|
GEN P/S ART INS X-LGE LT 25 MM
|
Facility
|
OP
|
$8,786.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,142.18 |
| Max. Negotiated Rate |
$8,434.56 |
| Rate for Payer: Aetna Commercial |
$6,765.22
|
| Rate for Payer: Anthem Medicaid |
$3,021.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,853.08
|
| Rate for Payer: Cash Price |
$4,393.00
|
| Rate for Payer: Cigna Commercial |
$7,292.38
|
| Rate for Payer: First Health Commercial |
$8,346.70
|
| Rate for Payer: Humana Commercial |
$7,468.10
|
| Rate for Payer: Humana KY Medicaid |
$3,021.51
|
| Rate for Payer: Kentucky WC Medicaid |
$3,052.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,204.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,484.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,635.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,082.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,731.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,589.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,757.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,142.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,723.66
|
| Rate for Payer: PHCS Commercial |
$8,434.56
|
| Rate for Payer: United Healthcare All Payer |
$7,731.68
|
|
|
GEN PSTR STBLZ ART INSRT SZ3/4
|
Facility
|
OP
|
$4,776.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$620.88 |
| Max. Negotiated Rate |
$4,584.96 |
| Rate for Payer: Aetna Commercial |
$3,677.52
|
| Rate for Payer: Anthem Medicaid |
$1,642.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,725.28
|
| Rate for Payer: Cash Price |
$2,388.00
|
| Rate for Payer: Cigna Commercial |
$3,964.08
|
| Rate for Payer: First Health Commercial |
$4,537.20
|
| Rate for Payer: Humana Commercial |
$4,059.60
|
| Rate for Payer: Humana KY Medicaid |
$1,642.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1,659.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,916.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,524.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,432.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,675.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,202.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,582.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$955.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$620.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,480.56
|
| Rate for Payer: PHCS Commercial |
$4,584.96
|
| Rate for Payer: United Healthcare All Payer |
$4,202.88
|
|
|
GEN PSTR STBLZ ART INSRT SZ3/4
|
Facility
|
IP
|
$4,776.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$620.88 |
| Max. Negotiated Rate |
$4,584.96 |
| Rate for Payer: Aetna Commercial |
$3,677.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,725.28
|
| Rate for Payer: Cash Price |
$2,388.00
|
| Rate for Payer: Cigna Commercial |
$3,964.08
|
| Rate for Payer: First Health Commercial |
$4,537.20
|
| Rate for Payer: Humana Commercial |
$4,059.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,916.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,524.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,432.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,202.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,582.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$955.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$620.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,480.56
|
| Rate for Payer: PHCS Commercial |
$4,584.96
|
| Rate for Payer: United Healthcare All Payer |
$4,202.88
|
|
|
GENRATOR SPECTRA WAVEWRITER SC
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1820
|
| Hospital Charge Code |
27000082
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
GENRATOR SPECTRA WAVEWRITER SC
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1820
|
| Hospital Charge Code |
27000082
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
GENRTR ALTRUA 20 DCRR S202/03
|
Facility
|
OP
|
$19,400.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,522.00 |
| Max. Negotiated Rate |
$18,624.00 |
| Rate for Payer: Aetna Commercial |
$14,938.00
|
| Rate for Payer: Anthem Medicaid |
$6,671.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,132.00
|
| Rate for Payer: Cash Price |
$9,700.00
|
| Rate for Payer: Cigna Commercial |
$16,102.00
|
| Rate for Payer: First Health Commercial |
$18,430.00
|
| Rate for Payer: Humana Commercial |
$16,490.00
|
| Rate for Payer: Humana KY Medicaid |
$6,671.66
|
| Rate for Payer: Kentucky WC Medicaid |
$6,739.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,908.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,317.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,820.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,805.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,072.00
|
| Rate for Payer: Ohio Health Group HMO |
$14,550.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,522.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,014.00
|
| Rate for Payer: PHCS Commercial |
