|
FIBERTAK DBL LD W/ 1.3 SUT TPE
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
FIBRINOGEN
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
HCPCS 85384
|
| Hospital Charge Code |
30000604
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.72 |
| Max. Negotiated Rate |
$109.44 |
| Rate for Payer: Aetna Commercial |
$87.78
|
| Rate for Payer: Anthem Medicaid |
$9.72
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.72
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$94.62
|
| Rate for Payer: First Health Commercial |
$108.30
|
| Rate for Payer: Humana Commercial |
$96.90
|
| Rate for Payer: Humana KY Medicaid |
$9.72
|
| Rate for Payer: Humana Medicare Advantage |
$9.72
|
| Rate for Payer: Kentucky WC Medicaid |
$9.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$93.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$100.32
|
| Rate for Payer: Ohio Health Group HMO |
$85.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.34
|
| Rate for Payer: PHCS Commercial |
$109.44
|
| Rate for Payer: United Healthcare All Payer |
$100.32
|
|
|
FIBRINOGEN
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
HCPCS 85384
|
| Hospital Charge Code |
30000604
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.82 |
| Max. Negotiated Rate |
$109.44 |
| Rate for Payer: Aetna Commercial |
$87.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.54
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$94.62
|
| Rate for Payer: First Health Commercial |
$108.30
|
| Rate for Payer: Humana Commercial |
$96.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$93.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$100.32
|
| Rate for Payer: Ohio Health Group HMO |
$85.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.34
|
| Rate for Payer: PHCS Commercial |
$109.44
|
| Rate for Payer: United Healthcare All Payer |
$100.32
|
|
|
FIELDER FC PTCA GW 180CM
|
Facility
|
OP
|
$1,151.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.63 |
| Max. Negotiated Rate |
$1,104.96 |
| Rate for Payer: Aetna Commercial |
$886.27
|
| Rate for Payer: Anthem Medicaid |
$395.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$897.78
|
| Rate for Payer: Cash Price |
$575.50
|
| Rate for Payer: Cigna Commercial |
$955.33
|
| Rate for Payer: First Health Commercial |
$1,093.45
|
| Rate for Payer: Humana Commercial |
$978.35
|
| Rate for Payer: Humana KY Medicaid |
$395.83
|
| Rate for Payer: Kentucky WC Medicaid |
$399.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$943.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$849.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$403.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,012.88
|
| Rate for Payer: Ohio Health Group HMO |
$863.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$230.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$149.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$356.81
|
| Rate for Payer: PHCS Commercial |
$1,104.96
|
| Rate for Payer: United Healthcare All Payer |
$1,012.88
|
|
|
FIELDER FC PTCA GW 180CM
|
Facility
|
IP
|
$1,151.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.63 |
| Max. Negotiated Rate |
$1,104.96 |
| Rate for Payer: Aetna Commercial |
$886.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$897.78
|
| Rate for Payer: Cash Price |
$575.50
|
| Rate for Payer: Cigna Commercial |
$955.33
|
| Rate for Payer: First Health Commercial |
$1,093.45
|
| Rate for Payer: Humana Commercial |
$978.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$943.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$849.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,012.88
|
| Rate for Payer: Ohio Health Group HMO |
$863.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$230.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$149.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$356.81
|
| Rate for Payer: PHCS Commercial |
$1,104.96
|
| Rate for Payer: United Healthcare All Payer |
$1,012.88
|
|
|
FIELDER FC PTCA GW 300CM
|
Facility
|
OP
|
$1,151.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.63 |
| Max. Negotiated Rate |
$1,104.96 |
| Rate for Payer: Aetna Commercial |
$886.27
|
| Rate for Payer: Anthem Medicaid |
$395.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$897.78
|
| Rate for Payer: Cash Price |
$575.50
|
| Rate for Payer: Cigna Commercial |
$955.33
|
| Rate for Payer: First Health Commercial |
$1,093.45
|
| Rate for Payer: Humana Commercial |
$978.35
|
| Rate for Payer: Humana KY Medicaid |
$395.83
|
| Rate for Payer: Kentucky WC Medicaid |
$399.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$943.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$849.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$403.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,012.88
|
| Rate for Payer: Ohio Health Group HMO |
$863.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$230.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$149.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$356.81
