|
SILICONE TIP STRAIGHT I/A
|
Facility
|
OP
|
$1,531.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$459.46 |
| Max. Negotiated Rate |
$1,470.29 |
| Rate for Payer: Aetna Commercial |
$1,179.29
|
| Rate for Payer: Anthem Medicaid |
$526.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,194.61
|
| Rate for Payer: Cash Price |
$765.78
|
| Rate for Payer: Cigna Commercial |
$1,271.19
|
| Rate for Payer: First Health Commercial |
$1,454.97
|
| Rate for Payer: Humana Commercial |
$1,301.82
|
| Rate for Payer: Humana KY Medicaid |
$526.70
|
| Rate for Payer: Kentucky WC Medicaid |
$532.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,255.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,130.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$459.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$537.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,347.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,148.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,225.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,332.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,056.77
|
| Rate for Payer: PHCS Commercial |
$1,470.29
|
| Rate for Payer: United Healthcare All Payer |
$1,347.76
|
|
|
SILICONE TIP STRAIGHT I/A
|
Facility
|
IP
|
$1,531.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$459.46 |
| Max. Negotiated Rate |
$1,470.29 |
| Rate for Payer: Aetna Commercial |
$1,179.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,194.61
|
| Rate for Payer: Cash Price |
$765.78
|
| Rate for Payer: Cigna Commercial |
$1,271.19
|
| Rate for Payer: First Health Commercial |
$1,454.97
|
| Rate for Payer: Humana Commercial |
$1,301.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,255.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,130.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$459.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,347.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,148.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,225.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,332.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,056.77
|
| Rate for Payer: PHCS Commercial |
$1,470.29
|
| Rate for Payer: United Healthcare All Payer |
$1,347.76
|
|
|
SILVADENE(SILVER SULFAD.) 50GM
|
Facility
|
OP
|
$1.84
|
|
|
Service Code
|
NDC 67877012450
|
| Hospital Charge Code |
25003444
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$1.77 |
| Rate for Payer: Aetna Commercial |
$1.42
|
| Rate for Payer: Anthem Medicaid |
$0.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.44
|
| Rate for Payer: Cash Price |
$0.92
|
| Rate for Payer: Cigna Commercial |
$1.53
|
| Rate for Payer: First Health Commercial |
$1.75
|
| Rate for Payer: Humana Commercial |
$1.56
|
| Rate for Payer: Humana KY Medicaid |
$0.63
|
| Rate for Payer: Kentucky WC Medicaid |
$0.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.62
|
| Rate for Payer: Ohio Health Group HMO |
$1.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.27
|
| Rate for Payer: PHCS Commercial |
$1.77
|
| Rate for Payer: United Healthcare All Payer |
$1.62
|
|
|
SILVADENE(SILVER SULFAD.) 50GM
|
Facility
|
IP
|
$1.84
|
|
|
Service Code
|
NDC 67877012450
|
| Hospital Charge Code |
25003444
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$1.77 |
| Rate for Payer: Aetna Commercial |
$1.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.44
|
| Rate for Payer: Cash Price |
$0.92
|
| Rate for Payer: Cigna Commercial |
$1.53
|
| Rate for Payer: First Health Commercial |
$1.75
|
| Rate for Payer: Humana Commercial |
$1.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.62
|
| Rate for Payer: Ohio Health Group HMO |
$1.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.27
|
| Rate for Payer: PHCS Commercial |
$1.77
|
| Rate for Payer: United Healthcare All Payer |
$1.62
|
|
|
SILVASORB GEL 45 ML
|
Facility
|
OP
|
$4.87
|
|
|
Service Code
|
NDC 8327030909
|
| Hospital Charge Code |
25003445
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.46 |
| 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 |
$3.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.36
|
| Rate for Payer: PHCS Commercial |
$4.68
|
| Rate for Payer: United Healthcare All Payer |
$4.29
|
|
|
SILVASORB GEL 45 ML
|
Facility
|
IP
|
$4.87
|
|
|
Service Code
|
NDC 8327030909
|
| Hospital Charge Code |
25003445
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.46 |
| 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 |
$3.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.36
|
| Rate for Payer: PHCS Commercial |
$4.68
|
| Rate for Payer: United Healthcare All Payer |
$4.29
|
|
|
SILVERHAWK PERIPHERAL CATH ES+
|
Facility
|
IP
|
$15,562.90
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,668.87 |
| Max. Negotiated Rate |
$14,940.38 |
| Rate for Payer: Aetna Commercial |
$11,983.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,139.06
|
| Rate for Payer: Cash Price |
$7,781.45
|
| Rate for Payer: Cigna Commercial |
$12,917.21
|
| Rate for Payer: First Health Commercial |
$14,784.75
|
| Rate for Payer: Humana Commercial |
$13,228.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,761.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,485.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,668.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,695.35
|
| Rate for Payer: Ohio Health Group HMO |
