|
SYN TI PF FEM COMP SZ 13
|
Facility
|
IP
|
$15,546.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,021.04 |
| Max. Negotiated Rate |
$14,924.62 |
| Rate for Payer: Aetna Commercial |
$11,970.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,126.25
|
| Rate for Payer: Cash Price |
$7,773.24
|
| Rate for Payer: Cigna Commercial |
$12,903.58
|
| Rate for Payer: First Health Commercial |
$14,769.16
|
| Rate for Payer: Humana Commercial |
$13,214.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,748.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,473.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,663.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,680.90
|
| Rate for Payer: Ohio Health Group HMO |
$11,659.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,109.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,021.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,819.41
|
| Rate for Payer: PHCS Commercial |
$14,924.62
|
| Rate for Payer: United Healthcare All Payer |
$13,680.90
|
|
|
SYN TI PF FEM COMP SZ 14
|
Facility
|
IP
|
$15,546.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,021.04 |
| Max. Negotiated Rate |
$14,924.62 |
| Rate for Payer: Aetna Commercial |
$11,970.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,126.25
|
| Rate for Payer: Cash Price |
$7,773.24
|
| Rate for Payer: Cigna Commercial |
$12,903.58
|
| Rate for Payer: First Health Commercial |
$14,769.16
|
| Rate for Payer: Humana Commercial |
$13,214.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,748.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,473.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,663.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,680.90
|
| Rate for Payer: Ohio Health Group HMO |
$11,659.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,109.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,021.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,819.41
|
| Rate for Payer: PHCS Commercial |
$14,924.62
|
| Rate for Payer: United Healthcare All Payer |
$13,680.90
|
|
|
SYN TI PF FEM COMP SZ 14
|
Facility
|
OP
|
$15,546.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,021.04 |
| Max. Negotiated Rate |
$14,924.62 |
| Rate for Payer: Aetna Commercial |
$11,970.79
|
| Rate for Payer: Anthem Medicaid |
$5,346.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,126.25
|
| Rate for Payer: Cash Price |
$7,773.24
|
| Rate for Payer: Cigna Commercial |
$12,903.58
|
| Rate for Payer: First Health Commercial |
$14,769.16
|
| Rate for Payer: Humana Commercial |
$13,214.51
|
| Rate for Payer: Humana KY Medicaid |
$5,346.43
|
| Rate for Payer: Kentucky WC Medicaid |
$5,400.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,748.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,473.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,663.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,453.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,680.90
|
| Rate for Payer: Ohio Health Group HMO |
$11,659.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,109.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,021.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,819.41
|
| Rate for Payer: PHCS Commercial |
$14,924.62
|
| Rate for Payer: United Healthcare All Payer |
$13,680.90
|
|
|
SYN TI PF FEM COMP SZ 15
|
Facility
|
OP
|
$15,546.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,021.04 |
| Max. Negotiated Rate |
$14,924.62 |
| Rate for Payer: Aetna Commercial |
$11,970.79
|
| Rate for Payer: Anthem Medicaid |
$5,346.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,126.25
|
| Rate for Payer: Cash Price |
$7,773.24
|
| Rate for Payer: Cigna Commercial |
$12,903.58
|
| Rate for Payer: First Health Commercial |
$14,769.16
|
| Rate for Payer: Humana Commercial |
$13,214.51
|
| Rate for Payer: Humana KY Medicaid |
$5,346.43
|
| Rate for Payer: Kentucky WC Medicaid |
$5,400.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,748.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,473.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,663.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,453.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,680.90
|
| Rate for Payer: Ohio Health Group HMO |
$11,659.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,109.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,021.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,819.41
|
| Rate for Payer: PHCS Commercial |
$14,924.62
|
| Rate for Payer: United Healthcare All Payer |
$13,680.90
|
|
|
SYN TI PF FEM COMP SZ 15
|
Facility
|
IP
|
