|
K FLOW/FUNCT IMAGE W/O DRUG
|
Professional
|
Both
|
$1,306.00
|
|
|
Service Code
|
HCPCS 78707
|
| Hospital Charge Code |
34000030
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$52.98 |
| Max. Negotiated Rate |
$783.60 |
| Rate for Payer: Aetna Commercial |
$358.82
|
| Rate for Payer: Ambetter Exchange |
$190.79
|
| Rate for Payer: Anthem Medicaid |
$161.13
|
| Rate for Payer: Buckeye Individual/Medicaid |
$190.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$190.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$228.95
|
| Rate for Payer: Cash Price |
$653.00
|
| Rate for Payer: Cash Price |
$653.00
|
| Rate for Payer: Cigna Commercial |
$335.19
|
| Rate for Payer: Healthspan PPO |
$358.64
|
| Rate for Payer: Humana Medicaid |
$161.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$52.98
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$190.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.79
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$164.35
|
| Rate for Payer: Molina Healthcare Passport |
$161.13
|
| Rate for Payer: Multiplan PHCS |
$783.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$248.03
|
| Rate for Payer: UHCCP Medicaid |
$457.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$162.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$190.79
|
|
|
K FLOW/FUNCT IMAGE W/O DRUG
|
Facility
|
IP
|
$1,306.00
|
|
|
Service Code
|
HCPCS 78707
|
| Hospital Charge Code |
34000030
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$391.80 |
| Max. Negotiated Rate |
$1,253.76 |
| Rate for Payer: Aetna Commercial |
$1,005.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,018.68
|
| Rate for Payer: Cash Price |
$653.00
|
| Rate for Payer: Cigna Commercial |
$1,083.98
|
| Rate for Payer: First Health Commercial |
$1,240.70
|
| Rate for Payer: Humana Commercial |
$1,110.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,070.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$963.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$391.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,149.28
|
| Rate for Payer: Ohio Health Group HMO |
$979.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,044.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,136.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$901.14
|
| Rate for Payer: PHCS Commercial |
$1,253.76
|
| Rate for Payer: United Healthcare All Payer |
$1,149.28
|
|
|
K FLOW/FUNCT IMAGE W/O DRUG(P
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 78707
|
| Hospital Charge Code |
340P0030
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$52.98 |
| Max. Negotiated Rate |
$358.82 |
| Rate for Payer: Aetna Commercial |
$358.82
|
| Rate for Payer: Ambetter Exchange |
$190.79
|
| Rate for Payer: Anthem Medicaid |
$161.13
|
| Rate for Payer: Buckeye Individual/Medicaid |
$190.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$190.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$228.95
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$335.19
|
| Rate for Payer: Healthspan PPO |
$358.64
|
| Rate for Payer: Humana Medicaid |
$161.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$52.98
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$190.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.79
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$164.35
|
| Rate for Payer: Molina Healthcare Passport |
$161.13
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$248.03
|
| Rate for Payer: UHCCP Medicaid |
$61.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$162.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$190.79
|
|
|
K FLOW/FUNCT IMAGE W/O DRUG(T
|
Facility
|
IP
|
$1,131.00
|
|
|
Service Code
|
HCPCS 78707
|
| Hospital Charge Code |
340T0030
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$339.30 |
| Max. Negotiated Rate |
$1,085.76 |
| Rate for Payer: Aetna Commercial |
$870.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$882.18
|
| Rate for Payer: Cash Price |
$565.50
|
| Rate for Payer: Cigna Commercial |
$938.73
|
| Rate for Payer: First Health Commercial |
$1,074.45
|
| Rate for Payer: Humana Commercial |
$961.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$927.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$834.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$339.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$995.28
|
| Rate for Payer: Ohio Health Group HMO |
$848.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$904.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$983.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$780.39
|
| Rate for Payer: PHCS Commercial |
$1,085.76
|
| Rate for Payer: United Healthcare All Payer |
$995.28
|
|
|
K FLOW/FUNCT IMAGE W/O DRUG(T
|
Facility
|
OP
|
$1,131.00
|
|
|
Service Code
|
HCPCS 78707
|
| Hospital Charge Code |
340T0030
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$388.95 |
| Max. Negotiated Rate |
$1,085.76 |
| Rate for Payer: Aetna Commercial |
$870.87
|
| Rate for Payer: Anthem Medicaid |
$388.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$497.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$882.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$696.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$671.42
|
| Rate for Payer: Cash Price |
$565.50
|
| Rate for Payer: Cash Price |
