|
HIB PRP-OMP VACC 3 DOSE IM(T
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
HCPCS 90647
|
| Hospital Charge Code |
770T0014
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$17.03 |
| Max. Negotiated Rate |
$125.76 |
| Rate for Payer: Aetna Commercial |
$100.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$102.18
|
| Rate for Payer: Cash Price |
$65.50
|
| Rate for Payer: Cigna Commercial |
$108.73
|
| Rate for Payer: First Health Commercial |
$124.45
|
| Rate for Payer: Humana Commercial |
$111.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$107.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$96.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$115.28
|
| Rate for Payer: Ohio Health Group HMO |
$98.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.61
|
| Rate for Payer: PHCS Commercial |
$125.76
|
| Rate for Payer: United Healthcare All Payer |
$115.28
|
|
|
HIB VACCINE(4 DOSE SCHEDULE)
|
Facility
|
IP
|
$113.22
|
|
|
Service Code
|
HCPCS 90648
|
| Hospital Charge Code |
77000015
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.72 |
| Max. Negotiated Rate |
$108.69 |
| Rate for Payer: Aetna Commercial |
$87.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.31
|
| Rate for Payer: Cash Price |
$56.61
|
| Rate for Payer: Cigna Commercial |
$93.97
|
| Rate for Payer: First Health Commercial |
$107.56
|
| Rate for Payer: Humana Commercial |
$96.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$99.63
|
| Rate for Payer: Ohio Health Group HMO |
$84.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.10
|
| Rate for Payer: PHCS Commercial |
$108.69
|
| Rate for Payer: United Healthcare All Payer |
$99.63
|
|
|
HIB VACCINE(4 DOSE SCHEDULE)
|
Facility
|
OP
|
$113.22
|
|
|
Service Code
|
HCPCS 90648
|
| Hospital Charge Code |
77000015
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.72 |
| Max. Negotiated Rate |
$108.69 |
| Rate for Payer: Aetna Commercial |
$87.18
|
| Rate for Payer: Anthem Medicaid |
$38.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.31
|
| Rate for Payer: Cash Price |
$56.61
|
| Rate for Payer: Cigna Commercial |
$93.97
|
| Rate for Payer: First Health Commercial |
$107.56
|
| Rate for Payer: Humana Commercial |
$96.24
|
| Rate for Payer: Humana KY Medicaid |
$38.94
|
| Rate for Payer: Kentucky WC Medicaid |
$39.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$99.63
|
| Rate for Payer: Ohio Health Group HMO |
$84.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.10
|
| Rate for Payer: PHCS Commercial |
$108.69
|
| Rate for Payer: United Healthcare All Payer |
$99.63
|
|
|
HIB VACCINE(4 DOSE SCHEDULE)
|
Professional
|
Both
|
$113.22
|
|
|
Service Code
|
HCPCS 90648
|
| Hospital Charge Code |
77000015
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.35 |
| Max. Negotiated Rate |
$113.22 |
| Rate for Payer: Buckeye Medicare Advantage |
$113.22
|
| Rate for Payer: Cash Price |
$56.61
|
| Rate for Payer: Cash Price |
$56.61
|
| Rate for Payer: Healthspan PPO |
$29.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$26.35
|
| Rate for Payer: Multiplan PHCS |
$67.93
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$79.25
|
| Rate for Payer: UHCCP Medicaid |
$39.63
|
|
|
HIB VACCINE(4 DOSE SCHEDULE)(T
|
Facility
|
OP
|
$113.22
|
|
|
Service Code
|
HCPCS 90648
|
| Hospital Charge Code |
770T0015
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.72 |
| Max. Negotiated Rate |
$108.69 |
| Rate for Payer: Aetna Commercial |
$87.18
|
| Rate for Payer: Anthem Medicaid |
$38.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.31
|
| Rate for Payer: Cash Price |
$56.61
|
| Rate for Payer: Cigna Commercial |
$93.97
|
| Rate for Payer: First Health Commercial |
$107.56
|
| Rate for Payer: Humana Commercial |
$96.24
|
| Rate for Payer: Humana KY Medicaid |
$38.94
|
| Rate for Payer: Kentucky WC Medicaid |
$39.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$99.63
|
| Rate for Payer: Ohio Health Group HMO |
$84.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.10
|
| Rate for Payer: PHCS Commercial |
$108.69
|
| Rate for Payer: United Healthcare All Payer |
$99.63
|
|
|
HIB VACCINE(4 DOSE SCHEDULE)(T
|
Facility
|
IP
|
$113.22
|
|
|
Service Code
|
HCPCS 90648
|
| Hospital Charge Code |
770T0015
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.72 |
| Max. Negotiated Rate |
$108.69 |
| Rate for Payer: Aetna Commercial |
$87.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.31
|
| Rate for Payer: Cash Price |
$56.61
|
| Rate for Payer: Cigna Commercial |
$93.97
|
| Rate for Payer: First Health Commercial |
$107.56
|
| Rate for Payer: Humana Commercial |
$96.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$99.63
|
| Rate for Payer: Ohio Health Group HMO |
$84.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.10
|
| Rate for Payer: PHCS Commercial |
$108.69
|
| Rate for Payer: United Healthcare All Payer |
$99.63
|
|
|
HI FLEX FLEXOR INTRODUCER 10F
|
Facility
|
OP
|
$1,530.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$198.90 |
| Max. Negotiated Rate |
$1,468.80 |
| Rate for Payer: Aetna Commercial |
$1,178.10
|
| Rate for Payer: Anthem Medicaid |
