|
SMART CONTROL ILIAC 6*60
|
Facility
|
OP
|
$4,475.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$581.75 |
| Max. Negotiated Rate |
$4,296.00 |
| Rate for Payer: Aetna Commercial |
$3,445.75
|
| Rate for Payer: Anthem Medicaid |
$1,538.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,490.50
|
| Rate for Payer: Cash Price |
$2,237.50
|
| Rate for Payer: Cigna Commercial |
$3,714.25
|
| Rate for Payer: First Health Commercial |
$4,251.25
|
| Rate for Payer: Humana Commercial |
$3,803.75
|
| Rate for Payer: Humana KY Medicaid |
$1,538.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,554.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,669.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,302.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,342.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,569.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,938.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$895.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$581.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,387.25
|
| Rate for Payer: PHCS Commercial |
$4,296.00
|
| Rate for Payer: United Healthcare All Payer |
$3,938.00
|
|
|
SMART CONTROL ILIAC 6*60
|
Facility
|
IP
|
$4,475.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$581.75 |
| Max. Negotiated Rate |
$4,296.00 |
| Rate for Payer: Aetna Commercial |
$3,445.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,490.50
|
| Rate for Payer: Cash Price |
$2,237.50
|
| Rate for Payer: Cigna Commercial |
$3,714.25
|
| Rate for Payer: First Health Commercial |
$4,251.25
|
| Rate for Payer: Humana Commercial |
$3,803.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,669.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,302.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,342.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,938.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$895.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$581.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,387.25
|
| Rate for Payer: PHCS Commercial |
$4,296.00
|
| Rate for Payer: United Healthcare All Payer |
$3,938.00
|
|
|
SMART CONTROL ILIAC 7*80
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
SMART CONTROL ILIAC 7*80
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
SMART PORT CT LP CT66LTPD-VI
|
Facility
|
OP
|
$3,524.75
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
27000108
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$458.22 |
| Max. Negotiated Rate |
$3,383.76 |
| Rate for Payer: Aetna Commercial |
$2,714.06
|
| Rate for Payer: Anthem Medicaid |
$1,212.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,749.30
|
| Rate for Payer: Cash Price |
$1,762.38
|
| Rate for Payer: Cigna Commercial |
$2,925.54
|
| Rate for Payer: First Health Commercial |
$3,348.51
|
| Rate for Payer: Humana Commercial |
$2,996.04
|
| Rate for Payer: Humana KY Medicaid |
$1,212.16
|
| Rate for Payer: Kentucky WC Medicaid |
$1,224.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,890.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,601.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,057.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,236.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,101.78
|
| Rate for Payer: Ohio Health Group HMO |
$2,643.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$704.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$458.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,092.67
|
| Rate for Payer: PHCS Commercial |
$3,383.76
|
| Rate for Payer: United Healthcare All Payer |
$3,101.78
|
|
|
SMART PORT CT LP CT66LTPD-VI
|
Facility
|
IP
|
$3,524.75
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
27000108
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$458.22 |
| Max. Negotiated Rate |
$3,383.76 |
| Rate for Payer: Aetna Commercial |
$2,714.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,749.30
|
| Rate for Payer: Cash Price |
$1,762.38
|
| Rate for Payer: Cigna Commercial |
$2,925.54
|
| Rate for Payer: First Health Commercial |
$3,348.51
|
| Rate for Payer: Humana Commercial |
$2,996.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,890.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,601.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,057.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,101.78
|
| Rate for Payer: Ohio Health Group HMO |
$2,643.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$704.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$458.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,092.67
|
| Rate for Payer: PHCS Commercial |
$3,383.76
|
| Rate for Payer: United Healthcare All Payer |
$3,101.78
|
|
|
SMART TOE ANGLED 16MM
|
Facility
|
IP
|
$6,906.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.81 |
| Max. Negotiated Rate |
$6,630.00 |
| Rate for Payer: Aetna Commercial |
$5,317.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,386.88
