|
0.9% NaCl Irrigation 500mL
|
Facility
OP
|
$20.25
|
|
| Hospital Charge Code |
636T0157
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.63 |
| Max. Negotiated Rate |
$19.44 |
| Rate for Payer: Aetna Commercial |
$15.59
|
| Rate for Payer: Anthem Medicaid |
$6.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15.80
|
| Rate for Payer: Cash Price |
$10.12
|
| Rate for Payer: Cigna Commercial |
$16.81
|
| Rate for Payer: First Health Commercial |
$19.24
|
| Rate for Payer: Humana Commercial |
$17.21
|
| Rate for Payer: Humana KY Medicaid |
$6.96
|
| Rate for Payer: Kentucky WC Medicaid |
$7.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$7.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$17.82
|
| Rate for Payer: Ohio Health Group HMO |
$15.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.28
|
| Rate for Payer: PHCS Commercial |
$19.44
|
| Rate for Payer: United Healthcare All Payer |
$17.82
|
|
|
0.9% NACL (VISIV) 100ML IV SOL
|
Facility
IP
|
$67.25
|
|
| Hospital Charge Code |
25002784
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.74 |
| Max. Negotiated Rate |
$64.56 |
| Rate for Payer: Aetna Commercial |
$51.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.46
|
| Rate for Payer: Cash Price |
$33.62
|
| Rate for Payer: Cigna Commercial |
$55.82
|
| Rate for Payer: First Health Commercial |
$63.89
|
| Rate for Payer: Humana Commercial |
$57.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$55.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$59.18
|
| Rate for Payer: Ohio Health Group HMO |
$50.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.85
|
| Rate for Payer: PHCS Commercial |
$64.56
|
|
|
0.9% NACL (VISIV) 100ML IV SOL
|
Facility
OP
|
$67.25
|
|
| Hospital Charge Code |
25002784
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.74 |
| Max. Negotiated Rate |
$64.56 |
| Rate for Payer: Aetna Commercial |
$51.78
|
| Rate for Payer: Anthem Medicaid |
$23.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.46
|
| Rate for Payer: Cash Price |
$33.62
|
| Rate for Payer: Cigna Commercial |
$55.82
|
| Rate for Payer: First Health Commercial |
$63.89
|
| Rate for Payer: Humana Commercial |
$57.16
|
| Rate for Payer: Humana KY Medicaid |
$23.13
|
| Rate for Payer: Kentucky WC Medicaid |
$23.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$55.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$23.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$59.18
|
| Rate for Payer: Ohio Health Group HMO |
$50.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.85
|
| Rate for Payer: PHCS Commercial |
$64.56
|
| Rate for Payer: United Healthcare All Payer |
$59.18
|
|
|
100SCM SKSBH/F/DIGITS 1ST100
|
Facility
OP
|
$2,324.00
|
|
|
Service Code
|
HCPCS 15277
|
| Hospital Charge Code |
76100196
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$302.12 |
| Max. Negotiated Rate |
$2,231.04 |
| Rate for Payer: Aetna Commercial |
$1,789.48
|
| Rate for Payer: Anthem Medicaid |
$799.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,576.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,812.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,207.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,128.92
|
| Rate for Payer: Cash Price |
$1,162.00
|
| Rate for Payer: Cash Price |
$1,162.00
|
| Rate for Payer: Cigna Commercial |
$1,928.92
|
| Rate for Payer: First Health Commercial |
$2,207.80
|
| Rate for Payer: Humana Commercial |
$1,975.40
|
| Rate for Payer: Humana KY Medicaid |
$799.22
|
| Rate for Payer: Humana Medicare Advantage |
$1,576.98
|
| Rate for Payer: Kentucky WC Medicaid |
$807.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,905.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,715.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,892.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$815.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,045.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,743.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$464.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$302.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$720.44
|
| Rate for Payer: PHCS Commercial |
$2,231.04
|
| Rate for Payer: United Healthcare All Payer |
$2,045.12
|
|
|
100SCM SKSBH/F/DIGITS 1ST100
|
Facility
IP
|
$2,324.00
|
|
|
Service Code
|
HCPCS 15277
|
| Hospital Charge Code |
76100196
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$302.12 |
| Max. Negotiated Rate |
$2,231.04 |
| Rate for Payer: Aetna Commercial |
$1,789.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,812.72
|
| Rate for Payer: Cash Price |
$1,162.00
|
| Rate for Payer: Cigna Commercial |
$1,928.92
|
| Rate for Payer: First Health Commercial |
$2,207.80
|
| Rate for Payer: Humana Commercial |
$1,975.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,905.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,715.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$697.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,045.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,743.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$464.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$302.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$720.44
|
| Rate for Payer: PHCS Commercial |
$2,231.04
|
|
|
10% DEXTRAN 40(LMD)/0.9% 500ML
|
Facility
OP
|
$126.19
|
|
|
Service Code
|
HCPCS J7100
|
| Hospital Charge Code |
25002790
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$121.14 |
