|
BBLV Partial Face-PP#2/3 25%
|
Professional
|
Both
|
$60.00
|
|
| Hospital Charge Code |
22200500
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$42.00 |
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Multiplan PHCS |
$36.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$42.00
|
| Rate for Payer: UHCCP Medicaid |
$21.00
|
|
|
BBLV SPOT TREATMENT UP TO 5
|
Professional
|
Both
|
$100.00
|
|
| Hospital Charge Code |
22200277
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.00
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
|
|
BCG Live 1mg (50mg SDV)
|
Facility
|
OP
|
$19.26
|
|
|
Service Code
|
HCPCS J9030
|
| Hospital Charge Code |
636T0079
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$18.49 |
| Rate for Payer: Aetna Commercial |
$14.83
|
| Rate for Payer: Anthem Medicaid |
$6.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15.02
|
| Rate for Payer: Cash Price |
$9.63
|
| Rate for Payer: Cigna Commercial |
$15.99
|
| Rate for Payer: First Health Commercial |
$18.30
|
| Rate for Payer: Humana Commercial |
$16.37
|
| Rate for Payer: Humana KY Medicaid |
$6.62
|
| Rate for Payer: Kentucky WC Medicaid |
$6.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$16.95
|
| Rate for Payer: Ohio Health Group HMO |
$14.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13.29
|
| Rate for Payer: PHCS Commercial |
$18.49
|
| Rate for Payer: United Healthcare All Payer |
$16.95
|
|
|
BCG Live 1mg (50mg SDV)
|
Facility
|
IP
|
$19.26
|
|
|
Service Code
|
HCPCS J9030
|
| Hospital Charge Code |
636T0079
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$18.49 |
| Rate for Payer: Aetna Commercial |
$14.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15.02
|
| Rate for Payer: Cash Price |
$9.63
|
| Rate for Payer: Cigna Commercial |
$15.99
|
| Rate for Payer: First Health Commercial |
$18.30
|
| Rate for Payer: Humana Commercial |
$16.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$16.95
|
| Rate for Payer: Ohio Health Group HMO |
$14.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13.29
|
| Rate for Payer: PHCS Commercial |
$18.49
|
| Rate for Payer: United Healthcare All Payer |
$16.95
|
|
|
BCG Live 1mg (50mg SDV)
|
Facility
|
IP
|
$19.26
|
|
|
Service Code
|
HCPCS J9030
|
| Hospital Charge Code |
63600079
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$18.49 |
| Rate for Payer: Aetna Commercial |
$14.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15.02
|
| Rate for Payer: Cash Price |
$9.63
|
| Rate for Payer: Cigna Commercial |
$15.99
|
| Rate for Payer: First Health Commercial |
$18.30
|
| Rate for Payer: Humana Commercial |
$16.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$16.95
|
| Rate for Payer: Ohio Health Group HMO |
$14.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13.29
|
| Rate for Payer: PHCS Commercial |
$18.49
|
| Rate for Payer: United Healthcare All Payer |
$16.95
|
|
|
BCG Live 1mg (50mg SDV)
|
Facility
|
OP
|
$19.26
|
|
|
Service Code
|
HCPCS J9030
|
| Hospital Charge Code |
63600079
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$18.49 |
| Rate for Payer: Aetna Commercial |
$14.83
|
| Rate for Payer: Anthem Medicaid |
$6.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15.02
|
| Rate for Payer: Cash Price |
$9.63
|
| Rate for Payer: Cigna Commercial |
$15.99
|
| Rate for Payer: First Health Commercial |
$18.30
|
| Rate for Payer: Humana Commercial |
$16.37
|
| Rate for Payer: Humana KY Medicaid |
$6.62
|
| Rate for Payer: Kentucky WC Medicaid |
$6.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$16.95
|
| Rate for Payer: Ohio Health Group HMO |
$14.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13.29
|
| Rate for Payer: PHCS Commercial |
$18.49
|
| Rate for Payer: United Healthcare All Payer |
$16.95
|
|
|
BCG Live 1mg (50mg SDV)
|
Facility
|
OP
|
$962.85
|
|
|
Service Code
|
HCPCS J9030
|
| Hospital Charge Code |
25002561
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$288.86 |
| Max. Negotiated Rate |
$924.34 |
| Rate for Payer: Aetna Commercial |
$741.39
|
| Rate for Payer: Anthem Medicaid |
$331.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$751.02
|
| Rate for Payer: Cash Price |
$481.42
|
| Rate for Payer: Cigna Commercial |
$799.17
|
| Rate for Payer: First Health Commercial |
$914.71
|
| Rate for Payer: Humana Commercial |
$818.42
|
| Rate for Payer: Humana KY Medicaid |
$331.12
|
| Rate for Payer: Kentucky WC Medicaid |
$334.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$789.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$710.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$288.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$337.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$847.31
|
| Rate for Payer: Ohio Health Group HMO |
$722.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$770.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$837.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$664.37
|
| Rate for Payer: PHCS Commercial |
$924.34
|
| Rate for Payer: United Healthcare All Payer |
$847.31
|
|
|
