|
SELECT PRI POR HUM STEM 10*125
|
Facility
|
OP
|
$7,916.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,374.97 |
| Max. Negotiated Rate |
$7,599.89 |
| Rate for Payer: Aetna Commercial |
$6,095.74
|
| Rate for Payer: Anthem Medicaid |
$2,722.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,174.91
|
| Rate for Payer: Cash Price |
$3,958.28
|
| Rate for Payer: Cigna Commercial |
$6,570.74
|
| Rate for Payer: First Health Commercial |
$7,520.72
|
| Rate for Payer: Humana Commercial |
$6,729.07
|
| Rate for Payer: Humana KY Medicaid |
$2,722.50
|
| Rate for Payer: Kentucky WC Medicaid |
$2,750.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,491.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,842.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,374.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,777.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,966.56
|
| Rate for Payer: Ohio Health Group HMO |
$5,937.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,333.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,887.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,462.42
|
| Rate for Payer: PHCS Commercial |
$7,599.89
|
| Rate for Payer: United Healthcare All Payer |
$6,966.56
|
|
|
SELENIUM 200MCG TABLET
|
Facility
|
IP
|
$4.25
|
|
|
Service Code
|
NDC 54629016300
|
| Hospital Charge Code |
25003436
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$4.08 |
| Rate for Payer: Aetna Commercial |
$3.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.31
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cigna Commercial |
$3.53
|
| Rate for Payer: First Health Commercial |
$4.04
|
| Rate for Payer: Humana Commercial |
$3.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.74
|
| Rate for Payer: Ohio Health Group HMO |
$3.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.93
|
| Rate for Payer: PHCS Commercial |
$4.08
|
| Rate for Payer: United Healthcare All Payer |
$3.74
|
|
|
SELENIUM 200MCG TABLET
|
Facility
|
OP
|
$4.25
|
|
|
Service Code
|
NDC 54629016300
|
| Hospital Charge Code |
25003436
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$4.08 |
| Rate for Payer: Aetna Commercial |
$3.27
|
| Rate for Payer: Anthem Medicaid |
$1.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.31
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cigna Commercial |
$3.53
|
| Rate for Payer: First Health Commercial |
$4.04
|
| Rate for Payer: Humana Commercial |
$3.61
|
| Rate for Payer: Humana KY Medicaid |
$1.46
|
| Rate for Payer: Kentucky WC Medicaid |
$1.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.74
|
| Rate for Payer: Ohio Health Group HMO |
$3.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.93
|
| Rate for Payer: PHCS Commercial |
$4.08
|
| Rate for Payer: United Healthcare All Payer |
$3.74
|
|
|
SELENIUM 600mcg/10mL
|
Facility
|
IP
|
$971.43
|
|
|
Service Code
|
NDC 517656005
|
| Hospital Charge Code |
25004168
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$291.43 |
| Max. Negotiated Rate |
$932.57 |
| Rate for Payer: Aetna Commercial |
$748.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$757.72
|
| Rate for Payer: Cash Price |
$485.71
|
| Rate for Payer: Cigna Commercial |
$806.29
|
| Rate for Payer: First Health Commercial |
$922.86
|
| Rate for Payer: Humana Commercial |
$825.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$796.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$716.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$291.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$854.86
|
| Rate for Payer: Ohio Health Group HMO |
$728.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$777.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$845.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$670.29
|
| Rate for Payer: PHCS Commercial |
$932.57
|
| Rate for Payer: United Healthcare All Payer |
$854.86
|
|
|
SELENIUM 600mcg/10mL
|
Facility
|
OP
|
$971.43
|
|
|
Service Code
|
NDC 517656005
|
| Hospital Charge Code |
25004168
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$291.43 |
| Max. Negotiated Rate |
$932.57 |
| Rate for Payer: Aetna Commercial |
$748.00
|
| Rate for Payer: Anthem Medicaid |
$334.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$757.72
|
| Rate for Payer: Cash Price |
$485.71
|
| Rate for Payer: Cigna Commercial |
$806.29
|
| Rate for Payer: First Health Commercial |
$922.86
|
| Rate for Payer: Humana Commercial |
$825.72
|
| Rate for Payer: Humana KY Medicaid |
$334.07
|
| Rate for Payer: Kentucky WC Medicaid |
$337.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$796.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$716.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$291.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$340.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$854.86
|
| Rate for Payer: Ohio Health Group HMO |
$728.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$777.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$845.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$670.29
|
| Rate for Payer: PHCS Commercial |
$932.57
|
| Rate for Payer: United Healthcare All Payer |
$854.86
|
|
|
SELEX/M2A-MAGNUM HIP 40MM +9
|
Facility
|
OP
|
$4,925.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,477.50 |
| Max. Negotiated Rate |
$4,728.00 |
| Rate for Payer: Aetna Commercial |
$3,792.25
|
| Rate for Payer: Anthem Medicaid |
$1,693.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,841.50
|
| Rate for Payer: Cash Price |
$2,462.50
|
| Rate for Payer: Cigna Commercial |
$4,087.75
|
