|
SYNVISC per 1mg (16mg SYRINGE)
|
Facility
|
IP
|
$2,488.14
|
|
|
Service Code
|
HCPCS J7325
|
| Hospital Charge Code |
25004125
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$323.46 |
| Max. Negotiated Rate |
$2,388.61 |
| Rate for Payer: Aetna Commercial |
$1,915.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,940.75
|
| 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: 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 |
$746.44
|
| 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
|
|
|
SYNVISC per 1mg (16mg SYRINGE)
|
Facility
|
IP
|
$149.80
|
|
|
Service Code
|
HCPCS J7325
|
| Hospital Charge Code |
636T0154
|
|
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
|
|
|
SYPRAHYOID LYMPHADENECTOMY
|
Facility
|
IP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 38700
|
| Hospital Charge Code |
76101604
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$1,536.00 |
| Rate for Payer: Aetna Commercial |
$1,232.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,248.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,328.00
|
| Rate for Payer: First Health Commercial |
$1,520.00
|
| Rate for Payer: Humana Commercial |
$1,360.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,312.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,180.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$480.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,408.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$208.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$496.00
|
| Rate for Payer: PHCS Commercial |
$1,536.00
|
| Rate for Payer: United Healthcare All Payer |
$1,408.00
|
|
|
SYPRAHYOID LYMPHADENECTOMY
|
Facility
|
OP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 38700
|
| Hospital Charge Code |
76101604
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$7,894.80 |
| Rate for Payer: Aetna Commercial |
$1,232.00
|
| Rate for Payer: Anthem Medicaid |
$550.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,639.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,248.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,894.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,612.84
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,328.00
|
| Rate for Payer: First Health Commercial |
$1,520.00
|
| Rate for Payer: Humana Commercial |
$1,360.00
|
| Rate for Payer: Humana KY Medicaid |
$550.24
|
| Rate for Payer: Humana Medicare Advantage |
$5,639.14
|
| Rate for Payer: Kentucky WC Medicaid |
$555.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,312.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,180.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,766.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$561.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,408.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$208.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$496.00
|
| Rate for Payer: PHCS Commercial |
$1,536.00
|
| Rate for Payer: United Healthcare All Payer |
$1,408.00
|
|
|
SYPRAHYOID LYMPHADENECTOMY
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 38700
|
| Hospital Charge Code |
76101604
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$512.23 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: Aetna Commercial |
$1,138.15
|
| Rate for Payer: Anthem Medicaid |
$512.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,600.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,054.63
|
| Rate for Payer: Healthspan PPO |
$910.05
|
| Rate for Payer: Humana Medicaid |
$512.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,030.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$522.47
|
| Rate for Payer: Molina Healthcare Passport |
$512.23
|
| Rate for Payer: Multiplan PHCS |
$960.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,120.00
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$517.35
|
|
|
SYPRAHYOID LYMPHADENECTOMY(P
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 38700
|
| Hospital Charge Code |
761P1604
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$512.23 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: Aetna Commercial |
$1,138.15
|
| Rate for Payer: Anthem Medicaid |
$512.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,600.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,054.63
|
| Rate for Payer: Healthspan PPO |
$910.05
|
| Rate for Payer: Humana Medicaid |
$512.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,030.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$522.47
|
| Rate for Payer: Molina Healthcare Passport |
$512.23
|
| Rate for Payer: Multiplan PHCS |
$960.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,120.00
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$517.35
|
|
|
SYSTANE EYE DROPS 15ML
|
Facility
|
OP
|
$4.51
|
|
|
Service Code
|
NDC 65043133
|
| Hospital Charge Code |
25001479
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.33 |
| Rate for Payer: Aetna Commercial |
$3.47
|
| Rate for Payer: Anthem Medicaid |
$1.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.52
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cigna Commercial |
$3.74
|
| Rate for Payer: First Health Commercial |
$4.28
|
| Rate for Payer: Humana Commercial |
$3.83
|
| Rate for Payer: Humana KY Medicaid |
$1.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.97
|
| Rate for Payer: Ohio Health Group HMO |
$3.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.40
|
| Rate for Payer: PHCS Commercial |
$4.33
|
| Rate for Payer: United Healthcare All Payer |
$3.97
|
|
|
SYSTANE EYE DROPS 15ML
|
Facility
|
IP
|
$4.51
|
|
|
Service Code
|
NDC 65043133
|
| Hospital Charge Code |
25001479
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.33 |
| Rate for Payer: Aetna Commercial |
$3.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.52
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cigna Commercial |
$3.74
|
| Rate for Payer: First Health Commercial |
$4.28
|
| Rate for Payer: Humana Commercial |
$3.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.97
