|
ABRE STENT 14*80
|
Facility
IP
|
$8,621.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$19,675.20 |
| Rate for Payer: Aetna Commercial |
$6,638.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,724.96
|
| Rate for Payer: Cash Price |
$4,310.88
|
| Rate for Payer: Cigna Commercial |
$7,156.05
|
| Rate for Payer: First Health Commercial |
$8,190.66
|
| Rate for Payer: Humana Commercial |
$7,328.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,069.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,362.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,586.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,587.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,466.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,724.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,120.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,672.74
|
| Rate for Payer: PHCS Commercial |
$8,276.88
|
|
|
ABRE STENT 16*100
|
Facility
IP
|
$8,621.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$19,675.20 |
| Rate for Payer: Aetna Commercial |
$6,638.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,724.96
|
| Rate for Payer: Cash Price |
$4,310.88
|
| Rate for Payer: Cigna Commercial |
$7,156.05
|
| Rate for Payer: First Health Commercial |
$8,190.66
|
| Rate for Payer: Humana Commercial |
$7,328.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,069.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,362.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,586.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,587.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,466.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,724.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,120.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,672.74
|
| Rate for Payer: PHCS Commercial |
$8,276.88
|
|
|
ABRE STENT 16*100
|
Facility
OP
|
$8,621.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$19,675.20 |
| Rate for Payer: Aetna Commercial |
$6,638.75
|
| Rate for Payer: Anthem Medicaid |
$2,965.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,724.96
|
| Rate for Payer: Cash Price |
$4,310.88
|
| Rate for Payer: Cigna Commercial |
$7,156.05
|
| Rate for Payer: First Health Commercial |
$8,190.66
|
| Rate for Payer: Humana Commercial |
$7,328.49
|
| Rate for Payer: Humana KY Medicaid |
$2,965.02
|
| Rate for Payer: Kentucky WC Medicaid |
$2,995.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,069.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,362.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,586.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,024.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,587.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,466.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,724.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,120.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,672.74
|
| Rate for Payer: PHCS Commercial |
$8,276.88
|
| Rate for Payer: United Healthcare All Payer |
$7,587.14
|
|
|
ABRE STENT 18*100
|
Facility
OP
|
$8,621.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$19,675.20 |
| Rate for Payer: Aetna Commercial |
$6,638.75
|
| Rate for Payer: Anthem Medicaid |
$2,965.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,724.96
|
| Rate for Payer: Cash Price |
$4,310.88
|
| Rate for Payer: Cigna Commercial |
$7,156.05
|
| Rate for Payer: First Health Commercial |
$8,190.66
|
| Rate for Payer: Humana Commercial |
$7,328.49
|
| Rate for Payer: Humana KY Medicaid |
$2,965.02
|
| Rate for Payer: Kentucky WC Medicaid |
$2,995.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,069.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,362.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,586.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,024.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,587.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,466.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,724.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,120.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,672.74
|
| Rate for Payer: PHCS Commercial |
$8,276.88
|
| Rate for Payer: United Healthcare All Payer |
$7,587.14
|
|
|
ABRE STENT 18*100
|
Facility
IP
|
$8,621.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$19,675.20 |
| Rate for Payer: Aetna Commercial |
$6,638.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,724.96
|
| Rate for Payer: Cash Price |
$4,310.88
|
| Rate for Payer: Cigna Commercial |
$7,156.05
|
| Rate for Payer: First Health Commercial |
$8,190.66
|
| Rate for Payer: Humana Commercial |
$7,328.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,069.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,362.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,586.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,587.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,466.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,724.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,120.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,672.74
