|
SHEATH W/GW 6FR*10CM*.038
|
Facility
|
OP
|
$163.12
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.21 |
| Max. Negotiated Rate |
$156.60 |
| Rate for Payer: Aetna Commercial |
$125.60
|
| Rate for Payer: Anthem Medicaid |
$56.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$127.23
|
| Rate for Payer: Cash Price |
$81.56
|
| Rate for Payer: Cigna Commercial |
$135.39
|
| Rate for Payer: First Health Commercial |
$154.96
|
| Rate for Payer: Humana Commercial |
$138.65
|
| Rate for Payer: Humana KY Medicaid |
$56.10
|
| Rate for Payer: Kentucky WC Medicaid |
$56.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$133.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$120.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$57.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$143.55
|
| Rate for Payer: Ohio Health Group HMO |
$122.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.57
|
| Rate for Payer: PHCS Commercial |
$156.60
|
| Rate for Payer: United Healthcare All Payer |
$143.55
|
|
|
SHEATH W/ GW 7FR*10CM*.038
|
Facility
|
IP
|
$3,248.25
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$422.27 |
| Max. Negotiated Rate |
$3,118.32 |
| Rate for Payer: Aetna Commercial |
$2,501.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,533.64
|
| Rate for Payer: Cash Price |
$1,624.12
|
| Rate for Payer: Cigna Commercial |
$2,696.05
|
| Rate for Payer: First Health Commercial |
$3,085.84
|
| Rate for Payer: Humana Commercial |
$2,761.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,663.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,397.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$974.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,858.46
|
| Rate for Payer: Ohio Health Group HMO |
$2,436.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$649.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$422.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,006.96
|
| Rate for Payer: PHCS Commercial |
$3,118.32
|
| Rate for Payer: United Healthcare All Payer |
$2,858.46
|
|
|
SHEATH W/ GW 7FR*10CM*.038
|
Facility
|
OP
|
$3,248.25
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$422.27 |
| Max. Negotiated Rate |
$3,118.32 |
| Rate for Payer: Aetna Commercial |
$2,501.15
|
| Rate for Payer: Anthem Medicaid |
$1,117.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,533.64
|
| Rate for Payer: Cash Price |
$1,624.12
|
| Rate for Payer: Cigna Commercial |
$2,696.05
|
| Rate for Payer: First Health Commercial |
$3,085.84
|
| Rate for Payer: Humana Commercial |
$2,761.01
|
| Rate for Payer: Humana KY Medicaid |
$1,117.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,128.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,663.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,397.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$974.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,139.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,858.46
|
| Rate for Payer: Ohio Health Group HMO |
$2,436.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$649.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$422.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,006.96
|
| Rate for Payer: PHCS Commercial |
$3,118.32
|
| Rate for Payer: United Healthcare All Payer |
$2,858.46
|
|
|
SHEATH W/O GW 6FR*10CM*.038
|
Facility
|
IP
|
$559.68
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.76 |
| Max. Negotiated Rate |
$537.29 |
| Rate for Payer: Aetna Commercial |
$430.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$436.55
|
| Rate for Payer: Cash Price |
$279.84
|
| Rate for Payer: Cigna Commercial |
$464.53
|
| Rate for Payer: First Health Commercial |
$531.70
|
| Rate for Payer: Humana Commercial |
$475.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$458.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$413.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$167.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$492.52
|
| Rate for Payer: Ohio Health Group HMO |
$419.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$111.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$173.50
|
| Rate for Payer: PHCS Commercial |
$537.29
|
| Rate for Payer: United Healthcare All Payer |
$492.52
|
|
|
SHEATH W/O GW 6FR*10CM*.038
|
Facility
|
OP
|
$559.68
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.76 |
| Max. Negotiated Rate |
$537.29 |
| Rate for Payer: Aetna Commercial |
$430.95
|
| Rate for Payer: Anthem Medicaid |
$192.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$436.55
|
| Rate for Payer: Cash Price |
$279.84
|
| Rate for Payer: Cigna Commercial |
$464.53
|
| Rate for Payer: First Health Commercial |
$531.70
|
| Rate for Payer: Humana Commercial |
$475.73
|
| Rate for Payer: Humana KY Medicaid |
$192.47
|
| Rate for Payer: Kentucky WC Medicaid |
