|
HCV RNA DETECT/QUANT S
|
Facility
|
IP
|
$484.00
|
|
|
Service Code
|
HCPCS 87522
|
| Hospital Charge Code |
30001377
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$62.92 |
| Max. Negotiated Rate |
$464.64 |
| Rate for Payer: Aetna Commercial |
$372.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$388.65
|
| Rate for Payer: Cash Price |
$242.00
|
| Rate for Payer: Cigna Commercial |
$401.72
|
| Rate for Payer: First Health Commercial |
$459.80
|
| Rate for Payer: Humana Commercial |
$411.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$396.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$357.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$145.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$425.92
|
| Rate for Payer: Ohio Health Group HMO |
$363.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$150.04
|
| Rate for Payer: PHCS Commercial |
$464.64
|
| Rate for Payer: United Healthcare All Payer |
$425.92
|
|
|
HDL CHOLESTEROL
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
HCPCS 83718
|
| Hospital Charge Code |
30000445
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.38 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.88
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cigna Commercial |
$21.58
|
| Rate for Payer: First Health Commercial |
$24.70
|
| Rate for Payer: Humana Commercial |
$22.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.88
|
| Rate for Payer: Ohio Health Group HMO |
$19.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.06
|
| Rate for Payer: PHCS Commercial |
$24.96
|
| Rate for Payer: United Healthcare All Payer |
$22.88
|
|
|
HDL CHOLESTEROL
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
HCPCS 83718
|
| Hospital Charge Code |
30000445
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.38 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Anthem Medicaid |
$8.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$11.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$8.19
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cigna Commercial |
$21.58
|
| Rate for Payer: First Health Commercial |
$24.70
|
| Rate for Payer: Humana Commercial |
$22.10
|
| Rate for Payer: Humana KY Medicaid |
$8.19
|
| Rate for Payer: Humana Medicare Advantage |
$8.19
|
| Rate for Payer: Kentucky WC Medicaid |
$8.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.88
|
| Rate for Payer: Ohio Health Group HMO |
$19.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.06
|
| Rate for Payer: PHCS Commercial |
$24.96
|
| Rate for Payer: United Healthcare All Payer |
$22.88
|
|
|
HDR RDNCL SKN SURF BRACHYTX
|
Facility
|
IP
|
$4,060.00
|
|
|
Service Code
|
HCPCS 77767
|
| Hospital Charge Code |
33300030
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$527.80 |
| Max. Negotiated Rate |
$3,897.60 |
| Rate for Payer: Aetna Commercial |
$3,126.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,166.80
|
| Rate for Payer: Cash Price |
$2,030.00
|
| Rate for Payer: Cigna Commercial |
$3,369.80
|
| Rate for Payer: First Health Commercial |
$3,857.00
|
| Rate for Payer: Humana Commercial |
$3,451.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,329.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,996.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,218.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,572.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,045.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$812.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$527.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,258.60
|
| Rate for Payer: PHCS Commercial |
$3,897.60
|
| Rate for Payer: United Healthcare All Payer |
$3,572.80
|
|
|
HDR RDNCL SKN SURF BRACHYTX
|
Facility
|
OP
|
$4,060.00
|
|
|
Service Code
|
HCPCS 77767
|
| Hospital Charge Code |
33300030
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$232.40 |
| Max. Negotiated Rate |
$3,897.60 |
| Rate for Payer: Aetna Commercial |
$3,126.20
|
| Rate for Payer: Anthem Medicaid |
$1,396.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$232.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,166.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$325.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$313.74
|
| Rate for Payer: Cash Price |
$2,030.00
|
| Rate for Payer: Cash Price |
$2,030.00
|
| Rate for Payer: Cigna Commercial |
$3,369.80
|
| Rate for Payer: First Health Commercial |
$3,857.00
|
| Rate for Payer: Humana Commercial |
$3,451.00
|
| Rate for Payer: Humana KY Medicaid |
$1,396.23
|
| Rate for Payer: Humana Medicare Advantage |
$232.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,410.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,329.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,996.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$278.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,424.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,572.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,045.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$812.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$527.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,258.60
|
| Rate for Payer: PHCS Commercial |
$3,897.60
|
| Rate for Payer: United Healthcare All Payer |
$3,572.80
|
|
|
HDR RDNCL SKN SURF BRACHYTX
|
Professional