$15,546.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,021.04 |
| Max. Negotiated Rate |
$14,924.62 |
| Rate for Payer: Aetna Commercial |
$11,970.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,126.25
|
| Rate for Payer: Cash Price |
$7,773.24
|
| Rate for Payer: Cigna Commercial |
$12,903.58
|
| Rate for Payer: First Health Commercial |
$14,769.16
|
| Rate for Payer: Humana Commercial |
$13,214.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,748.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,473.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,663.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,680.90
|
| Rate for Payer: Ohio Health Group HMO |
$11,659.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,109.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,021.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,819.41
|
| Rate for Payer: PHCS Commercial |
$14,924.62
|
| Rate for Payer: United Healthcare All Payer |
$13,680.90
|
|
|
SYN TI PF FEM COMP SZ 16
|
Facility
|
IP
|
$15,546.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,021.04 |
| Max. Negotiated Rate |
$14,924.62 |
| Rate for Payer: Aetna Commercial |
$11,970.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,126.25
|
| Rate for Payer: Cash Price |
$7,773.24
|
| Rate for Payer: Cigna Commercial |
$12,903.58
|
| Rate for Payer: First Health Commercial |
$14,769.16
|
| Rate for Payer: Humana Commercial |
$13,214.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,748.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,473.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,663.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,680.90
|
| Rate for Payer: Ohio Health Group HMO |
$11,659.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,109.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,021.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,819.41
|
| Rate for Payer: PHCS Commercial |
$14,924.62
|
| Rate for Payer: United Healthcare All Payer |
$13,680.90
|
|
|
SYN TI PF FEM COMP SZ 16
|
Facility
|
OP
|
$15,546.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,021.04 |
| Max. Negotiated Rate |
$14,924.62 |
| Rate for Payer: Aetna Commercial |
$11,970.79
|
| Rate for Payer: Anthem Medicaid |
$5,346.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,126.25
|
| Rate for Payer: Cash Price |
$7,773.24
|
| Rate for Payer: Cigna Commercial |
$12,903.58
|
| Rate for Payer: First Health Commercial |
$14,769.16
|
| Rate for Payer: Humana Commercial |
$13,214.51
|
| Rate for Payer: Humana KY Medicaid |
$5,346.43
|
| Rate for Payer: Kentucky WC Medicaid |
$5,400.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,748.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,473.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,663.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,453.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,680.90
|
| Rate for Payer: Ohio Health Group HMO |
$11,659.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,109.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,021.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,819.41
|
| Rate for Payer: PHCS Commercial |
$14,924.62
|
| Rate for Payer: United Healthcare All Payer |
$13,680.90
|
|
|
SYN TI PF FEM COMP SZ 17
|
Facility
|
IP
|
$15,546.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,021.04 |
| Max. Negotiated Rate |
$14,924.62 |
| Rate for Payer: Aetna Commercial |
$11,970.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,126.25
|
| Rate for Payer: Cash Price |
$7,773.24
|
| Rate for Payer: Cigna Commercial |
$12,903.58
|
| Rate for Payer: First Health Commercial |
$14,769.16
|
| Rate for Payer: Humana Commercial |
$13,214.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,748.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,473.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,663.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,680.90
|
| Rate for Payer: Ohio Health Group HMO |
$11,659.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,109.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,021.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,819.41
|
| Rate for Payer: PHCS Commercial |
$14,924.62
|
| Rate for Payer: United Healthcare All Payer |
$13,680.90
|
|
|
SYN TI PF FEM COMP SZ 17
|
Facility
|
OP
|
$15,546.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,021.04 |
| Max. Negotiated Rate |
$14,924.62 |
| Rate for Payer: Aetna Commercial |
$11,970.79
|
| Rate for Payer: Anthem Medicaid |
$5,346.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,126.25
|
| Rate for Payer: Cash Price |
