|
PITOCIN(OXYTOCIN)10U/1ML(UP TO
|
Facility
|
OP
|
$79.60
|
|
|
Service Code
|
HCPCS J2590
|
| Hospital Charge Code |
25002320
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.35 |
| Max. Negotiated Rate |
$76.42 |
| Rate for Payer: Aetna Commercial |
$61.29
|
| Rate for Payer: Anthem Medicaid |
$27.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.09
|
| Rate for Payer: Cash Price |
$39.80
|
| Rate for Payer: Cigna Commercial |
$66.07
|
| Rate for Payer: First Health Commercial |
$75.62
|
| Rate for Payer: Humana Commercial |
$67.66
|
| Rate for Payer: Humana KY Medicaid |
$27.37
|
| Rate for Payer: Kentucky WC Medicaid |
$27.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.05
|
| Rate for Payer: Ohio Health Group HMO |
$59.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.68
|
| Rate for Payer: PHCS Commercial |
$76.42
|
| Rate for Payer: United Healthcare All Payer |
$70.05
|
|
|
PITOCIN(OXYTOCIN)10U/1ML(UP TO
|
Facility
|
IP
|
$79.60
|
|
|
Service Code
|
HCPCS J2590
|
| Hospital Charge Code |
25002320
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.35 |
| Max. Negotiated Rate |
$76.42 |
| Rate for Payer: Aetna Commercial |
$61.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.09
|
| Rate for Payer: Cash Price |
$39.80
|
| Rate for Payer: Cigna Commercial |
$66.07
|
| Rate for Payer: First Health Commercial |
$75.62
|
| Rate for Payer: Humana Commercial |
$67.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.05
|
| Rate for Payer: Ohio Health Group HMO |
$59.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.68
|
| Rate for Payer: PHCS Commercial |
$76.42
|
| Rate for Payer: United Healthcare All Payer |
$70.05
|
|
|
PIVOT 1.5 CAL (8 OZ CAN) TF
|
Facility
|
IP
|
$70.16
|
|
|
Service Code
|
NDC 70074058014
|
| Hospital Charge Code |
25001189
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.12 |
| Max. Negotiated Rate |
$67.35 |
| Rate for Payer: Aetna Commercial |
$54.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.72
|
| Rate for Payer: Cash Price |
$35.08
|
| Rate for Payer: Cigna Commercial |
$58.23
|
| Rate for Payer: First Health Commercial |
$66.65
|
| Rate for Payer: Humana Commercial |
$59.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.74
|
| Rate for Payer: Ohio Health Group HMO |
$52.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.75
|
| Rate for Payer: PHCS Commercial |
$67.35
|
| Rate for Payer: United Healthcare All Payer |
$61.74
|
|
|
PIVOT 1.5 CAL (8 OZ CAN) TF
|
Facility
|
OP
|
$70.16
|
|
|
Service Code
|
NDC 70074058014
|
| Hospital Charge Code |
25001189
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.12 |
| Max. Negotiated Rate |
$67.35 |
| Rate for Payer: Aetna Commercial |
$54.02
|
| Rate for Payer: Anthem Medicaid |
$24.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.72
|
| Rate for Payer: Cash Price |
$35.08
|
| Rate for Payer: Cigna Commercial |
$58.23
|
| Rate for Payer: First Health Commercial |
$66.65
|
| Rate for Payer: Humana Commercial |
$59.64
|
| Rate for Payer: Humana KY Medicaid |
$24.13
|
| Rate for Payer: Kentucky WC Medicaid |
$24.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.74
|
| Rate for Payer: Ohio Health Group HMO |
$52.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.75
|
| Rate for Payer: PHCS Commercial |
$67.35
|
| Rate for Payer: United Healthcare All Payer |
$61.74
|
|
|
PIVOT READY TO HAND 1000ML
|
Facility
|
OP
|
$108.07
|
|
| Hospital Charge Code |
27000099
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.05 |
| Max. Negotiated Rate |
$103.75 |
| Rate for Payer: Aetna Commercial |
$83.21
|
| Rate for Payer: Anthem Medicaid |
$37.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$84.29
|
| Rate for Payer: Cash Price |
$54.03
|
| Rate for Payer: Cigna Commercial |
$89.70
|
| Rate for Payer: First Health Commercial |
$102.67
|
| Rate for Payer: Humana Commercial |
$91.86
|
| Rate for Payer: Humana KY Medicaid |
$37.17
|
| Rate for Payer: Kentucky WC Medicaid |
$37.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$88.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$79.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$37.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.10
|
| Rate for Payer: Ohio Health Group HMO |
$81.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.50
|
| Rate for Payer: PHCS Commercial |
$103.75
|
| Rate for Payer: United Healthcare All Payer |
$95.10
|
|
|
PIVOT READY TO HAND 1000ML
|
Facility
|
IP
|
$108.07
|
|
| Hospital Charge Code |
27000099
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.05 |
| Max. Negotiated Rate |
$103.75 |
| Rate for Payer: Aetna Commercial |
$83.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$84.29
|
| Rate for Payer: Cash Price |
$54.03
|
| Rate for Payer: Cigna Commercial |
$89.70
|
| Rate for Payer: First Health Commercial |
$102.67
|
| Rate for Payer: Humana Commercial |
$91.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$88.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$79.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.10
|
| Rate for Payer: Ohio Health Group HMO |
$81.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.50
|
| Rate for Payer: PHCS Commercial |
$103.75
|
| Rate for Payer: United Healthcare All Payer |
$95.10
|
|
|
PIVOT READY TO HAND 1000ML
|
Facility
|
IP
|
$98.08
|
