|
SWANSON PIP IMP SZ 00
|
Facility
|
OP
|
$7,394.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,218.38 |
| Max. Negotiated Rate |
$7,098.82 |
| Rate for Payer: Aetna Commercial |
$5,693.84
|
| Rate for Payer: Anthem Medicaid |
$2,543.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,767.79
|
| Rate for Payer: Cash Price |
$3,697.30
|
| Rate for Payer: Cigna Commercial |
$6,137.52
|
| Rate for Payer: First Health Commercial |
$7,024.87
|
| Rate for Payer: Humana Commercial |
$6,285.41
|
| Rate for Payer: Humana KY Medicaid |
$2,543.00
|
| Rate for Payer: Kentucky WC Medicaid |
$2,568.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,063.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,457.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,218.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,594.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,507.25
|
| Rate for Payer: Ohio Health Group HMO |
$5,545.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,915.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,433.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,102.27
|
| Rate for Payer: PHCS Commercial |
$7,098.82
|
| Rate for Payer: United Healthcare All Payer |
$6,507.25
|
|
|
SWANSON PIP IMP SZ 1
|
Facility
|
IP
|
$7,025.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,107.78 |
| Max. Negotiated Rate |
$6,744.91 |
| Rate for Payer: Aetna Commercial |
$5,409.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,480.24
|
| Rate for Payer: Cash Price |
$3,512.98
|
| Rate for Payer: Cigna Commercial |
$5,831.54
|
| Rate for Payer: First Health Commercial |
$6,674.65
|
| Rate for Payer: Humana Commercial |
$5,972.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,761.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,185.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,107.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,182.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,269.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,620.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,112.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,847.91
|
| Rate for Payer: PHCS Commercial |
$6,744.91
|
| Rate for Payer: United Healthcare All Payer |
$6,182.84
|
|
|
SWANSON PIP IMP SZ 1
|
Facility
|
OP
|
$7,025.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,107.78 |
| Max. Negotiated Rate |
$6,744.91 |
| Rate for Payer: Aetna Commercial |
$5,409.98
|
| Rate for Payer: Anthem Medicaid |
$2,416.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,480.24
|
| Rate for Payer: Cash Price |
$3,512.98
|
| Rate for Payer: Cigna Commercial |
$5,831.54
|
| Rate for Payer: First Health Commercial |
$6,674.65
|
| Rate for Payer: Humana Commercial |
$5,972.06
|
| Rate for Payer: Humana KY Medicaid |
$2,416.22
|
| Rate for Payer: Kentucky WC Medicaid |
$2,440.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,761.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,185.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,107.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,464.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,182.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,269.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,620.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,112.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,847.91
|
| Rate for Payer: PHCS Commercial |
$6,744.91
|
| Rate for Payer: United Healthcare All Payer |
$6,182.84
|
|
|
SWANSON PIP IMP SZ 2
|
Facility
|
IP
|
$4,786.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,435.88 |
| Max. Negotiated Rate |
$4,594.80 |
| Rate for Payer: Aetna Commercial |
$3,685.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,733.28
|
| Rate for Payer: Cash Price |
$2,393.12
|
| Rate for Payer: Cigna Commercial |
$3,972.59
|
| Rate for Payer: First Health Commercial |
$4,546.94
|
| Rate for Payer: Humana Commercial |
$4,068.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,924.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,532.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,435.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,211.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,589.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,829.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,164.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,302.51
|
| Rate for Payer: PHCS Commercial |
$4,594.80
|
| Rate for Payer: United Healthcare All Payer |
$4,211.90
|
|
|
SWANSON PIP IMP SZ 2
|
Facility
|
OP
|
$4,786.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,435.88 |
| Max. Negotiated Rate |
$4,594.80 |
| Rate for Payer: Aetna Commercial |
$3,685.41
|
| Rate for Payer: Anthem Medicaid |
$1,645.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,733.28
|
| Rate for Payer: Cash Price |
$2,393.12
|
| Rate for Payer: Cigna Commercial |
$3,972.59
|
| Rate for Payer: First Health Commercial |
$4,546.94
|
| Rate for Payer: Humana Commercial |
$4,068.31
|
| Rate for Payer: Humana KY Medicaid |
$1,645.99
|
| Rate for Payer: Kentucky WC Medicaid |
$1,662.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,924.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,532.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,435.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,679.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,211.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,589.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,829.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,164.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,302.51
