|
RESPIRATORY SIGNS AND SYMPTOMS
|
Facility
|
IP
|
$9,626.46
|
|
|
Service Code
|
MSDRG 204
|
| Min. Negotiated Rate |
$6,532.24 |
| Max. Negotiated Rate |
$9,626.46 |
| Rate for Payer: Anthem Medicaid |
$6,532.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,876.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,626.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$9,282.65
|
| Rate for Payer: Humana KY Medicaid |
$6,532.24
|
| Rate for Payer: Humana Medicare Advantage |
$6,876.04
|
| Rate for Payer: Kentucky WC Medicaid |
$6,597.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,251.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,662.88
|
|
|
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS
|
Facility
|
IP
|
$31,629.60
|
|
|
Service Code
|
MSDRG 208
|
| Min. Negotiated Rate |
$21,462.94 |
| Max. Negotiated Rate |
$31,629.60 |
| Rate for Payer: Anthem Medicaid |
$21,462.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$22,592.57
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$31,629.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$30,499.97
|
| Rate for Payer: Humana KY Medicaid |
$21,462.94
|
| Rate for Payer: Humana Medicare Advantage |
$22,592.57
|
| Rate for Payer: Kentucky WC Medicaid |
$21,677.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27,111.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$21,892.20
|
|
|
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS
|
Facility
|
IP
|
$80,811.21
|
|
|
Service Code
|
MSDRG 207
|
| Min. Negotiated Rate |
$54,836.18 |
| Max. Negotiated Rate |
$80,811.21 |
| Rate for Payer: Anthem Medicaid |
$54,836.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$57,722.29
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$80,811.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$77,925.09
|
| Rate for Payer: Humana KY Medicaid |
$54,836.18
|
| Rate for Payer: Humana Medicare Advantage |
$57,722.29
|
| Rate for Payer: Kentucky WC Medicaid |
$55,384.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$69,266.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$55,932.90
|
|
|
RESPOSIT. GASTRIC FEEDING TUBE
|
Facility
|
OP
|
$1,564.00
|
|
|
Service Code
|
HCPCS 43761
|
| Hospital Charge Code |
76101792
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$203.32 |
| Max. Negotiated Rate |
$1,501.44 |
| Rate for Payer: Aetna Commercial |
$1,204.28
|
| Rate for Payer: Anthem Medicaid |
$537.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$213.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,219.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$299.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$288.52
|
| Rate for Payer: Cash Price |
$782.00
|
| Rate for Payer: Cash Price |
$782.00
|
| Rate for Payer: Cigna Commercial |
$1,298.12
|
| Rate for Payer: First Health Commercial |
$1,485.80
|
| Rate for Payer: Humana Commercial |
$1,329.40
|
| Rate for Payer: Humana KY Medicaid |
$537.86
|
| Rate for Payer: Humana Medicare Advantage |
$213.72
|
| Rate for Payer: Kentucky WC Medicaid |
$543.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,282.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,154.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$256.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$548.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,376.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,173.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$312.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$203.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$484.84
|
| Rate for Payer: PHCS Commercial |
$1,501.44
|
| Rate for Payer: United Healthcare All Payer |
$1,376.32
|
|
|
RESPOSIT. GASTRIC FEEDING TUBE
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 43761
|
| Hospital Charge Code |
761P1792
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.44 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$165.44
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$82.44
|
| Rate for Payer: Anthem Medicaid |
$93.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$300.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$149.51
|
| Rate for Payer: Healthspan PPO |
$156.67
|
| Rate for Payer: Humana Medicaid |
$93.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$136.21
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$95.36
|
| Rate for Payer: Molina Healthcare Passport |
$93.49
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.00
|
| Rate for Payer: UHCCP Medicaid |
$86.56
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$94.42
|
|
|
RESPOSIT. GASTRIC FEEDING TUBE
|
Facility
|
OP
|
$1,264.00
|
|
|
Service Code
|
HCPCS 43761
|
| Hospital Charge Code |
761T1792
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$164.32 |
| Max. Negotiated Rate |
$1,213.44 |
| Rate for Payer: Aetna Commercial |
$973.28
|
| Rate for Payer: Anthem Medicaid |
$434.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$213.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$985.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$299.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$288.52
|
| Rate for Payer: Cash Price |
$632.00
|
| Rate for Payer: Cash Price |
