|
SURGIMEND COLLAGEN MATRIX 25*4
|
Facility
|
IP
|
$94,100.00
|
|
|
Service Code
|
HCPCS C9358
|
| Hospital Charge Code |
27000074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$28,230.00 |
| Max. Negotiated Rate |
$90,336.00 |
| Rate for Payer: Aetna Commercial |
$72,457.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73,398.00
|
| Rate for Payer: Cash Price |
$47,050.00
|
| Rate for Payer: Cigna Commercial |
$78,103.00
|
| Rate for Payer: First Health Commercial |
$89,395.00
|
| Rate for Payer: Humana Commercial |
$79,985.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77,162.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69,445.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,230.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$82,808.00
|
| Rate for Payer: Ohio Health Group HMO |
$70,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$75,280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$81,867.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$64,929.00
|
| Rate for Payer: PHCS Commercial |
$90,336.00
|
| Rate for Payer: United Healthcare All Payer |
$82,808.00
|
|
|
SURGIMEND MP MESH 10CM*15CM*2M
|
Facility
|
IP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C9358
|
| Hospital Charge Code |
27000074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
SURGIMEND MP MESH 10CM*15CM*2M
|
Facility
|
OP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C9358
|
| Hospital Charge Code |
27000074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem Medicaid |
$5,330.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Humana KY Medicaid |
$5,330.45
|
| Rate for Payer: Kentucky WC Medicaid |
$5,384.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,437.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
SURGIMEND MP MESH 16CM*20CM*2M
|
Facility
|
IP
|
$23,000.00
|
|
|
Service Code
|
HCPCS C9358
|
| Hospital Charge Code |
27000074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,900.00 |
| Max. Negotiated Rate |
$22,080.00 |
| Rate for Payer: Aetna Commercial |
$17,710.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,940.00
|
| Rate for Payer: Cash Price |
$11,500.00
|
| Rate for Payer: Cigna Commercial |
$19,090.00
|
| Rate for Payer: First Health Commercial |
$21,850.00
|
| Rate for Payer: Humana Commercial |
$19,550.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,860.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,974.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,900.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,240.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,010.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,870.00
|
| Rate for Payer: PHCS Commercial |
$22,080.00
|
| Rate for Payer: United Healthcare All Payer |
$20,240.00
|
|
|
SURGIMEND MP MESH 16CM*20CM*2M
|
Facility
|
OP
|
$23,000.00
|
|
|
Service Code
|
HCPCS C9358
|
| Hospital Charge Code |
27000074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,900.00 |
| Max. Negotiated Rate |
$22,080.00 |
| Rate for Payer: Aetna Commercial |
$17,710.00
|
| Rate for Payer: Anthem Medicaid |
$7,909.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,940.00
|
| Rate for Payer: Cash Price |
$11,500.00
|
| Rate for Payer: Cigna Commercial |
$19,090.00
|
| Rate for Payer: First Health Commercial |
$21,850.00
|
| Rate for Payer: Humana Commercial |
$19,550.00
|
| Rate for Payer: Humana KY Medicaid |
$7,909.70
|
| Rate for Payer: Kentucky WC Medicaid |
$7,990.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,860.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,974.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,900.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,068.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,240.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,010.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,870.00
|
| Rate for Payer: PHCS Commercial |
$22,080.00
|
| Rate for Payer: United Healthcare All Payer |
$20,240.00
|
|
|
SURGIMEND PRS MESH 10CM*15CM
|
Facility
|
OP
|
$17,165.00
|
|
|
Service Code
|
HCPCS C9358
|
| Hospital Charge Code |
27000074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,149.50 |
| Max. Negotiated Rate |
$16,478.40 |
| Rate for Payer: Aetna Commercial |
$13,217.05
|
| Rate for Payer: Anthem Medicaid |
$5,903.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,388.70
|
| Rate for Payer: Cash Price |
$8,582.50
|
| Rate for Payer: Cigna Commercial |
$14,246.95
|
| Rate for Payer: First Health Commercial |
$16,306.75
|
| Rate for Payer: Humana Commercial |
$14,590.25
|
| Rate for Payer: Humana KY Medicaid |
$5,903.04
|
| Rate for Payer: Kentucky WC Medicaid |
