|
HIB VACCINE(4 DOSE SCHEDULE)
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
HCPCS 90648
|
| Hospital Charge Code |
77000015
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.20 |
| Max. Negotiated Rate |
$109.44 |
| Rate for Payer: Aetna Commercial |
$87.78
|
| Rate for Payer: Anthem Medicaid |
$39.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.92
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$94.62
|
| Rate for Payer: First Health Commercial |
$108.30
|
| Rate for Payer: Humana Commercial |
$96.90
|
| Rate for Payer: Humana KY Medicaid |
$39.20
|
| Rate for Payer: Kentucky WC Medicaid |
$39.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$93.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$100.32
|
| Rate for Payer: Ohio Health Group HMO |
$85.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$91.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$78.66
|
| Rate for Payer: PHCS Commercial |
$109.44
|
| Rate for Payer: United Healthcare All Payer |
$100.32
|
|
|
HIB VACCINE(4 DOSE SCHEDULE)(T
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
HCPCS 90648
|
| Hospital Charge Code |
770T0015
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.20 |
| Max. Negotiated Rate |
$109.44 |
| Rate for Payer: Aetna Commercial |
$87.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.92
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$94.62
|
| Rate for Payer: First Health Commercial |
$108.30
|
| Rate for Payer: Humana Commercial |
$96.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$93.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$100.32
|
| Rate for Payer: Ohio Health Group HMO |
$85.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$91.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$78.66
|
| Rate for Payer: PHCS Commercial |
$109.44
|
| Rate for Payer: United Healthcare All Payer |
$100.32
|
|
|
HIB VACCINE(4 DOSE SCHEDULE)(T
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
HCPCS 90648
|
| Hospital Charge Code |
770T0015
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.20 |
| Max. Negotiated Rate |
$109.44 |
| Rate for Payer: Aetna Commercial |
$87.78
|
| Rate for Payer: Anthem Medicaid |
$39.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.92
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$94.62
|
| Rate for Payer: First Health Commercial |
$108.30
|
| Rate for Payer: Humana Commercial |
$96.90
|
| Rate for Payer: Humana KY Medicaid |
$39.20
|
| Rate for Payer: Kentucky WC Medicaid |
$39.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$93.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$100.32
|
| Rate for Payer: Ohio Health Group HMO |
$85.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$91.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$78.66
|
| Rate for Payer: PHCS Commercial |
$109.44
|
| Rate for Payer: United Healthcare All Payer |
$100.32
|
|
|
HI FLEX FLEXOR INTRODUCER 10F
|
Facility
|
OP
|
$1,504.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$451.20 |
| Max. Negotiated Rate |
$1,443.84 |
| Rate for Payer: Aetna Commercial |
$1,158.08
|
| Rate for Payer: Anthem Medicaid |
$517.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,173.12
|
| Rate for Payer: Cash Price |
$752.00
|
| Rate for Payer: Cigna Commercial |
$1,248.32
|
| Rate for Payer: First Health Commercial |
$1,428.80
|
| Rate for Payer: Humana Commercial |
$1,278.40
|
| Rate for Payer: Humana KY Medicaid |
$517.23
|
| Rate for Payer: Kentucky WC Medicaid |
$522.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,233.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,109.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$451.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$527.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,323.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,128.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,203.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,308.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,037.76
|
| Rate for Payer: PHCS Commercial |
$1,443.84
|
| Rate for Payer: United Healthcare All Payer |
$1,323.52
|
|
|
HI FLEX FLEXOR INTRODUCER 10F
|
Facility
|
IP
|
$1,504.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$451.20 |
| Max. Negotiated Rate |
$1,443.84 |
| Rate for Payer: Aetna Commercial |
$1,158.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,173.12
|
| Rate for Payer: Cash Price |
$752.00
|
| Rate for Payer: Cigna Commercial |
$1,248.32
|
| Rate for Payer: First Health Commercial |
$1,428.80
|
| Rate for Payer: Humana Commercial |
$1,278.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,233.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,109.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$451.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,323.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,128.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,203.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,308.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,037.76
