|
AV OPEN UPPER ARM
|
Facility
|
IP
|
$1,223.00
|
|
|
Service Code
|
HCPCS 36819
|
| Hospital Charge Code |
76101505
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$366.90 |
| Max. Negotiated Rate |
$1,174.08 |
| Rate for Payer: Aetna Commercial |
$941.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$953.94
|
| Rate for Payer: Cash Price |
$611.50
|
| Rate for Payer: Cigna Commercial |
$1,015.09
|
| Rate for Payer: First Health Commercial |
$1,161.85
|
| Rate for Payer: Humana Commercial |
$1,039.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,002.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$902.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$366.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,076.24
|
| Rate for Payer: Ohio Health Group HMO |
$917.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$978.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,064.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$843.87
|
| Rate for Payer: PHCS Commercial |
$1,174.08
|
| Rate for Payer: United Healthcare All Payer |
$1,076.24
|
|
|
AV OPEN UPPER ARM(P
|
Professional
|
Both
|
$1,223.00
|
|
|
Service Code
|
HCPCS 36819
|
| Hospital Charge Code |
761P1505
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$428.05 |
| Max. Negotiated Rate |
$1,271.56 |
| Rate for Payer: Aetna Commercial |
$1,271.56
|
| Rate for Payer: Ambetter Exchange |
$682.58
|
| Rate for Payer: Anthem Medicaid |
$612.48
|
| Rate for Payer: Buckeye Individual/Medicaid |
$682.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$682.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$819.10
|
| Rate for Payer: Cash Price |
$611.50
|
| Rate for Payer: Cash Price |
$611.50
|
| Rate for Payer: Cigna Commercial |
$1,210.34
|
| Rate for Payer: Healthspan PPO |
$1,016.73
|
| Rate for Payer: Humana Medicaid |
$612.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,070.27
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$682.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$682.58
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$624.73
|
| Rate for Payer: Molina Healthcare Passport |
$612.48
|
| Rate for Payer: Multiplan PHCS |
$733.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$887.35
|
| Rate for Payer: UHCCP Medicaid |
$428.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$618.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$682.58
|
|
|
AVUL NAILPLT SIMP ADTL NAILBED
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
HCPCS 11732
|
| Hospital Charge Code |
761T0097
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$59.70 |
| Max. Negotiated Rate |
$191.04 |
| Rate for Payer: Aetna Commercial |
$153.23
|
| Rate for Payer: Anthem Medicaid |
$68.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$155.22
|
| Rate for Payer: Cash Price |
$99.50
|
| Rate for Payer: Cigna Commercial |
$165.17
|
| Rate for Payer: First Health Commercial |
$189.05
|
| Rate for Payer: Humana Commercial |
$169.15
|
| Rate for Payer: Humana KY Medicaid |
$68.44
|
| Rate for Payer: Kentucky WC Medicaid |
$69.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$163.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$146.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$69.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$175.12
|
| Rate for Payer: Ohio Health Group HMO |
$149.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$159.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$173.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$137.31
|
| Rate for Payer: PHCS Commercial |
$191.04
|
| Rate for Payer: United Healthcare All Payer |
$175.12
|
|
|
AVUL NAILPLT SIMP ADTL NAILBED
|
Facility
|
OP
|
$429.00
|
|
|
Service Code
|
HCPCS 11732
|
| Hospital Charge Code |
76100097
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.70 |
| Max. Negotiated Rate |
$411.84 |
| Rate for Payer: Aetna Commercial |
$330.33
|
| Rate for Payer: Anthem Medicaid |
$147.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$334.62
|
| Rate for Payer: Cash Price |
$214.50
|
| Rate for Payer: Cigna Commercial |
$356.07
|
| Rate for Payer: First Health Commercial |
$407.55
|
| Rate for Payer: Humana Commercial |
$364.65
|
| Rate for Payer: Humana KY Medicaid |
$147.53
|
| Rate for Payer: Kentucky WC Medicaid |
$149.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$351.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$316.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$128.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$150.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$377.52
|
| Rate for Payer: Ohio Health Group HMO |
$321.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$343.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$373.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$296.01
|
| Rate for Payer: PHCS Commercial |
$411.84
|
| Rate for Payer: United Healthcare All Payer |
$377.52
|
|
|
AVUL NAILPLT SIMP ADTL NAILBED
|
Facility
|
IP
|
$199.00
|
|
|
Service Code
|
HCPCS 11732
|
| Hospital Charge Code |
45000036
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$59.70 |
| Max. Negotiated Rate |
$191.04 |
| Rate for Payer: Aetna Commercial |
$153.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$155.22
|
| Rate for Payer: Cash Price |
$99.50
|
| Rate for Payer: Cigna Commercial |
$165.17
|
| Rate for Payer: First Health Commercial |
$189.05
|
