|
SUTURE REPAIR INTERMED >30CM
|
Facility
|
OP
|
$218.00
|
|
| Hospital Charge Code |
45000330
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$28.34 |
| Max. Negotiated Rate |
$209.28 |
| Rate for Payer: Aetna Commercial |
$167.86
|
| Rate for Payer: Anthem Medicaid |
$74.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$170.04
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cigna Commercial |
$180.94
|
| Rate for Payer: First Health Commercial |
$207.10
|
| Rate for Payer: Humana Commercial |
$185.30
|
| Rate for Payer: Humana KY Medicaid |
$74.97
|
| Rate for Payer: Kentucky WC Medicaid |
$75.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$178.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$160.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$76.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$191.84
|
| Rate for Payer: Ohio Health Group HMO |
$163.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$43.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$67.58
|
| Rate for Payer: PHCS Commercial |
$209.28
|
| Rate for Payer: United Healthcare All Payer |
$191.84
|
|
|
SUTURE REPAIR INTERMED >30CM
|
Facility
|
OP
|
$209.00
|
|
| Hospital Charge Code |
76102558
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$27.17 |
| Max. Negotiated Rate |
$200.64 |
| Rate for Payer: Aetna Commercial |
$160.93
|
| Rate for Payer: Anthem Medicaid |
$71.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$163.02
|
| Rate for Payer: Cash Price |
$104.50
|
| Rate for Payer: Cigna Commercial |
$173.47
|
| Rate for Payer: First Health Commercial |
$198.55
|
| Rate for Payer: Humana Commercial |
$177.65
|
| Rate for Payer: Humana KY Medicaid |
$71.88
|
| Rate for Payer: Kentucky WC Medicaid |
$72.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$171.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$154.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$62.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$73.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$183.92
|
| Rate for Payer: Ohio Health Group HMO |
$156.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$41.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$64.79
|
| Rate for Payer: PHCS Commercial |
$200.64
|
| Rate for Payer: United Healthcare All Payer |
$183.92
|
|
|
SUTURE REPAIR INTERMED >30CM
|
Facility
|
OP
|
$218.00
|
|
| Hospital Charge Code |
45000323
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$28.34 |
| Max. Negotiated Rate |
$209.28 |
| Rate for Payer: Aetna Commercial |
$167.86
|
| Rate for Payer: Anthem Medicaid |
$74.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$170.04
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cigna Commercial |
$180.94
|
| Rate for Payer: First Health Commercial |
$207.10
|
| Rate for Payer: Humana Commercial |
$185.30
|
| Rate for Payer: Humana KY Medicaid |
$74.97
|
| Rate for Payer: Kentucky WC Medicaid |
$75.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$178.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$160.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$76.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$191.84
|
| Rate for Payer: Ohio Health Group HMO |
$163.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$43.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$67.58
|
| Rate for Payer: PHCS Commercial |
$209.28
|
| Rate for Payer: United Healthcare All Payer |
$191.84
|
|
|
SUTURE REPAIR INTERMED >30CM
|
Facility
|
IP
|
$218.00
|
|
| Hospital Charge Code |
45000323
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$28.34 |
| Max. Negotiated Rate |
$209.28 |
| Rate for Payer: Aetna Commercial |
$167.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$170.04
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cigna Commercial |
$180.94
|
| Rate for Payer: First Health Commercial |
$207.10
|
| Rate for Payer: Humana Commercial |
$185.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$178.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$160.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$191.84
|
| Rate for Payer: Ohio Health Group HMO |
$163.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$43.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$67.58
|
| Rate for Payer: PHCS Commercial |
$209.28
|
| Rate for Payer: United Healthcare All Payer |
$191.84
|
|
|
SUTURE REPAIR SIMPLE
|
Facility
|
IP
|
$218.00
|
|
| Hospital Charge Code |
45000322
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$28.34 |
| Max. Negotiated Rate |
$209.28 |
| Rate for Payer: Aetna Commercial |
