated Rate |
$1,493.16 |
| Rate for Payer: Aetna Commercial |
$1,197.64
|
| Rate for Payer: Anthem Medicaid |
$534.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,213.20
|
| Rate for Payer: Cash Price |
$777.69
|
| Rate for Payer: Cigna Commercial |
$1,290.97
|
| Rate for Payer: First Health Commercial |
$1,477.61
|
| Rate for Payer: Humana Commercial |
$1,322.07
|
| Rate for Payer: Humana KY Medicaid |
$534.90
|
| Rate for Payer: Kentucky WC Medicaid |
$540.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,275.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,147.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$466.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$545.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,368.73
|
| Rate for Payer: Ohio Health Group HMO |
$1,166.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$311.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$202.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$482.17
|
| Rate for Payer: PHCS Commercial |
$1,493.16
|
| Rate for Payer: United Healthcare All Payer |
$1,368.73
|
|
|
SILVADENE(SILVER SULFAD.) 50GM
|
Facility
|
OP
|
$1.75
|
|
|
Service Code
|
NDC 67877012450
|
| Hospital Charge Code |
25003444
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$1.68 |
| Rate for Payer: Aetna Commercial |
$1.35
|
| Rate for Payer: Anthem Medicaid |
$0.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.36
|
| Rate for Payer: Cash Price |
$0.88
|
| Rate for Payer: Cigna Commercial |
$1.45
|
| Rate for Payer: First Health Commercial |
$1.66
|
| Rate for Payer: Humana Commercial |
$1.49
|
| Rate for Payer: Humana KY Medicaid |
$0.60
|
| Rate for Payer: Kentucky WC Medicaid |
$0.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.54
|
| Rate for Payer: Ohio Health Group HMO |
$1.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.54
|
| Rate for Payer: PHCS Commercial |
$1.68
|
| Rate for Payer: United Healthcare All Payer |
$1.54
|
|
|
SILVADENE(SILVER SULFAD.) 50GM
|
Facility
|
IP
|
$1.75
|
|
|
Service Code
|
NDC 67877012450
|
| Hospital Charge Code |
25003444
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$1.68 |
| Rate for Payer: Aetna Commercial |
$1.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.36
|
| Rate for Payer: Cash Price |
$0.88
|
| Rate for Payer: Cigna Commercial |
$1.45
|
| Rate for Payer: First Health Commercial |
$1.66
|
| Rate for Payer: Humana Commercial |
$1.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.54
|
| Rate for Payer: Ohio Health Group HMO |
$1.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.54
|
| Rate for Payer: PHCS Commercial |
$1.68
|
| Rate for Payer: United Healthcare All Payer |
$1.54
|
|
|
SILVASORB GEL 45 ML
|
Facility
|
IP
|
$4.87
|
|
|
Service Code
|
NDC 8327030909
|
| Hospital Charge Code |
25003445
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$4.68 |
| Rate for Payer: Aetna Commercial |
$3.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.80
|
| Rate for Payer: Cash Price |
$2.44
|
| Rate for Payer: Cigna Commercial |
$4.04
|
| Rate for Payer: First Health Commercial |
$4.63
|
| Rate for Payer: Humana Commercial |
$4.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.29
|
| Rate for Payer: Ohio Health Group HMO |
$3.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.51
|
| Rate for Payer: PHCS Commercial |
$4.68
|
| Rate for Payer: United Healthcare All Payer |
$4.29
|
|
|
SILVASORB GEL 45 ML
|
Facility
|
OP
|
$4.87
|
|
|
Service Code
|
NDC 8327030909
|
| Hospital Charge Code |
25003445
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$4.68 |
| Rate for Payer: Aetna Commercial |
$3.75
|
| Rate for Payer: Anthem Medicaid |
$1.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.80
|
| Rate for Payer: Cash Price |
$2.44
|
| Rate for Payer: Cigna Commercial |
$4.04
|
| Rate for Payer: First Health Commercial |
$4.63
|
| Rate for Payer: Humana Commercial |
$4.14
|
| Rate for Payer: Humana KY Medicaid |
$1.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.29
|
| Rate for Payer: Ohio Health Group HMO |
$3.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.51
|
| Rate for Payer: PHCS Commercial |
$4.68
|
| Rate for Payer: United Healthcare All Payer |
$4.29
|
|
|
SILVERHAWK PERIPHERAL CATH ES+
|
Facility
|
IP
|
$15,061.20
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,957.96 |
| Max. Negotiated Rate |
$14,458.75 |
| Rate for Payer: Aetna Commercial |
$11,597.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,747.74
|
| Rate for Payer: Cash Price |
$7,530.60
|
| Rate for Payer: Cigna Commercial |
$12,500.80
|
| Rate for Payer: First Health Commercial |
$14,308.14
|
| Rate for Payer: Humana Commercial |
$12,802.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,350.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,115.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,518.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,253.86
|
| Rate for Payer: Ohio Health Group HMO |
$11,295.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,012.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,957.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,668.97
