|
SUTURE SMALL INTESTINE(P
|
Professional
|
Both
|
$2,124.00
|
|
|
Service Code
|
HCPCS 44603
|
| Hospital Charge Code |
761P1855
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$671.14 |
| Max. Negotiated Rate |
$2,266.28 |
| Rate for Payer: Aetna Commercial |
$2,266.28
|
| Rate for Payer: Ambetter Exchange |
$1,536.45
|
| Rate for Payer: Anthem Medicaid |
$671.14
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,536.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,536.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,843.74
|
| Rate for Payer: Cash Price |
$1,062.00
|
| Rate for Payer: Cash Price |
$1,062.00
|
| Rate for Payer: Cigna Commercial |
$2,051.23
|
| Rate for Payer: Healthspan PPO |
$1,911.19
|
| Rate for Payer: Humana Medicaid |
$671.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,059.23
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,536.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,536.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$684.56
|
| Rate for Payer: Molina Healthcare Passport |
$671.14
|
| Rate for Payer: Multiplan PHCS |
$1,274.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,997.38
|
| Rate for Payer: UHCCP Medicaid |
$743.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$677.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,536.45
|
|
|
SUTURETAK ANCHOR 3MM*14.5MM
|
Facility
|
IP
|
$3,200.94
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$960.28 |
| Max. Negotiated Rate |
$3,072.90 |
| Rate for Payer: Aetna Commercial |
$2,464.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,496.73
|
| Rate for Payer: Cash Price |
$1,600.47
|
| Rate for Payer: Cigna Commercial |
$2,656.78
|
| Rate for Payer: First Health Commercial |
$3,040.89
|
| Rate for Payer: Humana Commercial |
$2,720.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,624.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,362.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$960.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,816.83
|
| Rate for Payer: Ohio Health Group HMO |
$2,400.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,560.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,784.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,208.65
|
| Rate for Payer: PHCS Commercial |
$3,072.90
|
| Rate for Payer: United Healthcare All Payer |
$2,816.83
|
|
|
SUTURETAK ANCHOR 3MM*14.5MM
|
Facility
|
OP
|
$3,200.94
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$960.28 |
| Max. Negotiated Rate |
$3,072.90 |
| Rate for Payer: Aetna Commercial |
$2,464.72
|
| Rate for Payer: Anthem Medicaid |
$1,100.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,496.73
|
| Rate for Payer: Cash Price |
$1,600.47
|
| Rate for Payer: Cigna Commercial |
$2,656.78
|
| Rate for Payer: First Health Commercial |
$3,040.89
|
| Rate for Payer: Humana Commercial |
$2,720.80
|
| Rate for Payer: Humana KY Medicaid |
$1,100.80
|
| Rate for Payer: Kentucky WC Medicaid |
$1,112.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,624.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,362.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$960.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,122.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,816.83
|
| Rate for Payer: Ohio Health Group HMO |
$2,400.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,560.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,784.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,208.65
|
| Rate for Payer: PHCS Commercial |
$3,072.90
|
| Rate for Payer: United Healthcare All Payer |
$2,816.83
|
|
|
SUTURTAPE 0.9MM
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem Medicaid |
$275.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Humana KY Medicaid |
$275.12
|
| Rate for Payer: Kentucky WC Medicaid |
$277.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$280.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
SUTURTAPE 0.9MM
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
SVCU ROOM RATE
|
Facility
|
IP
|
$1,790.00
|
|
| Hospital Charge Code |
11000010
|
|
Hospital Revenue Code
|
110
|
| Min. Negotiated Rate |
$537.00 |
| Max. Negotiated Rate |
$1,718.40 |
| Rate for Payer: Aetna Commercial |
$1,378.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,396.20
|
| Rate for Payer: Cash Price |
$895.00
|
| Rate for Payer: Cigna Commercial |
$1,485.70
|
| Rate for Payer: First Health Commercial |
$1,700.50
|
| Rate for Payer: Humana Commercial |
$1,521.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,467.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,321.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$537.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,575.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,342.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,432.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,557.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,235.10
|
| Rate for Payer: PHCS Commercial |
$1,718.40
|
| Rate for Payer: United Healthcare All Payer |
$1,575.20
|
|
|
SWAN-GANZ PACING TD CATH 7FR
|
Facility
|
OP
|
$3,846.35
|
|
|
Service Code
|
HCPCS C1730
|
| Hospital Charge Code |
27000037
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,153.90 |
| Max. Negotiated Rate |
$3,692.50 |