|
| Rate for Payer: PHCS Commercial |
$1,104.96
|
| Rate for Payer: United Healthcare All Payer |
$1,012.88
|
|
|
FIELDER FC PTCA GW 300CM
|
Facility
|
IP
|
$1,151.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.63 |
| Max. Negotiated Rate |
$1,104.96 |
| Rate for Payer: Aetna Commercial |
$886.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$897.78
|
| Rate for Payer: Cash Price |
$575.50
|
| Rate for Payer: Cigna Commercial |
$955.33
|
| Rate for Payer: First Health Commercial |
$1,093.45
|
| Rate for Payer: Humana Commercial |
$978.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$943.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$849.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,012.88
|
| Rate for Payer: Ohio Health Group HMO |
$863.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$230.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$149.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$356.81
|
| Rate for Payer: PHCS Commercial |
$1,104.96
|
| Rate for Payer: United Healthcare All Payer |
$1,012.88
|
|
|
FIELDER PTCA GW 180CM
|
Facility
|
OP
|
$1,700.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$221.00 |
| Max. Negotiated Rate |
$1,632.00 |
| Rate for Payer: Aetna Commercial |
$1,309.00
|
| Rate for Payer: Anthem Medicaid |
$584.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,326.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,411.00
|
| Rate for Payer: First Health Commercial |
$1,615.00
|
| Rate for Payer: Humana Commercial |
$1,445.00
|
| Rate for Payer: Humana KY Medicaid |
$584.63
|
| Rate for Payer: Kentucky WC Medicaid |
$590.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,394.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,254.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$596.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$527.00
|
| Rate for Payer: PHCS Commercial |
$1,632.00
|
| Rate for Payer: United Healthcare All Payer |
$1,496.00
|
|
|
FIELDER PTCA GW 180CM
|
Facility
|
IP
|
$1,700.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$221.00 |
| Max. Negotiated Rate |
$1,632.00 |
| Rate for Payer: Aetna Commercial |
$1,309.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,326.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,411.00
|
| Rate for Payer: First Health Commercial |
$1,615.00
|
| Rate for Payer: Humana Commercial |
$1,445.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,394.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,254.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$527.00
|
| Rate for Payer: PHCS Commercial |
$1,632.00
|
| Rate for Payer: United Healthcare All Payer |
$1,496.00
|
|
|
FIELDER XT PTCA GW 190CM
|
Facility
|
IP
|
$1,770.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$230.10 |
| Max. Negotiated Rate |
$1,699.20 |
| Rate for Payer: Aetna Commercial |
$1,362.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,380.60
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Cigna Commercial |
$1,469.10
|
| Rate for Payer: First Health Commercial |
$1,681.50
|
| Rate for Payer: Humana Commercial |
$1,504.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,451.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,306.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$531.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,557.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,327.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$354.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$230.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.70
|
| Rate for Payer: PHCS Commercial |
$1,699.20
|
| Rate for Payer: United Healthcare All Payer |
$1,557.60
|
|
|
FIELDER XT PTCA GW 190CM
|
Facility
|
OP
|
$1,770.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$230.10 |
| Max. Negotiated Rate |
$1,699.20 |
| Rate for Payer: Aetna Commercial |
$1,362.90
|
| Rate for Payer: Anthem Medicaid |
$608.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,380.60
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Cigna Commercial |
$1,469.10
|
| Rate for Payer: First Health Commercial |
$1,681.50
|
| Rate for Payer: Humana Commercial |
$1,504.50
|
| Rate for Payer: Humana KY Medicaid |
$608.70
|
| Rate for Payer: Kentucky WC Medicaid |
$614.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,451.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,306.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$531.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$620.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,557.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,327.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$354.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$230.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.70
|
| Rate for Payer: PHCS Commercial |
$1,699.20
|
| Rate for Payer: United Healthcare All Payer |
$1,557.60
|
|
|
FIELDER XT PTCA GW 300CM
|
Facility
|
OP
|
