|
STERILE WATER IRRIGATIONBAG 3L
|
Professional
|
Both
|
$85.71
|
|
| Hospital Charge Code |
63600172
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$85.71 |
| Rate for Payer: Buckeye Medicare Advantage |
$85.71
|
| Rate for Payer: Cash Price |
$42.85
|
| Rate for Payer: Multiplan PHCS |
$51.43
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$60.00
|
| Rate for Payer: UHCCP Medicaid |
$30.00
|
|
|
STERILE WATER IRRIGATIONBAG 3L
|
Facility
|
OP
|
$85.71
|
|
|
Service Code
|
NDC 990797308
|
| Hospital Charge Code |
25004258
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.14 |
| Max. Negotiated Rate |
$82.28 |
| Rate for Payer: Aetna Commercial |
$66.00
|
| Rate for Payer: Anthem Medicaid |
$29.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$66.85
|
| Rate for Payer: Cash Price |
$42.85
|
| Rate for Payer: Cigna Commercial |
$71.14
|
| Rate for Payer: First Health Commercial |
$81.42
|
| Rate for Payer: Humana Commercial |
$72.85
|
| Rate for Payer: Humana KY Medicaid |
$29.48
|
| Rate for Payer: Kentucky WC Medicaid |
$29.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$30.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$75.42
|
| Rate for Payer: Ohio Health Group HMO |
$64.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.57
|
| Rate for Payer: PHCS Commercial |
$82.28
|
| Rate for Payer: United Healthcare All Payer |
$75.42
|
|
|
STERILE WATER IRRIGATIONBAG 3L
|
Facility
|
OP
|
$85.71
|
|
| Hospital Charge Code |
63600172
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.14 |
| Max. Negotiated Rate |
$82.28 |
| Rate for Payer: Aetna Commercial |
$66.00
|
| Rate for Payer: Anthem Medicaid |
$29.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$66.85
|
| Rate for Payer: Cash Price |
$42.85
|
| Rate for Payer: Cigna Commercial |
$71.14
|
| Rate for Payer: First Health Commercial |
$81.42
|
| Rate for Payer: Humana Commercial |
$72.85
|
| Rate for Payer: Humana KY Medicaid |
$29.48
|
| Rate for Payer: Kentucky WC Medicaid |
$29.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$30.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$75.42
|
| Rate for Payer: Ohio Health Group HMO |
$64.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.57
|
| Rate for Payer: PHCS Commercial |
$82.28
|
| Rate for Payer: United Healthcare All Payer |
$75.42
|
|
|
STERILE WATER IRRIGATIONBAG 3L
|
Facility
|
IP
|
$85.71
|
|
| Hospital Charge Code |
63600172
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.14 |
| Max. Negotiated Rate |
$82.28 |
| Rate for Payer: Aetna Commercial |
$66.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$66.85
|
| Rate for Payer: Cash Price |
$42.85
|
| Rate for Payer: Cigna Commercial |
$71.14
|
| Rate for Payer: First Health Commercial |
$81.42
|
| Rate for Payer: Humana Commercial |
$72.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$75.42
|
| Rate for Payer: Ohio Health Group HMO |
$64.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.57
|
| Rate for Payer: PHCS Commercial |
$82.28
|
| Rate for Payer: United Healthcare All Payer |
$75.42
|
|
|
STERILE WATER IRRIGATIONBAG 3L
|
Facility
|
OP
|
$85.71
|
|
| Hospital Charge Code |
636T0172
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.14 |
| Max. Negotiated Rate |
$82.28 |
| Rate for Payer: Aetna Commercial |
$66.00
|
| Rate for Payer: Anthem Medicaid |
$29.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$66.85
|
| Rate for Payer: Cash Price |
$42.85
|
| Rate for Payer: Cigna Commercial |
$71.14
|
| Rate for Payer: First Health Commercial |
$81.42
|
| Rate for Payer: Humana Commercial |
$72.85
|
| Rate for Payer: Humana KY Medicaid |
$29.48
|
| Rate for Payer: Kentucky WC Medicaid |
$29.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$30.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$75.42
|
| Rate for Payer: Ohio Health Group HMO |
$64.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.57
|
| Rate for Payer: PHCS Commercial |
$82.28
|
| Rate for Payer: United Healthcare All Payer |
$75.42
|
|
|
STERILE WATER IRRIGATIONBAG 3L
|
Facility
|
IP
|
$85.71
|
|
|
Service Code
|
NDC 990797308
|
| Hospital Charge Code |
25004258
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.14 |
| Max. Negotiated Rate |
$82.28 |
| Rate for Payer: Aetna Commercial |
$66.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$66.85
