|
HEART/LUNG RESUSCITATION CPR
|
Facility
|
OP
|
$852.00
|
|
|
Service Code
|
HCPCS 92950
|
| Hospital Charge Code |
41000066
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$287.73 |
| Max. Negotiated Rate |
$817.92 |
| Rate for Payer: Aetna Commercial |
$656.04
|
| Rate for Payer: Anthem Medicaid |
$293.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$287.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$664.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$402.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$388.44
|
| Rate for Payer: Cash Price |
$426.00
|
| Rate for Payer: Cash Price |
$426.00
|
| Rate for Payer: Cigna Commercial |
$707.16
|
| Rate for Payer: First Health Commercial |
$809.40
|
| Rate for Payer: Humana Commercial |
$724.20
|
| Rate for Payer: Humana KY Medicaid |
$293.00
|
| Rate for Payer: Humana Medicare Advantage |
$287.73
|
| Rate for Payer: Kentucky WC Medicaid |
$295.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$698.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$628.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$298.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$749.76
|
| Rate for Payer: Ohio Health Group HMO |
$639.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$681.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$741.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$587.88
|
| Rate for Payer: PHCS Commercial |
$817.92
|
| Rate for Payer: United Healthcare All Payer |
$749.76
|
|
|
HEART/LUNG RESUSCITATION CP(T
|
Facility
|
OP
|
$492.00
|
|
|
Service Code
|
HCPCS 92950
|
| Hospital Charge Code |
410T0066
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$169.20 |
| Max. Negotiated Rate |
$472.32 |
| Rate for Payer: Aetna Commercial |
$378.84
|
| Rate for Payer: Anthem Medicaid |
$169.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$287.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$383.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$402.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$388.44
|
| Rate for Payer: Cash Price |
$246.00
|
| Rate for Payer: Cash Price |
$246.00
|
| Rate for Payer: Cigna Commercial |
$408.36
|
| Rate for Payer: First Health Commercial |
$467.40
|
| Rate for Payer: Humana Commercial |
$418.20
|
| Rate for Payer: Humana KY Medicaid |
$169.20
|
| Rate for Payer: Humana Medicare Advantage |
$287.73
|
| Rate for Payer: Kentucky WC Medicaid |
$170.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$403.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$363.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$172.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$432.96
|
| Rate for Payer: Ohio Health Group HMO |
$369.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$393.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$428.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$339.48
|
| Rate for Payer: PHCS Commercial |
$472.32
|
| Rate for Payer: United Healthcare All Payer |
$432.96
|
|
|
HEART/LUNG RESUSCITATION CP(T
|
Facility
|
IP
|
$492.00
|
|
|
Service Code
|
HCPCS 92950
|
| Hospital Charge Code |
410T0066
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$147.60 |
| Max. Negotiated Rate |
$472.32 |
| Rate for Payer: Aetna Commercial |
$378.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$383.76
|
| Rate for Payer: Cash Price |
$246.00
|
| Rate for Payer: Cigna Commercial |
$408.36
|
| Rate for Payer: First Health Commercial |
$467.40
|
| Rate for Payer: Humana Commercial |
$418.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$403.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$363.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$147.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$432.96
|
| Rate for Payer: Ohio Health Group HMO |
$369.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$393.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$428.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$339.48
|
| Rate for Payer: PHCS Commercial |
$472.32
|
| Rate for Payer: United Healthcare All Payer |
$432.96
|
|
|
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 |
$4,665.50 |
| Rate for Payer: Aetna Commercial |
$2,081.06
|
| 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
|
OP
|
$6,665.00
|
|
|
Service Code
|
HCPCS 78459
|
| Hospital Charge Code |
34000019
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,206.24 |
| 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 |
$1,206.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,198.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,688.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,628.42
|
| 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 |
$1,206.24
|
| 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 |
$1,447.49
|
| 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 |
$5,332.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,798.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,598.85
|
| Rate for Payer: PHCS Commercial |
$6,398.40
|
| Rate for Payer: United Healthcare All Payer |