|
| Rate for Payer: PHCS Commercial |
$4,594.80
|
| Rate for Payer: United Healthcare All Payer |
$4,211.90
|
|
|
SWANSON PIP IMP SZ 3 W/GROMMET
|
Facility
|
IP
|
$4,786.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,435.88 |
| Max. Negotiated Rate |
$4,594.80 |
| Rate for Payer: Aetna Commercial |
$3,685.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,733.28
|
| Rate for Payer: Cash Price |
$2,393.12
|
| Rate for Payer: Cigna Commercial |
$3,972.59
|
| Rate for Payer: First Health Commercial |
$4,546.94
|
| Rate for Payer: Humana Commercial |
$4,068.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,924.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,532.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,435.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,211.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,589.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,829.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,164.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,302.51
|
| Rate for Payer: PHCS Commercial |
$4,594.80
|
| Rate for Payer: United Healthcare All Payer |
$4,211.90
|
|
|
SWANSON PIP IMP SZ 3 W/GROMMET
|
Facility
|
OP
|
$4,786.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,435.88 |
| Max. Negotiated Rate |
$4,594.80 |
| Rate for Payer: Aetna Commercial |
$3,685.41
|
| Rate for Payer: Anthem Medicaid |
$1,645.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,733.28
|
| Rate for Payer: Cash Price |
$2,393.12
|
| Rate for Payer: Cigna Commercial |
$3,972.59
|
| Rate for Payer: First Health Commercial |
$4,546.94
|
| Rate for Payer: Humana Commercial |
$4,068.31
|
| Rate for Payer: Humana KY Medicaid |
$1,645.99
|
| Rate for Payer: Kentucky WC Medicaid |
$1,662.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,924.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,532.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,435.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,679.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,211.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,589.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,829.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,164.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,302.51
|
| Rate for Payer: PHCS Commercial |
$4,594.80
|
| Rate for Payer: United Healthcare All Payer |
$4,211.90
|
|
|
SWANSON PIP IMP SZ 4 W/GROMMET
|
Facility
|
OP
|
$4,786.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,435.88 |
| Max. Negotiated Rate |
$4,594.80 |
| Rate for Payer: Aetna Commercial |
$3,685.41
|
| Rate for Payer: Anthem Medicaid |
$1,645.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,733.28
|
| Rate for Payer: Cash Price |
$2,393.12
|
| Rate for Payer: Cigna Commercial |
$3,972.59
|
| Rate for Payer: First Health Commercial |
$4,546.94
|
| Rate for Payer: Humana Commercial |
$4,068.31
|
| Rate for Payer: Humana KY Medicaid |
$1,645.99
|
| Rate for Payer: Kentucky WC Medicaid |
$1,662.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,924.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,532.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,435.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,679.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,211.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,589.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,829.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,164.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,302.51
|
| Rate for Payer: PHCS Commercial |
$4,594.80
|
| Rate for Payer: United Healthcare All Payer |
$4,211.90
|
|
|
SWANSON PIP IMP SZ 4 W/GROMMET
|
Facility
|
IP
|
$4,786.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,435.88 |
| Max. Negotiated Rate |
$4,594.80 |
| Rate for Payer: Aetna Commercial |
$3,685.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,733.28
|
| Rate for Payer: Cash Price |
$2,393.12
|
| Rate for Payer: Cigna Commercial |
$3,972.59
|
| Rate for Payer: First Health Commercial |
$4,546.94
|
| Rate for Payer: Humana Commercial |
$4,068.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,924.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,532.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,435.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,211.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,589.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,829.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,164.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,302.51
|
| Rate for Payer: PHCS Commercial |
$4,594.80
|
| Rate for Payer: United Healthcare All Payer |
$4,211.90
|
|
|
SWANSON PIP IMP SZ 5 W/GROMMET
|
Facility
|
OP
|
$4,786.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,435.88 |
| Max. Negotiated Rate |
$4,594.80 |
| Rate for Payer: Aetna Commercial |
$3,685.41
|
| Rate for Payer: Anthem Medicaid |
$1,645.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,733.28
|
| Rate for Payer: Cash Price |
$2,393.12
|
| Rate for Payer: Cigna Commercial |
$3,972.59
|
| Rate for Payer: First Health Commercial |
$4,546.94
|
| Rate for Payer: Humana Commercial |
$4,068.31
|
| Rate for Payer: Humana KY Medicaid |
$1,645.99
|
| Rate for Payer: Kentucky WC Medicaid |