|
| Rate for Payer: Ohio Health Group HMO |
$3.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.40
|
| Rate for Payer: PHCS Commercial |
$4.33
|
| Rate for Payer: United Healthcare All Payer |
$3.97
|
|
|
SZR STYL 410 FF RE-STERL 290CC
|
Facility
|
IP
|
$3,075.00
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$2,952.00 |
| Rate for Payer: Aetna Commercial |
$2,367.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Cash Price |
$1,537.50
|
| Rate for Payer: Cigna Commercial |
$2,552.25
|
| Rate for Payer: First Health Commercial |
$2,921.25
|
| Rate for Payer: Humana Commercial |
$2,613.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,521.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,269.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,706.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,306.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$615.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$399.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$953.25
|
| Rate for Payer: PHCS Commercial |
$2,952.00
|
| Rate for Payer: United Healthcare All Payer |
$2,706.00
|
|
|
SZR STYL 410 FF RE-STERL 290CC
|
Facility
|
OP
|
$3,075.00
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$2,952.00 |
| Rate for Payer: Aetna Commercial |
$2,367.75
|
| Rate for Payer: Anthem Medicaid |
$1,057.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Cash Price |
$1,537.50
|
| Rate for Payer: Cigna Commercial |
$2,552.25
|
| Rate for Payer: First Health Commercial |
$2,921.25
|
| Rate for Payer: Humana Commercial |
$2,613.75
|
| Rate for Payer: Humana KY Medicaid |
$1,057.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1,068.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,521.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,269.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,078.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,706.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,306.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$615.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$399.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$953.25
|
| Rate for Payer: PHCS Commercial |
$2,952.00
|
| Rate for Payer: United Healthcare All Payer |
$2,706.00
|
|
|
SZR STYL 410 FF RE-STERL 335CC
|
Facility
|
OP
|
$3,075.00
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$2,952.00 |
| Rate for Payer: Aetna Commercial |
$2,367.75
|
| Rate for Payer: Anthem Medicaid |
$1,057.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Cash Price |
$1,537.50
|
| Rate for Payer: Cigna Commercial |
$2,552.25
|
| Rate for Payer: First Health Commercial |
$2,921.25
|
| Rate for Payer: Humana Commercial |
$2,613.75
|
| Rate for Payer: Humana KY Medicaid |
$1,057.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1,068.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,521.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,269.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,078.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,706.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,306.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$615.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$399.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$953.25
|
| Rate for Payer: PHCS Commercial |
$2,952.00
|
| Rate for Payer: United Healthcare All Payer |
$2,706.00
|
|
|
SZR STYL 410 FF RE-STERL 335CC
|
Facility
|
IP
|
$3,075.00
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$2,952.00 |
| Rate for Payer: Aetna Commercial |
$2,367.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Cash Price |
$1,537.50
|
| Rate for Payer: Cigna Commercial |
$2,552.25
|
| Rate for Payer: First Health Commercial |
$2,921.25
|
| Rate for Payer: Humana Commercial |
$2,613.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,521.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,269.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,706.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,306.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$615.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$399.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$953.25
|
| Rate for Payer: PHCS Commercial |
$2,952.00
|
| Rate for Payer: United Healthcare All Payer |
$2,706.00
|
|
|
SZR STYL 410 FM RE-STERL 310CC
|
Facility
|
IP
|
$3,075.00
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$2,952.00 |
| Rate for Payer: Aetna Commercial |
$2,367.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Cash Price |
$1,537.50
|
| Rate for Payer: Cigna Commercial |
$2,552.25
|
| Rate for Payer: First Health Commercial |
$2,921.25
|
| Rate for Payer: Humana Commercial |
$2,613.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,521.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,269.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,706.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,306.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$615.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$399.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$953.25
|
| Rate for Payer: PHCS Commercial |
$2,952.00
|
| Rate for Payer: United Healthcare All Payer |
$2,706.00
|
|
|
SZR STYL 410 FM RE-STERL 310CC
|
Facility
|
OP
|
$3,075.00
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$2,952.00 |
| Rate for Payer: Aetna Commercial |
$2,367.75
|
| Rate for Payer: Anthem Medicaid |
$1,057.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Cash Price |
$1,537.50
|
| Rate for Payer: Cigna Commercial |
$2,552.25
|
| Rate for Payer: First Health Commercial |
$2,921.25
|
| Rate for Payer: Humana Commercial |
$2,613.75
|
| Rate for Payer: Humana KY Medicaid |
$1,057.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1,068.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,521.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,269.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,078.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,706.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,306.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$615.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$399.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$953.25