|
| Rate for Payer: PHCS Commercial |
$1,443.84
|
| Rate for Payer: United Healthcare All Payer |
$1,323.52
|
|
|
HI FLEX FLEXOR INTRODUCER 12F
|
Facility
|
IP
|
$1,522.24
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$456.67 |
| Max. Negotiated Rate |
$1,461.35 |
| Rate for Payer: Aetna Commercial |
$1,172.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,187.35
|
| Rate for Payer: Cash Price |
$761.12
|
| Rate for Payer: Cigna Commercial |
$1,263.46
|
| Rate for Payer: First Health Commercial |
$1,446.13
|
| Rate for Payer: Humana Commercial |
$1,293.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,248.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,123.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$456.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,339.57
|
| Rate for Payer: Ohio Health Group HMO |
$1,141.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,217.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,324.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,050.35
|
| Rate for Payer: PHCS Commercial |
$1,461.35
|
| Rate for Payer: United Healthcare All Payer |
$1,339.57
|
|
|
HI FLEX FLEXOR INTRODUCER 12F
|
Facility
|
OP
|
$1,522.24
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$456.67 |
| Max. Negotiated Rate |
$1,461.35 |
| Rate for Payer: Aetna Commercial |
$1,172.12
|
| Rate for Payer: Anthem Medicaid |
$523.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,187.35
|
| Rate for Payer: Cash Price |
$761.12
|
| Rate for Payer: Cigna Commercial |
$1,263.46
|
| Rate for Payer: First Health Commercial |
$1,446.13
|
| Rate for Payer: Humana Commercial |
$1,293.90
|
| Rate for Payer: Humana KY Medicaid |
$523.50
|
| Rate for Payer: Kentucky WC Medicaid |
$528.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,248.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,123.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$456.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$534.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,339.57
|
| Rate for Payer: Ohio Health Group HMO |
$1,141.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,217.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,324.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,050.35
|
| Rate for Payer: PHCS Commercial |
$1,461.35
|
| Rate for Payer: United Healthcare All Payer |
$1,339.57
|
|
|
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 |
$236.70 |
| 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 |
$631.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$686.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$544.41
|
| Rate for Payer: PHCS Commercial |
$757.44
|
| Rate for Payer: United Healthcare All Payer |
$694.32
|
|
|
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 |
$271.34 |
| 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 |
$316.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$615.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$442.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$427.09
|
| 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 |
$316.36
|
| 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 |
$379.63
|
| 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 |
$631.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$686.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$544.41
|
| Rate for Payer: PHCS Commercial |
$757.44
|
| Rate for Payer: United Healthcare All Payer |
$694.32
|
|
|
HIGH OFFSET NEU MOD NECK
|
Facility
|
IP
|
$3,875.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,162.50 |
| Max. Negotiated Rate |
$3,720.00 |
| Rate for Payer: Aetna Commercial |
$2,983.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,022.50
|
| Rate for Payer: Cash Price |
$1,937.50
|
| Rate for Payer: Cigna Commercial |
$3,216.25
|
| Rate for Payer: First Health Commercial |
$3,681.25
|
| Rate for Payer: Humana Commercial |
$3,293.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,177.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,859.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,162.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,410.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,906.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,371.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,673.75
|
| Rate for Payer: PHCS Commercial |
$3,720.00
|
| Rate for Payer: United Healthcare All Payer |
$3,410.00
|
|
|
HIGH OFFSET NEU MOD NECK
|
Facility
|
OP
|
$3,875.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,162.50 |
| Max. Negotiated Rate |
$3,720.00 |
| Rate for Payer: Aetna Commercial |
$2,983.75
|
| Rate for Payer: Anthem Medicaid |
$1,332.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,022.50
|
| Rate for Payer: Cash Price |
$1,937.50
|
| Rate for Payer: Cigna Commercial |
$3,216.25
|
| Rate for Payer: First Health Commercial |
$3,681.25
|
| Rate for Payer: Humana Commercial |
