|
CORIAL FEM STEM W/ COLLR SZ 15
|
Facility
|
OP
|
$21,497.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,449.10 |
| Max. Negotiated Rate |
$20,637.12 |
| Rate for Payer: Aetna Commercial |
$16,552.69
|
| Rate for Payer: Anthem Medicaid |
$7,392.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,767.66
|
| Rate for Payer: Cash Price |
$10,748.50
|
| Rate for Payer: Cigna Commercial |
$17,842.51
|
| Rate for Payer: First Health Commercial |
$20,422.15
|
| Rate for Payer: Humana Commercial |
$18,272.45
|
| Rate for Payer: Humana KY Medicaid |
$7,392.82
|
| Rate for Payer: Kentucky WC Medicaid |
$7,468.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,627.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,864.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,449.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,541.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,917.36
|
| Rate for Payer: Ohio Health Group HMO |
$16,122.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,197.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,702.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,832.93
|
| Rate for Payer: PHCS Commercial |
$20,637.12
|
| Rate for Payer: United Healthcare All Payer |
$18,917.36
|
|
|
CORIAL FEM STEM WO COLLAR SZ12
|
Facility
|
IP
|
$23,186.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,956.02 |
| Max. Negotiated Rate |
$22,259.28 |
| Rate for Payer: Aetna Commercial |
$17,853.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,085.67
|
| Rate for Payer: Cash Price |
$11,593.38
|
| Rate for Payer: Cigna Commercial |
$19,245.00
|
| Rate for Payer: First Health Commercial |
$22,027.41
|
| Rate for Payer: Humana Commercial |
$19,708.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,013.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,111.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,956.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,404.34
|
| Rate for Payer: Ohio Health Group HMO |
$17,390.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,549.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,172.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,998.86
|
| Rate for Payer: PHCS Commercial |
$22,259.28
|
| Rate for Payer: United Healthcare All Payer |
$20,404.34
|
|
|
CORIAL FEM STEM WO COLLAR SZ12
|
Facility
|
OP
|
$23,186.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,956.02 |
| Max. Negotiated Rate |
$22,259.28 |
| Rate for Payer: Aetna Commercial |
$17,853.80
|
| Rate for Payer: Anthem Medicaid |
$7,973.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,085.67
|
| Rate for Payer: Cash Price |
$11,593.38
|
| Rate for Payer: Cigna Commercial |
$19,245.00
|
| Rate for Payer: First Health Commercial |
$22,027.41
|
| Rate for Payer: Humana Commercial |
$19,708.74
|
| Rate for Payer: Humana KY Medicaid |
$7,973.92
|
| Rate for Payer: Kentucky WC Medicaid |
$8,055.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,013.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,111.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,956.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,133.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,404.34
|
| Rate for Payer: Ohio Health Group HMO |
$17,390.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,549.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,172.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,998.86
|
| Rate for Payer: PHCS Commercial |
$22,259.28
|
| Rate for Payer: United Healthcare All Payer |
$20,404.34
|
|
|
CORIAL FEM STEM WO COLLAR SZ13
|
Facility
|
IP
|
$23,186.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,956.02 |
| Max. Negotiated Rate |
$22,259.28 |
| Rate for Payer: Aetna Commercial |
$17,853.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,085.67
|
| Rate for Payer: Cash Price |
$11,593.38
|
| Rate for Payer: Cigna Commercial |
$19,245.00
|
| Rate for Payer: First Health Commercial |
$22,027.41
|
| Rate for Payer: Humana Commercial |
$19,708.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,013.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,111.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,956.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,404.34
|
| Rate for Payer: Ohio Health Group HMO |
$17,390.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,549.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,172.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,998.86
|
| Rate for Payer: PHCS Commercial |
$22,259.28
|
| Rate for Payer: United Healthcare All Payer |
$20,404.34
|
|
|
CORIAL FEM STEM WO COLLAR SZ13
|
Facility
|
OP
|
$23,186.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,956.02 |
| Max. Negotiated Rate |
$22,259.28 |
| Rate for Payer: Aetna Commercial |
$17,853.80
|
| Rate for Payer: Anthem Medicaid |
$7,973.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,085.67
|
| Rate for Payer: Cash Price |
$11,593.38
|
| Rate for Payer: Cigna Commercial |
$19,245.00
|
| Rate for Payer: First Health Commercial |
$22,027.41
|
| Rate for Payer: Humana Commercial |
$19,708.74
|
| Rate for Payer: Humana KY Medicaid |
$7,973.92
|
| Rate for Payer: Kentucky WC Medicaid |
$8,055.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,013.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,111.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,956.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,133.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,404.34
|
| Rate for Payer: Ohio Health Group HMO |
