|
SINUSOTOMY
|
Facility
|
OP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 31030
|
| Hospital Charge Code |
76101145
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$7,089.80 |
| Rate for Payer: Aetna Commercial |
$1,386.00
|
| Rate for Payer: Anthem Medicaid |
$619.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,064.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,404.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,089.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,836.59
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,494.00
|
| Rate for Payer: First Health Commercial |
$1,710.00
|
| Rate for Payer: Humana Commercial |
$1,530.00
|
| Rate for Payer: Humana KY Medicaid |
$619.02
|
| Rate for Payer: Humana Medicare Advantage |
$5,064.14
|
| Rate for Payer: Kentucky WC Medicaid |
$625.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,476.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,328.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,076.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$631.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,584.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,350.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$558.00
|
| Rate for Payer: PHCS Commercial |
$1,728.00
|
| Rate for Payer: United Healthcare All Payer |
$1,584.00
|
|
|
SINUSOTOMY
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
HCPCS 31030
|
| Hospital Charge Code |
76101145
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$264.57 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$737.85
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$264.57
|
| Rate for Payer: Anthem Medicaid |
$377.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,800.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$727.34
|
| Rate for Payer: Healthspan PPO |
$808.65
|
| Rate for Payer: Humana Medicaid |
$377.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$655.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$384.82
|
| Rate for Payer: Molina Healthcare Passport |
$377.27
|
| Rate for Payer: Multiplan PHCS |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,260.00
|
| Rate for Payer: UHCCP Medicaid |
$277.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$381.04
|
|
|
SINUSOTOMY(P
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
HCPCS 31030
|
| Hospital Charge Code |
761P1145
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$264.57 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$737.85
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$264.57
|
| Rate for Payer: Anthem Medicaid |
$377.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,800.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$727.34
|
| Rate for Payer: Healthspan PPO |
$808.65
|
| Rate for Payer: Humana Medicaid |
$377.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$655.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$384.82
|
| Rate for Payer: Molina Healthcare Passport |
$377.27
|
| Rate for Payer: Multiplan PHCS |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,260.00
|
| Rate for Payer: UHCCP Medicaid |
$277.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$381.04
|
|
|
SION BLUE PTCA GW 180CM
|
Facility
|
OP
|
$1,544.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$200.72 |
| Max. Negotiated Rate |
$1,482.24 |
| Rate for Payer: Aetna Commercial |
$1,188.88
|
| Rate for Payer: Anthem Medicaid |
$530.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,204.32
|
| Rate for Payer: Cash Price |
$772.00
|
| Rate for Payer: Cigna Commercial |
$1,281.52
|
| Rate for Payer: First Health Commercial |
$1,466.80
|
| Rate for Payer: Humana Commercial |
$1,312.40
|
| Rate for Payer: Humana KY Medicaid |
$530.98
|
| Rate for Payer: Kentucky WC Medicaid |
$536.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,266.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,139.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$463.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$541.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,358.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,158.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$308.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$200.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$478.64
|
| Rate for Payer: PHCS Commercial |
$1,482.24
|
| Rate for Payer: United Healthcare All Payer |
$1,358.72
|
|
|
SION BLUE PTCA GW 180CM
|
Facility
|
IP
|
$1,544.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$200.72 |
| Max. Negotiated Rate |
$1,482.24 |
| Rate for Payer: Aetna Commercial |
$1,188.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,204.32
|
| Rate for Payer: Cash Price |
$772.00
|
| Rate for Payer: Cigna Commercial |
$1,281.52
|
| Rate for Payer: First Health Commercial |
$1,466.80
|
| Rate for Payer: Humana Commercial |
$1,312.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,266.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,139.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$463.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,358.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,158.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$308.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$200.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$478.64
|
| Rate for Payer: PHCS Commercial |
$1,482.24
|
| Rate for Payer: United Healthcare All Payer |
$1,358.72
|
|
|
SION BLUE PTCA GW 300CM
|
Facility
|
OP
|
$1,544.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$200.72 |
| Max. Negotiated Rate |
$1,482.24 |
| Rate for Payer: Aetna Commercial |
$1,188.88
|
| Rate for Payer: Anthem Medicaid |
$530.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,204.32
|
| Rate for Payer: Cash Price |
$772.00
|
| Rate for Payer: Cigna Commercial |
$1,281.52
|
| Rate for Payer: First Health Commercial |
$1,466.80
|
| Rate for Payer: Humana Commercial |
$1,312.40
|
| Rate for Payer: Humana KY Medicaid |
$530.98
|
| Rate for Payer: Kentucky WC Medicaid |