|
|
Service Code
|
NDC 70074062719
|
| Hospital Charge Code |
27000099
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.75 |
| Max. Negotiated Rate |
$94.16 |
| Rate for Payer: Aetna Commercial |
$75.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$76.50
|
| Rate for Payer: Cash Price |
$49.04
|
| Rate for Payer: Cigna Commercial |
$81.41
|
| Rate for Payer: First Health Commercial |
$93.18
|
| Rate for Payer: Humana Commercial |
$83.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$80.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$72.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$86.31
|
| Rate for Payer: Ohio Health Group HMO |
$73.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30.40
|
| Rate for Payer: PHCS Commercial |
$94.16
|
| Rate for Payer: United Healthcare All Payer |
$86.31
|
|
|
PIVOT READY TO HAND 1000ML
|
Facility
|
OP
|
$98.08
|
|
|
Service Code
|
NDC 70074062719
|
| Hospital Charge Code |
27000099
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.75 |
| Max. Negotiated Rate |
$94.16 |
| Rate for Payer: Aetna Commercial |
$75.52
|
| Rate for Payer: Anthem Medicaid |
$33.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$76.50
|
| Rate for Payer: Cash Price |
$49.04
|
| Rate for Payer: Cigna Commercial |
$81.41
|
| Rate for Payer: First Health Commercial |
$93.18
|
| Rate for Payer: Humana Commercial |
$83.37
|
| Rate for Payer: Humana KY Medicaid |
$33.73
|
| Rate for Payer: Kentucky WC Medicaid |
$34.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$80.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$72.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$34.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$86.31
|
| Rate for Payer: Ohio Health Group HMO |
$73.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30.40
|
| Rate for Payer: PHCS Commercial |
$94.16
|
| Rate for Payer: United Healthcare All Payer |
$86.31
|
|
|
PKR BASEPLATE #1 LM/RL
|
Facility
|
IP
|
$8,713.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,132.69 |
| Max. Negotiated Rate |
$8,364.48 |
| Rate for Payer: Aetna Commercial |
$6,709.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,796.14
|
| Rate for Payer: Cash Price |
$4,356.50
|
| Rate for Payer: Cigna Commercial |
$7,231.79
|
| Rate for Payer: First Health Commercial |
$8,277.35
|
| Rate for Payer: Humana Commercial |
$7,406.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,144.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,430.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,613.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,667.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,534.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,742.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,132.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,701.03
|
| Rate for Payer: PHCS Commercial |
$8,364.48
|
| Rate for Payer: United Healthcare All Payer |
$7,667.44
|
|
|
PKR BASEPLATE #1 LM/RL
|
Facility
|
OP
|
$8,713.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,132.69 |
| Max. Negotiated Rate |
$8,364.48 |
| Rate for Payer: Aetna Commercial |
$6,709.01
|
| Rate for Payer: Anthem Medicaid |
$2,996.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,796.14
|
| Rate for Payer: Cash Price |
$4,356.50
|
| Rate for Payer: Cigna Commercial |
$7,231.79
|
| Rate for Payer: First Health Commercial |
$8,277.35
|
| Rate for Payer: Humana Commercial |
$7,406.05
|
| Rate for Payer: Humana KY Medicaid |
$2,996.40
|
| Rate for Payer: Kentucky WC Medicaid |
$3,026.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,144.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,430.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,613.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,056.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,667.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,534.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,742.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,132.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,701.03
|
| Rate for Payer: PHCS Commercial |
$8,364.48
|
| Rate for Payer: United Healthcare All Payer |
$7,667.44
|
|
|
PKR BASEPLATE #1 RM / LL
|
Facility
|
IP
|
$8,713.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,132.69 |
| Max. Negotiated Rate |
$8,364.48 |
| Rate for Payer: Aetna Commercial |
$6,709.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,796.14
|
| Rate for Payer: Cash Price |
$4,356.50
|
| Rate for Payer: Cigna Commercial |
$7,231.79
|
| Rate for Payer: First Health Commercial |
$8,277.35
|
| Rate for Payer: Humana Commercial |
$7,406.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,144.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,430.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,613.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,667.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,534.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,742.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,132.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,701.03
|
| Rate for Payer: PHCS Commercial |
$8,364.48
|
| Rate for Payer: United Healthcare All Payer |
$7,667.44
|
|
|
PKR BASEPLATE #1 RM / LL
|
Facility
|
OP
|
$8,713.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,132.69 |