|
| Rate for Payer: PHCS Commercial |
$14,458.75
|
| Rate for Payer: United Healthcare All Payer |
$13,253.86
|
|
|
SILVERHAWK PERIPHERAL CATH ES+
|
Facility
|
OP
|
$15,061.20
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,957.96 |
| Max. Negotiated Rate |
$14,458.75 |
| Rate for Payer: Aetna Commercial |
$11,597.12
|
| Rate for Payer: Anthem Medicaid |
$5,179.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,747.74
|
| Rate for Payer: Cash Price |
$7,530.60
|
| Rate for Payer: Cigna Commercial |
$12,500.80
|
| Rate for Payer: First Health Commercial |
$14,308.14
|
| Rate for Payer: Humana Commercial |
$12,802.02
|
| Rate for Payer: Humana KY Medicaid |
$5,179.55
|
| Rate for Payer: Kentucky WC Medicaid |
$5,232.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,350.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,115.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,518.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,283.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,253.86
|
| Rate for Payer: Ohio Health Group HMO |
$11,295.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,012.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,957.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,668.97
|
| Rate for Payer: PHCS Commercial |
$14,458.75
|
| Rate for Payer: United Healthcare All Payer |
$13,253.86
|
|
|
SILVERHAWK PERIPHERAL CATH SS
|
Facility
|
OP
|
$15,342.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,994.46 |
| Max. Negotiated Rate |
$14,728.32 |
| Rate for Payer: Aetna Commercial |
$11,813.34
|
| Rate for Payer: Anthem Medicaid |
$5,276.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,966.76
|
| Rate for Payer: Cash Price |
$7,671.00
|
| Rate for Payer: Cigna Commercial |
$12,733.86
|
| Rate for Payer: First Health Commercial |
$14,574.90
|
| Rate for Payer: Humana Commercial |
$13,040.70
|
| Rate for Payer: Humana KY Medicaid |
$5,276.11
|
| Rate for Payer: Kentucky WC Medicaid |
$5,329.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,580.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,322.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,602.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,381.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,500.96
|
| Rate for Payer: Ohio Health Group HMO |
$11,506.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,068.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,994.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,756.02
|
| Rate for Payer: PHCS Commercial |
$14,728.32
|
| Rate for Payer: United Healthcare All Payer |
$13,500.96
|
|
|
SILVERHAWK PERIPHERAL CATH SS
|
Facility
|
IP
|
$15,342.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,994.46 |
| Max. Negotiated Rate |
$14,728.32 |
| Rate for Payer: Aetna Commercial |
$11,813.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,966.76
|
| Rate for Payer: Cash Price |
$7,671.00
|
| Rate for Payer: Cigna Commercial |
$12,733.86
|
| Rate for Payer: First Health Commercial |
$14,574.90
|
| Rate for Payer: Humana Commercial |
$13,040.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,580.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,322.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,602.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,500.96
|
| Rate for Payer: Ohio Health Group HMO |
$11,506.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,068.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,994.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,756.02
|
| Rate for Payer: PHCS Commercial |
$14,728.32
|
| Rate for Payer: United Healthcare All Payer |
$13,500.96
|
|
|
SILVERHAWK PERIPHERL CATH MS-F
|
Facility
|
OP
|
$13,136.75
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,707.78 |
| Max. Negotiated Rate |
$12,611.28 |
| Rate for Payer: Aetna Commercial |
$10,115.30
|
| Rate for Payer: Anthem Medicaid |
$4,517.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,246.66
|
| Rate for Payer: Cash Price |
$6,568.38
|
| Rate for Payer: Cigna Commercial |
$10,903.50
|
| Rate for Payer: First Health Commercial |
$12,479.91
|
| Rate for Payer: Humana Commercial |
$11,166.24
|
| Rate for Payer: Humana KY Medicaid |
$4,517.73
|
| Rate for Payer: Kentucky WC Medicaid |
$4,563.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,772.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,694.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,941.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,608.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,560.34
|
| Rate for Payer: Ohio Health Group HMO |
$9,852.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,627.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,707.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,072.39
|
| Rate for Payer: PHCS Commercial |
$12,611.28
|
| Rate for Payer: United Healthcare All Payer |
$11,560.34
|
|
|
SILVERHAWK PERIPHERL CATH MS-F
|
Facility
|
IP
|
$13,136.75
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,707.78 |
| Max. Negotiated Rate |
$12,611.28 |