| Rate for Payer: Humana Commercial |
$169.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$163.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$146.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$175.12
|
| Rate for Payer: Ohio Health Group HMO |
$149.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$159.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$173.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$137.31
|
| Rate for Payer: PHCS Commercial |
$191.04
|
| Rate for Payer: United Healthcare All Payer |
$175.12
|
|
|
AVUL NAILPLT SIMP ADTL NAILBED
|
Facility
|
IP
|
$199.00
|
|
|
Service Code
|
HCPCS 11732
|
| Hospital Charge Code |
761T0097
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$59.70 |
| Max. Negotiated Rate |
$191.04 |
| Rate for Payer: Aetna Commercial |
$153.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$155.22
|
| Rate for Payer: Cash Price |
$99.50
|
| Rate for Payer: Cigna Commercial |
$165.17
|
| Rate for Payer: First Health Commercial |
$189.05
|
| Rate for Payer: Humana Commercial |
$169.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$163.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$146.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$175.12
|
| Rate for Payer: Ohio Health Group HMO |
$149.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$159.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$173.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$137.31
|
| Rate for Payer: PHCS Commercial |
$191.04
|
| Rate for Payer: United Healthcare All Payer |
$175.12
|
|
|
AVUL NAILPLT SIMP ADTL NAILBED
|
Professional
|
Both
|
$429.00
|
|
|
Service Code
|
HCPCS 11732
|
| Hospital Charge Code |
76100097
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$15.95 |
| Max. Negotiated Rate |
$257.40 |
| Rate for Payer: Aetna Commercial |
$46.98
|
| Rate for Payer: Ambetter Exchange |
$15.95
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$16.02
|
| Rate for Payer: Anthem Medicaid |
$18.34
|
| Rate for Payer: Buckeye Individual/Medicaid |
$15.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$15.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$19.14
|
| Rate for Payer: Cash Price |
$214.50
|
| Rate for Payer: Cash Price |
$214.50
|
| Rate for Payer: Cigna Commercial |
$60.01
|
| Rate for Payer: Healthspan PPO |
$52.12
|
| Rate for Payer: Humana Medicaid |
$18.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$33.99
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$15.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$18.71
|
| Rate for Payer: Molina Healthcare Passport |
$18.34
|
| Rate for Payer: Multiplan PHCS |
$257.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$20.73
|
| Rate for Payer: UHCCP Medicaid |
$16.82
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$18.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$15.95
|
|
|
AVUL NAILPLT SIMP ADTL NAILBED
|
Professional
|
Both
|
$230.00
|
|
|
Service Code
|
HCPCS 11732
|
| Hospital Charge Code |
761P0097
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$15.95 |
| Max. Negotiated Rate |
$138.00 |
| Rate for Payer: Aetna Commercial |
$46.98
|
| Rate for Payer: Ambetter Exchange |
$15.95
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$16.02
|
| Rate for Payer: Anthem Medicaid |
$18.34
|
| Rate for Payer: Buckeye Individual/Medicaid |
$15.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$15.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$19.14
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cigna Commercial |
$60.01
|
| Rate for Payer: Healthspan PPO |
$52.12
|
| Rate for Payer: Humana Medicaid |
$18.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$33.99
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$15.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$18.71
|
| Rate for Payer: Molina Healthcare Passport |
$18.34
|
| Rate for Payer: Multiplan PHCS |
$138.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$20.73
|
| Rate for Payer: UHCCP Medicaid |
$16.82
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$18.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$15.95
|
|
|
AVUL NAILPLT SIMP ADTL NAILBED
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
HCPCS 11732
|
| Hospital Charge Code |
45000036
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$59.70 |
| Max. Negotiated Rate |
$191.04 |
| Rate for Payer: Aetna Commercial |
$153.23
|
| Rate for Payer: Anthem Medicaid |
$68.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$155.22
|
| Rate for Payer: Cash Price |
$99.50
|
| Rate for Payer: Cigna Commercial |
$165.17
|
| Rate for Payer: First Health Commercial |
$189.05
|
| Rate for Payer: Humana Commercial |
$169.15
|
| Rate for Payer: Humana KY Medicaid |
$68.44
|
| Rate for Payer: Kentucky WC Medicaid |
$69.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$163.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$146.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$69.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$175.12
|
| Rate for Payer: Ohio Health Group HMO |
$149.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$159.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$173.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$137.31
|
| Rate for Payer: PHCS Commercial |
$191.04
|
| Rate for Payer: United Healthcare All Payer |
$175.12
|
|
|
AVUL NAILPLT SIMP ADTL NAILBED
