|
SYPRAHYOID LYMPHADENECTOMY(P
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 38700
|
| Hospital Charge Code |
761P1604
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$512.23 |
| Max. Negotiated Rate |
$1,138.15 |
| 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
|
|
|
SYSTANE EYE DROPS 15ML
|
Facility
|
OP
|
$4.51
|
|
|
Service Code
|
NDC 65043133
|
| Hospital Charge Code |
25001479
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$4.33 |
| Rate for Payer: Aetna Commercial |
$3.47
|
| Rate for Payer: Anthem Medicaid |
$1.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.52
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cigna Commercial |
$3.74
|
| Rate for Payer: First Health Commercial |
$4.28
|
| Rate for Payer: Humana Commercial |
$3.83
|
| Rate for Payer: Humana KY Medicaid |
$1.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.97
|
| Rate for Payer: Ohio Health Group HMO |
$3.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.11
|
| Rate for Payer: PHCS Commercial |
$4.33
|
| Rate for Payer: United Healthcare All Payer |
$3.97
|
|
|
SYSTANE EYE DROPS 15ML
|
Facility
|
IP
|
$4.51
|
|
|
Service Code
|
NDC 65043133
|
| Hospital Charge Code |
25001479
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$4.33 |
| Rate for Payer: Aetna Commercial |
$3.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.52
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cigna Commercial |
$3.74
|
| Rate for Payer: First Health Commercial |
$4.28
|
| Rate for Payer: Humana Commercial |
$3.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.97
|
| Rate for Payer: Ohio Health Group HMO |
$3.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.11
|
| Rate for Payer: PHCS Commercial |
$4.33
|
| Rate for Payer: United Healthcare All Payer |
$3.97
|
|
|
SZR STYL 410 FF RE-STERL 290CC
|
Facility
|
IP
|
$2,937.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$881.25 |
| Max. Negotiated Rate |
$2,820.00 |
| Rate for Payer: Aetna Commercial |
$2,261.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,291.25
|
| Rate for Payer: Cash Price |
$1,468.75
|
| Rate for Payer: Cigna Commercial |
$2,438.12
|
| Rate for Payer: First Health Commercial |
$2,790.62
|
| Rate for Payer: Humana Commercial |
$2,496.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,408.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$881.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,585.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,555.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,026.88
|
| Rate for Payer: PHCS Commercial |
$2,820.00
|
| Rate for Payer: United Healthcare All Payer |
$2,585.00
|
|
|
SZR STYL 410 FF RE-STERL 290CC
|
Facility
|
OP
|
$2,937.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$881.25 |
| Max. Negotiated Rate |
$2,820.00 |
| Rate for Payer: Aetna Commercial |
$2,261.88
|
| Rate for Payer: Anthem Medicaid |
$1,010.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,291.25
|
| Rate for Payer: Cash Price |
$1,468.75
|
| Rate for Payer: Cigna Commercial |
$2,438.12
|
| Rate for Payer: First Health Commercial |
$2,790.62
|
| Rate for Payer: Humana Commercial |
$2,496.88
|
| Rate for Payer: Humana KY Medicaid |
$1,010.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,020.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,408.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$881.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,030.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,585.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,555.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,026.88
|
| Rate for Payer: PHCS Commercial |
$2,820.00
|
| Rate for Payer: United Healthcare All Payer |
$2,585.00
|
|
|
SZR STYL 410 FF RE-STERL 335CC
|
Facility
|
OP
|
$2,937.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$881.25 |
| Max. Negotiated Rate |
$2,820.00 |
| Rate for Payer: Aetna Commercial |
$2,261.88
|
| Rate for Payer: Anthem Medicaid |
$1,010.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,291.25
|
| Rate for Payer: Cash Price |
$1,468.75
|
| Rate for Payer: Cigna Commercial |
$2,438.12
|
| Rate for Payer: First Health Commercial |
$2,790.62
|
| Rate for Payer: Humana Commercial |
$2,496.88
|
| Rate for Payer: Humana KY Medicaid |
$1,010.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,020.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,408.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$881.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,030.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,585.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,555.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,026.88
|
| Rate for Payer: PHCS Commercial |
$2,820.00
|
| Rate for Payer: United Healthcare All Payer |
$2,585.00
|
|
|
SZR STYL 410 FF RE-STERL 335CC
|
Facility
|
IP
|
