|
ANAT SHOULDER REM HEAD 19*52
|
Facility
|
IP
|
$10,647.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,384.17 |
| Max. Negotiated Rate |
$10,221.55 |
| Rate for Payer: Aetna Commercial |
$8,198.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,305.01
|
| Rate for Payer: Cash Price |
$5,323.73
|
| Rate for Payer: Cigna Commercial |
$8,837.38
|
| Rate for Payer: First Health Commercial |
$10,115.08
|
| Rate for Payer: Humana Commercial |
$9,050.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,730.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,857.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,194.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,369.76
|
| Rate for Payer: Ohio Health Group HMO |
$7,985.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,129.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,384.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,300.71
|
| Rate for Payer: PHCS Commercial |
$10,221.55
|
| Rate for Payer: United Healthcare All Payer |
$9,369.76
|
|
|
ANAT SHOULDER REM HEAD 19*52
|
Facility
|
OP
|
$10,647.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,384.17 |
| Max. Negotiated Rate |
$10,221.55 |
| Rate for Payer: Aetna Commercial |
$8,198.54
|
| Rate for Payer: Anthem Medicaid |
$3,661.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,305.01
|
| Rate for Payer: Cash Price |
$5,323.73
|
| Rate for Payer: Cigna Commercial |
$8,837.38
|
| Rate for Payer: First Health Commercial |
$10,115.08
|
| Rate for Payer: Humana Commercial |
$9,050.33
|
| Rate for Payer: Humana KY Medicaid |
$3,661.66
|
| Rate for Payer: Kentucky WC Medicaid |
$3,698.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,730.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,857.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,194.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,735.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,369.76
|
| Rate for Payer: Ohio Health Group HMO |
$7,985.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,129.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,384.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,300.71
|
| Rate for Payer: PHCS Commercial |
$10,221.55
|
| Rate for Payer: United Healthcare All Payer |
$9,369.76
|
|
|
ANAT SHOULDER REM HEAD 20*48
|
Facility
|
OP
|
$10,647.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,384.17 |
| Max. Negotiated Rate |
$10,221.55 |
| Rate for Payer: Aetna Commercial |
$8,198.54
|
| Rate for Payer: Anthem Medicaid |
$3,661.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,305.01
|
| Rate for Payer: Cash Price |
$5,323.73
|
| Rate for Payer: Cigna Commercial |
$8,837.38
|
| Rate for Payer: First Health Commercial |
$10,115.08
|
| Rate for Payer: Humana Commercial |
$9,050.33
|
| Rate for Payer: Humana KY Medicaid |
$3,661.66
|
| Rate for Payer: Kentucky WC Medicaid |
$3,698.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,730.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,857.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,194.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,735.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,369.76
|
| Rate for Payer: Ohio Health Group HMO |
$7,985.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,129.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,384.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,300.71
|
| Rate for Payer: PHCS Commercial |
$10,221.55
|
| Rate for Payer: United Healthcare All Payer |
$9,369.76
|
|
|
ANAT SHOULDER REM HEAD 20*48
|
Facility
|
IP
|
$10,647.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,384.17 |
| Max. Negotiated Rate |
$10,221.55 |
| Rate for Payer: Aetna Commercial |
$8,198.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,305.01
|
| Rate for Payer: Cash Price |
$5,323.73
|
| Rate for Payer: Cigna Commercial |
$8,837.38
|
| Rate for Payer: First Health Commercial |
$10,115.08
|
| Rate for Payer: Humana Commercial |
$9,050.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,730.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,857.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,194.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,369.76
|
| Rate for Payer: Ohio Health Group HMO |
$7,985.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,129.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,384.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,300.71
|
| Rate for Payer: PHCS Commercial |
$10,221.55
|
| Rate for Payer: United Healthcare All Payer |
$9,369.76
|
|
|
ANAT SHOULDER REM HEAD 21*50
|
Facility
|
IP
|
$10,647.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,384.17 |
| Max. Negotiated Rate |
$10,221.55 |
| Rate for Payer: Aetna Commercial |
$8,198.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,305.01
|
| Rate for Payer: Cash Price |
$5,323.73
|
| Rate for Payer: Cigna Commercial |
$8,837.38
|
| Rate for Payer: First Health Commercial |
$10,115.08
|
| Rate for Payer: Humana Commercial |
