|
HI TORQUE PILOT 200 10CM
|
Facility
|
IP
|
$1,519.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$197.54 |
| Max. Negotiated Rate |
$1,458.72 |
| Rate for Payer: Aetna Commercial |
$1,170.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,185.21
|
| Rate for Payer: Cash Price |
$759.75
|
| Rate for Payer: Cigna Commercial |
$1,261.18
|
| Rate for Payer: First Health Commercial |
$1,443.52
|
| Rate for Payer: Humana Commercial |
$1,291.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,245.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,121.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$455.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,337.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,139.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$303.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$197.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$471.04
|
| Rate for Payer: PHCS Commercial |
$1,458.72
|
| Rate for Payer: United Healthcare All Payer |
$1,337.16
|
|
|
HI TORQUE PILOT 200 10CM
|
Facility
|
OP
|
$1,519.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$197.54 |
| Max. Negotiated Rate |
$1,458.72 |
| Rate for Payer: Aetna Commercial |
$1,170.02
|
| Rate for Payer: Anthem Medicaid |
$522.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,185.21
|
| Rate for Payer: Cash Price |
$759.75
|
| Rate for Payer: Cigna Commercial |
$1,261.18
|
| Rate for Payer: First Health Commercial |
$1,443.52
|
| Rate for Payer: Humana Commercial |
$1,291.58
|
| Rate for Payer: Humana KY Medicaid |
$522.56
|
| Rate for Payer: Kentucky WC Medicaid |
$527.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,245.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,121.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$455.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$533.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,337.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,139.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$303.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$197.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$471.04
|
| Rate for Payer: PHCS Commercial |
$1,458.72
|
| Rate for Payer: United Healthcare All Payer |
$1,337.16
|
|
|
HI TORQUE PILOT 200 300CM
|
Facility
|
OP
|
$1,155.30
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$150.19 |
| Max. Negotiated Rate |
$1,109.09 |
| Rate for Payer: Aetna Commercial |
$889.58
|
| Rate for Payer: Anthem Medicaid |
$397.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$901.13
|
| Rate for Payer: Cash Price |
$577.65
|
| Rate for Payer: Cigna Commercial |
$958.90
|
| Rate for Payer: First Health Commercial |
$1,097.54
|
| Rate for Payer: Humana Commercial |
$982.00
|
| Rate for Payer: Humana KY Medicaid |
$397.31
|
| Rate for Payer: Kentucky WC Medicaid |
$401.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$947.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$852.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$346.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$405.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,016.66
|
| Rate for Payer: Ohio Health Group HMO |
$866.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$231.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$150.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$358.14
|
| Rate for Payer: PHCS Commercial |
$1,109.09
|
| Rate for Payer: United Healthcare All Payer |
$1,016.66
|
|
|
HI TORQUE PILOT 200 300CM
|
Facility
|
IP
|
$1,155.30
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$150.19 |
| Max. Negotiated Rate |
$1,109.09 |
| Rate for Payer: Aetna Commercial |
$889.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$901.13
|
| Rate for Payer: Cash Price |
$577.65
|
| Rate for Payer: Cigna Commercial |
$958.90
|
| Rate for Payer: First Health Commercial |
$1,097.54
|
| Rate for Payer: Humana Commercial |
$982.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$947.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$852.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$346.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,016.66
|
| Rate for Payer: Ohio Health Group HMO |
$866.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$231.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$150.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$358.14
|
| Rate for Payer: PHCS Commercial |
$1,109.09
|
| Rate for Payer: United Healthcare All Payer |
$1,016.66
|
|
|
HI TORQUE PILOT 50 300CM ST
|
Facility
|
OP
|
$1,155.30
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$150.19 |
| Max. Negotiated Rate |
$1,109.09 |
| Rate for Payer: Aetna Commercial |
$889.58
|
| Rate for Payer: Anthem Medicaid |
$397.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$901.13
|
| Rate for Payer: Cash Price |
$577.65
|
| Rate for Payer: Cigna Commercial |
$958.90
|
| Rate for Payer: First Health Commercial |
$1,097.54
|
| Rate for Payer: Humana Commercial |
$982.00
|
| Rate for Payer: Humana KY Medicaid |
$397.31
|
| Rate for Payer: Kentucky WC Medicaid |
