|
FEMUR RESURFACING AXIAL PIN SZ
|
Facility
|
IP
|
$16,749.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,177.45 |
| Max. Negotiated Rate |
$16,079.62 |
| Rate for Payer: Aetna Commercial |
$12,897.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,064.69
|
| Rate for Payer: Cash Price |
$8,374.80
|
| Rate for Payer: Cigna Commercial |
$13,902.17
|
| Rate for Payer: First Health Commercial |
$15,912.12
|
| Rate for Payer: Humana Commercial |
$14,237.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,734.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,361.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,024.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,739.65
|
| Rate for Payer: Ohio Health Group HMO |
$12,562.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,349.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,177.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,192.38
|
| Rate for Payer: PHCS Commercial |
$16,079.62
|
| Rate for Payer: United Healthcare All Payer |
$14,739.65
|
|
|
FEMUR RESURFACING AXIAL PIN SZ
|
Facility
|
OP
|
$16,749.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,177.45 |
| Max. Negotiated Rate |
$16,079.62 |
| Rate for Payer: Aetna Commercial |
$12,897.19
|
| Rate for Payer: Anthem Medicaid |
$5,760.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,064.69
|
| Rate for Payer: Cash Price |
$8,374.80
|
| Rate for Payer: Cigna Commercial |
$13,902.17
|
| Rate for Payer: First Health Commercial |
$15,912.12
|
| Rate for Payer: Humana Commercial |
$14,237.16
|
| Rate for Payer: Humana KY Medicaid |
$5,760.19
|
| Rate for Payer: Kentucky WC Medicaid |
$5,818.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,734.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,361.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,024.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,875.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,739.65
|
| Rate for Payer: Ohio Health Group HMO |
$12,562.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,349.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,177.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,192.38
|
| Rate for Payer: PHCS Commercial |
$16,079.62
|
| Rate for Payer: United Healthcare All Payer |
$14,739.65
|
|
|
FEMUR RESURFACING AX PIN SZ 1
|
Facility
|
OP
|
$13,465.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,750.48 |
| Max. Negotiated Rate |
$12,926.64 |
| Rate for Payer: Aetna Commercial |
$10,368.24
|
| Rate for Payer: Anthem Medicaid |
$4,630.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,502.90
|
| Rate for Payer: Cash Price |
$6,732.62
|
| Rate for Payer: Cigna Commercial |
$11,176.16
|
| Rate for Payer: First Health Commercial |
$12,791.99
|
| Rate for Payer: Humana Commercial |
$11,445.46
|
| Rate for Payer: Humana KY Medicaid |
$4,630.70
|
| Rate for Payer: Kentucky WC Medicaid |
$4,677.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,041.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,937.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,039.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,723.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,849.42
|
| Rate for Payer: Ohio Health Group HMO |
$10,098.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,693.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,750.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,174.23
|
| Rate for Payer: PHCS Commercial |
$12,926.64
|
| Rate for Payer: United Healthcare All Payer |
$11,849.42
|
|
|
FEMUR RESURFACING AX PIN SZ 1
|
Facility
|
IP
|
$13,465.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,750.48 |
| Max. Negotiated Rate |
$12,926.64 |
| Rate for Payer: Aetna Commercial |
$10,368.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,502.90
|
| Rate for Payer: Cash Price |
$6,732.62
|
| Rate for Payer: Cigna Commercial |
$11,176.16
|
| Rate for Payer: First Health Commercial |
$12,791.99
|
| Rate for Payer: Humana Commercial |
$11,445.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,041.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,937.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,039.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,849.42
|
| Rate for Payer: Ohio Health Group HMO |
$10,098.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,693.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,750.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,174.23
|
| Rate for Payer: PHCS Commercial |
$12,926.64