$5,865.20
|
|
|
HEART MUSCLE IMAGING (PET)
|
Facility
|
IP
|
$6,665.00
|
|
|
Service Code
|
HCPCS 78459
|
| Hospital Charge Code |
34000019
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,999.50 |
| 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 |
$5,332.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,798.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,598.85
|
| 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: 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
|
IP
|
$6,415.00
|
|
|
Service Code
|
HCPCS 78459
|
| Hospital Charge Code |
340T0019
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,924.50 |
| 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 |
$5,132.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,581.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,426.35
|
| Rate for Payer: PHCS Commercial |
$6,158.40
|
| Rate for Payer: United Healthcare All Payer |
$5,645.20
|
|
|
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 |
$1,206.24 |
| 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 |
$1,206.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,003.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,688.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,628.42
|
| 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 |
$1,206.24
|
| 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 |
$1,447.49
|
| 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 |
$5,132.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,581.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,426.35
|
| Rate for Payer: PHCS Commercial |
$6,158.40
|
| Rate for Payer: United Healthcare All Payer |
$5,645.20
|
|
|
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 |
$34.19 |
| 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 |
$91.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$78.63
|
| Rate for Payer: PHCS Commercial |
$109.40
|
| Rate for Payer: United Healthcare All Payer |
$100.28
|
|
|
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 |
$34.19 |
| 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 |
$91.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$78.63
|
| Rate for Payer: PHCS Commercial |
$109.40
|
| Rate for Payer: United Healthcare All Payer |
$100.28
|
|
|
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 |
$7.08 |
| 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 |
$18.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.28
|
| Rate for Payer: PHCS Commercial |
$22.65
|
| Rate for Payer: United Healthcare All Payer |
$20.76
|
|
|
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 |
$7.08 |
| 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 |
$18.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.28
|
| Rate for Payer: PHCS Commercial |
$22.65
|
| Rate for Payer: United Healthcare All Payer |
$20.76
|
|
|
HECTOROL(DOXERCALCIFROL)2.5MCG
|
Facility
|
IP
|
$32.28
|
|
|
Service Code
|
NDC 23155054025
|
| Hospital Charge Code |
25000750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.68 |
| Max. Negotiated Rate |
$30.99 |
| 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
|
| 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 |
$25.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.27
|
| Rate for Payer: PHCS Commercial |
$30.99
|
| Rate for Payer: United Healthcare All Payer |
$28.41
|
|
|
HECTOROL(DOXERCALCIFROL)2.5MCG
|
Facility
|
OP
|
$32.28
|
|
|
Service Code
|
NDC 23155054025
|
| Hospital Charge Code |
25000750
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.68 |
| 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 |
$25.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.27
|
| Rate for Payer: PHCS Commercial |
$30.99
|
| Rate for Payer: United Healthcare All Payer |
$28.41
|
|
|
HED BIOLOX CER C-TPR 28MM*-2.5
|
Facility
|
IP
|
$9,497.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,849.10 |
| Max. Negotiated Rate |
$9,117.12 |
| Rate for Payer: Aetna Commercial |
$7,312.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,407.66
|
| Rate for Payer: Cash Price |
$4,748.50
|
| Rate for Payer: Cigna Commercial |
$7,882.51
|
| Rate for Payer: First Health Commercial |
$9,022.15
|
| Rate for Payer: Humana Commercial |
$8,072.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,787.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,008.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,849.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,357.36
|
| Rate for Payer: Ohio Health Group HMO |
$7,122.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,597.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,262.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,552.93
|
| Rate for Payer: PHCS Commercial |
$9,117.12
|
| Rate for Payer: United Healthcare All Payer |
$8,357.36
|
|
|
HED BIOLOX CER C-TPR 28MM*-2.5
|
Facility
|
OP
|
$9,497.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,849.10 |
| Max. Negotiated Rate |
$9,117.12 |
| Rate for Payer: Aetna Commercial |
$7,312.69
|