| Rate for Payer: Aetna Commercial |
$2,961.69
|
| Rate for Payer: Anthem Medicaid |
$1,322.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,000.15
|
| Rate for Payer: Cash Price |
$1,923.17
|
| Rate for Payer: Cigna Commercial |
$3,192.47
|
| Rate for Payer: First Health Commercial |
$3,654.03
|
| Rate for Payer: Humana Commercial |
$3,269.40
|
| Rate for Payer: Humana KY Medicaid |
$1,322.76
|
| Rate for Payer: Kentucky WC Medicaid |
$1,336.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,154.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,838.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,153.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,349.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,384.79
|
| Rate for Payer: Ohio Health Group HMO |
$2,884.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,077.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,346.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,653.98
|
| Rate for Payer: PHCS Commercial |
$3,692.50
|
| Rate for Payer: United Healthcare All Payer |
$3,384.79
|
|
|
SWAN-GANZ PACING TD CATH 7FR
|
Facility
|
IP
|
$3,846.35
|
|
|
Service Code
|
HCPCS C1730
|
| Hospital Charge Code |
27000037
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,153.90 |
| Max. Negotiated Rate |
$3,692.50 |
| Rate for Payer: Aetna Commercial |
$2,961.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,000.15
|
| Rate for Payer: Cash Price |
$1,923.17
|
| Rate for Payer: Cigna Commercial |
$3,192.47
|
| Rate for Payer: First Health Commercial |
$3,654.03
|
| Rate for Payer: Humana Commercial |
$3,269.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,154.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,838.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,153.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,384.79
|
| Rate for Payer: Ohio Health Group HMO |
$2,884.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,077.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,346.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,653.98
|
| Rate for Payer: PHCS Commercial |
$3,692.50
|
| Rate for Payer: United Healthcare All Payer |
$3,384.79
|
|
|
SWANSN MP JOINT IMP KIT WO/SIZ
|
Facility
|
IP
|
$17,105.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,131.74 |
| Max. Negotiated Rate |
$16,421.57 |
| Rate for Payer: Aetna Commercial |
$13,171.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,342.52
|
| Rate for Payer: Cash Price |
$8,552.90
|
| Rate for Payer: Cigna Commercial |
$14,197.81
|
| Rate for Payer: First Health Commercial |
$16,250.51
|
| Rate for Payer: Humana Commercial |
$14,539.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,026.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,624.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,131.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,053.10
|
| Rate for Payer: Ohio Health Group HMO |
$12,829.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,684.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,882.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,803.00
|
| Rate for Payer: PHCS Commercial |
$16,421.57
|
| Rate for Payer: United Healthcare All Payer |
$15,053.10
|
|
|
SWANSN MP JOINT IMP KIT WO/SIZ
|
Facility
|
OP
|
$17,105.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,131.74 |
| Max. Negotiated Rate |
$16,421.57 |
| Rate for Payer: Aetna Commercial |
$13,171.47
|
| Rate for Payer: Anthem Medicaid |
$5,882.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,342.52
|
| Rate for Payer: Cash Price |
$8,552.90
|
| Rate for Payer: Cigna Commercial |
$14,197.81
|
| Rate for Payer: First Health Commercial |
$16,250.51
|
| Rate for Payer: Humana Commercial |
$14,539.93
|
| Rate for Payer: Humana KY Medicaid |
$5,882.68
|
| Rate for Payer: Kentucky WC Medicaid |
$5,942.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,026.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,624.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,131.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,000.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,053.10
|
| Rate for Payer: Ohio Health Group HMO |
$12,829.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,684.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,882.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,803.00
|
| Rate for Payer: PHCS Commercial |
$16,421.57
|
| Rate for Payer: United Healthcare All Payer |
$15,053.10
|
|
|
SWANSON CARPAL SCAPHOID #1 R
|
Facility
|
OP
|
$20,026.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,007.88 |
| Max. Negotiated Rate |
$19,225.20 |
| Rate for Payer: Aetna Commercial |
$15,420.21
|
| Rate for Payer: Anthem Medicaid |
$6,887.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,620.48
|
| Rate for Payer: Cash Price |
$10,013.12
|
| Rate for Payer: Cigna Commercial |
$16,621.79
|
| Rate for Payer: First Health Commercial |
$19,024.94
|
| Rate for Payer: Humana Commercial |
$17,022.31
|
| Rate for Payer: Humana KY Medicaid |
$6,887.03
|
| Rate for Payer: Kentucky WC Medicaid |
$6,957.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,421.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,779.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,007.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,025.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,623.10