|
| Rate for Payer: PHCS Commercial |
$8,276.88
|
|
|
ABRE STENT 18*120
|
Facility
OP
|
$8,621.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$19,675.20 |
| Rate for Payer: Aetna Commercial |
$6,638.75
|
| Rate for Payer: Anthem Medicaid |
$2,965.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,724.96
|
| Rate for Payer: Cash Price |
$4,310.88
|
| Rate for Payer: Cigna Commercial |
$7,156.05
|
| Rate for Payer: First Health Commercial |
$8,190.66
|
| Rate for Payer: Humana Commercial |
$7,328.49
|
| Rate for Payer: Humana KY Medicaid |
$2,965.02
|
| Rate for Payer: Kentucky WC Medicaid |
$2,995.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,069.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,362.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,586.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,024.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,587.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,466.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,724.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,120.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,672.74
|
| Rate for Payer: PHCS Commercial |
$8,276.88
|
| Rate for Payer: United Healthcare All Payer |
$7,587.14
|
|
|
ABRE STENT 18*120
|
Facility
IP
|
$8,621.75
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$19,675.20 |
| Rate for Payer: Aetna Commercial |
$6,638.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,724.96
|
| Rate for Payer: Cash Price |
$4,310.88
|
| Rate for Payer: Cigna Commercial |
$7,156.05
|
| Rate for Payer: First Health Commercial |
$8,190.66
|
| Rate for Payer: Humana Commercial |
$7,328.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,069.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,362.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,586.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,587.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,466.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,724.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,120.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,672.74
|
| Rate for Payer: PHCS Commercial |
$8,276.88
|
|
|
ABRE STENT 18*150
|
Facility
OP
|
$11,695.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$19,675.20 |
| Rate for Payer: Aetna Commercial |
$9,005.15
|
| Rate for Payer: Anthem Medicaid |
$4,021.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,122.10
|
| Rate for Payer: Cash Price |
$5,847.50
|
| Rate for Payer: Cigna Commercial |
$9,706.85
|
| Rate for Payer: First Health Commercial |
$11,110.25
|
| Rate for Payer: Humana Commercial |
$9,940.75
|
| Rate for Payer: Humana KY Medicaid |
$4,021.91
|
| Rate for Payer: Kentucky WC Medicaid |
$4,062.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,589.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,630.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,508.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,102.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,291.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,771.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,339.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,520.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,625.45
|
| Rate for Payer: PHCS Commercial |
$11,227.20
|
| Rate for Payer: United Healthcare All Payer |
$10,291.60
|
|
|
ABRE STENT 18*150
|
Facility
IP
|
$11,695.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$19,675.20 |
| Rate for Payer: Aetna Commercial |
$9,005.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,122.10
|
| Rate for Payer: Cash Price |
$5,847.50
|
| Rate for Payer: Cigna Commercial |
$9,706.85
|
| Rate for Payer: First Health Commercial |
$11,110.25
|
| Rate for Payer: Humana Commercial |
$9,940.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,589.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,630.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,508.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,291.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,771.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,339.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,520.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,625.45
|
| Rate for Payer: PHCS Commercial |
$11,227.20
|
|
|
ABREVA 10% DENTAL CRM 2 GRAM
|
Facility
OP
|
$0.28
|
|
| Hospital Charge Code |
25000133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Aetna Commercial |
$0.22
|
| Rate for Payer: Anthem Medicaid |
$0.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.22
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna Commercial |
$0.23
|
| Rate for Payer: First Health Commercial |
$0.27
|
| Rate for Payer: Humana Commercial |
$0.24
|
| Rate for Payer: Humana KY Medicaid |
$0.10
|
| Rate for Payer: Kentucky WC Medicaid |
$0.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.25
|
| Rate for Payer: Ohio Health Group HMO |
$0.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.09
|