|
Both
|
$4,060.00
|
|
|
Service Code
|
HCPCS 77767
|
| Hospital Charge Code |
33300030
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$68.71 |
| Max. Negotiated Rate |
$4,060.00 |
| Rate for Payer: Anthem Medicaid |
$167.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,060.00
|
| Rate for Payer: Cash Price |
$2,030.00
|
| Rate for Payer: Cash Price |
$2,030.00
|
| Rate for Payer: Cigna Commercial |
$353.41
|
| Rate for Payer: Humana Medicaid |
$167.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$68.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$171.19
|
| Rate for Payer: Molina Healthcare Passport |
$167.83
|
| Rate for Payer: Multiplan PHCS |
$2,436.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,842.00
|
| Rate for Payer: UHCCP Medicaid |
$1,421.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$169.51
|
|
|
HDR RDNCL SKN SURF BRACHYTX(P
|
Professional
|
Both
|
$260.00
|
|
|
Service Code
|
HCPCS 77767
|
| Hospital Charge Code |
333P0030
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$68.71 |
| Max. Negotiated Rate |
$353.41 |
| Rate for Payer: Anthem Medicaid |
$167.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$260.00
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cigna Commercial |
$353.41
|
| Rate for Payer: Humana Medicaid |
$167.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$68.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$171.19
|
| Rate for Payer: Molina Healthcare Passport |
$167.83
|
| Rate for Payer: Multiplan PHCS |
$156.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$182.00
|
| Rate for Payer: UHCCP Medicaid |
$91.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$169.51
|
|
|
HDR RDNCL SKN SURF BRACHYTX(T
|
Facility
|
IP
|
$3,800.00
|
|
|
Service Code
|
HCPCS 77767
|
| Hospital Charge Code |
333T0030
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$494.00 |
| Max. Negotiated Rate |
$3,648.00 |
| Rate for Payer: Aetna Commercial |
$2,926.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,964.00
|
| Rate for Payer: Cash Price |
$1,900.00
|
| Rate for Payer: Cigna Commercial |
$3,154.00
|
| Rate for Payer: First Health Commercial |
$3,610.00
|
| Rate for Payer: Humana Commercial |
$3,230.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,116.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,804.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,140.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,344.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,850.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$494.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,178.00
|
| Rate for Payer: PHCS Commercial |
$3,648.00
|
| Rate for Payer: United Healthcare All Payer |
$3,344.00
|
|
|
HDR RDNCL SKN SURF BRACHYTX(T
|
Facility
|
OP
|
$3,800.00
|
|
|
Service Code
|
HCPCS 77767
|
| Hospital Charge Code |
333T0030
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$232.40 |
| Max. Negotiated Rate |
$3,648.00 |
| Rate for Payer: Aetna Commercial |
$2,926.00
|
| Rate for Payer: Anthem Medicaid |
$1,306.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$232.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,964.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$325.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$313.74
|
| Rate for Payer: Cash Price |
$1,900.00
|
| Rate for Payer: Cash Price |
$1,900.00
|
| Rate for Payer: Cigna Commercial |
$3,154.00
|
| Rate for Payer: First Health Commercial |
$3,610.00
|
| Rate for Payer: Humana Commercial |
$3,230.00
|
| Rate for Payer: Humana KY Medicaid |
$1,306.82
|
| Rate for Payer: Humana Medicare Advantage |
$232.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,320.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,116.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,804.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$278.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,333.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,344.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,850.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$494.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,178.00
|
| Rate for Payer: PHCS Commercial |
$3,648.00
|
| Rate for Payer: United Healthcare All Payer |
$3,344.00
|
|
|
HEADACHES WITH MCC
|
Facility
|
IP
|
$14,115.07
|
|
|
Service Code
|
MSDRG 102
|
| Min. Negotiated Rate |
$9,578.08 |
| Max. Negotiated Rate |
$14,115.07 |
| Rate for Payer: Anthem Medicaid |
$9,578.08
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10,082.19
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$14,115.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$13,610.96
|
| Rate for Payer: Humana KY Medicaid |
$9,578.08
|
| Rate for Payer: Humana Medicare Advantage |
$10,082.19
|
| Rate for Payer: Kentucky WC Medicaid |
$9,673.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,098.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,769.64
|
|
|
HEADACHES WITHOUT MCC
|
Facility
|
IP
|
$9,854.57
|
|
|
Service Code
|
MSDRG 103
|
| Min. Negotiated Rate |
$6,687.03 |
| Max. Negotiated Rate |
$9,854.57 |
| Rate for Payer: Anthem Medicaid |
$6,687.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7,038.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,854.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$9,502.62