$1,770.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$230.10 |
| Max. Negotiated Rate |
$1,699.20 |
| Rate for Payer: Aetna Commercial |
$1,362.90
|
| Rate for Payer: Anthem Medicaid |
$608.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,380.60
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Cigna Commercial |
$1,469.10
|
| Rate for Payer: First Health Commercial |
$1,681.50
|
| Rate for Payer: Humana Commercial |
$1,504.50
|
| Rate for Payer: Humana KY Medicaid |
$608.70
|
| Rate for Payer: Kentucky WC Medicaid |
$614.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,451.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,306.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$531.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$620.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,557.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,327.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$354.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$230.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.70
|
| Rate for Payer: PHCS Commercial |
$1,699.20
|
| Rate for Payer: United Healthcare All Payer |
$1,557.60
|
|
|
FIELDER XT PTCA GW 300CM
|
Facility
|
IP
|
$1,770.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$230.10 |
| Max. Negotiated Rate |
$1,699.20 |
| Rate for Payer: Aetna Commercial |
$1,362.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,380.60
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Cigna Commercial |
$1,469.10
|
| Rate for Payer: First Health Commercial |
$1,681.50
|
| Rate for Payer: Humana Commercial |
$1,504.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,451.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,306.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$531.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,557.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,327.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$354.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$230.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.70
|
| Rate for Payer: PHCS Commercial |
$1,699.20
|
| Rate for Payer: United Healthcare All Payer |
$1,557.60
|
|
|
FIELD HOSPITAL ROOM RATE
|
Facility
|
IP
|
$500.00
|
|
| Hospital Charge Code |
11000014
|
|
Hospital Revenue Code
|
150
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: Aetna Commercial |
$385.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$390.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$415.00
|
| Rate for Payer: First Health Commercial |
$475.00
|
| Rate for Payer: Humana Commercial |
$425.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$410.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$369.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$150.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$440.00
|
| Rate for Payer: Ohio Health Group HMO |
$375.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$155.00
|
| Rate for Payer: PHCS Commercial |
$480.00
|
| Rate for Payer: United Healthcare All Payer |
$440.00
|
|
|
FILARIA BLOOD
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
HCPCS 87207
|
| Hospital Charge Code |
30001331
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.09 |
| Max. Negotiated Rate |
$89.28 |
| Rate for Payer: Aetna Commercial |
$71.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$74.68
|
| Rate for Payer: Cash Price |
$46.50
|
| Rate for Payer: Cigna Commercial |
$77.19
|
| Rate for Payer: First Health Commercial |
$88.35
|
| Rate for Payer: Humana Commercial |
$79.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$76.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$68.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$81.84
|
| Rate for Payer: Ohio Health Group HMO |
$69.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.83
|
| Rate for Payer: PHCS Commercial |
$89.28
|
| Rate for Payer: United Healthcare All Payer |
$81.84
|
|
|
FILARIA BLOOD
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
HCPCS 87207
|
| Hospital Charge Code |
30001331
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$89.28 |
| Rate for Payer: Aetna Commercial |
$71.61
|
| Rate for Payer: Anthem Medicaid |
$5.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$74.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.99
|
| Rate for Payer: Cash Price |
$46.50
|
| Rate for Payer: Cash Price |
$46.50
|
| Rate for Payer: Cigna Commercial |
$77.19
|
| Rate for Payer: First Health Commercial |
$88.35
|
| Rate for Payer: Humana Commercial |
$79.05
|
| Rate for Payer: Humana KY Medicaid |
$5.99
|
| Rate for Payer: Humana Medicare Advantage |
$5.99
|
| Rate for Payer: Kentucky WC Medicaid |
$6.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$76.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$68.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$81.84
|
| Rate for Payer: Ohio Health Group HMO |
$69.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.83
|
| Rate for Payer: PHCS Commercial |
$89.28
|
