|
LINCOMYCIN 300MG (600MG SDV)
|
Facility
|
IP
|
$64.57
|
|
|
Service Code
|
HCPCS J2010
|
| Hospital Charge Code |
63600042
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.39 |
| Max. Negotiated Rate |
$61.99 |
| Rate for Payer: Aetna Commercial |
$49.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$50.36
|
| Rate for Payer: Cash Price |
$32.28
|
| Rate for Payer: Cigna Commercial |
$53.59
|
| Rate for Payer: First Health Commercial |
$61.34
|
| Rate for Payer: Humana Commercial |
$54.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$52.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$56.82
|
| Rate for Payer: Ohio Health Group HMO |
$48.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.02
|
| Rate for Payer: PHCS Commercial |
$61.99
|
| Rate for Payer: United Healthcare All Payer |
$56.82
|
|
|
LINCOMYCIN 300MG (600MG SDV)
|
Facility
|
OP
|
$64.57
|
|
|
Service Code
|
HCPCS J2010
|
| Hospital Charge Code |
636T0042
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.39 |
| Max. Negotiated Rate |
$61.99 |
| Rate for Payer: Aetna Commercial |
$49.72
|
| Rate for Payer: Anthem Medicaid |
$22.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$50.36
|
| Rate for Payer: Cash Price |
$32.28
|
| Rate for Payer: Cigna Commercial |
$53.59
|
| Rate for Payer: First Health Commercial |
$61.34
|
| Rate for Payer: Humana Commercial |
$54.88
|
| Rate for Payer: Humana KY Medicaid |
$22.21
|
| Rate for Payer: Kentucky WC Medicaid |
$22.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$52.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$56.82
|
| Rate for Payer: Ohio Health Group HMO |
$48.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.02
|
| Rate for Payer: PHCS Commercial |
$61.99
|
| Rate for Payer: United Healthcare All Payer |
$56.82
|
|
|
LINCOMYCIN 300MG (600MG SDV)
|
Facility
|
IP
|
$64.57
|
|
|
Service Code
|
HCPCS J2010
|
| Hospital Charge Code |
636T0042
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.39 |
| Max. Negotiated Rate |
$61.99 |
| Rate for Payer: Aetna Commercial |
$49.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$50.36
|
| Rate for Payer: Cash Price |
$32.28
|
| Rate for Payer: Cigna Commercial |
$53.59
|
| Rate for Payer: First Health Commercial |
$61.34
|
| Rate for Payer: Humana Commercial |
$54.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$52.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$56.82
|
| Rate for Payer: Ohio Health Group HMO |
$48.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.02
|
| Rate for Payer: PHCS Commercial |
$61.99
|
| Rate for Payer: United Healthcare All Payer |
$56.82
|
|
|
LINCOMYCIN 300MG (600MG SDV)
|
Facility
|
IP
|
$139.08
|
|
|
Service Code
|
HCPCS J2010
|
| Hospital Charge Code |
25002216
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.08 |
| Max. Negotiated Rate |
$133.52 |
| Rate for Payer: Aetna Commercial |
$107.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$108.48
|
| Rate for Payer: Cash Price |
$69.54
|
| Rate for Payer: Cigna Commercial |
$115.44
|
| Rate for Payer: First Health Commercial |
$132.13
|
| Rate for Payer: Humana Commercial |
$118.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$114.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$102.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$122.39
|
| Rate for Payer: Ohio Health Group HMO |
$104.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$43.11
|
| Rate for Payer: PHCS Commercial |
$133.52
|
| Rate for Payer: United Healthcare All Payer |
$122.39
|
|
|
LINEAR 8 CONTACT LEAD 50CM KT
|
Facility
|
OP
|
$9,632.80
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27000060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,252.26 |
| Max. Negotiated Rate |
$9,247.49 |
| Rate for Payer: Aetna Commercial |
$7,417.26
|
| Rate for Payer: Anthem Medicaid |
$3,312.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,513.58
|
| Rate for Payer: Cash Price |
$4,816.40
|
| Rate for Payer: Cigna Commercial |
$7,995.22
|
| Rate for Payer: First Health Commercial |
$9,151.16
|
| Rate for Payer: Humana Commercial |
$8,187.88
|
| Rate for Payer: Humana KY Medicaid |
$3,312.72
|
| Rate for Payer: Kentucky WC Medicaid |
$3,346.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,898.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,109.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,889.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,379.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,476.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,224.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,926.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,252.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,986.17