$17,390.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,549.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,172.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,998.86
|
| Rate for Payer: PHCS Commercial |
$22,259.28
|
| Rate for Payer: United Healthcare All Payer |
$20,404.34
|
|
|
CORKSCREW FT II 5.5 SUT ANCHOR
|
Facility
|
IP
|
$3,068.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$920.62 |
| Max. Negotiated Rate |
$2,946.00 |
| Rate for Payer: Aetna Commercial |
$2,362.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,393.62
|
| Rate for Payer: Cash Price |
$1,534.38
|
| Rate for Payer: Cigna Commercial |
$2,547.06
|
| Rate for Payer: First Health Commercial |
$2,915.31
|
| Rate for Payer: Humana Commercial |
$2,608.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,516.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,264.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$920.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,700.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,301.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,455.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,669.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,117.44
|
| Rate for Payer: PHCS Commercial |
$2,946.00
|
| Rate for Payer: United Healthcare All Payer |
$2,700.50
|
|
|
CORKSCREW FT II 5.5 SUT ANCHOR
|
Facility
|
OP
|
$3,068.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$920.62 |
| Max. Negotiated Rate |
$2,946.00 |
| Rate for Payer: Aetna Commercial |
$2,362.94
|
| Rate for Payer: Anthem Medicaid |
$1,055.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,393.62
|
| Rate for Payer: Cash Price |
$1,534.38
|
| Rate for Payer: Cigna Commercial |
$2,547.06
|
| Rate for Payer: First Health Commercial |
$2,915.31
|
| Rate for Payer: Humana Commercial |
$2,608.44
|
| Rate for Payer: Humana KY Medicaid |
$1,055.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,066.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,516.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,264.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$920.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,076.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,700.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,301.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,455.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,669.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,117.44
|
| Rate for Payer: PHCS Commercial |
$2,946.00
|
| Rate for Payer: United Healthcare All Payer |
$2,700.50
|
|
|
CORKSCREW FT SUTURE ANCHOR 5.5
|
Facility
|
OP
|
$3,218.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$965.62 |
| Max. Negotiated Rate |
$3,090.00 |
| Rate for Payer: Aetna Commercial |
$2,478.44
|
| Rate for Payer: Anthem Medicaid |
$1,106.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,510.62
|
| Rate for Payer: Cash Price |
$1,609.38
|
| Rate for Payer: Cigna Commercial |
$2,671.56
|
| Rate for Payer: First Health Commercial |
$3,057.81
|
| Rate for Payer: Humana Commercial |
$2,735.94
|
| Rate for Payer: Humana KY Medicaid |
$1,106.93
|
| Rate for Payer: Kentucky WC Medicaid |
$1,118.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,639.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,375.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$965.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,129.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,832.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,414.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,575.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,800.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,220.94
|
| Rate for Payer: PHCS Commercial |
$3,090.00
|
| Rate for Payer: United Healthcare All Payer |
$2,832.50
|
|
|
CORKSCREW FT SUTURE ANCHOR 5.5
|
Facility
|
IP
|
$3,218.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$965.62 |
| Max. Negotiated Rate |
$3,090.00 |
| Rate for Payer: Aetna Commercial |
$2,478.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,510.62
|
| Rate for Payer: Cash Price |
$1,609.38
|
| Rate for Payer: Cigna Commercial |
$2,671.56
|
| Rate for Payer: First Health Commercial |
$3,057.81
|
| Rate for Payer: Humana Commercial |
$2,735.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,639.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,375.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$965.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,832.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,414.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,575.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,800.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,220.94
|
| Rate for Payer: PHCS Commercial |
$3,090.00
|
| Rate for Payer: United Healthcare All Payer |
$2,832.50
|
|
|
CORKSCRW FT 5.5*15 W/TIGERTAIL
|
Facility
|
IP
|
$3,293.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$988.12 |
| Max. Negotiated Rate |
$3,162.00 |
| Rate for Payer: Aetna Commercial |
$2,536.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,569.12
|
| Rate for Payer: Cash Price |
$1,646.88
|
| Rate for Payer: Cigna Commercial |
$2,733.81
|
| Rate for Payer: First Health Commercial |
$3,129.06
|
| Rate for Payer: Humana Commercial |
$2,799.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,700.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,430.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$988.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,898.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,470.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,635.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,865.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,272.69