| Rate for Payer: Anthem Medicaid |
$3,266.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,407.66
|
| Rate for Payer: Cash Price |
$4,748.50
|
| Rate for Payer: Cigna Commercial |
$7,882.51
|
| Rate for Payer: First Health Commercial |
$9,022.15
|
| Rate for Payer: Humana Commercial |
$8,072.45
|
| Rate for Payer: Humana KY Medicaid |
$3,266.02
|
| Rate for Payer: Kentucky WC Medicaid |
$3,299.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,787.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,008.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,849.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,331.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,357.36
|
| Rate for Payer: Ohio Health Group HMO |
$7,122.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,597.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,262.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,552.93
|
| Rate for Payer: PHCS Commercial |
$9,117.12
|
| Rate for Payer: United Healthcare All Payer |
$8,357.36
|
|
|
HED BIOLOX CER C-TPR 28MM +5MM
|
Facility
|
IP
|
$9,497.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,849.10 |
| Max. Negotiated Rate |
$9,117.12 |
| Rate for Payer: Aetna Commercial |
$7,312.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,407.66
|
| Rate for Payer: Cash Price |
$4,748.50
|
| Rate for Payer: Cigna Commercial |
$7,882.51
|
| Rate for Payer: First Health Commercial |
$9,022.15
|
| Rate for Payer: Humana Commercial |
$8,072.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,787.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,008.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,849.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,357.36
|
| Rate for Payer: Ohio Health Group HMO |
$7,122.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,597.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,262.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,552.93
|
| Rate for Payer: PHCS Commercial |
$9,117.12
|
| Rate for Payer: United Healthcare All Payer |
$8,357.36
|
|
|
HED BIOLOX CER C-TPR 28MM +5MM
|
Facility
|
OP
|
$9,497.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,849.10 |
| Max. Negotiated Rate |
$9,117.12 |
| Rate for Payer: Aetna Commercial |
$7,312.69
|
| Rate for Payer: Anthem Medicaid |
$3,266.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,407.66
|
| Rate for Payer: Cash Price |
$4,748.50
|
| Rate for Payer: Cigna Commercial |
$7,882.51
|
| Rate for Payer: First Health Commercial |
$9,022.15
|
| Rate for Payer: Humana Commercial |
$8,072.45
|
| Rate for Payer: Humana KY Medicaid |
$3,266.02
|
| Rate for Payer: Kentucky WC Medicaid |
$3,299.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,787.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,008.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,849.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,331.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,357.36
|
| Rate for Payer: Ohio Health Group HMO |
$7,122.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,597.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,262.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,552.93
|
| Rate for Payer: PHCS Commercial |
$9,117.12
|
| Rate for Payer: United Healthcare All Payer |
$8,357.36
|
|
|
HED BIOLOX DELTA CER 28MM +0MM
|
Facility
|
IP
|
$7,681.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,304.34 |
| Max. Negotiated Rate |
$7,373.88 |
| Rate for Payer: Aetna Commercial |
$5,914.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,991.27
|
| Rate for Payer: Cash Price |
$3,840.56
|
| Rate for Payer: Cigna Commercial |
$6,375.33
|
| Rate for Payer: First Health Commercial |
$7,297.06
|
| Rate for Payer: Humana Commercial |
$6,528.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,298.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,668.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,304.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,759.39
|
| Rate for Payer: Ohio Health Group HMO |
$5,760.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,144.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,682.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,299.97
|
| Rate for Payer: PHCS Commercial |
$7,373.88
|
| Rate for Payer: United Healthcare All Payer |
$6,759.39
|
|
|
HED BIOLOX DELTA CER 28MM +0MM
|
Facility
|
OP
|
$7,681.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,304.34 |
| Max. Negotiated Rate |
$7,373.88 |
| Rate for Payer: Aetna Commercial |
$5,914.46
|
| Rate for Payer: Anthem Medicaid |
$2,641.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,991.27
|
| Rate for Payer: Cash Price |
$3,840.56
|
| Rate for Payer: Cigna Commercial |
$6,375.33
|
| Rate for Payer: First Health Commercial |
$7,297.06
|
| Rate for Payer: Humana Commercial |
$6,528.95
|
| Rate for Payer: Humana KY Medicaid |
$2,641.54
|
| Rate for Payer: Kentucky WC Medicaid |
