|
BIO COMP SWVL LCK ANCH 3.9*17*
|
Facility
|
OP
|
$3,575.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,072.50 |
| Max. Negotiated Rate |
$3,432.00 |
| Rate for Payer: Aetna Commercial |
$2,752.75
|
| Rate for Payer: Anthem Medicaid |
$1,229.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,788.50
|
| Rate for Payer: Cash Price |
$1,787.50
|
| Rate for Payer: Cigna Commercial |
$2,967.25
|
| Rate for Payer: First Health Commercial |
$3,396.25
|
| Rate for Payer: Humana Commercial |
$3,038.75
|
| Rate for Payer: Humana KY Medicaid |
$1,229.44
|
| Rate for Payer: Kentucky WC Medicaid |
$1,241.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,931.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,638.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,072.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,254.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,146.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,681.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,110.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,466.75
|
| Rate for Payer: PHCS Commercial |
$3,432.00
|
| Rate for Payer: United Healthcare All Payer |
$3,146.00
|
|
|
BIO COMP SWVL LCK ANCH 3.9*17*
|
Facility
|
IP
|
$3,575.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,072.50 |
| Max. Negotiated Rate |
$3,432.00 |
| Rate for Payer: Aetna Commercial |
$2,752.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,788.50
|
| Rate for Payer: Cash Price |
$1,787.50
|
| Rate for Payer: Cigna Commercial |
$2,967.25
|
| Rate for Payer: First Health Commercial |
$3,396.25
|
| Rate for Payer: Humana Commercial |
$3,038.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,931.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,638.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,072.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,146.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,681.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,110.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,466.75
|
| Rate for Payer: PHCS Commercial |
$3,432.00
|
| Rate for Payer: United Healthcare All Payer |
$3,146.00
|
|
|
BIOCORNEUM SCAR CREAM 10G
|
Professional
|
Both
|
$45.00
|
|
| Hospital Charge Code |
22200204
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Multiplan PHCS |
$27.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$31.50
|
| Rate for Payer: UHCCP Medicaid |
$15.75
|
|
|
BIOCORNEUM SCAR CREAM 20G
|
Professional
|
Both
|
$72.00
|
|
| Hospital Charge Code |
22200205
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Multiplan PHCS |
$43.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$50.40
|
| Rate for Payer: UHCCP Medicaid |
$25.20
|
|
|
BIOFEEDBACK MODALITY
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
HCPCS 90901
|
| Hospital Charge Code |
43000001
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$22.50 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna Commercial |
$57.75
|
| Rate for Payer: Anthem Medicaid |
$25.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$62.25
|
| Rate for Payer: First Health Commercial |
$71.25
|
| Rate for Payer: Humana Commercial |
$63.75
|
| Rate for Payer: Humana KY Medicaid |
$25.79
|
| Rate for Payer: Kentucky WC Medicaid |
$26.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.00
|
| Rate for Payer: Ohio Health Group HMO |
$56.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.75
|
| Rate for Payer: PHCS Commercial |
$72.00
|
| Rate for Payer: United Healthcare All Payer |
$66.00
|
|
|
BIOFEEDBACK MODALITY
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
HCPCS 90901
|
| Hospital Charge Code |
42000001
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.50 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna Commercial |
$57.75
|
| Rate for Payer: Anthem Medicaid |
$25.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$62.25
|
| Rate for Payer: First Health Commercial |
$71.25
|
| Rate for Payer: Humana Commercial |
$63.75
|
| Rate for Payer: Humana KY Medicaid |
$25.79
|
| Rate for Payer: Kentucky WC Medicaid |
$26.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.00
|
| Rate for Payer: Ohio Health Group HMO |
$56.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.75
|
| Rate for Payer: PHCS Commercial |
$72.00
|
| Rate for Payer: United Healthcare All Payer |
$66.00
|
|
|
BIOFEEDBACK MODALITY
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
HCPCS 90901
|
| Hospital Charge Code |
43000001
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$22.50 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna Commercial |
$57.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$62.25
|
| Rate for Payer: First Health Commercial |
$71.25
|
| Rate for Payer: Humana Commercial |
$63.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.00
|
| Rate for Payer: Ohio Health Group HMO |
