|
RETROGRADE PYELOGRAM W/WO KUB
|
Facility
|
IP
|
$780.00
|
|
|
Service Code
|
HCPCS 74420
|
| Hospital Charge Code |
32000144
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$101.40 |
| Max. Negotiated Rate |
$748.80 |
| Rate for Payer: Aetna Commercial |
$600.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$608.40
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$647.40
|
| Rate for Payer: First Health Commercial |
$741.00
|
| Rate for Payer: Humana Commercial |
$663.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$639.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$575.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$234.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$686.40
|
| Rate for Payer: Ohio Health Group HMO |
$585.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.80
|
| Rate for Payer: PHCS Commercial |
$748.80
|
| Rate for Payer: United Healthcare All Payer |
$686.40
|
|
|
RETROGRADE PYELOGRAM W/WO KUB
|
Facility
|
OP
|
$780.00
|
|
|
Service Code
|
HCPCS 74420
|
| Hospital Charge Code |
32000144
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$101.40 |
| Max. Negotiated Rate |
$748.80 |
| Rate for Payer: Aetna Commercial |
$600.60
|
| Rate for Payer: Anthem Medicaid |
$268.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$332.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$608.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$448.96
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$647.40
|
| Rate for Payer: First Health Commercial |
$741.00
|
| Rate for Payer: Humana Commercial |
$663.00
|
| Rate for Payer: Humana KY Medicaid |
$268.24
|
| Rate for Payer: Humana Medicare Advantage |
$332.56
|
| Rate for Payer: Kentucky WC Medicaid |
$270.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$639.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$575.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$273.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$686.40
|
| Rate for Payer: Ohio Health Group HMO |
$585.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.80
|
| Rate for Payer: PHCS Commercial |
$748.80
|
| Rate for Payer: United Healthcare All Payer |
$686.40
|
|
|
RETROGRADE PYELOGRAM W/WO KUB
|
Professional
|
Both
|
$780.00
|
|
|
Service Code
|
HCPCS 74420
|
| Hospital Charge Code |
32000144
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$23.46 |
| Max. Negotiated Rate |
$780.00 |
| Rate for Payer: Aetna Commercial |
$190.23
|
| Rate for Payer: Anthem Medicaid |
$86.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$780.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$182.92
|
| Rate for Payer: Healthspan PPO |
$237.76
|
| Rate for Payer: Humana Medicaid |
$86.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$23.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$88.26
|
| Rate for Payer: Molina Healthcare Passport |
$86.53
|
| Rate for Payer: Multiplan PHCS |
$468.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$546.00
|
| Rate for Payer: UHCCP Medicaid |
$273.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$87.40
|
|
|
RETROGRADE PYELOGRAM W/WO KU(P
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 74420
|
| Hospital Charge Code |
320P0144
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$23.46 |
| Max. Negotiated Rate |
$237.76 |
| Rate for Payer: Aetna Commercial |
$190.23
|
| Rate for Payer: Anthem Medicaid |
$86.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$75.00
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$182.92
|
| Rate for Payer: Healthspan PPO |
$237.76
|
| Rate for Payer: Humana Medicaid |
$86.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$23.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$88.26
|
| Rate for Payer: Molina Healthcare Passport |
$86.53
|
| Rate for Payer: Multiplan PHCS |
$45.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$52.50
|
| Rate for Payer: UHCCP Medicaid |
$26.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$87.40
|
|
|
RETROGRADE PYELOGRAM W/WO KU(T
|
Facility
|
OP
|
$705.00
|
|
|
Service Code
|
HCPCS 74420
|
| Hospital Charge Code |
320T0144
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$91.65 |
| Max. Negotiated Rate |
$676.80 |
| Rate for Payer: Aetna Commercial |
$542.85
|
| Rate for Payer: Anthem Medicaid |
$242.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$332.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$549.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$448.96
|
| Rate for Payer: Cash Price |
$352.50
|
| Rate for Payer: Cash Price |
$352.50
|
| Rate for Payer: Cigna Commercial |
$585.15
|
| Rate for Payer: First Health Commercial |
$669.75
|
| Rate for Payer: Humana Commercial |
$599.25
|
| Rate for Payer: Humana KY Medicaid |
$242.45
|
| Rate for Payer: Humana Medicare Advantage |
$332.56
|
| Rate for Payer: Kentucky WC Medicaid |
$244.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$578.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$520.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$247.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$620.40
|
| Rate for Payer: Ohio Health Group HMO |
$528.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$141.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$91.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$218.55
|
