|
FETAL NON-STRESS TEST(P
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 59025
|
| Hospital Charge Code |
920P0004
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$34.83 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Aetna Commercial |
$75.93
|
| Rate for Payer: Anthem Medicaid |
$34.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$125.00
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$65.52
|
| Rate for Payer: Healthspan PPO |
$55.11
|
| Rate for Payer: Humana Medicaid |
$34.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$38.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$35.53
|
| Rate for Payer: Molina Healthcare Passport |
$34.83
|
| Rate for Payer: Multiplan PHCS |
$75.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$87.50
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$35.18
|
|
|
FETAL NON-STRESS TEST(T
|
Facility
|
IP
|
$480.00
|
|
|
Service Code
|
HCPCS 59025
|
| Hospital Charge Code |
920T0004
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$62.40 |
| Max. Negotiated Rate |
$460.80 |
| Rate for Payer: Aetna Commercial |
$369.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$374.40
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cigna Commercial |
$398.40
|
| Rate for Payer: First Health Commercial |
$456.00
|
| Rate for Payer: Humana Commercial |
$408.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$393.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$354.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$144.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$422.40
|
| Rate for Payer: Ohio Health Group HMO |
$360.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$148.80
|
| Rate for Payer: PHCS Commercial |
$460.80
|
| Rate for Payer: United Healthcare All Payer |
$422.40
|
|
|
FETAL NON-STRESS TEST(T
|
Facility
|
OP
|
$480.00
|
|
|
Service Code
|
HCPCS 59025
|
| Hospital Charge Code |
920T0004
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$62.40 |
| Max. Negotiated Rate |
$460.80 |
| Rate for Payer: Cigna Commercial |
$398.40
|
| Rate for Payer: Aetna Commercial |
$369.60
|
| Rate for Payer: Anthem Medicaid |
$165.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$172.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$374.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$241.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$232.63
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: First Health Commercial |
$456.00
|
| Rate for Payer: Humana Commercial |
$408.00
|
| Rate for Payer: Humana KY Medicaid |
$165.07
|
| Rate for Payer: Humana Medicare Advantage |
$172.32
|
| Rate for Payer: Kentucky WC Medicaid |
$166.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$393.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$354.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$206.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$168.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$422.40
|
| Rate for Payer: Ohio Health Group HMO |
$360.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$148.80
|
| Rate for Payer: PHCS Commercial |
$460.80
|
| Rate for Payer: United Healthcare All Payer |
$422.40
|
|
|
FEVER AND INFLAMMATORY CONDITIONS
|
Facility
|
IP
|
$10,327.18
|
|
|
Service Code
|
MSDRG 864
|
| Min. Negotiated Rate |
$7,007.73 |
| Max. Negotiated Rate |
$10,327.18 |
| Rate for Payer: Anthem Medicaid |
$7,007.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7,376.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10,327.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$9,958.36
|
| Rate for Payer: Humana KY Medicaid |
$7,007.73
|
| Rate for Payer: Humana Medicare Advantage |
$7,376.56
|
| Rate for Payer: Kentucky WC Medicaid |
$7,077.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,851.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,147.89
|
|
|
FEXOFENADINE HCL 180 MG TABLET
|
Facility
|
IP
|
$4.54
|
|
|
Service Code
|
NDC 41167041290
|
| Hospital Charge Code |
25003947
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.36 |
| Rate for Payer: Aetna Commercial |
$3.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.54
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Cigna Commercial |
$3.77
|
| Rate for Payer: First Health Commercial |
$4.31
|
| Rate for Payer: Humana Commercial |
$3.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.00
|
| Rate for Payer: Ohio Health Group HMO |
$3.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.41
|
| Rate for Payer: PHCS Commercial |
$4.36
|