$1,662.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,924.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,532.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,435.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,679.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,211.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,589.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,829.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,164.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,302.51
|
| Rate for Payer: PHCS Commercial |
$4,594.80
|
| Rate for Payer: United Healthcare All Payer |
$4,211.90
|
|
|
SWANSON PIP IMP SZ 5 W/GROMMET
|
Facility
|
IP
|
$4,786.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,435.88 |
| Max. Negotiated Rate |
$4,594.80 |
| Rate for Payer: Aetna Commercial |
$3,685.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,733.28
|
| Rate for Payer: Cash Price |
$2,393.12
|
| Rate for Payer: Cigna Commercial |
$3,972.59
|
| Rate for Payer: First Health Commercial |
$4,546.94
|
| Rate for Payer: Humana Commercial |
$4,068.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,924.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,532.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,435.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,211.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,589.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,829.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,164.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,302.51
|
| Rate for Payer: PHCS Commercial |
$4,594.80
|
| Rate for Payer: United Healthcare All Payer |
$4,211.90
|
|
|
SWANSON PIP IMP SZ6 W/GROMMETS
|
Facility
|
OP
|
$7,891.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,367.30 |
| Max. Negotiated Rate |
$7,575.36 |
| Rate for Payer: Aetna Commercial |
$6,076.07
|
| Rate for Payer: Anthem Medicaid |
$2,713.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,154.98
|
| Rate for Payer: Cash Price |
$3,945.50
|
| Rate for Payer: Cigna Commercial |
$6,549.53
|
| Rate for Payer: First Health Commercial |
$7,496.45
|
| Rate for Payer: Humana Commercial |
$6,707.35
|
| Rate for Payer: Humana KY Medicaid |
$2,713.71
|
| Rate for Payer: Kentucky WC Medicaid |
$2,741.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,470.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,823.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,367.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,768.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,944.08
|
| Rate for Payer: Ohio Health Group HMO |
$5,918.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,312.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,865.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,444.79
|
| Rate for Payer: PHCS Commercial |
$7,575.36
|
| Rate for Payer: United Healthcare All Payer |
$6,944.08
|
|
|
SWANSON PIP IMP SZ6 W/GROMMETS
|
Facility
|
IP
|
$7,891.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,367.30 |
| Max. Negotiated Rate |
$7,575.36 |
| Rate for Payer: Aetna Commercial |
$6,076.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,154.98
|
| Rate for Payer: Cash Price |
$3,945.50
|
| Rate for Payer: Cigna Commercial |
$6,549.53
|
| Rate for Payer: First Health Commercial |
$7,496.45
|
| Rate for Payer: Humana Commercial |
$6,707.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,470.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,823.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,367.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,944.08
|
| Rate for Payer: Ohio Health Group HMO |
$5,918.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,312.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,865.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,444.79
|
| Rate for Payer: PHCS Commercial |
$7,575.36
|
| Rate for Payer: United Healthcare All Payer |
$6,944.08
|
|
|
SWANSON PIP IMP SZ 7 W/GROMMET
|
Facility
|
OP
|
$4,786.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,435.88 |
| Max. Negotiated Rate |
$4,594.80 |
| Rate for Payer: Aetna Commercial |
$3,685.41
|
| Rate for Payer: Anthem Medicaid |
$1,645.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,733.28
|
| Rate for Payer: Cash Price |
$2,393.12
|
| Rate for Payer: Cigna Commercial |
$3,972.59
|
| Rate for Payer: First Health Commercial |
$4,546.94
|
| Rate for Payer: Humana Commercial |
$4,068.31
|
| Rate for Payer: Humana KY Medicaid |
$1,645.99
|
| Rate for Payer: Kentucky WC Medicaid |
$1,662.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,924.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,532.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,435.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,679.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,211.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,589.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,829.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,164.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,302.51
|
| Rate for Payer: PHCS Commercial |
$4,594.80
|
| Rate for Payer: United Healthcare All Payer |
$4,211.90
|
|
|
SWANSON PIP IMP SZ 7 W/GROMMET
|
Facility
|
IP
|
$4,786.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,435.88 |
| Max. Negotiated Rate |
$4,594.80 |
| Rate for Payer: Aetna Commercial |
$3,685.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,733.28
|
| Rate for Payer: Cash Price |
$2,393.12
|
| Rate for Payer: Cigna Commercial |
$3,972.59
|
| Rate for Payer: First Health Commercial |
$4,546.94
|
| Rate for Payer: Humana Commercial |