| Max. Negotiated Rate |
$8,364.48 |
| Rate for Payer: Aetna Commercial |
$6,709.01
|
| Rate for Payer: Anthem Medicaid |
$2,996.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,796.14
|
| Rate for Payer: Cash Price |
$4,356.50
|
| Rate for Payer: Cigna Commercial |
$7,231.79
|
| Rate for Payer: First Health Commercial |
$8,277.35
|
| Rate for Payer: Humana Commercial |
$7,406.05
|
| Rate for Payer: Humana KY Medicaid |
$2,996.40
|
| Rate for Payer: Kentucky WC Medicaid |
$3,026.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,144.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,430.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,613.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,056.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,667.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,534.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,742.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,132.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,701.03
|
| Rate for Payer: PHCS Commercial |
$8,364.48
|
| Rate for Payer: United Healthcare All Payer |
$7,667.44
|
|
|
PKR BASEPLATE #2LM/RL
|
Facility
|
IP
|
$8,713.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,132.69 |
| Max. Negotiated Rate |
$8,364.48 |
| Rate for Payer: Aetna Commercial |
$6,709.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,796.14
|
| Rate for Payer: Cash Price |
$4,356.50
|
| Rate for Payer: Cigna Commercial |
$7,231.79
|
| Rate for Payer: First Health Commercial |
$8,277.35
|
| Rate for Payer: Humana Commercial |
$7,406.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,144.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,430.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,613.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,667.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,534.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,742.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,132.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,701.03
|
| Rate for Payer: PHCS Commercial |
$8,364.48
|
| Rate for Payer: United Healthcare All Payer |
$7,667.44
|
|
|
PKR BASEPLATE #2LM/RL
|
Facility
|
OP
|
$8,713.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,132.69 |
| Max. Negotiated Rate |
$8,364.48 |
| Rate for Payer: Aetna Commercial |
$6,709.01
|
| Rate for Payer: Anthem Medicaid |
$2,996.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,796.14
|
| Rate for Payer: Cash Price |
$4,356.50
|
| Rate for Payer: Cigna Commercial |
$7,231.79
|
| Rate for Payer: First Health Commercial |
$8,277.35
|
| Rate for Payer: Humana Commercial |
$7,406.05
|
| Rate for Payer: Humana KY Medicaid |
$2,996.40
|
| Rate for Payer: Kentucky WC Medicaid |
$3,026.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,144.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,430.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,613.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,056.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,667.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,534.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,742.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,132.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,701.03
|
| Rate for Payer: PHCS Commercial |
$8,364.48
|
| Rate for Payer: United Healthcare All Payer |
$7,667.44
|
|
|
PKR BASEPLATE #2 RM / LL
|
Facility
|
OP
|
$8,713.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,132.69 |
| Max. Negotiated Rate |
$8,364.48 |
| Rate for Payer: Aetna Commercial |
$6,709.01
|
| Rate for Payer: Anthem Medicaid |
$2,996.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,796.14
|
| Rate for Payer: Cash Price |
$4,356.50
|
| Rate for Payer: Cigna Commercial |
$7,231.79
|
| Rate for Payer: First Health Commercial |
$8,277.35
|
| Rate for Payer: Humana Commercial |
$7,406.05
|
| Rate for Payer: Humana KY Medicaid |
$2,996.40
|
| Rate for Payer: Kentucky WC Medicaid |
$3,026.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,144.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,430.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,613.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,056.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,667.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,534.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,742.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,132.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,701.03
|
| Rate for Payer: PHCS Commercial |
$8,364.48
|
| Rate for Payer: United Healthcare All Payer |
$7,667.44
|
|
|
PKR BASEPLATE #2 RM / LL
|
Facility
|
IP
|
$8,713.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,132.69 |
| Max. Negotiated Rate |
$8,364.48 |
| Rate for Payer: Aetna Commercial |
$6,709.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,796.14
|
| Rate for Payer: Cash Price |
$4,356.50
|
| Rate for Payer: Cigna Commercial |
$7,231.79
|
| Rate for Payer: First Health Commercial |
$8,277.35
|
| Rate for Payer: Humana Commercial |
$7,406.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,144.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,430.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,613.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,667.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,534.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,742.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,132.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,701.03