$536.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,266.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,139.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$463.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$541.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,358.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,158.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$308.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$200.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$478.64
|
| Rate for Payer: PHCS Commercial |
$1,482.24
|
| Rate for Payer: United Healthcare All Payer |
$1,358.72
|
|
|
SION BLUE PTCA GW 300CM
|
Facility
|
IP
|
$1,544.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$200.72 |
| Max. Negotiated Rate |
$1,482.24 |
| Rate for Payer: Aetna Commercial |
$1,188.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,204.32
|
| Rate for Payer: Cash Price |
$772.00
|
| Rate for Payer: Cigna Commercial |
$1,281.52
|
| Rate for Payer: First Health Commercial |
$1,466.80
|
| Rate for Payer: Humana Commercial |
$1,312.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,266.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,139.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$463.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,358.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,158.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$308.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$200.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$478.64
|
| Rate for Payer: PHCS Commercial |
$1,482.24
|
| Rate for Payer: United Healthcare All Payer |
$1,358.72
|
|
|
SION PTCA GW 180CM
|
Facility
|
OP
|
$1,833.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$238.29 |
| Max. Negotiated Rate |
$1,759.68 |
| Rate for Payer: Aetna Commercial |
$1,411.41
|
| Rate for Payer: Anthem Medicaid |
$630.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,429.74
|
| Rate for Payer: Cash Price |
$916.50
|
| Rate for Payer: Cigna Commercial |
$1,521.39
|
| Rate for Payer: First Health Commercial |
$1,741.35
|
| Rate for Payer: Humana Commercial |
$1,558.05
|
| Rate for Payer: Humana KY Medicaid |
$630.37
|
| Rate for Payer: Kentucky WC Medicaid |
$636.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,503.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,352.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$549.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$643.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,613.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,374.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$366.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$238.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$568.23
|
| Rate for Payer: PHCS Commercial |
$1,759.68
|
| Rate for Payer: United Healthcare All Payer |
$1,613.04
|
|
|
SION PTCA GW 180CM
|
Facility
|
IP
|
$1,833.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$238.29 |
| Max. Negotiated Rate |
$1,759.68 |
| Rate for Payer: Aetna Commercial |
$1,411.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,429.74
|
| Rate for Payer: Cash Price |
$916.50
|
| Rate for Payer: Cigna Commercial |
$1,521.39
|
| Rate for Payer: First Health Commercial |
$1,741.35
|
| Rate for Payer: Humana Commercial |
$1,558.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,503.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,352.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$549.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,613.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,374.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$366.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$238.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$568.23
|
| Rate for Payer: PHCS Commercial |
$1,759.68
|
| Rate for Payer: United Healthcare All Payer |
$1,613.04
|
|
|
SION PTCA GW 300CM
|
Facility
|
IP
|
$1,787.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$232.38 |
| Max. Negotiated Rate |
$1,716.00 |
| Rate for Payer: Aetna Commercial |
$1,376.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,394.25
|
| Rate for Payer: Cash Price |
$893.75
|
| Rate for Payer: Cigna Commercial |
$1,483.62
|
| Rate for Payer: First Health Commercial |
$1,698.12
|
| Rate for Payer: Humana Commercial |
$1,519.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,465.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,319.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$536.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,573.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,340.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$357.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$232.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$554.12
|
| Rate for Payer: PHCS Commercial |
$1,716.00
|
| Rate for Payer: United Healthcare All Payer |
$1,573.00
|
|
|
SION PTCA GW 300CM
|
Facility
|
OP
|
$1,787.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$232.38 |
| Max. Negotiated Rate |
$1,716.00 |
| Rate for Payer: Aetna Commercial |
$1,376.38
|
| Rate for Payer: Anthem Medicaid |
$614.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,394.25
|
| Rate for Payer: Cash Price |
$893.75
|
| Rate for Payer: Cigna Commercial |
$1,483.62
|
| Rate for Payer: First Health Commercial |
$1,698.12
|
| Rate for Payer: Humana Commercial |
$1,519.38
|
| Rate for Payer: Humana KY Medicaid |
$614.72
|
| Rate for Payer: Kentucky WC Medicaid |
$620.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,465.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,319.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$536.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$627.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,573.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,340.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$357.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$232.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$554.12
|
| Rate for Payer: PHCS Commercial |
$1,716.00
|
| Rate for Payer: United Healthcare All Payer |
$1,573.00
|
|
|
SIROLIMUS 1MG/ML SOL (1ML)
|
Facility
|
IP
|
$34.54
|
|
|
Service Code
|
HCPCS J7520
|
| Hospital Charge Code |
25003765
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.49 |
| Max. Negotiated Rate |
$33.16 |
| Rate for Payer: Aetna Commercial |
$26.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26.94
|
| Rate for Payer: Cash Price |
