|
AUGMENT VNDR D FM 65X5 LL/RM
|
Facility
|
IP
|
$8,777.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,633.17 |
| Max. Negotiated Rate |
$8,426.13 |
| Rate for Payer: Aetna Commercial |
$6,758.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,846.23
|
| Rate for Payer: Cash Price |
$4,388.61
|
| Rate for Payer: Cigna Commercial |
$7,285.09
|
| Rate for Payer: First Health Commercial |
$8,338.36
|
| Rate for Payer: Humana Commercial |
$7,460.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,197.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,477.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,723.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,582.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,021.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,636.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,056.28
|
| Rate for Payer: PHCS Commercial |
$8,426.13
|
| Rate for Payer: United Healthcare All Payer |
$7,723.95
|
|
|
AUGMENT VNDR D FM 65X5 LL/RM
|
Facility
|
OP
|
$8,777.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,633.17 |
| Max. Negotiated Rate |
$8,426.13 |
| Rate for Payer: Aetna Commercial |
$6,758.46
|
| Rate for Payer: Anthem Medicaid |
$3,018.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,846.23
|
| Rate for Payer: Cash Price |
$4,388.61
|
| Rate for Payer: Cigna Commercial |
$7,285.09
|
| Rate for Payer: First Health Commercial |
$8,338.36
|
| Rate for Payer: Humana Commercial |
$7,460.64
|
| Rate for Payer: Humana KY Medicaid |
$3,018.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,049.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,197.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,477.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,079.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,723.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,582.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,021.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,636.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,056.28
|
| Rate for Payer: PHCS Commercial |
$8,426.13
|
| Rate for Payer: United Healthcare All Payer |
$7,723.95
|
|
|
AUGMENT VNDR D FM 67.5X5 LL/RM
|
Facility
|
IP
|
$8,777.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,633.17 |
| Max. Negotiated Rate |
$8,426.13 |
| Rate for Payer: Aetna Commercial |
$6,758.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,846.23
|
| Rate for Payer: Cash Price |
$4,388.61
|
| Rate for Payer: Cigna Commercial |
$7,285.09
|
| Rate for Payer: First Health Commercial |
$8,338.36
|
| Rate for Payer: Humana Commercial |
$7,460.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,197.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,477.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,723.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,582.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,021.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,636.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,056.28
|
| Rate for Payer: PHCS Commercial |
$8,426.13
|
| Rate for Payer: United Healthcare All Payer |
$7,723.95
|
|
|
AUGMENT VNDR D FM 67.5X5 LL/RM
|
Facility
|
OP
|
$8,777.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,633.17 |
| Max. Negotiated Rate |
$8,426.13 |
| Rate for Payer: Aetna Commercial |
$6,758.46
|
| Rate for Payer: Anthem Medicaid |
$3,018.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,846.23
|
| Rate for Payer: Cash Price |
$4,388.61
|
| Rate for Payer: Cigna Commercial |
$7,285.09
|
| Rate for Payer: First Health Commercial |
$8,338.36
|
| Rate for Payer: Humana Commercial |
$7,460.64
|
| Rate for Payer: Humana KY Medicaid |
$3,018.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,049.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,197.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,477.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,079.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,723.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,582.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,021.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,636.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,056.28
|
| Rate for Payer: PHCS Commercial |
$8,426.13
|
| Rate for Payer: United Healthcare All Payer |
$7,723.95
|
|
|
AUGMENT VNDR D FM 70X5 LL/RM
|
Facility
|
IP
|
$8,777.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,633.17 |
| Max. Negotiated Rate |
$8,426.13 |
| Rate for Payer: Aetna Commercial |
$6,758.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,846.23
|
| Rate for Payer: Cash Price |
$4,388.61
|
| Rate for Payer: Cigna Commercial |
$7,285.09
|
| Rate for Payer: First Health Commercial |
$8,338.36
|
| Rate for Payer: Humana Commercial |
$7,460.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,197.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,477.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,723.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,582.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,021.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,636.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,056.28
|
| Rate for Payer: PHCS Commercial |
$8,426.13
|
| Rate for Payer: United Healthcare All Payer |
$7,723.95
|
|
|
AUGMENT VNDR D FM 70X5 LL/RM
|
Facility
|
OP
|
$8,777.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,633.17 |
| Max. Negotiated Rate |
$8,426.13 |
| Rate for Payer: Aetna Commercial |
$6,758.46
|
| Rate for Payer: Anthem Medicaid |
$3,018.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,846.23