$18,624.00
|
| Rate for Payer: United Healthcare All Payer |
$17,072.00
|
|
|
GENRTR ALTRUA 20 DCRR S202/03
|
Facility
|
IP
|
$19,400.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,522.00 |
| Max. Negotiated Rate |
$18,624.00 |
| Rate for Payer: Aetna Commercial |
$14,938.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,132.00
|
| Rate for Payer: Cash Price |
$9,700.00
|
| Rate for Payer: Cigna Commercial |
$16,102.00
|
| Rate for Payer: First Health Commercial |
$18,430.00
|
| Rate for Payer: Humana Commercial |
$16,490.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,908.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,317.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,820.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,072.00
|
| Rate for Payer: Ohio Health Group HMO |
$14,550.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,522.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,014.00
|
| Rate for Payer: PHCS Commercial |
$18,624.00
|
| Rate for Payer: United Healthcare All Payer |
$17,072.00
|
|
|
GENRTR ALTRUA 20 SCRR S201/04
|
Facility
|
IP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,950.00 |
| Max. Negotiated Rate |
$14,400.00 |
| Rate for Payer: Aetna Commercial |
$11,550.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,700.00
|
| Rate for Payer: Cash Price |
$7,500.00
|
| Rate for Payer: Cigna Commercial |
$12,450.00
|
| Rate for Payer: First Health Commercial |
$14,250.00
|
| Rate for Payer: Humana Commercial |
$12,750.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,300.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,070.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,650.00
|
| Rate for Payer: PHCS Commercial |
$14,400.00
|
| Rate for Payer: United Healthcare All Payer |
$13,200.00
|
|
|
GENRTR ALTRUA 20 SCRR S201/04
|
Facility
|
OP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,950.00 |
| Max. Negotiated Rate |
$14,400.00 |
| Rate for Payer: Aetna Commercial |
$11,550.00
|
| Rate for Payer: Anthem Medicaid |
$5,158.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,700.00
|
| Rate for Payer: Cash Price |
$7,500.00
|
| Rate for Payer: Cigna Commercial |
$12,450.00
|
| Rate for Payer: First Health Commercial |
$14,250.00
|
| Rate for Payer: Humana Commercial |
$12,750.00
|
| Rate for Payer: Humana KY Medicaid |
$5,158.50
|
| Rate for Payer: Kentucky WC Medicaid |
$5,211.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,300.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,070.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,262.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,650.00
|
| Rate for Payer: PHCS Commercial |
$14,400.00
|
| Rate for Payer: United Healthcare All Payer |
$13,200.00
|
|
|
GENRTR ALTRUA 40 DCRR S402/03
|
Facility
|
OP
|
$21,225.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,759.25 |
| Max. Negotiated Rate |
$20,376.00 |
| Rate for Payer: Aetna Commercial |
$16,343.25
|
| Rate for Payer: Anthem Medicaid |
$7,299.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,555.50
|
| Rate for Payer: Cash Price |
$10,612.50
|
| Rate for Payer: Cigna Commercial |
$17,616.75
|
| Rate for Payer: First Health Commercial |
$20,163.75
|
| Rate for Payer: Humana Commercial |
$18,041.25
|
| Rate for Payer: Humana KY Medicaid |
$7,299.28
|
| Rate for Payer: Kentucky WC Medicaid |
$7,373.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,404.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,664.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,367.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,445.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,678.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,918.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,245.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,759.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,579.75
|
| Rate for Payer: PHCS Commercial |
$20,376.00
|
| Rate for Payer: United Healthcare All Payer |
$18,678.00
|
|
|
GENRTR ALTRUA 40 DCRR S402/03
|
Facility
|
IP
|
$21,225.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,759.25 |
| Max. Negotiated Rate |
$20,376.00 |
| Rate for Payer: Aetna Commercial |
$16,343.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,555.50
|
| Rate for Payer: Cash Price |
$10,612.50
|
| Rate for Payer: Cigna Commercial |
$17,616.75
|
| Rate for Payer: First Health Commercial |
$20,163.75
|
| Rate for Payer: Humana Commercial |
$18,041.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,404.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,664.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,367.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,678.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,918.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,245.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,759.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,579.75
|
| Rate for Payer: PHCS Commercial |