$9,050.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,730.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,857.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,194.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,369.76
|
| Rate for Payer: Ohio Health Group HMO |
$7,985.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,129.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,384.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,300.71
|
| Rate for Payer: PHCS Commercial |
$10,221.55
|
| Rate for Payer: United Healthcare All Payer |
$9,369.76
|
|
|
ANAT SHOULDER REM HEAD 21*50
|
Facility
|
OP
|
$10,647.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,384.17 |
| Max. Negotiated Rate |
$10,221.55 |
| Rate for Payer: Aetna Commercial |
$8,198.54
|
| Rate for Payer: Anthem Medicaid |
$3,661.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,305.01
|
| Rate for Payer: Cash Price |
$5,323.73
|
| Rate for Payer: Cigna Commercial |
$8,837.38
|
| Rate for Payer: First Health Commercial |
$10,115.08
|
| Rate for Payer: Humana Commercial |
$9,050.33
|
| Rate for Payer: Humana KY Medicaid |
$3,661.66
|
| Rate for Payer: Kentucky WC Medicaid |
$3,698.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,730.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,857.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,194.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,735.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,369.76
|
| Rate for Payer: Ohio Health Group HMO |
$7,985.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,129.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,384.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,300.71
|
| Rate for Payer: PHCS Commercial |
$10,221.55
|
| Rate for Payer: United Healthcare All Payer |
$9,369.76
|
|
|
ANCEF 500 MG (1GM/5ML)SYRINGE
|
Facility
|
OP
|
$68.05
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
636T0018
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.85 |
| Max. Negotiated Rate |
$65.33 |
| Rate for Payer: Aetna Commercial |
$52.40
|
| Rate for Payer: Anthem Medicaid |
$23.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53.08
|
| Rate for Payer: Cash Price |
$34.02
|
| Rate for Payer: Cigna Commercial |
$56.48
|
| Rate for Payer: First Health Commercial |
$64.65
|
| Rate for Payer: Humana Commercial |
$57.84
|
| Rate for Payer: Humana KY Medicaid |
$23.40
|
| Rate for Payer: Kentucky WC Medicaid |
$23.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$55.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$23.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$59.88
|
| Rate for Payer: Ohio Health Group HMO |
$51.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.10
|
| Rate for Payer: PHCS Commercial |
$65.33
|
| Rate for Payer: United Healthcare All Payer |
$59.88
|
|
|
ANCEF 500 MG (1GM/5ML)SYRINGE
|
Professional
|
Both
|
$68.05
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
63600018
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$68.05 |
| Rate for Payer: Aetna Commercial |
$1.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$68.05
|
| Rate for Payer: Cash Price |
$34.02
|
| Rate for Payer: Cash Price |
$34.02
|
| Rate for Payer: Healthspan PPO |
$1.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1.16
|
| Rate for Payer: Multiplan PHCS |
$40.83
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$47.64
|
| Rate for Payer: UHCCP Medicaid |
$23.82
|
|
|
ANCEF 500 MG (1GM/5ML)SYRINGE
|
Facility
|
IP
|
$68.05
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
636T0018
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.85 |
| Max. Negotiated Rate |
$65.33 |
| Rate for Payer: Aetna Commercial |
$52.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53.08
|
| Rate for Payer: Cash Price |
$34.02
|
| Rate for Payer: Cigna Commercial |
$56.48
|
| Rate for Payer: First Health Commercial |
$64.65
|
| Rate for Payer: Humana Commercial |
$57.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$55.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$59.88
|
| Rate for Payer: Ohio Health Group HMO |
$51.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.10
|
| Rate for Payer: PHCS Commercial |
$65.33
|
| Rate for Payer: United Healthcare All Payer |
$59.88
|
|
|
ANCEF 500 MG (1GM/5ML)SYRINGE
|
Facility
|
IP
|
$68.05
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
63600018
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.85 |
| Max. Negotiated Rate |
$65.33 |
| Rate for Payer: Aetna Commercial |
$52.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53.08
|
| Rate for Payer: Cash Price |
$34.02
|
| Rate for Payer: Cigna Commercial |
$56.48
|
| Rate for Payer: First Health Commercial |
$64.65
|
| Rate for Payer: Humana Commercial |
$57.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$55.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$59.88
|
| Rate for Payer: Ohio Health Group HMO |
$51.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.10
|
| Rate for Payer: PHCS Commercial |
$65.33