|
| Rate for Payer: PHCS Commercial |
$8,364.48
|
| Rate for Payer: United Healthcare All Payer |
$7,667.44
|
|
|
PKR BASEPLATE #3 LM/RL
|
Facility
|
IP
|
$8,713.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,132.69 |
| Max. Negotiated Rate |
$8,364.48 |
| Rate for Payer: Aetna Commercial |
$6,709.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,796.14
|
| Rate for Payer: Cash Price |
$4,356.50
|
| Rate for Payer: Cigna Commercial |
$7,231.79
|
| Rate for Payer: First Health Commercial |
$8,277.35
|
| Rate for Payer: Humana Commercial |
$7,406.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,144.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,430.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,613.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,667.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,534.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,742.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,132.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,701.03
|
| Rate for Payer: PHCS Commercial |
$8,364.48
|
| Rate for Payer: United Healthcare All Payer |
$7,667.44
|
|
|
PKR BASEPLATE #3 LM/RL
|
Facility
|
OP
|
$8,713.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,132.69 |
| Max. Negotiated Rate |
$8,364.48 |
| Rate for Payer: Aetna Commercial |
$6,709.01
|
| Rate for Payer: Anthem Medicaid |
$2,996.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,796.14
|
| Rate for Payer: Cash Price |
$4,356.50
|
| Rate for Payer: Cigna Commercial |
$7,231.79
|
| Rate for Payer: First Health Commercial |
$8,277.35
|
| Rate for Payer: Humana Commercial |
$7,406.05
|
| Rate for Payer: Humana KY Medicaid |
$2,996.40
|
| Rate for Payer: Kentucky WC Medicaid |
$3,026.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,144.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,430.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,613.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,056.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,667.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,534.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,742.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,132.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,701.03
|
| Rate for Payer: PHCS Commercial |
$8,364.48
|
| Rate for Payer: United Healthcare All Payer |
$7,667.44
|
|
|
PKR BASEPLATE #3 RM / LL
|
Facility
|
IP
|
$8,713.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,132.69 |
| Max. Negotiated Rate |
$8,364.48 |
| Rate for Payer: Aetna Commercial |
$6,709.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,796.14
|
| Rate for Payer: Cash Price |
$4,356.50
|
| Rate for Payer: Cigna Commercial |
$7,231.79
|
| Rate for Payer: First Health Commercial |
$8,277.35
|
| Rate for Payer: Humana Commercial |
$7,406.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,144.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,430.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,613.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,667.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,534.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,742.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,132.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,701.03
|
| Rate for Payer: PHCS Commercial |
$8,364.48
|
| Rate for Payer: United Healthcare All Payer |
$7,667.44
|
|
|
PKR BASEPLATE #3 RM / LL
|
Facility
|
OP
|
$8,713.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,132.69 |
| Max. Negotiated Rate |
$8,364.48 |
| Rate for Payer: Aetna Commercial |
$6,709.01
|
| Rate for Payer: Anthem Medicaid |
$2,996.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,796.14
|
| Rate for Payer: Cash Price |
$4,356.50
|
| Rate for Payer: Cigna Commercial |
$7,231.79
|
| Rate for Payer: First Health Commercial |
$8,277.35
|
| Rate for Payer: Humana Commercial |
$7,406.05
|
| Rate for Payer: Humana KY Medicaid |
$2,996.40
|
| Rate for Payer: Kentucky WC Medicaid |
$3,026.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,144.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,430.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,613.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,056.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,667.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,534.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,742.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,132.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,701.03
|
| Rate for Payer: PHCS Commercial |
$8,364.48
|
| Rate for Payer: United Healthcare All Payer |
$7,667.44
|
|
|
PKR BASEPLATE #4 LM/RL
|
Facility
|
OP
|
$8,713.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,132.69 |
| Max. Negotiated Rate |
$8,364.48 |
| Rate for Payer: Aetna Commercial |
$6,709.01
|
| Rate for Payer: Anthem Medicaid |
$2,996.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,796.14
|
| Rate for Payer: Cash Price |
$4,356.50
|
| Rate for Payer: Cigna Commercial |
$7,231.79
|
| Rate for Payer: First Health Commercial |
$8,277.35
