|
UNASYN 1.5GM (3 GM VIAL)
|
Facility
|
IP
|
$112.36
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
25001867
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.71 |
| Max. Negotiated Rate |
$107.87 |
| Rate for Payer: Aetna Commercial |
$86.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.64
|
| Rate for Payer: Cash Price |
$56.18
|
| Rate for Payer: Cigna Commercial |
$93.26
|
| Rate for Payer: First Health Commercial |
$106.74
|
| Rate for Payer: Humana Commercial |
$95.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$98.88
|
| Rate for Payer: Ohio Health Group HMO |
$84.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$89.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.53
|
| Rate for Payer: PHCS Commercial |
$107.87
|
| Rate for Payer: United Healthcare All Payer |
$98.88
|
|
|
UNASYN 1.5 GM VIAL
|
Facility
|
OP
|
$78.73
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
25001866
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.62 |
| Max. Negotiated Rate |
$75.58 |
| Rate for Payer: Aetna Commercial |
$60.62
|
| Rate for Payer: Anthem Medicaid |
$27.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.41
|
| Rate for Payer: Cash Price |
$39.37
|
| Rate for Payer: Cigna Commercial |
$65.35
|
| Rate for Payer: First Health Commercial |
$74.79
|
| Rate for Payer: Humana Commercial |
$66.92
|
| Rate for Payer: Humana KY Medicaid |
$27.08
|
| Rate for Payer: Kentucky WC Medicaid |
$27.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.28
|
| Rate for Payer: Ohio Health Group HMO |
$59.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.32
|
| Rate for Payer: PHCS Commercial |
$75.58
|
| Rate for Payer: United Healthcare All Payer |
$69.28
|
|
|
UNASYN 1.5 GM VIAL
|
Facility
|
IP
|
$78.73
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
25001866
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.62 |
| Max. Negotiated Rate |
$75.58 |
| Rate for Payer: Aetna Commercial |
$60.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.41
|
| Rate for Payer: Cash Price |
$39.37
|
| Rate for Payer: Cigna Commercial |
$65.35
|
| Rate for Payer: First Health Commercial |
$74.79
|
| Rate for Payer: Humana Commercial |
$66.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.28
|
| Rate for Payer: Ohio Health Group HMO |
$59.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.32
|
| Rate for Payer: PHCS Commercial |
$75.58
|
| Rate for Payer: United Healthcare All Payer |
$69.28
|
|
|
UNASYN IM 1.5GRAM VIAL
|
Facility
|
IP
|
$66.73
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
25001868
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.02 |
| Max. Negotiated Rate |
$64.06 |
| Rate for Payer: Aetna Commercial |
$51.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.05
|
| Rate for Payer: Cash Price |
$33.37
|
| Rate for Payer: Cigna Commercial |
$55.39
|
| Rate for Payer: First Health Commercial |
$63.39
|
| Rate for Payer: Humana Commercial |
$56.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.72
|
| Rate for Payer: Ohio Health Group HMO |
$50.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$53.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.04
|
| Rate for Payer: PHCS Commercial |
$64.06
|
| Rate for Payer: United Healthcare All Payer |
$58.72
|
|
|
UNASYN IM 1.5GRAM VIAL
|
Facility
|
OP
|
$66.73
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
25001868
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.02 |
| Max. Negotiated Rate |
$64.06 |
| Rate for Payer: Aetna Commercial |
$51.38
|
| Rate for Payer: Anthem Medicaid |
$22.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.05
|
| Rate for Payer: Cash Price |
$33.37
|
| Rate for Payer: Cigna Commercial |
$55.39
|
| Rate for Payer: First Health Commercial |
$63.39
|
| Rate for Payer: Humana Commercial |
$56.72
|
| Rate for Payer: Humana KY Medicaid |
$22.95
|
| Rate for Payer: Kentucky WC Medicaid |
$23.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$23.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.72
|
| Rate for Payer: Ohio Health Group HMO |
$50.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$53.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.04
|
| Rate for Payer: PHCS Commercial |
$64.06
|
| Rate for Payer: United Healthcare All Payer |
$58.72
|
|
|
Underarm LsrHairRem-PP#2/3 25%
|
Professional
|
Both
|
$95.00
|
|
| Hospital Charge Code |
22200465
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$33.25 |
| Max. Negotiated Rate |
$66.50 |
| Rate for Payer: Cash Price |
$47.50
|
| Rate for Payer: Multiplan PHCS |
$57.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$66.50
|
| Rate for Payer: UHCCP Medicaid |
$33.25
|
|
|
Underarms Laser Hair Removal
|
Professional
|
Both
|
$150.00
|
|
| Hospital Charge Code |
22200185
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.00
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
|
|
Underarms Laser Hair Removal
|
Facility
|
IP
|
$150.00
|
|
| Hospital Charge Code |
22200185
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$115.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$117.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$124.50
|
| Rate for Payer: First Health Commercial |
$142.50
|
| Rate for Payer: Humana Commercial |