| Rate for Payer: United Healthcare All Payer |
$4.00
|
|
|
FEXOFENADINE HCL 180 MG TABLET
|
Facility
|
OP
|
$4.54
|
|
|
Service Code
|
NDC 41167041290
|
| Hospital Charge Code |
25003947
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.36 |
| Rate for Payer: Aetna Commercial |
$3.50
|
| Rate for Payer: Anthem Medicaid |
$1.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.54
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Cigna Commercial |
$3.77
|
| Rate for Payer: First Health Commercial |
$4.31
|
| Rate for Payer: Humana Commercial |
$3.86
|
| Rate for Payer: Humana KY Medicaid |
$1.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.00
|
| Rate for Payer: Ohio Health Group HMO |
$3.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.41
|
| Rate for Payer: PHCS Commercial |
$4.36
|
| Rate for Payer: United Healthcare All Payer |
$4.00
|
|
|
FFP/CRYO THAWING; EACH UNIT
|
Facility
|
IP
|
$377.00
|
|
|
Service Code
|
HCPCS 86927
|
| Hospital Charge Code |
30001240
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.01 |
| Max. Negotiated Rate |
$361.92 |
| Rate for Payer: Aetna Commercial |
$290.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$302.73
|
| Rate for Payer: Cash Price |
$188.50
|
| Rate for Payer: Cigna Commercial |
$312.91
|
| Rate for Payer: First Health Commercial |
$358.15
|
| Rate for Payer: Humana Commercial |
$320.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$309.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$278.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$113.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$331.76
|
| Rate for Payer: Ohio Health Group HMO |
$282.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$75.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$49.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$116.87
|
| Rate for Payer: PHCS Commercial |
$361.92
|
| Rate for Payer: United Healthcare All Payer |
$331.76
|
|
|
FFP/CRYO THAWING; EACH UNIT
|
Facility
|
OP
|
$377.00
|
|
|
Service Code
|
HCPCS 86927
|
| Hospital Charge Code |
30001240
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.13 |
| Max. Negotiated Rate |
$361.92 |
| Rate for Payer: Aetna Commercial |
$290.29
|
| Rate for Payer: Anthem Medicaid |
$31.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$147.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$302.73
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$206.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$199.40
|
| Rate for Payer: Cash Price |
$188.50
|
| Rate for Payer: Cash Price |
$188.50
|
| Rate for Payer: Cigna Commercial |
$312.91
|
| Rate for Payer: First Health Commercial |
$358.15
|
| Rate for Payer: Humana Commercial |
$320.45
|
| Rate for Payer: Humana KY Medicaid |
$31.13
|
| Rate for Payer: Humana Medicare Advantage |
$147.70
|
| Rate for Payer: Kentucky WC Medicaid |
$31.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$309.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$278.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$177.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$31.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$331.76
|
| Rate for Payer: Ohio Health Group HMO |
$282.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$75.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$49.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$116.87
|
| Rate for Payer: PHCS Commercial |
$361.92
|
| Rate for Payer: United Healthcare All Payer |
$331.76
|
|
|
FFR NAVUUS II CATH.
|
Facility
|
IP
|
$4,825.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$627.25 |
| Max. Negotiated Rate |
$4,632.00 |
| Rate for Payer: Aetna Commercial |
$3,715.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,763.50
|
| Rate for Payer: Cash Price |
$2,412.50
|
| Rate for Payer: Cigna Commercial |
$4,004.75
|
| Rate for Payer: First Health Commercial |
$4,583.75
|
| Rate for Payer: Humana Commercial |
$4,101.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,956.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,560.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,447.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,246.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,618.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$965.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$627.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,495.75
|
| Rate for Payer: PHCS Commercial |
$4,632.00
|
| Rate for Payer: United Healthcare All Payer |
$4,246.00
|
|
|
FFR NAVUUS II CATH.