$20,376.00
|
| Rate for Payer: United Healthcare All Payer |
$18,678.00
|
|
|
GENRTR ALTRUA 60 DCRR S602/03
|
Facility
|
IP
|
$21,225.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,759.25 |
| Max. Negotiated Rate |
$20,376.00 |
| Rate for Payer: Aetna Commercial |
$16,343.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,555.50
|
| Rate for Payer: Cash Price |
$10,612.50
|
| Rate for Payer: Cigna Commercial |
$17,616.75
|
| Rate for Payer: First Health Commercial |
$20,163.75
|
| Rate for Payer: Humana Commercial |
$18,041.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,404.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,664.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,367.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,678.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,918.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,245.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,759.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,579.75
|
| Rate for Payer: PHCS Commercial |
$20,376.00
|
| Rate for Payer: United Healthcare All Payer |
$18,678.00
|
|
|
GENRTR ALTRUA 60 DCRR S602/03
|
Facility
|
OP
|
$21,225.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,759.25 |
| Max. Negotiated Rate |
$20,376.00 |
| Rate for Payer: Aetna Commercial |
$16,343.25
|
| Rate for Payer: Anthem Medicaid |
$7,299.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,555.50
|
| Rate for Payer: Cash Price |
$10,612.50
|
| Rate for Payer: Cigna Commercial |
$17,616.75
|
| Rate for Payer: First Health Commercial |
$20,163.75
|
| Rate for Payer: Humana Commercial |
$18,041.25
|
| Rate for Payer: Humana KY Medicaid |
$7,299.28
|
| Rate for Payer: Kentucky WC Medicaid |
$7,373.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,404.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,664.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,367.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,445.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,678.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,918.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,245.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,759.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,579.75
|
| Rate for Payer: PHCS Commercial |
$20,376.00
|
| Rate for Payer: United Healthcare All Payer |
$18,678.00
|
|
|
GENRTR DCRR CYLOS DR-T 349806
|
Facility
|
OP
|
$26,700.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,471.00 |
| Max. Negotiated Rate |
$25,632.00 |
| Rate for Payer: Aetna Commercial |
$20,559.00
|
| Rate for Payer: Anthem Medicaid |
$9,182.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,826.00
|
| Rate for Payer: Cash Price |
$13,350.00
|
| Rate for Payer: Cigna Commercial |
$22,161.00
|
| Rate for Payer: First Health Commercial |
$25,365.00
|
| Rate for Payer: Humana Commercial |
$22,695.00
|
| Rate for Payer: Humana KY Medicaid |
$9,182.13
|
| Rate for Payer: Kentucky WC Medicaid |
$9,275.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,894.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,704.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,010.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,366.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$20,025.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,471.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,277.00
|
| Rate for Payer: PHCS Commercial |
$25,632.00
|
| Rate for Payer: United Healthcare All Payer |
$23,496.00
|
|
|
GENRTR DCRR CYLOS DR-T 349806
|
Facility
|
IP
|
$26,700.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,471.00 |
| Max. Negotiated Rate |
$25,632.00 |
| Rate for Payer: Aetna Commercial |
$20,559.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,826.00
|
| Rate for Payer: Cash Price |
$13,350.00
|
| Rate for Payer: Cigna Commercial |
$22,161.00
|
| Rate for Payer: First Health Commercial |
$25,365.00
|
| Rate for Payer: Humana Commercial |
$22,695.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,894.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,704.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,010.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$20,025.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,471.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,277.00
|
| Rate for Payer: PHCS Commercial |
$25,632.00
|
| Rate for Payer: United Healthcare All Payer |
$23,496.00
|
|
|
GENRTR EON MINI IPG 16 CHANEL
|
Facility
|
OP
|
$81,700.00
|
|
|
Service Code
|
HCPCS C1820
|
| Hospital Charge Code |
27000082
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,621.00 |
| Max. Negotiated Rate |
$78,432.00 |
| Rate for Payer: Aetna Commercial |
$62,909.00
|
| Rate for Payer: Anthem Medicaid |
$28,096.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63,726.00
|
| Rate for Payer: Cash Price |
$40,850.00
|
| Rate for Payer: Cigna Commercial |
$67,811.00
|
| Rate for Payer: First Health Commercial |
$77,615.00
|
