|
SYN TI PF FEM COMP SZ 16
|
Facility
|
OP
|
$16,061.66
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,818.50 |
| Max. Negotiated Rate |
$15,419.19 |
| Rate for Payer: Aetna Commercial |
$12,367.48
|
| Rate for Payer: Anthem Medicaid |
$5,523.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,528.09
|
| Rate for Payer: Cash Price |
$8,030.83
|
| Rate for Payer: Cigna Commercial |
$13,331.18
|
| Rate for Payer: First Health Commercial |
$15,258.58
|
| Rate for Payer: Humana Commercial |
$13,652.41
|
| Rate for Payer: Humana KY Medicaid |
$5,523.60
|
| Rate for Payer: Kentucky WC Medicaid |
$5,579.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,170.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,853.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,818.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,634.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,134.26
|
| Rate for Payer: Ohio Health Group HMO |
$12,046.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,849.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,973.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,082.55
|
| Rate for Payer: PHCS Commercial |
$15,419.19
|
| Rate for Payer: United Healthcare All Payer |
$14,134.26
|
|
|
SYN TI PF FEM COMP SZ 16
|
Facility
|
IP
|
$16,061.66
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,818.50 |
| Max. Negotiated Rate |
$15,419.19 |
| Rate for Payer: Aetna Commercial |
$12,367.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,528.09
|
| Rate for Payer: Cash Price |
$8,030.83
|
| Rate for Payer: Cigna Commercial |
$13,331.18
|
| Rate for Payer: First Health Commercial |
$15,258.58
|
| Rate for Payer: Humana Commercial |
$13,652.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,170.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,853.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,818.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,134.26
|
| Rate for Payer: Ohio Health Group HMO |
$12,046.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,849.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,973.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,082.55
|
| Rate for Payer: PHCS Commercial |
$15,419.19
|
| Rate for Payer: United Healthcare All Payer |
$14,134.26
|
|
|
SYN TI PF FEM COMP SZ 17
|
Facility
|
OP
|
$16,061.66
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,818.50 |
| Max. Negotiated Rate |
$15,419.19 |
| Rate for Payer: Aetna Commercial |
$12,367.48
|
| Rate for Payer: Anthem Medicaid |
$5,523.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,528.09
|
| Rate for Payer: Cash Price |
$8,030.83
|
| Rate for Payer: Cigna Commercial |
$13,331.18
|
| Rate for Payer: First Health Commercial |
$15,258.58
|
| Rate for Payer: Humana Commercial |
$13,652.41
|
| Rate for Payer: Humana KY Medicaid |
$5,523.60
|
| Rate for Payer: Kentucky WC Medicaid |
$5,579.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,170.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,853.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,818.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,634.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,134.26
|
| Rate for Payer: Ohio Health Group HMO |
$12,046.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,849.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,973.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,082.55
|
| Rate for Payer: PHCS Commercial |
$15,419.19
|
| Rate for Payer: United Healthcare All Payer |
$14,134.26
|
|
|
SYN TI PF FEM COMP SZ 17
|
Facility
|
IP
|
$16,061.66
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,818.50 |
| Max. Negotiated Rate |
$15,419.19 |
| Rate for Payer: Aetna Commercial |
$12,367.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,528.09
|
| Rate for Payer: Cash Price |
$8,030.83
|
| Rate for Payer: Cigna Commercial |
$13,331.18
|
| Rate for Payer: First Health Commercial |
$15,258.58
|
| Rate for Payer: Humana Commercial |
$13,652.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,170.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,853.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,818.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,134.26
|
| Rate for Payer: Ohio Health Group HMO |
$12,046.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,849.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,973.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,082.55
|
| Rate for Payer: PHCS Commercial |
$15,419.19
|
| Rate for Payer: United Healthcare All Payer |
$14,134.26
|
|
|
SYN TI PF FEM COMP SZ 18
|
Facility
|
OP
|
$16,061.66
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,818.50 |
| Max. Negotiated Rate |
$15,419.19 |
| Rate for Payer: Aetna Commercial |
$12,367.48
|
| Rate for Payer: Anthem Medicaid |
$5,523.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,528.09
|
| Rate for Payer: Cash Price |
$8,030.83
|
| Rate for Payer: Cigna Commercial |
$13,331.18
|
| Rate for Payer: First Health Commercial |
$15,258.58
|
| Rate for Payer: Humana Commercial |
$13,652.41
|
| Rate for Payer: Humana KY Medicaid |
$5,523.60
|
| Rate for Payer: Kentucky WC Medicaid |