|
| Rate for Payer: United Healthcare All Payer |
$11,849.42
|
|
|
FEMUR RESURF AXIAL PIN SZ 3
|
Facility
|
IP
|
$16,749.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,177.45 |
| Max. Negotiated Rate |
$16,079.62 |
| Rate for Payer: Aetna Commercial |
$12,897.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,064.69
|
| Rate for Payer: Cash Price |
$8,374.80
|
| Rate for Payer: Cigna Commercial |
$13,902.17
|
| Rate for Payer: First Health Commercial |
$15,912.12
|
| Rate for Payer: Humana Commercial |
$14,237.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,734.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,361.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,024.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,739.65
|
| Rate for Payer: Ohio Health Group HMO |
$12,562.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,349.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,177.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,192.38
|
| Rate for Payer: PHCS Commercial |
$16,079.62
|
| Rate for Payer: United Healthcare All Payer |
$14,739.65
|
|
|
FEMUR RESURF AXIAL PIN SZ 3
|
Facility
|
OP
|
$16,749.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,177.45 |
| Max. Negotiated Rate |
$16,079.62 |
| Rate for Payer: Aetna Commercial |
$12,897.19
|
| Rate for Payer: Anthem Medicaid |
$5,760.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,064.69
|
| Rate for Payer: Cash Price |
$8,374.80
|
| Rate for Payer: Cigna Commercial |
$13,902.17
|
| Rate for Payer: First Health Commercial |
$15,912.12
|
| Rate for Payer: Humana Commercial |
$14,237.16
|
| Rate for Payer: Humana KY Medicaid |
$5,760.19
|
| Rate for Payer: Kentucky WC Medicaid |
$5,818.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,734.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,361.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,024.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,875.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,739.65
|
| Rate for Payer: Ohio Health Group HMO |
$12,562.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,349.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,177.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,192.38
|
| Rate for Payer: PHCS Commercial |
$16,079.62
|
| Rate for Payer: United Healthcare All Payer |
$14,739.65
|
|
|
FEMUR SEGMENTAL DIST XT SZ B L
|
Facility
|
OP
|
$36,319.57
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,721.54 |
| Max. Negotiated Rate |
$34,866.79 |
| Rate for Payer: Aetna Commercial |
$27,966.07
|
| Rate for Payer: Anthem Medicaid |
$12,490.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,329.26
|
| Rate for Payer: Cash Price |
$18,159.79
|
| Rate for Payer: Cigna Commercial |
$30,145.24
|
| Rate for Payer: First Health Commercial |
$34,503.59
|
| Rate for Payer: Humana Commercial |
$30,871.63
|
| Rate for Payer: Humana KY Medicaid |
$12,490.30
|
| Rate for Payer: Kentucky WC Medicaid |
$12,617.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,782.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,803.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,895.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,740.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,961.22
|
| Rate for Payer: Ohio Health Group HMO |
$27,239.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,263.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,721.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,259.07
|
| Rate for Payer: PHCS Commercial |
$34,866.79
|
| Rate for Payer: United Healthcare All Payer |
$31,961.22
|
|
|
FEMUR SEGMENTAL DIST XT SZ B L
|
Facility
|
IP
|
$36,319.57
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,721.54 |
| Max. Negotiated Rate |
$34,866.79 |
| Rate for Payer: Aetna Commercial |
$27,966.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,329.26
|
| Rate for Payer: Cash Price |
$18,159.79
|
| Rate for Payer: Cigna Commercial |
$30,145.24
|
| Rate for Payer: First Health Commercial |
$34,503.59
|
| Rate for Payer: Humana Commercial |
$30,871.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,782.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,803.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,895.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,961.22
|
| Rate for Payer: Ohio Health Group HMO |
$27,239.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,263.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,721.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,259.07