| Rate for Payer: Humana Commercial |
$69,445.00
|
| Rate for Payer: Humana KY Medicaid |
$28,096.63
|
| Rate for Payer: Kentucky WC Medicaid |
$28,382.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66,994.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60,294.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,510.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,660.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$71,896.00
|
| Rate for Payer: Ohio Health Group HMO |
$61,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,621.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,327.00
|
| Rate for Payer: PHCS Commercial |
$78,432.00
|
| Rate for Payer: United Healthcare All Payer |
$71,896.00
|
|
|
GENRTR EON MINI IPG 16 CHANEL
|
Facility
|
IP
|
$81,700.00
|
|
|
Service Code
|
HCPCS C1820
|
| Hospital Charge Code |
27000082
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,621.00 |
| Max. Negotiated Rate |
$78,432.00 |
| Rate for Payer: Aetna Commercial |
$62,909.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63,726.00
|
| Rate for Payer: Cash Price |
$40,850.00
|
| Rate for Payer: Cigna Commercial |
$67,811.00
|
| Rate for Payer: First Health Commercial |
$77,615.00
|
| Rate for Payer: Humana Commercial |
$69,445.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66,994.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60,294.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24,510.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$71,896.00
|
| Rate for Payer: Ohio Health Group HMO |
$61,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,621.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,327.00
|
| Rate for Payer: PHCS Commercial |
$78,432.00
|
| Rate for Payer: United Healthcare All Payer |
$71,896.00
|
|
|
GENRTR INSYNC II MARQUIS 7289
|
Facility
|
IP
|
$100,600.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$13,078.00 |
| Max. Negotiated Rate |
$96,576.00 |
| Rate for Payer: Aetna Commercial |
$77,462.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$78,468.00
|
| Rate for Payer: Cash Price |
$50,300.00
|
| Rate for Payer: Cigna Commercial |
$83,498.00
|
| Rate for Payer: First Health Commercial |
$95,570.00
|
| Rate for Payer: Humana Commercial |
$85,510.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$82,492.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$74,242.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30,180.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$88,528.00
|
| Rate for Payer: Ohio Health Group HMO |
$75,450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,078.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31,186.00
|
| Rate for Payer: PHCS Commercial |
$96,576.00
|
| Rate for Payer: United Healthcare All Payer |
$88,528.00
|
|
|
GENRTR INSYNC II MARQUIS 7289
|
Facility
|
OP
|
$100,600.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$13,078.00 |
| Max. Negotiated Rate |
$96,576.00 |
| Rate for Payer: Aetna Commercial |
$77,462.00
|
| Rate for Payer: Anthem Medicaid |
$34,596.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$78,468.00
|
| Rate for Payer: Cash Price |
$50,300.00
|
| Rate for Payer: Cigna Commercial |
$83,498.00
|
| Rate for Payer: First Health Commercial |
$95,570.00
|
| Rate for Payer: Humana Commercial |
$85,510.00
|
| Rate for Payer: Humana KY Medicaid |
$34,596.34
|
| Rate for Payer: Kentucky WC Medicaid |
$34,948.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$82,492.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$74,242.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30,180.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$35,290.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$88,528.00
|
| Rate for Payer: Ohio Health Group HMO |
$75,450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,078.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31,186.00
|
| Rate for Payer: PHCS Commercial |
$96,576.00
|
| Rate for Payer: United Healthcare All Payer |
$88,528.00
|
|
|
GENRTR ZEPHYR XL DR DCRR 5826
|
Facility
|
IP
|
$21,225.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,759.25 |
| Max. Negotiated Rate |
$20,376.00 |
| Rate for Payer: Aetna Commercial |
$16,343.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,555.50
|
| Rate for Payer: Cash Price |
$10,612.50
|
| Rate for Payer: Cigna Commercial |
$17,616.75
|
| Rate for Payer: First Health Commercial |
$20,163.75
|
| Rate for Payer: Humana Commercial |
$18,041.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,404.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,664.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,367.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,678.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,918.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,245.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,759.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,579.75
|
| Rate for Payer: PHCS Commercial |
$20,376.00
|
