|
LOW PROFILE SCREW 2.4 X 9MM
|
Facility
|
OP
|
$1,735.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$225.55 |
| Max. Negotiated Rate |
$1,665.60 |
| Rate for Payer: Aetna Commercial |
$1,335.95
|
| Rate for Payer: Anthem Medicaid |
$596.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,353.30
|
| Rate for Payer: Cash Price |
$867.50
|
| Rate for Payer: Cigna Commercial |
$1,440.05
|
| Rate for Payer: First Health Commercial |
$1,648.25
|
| Rate for Payer: Humana Commercial |
$1,474.75
|
| Rate for Payer: Humana KY Medicaid |
$596.67
|
| Rate for Payer: Kentucky WC Medicaid |
$602.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,422.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,280.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$520.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$608.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,526.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,301.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$347.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$225.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$537.85
|
| Rate for Payer: PHCS Commercial |
$1,665.60
|
| Rate for Payer: United Healthcare All Payer |
$1,526.80
|
|
|
LOW PROFILE SCREW 2.4 X 9MM
|
Facility
|
IP
|
$1,735.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$225.55 |
| Max. Negotiated Rate |
$1,665.60 |
| Rate for Payer: Aetna Commercial |
$1,335.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,353.30
|
| Rate for Payer: Cash Price |
$867.50
|
| Rate for Payer: Cigna Commercial |
$1,440.05
|
| Rate for Payer: First Health Commercial |
$1,648.25
|
| Rate for Payer: Humana Commercial |
$1,474.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,422.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,280.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$520.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,526.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,301.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$347.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$225.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$537.85
|
| Rate for Payer: PHCS Commercial |
$1,665.60
|
| Rate for Payer: United Healthcare All Payer |
$1,526.80
|
|
|
LOXAPINE 5 5MG CAPSULE PO
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
NDC 591036901
|
| Hospital Charge Code |
25000917
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$4.56 |
| Rate for Payer: Aetna Commercial |
$3.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.70
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cigna Commercial |
$3.94
|
| Rate for Payer: First Health Commercial |
$4.51
|
| Rate for Payer: Humana Commercial |
$4.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.18
|
| Rate for Payer: Ohio Health Group HMO |
$3.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.47
|
| Rate for Payer: PHCS Commercial |
$4.56
|
| Rate for Payer: United Healthcare All Payer |
$4.18
|
|
|
LOXAPINE 5 5MG CAPSULE PO
|
Facility
|
OP
|
$4.75
|
|
|
Service Code
|
NDC 591036901
|
| Hospital Charge Code |
25000917
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$4.56 |
| Rate for Payer: Aetna Commercial |
$3.66
|
| Rate for Payer: Anthem Medicaid |
$1.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.70
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cigna Commercial |
$3.94
|
| Rate for Payer: First Health Commercial |
$4.51
|
| Rate for Payer: Humana Commercial |
$4.04
|
| Rate for Payer: Humana KY Medicaid |
$1.63
|
| Rate for Payer: Kentucky WC Medicaid |
$1.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.18
|
| Rate for Payer: Ohio Health Group HMO |
$3.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.47
|
| Rate for Payer: PHCS Commercial |
$4.56
|
| Rate for Payer: United Healthcare All Payer |
$4.18
|
|
|
LOXITANE (LOXAPINE) 10MG/1CAP
|
Facility
|
IP
|
$4.92
|
|
|
Service Code
|
NDC 378701001
|
| Hospital Charge Code |
25000918
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$4.72 |
| Rate for Payer: Humana Commercial |
$4.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.33
|
| Rate for Payer: Ohio Health Group HMO |
$3.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.53
|
| Rate for Payer: PHCS Commercial |
$4.72
|
| Rate for Payer: United Healthcare All Payer |
$4.33
|
| Rate for Payer: Aetna Commercial |
$3.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.84
|
| Rate for Payer: Cash Price |
$2.46
|
| Rate for Payer: Cigna Commercial |
$4.08
|
| Rate for Payer: First Health Commercial |
$4.67
|
|
|
LOXITANE (LOXAPINE) 10MG/1CAP
|
Facility
|
OP
|
$4.92
|
|
|
Service Code
|
NDC 378701001
|
| Hospital Charge Code |
25000918
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$4.72 |
| Rate for Payer: Aetna Commercial |
$3.79
|
| Rate for Payer: Anthem Medicaid |
$1.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.84
|
| Rate for Payer: Cash Price |
$2.46
|
| Rate for Payer: Cigna Commercial |
$4.08
|