$7,773.24
|
| Rate for Payer: Cigna Commercial |
$12,903.58
|
| Rate for Payer: First Health Commercial |
$14,769.16
|
| Rate for Payer: Humana Commercial |
$13,214.51
|
| Rate for Payer: Humana KY Medicaid |
$5,346.43
|
| Rate for Payer: Kentucky WC Medicaid |
$5,400.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,748.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,473.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,663.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,453.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,680.90
|
| Rate for Payer: Ohio Health Group HMO |
$11,659.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,109.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,021.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,819.41
|
| Rate for Payer: PHCS Commercial |
$14,924.62
|
| Rate for Payer: United Healthcare All Payer |
$13,680.90
|
|
|
SYN TI PF FEM COMP SZ 18
|
Facility
|
IP
|
$15,546.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,021.04 |
| Max. Negotiated Rate |
$14,924.62 |
| Rate for Payer: Aetna Commercial |
$11,970.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,126.25
|
| Rate for Payer: Cash Price |
$7,773.24
|
| Rate for Payer: Cigna Commercial |
$12,903.58
|
| Rate for Payer: First Health Commercial |
$14,769.16
|
| Rate for Payer: Humana Commercial |
$13,214.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,748.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,473.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,663.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,680.90
|
| Rate for Payer: Ohio Health Group HMO |
$11,659.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,109.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,021.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,819.41
|
| Rate for Payer: PHCS Commercial |
$14,924.62
|
| Rate for Payer: United Healthcare All Payer |
$13,680.90
|
|
|
SYN TI PF FEM COMP SZ 18
|
Facility
|
OP
|
$15,546.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,021.04 |
| Max. Negotiated Rate |
$14,924.62 |
| Rate for Payer: Aetna Commercial |
$11,970.79
|
| Rate for Payer: Anthem Medicaid |
$5,346.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,126.25
|
| Rate for Payer: Cash Price |
$7,773.24
|
| Rate for Payer: Cigna Commercial |
$12,903.58
|
| Rate for Payer: First Health Commercial |
$14,769.16
|
| Rate for Payer: Humana Commercial |
$13,214.51
|
| Rate for Payer: Humana KY Medicaid |
$5,346.43
|
| Rate for Payer: Kentucky WC Medicaid |
$5,400.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,748.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,473.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,663.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,453.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,680.90
|
| Rate for Payer: Ohio Health Group HMO |
$11,659.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,109.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,021.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,819.41
|
| Rate for Payer: PHCS Commercial |
$14,924.62
|
| Rate for Payer: United Healthcare All Payer |
$13,680.90
|
|
|
SYN TI PF FEM COMP SZ 9
|
Facility
|
IP
|
$24,019.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,122.60 |
| Max. Negotiated Rate |
$23,059.19 |
| Rate for Payer: Aetna Commercial |
$18,495.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,735.59
|
| Rate for Payer: Cash Price |
$12,009.99
|
| Rate for Payer: Cigna Commercial |
$19,936.59
|
| Rate for Payer: First Health Commercial |
$22,818.99
|
| Rate for Payer: Humana Commercial |
$20,416.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,696.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,726.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,206.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,137.59
|
| Rate for Payer: Ohio Health Group HMO |
$18,014.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,804.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,122.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,446.20
|
| Rate for Payer: PHCS Commercial |
$23,059.19
|
| Rate for Payer: United Healthcare All Payer |
$21,137.59
|
|
|
SYN TI PF FEM COMP SZ 9
|
Facility
|
OP
|
$24,019.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,122.60 |
| Max. Negotiated Rate |
$23,059.19 |
| Rate for Payer: Aetna Commercial |
$18,495.39
|
| Rate for Payer: Anthem Medicaid |
$8,260.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,735.59
|
| Rate for Payer: Cash Price |
$12,009.99
|
| Rate for Payer: Cigna Commercial |
$19,936.59