$3,293.75
|
| Rate for Payer: Humana KY Medicaid |
$1,332.61
|
| Rate for Payer: Kentucky WC Medicaid |
$1,346.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,177.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,859.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,162.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,359.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,410.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,906.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,371.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,673.75
|
| Rate for Payer: PHCS Commercial |
$3,720.00
|
| Rate for Payer: United Healthcare All Payer |
$3,410.00
|
|
|
HIGH OSM CONT 1ML GASTROVIEW
|
Facility
|
IP
|
$0.46
|
|
|
Service Code
|
HCPCS Q9963
|
| Hospital Charge Code |
25003650
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.14 |
| 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 |
$0.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.32
|
| Rate for Payer: PHCS Commercial |
$0.44
|
| Rate for Payer: United Healthcare All Payer |
$0.40
|
|
|
HIGH OSM CONT 1ML GASTROVIEW
|
Facility
|
OP
|
$0.46
|
|
|
Service Code
|
HCPCS Q9963
|
| Hospital Charge Code |
25003650
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.14 |
| 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 |
$0.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.32
|
| Rate for Payer: PHCS Commercial |
$0.44
|
| Rate for Payer: United Healthcare All Payer |
$0.40
|
|
|
HII 10H CLAMP
|
Facility
|
IP
|
$5,063.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,518.90 |
| Max. Negotiated Rate |
$4,860.48 |
| Rate for Payer: Aetna Commercial |
$3,898.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,949.14
|
| Rate for Payer: Cash Price |
$2,531.50
|
| Rate for Payer: Cigna Commercial |
$4,202.29
|
| Rate for Payer: First Health Commercial |
$4,809.85
|
| Rate for Payer: Humana Commercial |
$4,303.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,151.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,736.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,518.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,455.44
|
| Rate for Payer: Ohio Health Group HMO |
$3,797.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,050.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,404.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,493.47
|
| Rate for Payer: PHCS Commercial |
$4,860.48
|
| Rate for Payer: United Healthcare All Payer |
$4,455.44
|
|
|
HII 10H CLAMP
|
Facility
|
OP
|
$5,063.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,518.90 |
| Max. Negotiated Rate |
$4,860.48 |
| Rate for Payer: Aetna Commercial |
$3,898.51
|
| Rate for Payer: Anthem Medicaid |
$1,741.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,949.14
|
| Rate for Payer: Cash Price |
$2,531.50
|
| Rate for Payer: Cigna Commercial |
$4,202.29
|
| Rate for Payer: First Health Commercial |
$4,809.85
|
| Rate for Payer: Humana Commercial |
$4,303.55
|
| Rate for Payer: Humana KY Medicaid |
$1,741.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,758.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,151.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,736.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,518.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,776.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,455.44
|
| Rate for Payer: Ohio Health Group HMO |
$3,797.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,050.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,404.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,493.47
|
| Rate for Payer: PHCS Commercial |
$4,860.48
|
| Rate for Payer: United Healthcare All Payer |
$4,455.44
|
|
|
HII ALUM CONNECTING ROD 8*65MM
|
Facility
|
IP
|
$1,166.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$349.80 |
| Max. Negotiated Rate |
$1,119.36 |
| Rate for Payer: Aetna Commercial |
$897.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$909.48
|
| Rate for Payer: Cash Price |
$583.00
|
| Rate for Payer: Cigna Commercial |
$967.78
|
| Rate for Payer: First Health Commercial |
$1,107.70
|
| Rate for Payer: Humana Commercial |
$991.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$956.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$860.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$349.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,026.08
|
| Rate for Payer: Ohio Health Group HMO |
$874.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$932.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,014.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$804.54
|
| Rate for Payer: PHCS Commercial |
$1,119.36
|
| Rate for Payer: United Healthcare All Payer |
$1,026.08
|
|
|
HII ALUM CONNECTING ROD 8*65MM
|
Facility
|
OP
|
$1,166.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$349.80 |
| Max. Negotiated Rate |
$1,119.36 |
| Rate for Payer: Aetna Commercial |
$897.82
|
| Rate for Payer: Anthem Medicaid |