|
| Rate for Payer: United Healthcare All Payer |
$59.88
|
|
|
ANCEF 500 MG (1GM/5ML)SYRINGE
|
Facility
|
IP
|
$118.05
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
25001924
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.35 |
| Max. Negotiated Rate |
$113.33 |
| Rate for Payer: Aetna Commercial |
$90.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.08
|
| Rate for Payer: Cash Price |
$59.02
|
| Rate for Payer: Cigna Commercial |
$97.98
|
| Rate for Payer: First Health Commercial |
$112.15
|
| Rate for Payer: Humana Commercial |
$100.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$96.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$103.88
|
| Rate for Payer: Ohio Health Group HMO |
$88.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.60
|
| Rate for Payer: PHCS Commercial |
$113.33
|
| Rate for Payer: United Healthcare All Payer |
$103.88
|
|
|
ANCEF 500 MG (1GM/5ML)SYRINGE
|
Facility
|
OP
|
$118.05
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
25001924
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.35 |
| Max. Negotiated Rate |
$113.33 |
| Rate for Payer: Aetna Commercial |
$90.90
|
| Rate for Payer: Anthem Medicaid |
$40.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.08
|
| Rate for Payer: Cash Price |
$59.02
|
| Rate for Payer: Cigna Commercial |
$97.98
|
| Rate for Payer: First Health Commercial |
$112.15
|
| Rate for Payer: Humana Commercial |
$100.34
|
| Rate for Payer: Humana KY Medicaid |
$40.60
|
| Rate for Payer: Kentucky WC Medicaid |
$41.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$96.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$41.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$103.88
|
| Rate for Payer: Ohio Health Group HMO |
$88.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.60
|
| Rate for Payer: PHCS Commercial |
$113.33
|
| Rate for Payer: United Healthcare All Payer |
$103.88
|
|
|
ANCEF 500 MG (1GM/5ML)SYRINGE
|
Facility
|
OP
|
$68.05
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
63600018
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.85 |
| Max. Negotiated Rate |
$65.33 |
| Rate for Payer: Aetna Commercial |
$52.40
|
| Rate for Payer: Anthem Medicaid |
$23.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53.08
|
| Rate for Payer: Cash Price |
$34.02
|
| Rate for Payer: Cigna Commercial |
$56.48
|
| Rate for Payer: First Health Commercial |
$64.65
|
| Rate for Payer: Humana Commercial |
$57.84
|
| Rate for Payer: Humana KY Medicaid |
$23.40
|
| Rate for Payer: Kentucky WC Medicaid |
$23.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$55.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$23.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$59.88
|
| Rate for Payer: Ohio Health Group HMO |
$51.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.10
|
| Rate for Payer: PHCS Commercial |
$65.33
|
| Rate for Payer: United Healthcare All Payer |
$59.88
|
|
|
ANCEF 500 MG 1GM VL
|
Facility
|
IP
|
$77.65
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
25001927
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.09 |
| Max. Negotiated Rate |
$74.54 |
| Rate for Payer: Aetna Commercial |
$59.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.57
|
| Rate for Payer: Cash Price |
$38.83
|
| Rate for Payer: Cigna Commercial |
$64.45
|
| Rate for Payer: First Health Commercial |
$73.77
|
| Rate for Payer: Humana Commercial |
$66.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.33
|
| Rate for Payer: Ohio Health Group HMO |
$58.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.07
|
| Rate for Payer: PHCS Commercial |
$74.54
|
| Rate for Payer: United Healthcare All Payer |
$68.33
|
|
|
ANCEF 500 MG 1GM VL
|
Facility
|
OP
|
$77.65
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
25001927
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.09 |
| Max. Negotiated Rate |
$74.54 |
| Rate for Payer: Aetna Commercial |
$59.79
|
| Rate for Payer: Anthem Medicaid |
$26.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.57
|
| Rate for Payer: Cash Price |
$38.83
|
| Rate for Payer: Cigna Commercial |
$64.45
|
| Rate for Payer: First Health Commercial |
$73.77
|
| Rate for Payer: Humana Commercial |
$66.00
|
| Rate for Payer: Humana KY Medicaid |
$26.70
|
| Rate for Payer: Kentucky WC Medicaid |
$26.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.33
|
| Rate for Payer: Ohio Health Group HMO |
$58.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.07
|
| Rate for Payer: PHCS Commercial |
$74.54
|
| Rate for Payer: United Healthcare All Payer |
$68.33
|
|
|
ANCEF 500 MG (2GM SYRINGE)
|
Facility
|
OP
|
$118.05
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
25001925
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.35 |
| Max. Negotiated Rate |
$113.33 |
| Rate for Payer: Aetna Commercial |
$90.90
|
| Rate for Payer: Anthem Medicaid |
$40.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.08
|
| Rate for Payer: Cash Price |
$59.02
|
| Rate for Payer: Cigna Commercial |
$97.98
|
