|
HEART MUSCLE IMAGING (PET)
|
Facility
|
OP
|
$6,665.00
|
|
|
Service Code
|
HCPCS 78459
|
| Hospital Charge Code |
34000019
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$866.45 |
| Max. Negotiated Rate |
$6,398.40 |
| Rate for Payer: Aetna Commercial |
$5,132.05
|
| Rate for Payer: Anthem Medicaid |
$2,292.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,227.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,198.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,719.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,657.69
|
| Rate for Payer: Cash Price |
$3,332.50
|
| Rate for Payer: Cash Price |
$3,332.50
|
| Rate for Payer: Cigna Commercial |
$5,531.95
|
| Rate for Payer: First Health Commercial |
$6,331.75
|
| Rate for Payer: Humana Commercial |
$5,665.25
|
| Rate for Payer: Humana KY Medicaid |
$2,292.09
|
| Rate for Payer: Humana Medicare Advantage |
$1,227.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,315.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,465.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,918.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,338.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,865.20
|
| Rate for Payer: Ohio Health Group HMO |
$4,998.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,333.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$866.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,066.15
|
| Rate for Payer: PHCS Commercial |
$6,398.40
|
| Rate for Payer: United Healthcare All Payer |
$5,865.20
|
|
|
HEART MUSCLE IMAGING (PET)
|
Professional
|
Both
|
$6,665.00
|
|
|
Service Code
|
HCPCS 78459
|
| Hospital Charge Code |
34000019
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$85.52 |
| Max. Negotiated Rate |
$6,665.00 |
| Rate for Payer: Aetna Commercial |
$2,081.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,665.00
|
| Rate for Payer: Cash Price |
$3,332.50
|
| Rate for Payer: Cash Price |
$3,332.50
|
| Rate for Payer: Cigna Commercial |
$385.10
|
| Rate for Payer: Healthspan PPO |
$1,231.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$85.52
|
| Rate for Payer: Multiplan PHCS |
$3,999.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,665.50
|
| Rate for Payer: UHCCP Medicaid |
$2,332.75
|
|
|
HEART MUSCLE IMAGING (PET)
|
Facility
|
IP
|
$6,665.00
|
|
|
Service Code
|
HCPCS 78459
|
| Hospital Charge Code |
34000019
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$866.45 |
| Max. Negotiated Rate |
$6,398.40 |
| Rate for Payer: Aetna Commercial |
$5,132.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,198.70
|
| Rate for Payer: Cash Price |
$3,332.50
|
| Rate for Payer: Cigna Commercial |
$5,531.95
|
| Rate for Payer: First Health Commercial |
$6,331.75
|
| Rate for Payer: Humana Commercial |
$5,665.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,465.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,918.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,999.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,865.20
|
| Rate for Payer: Ohio Health Group HMO |
$4,998.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,333.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$866.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,066.15
|
| Rate for Payer: PHCS Commercial |
$6,398.40
|
| Rate for Payer: United Healthcare All Payer |
$5,865.20
|
|
|
HEART MUSCLE IMAGING (PET)(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 78459
|
| Hospital Charge Code |
340P0019
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$85.52 |
| Max. Negotiated Rate |
$2,081.06 |
| Rate for Payer: Aetna Commercial |
$2,081.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$250.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$385.10
|
| Rate for Payer: Healthspan PPO |
$1,231.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$85.52
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
|
|
HEART MUSCLE IMAGING (PET)(T
|
Facility
|
OP
|
$6,415.00
|
|
|
Service Code
|
HCPCS 78459
|
| Hospital Charge Code |
340T0019
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$833.95 |
| Max. Negotiated Rate |
$6,158.40 |
| Rate for Payer: Aetna Commercial |
$4,939.55
|
| Rate for Payer: Anthem Medicaid |
$2,206.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,227.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,003.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,719.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,657.69
|
| Rate for Payer: Cash Price |
$3,207.50
|
| Rate for Payer: Cash Price |
$3,207.50
|
| Rate for Payer: Cigna Commercial |
$5,324.45
|
| Rate for Payer: First Health Commercial |
$6,094.25
|
| Rate for Payer: Humana Commercial |
$5,452.75
|
| Rate for Payer: Humana KY Medicaid |
$2,206.12
|
| Rate for Payer: Humana Medicare Advantage |
$1,227.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,228.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,260.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,734.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,250.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,645.20
|
| Rate for Payer: Ohio Health Group HMO |
$4,811.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,283.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$833.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,988.65
|