$11,672.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,450.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,539.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,738.40
|
| Rate for Payer: PHCS Commercial |
$14,940.38
|
| Rate for Payer: United Healthcare All Payer |
$13,695.35
|
|
|
SILVERHAWK PERIPHERAL CATH ES+
|
Facility
|
OP
|
$15,562.90
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,668.87 |
| Max. Negotiated Rate |
$14,940.38 |
| Rate for Payer: Aetna Commercial |
$11,983.43
|
| Rate for Payer: Anthem Medicaid |
$5,352.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,139.06
|
| Rate for Payer: Cash Price |
$7,781.45
|
| Rate for Payer: Cigna Commercial |
$12,917.21
|
| Rate for Payer: First Health Commercial |
$14,784.75
|
| Rate for Payer: Humana Commercial |
$13,228.47
|
| Rate for Payer: Humana KY Medicaid |
$5,352.08
|
| Rate for Payer: Kentucky WC Medicaid |
$5,406.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,761.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,485.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,668.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,459.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,695.35
|
| Rate for Payer: Ohio Health Group HMO |
$11,672.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,450.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,539.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,738.40
|
| Rate for Payer: PHCS Commercial |
$14,940.38
|
| Rate for Payer: United Healthcare All Payer |
$13,695.35
|
|
|
SILVERHAWK PERIPHERAL CATH SS
|
Facility
|
IP
|
$15,851.50
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,755.45 |
| Max. Negotiated Rate |
$15,217.44 |
| Rate for Payer: Aetna Commercial |
$12,205.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,364.17
|
| Rate for Payer: Cash Price |
$7,925.75
|
| Rate for Payer: Cigna Commercial |
$13,156.75
|
| Rate for Payer: First Health Commercial |
$15,058.92
|
| Rate for Payer: Humana Commercial |
$13,473.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,998.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,698.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,755.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,949.32
|
| Rate for Payer: Ohio Health Group HMO |
$11,888.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,681.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,790.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,937.53
|
| Rate for Payer: PHCS Commercial |
$15,217.44
|
| Rate for Payer: United Healthcare All Payer |
$13,949.32
|
|
|
SILVERHAWK PERIPHERAL CATH SS
|
Facility
|
OP
|
$15,851.50
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,755.45 |
| Max. Negotiated Rate |
$15,217.44 |
| Rate for Payer: Aetna Commercial |
$12,205.66
|
| Rate for Payer: Anthem Medicaid |
$5,451.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,364.17
|
| Rate for Payer: Cash Price |
$7,925.75
|
| Rate for Payer: Cigna Commercial |
$13,156.75
|
| Rate for Payer: First Health Commercial |
$15,058.92
|
| Rate for Payer: Humana Commercial |
$13,473.77
|
| Rate for Payer: Humana KY Medicaid |
$5,451.33
|
| Rate for Payer: Kentucky WC Medicaid |
$5,506.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,998.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,698.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,755.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,560.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,949.32
|
| Rate for Payer: Ohio Health Group HMO |
$11,888.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,681.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,790.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,937.53
|
| Rate for Payer: PHCS Commercial |
$15,217.44
|
| Rate for Payer: United Healthcare All Payer |
$13,949.32
|
|
|
SILVERHAWK PERIPHERL CATH MS-F
|
Facility
|
OP
|
$13,390.65
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,017.20 |
| Max. Negotiated Rate |
$12,855.02 |
| Rate for Payer: Aetna Commercial |
$10,310.80
|
| Rate for Payer: Anthem Medicaid |
$4,605.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,444.71
|
| Rate for Payer: Cash Price |
$6,695.32
|
| Rate for Payer: Cigna Commercial |
$11,114.24
|
| Rate for Payer: First Health Commercial |
$12,721.12
|
| Rate for Payer: Humana Commercial |
$11,382.05
|
| Rate for Payer: Humana KY Medicaid |
$4,605.04
|
| Rate for Payer: Kentucky WC Medicaid |
$4,651.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,980.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,882.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,017.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,697.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,783.77
|
| Rate for Payer: Ohio Health Group HMO |
$10,042.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,712.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,649.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,239.55
|
| Rate for Payer: PHCS Commercial |
$12,855.02
|
| Rate for Payer: United Healthcare All Payer |
$11,783.77
|
|
|
SILVERHAWK PERIPHERL CATH MS-F
|
Facility
|
IP
|
$13,390.65
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,017.20 |
| Max. Negotiated Rate |
$12,855.02 |
| Rate for Payer: Aetna Commercial |
$10,310.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,444.71
|
| Rate for Payer: Cash Price |
$6,695.32
|
| Rate for Payer: Cigna Commercial |
$11,114.24
|
| Rate for Payer: First Health Commercial |
$12,721.12
|
| Rate for Payer: Humana Commercial |