|
| Rate for Payer: Ohio Health Group HMO |
$15,019.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,021.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,422.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,818.11
|
| Rate for Payer: PHCS Commercial |
$19,225.20
|
| Rate for Payer: United Healthcare All Payer |
$17,623.10
|
|
|
SWANSON CARPAL SCAPHOID #1 R
|
Facility
|
IP
|
$20,026.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,007.88 |
| Max. Negotiated Rate |
$19,225.20 |
| Rate for Payer: Aetna Commercial |
$15,420.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,620.48
|
| Rate for Payer: Cash Price |
$10,013.12
|
| Rate for Payer: Cigna Commercial |
$16,621.79
|
| Rate for Payer: First Health Commercial |
$19,024.94
|
| Rate for Payer: Humana Commercial |
$17,022.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,421.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,779.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,007.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,623.10
|
| Rate for Payer: Ohio Health Group HMO |
$15,019.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,021.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,422.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,818.11
|
| Rate for Payer: PHCS Commercial |
$19,225.20
|
| Rate for Payer: United Healthcare All Payer |
$17,623.10
|
|
|
SWANSON CARPAL SCAPHOID #2 R
|
Facility
|
OP
|
$21,878.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,563.62 |
| Max. Negotiated Rate |
$21,003.60 |
| Rate for Payer: Aetna Commercial |
$16,846.64
|
| Rate for Payer: Anthem Medicaid |
$7,524.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,065.42
|
| Rate for Payer: Cash Price |
$10,939.38
|
| Rate for Payer: Cigna Commercial |
$18,159.36
|
| Rate for Payer: First Health Commercial |
$20,784.81
|
| Rate for Payer: Humana Commercial |
$18,596.94
|
| Rate for Payer: Humana KY Medicaid |
$7,524.10
|
| Rate for Payer: Kentucky WC Medicaid |
$7,600.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,940.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,146.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,563.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,675.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,253.30
|
| Rate for Payer: Ohio Health Group HMO |
$16,409.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,503.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,034.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,096.34
|
| Rate for Payer: PHCS Commercial |
$21,003.60
|
| Rate for Payer: United Healthcare All Payer |
$19,253.30
|
|
|
SWANSON CARPAL SCAPHOID #2 R
|
Facility
|
IP
|
$21,878.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,563.62 |
| Max. Negotiated Rate |
$21,003.60 |
| Rate for Payer: Aetna Commercial |
$16,846.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,065.42
|
| Rate for Payer: Cash Price |
$10,939.38
|
| Rate for Payer: Cigna Commercial |
$18,159.36
|
| Rate for Payer: First Health Commercial |
$20,784.81
|
| Rate for Payer: Humana Commercial |
$18,596.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,940.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,146.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,563.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,253.30
|
| Rate for Payer: Ohio Health Group HMO |
$16,409.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,503.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,034.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,096.34
|
| Rate for Payer: PHCS Commercial |
$21,003.60
|
| Rate for Payer: United Healthcare All Payer |
$19,253.30
|
|
|
SWANSON FINGER WIRE .035
|
Facility
|
OP
|
$484.07
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$145.22 |
| Max. Negotiated Rate |
$464.71 |
| Rate for Payer: Aetna Commercial |
$372.73
|
| Rate for Payer: Anthem Medicaid |
$166.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$377.57
|
| Rate for Payer: Cash Price |
$242.04
|
| Rate for Payer: Cigna Commercial |
$401.78
|
| Rate for Payer: First Health Commercial |
$459.87
|
| Rate for Payer: Humana Commercial |
$411.46
|
| Rate for Payer: Humana KY Medicaid |
$166.47
|
| Rate for Payer: Kentucky WC Medicaid |
$168.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$396.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$357.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$145.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$169.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$425.98
|
| Rate for Payer: Ohio Health Group HMO |
$363.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$387.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$421.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$334.01
|
| Rate for Payer: PHCS Commercial |
$464.71
|
| Rate for Payer: United Healthcare All Payer |
$425.98
|
|
|
SWANSON FINGER WIRE .035
|
Facility
|
IP
|
$484.07
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$145.22 |
| Max. Negotiated Rate |
$464.71 |
| Rate for Payer: Aetna Commercial |
$372.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$377.57
|
| Rate for Payer: Cash Price |
$242.04
|
| Rate for Payer: Cigna Commercial |
$401.78
|
| Rate for Payer: First Health Commercial |