|
| Rate for Payer: Humana KY Medicaid |
$6,687.03
|
| Rate for Payer: Humana Medicare Advantage |
$7,038.98
|
| Rate for Payer: Kentucky WC Medicaid |
$6,753.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,446.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,820.77
|
|
|
HEAD ALUMINA 28MM +0
|
Facility
|
OP
|
$6,975.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$906.83 |
| Max. Negotiated Rate |
$6,696.58 |
| Rate for Payer: Aetna Commercial |
$5,371.21
|
| Rate for Payer: Anthem Medicaid |
$2,398.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,440.97
|
| Rate for Payer: Cash Price |
$3,487.80
|
| Rate for Payer: Cigna Commercial |
$5,789.75
|
| Rate for Payer: First Health Commercial |
$6,626.82
|
| Rate for Payer: Humana Commercial |
$5,929.26
|
| Rate for Payer: Humana KY Medicaid |
$2,398.91
|
| Rate for Payer: Kentucky WC Medicaid |
$2,423.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,719.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,147.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,092.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,447.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,138.53
|
| Rate for Payer: Ohio Health Group HMO |
$5,231.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,395.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$906.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,162.44
|
| Rate for Payer: PHCS Commercial |
$6,696.58
|
| Rate for Payer: United Healthcare All Payer |
$6,138.53
|
|
|
HEAD ALUMINA 28MM +0
|
Facility
|
IP
|
$6,975.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$906.83 |
| Max. Negotiated Rate |
$6,696.58 |
| Rate for Payer: Aetna Commercial |
$5,371.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,440.97
|
| Rate for Payer: Cash Price |
$3,487.80
|
| Rate for Payer: Cigna Commercial |
$5,789.75
|
| Rate for Payer: First Health Commercial |
$6,626.82
|
| Rate for Payer: Humana Commercial |
$5,929.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,719.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,147.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,092.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,138.53
|
| Rate for Payer: Ohio Health Group HMO |
$5,231.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,395.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$906.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,162.44
|
| Rate for Payer: PHCS Commercial |
$6,696.58
|
| Rate for Payer: United Healthcare All Payer |
$6,138.53
|
|
|
HEAD ALUMINA 36MM +0
|
Facility
|
IP
|
$8,932.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.16 |
| Max. Negotiated Rate |
$8,574.72 |
| Rate for Payer: Aetna Commercial |
$6,877.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.96
|
| Rate for Payer: Cash Price |
$4,466.00
|
| Rate for Payer: Cigna Commercial |
$7,413.56
|
| Rate for Payer: First Health Commercial |
$8,485.40
|
| Rate for Payer: Humana Commercial |
$7,592.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,324.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,860.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,786.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.92
|
| Rate for Payer: PHCS Commercial |
$8,574.72
|
| Rate for Payer: United Healthcare All Payer |
$7,860.16
|
|
|
HEAD ALUMINA 36MM +0
|
Facility
|
OP
|
$8,932.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.16 |
| Max. Negotiated Rate |
$8,574.72 |
| Rate for Payer: Aetna Commercial |
$6,877.64
|
| Rate for Payer: Anthem Medicaid |
$3,071.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.96
|
| Rate for Payer: Cash Price |
$4,466.00
|
| Rate for Payer: Cigna Commercial |
$7,413.56
|
| Rate for Payer: First Health Commercial |
$8,485.40
|
| Rate for Payer: Humana Commercial |
$7,592.20
|
| Rate for Payer: Humana KY Medicaid |
$3,071.71
|
| Rate for Payer: Kentucky WC Medicaid |
$3,102.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,324.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,133.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,860.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,786.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.92
|
| Rate for Payer: PHCS Commercial |
$8,574.72
|
| Rate for Payer: United Healthcare All Payer |
$7,860.16
|
|
|
HEAD ALUMINA 36MM +5
|
Facility
|
OP
|
$8,932.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.16 |
| Max. Negotiated Rate |
$8,574.72 |
| Rate for Payer: Aetna Commercial |
$6,877.64
|
| Rate for Payer: Anthem Medicaid |
$3,071.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.96
|
| Rate for Payer: Cash Price |
$4,466.00
|
| Rate for Payer: Cigna Commercial |
$7,413.56
|
| Rate for Payer: First Health Commercial |
$8,485.40
|
| Rate for Payer: Humana Commercial |
$7,592.20
|
| Rate for Payer: Humana KY Medicaid |
$3,071.71
|
| Rate for Payer: Kentucky WC Medicaid |
$3,102.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,324.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,133.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,860.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,786.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.92
|
| Rate for Payer: PHCS Commercial |
$8,574.72
|
| Rate for Payer: United Healthcare All Payer |
$7,860.16
|
|
|
HEAD ALUMINA 36MM +5
|
