|
VERMOX EQUIV 100MG CHEW TAB
|
Facility
|
OP
|
$916.00
|
|
|
Service Code
|
NDC 64896066930
|
| Hospital Charge Code |
25001662
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$274.80 |
| Max. Negotiated Rate |
$879.36 |
| Rate for Payer: Aetna Commercial |
$705.32
|
| Rate for Payer: Anthem Medicaid |
$315.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$714.48
|
| Rate for Payer: Cash Price |
$458.00
|
| Rate for Payer: Cigna Commercial |
$760.28
|
| Rate for Payer: First Health Commercial |
$870.20
|
| Rate for Payer: Humana Commercial |
$778.60
|
| Rate for Payer: Humana KY Medicaid |
$315.01
|
| Rate for Payer: Kentucky WC Medicaid |
$318.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$751.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$676.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$274.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$321.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$806.08
|
| Rate for Payer: Ohio Health Group HMO |
$687.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$732.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$796.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$632.04
|
| Rate for Payer: PHCS Commercial |
$879.36
|
| Rate for Payer: United Healthcare All Payer |
$806.08
|
|
|
VERMOX EQUIV 100MG CHEW TAB
|
Facility
|
IP
|
$916.00
|
|
|
Service Code
|
NDC 64896066930
|
| Hospital Charge Code |
25001662
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$274.80 |
| Max. Negotiated Rate |
$879.36 |
| Rate for Payer: Aetna Commercial |
$705.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$714.48
|
| Rate for Payer: Cash Price |
$458.00
|
| Rate for Payer: Cigna Commercial |
$760.28
|
| Rate for Payer: First Health Commercial |
$870.20
|
| Rate for Payer: Humana Commercial |
$778.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$751.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$676.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$274.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$806.08
|
| Rate for Payer: Ohio Health Group HMO |
$687.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$732.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$796.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$632.04
|
| Rate for Payer: PHCS Commercial |
$879.36
|
| Rate for Payer: United Healthcare All Payer |
$806.08
|
|
|
VERRATA PLUS 185CM ST TIP GW
|
Facility
|
IP
|
$4,343.75
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,303.12 |
| Max. Negotiated Rate |
$4,170.00 |
| Rate for Payer: Aetna Commercial |
$3,344.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,388.12
|
| Rate for Payer: Cash Price |
$2,171.88
|
| Rate for Payer: Cigna Commercial |
$3,605.31
|
| Rate for Payer: First Health Commercial |
$4,126.56
|
| Rate for Payer: Humana Commercial |
$3,692.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,561.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,205.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,303.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,822.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,257.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,475.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,779.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,997.19
|
| Rate for Payer: PHCS Commercial |
$4,170.00
|
| Rate for Payer: United Healthcare All Payer |
$3,822.50
|
|
|
VERRATA PLUS 185CM ST TIP GW
|
Facility
|
OP
|
$4,343.75
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,303.12 |
| Max. Negotiated Rate |
$4,170.00 |
| Rate for Payer: Aetna Commercial |
$3,344.69
|
| Rate for Payer: Anthem Medicaid |
$1,493.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,388.12
|
| Rate for Payer: Cash Price |
$2,171.88
|
| Rate for Payer: Cigna Commercial |
$3,605.31
|
| Rate for Payer: First Health Commercial |
$4,126.56
|
| Rate for Payer: Humana Commercial |
$3,692.19
|
| Rate for Payer: Humana KY Medicaid |
$1,493.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,509.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,561.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,205.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,303.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,523.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,822.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,257.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,475.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,779.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,997.19
|
| Rate for Payer: PHCS Commercial |
$4,170.00
|
| Rate for Payer: United Healthcare All Payer |
$3,822.50
|
|
|
VERSA-DIAL 30*19*39MM HMRL HED
|
Facility
|
IP
|
$8,953.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,685.95 |
| Max. Negotiated Rate |
$8,595.02 |
| Rate for Payer: Aetna Commercial |
$6,893.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,983.46