$194.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$458.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$413.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$167.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$196.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$492.52
|
| Rate for Payer: Ohio Health Group HMO |
$419.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$111.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$173.50
|
| Rate for Payer: PHCS Commercial |
$537.29
|
| Rate for Payer: United Healthcare All Payer |
$492.52
|
|
|
SHEATH W/O GW 6FR*25CM*.038
|
Facility
|
OP
|
$770.78
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.20 |
| Max. Negotiated Rate |
$739.95 |
| Rate for Payer: Aetna Commercial |
$593.50
|
| Rate for Payer: Anthem Medicaid |
$265.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$601.21
|
| Rate for Payer: Cash Price |
$385.39
|
| Rate for Payer: Cigna Commercial |
$639.75
|
| Rate for Payer: First Health Commercial |
$732.24
|
| Rate for Payer: Humana Commercial |
$655.16
|
| Rate for Payer: Humana KY Medicaid |
$265.07
|
| Rate for Payer: Kentucky WC Medicaid |
$267.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$632.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$568.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$231.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$270.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$678.29
|
| Rate for Payer: Ohio Health Group HMO |
$578.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$154.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$238.94
|
| Rate for Payer: PHCS Commercial |
$739.95
|
| Rate for Payer: United Healthcare All Payer |
$678.29
|
|
|
SHEATH W/O GW 6FR*25CM*.038
|
Facility
|
IP
|
$770.78
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.20 |
| Max. Negotiated Rate |
$739.95 |
| Rate for Payer: Aetna Commercial |
$593.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$601.21
|
| Rate for Payer: Cash Price |
$385.39
|
| Rate for Payer: Cigna Commercial |
$639.75
|
| Rate for Payer: First Health Commercial |
$732.24
|
| Rate for Payer: Humana Commercial |
$655.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$632.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$568.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$231.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$678.29
|
| Rate for Payer: Ohio Health Group HMO |
$578.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$154.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$238.94
|
| Rate for Payer: PHCS Commercial |
$739.95
|
| Rate for Payer: United Healthcare All Payer |
$678.29
|
|
|
SHEATH W/O GW 7FR*25CM*.038
|
Facility
|
OP
|
$41.95
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.45 |
| Max. Negotiated Rate |
$40.27 |
| Rate for Payer: Aetna Commercial |
$32.30
|
| Rate for Payer: Anthem Medicaid |
$14.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32.72
|
| Rate for Payer: Cash Price |
$20.98
|
| Rate for Payer: Cigna Commercial |
$34.82
|
| Rate for Payer: First Health Commercial |
$39.85
|
| Rate for Payer: Humana Commercial |
$35.66
|
| Rate for Payer: Humana KY Medicaid |
$14.43
|
| Rate for Payer: Kentucky WC Medicaid |
$14.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$36.92
|
| Rate for Payer: Ohio Health Group HMO |
$31.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13.00
|
| Rate for Payer: PHCS Commercial |
$40.27
|
| Rate for Payer: United Healthcare All Payer |
$36.92
|
|
|
SHEATH W/O GW 7FR*25CM*.038
|
Facility
|
IP
|
$41.95
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.45 |
| Max. Negotiated Rate |
$40.27 |
| Rate for Payer: Aetna Commercial |
$32.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32.72
|
| Rate for Payer: Cash Price |
$20.98
|
| Rate for Payer: Cigna Commercial |
$34.82
|
| Rate for Payer: First Health Commercial |
$39.85
|
| Rate for Payer: Humana Commercial |
$35.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$36.92
|
| Rate for Payer: Ohio Health Group HMO |
$31.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13.00
|
| Rate for Payer: PHCS Commercial |
$40.27
|
| Rate for Payer: United Healthcare All Payer |
$36.92
|
|
|
SHEATH W/O GW 8FR*10CM*.038
|
Facility
|
IP
|
$515.80
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.05 |
| Max. Negotiated Rate |
$495.17 |
| Rate for Payer: Aetna Commercial |
$397.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$402.32
|
| Rate for Payer: Cash Price |
$257.90
|
| Rate for Payer: Cigna Commercial |
$428.11
|
| Rate for Payer: First Health Commercial |
$490.01
|
| Rate for Payer: Humana Commercial |
$438.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$422.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$380.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$154.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$453.90
|
| Rate for Payer: Ohio Health Group HMO |
$386.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$103.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$159.90
|
| Rate for Payer: PHCS Commercial |
$495.17
|