$632.00
|
| Rate for Payer: Cigna Commercial |
$1,049.12
|
| Rate for Payer: First Health Commercial |
$1,200.80
|
| Rate for Payer: Humana Commercial |
$1,074.40
|
| Rate for Payer: Humana KY Medicaid |
$434.69
|
| Rate for Payer: Humana Medicare Advantage |
$213.72
|
| Rate for Payer: Kentucky WC Medicaid |
$439.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,036.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$932.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$256.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$443.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,112.32
|
| Rate for Payer: Ohio Health Group HMO |
$948.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$252.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$164.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$391.84
|
| Rate for Payer: PHCS Commercial |
$1,213.44
|
| Rate for Payer: United Healthcare All Payer |
$1,112.32
|
|
|
RESPOSIT. GASTRIC FEEDING TUBE
|
Facility
|
IP
|
$1,264.00
|
|
|
Service Code
|
HCPCS 43761
|
| Hospital Charge Code |
761T1792
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$164.32 |
| Max. Negotiated Rate |
$1,213.44 |
| Rate for Payer: Aetna Commercial |
$973.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$985.92
|
| Rate for Payer: Cash Price |
$632.00
|
| Rate for Payer: Cigna Commercial |
$1,049.12
|
| Rate for Payer: First Health Commercial |
$1,200.80
|
| Rate for Payer: Humana Commercial |
$1,074.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,036.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$932.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$379.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,112.32
|
| Rate for Payer: Ohio Health Group HMO |
$948.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$252.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$164.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$391.84
|
| Rate for Payer: PHCS Commercial |
$1,213.44
|
| Rate for Payer: United Healthcare All Payer |
$1,112.32
|
|
|
RESPOSIT. GASTRIC FEEDING TUBE
|
Facility
|
IP
|
$1,564.00
|
|
|
Service Code
|
HCPCS 43761
|
| Hospital Charge Code |
76101792
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$203.32 |
| Max. Negotiated Rate |
$1,501.44 |
| Rate for Payer: Aetna Commercial |
$1,204.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,219.92
|
| Rate for Payer: Cash Price |
$782.00
|
| Rate for Payer: Cigna Commercial |
$1,298.12
|
| Rate for Payer: First Health Commercial |
$1,485.80
|
| Rate for Payer: Humana Commercial |
$1,329.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,282.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,154.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$469.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,376.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,173.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$312.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$203.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$484.84
|
| Rate for Payer: PHCS Commercial |
$1,501.44
|
| Rate for Payer: United Healthcare All Payer |
$1,376.32
|
|
|
RESPOSIT. GASTRIC FEEDING TUBE
|
Professional
|
Both
|
$1,564.00
|
|
|
Service Code
|
HCPCS 43761
|
| Hospital Charge Code |
76101792
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.44 |
| Max. Negotiated Rate |
$1,564.00 |
| Rate for Payer: Aetna Commercial |
$165.44
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$82.44
|
| Rate for Payer: Anthem Medicaid |
$93.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,564.00
|
| Rate for Payer: Cash Price |
$782.00
|
| Rate for Payer: Cash Price |
$782.00
|
| Rate for Payer: Cigna Commercial |
$149.51
|
| Rate for Payer: Healthspan PPO |
$156.67
|
| Rate for Payer: Humana Medicaid |
$93.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$136.21
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$95.36
|
| Rate for Payer: Molina Healthcare Passport |
$93.49
|
| Rate for Payer: Multiplan PHCS |
$938.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,094.80
|
| Rate for Payer: UHCCP Medicaid |
$86.56
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$94.42
|
|
|
RESP VIRUS MOLECULAR PANEL
|
Facility
|
IP
|
$915.00
|
|
|
Service Code
|
HCPCS 87633
|
| Hospital Charge Code |
30001389
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$118.95 |
| Max. Negotiated Rate |
$878.40 |
| Rate for Payer: Aetna Commercial |
$704.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$734.74
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cigna Commercial |
$759.45
|
| Rate for Payer: First Health Commercial |
$869.25
|
| Rate for Payer: Humana Commercial |
$777.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$750.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$675.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$274.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$805.20
|
| Rate for Payer: Ohio Health Group HMO |
$686.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$183.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$118.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$283.65
|
| Rate for Payer: PHCS Commercial |