|
| Rate for Payer: Cash Price |
$4,476.58
|
| Rate for Payer: Cigna Commercial |
$7,431.11
|
| Rate for Payer: First Health Commercial |
$8,505.49
|
| Rate for Payer: Humana Commercial |
$7,610.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,341.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,607.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,685.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,878.77
|
| Rate for Payer: Ohio Health Group HMO |
$6,714.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,162.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,789.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,177.67
|
| Rate for Payer: PHCS Commercial |
$8,595.02
|
| Rate for Payer: United Healthcare All Payer |
$7,878.77
|
|
|
VERSA-DIAL 30*19*39MM HMRL HED
|
Facility
|
OP
|
$8,953.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,685.95 |
| Max. Negotiated Rate |
$8,595.02 |
| Rate for Payer: Aetna Commercial |
$6,893.93
|
| Rate for Payer: Anthem Medicaid |
$3,078.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,983.46
|
| Rate for Payer: Cash Price |
$4,476.58
|
| Rate for Payer: Cigna Commercial |
$7,431.11
|
| Rate for Payer: First Health Commercial |
$8,505.49
|
| Rate for Payer: Humana Commercial |
$7,610.18
|
| Rate for Payer: Humana KY Medicaid |
$3,078.99
|
| Rate for Payer: Kentucky WC Medicaid |
$3,110.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,341.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,607.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,685.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,140.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,878.77
|
| Rate for Payer: Ohio Health Group HMO |
$6,714.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,162.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,789.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,177.67
|
| Rate for Payer: PHCS Commercial |
$8,595.02
|
| Rate for Payer: United Healthcare All Payer |
$7,878.77
|
|
|
VERSA-DIAL 30*21*38MM HMRL HED
|
Facility
|
IP
|
$8,953.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,685.95 |
| Max. Negotiated Rate |
$8,595.02 |
| Rate for Payer: Aetna Commercial |
$6,893.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,983.46
|
| Rate for Payer: Cash Price |
$4,476.58
|
| Rate for Payer: Cigna Commercial |
$7,431.11
|
| Rate for Payer: First Health Commercial |
$8,505.49
|
| Rate for Payer: Humana Commercial |
$7,610.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,341.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,607.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,685.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,878.77
|
| Rate for Payer: Ohio Health Group HMO |
$6,714.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,162.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,789.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,177.67
|
| Rate for Payer: PHCS Commercial |
$8,595.02
|
| Rate for Payer: United Healthcare All Payer |
$7,878.77
|
|
|
VERSA-DIAL 30*21*38MM HMRL HED
|
Facility
|
OP
|
$8,953.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,685.95 |
| Max. Negotiated Rate |
$8,595.02 |
| Rate for Payer: Aetna Commercial |
$6,893.93
|
| Rate for Payer: Anthem Medicaid |
$3,078.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,983.46
|
| Rate for Payer: Cash Price |
$4,476.58
|
| Rate for Payer: Cigna Commercial |
$7,431.11
|
| Rate for Payer: First Health Commercial |
$8,505.49
|
| Rate for Payer: Humana Commercial |
$7,610.18
|
| Rate for Payer: Humana KY Medicaid |
$3,078.99
|
| Rate for Payer: Kentucky WC Medicaid |
$3,110.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,341.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,607.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,685.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,140.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,878.77
|
| Rate for Payer: Ohio Health Group HMO |
$6,714.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,162.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,789.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,177.67
|
| Rate for Payer: PHCS Commercial |
$8,595.02
|
| Rate for Payer: United Healthcare All Payer |
$7,878.77
|
|
|
VERSA-DIAL 42*18*46MM HMRL HED
|
Facility
|
IP
|
$8,953.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,685.95 |
| Max. Negotiated Rate |
$8,595.02 |
| Rate for Payer: Aetna Commercial |
$6,893.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,983.46
|
| Rate for Payer: Cash Price |
$4,476.58
|
| Rate for Payer: Cigna Commercial |
$7,431.11
|
| Rate for Payer: First Health Commercial |
$8,505.49
|
| Rate for Payer: Humana Commercial |
$7,610.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,341.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,607.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,685.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,878.77