| Rate for Payer: PHCS Commercial |
$6,158.40
|
| Rate for Payer: United Healthcare All Payer |
$5,645.20
|
|
|
HEART MUSCLE IMAGING (PET)(T
|
Facility
|
IP
|
$6,415.00
|
|
|
Service Code
|
HCPCS 78459
|
| Hospital Charge Code |
340T0019
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$833.95 |
| Max. Negotiated Rate |
$6,158.40 |
| Rate for Payer: Aetna Commercial |
$4,939.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,003.70
|
| Rate for Payer: Cash Price |
$3,207.50
|
| Rate for Payer: Cigna Commercial |
$5,324.45
|
| Rate for Payer: First Health Commercial |
$6,094.25
|
| Rate for Payer: Humana Commercial |
$5,452.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,260.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,734.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,924.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,645.20
|
| Rate for Payer: Ohio Health Group HMO |
$4,811.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,283.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$833.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,988.65
|
| Rate for Payer: PHCS Commercial |
$6,158.40
|
| Rate for Payer: United Healthcare All Payer |
$5,645.20
|
|
|
HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC
|
Facility
|
IP
|
$317,004.98
|
|
|
Service Code
|
MSDRG 001
|
| Min. Negotiated Rate |
$215,110.52 |
| Max. Negotiated Rate |
$317,004.98 |
| Rate for Payer: Anthem Medicaid |
$215,110.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$226,432.13
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$317,004.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$305,683.38
|
| Rate for Payer: Humana KY Medicaid |
$215,110.52
|
| Rate for Payer: Humana Medicare Advantage |
$226,432.13
|
| Rate for Payer: Kentucky WC Medicaid |
$217,261.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$271,718.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$219,412.73
|
|
|
HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC
|
Facility
|
IP
|
$143,233.99
|
|
|
Service Code
|
MSDRG 002
|
| Min. Negotiated Rate |
$97,194.49 |
| Max. Negotiated Rate |
$143,233.99 |
| Rate for Payer: Anthem Medicaid |
$97,194.49
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$102,309.99
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$143,233.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$138,118.49
|
| Rate for Payer: Humana KY Medicaid |
$97,194.49
|
| Rate for Payer: Humana Medicare Advantage |
$102,309.99
|
| Rate for Payer: Kentucky WC Medicaid |
$98,166.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$122,771.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$99,138.38
|
|
|
HECTOROL 1 MCG (4 MCG/2ML VL)
|
Facility
|
IP
|
$113.96
|
|
|
Service Code
|
HCPCS J1270
|
| Hospital Charge Code |
25002047
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.81 |
| Max. Negotiated Rate |
$109.40 |
| Rate for Payer: Aetna Commercial |
$87.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.89
|
| Rate for Payer: Cash Price |
$56.98
|
| Rate for Payer: Cigna Commercial |
$94.59
|
| Rate for Payer: First Health Commercial |
$108.26
|
| Rate for Payer: Humana Commercial |
$96.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$93.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$100.28
|
| Rate for Payer: Ohio Health Group HMO |
$85.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.33
|
| Rate for Payer: PHCS Commercial |
$109.40
|
| Rate for Payer: United Healthcare All Payer |
$100.28
|
|
|
HECTOROL 1 MCG (4 MCG/2ML VL)
|
Facility
|
OP
|
$113.96
|
|
|
Service Code
|
HCPCS J1270
|
| Hospital Charge Code |
25002047
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.81 |
| Max. Negotiated Rate |
$109.40 |
| Rate for Payer: Aetna Commercial |
$87.75
|
| Rate for Payer: Anthem Medicaid |
$39.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.89
|
| Rate for Payer: Cash Price |
$56.98
|
| Rate for Payer: Cigna Commercial |
$94.59
|
| Rate for Payer: First Health Commercial |
$108.26
|
| Rate for Payer: Humana Commercial |
$96.87
|
| Rate for Payer: Humana KY Medicaid |
$39.19
|
| Rate for Payer: Kentucky WC Medicaid |
$39.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$93.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$100.28
|
| Rate for Payer: Ohio Health Group HMO |
$85.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.33
|
| Rate for Payer: PHCS Commercial |
$109.40
|
| Rate for Payer: United Healthcare All Payer |
$100.28
|
|
|
HECTOROL (COXERCAL)0.5 MCG CAP
|
Facility
|
IP
|
$23.59
|
|
|
Service Code
|
NDC 23155053825
|
| Hospital Charge Code |
25000749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.07 |
| Max. Negotiated Rate |
$22.65 |
| Rate for Payer: Aetna Commercial |
$18.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18.40
|
| Rate for Payer: Cash Price |
$11.80
|
| Rate for Payer: Cigna Commercial |
$19.58
|
| Rate for Payer: First Health Commercial |
$22.41
|
| Rate for Payer: Humana Commercial |
$20.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.76
|
| Rate for Payer: Ohio Health Group HMO |
$17.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.31
|
| Rate for Payer: PHCS Commercial |
$22.65
|
| Rate for Payer: United Healthcare All Payer |
$20.76
|
|
|
HECTOROL (COXERCAL)0.5 MCG CAP
|
Facility
|
OP
|
$23.59
|
|
|
Service Code
|
NDC 23155053825
|