$127.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$123.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$110.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$132.00
|
| Rate for Payer: Ohio Health Group HMO |
$112.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$103.50
|
| Rate for Payer: PHCS Commercial |
$144.00
|
| Rate for Payer: United Healthcare All Payer |
$132.00
|
|
|
Underarms Laser Hair Removal
|
Facility
|
OP
|
$150.00
|
|
| Hospital Charge Code |
22200185
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$115.50
|
| Rate for Payer: Anthem Medicaid |
$51.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$117.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$124.50
|
| Rate for Payer: First Health Commercial |
$142.50
|
| Rate for Payer: Humana Commercial |
$127.50
|
| Rate for Payer: Humana KY Medicaid |
$51.59
|
| Rate for Payer: Kentucky WC Medicaid |
$52.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$123.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$110.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$52.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$132.00
|
| Rate for Payer: Ohio Health Group HMO |
$112.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$103.50
|
| Rate for Payer: PHCS Commercial |
$144.00
|
| Rate for Payer: United Healthcare All Payer |
$132.00
|
|
|
Underarms LsrHairRem-PP#1 50%
|
Professional
|
Both
|
$192.00
|
|
| Hospital Charge Code |
22200349
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$134.40 |
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Multiplan PHCS |
$115.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$134.40
|
| Rate for Payer: UHCCP Medicaid |
$67.20
|
|
|
UNI 14/16 TPR SLV +0
|
Facility
|
IP
|
$1,892.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$567.84 |
| Max. Negotiated Rate |
$1,817.09 |
| Rate for Payer: Aetna Commercial |
$1,457.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,476.38
|
| Rate for Payer: Cash Price |
$946.40
|
| Rate for Payer: Cigna Commercial |
$1,571.02
|
| Rate for Payer: First Health Commercial |
$1,798.16
|
| Rate for Payer: Humana Commercial |
$1,608.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,552.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.66
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,514.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,646.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,306.03
|
| Rate for Payer: PHCS Commercial |
$1,817.09
|
| Rate for Payer: United Healthcare All Payer |
$1,665.66
|
|
|
UNI 14/16 TPR SLV +0
|
Facility
|
OP
|
$1,892.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$567.84 |
| Max. Negotiated Rate |
$1,817.09 |
| Rate for Payer: Aetna Commercial |
$1,457.46
|
| Rate for Payer: Anthem Medicaid |
$650.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,476.38
|
| Rate for Payer: Cash Price |
$946.40
|
| Rate for Payer: Cigna Commercial |
$1,571.02
|
| Rate for Payer: First Health Commercial |
$1,798.16
|
| Rate for Payer: Humana Commercial |
$1,608.88
|
| Rate for Payer: Humana KY Medicaid |
$650.93
|
| Rate for Payer: Kentucky WC Medicaid |
$657.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,552.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$663.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.66
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,514.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,646.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,306.03
|
| Rate for Payer: PHCS Commercial |
$1,817.09
|
| Rate for Payer: United Healthcare All Payer |
$1,665.66
|
|
|
UNI 14/16 TPR SLV +12
|
Facility
|
IP
|
$1,892.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$567.84 |
| Max. Negotiated Rate |
$1,817.09 |
| Rate for Payer: Aetna Commercial |
$1,457.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,476.38
|
| Rate for Payer: Cash Price |
$946.40
|
| Rate for Payer: Cigna Commercial |
$1,571.02
|
| Rate for Payer: First Health Commercial |
$1,798.16
|
| Rate for Payer: Humana Commercial |
$1,608.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,552.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.66
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,514.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,646.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,306.03
|
| Rate for Payer: PHCS Commercial |
$1,817.09
|
| Rate for Payer: United Healthcare All Payer |
$1,665.66
|
|
|
UNI 14/16 TPR SLV +12
|
Facility
|
OP
|
$1,892.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$567.84 |
| Max. Negotiated Rate |
$1,817.09 |
| Rate for Payer: Aetna Commercial |
$1,457.46
|
| Rate for Payer: Anthem Medicaid |
$650.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,476.38
|
| Rate for Payer: Cash Price |
$946.40
|
| Rate for Payer: Cigna Commercial |
$1,571.02
|
| Rate for Payer: First Health Commercial |
$1,798.16
|
| Rate for Payer: Humana Commercial |
$1,608.88
|
| Rate for Payer: Humana KY Medicaid |
$650.93
|
| Rate for Payer: Kentucky WC Medicaid |
$657.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,552.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$663.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.66