$878.40
|
| Rate for Payer: United Healthcare All Payer |
$805.20
|
|
|
RESP VIRUS MOLECULAR PANEL
|
Facility
|
OP
|
$915.00
|
|
|
Service Code
|
HCPCS 87633
|
| Hospital Charge Code |
30001389
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$118.95 |
| Max. Negotiated Rate |
$878.40 |
| Rate for Payer: Aetna Commercial |
$704.55
|
| Rate for Payer: Anthem Medicaid |
$314.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$416.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$734.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$583.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$416.78
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cigna Commercial |
$759.45
|
| Rate for Payer: First Health Commercial |
$869.25
|
| Rate for Payer: Humana Commercial |
$777.75
|
| Rate for Payer: Humana KY Medicaid |
$314.67
|
| Rate for Payer: Humana Medicare Advantage |
$416.78
|
| Rate for Payer: Kentucky WC Medicaid |
$317.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$750.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$675.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$500.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$320.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$805.20
|
| Rate for Payer: Ohio Health Group HMO |
$686.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$183.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$118.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$283.65
|
| Rate for Payer: PHCS Commercial |
$878.40
|
| Rate for Payer: United Healthcare All Payer |
$805.20
|
|
|
RESP VIRUS MOLECULAR PANEL
|
Professional
|
Both
|
$915.00
|
|
|
Service Code
|
HCPCS 87633
|
| Hospital Charge Code |
30001389
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$320.25 |
| Max. Negotiated Rate |
$915.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$915.00
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cigna Commercial |
$649.75
|
| Rate for Payer: Healthspan PPO |
$429.68
|
| Rate for Payer: Multiplan PHCS |
$549.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$640.50
|
| Rate for Payer: UHCCP Medicaid |
$320.25
|
|
|
RESTASIS 0.05% VIAL
|
Facility
|
IP
|
$27.76
|
|
|
Service Code
|
NDC 23916330
|
| Hospital Charge Code |
25001319
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.61 |
| Max. Negotiated Rate |
$26.65 |
| Rate for Payer: Aetna Commercial |
$21.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21.65
|
| Rate for Payer: Cash Price |
$13.88
|
| Rate for Payer: Cigna Commercial |
$23.04
|
| Rate for Payer: First Health Commercial |
$26.37
|
| Rate for Payer: Humana Commercial |
$23.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$24.43
|
| Rate for Payer: Ohio Health Group HMO |
$20.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.61
|
| Rate for Payer: PHCS Commercial |
$26.65
|
| Rate for Payer: United Healthcare All Payer |
$24.43
|
|
|
RESTASIS 0.05% VIAL
|
Facility
|
OP
|
$27.76
|
|
|
Service Code
|
NDC 23916330
|
| Hospital Charge Code |
25001319
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.61 |
| Max. Negotiated Rate |
$26.65 |
| Rate for Payer: Aetna Commercial |
$21.38
|
| Rate for Payer: Anthem Medicaid |
$9.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21.65
|
| Rate for Payer: Cash Price |
$13.88
|
| Rate for Payer: Cigna Commercial |
$23.04
|
| Rate for Payer: First Health Commercial |
$26.37
|
| Rate for Payer: Humana Commercial |
$23.60
|
| Rate for Payer: Humana KY Medicaid |
$9.55
|
| Rate for Payer: Kentucky WC Medicaid |
$9.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$24.43
|
| Rate for Payer: Ohio Health Group HMO |
$20.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.61
|
| Rate for Payer: PHCS Commercial |
$26.65
|
| Rate for Payer: United Healthcare All Payer |
$24.43
|
|
|
REST MOD CALCAR BODY 21 +20MM
|
Facility
|
OP
|
$19,738.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,566.03 |
| Max. Negotiated Rate |
$18,949.17 |
| Rate for Payer: Aetna Commercial |
$15,198.81
|
| Rate for Payer: Anthem Medicaid |
$6,788.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,396.20
|
| Rate for Payer: Cash Price |
$9,869.36
|
| Rate for Payer: Cigna Commercial |
$16,383.14
|
| Rate for Payer: First Health Commercial |
$18,751.78
|
| Rate for Payer: Humana Commercial |
$16,777.91
|
| Rate for Payer: Humana KY Medicaid |
$6,788.15
|
| Rate for Payer: Kentucky WC Medicaid |
$6,857.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,185.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,567.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,921.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,924.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,370.07
|
| Rate for Payer: Ohio Health Group HMO |
$14,804.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,947.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,566.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,119.00
|
| Rate for Payer: PHCS Commercial |
$18,949.17
|
| Rate for Payer: United Healthcare All Payer |
$17,370.07
|
|
|
REST MOD CALCAR BODY 21 +20MM
|
Facility
|
IP
|
$19,738.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,566.03 |
| Max. Negotiated Rate |