$565.50
|
| Rate for Payer: Cigna Commercial |
$938.73
|
| Rate for Payer: First Health Commercial |
$1,074.45
|
| Rate for Payer: Humana Commercial |
$961.35
|
| Rate for Payer: Humana KY Medicaid |
$388.95
|
| Rate for Payer: Humana Medicare Advantage |
$497.35
|
| Rate for Payer: Kentucky WC Medicaid |
$392.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$927.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$834.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$596.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$396.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$995.28
|
| Rate for Payer: Ohio Health Group HMO |
$848.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$904.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$983.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$780.39
|
| Rate for Payer: PHCS Commercial |
$1,085.76
|
| Rate for Payer: United Healthcare All Payer |
$995.28
|
|
|
KIMYRSA 10mg (1,200mg SDV)
|
Facility
|
IP
|
$29,086.00
|
|
|
Service Code
|
HCPCS J2406
|
| Hospital Charge Code |
25004312
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8,725.80 |
| Max. Negotiated Rate |
$27,922.56 |
| Rate for Payer: Aetna Commercial |
$22,396.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,687.08
|
| Rate for Payer: Cash Price |
$14,543.00
|
| Rate for Payer: Cigna Commercial |
$24,141.38
|
| Rate for Payer: First Health Commercial |
$27,631.70
|
| Rate for Payer: Humana Commercial |
$24,723.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,850.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,465.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,725.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,595.68
|
| Rate for Payer: Ohio Health Group HMO |
$21,814.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,268.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,304.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,069.34
|
| Rate for Payer: PHCS Commercial |
$27,922.56
|
| Rate for Payer: United Healthcare All Payer |
$25,595.68
|
|
|
KIMYRSA 10mg (1,200mg SDV)
|
Facility
|
OP
|
$29,086.00
|
|
|
Service Code
|
HCPCS J2406
|
| Hospital Charge Code |
25004312
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.40 |
| Max. Negotiated Rate |
$27,922.56 |
| Rate for Payer: Aetna Commercial |
$22,396.22
|
| Rate for Payer: Anthem Medicaid |
$10,002.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$41.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,687.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$57.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$55.89
|
| Rate for Payer: Cash Price |
$14,543.00
|
| Rate for Payer: Cash Price |
$14,543.00
|
| Rate for Payer: Cigna Commercial |
$24,141.38
|
| Rate for Payer: First Health Commercial |
$27,631.70
|
| Rate for Payer: Humana Commercial |
$24,723.10
|
| Rate for Payer: Humana KY Medicaid |
$10,002.68
|
| Rate for Payer: Humana Medicare Advantage |
$41.40
|
| Rate for Payer: Kentucky WC Medicaid |
$10,104.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,850.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,465.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,203.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,595.68
|
| Rate for Payer: Ohio Health Group HMO |
$21,814.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,268.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,304.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,069.34
|
| Rate for Payer: PHCS Commercial |
$27,922.56
|
| Rate for Payer: United Healthcare All Payer |
$25,595.68
|
|
|
KINEVAC (SINCALIDE) 5 MCG INJ
|
Facility
|
OP
|
$558.46
|
|
|
Service Code
|
HCPCS J2805
|
| Hospital Charge Code |
25002356
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$167.54 |
| Max. Negotiated Rate |
$536.12 |
| Rate for Payer: Aetna Commercial |
$430.01
|
| Rate for Payer: Anthem Medicaid |
$192.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$435.60
|
| Rate for Payer: Cash Price |
$279.23
|
| Rate for Payer: Cigna Commercial |
$463.52
|
| Rate for Payer: First Health Commercial |
$530.54
|
| Rate for Payer: Humana Commercial |
$474.69
|
| Rate for Payer: Humana KY Medicaid |
$192.05
|
| Rate for Payer: Kentucky WC Medicaid |
$194.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$457.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$412.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$167.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$195.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$491.44
|
| Rate for Payer: Ohio Health Group HMO |
$418.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$446.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$485.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$385.34
|
| Rate for Payer: PHCS Commercial |
$536.12
|
| Rate for Payer: United Healthcare All Payer |
$491.44
|
|
|
KINEVAC (SINCALIDE) 5 MCG INJ
|
Facility
|
IP
|
$558.46
|
|
|
Service Code
|
HCPCS J2805
|
| Hospital Charge Code |
25002356
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$167.54 |
| Max. Negotiated Rate |
$536.12 |
| Rate for Payer: Aetna Commercial |
$430.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$435.60
|
| Rate for Payer: Cash Price |
$279.23
|
| Rate for Payer: Cigna Commercial |
$463.52
|
| Rate for Payer: First Health Commercial |