$2,937.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$881.25 |
| Max. Negotiated Rate |
$2,820.00 |
| Rate for Payer: Aetna Commercial |
$2,261.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,291.25
|
| Rate for Payer: Cash Price |
$1,468.75
|
| Rate for Payer: Cigna Commercial |
$2,438.12
|
| Rate for Payer: First Health Commercial |
$2,790.62
|
| Rate for Payer: Humana Commercial |
$2,496.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,408.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$881.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,585.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,555.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,026.88
|
| Rate for Payer: PHCS Commercial |
$2,820.00
|
| Rate for Payer: United Healthcare All Payer |
$2,585.00
|
|
|
SZR STYL 410 FM RE-STERL 310CC
|
Facility
|
OP
|
$2,937.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$881.25 |
| Max. Negotiated Rate |
$2,820.00 |
| Rate for Payer: Aetna Commercial |
$2,261.88
|
| Rate for Payer: Anthem Medicaid |
$1,010.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,291.25
|
| Rate for Payer: Cash Price |
$1,468.75
|
| Rate for Payer: Cigna Commercial |
$2,438.12
|
| Rate for Payer: First Health Commercial |
$2,790.62
|
| Rate for Payer: Humana Commercial |
$2,496.88
|
| Rate for Payer: Humana KY Medicaid |
$1,010.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,020.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,408.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$881.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,030.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,585.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,555.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,026.88
|
| Rate for Payer: PHCS Commercial |
$2,820.00
|
| Rate for Payer: United Healthcare All Payer |
$2,585.00
|
|
|
SZR STYL 410 FM RE-STERL 310CC
|
Facility
|
IP
|
$2,937.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$881.25 |
| Max. Negotiated Rate |
$2,820.00 |
| Rate for Payer: Aetna Commercial |
$2,261.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,291.25
|
| Rate for Payer: Cash Price |
$1,468.75
|
| Rate for Payer: Cigna Commercial |
$2,438.12
|
| Rate for Payer: First Health Commercial |
$2,790.62
|
| Rate for Payer: Humana Commercial |
$2,496.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,408.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$881.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,585.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,555.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,026.88
|
| Rate for Payer: PHCS Commercial |
$2,820.00
|
| Rate for Payer: United Healthcare All Payer |
$2,585.00
|
|
|
SZR STYL 410 FM RE-STERL 350CC
|
Facility
|
IP
|
$2,937.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$881.25 |
| Max. Negotiated Rate |
$2,820.00 |
| Rate for Payer: Aetna Commercial |
$2,261.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,291.25
|
| Rate for Payer: Cash Price |
$1,468.75
|
| Rate for Payer: Cigna Commercial |
$2,438.12
|
| Rate for Payer: First Health Commercial |
$2,790.62
|
| Rate for Payer: Humana Commercial |
$2,496.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,408.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$881.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,585.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,555.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,026.88
|
| Rate for Payer: PHCS Commercial |
$2,820.00
|
| Rate for Payer: United Healthcare All Payer |
$2,585.00
|
|
|
SZR STYL 410 FM RE-STERL 350CC
|
Facility
|
OP
|
$2,937.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$881.25 |
| Max. Negotiated Rate |
$2,820.00 |
| Rate for Payer: Aetna Commercial |
$2,261.88
|
| Rate for Payer: Anthem Medicaid |
$1,010.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,291.25
|
| Rate for Payer: Cash Price |
$1,468.75
|
| Rate for Payer: Cigna Commercial |
$2,438.12
|
| Rate for Payer: First Health Commercial |
$2,790.62
|
| Rate for Payer: Humana Commercial |
$2,496.88
|
| Rate for Payer: Humana KY Medicaid |
$1,010.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,020.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,408.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$881.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,030.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,585.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,555.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,026.88
|
| Rate for Payer: PHCS Commercial |
$2,820.00
|
| Rate for Payer: United Healthcare All Payer |
$2,585.00
|
|
|
SZR STYL 410 MM RE-STERL 320CC
|
Facility
|
IP
|
$2,937.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$881.25 |
| Max. Negotiated Rate |
$2,820.00 |
| Rate for Payer: Aetna Commercial |
$2,261.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,291.25