| Rate for Payer: First Health Commercial |
$4,678.75
|
| Rate for Payer: Humana Commercial |
$4,186.25
|
| Rate for Payer: Humana KY Medicaid |
$1,693.71
|
| Rate for Payer: Kentucky WC Medicaid |
$1,710.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,038.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,634.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,477.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,727.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,334.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,693.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,940.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,284.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,398.25
|
| Rate for Payer: PHCS Commercial |
$4,728.00
|
| Rate for Payer: United Healthcare All Payer |
$4,334.00
|
|
|
SELEX/M2A-MAGNUM HIP 40MM +9
|
Facility
|
IP
|
$4,925.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,477.50 |
| Max. Negotiated Rate |
$4,728.00 |
| Rate for Payer: Aetna Commercial |
$3,792.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,841.50
|
| Rate for Payer: Cash Price |
$2,462.50
|
| Rate for Payer: Cigna Commercial |
$4,087.75
|
| Rate for Payer: First Health Commercial |
$4,678.75
|
| Rate for Payer: Humana Commercial |
$4,186.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,038.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,634.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,477.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,334.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,693.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,940.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,284.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,398.25
|
| Rate for Payer: PHCS Commercial |
$4,728.00
|
| Rate for Payer: United Healthcare All Payer |
$4,334.00
|
|
|
SELF CENT HEAD 41MM +5
|
Facility
|
OP
|
$8,788.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,636.67 |
| Max. Negotiated Rate |
$8,437.34 |
| Rate for Payer: Aetna Commercial |
$6,767.45
|
| Rate for Payer: Anthem Medicaid |
$3,022.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,855.34
|
| Rate for Payer: Cash Price |
$4,394.45
|
| Rate for Payer: Cigna Commercial |
$7,294.79
|
| Rate for Payer: First Health Commercial |
$8,349.45
|
| Rate for Payer: Humana Commercial |
$7,470.56
|
| Rate for Payer: Humana KY Medicaid |
$3,022.50
|
| Rate for Payer: Kentucky WC Medicaid |
$3,053.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,206.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,486.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,636.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,083.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,734.23
|
| Rate for Payer: Ohio Health Group HMO |
$6,591.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,031.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,646.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,064.34
|
| Rate for Payer: PHCS Commercial |
$8,437.34
|
| Rate for Payer: United Healthcare All Payer |
$7,734.23
|
|
|
SELF CENT HEAD 41MM +5
|
Facility
|
IP
|
$8,788.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,636.67 |
| Max. Negotiated Rate |
$8,437.34 |
| Rate for Payer: Aetna Commercial |
$6,767.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,855.34
|
| Rate for Payer: Cash Price |
$4,394.45
|
| Rate for Payer: Cigna Commercial |
$7,294.79
|
| Rate for Payer: First Health Commercial |
$8,349.45
|
| Rate for Payer: Humana Commercial |
$7,470.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,206.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,486.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,636.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,734.23
|
| Rate for Payer: Ohio Health Group HMO |
$6,591.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,031.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,646.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,064.34
|
| Rate for Payer: PHCS Commercial |
$8,437.34
|
| Rate for Payer: United Healthcare All Payer |
$7,734.23
|
|
|
SELF CENT HEAD 50MM +5
|
Facility
|
OP
|
$6,788.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,036.61 |
| Max. Negotiated Rate |
$6,517.15 |
| Rate for Payer: Aetna Commercial |
$5,227.30
|
| Rate for Payer: Anthem Medicaid |
$2,334.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,295.19
|
| Rate for Payer: Cash Price |
$3,394.35
|
| Rate for Payer: Cigna Commercial |
$5,634.62
|
| Rate for Payer: First Health Commercial |
$6,449.27
|
| Rate for Payer: Humana Commercial |
$5,770.40
|
| Rate for Payer: Humana KY Medicaid |
$2,334.63
|
| Rate for Payer: Kentucky WC Medicaid |
$2,358.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,566.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,010.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,036.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,381.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,974.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,091.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,430.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,906.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,684.20
|
| Rate for Payer: PHCS Commercial |
$6,517.15
|
| Rate for Payer: United Healthcare All Payer |
$5,974.06
|
|
|
SELF CENT HEAD 50MM +5
|
Facility
|
IP
|
$6,788.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,036.61 |
| Max. Negotiated Rate |
$6,517.15 |
| Rate for Payer: Aetna Commercial |