| Rate for Payer: Aetna Commercial |
$10,115.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,246.66
|
| Rate for Payer: Cash Price |
$6,568.38
|
| Rate for Payer: Cigna Commercial |
$10,903.50
|
| Rate for Payer: First Health Commercial |
$12,479.91
|
| Rate for Payer: Humana Commercial |
$11,166.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,772.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,694.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,941.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,560.34
|
| Rate for Payer: Ohio Health Group HMO |
$9,852.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,627.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,707.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,072.39
|
| Rate for Payer: PHCS Commercial |
$12,611.28
|
| Rate for Payer: United Healthcare All Payer |
$11,560.34
|
|
|
SILVER NITRATE 0.5% Soln 10mL
|
Facility
|
OP
|
$4.88
|
|
|
Service Code
|
NDC 93961413
|
| Hospital Charge Code |
25004385
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$4.68 |
| Rate for Payer: Aetna Commercial |
$3.76
|
| Rate for Payer: Anthem Medicaid |
$1.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.81
|
| Rate for Payer: Cash Price |
$2.44
|
| Rate for Payer: Cigna Commercial |
$4.05
|
| Rate for Payer: First Health Commercial |
$4.64
|
| Rate for Payer: Humana Commercial |
$4.15
|
| Rate for Payer: Humana KY Medicaid |
$1.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.29
|
| Rate for Payer: Ohio Health Group HMO |
$3.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.51
|
| Rate for Payer: PHCS Commercial |
$4.68
|
| Rate for Payer: United Healthcare All Payer |
$4.29
|
|
|
SILVER NITRATE 0.5% Soln 10mL
|
Facility
|
IP
|
$4.88
|
|
|
Service Code
|
NDC 93961413
|
| Hospital Charge Code |
25004385
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$4.68 |
| Rate for Payer: Aetna Commercial |
$3.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.81
|
| Rate for Payer: Cash Price |
$2.44
|
| Rate for Payer: Cigna Commercial |
$4.05
|
| Rate for Payer: First Health Commercial |
$4.64
|
| Rate for Payer: Humana Commercial |
$4.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.29
|
| Rate for Payer: Ohio Health Group HMO |
$3.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.51
|
| Rate for Payer: PHCS Commercial |
$4.68
|
| Rate for Payer: United Healthcare All Payer |
$4.29
|
|
|
SILVER NITRATE APPLICATOR 1EA
|
Facility
|
IP
|
$4.96
|
|
|
Service Code
|
NDC 12870000101
|
| Hospital Charge Code |
25001397
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$4.76 |
| Rate for Payer: Aetna Commercial |
$3.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.87
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Cigna Commercial |
$4.12
|
| Rate for Payer: First Health Commercial |
$4.71
|
| Rate for Payer: Humana Commercial |
$4.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.36
|
| Rate for Payer: Ohio Health Group HMO |
$3.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.54
|
| Rate for Payer: PHCS Commercial |
$4.76
|
| Rate for Payer: United Healthcare All Payer |
$4.36
|
|
|
SILVER NITRATE APPLICATOR 1EA
|
Facility
|
OP
|
$4.96
|
|
|
Service Code
|
NDC 12870000101
|
| Hospital Charge Code |
25001397
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$4.76 |
| Rate for Payer: Aetna Commercial |
$3.82
|
| Rate for Payer: Anthem Medicaid |
$1.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.87
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Cigna Commercial |
$4.12
|
| Rate for Payer: First Health Commercial |
$4.71
|
| Rate for Payer: Humana Commercial |
$4.22
|
| Rate for Payer: Humana KY Medicaid |
$1.71
|
| Rate for Payer: Kentucky WC Medicaid |
$1.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.36
|
| Rate for Payer: Ohio Health Group HMO |
$3.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.54
|
| Rate for Payer: PHCS Commercial |
$4.76
|
| Rate for Payer: United Healthcare All Payer |
$4.36
|
|
|
SIM2 BEACON TIP
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$69.42 |
| Max. Negotiated Rate |
$512.64 |
| Rate for Payer: Aetna Commercial |
$411.18
|
| Rate for Payer: Anthem Medicaid |
$183.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$416.52
|
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Cigna Commercial |
$443.22
|
| Rate for Payer: First Health Commercial |
$507.30
|
| Rate for Payer: Humana Commercial |
$453.90
|
| Rate for Payer: Humana KY Medicaid |
$183.64
|
| Rate for Payer: Kentucky WC Medicaid |
$185.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$437.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$394.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$160.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$187.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$469.92
|
| Rate for Payer: Ohio Health Group HMO |
$400.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$106.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$165.54
|
| Rate for Payer: PHCS Commercial |
$512.64
|
| Rate for Payer: United Healthcare All Payer |
$469.92
|
|
|