|
| Rate for Payer: PHCS Commercial |
$34,866.79
|
| Rate for Payer: United Healthcare All Payer |
$31,961.22
|
|
|
FEMUR SEGMENTAL DIST XT SZ B R
|
Facility
|
IP
|
$36,319.57
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,721.54 |
| Max. Negotiated Rate |
$34,866.79 |
| Rate for Payer: Aetna Commercial |
$27,966.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,329.26
|
| Rate for Payer: Cash Price |
$18,159.79
|
| Rate for Payer: Cigna Commercial |
$30,145.24
|
| Rate for Payer: First Health Commercial |
$34,503.59
|
| Rate for Payer: Humana Commercial |
$30,871.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,782.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,803.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,895.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,961.22
|
| Rate for Payer: Ohio Health Group HMO |
$27,239.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,263.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,721.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,259.07
|
| Rate for Payer: PHCS Commercial |
$34,866.79
|
| Rate for Payer: United Healthcare All Payer |
$31,961.22
|
|
|
FEMUR SEGMENTAL DIST XT SZ B R
|
Facility
|
OP
|
$36,319.57
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,721.54 |
| Max. Negotiated Rate |
$34,866.79 |
| Rate for Payer: Aetna Commercial |
$27,966.07
|
| Rate for Payer: Anthem Medicaid |
$12,490.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,329.26
|
| Rate for Payer: Cash Price |
$18,159.79
|
| Rate for Payer: Cigna Commercial |
$30,145.24
|
| Rate for Payer: First Health Commercial |
$34,503.59
|
| Rate for Payer: Humana Commercial |
$30,871.63
|
| Rate for Payer: Humana KY Medicaid |
$12,490.30
|
| Rate for Payer: Kentucky WC Medicaid |
$12,617.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,782.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,803.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,895.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,740.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,961.22
|
| Rate for Payer: Ohio Health Group HMO |
$27,239.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,263.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,721.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,259.07
|
| Rate for Payer: PHCS Commercial |
$34,866.79
|
| Rate for Payer: United Healthcare All Payer |
$31,961.22
|
|
|
FEMUR SEGMENTAL DIST XT SZ C L
|
Facility
|
OP
|
$36,319.57
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,721.54 |
| Max. Negotiated Rate |
$34,866.79 |
| Rate for Payer: Aetna Commercial |
$27,966.07
|
| Rate for Payer: Anthem Medicaid |
$12,490.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,329.26
|
| Rate for Payer: Cash Price |
$18,159.79
|
| Rate for Payer: Cigna Commercial |
$30,145.24
|
| Rate for Payer: First Health Commercial |
$34,503.59
|
| Rate for Payer: Humana Commercial |
$30,871.63
|
| Rate for Payer: Humana KY Medicaid |
$12,490.30
|
| Rate for Payer: Kentucky WC Medicaid |
$12,617.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,782.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,803.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,895.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,740.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,961.22
|
| Rate for Payer: Ohio Health Group HMO |
$27,239.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,263.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,721.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,259.07
|
| Rate for Payer: PHCS Commercial |
$34,866.79
|
| Rate for Payer: United Healthcare All Payer |
$31,961.22
|
|
|
FEMUR SEGMENTAL DIST XT SZ C L
|
Facility
|
IP
|
$36,319.57
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,721.54 |
| Max. Negotiated Rate |
$34,866.79 |
| Rate for Payer: Aetna Commercial |
$27,966.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,329.26
|
| Rate for Payer: Cash Price |
$18,159.79
|
| Rate for Payer: Cigna Commercial |
$30,145.24
|
| Rate for Payer: First Health Commercial |
$34,503.59
|
| Rate for Payer: Humana Commercial |
$30,871.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,782.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,803.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,895.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,961.22
|
| Rate for Payer: Ohio Health Group HMO |