$5,963.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,075.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,667.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,149.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,021.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,105.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,873.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,732.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,933.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,843.85
|
| Rate for Payer: PHCS Commercial |
$16,478.40
|
| Rate for Payer: United Healthcare All Payer |
$15,105.20
|
|
|
SURGIMEND PRS MESH 10CM*15CM
|
Facility
|
IP
|
$17,165.00
|
|
|
Service Code
|
HCPCS C9358
|
| Hospital Charge Code |
27000074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,149.50 |
| Max. Negotiated Rate |
$16,478.40 |
| Rate for Payer: Aetna Commercial |
$13,217.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,388.70
|
| Rate for Payer: Cash Price |
$8,582.50
|
| Rate for Payer: Cigna Commercial |
$14,246.95
|
| Rate for Payer: First Health Commercial |
$16,306.75
|
| Rate for Payer: Humana Commercial |
$14,590.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,075.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,667.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,149.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,105.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,873.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,732.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,933.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,843.85
|
| Rate for Payer: PHCS Commercial |
$16,478.40
|
| Rate for Payer: United Healthcare All Payer |
$15,105.20
|
|
|
SURGIMEND PRS MESH 20CM*10CM
|
Facility
|
OP
|
$30,875.00
|
|
|
Service Code
|
HCPCS C9358
|
| Hospital Charge Code |
27000074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,262.50 |
| Max. Negotiated Rate |
$29,640.00 |
| Rate for Payer: Aetna Commercial |
$23,773.75
|
| Rate for Payer: Anthem Medicaid |
$10,617.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,082.50
|
| Rate for Payer: Cash Price |
$15,437.50
|
| Rate for Payer: Cigna Commercial |
$25,626.25
|
| Rate for Payer: First Health Commercial |
$29,331.25
|
| Rate for Payer: Humana Commercial |
$26,243.75
|
| Rate for Payer: Humana KY Medicaid |
$10,617.91
|
| Rate for Payer: Kentucky WC Medicaid |
$10,725.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,317.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,785.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,262.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,830.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,170.00
|
| Rate for Payer: Ohio Health Group HMO |
$23,156.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26,861.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,303.75
|
| Rate for Payer: PHCS Commercial |
$29,640.00
|
| Rate for Payer: United Healthcare All Payer |
$27,170.00
|
|
|
SURGIMEND PRS MESH 20CM*10CM
|
Facility
|
IP
|
$30,875.00
|
|
|
Service Code
|
HCPCS C9358
|
| Hospital Charge Code |
27000074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,262.50 |
| Max. Negotiated Rate |
$29,640.00 |
| Rate for Payer: Aetna Commercial |
$23,773.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,082.50
|
| Rate for Payer: Cash Price |
$15,437.50
|
| Rate for Payer: Cigna Commercial |
$25,626.25
|
| Rate for Payer: First Health Commercial |
$29,331.25
|
| Rate for Payer: Humana Commercial |
$26,243.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,317.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,785.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,262.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,170.00
|
| Rate for Payer: Ohio Health Group HMO |
$23,156.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26,861.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,303.75
|
| Rate for Payer: PHCS Commercial |
$29,640.00
|
| Rate for Payer: United Healthcare All Payer |
$27,170.00
|
|
|
SURG STEEL MONO SUTURE 18*5
|
Facility
|
IP
|
$1,212.40
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$363.72 |
| Max. Negotiated Rate |
$1,163.90 |
| Rate for Payer: Aetna Commercial |
$933.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$945.67
|
| Rate for Payer: Cash Price |
$606.20
|
| Rate for Payer: Cigna Commercial |
$1,006.29
|
| Rate for Payer: First Health Commercial |
$1,151.78
|
| Rate for Payer: Humana Commercial |
$1,030.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$994.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$894.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$363.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,066.91
|
| Rate for Payer: Ohio Health Group HMO |
$909.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$969.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,054.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$836.56
