|
BIOPSY - SOFT TISSUE - THIGH(P
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 27323
|
| Hospital Charge Code |
761P0812
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$88.77 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna Commercial |
$254.23
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$88.77
|
| Rate for Payer: Anthem Medicaid |
$93.71
|
| 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 |
$271.35
|
| Rate for Payer: Healthspan PPO |
$330.15
|
| Rate for Payer: Humana Medicaid |
$93.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$221.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$95.58
|
| Rate for Payer: Molina Healthcare Passport |
$93.71
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$280.00
|
| Rate for Payer: UHCCP Medicaid |
$93.21
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$94.65
|
|
|
BIOPSY VESTIBULE
|
Facility
|
OP
|
$1,318.97
|
|
|
Service Code
|
HCPCS 40808
|
| Hospital Charge Code |
76101634
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$171.47 |
| Max. Negotiated Rate |
$1,266.21 |
| Rate for Payer: Aetna Commercial |
$1,015.61
|
| Rate for Payer: Anthem Medicaid |
$453.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$475.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,028.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$666.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$642.32
|
| Rate for Payer: Cash Price |
$659.48
|
| Rate for Payer: Cash Price |
$659.48
|
| Rate for Payer: Cigna Commercial |
$1,094.75
|
| Rate for Payer: First Health Commercial |
$1,253.02
|
| Rate for Payer: Humana Commercial |
$1,121.12
|
| Rate for Payer: Humana KY Medicaid |
$453.59
|
| Rate for Payer: Humana Medicare Advantage |
$475.79
|
| Rate for Payer: Kentucky WC Medicaid |
$458.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,081.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$973.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$462.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,160.69
|
| Rate for Payer: Ohio Health Group HMO |
$989.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$263.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$171.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$408.88
|
| Rate for Payer: PHCS Commercial |
$1,266.21
|
| Rate for Payer: United Healthcare All Payer |
$1,160.69
|
|
|
BIOPSY VESTIBULE
|
Facility
|
IP
|
$1,318.97
|
|
|
Service Code
|
HCPCS 40808
|
| Hospital Charge Code |
76101634
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$171.47 |
| Max. Negotiated Rate |
$1,266.21 |
| Rate for Payer: Aetna Commercial |
$1,015.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,028.80
|
| Rate for Payer: Cash Price |
$659.48
|
| Rate for Payer: Cigna Commercial |
$1,094.75
|
| Rate for Payer: First Health Commercial |
$1,253.02
|
| Rate for Payer: Humana Commercial |
$1,121.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,081.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$973.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,160.69
|
| Rate for Payer: Ohio Health Group HMO |
$989.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$263.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$171.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$408.88
|
| Rate for Payer: PHCS Commercial |
$1,266.21
|
| Rate for Payer: United Healthcare All Payer |
$1,160.69
|
|
|
BIOPSY VESTIBULE
|
Professional
|
Both
|
$1,318.97
|
|
|
Service Code
|
HCPCS 40808
|
| Hospital Charge Code |
76101634
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$38.84 |
| Max. Negotiated Rate |
$1,318.97 |
| Rate for Payer: Aetna Commercial |
$148.80
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$83.15
|
| Rate for Payer: Anthem Medicaid |
$38.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,318.97
|
| Rate for Payer: Cash Price |
$659.48
|
| Rate for Payer: Cash Price |
$659.48
|
| Rate for Payer: Cigna Commercial |
$221.51
|
| Rate for Payer: Healthspan PPO |
$204.47
|
| Rate for Payer: Humana Medicaid |
$38.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$135.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$39.62
|
| Rate for Payer: Molina Healthcare Passport |
$38.84
|
| Rate for Payer: Multiplan PHCS |
$791.38
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$923.28
|
| Rate for Payer: UHCCP Medicaid |
$87.31
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$39.23
|
|
|
BIOPSY VESTIBULE(P
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 40808
|
| Hospital Charge Code |
761P1634
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$38.84 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Aetna Commercial |
$148.80
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$83.15
|
| Rate for Payer: Anthem Medicaid |
$38.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$225.00
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$221.51
|
| Rate for Payer: Healthspan PPO |
$204.47
|
| Rate for Payer: Humana Medicaid |
$38.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$135.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$39.62
|
| Rate for Payer: Molina Healthcare Passport |
$38.84
|
| Rate for Payer: Multiplan PHCS |
$135.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$157.50
|