$27,239.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,263.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,721.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,259.07
|
| Rate for Payer: PHCS Commercial |
$34,866.79
|
| Rate for Payer: United Healthcare All Payer |
$31,961.22
|
|
|
FEMUR SEGMENTAL DIST XT SZ C R
|
Facility
|
OP
|
$36,319.57
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,721.54 |
| Max. Negotiated Rate |
$34,866.79 |
| Rate for Payer: Aetna Commercial |
$27,966.07
|
| Rate for Payer: Anthem Medicaid |
$12,490.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,329.26
|
| Rate for Payer: Cash Price |
$18,159.79
|
| Rate for Payer: Cigna Commercial |
$30,145.24
|
| Rate for Payer: First Health Commercial |
$34,503.59
|
| Rate for Payer: Humana Commercial |
$30,871.63
|
| Rate for Payer: Humana KY Medicaid |
$12,490.30
|
| Rate for Payer: Kentucky WC Medicaid |
$12,617.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,782.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,803.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,895.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,740.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,961.22
|
| Rate for Payer: Ohio Health Group HMO |
$27,239.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,263.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,721.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,259.07
|
| Rate for Payer: PHCS Commercial |
$34,866.79
|
| Rate for Payer: United Healthcare All Payer |
$31,961.22
|
|
|
FEMUR SEGMENTAL DIST XT SZ C R
|
Facility
|
IP
|
$36,319.57
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,721.54 |
| Max. Negotiated Rate |
$34,866.79 |
| Rate for Payer: Aetna Commercial |
$27,966.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,329.26
|
| Rate for Payer: Cash Price |
$18,159.79
|
| Rate for Payer: Cigna Commercial |
$30,145.24
|
| Rate for Payer: First Health Commercial |
$34,503.59
|
| Rate for Payer: Humana Commercial |
$30,871.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,782.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,803.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,895.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,961.22
|
| Rate for Payer: Ohio Health Group HMO |
$27,239.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,263.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,721.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,259.07
|
| Rate for Payer: PHCS Commercial |
$34,866.79
|
| Rate for Payer: United Healthcare All Payer |
$31,961.22
|
|
|
FEOSOL(FERROUS SULF 324MG/1TAB
|
Facility
|
IP
|
$4.21
|
|
|
Service Code
|
NDC 904759080
|
| Hospital Charge Code |
25000673
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$4.04 |
| Rate for Payer: Aetna Commercial |
$3.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.28
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$3.49
|
| Rate for Payer: First Health Commercial |
$4.00
|
| Rate for Payer: Humana Commercial |
$3.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.70
|
| Rate for Payer: Ohio Health Group HMO |
$3.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.31
|
| Rate for Payer: PHCS Commercial |
$4.04
|
| Rate for Payer: United Healthcare All Payer |
$3.70
|
|
|
FEOSOL(FERROUS SULF 324MG/1TAB
|
Facility
|
OP
|
$4.21
|
|
|
Service Code
|
NDC 904759080
|
| Hospital Charge Code |
25000673
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$4.04 |
| Rate for Payer: Aetna Commercial |
$3.24
|
| Rate for Payer: Anthem Medicaid |
$1.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.28
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$3.49
|
| Rate for Payer: First Health Commercial |
$4.00
|
| Rate for Payer: Humana Commercial |
$3.58
|
| Rate for Payer: Humana KY Medicaid |
$1.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.70
|
| Rate for Payer: Ohio Health Group HMO |
$3.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.31
|
| Rate for Payer: PHCS Commercial |
$4.04
|
| Rate for Payer: United Healthcare All Payer |
$3.70
|
|
|
FERAHEME 1 MG [510MG/17ML VL]
|
Facility
|
IP
|
$2,943.62
|
|
|
Service Code
|
HCPCS Q0138
|
| Hospital Charge Code |
25002700
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$382.67 |
| Max. Negotiated Rate |
$2,825.88 |
| Rate for Payer: Aetna Commercial |
$2,266.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,296.02
|
| Rate for Payer: Cash Price |
$1,471.81
|
| Rate for Payer: Cigna Commercial |
$2,443.20
|
| Rate for Payer: First Health Commercial |
$2,796.44