$459.87
|
| Rate for Payer: Humana Commercial |
$411.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$396.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$357.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$145.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$425.98
|
| Rate for Payer: Ohio Health Group HMO |
$363.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$387.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$421.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$334.01
|
| Rate for Payer: PHCS Commercial |
$464.71
|
| Rate for Payer: United Healthcare All Payer |
$425.98
|
|
|
SWANSON FINGER WIRE .045
|
Facility
|
OP
|
$484.07
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$145.22 |
| Max. Negotiated Rate |
$464.71 |
| Rate for Payer: Aetna Commercial |
$372.73
|
| Rate for Payer: Anthem Medicaid |
$166.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$377.57
|
| Rate for Payer: Cash Price |
$242.04
|
| Rate for Payer: Cigna Commercial |
$401.78
|
| Rate for Payer: First Health Commercial |
$459.87
|
| Rate for Payer: Humana Commercial |
$411.46
|
| Rate for Payer: Humana KY Medicaid |
$166.47
|
| Rate for Payer: Kentucky WC Medicaid |
$168.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$396.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$357.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$145.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$169.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$425.98
|
| Rate for Payer: Ohio Health Group HMO |
$363.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$387.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$421.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$334.01
|
| Rate for Payer: PHCS Commercial |
$464.71
|
| Rate for Payer: United Healthcare All Payer |
$425.98
|
|
|
SWANSON FINGER WIRE .045
|
Facility
|
IP
|
$484.07
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$145.22 |
| Max. Negotiated Rate |
$464.71 |
| Rate for Payer: Aetna Commercial |
$372.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$377.57
|
| Rate for Payer: Cash Price |
$242.04
|
| Rate for Payer: Cigna Commercial |
$401.78
|
| Rate for Payer: First Health Commercial |
$459.87
|
| Rate for Payer: Humana Commercial |
$411.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$396.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$357.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$145.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$425.98
|
| Rate for Payer: Ohio Health Group HMO |
$363.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$387.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$421.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$334.01
|
| Rate for Payer: PHCS Commercial |
$464.71
|
| Rate for Payer: United Healthcare All Payer |
$425.98
|
|
|
SWANSON FINGER WIRE .062
|
Facility
|
IP
|
$484.07
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$145.22 |
| Max. Negotiated Rate |
$464.71 |
| Rate for Payer: Aetna Commercial |
$372.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$377.57
|
| Rate for Payer: Cash Price |
$242.04
|
| Rate for Payer: Cigna Commercial |
$401.78
|
| Rate for Payer: First Health Commercial |
$459.87
|
| Rate for Payer: Humana Commercial |
$411.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$396.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$357.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$145.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$425.98
|
| Rate for Payer: Ohio Health Group HMO |
$363.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$387.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$421.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$334.01
|
| Rate for Payer: PHCS Commercial |
$464.71
|
| Rate for Payer: United Healthcare All Payer |
$425.98
|
|
|
SWANSON FINGER WIRE .062
|
Facility
|
OP
|
$484.07
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$145.22 |
| Max. Negotiated Rate |
$464.71 |
| Rate for Payer: Aetna Commercial |
$372.73
|
| Rate for Payer: Anthem Medicaid |
$166.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$377.57
|
| Rate for Payer: Cash Price |
$242.04
|
| Rate for Payer: Cigna Commercial |
$401.78
|
| Rate for Payer: First Health Commercial |
$459.87
|
| Rate for Payer: Humana Commercial |
$411.46
|
| Rate for Payer: Humana KY Medicaid |
$166.47
|
| Rate for Payer: Kentucky WC Medicaid |
$168.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$396.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$357.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$145.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$169.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$425.98
|
| Rate for Payer: Ohio Health Group HMO |
$363.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$387.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$421.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$334.01
|
| Rate for Payer: PHCS Commercial |
$464.71
|
| Rate for Payer: United Healthcare All Payer |
$425.98
|
|
|
SWANSON MP JOINT IMP KIT W/SZR
|
Facility
|
IP
|
$8,767.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,630.10 |
| Max. Negotiated Rate |
$8,416.32 |
| Rate for Payer: Aetna Commercial |
$6,750.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,838.26