| Rate for Payer: PHCS Commercial |
$676.80
|
| Rate for Payer: United Healthcare All Payer |
$620.40
|
|
|
RETROGRADE PYELOGRAM W/WO KU(T
|
Facility
|
IP
|
$705.00
|
|
|
Service Code
|
HCPCS 74420
|
| Hospital Charge Code |
320T0144
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$91.65 |
| Max. Negotiated Rate |
$676.80 |
| Rate for Payer: Aetna Commercial |
$542.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$549.90
|
| Rate for Payer: Cash Price |
$352.50
|
| Rate for Payer: Cigna Commercial |
$585.15
|
| Rate for Payer: First Health Commercial |
$669.75
|
| Rate for Payer: Humana Commercial |
$599.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$578.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$520.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$211.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$620.40
|
| Rate for Payer: Ohio Health Group HMO |
$528.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$141.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$91.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$218.55
|
| Rate for Payer: PHCS Commercial |
$676.80
|
| Rate for Payer: United Healthcare All Payer |
$620.40
|
|
|
RETROVIR EQUIV 5MG/0.5MLSYR
|
Facility
|
OP
|
$4.35
|
|
|
Service Code
|
NDC 65862004824
|
| Hospital Charge Code |
25003408
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.18 |
| Rate for Payer: Aetna Commercial |
$3.35
|
| Rate for Payer: Anthem Medicaid |
$1.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Cash Price |
$2.17
|
| Rate for Payer: Cigna Commercial |
$3.61
|
| Rate for Payer: First Health Commercial |
$4.13
|
| Rate for Payer: Humana Commercial |
$3.70
|
| Rate for Payer: Humana KY Medicaid |
$1.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.83
|
| Rate for Payer: Ohio Health Group HMO |
$3.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.35
|
| Rate for Payer: PHCS Commercial |
$4.18
|
| Rate for Payer: United Healthcare All Payer |
$3.83
|
|
|
RETROVIR EQUIV 5MG/0.5MLSYR
|
Facility
|
IP
|
$4.35
|
|
|
Service Code
|
NDC 65862004824
|
| Hospital Charge Code |
25003408
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.18 |
| Rate for Payer: Aetna Commercial |
$3.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Cash Price |
$2.17
|
| Rate for Payer: Cigna Commercial |
$3.61
|
| Rate for Payer: First Health Commercial |
$4.13
|
| Rate for Payer: Humana Commercial |
$3.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.83
|
| Rate for Payer: Ohio Health Group HMO |
$3.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.35
|
| Rate for Payer: PHCS Commercial |
$4.18
|
| Rate for Payer: United Healthcare All Payer |
$3.83
|
|
|
RETROVIR (ZIDOVUDINE) 10 100MG
|
Facility
|
IP
|
$9.51
|
|
|
Service Code
|
NDC 65862010701
|
| Hospital Charge Code |
25001321
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$9.13 |
| Rate for Payer: Aetna Commercial |
$7.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.42
|
| Rate for Payer: Cash Price |
$4.76
|
| Rate for Payer: Cigna Commercial |
$7.89
|
| Rate for Payer: First Health Commercial |
$9.03
|
| Rate for Payer: Humana Commercial |
$8.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.37
|
| Rate for Payer: Ohio Health Group HMO |
$7.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.95
|
| Rate for Payer: PHCS Commercial |
$9.13
|
| Rate for Payer: United Healthcare All Payer |
$8.37
|
|
|
RETROVIR (ZIDOVUDINE) 10 100MG
|
Facility
|
OP
|
$9.51
|
|
|
Service Code
|
NDC 65862010701
|
| Hospital Charge Code |
25001321
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$9.13 |
| Rate for Payer: Aetna Commercial |
$7.32
|
| Rate for Payer: Anthem Medicaid |
$3.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.42
|
| Rate for Payer: Cash Price |
$4.76
|
| Rate for Payer: Cigna Commercial |
$7.89
|
| Rate for Payer: First Health Commercial |
$9.03
|
| Rate for Payer: Humana Commercial |
$8.08
|
| Rate for Payer: Humana KY Medicaid |
$3.27
|
| Rate for Payer: Kentucky WC Medicaid |
$3.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.37
|
| Rate for Payer: Ohio Health Group HMO |
$7.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.95
|
| Rate for Payer: PHCS Commercial |
$9.13
|
| Rate for Payer: United Healthcare All Payer |
$8.37
|
|
|
REUNI MOD HUM STEM LG SZ12
|
Facility
|
OP
|
$21,225.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,759.25 |
| Max. Negotiated Rate |
$20,376.00 |
| Rate for Payer: Aetna Commercial |
$16,343.25
|
| Rate for Payer: Anthem Medicaid |
$7,299.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,555.50
|
| Rate for Payer: Cash Price |
$10,612.50
|
| Rate for Payer: Cigna Commercial |
$17,616.75
|
| Rate for Payer: First Health Commercial |
$20,163.75
|
| Rate for Payer: Humana Commercial |
$18,041.25
|
| Rate for Payer: Humana KY Medicaid |
$7,299.28
|
| Rate for Payer: Kentucky WC Medicaid |
$7,373.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,404.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,664.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,367.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,445.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,678.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,918.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,245.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,759.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,579.75