|
| Rate for Payer: Cash Price |
$42.85
|
| Rate for Payer: Cigna Commercial |
$71.14
|
| Rate for Payer: First Health Commercial |
$81.42
|
| Rate for Payer: Humana Commercial |
$72.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$75.42
|
| Rate for Payer: Ohio Health Group HMO |
$64.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.57
|
| Rate for Payer: PHCS Commercial |
$82.28
|
| Rate for Payer: United Healthcare All Payer |
$75.42
|
|
|
STERIL WATER/IRRIGATIO 1000ML
|
Facility
|
OP
|
$22.25
|
|
|
Service Code
|
NDC 990713909
|
| Hospital Charge Code |
25003488
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$21.36 |
| Rate for Payer: Aetna Commercial |
$17.13
|
| Rate for Payer: Anthem Medicaid |
$7.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.36
|
| Rate for Payer: Cash Price |
$11.12
|
| Rate for Payer: Cigna Commercial |
$18.47
|
| Rate for Payer: First Health Commercial |
$21.14
|
| Rate for Payer: Humana Commercial |
$18.91
|
| Rate for Payer: Humana KY Medicaid |
$7.65
|
| Rate for Payer: Kentucky WC Medicaid |
$7.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$7.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$19.58
|
| Rate for Payer: Ohio Health Group HMO |
$16.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.90
|
| Rate for Payer: PHCS Commercial |
$21.36
|
| Rate for Payer: United Healthcare All Payer |
$19.58
|
|
|
STERIL WATER/IRRIGATIO 1000ML
|
Facility
|
IP
|
$22.25
|
|
|
Service Code
|
NDC 990713909
|
| Hospital Charge Code |
25003488
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$21.36 |
| Rate for Payer: Aetna Commercial |
$17.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.36
|
| Rate for Payer: Cash Price |
$11.12
|
| Rate for Payer: Cigna Commercial |
$18.47
|
| Rate for Payer: First Health Commercial |
$21.14
|
| Rate for Payer: Humana Commercial |
$18.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$19.58
|
| Rate for Payer: Ohio Health Group HMO |
$16.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.90
|
| Rate for Payer: PHCS Commercial |
$21.36
|
| Rate for Payer: United Healthcare All Payer |
$19.58
|
|
|
STERITALC 1GM/50ML VIAL
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
NDC 62327022202
|
| Hospital Charge Code |
25003920
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.01 |
| Max. Negotiated Rate |
$73.92 |
| Rate for Payer: Aetna Commercial |
$59.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.06
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Cigna Commercial |
$63.91
|
| Rate for Payer: First Health Commercial |
$73.15
|
| Rate for Payer: Humana Commercial |
$65.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.76
|
| Rate for Payer: Ohio Health Group HMO |
$57.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.87
|
| Rate for Payer: PHCS Commercial |
$73.92
|
| Rate for Payer: United Healthcare All Payer |
$67.76
|
|
|
STERITALC 1GM/50ML VIAL
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
NDC 62327022202
|
| Hospital Charge Code |
25003920
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.01 |
| Max. Negotiated Rate |
$73.92 |
| Rate for Payer: Aetna Commercial |
$59.29
|
| Rate for Payer: Anthem Medicaid |
$26.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.06
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Cigna Commercial |
$63.91
|
| Rate for Payer: First Health Commercial |
$73.15
|
| Rate for Payer: Humana Commercial |
$65.45
|
| Rate for Payer: Humana KY Medicaid |
$26.48
|
| Rate for Payer: Kentucky WC Medicaid |
$26.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.76
|
| Rate for Payer: Ohio Health Group HMO |
$57.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.87
|
| Rate for Payer: PHCS Commercial |
$73.92
|
| Rate for Payer: United Healthcare All Payer |
$67.76
|
|
|
STERITALC 2GM/50ML VIAL
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
NDC 62327044404
|
| Hospital Charge Code |
25003921
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.01 |
| Max. Negotiated Rate |
$73.92 |
| Rate for Payer: Aetna Commercial |
$59.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.06
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Cigna Commercial |
$63.91
|
| Rate for Payer: First Health Commercial |
$73.15
|
| Rate for Payer: Humana Commercial |
$65.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.76