SIM2 BEACON TIP
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$69.42 |
| Max. Negotiated Rate |
$512.64 |
| Rate for Payer: Aetna Commercial |
$411.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$416.52
|
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Cigna Commercial |
$443.22
|
| Rate for Payer: First Health Commercial |
$507.30
|
| Rate for Payer: Humana Commercial |
$453.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$437.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$394.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$160.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$469.92
|
| Rate for Payer: Ohio Health Group HMO |
$400.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$106.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$165.54
|
| Rate for Payer: PHCS Commercial |
$512.64
|
| Rate for Payer: United Healthcare All Payer |
$469.92
|
|
|
SIM2 SLI CATH
|
Facility
|
OP
|
$1,574.62
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$204.70 |
| Max. Negotiated Rate |
$1,511.64 |
| Rate for Payer: Aetna Commercial |
$1,212.46
|
| Rate for Payer: Anthem Medicaid |
$541.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,228.20
|
| Rate for Payer: Cash Price |
$787.31
|
| Rate for Payer: Cigna Commercial |
$1,306.93
|
| Rate for Payer: First Health Commercial |
$1,495.89
|
| Rate for Payer: Humana Commercial |
$1,338.43
|
| Rate for Payer: Humana KY Medicaid |
$541.51
|
| Rate for Payer: Kentucky WC Medicaid |
$547.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,291.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,162.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$472.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$552.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,385.67
|
| Rate for Payer: Ohio Health Group HMO |
$1,180.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$314.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$204.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$488.13
|
| Rate for Payer: PHCS Commercial |
$1,511.64
|
| Rate for Payer: United Healthcare All Payer |
$1,385.67
|
|
|
SIM2 SLI CATH
|
Facility
|
IP
|
$1,574.62
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$204.70 |
| Max. Negotiated Rate |
$1,511.64 |
| Rate for Payer: Aetna Commercial |
$1,212.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,228.20
|
| Rate for Payer: Cash Price |
$787.31
|
| Rate for Payer: Cigna Commercial |
$1,306.93
|
| Rate for Payer: First Health Commercial |
$1,495.89
|
| Rate for Payer: Humana Commercial |
$1,338.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,291.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,162.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$472.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,385.67
|
| Rate for Payer: Ohio Health Group HMO |
$1,180.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$314.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$204.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$488.13
|
| Rate for Payer: PHCS Commercial |
$1,511.64
|
| Rate for Payer: United Healthcare All Payer |
$1,385.67
|
|
|
SIMPLE CYSTOMETROGRAM
|
Professional
|
Both
|
$1,445.00
|
|
|
Service Code
|
HCPCS 51725
|
| Hospital Charge Code |
32000261
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$74.07 |
| Max. Negotiated Rate |
$1,445.00 |
| Rate for Payer: Aetna Commercial |
$341.55
|
| Rate for Payer: Anthem Medicaid |
$74.07
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,445.00
|
| Rate for Payer: Cash Price |
$722.50
|
| Rate for Payer: Cash Price |
$722.50
|
| Rate for Payer: Cigna Commercial |
$379.41
|
| Rate for Payer: Healthspan PPO |
$273.10
|
| Rate for Payer: Humana Medicaid |
$74.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$102.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$75.55
|
| Rate for Payer: Molina Healthcare Passport |
$74.07
|
| Rate for Payer: Multiplan PHCS |
$867.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,011.50
|
| Rate for Payer: UHCCP Medicaid |
$505.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$74.81
|
|
|
SIMPLE CYSTOMETROGRAM
|
Facility
|
IP
|
$1,445.00
|
|
|
Service Code
|
HCPCS 51725
|
| Hospital Charge Code |
32000261
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$187.85 |
| Max. Negotiated Rate |
$1,387.20 |
| Rate for Payer: Aetna Commercial |
$1,112.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,127.10
|
| Rate for Payer: Cash Price |
$722.50
|
| Rate for Payer: Cigna Commercial |
$1,199.35
|
| Rate for Payer: First Health Commercial |
$1,372.75
|
| Rate for Payer: Humana Commercial |
$1,228.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,184.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,066.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$433.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,271.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,083.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$289.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$187.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$447.95
|
| Rate for Payer: PHCS Commercial |