$167.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$170.04
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cigna Commercial |
$180.94
|
| Rate for Payer: First Health Commercial |
$207.10
|
| Rate for Payer: Humana Commercial |
$185.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$178.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$160.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$191.84
|
| Rate for Payer: Ohio Health Group HMO |
$163.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$43.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$67.58
|
| Rate for Payer: PHCS Commercial |
$209.28
|
| Rate for Payer: United Healthcare All Payer |
$191.84
|
|
|
SUTURE REPAIR SIMPLE
|
Facility
|
OP
|
$218.00
|
|
| Hospital Charge Code |
45000322
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$28.34 |
| Max. Negotiated Rate |
$209.28 |
| Rate for Payer: Aetna Commercial |
$167.86
|
| Rate for Payer: Anthem Medicaid |
$74.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$170.04
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cigna Commercial |
$180.94
|
| Rate for Payer: First Health Commercial |
$207.10
|
| Rate for Payer: Humana Commercial |
$185.30
|
| Rate for Payer: Humana KY Medicaid |
$74.97
|
| Rate for Payer: Kentucky WC Medicaid |
$75.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$178.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$160.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$76.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$191.84
|
| Rate for Payer: Ohio Health Group HMO |
$163.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$43.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$67.58
|
| Rate for Payer: PHCS Commercial |
$209.28
|
| Rate for Payer: United Healthcare All Payer |
$191.84
|
|
|
SUTURE SECDRY ABDOM WALL EVI(P
|
Professional
|
Both
|
$1,115.00
|
|
|
Service Code
|
HCPCS 49900
|
| Hospital Charge Code |
761P2041
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$249.61 |
| Max. Negotiated Rate |
$1,166.15 |
| Rate for Payer: Aetna Commercial |
$1,166.15
|
| Rate for Payer: Anthem Medicaid |
$249.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,115.00
|
| Rate for Payer: Cash Price |
$557.50
|
| Rate for Payer: Cash Price |
$557.50
|
| Rate for Payer: Cigna Commercial |
$1,087.10
|
| Rate for Payer: Healthspan PPO |
$983.43
|
| Rate for Payer: Humana Medicaid |
$249.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,031.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$254.60
|
| Rate for Payer: Molina Healthcare Passport |
$249.61
|
| Rate for Payer: Multiplan PHCS |
$669.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$780.50
|
| Rate for Payer: UHCCP Medicaid |
$390.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$252.11
|
|
|
SUTURE SECDRY ABDOM WALL EVIS
|
Facility
|
OP
|
$1,115.00
|
|
|
Service Code
|
HCPCS 49900
|
| Hospital Charge Code |
76102041
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$144.95 |
| Max. Negotiated Rate |
$1,070.40 |
| Rate for Payer: Aetna Commercial |
$858.55
|
| Rate for Payer: Anthem Medicaid |
$383.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$869.70
|
| Rate for Payer: Cash Price |
$557.50
|
| Rate for Payer: Cigna Commercial |
$925.45
|
| Rate for Payer: First Health Commercial |
$1,059.25
|
| Rate for Payer: Humana Commercial |
$947.75
|
| Rate for Payer: Humana KY Medicaid |
$383.45
|
| Rate for Payer: Kentucky WC Medicaid |
$387.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$914.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$822.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$334.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$391.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$981.20
|
| Rate for Payer: Ohio Health Group HMO |
$836.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$223.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$144.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$345.65
|
| Rate for Payer: PHCS Commercial |
$1,070.40
|
| Rate for Payer: United Healthcare All Payer |
$981.20
|
|
|
SUTURE SECDRY ABDOM WALL EVIS
|
Professional
|
Both
|
$1,115.00
|
|
|
Service Code
|
HCPCS 49900
|
| Hospital Charge Code |
76102041
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$249.61 |
| Max. Negotiated Rate |
$1,166.15 |
| Rate for Payer: Aetna Commercial |
$1,166.15
|
| Rate for Payer: Anthem Medicaid |
$249.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,115.00
|
| Rate for Payer: Cash Price |
$557.50
|
| Rate for Payer: Cash Price |