|
| Rate for Payer: PHCS Commercial |
$20,376.00
|
| Rate for Payer: United Healthcare All Payer |
$18,678.00
|
|
|
REUNI MOD HUM STEM LG SZ12
|
Facility
|
IP
|
$21,225.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,759.25 |
| Max. Negotiated Rate |
$20,376.00 |
| Rate for Payer: Aetna Commercial |
$16,343.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,555.50
|
| Rate for Payer: Cash Price |
$10,612.50
|
| Rate for Payer: Cigna Commercial |
$17,616.75
|
| Rate for Payer: First Health Commercial |
$20,163.75
|
| Rate for Payer: Humana Commercial |
$18,041.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,404.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,664.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,367.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,678.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,918.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,245.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,759.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,579.75
|
| Rate for Payer: PHCS Commercial |
$20,376.00
|
| Rate for Payer: United Healthcare All Payer |
$18,678.00
|
|
|
REUNI MOD HUM STEM LG SZ9 118M
|
Facility
|
IP
|
$21,225.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,759.25 |
| Max. Negotiated Rate |
$20,376.00 |
| Rate for Payer: Aetna Commercial |
$16,343.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,555.50
|
| Rate for Payer: Cash Price |
$10,612.50
|
| Rate for Payer: Cigna Commercial |
$17,616.75
|
| Rate for Payer: First Health Commercial |
$20,163.75
|
| Rate for Payer: Humana Commercial |
$18,041.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,404.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,664.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,367.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,678.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,918.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,245.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,759.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,579.75
|
| Rate for Payer: PHCS Commercial |
$20,376.00
|
| Rate for Payer: United Healthcare All Payer |
$18,678.00
|
|
|
REUNI MOD HUM STEM LG SZ9 118M
|
Facility
|
OP
|
$21,225.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,759.25 |
| Max. Negotiated Rate |
$20,376.00 |
| Rate for Payer: Aetna Commercial |
$16,343.25
|
| Rate for Payer: Anthem Medicaid |
$7,299.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,555.50
|
| Rate for Payer: Cash Price |
$10,612.50
|
| Rate for Payer: Cigna Commercial |
$17,616.75
|
| Rate for Payer: First Health Commercial |
$20,163.75
|
| Rate for Payer: Humana Commercial |
$18,041.25
|
| Rate for Payer: Humana KY Medicaid |
$7,299.28
|
| Rate for Payer: Kentucky WC Medicaid |
$7,373.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,404.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,664.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,367.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,445.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,678.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,918.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,245.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,759.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,579.75
|
| Rate for Payer: PHCS Commercial |
$20,376.00
|
| Rate for Payer: United Healthcare All Payer |
$18,678.00
|
|
|
REUNION CEMNT HUM STEM 16*L101
|
Facility
|
OP
|
$21,225.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,759.25 |
| Max. Negotiated Rate |
$20,376.00 |
| Rate for Payer: Aetna Commercial |
$16,343.25
|
| Rate for Payer: Anthem Medicaid |
$7,299.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,555.50
|
| Rate for Payer: Cash Price |
$10,612.50
|
| Rate for Payer: Cigna Commercial |
$17,616.75
|
| Rate for Payer: First Health Commercial |
$20,163.75
|
| Rate for Payer: Humana Commercial |
$18,041.25
|
| Rate for Payer: Humana KY Medicaid |
$7,299.28
|
| Rate for Payer: Kentucky WC Medicaid |
$7,373.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,404.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,664.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,367.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,445.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,678.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,918.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,245.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,759.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,579.75
|
| Rate for Payer: PHCS Commercial |
$20,376.00
|
| Rate for Payer: United Healthcare All Payer |
$18,678.00
|
|
|
REUNION CEMNT HUM STEM 16*L101
|
Facility
|
IP
|
$21,225.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,759.25 |
| Max. Negotiated Rate |
$20,376.00 |
| Rate for Payer: Aetna Commercial |
$16,343.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,555.50
|
| Rate for Payer: Cash Price |
$10,612.50
|
| Rate for Payer: Cigna Commercial |
$17,616.75
|
| Rate for Payer: First Health Commercial |
$20,163.75
|
| Rate for Payer: Humana Commercial |