|
Facility
|
IP
|
$429.00
|
|
|
Service Code
|
HCPCS 11732
|
| Hospital Charge Code |
76100097
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.70 |
| Max. Negotiated Rate |
$411.84 |
| Rate for Payer: Aetna Commercial |
$330.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$334.62
|
| Rate for Payer: Cash Price |
$214.50
|
| Rate for Payer: Cigna Commercial |
$356.07
|
| Rate for Payer: First Health Commercial |
$407.55
|
| Rate for Payer: Humana Commercial |
$364.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$351.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$316.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$128.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$377.52
|
| Rate for Payer: Ohio Health Group HMO |
$321.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$343.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$373.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$296.01
|
| Rate for Payer: PHCS Commercial |
$411.84
|
| Rate for Payer: United Healthcare All Payer |
$377.52
|
|
|
AVULSION OF NAIL PLATE, PARTIAL OR COMPLETE, SIMPLE; SINGLE
|
Facility
|
OP
|
$257.03
|
|
|
Service Code
|
CPT 11730
|
|
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
|
|
|
AVX ULTRA
|
Facility
|
OP
|
$9,095.50
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,728.65 |
| Max. Negotiated Rate |
$8,731.68 |
| Rate for Payer: Aetna Commercial |
$7,003.53
|
| Rate for Payer: Anthem Medicaid |
$3,127.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,094.49
|
| Rate for Payer: Cash Price |
$4,547.75
|
| Rate for Payer: Cigna Commercial |
$7,549.27
|
| Rate for Payer: First Health Commercial |
$8,640.73
|
| Rate for Payer: Humana Commercial |
$7,731.18
|
| Rate for Payer: Humana KY Medicaid |
$3,127.94
|
| Rate for Payer: Kentucky WC Medicaid |
$3,159.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,458.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,712.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,728.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,190.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,004.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,821.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,276.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,913.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,275.90
|
| Rate for Payer: PHCS Commercial |
$8,731.68
|
| Rate for Payer: United Healthcare All Payer |
$8,004.04
|
|
|
AVX ULTRA
|
Facility
|
IP
|
$9,095.50
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,728.65 |
| Max. Negotiated Rate |
$8,731.68 |
| Rate for Payer: Aetna Commercial |
$7,003.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,094.49
|
| Rate for Payer: Cash Price |
$4,547.75
|
| Rate for Payer: Cigna Commercial |
$7,549.27
|
| Rate for Payer: First Health Commercial |
$8,640.73
|
| Rate for Payer: Humana Commercial |
$7,731.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,458.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,712.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,728.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,004.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,821.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,276.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,913.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,275.90
|
| Rate for Payer: PHCS Commercial |
$8,731.68
|
| Rate for Payer: United Healthcare All Payer |
$8,004.04
|
|
|
AVYCAZ 0.625gm (2.5gm SDV)
|
Facility
|
OP
|
$2,053.29
|
|
|
Service Code
|
HCPCS J0714
|
| Hospital Charge Code |
25001959
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$104.95 |
| Max. Negotiated Rate |
$1,971.16 |
| Rate for Payer: Aetna Commercial |
$1,581.03
|
| Rate for Payer: Anthem Medicaid |
$706.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$104.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,601.57
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$146.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$141.68
|
| Rate for Payer: Cash Price |
$1,026.64
|
| Rate for Payer: Cash Price |
$1,026.64
|
| Rate for Payer: Cigna Commercial |
$1,704.23
|
| Rate for Payer: First Health Commercial |
$1,950.63
|
| Rate for Payer: Humana Commercial |
$1,745.30
|
| Rate for Payer: Humana KY Medicaid |
$706.13
|
| Rate for Payer: Humana Medicare Advantage |
$104.95
|
| Rate for Payer: Kentucky WC Medicaid |
$713.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,683.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,515.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$125.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$720.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,806.90
|
| Rate for Payer: Ohio Health Group HMO |
$1,539.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,642.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,786.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,416.77
|
| Rate for Payer: PHCS Commercial |
$1,971.16
|
| Rate for Payer: United Healthcare All Payer |
$1,806.90
|
|
|
AVYCAZ 0.625gm (2.5gm SDV)
|
Facility
|
IP
|
$2,053.29
|
|
|
Service Code
|
HCPCS J0714
|
| Hospital Charge Code |
25001959
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$615.99 |
| Max. Negotiated Rate |
$1,971.16 |
| Rate for Payer: Aetna Commercial |
$1,581.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,601.57
|