|
| Rate for Payer: PHCS Commercial |
$9,247.49
|
| Rate for Payer: United Healthcare All Payer |
$8,476.86
|
|
|
LINEAR 8 CONTACT LEAD 50CM KT
|
Facility
|
IP
|
$9,632.80
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27000060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,252.26 |
| Max. Negotiated Rate |
$9,247.49 |
| Rate for Payer: Aetna Commercial |
$7,417.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,513.58
|
| Rate for Payer: Cash Price |
$4,816.40
|
| Rate for Payer: Cigna Commercial |
$7,995.22
|
| Rate for Payer: First Health Commercial |
$9,151.16
|
| Rate for Payer: Humana Commercial |
$8,187.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,898.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,109.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,889.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,476.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,224.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,926.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,252.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,986.17
|
| Rate for Payer: PHCS Commercial |
$9,247.49
|
| Rate for Payer: United Healthcare All Payer |
$8,476.86
|
|
|
LINEAR ST 8 CONT TRIAL LD 50CM
|
Facility
|
IP
|
$7,822.40
|
|
|
Service Code
|
HCPCS C1897
|
| Hospital Charge Code |
27000065
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,016.91 |
| Max. Negotiated Rate |
$7,509.50 |
| Rate for Payer: Aetna Commercial |
$6,023.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,101.47
|
| Rate for Payer: Cash Price |
$3,911.20
|
| Rate for Payer: Cigna Commercial |
$6,492.59
|
| Rate for Payer: First Health Commercial |
$7,431.28
|
| Rate for Payer: Humana Commercial |
$6,649.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,414.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,772.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,346.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,883.71
|
| Rate for Payer: Ohio Health Group HMO |
$5,866.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,564.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,016.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,424.94
|
| Rate for Payer: PHCS Commercial |
$7,509.50
|
| Rate for Payer: United Healthcare All Payer |
$6,883.71
|
|
|
LINEAR ST 8 CONT TRIAL LD 50CM
|
Facility
|
OP
|
$7,822.40
|
|
|
Service Code
|
HCPCS C1897
|
| Hospital Charge Code |
27000065
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,016.91 |
| Max. Negotiated Rate |
$7,509.50 |
| Rate for Payer: Aetna Commercial |
$6,023.25
|
| Rate for Payer: Anthem Medicaid |
$2,690.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,101.47
|
| Rate for Payer: Cash Price |
$3,911.20
|
| Rate for Payer: Cigna Commercial |
$6,492.59
|
| Rate for Payer: First Health Commercial |
$7,431.28
|
| Rate for Payer: Humana Commercial |
$6,649.04
|
| Rate for Payer: Humana KY Medicaid |
$2,690.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,717.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,414.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,772.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,346.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,744.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,883.71
|
| Rate for Payer: Ohio Health Group HMO |
$5,866.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,564.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,016.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,424.94
|
| Rate for Payer: PHCS Commercial |
$7,509.50
|
| Rate for Payer: United Healthcare All Payer |
$6,883.71
|
|
|
LINEAR ST 8 CONT TRIAL LD 70CM
|
Facility
|
OP
|
$7,822.40
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27000060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,016.91 |
| Max. Negotiated Rate |
$7,509.50 |
| Rate for Payer: Aetna Commercial |
$6,023.25
|
| Rate for Payer: Anthem Medicaid |
$2,690.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,101.47
|
| Rate for Payer: Cash Price |
$3,911.20
|
| Rate for Payer: Cigna Commercial |
$6,492.59
|
| Rate for Payer: First Health Commercial |
$7,431.28
|
| Rate for Payer: Humana Commercial |
$6,649.04
|
| Rate for Payer: Humana KY Medicaid |
$2,690.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,717.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,414.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,772.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,346.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,744.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,883.71
