|
SCREEN COLONOSCOPY NOT HIGH RI
|
Professional
|
Both
|
$554.00
|
|
|
Service Code
|
HCPCS G0121
|
| Hospital Charge Code |
51000135
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$172.90 |
| Max. Negotiated Rate |
$332.40 |
| Rate for Payer: Aetna Commercial |
$329.66
|
| Rate for Payer: Ambetter Exchange |
$172.90
|
| Rate for Payer: Anthem Medicaid |
$243.75
|
| Rate for Payer: Buckeye Individual/Medicaid |
$172.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$172.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$207.48
|
| Rate for Payer: Cash Price |
$277.00
|
| Rate for Payer: Cash Price |
$277.00
|
| Rate for Payer: Humana Medicaid |
$243.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$283.99
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$172.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$172.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$248.62
|
| Rate for Payer: Molina Healthcare Passport |
$243.75
|
| Rate for Payer: Multiplan PHCS |
$332.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$224.77
|
| Rate for Payer: UHCCP Medicaid |
$193.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$246.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$172.90
|
|
|
SCREEN COLONOSCOPY NOT HIGH RI
|
Facility
|
IP
|
$554.00
|
|
|
Service Code
|
HCPCS G0121
|
| Hospital Charge Code |
51000135
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$166.20 |
| Max. Negotiated Rate |
$531.84 |
| Rate for Payer: Aetna Commercial |
$426.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$432.12
|
| Rate for Payer: Cash Price |
$277.00
|
| Rate for Payer: Cigna Commercial |
$459.82
|
| Rate for Payer: First Health Commercial |
$526.30
|
| Rate for Payer: Humana Commercial |
$470.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$454.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$408.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$166.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$487.52
|
| Rate for Payer: Ohio Health Group HMO |
$415.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$443.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$481.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$382.26
|
| Rate for Payer: PHCS Commercial |
$531.84
|
| Rate for Payer: United Healthcare All Payer |
$487.52
|
|
|
SCREEN C/V THIN LAYER BY MD
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
HCPCS G0124
|
| Hospital Charge Code |
51000136
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$69.00 |
| Max. Negotiated Rate |
$220.80 |
| Rate for Payer: Aetna Commercial |
$177.10
|
| Rate for Payer: Anthem Medicaid |
$79.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$179.40
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cigna Commercial |
$190.90
|
| Rate for Payer: First Health Commercial |
$218.50
|
| Rate for Payer: Humana Commercial |
$195.50
|
| Rate for Payer: Humana KY Medicaid |
$79.10
|
| Rate for Payer: Kentucky WC Medicaid |
$79.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$188.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$169.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$69.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$80.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$202.40
|
| Rate for Payer: Ohio Health Group HMO |
$172.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$184.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$200.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$158.70
|
| Rate for Payer: PHCS Commercial |
$220.80
|
| Rate for Payer: United Healthcare All Payer |
$202.40
|
|
|
SCREEN C/V THIN LAYER BY MD
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
HCPCS G0124
|
| Hospital Charge Code |
51000136
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$69.00 |
| Max. Negotiated Rate |
$220.80 |
| Rate for Payer: Aetna Commercial |
$177.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$179.40
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cigna Commercial |
$190.90
|
| Rate for Payer: First Health Commercial |
$218.50
|
| Rate for Payer: Humana Commercial |
$195.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$188.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$169.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$69.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$202.40
|
| Rate for Payer: Ohio Health Group HMO |
$172.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$184.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$200.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$158.70
|
| Rate for Payer: PHCS Commercial |
$220.80
|
| Rate for Payer: United Healthcare All Payer |
$202.40
|
|
|
SCREEN C/V THIN LAYER BY MD
|
Professional
|
Both
|
$230.00
|
|
|
Service Code
|
HCPCS G0124
|
| Hospital Charge Code |
51000136
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$138.00 |
| Rate for Payer: Aetna Commercial |
$42.26
|
| Rate for Payer: Ambetter Exchange |
$22.89
|
| Rate for Payer: Buckeye Individual/Medicaid |
$22.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$22.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$27.47
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$15.40
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$22.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.89
|
| Rate for Payer: Multiplan PHCS |
$138.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$29.76
|
| Rate for Payer: UHCCP Medicaid |
$80.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$22.89
|
|
|
SCREENING PAP SMEAR BY PHYS
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
HCPCS P3001
|
| Hospital Charge Code |
30001587
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$72.00 |
| Max. Negotiated Rate |
$230.40 |
| Rate for Payer: Aetna Commercial |
$184.80
|
| Rate for Payer: Anthem Medicaid |
$82.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$192.72
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cigna Commercial |
$199.20
|
| Rate for Payer: First Health Commercial |
$228.00
|
| Rate for Payer: Humana Commercial |
$204.00
|
| Rate for Payer: Humana KY Medicaid |
$82.54
|
| Rate for Payer: Kentucky WC Medicaid |
$83.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$196.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$177.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$72.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$84.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$211.20