| Rate for Payer: United Healthcare All Payer |
$18,678.00
|
|
|
GENRTR ZEPHYR XL DR DCRR 5826
|
Facility
|
OP
|
$21,225.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,759.25 |
| Max. Negotiated Rate |
$20,376.00 |
| Rate for Payer: Aetna Commercial |
$16,343.25
|
| Rate for Payer: Anthem Medicaid |
$7,299.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,555.50
|
| Rate for Payer: Cash Price |
$10,612.50
|
| Rate for Payer: Cigna Commercial |
$17,616.75
|
| Rate for Payer: First Health Commercial |
$20,163.75
|
| Rate for Payer: Humana Commercial |
$18,041.25
|
| Rate for Payer: Humana KY Medicaid |
$7,299.28
|
| Rate for Payer: Kentucky WC Medicaid |
$7,373.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,404.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,664.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,367.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,445.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,678.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,918.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,245.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,759.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,579.75
|
| Rate for Payer: PHCS Commercial |
$20,376.00
|
| Rate for Payer: United Healthcare All Payer |
$18,678.00
|
|
|
GENTAMICIN 20MG PF SDV
|
Facility
|
OP
|
$112.41
|
|
|
Service Code
|
HCPCS J1580
|
| Hospital Charge Code |
25002111
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.61 |
| Max. Negotiated Rate |
$107.91 |
| Rate for Payer: Aetna Commercial |
$86.56
|
| Rate for Payer: Anthem Medicaid |
$38.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.68
|
| Rate for Payer: Cash Price |
$56.20
|
| Rate for Payer: Cigna Commercial |
$93.30
|
| Rate for Payer: First Health Commercial |
$106.79
|
| Rate for Payer: Humana Commercial |
$95.55
|
| Rate for Payer: Humana KY Medicaid |
$38.66
|
| Rate for Payer: Kentucky WC Medicaid |
$39.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$98.92
|
| Rate for Payer: Ohio Health Group HMO |
$84.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.85
|
| Rate for Payer: PHCS Commercial |
$107.91
|
| Rate for Payer: United Healthcare All Payer |
$98.92
|
|
|
GENTAMICIN 20MG PF SDV
|
Facility
|
IP
|
$112.41
|
|
|
Service Code
|
HCPCS J1580
|
| Hospital Charge Code |
25002111
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.61 |
| Max. Negotiated Rate |
$107.91 |
| Rate for Payer: Aetna Commercial |
$86.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.68
|
| Rate for Payer: Cash Price |
$56.20
|
| Rate for Payer: Cigna Commercial |
$93.30
|
| Rate for Payer: First Health Commercial |
$106.79
|
| Rate for Payer: Humana Commercial |
$95.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$98.92
|
| Rate for Payer: Ohio Health Group HMO |
$84.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.85
|
| Rate for Payer: PHCS Commercial |
$107.91
|
| Rate for Payer: United Healthcare All Payer |
$98.92
|
|
|
GENTAMICIN 280MG/107ML IN D5W
|
Facility
|
OP
|
$123.35
|
|
|
Service Code
|
HCPCS J1580
|
| Hospital Charge Code |
25002112
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.04 |
| Max. Negotiated Rate |
$118.42 |
| Rate for Payer: Aetna Commercial |
$94.98
|
| Rate for Payer: Anthem Medicaid |
$42.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$96.21
|
| Rate for Payer: Cash Price |
$61.67
|
| Rate for Payer: Cigna Commercial |
$102.38
|
| Rate for Payer: First Health Commercial |
$117.18
|
| Rate for Payer: Humana Commercial |
$104.85
|
| Rate for Payer: Humana KY Medicaid |
$42.42
|
| Rate for Payer: Kentucky WC Medicaid |
$42.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$101.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$91.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$43.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$108.55
|
| Rate for Payer: Ohio Health Group HMO |
$92.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$38.24
|
| Rate for Payer: PHCS Commercial |
$118.42
|
| Rate for Payer: United Healthcare All Payer |
$108.55
|
|
|
GENTAMICIN 280MG/107ML IN D5W
|
Facility
|
IP
|
$123.35
|
|
|
Service Code
|
HCPCS J1580
|
| Hospital Charge Code |
25002112
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.04 |
| Max. Negotiated Rate |
$118.42 |
| Rate for Payer: Aetna Commercial |
$94.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$96.21
|
| Rate for Payer: Cash Price |
$61.67
|
| Rate for Payer: Cigna Commercial |
$102.38
|
| Rate for Payer: First Health Commercial |
$117.18
|
| Rate for Payer: Humana Commercial |
$104.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$101.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$91.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$108.55
|
| Rate for Payer: Ohio Health Group HMO |
$92.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$38.24
|
| Rate for Payer: PHCS Commercial |
$118.42
|
| Rate for Payer: United Healthcare All Payer |
$108.55
|
|