$401.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$947.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$852.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$346.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$405.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,016.66
|
| Rate for Payer: Ohio Health Group HMO |
$866.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$231.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$150.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$358.14
|
| Rate for Payer: PHCS Commercial |
$1,109.09
|
| Rate for Payer: United Healthcare All Payer |
$1,016.66
|
|
|
HI TORQUE PILOT 50 300CM ST
|
Facility
|
IP
|
$1,155.30
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$150.19 |
| Max. Negotiated Rate |
$1,109.09 |
| Rate for Payer: Aetna Commercial |
$889.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$901.13
|
| Rate for Payer: Cash Price |
$577.65
|
| Rate for Payer: Cigna Commercial |
$958.90
|
| Rate for Payer: First Health Commercial |
$1,097.54
|
| Rate for Payer: Humana Commercial |
$982.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$947.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$852.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$346.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,016.66
|
| Rate for Payer: Ohio Health Group HMO |
$866.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$231.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$150.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$358.14
|
| Rate for Payer: PHCS Commercial |
$1,109.09
|
| Rate for Payer: United Healthcare All Payer |
$1,016.66
|
|
|
HI TORQUE STEELCORE 190CM
|
Facility
|
IP
|
$1,151.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.63 |
| Max. Negotiated Rate |
$1,104.96 |
| Rate for Payer: Aetna Commercial |
$886.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$897.78
|
| Rate for Payer: Cash Price |
$575.50
|
| Rate for Payer: Cigna Commercial |
$955.33
|
| Rate for Payer: First Health Commercial |
$1,093.45
|
| Rate for Payer: Humana Commercial |
$978.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$943.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$849.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,012.88
|
| Rate for Payer: Ohio Health Group HMO |
$863.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$230.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$149.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$356.81
|
| Rate for Payer: PHCS Commercial |
$1,104.96
|
| Rate for Payer: United Healthcare All Payer |
$1,012.88
|
|
|
HI TORQUE STEELCORE 190CM
|
Facility
|
OP
|
$1,151.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.63 |
| Max. Negotiated Rate |
$1,104.96 |
| Rate for Payer: Aetna Commercial |
$886.27
|
| Rate for Payer: Anthem Medicaid |
$395.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$897.78
|
| Rate for Payer: Cash Price |
$575.50
|
| Rate for Payer: Cigna Commercial |
$955.33
|
| Rate for Payer: First Health Commercial |
$1,093.45
|
| Rate for Payer: Humana Commercial |
$978.35
|
| Rate for Payer: Humana KY Medicaid |
$395.83
|
| Rate for Payer: Kentucky WC Medicaid |
$399.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$943.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$849.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$403.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,012.88
|
| Rate for Payer: Ohio Health Group HMO |
$863.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$230.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$149.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$356.81
|
| Rate for Payer: PHCS Commercial |
$1,104.96
|
| Rate for Payer: United Healthcare All Payer |
$1,012.88
|
|
|
HI TORQUE STEELCORE 300CM
|
Facility
|
OP
|
$1,151.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.63 |
| Max. Negotiated Rate |
$1,104.96 |
| Rate for Payer: Aetna Commercial |
$886.27
|
| Rate for Payer: Anthem Medicaid |
$395.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$897.78
|
| Rate for Payer: Cash Price |
$575.50
|
| Rate for Payer: Cigna Commercial |
$955.33
|
| Rate for Payer: First Health Commercial |
$1,093.45
|
| Rate for Payer: Humana Commercial |
$978.35
|
| Rate for Payer: Humana KY Medicaid |
$395.83
|
| Rate for Payer: Kentucky WC Medicaid |
$399.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$943.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$849.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$403.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,012.88
|
| Rate for Payer: Ohio Health Group HMO |
$863.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$230.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$149.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$356.81
|
| Rate for Payer: PHCS Commercial |
$1,104.96
|
| Rate for Payer: United Healthcare All Payer |
$1,012.88
|
|
|
HI TORQUE STEELCORE 300CM
|
Facility
|
IP
|
$1,151.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.63 |
| Max. Negotiated Rate |
$1,104.96 |
| Rate for Payer: Aetna Commercial |