$5,227.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,295.19
|
| Rate for Payer: Cash Price |
$3,394.35
|
| Rate for Payer: Cigna Commercial |
$5,634.62
|
| Rate for Payer: First Health Commercial |
$6,449.27
|
| Rate for Payer: Humana Commercial |
$5,770.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,566.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,010.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,036.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,974.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,091.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,430.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,906.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,684.20
|
| Rate for Payer: PHCS Commercial |
$6,517.15
|
| Rate for Payer: United Healthcare All Payer |
$5,974.06
|
|
|
SELF CENT HIP COMP 41MM 28MM
|
Facility
|
OP
|
$10,051.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,015.54 |
| Max. Negotiated Rate |
$9,649.73 |
| Rate for Payer: Aetna Commercial |
$7,739.89
|
| Rate for Payer: Anthem Medicaid |
$3,456.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,840.40
|
| Rate for Payer: Cash Price |
$5,025.90
|
| Rate for Payer: Cigna Commercial |
$8,342.99
|
| Rate for Payer: First Health Commercial |
$9,549.21
|
| Rate for Payer: Humana Commercial |
$8,544.03
|
| Rate for Payer: Humana KY Medicaid |
$3,456.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,492.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,242.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,418.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,015.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,526.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,845.58
|
| Rate for Payer: Ohio Health Group HMO |
$7,538.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,041.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,745.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,935.74
|
| Rate for Payer: PHCS Commercial |
$9,649.73
|
| Rate for Payer: United Healthcare All Payer |
$8,845.58
|
|
|
SELF CENT HIP COMP 41MM 28MM
|
Facility
|
IP
|
$10,051.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,015.54 |
| Max. Negotiated Rate |
$9,649.73 |
| Rate for Payer: Aetna Commercial |
$7,739.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,840.40
|
| Rate for Payer: Cash Price |
$5,025.90
|
| Rate for Payer: Cigna Commercial |
$8,342.99
|
| Rate for Payer: First Health Commercial |
$9,549.21
|
| Rate for Payer: Humana Commercial |
$8,544.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,242.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,418.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,015.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,845.58
|
| Rate for Payer: Ohio Health Group HMO |
$7,538.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,041.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,745.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,935.74
|
| Rate for Payer: PHCS Commercial |
$9,649.73
|
| Rate for Payer: United Healthcare All Payer |
$8,845.58
|
|
|
SELF CENT HIP COMP 42MM 28MM
|
Facility
|
IP
|
$10,051.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,015.54 |
| Max. Negotiated Rate |
$9,649.73 |
| Rate for Payer: Aetna Commercial |
$7,739.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,840.40
|
| Rate for Payer: Cash Price |
$5,025.90
|
| Rate for Payer: Cigna Commercial |
$8,342.99
|
| Rate for Payer: First Health Commercial |
$9,549.21
|
| Rate for Payer: Humana Commercial |
$8,544.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,242.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,418.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,015.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,845.58
|
| Rate for Payer: Ohio Health Group HMO |
$7,538.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,041.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,745.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,935.74
|
| Rate for Payer: PHCS Commercial |
$9,649.73
|
| Rate for Payer: United Healthcare All Payer |
$8,845.58
|
|
|
SELF CENT HIP COMP 42MM 28MM
|
Facility
|
OP
|
$10,051.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,015.54 |
| Max. Negotiated Rate |
$9,649.73 |
| Rate for Payer: Aetna Commercial |
$7,739.89
|
| Rate for Payer: Anthem Medicaid |
$3,456.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,840.40
|
| Rate for Payer: Cash Price |
$5,025.90
|
| Rate for Payer: Cigna Commercial |
$8,342.99
|
| Rate for Payer: First Health Commercial |
$9,549.21
|
| Rate for Payer: Humana Commercial |
$8,544.03
|
| Rate for Payer: Humana KY Medicaid |
$3,456.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,492.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,242.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,418.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,015.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,526.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,845.58
|
| Rate for Payer: Ohio Health Group HMO |
$7,538.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,041.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,745.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,935.74
|
| Rate for Payer: PHCS Commercial |
$9,649.73
|
| Rate for Payer: United Healthcare All Payer |
$8,845.58
|
|
|
SELF CENT HIP COMP 43MM 28MM
|
Facility
|
IP
|
$10,051.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,015.54 |
| Max. Negotiated Rate |
$9,649.73 |
| Rate for Payer: Aetna Commercial |