| Rate for Payer: United Healthcare All Payer |
$453.90
|
|
|
SHEATH W/O GW 8FR*10CM*.038
|
Facility
|
OP
|
$515.80
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.05 |
| Max. Negotiated Rate |
$495.17 |
| Rate for Payer: Aetna Commercial |
$397.17
|
| Rate for Payer: Anthem Medicaid |
$177.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$402.32
|
| Rate for Payer: Cash Price |
$257.90
|
| Rate for Payer: Cigna Commercial |
$428.11
|
| Rate for Payer: First Health Commercial |
$490.01
|
| Rate for Payer: Humana Commercial |
$438.43
|
| Rate for Payer: Humana KY Medicaid |
$177.38
|
| Rate for Payer: Kentucky WC Medicaid |
$179.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$422.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$380.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$154.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$180.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$453.90
|
| Rate for Payer: Ohio Health Group HMO |
$386.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$103.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$159.90
|
| Rate for Payer: PHCS Commercial |
$495.17
|
| Rate for Payer: United Healthcare All Payer |
$453.90
|
|
|
SHEEP SORREL IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000770
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
SHEEP SORREL IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000770
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem Medicaid |
$22.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Humana KY Medicaid |
$22.35
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Kentucky WC Medicaid |
$22.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
SHEETING SILICONE 2*3*.020
|
Facility
|
IP
|
$755.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$98.18 |
| Max. Negotiated Rate |
$725.04 |
| Rate for Payer: Aetna Commercial |
$581.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$589.10
|
| Rate for Payer: Cash Price |
$377.62
|
| Rate for Payer: Cigna Commercial |
$626.86
|
| Rate for Payer: First Health Commercial |
$717.49
|
| Rate for Payer: Humana Commercial |
$641.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$619.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$557.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$226.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$664.62
|
| Rate for Payer: Ohio Health Group HMO |
$566.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$151.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$234.13
|
| Rate for Payer: PHCS Commercial |
$725.04
|
| Rate for Payer: United Healthcare All Payer |
$664.62
|
|
|
SHEETING SILICONE 2*3*.020
|
Facility
|
OP
|
$755.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$98.18 |
| Max. Negotiated Rate |
$725.04 |
| Rate for Payer: Aetna Commercial |
$581.54
|
| Rate for Payer: Anthem Medicaid |
$259.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$589.10
|
| Rate for Payer: Cash Price |
$377.62
|
| Rate for Payer: Cigna Commercial |
$626.86
|
| Rate for Payer: First Health Commercial |
$717.49
|
| Rate for Payer: Humana Commercial |
$641.96
|
| Rate for Payer: Humana KY Medicaid |
$259.73
|
| Rate for Payer: Kentucky WC Medicaid |
$262.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$619.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$557.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$226.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$264.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$664.62
|
| Rate for Payer: Ohio Health Group HMO |
$566.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$151.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$234.13
|
| Rate for Payer: PHCS Commercial |
$725.04
|
| Rate for Payer: United Healthcare All Payer |
$664.62
|
|
|
SHEETING SILICONE 8*6*.020
|
Facility
|
IP
|
$1,903.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$247.39 |
| Max. Negotiated Rate |
$1,826.88 |
| Rate for Payer: Aetna Commercial |
$1,465.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,484.34
|
| Rate for Payer: Cash Price |
$951.50
|
| Rate for Payer: Cigna Commercial |
$1,579.49
|
| Rate for Payer: First Health Commercial |
$1,807.85
|
| Rate for Payer: Humana Commercial |
$1,617.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,560.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,404.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,674.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,427.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$380.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$589.93
|
| Rate for Payer: PHCS Commercial |
$1,826.88
|
| Rate for Payer: United Healthcare All Payer |
$1,674.64
|
|
|
SHEETING SILICONE 8*6*.020
|
Facility
|
OP
|
$1,903.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$247.39 |
| Max. Negotiated Rate |
$1,826.88 |
| Rate for Payer: Aetna Commercial |
$1,465.31
|
| Rate for Payer: Anthem Medicaid |