$530.54
|
| Rate for Payer: Humana Commercial |
$474.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$457.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$412.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$167.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$491.44
|
| Rate for Payer: Ohio Health Group HMO |
$418.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$446.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$485.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$385.34
|
| Rate for Payer: PHCS Commercial |
$536.12
|
| Rate for Payer: United Healthcare All Payer |
$491.44
|
|
|
KIT ASCITE SHUNT PERC ACC 15.5
|
Facility
|
OP
|
$22,178.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,653.62 |
| Max. Negotiated Rate |
$21,291.60 |
| Rate for Payer: Aetna Commercial |
$17,077.64
|
| Rate for Payer: Anthem Medicaid |
$7,627.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,299.42
|
| Rate for Payer: Cash Price |
$11,089.38
|
| Rate for Payer: Cigna Commercial |
$18,408.36
|
| Rate for Payer: First Health Commercial |
$21,069.81
|
| Rate for Payer: Humana Commercial |
$18,851.94
|
| Rate for Payer: Humana KY Medicaid |
$7,627.27
|
| Rate for Payer: Kentucky WC Medicaid |
$7,704.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,186.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,367.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,653.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,780.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,517.30
|
| Rate for Payer: Ohio Health Group HMO |
$16,634.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,743.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,295.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,303.34
|
| Rate for Payer: PHCS Commercial |
$21,291.60
|
| Rate for Payer: United Healthcare All Payer |
$19,517.30
|
|
|
KIT ASCITE SHUNT PERC ACC 15.5
|
Facility
|
IP
|
$22,178.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,653.62 |
| Max. Negotiated Rate |
$21,291.60 |
| Rate for Payer: Aetna Commercial |
$17,077.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,299.42
|
| Rate for Payer: Cash Price |
$11,089.38
|
| Rate for Payer: Cigna Commercial |
$18,408.36
|
| Rate for Payer: First Health Commercial |
$21,069.81
|
| Rate for Payer: Humana Commercial |
$18,851.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,186.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,367.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,653.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,517.30
|
| Rate for Payer: Ohio Health Group HMO |
$16,634.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,743.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,295.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,303.34
|
| Rate for Payer: PHCS Commercial |
$21,291.60
|
| Rate for Payer: United Healthcare All Payer |
$19,517.30
|
|
|
KIT BIO PREP BONE
|
Facility
|
IP
|
$1,721.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$516.38 |
| Max. Negotiated Rate |
$1,652.41 |
| Rate for Payer: Aetna Commercial |
$1,325.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,342.58
|
| Rate for Payer: Cash Price |
$860.63
|
| Rate for Payer: Cigna Commercial |
$1,428.65
|
| Rate for Payer: First Health Commercial |
$1,635.20
|
| Rate for Payer: Humana Commercial |
$1,463.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,411.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,270.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$516.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,514.71
|
| Rate for Payer: Ohio Health Group HMO |
$1,290.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,377.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,497.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,187.67
|
| Rate for Payer: PHCS Commercial |
$1,652.41
|
| Rate for Payer: United Healthcare All Payer |
$1,514.71
|
|
|
KIT BIO PREP BONE
|
Facility
|
OP
|
$1,721.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$516.38 |
| Max. Negotiated Rate |
$1,652.41 |
| Rate for Payer: Aetna Commercial |
$1,325.37
|
| Rate for Payer: Anthem Medicaid |
$591.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,342.58
|
| Rate for Payer: Cash Price |
$860.63
|
| Rate for Payer: Cigna Commercial |
$1,428.65
|
| Rate for Payer: First Health Commercial |
$1,635.20
|
| Rate for Payer: Humana Commercial |
$1,463.07
|
| Rate for Payer: Humana KY Medicaid |
$591.94
|
| Rate for Payer: Kentucky WC Medicaid |
$597.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,411.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,270.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$516.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$603.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,514.71
|
| Rate for Payer: Ohio Health Group HMO |
$1,290.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,377.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,497.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,187.67
|
| Rate for Payer: PHCS Commercial |
$1,652.41
|
| Rate for Payer: United Healthcare All Payer |
$1,514.71
|
|
|
KIT BIOPRO IMPLANT
|
Facility
|
OP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem Medicaid |
$2,914.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Humana KY Medicaid |