$7,739.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,840.40
|
| Rate for Payer: Cash Price |
$5,025.90
|
| Rate for Payer: Cigna Commercial |
$8,342.99
|
| Rate for Payer: First Health Commercial |
$9,549.21
|
| Rate for Payer: Humana Commercial |
$8,544.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,242.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,418.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,015.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,845.58
|
| Rate for Payer: Ohio Health Group HMO |
$7,538.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,041.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,745.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,935.74
|
| Rate for Payer: PHCS Commercial |
$9,649.73
|
| Rate for Payer: United Healthcare All Payer |
$8,845.58
|
|
|
SELF CENT HIP COMP 43MM 28MM
|
Facility
|
OP
|
$10,051.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,015.54 |
| Max. Negotiated Rate |
$9,649.73 |
| Rate for Payer: Aetna Commercial |
$7,739.89
|
| Rate for Payer: Anthem Medicaid |
$3,456.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,840.40
|
| Rate for Payer: Cash Price |
$5,025.90
|
| Rate for Payer: Cigna Commercial |
$8,342.99
|
| Rate for Payer: First Health Commercial |
$9,549.21
|
| Rate for Payer: Humana Commercial |
$8,544.03
|
| Rate for Payer: Humana KY Medicaid |
$3,456.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,492.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,242.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,418.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,015.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,526.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,845.58
|
| Rate for Payer: Ohio Health Group HMO |
$7,538.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,041.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,745.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,935.74
|
| Rate for Payer: PHCS Commercial |
$9,649.73
|
| Rate for Payer: United Healthcare All Payer |
$8,845.58
|
|
|
SELF CENT HIP COMP 44MM 28MM
|
Facility
|
IP
|
$10,051.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,015.54 |
| Max. Negotiated Rate |
$9,649.73 |
| Rate for Payer: Aetna Commercial |
$7,739.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,840.40
|
| Rate for Payer: Cash Price |
$5,025.90
|
| Rate for Payer: Cigna Commercial |
$8,342.99
|
| Rate for Payer: First Health Commercial |
$9,549.21
|
| Rate for Payer: Humana Commercial |
$8,544.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,242.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,418.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,015.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,845.58
|
| Rate for Payer: Ohio Health Group HMO |
$7,538.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,041.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,745.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,935.74
|
| Rate for Payer: PHCS Commercial |
$9,649.73
|
| Rate for Payer: United Healthcare All Payer |
$8,845.58
|
|
|
SELF CENT HIP COMP 44MM 28MM
|
Facility
|
OP
|
$10,051.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,015.54 |
| Max. Negotiated Rate |
$9,649.73 |
| Rate for Payer: Aetna Commercial |
$7,739.89
|
| Rate for Payer: Anthem Medicaid |
$3,456.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,840.40
|
| Rate for Payer: Cash Price |
$5,025.90
|
| Rate for Payer: Cigna Commercial |
$8,342.99
|
| Rate for Payer: First Health Commercial |
$9,549.21
|
| Rate for Payer: Humana Commercial |
$8,544.03
|
| Rate for Payer: Humana KY Medicaid |
$3,456.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,492.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,242.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,418.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,015.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,526.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,845.58
|
| Rate for Payer: Ohio Health Group HMO |
$7,538.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,041.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,745.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,935.74
|
| Rate for Payer: PHCS Commercial |
$9,649.73
|
| Rate for Payer: United Healthcare All Payer |
$8,845.58
|
|
|
SELF CENT HIP COMP 44MM 32MM
|
Facility
|
IP
|
$10,051.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,015.54 |
| Max. Negotiated Rate |
$9,649.73 |
| Rate for Payer: Aetna Commercial |
$7,739.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,840.40
|
| Rate for Payer: Cash Price |
$5,025.90
|
| Rate for Payer: Cigna Commercial |
$8,342.99
|
| Rate for Payer: First Health Commercial |
$9,549.21
|
| Rate for Payer: Humana Commercial |
$8,544.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,242.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,418.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,015.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,845.58
|
| Rate for Payer: Ohio Health Group HMO |
$7,538.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,041.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,745.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,935.74
|
| Rate for Payer: PHCS Commercial |
$9,649.73
|
| Rate for Payer: United Healthcare All Payer |
$8,845.58
|
|
|
SELF CENT HIP COMP 44MM 32MM
|
Facility
|
OP
|
$10,051.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,015.54 |
| Max. Negotiated Rate |
$9,649.73 |
| Rate for Payer: Aetna Commercial |
$7,739.89
|