|
| Rate for Payer: PHCS Commercial |
$2,952.00
|
| Rate for Payer: United Healthcare All Payer |
$2,706.00
|
|
|
SZR STYL 410 FM RE-STERL 350CC
|
Facility
|
OP
|
$3,075.00
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$2,952.00 |
| Rate for Payer: Aetna Commercial |
$2,367.75
|
| Rate for Payer: Anthem Medicaid |
$1,057.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Cash Price |
$1,537.50
|
| Rate for Payer: Cigna Commercial |
$2,552.25
|
| Rate for Payer: First Health Commercial |
$2,921.25
|
| Rate for Payer: Humana Commercial |
$2,613.75
|
| Rate for Payer: Humana KY Medicaid |
$1,057.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1,068.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,521.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,269.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,078.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,706.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,306.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$615.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$399.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$953.25
|
| Rate for Payer: PHCS Commercial |
$2,952.00
|
| Rate for Payer: United Healthcare All Payer |
$2,706.00
|
|
|
SZR STYL 410 FM RE-STERL 350CC
|
Facility
|
IP
|
$3,075.00
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$2,952.00 |
| Rate for Payer: Aetna Commercial |
$2,367.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Cash Price |
$1,537.50
|
| Rate for Payer: Cigna Commercial |
$2,552.25
|
| Rate for Payer: First Health Commercial |
$2,921.25
|
| Rate for Payer: Humana Commercial |
$2,613.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,521.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,269.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,706.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,306.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$615.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$399.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$953.25
|
| Rate for Payer: PHCS Commercial |
$2,952.00
|
| Rate for Payer: United Healthcare All Payer |
$2,706.00
|
|
|
SZR STYL 410 MM RE-STERL 320CC
|
Facility
|
OP
|
$3,075.00
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$2,952.00 |
| Rate for Payer: Aetna Commercial |
$2,367.75
|
| Rate for Payer: Anthem Medicaid |
$1,057.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Cash Price |
$1,537.50
|
| Rate for Payer: Cigna Commercial |
$2,552.25
|
| Rate for Payer: First Health Commercial |
$2,921.25
|
| Rate for Payer: Humana Commercial |
$2,613.75
|
| Rate for Payer: Humana KY Medicaid |
$1,057.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1,068.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,521.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,269.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,078.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,706.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,306.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$615.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$399.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$953.25
|
| Rate for Payer: PHCS Commercial |
$2,952.00
|
| Rate for Payer: United Healthcare All Payer |
$2,706.00
|
|
|
SZR STYL 410 MM RE-STERL 320CC
|
Facility
|
IP
|
$3,075.00
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$2,952.00 |
| Rate for Payer: Aetna Commercial |
$2,367.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Cash Price |
$1,537.50
|
| Rate for Payer: Cigna Commercial |
$2,552.25
|
| Rate for Payer: First Health Commercial |
$2,921.25
|
| Rate for Payer: Humana Commercial |
$2,613.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,521.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,269.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,706.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,306.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$615.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$399.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$953.25
|
| Rate for Payer: PHCS Commercial |
$2,952.00
|
| Rate for Payer: United Healthcare All Payer |
$2,706.00
|
|
|
SZR STYL 410 MM RE-STERL 360CC
|
Facility
|
IP
|
$3,075.00
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$2,952.00 |
| Rate for Payer: Aetna Commercial |
$2,367.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Cash Price |
$1,537.50
|
| Rate for Payer: Cigna Commercial |
$2,552.25
|
| Rate for Payer: First Health Commercial |
$2,921.25
|
| Rate for Payer: Humana Commercial |
$2,613.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,521.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,269.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,706.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,306.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$615.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$399.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$953.25
|
| Rate for Payer: PHCS Commercial |
$2,952.00
|
| Rate for Payer: United Healthcare All Payer |
$2,706.00
|
|
|
SZR STYL 410 MM RE-STERL 360CC
|
Facility
|
OP
|
$3,075.00
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$2,952.00 |
| Rate for Payer: Aetna Commercial |
$2,367.75
|
| Rate for Payer: Anthem Medicaid |
$1,057.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Cash Price |
$1,537.50
|
| Rate for Payer: Cigna Commercial |
$2,552.25
|
| Rate for Payer: First Health Commercial |
$2,921.25
|
| Rate for Payer: Humana Commercial |
$2,613.75
|
| Rate for Payer: Humana KY Medicaid |