BCG Live 1mg (50mg SDV)
|
Professional
|
Both
|
$19.26
|
|
|
Service Code
|
HCPCS J9030
|
| Hospital Charge Code |
63600079
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$11.56 |
| Rate for Payer: Aetna Commercial |
$3.90
|
| Rate for Payer: Ambetter Exchange |
$3.12
|
| Rate for Payer: Buckeye Individual/Medicaid |
$3.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$3.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.74
|
| Rate for Payer: Cash Price |
$9.63
|
| Rate for Payer: Cash Price |
$9.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$4.06
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$3.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.12
|
| Rate for Payer: Multiplan PHCS |
$11.56
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4.06
|
| Rate for Payer: UHCCP Medicaid |
$6.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$3.12
|
|
|
BCG Live 1mg (50mg SDV)
|
Facility
|
IP
|
$962.85
|
|
|
Service Code
|
HCPCS J9030
|
| Hospital Charge Code |
25002561
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$288.86 |
| Max. Negotiated Rate |
$924.34 |
| Rate for Payer: Aetna Commercial |
$741.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$751.02
|
| Rate for Payer: Cash Price |
$481.42
|
| Rate for Payer: Cigna Commercial |
$799.17
|
| Rate for Payer: First Health Commercial |
$914.71
|
| Rate for Payer: Humana Commercial |
$818.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$789.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$710.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$288.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$847.31
|
| Rate for Payer: Ohio Health Group HMO |
$722.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$770.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$837.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$664.37
|
| Rate for Payer: PHCS Commercial |
$924.34
|
| Rate for Payer: United Healthcare All Payer |
$847.31
|
|
|
BEAM FULLY THREADED 6.5-70
|
Facility
|
IP
|
$6,832.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,049.75 |
| Max. Negotiated Rate |
$6,559.20 |
| Rate for Payer: Aetna Commercial |
$5,261.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,329.35
|
| Rate for Payer: Cash Price |
$3,416.25
|
| Rate for Payer: Cigna Commercial |
$5,670.98
|
| Rate for Payer: First Health Commercial |
$6,490.88
|
| Rate for Payer: Humana Commercial |
$5,807.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,602.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,042.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,049.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,012.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,124.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,466.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,944.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,714.43
|
| Rate for Payer: PHCS Commercial |
$6,559.20
|
| Rate for Payer: United Healthcare All Payer |
$6,012.60
|
|
|
BEAM FULLY THREADED 6.5-70
|
Facility
|
OP
|
$6,832.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,049.75 |
| Max. Negotiated Rate |
$6,559.20 |
| Rate for Payer: Aetna Commercial |
$5,261.02
|
| Rate for Payer: Anthem Medicaid |
$2,349.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,329.35
|
| Rate for Payer: Cash Price |
$3,416.25
|
| Rate for Payer: Cigna Commercial |
$5,670.98
|
| Rate for Payer: First Health Commercial |
$6,490.88
|
| Rate for Payer: Humana Commercial |
$5,807.62
|
| Rate for Payer: Humana KY Medicaid |
$2,349.70
|
| Rate for Payer: Kentucky WC Medicaid |
$2,373.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,602.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,042.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,049.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,396.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,012.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,124.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,466.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,944.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,714.43
|
| Rate for Payer: PHCS Commercial |
$6,559.20
|
| Rate for Payer: United Healthcare All Payer |
$6,012.60
|
|
|
BEARING E1 ANTIOXINFSD 22*32MM
|
Facility
|
IP
|
$13,409.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,022.70 |
| Max. Negotiated Rate |
$12,872.64 |
| Rate for Payer: Aetna Commercial |
$10,324.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,459.02
|
| Rate for Payer: Cash Price |
$6,704.50
|
| Rate for Payer: Cigna Commercial |
$11,129.47
|
| Rate for Payer: First Health Commercial |
$12,738.55
|
| Rate for Payer: Humana Commercial |
$11,397.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,995.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,895.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,022.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,799.92
|
| Rate for Payer: Ohio Health Group HMO |
