|
4FR. PIGTAIL 90CM
|
Facility
|
OP
|
$830.83
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$249.25 |
| Max. Negotiated Rate |
$797.60 |
| Rate for Payer: Aetna Commercial |
$639.74
|
| Rate for Payer: Anthem Medicaid |
$285.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$648.05
|
| Rate for Payer: Cash Price |
$415.42
|
| Rate for Payer: Cigna Commercial |
$689.59
|
| Rate for Payer: First Health Commercial |
$789.29
|
| Rate for Payer: Humana Commercial |
$706.21
|
| Rate for Payer: Humana KY Medicaid |
$285.72
|
| Rate for Payer: Kentucky WC Medicaid |
$288.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$681.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$613.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$249.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$291.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$731.13
|
| Rate for Payer: Ohio Health Group HMO |
$623.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$664.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$722.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$573.27
|
| Rate for Payer: PHCS Commercial |
$797.60
|
| Rate for Payer: United Healthcare All Payer |
$731.13
|
|
|
4FR. PIGTAIL 90CM
|
Facility
|
IP
|
$830.83
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$249.25 |
| Max. Negotiated Rate |
$797.60 |
| Rate for Payer: Aetna Commercial |
$639.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$648.05
|
| Rate for Payer: Cash Price |
$415.42
|
| Rate for Payer: Cigna Commercial |
$689.59
|
| Rate for Payer: First Health Commercial |
$789.29
|
| Rate for Payer: Humana Commercial |
$706.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$681.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$613.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$249.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$731.13
|
| Rate for Payer: Ohio Health Group HMO |
$623.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$664.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$722.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$573.27
|
| Rate for Payer: PHCS Commercial |
$797.60
|
| Rate for Payer: United Healthcare All Payer |
$731.13
|
|
|
4FR SINGLE BIOFLO PICC
|
Facility
|
OP
|
$1,684.56
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$505.37 |
| Max. Negotiated Rate |
$1,617.18 |
| Rate for Payer: Aetna Commercial |
$1,297.11
|
| Rate for Payer: Anthem Medicaid |
$579.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,313.96
|
| Rate for Payer: Cash Price |
$842.28
|
| Rate for Payer: Cigna Commercial |
$1,398.18
|
| Rate for Payer: First Health Commercial |
$1,600.33
|
| Rate for Payer: Humana Commercial |
$1,431.88
|
| Rate for Payer: Humana KY Medicaid |
$579.32
|
| Rate for Payer: Kentucky WC Medicaid |
$585.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,381.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,243.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$505.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$590.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,482.41
|
| Rate for Payer: Ohio Health Group HMO |
$1,263.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,347.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,465.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,162.35
|
| Rate for Payer: PHCS Commercial |
$1,617.18
|
| Rate for Payer: United Healthcare All Payer |
$1,482.41
|
|
|
4FR SINGLE BIOFLO PICC
|
Facility
|
IP
|
$1,684.56
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$505.37 |
| Max. Negotiated Rate |
$1,617.18 |
| Rate for Payer: Aetna Commercial |
$1,297.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,313.96
|
| Rate for Payer: Cash Price |
$842.28
|
| Rate for Payer: Cigna Commercial |
$1,398.18
|
| Rate for Payer: First Health Commercial |
$1,600.33
|
| Rate for Payer: Humana Commercial |
$1,431.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,381.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,243.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$505.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,482.41
|
| Rate for Payer: Ohio Health Group HMO |
$1,263.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,347.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,465.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,162.35
|
| Rate for Payer: PHCS Commercial |
$1,617.18
|
| Rate for Payer: United Healthcare All Payer |
$1,482.41
|
|
|
5.0M SCREW
|
Facility
|
IP
|
$2,003.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$600.90 |
| Max. Negotiated Rate |
$1,922.88 |
| Rate for Payer: Aetna Commercial |
$1,542.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,562.34
|
| Rate for Payer: Cash Price |
$1,001.50
|
| Rate for Payer: Cigna Commercial |
$1,662.49
|
| Rate for Payer: First Health Commercial |
$1,902.85
|
| Rate for Payer: Humana Commercial |
$1,702.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,642.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,478.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,762.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,502.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,602.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,742.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,382.07
