|
ACET LNR 28*56-62 20 DEG
|
Facility
|
OP
|
$5,136.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.72 |
| Max. Negotiated Rate |
$4,930.87 |
| Rate for Payer: Aetna Commercial |
$3,954.97
|
| Rate for Payer: Anthem Medicaid |
$1,766.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,006.33
|
| Rate for Payer: Cash Price |
$2,568.16
|
| Rate for Payer: Cigna Commercial |
$4,263.15
|
| Rate for Payer: First Health Commercial |
$4,879.50
|
| Rate for Payer: Humana Commercial |
$4,365.87
|
| Rate for Payer: Humana KY Medicaid |
$1,766.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,784.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,211.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,790.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,540.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,801.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,519.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,852.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,027.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,592.26
|
| Rate for Payer: PHCS Commercial |
$4,930.87
|
| Rate for Payer: United Healthcare All Payer |
$4,519.96
|
|
|
ACET LNR 28*63-70 0 DEG
|
Facility
|
OP
|
$5,136.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.72 |
| Max. Negotiated Rate |
$4,930.87 |
| Rate for Payer: Aetna Commercial |
$3,954.97
|
| Rate for Payer: Anthem Medicaid |
$1,766.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,006.33
|
| Rate for Payer: Cash Price |
$2,568.16
|
| Rate for Payer: Cigna Commercial |
$4,263.15
|
| Rate for Payer: First Health Commercial |
$4,879.50
|
| Rate for Payer: Humana Commercial |
$4,365.87
|
| Rate for Payer: Humana KY Medicaid |
$1,766.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,784.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,211.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,790.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,540.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,801.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,519.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,852.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,027.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,592.26
|
| Rate for Payer: PHCS Commercial |
$4,930.87
|
| Rate for Payer: United Healthcare All Payer |
$4,519.96
|
|
|
ACET LNR 28*63-70 0 DEG
|
Facility
|
IP
|
$5,136.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.72 |
| Max. Negotiated Rate |
$4,930.87 |
| Rate for Payer: Aetna Commercial |
$3,954.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,006.33
|
| Rate for Payer: Cash Price |
$2,568.16
|
| Rate for Payer: Cigna Commercial |
$4,263.15
|
| Rate for Payer: First Health Commercial |
$4,879.50
|
| Rate for Payer: Humana Commercial |
$4,365.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,211.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,790.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,540.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,519.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,852.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,027.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,592.26
|
| Rate for Payer: PHCS Commercial |
$4,930.87
|
| Rate for Payer: United Healthcare All Payer |
$4,519.96
|
|
|
ACET LNR 28*63-70 20 DEG
|
Facility
|
IP
|
$5,136.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.72 |
| Max. Negotiated Rate |
$4,930.87 |
| Rate for Payer: Aetna Commercial |
$3,954.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,006.33
|
| Rate for Payer: Cash Price |
$2,568.16
|
| Rate for Payer: Cigna Commercial |
$4,263.15
|
| Rate for Payer: First Health Commercial |
$4,879.50
|
| Rate for Payer: Humana Commercial |
$4,365.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,211.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,790.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,540.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,519.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,852.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,027.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,592.26
|
| Rate for Payer: PHCS Commercial |
$4,930.87
|
| Rate for Payer: United Healthcare All Payer |
$4,519.96
|
|
|
ACET LNR 28*63-70 20 DEG
|
Facility
|
OP
|
$5,136.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.72 |
| Max. Negotiated Rate |
$4,930.87 |
| Rate for Payer: Aetna Commercial |
$3,954.97
|
| Rate for Payer: Anthem Medicaid |
$1,766.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,006.33
|
| Rate for Payer: Cash Price |
$2,568.16
|
| Rate for Payer: Cigna Commercial |
$4,263.15
|
| Rate for Payer: First Health Commercial |
$4,879.50
|
| Rate for Payer: Humana Commercial |
$4,365.87
|
| Rate for Payer: Humana KY Medicaid |
$1,766.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,784.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,211.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,790.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,540.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,801.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,519.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,852.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,027.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,592.26