|
| Rate for Payer: PHCS Commercial |
$3,162.00
|
| Rate for Payer: United Healthcare All Payer |
$2,898.50
|
|
|
CORKSCRW FT 5.5*15 W/TIGERTAIL
|
Facility
|
OP
|
$3,293.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$988.12 |
| Max. Negotiated Rate |
$3,162.00 |
| Rate for Payer: Aetna Commercial |
$2,536.19
|
| Rate for Payer: Anthem Medicaid |
$1,132.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,569.12
|
| Rate for Payer: Cash Price |
$1,646.88
|
| Rate for Payer: Cigna Commercial |
$2,733.81
|
| Rate for Payer: First Health Commercial |
$3,129.06
|
| Rate for Payer: Humana Commercial |
$2,799.69
|
| Rate for Payer: Humana KY Medicaid |
$1,132.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1,144.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,700.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,430.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$988.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,155.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,898.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,470.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,635.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,865.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,272.69
|
| Rate for Payer: PHCS Commercial |
$3,162.00
|
| Rate for Payer: United Healthcare All Payer |
$2,898.50
|
|
|
CORMATRIX 4*7 TISSUE REPAIR
|
Facility
|
OP
|
$4,981.25
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
27000051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,494.38 |
| Max. Negotiated Rate |
$4,782.00 |
| Rate for Payer: Aetna Commercial |
$3,835.56
|
| Rate for Payer: Anthem Medicaid |
$1,713.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,885.38
|
| Rate for Payer: Cash Price |
$2,490.62
|
| Rate for Payer: Cigna Commercial |
$4,134.44
|
| Rate for Payer: First Health Commercial |
$4,732.19
|
| Rate for Payer: Humana Commercial |
$4,234.06
|
| Rate for Payer: Humana KY Medicaid |
$1,713.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,730.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,084.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,676.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,747.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,383.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,735.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,333.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,437.06
|
| Rate for Payer: PHCS Commercial |
$4,782.00
|
| Rate for Payer: United Healthcare All Payer |
$4,383.50
|
|
|
CORMATRIX 4*7 TISSUE REPAIR
|
Facility
|
IP
|
$4,981.25
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
27000051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,494.38 |
| Max. Negotiated Rate |
$4,782.00 |
| Rate for Payer: Aetna Commercial |
$3,835.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,885.38
|
| Rate for Payer: Cash Price |
$2,490.62
|
| Rate for Payer: Cigna Commercial |
$4,134.44
|
| Rate for Payer: First Health Commercial |
$4,732.19
|
| Rate for Payer: Humana Commercial |
$4,234.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,084.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,676.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,383.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,735.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,333.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,437.06
|
| Rate for Payer: PHCS Commercial |
$4,782.00
|
| Rate for Payer: United Healthcare All Payer |
$4,383.50
|
|
|
CORMATRIX 7*10 TISSUE REPAIR
|
Facility
|
OP
|
$5,656.25
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
27000051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,696.88 |
| Max. Negotiated Rate |
$5,430.00 |
| Rate for Payer: Aetna Commercial |
$4,355.31
|
| Rate for Payer: Anthem Medicaid |
$1,945.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,411.88
|
| Rate for Payer: Cash Price |
$2,828.12
|
| Rate for Payer: Cigna Commercial |
$4,694.69
|
| Rate for Payer: First Health Commercial |
$5,373.44
|
| Rate for Payer: Humana Commercial |
$4,807.81
|
| Rate for Payer: Humana KY Medicaid |
$1,945.18
|
| Rate for Payer: Kentucky WC Medicaid |
$1,964.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,638.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,174.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,696.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,984.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,977.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,242.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,525.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,920.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,902.81
|
| Rate for Payer: PHCS Commercial |
$5,430.00
|
| Rate for Payer: United Healthcare All Payer |
$4,977.50
|
|
|
CORMATRIX 7*10 TISSUE REPAIR
|
Facility
|
IP
|
$5,656.25
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
27000051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,696.88 |
| Max. Negotiated Rate |
$5,430.00 |
| Rate for Payer: Aetna Commercial |
$4,355.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,411.88
|
| Rate for Payer: Cash Price |
$2,828.12
|
| Rate for Payer: Cigna Commercial |
$4,694.69
|
| Rate for Payer: First Health Commercial |
$5,373.44
|