$11,382.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,980.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,882.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,017.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,783.77
|
| Rate for Payer: Ohio Health Group HMO |
$10,042.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,712.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,649.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,239.55
|
| Rate for Payer: PHCS Commercial |
$12,855.02
|
| Rate for Payer: United Healthcare All Payer |
$11,783.77
|
|
|
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 |
$1.46 |
| 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 |
$3.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.37
|
| Rate for Payer: PHCS Commercial |
$4.68
|
| Rate for Payer: United Healthcare All Payer |
$4.29
|
|
|
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 |
$1.46 |
| 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 |
$3.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.37
|
| 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 |
$1.49 |
| 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 |
$3.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.42
|
| 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 |
$1.49 |
| 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 |
$3.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.42
|
| Rate for Payer: PHCS Commercial |
$4.76
|
| Rate for Payer: United Healthcare All Payer |
$4.36
|
|
|
SIM2 BEACON TIP
|
Facility
|
IP
|
$540.50
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$162.15 |
| Max. Negotiated Rate |
$518.88 |
| Rate for Payer: Aetna Commercial |
$416.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$421.59
|
| Rate for Payer: Cash Price |
$270.25
|
| Rate for Payer: Cigna Commercial |
$448.62
|
| Rate for Payer: First Health Commercial |
$513.48
|
| Rate for Payer: Humana Commercial |
$459.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$443.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$398.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$475.64
|
| Rate for Payer: Ohio Health Group HMO |
$405.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$432.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$470.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$372.94
|
| Rate for Payer: PHCS Commercial |
$518.88
|
| Rate for Payer: United Healthcare All Payer |
$475.64
|
|
|
SIM2 BEACON TIP
|
Facility
|
OP
|
$540.50
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$162.15 |
| Max. Negotiated Rate |
$518.88 |
| Rate for Payer: Aetna Commercial |
$416.19
|
| Rate for Payer: Anthem Medicaid |
$185.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$421.59
|
| Rate for Payer: Cash Price |
$270.25
|
| Rate for Payer: Cigna Commercial |
$448.62
|
| Rate for Payer: First Health Commercial |
$513.48
|
| Rate for Payer: Humana Commercial |
$459.43
|
| Rate for Payer: Humana KY Medicaid |
$185.88
|
| Rate for Payer: Kentucky WC Medicaid |
$187.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$443.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$398.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$189.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$475.64
|
| Rate for Payer: Ohio Health Group HMO |
$405.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$432.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$470.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$372.94
|
| Rate for Payer: PHCS Commercial |
$518.88
|
| Rate for Payer: United Healthcare All Payer |
$475.64
|
|
|
SIMPLE CYSTOMETROGRAM
|
Facility
|
OP
|
$1,478.00
|
|
|
Service Code
|
HCPCS 51725
|
| Hospital Charge Code |
32000261
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$224.72 |
| Max. Negotiated Rate |
$1,418.88 |
| Rate for Payer: Aetna Commercial |
$1,138.06
|
| Rate for Payer: Anthem Medicaid |
$508.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$224.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,152.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$314.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$303.37
|
| Rate for Payer: Cash Price |
$739.00
|
| Rate for Payer: Cash Price |
$739.00
|
| Rate for Payer: Cigna Commercial |
$1,226.74
|
| Rate for Payer: First Health Commercial |
$1,404.10
|
| Rate for Payer: Humana Commercial |
$1,256.30
|
| Rate for Payer: Humana KY Medicaid |
$508.28
|
| Rate for Payer: Humana Medicare Advantage |
$224.72
|
| Rate for Payer: Kentucky WC Medicaid |
$513.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,211.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,090.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$269.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$518.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,300.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,108.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,182.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,285.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,019.82
|
| Rate for Payer: PHCS Commercial |
$1,418.88
|
| Rate for Payer: United Healthcare All Payer |
$1,300.64
|
|
|
SIMPLE CYSTOMETROGRAM
|
Professional
|
Both
|
$1,478.00
|
|
|
Service Code
|
HCPCS 51725
|
| Hospital Charge Code |
32000261
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$74.07 |
| Max. Negotiated Rate |
$886.80 |
| Rate for Payer: Aetna Commercial |
$341.55
|