|
| Rate for Payer: PHCS Commercial |
$4,930.87
|
| Rate for Payer: United Healthcare All Payer |
$4,519.96
|
|
|
ACET LNR 32*56-62 0 DEG
|
Facility
|
IP
|
$5,136.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.72 |
| Max. Negotiated Rate |
$4,930.87 |
| Rate for Payer: Aetna Commercial |
$3,954.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,006.33
|
| Rate for Payer: Cash Price |
$2,568.16
|
| Rate for Payer: Cigna Commercial |
$4,263.15
|
| Rate for Payer: First Health Commercial |
$4,879.50
|
| Rate for Payer: Humana Commercial |
$4,365.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,211.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,790.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,540.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,519.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,852.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,027.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,592.26
|
| Rate for Payer: PHCS Commercial |
$4,930.87
|
| Rate for Payer: United Healthcare All Payer |
$4,519.96
|
|
|
ACET LNR 32*56-62 0 DEG
|
Facility
|
OP
|
$5,136.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.72 |
| Max. Negotiated Rate |
$4,930.87 |
| Rate for Payer: Aetna Commercial |
$3,954.97
|
| Rate for Payer: Anthem Medicaid |
$1,766.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,006.33
|
| Rate for Payer: Cash Price |
$2,568.16
|
| Rate for Payer: Cigna Commercial |
$4,263.15
|
| Rate for Payer: First Health Commercial |
$4,879.50
|
| Rate for Payer: Humana Commercial |
$4,365.87
|
| Rate for Payer: Humana KY Medicaid |
$1,766.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,784.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,211.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,790.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,540.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,801.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,519.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,852.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,027.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,592.26
|
| Rate for Payer: PHCS Commercial |
$4,930.87
|
| Rate for Payer: United Healthcare All Payer |
$4,519.96
|
|
|
ACET LNR 32*56-62 20 DEG
|
Facility
|
IP
|
$5,136.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.72 |
| Max. Negotiated Rate |
$4,930.87 |
| Rate for Payer: Aetna Commercial |
$3,954.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,006.33
|
| Rate for Payer: Cash Price |
$2,568.16
|
| Rate for Payer: Cigna Commercial |
$4,263.15
|
| Rate for Payer: First Health Commercial |
$4,879.50
|
| Rate for Payer: Humana Commercial |
$4,365.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,211.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,790.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,540.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,519.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,852.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,027.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,592.26
|
| Rate for Payer: PHCS Commercial |
$4,930.87
|
| Rate for Payer: United Healthcare All Payer |
$4,519.96
|
|
|
ACET LNR 32*56-62 20 DEG
|
Facility
|
OP
|
$5,136.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.72 |
| Max. Negotiated Rate |
$4,930.87 |
| Rate for Payer: Aetna Commercial |
$3,954.97
|
| Rate for Payer: Anthem Medicaid |
$1,766.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,006.33
|
| Rate for Payer: Cash Price |
$2,568.16
|
| Rate for Payer: Cigna Commercial |
$4,263.15
|
| Rate for Payer: First Health Commercial |
$4,879.50
|
| Rate for Payer: Humana Commercial |
$4,365.87
|
| Rate for Payer: Humana KY Medicaid |
$1,766.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,784.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,211.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,790.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,540.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,801.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,519.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,852.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,027.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,592.26
|
| Rate for Payer: PHCS Commercial |
$4,930.87
|
| Rate for Payer: United Healthcare All Payer |
$4,519.96
|
|
|
ACET LNR 32*63-70 0 DEG
|
Facility
|
OP
|
$5,136.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.72 |
| Max. Negotiated Rate |
$4,930.87 |
| Rate for Payer: Aetna Commercial |
$3,954.97
|
| Rate for Payer: Anthem Medicaid |
$1,766.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,006.33
|
| Rate for Payer: Cash Price |
$2,568.16
|
| Rate for Payer: Cigna Commercial |
$4,263.15
|
| Rate for Payer: First Health Commercial |
$4,879.50
|
| Rate for Payer: Humana Commercial |
$4,365.87
|
| Rate for Payer: Humana KY Medicaid |
$1,766.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,784.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,211.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,790.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,540.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,801.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,519.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,852.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,027.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,592.26