| Rate for Payer: United Healthcare All Payer |
$81.84
|
|
|
FILLETED FINGER/TOE FLAP
|
Professional
|
Both
|
$875.00
|
|
|
Service Code
|
HCPCS 14350
|
| Hospital Charge Code |
76102680
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$306.25 |
| Max. Negotiated Rate |
$1,090.93 |
| Rate for Payer: Aetna Commercial |
$1,090.93
|
| Rate for Payer: Anthem Medicaid |
$453.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$875.00
|
| Rate for Payer: Cash Price |
$437.50
|
| Rate for Payer: Cash Price |
$437.50
|
| Rate for Payer: Cigna Commercial |
$1,043.02
|
| Rate for Payer: Healthspan PPO |
$872.29
|
| Rate for Payer: Humana Medicaid |
$453.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$898.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$462.96
|
| Rate for Payer: Molina Healthcare Passport |
$453.88
|
| Rate for Payer: Multiplan PHCS |
$525.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$612.50
|
| Rate for Payer: UHCCP Medicaid |
$306.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$458.42
|
|
|
FILL POLYMER KIT SEAL TV-CS14-
|
Facility
|
IP
|
$5,696.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$740.54 |
| Max. Negotiated Rate |
$5,468.64 |
| Rate for Payer: Aetna Commercial |
$4,386.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,443.27
|
| Rate for Payer: Cash Price |
$2,848.25
|
| Rate for Payer: Cigna Commercial |
$4,728.10
|
| Rate for Payer: First Health Commercial |
$5,411.68
|
| Rate for Payer: Humana Commercial |
$4,842.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,671.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,204.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,708.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,012.92
|
| Rate for Payer: Ohio Health Group HMO |
$4,272.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,139.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$740.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,765.92
|
| Rate for Payer: PHCS Commercial |
$5,468.64
|
| Rate for Payer: United Healthcare All Payer |
$5,012.92
|
|
|
FILL POLYMER KIT SEAL TV-CS14-
|
Facility
|
OP
|
$5,696.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$740.54 |
| Max. Negotiated Rate |
$5,468.64 |
| Rate for Payer: Aetna Commercial |
$4,386.30
|
| Rate for Payer: Anthem Medicaid |
$1,959.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,443.27
|
| Rate for Payer: Cash Price |
$2,848.25
|
| Rate for Payer: Cigna Commercial |
$4,728.10
|
| Rate for Payer: First Health Commercial |
$5,411.68
|
| Rate for Payer: Humana Commercial |
$4,842.02
|
| Rate for Payer: Humana KY Medicaid |
$1,959.03
|
| Rate for Payer: Kentucky WC Medicaid |
$1,978.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,671.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,204.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,708.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,998.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,012.92
|
| Rate for Payer: Ohio Health Group HMO |
$4,272.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,139.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$740.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,765.92
|
| Rate for Payer: PHCS Commercial |
$5,468.64
|
| Rate for Payer: United Healthcare All Payer |
$5,012.92
|
|
|
FILTER TRAPEASE
|
Facility
|
IP
|
$6,815.00
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27000047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$885.95 |
| Max. Negotiated Rate |
$6,542.40 |
| Rate for Payer: Aetna Commercial |
$5,247.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,315.70
|
| Rate for Payer: Cash Price |
$3,407.50
|
| Rate for Payer: Cigna Commercial |
$5,656.45
|
| Rate for Payer: First Health Commercial |
$6,474.25
|
| Rate for Payer: Humana Commercial |
$5,792.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,588.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,029.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,044.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,997.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,111.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,363.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$885.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,112.65
|
| Rate for Payer: PHCS Commercial |
$6,542.40
|
| Rate for Payer: United Healthcare All Payer |
$5,997.20
|
|
|
FILTER TRAPEASE
|
Facility
|
OP
|
$6,815.00
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27000047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$885.95 |
| Max. Negotiated Rate |
$6,542.40 |
| Rate for Payer: Aetna Commercial |
$5,247.55
|
| Rate for Payer: Anthem Medicaid |
$2,343.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,315.70
|
| Rate for Payer: Cash Price |
$3,407.50
|
| Rate for Payer: Cigna Commercial |
$5,656.45
|
| Rate for Payer: First Health Commercial |
$6,474.25
|
| Rate for Payer: Humana Commercial |
$5,792.75
|
| Rate for Payer: Humana KY Medicaid |
$2,343.68
|