| Rate for Payer: UHCCP Medicaid |
$87.31
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$39.23
|
|
|
BIOPSY VESTIBULE(T
|
Facility
|
OP
|
$1,093.97
|
|
|
Service Code
|
HCPCS 40808
|
| Hospital Charge Code |
761T1634
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$142.22 |
| Max. Negotiated Rate |
$1,050.21 |
| Rate for Payer: Aetna Commercial |
$842.36
|
| Rate for Payer: Anthem Medicaid |
$376.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$475.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$853.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$666.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$642.32
|
| Rate for Payer: Cash Price |
$546.98
|
| Rate for Payer: Cash Price |
$546.98
|
| Rate for Payer: Cigna Commercial |
$908.00
|
| Rate for Payer: First Health Commercial |
$1,039.27
|
| Rate for Payer: Humana Commercial |
$929.87
|
| Rate for Payer: Humana KY Medicaid |
$376.22
|
| Rate for Payer: Humana Medicare Advantage |
$475.79
|
| Rate for Payer: Kentucky WC Medicaid |
$380.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$897.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$807.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$383.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$962.69
|
| Rate for Payer: Ohio Health Group HMO |
$820.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$218.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$142.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$339.13
|
| Rate for Payer: PHCS Commercial |
$1,050.21
|
| Rate for Payer: United Healthcare All Payer |
$962.69
|
|
|
BIOPSY VESTIBULE(T
|
Facility
|
IP
|
$1,093.97
|
|
|
Service Code
|
HCPCS 40808
|
| Hospital Charge Code |
761T1634
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$142.22 |
| Max. Negotiated Rate |
$1,050.21 |
| Rate for Payer: Aetna Commercial |
$842.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$853.30
|
| Rate for Payer: Cash Price |
$546.98
|
| Rate for Payer: Cigna Commercial |
$908.00
|
| Rate for Payer: First Health Commercial |
$1,039.27
|
| Rate for Payer: Humana Commercial |
$929.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$897.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$807.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$328.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$962.69
|
| Rate for Payer: Ohio Health Group HMO |
$820.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$218.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$142.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$339.13
|
| Rate for Payer: PHCS Commercial |
$1,050.21
|
| Rate for Payer: United Healthcare All Payer |
$962.69
|
|
|
BIO-STUR TAK 2.4 TO 3.7ANCHOR
|
Facility
|
OP
|
$3,197.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$415.68 |
| Max. Negotiated Rate |
$3,069.60 |
| Rate for Payer: Aetna Commercial |
$2,462.08
|
| Rate for Payer: Anthem Medicaid |
$1,099.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,494.05
|
| Rate for Payer: Cash Price |
$1,598.75
|
| Rate for Payer: Cigna Commercial |
$2,653.92
|
| Rate for Payer: First Health Commercial |
$3,037.62
|
| Rate for Payer: Humana Commercial |
$2,717.88
|
| Rate for Payer: Humana KY Medicaid |
$1,099.62
|
| Rate for Payer: Kentucky WC Medicaid |
$1,110.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,621.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,359.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$959.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,121.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,813.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,398.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$639.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$415.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$991.22
|
| Rate for Payer: PHCS Commercial |
$3,069.60
|
| Rate for Payer: United Healthcare All Payer |
$2,813.80
|
|
|
BIO-STUR TAK 2.4 TO 3.7ANCHOR
|
Facility
|
IP
|
$3,197.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$415.68 |
| Max. Negotiated Rate |
$3,069.60 |
| Rate for Payer: Aetna Commercial |
$2,462.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,494.05
|
| Rate for Payer: Cash Price |
$1,598.75
|
| Rate for Payer: Cigna Commercial |
$2,653.92
|
| Rate for Payer: First Health Commercial |
$3,037.62
|
| Rate for Payer: Humana Commercial |
$2,717.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,621.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,359.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$959.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,813.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,398.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$639.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$415.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$991.22
|
| Rate for Payer: PHCS Commercial |
$3,069.60
|
| Rate for Payer: United Healthcare All Payer |
$2,813.80
|
|
|
BIO SURGE KIT/W 5CC ALLOSYNC
|
Facility
|
OP
|
$9,187.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,194.38 |
| Max. Negotiated Rate |
$8,820.00 |
| Rate for Payer: Aetna Commercial |
$7,074.38
|
| Rate for Payer: Anthem Medicaid |
$3,159.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,166.25
|
| Rate for Payer: Cash Price |