$400.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$909.48
|
| Rate for Payer: Cash Price |
$583.00
|
| Rate for Payer: Cigna Commercial |
$967.78
|
| Rate for Payer: First Health Commercial |
$1,107.70
|
| Rate for Payer: Humana Commercial |
$991.10
|
| Rate for Payer: Humana KY Medicaid |
$400.99
|
| Rate for Payer: Kentucky WC Medicaid |
$405.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$956.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$860.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$349.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$409.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,026.08
|
| Rate for Payer: Ohio Health Group HMO |
$874.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$932.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,014.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$804.54
|
| Rate for Payer: PHCS Commercial |
$1,119.36
|
| Rate for Payer: United Healthcare All Payer |
$1,026.08
|
|
|
HII ALUM CONNECTNG ROD 8*100MM
|
Facility
|
OP
|
$1,166.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$349.80 |
| Max. Negotiated Rate |
$1,119.36 |
| Rate for Payer: Aetna Commercial |
$897.82
|
| Rate for Payer: Anthem Medicaid |
$400.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$909.48
|
| Rate for Payer: Cash Price |
$583.00
|
| Rate for Payer: Cigna Commercial |
$967.78
|
| Rate for Payer: First Health Commercial |
$1,107.70
|
| Rate for Payer: Humana Commercial |
$991.10
|
| Rate for Payer: Humana KY Medicaid |
$400.99
|
| Rate for Payer: Kentucky WC Medicaid |
$405.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$956.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$860.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$349.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$409.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,026.08
|
| Rate for Payer: Ohio Health Group HMO |
$874.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$932.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,014.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$804.54
|
| Rate for Payer: PHCS Commercial |
$1,119.36
|
| Rate for Payer: United Healthcare All Payer |
$1,026.08
|
|
|
HII ALUM CONNECTNG ROD 8*100MM
|
Facility
|
IP
|
$1,166.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$349.80 |
| Max. Negotiated Rate |
$1,119.36 |
| Rate for Payer: Aetna Commercial |
$897.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$909.48
|
| Rate for Payer: Cash Price |
$583.00
|
| Rate for Payer: Cigna Commercial |
$967.78
|
| Rate for Payer: First Health Commercial |
$1,107.70
|
| Rate for Payer: Humana Commercial |
$991.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$956.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$860.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$349.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,026.08
|
| Rate for Payer: Ohio Health Group HMO |
$874.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$932.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,014.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$804.54
|
| Rate for Payer: PHCS Commercial |
$1,119.36
|
| Rate for Payer: United Healthcare All Payer |
$1,026.08
|
|
|
HII ALUM CONNECTNG ROD 8*150MM
|
Facility
|
OP
|
$1,166.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$349.80 |
| Max. Negotiated Rate |
$1,119.36 |
| Rate for Payer: Aetna Commercial |
$897.82
|
| Rate for Payer: Anthem Medicaid |
$400.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$909.48
|
| Rate for Payer: Cash Price |
$583.00
|
| Rate for Payer: Cigna Commercial |
$967.78
|
| Rate for Payer: First Health Commercial |
$1,107.70
|
| Rate for Payer: Humana Commercial |
$991.10
|
| Rate for Payer: Humana KY Medicaid |
$400.99
|
| Rate for Payer: Kentucky WC Medicaid |
$405.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$956.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$860.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$349.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$409.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,026.08
|
| Rate for Payer: Ohio Health Group HMO |
$874.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$932.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,014.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$804.54
|
| Rate for Payer: PHCS Commercial |
$1,119.36
|
| Rate for Payer: United Healthcare All Payer |
$1,026.08
|
|
|
HII ALUM CONNECTNG ROD 8*150MM
|
Facility
|
IP
|
$1,166.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$349.80 |
| Max. Negotiated Rate |
$1,119.36 |
| Rate for Payer: Aetna Commercial |
$897.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$909.48
|
| Rate for Payer: Cash Price |
$583.00
|
| Rate for Payer: Cigna Commercial |
$967.78
|
| Rate for Payer: First Health Commercial |
$1,107.70
|
| Rate for Payer: Humana Commercial |