$526.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,193.40
|
| Rate for Payer: Cash Price |
$765.00
|
| Rate for Payer: Cigna Commercial |
$1,269.90
|
| Rate for Payer: First Health Commercial |
$1,453.50
|
| Rate for Payer: Humana Commercial |
$1,300.50
|
| Rate for Payer: Humana KY Medicaid |
$526.17
|
| Rate for Payer: Kentucky WC Medicaid |
$531.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,254.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,129.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$459.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$536.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,346.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,147.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$306.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$198.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$474.30
|
| Rate for Payer: PHCS Commercial |
$1,468.80
|
| Rate for Payer: United Healthcare All Payer |
$1,346.40
|
|
|
HI FLEX FLEXOR INTRODUCER 10F
|
Facility
|
IP
|
$1,530.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$198.90 |
| Max. Negotiated Rate |
$1,468.80 |
| Rate for Payer: Aetna Commercial |
$1,178.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,193.40
|
| Rate for Payer: Cash Price |
$765.00
|
| Rate for Payer: Cigna Commercial |
$1,269.90
|
| Rate for Payer: First Health Commercial |
$1,453.50
|
| Rate for Payer: Humana Commercial |
$1,300.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,254.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,129.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$459.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,346.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,147.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$306.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$198.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$474.30
|
| Rate for Payer: PHCS Commercial |
$1,468.80
|
| Rate for Payer: United Healthcare All Payer |
$1,346.40
|
|
|
HI FLEX FLEXOR INTRODUCER 12F
|
Facility
|
IP
|
$1,546.80
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$201.08 |
| Max. Negotiated Rate |
$1,484.93 |
| Rate for Payer: Aetna Commercial |
$1,191.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,206.50
|
| Rate for Payer: Cash Price |
$773.40
|
| Rate for Payer: Cigna Commercial |
$1,283.84
|
| Rate for Payer: First Health Commercial |
$1,469.46
|
| Rate for Payer: Humana Commercial |
$1,314.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,268.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,141.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$464.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,361.18
|
| Rate for Payer: Ohio Health Group HMO |
$1,160.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$309.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$201.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$479.51
|
| Rate for Payer: PHCS Commercial |
$1,484.93
|
| Rate for Payer: United Healthcare All Payer |
$1,361.18
|
|
|
HI FLEX FLEXOR INTRODUCER 12F
|
Facility
|
OP
|
$1,546.80
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$201.08 |
| Max. Negotiated Rate |
$1,484.93 |
| Rate for Payer: Aetna Commercial |
$1,191.04
|
| Rate for Payer: Anthem Medicaid |
$531.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,206.50
|
| Rate for Payer: Cash Price |
$773.40
|
| Rate for Payer: Cigna Commercial |
$1,283.84
|
| Rate for Payer: First Health Commercial |
$1,469.46
|
| Rate for Payer: Humana Commercial |
$1,314.78
|
| Rate for Payer: Humana KY Medicaid |
$531.94
|
| Rate for Payer: Kentucky WC Medicaid |
$537.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,268.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,141.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$464.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$542.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,361.18
|
| Rate for Payer: Ohio Health Group HMO |
$1,160.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$309.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$201.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$479.51
|
| Rate for Payer: PHCS Commercial |
$1,484.93
|
| Rate for Payer: United Healthcare All Payer |
$1,361.18
|
|
|
HIGH DOSE RATE IRIDIUM 192 EA
|
Facility
|
OP
|
$789.00
|
|
|
Service Code
|
HCPCS C1717
|
| Hospital Charge Code |
27000034
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$102.57 |
| Max. Negotiated Rate |
$757.44 |
| Rate for Payer: Aetna Commercial |
$607.53
|
| Rate for Payer: Anthem Medicaid |
$271.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$314.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$615.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$440.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$425.14
|
| Rate for Payer: Cash Price |
$394.50
|
| Rate for Payer: Cash Price |
$394.50
|
| Rate for Payer: Cigna Commercial |
$654.87
|
| Rate for Payer: First Health Commercial |
$749.55
|
| Rate for Payer: Humana Commercial |
$670.65
|
| Rate for Payer: Humana KY Medicaid |
$271.34
|
| Rate for Payer: Humana Medicare Advantage |