$5,579.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,170.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,853.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,818.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,634.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,134.26
|
| Rate for Payer: Ohio Health Group HMO |
$12,046.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,849.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,973.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,082.55
|
| Rate for Payer: PHCS Commercial |
$15,419.19
|
| Rate for Payer: United Healthcare All Payer |
$14,134.26
|
|
|
SYN TI PF FEM COMP SZ 18
|
Facility
|
IP
|
$16,061.66
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,818.50 |
| Max. Negotiated Rate |
$15,419.19 |
| Rate for Payer: Aetna Commercial |
$12,367.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,528.09
|
| Rate for Payer: Cash Price |
$8,030.83
|
| Rate for Payer: Cigna Commercial |
$13,331.18
|
| Rate for Payer: First Health Commercial |
$15,258.58
|
| Rate for Payer: Humana Commercial |
$13,652.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,170.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,853.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,818.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,134.26
|
| Rate for Payer: Ohio Health Group HMO |
$12,046.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,849.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,973.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,082.55
|
| Rate for Payer: PHCS Commercial |
$15,419.19
|
| Rate for Payer: United Healthcare All Payer |
$14,134.26
|
|
|
SYN TI PF FEM COMP SZ 9
|
Facility
|
IP
|
$24,746.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,423.97 |
| Max. Negotiated Rate |
$23,756.70 |
| Rate for Payer: Aetna Commercial |
$19,054.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,302.32
|
| Rate for Payer: Cash Price |
$12,373.28
|
| Rate for Payer: Cigna Commercial |
$20,539.64
|
| Rate for Payer: First Health Commercial |
$23,509.23
|
| Rate for Payer: Humana Commercial |
$21,034.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,292.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,262.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,776.97
|
| Rate for Payer: Ohio Health Group HMO |
$18,559.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,797.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,529.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,075.13
|
| Rate for Payer: PHCS Commercial |
$23,756.70
|
| Rate for Payer: United Healthcare All Payer |
$21,776.97
|
|
|
SYN TI PF FEM COMP SZ 9
|
Facility
|
OP
|
$24,746.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,423.97 |
| Max. Negotiated Rate |
$23,756.70 |
| Rate for Payer: Aetna Commercial |
$19,054.85
|
| Rate for Payer: Anthem Medicaid |
$8,510.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,302.32
|
| Rate for Payer: Cash Price |
$12,373.28
|
| Rate for Payer: Cigna Commercial |
$20,539.64
|
| Rate for Payer: First Health Commercial |
$23,509.23
|
| Rate for Payer: Humana Commercial |
$21,034.58
|
| Rate for Payer: Humana KY Medicaid |
$8,510.34
|
| Rate for Payer: Kentucky WC Medicaid |
$8,596.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,292.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,262.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,681.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,776.97
|
| Rate for Payer: Ohio Health Group HMO |
$18,559.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,797.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,529.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,075.13
|
| Rate for Payer: PHCS Commercial |
$23,756.70
|
| Rate for Payer: United Healthcare All Payer |
$21,776.97
|
|
|
SYNVISC-ONE per 1mg (48mg SYR)
|
Professional
|
Both
|
$155.51
|
|
|
Service Code
|
HCPCS J7325
|
| Hospital Charge Code |
63600155
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$93.31 |
| Rate for Payer: Aetna Commercial |
$15.37
|
| Rate for Payer: Ambetter Exchange |
$9.09
|
| Rate for Payer: Buckeye Individual/Medicaid |
$9.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$9.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$10.91
|
| Rate for Payer: Cash Price |
$77.75
|
| Rate for Payer: Cash Price |
$77.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$14.41
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$9.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.09
|
| Rate for Payer: Multiplan PHCS |
$93.31
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$11.82
|
| Rate for Payer: UHCCP Medicaid |
$54.43
|
| Rate for Payer: Wellcare Medicare Advantage |
$9.09
|
|
|
SYNVISC-ONE per 1mg (48mg SYR)
|
Facility
|
IP
|
$7,464.43
|
|
|
Service Code
|
HCPCS J7325
|
| Hospital Charge Code |
25004126
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,239.33 |
| Max. Negotiated Rate |
$7,165.85 |
| Rate for Payer: Aetna Commercial |
$5,747.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,822.26
|
| Rate for Payer: Cash Price |
$3,732.22
|
| Rate for Payer: Cigna Commercial |
$6,195.48
|
| Rate for Payer: First Health Commercial |
$7,091.21
|
| Rate for Payer: Humana Commercial |