|
| Rate for Payer: First Health Commercial |
$22,818.99
|
| Rate for Payer: Humana Commercial |
$20,416.99
|
| Rate for Payer: Humana KY Medicaid |
$8,260.47
|
| Rate for Payer: Kentucky WC Medicaid |
$8,344.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,696.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,726.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,206.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,426.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,137.59
|
| Rate for Payer: Ohio Health Group HMO |
$18,014.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,804.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,122.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,446.20
|
| Rate for Payer: PHCS Commercial |
$23,059.19
|
| Rate for Payer: United Healthcare All Payer |
$21,137.59
|
|
|
SYNVISC-ONE per 1mg (48mg SYR)
|
Facility
|
IP
|
$7,464.43
|
|
|
Service Code
|
HCPCS J7325
|
| Hospital Charge Code |
25004126
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$970.38 |
| Max. Negotiated Rate |
$7,165.85 |
| Rate for Payer: Aetna Commercial |
$5,747.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,822.26
|
| Rate for Payer: Cash Price |
$3,732.22
|
| Rate for Payer: Cigna Commercial |
$6,195.48
|
| Rate for Payer: First Health Commercial |
$7,091.21
|
| Rate for Payer: Humana Commercial |
$6,344.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,120.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,508.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,239.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,568.70
|
| Rate for Payer: Ohio Health Group HMO |
$5,598.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,492.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$970.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,313.97
|
| Rate for Payer: PHCS Commercial |
$7,165.85
|
| Rate for Payer: United Healthcare All Payer |
$6,568.70
|
|
|
SYNVISC-ONE per 1mg (48mg SYR)
|
Facility
|
OP
|
$7,464.43
|
|
|
Service Code
|
HCPCS J7325
|
| Hospital Charge Code |
25004126
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.12 |
| Max. Negotiated Rate |
$7,165.85 |
| Rate for Payer: Aetna Commercial |
$5,747.61
|
| Rate for Payer: Anthem Medicaid |
$2,567.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,822.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.31
|
| Rate for Payer: Cash Price |
$3,732.22
|
| Rate for Payer: Cash Price |
$3,732.22
|
| Rate for Payer: Cigna Commercial |
$6,195.48
|
| Rate for Payer: First Health Commercial |
$7,091.21
|
| Rate for Payer: Humana Commercial |
$6,344.77
|
| Rate for Payer: Humana KY Medicaid |
$2,567.02
|
| Rate for Payer: Humana Medicare Advantage |
$9.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,593.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,120.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,508.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,618.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,568.70
|
| Rate for Payer: Ohio Health Group HMO |
$5,598.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,492.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$970.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,313.97
|
| Rate for Payer: PHCS Commercial |
$7,165.85
|
| Rate for Payer: United Healthcare All Payer |
$6,568.70
|
|
|
SYNVISC-ONE per 1mg (48mg SYR)
|
Professional
|
Both
|
$149.80
|
|
|
Service Code
|
HCPCS J7325
|
| Hospital Charge Code |
63600155
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.41 |
| Max. Negotiated Rate |
$149.80 |
| Rate for Payer: Aetna Commercial |
$15.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$149.80
|
| Rate for Payer: Cash Price |
$74.90
|
| Rate for Payer: Cash Price |
$74.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$14.41
|
| Rate for Payer: Multiplan PHCS |
$89.88
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$104.86
|
| Rate for Payer: UHCCP Medicaid |
$52.43
|
|
|
SYNVISC-ONE per 1mg (48mg SYR)
|
Facility
|
IP
|
$149.80
|
|
|
Service Code
|
HCPCS J7325
|
| Hospital Charge Code |
63600155
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.47 |
| Max. Negotiated Rate |
$143.81 |
| Rate for Payer: Aetna Commercial |
$115.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$116.84
|
| Rate for Payer: Cash Price |
$74.90
|
| Rate for Payer: Cigna Commercial |
$124.33
|
| Rate for Payer: First Health Commercial |
$142.31
|
| Rate for Payer: Humana Commercial |
$127.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$122.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$110.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$44.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$131.82