$4,593.75
|
| Rate for Payer: Cigna Commercial |
$7,625.62
|
| Rate for Payer: First Health Commercial |
$8,728.12
|
| Rate for Payer: Humana Commercial |
$7,809.38
|
| Rate for Payer: Humana KY Medicaid |
$3,159.58
|
| Rate for Payer: Kentucky WC Medicaid |
$3,191.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,533.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,780.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,756.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,222.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,085.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,890.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,837.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,194.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,848.12
|
| Rate for Payer: PHCS Commercial |
$8,820.00
|
| Rate for Payer: United Healthcare All Payer |
$8,085.00
|
|
|
BIO SURGE KIT/W 5CC ALLOSYNC
|
Facility
|
IP
|
$9,187.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,194.38 |
| Max. Negotiated Rate |
$8,820.00 |
| Rate for Payer: Aetna Commercial |
$7,074.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,166.25
|
| Rate for Payer: Cash Price |
$4,593.75
|
| Rate for Payer: Cigna Commercial |
$7,625.62
|
| Rate for Payer: First Health Commercial |
$8,728.12
|
| Rate for Payer: Humana Commercial |
$7,809.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,533.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,780.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,756.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,085.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,890.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,837.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,194.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,848.12
|
| Rate for Payer: PHCS Commercial |
$8,820.00
|
| Rate for Payer: United Healthcare All Payer |
$8,085.00
|
|
|
BIOTENE ORAL RINSE 237ML
|
Facility
|
OP
|
$3.49
|
|
|
Service Code
|
NDC 48582080220
|
| Hospital Charge Code |
25004237
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$3.35 |
| Rate for Payer: Anthem Medicaid |
$1.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.72
|
| Rate for Payer: Cash Price |
$1.75
|
| Rate for Payer: Cigna Commercial |
$2.90
|
| Rate for Payer: First Health Commercial |
$3.32
|
| Rate for Payer: Humana Commercial |
$2.97
|
| Rate for Payer: Humana KY Medicaid |
$1.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.07
|
| Rate for Payer: Ohio Health Group HMO |
$2.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.08
|
| Rate for Payer: PHCS Commercial |
$3.35
|
| Rate for Payer: United Healthcare All Payer |
$3.07
|
| Rate for Payer: Aetna Commercial |
$2.69
|
|
|
BIOTENE ORAL RINSE 237ML
|
Facility
|
IP
|
$3.49
|
|
|
Service Code
|
NDC 48582080220
|
| Hospital Charge Code |
25004237
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$3.35 |
| Rate for Payer: Aetna Commercial |
$2.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2.72
|
| Rate for Payer: Cash Price |
$1.75
|
| Rate for Payer: Cigna Commercial |
$2.90
|
| Rate for Payer: First Health Commercial |
$3.32
|
| Rate for Payer: Humana Commercial |
$2.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.07
|
| Rate for Payer: Ohio Health Group HMO |
$2.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.08
|
| Rate for Payer: PHCS Commercial |
$3.35
|
| Rate for Payer: United Healthcare All Payer |
$3.07
|
|
|
BIOTIN 1000 MCG TABLET
|
Facility
|
OP
|
$4.25
|
|
|
Service Code
|
NDC 79854003985
|
| Hospital Charge Code |
25000338
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$4.08 |
| Rate for Payer: Aetna Commercial |
$3.27
|
| Rate for Payer: Anthem Medicaid |
$1.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.32
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cigna Commercial |
$3.53
|
| Rate for Payer: First Health Commercial |
$4.04
|
| Rate for Payer: Humana Commercial |
$3.61
|
| Rate for Payer: Humana KY Medicaid |
$1.46
|
| Rate for Payer: Kentucky WC Medicaid |
$1.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.74
|
| Rate for Payer: Ohio Health Group HMO |
$3.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.32
|
| Rate for Payer: PHCS Commercial |
$4.08
|
| Rate for Payer: United Healthcare All Payer |
$3.74
|
|
|
BIOTIN 1000 MCG TABLET
|
Facility
|
IP
|
$4.25
|
|
|
Service Code
|
NDC 79854003985
|
| Hospital Charge Code |
25000338
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$4.08 |
| Rate for Payer: Aetna Commercial |
$3.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.32
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cigna Commercial |
$3.53
|
| Rate for Payer: First Health Commercial |
$4.04
|
| Rate for Payer: Humana Commercial |
$3.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.74
|
| Rate for Payer: Ohio Health Group HMO |
$3.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.32
|
| Rate for Payer: PHCS Commercial |
$4.08
|
| Rate for Payer: United Healthcare All Payer |
$3.74
|
|
|
BIOTRAK GUIDEWIRE .045*8 DT
|
Facility
|
OP
|
$462.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.12 |
| Max. Negotiated Rate |
$444.00 |
| Rate for Payer: Aetna Commercial |
$356.12
|
| Rate for Payer: Anthem Medicaid |