|
| Rate for Payer: PHCS Commercial |
$1,163.90
|
| Rate for Payer: United Healthcare All Payer |
$1,066.91
|
|
|
SURG STEEL MONO SUTURE 18*5
|
Facility
|
OP
|
$1,212.40
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$363.72 |
| Max. Negotiated Rate |
$1,163.90 |
| Rate for Payer: Aetna Commercial |
$933.55
|
| Rate for Payer: Anthem Medicaid |
$416.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$945.67
|
| Rate for Payer: Cash Price |
$606.20
|
| Rate for Payer: Cigna Commercial |
$1,006.29
|
| Rate for Payer: First Health Commercial |
$1,151.78
|
| Rate for Payer: Humana Commercial |
$1,030.54
|
| Rate for Payer: Humana KY Medicaid |
$416.94
|
| Rate for Payer: Kentucky WC Medicaid |
$421.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$994.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$894.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$363.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$425.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,066.91
|
| Rate for Payer: Ohio Health Group HMO |
$909.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$969.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,054.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$836.56
|
| Rate for Payer: PHCS Commercial |
$1,163.90
|
| Rate for Payer: United Healthcare All Payer |
$1,066.91
|
|
|
SURG TREATMENT OF ANAL FISS
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 46270
|
| Hospital Charge Code |
76101922
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$162.14 |
| Max. Negotiated Rate |
$532.60 |
| Rate for Payer: Aetna Commercial |
$506.32
|
| Rate for Payer: Ambetter Exchange |
$380.44
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$207.12
|
| Rate for Payer: Anthem Medicaid |
$162.14
|
| Rate for Payer: Buckeye Individual/Medicaid |
$380.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$380.44
|
| Rate for Payer: CareSource Just4Me Medicare |
$456.53
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$452.11
|
| Rate for Payer: Healthspan PPO |
$532.60
|
| Rate for Payer: Humana Medicaid |
$162.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$475.64
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$380.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$380.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$165.38
|
| Rate for Payer: Molina Healthcare Passport |
$162.14
|
| Rate for Payer: Multiplan PHCS |
$510.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$494.57
|
| Rate for Payer: UHCCP Medicaid |
$217.48
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$163.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$380.44
|
|
|
SURG TREATMENT OF ANAL FISS
|
Facility
|
OP
|
$850.00
|
|
|
Service Code
|
HCPCS 46270
|
| Hospital Charge Code |
76101922
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$292.31 |
| Max. Negotiated Rate |
$3,547.47 |
| Rate for Payer: Aetna Commercial |
$654.50
|
| Rate for Payer: Anthem Medicaid |
$292.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,533.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$663.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,547.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,420.78
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$705.50
|
| Rate for Payer: First Health Commercial |
$807.50
|
| Rate for Payer: Humana Commercial |
$722.50
|
| Rate for Payer: Humana KY Medicaid |
$292.31
|
| Rate for Payer: Humana Medicare Advantage |
$2,533.91
|
| Rate for Payer: Kentucky WC Medicaid |
$295.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$697.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$627.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,040.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$298.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$748.00
|
| Rate for Payer: Ohio Health Group HMO |
$637.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$739.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$586.50
|
| Rate for Payer: PHCS Commercial |
$816.00
|
| Rate for Payer: United Healthcare All Payer |
$748.00
|
|
|
SURG TREATMENT OF ANAL FISS
|
Facility
|
IP
|
$850.00
|
|
|
Service Code
|
HCPCS 46270
|
| Hospital Charge Code |
76101922
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$255.00 |
| Max. Negotiated Rate |
$816.00 |
| Rate for Payer: Aetna Commercial |
$654.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$663.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$705.50
|
| Rate for Payer: First Health Commercial |
$807.50
|
| Rate for Payer: Humana Commercial |
$722.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$697.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$627.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$255.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$748.00