|
| Rate for Payer: Humana Commercial |
$7,406.05
|
| Rate for Payer: Humana KY Medicaid |
$2,996.40
|
| Rate for Payer: Kentucky WC Medicaid |
$3,026.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,144.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,430.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,613.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,056.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,667.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,534.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,742.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,132.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,701.03
|
| Rate for Payer: PHCS Commercial |
$8,364.48
|
| Rate for Payer: United Healthcare All Payer |
$7,667.44
|
|
|
PKR BASEPLATE #4 LM/RL
|
Facility
|
IP
|
$8,713.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,132.69 |
| Max. Negotiated Rate |
$8,364.48 |
| Rate for Payer: Aetna Commercial |
$6,709.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,796.14
|
| Rate for Payer: Cash Price |
$4,356.50
|
| Rate for Payer: Cigna Commercial |
$7,231.79
|
| Rate for Payer: First Health Commercial |
$8,277.35
|
| Rate for Payer: Humana Commercial |
$7,406.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,144.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,430.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,613.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,667.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,534.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,742.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,132.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,701.03
|
| Rate for Payer: PHCS Commercial |
$8,364.48
|
| Rate for Payer: United Healthcare All Payer |
$7,667.44
|
|
|
PKR BASEPLATE #4 RM / LL
|
Facility
|
OP
|
$8,713.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,132.69 |
| Max. Negotiated Rate |
$8,364.48 |
| Rate for Payer: Aetna Commercial |
$6,709.01
|
| Rate for Payer: Anthem Medicaid |
$2,996.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,796.14
|
| Rate for Payer: Cash Price |
$4,356.50
|
| Rate for Payer: Cigna Commercial |
$7,231.79
|
| Rate for Payer: First Health Commercial |
$8,277.35
|
| Rate for Payer: Humana Commercial |
$7,406.05
|
| Rate for Payer: Humana KY Medicaid |
$2,996.40
|
| Rate for Payer: Kentucky WC Medicaid |
$3,026.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,144.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,430.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,613.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,056.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,667.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,534.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,742.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,132.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,701.03
|
| Rate for Payer: PHCS Commercial |
$8,364.48
|
| Rate for Payer: United Healthcare All Payer |
$7,667.44
|
|
|
PKR BASEPLATE #4 RM / LL
|
Facility
|
IP
|
$8,713.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,132.69 |
| Max. Negotiated Rate |
$8,364.48 |
| Rate for Payer: Aetna Commercial |
$6,709.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,796.14
|
| Rate for Payer: Cash Price |
$4,356.50
|
| Rate for Payer: Cigna Commercial |
$7,231.79
|
| Rate for Payer: First Health Commercial |
$8,277.35
|
| Rate for Payer: Humana Commercial |
$7,406.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,144.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,430.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,613.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,667.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,534.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,742.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,132.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,701.03
|
| Rate for Payer: PHCS Commercial |
$8,364.48
|
| Rate for Payer: United Healthcare All Payer |
$7,667.44
|
|
|
PKR BASEPLATE #5 LM/RL
|
Facility
|
OP
|
$8,713.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,132.69 |
| Max. Negotiated Rate |
$8,364.48 |
| Rate for Payer: Aetna Commercial |
$6,709.01
|
| Rate for Payer: Anthem Medicaid |
$2,996.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,796.14
|
| Rate for Payer: Cash Price |
$4,356.50
|
| Rate for Payer: Cigna Commercial |
$7,231.79
|
| Rate for Payer: First Health Commercial |
$8,277.35
|
| Rate for Payer: Humana Commercial |
$7,406.05
|
| Rate for Payer: Humana KY Medicaid |
$2,996.40
|
| Rate for Payer: Kentucky WC Medicaid |
$3,026.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,144.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,430.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,613.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,056.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,667.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,534.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,742.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,132.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,701.03
|
| Rate for Payer: PHCS Commercial |
$8,364.48
|
| Rate for Payer: United Healthcare All Payer |
$7,667.44
|
|