$4,068.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,924.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,532.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,435.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,211.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,589.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,829.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,164.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,302.51
|
| Rate for Payer: PHCS Commercial |
$4,594.80
|
| Rate for Payer: United Healthcare All Payer |
$4,211.90
|
|
|
SWEEN CREAM (85GM)
|
Facility
|
OP
|
$0.05
|
|
|
Service Code
|
NDC 11701000216
|
| Hospital Charge Code |
25003505
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Aetna Commercial |
$0.04
|
| Rate for Payer: Anthem Medicaid |
$0.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna Commercial |
$0.04
|
| Rate for Payer: First Health Commercial |
$0.05
|
| Rate for Payer: Humana Commercial |
$0.04
|
| Rate for Payer: Humana KY Medicaid |
$0.02
|
| Rate for Payer: Kentucky WC Medicaid |
$0.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.04
|
| Rate for Payer: Ohio Health Group HMO |
$0.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.03
|
| Rate for Payer: PHCS Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Payer |
$0.04
|
|
|
SWEEN CREAM (85GM)
|
Facility
|
IP
|
$0.05
|
|
|
Service Code
|
NDC 11701000216
|
| Hospital Charge Code |
25003505
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Aetna Commercial |
$0.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.04
|
| Rate for Payer: Cash Price |
$0.03
|
| Rate for Payer: Cigna Commercial |
$0.04
|
| Rate for Payer: First Health Commercial |
$0.05
|
| Rate for Payer: Humana Commercial |
$0.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.04
|
| Rate for Payer: Ohio Health Group HMO |
$0.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.03
|
| Rate for Payer: PHCS Commercial |
$0.05
|
| Rate for Payer: United Healthcare All Payer |
$0.04
|
|
|
SWIVELOCK 3.9 ACHILLES
|
Facility
|
IP
|
$13,757.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,127.30 |
| Max. Negotiated Rate |
$13,207.34 |
| Rate for Payer: Aetna Commercial |
$10,593.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,730.97
|
| Rate for Payer: Cash Price |
$6,878.82
|
| Rate for Payer: Cigna Commercial |
$11,418.85
|
| Rate for Payer: First Health Commercial |
$13,069.77
|
| Rate for Payer: Humana Commercial |
$11,694.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,281.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,153.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,127.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,106.73
|
| Rate for Payer: Ohio Health Group HMO |
$10,318.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,006.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,969.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,492.78
|
| Rate for Payer: PHCS Commercial |
$13,207.34
|
| Rate for Payer: United Healthcare All Payer |
$12,106.73
|
|
|
SWIVELOCK 3.9 ACHILLES
|
Facility
|
OP
|
$13,757.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,127.30 |
| Max. Negotiated Rate |
$13,207.34 |
| Rate for Payer: Aetna Commercial |
$10,593.39
|
| Rate for Payer: Anthem Medicaid |
$4,731.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,730.97
|
| Rate for Payer: Cash Price |
$6,878.82
|
| Rate for Payer: Cigna Commercial |
$11,418.85
|
| Rate for Payer: First Health Commercial |
$13,069.77
|
| Rate for Payer: Humana Commercial |
$11,694.00
|
| Rate for Payer: Humana KY Medicaid |
$4,731.26
|
| Rate for Payer: Kentucky WC Medicaid |
$4,779.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,281.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,153.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,127.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,826.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,106.73
|
| Rate for Payer: Ohio Health Group HMO |
$10,318.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,006.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,969.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,492.78
|
| Rate for Payer: PHCS Commercial |
$13,207.34
|
| Rate for Payer: United Healthcare All Payer |
$12,106.73
|
|
|
SWIVELOCK 4.75*19.1MM PEEK
|
Facility
|
IP
|
$3,406.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,021.88 |
| Max. Negotiated Rate |
$3,270.00 |
| Rate for Payer: Aetna Commercial |
$2,622.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,656.88
|
| Rate for Payer: Cash Price |
$1,703.12
|
| Rate for Payer: Cigna Commercial |
$2,827.19
|
| Rate for Payer: First Health Commercial |
$3,235.94
|
| Rate for Payer: Humana Commercial |
$2,895.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,793.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,513.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,021.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,997.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,554.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,725.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,963.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,350.31
|
| Rate for Payer: PHCS Commercial |
$3,270.00
|
| Rate for Payer: United Healthcare All Payer |
$2,997.50
|
|
|
SWIVELOCK 4.75*19.1MM PEEK
|
Facility
|
OP
|
$3,406.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,021.88 |
| Max. Negotiated Rate |
$3,270.00 |