| Rate for Payer: Cash Price |
$1,026.64
|
| Rate for Payer: Cigna Commercial |
$1,704.23
|
| Rate for Payer: First Health Commercial |
$1,950.63
|
| Rate for Payer: Humana Commercial |
$1,745.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,683.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,515.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,806.90
|
| Rate for Payer: Ohio Health Group HMO |
$1,539.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,642.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,786.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,416.77
|
| Rate for Payer: PHCS Commercial |
$1,971.16
|
| Rate for Payer: United Healthcare All Payer |
$1,806.90
|
|
|
AXIL LYMPHECTMY COMPLETE
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 38745
|
| Hospital Charge Code |
76101607
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$687.80 |
| Max. Negotiated Rate |
$7,547.16 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem Medicaid |
$687.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,390.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,547.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,277.62
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Humana KY Medicaid |
$687.80
|
| Rate for Payer: Humana Medicare Advantage |
$5,390.83
|
| Rate for Payer: Kentucky WC Medicaid |
$694.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,469.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$701.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
AXIL LYMPHECTMY COMPLETE
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 38745
|
| Hospital Charge Code |
76101607
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
AXIL LYMPHECTMY COMPLETE
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 38745
|
| Hospital Charge Code |
76101607
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$501.95 |
| Max. Negotiated Rate |
$1,247.69 |
| Rate for Payer: Aetna Commercial |
$1,247.69
|
| Rate for Payer: Ambetter Exchange |
$842.94
|
| Rate for Payer: Anthem Medicaid |
$501.95
|
| Rate for Payer: Buckeye Individual/Medicaid |
$842.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$842.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,011.53
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,161.30
|
| Rate for Payer: Healthspan PPO |
$997.64
|
| Rate for Payer: Humana Medicaid |
$501.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,109.67
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$842.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$842.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$511.99
|
| Rate for Payer: Molina Healthcare Passport |
$501.95
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,095.82
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$506.97
|
| Rate for Payer: Wellcare Medicare Advantage |
$842.94
|
|
|
AXIL LYMPHECTMY COMPLETE(P
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 38745
|
| Hospital Charge Code |
761P1607
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$501.95 |
| Max. Negotiated Rate |
$1,247.69 |
| Rate for Payer: Aetna Commercial |
$1,247.69
|
| Rate for Payer: Ambetter Exchange |
$842.94
|
| Rate for Payer: Anthem Medicaid |
$501.95
|
| Rate for Payer: Buckeye Individual/Medicaid |
$842.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$842.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,011.53
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,161.30
|
| Rate for Payer: Healthspan PPO |
$997.64
|
| Rate for Payer: Humana Medicaid |
$501.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,109.67
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$842.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$842.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$511.99
|
| Rate for Payer: Molina Healthcare Passport |
$501.95
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,095.82
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$506.97
|
| Rate for Payer: Wellcare Medicare Advantage |
$842.94
|
|
|
AXIS PIN 2.5MM * 50MM
|
Facility
|
OP
|
$3,222.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$966.75 |
| Max. Negotiated Rate |
$3,093.60 |
| Rate for Payer: Aetna Commercial |
$2,481.32
|
| Rate for Payer: Anthem Medicaid |
$1,108.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,513.55
|
| Rate for Payer: Cash Price |
$1,611.25
|
| Rate for Payer: Cigna Commercial |
$2,674.68
|
| Rate for Payer: First Health Commercial |
$3,061.38
|
| Rate for Payer: Humana Commercial |
$2,739.12
|
| Rate for Payer: Humana KY Medicaid |
$1,108.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,119.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,642.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,378.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$966.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,130.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,835.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,416.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,578.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,803.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,223.53
|
| Rate for Payer: PHCS Commercial |
$3,093.60
|
| Rate for Payer: United Healthcare All Payer |
$2,835.80
|
|
|
AXIS PIN 2.5MM * 50MM
|
Facility
|
IP
|
$3,222.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$966.75 |
| Max. Negotiated Rate |