$654.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,484.34
|
| Rate for Payer: Cash Price |
$951.50
|
| Rate for Payer: Cigna Commercial |
$1,579.49
|
| Rate for Payer: First Health Commercial |
$1,807.85
|
| Rate for Payer: Humana Commercial |
$1,617.55
|
| Rate for Payer: Humana KY Medicaid |
$654.44
|
| Rate for Payer: Kentucky WC Medicaid |
$661.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,560.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,404.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$667.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,674.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,427.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$380.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$589.93
|
| Rate for Payer: PHCS Commercial |
$1,826.88
|
| Rate for Payer: United Healthcare All Payer |
$1,674.64
|
|
|
SHELL CONT CLUSTER HOLE 44EE
|
Facility
|
IP
|
$9,041.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,175.40 |
| Max. Negotiated Rate |
$8,679.84 |
| Rate for Payer: Aetna Commercial |
$6,961.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,052.37
|
| Rate for Payer: Cash Price |
$4,520.75
|
| Rate for Payer: Cigna Commercial |
$7,504.44
|
| Rate for Payer: First Health Commercial |
$8,589.42
|
| Rate for Payer: Humana Commercial |
$7,685.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,414.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,672.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,712.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,956.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,781.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,808.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,175.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,802.86
|
| Rate for Payer: PHCS Commercial |
$8,679.84
|
| Rate for Payer: United Healthcare All Payer |
$7,956.52
|
|
|
SHELL CONT CLUSTER HOLE 44EE
|
Facility
|
OP
|
$9,041.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,175.40 |
| Max. Negotiated Rate |
$8,679.84 |
| Rate for Payer: Aetna Commercial |
$6,961.96
|
| Rate for Payer: Anthem Medicaid |
$3,109.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,052.37
|
| Rate for Payer: Cash Price |
$4,520.75
|
| Rate for Payer: Cigna Commercial |
$7,504.44
|
| Rate for Payer: First Health Commercial |
$8,589.42
|
| Rate for Payer: Humana Commercial |
$7,685.28
|
| Rate for Payer: Humana KY Medicaid |
$3,109.37
|
| Rate for Payer: Kentucky WC Medicaid |
$3,141.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,414.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,672.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,712.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,171.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,956.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,781.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,808.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,175.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,802.86
|
| Rate for Payer: PHCS Commercial |
$8,679.84
|
| Rate for Payer: United Healthcare All Payer |
$7,956.52
|
|
|
SHELL CONT CLUSTER HOLE 46FF
|
Facility
|
IP
|
$9,041.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,175.40 |
| Max. Negotiated Rate |
$8,679.84 |
| Rate for Payer: Aetna Commercial |
$6,961.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,052.37
|
| Rate for Payer: Cash Price |
$4,520.75
|
| Rate for Payer: Cigna Commercial |
$7,504.44
|
| Rate for Payer: First Health Commercial |
$8,589.42
|
| Rate for Payer: Humana Commercial |
$7,685.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,414.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,672.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,712.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,956.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,781.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,808.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,175.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,802.86
|
| Rate for Payer: PHCS Commercial |
$8,679.84
|
| Rate for Payer: United Healthcare All Payer |
$7,956.52
|
|
|
SHELL CONT CLUSTER HOLE 46FF
|
Facility
|
OP
|
$9,041.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,175.40 |
| Max. Negotiated Rate |
$8,679.84 |
| Rate for Payer: Aetna Commercial |
$6,961.96
|
| Rate for Payer: Anthem Medicaid |
$3,109.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,052.37
|
| Rate for Payer: Cash Price |
$4,520.75
|
| Rate for Payer: Cigna Commercial |
$7,504.44
|
| Rate for Payer: First Health Commercial |
$8,589.42
|
| Rate for Payer: Humana Commercial |
$7,685.28
|
| Rate for Payer: Humana KY Medicaid |
$3,109.37
|
| Rate for Payer: Kentucky WC Medicaid |