|
| Rate for Payer: Ohio Health Group HMO |
$637.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$739.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$586.50
|
| Rate for Payer: PHCS Commercial |
$816.00
|
| Rate for Payer: United Healthcare All Payer |
$748.00
|
|
|
SURG TREATMENT OF ANAL FISS(P
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 46270
|
| Hospital Charge Code |
761P1922
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$162.14 |
| Max. Negotiated Rate |
$532.60 |
| Rate for Payer: Aetna Commercial |
$506.32
|
| Rate for Payer: Ambetter Exchange |
$380.44
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$207.12
|
| Rate for Payer: Anthem Medicaid |
$162.14
|
| Rate for Payer: Buckeye Individual/Medicaid |
$380.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$380.44
|
| Rate for Payer: CareSource Just4Me Medicare |
$456.53
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$452.11
|
| Rate for Payer: Healthspan PPO |
$532.60
|
| Rate for Payer: Humana Medicaid |
$162.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$475.64
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$380.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$380.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$165.38
|
| Rate for Payer: Molina Healthcare Passport |
$162.14
|
| Rate for Payer: Multiplan PHCS |
$510.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$494.57
|
| Rate for Payer: UHCCP Medicaid |
$217.48
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$163.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$380.44
|
|
|
SURG VENT RESTORATION
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS 33548
|
| Hospital Charge Code |
76101312
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
SURG VENT RESTORATION
|
Professional
|
Both
|
$5,000.00
|
|
|
Service Code
|
HCPCS 33548
|
| Hospital Charge Code |
76101312
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,750.00 |
| Max. Negotiated Rate |
$4,998.65 |
| Rate for Payer: Aetna Commercial |
$4,998.65
|
| Rate for Payer: Ambetter Exchange |
$2,760.45
|
| Rate for Payer: Anthem Medicaid |
$1,763.03
|
| Rate for Payer: Buckeye Individual/Medicaid |
$2,760.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,760.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,312.54
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,622.60
|
| Rate for Payer: Healthspan PPO |
$4,914.65
|
| Rate for Payer: Humana Medicaid |
$1,763.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$4,214.70
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$2,760.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,760.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,798.29
|
| Rate for Payer: Molina Healthcare Passport |
$1,763.03
|
| Rate for Payer: Multiplan PHCS |
$3,000.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,588.59
|
| Rate for Payer: UHCCP Medicaid |
$1,750.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,780.66
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,760.45
|
|
|
SURG VENT RESTORATION
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS 33548
|
| Hospital Charge Code |
76101312
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
SURG VENT RESTORATION(P
|
Professional
|
Both
|
$5,000.00
|
|
|
Service Code
|
HCPCS 33548
|
| Hospital Charge Code |
761P1312
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,750.00 |
| Max. Negotiated Rate |
$4,998.65 |
| Rate for Payer: Aetna Commercial |
$4,998.65
|
| Rate for Payer: Ambetter Exchange |
$2,760.45
|
| Rate for Payer: Anthem Medicaid |
$1,763.03
|
| Rate for Payer: Buckeye Individual/Medicaid |
$2,760.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,760.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,312.54
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,622.60
|
| Rate for Payer: Healthspan PPO |
$4,914.65
|
| Rate for Payer: Humana Medicaid |
$1,763.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$4,214.70
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$2,760.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,760.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,798.29
|
| Rate for Payer: Molina Healthcare Passport |
$1,763.03
|
| Rate for Payer: Multiplan PHCS |
$3,000.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,588.59
|
| Rate for Payer: UHCCP Medicaid |
$1,750.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,780.66
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,760.45
|
|
|
SURMONTIL 50MG CAPSULE
|
Facility
|
OP
|
$12.50
|
|
|
Service Code
|
NDC 51991094501
|
| Hospital Charge Code |
25001454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.75 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: Aetna Commercial |