| Rate for Payer: Aetna Commercial |
$97.17
|
| Rate for Payer: Anthem Medicaid |
$43.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$98.43
|
| Rate for Payer: Cash Price |
$63.09
|
| Rate for Payer: Cigna Commercial |
$104.74
|
| Rate for Payer: First Health Commercial |
$119.88
|
| Rate for Payer: Humana Commercial |
$107.26
|
| Rate for Payer: Humana KY Medicaid |
$43.40
|
| Rate for Payer: Kentucky WC Medicaid |
$43.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$103.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$93.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$44.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$111.05
|
| Rate for Payer: Ohio Health Group HMO |
$94.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$39.12
|
| Rate for Payer: PHCS Commercial |
$121.14
|
| Rate for Payer: United Healthcare All Payer |
$111.05
|
|
|
10% DEXTRAN 40(LMD)/0.9% 500ML
|
Facility
IP
|
$126.19
|
|
|
Service Code
|
HCPCS J7100
|
| Hospital Charge Code |
25002790
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$121.14 |
| Rate for Payer: Aetna Commercial |
$97.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$98.43
|
| Rate for Payer: Cash Price |
$63.09
|
| Rate for Payer: Cigna Commercial |
$104.74
|
| Rate for Payer: First Health Commercial |
$119.88
|
| Rate for Payer: Humana Commercial |
$107.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$103.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$93.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$111.05
|
| Rate for Payer: Ohio Health Group HMO |
$94.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$39.12
|
| Rate for Payer: PHCS Commercial |
$121.14
|
|
|
10 FR SHEATH
|
Facility
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$10,176.00 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
|
|
10 FR SHEATH
|
Facility
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$10,176.00 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
10% VITAMIN C 50 ML GBL
|
Professional
|
$93.00
|
|
| Hospital Charge Code |
22200147
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$32.55 |
| Max. Negotiated Rate |
$93.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$93.00
|
| Rate for Payer: Cash Price |
$46.50
|
| Rate for Payer: Multiplan PHCS |
$55.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$65.10
|
| Rate for Payer: UHCCP Medicaid |
$32.55
|
|
|
11 FR SHEATH
|
Facility
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$10,176.00 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
11 FR SHEATH
|
Facility
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$10,176.00 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
|
|
11 LNG REV POL+20 L IMPLT STEM
|
Facility
IP
|
$27,879.50
|
|
|
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 |
$21,467.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,746.01
|
| Rate for Payer: Cash Price |
$13,939.75
|
| Rate for Payer: Cigna Commercial |
$23,139.98
|
| Rate for Payer: First Health Commercial |
$26,485.52
|
| Rate for Payer: Humana Commercial |
$23,697.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,861.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,575.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,363.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,533.96
|
| Rate for Payer: Ohio Health Group HMO |
$20,909.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,575.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,624.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,642.64
|
| Rate for Payer: PHCS Commercial |
$26,764.32
|
|
|
11 LNG REV POL+20 L IMPLT STEM
|
Facility
OP
|
$27,879.50
|
|
|
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 |
$21,467.22
|
| Rate for Payer: Anthem Medicaid |
$9,587.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,746.01
|
| Rate for Payer: Cash Price |
$13,939.75
|
| Rate for Payer: Cigna Commercial |
$23,139.98
|
| Rate for Payer: First Health Commercial |
$26,485.52
|
| Rate for Payer: Humana Commercial |
$23,697.58
|
| Rate for Payer: Humana KY Medicaid |
$9,587.76
|
| Rate for Payer: Kentucky WC Medicaid |
$9,685.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,861.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,575.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,363.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,780.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,533.96
|
| Rate for Payer: Ohio Health Group HMO |
$20,909.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,575.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,624.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,642.64
|
| Rate for Payer: PHCS Commercial |
$26,764.32
|
| Rate for Payer: United Healthcare All Payer |
$24,533.96
|
|
|
11 LNG REV POL+20 R IMPLT STEM
|
Facility
OP
|
$27,879.50
|
|
|
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 |
$21,467.22
|
| Rate for Payer: Anthem Medicaid |
$9,587.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,746.01
|
| Rate for Payer: Cash Price |
$13,939.75
|
| Rate for Payer: Cigna Commercial |
$23,139.98
|
| Rate for Payer: First Health Commercial |
$26,485.52
|
| Rate for Payer: Humana Commercial |
$23,697.58
|
| Rate for Payer: Humana KY Medicaid |
$9,587.76
|
| Rate for Payer: Kentucky WC Medicaid |