|
Facility
|
OP
|
$4,825.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$627.25 |
| Max. Negotiated Rate |
$4,632.00 |
| Rate for Payer: Aetna Commercial |
$3,715.25
|
| Rate for Payer: Anthem Medicaid |
$1,659.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,763.50
|
| Rate for Payer: Cash Price |
$2,412.50
|
| Rate for Payer: Cigna Commercial |
$4,004.75
|
| Rate for Payer: First Health Commercial |
$4,583.75
|
| Rate for Payer: Humana Commercial |
$4,101.25
|
| Rate for Payer: Humana KY Medicaid |
$1,659.32
|
| Rate for Payer: Kentucky WC Medicaid |
$1,676.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,956.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,560.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,447.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,692.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,246.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,618.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$965.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$627.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,495.75
|
| Rate for Payer: PHCS Commercial |
$4,632.00
|
| Rate for Payer: United Healthcare All Payer |
$4,246.00
|
|
|
FIBERCON (POLYCARBOPHIL) 1TAB
|
Facility
|
OP
|
$4.89
|
|
|
Service Code
|
NDC 77333012050
|
| Hospital Charge Code |
25000676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$4.69 |
| Rate for Payer: Anthem Medicaid |
$1.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.81
|
| Rate for Payer: Cash Price |
$2.44
|
| Rate for Payer: Cigna Commercial |
$4.06
|
| Rate for Payer: First Health Commercial |
$4.65
|
| Rate for Payer: Humana Commercial |
$4.16
|
| Rate for Payer: Humana KY Medicaid |
$1.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.30
|
| Rate for Payer: Ohio Health Group HMO |
$3.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.52
|
| Rate for Payer: PHCS Commercial |
$4.69
|
| Rate for Payer: United Healthcare All Payer |
$4.30
|
| Rate for Payer: Aetna Commercial |
$3.77
|
|
|
FIBERCON (POLYCARBOPHIL) 1TAB
|
Facility
|
IP
|
$4.89
|
|
|
Service Code
|
NDC 77333012050
|
| Hospital Charge Code |
25000676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$4.69 |
| Rate for Payer: Aetna Commercial |
$3.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.81
|
| Rate for Payer: Cash Price |
$2.44
|
| Rate for Payer: Cigna Commercial |
$4.06
|
| Rate for Payer: First Health Commercial |
$4.65
|
| Rate for Payer: Humana Commercial |
$4.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.30
|
| Rate for Payer: Ohio Health Group HMO |
$3.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.52
|
| Rate for Payer: PHCS Commercial |
$4.69
|
| Rate for Payer: United Healthcare All Payer |
$4.30
|
|
|
FIBERLOOP #2 BLUE CVD AR-7234C
|
Facility
|
OP
|
$1,065.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.45 |
| Max. Negotiated Rate |
$1,022.40 |
| Rate for Payer: Aetna Commercial |
$820.05
|
| Rate for Payer: Anthem Medicaid |
$366.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$830.70
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$883.95
|
| Rate for Payer: First Health Commercial |
$1,011.75
|
| Rate for Payer: Humana Commercial |
$905.25
|
| Rate for Payer: Humana KY Medicaid |
$366.25
|
| Rate for Payer: Kentucky WC Medicaid |
$369.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$873.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$785.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$319.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$373.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$937.20
|
| Rate for Payer: Ohio Health Group HMO |
$798.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$213.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$138.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$330.15
|
| Rate for Payer: PHCS Commercial |
$1,022.40
|
| Rate for Payer: United Healthcare All Payer |
$937.20
|
|
|
FIBERLOOP #2 BLUE CVD AR-7234C
|
Facility
|
IP
|
$1,065.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.45 |
| Max. Negotiated Rate |
$1,022.40 |
| Rate for Payer: Aetna Commercial |
$820.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$830.70
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$883.95
|
| Rate for Payer: First Health Commercial |
$1,011.75
|
| Rate for Payer: Humana Commercial |
$905.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$873.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$785.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$319.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$937.20
|
| Rate for Payer: Ohio Health Group HMO |
$798.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$213.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$138.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$330.15
|
| Rate for Payer: PHCS Commercial |
$1,022.40
|
| Rate for Payer: United Healthcare All Payer |
$937.20
|
|
|
FIBERSTITCH IMPLANT 24 DEGREE
|
Facility
|
IP
|
$3,932.50
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$511.22 |
| Max. Negotiated Rate |
$3,775.20 |
| Rate for Payer: Aetna Commercial |
$3,028.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,067.35
|
| Rate for Payer: Cash Price |
$1,966.25
|
| Rate for Payer: Cigna Commercial |
$3,263.98
|
| Rate for Payer: First Health Commercial |
$3,735.88
|
| Rate for Payer: Humana Commercial |
$3,342.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,224.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,902.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,179.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,460.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,949.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$786.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$511.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,219.08