|
| Rate for Payer: Cash Price |
$1,468.75
|
| Rate for Payer: Cigna Commercial |
$2,438.12
|
| Rate for Payer: First Health Commercial |
$2,790.62
|
| Rate for Payer: Humana Commercial |
$2,496.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,408.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$881.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,585.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,555.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,026.88
|
| Rate for Payer: PHCS Commercial |
$2,820.00
|
| Rate for Payer: United Healthcare All Payer |
$2,585.00
|
|
|
SZR STYL 410 MM RE-STERL 320CC
|
Facility
|
OP
|
$2,937.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$881.25 |
| Max. Negotiated Rate |
$2,820.00 |
| Rate for Payer: Aetna Commercial |
$2,261.88
|
| Rate for Payer: Anthem Medicaid |
$1,010.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,291.25
|
| Rate for Payer: Cash Price |
$1,468.75
|
| Rate for Payer: Cigna Commercial |
$2,438.12
|
| Rate for Payer: First Health Commercial |
$2,790.62
|
| Rate for Payer: Humana Commercial |
$2,496.88
|
| Rate for Payer: Humana KY Medicaid |
$1,010.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,020.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,408.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$881.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,030.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,585.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,555.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,026.88
|
| Rate for Payer: PHCS Commercial |
$2,820.00
|
| Rate for Payer: United Healthcare All Payer |
$2,585.00
|
|
|
SZR STYL 410 MM RE-STERL 360CC
|
Facility
|
IP
|
$2,937.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$881.25 |
| Max. Negotiated Rate |
$2,820.00 |
| Rate for Payer: Aetna Commercial |
$2,261.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,291.25
|
| Rate for Payer: Cash Price |
$1,468.75
|
| Rate for Payer: Cigna Commercial |
$2,438.12
|
| Rate for Payer: First Health Commercial |
$2,790.62
|
| Rate for Payer: Humana Commercial |
$2,496.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,408.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$881.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,585.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,555.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,026.88
|
| Rate for Payer: PHCS Commercial |
$2,820.00
|
| Rate for Payer: United Healthcare All Payer |
$2,585.00
|
|
|
SZR STYL 410 MM RE-STERL 360CC
|
Facility
|
OP
|
$2,937.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$881.25 |
| Max. Negotiated Rate |
$2,820.00 |
| Rate for Payer: Aetna Commercial |
$2,261.88
|
| Rate for Payer: Anthem Medicaid |
$1,010.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,291.25
|
| Rate for Payer: Cash Price |
$1,468.75
|
| Rate for Payer: Cigna Commercial |
$2,438.12
|
| Rate for Payer: First Health Commercial |
$2,790.62
|
| Rate for Payer: Humana Commercial |
$2,496.88
|
| Rate for Payer: Humana KY Medicaid |
$1,010.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,020.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,408.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$881.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,030.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,585.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,555.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,026.88
|
| Rate for Payer: PHCS Commercial |
$2,820.00
|
| Rate for Payer: United Healthcare All Payer |
$2,585.00
|
|
|
T2 GUIDEWIRE BALL TIP 3*1000
|
Facility
|
IP
|
$1,866.20
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$559.86 |
| Max. Negotiated Rate |
$1,791.55 |
| Rate for Payer: Aetna Commercial |
$1,436.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,455.64
|
| Rate for Payer: Cash Price |
$933.10
|
| Rate for Payer: Cigna Commercial |
$1,548.95
|
| Rate for Payer: First Health Commercial |
$1,772.89
|
| Rate for Payer: Humana Commercial |
$1,586.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,530.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,377.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$559.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,642.26
|
| Rate for Payer: Ohio Health Group HMO |
$1,399.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,492.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,623.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,287.68
|
| Rate for Payer: PHCS Commercial |
$1,791.55
|
| Rate for Payer: United Healthcare All Payer |
$1,642.26
|
|
|
T2 GUIDEWIRE BALL TIP 3*1000
|
Facility
|
OP
|
$1,866.20
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$559.86 |
| Max. Negotiated Rate |
$1,791.55 |
| Rate for Payer: Aetna Commercial |
$1,436.97
|
| Rate for Payer: Anthem Medicaid |