$886.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$897.78
|
| Rate for Payer: Cash Price |
$575.50
|
| Rate for Payer: Cigna Commercial |
$955.33
|
| Rate for Payer: First Health Commercial |
$1,093.45
|
| Rate for Payer: Humana Commercial |
$978.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$943.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$849.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,012.88
|
| Rate for Payer: Ohio Health Group HMO |
$863.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$230.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$149.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$356.81
|
| Rate for Payer: PHCS Commercial |
$1,104.96
|
| Rate for Payer: United Healthcare All Payer |
$1,012.88
|
|
|
HI TORQUE WHISPER MS 300CM ST
|
Facility
|
IP
|
$1,155.30
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$150.19 |
| Max. Negotiated Rate |
$1,109.09 |
| Rate for Payer: Aetna Commercial |
$889.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$901.13
|
| Rate for Payer: Cash Price |
$577.65
|
| Rate for Payer: Cigna Commercial |
$958.90
|
| Rate for Payer: First Health Commercial |
$1,097.54
|
| Rate for Payer: Humana Commercial |
$982.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$947.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$852.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$346.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,016.66
|
| Rate for Payer: Ohio Health Group HMO |
$866.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$231.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$150.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$358.14
|
| Rate for Payer: PHCS Commercial |
$1,109.09
|
| Rate for Payer: United Healthcare All Payer |
$1,016.66
|
|
|
HI TORQUE WHISPER MS 300CM ST
|
Facility
|
OP
|
$1,155.30
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$150.19 |
| Max. Negotiated Rate |
$1,109.09 |
| Rate for Payer: Aetna Commercial |
$889.58
|
| Rate for Payer: Anthem Medicaid |
$397.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$901.13
|
| Rate for Payer: Cash Price |
$577.65
|
| Rate for Payer: Cigna Commercial |
$958.90
|
| Rate for Payer: First Health Commercial |
$1,097.54
|
| Rate for Payer: Humana Commercial |
$982.00
|
| Rate for Payer: Humana KY Medicaid |
$397.31
|
| Rate for Payer: Kentucky WC Medicaid |
$401.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$947.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$852.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$346.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$405.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,016.66
|
| Rate for Payer: Ohio Health Group HMO |
$866.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$231.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$150.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$358.14
|
| Rate for Payer: PHCS Commercial |
$1,109.09
|
| Rate for Payer: United Healthcare All Payer |
$1,016.66
|
|
|
HI TORQUE X-S'PORT 190CM
|
Facility
|
IP
|
$1,565.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$203.45 |
| Max. Negotiated Rate |
$1,502.40 |
| Rate for Payer: Aetna Commercial |
$1,205.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,220.70
|
| Rate for Payer: Cash Price |
$782.50
|
| Rate for Payer: Cigna Commercial |
$1,298.95
|
| Rate for Payer: First Health Commercial |
$1,486.75
|
| Rate for Payer: Humana Commercial |
$1,330.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,283.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,154.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$469.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,377.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,173.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$313.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$203.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$485.15
|
| Rate for Payer: PHCS Commercial |
$1,502.40
|
| Rate for Payer: United Healthcare All Payer |
$1,377.20
|
|
|
HI TORQUE X-S'PORT 190CM
|
Facility
|
OP
|
$1,565.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$203.45 |
| Max. Negotiated Rate |
$1,502.40 |
| Rate for Payer: Aetna Commercial |
$1,205.05
|
| Rate for Payer: Anthem Medicaid |
$538.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,220.70
|
| Rate for Payer: Cash Price |
$782.50
|
| Rate for Payer: Cigna Commercial |
$1,298.95
|
| Rate for Payer: First Health Commercial |
$1,486.75
|
| Rate for Payer: Humana Commercial |
$1,330.25
|
| Rate for Payer: Humana KY Medicaid |
$538.20
|
| Rate for Payer: Kentucky WC Medicaid |
$543.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,283.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,154.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$469.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$549.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,377.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,173.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$313.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$203.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$485.15