$3,141.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,414.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,672.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,712.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,171.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,956.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,781.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,808.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,175.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,802.86
|
| Rate for Payer: PHCS Commercial |
$8,679.84
|
| Rate for Payer: United Healthcare All Payer |
$7,956.52
|
|
|
SHELL CONT CLUSTER HOLE 48GG
|
Facility
|
OP
|
$9,041.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,175.40 |
| Max. Negotiated Rate |
$8,679.84 |
| Rate for Payer: Aetna Commercial |
$6,961.96
|
| Rate for Payer: Anthem Medicaid |
$3,109.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,052.37
|
| Rate for Payer: Cash Price |
$4,520.75
|
| Rate for Payer: Cigna Commercial |
$7,504.44
|
| Rate for Payer: First Health Commercial |
$8,589.42
|
| Rate for Payer: Humana Commercial |
$7,685.28
|
| Rate for Payer: Humana KY Medicaid |
$3,109.37
|
| Rate for Payer: Kentucky WC Medicaid |
$3,141.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,414.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,672.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,712.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,171.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,956.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,781.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,808.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,175.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,802.86
|
| Rate for Payer: PHCS Commercial |
$8,679.84
|
| Rate for Payer: United Healthcare All Payer |
$7,956.52
|
|
|
SHELL CONT CLUSTER HOLE 48GG
|
Facility
|
IP
|
$9,041.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,175.40 |
| Max. Negotiated Rate |
$8,679.84 |
| Rate for Payer: Aetna Commercial |
$6,961.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,052.37
|
| Rate for Payer: Cash Price |
$4,520.75
|
| Rate for Payer: Cigna Commercial |
$7,504.44
|
| Rate for Payer: First Health Commercial |
$8,589.42
|
| Rate for Payer: Humana Commercial |
$7,685.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,414.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,672.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,712.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,956.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,781.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,808.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,175.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,802.86
|
| Rate for Payer: PHCS Commercial |
$8,679.84
|
| Rate for Payer: United Healthcare All Payer |
$7,956.52
|
|
|
SHELL CONT CLUSTER HOLE 50HH
|
Facility
|
OP
|
$9,041.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,175.40 |
| Max. Negotiated Rate |
$8,679.84 |
| Rate for Payer: Aetna Commercial |
$6,961.96
|
| Rate for Payer: Anthem Medicaid |
$3,109.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,052.37
|
| Rate for Payer: Cash Price |
$4,520.75
|
| Rate for Payer: Cigna Commercial |
$7,504.44
|
| Rate for Payer: First Health Commercial |
$8,589.42
|
| Rate for Payer: Humana Commercial |
$7,685.28
|
| Rate for Payer: Humana KY Medicaid |
$3,109.37
|
| Rate for Payer: Kentucky WC Medicaid |
$3,141.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,414.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,672.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,712.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,171.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,956.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,781.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,808.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,175.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,802.86
|
| Rate for Payer: PHCS Commercial |
$8,679.84
|
| Rate for Payer: United Healthcare All Payer |
$7,956.52
|
|
|
SHELL CONT CLUSTER HOLE 50HH
|
Facility
|
IP
|
$9,041.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,175.40 |
| Max. Negotiated Rate |
$8,679.84 |
| Rate for Payer: Aetna Commercial |
$6,961.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,052.37
|
| Rate for Payer: Cash Price |
$4,520.75
|
| Rate for Payer: Cigna Commercial |
$7,504.44
|
| Rate for Payer: First Health Commercial |
$8,589.42
|
| Rate for Payer: Humana Commercial |
$7,685.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,414.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,672.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,712.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,956.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,781.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,808.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,175.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,802.86
|
| Rate for Payer: PHCS Commercial |
$8,679.84
|
| Rate for Payer: United Healthcare All Payer |
$7,956.52
|
|