$314.92
|
| Rate for Payer: Kentucky WC Medicaid |
$274.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$646.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$582.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$377.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$276.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$694.32
|
| Rate for Payer: Ohio Health Group HMO |
$591.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$157.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$244.59
|
| Rate for Payer: PHCS Commercial |
$757.44
|
| Rate for Payer: United Healthcare All Payer |
$694.32
|
|
|
HIGH DOSE RATE IRIDIUM 192 EA
|
Facility
|
IP
|
$789.00
|
|
|
Service Code
|
HCPCS C1717
|
| Hospital Charge Code |
27000034
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$102.57 |
| Max. Negotiated Rate |
$757.44 |
| Rate for Payer: Aetna Commercial |
$607.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$615.42
|
| Rate for Payer: Cash Price |
$394.50
|
| Rate for Payer: Cigna Commercial |
$654.87
|
| Rate for Payer: First Health Commercial |
$749.55
|
| Rate for Payer: Humana Commercial |
$670.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$646.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$582.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$236.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$694.32
|
| Rate for Payer: Ohio Health Group HMO |
$591.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$157.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$244.59
|
| Rate for Payer: PHCS Commercial |
$757.44
|
| Rate for Payer: United Healthcare All Payer |
$694.32
|
|
|
HIGH OFFSET NEU MOD NECK
|
Facility
|
OP
|
$3,950.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$513.50 |
| Max. Negotiated Rate |
$3,792.00 |
| Rate for Payer: Aetna Commercial |
$3,041.50
|
| Rate for Payer: Anthem Medicaid |
$1,358.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,081.00
|
| Rate for Payer: Cash Price |
$1,975.00
|
| Rate for Payer: Cigna Commercial |
$3,278.50
|
| Rate for Payer: First Health Commercial |
$3,752.50
|
| Rate for Payer: Humana Commercial |
$3,357.50
|
| Rate for Payer: Humana KY Medicaid |
$1,358.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,372.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,239.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,915.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,185.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,385.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,476.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,962.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$790.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$513.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.50
|
| Rate for Payer: PHCS Commercial |
$3,792.00
|
| Rate for Payer: United Healthcare All Payer |
$3,476.00
|
|
|
HIGH OFFSET NEU MOD NECK
|
Facility
|
IP
|
$3,950.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$513.50 |
| Max. Negotiated Rate |
$3,792.00 |
| Rate for Payer: Aetna Commercial |
$3,041.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,081.00
|
| Rate for Payer: Cash Price |
$1,975.00
|
| Rate for Payer: Cigna Commercial |
$3,278.50
|
| Rate for Payer: First Health Commercial |
$3,752.50
|
| Rate for Payer: Humana Commercial |
$3,357.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,239.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,915.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,185.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,476.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,962.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$790.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$513.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.50
|
| Rate for Payer: PHCS Commercial |
$3,792.00
|
| Rate for Payer: United Healthcare All Payer |
$3,476.00
|
|
|
HIGH OSM CONT 1ML GASTROVIEW
|
Facility
|
OP
|
$0.46
|
|
|
Service Code
|
HCPCS Q9963
|
| Hospital Charge Code |
25003650
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: Aetna Commercial |
$0.35
|
| Rate for Payer: Anthem Medicaid |
$0.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.36
|
| Rate for Payer: Cash Price |
$0.23
|
| Rate for Payer: Cigna Commercial |
$0.38
|
| Rate for Payer: First Health Commercial |
$0.44
|
| Rate for Payer: Humana Commercial |
$0.39
|
| Rate for Payer: Humana KY Medicaid |
$0.16
|
| Rate for Payer: Kentucky WC Medicaid |
$0.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.40
|
| Rate for Payer: Ohio Health Group HMO |
$0.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.14
|
| Rate for Payer: PHCS Commercial |
$0.44
|
| Rate for Payer: United Healthcare All Payer |
$0.40
|
|
|
HIGH OSM CONT 1ML GASTROVIEW
|
Facility
|
IP
|
$0.46
|
|
|
Service Code
|
HCPCS Q9963
|
| Hospital Charge Code |
25003650
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: Aetna Commercial |
$0.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.36
|
| Rate for Payer: Cash Price |
$0.23
|
| Rate for Payer: Cigna Commercial |
$0.38
|
| Rate for Payer: First Health Commercial |