|
| Rate for Payer: PHCS Commercial |
$1,922.88
|
| Rate for Payer: United Healthcare All Payer |
$1,762.64
|
|
|
5.0M SCREW
|
Facility
|
OP
|
$2,003.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$600.90 |
| Max. Negotiated Rate |
$1,922.88 |
| Rate for Payer: Aetna Commercial |
$1,542.31
|
| Rate for Payer: Anthem Medicaid |
$688.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,562.34
|
| Rate for Payer: Cash Price |
$1,001.50
|
| Rate for Payer: Cigna Commercial |
$1,662.49
|
| Rate for Payer: First Health Commercial |
$1,902.85
|
| Rate for Payer: Humana Commercial |
$1,702.55
|
| Rate for Payer: Humana KY Medicaid |
$688.83
|
| Rate for Payer: Kentucky WC Medicaid |
$695.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,642.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,478.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$702.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,762.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,502.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,602.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,742.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,382.07
|
| Rate for Payer: PHCS Commercial |
$1,922.88
|
| Rate for Payer: United Healthcare All Payer |
$1,762.64
|
|
|
52MM GLNOD W/46MM SUFC KEEL
|
Facility
|
OP
|
$8,807.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,642.14 |
| Max. Negotiated Rate |
$8,454.86 |
| Rate for Payer: Aetna Commercial |
$6,781.51
|
| Rate for Payer: Anthem Medicaid |
$3,028.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,869.58
|
| Rate for Payer: Cash Price |
$4,403.58
|
| Rate for Payer: Cigna Commercial |
$7,309.93
|
| Rate for Payer: First Health Commercial |
$8,366.79
|
| Rate for Payer: Humana Commercial |
$7,486.08
|
| Rate for Payer: Humana KY Medicaid |
$3,028.78
|
| Rate for Payer: Kentucky WC Medicaid |
$3,059.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,221.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,499.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,642.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,089.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,750.29
|
| Rate for Payer: Ohio Health Group HMO |
$6,605.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,045.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,662.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,076.93
|
| Rate for Payer: PHCS Commercial |
$8,454.86
|
| Rate for Payer: United Healthcare All Payer |
$7,750.29
|
|
|
52MM GLNOD W/46MM SUFC KEEL
|
Facility
|
IP
|
$8,807.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,642.14 |
| Max. Negotiated Rate |
$8,454.86 |
| Rate for Payer: Aetna Commercial |
$6,781.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,869.58
|
| Rate for Payer: Cash Price |
$4,403.58
|
| Rate for Payer: Cigna Commercial |
$7,309.93
|
| Rate for Payer: First Health Commercial |
$8,366.79
|
| Rate for Payer: Humana Commercial |
$7,486.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,221.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,499.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,642.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,750.29
|
| Rate for Payer: Ohio Health Group HMO |
$6,605.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,045.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,662.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,076.93
|
| Rate for Payer: PHCS Commercial |
$8,454.86
|
| Rate for Payer: United Healthcare All Payer |
$7,750.29
|
|
|
52MM GLNOD W/56MM SUFC KEEL
|
Facility
|
IP
|
$8,807.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,642.14 |
| Max. Negotiated Rate |
$8,454.86 |
| Rate for Payer: Aetna Commercial |
$6,781.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,869.58
|
| Rate for Payer: Cash Price |
$4,403.58
|
| Rate for Payer: Cigna Commercial |
$7,309.93
|
| Rate for Payer: First Health Commercial |
$8,366.79
|
| Rate for Payer: Humana Commercial |
$7,486.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,221.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,499.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,642.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,750.29
|
| Rate for Payer: Ohio Health Group HMO |
$6,605.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,045.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,662.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,076.93
|
| Rate for Payer: PHCS Commercial |
$8,454.86
|
| Rate for Payer: United Healthcare All Payer |
$7,750.29
|
|
|
52MM GLNOD W/56MM SUFC KEEL
|
Facility
|
OP
|
$8,807.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,642.14 |
| Max. Negotiated Rate |
$8,454.86 |
| Rate for Payer: Aetna Commercial |
$6,781.51
|
| Rate for Payer: Anthem Medicaid |
$3,028.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,869.58
|
| Rate for Payer: Cash Price |
$4,403.58
|
| Rate for Payer: Cigna Commercial |
$7,309.93
|
| Rate for Payer: First Health Commercial |
$8,366.79
|
| Rate for Payer: Humana Commercial |
$7,486.08
|