| Rate for Payer: Humana Commercial |
$4,807.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,638.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,174.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,696.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,977.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,242.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,525.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,920.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,902.81
|
| Rate for Payer: PHCS Commercial |
$5,430.00
|
| Rate for Payer: United Healthcare All Payer |
$4,977.50
|
|
|
CORN IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000799
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.70 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
CORN IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000799
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Humana KY Medicaid |
$5.22
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Kentucky WC Medicaid |
$5.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
CORONARY ART BYPASS 3 GRAFTS
|
Facility
|
OP
|
$6,200.00
|
|
|
Service Code
|
HCPCS 33535
|
| Hospital Charge Code |
76101310
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,860.00 |
| Max. Negotiated Rate |
$5,952.00 |
| Rate for Payer: Aetna Commercial |
$4,774.00
|
| Rate for Payer: Anthem Medicaid |
$2,132.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,836.00
|
| Rate for Payer: Cash Price |
$3,100.00
|
| Rate for Payer: Cigna Commercial |
$5,146.00
|
| Rate for Payer: First Health Commercial |
$5,890.00
|
| Rate for Payer: Humana Commercial |
$5,270.00
|
| Rate for Payer: Humana KY Medicaid |
$2,132.18
|
| Rate for Payer: Kentucky WC Medicaid |
$2,153.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,084.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,575.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,860.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,174.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,456.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,650.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,960.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,394.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,278.00
|
| Rate for Payer: PHCS Commercial |
$5,952.00
|
| Rate for Payer: United Healthcare All Payer |
$5,456.00
|
|
|
CORONARY ART BYPASS 3 GRAFTS
|
Facility
|
IP
|
$6,200.00
|
|
|
Service Code
|
HCPCS 33535
|
| Hospital Charge Code |
76101310
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,860.00 |
| Max. Negotiated Rate |
$5,952.00 |
| Rate for Payer: Aetna Commercial |
$4,774.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,836.00
|
| Rate for Payer: Cash Price |
$3,100.00
|
| Rate for Payer: Cigna Commercial |
$5,146.00
|
| Rate for Payer: First Health Commercial |
$5,890.00
|
| Rate for Payer: Humana Commercial |
$5,270.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,084.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,575.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,860.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,456.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,650.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,960.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,394.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,278.00
|
| Rate for Payer: PHCS Commercial |
$5,952.00
|
| Rate for Payer: United Healthcare All Payer |
$5,456.00
|
|
|
CORONARY ART BYPASS 3 GRAFTS
|
Professional
|
Both
|
$6,200.00
|
|
|
Service Code
|
HCPCS 33535
|
| Hospital Charge Code |
76101310
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,062.56 |
| Max. Negotiated Rate |
$4,195.78 |
| Rate for Payer: Aetna Commercial |
$4,195.78
|
| Rate for Payer: Ambetter Exchange |
$2,297.02
|
| Rate for Payer: Anthem Medicaid |
$2,062.56
|
| Rate for Payer: Buckeye Individual/Medicaid |
$2,297.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,297.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,756.42
|
| Rate for Payer: Cash Price |
$3,100.00
|
| Rate for Payer: Cash Price |
$3,100.00
|
| Rate for Payer: Cigna Commercial |
$3,950.31
|
| Rate for Payer: Healthspan PPO |
$4,125.27
|
| Rate for Payer: Humana Medicaid |
$2,062.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$3,494.21
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$2,297.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,297.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$2,103.81
|
| Rate for Payer: Molina Healthcare Passport |
$2,062.56
|
| Rate for Payer: Multiplan PHCS |
$3,720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,986.13
|
| Rate for Payer: UHCCP Medicaid |
$2,170.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$2,083.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,297.02
|
|
|
CORONARY ART BYPASS 3 GRAFTS(P
|
Professional
|
Both
|
$6,200.00
|
|
|
Service Code
|
HCPCS 33535
|
| Hospital Charge Code |
761P1310
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,062.56 |
| Max. Negotiated Rate |
$4,195.78 |
| Rate for Payer: Aetna Commercial |
$4,195.78
|
| Rate for Payer: Ambetter Exchange |
$2,297.02
|
| Rate for Payer: Anthem Medicaid |
$2,062.56
|
| Rate for Payer: Buckeye Individual/Medicaid |
$2,297.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,297.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,756.42
|
| Rate for Payer: Cash Price |
$3,100.00
|
| Rate for Payer: Cash Price |
$3,100.00
|
| Rate for Payer: Cigna Commercial |
$3,950.31
|