$6,344.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,120.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,508.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,239.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,568.70
|
| Rate for Payer: Ohio Health Group HMO |
$5,598.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,971.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,494.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,150.46
|
| Rate for Payer: PHCS Commercial |
$7,165.85
|
| Rate for Payer: United Healthcare All Payer |
$6,568.70
|
|
|
SYNVISC-ONE per 1mg (48mg SYR)
|
Facility
|
OP
|
$155.51
|
|
|
Service Code
|
HCPCS J7325
|
| Hospital Charge Code |
636T0155
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$149.29 |
| Rate for Payer: Aetna Commercial |
$119.74
|
| Rate for Payer: Anthem Medicaid |
$53.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$121.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.27
|
| Rate for Payer: Cash Price |
$77.75
|
| Rate for Payer: Cash Price |
$77.75
|
| Rate for Payer: Cigna Commercial |
$129.07
|
| Rate for Payer: First Health Commercial |
$147.73
|
| Rate for Payer: Humana Commercial |
$132.18
|
| Rate for Payer: Humana KY Medicaid |
$53.48
|
| Rate for Payer: Humana Medicare Advantage |
$9.09
|
| Rate for Payer: Kentucky WC Medicaid |
$54.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$127.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$114.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$54.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$136.85
|
| Rate for Payer: Ohio Health Group HMO |
$116.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$124.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$135.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$107.30
|
| Rate for Payer: PHCS Commercial |
$149.29
|
| Rate for Payer: United Healthcare All Payer |
$136.85
|
|
|
SYNVISC-ONE per 1mg (48mg SYR)
|
Facility
|
OP
|
$155.51
|
|
|
Service Code
|
HCPCS J7325
|
| Hospital Charge Code |
63600155
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$149.29 |
| Rate for Payer: Aetna Commercial |
$119.74
|
| Rate for Payer: Anthem Medicaid |
$53.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$121.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.27
|
| Rate for Payer: Cash Price |
$77.75
|
| Rate for Payer: Cash Price |
$77.75
|
| Rate for Payer: Cigna Commercial |
$129.07
|
| Rate for Payer: First Health Commercial |
$147.73
|
| Rate for Payer: Humana Commercial |
$132.18
|
| Rate for Payer: Humana KY Medicaid |
$53.48
|
| Rate for Payer: Humana Medicare Advantage |
$9.09
|
| Rate for Payer: Kentucky WC Medicaid |
$54.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$127.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$114.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$54.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$136.85
|
| Rate for Payer: Ohio Health Group HMO |
$116.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$124.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$135.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$107.30
|
| Rate for Payer: PHCS Commercial |
$149.29
|
| Rate for Payer: United Healthcare All Payer |
$136.85
|
|
|
SYNVISC-ONE per 1mg (48mg SYR)
|
Facility
|
IP
|
$155.51
|
|
|
Service Code
|
HCPCS J7325
|
| Hospital Charge Code |
63600155
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.65 |
| Max. Negotiated Rate |
$149.29 |
| Rate for Payer: Aetna Commercial |
$119.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$121.30
|
| Rate for Payer: Cash Price |
$77.75
|
| Rate for Payer: Cigna Commercial |
$129.07
|
| Rate for Payer: First Health Commercial |
$147.73
|
| Rate for Payer: Humana Commercial |
$132.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$127.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$114.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$136.85
|
| Rate for Payer: Ohio Health Group HMO |
$116.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$124.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$135.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$107.30
|
| Rate for Payer: PHCS Commercial |
$149.29
|
| Rate for Payer: United Healthcare All Payer |
$136.85
|
|
|
SYNVISC-ONE per 1mg (48mg SYR)
|
Facility
|
IP
|
$155.51
|
|
|
Service Code
|
HCPCS J7325
|
| Hospital Charge Code |
636T0155
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.65 |
| Max. Negotiated Rate |
$149.29 |
| Rate for Payer: Aetna Commercial |
$119.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$121.30
|
| Rate for Payer: Cash Price |
$77.75
|
| Rate for Payer: Cigna Commercial |
$129.07
|
| Rate for Payer: First Health Commercial |
$147.73
|
| Rate for Payer: Humana Commercial |
$132.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$127.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$114.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$136.85
|
| Rate for Payer: Ohio Health Group HMO |
$116.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$124.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$135.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$107.30
|
| Rate for Payer: PHCS Commercial |
$149.29
|
| Rate for Payer: United Healthcare All Payer |
$136.85
|
|
|
SYNVISC-ONE per 1mg (48mg SYR)
|
Facility
|
OP
|
$7,464.43
|
|
|
Service Code
|
HCPCS J7325