$2,914.55
|
| Rate for Payer: Kentucky WC Medicaid |
$2,944.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,973.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
|
KIT BIOPRO IMPLANT
|
Facility
|
IP
|
$8,475.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,542.50 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$6,525.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,610.50
|
| Rate for Payer: Cash Price |
$4,237.50
|
| Rate for Payer: Cigna Commercial |
$7,034.25
|
| Rate for Payer: First Health Commercial |
$8,051.25
|
| Rate for Payer: Humana Commercial |
$7,203.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,949.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,254.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,542.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,458.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,780.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,373.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,847.75
|
| Rate for Payer: PHCS Commercial |
$8,136.00
|
| Rate for Payer: United Healthcare All Payer |
$7,458.00
|
|
|
KIT PERC SHEATH INTRO 8.5FR
|
Facility
|
IP
|
$849.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$254.70 |
| Max. Negotiated Rate |
$815.04 |
| Rate for Payer: Aetna Commercial |
$653.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$662.22
|
| Rate for Payer: Cash Price |
$424.50
|
| Rate for Payer: Cigna Commercial |
$704.67
|
| Rate for Payer: First Health Commercial |
$806.55
|
| Rate for Payer: Humana Commercial |
$721.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$696.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$626.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$747.12
|
| Rate for Payer: Ohio Health Group HMO |
$636.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$679.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$738.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$585.81
|
| Rate for Payer: PHCS Commercial |
$815.04
|
| Rate for Payer: United Healthcare All Payer |
$747.12
|
|
|
KIT PERC SHEATH INTRO 8.5FR
|
Facility
|
OP
|
$849.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$254.70 |
| Max. Negotiated Rate |
$815.04 |
| Rate for Payer: Aetna Commercial |
$653.73
|
| Rate for Payer: Anthem Medicaid |
$291.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$662.22
|
| Rate for Payer: Cash Price |
$424.50
|
| Rate for Payer: Cigna Commercial |
$704.67
|
| Rate for Payer: First Health Commercial |
$806.55
|
| Rate for Payer: Humana Commercial |
$721.65
|
| Rate for Payer: Humana KY Medicaid |
$291.97
|
| Rate for Payer: Kentucky WC Medicaid |
$294.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$696.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$626.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$297.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$747.12
|
| Rate for Payer: Ohio Health Group HMO |
$636.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$679.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$738.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$585.81
|
| Rate for Payer: PHCS Commercial |
$815.04
|
| Rate for Payer: United Healthcare All Payer |
$747.12
|
|
|
KIT TITAN STANDARD ASSEMBLY
|
Facility
|
IP
|
$4,801.25
|
|
|
Service Code
|
HCPCS C1813
|
| Hospital Charge Code |
27000110
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,440.38 |
| Max. Negotiated Rate |
$4,609.20 |
| Rate for Payer: Aetna Commercial |
$3,696.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,744.97
|
| Rate for Payer: Cash Price |
$2,400.62
|
| Rate for Payer: Cigna Commercial |
$3,985.04
|
| Rate for Payer: First Health Commercial |
$4,561.19
|
| Rate for Payer: Humana Commercial |
$4,081.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,937.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,543.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,440.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,225.10
|
| Rate for Payer: Ohio Health Group HMO |
$3,600.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,841.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,177.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,312.86
|
| Rate for Payer: PHCS Commercial |
$4,609.20
|
| Rate for Payer: United Healthcare All Payer |
$4,225.10
|
|
|
KIT TITAN STANDARD ASSEMBLY
|
Facility
|
OP
|
$4,801.25
|
|
|
Service Code
|
HCPCS C1813
|
| Hospital Charge Code |
27000110
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,440.38 |
| Max. Negotiated Rate |
$4,609.20 |
| Rate for Payer: Aetna Commercial |
$3,696.96
|
| Rate for Payer: Anthem Medicaid |
$1,651.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,744.97
|
| Rate for Payer: Cash Price |
$2,400.62
|
| Rate for Payer: Cigna Commercial |
$3,985.04
|
| Rate for Payer: First Health Commercial |
$4,561.19
|
| Rate for Payer: Humana Commercial |
$4,081.06
|
| Rate for Payer: Humana KY Medicaid |
$1,651.15
|
| Rate for Payer: Kentucky WC Medicaid |
$1,667.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,937.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,543.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,440.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,684.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,225.10
|