|
| Rate for Payer: Ohio Health Group HMO |
$112.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.44
|
| Rate for Payer: PHCS Commercial |
$143.81
|
| Rate for Payer: United Healthcare All Payer |
$131.82
|
|
|
SYNVISC-ONE per 1mg (48mg SYR)
|
Facility
|
IP
|
$149.80
|
|
|
Service Code
|
HCPCS J7325
|
| Hospital Charge Code |
636T0155
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.47 |
| Max. Negotiated Rate |
$143.81 |
| Rate for Payer: Aetna Commercial |
$115.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$116.84
|
| Rate for Payer: Cash Price |
$74.90
|
| Rate for Payer: Cigna Commercial |
$124.33
|
| Rate for Payer: First Health Commercial |
$142.31
|
| Rate for Payer: Humana Commercial |
$127.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$122.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$110.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$44.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$131.82
|
| Rate for Payer: Ohio Health Group HMO |
$112.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.44
|
| Rate for Payer: PHCS Commercial |
$143.81
|
| Rate for Payer: United Healthcare All Payer |
$131.82
|
|
|
SYNVISC-ONE per 1mg (48mg SYR)
|
Facility
|
OP
|
$149.80
|
|
|
Service Code
|
HCPCS J7325
|
| Hospital Charge Code |
636T0155
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.12 |
| Max. Negotiated Rate |
$143.81 |
| Rate for Payer: Aetna Commercial |
$115.35
|
| Rate for Payer: Anthem Medicaid |
$51.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$116.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.31
|
| Rate for Payer: Cash Price |
$74.90
|
| Rate for Payer: Cash Price |
$74.90
|
| Rate for Payer: Cigna Commercial |
$124.33
|
| Rate for Payer: First Health Commercial |
$142.31
|
| Rate for Payer: Humana Commercial |
$127.33
|
| Rate for Payer: Humana KY Medicaid |
$51.52
|
| Rate for Payer: Humana Medicare Advantage |
$9.12
|
| Rate for Payer: Kentucky WC Medicaid |
$52.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$122.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$110.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$52.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$131.82
|
| Rate for Payer: Ohio Health Group HMO |
$112.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.44
|
| Rate for Payer: PHCS Commercial |
$143.81
|
| Rate for Payer: United Healthcare All Payer |
$131.82
|
|
|
SYNVISC-ONE per 1mg (48mg SYR)
|
Facility
|
OP
|
$149.80
|
|
|
Service Code
|
HCPCS J7325
|
| Hospital Charge Code |
63600155
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.12 |
| Max. Negotiated Rate |
$143.81 |
| Rate for Payer: Aetna Commercial |
$115.35
|
| Rate for Payer: Anthem Medicaid |
$51.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$116.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.31
|
| Rate for Payer: Cash Price |
$74.90
|
| Rate for Payer: Cash Price |
$74.90
|
| Rate for Payer: Cigna Commercial |
$124.33
|
| Rate for Payer: First Health Commercial |
$142.31
|
| Rate for Payer: Humana Commercial |
$127.33
|
| Rate for Payer: Humana KY Medicaid |
$51.52
|
| Rate for Payer: Humana Medicare Advantage |
$9.12
|
| Rate for Payer: Kentucky WC Medicaid |
$52.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$122.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$110.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$52.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$131.82
|
| Rate for Payer: Ohio Health Group HMO |
$112.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.44
|
| Rate for Payer: PHCS Commercial |
$143.81
|
| Rate for Payer: United Healthcare All Payer |
$131.82
|
|
|
SYNVISC per 1mg (16mg SYRINGE)
|
Facility
|
OP
|
$149.80
|
|
|
Service Code
|
HCPCS J7325
|
| Hospital Charge Code |
63600154
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.12 |
| Max. Negotiated Rate |
$143.81 |
| Rate for Payer: Aetna Commercial |
$115.35
|
| Rate for Payer: Anthem Medicaid |
$51.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$116.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.31
|
| Rate for Payer: Cash Price |
$74.90
|
| Rate for Payer: Cash Price |
$74.90
|
| Rate for Payer: Cigna Commercial |
$124.33
|
| Rate for Payer: First Health Commercial |
$142.31
|
| Rate for Payer: Humana Commercial |
$127.33
|
| Rate for Payer: Humana KY Medicaid |
$51.52
|
| Rate for Payer: Humana Medicare Advantage |
$9.12
|
| Rate for Payer: Kentucky WC Medicaid |