|
| Rate for Payer: Cash Price |
$3,453.12
|
| Rate for Payer: Cigna Commercial |
$5,732.19
|
| Rate for Payer: First Health Commercial |
$6,560.94
|
| Rate for Payer: Humana Commercial |
$5,870.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,663.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,096.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,077.50
|
| Rate for Payer: Ohio Health Group HMO |
$5,179.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,381.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$897.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,140.94
|
| Rate for Payer: PHCS Commercial |
$6,630.00
|
| Rate for Payer: United Healthcare All Payer |
$6,077.50
|
|
|
SMART TOE ANGLED 16MM
|
Facility
|
OP
|
$6,906.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.81 |
| Max. Negotiated Rate |
$6,630.00 |
| Rate for Payer: Aetna Commercial |
$5,317.81
|
| Rate for Payer: Anthem Medicaid |
$2,375.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,386.88
|
| Rate for Payer: Cash Price |
$3,453.12
|
| Rate for Payer: Cigna Commercial |
$5,732.19
|
| Rate for Payer: First Health Commercial |
$6,560.94
|
| Rate for Payer: Humana Commercial |
$5,870.31
|
| Rate for Payer: Humana KY Medicaid |
$2,375.06
|
| Rate for Payer: Kentucky WC Medicaid |
$2,399.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,663.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,096.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,422.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,077.50
|
| Rate for Payer: Ohio Health Group HMO |
$5,179.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,381.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$897.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,140.94
|
| Rate for Payer: PHCS Commercial |
$6,630.00
|
| Rate for Payer: United Healthcare All Payer |
$6,077.50
|
|
|
SMART TOE ANGLED 19MM
|
Facility
|
OP
|
$6,906.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.81 |
| Max. Negotiated Rate |
$6,630.00 |
| Rate for Payer: Aetna Commercial |
$5,317.81
|
| Rate for Payer: Anthem Medicaid |
$2,375.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,386.88
|
| Rate for Payer: Cash Price |
$3,453.12
|
| Rate for Payer: Cigna Commercial |
$5,732.19
|
| Rate for Payer: First Health Commercial |
$6,560.94
|
| Rate for Payer: Humana Commercial |
$5,870.31
|
| Rate for Payer: Humana KY Medicaid |
$2,375.06
|
| Rate for Payer: Kentucky WC Medicaid |
$2,399.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,663.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,096.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,422.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,077.50
|
| Rate for Payer: Ohio Health Group HMO |
$5,179.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,381.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$897.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,140.94
|
| Rate for Payer: PHCS Commercial |
$6,630.00
|
| Rate for Payer: United Healthcare All Payer |
$6,077.50
|
|
|
SMART TOE ANGLED 19MM
|
Facility
|
IP
|
$6,906.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.81 |
| Max. Negotiated Rate |
$6,630.00 |
| Rate for Payer: Aetna Commercial |
$5,317.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,386.88
|
| Rate for Payer: Cash Price |
$3,453.12
|
| Rate for Payer: Cigna Commercial |
$5,732.19
|
| Rate for Payer: First Health Commercial |
$6,560.94
|
| Rate for Payer: Humana Commercial |
$5,870.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,663.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,096.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,077.50
|
| Rate for Payer: Ohio Health Group HMO |
$5,179.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,381.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$897.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,140.94
|
| Rate for Payer: PHCS Commercial |
$6,630.00
|
| Rate for Payer: United Healthcare All Payer |
$6,077.50
|
|
|
SMART TOE DIP IMPLANT 11MM
|
Facility
|
OP
|
$6,906.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.81 |
| Max. Negotiated Rate |
$6,630.00 |
| Rate for Payer: Aetna Commercial |
$5,317.81
|
| Rate for Payer: Anthem Medicaid |
$2,375.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,386.88
|
| Rate for Payer: Cash Price |
$3,453.12
|
| Rate for Payer: Cigna Commercial |
$5,732.19
|
| Rate for Payer: First Health Commercial |
$6,560.94
|
| Rate for Payer: Humana Commercial |
$5,870.31
|
| Rate for Payer: Humana KY Medicaid |
$2,375.06
|
| Rate for Payer: Kentucky WC Medicaid |
$2,399.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,663.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,096.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,422.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,077.50
|
| Rate for Payer: Ohio Health Group HMO |