|
| Rate for Payer: Ohio Health Group HMO |
$5,866.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,564.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,016.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,424.94
|
| Rate for Payer: PHCS Commercial |
$7,509.50
|
| Rate for Payer: United Healthcare All Payer |
$6,883.71
|
|
|
LINEAR ST 8 CONT TRIAL LD 70CM
|
Facility
|
IP
|
$7,822.40
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
27000060
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,016.91 |
| Max. Negotiated Rate |
$7,509.50 |
| Rate for Payer: Aetna Commercial |
$6,023.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,101.47
|
| Rate for Payer: Cash Price |
$3,911.20
|
| Rate for Payer: Cigna Commercial |
$6,492.59
|
| Rate for Payer: First Health Commercial |
$7,431.28
|
| Rate for Payer: Humana Commercial |
$6,649.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,414.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,772.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,346.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,883.71
|
| Rate for Payer: Ohio Health Group HMO |
$5,866.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,564.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,016.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,424.94
|
| Rate for Payer: PHCS Commercial |
$7,509.50
|
| Rate for Payer: United Healthcare All Payer |
$6,883.71
|
|
|
LINE PLACEMENT UNDER FLUORO(P
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
HCPCS 77001
|
| Hospital Charge Code |
320P0222
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.75 |
| Max. Negotiated Rate |
$220.00 |
| Rate for Payer: Aetna Commercial |
$157.68
|
| Rate for Payer: Anthem Medicaid |
$57.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$220.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna Commercial |
$142.16
|
| Rate for Payer: Healthspan PPO |
$147.75
|
| Rate for Payer: Humana Medicaid |
$57.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$24.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$58.78
|
| Rate for Payer: Molina Healthcare Passport |
$57.63
|
| Rate for Payer: Multiplan PHCS |
$132.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$154.00
|
| Rate for Payer: UHCCP Medicaid |
$77.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$58.21
|
|
|
LINE PLACEMENT UNDER FLUORO(T
|
Facility
|
IP
|
$704.00
|
|
|
Service Code
|
HCPCS 77001
|
| Hospital Charge Code |
320T0222
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$91.52 |
| Max. Negotiated Rate |
$675.84 |
| Rate for Payer: Aetna Commercial |
$542.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$549.12
|
| Rate for Payer: Cash Price |
$352.00
|
| Rate for Payer: Cigna Commercial |
$584.32
|
| Rate for Payer: First Health Commercial |
$668.80
|
| Rate for Payer: Humana Commercial |
$598.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$577.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$519.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$211.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$619.52
|
| Rate for Payer: Ohio Health Group HMO |
$528.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$140.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$91.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$218.24
|
| Rate for Payer: PHCS Commercial |
$675.84
|
| Rate for Payer: United Healthcare All Payer |
$619.52
|
|
|
LINE PLACEMENT UNDER FLUORO(T
|
Facility
|
OP
|
$704.00
|
|
|
Service Code
|
HCPCS 77001
|
| Hospital Charge Code |
320T0222
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$91.52 |
| Max. Negotiated Rate |
$675.84 |
| Rate for Payer: Aetna Commercial |
$542.08
|
| Rate for Payer: Anthem Medicaid |
$242.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$549.12
|
| Rate for Payer: Cash Price |
$352.00
|
| Rate for Payer: Cigna Commercial |
$584.32
|
| Rate for Payer: First Health Commercial |
$668.80
|
| Rate for Payer: Humana Commercial |
$598.40
|
| Rate for Payer: Humana KY Medicaid |
$242.11
|
| Rate for Payer: Kentucky WC Medicaid |
$244.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$577.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$519.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$211.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$246.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$619.52
|
| Rate for Payer: Ohio Health Group HMO |
$528.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$140.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$91.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$218.24