|
| Rate for Payer: PHCS Commercial |
$4,930.87
|
| Rate for Payer: United Healthcare All Payer |
$4,519.96
|
|
|
ACET LNR 32*63-70 0 DEG
|
Facility
|
IP
|
$5,136.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.72 |
| Max. Negotiated Rate |
$4,930.87 |
| Rate for Payer: Aetna Commercial |
$3,954.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,006.33
|
| Rate for Payer: Cash Price |
$2,568.16
|
| Rate for Payer: Cigna Commercial |
$4,263.15
|
| Rate for Payer: First Health Commercial |
$4,879.50
|
| Rate for Payer: Humana Commercial |
$4,365.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,211.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,790.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,540.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,519.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,852.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,027.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,592.26
|
| Rate for Payer: PHCS Commercial |
$4,930.87
|
| Rate for Payer: United Healthcare All Payer |
$4,519.96
|
|
|
ACET LNR 32*63-70 20 DEG
|
Facility
|
IP
|
$5,136.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.72 |
| Max. Negotiated Rate |
$4,930.87 |
| Rate for Payer: Aetna Commercial |
$3,954.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,006.33
|
| Rate for Payer: Cash Price |
$2,568.16
|
| Rate for Payer: Cigna Commercial |
$4,263.15
|
| Rate for Payer: First Health Commercial |
$4,879.50
|
| Rate for Payer: Humana Commercial |
$4,365.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,211.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,790.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,540.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,519.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,852.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,027.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,592.26
|
| Rate for Payer: PHCS Commercial |
$4,930.87
|
| Rate for Payer: United Healthcare All Payer |
$4,519.96
|
|
|
ACET LNR 32*63-70 20 DEG
|
Facility
|
OP
|
$5,136.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.72 |
| Max. Negotiated Rate |
$4,930.87 |
| Rate for Payer: Aetna Commercial |
$3,954.97
|
| Rate for Payer: Anthem Medicaid |
$1,766.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,006.33
|
| Rate for Payer: Cash Price |
$2,568.16
|
| Rate for Payer: Cigna Commercial |
$4,263.15
|
| Rate for Payer: First Health Commercial |
$4,879.50
|
| Rate for Payer: Humana Commercial |
$4,365.87
|
| Rate for Payer: Humana KY Medicaid |
$1,766.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,784.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,211.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,790.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,540.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,801.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,519.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,852.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,027.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,592.26
|
| Rate for Payer: PHCS Commercial |
$4,930.87
|
| Rate for Payer: United Healthcare All Payer |
$4,519.96
|
|
|
ACETYLCYSTEINE 20% 10mL
|
Facility
|
IP
|
$32.16
|
|
|
Service Code
|
NDC 63323069210
|
| Hospital Charge Code |
25004180
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.18 |
| Max. Negotiated Rate |
$30.87 |
| Rate for Payer: Aetna Commercial |
$24.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25.08
|
| Rate for Payer: Cash Price |
$16.08
|
| Rate for Payer: Cigna Commercial |
$26.69
|
| Rate for Payer: First Health Commercial |
$30.55
|
| Rate for Payer: Humana Commercial |
$27.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$28.30
|
| Rate for Payer: Ohio Health Group HMO |
$24.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.97
|
| Rate for Payer: PHCS Commercial |
$30.87
|
| Rate for Payer: United Healthcare All Payer |
$28.30
|
|
|
ACETYLCYSTEINE 20% 10mL
|
Facility
|
OP
|
$32.16
|
|
|
Service Code
|
NDC 63323069210
|
| Hospital Charge Code |
25004180
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.18 |
| Max. Negotiated Rate |
$30.87 |
| Rate for Payer: Aetna Commercial |
$24.76
|
| Rate for Payer: Anthem Medicaid |
$11.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25.08
|
| Rate for Payer: Cash Price |
$16.08
|
| Rate for Payer: Cigna Commercial |
$26.69
|
| Rate for Payer: First Health Commercial |
$30.55
|
| Rate for Payer: Humana Commercial |
$27.34
|
| Rate for Payer: Humana KY Medicaid |
$11.06
|
| Rate for Payer: Kentucky WC Medicaid |
$11.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$11.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$28.30
|
| Rate for Payer: Ohio Health Group HMO |
$24.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.97
|
| Rate for Payer: PHCS Commercial |
$30.87
|
| Rate for Payer: United Healthcare All Payer |
$28.30
|
|
|
ACHILLES SPDBRG KT 3.9MM
|
Facility
|
IP
|
$15,702.00
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,041.26 |
| Max. Negotiated Rate |
$15,073.92 |
| Rate for Payer: Aetna Commercial |
$12,090.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,247.56