$56.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.75
|
| Rate for Payer: PHCS Commercial |
$72.00
|
| Rate for Payer: United Healthcare All Payer |
$66.00
|
|
|
BIOFEEDBACK MODALITY
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
HCPCS 90901
|
| Hospital Charge Code |
42000001
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.50 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna Commercial |
$57.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$62.25
|
| Rate for Payer: First Health Commercial |
$71.25
|
| Rate for Payer: Humana Commercial |
$63.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.00
|
| Rate for Payer: Ohio Health Group HMO |
$56.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.75
|
| Rate for Payer: PHCS Commercial |
$72.00
|
| Rate for Payer: United Healthcare All Payer |
$66.00
|
|
|
BIOFLO MIDLINE 4.5FR
|
Facility
|
OP
|
$2,993.47
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$898.04 |
| Max. Negotiated Rate |
$2,873.73 |
| Rate for Payer: Aetna Commercial |
$2,304.97
|
| Rate for Payer: Anthem Medicaid |
$1,029.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,334.91
|
| Rate for Payer: Cash Price |
$1,496.73
|
| Rate for Payer: Cigna Commercial |
$2,484.58
|
| Rate for Payer: First Health Commercial |
$2,843.80
|
| Rate for Payer: Humana Commercial |
$2,544.45
|
| Rate for Payer: Humana KY Medicaid |
$1,029.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1,039.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,454.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,209.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$898.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,050.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,634.25
|
| Rate for Payer: Ohio Health Group HMO |
$2,245.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,394.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,604.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,065.49
|
| Rate for Payer: PHCS Commercial |
$2,873.73
|
| Rate for Payer: United Healthcare All Payer |
$2,634.25
|
|
|
BIOFLO MIDLINE 4.5FR
|
Facility
|
IP
|
$2,993.47
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$898.04 |
| Max. Negotiated Rate |
$2,873.73 |
| Rate for Payer: Aetna Commercial |
$2,304.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,334.91
|
| Rate for Payer: Cash Price |
$1,496.73
|
| Rate for Payer: Cigna Commercial |
$2,484.58
|
| Rate for Payer: First Health Commercial |
$2,843.80
|
| Rate for Payer: Humana Commercial |
$2,544.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,454.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,209.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$898.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,634.25
|
| Rate for Payer: Ohio Health Group HMO |
$2,245.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,394.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,604.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,065.49
|
| Rate for Payer: PHCS Commercial |
$2,873.73
|
| Rate for Payer: United Healthcare All Payer |
$2,634.25
|
|
|
BIOFLO PORT 8FR 44-022
|
Facility
|
IP
|
$4,047.50
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
27000108
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,214.25 |
| Max. Negotiated Rate |
$3,885.60 |
| Rate for Payer: Aetna Commercial |
$3,116.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,157.05
|
| Rate for Payer: Cash Price |
$2,023.75
|
| Rate for Payer: Cigna Commercial |
$3,359.43
|
| Rate for Payer: First Health Commercial |
$3,845.12
|
| Rate for Payer: Humana Commercial |
$3,440.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,318.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,987.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,214.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,561.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,035.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,238.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,521.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,792.78
|
| Rate for Payer: PHCS Commercial |
$3,885.60
|
| Rate for Payer: United Healthcare All Payer |
$3,561.80
|
|
|
BIOFLO PORT 8FR 44-022
|
Facility
|
OP
|
$4,047.50
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
27000108
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,214.25 |
| Max. Negotiated Rate |
$3,885.60 |
| Rate for Payer: Aetna Commercial |
$3,116.57
|
| Rate for Payer: Anthem Medicaid |
$1,391.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,157.05
|
| Rate for Payer: Cash Price |
$2,023.75
|
| Rate for Payer: Cigna Commercial |
$3,359.43
|
| Rate for Payer: First Health Commercial |
$3,845.12
|
| Rate for Payer: Humana Commercial |
$3,440.38
|
| Rate for Payer: Humana KY Medicaid |