$17.27
|
| Rate for Payer: Cigna Commercial |
$28.67
|
| Rate for Payer: First Health Commercial |
$32.81
|
| Rate for Payer: Humana Commercial |
$29.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$30.40
|
| Rate for Payer: Ohio Health Group HMO |
$25.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10.71
|
| Rate for Payer: PHCS Commercial |
$33.16
|
| Rate for Payer: United Healthcare All Payer |
$30.40
|
|
|
SIROLIMUS 1MG/ML SOL (1ML)
|
Facility
|
OP
|
$34.54
|
|
|
Service Code
|
HCPCS J7520
|
| Hospital Charge Code |
25003765
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.49 |
| Max. Negotiated Rate |
$33.16 |
| Rate for Payer: Aetna Commercial |
$26.60
|
| Rate for Payer: Anthem Medicaid |
$11.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26.94
|
| Rate for Payer: Cash Price |
$17.27
|
| Rate for Payer: Cigna Commercial |
$28.67
|
| Rate for Payer: First Health Commercial |
$32.81
|
| Rate for Payer: Humana Commercial |
$29.36
|
| Rate for Payer: Humana KY Medicaid |
$11.88
|
| Rate for Payer: Kentucky WC Medicaid |
$12.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$30.40
|
| Rate for Payer: Ohio Health Group HMO |
$25.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10.71
|
| Rate for Payer: PHCS Commercial |
$33.16
|
| Rate for Payer: United Healthcare All Payer |
$30.40
|
|
|
SITZMARKS RADIOPAQUE MARK 1EA
|
Facility
|
OP
|
$171.90
|
|
|
Service Code
|
NDC 10858008107
|
| Hospital Charge Code |
25003869
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$22.35 |
| Max. Negotiated Rate |
$165.02 |
| Rate for Payer: Aetna Commercial |
$132.36
|
| Rate for Payer: Anthem Medicaid |
$59.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$134.08
|
| Rate for Payer: Cash Price |
$85.95
|
| Rate for Payer: Cigna Commercial |
$142.68
|
| Rate for Payer: First Health Commercial |
$163.30
|
| Rate for Payer: Humana Commercial |
$146.12
|
| Rate for Payer: Humana KY Medicaid |
$59.12
|
| Rate for Payer: Kentucky WC Medicaid |
$59.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$140.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$60.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$151.27
|
| Rate for Payer: Ohio Health Group HMO |
$128.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.29
|
| Rate for Payer: PHCS Commercial |
$165.02
|
| Rate for Payer: United Healthcare All Payer |
$151.27
|
|
|
SITZMARKS RADIOPAQUE MARK 1EA
|
Facility
|
IP
|
$171.90
|
|
|
Service Code
|
NDC 10858008107
|
| Hospital Charge Code |
25003869
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$22.35 |
| Max. Negotiated Rate |
$165.02 |
| Rate for Payer: Aetna Commercial |
$132.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$134.08
|
| Rate for Payer: Cash Price |
$85.95
|
| Rate for Payer: Cigna Commercial |
$142.68
|
| Rate for Payer: First Health Commercial |
$163.30
|
| Rate for Payer: Humana Commercial |
$146.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$140.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$151.27
|
| Rate for Payer: Ohio Health Group HMO |
$128.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.29
|
| Rate for Payer: PHCS Commercial |
$165.02
|
| Rate for Payer: United Healthcare All Payer |
$151.27
|
|
|
SIZER DURALOC THD 64MM STD
|
Facility
|
IP
|
$5,149.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$669.43 |
| Max. Negotiated Rate |
$4,943.47 |
| Rate for Payer: Aetna Commercial |
$3,965.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,016.57
|
| Rate for Payer: Cash Price |
$2,574.72
|
| Rate for Payer: Cigna Commercial |
$4,274.04
|
| Rate for Payer: First Health Commercial |
$4,891.98
|
| Rate for Payer: Humana Commercial |
$4,377.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,222.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,800.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,544.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,531.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,029.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$669.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,596.33
|
| Rate for Payer: PHCS Commercial |
$4,943.47
|
| Rate for Payer: United Healthcare All Payer |
$4,531.52
|
|
|
SIZER DURALOC THD 64MM STD
|
Facility
|
OP
|
$5,149.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$669.43 |
| Max. Negotiated Rate |
$4,943.47 |
| Rate for Payer: Aetna Commercial |
$3,965.08
|
| Rate for Payer: Anthem Medicaid |
$1,770.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,016.57
|
| Rate for Payer: Cash Price |
$2,574.72
|
| Rate for Payer: Cigna Commercial |
$4,274.04
|
| Rate for Payer: First Health Commercial |
$4,891.98
|
| Rate for Payer: Humana Commercial |
$4,377.03
|
| Rate for Payer: Humana KY Medicaid |
$1,770.90
|
| Rate for Payer: Kentucky WC Medicaid |
$1,788.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,222.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,800.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,544.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,806.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,531.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,029.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$669.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,596.33
|
| Rate for Payer: PHCS Commercial |
$4,943.47
|
| Rate for Payer: United Healthcare All Payer |
$4,531.52
|
|
|
SIZER STYLE 10 RE-STERIL 270CC
|
Facility
|
OP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$243.75 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,443.75
|
| Rate for Payer: Anthem Medicaid |
$644.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,462.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,556.25
|
| Rate for Payer: First Health Commercial |
$1,781.25
|
| Rate for Payer: Humana Commercial |
$1,593.75
|
| Rate for Payer: Humana KY Medicaid |
$644.81
|
| Rate for Payer: Kentucky WC Medicaid |
$651.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,537.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,383.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$657.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,650.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$375.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$581.25