|
| Rate for Payer: Ohio Health Group HMO |
$57.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.87
|
| Rate for Payer: PHCS Commercial |
$73.92
|
| Rate for Payer: United Healthcare All Payer |
$67.76
|
|
|
STERITALC 2GM/50ML VIAL
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
NDC 62327044404
|
| Hospital Charge Code |
25003921
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.01 |
| Max. Negotiated Rate |
$73.92 |
| Rate for Payer: Aetna Commercial |
$59.29
|
| Rate for Payer: Anthem Medicaid |
$26.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.06
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Cigna Commercial |
$63.91
|
| Rate for Payer: First Health Commercial |
$73.15
|
| Rate for Payer: Humana Commercial |
$65.45
|
| Rate for Payer: Humana KY Medicaid |
$26.48
|
| Rate for Payer: Kentucky WC Medicaid |
$26.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.76
|
| Rate for Payer: Ohio Health Group HMO |
$57.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.87
|
| Rate for Payer: PHCS Commercial |
$73.92
|
| Rate for Payer: United Healthcare All Payer |
$67.76
|
|
|
STERITALC 2GM VIAL
|
Facility
|
IP
|
$540.00
|
|
|
Service Code
|
NDC 62327022202
|
| Hospital Charge Code |
25003494
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$70.20 |
| Max. Negotiated Rate |
$518.40 |
| Rate for Payer: Aetna Commercial |
$415.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$421.20
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Cigna Commercial |
$448.20
|
| Rate for Payer: First Health Commercial |
$513.00
|
| Rate for Payer: Humana Commercial |
$459.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$442.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$398.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$475.20
|
| Rate for Payer: Ohio Health Group HMO |
$405.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$108.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$167.40
|
| Rate for Payer: PHCS Commercial |
$518.40
|
| Rate for Payer: United Healthcare All Payer |
$475.20
|
|
|
STERITALC 2GM VIAL
|
Facility
|
OP
|
$540.00
|
|
|
Service Code
|
NDC 62327022202
|
| Hospital Charge Code |
25003494
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$70.20 |
| Max. Negotiated Rate |
$518.40 |
| Rate for Payer: Aetna Commercial |
$415.80
|
| Rate for Payer: Anthem Medicaid |
$185.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$421.20
|
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Cigna Commercial |
$448.20
|
| Rate for Payer: First Health Commercial |
$513.00
|
| Rate for Payer: Humana Commercial |
$459.00
|
| Rate for Payer: Humana KY Medicaid |
$185.71
|
| Rate for Payer: Kentucky WC Medicaid |
$187.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$442.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$398.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$189.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$475.20
|
| Rate for Payer: Ohio Health Group HMO |
$405.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$108.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$167.40
|
| Rate for Payer: PHCS Commercial |
$518.40
|
| Rate for Payer: United Healthcare All Payer |
$475.20
|
|
|
STERITALC 4GM VIAL
|
Facility
|
OP
|
$587.00
|
|
|
Service Code
|
NDC 62327044404
|
| Hospital Charge Code |
25003495
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$76.31 |
| Max. Negotiated Rate |
$563.52 |
| Rate for Payer: Aetna Commercial |
$451.99
|
| Rate for Payer: Anthem Medicaid |
$201.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$457.86
|
| Rate for Payer: Cash Price |
$293.50
|
| Rate for Payer: Cigna Commercial |
$487.21
|
| Rate for Payer: First Health Commercial |
$557.65
|
| Rate for Payer: Humana Commercial |
$498.95
|
| Rate for Payer: Humana KY Medicaid |
$201.87
|
| Rate for Payer: Kentucky WC Medicaid |
$203.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$481.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$433.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$176.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$205.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$516.56
|
| Rate for Payer: Ohio Health Group HMO |
$440.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$117.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$76.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$181.97