$1,391.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,406.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,318.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,987.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,214.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,419.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,561.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,035.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,238.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,521.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,792.78
|
| Rate for Payer: PHCS Commercial |
$3,885.60
|
| Rate for Payer: United Healthcare All Payer |
$3,561.80
|
|
|
BIOFLO PORT DUAL 8FR 44-028
|
Facility
|
OP
|
$8,485.95
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
27000108
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,545.78 |
| Max. Negotiated Rate |
$8,146.51 |
| Rate for Payer: Aetna Commercial |
$6,534.18
|
| Rate for Payer: Anthem Medicaid |
$2,918.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,619.04
|
| Rate for Payer: Cash Price |
$4,242.98
|
| Rate for Payer: Cigna Commercial |
$7,043.34
|
| Rate for Payer: First Health Commercial |
$8,061.65
|
| Rate for Payer: Humana Commercial |
$7,213.06
|
| Rate for Payer: Humana KY Medicaid |
$2,918.32
|
| Rate for Payer: Kentucky WC Medicaid |
$2,948.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,958.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,262.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,545.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,976.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,467.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,364.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,788.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,382.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,855.31
|
| Rate for Payer: PHCS Commercial |
$8,146.51
|
| Rate for Payer: United Healthcare All Payer |
$7,467.64
|
|
|
BIOFLO PORT DUAL 8FR 44-028
|
Facility
|
IP
|
$8,485.95
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
27000108
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,545.78 |
| Max. Negotiated Rate |
$8,146.51 |
| Rate for Payer: Aetna Commercial |
$6,534.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,619.04
|
| Rate for Payer: Cash Price |
$4,242.98
|
| Rate for Payer: Cigna Commercial |
$7,043.34
|
| Rate for Payer: First Health Commercial |
$8,061.65
|
| Rate for Payer: Humana Commercial |
$7,213.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,958.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,262.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,545.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,467.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,364.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,788.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,382.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,855.31
|
| Rate for Payer: PHCS Commercial |
$8,146.51
|
| Rate for Payer: United Healthcare All Payer |
$7,467.64
|
|
|
BIOFREEZE 89ML SPRAY CAN
|
Facility
|
IP
|
$0.93
|
|
|
Service Code
|
NDC 59316083310
|
| Hospital Charge Code |
25004575
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$0.89 |
| Rate for Payer: Aetna Commercial |
$0.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.73
|
| Rate for Payer: Cash Price |
$0.47
|
| Rate for Payer: Cigna Commercial |
$0.77
|
| Rate for Payer: First Health Commercial |
$0.88
|
| Rate for Payer: Humana Commercial |
$0.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.82
|
| Rate for Payer: Ohio Health Group HMO |
$0.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.64
|
| Rate for Payer: PHCS Commercial |
$0.89
|
| Rate for Payer: United Healthcare All Payer |
$0.82
|
|
|
BIOFREEZE 89ML SPRAY CAN
|
Facility
|
OP
|
$0.93
|
|
|
Service Code
|
NDC 59316083310
|
| Hospital Charge Code |
25004575
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$0.89 |
| Rate for Payer: Aetna Commercial |
$0.72
|
| Rate for Payer: Anthem Medicaid |
$0.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.73
|
| Rate for Payer: Cash Price |
$0.47
|
| Rate for Payer: Cigna Commercial |
$0.77
|
| Rate for Payer: First Health Commercial |
$0.88
|
| Rate for Payer: Humana Commercial |
$0.79
|
| Rate for Payer: Humana KY Medicaid |
$0.32
|
| Rate for Payer: Kentucky WC Medicaid |
$0.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.82
|
| Rate for Payer: Ohio Health Group HMO |
$0.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.64
|
| Rate for Payer: PHCS Commercial |
$0.89
|
| Rate for Payer: United Healthcare All Payer |
$0.82
|
|
|
BIOIMPEDANCE
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
HCPCS 93701
|
| Hospital Charge Code |
48000100
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$44.71 |
| Max. Negotiated Rate |
$166.74 |
| Rate for Payer: Aetna Commercial |