$10,056.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,727.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,665.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,252.21
|
| Rate for Payer: PHCS Commercial |
$12,872.64
|
| Rate for Payer: United Healthcare All Payer |
$11,799.92
|
|
|
BEARING E1 ANTIOXINFSD 22*32MM
|
Facility
|
OP
|
$13,409.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,022.70 |
| Max. Negotiated Rate |
$12,872.64 |
| Rate for Payer: Aetna Commercial |
$10,324.93
|
| Rate for Payer: Anthem Medicaid |
$4,611.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,459.02
|
| Rate for Payer: Cash Price |
$6,704.50
|
| Rate for Payer: Cigna Commercial |
$11,129.47
|
| Rate for Payer: First Health Commercial |
$12,738.55
|
| Rate for Payer: Humana Commercial |
$11,397.65
|
| Rate for Payer: Humana KY Medicaid |
$4,611.36
|
| Rate for Payer: Kentucky WC Medicaid |
$4,658.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,995.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,895.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,022.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,703.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,799.92
|
| Rate for Payer: Ohio Health Group HMO |
$10,056.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,727.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,665.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,252.21
|
| Rate for Payer: PHCS Commercial |
$12,872.64
|
| Rate for Payer: United Healthcare All Payer |
$11,799.92
|
|
|
BEARING E1 ANTIOXINFSD 22*36MM
|
Facility
|
IP
|
$13,409.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,022.70 |
| Max. Negotiated Rate |
$12,872.64 |
| Rate for Payer: Aetna Commercial |
$10,324.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,459.02
|
| Rate for Payer: Cash Price |
$6,704.50
|
| Rate for Payer: Cigna Commercial |
$11,129.47
|
| Rate for Payer: First Health Commercial |
$12,738.55
|
| Rate for Payer: Humana Commercial |
$11,397.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,995.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,895.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,022.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,799.92
|
| Rate for Payer: Ohio Health Group HMO |
$10,056.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,727.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,665.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,252.21
|
| Rate for Payer: PHCS Commercial |
$12,872.64
|
| Rate for Payer: United Healthcare All Payer |
$11,799.92
|
|
|
BEARING E1 ANTIOXINFSD 22*36MM
|
Facility
|
OP
|
$13,409.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,022.70 |
| Max. Negotiated Rate |
$12,872.64 |
| Rate for Payer: Aetna Commercial |
$10,324.93
|
| Rate for Payer: Anthem Medicaid |
$4,611.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,459.02
|
| Rate for Payer: Cash Price |
$6,704.50
|
| Rate for Payer: Cigna Commercial |
$11,129.47
|
| Rate for Payer: First Health Commercial |
$12,738.55
|
| Rate for Payer: Humana Commercial |
$11,397.65
|
| Rate for Payer: Humana KY Medicaid |
$4,611.36
|
| Rate for Payer: Kentucky WC Medicaid |
$4,658.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,995.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,895.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,022.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,703.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,799.92
|
| Rate for Payer: Ohio Health Group HMO |
$10,056.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,727.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,665.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,252.21
|
| Rate for Payer: PHCS Commercial |
$12,872.64
|
| Rate for Payer: United Healthcare All Payer |
$11,799.92
|
|
|
BEARING E1 ANTIOXINFSD 28*38MM
|
Facility
|
OP
|
$13,409.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,022.70 |
| Max. Negotiated Rate |
$12,872.64 |
| Rate for Payer: Aetna Commercial |
$10,324.93
|
| Rate for Payer: Anthem Medicaid |
$4,611.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,459.02
|
| Rate for Payer: Cash Price |
$6,704.50
|
| Rate for Payer: Cigna Commercial |
$11,129.47
|
| Rate for Payer: First Health Commercial |
$12,738.55
|
| Rate for Payer: Humana Commercial |
$11,397.65
|
| Rate for Payer: Humana KY Medicaid |
$4,611.36
|
| Rate for Payer: Kentucky WC Medicaid |
$4,658.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,995.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,895.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,022.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,703.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,799.92
|
| Rate for Payer: Ohio Health Group HMO |
$10,056.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,727.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,665.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,252.21
|
| Rate for Payer: PHCS Commercial |
$12,872.64
|
| Rate for Payer: United Healthcare All Payer |
$11,799.92
|
|
|
BEARING E1 ANTIOXINFSD 28*38MM
|
Facility
|
IP
|