|
| Rate for Payer: PHCS Commercial |
$1,502.40
|
| Rate for Payer: United Healthcare All Payer |
$1,377.20
|
|
|
HI-TORQU SUPRA CORE WIRE 300CM
|
Facility
|
IP
|
$1,540.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$200.26 |
| Max. Negotiated Rate |
$1,478.88 |
| Rate for Payer: Aetna Commercial |
$1,186.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,201.59
|
| Rate for Payer: Cash Price |
$770.25
|
| Rate for Payer: Cigna Commercial |
$1,278.62
|
| Rate for Payer: First Health Commercial |
$1,463.48
|
| Rate for Payer: Humana Commercial |
$1,309.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,263.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,136.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$462.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,355.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,155.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$308.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$200.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$477.56
|
| Rate for Payer: PHCS Commercial |
$1,478.88
|
| Rate for Payer: United Healthcare All Payer |
$1,355.64
|
|
|
HI-TORQU SUPRA CORE WIRE 300CM
|
Facility
|
OP
|
$1,540.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$200.26 |
| Max. Negotiated Rate |
$1,478.88 |
| Rate for Payer: Aetna Commercial |
$1,186.18
|
| Rate for Payer: Anthem Medicaid |
$529.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,201.59
|
| Rate for Payer: Cash Price |
$770.25
|
| Rate for Payer: Cigna Commercial |
$1,278.62
|
| Rate for Payer: First Health Commercial |
$1,463.48
|
| Rate for Payer: Humana Commercial |
$1,309.42
|
| Rate for Payer: Humana KY Medicaid |
$529.78
|
| Rate for Payer: Kentucky WC Medicaid |
$535.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,263.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,136.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$462.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$540.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,355.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,155.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$308.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$200.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$477.56
|
| Rate for Payer: PHCS Commercial |
$1,478.88
|
| Rate for Payer: United Healthcare All Payer |
$1,355.64
|
|
|
HIV 1/2 AG/AB COMBO
|
Facility
|
OP
|
$143.00
|
|
|
Service Code
|
HCPCS 87806
|
| Hospital Charge Code |
30001411
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.59 |
| Max. Negotiated Rate |
$137.28 |
| Rate for Payer: Aetna Commercial |
$110.11
|
| Rate for Payer: Anthem Medicaid |
$32.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$32.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$114.83
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$45.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$32.77
|
| Rate for Payer: Cash Price |
$71.50
|
| Rate for Payer: Cash Price |
$71.50
|
| Rate for Payer: Cigna Commercial |
$118.69
|
| Rate for Payer: First Health Commercial |
$135.85
|
| Rate for Payer: Humana Commercial |
$121.55
|
| Rate for Payer: Humana KY Medicaid |
$32.77
|
| Rate for Payer: Humana Medicare Advantage |
$32.77
|
| Rate for Payer: Kentucky WC Medicaid |
$33.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$117.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$105.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$33.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$125.84
|
| Rate for Payer: Ohio Health Group HMO |
$107.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.33
|
| Rate for Payer: PHCS Commercial |
$137.28
|
| Rate for Payer: United Healthcare All Payer |
$125.84
|
|
|
HIV 1/2 AG/AB COMBO
|
Facility
|
IP
|
$143.00
|
|
|
Service Code
|
HCPCS 87806
|
| Hospital Charge Code |
30001411
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.59 |
| Max. Negotiated Rate |
$137.28 |
| Rate for Payer: Aetna Commercial |
$110.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$114.83
|
| Rate for Payer: Cash Price |
$71.50
|
| Rate for Payer: Cigna Commercial |
$118.69
|
| Rate for Payer: First Health Commercial |
$135.85
|
| Rate for Payer: Humana Commercial |
$121.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$117.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$105.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$125.84
|
| Rate for Payer: Ohio Health Group HMO |
$107.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.33
|
| Rate for Payer: PHCS Commercial |
$137.28
|
| Rate for Payer: United Healthcare All Payer |
$125.84
|
|
|
HIV SCREEN 4TH GENERATION
|
Facility
|
OP
|
$161.00
|
|
|
Service Code
|
HCPCS 87389
|
| Hospital Charge Code |
30001357
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.93 |
| Max. Negotiated Rate |
$154.56 |
| Rate for Payer: Aetna Commercial |
$123.97
|
| Rate for Payer: Anthem Medicaid |
$24.08
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$24.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$129.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$33.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$24.08