$5,179.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,381.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$897.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,140.94
|
| Rate for Payer: PHCS Commercial |
$6,630.00
|
| Rate for Payer: United Healthcare All Payer |
$6,077.50
|
|
|
SMART TOE DIP IMPLANT 11MM
|
Facility
|
IP
|
$6,906.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.81 |
| Max. Negotiated Rate |
$6,630.00 |
| Rate for Payer: Aetna Commercial |
$5,317.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,386.88
|
| Rate for Payer: Cash Price |
$3,453.12
|
| Rate for Payer: Cigna Commercial |
$5,732.19
|
| Rate for Payer: First Health Commercial |
$6,560.94
|
| Rate for Payer: Humana Commercial |
$5,870.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,663.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,096.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,077.50
|
| Rate for Payer: Ohio Health Group HMO |
$5,179.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,381.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$897.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,140.94
|
| Rate for Payer: PHCS Commercial |
$6,630.00
|
| Rate for Payer: United Healthcare All Payer |
$6,077.50
|
|
|
SMART TOE DIP IMPLANT 13MM
|
Facility
|
OP
|
$5,350.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$695.50 |
| Max. Negotiated Rate |
$5,136.00 |
| Rate for Payer: Aetna Commercial |
$4,119.50
|
| Rate for Payer: Anthem Medicaid |
$1,839.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,173.00
|
| Rate for Payer: Cash Price |
$2,675.00
|
| Rate for Payer: Cigna Commercial |
$4,440.50
|
| Rate for Payer: First Health Commercial |
$5,082.50
|
| Rate for Payer: Humana Commercial |
$4,547.50
|
| Rate for Payer: Humana KY Medicaid |
$1,839.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,858.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,387.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,948.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,605.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,876.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,708.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,070.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$695.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,658.50
|
| Rate for Payer: PHCS Commercial |
$5,136.00
|
| Rate for Payer: United Healthcare All Payer |
$4,708.00
|
|
|
SMART TOE DIP IMPLANT 13MM
|
Facility
|
IP
|
$5,350.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$695.50 |
| Max. Negotiated Rate |
$5,136.00 |
| Rate for Payer: Aetna Commercial |
$4,119.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,173.00
|
| Rate for Payer: Cash Price |
$2,675.00
|
| Rate for Payer: Cigna Commercial |
$4,440.50
|
| Rate for Payer: First Health Commercial |
$5,082.50
|
| Rate for Payer: Humana Commercial |
$4,547.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,387.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,948.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,605.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,708.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,070.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$695.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,658.50
|
| Rate for Payer: PHCS Commercial |
$5,136.00
|
| Rate for Payer: United Healthcare All Payer |
$4,708.00
|
|
|
SMART TOE STRAIGHT 16MM
|
Facility
|
IP
|
$6,906.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.81 |
| Max. Negotiated Rate |
$6,630.00 |
| Rate for Payer: Aetna Commercial |
$5,317.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,386.88
|
| Rate for Payer: Cash Price |
$3,453.12
|
| Rate for Payer: Cigna Commercial |
$5,732.19
|
| Rate for Payer: First Health Commercial |
$6,560.94
|
| Rate for Payer: Humana Commercial |
$5,870.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,663.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,096.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,077.50
|
| Rate for Payer: Ohio Health Group HMO |
$5,179.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,381.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$897.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,140.94
|
| Rate for Payer: PHCS Commercial |
$6,630.00
|
| Rate for Payer: United Healthcare All Payer |
$6,077.50
|
|
|
SMART TOE STRAIGHT 16MM
|
Facility
|
OP
|
$6,906.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.81 |
| Max. Negotiated Rate |
$6,630.00 |
| Rate for Payer: Aetna Commercial |
$5,317.81
|
| Rate for Payer: Anthem Medicaid |
$2,375.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,386.88
|
| Rate for Payer: Cash Price |
$3,453.12
|
| Rate for Payer: Cigna Commercial |
$5,732.19
|
| Rate for Payer: First Health Commercial |
$6,560.94
|
| Rate for Payer: Humana Commercial |
$5,870.31
|
| Rate for Payer: Humana KY Medicaid |
$2,375.06
|
| Rate for Payer: Kentucky WC Medicaid |