$557.50
|
| Rate for Payer: Cigna Commercial |
$1,087.10
|
| Rate for Payer: Healthspan PPO |
$983.43
|
| Rate for Payer: Humana Medicaid |
$249.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,031.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$254.60
|
| Rate for Payer: Molina Healthcare Passport |
$249.61
|
| Rate for Payer: Multiplan PHCS |
$669.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$780.50
|
| Rate for Payer: UHCCP Medicaid |
$390.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$252.11
|
|
|
SUTURE SECDRY ABDOM WALL EVIS
|
Facility
|
IP
|
$1,115.00
|
|
|
Service Code
|
HCPCS 49900
|
| Hospital Charge Code |
76102041
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$144.95 |
| Max. Negotiated Rate |
$1,070.40 |
| Rate for Payer: Aetna Commercial |
$858.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$869.70
|
| Rate for Payer: Cash Price |
$557.50
|
| Rate for Payer: Cigna Commercial |
$925.45
|
| Rate for Payer: First Health Commercial |
$1,059.25
|
| Rate for Payer: Humana Commercial |
$947.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$914.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$822.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$334.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$981.20
|
| Rate for Payer: Ohio Health Group HMO |
$836.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$223.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$144.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$345.65
|
| Rate for Payer: PHCS Commercial |
$1,070.40
|
| Rate for Payer: United Healthcare All Payer |
$981.20
|
|
|
SUTURE SMALL INTESTINE
|
Professional
|
Both
|
$2,124.00
|
|
|
Service Code
|
HCPCS 44603
|
| Hospital Charge Code |
76101855
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$671.14 |
| Max. Negotiated Rate |
$2,266.28 |
| Rate for Payer: Aetna Commercial |
$2,266.28
|
| Rate for Payer: Anthem Medicaid |
$671.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,124.00
|
| Rate for Payer: Cash Price |
$1,062.00
|
| Rate for Payer: Cash Price |
$1,062.00
|
| Rate for Payer: Cigna Commercial |
$2,051.23
|
| Rate for Payer: Healthspan PPO |
$1,911.20
|
| Rate for Payer: Humana Medicaid |
$671.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,059.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$684.56
|
| Rate for Payer: Molina Healthcare Passport |
$671.14
|
| Rate for Payer: Multiplan PHCS |
$1,274.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,486.80
|
| Rate for Payer: UHCCP Medicaid |
$743.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$677.85
|
|
|
SUTURE SMALL INTESTINE
|
Facility
|
OP
|
$2,124.00
|
|
|
Service Code
|
HCPCS 44603
|
| Hospital Charge Code |
76101855
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$276.12 |
| Max. Negotiated Rate |
$2,039.04 |
| Rate for Payer: Aetna Commercial |
$1,635.48
|
| Rate for Payer: Anthem Medicaid |
$730.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,656.72
|
| Rate for Payer: Cash Price |
$1,062.00
|
| Rate for Payer: Cigna Commercial |
$1,762.92
|
| Rate for Payer: First Health Commercial |
$2,017.80
|
| Rate for Payer: Humana Commercial |
$1,805.40
|
| Rate for Payer: Humana KY Medicaid |
$730.44
|
| Rate for Payer: Kentucky WC Medicaid |
$737.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,741.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,567.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$637.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$745.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,869.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,593.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$424.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$276.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$658.44
|
| Rate for Payer: PHCS Commercial |
$2,039.04
|
| Rate for Payer: United Healthcare All Payer |
$1,869.12
|
|
|
SUTURE SMALL INTESTINE
|
Facility
|
IP
|
$2,124.00
|
|
|
Service Code
|
HCPCS 44603
|
| Hospital Charge Code |
76101855
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$276.12 |
| Max. Negotiated Rate |
$2,039.04 |
| Rate for Payer: Aetna Commercial |
$1,635.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,656.72
|
| Rate for Payer: Cash Price |
$1,062.00
|
| Rate for Payer: Cigna Commercial |
$1,762.92
|
| Rate for Payer: First Health Commercial |
$2,017.80
|
| Rate for Payer: Humana Commercial |