Facility
|
IP
|
$8,932.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.16 |
| Max. Negotiated Rate |
$8,574.72 |
| Rate for Payer: Aetna Commercial |
$6,877.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.96
|
| Rate for Payer: Cash Price |
$4,466.00
|
| Rate for Payer: Cigna Commercial |
$7,413.56
|
| Rate for Payer: First Health Commercial |
$8,485.40
|
| Rate for Payer: Humana Commercial |
$7,592.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,324.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,860.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,786.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.92
|
| Rate for Payer: PHCS Commercial |
$8,574.72
|
| Rate for Payer: United Healthcare All Payer |
$7,860.16
|
|
|
HEAD ALUMINA 36MM -5
|
Facility
|
OP
|
$8,578.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,115.23 |
| Max. Negotiated Rate |
$8,235.53 |
| Rate for Payer: Aetna Commercial |
$6,605.58
|
| Rate for Payer: Anthem Medicaid |
$2,950.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,691.37
|
| Rate for Payer: Cash Price |
$4,289.34
|
| Rate for Payer: Cigna Commercial |
$7,120.30
|
| Rate for Payer: First Health Commercial |
$8,149.75
|
| Rate for Payer: Humana Commercial |
$7,291.88
|
| Rate for Payer: Humana KY Medicaid |
$2,950.21
|
| Rate for Payer: Kentucky WC Medicaid |
$2,980.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,034.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,331.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,573.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,009.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,549.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,434.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,715.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,115.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,659.39
|
| Rate for Payer: PHCS Commercial |
$8,235.53
|
| Rate for Payer: United Healthcare All Payer |
$7,549.24
|
|
|
HEAD ALUMINA 36MM -5
|
Facility
|
IP
|
$8,578.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,115.23 |
| Max. Negotiated Rate |
$8,235.53 |
| Rate for Payer: Aetna Commercial |
$6,605.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,691.37
|
| Rate for Payer: Cash Price |
$4,289.34
|
| Rate for Payer: Cigna Commercial |
$7,120.30
|
| Rate for Payer: First Health Commercial |
$8,149.75
|
| Rate for Payer: Humana Commercial |
$7,291.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,034.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,331.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,573.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,549.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,434.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,715.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,115.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,659.39
|
| Rate for Payer: PHCS Commercial |
$8,235.53
|
| Rate for Payer: United Healthcare All Payer |
$7,549.24
|
|
|
HEAD BIOLOX CER C-TPR 32MM +0M
|
Facility
|
OP
|
$9,297.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,208.61 |
| Max. Negotiated Rate |
$8,925.12 |
| Rate for Payer: Aetna Commercial |
$7,158.69
|
| Rate for Payer: Anthem Medicaid |
$3,197.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,251.66
|
| Rate for Payer: Cash Price |
$4,648.50
|
| Rate for Payer: Cigna Commercial |
$7,716.51
|
| Rate for Payer: First Health Commercial |
$8,832.15
|
| Rate for Payer: Humana Commercial |
$7,902.45
|
| Rate for Payer: Humana KY Medicaid |
$3,197.24
|
| Rate for Payer: Kentucky WC Medicaid |
$3,229.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,623.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,861.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,789.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,261.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,181.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,972.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,859.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,208.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,882.07
|
| Rate for Payer: PHCS Commercial |
$8,925.12
|
| Rate for Payer: United Healthcare All Payer |
$8,181.36
|
|
|
HEAD BIOLOX CER C-TPR 32MM +0M
|
Facility
|
IP
|
$9,297.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,208.61 |
| Max. Negotiated Rate |
$8,925.12 |
| Rate for Payer: Aetna Commercial |
$7,158.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,251.66
|
| Rate for Payer: Cash Price |
$4,648.50
|
| Rate for Payer: Cigna Commercial |
$7,716.51
|
| Rate for Payer: First Health Commercial |
$8,832.15
|
| Rate for Payer: Humana Commercial |
$7,902.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,623.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,861.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,789.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,181.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,972.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,859.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,208.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,882.07
|
| Rate for Payer: PHCS Commercial |
$8,925.12
|
| Rate for Payer: United Healthcare All Payer |
$8,181.36
|
|
|
HEAD BIOLOX CER C-TPR 32MM +2.