$1,057.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1,068.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,521.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,269.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,078.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,706.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,306.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$615.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$399.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$953.25
|
| Rate for Payer: PHCS Commercial |
$2,952.00
|
| Rate for Payer: United Healthcare All Payer |
$2,706.00
|
|
|
T2 GUIDEWIRE BALL TIP 3*1000
|
Facility
|
IP
|
$1,855.86
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.26 |
| Max. Negotiated Rate |
$1,781.63 |
| Rate for Payer: Aetna Commercial |
$1,429.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,447.57
|
| Rate for Payer: Cash Price |
$927.93
|
| Rate for Payer: Cigna Commercial |
$1,540.36
|
| Rate for Payer: First Health Commercial |
$1,763.07
|
| Rate for Payer: Humana Commercial |
$1,577.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,521.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,369.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$556.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,633.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,391.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$371.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$241.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$575.32
|
| Rate for Payer: PHCS Commercial |
$1,781.63
|
| Rate for Payer: United Healthcare All Payer |
$1,633.16
|
|
|
T2 GUIDEWIRE BALL TIP 3*1000
|
Facility
|
OP
|
$1,855.86
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.26 |
| Max. Negotiated Rate |
$1,781.63 |
| Rate for Payer: Aetna Commercial |
$1,429.01
|
| Rate for Payer: Anthem Medicaid |
$638.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,447.57
|
| Rate for Payer: Cash Price |
$927.93
|
| Rate for Payer: Cigna Commercial |
$1,540.36
|
| Rate for Payer: First Health Commercial |
$1,763.07
|
| Rate for Payer: Humana Commercial |
$1,577.48
|
| Rate for Payer: Humana KY Medicaid |
$638.23
|
| Rate for Payer: Kentucky WC Medicaid |
$644.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,521.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,369.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$556.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$651.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,633.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,391.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$371.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$241.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$575.32
|
| Rate for Payer: PHCS Commercial |
$1,781.63
|
| Rate for Payer: United Healthcare All Payer |
$1,633.16
|
|
|
T2 SCREW FTHRD LOCKING 5*27.5
|
Facility
|
IP
|
$1,832.09
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$238.17 |
| Max. Negotiated Rate |
$1,758.81 |
| Rate for Payer: Aetna Commercial |
$1,410.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,429.03
|
| Rate for Payer: Cash Price |
$916.04
|
| Rate for Payer: Cigna Commercial |
$1,520.63
|
| Rate for Payer: First Health Commercial |
$1,740.49
|
| Rate for Payer: Humana Commercial |
$1,557.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,502.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,352.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$549.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,612.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,374.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$366.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$238.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$567.95
|
| Rate for Payer: PHCS Commercial |
$1,758.81
|
| Rate for Payer: United Healthcare All Payer |
$1,612.24
|
|
|
T2 SCREW FTHRD LOCKING 5*27.5
|
Facility
|
OP
|
$1,832.09
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$238.17 |
| Max. Negotiated Rate |
$1,758.81 |
| Rate for Payer: Aetna Commercial |
$1,410.71
|
| Rate for Payer: Anthem Medicaid |
$630.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,429.03
|
| Rate for Payer: Cash Price |
$916.04
|
| Rate for Payer: Cigna Commercial |
$1,520.63
|
| Rate for Payer: First Health Commercial |
$1,740.49
|
| Rate for Payer: Humana Commercial |
$1,557.28
|
| Rate for Payer: Humana KY Medicaid |
$630.06
|
| Rate for Payer: Kentucky WC Medicaid |
$636.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,502.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,352.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$549.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$642.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,612.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,374.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$366.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$238.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$567.95
|
| Rate for Payer: PHCS Commercial |
$1,758.81
|
| Rate for Payer: United Healthcare All Payer |
$1,612.24
|
|
|
T2 SCREW FTHRD LOCKING 5*32.5
|
Facility
|
IP
|
$1,832.09
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$238.17 |
| Max. Negotiated Rate |
$1,758.81 |
| Rate for Payer: Aetna Commercial |
$1,410.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,429.03
|
| Rate for Payer: Cash Price |
$916.04
|
| Rate for Payer: Cigna Commercial |
$1,520.63
|
| Rate for Payer: First Health Commercial |
$1,740.49
|
| Rate for Payer: Humana Commercial |
$1,557.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,502.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,352.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$549.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,612.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,374.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$366.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$238.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$567.95
|
| Rate for Payer: PHCS Commercial |
$1,758.81
|
| Rate for Payer: United Healthcare All Payer |
$1,612.24
|
|