| Hospital Charge Code |
25000749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.07 |
| Max. Negotiated Rate |
$22.65 |
| Rate for Payer: Aetna Commercial |
$18.16
|
| Rate for Payer: Anthem Medicaid |
$8.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18.40
|
| Rate for Payer: Cash Price |
$11.80
|
| Rate for Payer: Cigna Commercial |
$19.58
|
| Rate for Payer: First Health Commercial |
$22.41
|
| Rate for Payer: Humana Commercial |
$20.05
|
| Rate for Payer: Humana KY Medicaid |
$8.11
|
| Rate for Payer: Kentucky WC Medicaid |
$8.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.76
|
| Rate for Payer: Ohio Health Group HMO |
$17.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.31
|
| Rate for Payer: PHCS Commercial |
$22.65
|
| Rate for Payer: United Healthcare All Payer |
$20.76
|
|
|
HECTOROL(DOXERCALCIFROL)2.5MCG
|
Facility
|
OP
|
$32.28
|
|
|
Service Code
|
NDC 23155054025
|
| Hospital Charge Code |
25000750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$30.99 |
| Rate for Payer: Aetna Commercial |
$24.86
|
| Rate for Payer: Anthem Medicaid |
$11.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25.18
|
| Rate for Payer: Cash Price |
$16.14
|
| Rate for Payer: Cigna Commercial |
$26.79
|
| Rate for Payer: First Health Commercial |
$30.67
|
| Rate for Payer: Humana Commercial |
$27.44
|
| Rate for Payer: Humana KY Medicaid |
$11.10
|
| Rate for Payer: Kentucky WC Medicaid |
$11.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$11.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$28.41
|
| Rate for Payer: Ohio Health Group HMO |
$24.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10.01
|
| Rate for Payer: PHCS Commercial |
$30.99
|
| Rate for Payer: United Healthcare All Payer |
$28.41
|
|
|
HECTOROL(DOXERCALCIFROL)2.5MCG
|
Facility
|
IP
|
$32.28
|
|
|
Service Code
|
NDC 23155054025
|
| Hospital Charge Code |
25000750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$30.99 |
| Rate for Payer: Humana Commercial |
$27.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$28.41
|
| Rate for Payer: Ohio Health Group HMO |
$24.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10.01
|
| Rate for Payer: PHCS Commercial |
$30.99
|
| Rate for Payer: United Healthcare All Payer |
$28.41
|
| Rate for Payer: Aetna Commercial |
$24.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25.18
|
| Rate for Payer: Cash Price |
$16.14
|
| Rate for Payer: Cigna Commercial |
$26.79
|
| Rate for Payer: First Health Commercial |
$30.67
|
|
|
HED BIOLOX CER C-TPR 28MM*-2.5
|
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
|
|
|
HED BIOLOX CER C-TPR 28MM*-2.5
|
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
|
|
|
HED BIOLOX CER C-TPR 28MM +5MM
|
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
|
|
|
HED BIOLOX CER C-TPR 28MM +5MM
|
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
|
|
|
HED BIOLOX DELTA CER 28MM +0MM
|
Facility
|
IP
|
$7,481.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$972.55 |
| Max. Negotiated Rate |
$7,181.88 |
| Rate for Payer: Aetna Commercial |
$5,760.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,835.27
|
| Rate for Payer: Cash Price |
$3,740.56
|
| Rate for Payer: Cigna Commercial |
$6,209.33
|
| Rate for Payer: First Health Commercial |
$7,107.06
|
| Rate for Payer: Humana Commercial |
$6,358.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,134.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,521.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,244.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,583.39
|
| Rate for Payer: Ohio Health Group HMO |
$5,610.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,496.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$972.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,319.15
|
| Rate for Payer: PHCS Commercial |
$7,181.88
|
| Rate for Payer: United Healthcare All Payer |
$6,583.39
|
|
|
HED BIOLOX DELTA CER 28MM +0MM
|
Facility
|
OP
|
$7,481.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$972.55 |
| Max. Negotiated Rate |
$7,181.88 |
| Rate for Payer: Aetna Commercial |
$5,760.46
|
| Rate for Payer: Anthem Medicaid |
$2,572.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,835.27
|
| Rate for Payer: Cash Price |
$3,740.56
|
| Rate for Payer: Cigna Commercial |
$6,209.33
|
| Rate for Payer: First Health Commercial |
$7,107.06
|
| Rate for Payer: Humana Commercial |
$6,358.95
|
| Rate for Payer: Humana KY Medicaid |
$2,572.76
|
| Rate for Payer: Kentucky WC Medicaid |
$2,598.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,134.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,521.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,244.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,624.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,583.39
|
| Rate for Payer: Ohio Health Group HMO |
$5,610.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,496.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$972.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,319.15
|
| Rate for Payer: PHCS Commercial |
$7,181.88
|
| Rate for Payer: United Healthcare All Payer |
$6,583.39
|
|
|
HED BIOLOX DELTA CER 32MM +0MM
|
Facility
|
OP
|
$7,481.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$972.55 |
| Max. Negotiated Rate |
$7,181.88 |
| Rate for Payer: Aetna Commercial |
