|
PINN SECTOR HA ACET CUP 50MM
|
Facility
|
OP
|
$13,943.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,812.64 |
| Max. Negotiated Rate |
$13,385.66 |
| Rate for Payer: Aetna Commercial |
$10,736.42
|
| Rate for Payer: Anthem Medicaid |
$4,795.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,875.85
|
| Rate for Payer: Cash Price |
$6,971.70
|
| Rate for Payer: Cigna Commercial |
$11,573.02
|
| Rate for Payer: First Health Commercial |
$13,246.23
|
| Rate for Payer: Humana Commercial |
$11,851.89
|
| Rate for Payer: Humana KY Medicaid |
$4,795.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,843.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,433.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,290.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,183.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,891.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,270.19
|
| Rate for Payer: Ohio Health Group HMO |
$10,457.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,788.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,812.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,322.45
|
| Rate for Payer: PHCS Commercial |
$13,385.66
|
| Rate for Payer: United Healthcare All Payer |
$12,270.19
|
|
|
PINN SECTOR HA ACET CUP 52MM
|
Facility
|
IP
|
$13,943.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,812.64 |
| Max. Negotiated Rate |
$13,385.66 |
| Rate for Payer: Aetna Commercial |
$10,736.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,875.85
|
| Rate for Payer: Cash Price |
$6,971.70
|
| Rate for Payer: Cigna Commercial |
$11,573.02
|
| Rate for Payer: First Health Commercial |
$13,246.23
|
| Rate for Payer: Humana Commercial |
$11,851.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,433.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,290.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,183.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,270.19
|
| Rate for Payer: Ohio Health Group HMO |
$10,457.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,788.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,812.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,322.45
|
| Rate for Payer: PHCS Commercial |
$13,385.66
|
| Rate for Payer: United Healthcare All Payer |
$12,270.19
|
|
|
PINN SECTOR HA ACET CUP 52MM
|
Facility
|
OP
|
$13,943.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,812.64 |
| Max. Negotiated Rate |
$13,385.66 |
| Rate for Payer: Aetna Commercial |
$10,736.42
|
| Rate for Payer: Anthem Medicaid |
$4,795.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,875.85
|
| Rate for Payer: Cash Price |
$6,971.70
|
| Rate for Payer: Cigna Commercial |
$11,573.02
|
| Rate for Payer: First Health Commercial |
$13,246.23
|
| Rate for Payer: Humana Commercial |
$11,851.89
|
| Rate for Payer: Humana KY Medicaid |
$4,795.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,843.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,433.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,290.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,183.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,891.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,270.19
|
| Rate for Payer: Ohio Health Group HMO |
$10,457.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,788.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,812.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,322.45
|
| Rate for Payer: PHCS Commercial |
$13,385.66
|
| Rate for Payer: United Healthcare All Payer |
$12,270.19
|
|
|
PINN SECTOR HA ACET CUP 54MM
|
Facility
|
OP
|
$13,943.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,812.64 |
| Max. Negotiated Rate |
$13,385.66 |
| Rate for Payer: Aetna Commercial |
$10,736.42
|
| Rate for Payer: Anthem Medicaid |
$4,795.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,875.85
|
| Rate for Payer: Cash Price |
$6,971.70
|
| Rate for Payer: Cigna Commercial |
$11,573.02
|
| Rate for Payer: First Health Commercial |
$13,246.23
|
| Rate for Payer: Humana Commercial |
$11,851.89
|
| Rate for Payer: Humana KY Medicaid |
$4,795.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,843.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,433.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,290.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,183.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,891.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,270.19
|
| Rate for Payer: Ohio Health Group HMO |
$10,457.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,788.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,812.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,322.45
|
| Rate for Payer: PHCS Commercial |
$13,385.66
|
| Rate for Payer: United Healthcare All Payer |
$12,270.19
|
|
|
PINN SECTOR HA ACET CUP 54MM
|
Facility
|
IP
|
$13,943.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,812.64 |
| Max. Negotiated Rate |
$13,385.66 |
| Rate for Payer: Aetna Commercial |
$10,736.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,875.85
|
| Rate for Payer: Cash Price |
$6,971.70
|
| Rate for Payer: Cigna Commercial |
$11,573.02
|
| Rate for Payer: First Health Commercial |
$13,246.23
|
| Rate for Payer: Humana Commercial |
$11,851.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,433.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,290.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,183.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,270.19
|
| Rate for Payer: Ohio Health Group HMO |