|
| Rate for Payer: Ohio Health Group HMO |
$180.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$192.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$208.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$165.60
|
| Rate for Payer: PHCS Commercial |
$230.40
|
| Rate for Payer: United Healthcare All Payer |
$211.20
|
|
|
SCREENING PAP SMEAR BY PHYS
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
HCPCS P3001
|
| Hospital Charge Code |
30001587
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$72.00 |
| Max. Negotiated Rate |
$230.40 |
| Rate for Payer: Aetna Commercial |
$184.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$192.72
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cigna Commercial |
$199.20
|
| Rate for Payer: First Health Commercial |
$228.00
|
| Rate for Payer: Humana Commercial |
$204.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$196.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$177.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$72.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$211.20
|
| Rate for Payer: Ohio Health Group HMO |
$180.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$192.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$208.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$165.60
|
| Rate for Payer: PHCS Commercial |
$230.40
|
| Rate for Payer: United Healthcare All Payer |
$211.20
|
|
|
SCREENING PAP SMEAR PROCEDURE
|
Facility
|
IP
|
$53.00
|
|
|
Service Code
|
HCPCS 88164
|
| Hospital Charge Code |
30001421
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$15.90 |
| Max. Negotiated Rate |
$50.88 |
| Rate for Payer: Aetna Commercial |
$40.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$42.56
|
| Rate for Payer: Cash Price |
$26.50
|
| Rate for Payer: Cigna Commercial |
$43.99
|
| Rate for Payer: First Health Commercial |
$50.35
|
| Rate for Payer: Humana Commercial |
$45.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$43.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$39.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$46.64
|
| Rate for Payer: Ohio Health Group HMO |
$39.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$42.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$46.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.57
|
| Rate for Payer: PHCS Commercial |
$50.88
|
| Rate for Payer: United Healthcare All Payer |
$46.64
|
|
|
SCREENING PAP SMEAR PROCEDURE
|
Facility
|
OP
|
$53.00
|
|
|
Service Code
|
HCPCS 88164
|
| Hospital Charge Code |
30001421
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$18.19 |
| Max. Negotiated Rate |
$50.88 |
| Rate for Payer: Aetna Commercial |
$40.81
|
| Rate for Payer: Anthem Medicaid |
$18.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$18.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$42.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$25.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$18.19
|
| Rate for Payer: Cash Price |
$26.50
|
| Rate for Payer: Cash Price |
$26.50
|
| Rate for Payer: Cigna Commercial |
$43.99
|
| Rate for Payer: First Health Commercial |
$50.35
|
| Rate for Payer: Humana Commercial |
$45.05
|
| Rate for Payer: Humana KY Medicaid |
$18.19
|
| Rate for Payer: Humana Medicare Advantage |
$18.19
|
| Rate for Payer: Kentucky WC Medicaid |
$18.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$43.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$39.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$46.64
|
| Rate for Payer: Ohio Health Group HMO |
$39.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$42.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$46.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.57
|
| Rate for Payer: PHCS Commercial |
$50.88
|
| Rate for Payer: United Healthcare All Payer |
$46.64
|
|
|
SCREENING PAP - SPECIMEN COLL
|
Professional
|
Both
|
$104.00
|
|
|
Service Code
|
HCPCS Q0091
|
| Hospital Charge Code |
30001588
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.06 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$28.67
|
| Rate for Payer: Ambetter Exchange |
$17.06
|
| Rate for Payer: Buckeye Individual/Medicaid |
$17.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$17.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$20.47
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$18.97
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$17.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.06
|
| Rate for Payer: Multiplan PHCS |
$62.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$22.18
|
| Rate for Payer: UHCCP Medicaid |
$36.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.06
|
|
|
SCREENING PAP - SPECIMEN COLL
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
HCPCS Q0091
|
| Hospital Charge Code |
30001588
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.63 |
| Max. Negotiated Rate |
$99.84 |
| Rate for Payer: Aetna Commercial |
$80.08
|
| Rate for Payer: Anthem Medicaid |
$22.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$22.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$83.51
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$31.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$22.63
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cigna Commercial |
$86.32
|
| Rate for Payer: First Health Commercial |
$98.80
|
| Rate for Payer: Humana Commercial |
$88.40
|
| Rate for Payer: Humana KY Medicaid |
$22.63
|
| Rate for Payer: Humana Medicare Advantage |
$22.63
|
| Rate for Payer: Kentucky WC Medicaid |
$22.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$85.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$76.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$23.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$91.52
|
| Rate for Payer: Ohio Health Group HMO |
$78.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$83.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$90.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$71.76
|
| Rate for Payer: PHCS Commercial |
$99.84
|
| Rate for Payer: United Healthcare All Payer |
$91.52
|
|
|
SCREENING PAP - SPECIMEN COLL
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
HCPCS Q0091
|
| Hospital Charge Code |
30001588
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$99.84 |
| Rate for Payer: Aetna Commercial |