|
| Rate for Payer: Cash Price |
$4,388.61
|
| Rate for Payer: Cigna Commercial |
$7,285.09
|
| Rate for Payer: First Health Commercial |
$8,338.36
|
| Rate for Payer: Humana Commercial |
$7,460.64
|
| Rate for Payer: Humana KY Medicaid |
$3,018.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,049.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,197.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,477.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,079.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,723.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,582.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,021.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,636.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,056.28
|
| Rate for Payer: PHCS Commercial |
$8,426.13
|
| Rate for Payer: United Healthcare All Payer |
$7,723.95
|
|
|
AUGMENT VNDR D FM 75X5 LL/RM
|
Facility
|
OP
|
$8,777.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,633.17 |
| Max. Negotiated Rate |
$8,426.13 |
| Rate for Payer: Aetna Commercial |
$6,758.46
|
| Rate for Payer: Anthem Medicaid |
$3,018.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,846.23
|
| Rate for Payer: Cash Price |
$4,388.61
|
| Rate for Payer: Cigna Commercial |
$7,285.09
|
| Rate for Payer: First Health Commercial |
$8,338.36
|
| Rate for Payer: Humana Commercial |
$7,460.64
|
| Rate for Payer: Humana KY Medicaid |
$3,018.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,049.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,197.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,477.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,079.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,723.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,582.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,021.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,636.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,056.28
|
| Rate for Payer: PHCS Commercial |
$8,426.13
|
| Rate for Payer: United Healthcare All Payer |
$7,723.95
|
|
|
AUGMENT VNDR D FM 75X5 LL/RM
|
Facility
|
IP
|
$8,777.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,633.17 |
| Max. Negotiated Rate |
$8,426.13 |
| Rate for Payer: Aetna Commercial |
$6,758.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,846.23
|
| Rate for Payer: Cash Price |
$4,388.61
|
| Rate for Payer: Cigna Commercial |
$7,285.09
|
| Rate for Payer: First Health Commercial |
$8,338.36
|
| Rate for Payer: Humana Commercial |
$7,460.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,197.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,477.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,723.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,582.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,021.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,636.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,056.28
|
| Rate for Payer: PHCS Commercial |
$8,426.13
|
| Rate for Payer: United Healthcare All Payer |
$7,723.95
|
|
|
AUGMENT VNDR D FM 80X5 LL/RM
|
Facility
|
OP
|
$8,777.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,633.17 |
| Max. Negotiated Rate |
$8,426.13 |
| Rate for Payer: Aetna Commercial |
$6,758.46
|
| Rate for Payer: Anthem Medicaid |
$3,018.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,846.23
|
| Rate for Payer: Cash Price |
$4,388.61
|
| Rate for Payer: Cigna Commercial |
$7,285.09
|
| Rate for Payer: First Health Commercial |
$8,338.36
|
| Rate for Payer: Humana Commercial |
$7,460.64
|
| Rate for Payer: Humana KY Medicaid |
$3,018.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,049.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,197.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,477.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,079.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,723.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,582.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,021.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,636.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,056.28
|
| Rate for Payer: PHCS Commercial |
$8,426.13
|
| Rate for Payer: United Healthcare All Payer |
$7,723.95
|
|
|
AUGMENT VNDR D FM 80X5 LL/RM
|
Facility
|
IP
|
$8,777.22
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,633.17 |
| Max. Negotiated Rate |
$8,426.13 |
| Rate for Payer: Aetna Commercial |
$6,758.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,846.23
|
| Rate for Payer: Cash Price |
$4,388.61
|
| Rate for Payer: Cigna Commercial |
$7,285.09
|
| Rate for Payer: First Health Commercial |
$8,338.36
|
| Rate for Payer: Humana Commercial |
$7,460.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,197.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,477.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,723.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,582.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,021.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,636.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,056.28
|
| Rate for Payer: PHCS Commercial |
$8,426.13
|
| Rate for Payer: United Healthcare All Payer |
$7,723.95
|
|
|
AUGMENT XR(AMOX TR/KCLV)1000MG
|
Facility
|
IP
|
$23.70
|
|
|
Service Code
|
NDC 43598002028
|
| Hospital Charge Code |
25002858
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.11 |
| Max. Negotiated Rate |
$22.75 |
| Rate for Payer: Aetna Commercial |
$18.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18.49
|
| Rate for Payer: Cash Price |
$11.85
|
| Rate for Payer: Cigna Commercial |