$1,387.20
|
| Rate for Payer: United Healthcare All Payer |
$1,271.60
|
|
|
SIMPLE CYSTOMETROGRAM
|
Facility
|
OP
|
$1,445.00
|
|
|
Service Code
|
HCPCS 51725
|
| Hospital Charge Code |
32000261
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$187.85 |
| Max. Negotiated Rate |
$1,387.20 |
| Rate for Payer: Aetna Commercial |
$1,112.65
|
| Rate for Payer: Anthem Medicaid |
$496.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$213.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,127.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$299.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$288.52
|
| Rate for Payer: Cash Price |
$722.50
|
| Rate for Payer: Cash Price |
$722.50
|
| Rate for Payer: Cigna Commercial |
$1,199.35
|
| Rate for Payer: First Health Commercial |
$1,372.75
|
| Rate for Payer: Humana Commercial |
$1,228.25
|
| Rate for Payer: Humana KY Medicaid |
$496.94
|
| Rate for Payer: Humana Medicare Advantage |
$213.72
|
| Rate for Payer: Kentucky WC Medicaid |
$501.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,184.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,066.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$256.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$506.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,271.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,083.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$289.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$187.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$447.95
|
| Rate for Payer: PHCS Commercial |
$1,387.20
|
| Rate for Payer: United Healthcare All Payer |
$1,271.60
|
|
|
SIMPLE CYSTOMETROGRAM(P
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 51725
|
| Hospital Charge Code |
320P0261
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$74.07 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna Commercial |
$341.55
|
| Rate for Payer: Anthem Medicaid |
$74.07
|
| Rate for Payer: Buckeye Medicare Advantage |
$500.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$379.41
|
| Rate for Payer: Healthspan PPO |
$273.10
|
| Rate for Payer: Humana Medicaid |
$74.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$102.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$75.55
|
| Rate for Payer: Molina Healthcare Passport |
$74.07
|
| Rate for Payer: Multiplan PHCS |
$300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$350.00
|
| Rate for Payer: UHCCP Medicaid |
$175.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$74.81
|
|
|
SIMPLE CYSTOMETROGRAM(T
|
Facility
|
OP
|
$945.00
|
|
|
Service Code
|
HCPCS 51725
|
| Hospital Charge Code |
320T0261
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$122.85 |
| Max. Negotiated Rate |
$907.20 |
| Rate for Payer: Aetna Commercial |
$727.65
|
| Rate for Payer: Anthem Medicaid |
$324.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$213.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$737.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$299.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$288.52
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cigna Commercial |
$784.35
|
| Rate for Payer: First Health Commercial |
$897.75
|
| Rate for Payer: Humana Commercial |
$803.25
|
| Rate for Payer: Humana KY Medicaid |
$324.99
|
| Rate for Payer: Humana Medicare Advantage |
$213.72
|
| Rate for Payer: Kentucky WC Medicaid |
$328.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$774.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$697.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$256.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$331.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$831.60
|
| Rate for Payer: Ohio Health Group HMO |
$708.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$189.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$122.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$292.95
|
| Rate for Payer: PHCS Commercial |
$907.20
|
| Rate for Payer: United Healthcare All Payer |
$831.60
|
|
|
SIMPLE CYSTOMETROGRAM(T
|
Facility
|
IP
|
$945.00
|
|
|
Service Code
|
HCPCS 51725
|
| Hospital Charge Code |
320T0261
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$122.85 |
| Max. Negotiated Rate |
$907.20 |
| Rate for Payer: Aetna Commercial |
$727.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$737.10
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cigna Commercial |
$784.35
|
| Rate for Payer: First Health Commercial |
$897.75
|
| Rate for Payer: Humana Commercial |
$803.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$774.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$697.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$283.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$831.60
|
| Rate for Payer: Ohio Health Group HMO |
$708.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$189.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$122.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$292.95
|
| Rate for Payer: PHCS Commercial |
$907.20
|
| Rate for Payer: United Healthcare All Payer |
$831.60
|
|