$2,399.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,663.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,096.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,422.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,077.50
|
| Rate for Payer: Ohio Health Group HMO |
$5,179.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,381.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$897.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,140.94
|
| Rate for Payer: PHCS Commercial |
$6,630.00
|
| Rate for Payer: United Healthcare All Payer |
$6,077.50
|
|
|
SMART TOE STRAIGHT 19MM
|
Facility
|
IP
|
$6,906.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.81 |
| Max. Negotiated Rate |
$6,630.00 |
| Rate for Payer: Aetna Commercial |
$5,317.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,386.88
|
| Rate for Payer: Cash Price |
$3,453.12
|
| Rate for Payer: Cigna Commercial |
$5,732.19
|
| Rate for Payer: First Health Commercial |
$6,560.94
|
| Rate for Payer: Humana Commercial |
$5,870.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,663.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,096.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,077.50
|
| Rate for Payer: Ohio Health Group HMO |
$5,179.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,381.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$897.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,140.94
|
| Rate for Payer: PHCS Commercial |
$6,630.00
|
| Rate for Payer: United Healthcare All Payer |
$6,077.50
|
|
|
SMART TOE STRAIGHT 19MM
|
Facility
|
OP
|
$6,906.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.81 |
| Max. Negotiated Rate |
$6,630.00 |
| Rate for Payer: Aetna Commercial |
$5,317.81
|
| Rate for Payer: Anthem Medicaid |
$2,375.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,386.88
|
| Rate for Payer: Cash Price |
$3,453.12
|
| Rate for Payer: Cigna Commercial |
$5,732.19
|
| Rate for Payer: First Health Commercial |
$6,560.94
|
| Rate for Payer: Humana Commercial |
$5,870.31
|
| Rate for Payer: Humana KY Medicaid |
$2,375.06
|
| Rate for Payer: Kentucky WC Medicaid |
$2,399.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,663.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,096.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,422.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,077.50
|
| Rate for Payer: Ohio Health Group HMO |
$5,179.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,381.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$897.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,140.94
|
| Rate for Payer: PHCS Commercial |
$6,630.00
|
| Rate for Payer: United Healthcare All Payer |
$6,077.50
|
|
|
SMEAR KOH PREP
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
HCPCS 87210
|
| Hospital Charge Code |
30001337
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$65.28 |
| Rate for Payer: Aetna Commercial |
$52.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.60
|
| Rate for Payer: Cash Price |
$34.00
|
| Rate for Payer: Cigna Commercial |
$56.44
|
| Rate for Payer: First Health Commercial |
$64.60
|
| Rate for Payer: Humana Commercial |
$57.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$55.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$59.84
|
| Rate for Payer: Ohio Health Group HMO |
$51.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.08
|
| Rate for Payer: PHCS Commercial |
$65.28
|
| Rate for Payer: United Healthcare All Payer |
$59.84
|
|
|
SMEAR KOH PREP
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
HCPCS 87210
|
| Hospital Charge Code |
30001337
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.82 |
| Max. Negotiated Rate |
$65.28 |
| Rate for Payer: Aetna Commercial |
$52.36
|
| Rate for Payer: Anthem Medicaid |
$23.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.82
|
| Rate for Payer: Cash Price |
$34.00
|
| Rate for Payer: Cash Price |
$34.00
|
| Rate for Payer: Cigna Commercial |
$56.44
|
| Rate for Payer: First Health Commercial |
$64.60
|
| Rate for Payer: Humana Commercial |
$57.80
|
| Rate for Payer: Humana KY Medicaid |
$23.39
|
| Rate for Payer: Humana Medicare Advantage |
$5.82
|
| Rate for Payer: Kentucky WC Medicaid |
$23.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$55.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$23.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$59.84
|
| Rate for Payer: Ohio Health Group HMO |
$51.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.08
|
| Rate for Payer: PHCS Commercial |
$65.28
|
| Rate for Payer: United Healthcare All Payer |
$59.84
|
|
|
SM INT ENDSCPYENTRSCPY SECPRTN
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
HCPCS 44373
|
| Hospital Charge Code |
76101847
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$52.00 |
| Max. Negotiated Rate |
$2,303.66 |
| Rate for Payer: Aetna Commercial |
$308.00
|
| Rate for Payer: Anthem Medicaid |