$9,685.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,861.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,575.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,363.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,780.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,533.96
|
| Rate for Payer: Ohio Health Group HMO |
$20,909.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,575.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,624.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,642.64
|
| Rate for Payer: PHCS Commercial |
$26,764.32
|
| Rate for Payer: United Healthcare All Payer |
$24,533.96
|
|
|
11 LNG REV POL+20 R IMPLT STEM
|
Facility
IP
|
$27,879.50
|
|
|
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 |
$21,467.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,746.01
|
| Rate for Payer: Cash Price |
$13,939.75
|
| Rate for Payer: Cigna Commercial |
$23,139.98
|
| Rate for Payer: First Health Commercial |
$26,485.52
|
| Rate for Payer: Humana Commercial |
$23,697.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,861.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,575.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,363.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,533.96
|
| Rate for Payer: Ohio Health Group HMO |
$20,909.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,575.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,624.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,642.64
|
| Rate for Payer: PHCS Commercial |
$26,764.32
|
|
|
11 STEM PRIMARY HO
|
Facility
IP
|
$18,000.60
|
|
|
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 |
$13,860.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,040.47
|
| Rate for Payer: Cash Price |
$9,000.30
|
| Rate for Payer: Cigna Commercial |
$14,940.50
|
| Rate for Payer: First Health Commercial |
$17,100.57
|
| Rate for Payer: Humana Commercial |
$15,300.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,760.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,284.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,400.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,840.53
|
| Rate for Payer: Ohio Health Group HMO |
$13,500.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,600.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,340.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,580.19
|
| Rate for Payer: PHCS Commercial |
$17,280.58
|
|
|
11 STEM PRIMARY HO
|
Facility
OP
|
$18,000.60
|
|
|
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 |
$13,860.46
|
| Rate for Payer: Anthem Medicaid |
$6,190.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,040.47
|
| Rate for Payer: Cash Price |
$9,000.30
|
| Rate for Payer: Cigna Commercial |
$14,940.50
|
| Rate for Payer: First Health Commercial |
$17,100.57
|
| Rate for Payer: Humana Commercial |
$15,300.51
|
| Rate for Payer: Humana KY Medicaid |
$6,190.41
|
| Rate for Payer: Kentucky WC Medicaid |
$6,253.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,760.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,284.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,400.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,314.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,840.53
|
| Rate for Payer: Ohio Health Group HMO |
$13,500.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,600.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,340.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,580.19
|
| Rate for Payer: PHCS Commercial |
$17,280.58
|
| Rate for Payer: United Healthcare All Payer |
$15,840.53
|
|
|
11 STEM PRIMARY SO
|
Facility
IP
|
$17,679.30
|
|
|
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 |
$13,613.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,789.85
|
| Rate for Payer: Cash Price |
$8,839.65
|
| Rate for Payer: Cigna Commercial |
$14,673.82
|
| Rate for Payer: First Health Commercial |
$16,795.34
|
| Rate for Payer: Humana Commercial |
$15,027.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,497.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,047.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,303.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,557.78
|
| Rate for Payer: Ohio Health Group HMO |
$13,259.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,535.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,298.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,480.58
|
| Rate for Payer: PHCS Commercial |
$16,972.13
|
|
|
11 STEM PRIMARY SO
|
Facility
OP
|
$17,679.30
|
|
|
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 |
$13,613.06
|
| Rate for Payer: Anthem Medicaid |
$6,079.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,789.85
|
| Rate for Payer: Cash Price |
$8,839.65
|
| Rate for Payer: Cigna Commercial |
$14,673.82
|
| Rate for Payer: First Health Commercial |
$16,795.34
|
| Rate for Payer: Humana Commercial |
$15,027.40
|
| Rate for Payer: Humana KY Medicaid |
$6,079.91
|
| Rate for Payer: Kentucky WC Medicaid |
$6,141.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,497.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,047.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,303.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,201.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,557.78
|
| Rate for Payer: Ohio Health Group HMO |
$13,259.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,535.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,298.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,480.58
|
| Rate for Payer: PHCS Commercial |
$16,972.13
|