|
| Rate for Payer: PHCS Commercial |
$675.84
|
| Rate for Payer: United Healthcare All Payer |
$619.52
|
|
|
LINER ACE COCR 40MMID 52MM OD
|
Facility
|
OP
|
$20,002.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,600.29 |
| Max. Negotiated Rate |
$19,202.16 |
| Rate for Payer: Aetna Commercial |
$15,401.73
|
| Rate for Payer: Anthem Medicaid |
$6,878.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,601.76
|
| Rate for Payer: Cash Price |
$10,001.12
|
| Rate for Payer: Cigna Commercial |
$16,601.87
|
| Rate for Payer: First Health Commercial |
$19,002.14
|
| Rate for Payer: Humana Commercial |
$17,001.91
|
| Rate for Payer: Humana KY Medicaid |
$6,878.77
|
| Rate for Payer: Kentucky WC Medicaid |
$6,948.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,401.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,761.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,000.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,016.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,601.98
|
| Rate for Payer: Ohio Health Group HMO |
$15,001.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,000.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,600.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,200.70
|
| Rate for Payer: PHCS Commercial |
$19,202.16
|
| Rate for Payer: United Healthcare All Payer |
$17,601.98
|
|
|
LINER ACE COCR 40MMID 52MM OD
|
Facility
|
IP
|
$20,002.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,600.29 |
| Max. Negotiated Rate |
$19,202.16 |
| Rate for Payer: Aetna Commercial |
$15,401.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,601.76
|
| Rate for Payer: Cash Price |
$10,001.12
|
| Rate for Payer: Cigna Commercial |
$16,601.87
|
| Rate for Payer: First Health Commercial |
$19,002.14
|
| Rate for Payer: Humana Commercial |
$17,001.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,401.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,761.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,000.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,601.98
|
| Rate for Payer: Ohio Health Group HMO |
$15,001.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,000.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,600.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,200.70
|
| Rate for Payer: PHCS Commercial |
$19,202.16
|
| Rate for Payer: United Healthcare All Payer |
$17,601.98
|
|
|
LINER ACE COCR 42MMID 54MM OD
|
Facility
|
IP
|
$22,685.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,949.05 |
| Max. Negotiated Rate |
$21,777.60 |
| Rate for Payer: Aetna Commercial |
$17,467.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,694.30
|
| Rate for Payer: Cash Price |
$11,342.50
|
| Rate for Payer: Cigna Commercial |
$18,828.55
|
| Rate for Payer: First Health Commercial |
$21,550.75
|
| Rate for Payer: Humana Commercial |
$19,282.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,601.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,741.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,805.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,962.80
|
| Rate for Payer: Ohio Health Group HMO |
$17,013.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,537.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,949.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,032.35
|
| Rate for Payer: PHCS Commercial |
$21,777.60
|
| Rate for Payer: United Healthcare All Payer |
$19,962.80
|
|
|
LINER ACE COCR 42MMID 54MM OD
|
Facility
|
OP
|
$22,685.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,949.05 |
| Max. Negotiated Rate |
$21,777.60 |
| Rate for Payer: Aetna Commercial |
$17,467.45
|
| Rate for Payer: Anthem Medicaid |
$7,801.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,694.30
|
| Rate for Payer: Cash Price |
$11,342.50
|
| Rate for Payer: Cigna Commercial |
$18,828.55
|
| Rate for Payer: First Health Commercial |
$21,550.75
|
| Rate for Payer: Humana Commercial |
$19,282.25
|
| Rate for Payer: Humana KY Medicaid |
$7,801.37
|
| Rate for Payer: Kentucky WC Medicaid |
$7,880.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,601.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,741.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,805.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,957.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,962.80
|
| Rate for Payer: Ohio Health Group HMO |
$17,013.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,537.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,949.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,032.35