$1,805.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,741.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,567.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$637.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,869.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,593.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$424.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$276.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$658.44
|
| Rate for Payer: PHCS Commercial |
$2,039.04
|
| Rate for Payer: United Healthcare All Payer |
$1,869.12
|
|
|
SUTURE SMALL INTESTINE(P
|
Professional
|
Both
|
$2,124.00
|
|
|
Service Code
|
HCPCS 44603
|
| Hospital Charge Code |
761P1855
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$671.14 |
| Max. Negotiated Rate |
$2,266.28 |
| Rate for Payer: Aetna Commercial |
$2,266.28
|
| Rate for Payer: Anthem Medicaid |
$671.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,124.00
|
| Rate for Payer: Cash Price |
$1,062.00
|
| Rate for Payer: Cash Price |
$1,062.00
|
| Rate for Payer: Cigna Commercial |
$2,051.23
|
| Rate for Payer: Healthspan PPO |
$1,911.20
|
| Rate for Payer: Humana Medicaid |
$671.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,059.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$684.56
|
| Rate for Payer: Molina Healthcare Passport |
$671.14
|
| Rate for Payer: Multiplan PHCS |
$1,274.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,486.80
|
| Rate for Payer: UHCCP Medicaid |
$743.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$677.85
|
|
|
SUTURETAK ANCHOR 3MM*14.5MM
|
Facility
|
OP
|
$3,320.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$431.71 |
| Max. Negotiated Rate |
$3,188.04 |
| Rate for Payer: Aetna Commercial |
$2,557.08
|
| Rate for Payer: Anthem Medicaid |
$1,142.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,590.29
|
| Rate for Payer: Cash Price |
$1,660.44
|
| Rate for Payer: Cigna Commercial |
$2,756.33
|
| Rate for Payer: First Health Commercial |
$3,154.84
|
| Rate for Payer: Humana Commercial |
$2,822.75
|
| Rate for Payer: Humana KY Medicaid |
$1,142.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,153.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,723.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,450.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$996.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,164.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,922.37
|
| Rate for Payer: Ohio Health Group HMO |
$2,490.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$664.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$431.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,029.47
|
| Rate for Payer: PHCS Commercial |
$3,188.04
|
| Rate for Payer: United Healthcare All Payer |
$2,922.37
|
|
|
SUTURETAK ANCHOR 3MM*14.5MM
|
Facility
|
IP
|
$3,320.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$431.71 |
| Max. Negotiated Rate |
$3,188.04 |
| Rate for Payer: Aetna Commercial |
$2,557.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,590.29
|
| Rate for Payer: Cash Price |
$1,660.44
|
| Rate for Payer: Cigna Commercial |
$2,756.33
|
| Rate for Payer: First Health Commercial |
$3,154.84
|
| Rate for Payer: Humana Commercial |
$2,822.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,723.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,450.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$996.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,922.37
|
| Rate for Payer: Ohio Health Group HMO |
$2,490.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$664.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$431.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,029.47
|
| Rate for Payer: PHCS Commercial |
$3,188.04
|
| Rate for Payer: United Healthcare All Payer |
$2,922.37
|
|
|
SUTURTAPE 0.9MM
|
Facility
|
IP
|
$780.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$101.40 |
| Max. Negotiated Rate |
$748.80 |
| Rate for Payer: Aetna Commercial |
$600.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$608.40
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$647.40
|
| Rate for Payer: First Health Commercial |
$741.00
|
| Rate for Payer: Humana Commercial |
$663.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$639.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$575.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$234.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$686.40
|
| Rate for Payer: Ohio Health Group HMO |
$585.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.80
|
| Rate for Payer: PHCS Commercial |
$748.80
|
| Rate for Payer: United Healthcare All Payer |