$137.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,645.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$312.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,303.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,221.38
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$332.00
|
| Rate for Payer: First Health Commercial |
$380.00
|
| Rate for Payer: Humana Commercial |
$340.00
|
| Rate for Payer: Humana KY Medicaid |
$137.56
|
| Rate for Payer: Humana Medicare Advantage |
$1,645.47
|
| Rate for Payer: Kentucky WC Medicaid |
$138.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$328.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$295.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,974.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$140.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$352.00
|
| Rate for Payer: Ohio Health Group HMO |
$300.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.00
|
| Rate for Payer: PHCS Commercial |
$384.00
|
| Rate for Payer: United Healthcare All Payer |
$352.00
|
|
|
SM INT ENDSCPYENTRSCPY SECPRTN
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 44373
|
| Hospital Charge Code |
76101847
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna Commercial |
$314.37
|
| Rate for Payer: Anthem Medicaid |
$262.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$400.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$283.40
|
| Rate for Payer: Healthspan PPO |
$265.11
|
| Rate for Payer: Humana Medicaid |
$262.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$269.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$267.93
|
| Rate for Payer: Molina Healthcare Passport |
$262.68
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$280.00
|
| Rate for Payer: UHCCP Medicaid |
$140.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$265.31
|
|
|
SM INT ENDSCPYENTRSCPY SECPRTN
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 44373
|
| Hospital Charge Code |
761P1847
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna Commercial |
$314.37
|
| Rate for Payer: Anthem Medicaid |
$262.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$400.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$283.40
|
| Rate for Payer: Healthspan PPO |
$265.11
|
| Rate for Payer: Humana Medicaid |
$262.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$269.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$267.93
|
| Rate for Payer: Molina Healthcare Passport |
$262.68
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$280.00
|
| Rate for Payer: UHCCP Medicaid |
$140.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$265.31
|
|
|
SM INT ENDSCPYENTRSCPY SECPRTN
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
HCPCS 44373
|
| Hospital Charge Code |
76101847
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$52.00 |
| Max. Negotiated Rate |
$384.00 |
| Rate for Payer: Aetna Commercial |
$308.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$312.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$332.00
|
| Rate for Payer: First Health Commercial |
$380.00
|
| Rate for Payer: Humana Commercial |
$340.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$328.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$295.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$120.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$352.00
|
| Rate for Payer: Ohio Health Group HMO |
$300.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.00
|
| Rate for Payer: PHCS Commercial |
$384.00
|
| Rate for Payer: United Healthcare All Payer |
$352.00
|
|
|
SMOKE TOBAC CESSATION > 10 MIN
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
HCPCS 99407
|
| Hospital Charge Code |
94200010
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$11.57 |
| Max. Negotiated Rate |
$85.44 |
| Rate for Payer: Aetna Commercial |
$68.53
|
| Rate for Payer: Anthem Medicaid |
$30.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$24.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$69.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$34.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$33.49
|
| Rate for Payer: Cash Price |
$44.50
|
| Rate for Payer: Cash Price |
$44.50
|
| Rate for Payer: Cigna Commercial |
$73.87
|
| Rate for Payer: First Health Commercial |
$84.55
|
| Rate for Payer: Humana Commercial |
$75.65
|
| Rate for Payer: Humana KY Medicaid |
$30.61
|
| Rate for Payer: Humana Medicare Advantage |
$24.81
|
| Rate for Payer: Kentucky WC Medicaid |
$30.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$72.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$65.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$31.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$78.32
|
| Rate for Payer: Ohio Health Group HMO |
$66.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27.59
|
| Rate for Payer: PHCS Commercial |
$85.44
|
| Rate for Payer: United Healthcare All Payer |
$78.32
|
|