|
| Rate for Payer: PHCS Commercial |
$3,775.20
|
| Rate for Payer: United Healthcare All Payer |
$3,460.60
|
|
|
FIBERSTITCH IMPLANT 24 DEGREE
|
Facility
|
OP
|
$3,932.50
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$511.22 |
| Max. Negotiated Rate |
$3,775.20 |
| Rate for Payer: Aetna Commercial |
$3,028.02
|
| Rate for Payer: Anthem Medicaid |
$1,352.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,067.35
|
| Rate for Payer: Cash Price |
$1,966.25
|
| Rate for Payer: Cigna Commercial |
$3,263.98
|
| Rate for Payer: First Health Commercial |
$3,735.88
|
| Rate for Payer: Humana Commercial |
$3,342.62
|
| Rate for Payer: Humana KY Medicaid |
$1,352.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,366.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,224.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,902.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,179.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,379.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,460.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,949.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$786.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$511.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,219.08
|
| Rate for Payer: PHCS Commercial |
$3,775.20
|
| Rate for Payer: United Healthcare All Payer |
$3,460.60
|
|
|
FIBERSTITCH IMPLANT REVRS CVD
|
Facility
|
OP
|
$3,932.50
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$511.22 |
| Max. Negotiated Rate |
$3,775.20 |
| Rate for Payer: Aetna Commercial |
$3,028.02
|
| Rate for Payer: Anthem Medicaid |
$1,352.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,067.35
|
| Rate for Payer: Cash Price |
$1,966.25
|
| Rate for Payer: Cigna Commercial |
$3,263.98
|
| Rate for Payer: First Health Commercial |
$3,735.88
|
| Rate for Payer: Humana Commercial |
$3,342.62
|
| Rate for Payer: Humana KY Medicaid |
$1,352.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,366.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,224.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,902.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,179.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,379.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,460.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,949.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$786.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$511.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,219.08
|
| Rate for Payer: PHCS Commercial |
$3,775.20
|
| Rate for Payer: United Healthcare All Payer |
$3,460.60
|
|
|
FIBERSTITCH IMPLANT REVRS CVD
|
Facility
|
IP
|
$3,932.50
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$511.22 |
| Max. Negotiated Rate |
$3,775.20 |
| Rate for Payer: Aetna Commercial |
$3,028.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,067.35
|
| Rate for Payer: Cash Price |
$1,966.25
|
| Rate for Payer: Cigna Commercial |
$3,263.98
|
| Rate for Payer: First Health Commercial |
$3,735.88
|
| Rate for Payer: Humana Commercial |
$3,342.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,224.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,902.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,179.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,460.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,949.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$786.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$511.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,219.08
|
| Rate for Payer: PHCS Commercial |
$3,775.20
|
| Rate for Payer: United Healthcare All Payer |
$3,460.60
|
|
|
FIBERSTITCH IMPLANT STRAIGHT
|
Facility
|
OP
|
$3,932.50
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$511.22 |
| Max. Negotiated Rate |
$3,775.20 |
| Rate for Payer: Aetna Commercial |
$3,028.02
|
| Rate for Payer: Anthem Medicaid |
$1,352.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,067.35
|
| Rate for Payer: Cash Price |
$1,966.25
|
| Rate for Payer: Cigna Commercial |
$3,263.98
|
| Rate for Payer: First Health Commercial |
$3,735.88
|
| Rate for Payer: Humana Commercial |
$3,342.62
|
| Rate for Payer: Humana KY Medicaid |
$1,352.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,366.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,224.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,902.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,179.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,379.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,460.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,949.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$786.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$511.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,219.08
|
| Rate for Payer: PHCS Commercial |
$3,775.20
|
| Rate for Payer: United Healthcare All Payer |
$3,460.60
|
|
|
FIBERSTITCH IMPLANT STRAIGHT
|
Facility
|
IP
|
$3,932.50
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$511.22 |
| Max. Negotiated Rate |
$3,775.20 |
| Rate for Payer: Aetna Commercial |
$3,028.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,067.35
|
| Rate for Payer: Cash Price |
$1,966.25
|
| Rate for Payer: Cigna Commercial |
$3,263.98
|
| Rate for Payer: First Health Commercial |
$3,735.88
|
| Rate for Payer: Humana Commercial |
$3,342.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,224.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,902.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,179.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,460.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,949.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$786.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$511.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,219.08
|
| Rate for Payer: PHCS Commercial |