|
| Hospital Charge Code |
25004126
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$7,165.85 |
| Rate for Payer: Aetna Commercial |
$5,747.61
|
| Rate for Payer: Anthem Medicaid |
$2,567.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,822.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.27
|
| Rate for Payer: Cash Price |
$3,732.22
|
| Rate for Payer: Cash Price |
$3,732.22
|
| Rate for Payer: Cigna Commercial |
$6,195.48
|
| Rate for Payer: First Health Commercial |
$7,091.21
|
| Rate for Payer: Humana Commercial |
$6,344.77
|
| Rate for Payer: Humana KY Medicaid |
$2,567.02
|
| Rate for Payer: Humana Medicare Advantage |
$9.09
|
| Rate for Payer: Kentucky WC Medicaid |
$2,593.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,120.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,508.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,618.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,568.70
|
| Rate for Payer: Ohio Health Group HMO |
$5,598.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,971.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,494.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,150.46
|
| Rate for Payer: PHCS Commercial |
$7,165.85
|
| Rate for Payer: United Healthcare All Payer |
$6,568.70
|
|
|
SYNVISC per 1mg (16mg SYRINGE)
|
Facility
|
OP
|
$2,488.14
|
|
|
Service Code
|
HCPCS J7325
|
| Hospital Charge Code |
25004125
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$2,388.61 |
| Rate for Payer: Aetna Commercial |
$1,915.87
|
| Rate for Payer: Anthem Medicaid |
$855.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,940.75
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.27
|
| Rate for Payer: Cash Price |
$1,244.07
|
| Rate for Payer: Cash Price |
$1,244.07
|
| Rate for Payer: Cigna Commercial |
$2,065.16
|
| Rate for Payer: First Health Commercial |
$2,363.73
|
| Rate for Payer: Humana Commercial |
$2,114.92
|
| Rate for Payer: Humana KY Medicaid |
$855.67
|
| Rate for Payer: Humana Medicare Advantage |
$9.09
|
| Rate for Payer: Kentucky WC Medicaid |
$864.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,040.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,836.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$872.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,189.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,866.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,990.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,164.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,716.82
|
| 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
|
$2,488.14
|
|
|
Service Code
|
HCPCS J7325
|
| Hospital Charge Code |
25004125
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$746.44 |
| 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 |
$1,866.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,990.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,164.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,716.82
|
| Rate for Payer: PHCS Commercial |
$2,388.61
|
| Rate for Payer: United Healthcare All Payer |
$2,189.56
|
|
|
SYNVISC per 1mg (16mg SYRINGE)
|
Facility
|
OP
|
$155.51
|
|
|
Service Code
|
HCPCS J7325
|
| Hospital Charge Code |
63600154
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$149.29 |
| Rate for Payer: Aetna Commercial |
$119.74
|
| Rate for Payer: Anthem Medicaid |
$53.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$121.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.27
|
| Rate for Payer: Cash Price |
$77.75
|
| Rate for Payer: Cash Price |
$77.75
|
| Rate for Payer: Cigna Commercial |
$129.07
|
| Rate for Payer: First Health Commercial |
$147.73
|
| Rate for Payer: Humana Commercial |
$132.18
|
| Rate for Payer: Humana KY Medicaid |
$53.48
|
| Rate for Payer: Humana Medicare Advantage |
$9.09
|
| Rate for Payer: Kentucky WC Medicaid |
$54.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$127.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$114.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$54.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$136.85
|
| Rate for Payer: Ohio Health Group HMO |
$116.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$124.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$135.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$107.30
|
| Rate for Payer: PHCS Commercial |
$149.29
|
| Rate for Payer: United Healthcare All Payer |
$136.85
|
|
|
SYNVISC per 1mg (16mg SYRINGE)
|
Facility
|
IP
|
$155.51
|
|
|
Service Code
|
HCPCS J7325
|
| Hospital Charge Code |
636T0154
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.65 |
| Max. Negotiated Rate |
$149.29 |
| Rate for Payer: Aetna Commercial |
$119.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$121.30
|
| Rate for Payer: Cash Price |
$77.75
|
| Rate for Payer: Cigna Commercial |
$129.07
|
| Rate for Payer: First Health Commercial |
$147.73
|
| Rate for Payer: Humana Commercial |
$132.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$127.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$114.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$136.85
|
| Rate for Payer: Ohio Health Group HMO |
$116.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$124.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$135.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$107.30