|
| Rate for Payer: Humana Commercial |
$2,502.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,413.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,172.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$883.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,590.39
|
| Rate for Payer: Ohio Health Group HMO |
$2,207.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$588.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$382.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$912.52
|
| Rate for Payer: PHCS Commercial |
$2,825.88
|
| Rate for Payer: United Healthcare All Payer |
$2,590.39
|
|
|
FERAHEME 1 MG [510MG/17ML VL]
|
Facility
|
OP
|
$2,943.62
|
|
|
Service Code
|
HCPCS Q0138
|
| Hospital Charge Code |
25002700
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$2,825.88 |
| Rate for Payer: Aetna Commercial |
$2,266.59
|
| Rate for Payer: Anthem Medicaid |
$1,012.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$0.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,296.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$0.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$0.48
|
| Rate for Payer: Cash Price |
$1,471.81
|
| Rate for Payer: Cash Price |
$1,471.81
|
| Rate for Payer: Cigna Commercial |
$2,443.20
|
| Rate for Payer: First Health Commercial |
$2,796.44
|
| Rate for Payer: Humana Commercial |
$2,502.08
|
| Rate for Payer: Humana KY Medicaid |
$1,012.31
|
| Rate for Payer: Humana Medicare Advantage |
$0.36
|
| Rate for Payer: Kentucky WC Medicaid |
$1,022.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,413.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,172.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,032.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,590.39
|
| Rate for Payer: Ohio Health Group HMO |
$2,207.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$588.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$382.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$912.52
|
| Rate for Payer: PHCS Commercial |
$2,825.88
|
| Rate for Payer: United Healthcare All Payer |
$2,590.39
|
|
|
FERRIC SUBSULFATE (100mL)
|
Facility
|
IP
|
$197.71
|
|
|
Service Code
|
NDC 38779128405
|
| Hospital Charge Code |
25004161
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.70 |
| Max. Negotiated Rate |
$189.80 |
| Rate for Payer: Aetna Commercial |
$152.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$154.21
|
| Rate for Payer: Cash Price |
$98.86
|
| Rate for Payer: Cigna Commercial |
$164.10
|
| Rate for Payer: First Health Commercial |
$187.82
|
| Rate for Payer: Humana Commercial |
$168.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$162.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$145.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$173.98
|
| Rate for Payer: Ohio Health Group HMO |
$148.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$39.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$61.29
|
| Rate for Payer: PHCS Commercial |
$189.80
|
| Rate for Payer: United Healthcare All Payer |
$173.98
|
|
|
FERRIC SUBSULFATE (100mL)
|
Facility
|
OP
|
$197.71
|
|
|
Service Code
|
NDC 38779128405
|
| Hospital Charge Code |
25004161
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.70 |
| Max. Negotiated Rate |
$189.80 |
| Rate for Payer: Aetna Commercial |
$152.24
|
| Rate for Payer: Anthem Medicaid |
$67.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$154.21
|
| Rate for Payer: Cash Price |
$98.86
|
| Rate for Payer: Cigna Commercial |
$164.10
|
| Rate for Payer: First Health Commercial |
$187.82
|
| Rate for Payer: Humana Commercial |
$168.05
|
| Rate for Payer: Humana KY Medicaid |
$67.99
|
| Rate for Payer: Kentucky WC Medicaid |
$68.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$162.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$145.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$69.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$173.98
|
| Rate for Payer: Ohio Health Group HMO |
$148.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$39.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$61.29
|
| Rate for Payer: PHCS Commercial |
$189.80
|
| Rate for Payer: United Healthcare All Payer |
$173.98
|
|
|
FERRITIN
|
Professional
|
Both
|
$122.00
|
|
|
Service Code
|
HCPCS 82728
|
| Hospital Charge Code |
30000319
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.18 |
| Max. Negotiated Rate |
$122.00 |
| Rate for Payer: Aetna Commercial |
$20.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$122.00