$5,760.46
|
| Rate for Payer: Anthem Medicaid |
$2,572.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,835.27
|
| Rate for Payer: Cash Price |
$3,740.56
|
| Rate for Payer: Cigna Commercial |
$6,209.33
|
| Rate for Payer: First Health Commercial |
$7,107.06
|
| Rate for Payer: Humana Commercial |
$6,358.95
|
| Rate for Payer: Humana KY Medicaid |
$2,572.76
|
| Rate for Payer: Kentucky WC Medicaid |
$2,598.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,134.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,521.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,244.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,624.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,583.39
|
| Rate for Payer: Ohio Health Group HMO |
$5,610.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,496.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$972.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,319.15
|
| Rate for Payer: PHCS Commercial |
$7,181.88
|
| Rate for Payer: United Healthcare All Payer |
$6,583.39
|
|
|
HED BIOLOX DELTA CER 32MM +0MM
|
Facility
|
IP
|
$7,481.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$972.55 |
| Max. Negotiated Rate |
$7,181.88 |
| Rate for Payer: Aetna Commercial |
$5,760.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,835.27
|
| Rate for Payer: Cash Price |
$3,740.56
|
| Rate for Payer: Cigna Commercial |
$6,209.33
|
| Rate for Payer: First Health Commercial |
$7,107.06
|
| Rate for Payer: Humana Commercial |
$6,358.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,134.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,521.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,244.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,583.39
|
| Rate for Payer: Ohio Health Group HMO |
$5,610.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,496.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$972.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,319.15
|
| Rate for Payer: PHCS Commercial |
$7,181.88
|
| Rate for Payer: United Healthcare All Payer |
$6,583.39
|
|
|
HED BIOLOX DELTA CER 32MM +7MM
|
Facility
|
OP
|
$7,481.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$972.55 |
| Max. Negotiated Rate |
$7,181.88 |
| Rate for Payer: Aetna Commercial |
$5,760.46
|
| Rate for Payer: Anthem Medicaid |
$2,572.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,835.27
|
| Rate for Payer: Cash Price |
$3,740.56
|
| Rate for Payer: Cigna Commercial |
$6,209.33
|
| Rate for Payer: First Health Commercial |
$7,107.06
|
| Rate for Payer: Humana Commercial |
$6,358.95
|
| Rate for Payer: Humana KY Medicaid |
$2,572.76
|
| Rate for Payer: Kentucky WC Medicaid |
$2,598.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,134.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,521.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,244.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,624.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,583.39
|
| Rate for Payer: Ohio Health Group HMO |
$5,610.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,496.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$972.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,319.15
|
| Rate for Payer: PHCS Commercial |
$7,181.88
|
| Rate for Payer: United Healthcare All Payer |
$6,583.39
|
|
|
HED BIOLOX DELTA CER 32MM +7MM
|
Facility
|
IP
|
$7,481.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$972.55 |
| Max. Negotiated Rate |
$7,181.88 |
| Rate for Payer: Aetna Commercial |
$5,760.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,835.27
|
| Rate for Payer: Cash Price |
$3,740.56
|
| Rate for Payer: Cigna Commercial |
$6,209.33
|
| Rate for Payer: First Health Commercial |
$7,107.06
|
| Rate for Payer: Humana Commercial |
$6,358.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,134.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,521.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,244.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,583.39
|
| Rate for Payer: Ohio Health Group HMO |
$5,610.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,496.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$972.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,319.15
|
| Rate for Payer: PHCS Commercial |
$7,181.88
|
| Rate for Payer: United Healthcare All Payer |
$6,583.39
|
|
|
HED BIOLOX DELTA CER 36MM +0MM
|
Facility
|
IP
|
$8,001.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,040.16 |
| Max. Negotiated Rate |
$7,681.20 |
| Rate for Payer: Aetna Commercial |
$6,160.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,240.98
|
| Rate for Payer: Cash Price |
$4,000.62
|
| Rate for Payer: Cigna Commercial |
$6,641.04
|
| Rate for Payer: First Health Commercial |
$7,601.19
|
| Rate for Payer: Humana Commercial |
$6,801.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,561.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,904.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,400.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,041.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,000.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,040.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,480.39
|
| Rate for Payer: PHCS Commercial |
$7,681.20
|
| Rate for Payer: United Healthcare All Payer |
$7,041.10
|
|