$991.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$956.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$860.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$349.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,026.08
|
| Rate for Payer: Ohio Health Group HMO |
$874.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$932.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,014.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$804.54
|
| Rate for Payer: PHCS Commercial |
$1,119.36
|
| Rate for Payer: United Healthcare All Payer |
$1,026.08
|
|
|
HII ALUM CONNECTNG ROD 8*200MM
|
Facility
|
IP
|
$1,190.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$357.00 |
| Max. Negotiated Rate |
$1,142.40 |
| Rate for Payer: Aetna Commercial |
$916.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$928.20
|
| Rate for Payer: Cash Price |
$595.00
|
| Rate for Payer: Cigna Commercial |
$987.70
|
| Rate for Payer: First Health Commercial |
$1,130.50
|
| Rate for Payer: Humana Commercial |
$1,011.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$975.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$878.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$357.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,047.20
|
| Rate for Payer: Ohio Health Group HMO |
$892.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$952.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,035.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$821.10
|
| Rate for Payer: PHCS Commercial |
$1,142.40
|
| Rate for Payer: United Healthcare All Payer |
$1,047.20
|
|
|
HII ALUM CONNECTNG ROD 8*200MM
|
Facility
|
OP
|
$1,190.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$357.00 |
| Max. Negotiated Rate |
$1,142.40 |
| Rate for Payer: Aetna Commercial |
$916.30
|
| Rate for Payer: Anthem Medicaid |
$409.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$928.20
|
| Rate for Payer: Cash Price |
$595.00
|
| Rate for Payer: Cigna Commercial |
$987.70
|
| Rate for Payer: First Health Commercial |
$1,130.50
|
| Rate for Payer: Humana Commercial |
$1,011.50
|
| Rate for Payer: Humana KY Medicaid |
$409.24
|
| Rate for Payer: Kentucky WC Medicaid |
$413.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$975.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$878.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$357.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$417.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,047.20
|
| Rate for Payer: Ohio Health Group HMO |
$892.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$952.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,035.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$821.10
|
| Rate for Payer: PHCS Commercial |
$1,142.40
|
| Rate for Payer: United Healthcare All Payer |
$1,047.20
|
|
|
HII ALUM CONNECTNG ROD 8*300MM
|
Facility
|
OP
|
$1,190.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$357.00 |
| Max. Negotiated Rate |
$1,142.40 |
| Rate for Payer: Aetna Commercial |
$916.30
|
| Rate for Payer: Anthem Medicaid |
$409.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$928.20
|
| Rate for Payer: Cash Price |
$595.00
|
| Rate for Payer: Cigna Commercial |
$987.70
|
| Rate for Payer: First Health Commercial |
$1,130.50
|
| Rate for Payer: Humana Commercial |
$1,011.50
|
| Rate for Payer: Humana KY Medicaid |
$409.24
|
| Rate for Payer: Kentucky WC Medicaid |
$413.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$975.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$878.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$357.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$417.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,047.20
|
| Rate for Payer: Ohio Health Group HMO |
$892.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$952.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,035.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$821.10
|
| Rate for Payer: PHCS Commercial |
$1,142.40
|
| Rate for Payer: United Healthcare All Payer |
$1,047.20
|
|
|
HII ALUM CONNECTNG ROD 8*300MM
|
Facility
|
IP
|
$1,190.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$357.00 |
| Max. Negotiated Rate |
$1,142.40 |
| Rate for Payer: Aetna Commercial |
$916.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$928.20
|
| Rate for Payer: Cash Price |
$595.00
|
| Rate for Payer: Cigna Commercial |
$987.70
|
| Rate for Payer: First Health Commercial |
$1,130.50
|
| Rate for Payer: Humana Commercial |
$1,011.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$975.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$878.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$357.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,047.20
|
| Rate for Payer: Ohio Health Group HMO |
$892.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$952.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,035.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$821.10
|
| Rate for Payer: PHCS Commercial |
$1,142.40
|
| Rate for Payer: United Healthcare All Payer |
$1,047.20
|
|