$10,457.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,788.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,812.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,322.45
|
| Rate for Payer: PHCS Commercial |
$13,385.66
|
| Rate for Payer: United Healthcare All Payer |
$12,270.19
|
|
|
PINN SECTOR HA ACET CUP 56MM
|
Facility
|
OP
|
$13,943.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,812.64 |
| Max. Negotiated Rate |
$13,385.66 |
| Rate for Payer: Aetna Commercial |
$10,736.42
|
| Rate for Payer: Anthem Medicaid |
$4,795.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,875.85
|
| Rate for Payer: Cash Price |
$6,971.70
|
| Rate for Payer: Cigna Commercial |
$11,573.02
|
| Rate for Payer: First Health Commercial |
$13,246.23
|
| Rate for Payer: Humana Commercial |
$11,851.89
|
| Rate for Payer: Humana KY Medicaid |
$4,795.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,843.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,433.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,290.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,183.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,891.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,270.19
|
| Rate for Payer: Ohio Health Group HMO |
$10,457.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,788.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,812.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,322.45
|
| Rate for Payer: PHCS Commercial |
$13,385.66
|
| Rate for Payer: United Healthcare All Payer |
$12,270.19
|
|
|
PINN SECTOR HA ACET CUP 56MM
|
Facility
|
IP
|
$13,943.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,812.64 |
| Max. Negotiated Rate |
$13,385.66 |
| Rate for Payer: Aetna Commercial |
$10,736.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,875.85
|
| Rate for Payer: Cash Price |
$6,971.70
|
| Rate for Payer: Cigna Commercial |
$11,573.02
|
| Rate for Payer: First Health Commercial |
$13,246.23
|
| Rate for Payer: Humana Commercial |
$11,851.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,433.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,290.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,183.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,270.19
|
| Rate for Payer: Ohio Health Group HMO |
$10,457.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,788.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,812.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,322.45
|
| Rate for Payer: PHCS Commercial |
$13,385.66
|
| Rate for Payer: United Healthcare All Payer |
$12,270.19
|
|
|
PINN SECTOR HA ACET CUP 58MM
|
Facility
|
IP
|
$13,943.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,812.64 |
| Max. Negotiated Rate |
$13,385.66 |
| Rate for Payer: Aetna Commercial |
$10,736.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,875.85
|
| Rate for Payer: Cash Price |
$6,971.70
|
| Rate for Payer: Cigna Commercial |
$11,573.02
|
| Rate for Payer: First Health Commercial |
$13,246.23
|
| Rate for Payer: Humana Commercial |
$11,851.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,433.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,290.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,183.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,270.19
|
| Rate for Payer: Ohio Health Group HMO |
$10,457.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,788.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,812.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,322.45
|
| Rate for Payer: PHCS Commercial |
$13,385.66
|
| Rate for Payer: United Healthcare All Payer |
$12,270.19
|
|
|
PINN SECTOR HA ACET CUP 58MM
|
Facility
|
OP
|
$13,943.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,812.64 |
| Max. Negotiated Rate |
$13,385.66 |
| Rate for Payer: Aetna Commercial |
$10,736.42
|
| Rate for Payer: Anthem Medicaid |
$4,795.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,875.85
|
| Rate for Payer: Cash Price |
$6,971.70
|
| Rate for Payer: Cigna Commercial |
$11,573.02
|
| Rate for Payer: First Health Commercial |
$13,246.23
|
| Rate for Payer: Humana Commercial |
$11,851.89
|
| Rate for Payer: Humana KY Medicaid |
$4,795.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,843.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,433.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,290.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,183.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,891.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,270.19
|
| Rate for Payer: Ohio Health Group HMO |
$10,457.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,788.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,812.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,322.45
|
| Rate for Payer: PHCS Commercial |
$13,385.66
|
| Rate for Payer: United Healthcare All Payer |
$12,270.19
|
|
|
PINN SECTOR HA ACET CUP 60MM
|
Facility
|
OP
|
$13,943.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,812.64 |
| Max. Negotiated Rate |
$13,385.66 |
| Rate for Payer: Aetna Commercial |
$10,736.42
|
| Rate for Payer: Anthem Medicaid |
$4,795.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,875.85
|
| Rate for Payer: Cash Price |
$6,971.70
|
| Rate for Payer: Cigna Commercial |
$11,573.02
|
| Rate for Payer: First Health Commercial |
$13,246.23
|
| Rate for Payer: Humana Commercial |
$11,851.89
|
| Rate for Payer: Humana KY Medicaid |