| Rate for Payer: Kentucky WC Medicaid |
$2,367.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,588.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,029.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,044.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,390.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,997.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,111.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,363.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$885.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,112.65
|
| Rate for Payer: PHCS Commercial |
$6,542.40
|
| Rate for Payer: United Healthcare All Payer |
$5,997.20
|
|
|
FILTER WIRE 190CM 2.25-3.5
|
Facility
|
IP
|
$7,181.82
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27000047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$933.64 |
| Max. Negotiated Rate |
$6,894.55 |
| Rate for Payer: Aetna Commercial |
$5,530.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,601.82
|
| Rate for Payer: Cash Price |
$3,590.91
|
| Rate for Payer: Cigna Commercial |
$5,960.91
|
| Rate for Payer: First Health Commercial |
$6,822.73
|
| Rate for Payer: Humana Commercial |
$6,104.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,889.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,300.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,386.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,436.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$933.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,226.36
|
| Rate for Payer: PHCS Commercial |
$6,894.55
|
| Rate for Payer: United Healthcare All Payer |
$6,320.00
|
|
|
FILTER WIRE 190CM 2.25-3.5
|
Facility
|
OP
|
$7,181.82
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27000047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$933.64 |
| Max. Negotiated Rate |
$6,894.55 |
| Rate for Payer: Aetna Commercial |
$5,530.00
|
| Rate for Payer: Anthem Medicaid |
$2,469.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,601.82
|
| Rate for Payer: Cash Price |
$3,590.91
|
| Rate for Payer: Cigna Commercial |
$5,960.91
|
| Rate for Payer: First Health Commercial |
$6,822.73
|
| Rate for Payer: Humana Commercial |
$6,104.55
|
| Rate for Payer: Humana KY Medicaid |
$2,469.83
|
| Rate for Payer: Kentucky WC Medicaid |
$2,494.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,889.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,300.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,519.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,386.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,436.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$933.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,226.36
|
| Rate for Payer: PHCS Commercial |
$6,894.55
|
| Rate for Payer: United Healthcare All Payer |
$6,320.00
|
|
|
FILTER WIRE EZ 190CM
|
Facility
|
OP
|
$7,181.82
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27000047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$933.64 |
| Max. Negotiated Rate |
$6,894.55 |
| Rate for Payer: Aetna Commercial |
$5,530.00
|
| Rate for Payer: Anthem Medicaid |
$2,469.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,601.82
|
| Rate for Payer: Cash Price |
$3,590.91
|
| Rate for Payer: Cigna Commercial |
$5,960.91
|
| Rate for Payer: First Health Commercial |
$6,822.73
|
| Rate for Payer: Humana Commercial |
$6,104.55
|
| Rate for Payer: Humana KY Medicaid |
$2,469.83
|
| Rate for Payer: Kentucky WC Medicaid |
$2,494.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,889.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,300.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,519.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,386.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,436.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$933.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,226.36
|
| Rate for Payer: PHCS Commercial |
$6,894.55
|
| Rate for Payer: United Healthcare All Payer |
$6,320.00
|
|
|
FILTER WIRE EZ 190CM
|
Facility
|
IP
|
$7,181.82
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
27000047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$933.64 |
| Max. Negotiated Rate |
$6,894.55 |
| Rate for Payer: Aetna Commercial |
$5,530.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,601.82
|
| Rate for Payer: Cash Price |
$3,590.91
|
| Rate for Payer: Cigna Commercial |
$5,960.91
|
| Rate for Payer: First Health Commercial |
$6,822.73
|
| Rate for Payer: Humana Commercial |
$6,104.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,889.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,300.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,386.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,436.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$933.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,226.36
|
| Rate for Payer: PHCS Commercial |
$6,894.55
|
| Rate for Payer: United Healthcare All Payer |
$6,320.00
|
|