| Rate for Payer: First Health Commercial |
$4.67
|
| Rate for Payer: Humana Commercial |
$4.18
|
| Rate for Payer: Humana KY Medicaid |
$1.69
|
| Rate for Payer: Kentucky WC Medicaid |
$1.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.33
|
| Rate for Payer: Ohio Health Group HMO |
$3.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.53
|
| Rate for Payer: PHCS Commercial |
$4.72
|
| Rate for Payer: United Healthcare All Payer |
$4.33
|
|
|
LOZOL (INDAPAMIDE) 2.5MG/1TAB
|
Facility
|
OP
|
$4.49
|
|
|
Service Code
|
NDC 43975030410
|
| Hospital Charge Code |
25000921
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$4.31 |
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: Anthem Medicaid |
$1.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.50
|
| Rate for Payer: Cash Price |
$2.24
|
| Rate for Payer: Cigna Commercial |
$3.73
|
| Rate for Payer: First Health Commercial |
$4.27
|
| Rate for Payer: Humana Commercial |
$3.82
|
| Rate for Payer: Humana KY Medicaid |
$1.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.95
|
| Rate for Payer: Ohio Health Group HMO |
$3.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.39
|
| Rate for Payer: PHCS Commercial |
$4.31
|
| Rate for Payer: United Healthcare All Payer |
$3.95
|
|
|
LOZOL (INDAPAMIDE) 2.5MG/1TAB
|
Facility
|
IP
|
$4.49
|
|
|
Service Code
|
NDC 43975030410
|
| Hospital Charge Code |
25000921
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$4.31 |
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.50
|
| Rate for Payer: Cash Price |
$2.24
|
| Rate for Payer: Cigna Commercial |
$3.73
|
| Rate for Payer: First Health Commercial |
$4.27
|
| Rate for Payer: Humana Commercial |
$3.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.95
|
| Rate for Payer: Ohio Health Group HMO |
$3.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.39
|
| Rate for Payer: PHCS Commercial |
$4.31
|
| Rate for Payer: United Healthcare All Payer |
$3.95
|
|
|
LPS DISTAL FEM COMP XSM LT
|
Facility
|
IP
|
$75,932.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,871.22 |
| Max. Negotiated Rate |
$72,895.14 |
| Rate for Payer: Aetna Commercial |
$58,467.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,227.30
|
| Rate for Payer: Cash Price |
$37,966.22
|
| Rate for Payer: Cigna Commercial |
$63,023.93
|
| Rate for Payer: First Health Commercial |
$72,135.82
|
| Rate for Payer: Humana Commercial |
$64,542.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,264.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,038.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,779.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,820.55
|
| Rate for Payer: Ohio Health Group HMO |
$56,949.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,186.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,871.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,539.06
|
| Rate for Payer: PHCS Commercial |
$72,895.14
|
| Rate for Payer: United Healthcare All Payer |
$66,820.55
|
|
|
LPS DISTAL FEM COMP XSM LT
|
Facility
|
OP
|
$75,932.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,871.22 |
| Max. Negotiated Rate |
$72,895.14 |
| Rate for Payer: Aetna Commercial |
$58,467.98
|
| Rate for Payer: Anthem Medicaid |
$26,113.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,227.30
|
| Rate for Payer: Cash Price |
$37,966.22
|
| Rate for Payer: Cigna Commercial |
$63,023.93
|
| Rate for Payer: First Health Commercial |
$72,135.82
|
| Rate for Payer: Humana Commercial |
$64,542.57
|
| Rate for Payer: Humana KY Medicaid |
$26,113.17
|
| Rate for Payer: Kentucky WC Medicaid |
$26,378.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,264.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,038.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,779.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,637.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,820.55
|
| Rate for Payer: Ohio Health Group HMO |
$56,949.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,186.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,871.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,539.06
|
| Rate for Payer: PHCS Commercial |
$72,895.14
|
| Rate for Payer: United Healthcare All Payer |
$66,820.55
|
|
|
LPS DISTAL FEM COMP XSM RT
|
Facility
|
OP
|
$75,932.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,871.22 |
| Max. Negotiated Rate |
$72,895.14 |
| Rate for Payer: Aetna Commercial |
$58,467.98
|
| Rate for Payer: Anthem Medicaid |
$26,113.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,227.30
|
| Rate for Payer: Cash Price |
$37,966.22
|
| Rate for Payer: Cigna Commercial |
$63,023.93
|
| Rate for Payer: First Health Commercial |
$72,135.82
|
| Rate for Payer: Humana Commercial |
$64,542.57
|
| Rate for Payer: Humana KY Medicaid |
$26,113.17
|
| Rate for Payer: Kentucky WC Medicaid |
$26,378.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,264.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,038.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,779.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,637.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,820.55