$3,775.20
|
| Rate for Payer: United Healthcare All Payer |
$3,460.60
|
|
|
FIBERTAG TIGHTROPE 2 ABS
|
Facility
|
IP
|
$3,617.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$470.28 |
| Max. Negotiated Rate |
$3,472.80 |
| Rate for Payer: Aetna Commercial |
$2,785.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,821.65
|
| Rate for Payer: Cash Price |
$1,808.75
|
| Rate for Payer: Cigna Commercial |
$3,002.52
|
| Rate for Payer: First Health Commercial |
$3,436.62
|
| Rate for Payer: Humana Commercial |
$3,074.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,966.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,669.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,085.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,183.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,713.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$723.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$470.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,121.42
|
| Rate for Payer: PHCS Commercial |
$3,472.80
|
| Rate for Payer: United Healthcare All Payer |
$3,183.40
|
|
|
FIBERTAG TIGHTROPE 2 ABS
|
Facility
|
OP
|
$3,617.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$470.28 |
| Max. Negotiated Rate |
$3,472.80 |
| Rate for Payer: Aetna Commercial |
$2,785.48
|
| Rate for Payer: Anthem Medicaid |
$1,244.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,821.65
|
| Rate for Payer: Cash Price |
$1,808.75
|
| Rate for Payer: Cigna Commercial |
$3,002.52
|
| Rate for Payer: First Health Commercial |
$3,436.62
|
| Rate for Payer: Humana Commercial |
$3,074.88
|
| Rate for Payer: Humana KY Medicaid |
$1,244.06
|
| Rate for Payer: Kentucky WC Medicaid |
$1,256.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,966.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,669.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,085.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,269.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,183.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,713.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$723.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$470.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,121.42
|
| Rate for Payer: PHCS Commercial |
$3,472.80
|
| Rate for Payer: United Healthcare All Payer |
$3,183.40
|
|
|
FIBERTAG TIGHTROPE 2 W/BRACE
|
Facility
|
OP
|
$4,737.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$615.88 |
| Max. Negotiated Rate |
$4,548.00 |
| Rate for Payer: Cash Price |
$2,368.75
|
| Rate for Payer: Cigna Commercial |
$3,932.12
|
| Rate for Payer: First Health Commercial |
$4,500.62
|
| Rate for Payer: Humana Commercial |
$4,026.88
|
| Rate for Payer: Humana KY Medicaid |
$1,629.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,645.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,884.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,496.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,421.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,661.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,169.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,553.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$947.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$615.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,468.62
|
| Rate for Payer: PHCS Commercial |
$4,548.00
|
| Rate for Payer: United Healthcare All Payer |
$4,169.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,695.25
|
| Rate for Payer: Aetna Commercial |
$3,647.88
|
| Rate for Payer: Anthem Medicaid |
$1,629.23
|
|
|
FIBERTAG TIGHTROPE 2 W/BRACE
|
Facility
|
IP
|
$4,737.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$615.88 |
| Max. Negotiated Rate |
$4,548.00 |
| Rate for Payer: Aetna Commercial |
$3,647.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,695.25
|
| Rate for Payer: Cash Price |
$2,368.75
|
| Rate for Payer: Cigna Commercial |
$3,932.12
|
| Rate for Payer: First Health Commercial |
$4,500.62
|
| Rate for Payer: Humana Commercial |
$4,026.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,884.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,496.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,421.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,169.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,553.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$947.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$615.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,468.62
|
| Rate for Payer: PHCS Commercial |
$4,548.00
|
| Rate for Payer: United Healthcare All Payer |
$4,169.00
|
|
|
FIBERTAK DBL LD W/ 1.3 SUT TPE
|
Facility
|
OP
|
$3,495.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$454.35 |
| Max. Negotiated Rate |
$3,355.20 |
| Rate for Payer: Aetna Commercial |
$2,691.15
|
| Rate for Payer: Anthem Medicaid |
$1,201.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,726.10
|
| Rate for Payer: Cash Price |
$1,747.50
|
| Rate for Payer: Cigna Commercial |
$2,900.85
|
| Rate for Payer: First Health Commercial |
$3,320.25
|
| Rate for Payer: Humana Commercial |
$2,970.75
|
| Rate for Payer: Humana KY Medicaid |
$1,201.93
|
| Rate for Payer: Kentucky WC Medicaid |
$1,214.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,865.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,579.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,048.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,226.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,075.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,621.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$699.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$454.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,083.45
|
| Rate for Payer: PHCS Commercial |
$3,355.20
|
| Rate for Payer: United Healthcare All Payer |
$3,075.60
|
|