|
| Rate for Payer: PHCS Commercial |
$563.52
|
| Rate for Payer: United Healthcare All Payer |
$516.56
|
|
|
STERITALC 4GM VIAL
|
Facility
|
IP
|
$587.00
|
|
|
Service Code
|
NDC 62327044404
|
| Hospital Charge Code |
25003495
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$76.31 |
| Max. Negotiated Rate |
$563.52 |
| Rate for Payer: Aetna Commercial |
$451.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$457.86
|
| Rate for Payer: Cash Price |
$293.50
|
| Rate for Payer: Cigna Commercial |
$487.21
|
| Rate for Payer: First Health Commercial |
$557.65
|
| Rate for Payer: Humana Commercial |
$498.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$481.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$433.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$176.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$516.56
|
| Rate for Payer: Ohio Health Group HMO |
$440.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$117.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$76.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$181.97
|
| Rate for Payer: PHCS Commercial |
$563.52
|
| Rate for Payer: United Healthcare All Payer |
$516.56
|
|
|
STERLING BALLOON 10*2*135
|
Facility
|
IP
|
$1,934.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.48 |
| Max. Negotiated Rate |
$1,857.12 |
| Rate for Payer: Aetna Commercial |
$1,489.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.91
|
| Rate for Payer: Cash Price |
$967.25
|
| Rate for Payer: Cigna Commercial |
$1,605.64
|
| Rate for Payer: First Health Commercial |
$1,837.78
|
| Rate for Payer: Humana Commercial |
$1,644.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,586.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,702.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$599.70
|
| Rate for Payer: PHCS Commercial |
$1,857.12
|
| Rate for Payer: United Healthcare All Payer |
$1,702.36
|
|
|
STERLING BALLOON 10*2*135
|
Facility
|
OP
|
$1,934.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.48 |
| Max. Negotiated Rate |
$1,857.12 |
| Rate for Payer: Aetna Commercial |
$1,489.56
|
| Rate for Payer: Anthem Medicaid |
$665.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.91
|
| Rate for Payer: Cash Price |
$967.25
|
| Rate for Payer: Cigna Commercial |
$1,605.64
|
| Rate for Payer: First Health Commercial |
$1,837.78
|
| Rate for Payer: Humana Commercial |
$1,644.32
|
| Rate for Payer: Humana KY Medicaid |
$665.27
|
| Rate for Payer: Kentucky WC Medicaid |
$672.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,586.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$678.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,702.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$599.70
|
| Rate for Payer: PHCS Commercial |
$1,857.12
|
| Rate for Payer: United Healthcare All Payer |
$1,702.36
|
|
|
STERLING BALLOON 10*30*135 OTW
|
Facility
|
IP
|
$1,934.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.48 |
| Max. Negotiated Rate |
$1,857.12 |
| Rate for Payer: Aetna Commercial |
$1,489.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.91
|
| Rate for Payer: Cash Price |
$967.25
|
| Rate for Payer: Cigna Commercial |
$1,605.64
|
| Rate for Payer: First Health Commercial |
$1,837.78
|
| Rate for Payer: Humana Commercial |
$1,644.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,586.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,702.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$599.70
|
| Rate for Payer: PHCS Commercial |
$1,857.12
|
| Rate for Payer: United Healthcare All Payer |
$1,702.36
|
|
|
STERLING BALLOON 10*30*135 OTW
|
Facility
|
OP
|
$1,934.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.48 |
| Max. Negotiated Rate |
$1,857.12 |
| Rate for Payer: Aetna Commercial |
$1,489.56
|
| Rate for Payer: Anthem Medicaid |
$665.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.91
|
| Rate for Payer: Cash Price |
$967.25
|
| Rate for Payer: Cigna Commercial |
$1,605.64
|
| Rate for Payer: First Health Commercial |
$1,837.78
|
| Rate for Payer: Humana Commercial |
$1,644.32
|
| Rate for Payer: Humana KY Medicaid |
$665.27
|
| Rate for Payer: Kentucky WC Medicaid |