|
| Rate for Payer: Cash Price |
$4,383.50
|
| Rate for Payer: Cigna Commercial |
$7,276.61
|
| Rate for Payer: First Health Commercial |
$8,328.65
|
| Rate for Payer: Humana Commercial |
$7,451.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,188.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,470.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,630.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,714.96
|
| Rate for Payer: Ohio Health Group HMO |
$6,575.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,013.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,627.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,049.23
|
| Rate for Payer: PHCS Commercial |
$8,416.32
|
| Rate for Payer: United Healthcare All Payer |
$7,714.96
|
|
|
SWANSON MP JOINT IMP KIT W/SZR
|
Facility
|
OP
|
$8,767.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,630.10 |
| Max. Negotiated Rate |
$8,416.32 |
| Rate for Payer: Aetna Commercial |
$6,750.59
|
| Rate for Payer: Anthem Medicaid |
$3,014.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,838.26
|
| Rate for Payer: Cash Price |
$4,383.50
|
| Rate for Payer: Cigna Commercial |
$7,276.61
|
| Rate for Payer: First Health Commercial |
$8,328.65
|
| Rate for Payer: Humana Commercial |
$7,451.95
|
| Rate for Payer: Humana KY Medicaid |
$3,014.97
|
| Rate for Payer: Kentucky WC Medicaid |
$3,045.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,188.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,470.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,630.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,075.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,714.96
|
| Rate for Payer: Ohio Health Group HMO |
$6,575.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,013.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,627.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,049.23
|
| Rate for Payer: PHCS Commercial |
$8,416.32
|
| Rate for Payer: United Healthcare All Payer |
$7,714.96
|
|
|
SWANSON PIP IMP SZ 0
|
Facility
|
IP
|
$7,025.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,107.78 |
| Max. Negotiated Rate |
$6,744.91 |
| Rate for Payer: Aetna Commercial |
$5,409.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,480.24
|
| Rate for Payer: Cash Price |
$3,512.98
|
| Rate for Payer: Cigna Commercial |
$5,831.54
|
| Rate for Payer: First Health Commercial |
$6,674.65
|
| Rate for Payer: Humana Commercial |
$5,972.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,761.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,185.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,107.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,182.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,269.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,620.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,112.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,847.91
|
| Rate for Payer: PHCS Commercial |
$6,744.91
|
| Rate for Payer: United Healthcare All Payer |
$6,182.84
|
|
|
SWANSON PIP IMP SZ 0
|
Facility
|
OP
|
$7,025.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,107.78 |
| Max. Negotiated Rate |
$6,744.91 |
| Rate for Payer: Aetna Commercial |
$5,409.98
|
| Rate for Payer: Anthem Medicaid |
$2,416.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,480.24
|
| Rate for Payer: Cash Price |
$3,512.98
|
| Rate for Payer: Cigna Commercial |
$5,831.54
|
| Rate for Payer: First Health Commercial |
$6,674.65
|
| Rate for Payer: Humana Commercial |
$5,972.06
|
| Rate for Payer: Humana KY Medicaid |
$2,416.22
|
| Rate for Payer: Kentucky WC Medicaid |
$2,440.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,761.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,185.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,107.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,464.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,182.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,269.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,620.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,112.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,847.91
|
| Rate for Payer: PHCS Commercial |
$6,744.91
|
| Rate for Payer: United Healthcare All Payer |
$6,182.84
|
|
|
SWANSON PIP IMP SZ 00
|
Facility
|
IP
|
$7,394.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,218.38 |
| Max. Negotiated Rate |
$7,098.82 |
| Rate for Payer: Aetna Commercial |
$5,693.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,767.79
|
| Rate for Payer: Cash Price |
$3,697.30
|
| Rate for Payer: Cigna Commercial |
$6,137.52
|
| Rate for Payer: First Health Commercial |
$7,024.87
|
| Rate for Payer: Humana Commercial |
$6,285.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,063.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,457.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,218.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,507.25
|
| Rate for Payer: Ohio Health Group HMO |
$5,545.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,915.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,433.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,102.27
|
| Rate for Payer: PHCS Commercial |
$7,098.82
|
| Rate for Payer: United Healthcare All Payer |
$6,507.25
|
|