|
| Rate for Payer: Ohio Health Group HMO |
$6,714.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,162.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,789.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,177.67
|
| Rate for Payer: PHCS Commercial |
$8,595.02
|
| Rate for Payer: United Healthcare All Payer |
$7,878.77
|
|
|
VERSA-DIAL 42*18*46MM HMRL HED
|
Facility
|
OP
|
$8,953.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,685.95 |
| Max. Negotiated Rate |
$8,595.02 |
| Rate for Payer: Aetna Commercial |
$6,893.93
|
| Rate for Payer: Anthem Medicaid |
$3,078.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,983.46
|
| Rate for Payer: Cash Price |
$4,476.58
|
| Rate for Payer: Cigna Commercial |
$7,431.11
|
| Rate for Payer: First Health Commercial |
$8,505.49
|
| Rate for Payer: Humana Commercial |
$7,610.18
|
| Rate for Payer: Humana KY Medicaid |
$3,078.99
|
| Rate for Payer: Kentucky WC Medicaid |
$3,110.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,341.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,607.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,685.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,140.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,878.77
|
| Rate for Payer: Ohio Health Group HMO |
$6,714.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,162.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,789.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,177.67
|
| Rate for Payer: PHCS Commercial |
$8,595.02
|
| Rate for Payer: United Healthcare All Payer |
$7,878.77
|
|
|
VERSA-DIAL 42*21*43MM HMRL HED
|
Facility
|
IP
|
$8,953.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,685.95 |
| Max. Negotiated Rate |
$8,595.02 |
| Rate for Payer: Aetna Commercial |
$6,893.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,983.46
|
| Rate for Payer: Cash Price |
$4,476.58
|
| Rate for Payer: Cigna Commercial |
$7,431.11
|
| Rate for Payer: First Health Commercial |
$8,505.49
|
| Rate for Payer: Humana Commercial |
$7,610.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,341.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,607.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,685.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,878.77
|
| Rate for Payer: Ohio Health Group HMO |
$6,714.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,162.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,789.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,177.67
|
| Rate for Payer: PHCS Commercial |
$8,595.02
|
| Rate for Payer: United Healthcare All Payer |
$7,878.77
|
|
|
VERSA-DIAL 42*21*43MM HMRL HED
|
Facility
|
OP
|
$8,953.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,685.95 |
| Max. Negotiated Rate |
$8,595.02 |
| Rate for Payer: Aetna Commercial |
$6,893.93
|
| Rate for Payer: Anthem Medicaid |
$3,078.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,983.46
|
| Rate for Payer: Cash Price |
$4,476.58
|
| Rate for Payer: Cigna Commercial |
$7,431.11
|
| Rate for Payer: First Health Commercial |
$8,505.49
|
| Rate for Payer: Humana Commercial |
$7,610.18
|
| Rate for Payer: Humana KY Medicaid |
$3,078.99
|
| Rate for Payer: Kentucky WC Medicaid |
$3,110.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,341.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,607.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,685.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,140.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,878.77
|
| Rate for Payer: Ohio Health Group HMO |
$6,714.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,162.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,789.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,177.67
|
| Rate for Payer: PHCS Commercial |
$8,595.02
|
| Rate for Payer: United Healthcare All Payer |
$7,878.77
|
|
|
VERSA-DIAL 42*24*42MM HMRL HED
|
Facility
|
OP
|
$8,953.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,685.95 |
| Max. Negotiated Rate |
$8,595.02 |
| Rate for Payer: Aetna Commercial |
$6,893.93
|
| Rate for Payer: Anthem Medicaid |
$3,078.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,983.46
|
| Rate for Payer: Cash Price |
$4,476.58
|
| Rate for Payer: Cigna Commercial |
$7,431.11
|
| Rate for Payer: First Health Commercial |
$8,505.49
|
| Rate for Payer: Humana Commercial |
$7,610.18
|
| Rate for Payer: Humana KY Medicaid |
$3,078.99
|
| Rate for Payer: Kentucky WC Medicaid |
$3,110.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,341.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,607.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,685.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,140.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,878.77
|
| Rate for Payer: Ohio Health Group HMO |