$100.10
|
| Rate for Payer: Anthem Medicaid |
$44.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$101.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.78
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna Commercial |
$107.90
|
| Rate for Payer: First Health Commercial |
$123.50
|
| Rate for Payer: Humana Commercial |
$110.50
|
| Rate for Payer: Humana KY Medicaid |
$44.71
|
| Rate for Payer: Humana Medicare Advantage |
$119.10
|
| Rate for Payer: Kentucky WC Medicaid |
$45.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$106.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$45.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$114.40
|
| Rate for Payer: Ohio Health Group HMO |
$97.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.70
|
| Rate for Payer: PHCS Commercial |
$124.80
|
| Rate for Payer: United Healthcare All Payer |
$114.40
|
|
|
BIOIMPEDANCE
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
HCPCS 93701
|
| Hospital Charge Code |
48000100
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$124.80 |
| Rate for Payer: Aetna Commercial |
$100.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$101.40
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna Commercial |
$107.90
|
| Rate for Payer: First Health Commercial |
$123.50
|
| Rate for Payer: Humana Commercial |
$110.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$106.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$114.40
|
| Rate for Payer: Ohio Health Group HMO |
$97.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.70
|
| Rate for Payer: PHCS Commercial |
$124.80
|
| Rate for Payer: United Healthcare All Payer |
$114.40
|
|
|
BIOLOX CERAMIC HEAD 36*16/18
|
Facility
|
IP
|
$14,377.29
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,313.19 |
| Max. Negotiated Rate |
$13,802.20 |
| Rate for Payer: Aetna Commercial |
$11,070.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,214.29
|
| Rate for Payer: Cash Price |
$7,188.65
|
| Rate for Payer: Cigna Commercial |
$11,933.15
|
| Rate for Payer: First Health Commercial |
$13,658.43
|
| Rate for Payer: Humana Commercial |
$12,220.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,789.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,610.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,313.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,652.02
|
| Rate for Payer: Ohio Health Group HMO |
$10,782.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,501.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,508.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,920.33
|
| Rate for Payer: PHCS Commercial |
$13,802.20
|
| Rate for Payer: United Healthcare All Payer |
$12,652.02
|
|
|
BIOLOX CERAMIC HEAD 36*16/18
|
Facility
|
OP
|
$14,377.29
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,313.19 |
| Max. Negotiated Rate |
$13,802.20 |
| Rate for Payer: Aetna Commercial |
$11,070.51
|
| Rate for Payer: Anthem Medicaid |
$4,944.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,214.29
|
| Rate for Payer: Cash Price |
$7,188.65
|
| Rate for Payer: Cigna Commercial |
$11,933.15
|
| Rate for Payer: First Health Commercial |
$13,658.43
|
| Rate for Payer: Humana Commercial |
$12,220.70
|
| Rate for Payer: Humana KY Medicaid |
$4,944.35
|
| Rate for Payer: Kentucky WC Medicaid |
$4,994.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,789.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,610.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,313.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,043.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,652.02
|
| Rate for Payer: Ohio Health Group HMO |
$10,782.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,501.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,508.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,920.33
|
| Rate for Payer: PHCS Commercial |
$13,802.20
|
| Rate for Payer: United Healthcare All Payer |
$12,652.02
|
|
|
BIOLOX CER FEM HEAD 12/14
|
Facility
|
OP
|
$7,664.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,299.41 |
| Max. Negotiated Rate |
$7,358.11 |
| Rate for Payer: Aetna Commercial |
$5,901.82
|
| Rate for Payer: Anthem Medicaid |
$2,635.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,978.47
|
| Rate for Payer: Cash Price |
$3,832.35
|
| Rate for Payer: Cigna Commercial |
$6,361.70
|
| Rate for Payer: First Health Commercial |
$7,281.47
|
| Rate for Payer: Humana Commercial |
$6,514.99
|
| Rate for Payer: Humana KY Medicaid |
$2,635.89
|
| Rate for Payer: Kentucky WC Medicaid |
$2,662.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,285.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,656.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,299.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,688.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,744.94
|