$0.44
|
| Rate for Payer: Humana Commercial |
$0.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.40
|
| Rate for Payer: Ohio Health Group HMO |
$0.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.14
|
| Rate for Payer: PHCS Commercial |
$0.44
|
| Rate for Payer: United Healthcare All Payer |
$0.40
|
|
|
HII 10H CLAMP
|
Facility
|
OP
|
$5,058.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$657.64 |
| Max. Negotiated Rate |
$4,856.45 |
| Rate for Payer: Aetna Commercial |
$3,895.28
|
| Rate for Payer: Anthem Medicaid |
$1,739.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,945.86
|
| Rate for Payer: Cash Price |
$2,529.40
|
| Rate for Payer: Cigna Commercial |
$4,198.80
|
| Rate for Payer: First Health Commercial |
$4,805.86
|
| Rate for Payer: Humana Commercial |
$4,299.98
|
| Rate for Payer: Humana KY Medicaid |
$1,739.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1,757.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,148.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,733.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,517.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,774.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,451.74
|
| Rate for Payer: Ohio Health Group HMO |
$3,794.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,011.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$657.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,568.23
|
| Rate for Payer: PHCS Commercial |
$4,856.45
|
| Rate for Payer: United Healthcare All Payer |
$4,451.74
|
|
|
HII 10H CLAMP
|
Facility
|
IP
|
$5,058.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$657.64 |
| Max. Negotiated Rate |
$4,856.45 |
| Rate for Payer: Aetna Commercial |
$3,895.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,945.86
|
| Rate for Payer: Cash Price |
$2,529.40
|
| Rate for Payer: Cigna Commercial |
$4,198.80
|
| Rate for Payer: First Health Commercial |
$4,805.86
|
| Rate for Payer: Humana Commercial |
$4,299.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,148.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,733.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,517.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,451.74
|
| Rate for Payer: Ohio Health Group HMO |
$3,794.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,011.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$657.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,568.23
|
| Rate for Payer: PHCS Commercial |
$4,856.45
|
| Rate for Payer: United Healthcare All Payer |
$4,451.74
|
|
|
HII ALUM CONNECTING ROD 8*65MM
|
Facility
|
IP
|
$1,121.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$145.83 |
| Max. Negotiated Rate |
$1,076.89 |
| Rate for Payer: Aetna Commercial |
$863.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$874.97
|
| Rate for Payer: Cash Price |
$560.88
|
| Rate for Payer: Cigna Commercial |
$931.06
|
| Rate for Payer: First Health Commercial |
$1,065.67
|
| Rate for Payer: Humana Commercial |
$953.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$919.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$827.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$336.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$987.15
|
| Rate for Payer: Ohio Health Group HMO |
$841.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$224.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$145.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$347.75
|
| Rate for Payer: PHCS Commercial |
$1,076.89
|
| Rate for Payer: United Healthcare All Payer |
$987.15
|
|
|
HII ALUM CONNECTING ROD 8*65MM
|
Facility
|
OP
|
$1,121.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$145.83 |
| Max. Negotiated Rate |
$1,076.89 |
| Rate for Payer: Aetna Commercial |
$863.76
|
| Rate for Payer: Anthem Medicaid |
$385.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$874.97
|
| Rate for Payer: Cash Price |
$560.88
|
| Rate for Payer: Cigna Commercial |
$931.06
|
| Rate for Payer: First Health Commercial |
$1,065.67
|
| Rate for Payer: Humana Commercial |
$953.50
|
| Rate for Payer: Humana KY Medicaid |
$385.77
|
| Rate for Payer: Kentucky WC Medicaid |
$389.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$919.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$827.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$336.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$393.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$987.15
|
| Rate for Payer: Ohio Health Group HMO |
$841.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$224.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$145.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$347.75
|
| Rate for Payer: PHCS Commercial |
$1,076.89
|
| Rate for Payer: United Healthcare All Payer |
$987.15
|
|
|
HII ALUM CONNECTNG ROD 8*100MM
|
Facility
|
OP
|
$1,121.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$145.83 |
| Max. Negotiated Rate |
$1,076.89 |
| Rate for Payer: Aetna Commercial |
$863.76
|
| Rate for Payer: Anthem Medicaid |
$385.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$874.97
|
| Rate for Payer: Cash Price |
$560.88