$13,409.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,022.70 |
| Max. Negotiated Rate |
$12,872.64 |
| Rate for Payer: Aetna Commercial |
$10,324.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,459.02
|
| Rate for Payer: Cash Price |
$6,704.50
|
| Rate for Payer: Cigna Commercial |
$11,129.47
|
| Rate for Payer: First Health Commercial |
$12,738.55
|
| Rate for Payer: Humana Commercial |
$11,397.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,995.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,895.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,022.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,799.92
|
| Rate for Payer: Ohio Health Group HMO |
$10,056.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,727.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,665.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,252.21
|
| Rate for Payer: PHCS Commercial |
$12,872.64
|
| Rate for Payer: United Healthcare All Payer |
$11,799.92
|
|
|
BEARING E1 ANTIOXINFSD 28*40MM
|
Facility
|
IP
|
$13,409.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,022.70 |
| Max. Negotiated Rate |
$12,872.64 |
| Rate for Payer: Aetna Commercial |
$10,324.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,459.02
|
| Rate for Payer: Cash Price |
$6,704.50
|
| Rate for Payer: Cigna Commercial |
$11,129.47
|
| Rate for Payer: First Health Commercial |
$12,738.55
|
| Rate for Payer: Humana Commercial |
$11,397.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,995.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,895.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,022.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,799.92
|
| Rate for Payer: Ohio Health Group HMO |
$10,056.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,727.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,665.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,252.21
|
| Rate for Payer: PHCS Commercial |
$12,872.64
|
| Rate for Payer: United Healthcare All Payer |
$11,799.92
|
|
|
BEARING E1 ANTIOXINFSD 28*40MM
|
Facility
|
OP
|
$13,409.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,022.70 |
| Max. Negotiated Rate |
$12,872.64 |
| Rate for Payer: Aetna Commercial |
$10,324.93
|
| Rate for Payer: Anthem Medicaid |
$4,611.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,459.02
|
| Rate for Payer: Cash Price |
$6,704.50
|
| Rate for Payer: Cigna Commercial |
$11,129.47
|
| Rate for Payer: First Health Commercial |
$12,738.55
|
| Rate for Payer: Humana Commercial |
$11,397.65
|
| Rate for Payer: Humana KY Medicaid |
$4,611.36
|
| Rate for Payer: Kentucky WC Medicaid |
$4,658.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,995.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,895.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,022.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,703.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,799.92
|
| Rate for Payer: Ohio Health Group HMO |
$10,056.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,727.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,665.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,252.21
|
| Rate for Payer: PHCS Commercial |
$12,872.64
|
| Rate for Payer: United Healthcare All Payer |
$11,799.92
|
|
|
BEARING E1 ANTIOXINFSD 28*42MM
|
Facility
|
IP
|
$13,409.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,022.70 |
| Max. Negotiated Rate |
$12,872.64 |
| Rate for Payer: Aetna Commercial |
$10,324.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,459.02
|
| Rate for Payer: Cash Price |
$6,704.50
|
| Rate for Payer: Cigna Commercial |
$11,129.47
|
| Rate for Payer: First Health Commercial |
$12,738.55
|
| Rate for Payer: Humana Commercial |
$11,397.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,995.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,895.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,022.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,799.92
|
| Rate for Payer: Ohio Health Group HMO |
$10,056.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,727.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,665.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,252.21
|
| Rate for Payer: PHCS Commercial |
$12,872.64
|
| Rate for Payer: United Healthcare All Payer |
$11,799.92
|
|
|
BEARING E1 ANTIOXINFSD 28*42MM
|
Facility
|
OP
|
$13,409.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,022.70 |
| Max. Negotiated Rate |
$12,872.64 |
| Rate for Payer: Aetna Commercial |
$10,324.93
|
| Rate for Payer: Anthem Medicaid |
$4,611.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,459.02
|
| Rate for Payer: Cash Price |
$6,704.50
|
| Rate for Payer: Cigna Commercial |
$11,129.47
|
| Rate for Payer: First Health Commercial |
$12,738.55
|
| Rate for Payer: Humana Commercial |
$11,397.65
|
| Rate for Payer: Humana KY Medicaid |
$4,611.36
|
| Rate for Payer: Kentucky WC Medicaid |
$4,658.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,995.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,895.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,022.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,703.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,799.92