| Rate for Payer: Humana KY Medicaid |
$3,028.78
|
| Rate for Payer: Kentucky WC Medicaid |
$3,059.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,221.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,499.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,642.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,089.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,750.29
|
| Rate for Payer: Ohio Health Group HMO |
$6,605.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,045.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,662.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,076.93
|
| Rate for Payer: PHCS Commercial |
$8,454.86
|
| Rate for Payer: United Healthcare All Payer |
$7,750.29
|
|
|
5 FR DUAL BIOFLO W/LONG WIRE
|
Facility
|
OP
|
$1,832.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$549.60 |
| Max. Negotiated Rate |
$1,758.72 |
| Rate for Payer: Aetna Commercial |
$1,410.64
|
| Rate for Payer: Anthem Medicaid |
$630.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,428.96
|
| Rate for Payer: Cash Price |
$916.00
|
| Rate for Payer: Cigna Commercial |
$1,520.56
|
| Rate for Payer: First Health Commercial |
$1,740.40
|
| Rate for Payer: Humana Commercial |
$1,557.20
|
| Rate for Payer: Humana KY Medicaid |
$630.02
|
| Rate for Payer: Kentucky WC Medicaid |
$636.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,502.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,352.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$549.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$642.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,612.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,374.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,465.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,593.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,264.08
|
| Rate for Payer: PHCS Commercial |
$1,758.72
|
| Rate for Payer: United Healthcare All Payer |
$1,612.16
|
|
|
5 FR DUAL BIOFLO W/LONG WIRE
|
Facility
|
IP
|
$1,832.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$549.60 |
| Max. Negotiated Rate |
$1,758.72 |
| Rate for Payer: Aetna Commercial |
$1,410.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,428.96
|
| Rate for Payer: Cash Price |
$916.00
|
| Rate for Payer: Cigna Commercial |
$1,520.56
|
| Rate for Payer: First Health Commercial |
$1,740.40
|
| Rate for Payer: Humana Commercial |
$1,557.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,502.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,352.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$549.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,612.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,374.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,465.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,593.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,264.08
|
| Rate for Payer: PHCS Commercial |
$1,758.72
|
| Rate for Payer: United Healthcare All Payer |
$1,612.16
|
|
|
5 FRENCH PIGTAIL 100CM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
5 FRENCH PIGTAIL 100CM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
5FR IM CATH 100CM
|
Facility
|
IP
|
$440.10
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$132.03 |
| Max. Negotiated Rate |
$422.50 |
| Rate for Payer: Aetna Commercial |
$338.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$343.28
|
| Rate for Payer: Cash Price |
$220.05
|
| Rate for Payer: Cigna Commercial |
$365.28
|
| Rate for Payer: First Health Commercial |
$418.10
|
| Rate for Payer: Humana Commercial |
$374.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$360.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$324.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$387.29
|
| Rate for Payer: Ohio Health Group HMO |
$330.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$352.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$382.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$303.67
|
| Rate for Payer: PHCS Commercial |
$422.50
|
| Rate for Payer: United Healthcare All Payer |
$387.29
|
|
|
5FR IM CATH 100CM
|
Facility
|
OP
|
$440.10
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$132.03 |
| Max. Negotiated Rate |
$422.50 |
| Rate for Payer: Aetna Commercial |
$338.88
|
| Rate for Payer: Anthem Medicaid |
$151.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$343.28
|
| Rate for Payer: Cash Price |
$220.05
|
| Rate for Payer: Cigna Commercial |
$365.28
|
| Rate for Payer: First Health Commercial |
$418.10
|
| Rate for Payer: Humana Commercial |
$374.08
|
| Rate for Payer: Humana KY Medicaid |
$151.35
|
| Rate for Payer: Kentucky WC Medicaid |
$152.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$360.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$324.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$154.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$387.29
|
| Rate for Payer: Ohio Health Group HMO |
$330.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$352.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$382.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$303.67
|
| Rate for Payer: PHCS Commercial |
$422.50
|