|
| Rate for Payer: Ohio Health Group HMO |
$56,949.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,186.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,871.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,539.06
|
| Rate for Payer: PHCS Commercial |
$72,895.14
|
| Rate for Payer: United Healthcare All Payer |
$66,820.55
|
|
|
LPS DISTAL FEM COMP XSM RT
|
Facility
|
IP
|
$75,932.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,871.22 |
| Max. Negotiated Rate |
$72,895.14 |
| Rate for Payer: Aetna Commercial |
$58,467.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,227.30
|
| Rate for Payer: Cash Price |
$37,966.22
|
| Rate for Payer: Cigna Commercial |
$63,023.93
|
| Rate for Payer: First Health Commercial |
$72,135.82
|
| Rate for Payer: Humana Commercial |
$64,542.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,264.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,038.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,779.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,820.55
|
| Rate for Payer: Ohio Health Group HMO |
$56,949.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,186.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,871.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,539.06
|
| Rate for Payer: PHCS Commercial |
$72,895.14
|
| Rate for Payer: United Healthcare All Payer |
$66,820.55
|
|
|
LPS DISTAL FEM COMP XXSM L
|
Facility
|
IP
|
$75,932.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,871.22 |
| Max. Negotiated Rate |
$72,895.14 |
| Rate for Payer: Aetna Commercial |
$58,467.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,227.30
|
| Rate for Payer: Cash Price |
$37,966.22
|
| Rate for Payer: Cigna Commercial |
$63,023.93
|
| Rate for Payer: First Health Commercial |
$72,135.82
|
| Rate for Payer: Humana Commercial |
$64,542.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,264.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,038.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,779.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,820.55
|
| Rate for Payer: Ohio Health Group HMO |
$56,949.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,186.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,871.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,539.06
|
| Rate for Payer: PHCS Commercial |
$72,895.14
|
| Rate for Payer: United Healthcare All Payer |
$66,820.55
|
|
|
LPS DISTAL FEM COMP XXSM L
|
Facility
|
OP
|
$75,932.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,871.22 |
| Max. Negotiated Rate |
$72,895.14 |
| Rate for Payer: Aetna Commercial |
$58,467.98
|
| Rate for Payer: Anthem Medicaid |
$26,113.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,227.30
|
| Rate for Payer: Cash Price |
$37,966.22
|
| Rate for Payer: Cigna Commercial |
$63,023.93
|
| Rate for Payer: First Health Commercial |
$72,135.82
|
| Rate for Payer: Humana Commercial |
$64,542.57
|
| Rate for Payer: Humana KY Medicaid |
$26,113.17
|
| Rate for Payer: Kentucky WC Medicaid |
$26,378.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,264.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,038.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,779.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,637.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,820.55
|
| Rate for Payer: Ohio Health Group HMO |
$56,949.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,186.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,871.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,539.06
|
| Rate for Payer: PHCS Commercial |
$72,895.14
|
| Rate for Payer: United Healthcare All Payer |
$66,820.55
|
|
|
LPS DISTAL FEM COMP XXSM RT
|
Facility
|
IP
|
$75,932.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,871.22 |
| Max. Negotiated Rate |
$72,895.14 |
| Rate for Payer: Aetna Commercial |
$58,467.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,227.30
|
| Rate for Payer: Cash Price |
$37,966.22
|
| Rate for Payer: Cigna Commercial |
$63,023.93
|
| Rate for Payer: First Health Commercial |
$72,135.82
|
| Rate for Payer: Humana Commercial |
$64,542.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,264.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,038.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,779.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,820.55
|
| Rate for Payer: Ohio Health Group HMO |
$56,949.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,186.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,871.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,539.06
|
| Rate for Payer: PHCS Commercial |
$72,895.14
|
| Rate for Payer: United Healthcare All Payer |
$66,820.55
|
|
|
LPS DISTAL FEM COMP XXSM RT
|
Facility
|
OP
|
$75,932.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,871.22 |
| Max. Negotiated Rate |
$72,895.14 |