| Rate for Payer: Healthspan PPO |
$4,125.27
|
| Rate for Payer: Humana Medicaid |
$2,062.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$3,494.21
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$2,297.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,297.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$2,103.81
|
| Rate for Payer: Molina Healthcare Passport |
$2,062.56
|
| Rate for Payer: Multiplan PHCS |
$3,720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,986.13
|
| Rate for Payer: UHCCP Medicaid |
$2,170.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$2,083.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,297.02
|
|
|
CORONARY ART BYPASS 4 OR MORE
|
Professional
|
Both
|
$6,000.00
|
|
|
Service Code
|
HCPCS 33536
|
| Hospital Charge Code |
76101311
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,100.00 |
| Max. Negotiated Rate |
$4,498.97 |
| Rate for Payer: Aetna Commercial |
$4,498.97
|
| Rate for Payer: Ambetter Exchange |
$2,475.27
|
| Rate for Payer: Anthem Medicaid |
$2,267.94
|
| Rate for Payer: Buckeye Individual/Medicaid |
$2,475.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,475.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,970.32
|
| Rate for Payer: Cash Price |
$3,000.00
|
| Rate for Payer: Cash Price |
$3,000.00
|
| Rate for Payer: Cigna Commercial |
$4,209.58
|
| Rate for Payer: Healthspan PPO |
$4,423.37
|
| Rate for Payer: Humana Medicaid |
$2,267.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$3,760.54
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$2,475.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,475.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$2,313.30
|
| Rate for Payer: Molina Healthcare Passport |
$2,267.94
|
| Rate for Payer: Multiplan PHCS |
$3,600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,217.85
|
| Rate for Payer: UHCCP Medicaid |
$2,100.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$2,290.62
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,475.27
|
|
|
CORONARY ART BYPASS VEIN ONLY
|
Professional
|
Both
|
$4,600.00
|
|
|
Service Code
|
HCPCS 33510
|
| Hospital Charge Code |
76101297
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,602.35 |
| Max. Negotiated Rate |
$3,351.00 |
| Rate for Payer: Aetna Commercial |
$3,351.00
|
| Rate for Payer: Ambetter Exchange |
$1,815.65
|
| Rate for Payer: Anthem Medicaid |
$1,602.35
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,815.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,815.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,178.78
|
| Rate for Payer: Cash Price |
$2,300.00
|
| Rate for Payer: Cash Price |
$2,300.00
|
| Rate for Payer: Cigna Commercial |
$3,216.19
|
| Rate for Payer: Healthspan PPO |
$3,294.68
|
| Rate for Payer: Humana Medicaid |
$1,602.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,761.67
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,815.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,815.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,634.40
|
| Rate for Payer: Molina Healthcare Passport |
$1,602.35
|
| Rate for Payer: Multiplan PHCS |
$2,760.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,360.34
|
| Rate for Payer: UHCCP Medicaid |
$1,610.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,618.37
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,815.65
|
|
|
CORONARY ARTER BYPASS
|
Facility
|
OP
|
$6,000.00
|
|
|
Service Code
|
HCPCS 33513
|
| Hospital Charge Code |
76101300
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,800.00 |
| Max. Negotiated Rate |
$5,760.00 |
| Rate for Payer: Aetna Commercial |
$4,620.00
|
| Rate for Payer: Anthem Medicaid |
$2,063.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,680.00
|
| Rate for Payer: Cash Price |
$3,000.00
|
| Rate for Payer: Cigna Commercial |
$4,980.00
|
| Rate for Payer: First Health Commercial |
$5,700.00
|
| Rate for Payer: Humana Commercial |
$5,100.00
|
| Rate for Payer: Humana KY Medicaid |
$2,063.40
|
| Rate for Payer: Kentucky WC Medicaid |
$2,084.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,920.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,428.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,800.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,104.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,280.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,220.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,140.00
|
| Rate for Payer: PHCS Commercial |
$5,760.00
|
| Rate for Payer: United Healthcare All Payer |
$5,280.00
|
|
|
CORONARY ARTER BYPASS
|
Facility
|
IP
|
$6,000.00
|
|
|
Service Code
|
HCPCS 33513
|
| Hospital Charge Code |
76101300
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,800.00 |
| Max. Negotiated Rate |
$5,760.00 |
| Rate for Payer: Aetna Commercial |
$4,620.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,680.00
|
| Rate for Payer: Cash Price |
$3,000.00
|
| Rate for Payer: Cigna Commercial |
$4,980.00
|
| Rate for Payer: First Health Commercial |
$5,700.00
|
| Rate for Payer: Humana Commercial |
$5,100.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,920.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,428.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,800.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,280.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,220.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,140.00
|
| Rate for Payer: PHCS Commercial |
$5,760.00
|
| Rate for Payer: United Healthcare All Payer |
$5,280.00
|
|