| Rate for Payer: Anthem Medicaid |
$3,456.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,840.40
|
| Rate for Payer: Cash Price |
$5,025.90
|
| Rate for Payer: Cigna Commercial |
$8,342.99
|
| Rate for Payer: First Health Commercial |
$9,549.21
|
| Rate for Payer: Humana Commercial |
$8,544.03
|
| Rate for Payer: Humana KY Medicaid |
$3,456.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,492.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,242.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,418.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,015.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,526.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,845.58
|
| Rate for Payer: Ohio Health Group HMO |
$7,538.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,041.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,745.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,935.74
|
| Rate for Payer: PHCS Commercial |
$9,649.73
|
| Rate for Payer: United Healthcare All Payer |
$8,845.58
|
|
|
SELF CENT HIP COMP 45MM 28MM
|
Facility
|
OP
|
$10,051.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,015.54 |
| Max. Negotiated Rate |
$9,649.73 |
| Rate for Payer: Aetna Commercial |
$7,739.89
|
| Rate for Payer: Anthem Medicaid |
$3,456.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,840.40
|
| Rate for Payer: Cash Price |
$5,025.90
|
| Rate for Payer: Cigna Commercial |
$8,342.99
|
| Rate for Payer: First Health Commercial |
$9,549.21
|
| Rate for Payer: Humana Commercial |
$8,544.03
|
| Rate for Payer: Humana KY Medicaid |
$3,456.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,492.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,242.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,418.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,015.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,526.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,845.58
|
| Rate for Payer: Ohio Health Group HMO |
$7,538.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,041.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,745.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,935.74
|
| Rate for Payer: PHCS Commercial |
$9,649.73
|
| Rate for Payer: United Healthcare All Payer |
$8,845.58
|
|
|
SELF CENT HIP COMP 45MM 28MM
|
Facility
|
IP
|
$10,051.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,015.54 |
| Max. Negotiated Rate |
$9,649.73 |
| Rate for Payer: Aetna Commercial |
$7,739.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,840.40
|
| Rate for Payer: Cash Price |
$5,025.90
|
| Rate for Payer: Cigna Commercial |
$8,342.99
|
| Rate for Payer: First Health Commercial |
$9,549.21
|
| Rate for Payer: Humana Commercial |
$8,544.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,242.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,418.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,015.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,845.58
|
| Rate for Payer: Ohio Health Group HMO |
$7,538.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,041.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,745.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,935.74
|
| Rate for Payer: PHCS Commercial |
$9,649.73
|
| Rate for Payer: United Healthcare All Payer |
$8,845.58
|
|
|
SELF CENT HIP COMP 46MM 28MM
|
Facility
|
OP
|
$10,051.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,015.54 |
| Max. Negotiated Rate |
$9,649.73 |
| Rate for Payer: Aetna Commercial |
$7,739.89
|
| Rate for Payer: Anthem Medicaid |
$3,456.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,840.40
|
| Rate for Payer: Cash Price |
$5,025.90
|
| Rate for Payer: Cigna Commercial |
$8,342.99
|
| Rate for Payer: First Health Commercial |
$9,549.21
|
| Rate for Payer: Humana Commercial |
$8,544.03
|
| Rate for Payer: Humana KY Medicaid |
$3,456.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,492.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,242.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,418.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,015.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,526.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,845.58
|
| Rate for Payer: Ohio Health Group HMO |
$7,538.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,041.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,745.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,935.74
|
| Rate for Payer: PHCS Commercial |
$9,649.73
|
| Rate for Payer: United Healthcare All Payer |
$8,845.58
|
|
|
SELF CENT HIP COMP 46MM 28MM
|
Facility
|
IP
|
$10,051.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,015.54 |
| Max. Negotiated Rate |
$9,649.73 |
| Rate for Payer: Aetna Commercial |
$7,739.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,840.40
|
| Rate for Payer: Cash Price |
$5,025.90
|
| Rate for Payer: Cigna Commercial |
$8,342.99
|
| Rate for Payer: First Health Commercial |
$9,549.21
|
| Rate for Payer: Humana Commercial |
$8,544.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,242.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,418.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,015.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,845.58
|
| Rate for Payer: Ohio Health Group HMO |
$7,538.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,041.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,745.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,935.74
|
| Rate for Payer: PHCS Commercial |
$9,649.73
|
| Rate for Payer: United Healthcare All Payer |
$8,845.58
|
|