| Rate for Payer: United Healthcare All Payer |
$15,557.78
|
|
|
12X120MM OVATION IX
|
Facility
IP
|
$25,601.35
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$80,156.54 |
| Rate for Payer: Aetna Commercial |
$19,713.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,969.05
|
| Rate for Payer: Cash Price |
$12,800.67
|
| Rate for Payer: Cigna Commercial |
$21,249.12
|
| Rate for Payer: First Health Commercial |
$24,321.28
|
| Rate for Payer: Humana Commercial |
$21,761.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,993.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,893.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,680.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,529.19
|
| Rate for Payer: Ohio Health Group HMO |
$19,201.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,120.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,328.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,936.42
|
| Rate for Payer: PHCS Commercial |
$24,577.30
|
|
|
12X120MM OVATION IX
|
Facility
OP
|
$25,601.35
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$80,156.54 |
| Rate for Payer: Aetna Commercial |
$19,713.04
|
| Rate for Payer: Anthem Medicaid |
$8,804.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,969.05
|
| Rate for Payer: Cash Price |
$12,800.67
|
| Rate for Payer: Cigna Commercial |
$21,249.12
|
| Rate for Payer: First Health Commercial |
$24,321.28
|
| Rate for Payer: Humana Commercial |
$21,761.15
|
| Rate for Payer: Humana KY Medicaid |
$8,804.30
|
| Rate for Payer: Kentucky WC Medicaid |
$8,893.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,993.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,893.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,680.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,980.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,529.19
|
| Rate for Payer: Ohio Health Group HMO |
$19,201.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,120.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,328.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,936.42
|
| Rate for Payer: PHCS Commercial |
$24,577.30
|
| Rate for Payer: United Healthcare All Payer |
$22,529.19
|
|
|
13 SLV MD CONE 1 SPT TALL SLOT
|
Facility
IP
|
$17,679.30
|
|
|
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 |
$13,613.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,789.85
|
| Rate for Payer: Cash Price |
$8,839.65
|
| Rate for Payer: Cigna Commercial |
$14,673.82
|
| Rate for Payer: First Health Commercial |
$16,795.34
|
| Rate for Payer: Humana Commercial |
$15,027.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,497.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,047.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,303.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,557.78
|
| Rate for Payer: Ohio Health Group HMO |
$13,259.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,535.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,298.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,480.58
|
| Rate for Payer: PHCS Commercial |
$16,972.13
|
|
|
13 SLV MD CONE 1 SPT TALL SLOT
|
Facility
OP
|
$17,679.30
|
|
|
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 |
$13,613.06
|
| Rate for Payer: Anthem Medicaid |
$6,079.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,789.85
|
| Rate for Payer: Cash Price |
$8,839.65
|
| Rate for Payer: Cigna Commercial |
$14,673.82
|
| Rate for Payer: First Health Commercial |
$16,795.34
|
| Rate for Payer: Humana Commercial |
$15,027.40
|
| Rate for Payer: Humana KY Medicaid |
$6,079.91
|
| Rate for Payer: Kentucky WC Medicaid |
$6,141.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,497.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,047.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,303.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,201.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,557.78
|
| Rate for Payer: Ohio Health Group HMO |
$13,259.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,535.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,298.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,480.58
|
| Rate for Payer: PHCS Commercial |
$16,972.13
|
| Rate for Payer: United Healthcare All Payer |
$15,557.78
|
|
|
13 SLV MD CONE 2 SPT TALL SLOT
|
Facility
OP
|
$17,679.30
|
|
|
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 |
$13,613.06
|
| Rate for Payer: Anthem Medicaid |
$6,079.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,789.85
|
| Rate for Payer: Cash Price |
$8,839.65
|
| Rate for Payer: Cigna Commercial |
$14,673.82
|
| Rate for Payer: First Health Commercial |
$16,795.34
|
| Rate for Payer: Humana Commercial |
$15,027.40
|
| Rate for Payer: Humana KY Medicaid |
$6,079.91
|
| Rate for Payer: Kentucky WC Medicaid |
$6,141.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,497.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,047.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,303.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,201.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,557.78
|
| Rate for Payer: Ohio Health Group HMO |
$13,259.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,535.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,298.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,480.58
|
| Rate for Payer: PHCS Commercial |
$16,972.13
|
| Rate for Payer: United Healthcare All Payer |
$15,557.78
|
|