| Rate for Payer: PHCS Commercial |
$0.27
|
| Rate for Payer: United Healthcare All Payer |
$0.25
|
|
|
ABREVA 10% DENTAL CRM 2 GRAM
|
Facility
IP
|
$0.28
|
|
| Hospital Charge Code |
25000133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Aetna Commercial |
$0.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.22
|
| Rate for Payer: Cash Price |
$0.14
|
| Rate for Payer: Cigna Commercial |
$0.23
|
| Rate for Payer: First Health Commercial |
$0.27
|
| Rate for Payer: Humana Commercial |
$0.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.25
|
| Rate for Payer: Ohio Health Group HMO |
$0.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.09
|
| Rate for Payer: PHCS Commercial |
$0.27
|
|
|
ABR - SCREENING
|
Facility
OP
|
$211.00
|
|
|
Service Code
|
HCPCS 92650
|
| Hospital Charge Code |
47000017
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$27.43 |
| Max. Negotiated Rate |
$202.56 |
| Rate for Payer: Aetna Commercial |
$162.47
|
| Rate for Payer: Anthem Medicaid |
$72.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$164.58
|
| Rate for Payer: Cash Price |
$105.50
|
| Rate for Payer: Cigna Commercial |
$175.13
|
| Rate for Payer: First Health Commercial |
$200.45
|
| Rate for Payer: Humana Commercial |
$179.35
|
| Rate for Payer: Humana KY Medicaid |
$72.56
|
| Rate for Payer: Kentucky WC Medicaid |
$73.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$173.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$155.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$74.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$185.68
|
| Rate for Payer: Ohio Health Group HMO |
$158.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$42.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$65.41
|
| Rate for Payer: PHCS Commercial |
$202.56
|
| Rate for Payer: United Healthcare All Payer |
$185.68
|
|
|
ABR - SCREENING
|
Facility
IP
|
$211.00
|
|
|
Service Code
|
HCPCS 92650
|
| Hospital Charge Code |
47000017
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$27.43 |
| Max. Negotiated Rate |
$202.56 |
| Rate for Payer: Aetna Commercial |
$162.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$164.58
|
| Rate for Payer: Cash Price |
$105.50
|
| Rate for Payer: Cigna Commercial |
$175.13
|
| Rate for Payer: First Health Commercial |
$200.45
|
| Rate for Payer: Humana Commercial |
$179.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$173.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$155.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$185.68
|
| Rate for Payer: Ohio Health Group HMO |
$158.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$42.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$65.41
|
| Rate for Payer: PHCS Commercial |
$202.56
|
|
|
ABRYSVO 120MCG/0.5ML SDV
|
Facility
OP
|
$857.00
|
|
|
Service Code
|
HCPCS 90678
|
| Hospital Charge Code |
63600220
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$111.41 |
| Max. Negotiated Rate |
$822.72 |
| Rate for Payer: Aetna Commercial |
$659.89
|
| Rate for Payer: Anthem Medicaid |
$294.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$668.46
|
| Rate for Payer: Cash Price |
$428.50
|
| Rate for Payer: Cigna Commercial |
$711.31
|
| Rate for Payer: First Health Commercial |
$814.15
|
| Rate for Payer: Humana Commercial |
$728.45
|
| Rate for Payer: Humana KY Medicaid |
$294.72
|
| Rate for Payer: Kentucky WC Medicaid |
$297.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$702.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$632.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$257.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$300.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$754.16
|
| Rate for Payer: Ohio Health Group HMO |
$642.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$171.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$111.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$265.67
|
| Rate for Payer: PHCS Commercial |
$822.72
|
| Rate for Payer: United Healthcare All Payer |
$754.16
|
|
|
ABRYSVO 120MCG/0.5ML SDV
|
Professional
|
$857.00
|
|
|
Service Code
|
HCPCS 90678
|
| Hospital Charge Code |
63600220
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$299.95 |
| Max. Negotiated Rate |
$857.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$857.00
|
| Rate for Payer: Cash Price |
$428.50
|
| Rate for Payer: Multiplan PHCS |
$514.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$599.90
|
| Rate for Payer: UHCCP Medicaid |
$299.95
|
|
|
ABRYSVO 120MCG/0.5ML SDV
|
Facility
IP
|
$857.00
|
|
|
Service Code
|
HCPCS 90678
|
| Hospital Charge Code |
63600220
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$111.41 |
| Max. Negotiated Rate |
$822.72 |
| Rate for Payer: Aetna Commercial |
$659.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$668.46
|
| Rate for Payer: Cash Price |
$428.50
|
| Rate for Payer: Cigna Commercial |
$711.31
|
| Rate for Payer: First Health Commercial |
$814.15
|
| Rate for Payer: Humana Commercial |