$18,949.17 |
| Rate for Payer: Aetna Commercial |
$15,198.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,396.20
|
| Rate for Payer: Cash Price |
$9,869.36
|
| Rate for Payer: Cigna Commercial |
$16,383.14
|
| Rate for Payer: First Health Commercial |
$18,751.78
|
| Rate for Payer: Humana Commercial |
$16,777.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,185.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,567.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,921.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,370.07
|
| Rate for Payer: Ohio Health Group HMO |
$14,804.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,947.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,566.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,119.00
|
| Rate for Payer: PHCS Commercial |
$18,949.17
|
| Rate for Payer: United Healthcare All Payer |
$17,370.07
|
|
|
RESTOCKING FEE HEARING AID SP
|
Professional
|
Both
|
$120.00
|
|
| Hospital Charge Code |
47000105
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$120.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Multiplan PHCS |
$72.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$84.00
|
| Rate for Payer: UHCCP Medicaid |
$42.00
|
|
|
RESTORATION DIST STEM 14*195MM
|
Facility
|
OP
|
$20,778.97
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,701.27 |
| Max. Negotiated Rate |
$19,947.81 |
| Rate for Payer: Aetna Commercial |
$15,999.81
|
| Rate for Payer: Anthem Medicaid |
$7,145.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,207.60
|
| Rate for Payer: Cash Price |
$10,389.49
|
| Rate for Payer: Cigna Commercial |
$17,246.55
|
| Rate for Payer: First Health Commercial |
$19,740.02
|
| Rate for Payer: Humana Commercial |
$17,662.12
|
| Rate for Payer: Humana KY Medicaid |
$7,145.89
|
| Rate for Payer: Kentucky WC Medicaid |
$7,218.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,038.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,334.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,233.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,289.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,285.49
|
| Rate for Payer: Ohio Health Group HMO |
$15,584.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,155.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,701.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,441.48
|
| Rate for Payer: PHCS Commercial |
$19,947.81
|
| Rate for Payer: United Healthcare All Payer |
$18,285.49
|
|
|
RESTORATION DIST STEM 14*195MM
|
Facility
|
IP
|
$20,778.97
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,701.27 |
| Max. Negotiated Rate |
$19,947.81 |
| Rate for Payer: Aetna Commercial |
$15,999.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,207.60
|
| Rate for Payer: Cash Price |
$10,389.49
|
| Rate for Payer: Cigna Commercial |
$17,246.55
|
| Rate for Payer: First Health Commercial |
$19,740.02
|
| Rate for Payer: Humana Commercial |
$17,662.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,038.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,334.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,233.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,285.49
|
| Rate for Payer: Ohio Health Group HMO |
$15,584.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,155.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,701.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,441.48
|
| Rate for Payer: PHCS Commercial |
$19,947.81
|
| Rate for Payer: United Healthcare All Payer |
$18,285.49
|
|
|
RESTORATION DIST STEM 15*155MM
|
Facility
|
OP
|
$18,299.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,378.92 |
| Max. Negotiated Rate |
$17,567.42 |
| Rate for Payer: Aetna Commercial |
$14,090.54
|
| Rate for Payer: Anthem Medicaid |
$6,293.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,273.53
|
| Rate for Payer: Cash Price |
$9,149.70
|
| Rate for Payer: Cigna Commercial |
$15,188.50
|
| Rate for Payer: First Health Commercial |
$17,384.43
|
| Rate for Payer: Humana Commercial |
$15,554.49
|
| Rate for Payer: Humana KY Medicaid |
$6,293.16
|
| Rate for Payer: Kentucky WC Medicaid |
$6,357.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,005.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,504.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,489.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,419.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,103.47
|
| Rate for Payer: Ohio Health Group HMO |
$13,724.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,659.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,378.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,672.81
|
| Rate for Payer: PHCS Commercial |
$17,567.42
|
| Rate for Payer: United Healthcare All Payer |
$16,103.47
|
|
|
RESTORATION DIST STEM 15*155MM
|
Facility
|
IP
|
$18,299.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,378.92 |
| Max. Negotiated Rate |
$17,567.42 |
| Rate for Payer: Aetna Commercial |
$14,090.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,273.53
|
| Rate for Payer: Cash Price |
$9,149.70
|
| Rate for Payer: Cigna Commercial |
$15,188.50
|
| Rate for Payer: First Health Commercial |
$17,384.43