$672.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,586.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$678.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,702.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$599.70
|
| Rate for Payer: PHCS Commercial |
$1,857.12
|
| Rate for Payer: United Healthcare All Payer |
$1,702.36
|
|
|
STERLING BALLOON 10*4
|
Facility
|
OP
|
$1,934.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.48 |
| Max. Negotiated Rate |
$1,857.12 |
| Rate for Payer: Aetna Commercial |
$1,489.56
|
| Rate for Payer: Anthem Medicaid |
$665.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.91
|
| Rate for Payer: Cash Price |
$967.25
|
| Rate for Payer: Cigna Commercial |
$1,605.64
|
| Rate for Payer: First Health Commercial |
$1,837.78
|
| Rate for Payer: Humana Commercial |
$1,644.32
|
| Rate for Payer: Humana KY Medicaid |
$665.27
|
| Rate for Payer: Kentucky WC Medicaid |
$672.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,586.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$678.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,702.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$599.70
|
| Rate for Payer: PHCS Commercial |
$1,857.12
|
| Rate for Payer: United Healthcare All Payer |
$1,702.36
|
|
|
STERLING BALLOON 10*4
|
Facility
|
IP
|
$1,934.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.48 |
| Max. Negotiated Rate |
$1,857.12 |
| Rate for Payer: Aetna Commercial |
$1,489.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.91
|
| Rate for Payer: Cash Price |
$967.25
|
| Rate for Payer: Cigna Commercial |
$1,605.64
|
| Rate for Payer: First Health Commercial |
$1,837.78
|
| Rate for Payer: Humana Commercial |
$1,644.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,586.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,702.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$599.70
|
| Rate for Payer: PHCS Commercial |
$1,857.12
|
| Rate for Payer: United Healthcare All Payer |
$1,702.36
|
|
|
STERLING BALLOON 10*4*135
|
Facility
|
OP
|
$1,934.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.48 |
| Max. Negotiated Rate |
$1,857.12 |
| Rate for Payer: Aetna Commercial |
$1,489.56
|
| Rate for Payer: Anthem Medicaid |
$665.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.91
|
| Rate for Payer: Cash Price |
$967.25
|
| Rate for Payer: Cigna Commercial |
$1,605.64
|
| Rate for Payer: First Health Commercial |
$1,837.78
|
| Rate for Payer: Humana Commercial |
$1,644.32
|
| Rate for Payer: Humana KY Medicaid |
$665.27
|
| Rate for Payer: Kentucky WC Medicaid |
$672.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,586.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$678.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,702.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$599.70
|
| Rate for Payer: PHCS Commercial |
$1,857.12
|
| Rate for Payer: United Healthcare All Payer |
$1,702.36
|
|
|
STERLING BALLOON 10*4*135
|
Facility
|
IP
|
$1,934.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.48 |
| Max. Negotiated Rate |
$1,857.12 |
| Rate for Payer: Aetna Commercial |
$1,489.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.91
|
| Rate for Payer: Cash Price |
$967.25
|
| Rate for Payer: Cigna Commercial |
$1,605.64
|
| Rate for Payer: First Health Commercial |
$1,837.78
|
| Rate for Payer: Humana Commercial |
$1,644.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,586.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,702.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$599.70
|
| Rate for Payer: PHCS Commercial |
$1,857.12
|
| Rate for Payer: United Healthcare All Payer |
$1,702.36
|
|
|
STERLING BALLOON 10*60*135 OTW
|
Facility
|
IP
|
$1,934.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.48 |
| Max. Negotiated Rate |
$1,857.12 |
| Rate for Payer: Aetna Commercial |
$1,489.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.91
|
| Rate for Payer: Cash Price |
$967.25
|
| Rate for Payer: Cigna Commercial |
$1,605.64
|
| Rate for Payer: First Health Commercial |
$1,837.78
|
| Rate for Payer: Humana Commercial |
$1,644.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,586.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,702.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$599.70
|
| Rate for Payer: PHCS Commercial |
$1,857.12
|
| Rate for Payer: United Healthcare All Payer |
$1,702.36
|
|