| Rate for Payer: First Health Commercial |
$112.15
|
| Rate for Payer: Humana Commercial |
$100.34
|
| Rate for Payer: Humana KY Medicaid |
$40.60
|
| Rate for Payer: Kentucky WC Medicaid |
$41.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$96.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$41.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$103.88
|
| Rate for Payer: Ohio Health Group HMO |
$88.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.60
|
| Rate for Payer: PHCS Commercial |
$113.33
|
| Rate for Payer: United Healthcare All Payer |
$103.88
|
|
|
ANCEF 500 MG (2GM SYRINGE)
|
Facility
|
IP
|
$118.05
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
25001925
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.35 |
| Max. Negotiated Rate |
$113.33 |
| Rate for Payer: Aetna Commercial |
$90.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.08
|
| Rate for Payer: Cash Price |
$59.02
|
| Rate for Payer: Cigna Commercial |
$97.98
|
| Rate for Payer: First Health Commercial |
$112.15
|
| Rate for Payer: Humana Commercial |
$100.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$96.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$103.88
|
| Rate for Payer: Ohio Health Group HMO |
$88.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.60
|
| Rate for Payer: PHCS Commercial |
$113.33
|
| Rate for Payer: United Healthcare All Payer |
$103.88
|
|
|
ANCEF 500 MG [3GRAM/30ML]
|
Facility
|
OP
|
$118.05
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
25001926
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.35 |
| Max. Negotiated Rate |
$113.33 |
| Rate for Payer: Aetna Commercial |
$90.90
|
| Rate for Payer: Anthem Medicaid |
$40.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.08
|
| Rate for Payer: Cash Price |
$59.02
|
| Rate for Payer: Cigna Commercial |
$97.98
|
| Rate for Payer: First Health Commercial |
$112.15
|
| Rate for Payer: Humana Commercial |
$100.34
|
| Rate for Payer: Humana KY Medicaid |
$40.60
|
| Rate for Payer: Kentucky WC Medicaid |
$41.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$96.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$41.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$103.88
|
| Rate for Payer: Ohio Health Group HMO |
$88.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.60
|
| Rate for Payer: PHCS Commercial |
$113.33
|
| Rate for Payer: United Healthcare All Payer |
$103.88
|
|
|
ANCEF 500 MG [3GRAM/30ML]
|
Facility
|
IP
|
$118.05
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
25001926
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.35 |
| Max. Negotiated Rate |
$113.33 |
| Rate for Payer: Humana Commercial |
$100.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$96.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$103.88
|
| Rate for Payer: Ohio Health Group HMO |
$88.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.60
|
| Rate for Payer: PHCS Commercial |
$113.33
|
| Rate for Payer: United Healthcare All Payer |
$103.88
|
| Rate for Payer: Aetna Commercial |
$90.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.08
|
| Rate for Payer: Cash Price |
$59.02
|
| Rate for Payer: Cigna Commercial |
$97.98
|
| Rate for Payer: First Health Commercial |
$112.15
|
|
|
ANCHOR 3.8*0.5CM SWIFTLOCK
|
Facility
|
OP
|
$1,787.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$232.38 |
| Max. Negotiated Rate |
$1,716.00 |
| Rate for Payer: Aetna Commercial |
$1,376.38
|
| Rate for Payer: Anthem Medicaid |
$614.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,394.25
|
| Rate for Payer: Cash Price |
$893.75
|
| Rate for Payer: Cigna Commercial |
$1,483.62
|
| Rate for Payer: First Health Commercial |
$1,698.12
|
| Rate for Payer: Humana Commercial |
$1,519.38
|
| Rate for Payer: Humana KY Medicaid |
$614.72
|
| Rate for Payer: Kentucky WC Medicaid |
$620.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,465.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,319.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$536.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$627.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,573.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,340.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$357.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$232.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$554.12
|
| Rate for Payer: PHCS Commercial |
$1,716.00
|
| Rate for Payer: United Healthcare All Payer |
$1,573.00
|
|
|
ANCHOR 3.8*0.5CM SWIFTLOCK
|
Facility
|
IP
|
$1,787.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$232.38 |
| Max. Negotiated Rate |
$1,716.00 |
| Rate for Payer: Humana Commercial |
$1,519.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,465.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,319.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$536.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,573.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,340.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$357.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$232.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$554.12