|
| Rate for Payer: Cash Price |
$7,851.00
|
| Rate for Payer: Cigna Commercial |
$13,032.66
|
| Rate for Payer: First Health Commercial |
$14,916.90
|
| Rate for Payer: Humana Commercial |
$13,346.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,875.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,588.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,710.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,817.76
|
| Rate for Payer: Ohio Health Group HMO |
$11,776.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,140.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,041.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,867.62
|
| Rate for Payer: PHCS Commercial |
$15,073.92
|
| Rate for Payer: United Healthcare All Payer |
$13,817.76
|
|
|
ACHILLES SPDBRG KT 3.9MM
|
Facility
|
OP
|
$15,702.00
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,041.26 |
| Max. Negotiated Rate |
$15,073.92 |
| Rate for Payer: Aetna Commercial |
$12,090.54
|
| Rate for Payer: Anthem Medicaid |
$5,399.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,247.56
|
| Rate for Payer: Cash Price |
$7,851.00
|
| Rate for Payer: Cigna Commercial |
$13,032.66
|
| Rate for Payer: First Health Commercial |
$14,916.90
|
| Rate for Payer: Humana Commercial |
$13,346.70
|
| Rate for Payer: Humana KY Medicaid |
$5,399.92
|
| Rate for Payer: Kentucky WC Medicaid |
$5,454.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,875.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,588.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,710.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,508.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,817.76
|
| Rate for Payer: Ohio Health Group HMO |
$11,776.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,140.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,041.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,867.62
|
| Rate for Payer: PHCS Commercial |
$15,073.92
|
| Rate for Payer: United Healthcare All Payer |
$13,817.76
|
|
|
ACHILLESTENDONALLOGRAFT
|
Facility
|
IP
|
$4,619.50
|
|
|
Service Code
|
HCPCS 20999
|
| Hospital Charge Code |
76100361
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$600.54 |
| Max. Negotiated Rate |
$4,434.72 |
| Rate for Payer: Aetna Commercial |
$3,557.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,603.21
|
| Rate for Payer: Cash Price |
$2,309.75
|
| Rate for Payer: Cigna Commercial |
$3,834.18
|
| Rate for Payer: First Health Commercial |
$4,388.52
|
| Rate for Payer: Humana Commercial |
$3,926.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,787.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,409.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,385.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,065.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,464.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$923.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$600.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,432.04
|
| Rate for Payer: PHCS Commercial |
$4,434.72
|
| Rate for Payer: United Healthcare All Payer |
$4,065.16
|
|
|
ACHILLESTENDONALLOGRAFT
|
Facility
|
OP
|
$4,619.50
|
|
|
Service Code
|
HCPCS 20999
|
| Hospital Charge Code |
76100361
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$203.93 |
| Max. Negotiated Rate |
$4,434.72 |
| Rate for Payer: Aetna Commercial |
$3,557.02
|
| Rate for Payer: Anthem Medicaid |
$1,588.65
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,603.21
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$2,309.75
|
| Rate for Payer: Cash Price |
$2,309.75
|
| Rate for Payer: Cigna Commercial |
$3,834.18
|
| Rate for Payer: First Health Commercial |
$4,388.52
|
| Rate for Payer: Humana Commercial |
$3,926.58
|
| Rate for Payer: Humana KY Medicaid |
$1,588.65
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$1,604.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,787.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,409.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,620.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,065.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,464.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$923.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$600.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,432.04
|
| Rate for Payer: PHCS Commercial |
$4,434.72
|
| Rate for Payer: United Healthcare All Payer |
$4,065.16
|
|
|
ACHILLESTENDONALLOGRAFT
|
Professional
|
Both
|
$4,619.50
|
|
|
Service Code
|
HCPCS 20999
|
| Hospital Charge Code |
76100361
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$4,619.50 |
| Rate for Payer: Buckeye Medicare Advantage |
$4,619.50
|
| Rate for Payer: Cash Price |
$2,309.75
|
| Rate for Payer: Cash Price |
$2,309.75
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$2,771.70
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,233.65
|
| Rate for Payer: UHCCP Medicaid |
$1,616.82
|
|
|
ACHILLESTENDONALLOGRAFT(T
|
Facility
|
OP
|
$4,619.50
|
|
|
Service Code
|
HCPCS 20999
|
| Hospital Charge Code |
761T0361
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$203.93 |
| Max. Negotiated Rate |
$4,434.72 |
| Rate for Payer: Aetna Commercial |
$3,557.02
|
| Rate for Payer: Anthem Medicaid |
$1,588.65
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,603.21