$18,041.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,404.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,664.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,367.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,678.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,918.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,245.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,759.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,579.75
|
| Rate for Payer: PHCS Commercial |
$20,376.00
|
| Rate for Payer: United Healthcare All Payer |
$18,678.00
|
|
|
REUNION CEMNT HUM STEM 17*L102
|
Facility
|
IP
|
$21,225.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,759.25 |
| Max. Negotiated Rate |
$20,376.00 |
| Rate for Payer: Aetna Commercial |
$16,343.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,555.50
|
| Rate for Payer: Cash Price |
$10,612.50
|
| Rate for Payer: Cigna Commercial |
$17,616.75
|
| Rate for Payer: First Health Commercial |
$20,163.75
|
| Rate for Payer: Humana Commercial |
$18,041.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,404.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,664.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,367.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,678.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,918.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,245.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,759.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,579.75
|
| Rate for Payer: PHCS Commercial |
$20,376.00
|
| Rate for Payer: United Healthcare All Payer |
$18,678.00
|
|
|
REUNION CEMNT HUM STEM 17*L102
|
Facility
|
OP
|
$21,225.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,759.25 |
| Max. Negotiated Rate |
$20,376.00 |
| Rate for Payer: Aetna Commercial |
$16,343.25
|
| Rate for Payer: Anthem Medicaid |
$7,299.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,555.50
|
| Rate for Payer: Cash Price |
$10,612.50
|
| Rate for Payer: Cigna Commercial |
$17,616.75
|
| Rate for Payer: First Health Commercial |
$20,163.75
|
| Rate for Payer: Humana Commercial |
$18,041.25
|
| Rate for Payer: Humana KY Medicaid |
$7,299.28
|
| Rate for Payer: Kentucky WC Medicaid |
$7,373.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,404.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,664.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,367.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,445.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,678.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,918.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,245.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,759.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,579.75
|
| Rate for Payer: PHCS Commercial |
$20,376.00
|
| Rate for Payer: United Healthcare All Payer |
$18,678.00
|
|
|
REUNION CEMNT HUM STEM 18*L103
|
Facility
|
IP
|
$21,225.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,759.25 |
| Max. Negotiated Rate |
$20,376.00 |
| Rate for Payer: Aetna Commercial |
$16,343.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,555.50
|
| Rate for Payer: Cash Price |
$10,612.50
|
| Rate for Payer: Cigna Commercial |
$17,616.75
|
| Rate for Payer: First Health Commercial |
$20,163.75
|
| Rate for Payer: Humana Commercial |
$18,041.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,404.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,664.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,367.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,678.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,918.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,245.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,759.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,579.75
|
| Rate for Payer: PHCS Commercial |
$20,376.00
|
| Rate for Payer: United Healthcare All Payer |
$18,678.00
|
|
|
REUNION CEMNT HUM STEM 18*L103
|
Facility
|
OP
|
$21,225.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,759.25 |
| Max. Negotiated Rate |
$20,376.00 |
| Rate for Payer: Aetna Commercial |
$16,343.25
|
| Rate for Payer: Anthem Medicaid |
$7,299.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,555.50
|
| Rate for Payer: Cash Price |
$10,612.50
|
| Rate for Payer: Cigna Commercial |
$17,616.75
|
| Rate for Payer: First Health Commercial |
$20,163.75
|
| Rate for Payer: Humana Commercial |
$18,041.25
|
| Rate for Payer: Humana KY Medicaid |
$7,299.28
|
| Rate for Payer: Kentucky WC Medicaid |
$7,373.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,404.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,664.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,367.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,445.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,678.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,918.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,245.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,759.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,579.75
|
| Rate for Payer: PHCS Commercial |
$20,376.00
|
| Rate for Payer: United Healthcare All Payer |
$18,678.00
|
|
|
REUNION HUMERAL HEAD SZ40*14MM
|
Facility
|
IP
|
$12,574.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,634.70 |
| Max. Negotiated Rate |
$12,071.66 |
| Rate for Payer: Aetna Commercial |
$9,682.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,808.23
|