$80.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$83.51
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cigna Commercial |
$86.32
|
| Rate for Payer: First Health Commercial |
$98.80
|
| Rate for Payer: Humana Commercial |
$88.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$85.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$76.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$31.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$91.52
|
| Rate for Payer: Ohio Health Group HMO |
$78.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$83.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$90.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$71.76
|
| Rate for Payer: PHCS Commercial |
$99.84
|
| Rate for Payer: United Healthcare All Payer |
$91.52
|
|
|
SCREENING PAP-SPECIMEN COLL (P
|
Professional
|
Both
|
$104.00
|
|
|
Service Code
|
HCPCS Q0091
|
| Hospital Charge Code |
300P1588
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.06 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$28.67
|
| Rate for Payer: Ambetter Exchange |
$17.06
|
| Rate for Payer: Buckeye Individual/Medicaid |
$17.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$17.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$20.47
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$18.97
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$17.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.06
|
| Rate for Payer: Multiplan PHCS |
$62.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$22.18
|
| Rate for Payer: UHCCP Medicaid |
$36.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$17.06
|
|
|
SCREW 1.9MM*5
|
Facility
|
OP
|
$1,724.84
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$517.45 |
| Max. Negotiated Rate |
$1,655.85 |
| Rate for Payer: Aetna Commercial |
$1,328.13
|
| Rate for Payer: Anthem Medicaid |
$593.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,345.38
|
| Rate for Payer: Cash Price |
$862.42
|
| Rate for Payer: Cigna Commercial |
$1,431.62
|
| Rate for Payer: First Health Commercial |
$1,638.60
|
| Rate for Payer: Humana Commercial |
$1,466.11
|
| Rate for Payer: Humana KY Medicaid |
$593.17
|
| Rate for Payer: Kentucky WC Medicaid |
$599.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,414.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,272.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$517.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$605.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,517.86
|
| Rate for Payer: Ohio Health Group HMO |
$1,293.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,379.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,500.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,190.14
|
| Rate for Payer: PHCS Commercial |
$1,655.85
|
| Rate for Payer: United Healthcare All Payer |
$1,517.86
|
|
|
SCREW 1.9MM*5
|
Facility
|
IP
|
$1,724.84
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$517.45 |
| Max. Negotiated Rate |
$1,655.85 |
| Rate for Payer: Aetna Commercial |
$1,328.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,345.38
|
| Rate for Payer: Cash Price |
$862.42
|
| Rate for Payer: Cigna Commercial |
$1,431.62
|
| Rate for Payer: First Health Commercial |
$1,638.60
|
| Rate for Payer: Humana Commercial |
$1,466.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,414.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,272.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$517.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,517.86
|
| Rate for Payer: Ohio Health Group HMO |
$1,293.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,379.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,500.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,190.14
|
| Rate for Payer: PHCS Commercial |
$1,655.85
|
| Rate for Payer: United Healthcare All Payer |
$1,517.86
|
|
|
SCREW 2.0*12 SNAP OFF
|
Facility
|
IP
|
$2,088.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$626.55 |
| Max. Negotiated Rate |
$2,004.96 |
| Rate for Payer: Aetna Commercial |
$1,608.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,629.03
|
| Rate for Payer: Cash Price |
$1,044.25
|
| Rate for Payer: Cigna Commercial |
$1,733.45
|
| Rate for Payer: First Health Commercial |
$1,984.08
|
| Rate for Payer: Humana Commercial |
$1,775.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,712.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,541.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$626.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,837.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,566.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,670.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,816.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,441.07
|
| Rate for Payer: PHCS Commercial |
$2,004.96
|
| Rate for Payer: United Healthcare All Payer |
$1,837.88
|
|
|
SCREW 2.0*12 SNAP OFF
|
Facility
|
OP
|
$2,088.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$626.55 |
| Max. Negotiated Rate |
$2,004.96 |
| Rate for Payer: Aetna Commercial |
$1,608.14
|
| Rate for Payer: Anthem Medicaid |
$718.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,629.03
|
| Rate for Payer: Cash Price |
$1,044.25
|
| Rate for Payer: Cigna Commercial |
$1,733.45
|
| Rate for Payer: First Health Commercial |
$1,984.08
|
| Rate for Payer: Humana Commercial |
$1,775.22
|
| Rate for Payer: Humana KY Medicaid |
$718.24
|
| Rate for Payer: Kentucky WC Medicaid |
$725.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,712.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,541.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$626.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$732.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,837.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,566.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,670.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,816.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,441.07
|
| Rate for Payer: PHCS Commercial |
$2,004.96
|
| Rate for Payer: United Healthcare All Payer |
$1,837.88
|
|
|
SCREW 2.3MM*8 NON LCK VARIAX
|
Facility
|
IP
|
$1,200.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$360.00 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$360.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$960.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,044.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$828.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