| Rate for Payer: Ohio Health Group HMO |
$5,748.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,131.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,668.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,288.64
|
| Rate for Payer: PHCS Commercial |
$7,358.11
|
| Rate for Payer: United Healthcare All Payer |
$6,744.94
|
|
|
BIOLOX CER FEM HEAD 12/14
|
Facility
|
IP
|
$7,664.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,299.41 |
| Max. Negotiated Rate |
$7,358.11 |
| Rate for Payer: Aetna Commercial |
$5,901.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,978.47
|
| Rate for Payer: Cash Price |
$3,832.35
|
| Rate for Payer: Cigna Commercial |
$6,361.70
|
| Rate for Payer: First Health Commercial |
$7,281.47
|
| Rate for Payer: Humana Commercial |
$6,514.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,285.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,656.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,299.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,744.94
|
| Rate for Payer: Ohio Health Group HMO |
$5,748.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,131.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,668.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,288.64
|
| Rate for Payer: PHCS Commercial |
$7,358.11
|
| Rate for Payer: United Healthcare All Payer |
$6,744.94
|
|
|
BIOLOX CER FEM HEAD 36MM +0
|
Facility
|
OP
|
$8,201.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,460.38 |
| Max. Negotiated Rate |
$7,873.20 |
| Rate for Payer: Aetna Commercial |
$6,314.96
|
| Rate for Payer: Anthem Medicaid |
$2,820.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,396.98
|
| Rate for Payer: Cash Price |
$4,100.62
|
| Rate for Payer: Cigna Commercial |
$6,807.04
|
| Rate for Payer: First Health Commercial |
$7,791.19
|
| Rate for Payer: Humana Commercial |
$6,971.06
|
| Rate for Payer: Humana KY Medicaid |
$2,820.41
|
| Rate for Payer: Kentucky WC Medicaid |
$2,849.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,725.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,052.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,460.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,877.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,217.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,150.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,561.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,135.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,658.86
|
| Rate for Payer: PHCS Commercial |
$7,873.20
|
| Rate for Payer: United Healthcare All Payer |
$7,217.10
|
|
|
BIOLOX CER FEM HEAD 36MM +0
|
Facility
|
IP
|
$8,201.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,460.38 |
| Max. Negotiated Rate |
$7,873.20 |
| Rate for Payer: Aetna Commercial |
$6,314.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,396.98
|
| Rate for Payer: Cash Price |
$4,100.62
|
| Rate for Payer: Cigna Commercial |
$6,807.04
|
| Rate for Payer: First Health Commercial |
$7,791.19
|
| Rate for Payer: Humana Commercial |
$6,971.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,725.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,052.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,460.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,217.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,150.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,561.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,135.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,658.86
|
| Rate for Payer: PHCS Commercial |
$7,873.20
|
| Rate for Payer: United Healthcare All Payer |
$7,217.10
|
|
|
BIOLOX DELTA FEM HEAD PHA04402
|
Facility
|
OP
|
$8,292.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,487.75 |
| Max. Negotiated Rate |
$7,960.80 |
| Rate for Payer: Aetna Commercial |
$6,385.23
|
| Rate for Payer: Anthem Medicaid |
$2,851.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,468.15
|
| Rate for Payer: Cash Price |
$4,146.25
|
| Rate for Payer: Cigna Commercial |
$6,882.77
|
| Rate for Payer: First Health Commercial |
$7,877.88
|
| Rate for Payer: Humana Commercial |
$7,048.62
|
| Rate for Payer: Humana KY Medicaid |
$2,851.79
|
| Rate for Payer: Kentucky WC Medicaid |
$2,880.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,799.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,119.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,487.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,909.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,297.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,219.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,634.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,214.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,721.82
|
| Rate for Payer: PHCS Commercial |
$7,960.80
|
| Rate for Payer: United Healthcare All Payer |
$7,297.40
|
|