$52.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$122.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$110.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$52.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$131.82
|
| Rate for Payer: Ohio Health Group HMO |
$112.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.44
|
| Rate for Payer: PHCS Commercial |
$143.81
|
| Rate for Payer: United Healthcare All Payer |
$131.82
|
|
|
SYNVISC per 1mg (16mg SYRINGE)
|
Professional
|
Both
|
$149.80
|
|
|
Service Code
|
HCPCS J7325
|
| Hospital Charge Code |
63600154
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.41 |
| Max. Negotiated Rate |
$149.80 |
| Rate for Payer: Aetna Commercial |
$15.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$149.80
|
| Rate for Payer: Cash Price |
$74.90
|
| Rate for Payer: Cash Price |
$74.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$14.41
|
| Rate for Payer: Multiplan PHCS |
$89.88
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$104.86
|
| Rate for Payer: UHCCP Medicaid |
$52.43
|
|
|
SYNVISC per 1mg (16mg SYRINGE)
|
Facility
|
OP
|
$149.80
|
|
|
Service Code
|
HCPCS J7325
|
| Hospital Charge Code |
636T0154
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.12 |
| Max. Negotiated Rate |
$143.81 |
| Rate for Payer: Aetna Commercial |
$115.35
|
| Rate for Payer: Anthem Medicaid |
$51.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$116.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.31
|
| Rate for Payer: Cash Price |
$74.90
|
| Rate for Payer: Cash Price |
$74.90
|
| Rate for Payer: Cigna Commercial |
$124.33
|
| Rate for Payer: First Health Commercial |
$142.31
|
| Rate for Payer: Humana Commercial |
$127.33
|
| Rate for Payer: Humana KY Medicaid |
$51.52
|
| Rate for Payer: Humana Medicare Advantage |
$9.12
|
| Rate for Payer: Kentucky WC Medicaid |
$52.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$122.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$110.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$52.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$131.82
|
| Rate for Payer: Ohio Health Group HMO |
$112.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.44
|
| Rate for Payer: PHCS Commercial |
$143.81
|
| Rate for Payer: United Healthcare All Payer |
$131.82
|
|
|
SYNVISC per 1mg (16mg SYRINGE)
|
Facility
|
IP
|
$149.80
|
|
|
Service Code
|
HCPCS J7325
|
| Hospital Charge Code |
63600154
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.47 |
| Max. Negotiated Rate |
$143.81 |
| Rate for Payer: Aetna Commercial |
$115.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$116.84
|
| Rate for Payer: Cash Price |
$74.90
|
| Rate for Payer: Cigna Commercial |
$124.33
|
| Rate for Payer: First Health Commercial |
$142.31
|
| Rate for Payer: Humana Commercial |
$127.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$122.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$110.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$44.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$131.82
|
| Rate for Payer: Ohio Health Group HMO |
$112.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.44
|
| Rate for Payer: PHCS Commercial |
$143.81
|
| Rate for Payer: United Healthcare All Payer |
$131.82
|
|
|
SYNVISC per 1mg (16mg SYRINGE)
|
Facility
|
OP
|
$2,488.14
|
|
|
Service Code
|
HCPCS J7325
|
| Hospital Charge Code |
25004125
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.12 |
| Max. Negotiated Rate |
$2,388.61 |
| Rate for Payer: Aetna Commercial |
$1,915.87
|
| Rate for Payer: Anthem Medicaid |
$855.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,940.75
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.31
|
| Rate for Payer: Cash Price |
$1,244.07
|
| Rate for Payer: Cash Price |
$1,244.07
|
| Rate for Payer: Cigna Commercial |
$2,065.16
|
| Rate for Payer: First Health Commercial |
$2,363.73
|
| Rate for Payer: Humana Commercial |
$2,114.92
|
| Rate for Payer: Humana KY Medicaid |
$855.67
|
| Rate for Payer: Humana Medicare Advantage |
$9.12
|
| Rate for Payer: Kentucky WC Medicaid |
$864.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,040.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,836.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$872.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,189.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,866.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$497.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$323.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$771.32
|
| Rate for Payer: PHCS Commercial |
$2,388.61
|
| Rate for Payer: United Healthcare All Payer |
$2,189.56
|
|