$9.62
|
| Rate for Payer: Anthem Medicaid |
$4.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.75
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cigna Commercial |
$10.38
|
| Rate for Payer: First Health Commercial |
$11.88
|
| Rate for Payer: Humana Commercial |
$10.62
|
| Rate for Payer: Humana KY Medicaid |
$4.30
|
| Rate for Payer: Kentucky WC Medicaid |
$4.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$11.00
|
| Rate for Payer: Ohio Health Group HMO |
$9.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.62
|
| Rate for Payer: PHCS Commercial |
$12.00
|
| Rate for Payer: United Healthcare All Payer |
$11.00
|
|
|
SURMONTIL 50MG CAPSULE
|
Facility
|
IP
|
$12.50
|
|
|
Service Code
|
NDC 51991094501
|
| Hospital Charge Code |
25001454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.75 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: Aetna Commercial |
$9.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.75
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cigna Commercial |
$10.38
|
| Rate for Payer: First Health Commercial |
$11.88
|
| Rate for Payer: Humana Commercial |
$10.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$11.00
|
| Rate for Payer: Ohio Health Group HMO |
$9.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.62
|
| Rate for Payer: PHCS Commercial |
$12.00
|
| Rate for Payer: United Healthcare All Payer |
$11.00
|
|
|
SURMONTIL(TRIMIPRAMINE)25MGCAP
|
Facility
|
OP
|
$10.70
|
|
|
Service Code
|
NDC 51991094401
|
| Hospital Charge Code |
25001455
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$10.27 |
| Rate for Payer: Aetna Commercial |
$8.24
|
| Rate for Payer: Anthem Medicaid |
$3.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.35
|
| Rate for Payer: Cash Price |
$5.35
|
| Rate for Payer: Cigna Commercial |
$8.88
|
| Rate for Payer: First Health Commercial |
$10.16
|
| Rate for Payer: Humana Commercial |
$9.10
|
| Rate for Payer: Humana KY Medicaid |
$3.68
|
| Rate for Payer: Kentucky WC Medicaid |
$3.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.42
|
| Rate for Payer: Ohio Health Group HMO |
$8.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.38
|
| Rate for Payer: PHCS Commercial |
$10.27
|
| Rate for Payer: United Healthcare All Payer |
$9.42
|
|
|
SURMONTIL(TRIMIPRAMINE)25MGCAP
|
Facility
|
IP
|
$10.70
|
|
|
Service Code
|
NDC 51991094401
|
| Hospital Charge Code |
25001455
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$10.27 |
| Rate for Payer: Aetna Commercial |
$8.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.35
|
| Rate for Payer: Cash Price |
$5.35
|
| Rate for Payer: Cigna Commercial |
$8.88
|
| Rate for Payer: First Health Commercial |
$10.16
|
| Rate for Payer: Humana Commercial |
$9.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$9.42
|
| Rate for Payer: Ohio Health Group HMO |
$8.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.38
|
| Rate for Payer: PHCS Commercial |
$10.27
|
| Rate for Payer: United Healthcare All Payer |
$9.42
|
|
|
SUSCEPTIBILITY E TEST
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
HCPCS 87181
|
| Hospital Charge Code |
30001318
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.75 |
| Max. Negotiated Rate |
$33.60 |
| Rate for Payer: Aetna Commercial |
$26.95
|
| Rate for Payer: Anthem Medicaid |
$4.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28.11
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.75
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cigna Commercial |
$29.05
|
| Rate for Payer: First Health Commercial |
$33.25
|
| Rate for Payer: Humana Commercial |
$29.75
|
| Rate for Payer: Humana KY Medicaid |
$4.75
|
| Rate for Payer: Humana Medicare Advantage |
$4.75
|
| Rate for Payer: Kentucky WC Medicaid |
$4.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$30.80
|
| Rate for Payer: Ohio Health Group HMO |
$26.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.15
|
| Rate for Payer: PHCS Commercial |
$33.60
|
| Rate for Payer: United Healthcare All Payer |
$30.80
|
|
|
SUSCEPTIBILITY E TEST
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
HCPCS 87181
|
| Hospital Charge Code |
30001318
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$33.60 |
| Rate for Payer: Aetna Commercial |
$26.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28.11
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cigna Commercial |
$29.05
|
| Rate for Payer: First Health Commercial |
$33.25
|
| Rate for Payer: Humana Commercial |
$29.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$30.80
|
| Rate for Payer: Ohio Health Group HMO |
$26.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.15
|
| Rate for Payer: PHCS Commercial |
$33.60
|
| Rate for Payer: United Healthcare All Payer |
$30.80
|
|