|
| Rate for Payer: Cigna Commercial |
$931.06
|
| Rate for Payer: First Health Commercial |
$1,065.67
|
| Rate for Payer: Humana Commercial |
$953.50
|
| Rate for Payer: Humana KY Medicaid |
$385.77
|
| Rate for Payer: Kentucky WC Medicaid |
$389.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$919.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$827.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$336.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$393.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$987.15
|
| Rate for Payer: Ohio Health Group HMO |
$841.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$224.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$145.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$347.75
|
| Rate for Payer: PHCS Commercial |
$1,076.89
|
| Rate for Payer: United Healthcare All Payer |
$987.15
|
|
|
HII ALUM CONNECTNG ROD 8*100MM
|
Facility
|
IP
|
$1,121.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$145.83 |
| Max. Negotiated Rate |
$1,076.89 |
| Rate for Payer: Aetna Commercial |
$863.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$874.97
|
| Rate for Payer: Cash Price |
$560.88
|
| Rate for Payer: Cigna Commercial |
$931.06
|
| Rate for Payer: First Health Commercial |
$1,065.67
|
| Rate for Payer: Humana Commercial |
$953.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$919.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$827.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$336.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$987.15
|
| Rate for Payer: Ohio Health Group HMO |
$841.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$224.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$145.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$347.75
|
| Rate for Payer: PHCS Commercial |
$1,076.89
|
| Rate for Payer: United Healthcare All Payer |
$987.15
|
|
|
HII ALUM CONNECTNG ROD 8*150MM
|
Facility
|
IP
|
$1,121.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$145.83 |
| Max. Negotiated Rate |
$1,076.89 |
| Rate for Payer: Aetna Commercial |
$863.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$874.97
|
| Rate for Payer: Cash Price |
$560.88
|
| Rate for Payer: Cigna Commercial |
$931.06
|
| Rate for Payer: First Health Commercial |
$1,065.67
|
| Rate for Payer: Humana Commercial |
$953.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$919.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$827.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$336.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$987.15
|
| Rate for Payer: Ohio Health Group HMO |
$841.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$224.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$145.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$347.75
|
| Rate for Payer: PHCS Commercial |
$1,076.89
|
| Rate for Payer: United Healthcare All Payer |
$987.15
|
|
|
HII ALUM CONNECTNG ROD 8*150MM
|
Facility
|
OP
|
$1,121.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$145.83 |
| Max. Negotiated Rate |
$1,076.89 |
| Rate for Payer: Aetna Commercial |
$863.76
|
| Rate for Payer: Anthem Medicaid |
$385.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$874.97
|
| Rate for Payer: Cash Price |
$560.88
|
| Rate for Payer: Cigna Commercial |
$931.06
|
| Rate for Payer: First Health Commercial |
$1,065.67
|
| Rate for Payer: Humana Commercial |
$953.50
|
| Rate for Payer: Humana KY Medicaid |
$385.77
|
| Rate for Payer: Kentucky WC Medicaid |
$389.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$919.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$827.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$336.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$393.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$987.15
|
| Rate for Payer: Ohio Health Group HMO |
$841.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$224.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$145.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$347.75
|
| Rate for Payer: PHCS Commercial |
$1,076.89
|
| Rate for Payer: United Healthcare All Payer |
$987.15
|
|
|
HII ALUM CONNECTNG ROD 8*200MM
|
Facility
|
IP
|
$1,142.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$148.51 |
| Max. Negotiated Rate |
$1,096.70 |
| Rate for Payer: Aetna Commercial |
$879.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$891.07
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cigna Commercial |
$948.19
|
| Rate for Payer: First Health Commercial |
$1,085.28
|
| Rate for Payer: Humana Commercial |
$971.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$936.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$843.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$342.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,005.31
|
| Rate for Payer: Ohio Health Group HMO |
$856.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$228.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$148.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$354.14
|
| Rate for Payer: PHCS Commercial |
$1,096.70
|
| Rate for Payer: United Healthcare All Payer |
$1,005.31
|
|