| Rate for Payer: United Healthcare All Payer |
$387.29
|
|
|
650 36MM RETENTVE POLY LNR+0MM
|
Facility
|
OP
|
$7,081.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,124.38 |
| Max. Negotiated Rate |
$6,798.00 |
| Rate for Payer: Aetna Commercial |
$5,452.56
|
| Rate for Payer: Anthem Medicaid |
$2,435.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,523.38
|
| Rate for Payer: Cash Price |
$3,540.62
|
| Rate for Payer: Cigna Commercial |
$5,877.44
|
| Rate for Payer: First Health Commercial |
$6,727.19
|
| Rate for Payer: Humana Commercial |
$6,019.06
|
| Rate for Payer: Humana KY Medicaid |
$2,435.24
|
| Rate for Payer: Kentucky WC Medicaid |
$2,460.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,806.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,225.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,124.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,484.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,231.50
|
| Rate for Payer: Ohio Health Group HMO |
$5,310.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,665.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,160.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,886.06
|
| Rate for Payer: PHCS Commercial |
$6,798.00
|
| Rate for Payer: United Healthcare All Payer |
$6,231.50
|
|
|
650 36MM RETENTVE POLY LNR+0MM
|
Facility
|
IP
|
$7,081.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,124.38 |
| Max. Negotiated Rate |
$6,798.00 |
| Rate for Payer: Aetna Commercial |
$5,452.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,523.38
|
| Rate for Payer: Cash Price |
$3,540.62
|
| Rate for Payer: Cigna Commercial |
$5,877.44
|
| Rate for Payer: First Health Commercial |
$6,727.19
|
| Rate for Payer: Humana Commercial |
$6,019.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,806.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,225.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,124.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,231.50
|
| Rate for Payer: Ohio Health Group HMO |
$5,310.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,665.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,160.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,886.06
|
| Rate for Payer: PHCS Commercial |
$6,798.00
|
| Rate for Payer: United Healthcare All Payer |
$6,231.50
|
|
|
650 36MM RETENTVE POLY LNR+3MM
|
Facility
|
OP
|
$7,081.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,124.38 |
| Max. Negotiated Rate |
$6,798.00 |
| Rate for Payer: Aetna Commercial |
$5,452.56
|
| Rate for Payer: Anthem Medicaid |
$2,435.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,523.38
|
| Rate for Payer: Cash Price |
$3,540.62
|
| Rate for Payer: Cigna Commercial |
$5,877.44
|
| Rate for Payer: First Health Commercial |
$6,727.19
|
| Rate for Payer: Humana Commercial |
$6,019.06
|
| Rate for Payer: Humana KY Medicaid |
$2,435.24
|
| Rate for Payer: Kentucky WC Medicaid |
$2,460.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,806.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,225.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,124.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,484.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,231.50
|
| Rate for Payer: Ohio Health Group HMO |
$5,310.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,665.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,160.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,886.06
|
| Rate for Payer: PHCS Commercial |
$6,798.00
|
| Rate for Payer: United Healthcare All Payer |
$6,231.50
|
|
|
650 36MM RETENTVE POLY LNR+3MM
|
Facility
|
IP
|
$7,081.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,124.38 |
| Max. Negotiated Rate |
$6,798.00 |
| Rate for Payer: Aetna Commercial |
$5,452.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,523.38
|
| Rate for Payer: Cash Price |
$3,540.62
|
| Rate for Payer: Cigna Commercial |
$5,877.44
|
| Rate for Payer: First Health Commercial |
$6,727.19
|
| Rate for Payer: Humana Commercial |
$6,019.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,806.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,225.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,124.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,231.50
|
| Rate for Payer: Ohio Health Group HMO |
$5,310.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,665.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,160.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,886.06
|
| Rate for Payer: PHCS Commercial |
$6,798.00
|
| Rate for Payer: United Healthcare All Payer |
$6,231.50
|
|
|
650 36MM RETENTVE POLY LNR+6MM
|
Facility
|
IP
|
$7,081.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,124.38 |
| Max. Negotiated Rate |
$6,798.00 |
| Rate for Payer: Aetna Commercial |
$5,452.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,523.38
|
| Rate for Payer: Cash Price |
$3,540.62
|
| Rate for Payer: Cigna Commercial |
$5,877.44
|
| Rate for Payer: First Health Commercial |
$6,727.19
|
| Rate for Payer: Humana Commercial |
$6,019.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,806.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,225.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,124.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,231.50