| Rate for Payer: Aetna Commercial |
$2,622.81
|
| Rate for Payer: Anthem Medicaid |
$1,171.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,656.88
|
| Rate for Payer: Cash Price |
$1,703.12
|
| Rate for Payer: Cigna Commercial |
$2,827.19
|
| Rate for Payer: First Health Commercial |
$3,235.94
|
| Rate for Payer: Humana Commercial |
$2,895.31
|
| Rate for Payer: Humana KY Medicaid |
$1,171.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,183.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,793.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,513.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,021.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,194.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,997.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,554.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,725.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,963.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,350.31
|
| Rate for Payer: PHCS Commercial |
$3,270.00
|
| Rate for Payer: United Healthcare All Payer |
$2,997.50
|
|
|
SWIVELOCK 4.75*19.1 W/ BLUE FI
|
Facility
|
IP
|
$3,850.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,155.19 |
| Max. Negotiated Rate |
$3,696.60 |
| Rate for Payer: Aetna Commercial |
$2,964.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,003.48
|
| Rate for Payer: Cash Price |
$1,925.31
|
| Rate for Payer: Cigna Commercial |
$3,196.01
|
| Rate for Payer: First Health Commercial |
$3,658.09
|
| Rate for Payer: Humana Commercial |
$3,273.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,157.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,841.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,155.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,388.55
|
| Rate for Payer: Ohio Health Group HMO |
$2,887.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,080.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,350.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,656.93
|
| Rate for Payer: PHCS Commercial |
$3,696.60
|
| Rate for Payer: United Healthcare All Payer |
$3,388.55
|
|
|
SWIVELOCK 4.75*19.1 W/ BLUE FI
|
Facility
|
OP
|
$3,850.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,155.19 |
| Max. Negotiated Rate |
$3,696.60 |
| Rate for Payer: Aetna Commercial |
$2,964.98
|
| Rate for Payer: Anthem Medicaid |
$1,324.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,003.48
|
| Rate for Payer: Cash Price |
$1,925.31
|
| Rate for Payer: Cigna Commercial |
$3,196.01
|
| Rate for Payer: First Health Commercial |
$3,658.09
|
| Rate for Payer: Humana Commercial |
$3,273.03
|
| Rate for Payer: Humana KY Medicaid |
$1,324.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,337.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,157.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,841.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,155.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,350.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,388.55
|
| Rate for Payer: Ohio Health Group HMO |
$2,887.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,080.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,350.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,656.93
|
| Rate for Payer: PHCS Commercial |
$3,696.60
|
| Rate for Payer: United Healthcare All Payer |
$3,388.55
|
|
|
SWIVELOCK 4.75*19.1 W/CLD EYEL
|
Facility
|
OP
|
$3,575.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,072.50 |
| Max. Negotiated Rate |
$3,432.00 |
| Rate for Payer: Aetna Commercial |
$2,752.75
|
| Rate for Payer: Anthem Medicaid |
$1,229.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,788.50
|
| Rate for Payer: Cash Price |
$1,787.50
|
| Rate for Payer: Cigna Commercial |
$2,967.25
|
| Rate for Payer: First Health Commercial |
$3,396.25
|
| Rate for Payer: Humana Commercial |
$3,038.75
|
| Rate for Payer: Humana KY Medicaid |
$1,229.44
|
| Rate for Payer: Kentucky WC Medicaid |
$1,241.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,931.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,638.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,072.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,254.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,146.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,681.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,110.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,466.75
|
| Rate for Payer: PHCS Commercial |
$3,432.00
|
| Rate for Payer: United Healthcare All Payer |
$3,146.00
|
|
|
SWIVELOCK 4.75*19.1 W/CLD EYEL
|
Facility
|
IP
|
$3,575.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,072.50 |
| Max. Negotiated Rate |
$3,432.00 |
| Rate for Payer: Aetna Commercial |
$2,752.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,788.50
|
| Rate for Payer: Cash Price |
$1,787.50
|
| Rate for Payer: Cigna Commercial |
$2,967.25
|
| Rate for Payer: First Health Commercial |
$3,396.25
|
| Rate for Payer: Humana Commercial |
$3,038.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,931.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,638.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,072.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,146.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,681.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,110.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,466.75
|
| Rate for Payer: PHCS Commercial |
$3,432.00
|
| Rate for Payer: United Healthcare All Payer |
$3,146.00
|
|