|
| Rate for Payer: PHCS Commercial |
$1,800.00
|
| Rate for Payer: United Healthcare All Payer |
$1,650.00
|
|
|
SIZER STYLE 10 RE-STERIL 270CC
|
Facility
|
IP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$243.75 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,443.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,462.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,556.25
|
| Rate for Payer: First Health Commercial |
$1,781.25
|
| Rate for Payer: Humana Commercial |
$1,593.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,537.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,383.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,650.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$375.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$581.25
|
| Rate for Payer: PHCS Commercial |
$1,800.00
|
| Rate for Payer: United Healthcare All Payer |
$1,650.00
|
|
|
SIZER STYLE 10 RE-STERIL 300CC
|
Facility
|
IP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$243.75 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,443.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,462.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,556.25
|
| Rate for Payer: First Health Commercial |
$1,781.25
|
| Rate for Payer: Humana Commercial |
$1,593.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,537.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,383.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,650.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$375.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$581.25
|
| Rate for Payer: PHCS Commercial |
$1,800.00
|
| Rate for Payer: United Healthcare All Payer |
$1,650.00
|
|
|
SIZER STYLE 10 RE-STERIL 300CC
|
Facility
|
OP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$243.75 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,443.75
|
| Rate for Payer: Anthem Medicaid |
$644.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,462.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,556.25
|
| Rate for Payer: First Health Commercial |
$1,781.25
|
| Rate for Payer: Humana Commercial |
$1,593.75
|
| Rate for Payer: Humana KY Medicaid |
$644.81
|
| Rate for Payer: Kentucky WC Medicaid |
$651.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,537.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,383.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$657.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,650.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$375.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$581.25
|
| Rate for Payer: PHCS Commercial |
$1,800.00
|
| Rate for Payer: United Healthcare All Payer |
$1,650.00
|
|
|
SIZER STYLE 10 RE-STERIL 330CC
|
Facility
|
IP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$243.75 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,443.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,462.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,556.25
|
| Rate for Payer: First Health Commercial |
$1,781.25
|
| Rate for Payer: Humana Commercial |
$1,593.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,537.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,383.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,650.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$375.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$581.25
|
| Rate for Payer: PHCS Commercial |
$1,800.00
|
| Rate for Payer: United Healthcare All Payer |
$1,650.00
|
|
|
SIZER STYLE 10 RE-STERIL 330CC
|
Facility
|
OP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$243.75 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,443.75
|
| Rate for Payer: Anthem Medicaid |
$644.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,462.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,556.25
|
| Rate for Payer: First Health Commercial |
$1,781.25
|
| Rate for Payer: Humana Commercial |
$1,593.75
|
| Rate for Payer: Humana KY Medicaid |
$644.81
|
| Rate for Payer: Kentucky WC Medicaid |
$651.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,537.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,383.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$657.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,650.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$375.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$581.25
|
| Rate for Payer: PHCS Commercial |
$1,800.00
|
| Rate for Payer: United Healthcare All Payer |
$1,650.00
|
|
|
SIZER STYLE 10 RE-STERIL 360CC
|
Facility
|
IP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$243.75 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,443.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,462.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,556.25
|
| Rate for Payer: First Health Commercial |
$1,781.25
|
| Rate for Payer: Humana Commercial |
$1,593.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,537.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,383.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,650.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$375.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$581.25
|
| Rate for Payer: PHCS Commercial |
$1,800.00
|
| Rate for Payer: United Healthcare All Payer |
$1,650.00
|
|
|
SIZER STYLE 10 RE-STERIL 360CC
|
Facility
|
OP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$243.75 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,443.75
|
| Rate for Payer: Anthem Medicaid |
$644.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,462.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,556.25
|
| Rate for Payer: First Health Commercial |
$1,781.25
|
| Rate for Payer: Humana Commercial |
$1,593.75
|
| Rate for Payer: Humana KY Medicaid |
$644.81
|
| Rate for Payer: Kentucky WC Medicaid |
$651.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,537.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,383.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$657.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,650.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$375.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$581.25
|
| Rate for Payer: PHCS Commercial |
$1,800.00
|
| Rate for Payer: United Healthcare All Payer |
$1,650.00
|
|