$641.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,455.64
|
| Rate for Payer: Cash Price |
$933.10
|
| Rate for Payer: Cigna Commercial |
$1,548.95
|
| Rate for Payer: First Health Commercial |
$1,772.89
|
| Rate for Payer: Humana Commercial |
$1,586.27
|
| Rate for Payer: Humana KY Medicaid |
$641.79
|
| Rate for Payer: Kentucky WC Medicaid |
$648.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,530.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,377.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$559.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$654.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,642.26
|
| Rate for Payer: Ohio Health Group HMO |
$1,399.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,492.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,623.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,287.68
|
| Rate for Payer: PHCS Commercial |
$1,791.55
|
| Rate for Payer: United Healthcare All Payer |
$1,642.26
|
|
|
T2 SCN NAIL 12*360MM
|
Facility
|
IP
|
$8,902.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,670.61 |
| Max. Negotiated Rate |
$8,545.97 |
| Rate for Payer: Aetna Commercial |
$6,854.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,943.60
|
| Rate for Payer: Cash Price |
$4,451.02
|
| Rate for Payer: Cigna Commercial |
$7,388.70
|
| Rate for Payer: First Health Commercial |
$8,456.95
|
| Rate for Payer: Humana Commercial |
$7,566.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,299.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,569.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,670.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,833.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,676.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,121.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,744.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,142.41
|
| Rate for Payer: PHCS Commercial |
$8,545.97
|
| Rate for Payer: United Healthcare All Payer |
$7,833.80
|
|
|
T2 SCN NAIL 12*360MM
|
Facility
|
OP
|
$8,902.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,670.61 |
| Max. Negotiated Rate |
$8,545.97 |
| Rate for Payer: Aetna Commercial |
$6,854.58
|
| Rate for Payer: Anthem Medicaid |
$3,061.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,943.60
|
| Rate for Payer: Cash Price |
$4,451.02
|
| Rate for Payer: Cigna Commercial |
$7,388.70
|
| Rate for Payer: First Health Commercial |
$8,456.95
|
| Rate for Payer: Humana Commercial |
$7,566.74
|
| Rate for Payer: Humana KY Medicaid |
$3,061.41
|
| Rate for Payer: Kentucky WC Medicaid |
$3,092.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,299.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,569.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,670.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,122.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,833.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,676.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,121.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,744.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,142.41
|
| Rate for Payer: PHCS Commercial |
$8,545.97
|
| Rate for Payer: United Healthcare All Payer |
$7,833.80
|
|
|
T2 SCREW FTHRD LOCKING 5*27.5
|
Facility
|
OP
|
$1,823.41
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$547.02 |
| Max. Negotiated Rate |
$1,750.47 |
| Rate for Payer: Aetna Commercial |
$1,404.03
|
| Rate for Payer: Anthem Medicaid |
$627.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,422.26
|
| Rate for Payer: Cash Price |
$911.71
|
| Rate for Payer: Cigna Commercial |
$1,513.43
|
| Rate for Payer: First Health Commercial |
$1,732.24
|
| Rate for Payer: Humana Commercial |
$1,549.90
|
| Rate for Payer: Humana KY Medicaid |
$627.07
|
| Rate for Payer: Kentucky WC Medicaid |
$633.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,495.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,345.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$547.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$639.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,604.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,367.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,458.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,586.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,258.15
|
| Rate for Payer: PHCS Commercial |
$1,750.47
|
| Rate for Payer: United Healthcare All Payer |
$1,604.60
|
|
|
T2 SCREW FTHRD LOCKING 5*27.5
|
Facility
|
IP
|
$1,823.41
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$547.02 |
| Max. Negotiated Rate |
$1,750.47 |
| Rate for Payer: Aetna Commercial |
$1,404.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,422.26
|
| Rate for Payer: Cash Price |
$911.71
|
| Rate for Payer: Cigna Commercial |
$1,513.43
|
| Rate for Payer: First Health Commercial |