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$2,309.75
|
| Rate for Payer: Cash Price |
$2,309.75
|
| Rate for Payer: Cigna Commercial |
$3,834.18
|
| Rate for Payer: First Health Commercial |
$4,388.52
|
| Rate for Payer: Humana Commercial |
$3,926.58
|
| Rate for Payer: Humana KY Medicaid |
$1,588.65
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$1,604.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,787.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,409.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,620.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,065.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,464.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$923.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$600.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,432.04
|
| Rate for Payer: PHCS Commercial |
$4,434.72
|
| Rate for Payer: United Healthcare All Payer |
$4,065.16
|
|
|
ACHILLESTENDONALLOGRAFT(T
|
Facility
|
IP
|
$4,619.50
|
|
|
Service Code
|
HCPCS 20999
|
| Hospital Charge Code |
761T0361
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$600.54 |
| Max. Negotiated Rate |
$4,434.72 |
| Rate for Payer: Aetna Commercial |
$3,557.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,603.21
|
| Rate for Payer: Cash Price |
$2,309.75
|
| Rate for Payer: Cigna Commercial |
$3,834.18
|
| Rate for Payer: First Health Commercial |
$4,388.52
|
| Rate for Payer: Humana Commercial |
$3,926.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,787.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,409.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,385.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,065.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,464.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$923.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$600.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,432.04
|
| Rate for Payer: PHCS Commercial |
$4,434.72
|
| Rate for Payer: United Healthcare All Payer |
$4,065.16
|
|
|
ACHILLES TENDON W/BONE
|
Facility
|
IP
|
$10,081.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,310.63 |
| Max. Negotiated Rate |
$9,678.48 |
| Rate for Payer: Aetna Commercial |
$7,762.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,863.76
|
| Rate for Payer: Cash Price |
$5,040.88
|
| Rate for Payer: Cigna Commercial |
$8,367.85
|
| Rate for Payer: First Health Commercial |
$9,577.66
|
| Rate for Payer: Humana Commercial |
$8,569.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,267.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,440.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,024.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,871.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,561.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,016.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,310.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,125.34
|
| Rate for Payer: PHCS Commercial |
$9,678.48
|
| Rate for Payer: United Healthcare All Payer |
$8,871.94
|
|
|
ACHILLES TENDON W/BONE
|
Facility
|
OP
|
$10,081.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,310.63 |
| Max. Negotiated Rate |
$9,678.48 |
| Rate for Payer: Aetna Commercial |
$7,762.95
|
| Rate for Payer: Anthem Medicaid |
$3,467.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,863.76
|
| Rate for Payer: Cash Price |
$5,040.88
|
| Rate for Payer: Cigna Commercial |
$8,367.85
|
| Rate for Payer: First Health Commercial |
$9,577.66
|
| Rate for Payer: Humana Commercial |
$8,569.49
|
| Rate for Payer: Humana KY Medicaid |
$3,467.11
|
| Rate for Payer: Kentucky WC Medicaid |
$3,502.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,267.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,440.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,024.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,536.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,871.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,561.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,016.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,310.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,125.34
|
| Rate for Payer: PHCS Commercial |
$9,678.48
|
| Rate for Payer: United Healthcare All Payer |
$8,871.94
|
|
|
ACHILLES TENDON W/O BONE
|
Facility
|
IP
|
$12,607.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,638.98 |
| Max. Negotiated Rate |
$12,103.20 |
| Rate for Payer: Humana Commercial |
$10,716.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,338.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,304.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,782.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,094.60
|
| Rate for Payer: Ohio Health Group HMO |
$9,455.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,521.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,638.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,908.32
|
| Rate for Payer: PHCS Commercial |
$12,103.20
|
| Rate for Payer: United Healthcare All Payer |
$11,094.60
|
| Rate for Payer: Aetna Commercial |
$9,707.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,833.85
|
| Rate for Payer: Cash Price |
$6,303.75
|
| Rate for Payer: Cigna Commercial |
$10,464.22
|
| Rate for Payer: First Health Commercial |
$11,977.12
|
|