$19.67
|
| Rate for Payer: First Health Commercial |
$22.52
|
| Rate for Payer: Humana Commercial |
$20.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.86
|
| Rate for Payer: Ohio Health Group HMO |
$17.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.35
|
| Rate for Payer: PHCS Commercial |
$22.75
|
| Rate for Payer: United Healthcare All Payer |
$20.86
|
|
|
AUGMENT XR(AMOX TR/KCLV)1000MG
|
Facility
|
OP
|
$23.70
|
|
|
Service Code
|
NDC 43598002028
|
| Hospital Charge Code |
25002858
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.11 |
| Max. Negotiated Rate |
$22.75 |
| Rate for Payer: Aetna Commercial |
$18.25
|
| Rate for Payer: Anthem Medicaid |
$8.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18.49
|
| Rate for Payer: Cash Price |
$11.85
|
| Rate for Payer: Cigna Commercial |
$19.67
|
| Rate for Payer: First Health Commercial |
$22.52
|
| Rate for Payer: Humana Commercial |
$20.14
|
| Rate for Payer: Humana KY Medicaid |
$8.15
|
| Rate for Payer: Kentucky WC Medicaid |
$8.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.86
|
| Rate for Payer: Ohio Health Group HMO |
$17.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.35
|
| Rate for Payer: PHCS Commercial |
$22.75
|
| Rate for Payer: United Healthcare All Payer |
$20.86
|
|
|
AUTGRFT IMPLNT KNEE W/SCOPE
|
Professional
|
Both
|
$1,255.00
|
|
|
Service Code
|
HCPCS 29866
|
| Hospital Charge Code |
76101092
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$439.25 |
| Max. Negotiated Rate |
$1,702.81 |
| Rate for Payer: Aetna Commercial |
$1,547.30
|
| Rate for Payer: Ambetter Exchange |
$1,001.75
|
| Rate for Payer: Anthem Medicaid |
$763.08
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,001.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,001.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,202.10
|
| Rate for Payer: Cash Price |
$627.50
|
| Rate for Payer: Cash Price |
$627.50
|
| Rate for Payer: Cigna Commercial |
$1,702.81
|
| Rate for Payer: Healthspan PPO |
$1,401.53
|
| Rate for Payer: Humana Medicaid |
$763.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,306.31
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,001.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,001.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$778.34
|
| Rate for Payer: Molina Healthcare Passport |
$763.08
|
| Rate for Payer: Multiplan PHCS |
$753.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,302.28
|
| Rate for Payer: UHCCP Medicaid |
$439.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$770.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,001.75
|
|
|
AUTGRFT IMPLNT KNEE W/SCOPE
|
Facility
|
OP
|
$1,255.00
|
|
|
Service Code
|
HCPCS 29866
|
| Hospital Charge Code |
76101092
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$431.59 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$966.35
|
| Rate for Payer: Anthem Medicaid |
$431.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$978.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| Rate for Payer: Cash Price |
$627.50
|
| Rate for Payer: Cash Price |
$627.50
|
| Rate for Payer: Cigna Commercial |
$1,041.65
|
| Rate for Payer: First Health Commercial |
$1,192.25
|
| Rate for Payer: Humana Commercial |
$1,066.75
|
| Rate for Payer: Humana KY Medicaid |
$431.59
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$435.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,029.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$926.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$440.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,104.40
|
| Rate for Payer: Ohio Health Group HMO |
$941.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,004.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,091.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$865.95
|
| Rate for Payer: PHCS Commercial |
$1,204.80
|
| Rate for Payer: United Healthcare All Payer |
$1,104.40
|
|
|
AUTGRFT IMPLNT KNEE W/SCOPE
|
Facility
|
IP
|
$1,255.00
|
|
|
Service Code
|
HCPCS 29866
|
| Hospital Charge Code |
76101092
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$376.50 |
| Max. Negotiated Rate |
$1,204.80 |
| Rate for Payer: Aetna Commercial |
$966.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$978.90
|
| Rate for Payer: Cash Price |
$627.50
|
| Rate for Payer: Cigna Commercial |
$1,041.65
|
| Rate for Payer: First Health Commercial |
$1,192.25
|
| Rate for Payer: Humana Commercial |
$1,066.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,029.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$926.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$376.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,104.40
|
| Rate for Payer: Ohio Health Group HMO |
$941.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,004.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,091.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$865.95
|
| Rate for Payer: PHCS Commercial |
$1,204.80
|
| Rate for Payer: United Healthcare All Payer |
$1,104.40
|
|
|
AUTGRFT IMPLNT KNEE W/SCOPE(P
|
Professional
|
Both
|
$1,255.00
|
|
|
Service Code
|
HCPCS 29866
|
| Hospital Charge Code |
761P1092
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$439.25 |
| Max. Negotiated Rate |
$1,702.81 |
| Rate for Payer: Aetna Commercial |
$1,547.30
|
| Rate for Payer: Ambetter Exchange |
$1,001.75
|
| Rate for Payer: Anthem Medicaid |
$763.08
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,001.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,001.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,202.10
|
| Rate for Payer: Cash Price |