|
| Rate for Payer: Ohio Health Group HMO |
$10,056.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,727.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,665.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,252.21
|
| Rate for Payer: PHCS Commercial |
$12,872.64
|
| Rate for Payer: United Healthcare All Payer |
$11,799.92
|
|
|
BEARING E1 ANTIOXINFSD 28*46MM
|
Facility
|
OP
|
$13,409.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,022.70 |
| Max. Negotiated Rate |
$12,872.64 |
| Rate for Payer: Aetna Commercial |
$10,324.93
|
| Rate for Payer: Anthem Medicaid |
$4,611.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,459.02
|
| Rate for Payer: Cash Price |
$6,704.50
|
| Rate for Payer: Cigna Commercial |
$11,129.47
|
| Rate for Payer: First Health Commercial |
$12,738.55
|
| Rate for Payer: Humana Commercial |
$11,397.65
|
| Rate for Payer: Humana KY Medicaid |
$4,611.36
|
| Rate for Payer: Kentucky WC Medicaid |
$4,658.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,995.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,895.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,022.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,703.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,799.92
|
| Rate for Payer: Ohio Health Group HMO |
$10,056.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,727.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,665.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,252.21
|
| Rate for Payer: PHCS Commercial |
$12,872.64
|
| Rate for Payer: United Healthcare All Payer |
$11,799.92
|
|
|
BEARING E1 ANTIOXINFSD 28*46MM
|
Facility
|
IP
|
$13,409.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,022.70 |
| Max. Negotiated Rate |
$12,872.64 |
| Rate for Payer: Aetna Commercial |
$10,324.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,459.02
|
| Rate for Payer: Cash Price |
$6,704.50
|
| Rate for Payer: Cigna Commercial |
$11,129.47
|
| Rate for Payer: First Health Commercial |
$12,738.55
|
| Rate for Payer: Humana Commercial |
$11,397.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,995.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,895.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,022.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,799.92
|
| Rate for Payer: Ohio Health Group HMO |
$10,056.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,727.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,665.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,252.21
|
| Rate for Payer: PHCS Commercial |
$12,872.64
|
| Rate for Payer: United Healthcare All Payer |
$11,799.92
|
|
|
BEARING E1 ANTIOXINFSD 28*48MM
|
Facility
|
IP
|
$13,409.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,022.70 |
| Max. Negotiated Rate |
$12,872.64 |
| Rate for Payer: Aetna Commercial |
$10,324.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,459.02
|
| Rate for Payer: Cash Price |
$6,704.50
|
| Rate for Payer: Cigna Commercial |
$11,129.47
|
| Rate for Payer: First Health Commercial |
$12,738.55
|
| Rate for Payer: Humana Commercial |
$11,397.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,995.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,895.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,022.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,799.92
|
| Rate for Payer: Ohio Health Group HMO |
$10,056.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,727.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,665.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,252.21
|
| Rate for Payer: PHCS Commercial |
$12,872.64
|
| Rate for Payer: United Healthcare All Payer |
$11,799.92
|
|
|
BEARING E1 ANTIOXINFSD 28*48MM
|
Facility
|
OP
|
$13,409.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,022.70 |
| Max. Negotiated Rate |
$12,872.64 |
| Rate for Payer: Aetna Commercial |
$10,324.93
|
| Rate for Payer: Anthem Medicaid |
$4,611.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,459.02
|
| Rate for Payer: Cash Price |
$6,704.50
|
| Rate for Payer: Cigna Commercial |
$11,129.47
|
| Rate for Payer: First Health Commercial |
$12,738.55
|
| Rate for Payer: Humana Commercial |
$11,397.65
|
| Rate for Payer: Humana KY Medicaid |
$4,611.36
|
| Rate for Payer: Kentucky WC Medicaid |
$4,658.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,995.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,895.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,022.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,703.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,799.92
|
| Rate for Payer: Ohio Health Group HMO |
$10,056.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,727.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,665.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,252.21
|
| Rate for Payer: PHCS Commercial |
$12,872.64
|
| Rate for Payer: United Healthcare All Payer |
$11,799.92
|
|