|
| Rate for Payer: Cash Price |
$61.00
|
| Rate for Payer: Cash Price |
$61.00
|
| Rate for Payer: Cigna Commercial |
$11.98
|
| Rate for Payer: Healthspan PPO |
$14.27
|
| Rate for Payer: Multiplan PHCS |
$73.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$85.40
|
| Rate for Payer: UHCCP Medicaid |
$42.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$8.18
|
|
|
FERRITIN
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
HCPCS 82728
|
| Hospital Charge Code |
30000319
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.86 |
| Max. Negotiated Rate |
$117.12 |
| Rate for Payer: Aetna Commercial |
$93.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$97.97
|
| Rate for Payer: Cash Price |
$61.00
|
| Rate for Payer: Cigna Commercial |
$101.26
|
| Rate for Payer: First Health Commercial |
$115.90
|
| Rate for Payer: Humana Commercial |
$103.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$107.36
|
| Rate for Payer: Ohio Health Group HMO |
$91.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.82
|
| Rate for Payer: PHCS Commercial |
$117.12
|
| Rate for Payer: United Healthcare All Payer |
$107.36
|
|
|
FERRITIN
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
HCPCS 82728
|
| Hospital Charge Code |
30000319
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.63 |
| Max. Negotiated Rate |
$117.12 |
| Rate for Payer: Aetna Commercial |
$93.94
|
| Rate for Payer: Anthem Medicaid |
$13.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$97.97
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$19.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.63
|
| Rate for Payer: Cash Price |
$61.00
|
| Rate for Payer: Cash Price |
$61.00
|
| Rate for Payer: Cigna Commercial |
$101.26
|
| Rate for Payer: First Health Commercial |
$115.90
|
| Rate for Payer: Humana Commercial |
$103.70
|
| Rate for Payer: Humana KY Medicaid |
$13.63
|
| Rate for Payer: Humana Medicare Advantage |
$13.63
|
| Rate for Payer: Kentucky WC Medicaid |
$13.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$107.36
|
| Rate for Payer: Ohio Health Group HMO |
$91.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.82
|
| Rate for Payer: PHCS Commercial |
$117.12
|
| Rate for Payer: United Healthcare All Payer |
$107.36
|
|
|
FERRLECIT 12.5MG[62.5MG/5ML]
|
Facility
|
IP
|
$187.80
|
|
|
Service Code
|
HCPCS J2916
|
| Hospital Charge Code |
25002359
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.41 |
| Max. Negotiated Rate |
$180.29 |
| Rate for Payer: Aetna Commercial |
$144.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$146.48
|
| Rate for Payer: Cash Price |
$93.90
|
| Rate for Payer: Cigna Commercial |
$155.87
|
| Rate for Payer: First Health Commercial |
$178.41
|
| Rate for Payer: Humana Commercial |
$159.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$154.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$138.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$56.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$165.26
|
| Rate for Payer: Ohio Health Group HMO |
$140.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$37.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$58.22
|
| Rate for Payer: PHCS Commercial |
$180.29
|
| Rate for Payer: United Healthcare All Payer |
$165.26
|
|
|
FERRLECIT 12.5MG[62.5MG/5ML]
|
Facility
|
OP
|
$187.80
|
|
|
Service Code
|
HCPCS J2916
|
| Hospital Charge Code |
25002359
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.41 |
| Max. Negotiated Rate |
$180.29 |
| Rate for Payer: Aetna Commercial |
$144.61
|
| Rate for Payer: Anthem Medicaid |
$64.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$146.48
|
| Rate for Payer: Cash Price |
$93.90
|
| Rate for Payer: Cigna Commercial |
$155.87
|
| Rate for Payer: First Health Commercial |
$178.41
|
| Rate for Payer: Humana Commercial |
$159.63
|
| Rate for Payer: Humana KY Medicaid |
$64.58
|
| Rate for Payer: Kentucky WC Medicaid |
$65.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$154.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$138.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$56.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$65.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$165.26
|
| Rate for Payer: Ohio Health Group HMO |
$140.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$37.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$58.22
|
| Rate for Payer: PHCS Commercial |
$180.29
|
| Rate for Payer: United Healthcare All Payer |
$165.26
|
|