$1,732.24
|
| Rate for Payer: Humana Commercial |
$1,549.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,495.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,345.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$547.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,604.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,367.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,458.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,586.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,258.15
|
| Rate for Payer: PHCS Commercial |
$1,750.47
|
| Rate for Payer: United Healthcare All Payer |
$1,604.60
|
|
|
T2 SCREW FTHRD LOCKING 5*32.5
|
Facility
|
IP
|
$1,892.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$567.84 |
| Max. Negotiated Rate |
$1,817.09 |
| Rate for Payer: Aetna Commercial |
$1,457.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,476.38
|
| Rate for Payer: Cash Price |
$946.40
|
| Rate for Payer: Cigna Commercial |
$1,571.02
|
| Rate for Payer: First Health Commercial |
$1,798.16
|
| Rate for Payer: Humana Commercial |
$1,608.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,552.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.66
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,514.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,646.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,306.03
|
| Rate for Payer: PHCS Commercial |
$1,817.09
|
| Rate for Payer: United Healthcare All Payer |
$1,665.66
|
|
|
T2 SCREW FTHRD LOCKING 5*32.5
|
Facility
|
OP
|
$1,892.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$567.84 |
| Max. Negotiated Rate |
$1,817.09 |
| Rate for Payer: Aetna Commercial |
$1,457.46
|
| Rate for Payer: Anthem Medicaid |
$650.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,476.38
|
| Rate for Payer: Cash Price |
$946.40
|
| Rate for Payer: Cigna Commercial |
$1,571.02
|
| Rate for Payer: First Health Commercial |
$1,798.16
|
| Rate for Payer: Humana Commercial |
$1,608.88
|
| Rate for Payer: Humana KY Medicaid |
$650.93
|
| Rate for Payer: Kentucky WC Medicaid |
$657.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,552.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$663.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.66
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,514.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,646.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,306.03
|
| Rate for Payer: PHCS Commercial |
$1,817.09
|
| Rate for Payer: United Healthcare All Payer |
$1,665.66
|
|
|
T3 TOTAL
|
Facility
|
OP
|
$205.00
|
|
|
Service Code
|
HCPCS 84480
|
| Hospital Charge Code |
30000542
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.18 |
| Max. Negotiated Rate |
$196.80 |
| Rate for Payer: Aetna Commercial |
$157.85
|
| Rate for Payer: Anthem Medicaid |
$14.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$164.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$19.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.18
|
| Rate for Payer: Cash Price |
$102.50
|
| Rate for Payer: Cash Price |
$102.50
|
| Rate for Payer: Cigna Commercial |
$170.15
|
| Rate for Payer: First Health Commercial |
$194.75
|
| Rate for Payer: Humana Commercial |
$174.25
|
| Rate for Payer: Humana KY Medicaid |
$14.18
|
| Rate for Payer: Humana Medicare Advantage |
$14.18
|
| Rate for Payer: Kentucky WC Medicaid |
$14.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$168.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$151.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$180.40
|
| Rate for Payer: Ohio Health Group HMO |
$153.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$164.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$178.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$141.45
|
| Rate for Payer: PHCS Commercial |
$196.80
|
| Rate for Payer: United Healthcare All Payer |
$180.40
|
|
|
T3 TOTAL
|
Facility
|
IP
|
$205.00
|
|
|
Service Code
|
HCPCS 84480
|
| Hospital Charge Code |
30000542
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$61.50 |
| Max. Negotiated Rate |
$196.80 |
| Rate for Payer: Aetna Commercial |
$157.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$164.62
|
| Rate for Payer: Cash Price |
$102.50
|
| Rate for Payer: Cigna Commercial |
$170.15
|
| Rate for Payer: First Health Commercial |
$194.75
|
| Rate for Payer: Humana Commercial |
$174.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$168.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$151.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$180.40
|
| Rate for Payer: Ohio Health Group HMO |
$153.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$164.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$178.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$141.45
|
| Rate for Payer: PHCS Commercial |
$196.80
|
| Rate for Payer: United Healthcare All Payer |
$180.40
|
|