|
| Rate for Payer: Ohio Health Group HMO |
$5,310.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,665.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,160.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,886.06
|
| Rate for Payer: PHCS Commercial |
$6,798.00
|
| Rate for Payer: United Healthcare All Payer |
$6,231.50
|
|
|
650 36MM RETENTVE POLY LNR+6MM
|
Facility
|
OP
|
$7,081.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,124.38 |
| Max. Negotiated Rate |
$6,798.00 |
| Rate for Payer: Aetna Commercial |
$5,452.56
|
| Rate for Payer: Anthem Medicaid |
$2,435.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,523.38
|
| Rate for Payer: Cash Price |
$3,540.62
|
| Rate for Payer: Cigna Commercial |
$5,877.44
|
| Rate for Payer: First Health Commercial |
$6,727.19
|
| Rate for Payer: Humana Commercial |
$6,019.06
|
| Rate for Payer: Humana KY Medicaid |
$2,435.24
|
| Rate for Payer: Kentucky WC Medicaid |
$2,460.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,806.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,225.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,124.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,484.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,231.50
|
| Rate for Payer: Ohio Health Group HMO |
$5,310.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,665.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,160.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,886.06
|
| Rate for Payer: PHCS Commercial |
$6,798.00
|
| Rate for Payer: United Healthcare All Payer |
$6,231.50
|
|
|
650 40MM RETENTVE POLY LNR+0MM
|
Facility
|
OP
|
$7,081.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,124.38 |
| Max. Negotiated Rate |
$6,798.00 |
| Rate for Payer: Aetna Commercial |
$5,452.56
|
| Rate for Payer: Anthem Medicaid |
$2,435.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,523.38
|
| Rate for Payer: Cash Price |
$3,540.62
|
| Rate for Payer: Cigna Commercial |
$5,877.44
|
| Rate for Payer: First Health Commercial |
$6,727.19
|
| Rate for Payer: Humana Commercial |
$6,019.06
|
| Rate for Payer: Humana KY Medicaid |
$2,435.24
|
| Rate for Payer: Kentucky WC Medicaid |
$2,460.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,806.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,225.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,124.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,484.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,231.50
|
| Rate for Payer: Ohio Health Group HMO |
$5,310.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,665.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,160.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,886.06
|
| Rate for Payer: PHCS Commercial |
$6,798.00
|
| Rate for Payer: United Healthcare All Payer |
$6,231.50
|
|
|
650 40MM RETENTVE POLY LNR+0MM
|
Facility
|
IP
|
$7,081.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,124.38 |
| Max. Negotiated Rate |
$6,798.00 |
| Rate for Payer: Aetna Commercial |
$5,452.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,523.38
|
| Rate for Payer: Cash Price |
$3,540.62
|
| Rate for Payer: Cigna Commercial |
$5,877.44
|
| Rate for Payer: First Health Commercial |
$6,727.19
|
| Rate for Payer: Humana Commercial |
$6,019.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,806.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,225.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,124.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,231.50
|
| Rate for Payer: Ohio Health Group HMO |
$5,310.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,665.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,160.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,886.06
|
| Rate for Payer: PHCS Commercial |
$6,798.00
|
| Rate for Payer: United Healthcare All Payer |
$6,231.50
|
|
|
650 40MM RETENTVE POLY LNR+3MM
|
Facility
|
OP
|
$7,081.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,124.38 |
| Max. Negotiated Rate |
$6,798.00 |
| Rate for Payer: Aetna Commercial |
$5,452.56
|
| Rate for Payer: Anthem Medicaid |
$2,435.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,523.38
|
| Rate for Payer: Cash Price |
$3,540.62
|
| Rate for Payer: Cigna Commercial |
$5,877.44
|
| Rate for Payer: First Health Commercial |
$6,727.19
|
| Rate for Payer: Humana Commercial |
$6,019.06
|
| Rate for Payer: Humana KY Medicaid |
$2,435.24
|
| Rate for Payer: Kentucky WC Medicaid |
$2,460.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,806.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,225.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,124.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,484.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,231.50
|
| Rate for Payer: Ohio Health Group HMO |
$5,310.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,665.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,160.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,886.06
|
| Rate for Payer: PHCS Commercial |
$6,798.00
|
| Rate for Payer: United Healthcare All Payer |
$6,231.50
|
|