$4,795.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,843.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,433.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,290.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,183.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,891.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,270.19
|
| Rate for Payer: Ohio Health Group HMO |
$10,457.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,788.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,812.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,322.45
|
| Rate for Payer: PHCS Commercial |
$13,385.66
|
| Rate for Payer: United Healthcare All Payer |
$12,270.19
|
|
|
PINN SECTOR HA ACET CUP 60MM
|
Facility
|
IP
|
$13,943.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,812.64 |
| Max. Negotiated Rate |
$13,385.66 |
| Rate for Payer: Aetna Commercial |
$10,736.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,875.85
|
| Rate for Payer: Cash Price |
$6,971.70
|
| Rate for Payer: Cigna Commercial |
$11,573.02
|
| Rate for Payer: First Health Commercial |
$13,246.23
|
| Rate for Payer: Humana Commercial |
$11,851.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,433.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,290.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,183.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,270.19
|
| Rate for Payer: Ohio Health Group HMO |
$10,457.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,788.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,812.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,322.45
|
| Rate for Payer: PHCS Commercial |
$13,385.66
|
| Rate for Payer: United Healthcare All Payer |
$12,270.19
|
|
|
PINN SECTOR HA ACET CUP 62MM
|
Facility
|
OP
|
$13,943.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,812.64 |
| Max. Negotiated Rate |
$13,385.66 |
| Rate for Payer: Aetna Commercial |
$10,736.42
|
| Rate for Payer: Anthem Medicaid |
$4,795.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,875.85
|
| Rate for Payer: Cash Price |
$6,971.70
|
| Rate for Payer: Cigna Commercial |
$11,573.02
|
| Rate for Payer: First Health Commercial |
$13,246.23
|
| Rate for Payer: Humana Commercial |
$11,851.89
|
| Rate for Payer: Humana KY Medicaid |
$4,795.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,843.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,433.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,290.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,183.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,891.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,270.19
|
| Rate for Payer: Ohio Health Group HMO |
$10,457.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,788.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,812.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,322.45
|
| Rate for Payer: PHCS Commercial |
$13,385.66
|
| Rate for Payer: United Healthcare All Payer |
$12,270.19
|
|
|
PINN SECTOR HA ACET CUP 62MM
|
Facility
|
IP
|
$13,943.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,812.64 |
| Max. Negotiated Rate |
$13,385.66 |
| Rate for Payer: Aetna Commercial |
$10,736.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,875.85
|
| Rate for Payer: Cash Price |
$6,971.70
|
| Rate for Payer: Cigna Commercial |
$11,573.02
|
| Rate for Payer: First Health Commercial |
$13,246.23
|
| Rate for Payer: Humana Commercial |
$11,851.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,433.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,290.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,183.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,270.19
|
| Rate for Payer: Ohio Health Group HMO |
$10,457.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,788.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,812.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,322.45
|
| Rate for Payer: PHCS Commercial |
$13,385.66
|
| Rate for Payer: United Healthcare All Payer |
$12,270.19
|
|
|
PINN SECTOR HA ACET CUP 64MM
|
Facility
|
IP
|
$13,943.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,812.64 |
| Max. Negotiated Rate |
$13,385.66 |
| Rate for Payer: Aetna Commercial |
$10,736.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,875.85
|
| Rate for Payer: Cash Price |
$6,971.70
|
| Rate for Payer: Cigna Commercial |
$11,573.02
|
| Rate for Payer: First Health Commercial |
$13,246.23
|
| Rate for Payer: Humana Commercial |
$11,851.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,433.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,290.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,183.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,270.19
|
| Rate for Payer: Ohio Health Group HMO |
$10,457.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,788.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,812.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,322.45
|
| Rate for Payer: PHCS Commercial |
$13,385.66
|
| Rate for Payer: United Healthcare All Payer |
$12,270.19
|
|
|
PINN SECTOR HA ACET CUP 64MM
|
Facility
|
OP
|
$13,943.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,812.64 |
| Max. Negotiated Rate |
$13,385.66 |
| Rate for Payer: Aetna Commercial |
$10,736.42
|
| Rate for Payer: Anthem Medicaid |
$4,795.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,875.85
|
| Rate for Payer: Cash Price |
$6,971.70
|
| Rate for Payer: Cigna Commercial |
$11,573.02
|
| Rate for Payer: First Health Commercial |
$13,246.23
|
| Rate for Payer: Humana Commercial |
$11,851.89
|
| Rate for Payer: Humana KY Medicaid |