|
| Rate for Payer: PHCS Commercial |
$1,716.00
|
| Rate for Payer: United Healthcare All Payer |
$1,573.00
|
| Rate for Payer: Aetna Commercial |
$1,376.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,394.25
|
| Rate for Payer: Cash Price |
$893.75
|
| Rate for Payer: Cigna Commercial |
$1,483.62
|
| Rate for Payer: First Health Commercial |
$1,698.12
|
|
|
ANCHORAGE CP LAP PLATE 0DEG L
|
Facility
|
IP
|
$9,716.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,263.18 |
| Max. Negotiated Rate |
$9,328.08 |
| Rate for Payer: Aetna Commercial |
$7,481.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,579.06
|
| Rate for Payer: Cash Price |
$4,858.38
|
| Rate for Payer: Cigna Commercial |
$8,064.90
|
| Rate for Payer: First Health Commercial |
$9,230.91
|
| Rate for Payer: Humana Commercial |
$8,259.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,967.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,170.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,915.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,550.74
|
| Rate for Payer: Ohio Health Group HMO |
$7,287.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,943.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,263.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,012.19
|
| Rate for Payer: PHCS Commercial |
$9,328.08
|
| Rate for Payer: United Healthcare All Payer |
$8,550.74
|
|
|
ANCHORAGE CP LAP PLATE 0DEG L
|
Facility
|
OP
|
$9,716.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,263.18 |
| Max. Negotiated Rate |
$9,328.08 |
| Rate for Payer: Aetna Commercial |
$7,481.90
|
| Rate for Payer: Anthem Medicaid |
$3,341.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,579.06
|
| Rate for Payer: Cash Price |
$4,858.38
|
| Rate for Payer: Cigna Commercial |
$8,064.90
|
| Rate for Payer: First Health Commercial |
$9,230.91
|
| Rate for Payer: Humana Commercial |
$8,259.24
|
| Rate for Payer: Humana KY Medicaid |
$3,341.59
|
| Rate for Payer: Kentucky WC Medicaid |
$3,375.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,967.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,170.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,915.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,408.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,550.74
|
| Rate for Payer: Ohio Health Group HMO |
$7,287.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,943.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,263.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,012.19
|
| Rate for Payer: PHCS Commercial |
$9,328.08
|
| Rate for Payer: United Healthcare All Payer |
$8,550.74
|
|
|
ANCHORAGE CP LAP PLATE 0DEG R
|
Facility
|
OP
|
$9,716.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,263.18 |
| Max. Negotiated Rate |
$9,328.08 |
| Rate for Payer: Aetna Commercial |
$7,481.90
|
| Rate for Payer: Anthem Medicaid |
$3,341.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,579.06
|
| Rate for Payer: Cash Price |
$4,858.38
|
| Rate for Payer: Cigna Commercial |
$8,064.90
|
| Rate for Payer: First Health Commercial |
$9,230.91
|
| Rate for Payer: Humana Commercial |
$8,259.24
|
| Rate for Payer: Humana KY Medicaid |
$3,341.59
|
| Rate for Payer: Kentucky WC Medicaid |
$3,375.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,967.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,170.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,915.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,408.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,550.74
|
| Rate for Payer: Ohio Health Group HMO |
$7,287.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,943.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,263.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,012.19
|
| Rate for Payer: PHCS Commercial |
$9,328.08
|
| Rate for Payer: United Healthcare All Payer |
$8,550.74
|
|
|
ANCHORAGE CP LAP PLATE 0DEG R
|
Facility
|
IP
|
$9,716.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,263.18 |
| Max. Negotiated Rate |
$9,328.08 |
| Rate for Payer: Aetna Commercial |
$7,481.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,579.06
|
| Rate for Payer: Cash Price |
$4,858.38
|
| Rate for Payer: Cigna Commercial |
$8,064.90
|
| Rate for Payer: First Health Commercial |
$9,230.91
|
| Rate for Payer: Humana Commercial |
$8,259.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,967.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,170.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,915.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,550.74
|
| Rate for Payer: Ohio Health Group HMO |
$7,287.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,943.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,263.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,012.19
|
| Rate for Payer: PHCS Commercial |
$9,328.08
|
| Rate for Payer: United Healthcare All Payer |
$8,550.74
|
|