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: Cigna Commercial |
$133.63
|
| Rate for Payer: First Health Commercial |
$152.95
|
| Rate for Payer: Humana Commercial |
$136.85
|
| Rate for Payer: Humana KY Medicaid |
$24.08
|
| Rate for Payer: Humana Medicare Advantage |
$24.08
|
| Rate for Payer: Kentucky WC Medicaid |
$24.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$132.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$141.68
|
| Rate for Payer: Ohio Health Group HMO |
$120.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.91
|
| Rate for Payer: PHCS Commercial |
$154.56
|
| Rate for Payer: United Healthcare All Payer |
$141.68
|
|
|
HIV SCREEN 4TH GENERATION
|
Facility
|
IP
|
$161.00
|
|
|
Service Code
|
HCPCS 87389
|
| Hospital Charge Code |
30001357
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.93 |
| Max. Negotiated Rate |
$154.56 |
| Rate for Payer: Aetna Commercial |
$123.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$129.28
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: Cigna Commercial |
$133.63
|
| Rate for Payer: First Health Commercial |
$152.95
|
| Rate for Payer: Humana Commercial |
$136.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$132.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$141.68
|
| Rate for Payer: Ohio Health Group HMO |
$120.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.91
|
| Rate for Payer: PHCS Commercial |
$154.56
|
| Rate for Payer: United Healthcare All Payer |
$141.68
|
|
|
HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$80,397.10
|
|
|
Service Code
|
MSDRG 969
|
| Min. Negotiated Rate |
$54,555.18 |
| Max. Negotiated Rate |
$80,397.10 |
| Rate for Payer: Anthem Medicaid |
$54,555.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$57,426.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$80,397.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$77,525.78
|
| Rate for Payer: Humana KY Medicaid |
$54,555.18
|
| Rate for Payer: Humana Medicare Advantage |
$57,426.50
|
| Rate for Payer: Kentucky WC Medicaid |
$55,100.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$68,911.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$55,646.28
|
|
|
HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC
|
Facility
|
IP
|
$32,516.33
|
|
|
Service Code
|
MSDRG 970
|
| Min. Negotiated Rate |
$22,064.65 |
| Max. Negotiated Rate |
$32,516.33 |
| Rate for Payer: Anthem Medicaid |
$22,064.65
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$23,225.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$32,516.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$31,355.03
|
| Rate for Payer: Humana KY Medicaid |
$22,064.65
|
| Rate for Payer: Humana Medicare Advantage |
$23,225.95
|
| Rate for Payer: Kentucky WC Medicaid |
$22,285.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27,871.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$22,505.95
|
|
|
HIV WITH MAJOR RELATED CONDITION WITH CC
|
Facility
|
IP
|
$15,948.17
|
|
|
Service Code
|
MSDRG 975
|
| Min. Negotiated Rate |
$10,821.97 |
| Max. Negotiated Rate |
$15,948.17 |
| Rate for Payer: Anthem Medicaid |
$10,821.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,391.55
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15,948.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$15,378.59
|
| Rate for Payer: Humana KY Medicaid |
$10,821.97
|
| Rate for Payer: Humana Medicare Advantage |
$11,391.55
|
| Rate for Payer: Kentucky WC Medicaid |
$10,930.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13,669.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,038.41
|
|
|
HIV WITH MAJOR RELATED CONDITION WITH MCC
|
Facility
|
IP
|
$34,117.82
|
|
|
Service Code
|
MSDRG 974
|
| Min. Negotiated Rate |
$23,151.38 |
| Max. Negotiated Rate |
$34,117.82 |
| Rate for Payer: Anthem Medicaid |
$23,151.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$24,369.87
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$34,117.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$32,899.32
|
| Rate for Payer: Humana KY Medicaid |
$23,151.38
|
| Rate for Payer: Humana Medicare Advantage |
$24,369.87
|
| Rate for Payer: Kentucky WC Medicaid |
$23,382.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29,243.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$23,614.40
|
|
|
HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC
|
Facility
|
IP
|
$9,888.48
|
|
|
Service Code
|
MSDRG 976
|
| Min. Negotiated Rate |
$6,710.04 |
| Max. Negotiated Rate |
$9,888.48 |
| Rate for Payer: Anthem Medicaid |
$6,710.04
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7,063.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,888.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$9,535.32
|
| Rate for Payer: Humana KY Medicaid |
$6,710.04
|
| Rate for Payer: Humana Medicare Advantage |
$7,063.20
|
| Rate for Payer: Kentucky WC Medicaid |
$6,777.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,475.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,844.24
|
|