SCREW 2.3MM*8 NON LCK VARIAX
|
Facility
|
OP
|
$1,200.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$360.00 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem Medicaid |
$412.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Humana KY Medicaid |
$412.68
|
| Rate for Payer: Kentucky WC Medicaid |
$416.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$360.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$420.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$960.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,044.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$828.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
SCREW 2.3MM*9 NON LCK VARIAX
|
Facility
|
OP
|
$1,200.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$360.00 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem Medicaid |
$412.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Humana KY Medicaid |
$412.68
|
| Rate for Payer: Kentucky WC Medicaid |
$416.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$360.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$420.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$960.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,044.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$828.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
SCREW 2.3MM*9 NON LCK VARIAX
|
Facility
|
IP
|
$1,200.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$360.00 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$360.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$960.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,044.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$828.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
SCREW 2.5X10 LOCKING
|
Facility
|
IP
|
$1,946.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$583.80 |
| Max. Negotiated Rate |
$1,868.16 |
| Rate for Payer: Aetna Commercial |
$1,498.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,517.88
|
| Rate for Payer: Cash Price |
$973.00
|
| Rate for Payer: Cigna Commercial |
$1,615.18
|
| Rate for Payer: First Health Commercial |
$1,848.70
|
| Rate for Payer: Humana Commercial |
$1,654.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,595.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,436.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$583.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,712.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,459.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,556.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,693.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,342.74
|
| Rate for Payer: PHCS Commercial |
$1,868.16
|
| Rate for Payer: United Healthcare All Payer |
$1,712.48
|
|
|
SCREW 2.5X10 LOCKING
|
Facility
|
OP
|
$1,946.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$583.80 |
| Max. Negotiated Rate |
$1,868.16 |
| Rate for Payer: Aetna Commercial |
$1,498.42
|
| Rate for Payer: Anthem Medicaid |
$669.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,517.88
|
| Rate for Payer: Cash Price |
$973.00
|
| Rate for Payer: Cigna Commercial |
$1,615.18
|
| Rate for Payer: First Health Commercial |
$1,848.70
|
| Rate for Payer: Humana Commercial |
$1,654.10
|
| Rate for Payer: Humana KY Medicaid |
$669.23
|
| Rate for Payer: Kentucky WC Medicaid |
$676.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,595.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,436.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$583.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$682.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,712.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,459.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,556.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,693.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,342.74
|
| Rate for Payer: PHCS Commercial |
$1,868.16
|
| Rate for Payer: United Healthcare All Payer |
$1,712.48
|
|
|
SCREW 2.5X12 LOCKING
|
Facility
|
OP
|
$1,946.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$583.80 |
| Max. Negotiated Rate |
$1,868.16 |
| Rate for Payer: Aetna Commercial |
$1,498.42
|
| Rate for Payer: Anthem Medicaid |
$669.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,517.88
|
| Rate for Payer: Cash Price |
$973.00
|
| Rate for Payer: Cigna Commercial |
$1,615.18
|
| Rate for Payer: First Health Commercial |
$1,848.70
|
| Rate for Payer: Humana Commercial |
$1,654.10
|
| Rate for Payer: Humana KY Medicaid |
$669.23
|
| Rate for Payer: Kentucky WC Medicaid |
$676.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,595.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,436.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$583.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$682.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,712.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,459.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,556.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,693.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,342.74
|
| Rate for Payer: PHCS Commercial |
$1,868.16
|
| Rate for Payer: United Healthcare All Payer |
$1,712.48
|
|
|
SCREW 2.5X12 LOCKING
|
Facility
|
IP
|
$1,946.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$583.80 |
| Max. Negotiated Rate |
$1,868.16 |
| Rate for Payer: Aetna Commercial |
$1,498.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,517.88
|
| Rate for Payer: Cash Price |
$973.00
|
| Rate for Payer: Cigna Commercial |
$1,615.18
|
| Rate for Payer: First Health Commercial |
$1,848.70
|
| Rate for Payer: Humana Commercial |
$1,654.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,595.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,436.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$583.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,712.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,459.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,556.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,693.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,342.74
|
| Rate for Payer: PHCS Commercial |
$1,868.16
|
| Rate for Payer: United Healthcare All Payer |
$1,712.48
|
|