$159.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$360.75
|
| Rate for Payer: Cash Price |
$231.25
|
| Rate for Payer: Cigna Commercial |
$383.88
|
| Rate for Payer: First Health Commercial |
$439.38
|
| Rate for Payer: Humana Commercial |
$393.12
|
| Rate for Payer: Humana KY Medicaid |
$159.05
|
| Rate for Payer: Kentucky WC Medicaid |
$160.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$379.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$341.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$138.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$162.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$407.00
|
| Rate for Payer: Ohio Health Group HMO |
$346.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$143.38
|
| Rate for Payer: PHCS Commercial |
$444.00
|
| Rate for Payer: United Healthcare All Payer |
$407.00
|
|
|
BIOTRAK GUIDEWIRE .045*8 DT
|
Facility
|
IP
|
$462.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.12 |
| Max. Negotiated Rate |
$444.00 |
| Rate for Payer: Aetna Commercial |
$356.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$360.75
|
| Rate for Payer: Cash Price |
$231.25
|
| Rate for Payer: Cigna Commercial |
$383.88
|
| Rate for Payer: First Health Commercial |
$439.38
|
| Rate for Payer: Humana Commercial |
$393.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$379.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$341.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$138.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$407.00
|
| Rate for Payer: Ohio Health Group HMO |
$346.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$143.38
|
| Rate for Payer: PHCS Commercial |
$444.00
|
| Rate for Payer: United Healthcare All Payer |
$407.00
|
|
|
BIOTRAK GUIDEWIRE .045*8 ST
|
Facility
|
IP
|
$145.80
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.95 |
| Max. Negotiated Rate |
$139.97 |
| Rate for Payer: Aetna Commercial |
$112.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$113.72
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cigna Commercial |
$121.01
|
| Rate for Payer: First Health Commercial |
$138.51
|
| Rate for Payer: Humana Commercial |
$123.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$119.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$107.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$43.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$128.30
|
| Rate for Payer: Ohio Health Group HMO |
$109.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$45.20
|
| Rate for Payer: PHCS Commercial |
$139.97
|
| Rate for Payer: United Healthcare All Payer |
$128.30
|
|
|
BIOTRAK GUIDEWIRE .045*8 ST
|
Facility
|
OP
|
$145.80
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.95 |
| Max. Negotiated Rate |
$139.97 |
| Rate for Payer: Aetna Commercial |
$112.27
|
| Rate for Payer: Anthem Medicaid |
$50.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$113.72
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cigna Commercial |
$121.01
|
| Rate for Payer: First Health Commercial |
$138.51
|
| Rate for Payer: Humana Commercial |
$123.93
|
| Rate for Payer: Humana KY Medicaid |
$50.14
|
| Rate for Payer: Kentucky WC Medicaid |
$50.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$119.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$107.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$43.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$51.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$128.30
|
| Rate for Payer: Ohio Health Group HMO |
$109.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$45.20
|
| Rate for Payer: PHCS Commercial |
$139.97
|
| Rate for Payer: United Healthcare All Payer |
$128.30
|
|
|
BIO-TRANSFIX IMPLANT 3*40
|
Facility
|
IP
|
$1,787.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$232.38 |
| Max. Negotiated Rate |
$1,716.00 |
| Rate for Payer: Aetna Commercial |
$1,376.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,394.25
|
| Rate for Payer: Cash Price |
$893.75
|
| Rate for Payer: Cigna Commercial |
$1,483.62
|
| Rate for Payer: First Health Commercial |
$1,698.12
|
| Rate for Payer: Humana Commercial |
$1,519.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,465.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,319.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$536.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,573.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,340.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$357.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$232.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$554.12
|
| Rate for Payer: PHCS Commercial |
$1,716.00
|
| Rate for Payer: United Healthcare All Payer |
$1,573.00
|
|
|
BIO-TRANSFIX IMPLANT 3*40
|
Facility
|
OP
|
$1,787.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$232.38 |
| Max. Negotiated Rate |
$1,716.00 |
| Rate for Payer: Anthem Medicaid |
$614.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,394.25
|
| Rate for Payer: Cash Price |
$893.75
|
| Rate for Payer: Cigna Commercial |
$1,483.62
|
| Rate for Payer: First Health Commercial |
$1,698.12
|
| Rate for Payer: Humana Commercial |
$1,519.38
|
| Rate for Payer: Humana KY Medicaid |
$614.72
|
| Rate for Payer: Kentucky WC Medicaid |