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,514.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,646.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,306.03
|
| Rate for Payer: PHCS Commercial |
$1,817.09
|
| Rate for Payer: United Healthcare All Payer |
$1,665.66
|
|
|
UNI 14/16 TPR SLV +8
|
Facility
|
OP
|
$1,892.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$567.84 |
| Max. Negotiated Rate |
$1,817.09 |
| Rate for Payer: Aetna Commercial |
$1,457.46
|
| Rate for Payer: Anthem Medicaid |
$650.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,476.38
|
| Rate for Payer: Cash Price |
$946.40
|
| Rate for Payer: Cigna Commercial |
$1,571.02
|
| Rate for Payer: First Health Commercial |
$1,798.16
|
| Rate for Payer: Humana Commercial |
$1,608.88
|
| Rate for Payer: Humana KY Medicaid |
$650.93
|
| Rate for Payer: Kentucky WC Medicaid |
$657.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,552.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$663.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.66
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,514.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,646.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,306.03
|
| Rate for Payer: PHCS Commercial |
$1,817.09
|
| Rate for Payer: United Healthcare All Payer |
$1,665.66
|
|
|
UNI 14/16 TPR SLV +8
|
Facility
|
IP
|
$1,892.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$567.84 |
| Max. Negotiated Rate |
$1,817.09 |
| Rate for Payer: Aetna Commercial |
$1,457.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,476.38
|
| Rate for Payer: Cash Price |
$946.40
|
| Rate for Payer: Cigna Commercial |
$1,571.02
|
| Rate for Payer: First Health Commercial |
$1,798.16
|
| Rate for Payer: Humana Commercial |
$1,608.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,552.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.66
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,514.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,646.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,306.03
|
| Rate for Payer: PHCS Commercial |
$1,817.09
|
| Rate for Payer: United Healthcare All Payer |
$1,665.66
|
|
|
UNI BR IMPLANT REM-INTACT OFC
|
Professional
|
Both
|
$1,000.00
|
|
| Hospital Charge Code |
22200720
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
|
|
UNI BR IMPLANT REM-RUPT OFC
|
Professional
|
Both
|
$1,000.00
|
|
| Hospital Charge Code |
22200721
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
|
|
UNICORTICAL TF SHAFT 3.5MM
|
Facility
|
IP
|
$3,087.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$926.25 |
| Max. Negotiated Rate |
$2,964.00 |
| Rate for Payer: Aetna Commercial |
$2,377.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,408.25
|
| Rate for Payer: Cash Price |
$1,543.75
|
| Rate for Payer: Cigna Commercial |
$2,562.62
|
| Rate for Payer: First Health Commercial |
$2,933.12
|
| Rate for Payer: Humana Commercial |
$2,624.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,531.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,278.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$926.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,717.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,315.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,470.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,686.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,130.38
|
| Rate for Payer: PHCS Commercial |
$2,964.00
|
| Rate for Payer: United Healthcare All Payer |
$2,717.00
|
|
|
UNICORTICAL TF SHAFT 3.5MM
|
Facility
|
OP
|
$3,087.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$926.25 |
| Max. Negotiated Rate |
$2,964.00 |
| Rate for Payer: Aetna Commercial |
$2,377.38
|
| Rate for Payer: Anthem Medicaid |
$1,061.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,408.25
|
| Rate for Payer: Cash Price |
$1,543.75
|
| Rate for Payer: Cigna Commercial |
$2,562.62
|
| Rate for Payer: First Health Commercial |
$2,933.12
|
| Rate for Payer: Humana Commercial |
$2,624.38
|
| Rate for Payer: Humana KY Medicaid |
$1,061.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,072.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,531.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,278.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$926.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,083.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,717.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,315.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,470.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,686.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,130.38
|
| Rate for Payer: PHCS Commercial |
$2,964.00
|
| Rate for Payer: United Healthcare All Payer |
$2,717.00
|
|
|
UNI EIUS FEM LARGE LM/RL
|
Facility
|
IP
|
$12,313.87
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,694.16 |
| Max. Negotiated Rate |
$11,821.32 |
| Rate for Payer: Aetna Commercial |
$9,481.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,604.82
|
| Rate for Payer: Cash Price |
$6,156.94
|
| Rate for Payer: Cigna Commercial |
$10,220.51
|
| Rate for Payer: First Health Commercial |
$11,698.18
|
| Rate for Payer: Humana Commercial |