$686.40
|
|
|
SUTURTAPE 0.9MM
|
Facility
|
OP
|
$780.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$101.40 |
| Max. Negotiated Rate |
$748.80 |
| Rate for Payer: Aetna Commercial |
$600.60
|
| Rate for Payer: Anthem Medicaid |
$268.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$608.40
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$647.40
|
| Rate for Payer: First Health Commercial |
$741.00
|
| Rate for Payer: Humana Commercial |
$663.00
|
| Rate for Payer: Humana KY Medicaid |
$268.24
|
| Rate for Payer: Kentucky WC Medicaid |
$270.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$639.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$575.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$234.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$273.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$686.40
|
| Rate for Payer: Ohio Health Group HMO |
$585.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.80
|
| Rate for Payer: PHCS Commercial |
$748.80
|
| Rate for Payer: United Healthcare All Payer |
$686.40
|
|
|
SVCU ROOM RATE
|
Facility
|
IP
|
$1,679.00
|
|
| Hospital Charge Code |
11000010
|
|
Hospital Revenue Code
|
110
|
| Min. Negotiated Rate |
$218.27 |
| Max. Negotiated Rate |
$1,611.84 |
| Rate for Payer: Aetna Commercial |
$1,292.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,309.62
|
| Rate for Payer: Cash Price |
$839.50
|
| Rate for Payer: Cigna Commercial |
$1,393.57
|
| Rate for Payer: First Health Commercial |
$1,595.05
|
| Rate for Payer: Humana Commercial |
$1,427.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,376.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,239.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$503.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,477.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,259.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$335.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$218.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$520.49
|
| Rate for Payer: PHCS Commercial |
$1,611.84
|
| Rate for Payer: United Healthcare All Payer |
$1,477.52
|
|
|
SWAN-GANZ PACING TD CATH 7FR
|
Facility
|
OP
|
$3,923.26
|
|
|
Service Code
|
HCPCS C1730
|
| Hospital Charge Code |
27000037
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$510.02 |
| Max. Negotiated Rate |
$3,766.33 |
| Rate for Payer: Aetna Commercial |
$3,020.91
|
| Rate for Payer: Anthem Medicaid |
$1,349.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,060.14
|
| Rate for Payer: Cash Price |
$1,961.63
|
| Rate for Payer: Cigna Commercial |
$3,256.31
|
| Rate for Payer: First Health Commercial |
$3,727.10
|
| Rate for Payer: Humana Commercial |
$3,334.77
|
| Rate for Payer: Humana KY Medicaid |
$1,349.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,362.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,217.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,895.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,176.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,376.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,452.47
|
| Rate for Payer: Ohio Health Group HMO |
$2,942.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$784.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$510.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,216.21
|
| Rate for Payer: PHCS Commercial |
$3,766.33
|
| Rate for Payer: United Healthcare All Payer |
$3,452.47
|
|
|
SWAN-GANZ PACING TD CATH 7FR
|
Facility
|
IP
|
$3,923.26
|
|
|
Service Code
|
HCPCS C1730
|
| Hospital Charge Code |
27000037
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$510.02 |
| Max. Negotiated Rate |
$3,766.33 |
| Rate for Payer: Aetna Commercial |
$3,020.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,060.14
|
| Rate for Payer: Cash Price |
$1,961.63
|
| Rate for Payer: Cigna Commercial |
$3,256.31
|
| Rate for Payer: First Health Commercial |
$3,727.10
|
| Rate for Payer: Humana Commercial |
$3,334.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,217.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,895.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,176.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,452.47
|
| Rate for Payer: Ohio Health Group HMO |
$2,942.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$784.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$510.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,216.21
|
| Rate for Payer: PHCS Commercial |
$3,766.33
|
| Rate for Payer: United Healthcare All Payer |
$3,452.47
|
|
|