| Rate for Payer: Cash Price |
$6,287.32
|
| Rate for Payer: Cigna Commercial |
$10,436.96
|
| Rate for Payer: First Health Commercial |
$11,945.92
|
| Rate for Payer: Humana Commercial |
$10,688.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,311.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,280.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,772.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,065.69
|
| Rate for Payer: Ohio Health Group HMO |
$9,430.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,514.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,634.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,898.14
|
| Rate for Payer: PHCS Commercial |
$12,071.66
|
| Rate for Payer: United Healthcare All Payer |
$11,065.69
|
|
|
REUNION HUMERAL HEAD SZ40*14MM
|
Facility
|
OP
|
$12,574.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,634.70 |
| Max. Negotiated Rate |
$12,071.66 |
| Rate for Payer: Aetna Commercial |
$9,682.48
|
| Rate for Payer: Anthem Medicaid |
$4,324.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,808.23
|
| Rate for Payer: Cash Price |
$6,287.32
|
| Rate for Payer: Cigna Commercial |
$10,436.96
|
| Rate for Payer: First Health Commercial |
$11,945.92
|
| Rate for Payer: Humana Commercial |
$10,688.45
|
| Rate for Payer: Humana KY Medicaid |
$4,324.42
|
| Rate for Payer: Kentucky WC Medicaid |
$4,368.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,311.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,280.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,772.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,411.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,065.69
|
| Rate for Payer: Ohio Health Group HMO |
$9,430.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,514.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,634.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,898.14
|
| Rate for Payer: PHCS Commercial |
$12,071.66
|
| Rate for Payer: United Healthcare All Payer |
$11,065.69
|
|
|
REUNION HUMERAL HEAD SZ40*17MM
|
Facility
|
IP
|
$12,574.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,634.70 |
| Max. Negotiated Rate |
$12,071.66 |
| Rate for Payer: Aetna Commercial |
$9,682.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,808.23
|
| Rate for Payer: Cash Price |
$6,287.32
|
| Rate for Payer: Cigna Commercial |
$10,436.96
|
| Rate for Payer: First Health Commercial |
$11,945.92
|
| Rate for Payer: Humana Commercial |
$10,688.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,311.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,280.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,772.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,065.69
|
| Rate for Payer: Ohio Health Group HMO |
$9,430.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,514.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,634.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,898.14
|
| Rate for Payer: PHCS Commercial |
$12,071.66
|
| Rate for Payer: United Healthcare All Payer |
$11,065.69
|
|
|
REUNION HUMERAL HEAD SZ40*17MM
|
Facility
|
OP
|
$12,574.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,634.70 |
| Max. Negotiated Rate |
$12,071.66 |
| Rate for Payer: Aetna Commercial |
$9,682.48
|
| Rate for Payer: Anthem Medicaid |
$4,324.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,808.23
|
| Rate for Payer: Cash Price |
$6,287.32
|
| Rate for Payer: Cigna Commercial |
$10,436.96
|
| Rate for Payer: First Health Commercial |
$11,945.92
|
| Rate for Payer: Humana Commercial |
$10,688.45
|
| Rate for Payer: Humana KY Medicaid |
$4,324.42
|
| Rate for Payer: Kentucky WC Medicaid |
$4,368.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,311.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,280.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,772.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,411.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,065.69
|
| Rate for Payer: Ohio Health Group HMO |
$9,430.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,514.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,634.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,898.14
|
| Rate for Payer: PHCS Commercial |
$12,071.66
|
| Rate for Payer: United Healthcare All Payer |
$11,065.69
|
|
|
REUNION HUMERAL HEAD SZ40*20MM
|
Facility
|
IP
|
$12,574.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,634.70 |
| Max. Negotiated Rate |
$12,071.66 |
| Rate for Payer: Aetna Commercial |
$9,682.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,808.23
|
| Rate for Payer: Cash Price |
$6,287.32
|
| Rate for Payer: Cigna Commercial |
$10,436.96
|
| Rate for Payer: First Health Commercial |
$11,945.92
|
| Rate for Payer: Humana Commercial |
$10,688.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,311.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,280.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,772.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,065.69
|
| Rate for Payer: Ohio Health Group HMO |
$9,430.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,514.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,634.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,898.14
|
| Rate for Payer: PHCS Commercial |
$12,071.66
|
| Rate for Payer: United Healthcare All Payer |
$11,065.69
|
|