$4,795.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,843.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,433.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,290.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,183.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,891.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,270.19
|
| Rate for Payer: Ohio Health Group HMO |
$10,457.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,788.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,812.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,322.45
|
| Rate for Payer: PHCS Commercial |
$13,385.66
|
| Rate for Payer: United Healthcare All Payer |
$12,270.19
|
|
|
PINN SECTOR HA ACET CUP 66MM
|
Facility
|
OP
|
$13,943.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,812.64 |
| Max. Negotiated Rate |
$13,385.66 |
| Rate for Payer: Aetna Commercial |
$10,736.42
|
| Rate for Payer: Anthem Medicaid |
$4,795.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,875.85
|
| Rate for Payer: Cash Price |
$6,971.70
|
| Rate for Payer: Cigna Commercial |
$11,573.02
|
| Rate for Payer: First Health Commercial |
$13,246.23
|
| Rate for Payer: Humana Commercial |
$11,851.89
|
| Rate for Payer: Humana KY Medicaid |
$4,795.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,843.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,433.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,290.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,183.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,891.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,270.19
|
| Rate for Payer: Ohio Health Group HMO |
$10,457.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,788.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,812.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,322.45
|
| Rate for Payer: PHCS Commercial |
$13,385.66
|
| Rate for Payer: United Healthcare All Payer |
$12,270.19
|
|
|
PINN SECTOR HA ACET CUP 66MM
|
Facility
|
IP
|
$13,943.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,812.64 |
| Max. Negotiated Rate |
$13,385.66 |
| Rate for Payer: Aetna Commercial |
$10,736.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,875.85
|
| Rate for Payer: Cash Price |
$6,971.70
|
| Rate for Payer: Cigna Commercial |
$11,573.02
|
| Rate for Payer: First Health Commercial |
$13,246.23
|
| Rate for Payer: Humana Commercial |
$11,851.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,433.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,290.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,183.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,270.19
|
| Rate for Payer: Ohio Health Group HMO |
$10,457.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,788.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,812.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,322.45
|
| Rate for Payer: PHCS Commercial |
$13,385.66
|
| Rate for Payer: United Healthcare All Payer |
$12,270.19
|
|
|
PIN WORM SLIDE
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
HCPCS 87172
|
| Hospital Charge Code |
30001314
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$44.16 |
| Rate for Payer: Aetna Commercial |
$35.42
|
| Rate for Payer: Anthem Medicaid |
$4.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$36.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$5.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.27
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Cigna Commercial |
$38.18
|
| Rate for Payer: First Health Commercial |
$43.70
|
| Rate for Payer: Humana Commercial |
$39.10
|
| Rate for Payer: Humana KY Medicaid |
$4.27
|
| Rate for Payer: Humana Medicare Advantage |
$4.27
|
| Rate for Payer: Kentucky WC Medicaid |
$4.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$37.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$33.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$40.48
|
| Rate for Payer: Ohio Health Group HMO |
$34.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14.26
|
| Rate for Payer: PHCS Commercial |
$44.16
|
| Rate for Payer: United Healthcare All Payer |
$40.48
|
|
|
PIN WORM SLIDE
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
HCPCS 87172
|
| Hospital Charge Code |
30001314
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.98 |
| Max. Negotiated Rate |
$44.16 |
| Rate for Payer: Aetna Commercial |
$35.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$36.94
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Cigna Commercial |
$38.18
|
| Rate for Payer: First Health Commercial |
$43.70
|
| Rate for Payer: Humana Commercial |
$39.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$37.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$33.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$40.48
|
| Rate for Payer: Ohio Health Group HMO |
$34.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14.26
|
| Rate for Payer: PHCS Commercial |
$44.16
|
| Rate for Payer: United Healthcare All Payer |
$40.48
|
|
|
PIN-X 144MG/ML/30 ML ORAL SUSP
|
Facility
|
OP
|
$23.03
|
|
|
Service Code
|
NDC 23513061801
|
| Hospital Charge Code |
25001188
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.11 |
| Rate for Payer: Aetna Commercial |
$17.73
|
| Rate for Payer: Anthem Medicaid |
$7.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.96
|
| Rate for Payer: Cash Price |
$11.52
|
| Rate for Payer: Cigna Commercial |
$19.11
|
| Rate for Payer: First Health Commercial |
$21.88
|
| Rate for Payer: Humana Commercial |
$19.58
|
| Rate for Payer: Humana KY Medicaid |