|
| Rate for Payer: PHCS Commercial |
$21,777.60
|
| Rate for Payer: United Healthcare All Payer |
$19,962.80
|
|
|
LINER ALTRX +4 10 DEG 40*56
|
Facility
|
IP
|
$11,201.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,456.20 |
| Max. Negotiated Rate |
$10,753.46 |
| Rate for Payer: Aetna Commercial |
$8,625.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,737.19
|
| Rate for Payer: Cash Price |
$5,600.76
|
| Rate for Payer: Cigna Commercial |
$9,297.26
|
| Rate for Payer: First Health Commercial |
$10,641.44
|
| Rate for Payer: Humana Commercial |
$9,521.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,185.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,266.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,360.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,857.34
|
| Rate for Payer: Ohio Health Group HMO |
$8,401.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,240.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,456.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,472.47
|
| Rate for Payer: PHCS Commercial |
$10,753.46
|
| Rate for Payer: United Healthcare All Payer |
$9,857.34
|
|
|
LINER ALTRX +4 10 DEG 40*56
|
Facility
|
OP
|
$11,201.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,456.20 |
| Max. Negotiated Rate |
$10,753.46 |
| Rate for Payer: Aetna Commercial |
$8,625.17
|
| Rate for Payer: Anthem Medicaid |
$3,852.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,737.19
|
| Rate for Payer: Cash Price |
$5,600.76
|
| Rate for Payer: Cigna Commercial |
$9,297.26
|
| Rate for Payer: First Health Commercial |
$10,641.44
|
| Rate for Payer: Humana Commercial |
$9,521.29
|
| Rate for Payer: Humana KY Medicaid |
$3,852.20
|
| Rate for Payer: Kentucky WC Medicaid |
$3,891.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,185.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,266.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,360.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,929.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,857.34
|
| Rate for Payer: Ohio Health Group HMO |
$8,401.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,240.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,456.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,472.47
|
| Rate for Payer: PHCS Commercial |
$10,753.46
|
| Rate for Payer: United Healthcare All Payer |
$9,857.34
|
|
|
LINER ALTRX +4 10 DEG 40*58
|
Facility
|
IP
|
$11,201.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,456.20 |
| Max. Negotiated Rate |
$10,753.46 |
| Rate for Payer: Aetna Commercial |
$8,625.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,737.19
|
| Rate for Payer: Cash Price |
$5,600.76
|
| Rate for Payer: Cigna Commercial |
$9,297.26
|
| Rate for Payer: First Health Commercial |
$10,641.44
|
| Rate for Payer: Humana Commercial |
$9,521.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,185.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,266.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,360.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,857.34
|
| Rate for Payer: Ohio Health Group HMO |
$8,401.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,240.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,456.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,472.47
|
| Rate for Payer: PHCS Commercial |
$10,753.46
|
| Rate for Payer: United Healthcare All Payer |
$9,857.34
|
|
|
LINER ALTRX +4 10 DEG 40*58
|
Facility
|
OP
|
$11,201.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,456.20 |
| Max. Negotiated Rate |
$10,753.46 |
| Rate for Payer: Aetna Commercial |
$8,625.17
|
| Rate for Payer: Anthem Medicaid |
$3,852.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,737.19
|
| Rate for Payer: Cash Price |
$5,600.76
|
| Rate for Payer: Cigna Commercial |
$9,297.26
|
| Rate for Payer: First Health Commercial |
$10,641.44
|
| Rate for Payer: Humana Commercial |
$9,521.29
|
| Rate for Payer: Humana KY Medicaid |
$3,852.20
|
| Rate for Payer: Kentucky WC Medicaid |
$3,891.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,185.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,266.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,360.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,929.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,857.34
|
| Rate for Payer: Ohio Health Group HMO |
$8,401.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,240.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,456.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,472.47
|
| Rate for Payer: PHCS Commercial |