| Rate for Payer: Aetna Commercial |
$58,467.98
|
| Rate for Payer: Anthem Medicaid |
$26,113.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,227.30
|
| Rate for Payer: Cash Price |
$37,966.22
|
| Rate for Payer: Cigna Commercial |
$63,023.93
|
| Rate for Payer: First Health Commercial |
$72,135.82
|
| Rate for Payer: Humana Commercial |
$64,542.57
|
| Rate for Payer: Humana KY Medicaid |
$26,113.17
|
| Rate for Payer: Kentucky WC Medicaid |
$26,378.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,264.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,038.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,779.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,637.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,820.55
|
| Rate for Payer: Ohio Health Group HMO |
$56,949.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,186.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,871.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,539.06
|
| Rate for Payer: PHCS Commercial |
$72,895.14
|
| Rate for Payer: United Healthcare All Payer |
$66,820.55
|
|
|
LPS-FLEX GSF OPTION FEM C LT
|
Facility
|
IP
|
$16,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.10 |
| Max. Negotiated Rate |
$15,523.20 |
| Rate for Payer: Aetna Commercial |
$12,450.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,612.60
|
| Rate for Payer: Cash Price |
$8,085.00
|
| Rate for Payer: Cigna Commercial |
$13,421.10
|
| Rate for Payer: First Health Commercial |
$15,361.50
|
| Rate for Payer: Humana Commercial |
$13,744.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,259.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,933.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,851.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,102.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.70
|
| Rate for Payer: PHCS Commercial |
$15,523.20
|
| Rate for Payer: United Healthcare All Payer |
$14,229.60
|
|
|
LPS-FLEX GSF OPTION FEM C LT
|
Facility
|
OP
|
$16,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.10 |
| Max. Negotiated Rate |
$15,523.20 |
| Rate for Payer: Aetna Commercial |
$12,450.90
|
| Rate for Payer: Anthem Medicaid |
$5,560.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,612.60
|
| Rate for Payer: Cash Price |
$8,085.00
|
| Rate for Payer: Cigna Commercial |
$13,421.10
|
| Rate for Payer: First Health Commercial |
$15,361.50
|
| Rate for Payer: Humana Commercial |
$13,744.50
|
| Rate for Payer: Humana KY Medicaid |
$5,560.86
|
| Rate for Payer: Kentucky WC Medicaid |
$5,617.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,259.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,933.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,851.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,672.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,102.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.70
|
| Rate for Payer: PHCS Commercial |
$15,523.20
|
| Rate for Payer: United Healthcare All Payer |
$14,229.60
|
|
|
LPS-FLEX GSF OPTION FEM C RT
|
Facility
|
OP
|
$16,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.10 |
| Max. Negotiated Rate |
$15,523.20 |
| Rate for Payer: Aetna Commercial |
$12,450.90
|
| Rate for Payer: Anthem Medicaid |
$5,560.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,612.60
|
| Rate for Payer: Cash Price |
$8,085.00
|
| Rate for Payer: Cigna Commercial |
$13,421.10
|
| Rate for Payer: First Health Commercial |
$15,361.50
|
| Rate for Payer: Humana Commercial |
$13,744.50
|
| Rate for Payer: Humana KY Medicaid |
$5,560.86
|
| Rate for Payer: Kentucky WC Medicaid |
$5,617.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,259.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,933.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,851.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,672.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,102.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.70
|
| Rate for Payer: PHCS Commercial |
$15,523.20
|
| Rate for Payer: United Healthcare All Payer |
$14,229.60
|
|
|
LPS-FLEX GSF OPTION FEM C RT
|
Facility
|
IP
|
$16,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.10 |
| Max. Negotiated Rate |
$15,523.20 |
| Rate for Payer: Aetna Commercial |
$12,450.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,612.60
|
| Rate for Payer: Cash Price |
$8,085.00
|
| Rate for Payer: Cigna Commercial |
$13,421.10
|
| Rate for Payer: First Health Commercial |
$15,361.50
|
| Rate for Payer: Humana Commercial |
$13,744.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,259.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,933.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,851.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,102.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.70
|
| Rate for Payer: PHCS Commercial |
$15,523.20
|
| Rate for Payer: United Healthcare All Payer |
$14,229.60
|
|
|
LPS-FLEX GSF OPTION FEM D LT
|
Facility
|
OP
|