|
| Rate for Payer: PHCS Commercial |
$149.29
|
| Rate for Payer: United Healthcare All Payer |
$136.85
|
|
|
SYNVISC per 1mg (16mg SYRINGE)
|
Professional
|
Both
|
$155.51
|
|
|
Service Code
|
HCPCS J7325
|
| Hospital Charge Code |
63600154
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$93.31 |
| Rate for Payer: Aetna Commercial |
$15.37
|
| Rate for Payer: Ambetter Exchange |
$9.09
|
| Rate for Payer: Buckeye Individual/Medicaid |
$9.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$9.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$10.91
|
| Rate for Payer: Cash Price |
$77.75
|
| Rate for Payer: Cash Price |
$77.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$14.41
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$9.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.09
|
| Rate for Payer: Multiplan PHCS |
$93.31
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$11.82
|
| Rate for Payer: UHCCP Medicaid |
$54.43
|
| Rate for Payer: Wellcare Medicare Advantage |
$9.09
|
|
|
SYNVISC per 1mg (16mg SYRINGE)
|
Facility
|
IP
|
$155.51
|
|
|
Service Code
|
HCPCS J7325
|
| Hospital Charge Code |
63600154
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.65 |
| Max. Negotiated Rate |
$149.29 |
| Rate for Payer: Aetna Commercial |
$119.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$121.30
|
| Rate for Payer: Cash Price |
$77.75
|
| Rate for Payer: Cigna Commercial |
$129.07
|
| Rate for Payer: First Health Commercial |
$147.73
|
| Rate for Payer: Humana Commercial |
$132.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$127.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$114.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$136.85
|
| Rate for Payer: Ohio Health Group HMO |
$116.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$124.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$135.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$107.30
|
| Rate for Payer: PHCS Commercial |
$149.29
|
| Rate for Payer: United Healthcare All Payer |
$136.85
|
|
|
SYNVISC per 1mg (16mg SYRINGE)
|
Facility
|
OP
|
$155.51
|
|
|
Service Code
|
HCPCS J7325
|
| Hospital Charge Code |
636T0154
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$149.29 |
| Rate for Payer: Aetna Commercial |
$119.74
|
| Rate for Payer: Anthem Medicaid |
$53.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$121.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.27
|
| Rate for Payer: Cash Price |
$77.75
|
| Rate for Payer: Cash Price |
$77.75
|
| Rate for Payer: Cigna Commercial |
$129.07
|
| Rate for Payer: First Health Commercial |
$147.73
|
| Rate for Payer: Humana Commercial |
$132.18
|
| Rate for Payer: Humana KY Medicaid |
$53.48
|
| Rate for Payer: Humana Medicare Advantage |
$9.09
|
| Rate for Payer: Kentucky WC Medicaid |
$54.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$127.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$114.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$54.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$136.85
|
| Rate for Payer: Ohio Health Group HMO |
$116.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$124.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$135.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$107.30
|
| Rate for Payer: PHCS Commercial |
$149.29
|
| Rate for Payer: United Healthcare All Payer |
$136.85
|
|
|
SYPRAHYOID LYMPHADENECTOMY
|
Facility
|
IP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 38700
|
| Hospital Charge Code |
76101604
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$480.00 |
| 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 |
$1,280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,392.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,104.00
|
| 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 |
$550.24 |
| Max. Negotiated Rate |
$8,435.98 |
| Rate for Payer: Aetna Commercial |
$1,232.00
|
| Rate for Payer: Anthem Medicaid |
$550.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,025.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,248.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,435.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,134.69
|
| 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 |
$6,025.70
|
| 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 |
$7,230.84
|
| 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 |
$1,280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,392.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,104.00
|
| 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 |
$1,138.15 |
| Rate for Payer: Aetna Commercial |
$1,138.15
|
| Rate for Payer: Ambetter Exchange |
$763.43
|
| Rate for Payer: Anthem Medicaid |
$512.23
|
| Rate for Payer: Buckeye Individual/Medicaid |
$763.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$763.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$916.12
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$763.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$763.43
|
| 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 |
$992.46
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$517.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$763.43
|
|