$627.50
|
| Rate for Payer: Cash Price |
$627.50
|
| Rate for Payer: Cigna Commercial |
$1,702.81
|
| Rate for Payer: Healthspan PPO |
$1,401.53
|
| Rate for Payer: Humana Medicaid |
$763.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,306.31
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,001.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,001.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$778.34
|
| Rate for Payer: Molina Healthcare Passport |
$763.08
|
| Rate for Payer: Multiplan PHCS |
$753.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,302.28
|
| Rate for Payer: UHCCP Medicaid |
$439.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$770.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,001.75
|
|
|
AUTOINJECTOR TV-AI01-E
|
Facility
|
IP
|
$3,871.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.38 |
| Max. Negotiated Rate |
$3,716.40 |
| Rate for Payer: Aetna Commercial |
$2,980.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,019.57
|
| Rate for Payer: Cash Price |
$1,935.62
|
| Rate for Payer: Cigna Commercial |
$3,213.14
|
| Rate for Payer: First Health Commercial |
$3,677.69
|
| Rate for Payer: Humana Commercial |
$3,290.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,174.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,856.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,161.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,406.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,903.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,097.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,367.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,671.16
|
| Rate for Payer: PHCS Commercial |
$3,716.40
|
| Rate for Payer: United Healthcare All Payer |
$3,406.70
|
|
|
AUTOINJECTOR TV-AI01-E
|
Facility
|
OP
|
$3,871.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.38 |
| Max. Negotiated Rate |
$3,716.40 |
| Rate for Payer: Aetna Commercial |
$2,980.86
|
| Rate for Payer: Anthem Medicaid |
$1,331.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,019.57
|
| Rate for Payer: Cash Price |
$1,935.62
|
| Rate for Payer: Cigna Commercial |
$3,213.14
|
| Rate for Payer: First Health Commercial |
$3,677.69
|
| Rate for Payer: Humana Commercial |
$3,290.56
|
| Rate for Payer: Humana KY Medicaid |
$1,331.32
|
| Rate for Payer: Kentucky WC Medicaid |
$1,344.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,174.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,856.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,161.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,358.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,406.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,903.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,097.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,367.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,671.16
|
| Rate for Payer: PHCS Commercial |
$3,716.40
|
| Rate for Payer: United Healthcare All Payer |
$3,406.70
|
|
|
AUTOINJECTOR TV-AI01-N
|
Facility
|
OP
|
$3,871.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.38 |
| Max. Negotiated Rate |
$3,716.40 |
| Rate for Payer: Aetna Commercial |
$2,980.86
|
| Rate for Payer: Anthem Medicaid |
$1,331.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,019.57
|
| Rate for Payer: Cash Price |
$1,935.62
|
| Rate for Payer: Cigna Commercial |
$3,213.14
|
| Rate for Payer: First Health Commercial |
$3,677.69
|
| Rate for Payer: Humana Commercial |
$3,290.56
|
| Rate for Payer: Humana KY Medicaid |
$1,331.32
|
| Rate for Payer: Kentucky WC Medicaid |
$1,344.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,174.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,856.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,161.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,358.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,406.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,903.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,097.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,367.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,671.16
|
| Rate for Payer: PHCS Commercial |
$3,716.40
|
| Rate for Payer: United Healthcare All Payer |
$3,406.70
|
|
|
AUTOINJECTOR TV-AI01-N
|
Facility
|
IP
|
$3,871.25
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.38 |
| Max. Negotiated Rate |
$3,716.40 |
| Rate for Payer: Aetna Commercial |
$2,980.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,019.57
|
| Rate for Payer: Cash Price |
$1,935.62
|
| Rate for Payer: Cigna Commercial |
$3,213.14
|
| Rate for Payer: First Health Commercial |
$3,677.69
|
| Rate for Payer: Humana Commercial |
$3,290.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,174.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,856.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,161.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,406.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,903.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,097.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,367.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,671.16
|
| Rate for Payer: PHCS Commercial |
$3,716.40
|
| Rate for Payer: United Healthcare All Payer |
$3,406.70
|
|
|
AUTOLITH TOUCH EHL PROBE
|
Facility
|
IP
|
$3,856.25
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,156.88 |
| Max. Negotiated Rate |
$3,702.00 |
| Rate for Payer: Aetna Commercial |
$2,969.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,007.88
|
| Rate for Payer: Cash Price |
$1,928.12
|
| Rate for Payer: Cigna Commercial |