$10,466.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,097.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,087.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,694.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,836.21
|
| Rate for Payer: Ohio Health Group HMO |
$9,235.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,851.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,713.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,496.57
|
| Rate for Payer: PHCS Commercial |
$11,821.32
|
| Rate for Payer: United Healthcare All Payer |
$10,836.21
|
|
|
UNI EIUS FEM LARGE LM/RL
|
Facility
|
OP
|
$12,313.87
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,694.16 |
| Max. Negotiated Rate |
$11,821.32 |
| Rate for Payer: Aetna Commercial |
$9,481.68
|
| Rate for Payer: Anthem Medicaid |
$4,234.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,604.82
|
| Rate for Payer: Cash Price |
$6,156.94
|
| Rate for Payer: Cigna Commercial |
$10,220.51
|
| Rate for Payer: First Health Commercial |
$11,698.18
|
| Rate for Payer: Humana Commercial |
$10,466.79
|
| Rate for Payer: Humana KY Medicaid |
$4,234.74
|
| Rate for Payer: Kentucky WC Medicaid |
$4,277.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,097.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,087.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,694.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,319.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,836.21
|
| Rate for Payer: Ohio Health Group HMO |
$9,235.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,851.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,713.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,496.57
|
| Rate for Payer: PHCS Commercial |
$11,821.32
|
| Rate for Payer: United Healthcare All Payer |
$10,836.21
|
|
|
UNI EIUS FEM LARGE RM/LL
|
Facility
|
IP
|
$11,192.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,357.70 |
| Max. Negotiated Rate |
$10,744.63 |
| Rate for Payer: Aetna Commercial |
$8,618.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,730.01
|
| Rate for Payer: Cash Price |
$5,596.16
|
| Rate for Payer: Cigna Commercial |
$9,289.63
|
| Rate for Payer: First Health Commercial |
$10,632.70
|
| Rate for Payer: Humana Commercial |
$9,513.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,177.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,259.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,357.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,849.24
|
| Rate for Payer: Ohio Health Group HMO |
$8,394.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,953.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,737.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,722.70
|
| Rate for Payer: PHCS Commercial |
$10,744.63
|
| Rate for Payer: United Healthcare All Payer |
$9,849.24
|
|
|
UNI EIUS FEM LARGE RM/LL
|
Facility
|
OP
|
$11,192.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,357.70 |
| Max. Negotiated Rate |
$10,744.63 |
| Rate for Payer: Aetna Commercial |
$8,618.09
|
| Rate for Payer: Anthem Medicaid |
$3,849.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,730.01
|
| Rate for Payer: Cash Price |
$5,596.16
|
| Rate for Payer: Cigna Commercial |
$9,289.63
|
| Rate for Payer: First Health Commercial |
$10,632.70
|
| Rate for Payer: Humana Commercial |
$9,513.47
|
| Rate for Payer: Humana KY Medicaid |
$3,849.04
|
| Rate for Payer: Kentucky WC Medicaid |
$3,888.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,177.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,259.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,357.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,926.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,849.24
|
| Rate for Payer: Ohio Health Group HMO |
$8,394.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,953.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,737.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,722.70
|
| Rate for Payer: PHCS Commercial |
$10,744.63
|
| Rate for Payer: United Healthcare All Payer |
$9,849.24
|
|
|
UNI EIUS FEM MEDIUM LM/RL
|
Facility
|
OP
|
$11,424.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,427.28 |
| Max. Negotiated Rate |
$10,967.29 |
| Rate for Payer: Aetna Commercial |
$8,796.68
|
| Rate for Payer: Anthem Medicaid |
$3,928.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,910.92
|
| Rate for Payer: Cash Price |
$5,712.13
|
| Rate for Payer: Cigna Commercial |
$9,482.14
|
| Rate for Payer: First Health Commercial |
$10,853.05
|
| Rate for Payer: Humana Commercial |
$9,710.62
|
| Rate for Payer: Humana KY Medicaid |
$3,928.80
|
| Rate for Payer: Kentucky WC Medicaid |
$3,968.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,367.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,431.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,427.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,007.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,053.35
|
| Rate for Payer: Ohio Health Group HMO |
$8,568.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,139.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,939.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,882.74
|
| Rate for Payer: PHCS Commercial |
$10,967.29
|
| Rate for Payer: United Healthcare All Payer |
$10,053.35
|
|