SWANSN MP JOINT IMP KIT WO/SIZ
|
Facility
|
OP
|
$16,562.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,153.11 |
| Max. Negotiated Rate |
$15,899.90 |
| Rate for Payer: Aetna Commercial |
$12,753.05
|
| Rate for Payer: Anthem Medicaid |
$5,695.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,918.67
|
| Rate for Payer: Cash Price |
$8,281.20
|
| Rate for Payer: Cigna Commercial |
$13,746.79
|
| Rate for Payer: First Health Commercial |
$15,734.28
|
| Rate for Payer: Humana Commercial |
$14,078.04
|
| Rate for Payer: Humana KY Medicaid |
$5,695.81
|
| Rate for Payer: Kentucky WC Medicaid |
$5,753.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,581.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,223.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,968.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,810.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,574.91
|
| Rate for Payer: Ohio Health Group HMO |
$12,421.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,312.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,153.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,134.34
|
| Rate for Payer: PHCS Commercial |
$15,899.90
|
| Rate for Payer: United Healthcare All Payer |
$14,574.91
|
|
|
SWANSN MP JOINT IMP KIT WO/SIZ
|
Facility
|
IP
|
$16,562.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,153.11 |
| Max. Negotiated Rate |
$15,899.90 |
| Rate for Payer: Aetna Commercial |
$12,753.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,918.67
|
| Rate for Payer: Cash Price |
$8,281.20
|
| Rate for Payer: Cigna Commercial |
$13,746.79
|
| Rate for Payer: First Health Commercial |
$15,734.28
|
| Rate for Payer: Humana Commercial |
$14,078.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,581.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,223.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,968.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,574.91
|
| Rate for Payer: Ohio Health Group HMO |
$12,421.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,312.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,153.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,134.34
|
| Rate for Payer: PHCS Commercial |
$15,899.90
|
| Rate for Payer: United Healthcare All Payer |
$14,574.91
|
|
|
SWANSON CARPAL SCAPHOID #1 R
|
Facility
|
OP
|
$19,425.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,525.32 |
| Max. Negotiated Rate |
$18,648.53 |
| Rate for Payer: Aetna Commercial |
$14,957.67
|
| Rate for Payer: Anthem Medicaid |
$6,680.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,151.93
|
| Rate for Payer: Cash Price |
$9,712.77
|
| Rate for Payer: Cigna Commercial |
$16,123.21
|
| Rate for Payer: First Health Commercial |
$18,454.27
|
| Rate for Payer: Humana Commercial |
$16,511.72
|
| Rate for Payer: Humana KY Medicaid |
$6,680.45
|
| Rate for Payer: Kentucky WC Medicaid |
$6,748.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,928.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,336.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,827.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,814.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,094.48
|
| Rate for Payer: Ohio Health Group HMO |
$14,569.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,885.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,525.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,021.92
|
| Rate for Payer: PHCS Commercial |
$18,648.53
|
| Rate for Payer: United Healthcare All Payer |
$17,094.48
|
|
|
SWANSON CARPAL SCAPHOID #1 R
|
Facility
|
IP
|
$19,425.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,525.32 |
| Max. Negotiated Rate |
$18,648.53 |
| Rate for Payer: Aetna Commercial |
$14,957.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,151.93
|
| Rate for Payer: Cash Price |
$9,712.77
|
| Rate for Payer: Cigna Commercial |
$16,123.21
|
| Rate for Payer: First Health Commercial |
$18,454.27
|
| Rate for Payer: Humana Commercial |
$16,511.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,928.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,336.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,827.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,094.48
|
| Rate for Payer: Ohio Health Group HMO |
$14,569.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,885.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,525.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,021.92
|
| Rate for Payer: PHCS Commercial |
$18,648.53
|
| Rate for Payer: United Healthcare All Payer |
$17,094.48
|
|