$728.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$702.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$632.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$257.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$754.16
|
| Rate for Payer: Ohio Health Group HMO |
$642.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$171.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$111.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$265.67
|
| Rate for Payer: PHCS Commercial |
$822.72
|
|
|
ABRYSVO 120MCG/0.5ML SDV
|
Facility
OP
|
$857.00
|
|
|
Service Code
|
HCPCS 90678
|
| Hospital Charge Code |
636T0220
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$111.41 |
| Max. Negotiated Rate |
$822.72 |
| Rate for Payer: Aetna Commercial |
$659.89
|
| Rate for Payer: Anthem Medicaid |
$294.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$668.46
|
| Rate for Payer: Cash Price |
$428.50
|
| Rate for Payer: Cigna Commercial |
$711.31
|
| Rate for Payer: First Health Commercial |
$814.15
|
| Rate for Payer: Humana Commercial |
$728.45
|
| Rate for Payer: Humana KY Medicaid |
$294.72
|
| Rate for Payer: Kentucky WC Medicaid |
$297.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$702.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$632.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$257.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$300.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$754.16
|
| Rate for Payer: Ohio Health Group HMO |
$642.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$171.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$111.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$265.67
|
| Rate for Payer: PHCS Commercial |
$822.72
|
| Rate for Payer: United Healthcare All Payer |
$754.16
|
|
|
ABRYSVO 120MCG/0.5ML SDV
|
Facility
IP
|
$857.00
|
|
|
Service Code
|
HCPCS 90678
|
| Hospital Charge Code |
636T0220
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$111.41 |
| Max. Negotiated Rate |
$822.72 |
| Rate for Payer: Aetna Commercial |
$659.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$668.46
|
| Rate for Payer: Cash Price |
$428.50
|
| Rate for Payer: Cigna Commercial |
$711.31
|
| Rate for Payer: First Health Commercial |
$814.15
|
| Rate for Payer: Humana Commercial |
$728.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$702.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$632.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$257.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$754.16
|
| Rate for Payer: Ohio Health Group HMO |
$642.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$171.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$111.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$265.67
|
| Rate for Payer: PHCS Commercial |
$822.72
|
|
|
ABS BUTTON CONCVE 11MM/ IB
|
Facility
IP
|
$3,210.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$39,122.40 |
| Rate for Payer: Aetna Commercial |
$2,472.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,504.28
|
| Rate for Payer: Cash Price |
$1,605.31
|
| Rate for Payer: Cigna Commercial |
$2,664.81
|
| Rate for Payer: First Health Commercial |
$3,050.09
|
| Rate for Payer: Humana Commercial |
$2,729.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,632.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,369.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$963.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,825.35
|
| Rate for Payer: Ohio Health Group HMO |
$2,407.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$642.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$417.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$995.29
|
| Rate for Payer: PHCS Commercial |
$3,082.20
|
|
|
ABS BUTTON CONCVE 11MM/ IB
|
Facility
OP
|
$3,210.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$39,122.40 |
| Rate for Payer: Aetna Commercial |
$2,472.18
|
| Rate for Payer: Anthem Medicaid |
$1,104.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,504.28
|
| Rate for Payer: Cash Price |
$1,605.31
|
| Rate for Payer: Cigna Commercial |
$2,664.81
|
| Rate for Payer: First Health Commercial |
$3,050.09
|
| Rate for Payer: Humana Commercial |
$2,729.03
|
| Rate for Payer: Humana KY Medicaid |
$1,104.13
|
| Rate for Payer: Kentucky WC Medicaid |
$1,115.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,632.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,369.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$963.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,126.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,825.35
|
| Rate for Payer: Ohio Health Group HMO |
$2,407.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$642.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$417.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$995.29
|
| Rate for Payer: PHCS Commercial |
$3,082.20
|
| Rate for Payer: United Healthcare All Payer |
$2,825.35
|
|
|
ABS FIBERTAG
|
Facility
IP
|
$3,431.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$39,122.40 |
| Rate for Payer: Aetna Commercial |
$2,641.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,676.27
|