$3,093.60 |
| Rate for Payer: Aetna Commercial |
$2,481.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,513.55
|
| Rate for Payer: Cash Price |
$1,611.25
|
| Rate for Payer: Cigna Commercial |
$2,674.68
|
| Rate for Payer: First Health Commercial |
$3,061.38
|
| Rate for Payer: Humana Commercial |
$2,739.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,642.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,378.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$966.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,835.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,416.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,578.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,803.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,223.53
|
| Rate for Payer: PHCS Commercial |
$3,093.60
|
| Rate for Payer: United Healthcare All Payer |
$2,835.80
|
|
|
AXLE OSS
|
Facility
|
IP
|
$4,513.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,354.08 |
| Max. Negotiated Rate |
$4,333.05 |
| Rate for Payer: Aetna Commercial |
$3,475.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,520.60
|
| Rate for Payer: Cash Price |
$2,256.79
|
| Rate for Payer: Cigna Commercial |
$3,746.28
|
| Rate for Payer: First Health Commercial |
$4,287.91
|
| Rate for Payer: Humana Commercial |
$3,836.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,701.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,331.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,354.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,971.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,385.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,610.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,926.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,114.38
|
| Rate for Payer: PHCS Commercial |
$4,333.05
|
| Rate for Payer: United Healthcare All Payer |
$3,971.96
|
|
|
AXLE OSS
|
Facility
|
OP
|
$4,513.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,354.08 |
| Max. Negotiated Rate |
$4,333.05 |
| Rate for Payer: Aetna Commercial |
$3,475.46
|
| Rate for Payer: Anthem Medicaid |
$1,552.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,520.60
|
| Rate for Payer: Cash Price |
$2,256.79
|
| Rate for Payer: Cigna Commercial |
$3,746.28
|
| Rate for Payer: First Health Commercial |
$4,287.91
|
| Rate for Payer: Humana Commercial |
$3,836.55
|
| Rate for Payer: Humana KY Medicaid |
$1,552.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,568.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,701.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,331.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,354.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,583.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,971.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,385.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,610.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,926.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,114.38
|
| Rate for Payer: PHCS Commercial |
$4,333.05
|
| Rate for Payer: United Healthcare All Payer |
$3,971.96
|
|
|
AXLE PIN REPLACEMENT SM
|
Facility
|
IP
|
$4,085.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,225.50 |
| Max. Negotiated Rate |
$3,921.60 |
| Rate for Payer: Aetna Commercial |
$3,145.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,186.30
|
| Rate for Payer: Cash Price |
$2,042.50
|
| Rate for Payer: Cigna Commercial |
$3,390.55
|
| Rate for Payer: First Health Commercial |
$3,880.75
|
| Rate for Payer: Humana Commercial |
$3,472.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,349.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,014.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,225.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,594.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,063.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,268.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,553.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,818.65
|
| Rate for Payer: PHCS Commercial |
$3,921.60
|
| Rate for Payer: United Healthcare All Payer |
$3,594.80
|
|
|
AXLE PIN REPLACEMENT SM
|
Facility
|
OP
|
$4,085.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,225.50 |
| Max. Negotiated Rate |
$3,921.60 |
| Rate for Payer: Aetna Commercial |
$3,145.45
|
| Rate for Payer: Anthem Medicaid |
$1,404.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,186.30
|
| Rate for Payer: Cash Price |
$2,042.50
|
| Rate for Payer: Cigna Commercial |
$3,390.55
|
| Rate for Payer: First Health Commercial |
$3,880.75
|
| Rate for Payer: Humana Commercial |
$3,472.25
|
| Rate for Payer: Humana KY Medicaid |
$1,404.83
|
| Rate for Payer: Kentucky WC Medicaid |
$1,419.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,349.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,014.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,225.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,433.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,594.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,063.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,268.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,553.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,818.65
|
| Rate for Payer: PHCS Commercial |
$3,921.60
|
| Rate for Payer: United Healthcare All Payer |
$3,594.80
|
|