|
| Rate for Payer: Humana Commercial |
$15,554.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,005.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,504.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,489.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,103.47
|
| Rate for Payer: Ohio Health Group HMO |
$13,724.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,659.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,378.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,672.81
|
| Rate for Payer: PHCS Commercial |
$17,567.42
|
| Rate for Payer: United Healthcare All Payer |
$16,103.47
|
|
|
RESTORATION DIST STEM 18*155MM
|
Facility
|
IP
|
$18,299.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,378.92 |
| Max. Negotiated Rate |
$17,567.42 |
| Rate for Payer: Aetna Commercial |
$14,090.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,273.53
|
| Rate for Payer: Cash Price |
$9,149.70
|
| Rate for Payer: Cigna Commercial |
$15,188.50
|
| Rate for Payer: First Health Commercial |
$17,384.43
|
| Rate for Payer: Humana Commercial |
$15,554.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,005.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,504.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,489.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,103.47
|
| Rate for Payer: Ohio Health Group HMO |
$13,724.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,659.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,378.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,672.81
|
| Rate for Payer: PHCS Commercial |
$17,567.42
|
| Rate for Payer: United Healthcare All Payer |
$16,103.47
|
|
|
RESTORATION DIST STEM 18*155MM
|
Facility
|
OP
|
$18,299.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,378.92 |
| Max. Negotiated Rate |
$17,567.42 |
| Rate for Payer: Aetna Commercial |
$14,090.54
|
| Rate for Payer: Anthem Medicaid |
$6,293.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,273.53
|
| Rate for Payer: Cash Price |
$9,149.70
|
| Rate for Payer: Cigna Commercial |
$15,188.50
|
| Rate for Payer: First Health Commercial |
$17,384.43
|
| Rate for Payer: Humana Commercial |
$15,554.49
|
| Rate for Payer: Humana KY Medicaid |
$6,293.16
|
| Rate for Payer: Kentucky WC Medicaid |
$6,357.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,005.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,504.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,489.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,419.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,103.47
|
| Rate for Payer: Ohio Health Group HMO |
$13,724.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,659.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,378.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,672.81
|
| Rate for Payer: PHCS Commercial |
$17,567.42
|
| Rate for Payer: United Healthcare All Payer |
$16,103.47
|
|
|
RESTORATION GAP RING 48MM
|
Facility
|
IP
|
$13,654.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,775.06 |
| Max. Negotiated Rate |
$13,108.15 |
| Rate for Payer: Aetna Commercial |
$10,513.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,650.37
|
| Rate for Payer: Cash Price |
$6,827.16
|
| Rate for Payer: Cigna Commercial |
$11,333.09
|
| Rate for Payer: First Health Commercial |
$12,971.60
|
| Rate for Payer: Humana Commercial |
$11,606.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,196.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,076.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,096.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,015.80
|
| Rate for Payer: Ohio Health Group HMO |
$10,240.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,730.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,775.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,232.84
|
| Rate for Payer: PHCS Commercial |
$13,108.15
|
| Rate for Payer: United Healthcare All Payer |
$12,015.80
|
|
|
RESTORATION GAP RING 48MM
|
Facility
|
OP
|
$13,654.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,775.06 |
| Max. Negotiated Rate |
$13,108.15 |
| Rate for Payer: Aetna Commercial |
$10,513.83
|
| Rate for Payer: Anthem Medicaid |
$4,695.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,650.37
|
| Rate for Payer: Cash Price |
$6,827.16
|
| Rate for Payer: Cigna Commercial |
$11,333.09
|
| Rate for Payer: First Health Commercial |
$12,971.60
|
| Rate for Payer: Humana Commercial |
$11,606.17
|
| Rate for Payer: Humana KY Medicaid |
$4,695.72
|
| Rate for Payer: Kentucky WC Medicaid |
$4,743.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,196.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,076.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,096.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,789.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,015.80
|
| Rate for Payer: Ohio Health Group HMO |
$10,240.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,730.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,775.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,232.84
|
| Rate for Payer: PHCS Commercial |
$13,108.15
|
| Rate for Payer: United Healthcare All Payer |
$12,015.80
|
|