$16,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.10 |
| Max. Negotiated Rate |
$15,523.20 |
| Rate for Payer: Aetna Commercial |
$12,450.90
|
| Rate for Payer: Anthem Medicaid |
$5,560.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,612.60
|
| Rate for Payer: Cash Price |
$8,085.00
|
| Rate for Payer: Cigna Commercial |
$13,421.10
|
| Rate for Payer: First Health Commercial |
$15,361.50
|
| Rate for Payer: Humana Commercial |
$13,744.50
|
| Rate for Payer: Humana KY Medicaid |
$5,560.86
|
| Rate for Payer: Kentucky WC Medicaid |
$5,617.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,259.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,933.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,851.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,672.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,102.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.70
|
| Rate for Payer: PHCS Commercial |
$15,523.20
|
| Rate for Payer: United Healthcare All Payer |
$14,229.60
|
|
|
LPS-FLEX GSF OPTION FEM D LT
|
Facility
|
IP
|
$16,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.10 |
| Max. Negotiated Rate |
$15,523.20 |
| Rate for Payer: Aetna Commercial |
$12,450.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,612.60
|
| Rate for Payer: Cash Price |
$8,085.00
|
| Rate for Payer: Cigna Commercial |
$13,421.10
|
| Rate for Payer: First Health Commercial |
$15,361.50
|
| Rate for Payer: Humana Commercial |
$13,744.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,259.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,933.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,851.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,102.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.70
|
| Rate for Payer: PHCS Commercial |
$15,523.20
|
| Rate for Payer: United Healthcare All Payer |
$14,229.60
|
|
|
LPS-FLEX GSF OPTION FEM D RT
|
Facility
|
IP
|
$16,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.10 |
| Max. Negotiated Rate |
$15,523.20 |
| Rate for Payer: Aetna Commercial |
$12,450.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,612.60
|
| Rate for Payer: Cash Price |
$8,085.00
|
| Rate for Payer: Cigna Commercial |
$13,421.10
|
| Rate for Payer: First Health Commercial |
$15,361.50
|
| Rate for Payer: Humana Commercial |
$13,744.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,259.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,933.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,851.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,102.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.70
|
| Rate for Payer: PHCS Commercial |
$15,523.20
|
| Rate for Payer: United Healthcare All Payer |
$14,229.60
|
|
|
LPS-FLEX GSF OPTION FEM D RT
|
Facility
|
OP
|
$16,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.10 |
| Max. Negotiated Rate |
$15,523.20 |
| Rate for Payer: Aetna Commercial |
$12,450.90
|
| Rate for Payer: Anthem Medicaid |
$5,560.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,612.60
|
| Rate for Payer: Cash Price |
$8,085.00
|
| Rate for Payer: Cigna Commercial |
$13,421.10
|
| Rate for Payer: First Health Commercial |
$15,361.50
|
| Rate for Payer: Humana Commercial |
$13,744.50
|
| Rate for Payer: Humana KY Medicaid |
$5,560.86
|
| Rate for Payer: Kentucky WC Medicaid |
$5,617.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,259.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,933.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,851.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,672.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,102.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.70
|
| Rate for Payer: PHCS Commercial |
$15,523.20
|
| Rate for Payer: United Healthcare All Payer |
$14,229.60
|
|
|
LPS-FLEX GSF OPTION FEM E LT
|
Facility
|
OP
|
$16,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.10 |
| Max. Negotiated Rate |
$15,523.20 |
| Rate for Payer: Aetna Commercial |
$12,450.90
|
| Rate for Payer: Anthem Medicaid |
$5,560.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,612.60
|
| Rate for Payer: Cash Price |
$8,085.00
|
| Rate for Payer: Cigna Commercial |
$13,421.10
|
| Rate for Payer: First Health Commercial |
$15,361.50
|
| Rate for Payer: Humana Commercial |
$13,744.50
|
| Rate for Payer: Humana KY Medicaid |
$5,560.86
|
| Rate for Payer: Kentucky WC Medicaid |
$5,617.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,259.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,933.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,851.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,672.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,229.60
|
| Rate for Payer: Ohio Health Group HMO |
$12,127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,234.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,102.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,012.70
|
| Rate for Payer: PHCS Commercial |
$15,523.20
|
| Rate for Payer: United Healthcare All Payer |
$14,229.60
|
|