$3,200.69
|
| Rate for Payer: First Health Commercial |
$3,663.44
|
| Rate for Payer: Humana Commercial |
$3,277.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,162.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,845.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,156.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,393.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,892.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,085.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,354.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,660.81
|
| Rate for Payer: PHCS Commercial |
$3,702.00
|
| Rate for Payer: United Healthcare All Payer |
$3,393.50
|
|
|
AUTOLITH TOUCH EHL PROBE
|
Facility
|
OP
|
$3,856.25
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,156.88 |
| Max. Negotiated Rate |
$3,702.00 |
| Rate for Payer: Aetna Commercial |
$2,969.31
|
| Rate for Payer: Anthem Medicaid |
$1,326.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,007.88
|
| Rate for Payer: Cash Price |
$1,928.12
|
| Rate for Payer: Cigna Commercial |
$3,200.69
|
| Rate for Payer: First Health Commercial |
$3,663.44
|
| Rate for Payer: Humana Commercial |
$3,277.81
|
| Rate for Payer: Humana KY Medicaid |
$1,326.16
|
| Rate for Payer: Kentucky WC Medicaid |
$1,339.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,162.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,845.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,156.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,352.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,393.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,892.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,085.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,354.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,660.81
|
| Rate for Payer: PHCS Commercial |
$3,702.00
|
| Rate for Payer: United Healthcare All Payer |
$3,393.50
|
|
|
AUTONOMIC NRV PARASYM INERVJ
|
Professional
|
Both
|
$625.00
|
|
|
Service Code
|
HCPCS 95921
|
| Hospital Charge Code |
51000038
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$53.32 |
| Max. Negotiated Rate |
$375.00 |
| Rate for Payer: Aetna Commercial |
$112.43
|
| Rate for Payer: Ambetter Exchange |
$79.07
|
| Rate for Payer: Anthem Medicaid |
$64.30
|
| Rate for Payer: Buckeye Individual/Medicaid |
$79.07
|
| Rate for Payer: Buckeye Medicare Advantage |
$79.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$94.88
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Cigna Commercial |
$98.95
|
| Rate for Payer: Healthspan PPO |
$99.02
|
| Rate for Payer: Humana Medicaid |
$64.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$53.32
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$79.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$79.07
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$65.59
|
| Rate for Payer: Molina Healthcare Passport |
$64.30
|
| Rate for Payer: Multiplan PHCS |
$375.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$102.79
|
| Rate for Payer: UHCCP Medicaid |
$218.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$64.94
|
| Rate for Payer: Wellcare Medicare Advantage |
$79.07
|
|
|
AUTONOMIC NRV PARASYM INERVJ
|
Facility
|
OP
|
$625.00
|
|
|
Service Code
|
HCPCS 95921
|
| Hospital Charge Code |
51000038
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$144.57 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$481.25
|
| Rate for Payer: Anthem Medicaid |
$214.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$144.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$487.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$202.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$195.17
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Cigna Commercial |
$518.75
|
| Rate for Payer: First Health Commercial |
$593.75
|
| Rate for Payer: Humana Commercial |
$531.25
|
| Rate for Payer: Humana KY Medicaid |
$214.94
|
| Rate for Payer: Humana Medicare Advantage |
$144.57
|
| Rate for Payer: Kentucky WC Medicaid |
$217.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$512.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$461.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$173.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$219.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$550.00
|
| Rate for Payer: Ohio Health Group HMO |
$468.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$543.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$431.25
|
| Rate for Payer: PHCS Commercial |
$600.00
|
| Rate for Payer: United Healthcare All Payer |
$550.00
|
|
|
AUTONOMIC NRV PARASYM INERVJ
|
Facility
|
IP
|
$625.00
|
|
|
Service Code
|
HCPCS 95921
|
| Hospital Charge Code |
51000038
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$187.50 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$481.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$487.50
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Cigna Commercial |
$518.75
|
| Rate for Payer: First Health Commercial |
$593.75
|
| Rate for Payer: Humana Commercial |
$531.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$512.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$461.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$187.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$550.00
|
| Rate for Payer: Ohio Health Group HMO |
$468.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$543.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$431.25
|
| Rate for Payer: PHCS Commercial |
$600.00
|
| Rate for Payer: United Healthcare All Payer |
$550.00
|
|