| Rate for Payer: Ambetter Exchange |
$188.05
|
| Rate for Payer: Anthem Medicaid |
$74.07
|
| Rate for Payer: Buckeye Individual/Medicaid |
$188.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$188.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$225.66
|
| Rate for Payer: Cash Price |
$739.00
|
| Rate for Payer: Cash Price |
$739.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$188.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$188.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$75.55
|
| Rate for Payer: Molina Healthcare Passport |
$74.07
|
| Rate for Payer: Multiplan PHCS |
$886.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$244.47
|
| Rate for Payer: UHCCP Medicaid |
$517.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$74.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$188.05
|
|
|
SIMPLE CYSTOMETROGRAM
|
Facility
|
IP
|
$1,478.00
|
|
|
Service Code
|
HCPCS 51725
|
| Hospital Charge Code |
32000261
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$443.40 |
| Max. Negotiated Rate |
$1,418.88 |
| Rate for Payer: Aetna Commercial |
$1,138.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,152.84
|
| Rate for Payer: Cash Price |
$739.00
|
| Rate for Payer: Cigna Commercial |
$1,226.74
|
| Rate for Payer: First Health Commercial |
$1,404.10
|
| Rate for Payer: Humana Commercial |
$1,256.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,211.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,090.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$443.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,300.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,108.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,182.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,285.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,019.82
|
| Rate for Payer: PHCS Commercial |
$1,418.88
|
| Rate for Payer: United Healthcare All Payer |
$1,300.64
|
|
|
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 |
$379.41 |
| Rate for Payer: Aetna Commercial |
$341.55
|
| Rate for Payer: Ambetter Exchange |
$188.05
|
| Rate for Payer: Anthem Medicaid |
$74.07
|
| Rate for Payer: Buckeye Individual/Medicaid |
$188.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$188.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$225.66
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$188.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$188.05
|
| 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 |
$244.47
|
| Rate for Payer: UHCCP Medicaid |
$175.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$74.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$188.05
|
|
|
SIMPLE CYSTOMETROGRAM(T
|
Facility
|
OP
|
$978.00
|
|
|
Service Code
|
HCPCS 51725
|
| Hospital Charge Code |
320T0261
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$224.72 |
| Max. Negotiated Rate |
$938.88 |
| Rate for Payer: Aetna Commercial |
$753.06
|
| Rate for Payer: Anthem Medicaid |
$336.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$224.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$762.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$314.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$303.37
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$811.74
|
| Rate for Payer: First Health Commercial |
$929.10
|
| Rate for Payer: Humana Commercial |
$831.30
|
| Rate for Payer: Humana KY Medicaid |
$336.33
|
| Rate for Payer: Humana Medicare Advantage |
$224.72
|
| Rate for Payer: Kentucky WC Medicaid |
$339.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$801.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$721.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$269.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$343.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$860.64
|
| Rate for Payer: Ohio Health Group HMO |
$733.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$782.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$850.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$674.82
|
| Rate for Payer: PHCS Commercial |
$938.88
|
| Rate for Payer: United Healthcare All Payer |
$860.64
|
|
|
SIMPLE CYSTOMETROGRAM(T
|
Facility
|
IP
|
$978.00
|
|
|
Service Code
|
HCPCS 51725
|
| Hospital Charge Code |
320T0261
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$293.40 |
| Max. Negotiated Rate |
$938.88 |
| Rate for Payer: Aetna Commercial |
$753.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$762.84
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$811.74
|
| Rate for Payer: First Health Commercial |
$929.10
|
| Rate for Payer: Humana Commercial |
$831.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$801.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$721.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$293.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$860.64
|
| Rate for Payer: Ohio Health Group HMO |
$733.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$782.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$850.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$674.82
|
| Rate for Payer: PHCS Commercial |
$938.88
|
| Rate for Payer: United Healthcare All Payer |
$860.64
|
|
|
SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANES; 2.5 CM OR LESS
|
Facility
|
OP
|
$257.03
|
|
|
Service Code
|
CPT 12011
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$183.59 |
| Max. Negotiated Rate |
$257.03 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
|