$7.92
|
| Rate for Payer: Kentucky WC Medicaid |
$8.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.27
|
| Rate for Payer: Ohio Health Group HMO |
$17.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.14
|
| Rate for Payer: PHCS Commercial |
$22.11
|
| Rate for Payer: United Healthcare All Payer |
$20.27
|
|
|
PIN-X 144MG/ML/30 ML ORAL SUSP
|
Facility
|
IP
|
$23.03
|
|
|
Service Code
|
NDC 23513061801
|
| Hospital Charge Code |
25001188
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.11 |
| Rate for Payer: Aetna Commercial |
$17.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.96
|
| Rate for Payer: Cash Price |
$11.52
|
| Rate for Payer: Cigna Commercial |
$19.11
|
| Rate for Payer: First Health Commercial |
$21.88
|
| Rate for Payer: Humana Commercial |
$19.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.27
|
| Rate for Payer: Ohio Health Group HMO |
$17.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.14
|
| Rate for Payer: PHCS Commercial |
$22.11
|
| Rate for Payer: United Healthcare All Payer |
$20.27
|
|
|
PIONEER PLUS CATH
|
Facility
|
OP
|
$13,337.50
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
27000042
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,733.88 |
| Max. Negotiated Rate |
$12,804.00 |
| Rate for Payer: Aetna Commercial |
$10,269.88
|
| Rate for Payer: Anthem Medicaid |
$4,586.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,403.25
|
| Rate for Payer: Cash Price |
$6,668.75
|
| Rate for Payer: Cigna Commercial |
$11,070.12
|
| Rate for Payer: First Health Commercial |
$12,670.62
|
| Rate for Payer: Humana Commercial |
$11,336.88
|
| Rate for Payer: Humana KY Medicaid |
$4,586.77
|
| Rate for Payer: Kentucky WC Medicaid |
$4,633.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,936.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,843.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,001.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,678.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,737.00
|
| Rate for Payer: Ohio Health Group HMO |
$10,003.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,667.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,733.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,134.62
|
| Rate for Payer: PHCS Commercial |
$12,804.00
|
| Rate for Payer: United Healthcare All Payer |
$11,737.00
|
|
|
PIONEER PLUS CATH
|
Facility
|
IP
|
$13,337.50
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
27000042
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,733.88 |
| Max. Negotiated Rate |
$12,804.00 |
| Rate for Payer: Aetna Commercial |
$10,269.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,403.25
|
| Rate for Payer: Cash Price |
$6,668.75
|
| Rate for Payer: Cigna Commercial |
$11,070.12
|
| Rate for Payer: First Health Commercial |
$12,670.62
|
| Rate for Payer: Humana Commercial |
$11,336.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,936.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,843.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,001.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,737.00
|
| Rate for Payer: Ohio Health Group HMO |
$10,003.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,667.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,733.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,134.62
|
| Rate for Payer: PHCS Commercial |
$12,804.00
|
| Rate for Payer: United Healthcare All Payer |
$11,737.00
|
|
|
PITOCIN LDRP 30MG/500ML
|
Facility
|
IP
|
$105.05
|
|
|
Service Code
|
HCPCS J2590
|
| Hospital Charge Code |
25002319
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.66 |
| Max. Negotiated Rate |
$100.85 |
| Rate for Payer: Aetna Commercial |
$80.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$81.94
|
| Rate for Payer: Cash Price |
$52.52
|
| Rate for Payer: Cigna Commercial |
$87.19
|
| Rate for Payer: First Health Commercial |
$99.80
|
| Rate for Payer: Humana Commercial |
$89.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$86.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$77.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$31.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$92.44
|
| Rate for Payer: Ohio Health Group HMO |
$78.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$32.57
|
| Rate for Payer: PHCS Commercial |
$100.85
|
| Rate for Payer: United Healthcare All Payer |
$92.44
|
|
|
PITOCIN LDRP 30MG/500ML
|
Facility
|
OP
|
$105.05
|
|
|
Service Code
|
HCPCS J2590
|
| Hospital Charge Code |
25002319
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.66 |
| Max. Negotiated Rate |
$100.85 |
| Rate for Payer: Aetna Commercial |
$80.89
|
| Rate for Payer: Anthem Medicaid |
$36.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$81.94
|
| Rate for Payer: Cash Price |
$52.52
|
| Rate for Payer: Cigna Commercial |
$87.19
|
| Rate for Payer: First Health Commercial |
$99.80
|
| Rate for Payer: Humana Commercial |
$89.29
|
| Rate for Payer: Humana KY Medicaid |
$36.13
|
| Rate for Payer: Kentucky WC Medicaid |
$36.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$86.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$77.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$31.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$36.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$92.44
|
| Rate for Payer: Ohio Health Group HMO |
$78.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$32.57
|
| Rate for Payer: PHCS Commercial |
$100.85
|
| Rate for Payer: United Healthcare All Payer |
$92.44
|
|