$10,753.46
|
| Rate for Payer: United Healthcare All Payer |
$9,857.34
|
|
|
LINER ALTRX +4 10DEG 44*62
|
Facility
|
IP
|
$11,488.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,493.49 |
| Max. Negotiated Rate |
$11,028.87 |
| Rate for Payer: Aetna Commercial |
$8,846.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,960.96
|
| Rate for Payer: Cash Price |
$5,744.20
|
| Rate for Payer: Cigna Commercial |
$9,535.38
|
| Rate for Payer: First Health Commercial |
$10,913.99
|
| Rate for Payer: Humana Commercial |
$9,765.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,420.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,478.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,446.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,109.80
|
| Rate for Payer: Ohio Health Group HMO |
$8,616.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,297.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,493.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,561.41
|
| Rate for Payer: PHCS Commercial |
$11,028.87
|
| Rate for Payer: United Healthcare All Payer |
$10,109.80
|
|
|
LINER ALTRX +4 10DEG 44*62
|
Facility
|
OP
|
$11,488.41
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,493.49 |
| Max. Negotiated Rate |
$11,028.87 |
| Rate for Payer: Aetna Commercial |
$8,846.08
|
| Rate for Payer: Anthem Medicaid |
$3,950.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,960.96
|
| Rate for Payer: Cash Price |
$5,744.20
|
| Rate for Payer: Cigna Commercial |
$9,535.38
|
| Rate for Payer: First Health Commercial |
$10,913.99
|
| Rate for Payer: Humana Commercial |
$9,765.15
|
| Rate for Payer: Humana KY Medicaid |
$3,950.86
|
| Rate for Payer: Kentucky WC Medicaid |
$3,991.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,420.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,478.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,446.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,030.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,109.80
|
| Rate for Payer: Ohio Health Group HMO |
$8,616.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,297.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,493.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,561.41
|
| Rate for Payer: PHCS Commercial |
$11,028.87
|
| Rate for Payer: United Healthcare All Payer |
$10,109.80
|
|
|
LINER ALTRX +4 10DEG 44* 64
|
Facility
|
OP
|
$9,676.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,257.96 |
| Max. Negotiated Rate |
$9,289.54 |
| Rate for Payer: Aetna Commercial |
$7,450.98
|
| Rate for Payer: Anthem Medicaid |
$3,327.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,547.75
|
| Rate for Payer: Cash Price |
$4,838.30
|
| Rate for Payer: Cigna Commercial |
$8,031.58
|
| Rate for Payer: First Health Commercial |
$9,192.77
|
| Rate for Payer: Humana Commercial |
$8,225.11
|
| Rate for Payer: Humana KY Medicaid |
$3,327.78
|
| Rate for Payer: Kentucky WC Medicaid |
$3,361.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,934.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,141.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,902.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,394.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,515.41
|
| Rate for Payer: Ohio Health Group HMO |
$7,257.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,935.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,257.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,999.75
|
| Rate for Payer: PHCS Commercial |
$9,289.54
|
| Rate for Payer: United Healthcare All Payer |
$8,515.41
|
|
|
LINER ALTRX +4 10DEG 44* 64
|
Facility
|
IP
|
$9,676.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,257.96 |
| Max. Negotiated Rate |
$9,289.54 |
| Rate for Payer: Aetna Commercial |
$7,450.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,547.75
|
| Rate for Payer: Cash Price |
$4,838.30
|
| Rate for Payer: Cigna Commercial |
$8,031.58
|
| Rate for Payer: First Health Commercial |
$9,192.77
|
| Rate for Payer: Humana Commercial |
$8,225.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,934.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,141.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,902.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,515.41
|
| Rate for Payer: Ohio Health Group HMO |
$7,257.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,935.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,257.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,999.75
|
| Rate for Payer: PHCS Commercial |
$9,289.54
|
| Rate for Payer: United Healthcare All Payer |
$8,515.41
|
|