$620.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,465.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,319.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$536.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$627.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,573.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,340.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$357.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$232.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$554.12
|
| Rate for Payer: PHCS Commercial |
$1,716.00
|
| Rate for Payer: United Healthcare All Payer |
$1,573.00
|
| Rate for Payer: Aetna Commercial |
$1,376.38
|
|
|
BIPAP 1ST DAY
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
HCPCS 94660
|
| Hospital Charge Code |
41000080
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: Aetna Commercial |
$385.00
|
| Rate for Payer: Anthem Medicaid |
$171.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$184.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$390.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$258.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$248.99
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$415.00
|
| Rate for Payer: First Health Commercial |
$475.00
|
| Rate for Payer: Humana Commercial |
$425.00
|
| Rate for Payer: Humana KY Medicaid |
$171.95
|
| Rate for Payer: Humana Medicare Advantage |
$184.44
|
| Rate for Payer: Kentucky WC Medicaid |
$173.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$410.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$369.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$221.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$175.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$440.00
|
| Rate for Payer: Ohio Health Group HMO |
$375.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$155.00
|
| Rate for Payer: PHCS Commercial |
$480.00
|
| Rate for Payer: United Healthcare All Payer |
$440.00
|
|
|
BIPAP 1ST DAY
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
HCPCS 94660
|
| Hospital Charge Code |
41000080
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: Aetna Commercial |
$385.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$390.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$415.00
|
| Rate for Payer: First Health Commercial |
$475.00
|
| Rate for Payer: Humana Commercial |
$425.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$410.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$369.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$150.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$440.00
|
| Rate for Payer: Ohio Health Group HMO |
$375.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$155.00
|
| Rate for Payer: PHCS Commercial |
$480.00
|
| Rate for Payer: United Healthcare All Payer |
$440.00
|
|
|
BIPAP 1ST DAY
|
Professional
|
Both
|
$483.00
|
|
|
Service Code
|
HCPCS 94660
|
| Hospital Charge Code |
41000080
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$19.21 |
| Max. Negotiated Rate |
$483.00 |
| Rate for Payer: Aetna Commercial |
$57.42
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$19.21
|
| Rate for Payer: Anthem Medicaid |
$42.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$483.00
|
| Rate for Payer: Cash Price |
$241.50
|
| Rate for Payer: Cash Price |
$241.50
|
| Rate for Payer: Cigna Commercial |
$80.47
|
| Rate for Payer: Healthspan PPO |
$67.28
|
| Rate for Payer: Humana Medicaid |
$42.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$45.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$43.66
|
| Rate for Payer: Molina Healthcare Passport |
$42.80
|
| Rate for Payer: Multiplan PHCS |
$289.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$338.10
|
| Rate for Payer: UHCCP Medicaid |
$20.17
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$43.23
|
|
|
BIPAP 1ST DAY(T
|
Facility
|
OP
|
$483.00
|
|
|
Service Code
|
HCPCS 94660
|
| Hospital Charge Code |
410T0080
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$62.79 |
| Max. Negotiated Rate |
$463.68 |
| Rate for Payer: Aetna Commercial |
$371.91
|
| Rate for Payer: Anthem Medicaid |
$166.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$184.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$376.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$258.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$248.99
|
| Rate for Payer: Cash Price |
$241.50
|
| Rate for Payer: Cash Price |
$241.50
|
| Rate for Payer: Cigna Commercial |
$400.89
|
| Rate for Payer: First Health Commercial |
$458.85
|
| Rate for Payer: Humana Commercial |
$410.55
|
| Rate for Payer: Humana KY Medicaid |
$166.10
|
| Rate for Payer: Humana Medicare Advantage |
$184.44
|
| Rate for Payer: Kentucky WC Medicaid |
$167.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$396.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$356.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$221.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$169.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$425.04
|
| Rate for Payer: Ohio Health Group HMO |
$362.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$149.73
|
| Rate for Payer: PHCS Commercial |
$463.68
|
| Rate for Payer: United Healthcare All Payer |
$425.04
|
|