$2,668.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,298.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,668.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,304.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,694.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,759.39
|
| Rate for Payer: Ohio Health Group HMO |
$5,760.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,144.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,682.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,299.97
|
| Rate for Payer: PHCS Commercial |
$7,373.88
|
| Rate for Payer: United Healthcare All Payer |
$6,759.39
|
|
|
HED BIOLOX DELTA CER 32MM +0MM
|
Facility
|
OP
|
$7,681.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,304.34 |
| Max. Negotiated Rate |
$7,373.88 |
| Rate for Payer: Aetna Commercial |
$5,914.46
|
| Rate for Payer: Anthem Medicaid |
$2,641.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,991.27
|
| Rate for Payer: Cash Price |
$3,840.56
|
| Rate for Payer: Cigna Commercial |
$6,375.33
|
| Rate for Payer: First Health Commercial |
$7,297.06
|
| Rate for Payer: Humana Commercial |
$6,528.95
|
| Rate for Payer: Humana KY Medicaid |
$2,641.54
|
| Rate for Payer: Kentucky WC Medicaid |
$2,668.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,298.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,668.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,304.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,694.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,759.39
|
| Rate for Payer: Ohio Health Group HMO |
$5,760.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,144.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,682.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,299.97
|
| Rate for Payer: PHCS Commercial |
$7,373.88
|
| Rate for Payer: United Healthcare All Payer |
$6,759.39
|
|
|
HED BIOLOX DELTA CER 32MM +0MM
|
Facility
|
IP
|
$7,681.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,304.34 |
| Max. Negotiated Rate |
$7,373.88 |
| Rate for Payer: Aetna Commercial |
$5,914.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,991.27
|
| Rate for Payer: Cash Price |
$3,840.56
|
| Rate for Payer: Cigna Commercial |
$6,375.33
|
| Rate for Payer: First Health Commercial |
$7,297.06
|
| Rate for Payer: Humana Commercial |
$6,528.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,298.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,668.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,304.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,759.39
|
| Rate for Payer: Ohio Health Group HMO |
$5,760.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,144.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,682.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,299.97
|
| Rate for Payer: PHCS Commercial |
$7,373.88
|
| Rate for Payer: United Healthcare All Payer |
$6,759.39
|
|
|
HED BIOLOX DELTA CER 32MM +7MM
|
Facility
|
OP
|
$7,681.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,304.34 |
| Max. Negotiated Rate |
$7,373.88 |
| Rate for Payer: Aetna Commercial |
$5,914.46
|
| Rate for Payer: Anthem Medicaid |
$2,641.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,991.27
|
| Rate for Payer: Cash Price |
$3,840.56
|
| Rate for Payer: Cigna Commercial |
$6,375.33
|
| Rate for Payer: First Health Commercial |
$7,297.06
|
| Rate for Payer: Humana Commercial |
$6,528.95
|
| Rate for Payer: Humana KY Medicaid |
$2,641.54
|
| Rate for Payer: Kentucky WC Medicaid |
$2,668.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,298.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,668.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,304.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,694.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,759.39
|
| Rate for Payer: Ohio Health Group HMO |
$5,760.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,144.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,682.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,299.97
|
| Rate for Payer: PHCS Commercial |
$7,373.88
|
| Rate for Payer: United Healthcare All Payer |
$6,759.39
|
|
|
HED BIOLOX DELTA CER 32MM +7MM
|
Facility
|
IP
|
$7,681.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,304.34 |
| Max. Negotiated Rate |
$7,373.88 |
| Rate for Payer: Aetna Commercial |
$5,914.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,991.27
|
| Rate for Payer: Cash Price |
$3,840.56
|
| Rate for Payer: Cigna Commercial |
$6,375.33
|
| Rate for Payer: First Health Commercial |
$7,297.06
|
| Rate for Payer: Humana Commercial |
$6,528.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,298.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,668.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,304.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,759.39
|
| Rate for Payer: Ohio Health Group HMO |
$5,760.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,144.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,682.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,299.97
|
| Rate for Payer: PHCS Commercial |
$7,373.88
|
| Rate for Payer: United Healthcare All Payer |
$6,759.39
|
|