|
Facility
|
IP
|
$9,297.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,208.61 |
| Max. Negotiated Rate |
$8,925.12 |
| Rate for Payer: Aetna Commercial |
$7,158.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,251.66
|
| Rate for Payer: Cash Price |
$4,648.50
|
| Rate for Payer: Cigna Commercial |
$7,716.51
|
| Rate for Payer: First Health Commercial |
$8,832.15
|
| Rate for Payer: Humana Commercial |
$7,902.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,623.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,861.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,789.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,181.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,972.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,859.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,208.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,882.07
|
| Rate for Payer: PHCS Commercial |
$8,925.12
|
| Rate for Payer: United Healthcare All Payer |
$8,181.36
|
|
|
HEAD BIOLOX CER C-TPR 32MM +2.
|
Facility
|
OP
|
$9,297.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,208.61 |
| Max. Negotiated Rate |
$8,925.12 |
| Rate for Payer: Aetna Commercial |
$7,158.69
|
| Rate for Payer: Anthem Medicaid |
$3,197.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,251.66
|
| Rate for Payer: Cash Price |
$4,648.50
|
| Rate for Payer: Cigna Commercial |
$7,716.51
|
| Rate for Payer: First Health Commercial |
$8,832.15
|
| Rate for Payer: Humana Commercial |
$7,902.45
|
| Rate for Payer: Humana KY Medicaid |
$3,197.24
|
| Rate for Payer: Kentucky WC Medicaid |
$3,229.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,623.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,861.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,789.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,261.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,181.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,972.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,859.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,208.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,882.07
|
| Rate for Payer: PHCS Commercial |
$8,925.12
|
| Rate for Payer: United Healthcare All Payer |
$8,181.36
|
|
|
HEAD BIOLOX CER C-TPR 32MM -2.
|
Facility
|
OP
|
$9,297.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,208.61 |
| Max. Negotiated Rate |
$8,925.12 |
| Rate for Payer: Aetna Commercial |
$7,158.69
|
| Rate for Payer: Anthem Medicaid |
$3,197.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,251.66
|
| Rate for Payer: Cash Price |
$4,648.50
|
| Rate for Payer: Cigna Commercial |
$7,716.51
|
| Rate for Payer: First Health Commercial |
$8,832.15
|
| Rate for Payer: Humana Commercial |
$7,902.45
|
| Rate for Payer: Humana KY Medicaid |
$3,197.24
|
| Rate for Payer: Kentucky WC Medicaid |
$3,229.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,623.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,861.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,789.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,261.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,181.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,972.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,859.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,208.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,882.07
|
| Rate for Payer: PHCS Commercial |
$8,925.12
|
| Rate for Payer: United Healthcare All Payer |
$8,181.36
|
|
|
HEAD BIOLOX CER C-TPR 32MM -2.
|
Facility
|
IP
|
$9,297.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,208.61 |
| Max. Negotiated Rate |
$8,925.12 |
| Rate for Payer: Aetna Commercial |
$7,158.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,251.66
|
| Rate for Payer: Cash Price |
$4,648.50
|
| Rate for Payer: Cigna Commercial |
$7,716.51
|
| Rate for Payer: First Health Commercial |
$8,832.15
|
| Rate for Payer: Humana Commercial |
$7,902.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,623.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,861.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,789.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,181.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,972.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,859.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,208.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,882.07
|
| Rate for Payer: PHCS Commercial |
$8,925.12
|
| Rate for Payer: United Healthcare All Payer |
$8,181.36
|
|