| Rate for Payer: Ohio Health Group HMO |
$3,600.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,841.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,177.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,312.86
|
| Rate for Payer: PHCS Commercial |
$4,609.20
|
| Rate for Payer: United Healthcare All Payer |
$4,225.10
|
|
|
KLEBSIELLA OXYTOCA OMPA GENE
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001306
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Aetna Commercial |
$55.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.82
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$59.76
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: Humana Commercial |
$61.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.36
|
| Rate for Payer: Ohio Health Group HMO |
$54.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.68
|
| Rate for Payer: PHCS Commercial |
$69.12
|
| Rate for Payer: United Healthcare All Payer |
$63.36
|
|
|
KLEBSIELLA OXYTOCA OMPA GENE
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001306
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$20.05 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Aetna Commercial |
$55.44
|
| Rate for Payer: Anthem Medicaid |
$20.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$20.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$28.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$20.05
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$59.76
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: Humana Commercial |
$61.20
|
| Rate for Payer: Humana KY Medicaid |
$20.05
|
| Rate for Payer: Humana Medicare Advantage |
$20.05
|
| Rate for Payer: Kentucky WC Medicaid |
$20.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$20.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.36
|
| Rate for Payer: Ohio Health Group HMO |
$54.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.68
|
| Rate for Payer: PHCS Commercial |
$69.12
|
| Rate for Payer: United Healthcare All Payer |
$63.36
|
|
|
KLEBSIELLA PNEUMONIAE YGGEGENE
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001298
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Aetna Commercial |
$55.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.82
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$59.76
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: Humana Commercial |
$61.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.36
|
| Rate for Payer: Ohio Health Group HMO |
$54.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.68
|
| Rate for Payer: PHCS Commercial |
$69.12
|
| Rate for Payer: United Healthcare All Payer |
$63.36
|
|
|
KLEBSIELLA PNEUMONIAE YGGEGENE
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001298
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$20.05 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Aetna Commercial |
$55.44
|
| Rate for Payer: Anthem Medicaid |
$20.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$20.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$28.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$20.05
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$59.76
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: Humana Commercial |
$61.20
|
| Rate for Payer: Humana KY Medicaid |
$20.05
|
| Rate for Payer: Humana Medicare Advantage |
$20.05
|
| Rate for Payer: Kentucky WC Medicaid |
$20.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$20.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.36
|
| Rate for Payer: Ohio Health Group HMO |
$54.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.68
|
| Rate for Payer: PHCS Commercial |
$69.12
|
| Rate for Payer: United Healthcare All Payer |
$63.36
|
|
|
KLOR CON (POT CHLR) 10 MEQ TAB
|
Facility
|
OP
|
$4.70
|
|
|
Service Code
|
NDC 245531601
|
| Hospital Charge Code |
25000823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$4.51 |
| Rate for Payer: Aetna Commercial |
$3.62
|
| Rate for Payer: Anthem Medicaid |
$1.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.67
|
| Rate for Payer: Cash Price |
$2.35
|
| Rate for Payer: Cigna Commercial |
$3.90
|
| Rate for Payer: First Health Commercial |
$4.46
|
| Rate for Payer: Humana Commercial |
$4.00
|
| Rate for Payer: Humana KY Medicaid |
$1.62
|
| Rate for Payer: Kentucky WC Medicaid |
$1.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.14
|
| Rate for Payer: Ohio Health Group HMO |
$3.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.24
|
| Rate for Payer: PHCS Commercial |
$4.51
|
| Rate for Payer: United Healthcare All Payer |
$4.14
|
|
|
KLOR CON (POT CHLR) 10 MEQ TAB
|
Facility
|
IP
|
$4.70
|
|
|
Service Code
|
NDC 245531601
|
| Hospital Charge Code |
25000823
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$4.51 |
| Rate for Payer: Aetna Commercial |
$3.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.67
|
| Rate for Payer: Cash Price |
$2.35
|
| Rate for Payer: Cigna Commercial |
$3.90
|
| Rate for Payer: First Health Commercial |
$4.46
|
| Rate for Payer: Humana Commercial |
$4.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.14
|
| Rate for Payer: Ohio Health Group HMO |
$3.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.24
|
| Rate for Payer: PHCS Commercial |
$4.51
|
| Rate for Payer: United Healthcare All Payer |
$4.14
|
|