| Rate for Payer: Cash Price |
$1,715.56
|
| Rate for Payer: Cigna Commercial |
$2,847.83
|
| Rate for Payer: First Health Commercial |
$3,259.56
|
| Rate for Payer: Humana Commercial |
$2,916.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,813.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,532.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,029.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,019.39
|
| Rate for Payer: Ohio Health Group HMO |
$2,573.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$686.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$446.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,063.65
|
| Rate for Payer: PHCS Commercial |
$3,293.88
|
|
|
ABS FIBERTAG
|
Facility
OP
|
$3,431.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$39,122.40 |
| Rate for Payer: Aetna Commercial |
$2,641.96
|
| Rate for Payer: Anthem Medicaid |
$1,179.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,676.27
|
| Rate for Payer: Cash Price |
$1,715.56
|
| Rate for Payer: Cigna Commercial |
$2,847.83
|
| Rate for Payer: First Health Commercial |
$3,259.56
|
| Rate for Payer: Humana Commercial |
$2,916.45
|
| Rate for Payer: Humana KY Medicaid |
$1,179.96
|
| Rate for Payer: Kentucky WC Medicaid |
$1,191.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,813.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,532.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,029.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,203.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,019.39
|
| Rate for Payer: Ohio Health Group HMO |
$2,573.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$686.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$446.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,063.65
|
| Rate for Payer: PHCS Commercial |
$3,293.88
|
| Rate for Payer: United Healthcare All Payer |
$3,019.39
|
|
|
ACC ELBW ULNAR LT 60MM LG
|
Facility
OP
|
$9,406.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$7,243.00
|
| Rate for Payer: Anthem Medicaid |
$3,234.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,337.07
|
| Rate for Payer: Cash Price |
$4,703.25
|
| Rate for Payer: Cigna Commercial |
$7,807.40
|
| Rate for Payer: First Health Commercial |
$8,936.18
|
| Rate for Payer: Humana Commercial |
$7,995.52
|
| Rate for Payer: Humana KY Medicaid |
$3,234.90
|
| Rate for Payer: Kentucky WC Medicaid |
$3,267.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,713.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,942.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,821.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,299.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,277.72
|
| Rate for Payer: Ohio Health Group HMO |
$7,054.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,881.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,222.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,916.02
|
| Rate for Payer: PHCS Commercial |
$9,030.24
|
| Rate for Payer: United Healthcare All Payer |
$8,277.72
|
|
|
ACC ELBW ULNAR LT 60MM LG
|
Facility
IP
|
$9,406.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$7,243.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,337.07
|
| Rate for Payer: Cash Price |
$4,703.25
|
| Rate for Payer: Cigna Commercial |
$7,807.40
|
| Rate for Payer: First Health Commercial |
$8,936.18
|
| Rate for Payer: Humana Commercial |
$7,995.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,713.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,942.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,821.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,277.72
|
| Rate for Payer: Ohio Health Group HMO |
$7,054.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,881.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,222.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,916.02
|
| Rate for Payer: PHCS Commercial |
$9,030.24
|
|
|
ACCLAIM ELBOW BOBBIN
|
Facility
OP
|
$11,731.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$9,033.26
|
| Rate for Payer: Anthem Medicaid |
$4,034.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,150.57
|
| Rate for Payer: Cash Price |
$5,865.75
|
| Rate for Payer: Cigna Commercial |
$9,737.14
|
| Rate for Payer: First Health Commercial |
$11,144.92
|
| Rate for Payer: Humana Commercial |
$9,971.78
|
| Rate for Payer: Humana KY Medicaid |
$4,034.46
|
| Rate for Payer: Kentucky WC Medicaid |
$4,075.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,619.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,657.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,519.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,115.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,323.72
|
| Rate for Payer: Ohio Health Group HMO |
$8,798.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,346.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,525.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,636.76
|
| Rate for Payer: PHCS Commercial |
$11,262.24
|
| Rate for Payer: United Healthcare All Payer |
$10,323.72
|
|