$6,714.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,162.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,789.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,177.67
|
| Rate for Payer: PHCS Commercial |
$8,595.02
|
| Rate for Payer: United Healthcare All Payer |
$7,878.77
|
|
|
VERSA-DIAL 42*24*42MM HMRL HED
|
Facility
|
IP
|
$8,953.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,685.95 |
| Max. Negotiated Rate |
$8,595.02 |
| Rate for Payer: Aetna Commercial |
$6,893.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,983.46
|
| Rate for Payer: Cash Price |
$4,476.58
|
| Rate for Payer: Cigna Commercial |
$7,431.11
|
| Rate for Payer: First Health Commercial |
$8,505.49
|
| Rate for Payer: Humana Commercial |
$7,610.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,341.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,607.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,685.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,878.77
|
| Rate for Payer: Ohio Health Group HMO |
$6,714.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,162.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,789.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,177.67
|
| Rate for Payer: PHCS Commercial |
$8,595.02
|
| Rate for Payer: United Healthcare All Payer |
$7,878.77
|
|
|
VERSA-DIAL 46*18*53MM HMRL HED
|
Facility
|
IP
|
$8,953.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,685.95 |
| Max. Negotiated Rate |
$8,595.02 |
| Rate for Payer: Aetna Commercial |
$6,893.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,983.46
|
| Rate for Payer: Cash Price |
$4,476.58
|
| Rate for Payer: Cigna Commercial |
$7,431.11
|
| Rate for Payer: First Health Commercial |
$8,505.49
|
| Rate for Payer: Humana Commercial |
$7,610.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,341.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,607.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,685.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,878.77
|
| Rate for Payer: Ohio Health Group HMO |
$6,714.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,162.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,789.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,177.67
|
| Rate for Payer: PHCS Commercial |
$8,595.02
|
| Rate for Payer: United Healthcare All Payer |
$7,878.77
|
|
|
VERSA-DIAL 46*18*53MM HMRL HED
|
Facility
|
OP
|
$8,953.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,685.95 |
| Max. Negotiated Rate |
$8,595.02 |
| Rate for Payer: Aetna Commercial |
$6,893.93
|
| Rate for Payer: Anthem Medicaid |
$3,078.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,983.46
|
| Rate for Payer: Cash Price |
$4,476.58
|
| Rate for Payer: Cigna Commercial |
$7,431.11
|
| Rate for Payer: First Health Commercial |
$8,505.49
|
| Rate for Payer: Humana Commercial |
$7,610.18
|
| Rate for Payer: Humana KY Medicaid |
$3,078.99
|
| Rate for Payer: Kentucky WC Medicaid |
$3,110.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,341.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,607.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,685.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,140.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,878.77
|
| Rate for Payer: Ohio Health Group HMO |
$6,714.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,162.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,789.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,177.67
|
| Rate for Payer: PHCS Commercial |
$8,595.02
|
| Rate for Payer: United Healthcare All Payer |
$7,878.77
|
|
|
VERSA-DIAL 46*21*50MM HMRL HED
|
Facility
|
OP
|
$8,953.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,685.95 |
| Max. Negotiated Rate |
$8,595.02 |
| Rate for Payer: Aetna Commercial |
$6,893.93
|
| Rate for Payer: Anthem Medicaid |
$3,078.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,983.46
|
| Rate for Payer: Cash Price |
$4,476.58
|
| Rate for Payer: Cigna Commercial |
$7,431.11
|
| Rate for Payer: First Health Commercial |
$8,505.49
|
| Rate for Payer: Humana Commercial |
$7,610.18
|
| Rate for Payer: Humana KY Medicaid |
$3,078.99
|
| Rate for Payer: Kentucky WC Medicaid |
$3,110.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,341.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,607.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,685.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,140.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,878.77
|
| Rate for Payer: Ohio Health Group HMO |
$6,714.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,162.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,789.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,177.67
|
| Rate for Payer: PHCS Commercial |
$8,595.02
|
| Rate for Payer: United Healthcare All Payer |
$7,878.77
|
|
|
VERSA-DIAL 46*21*50MM HMRL HED
|
Facility
|
IP
|
$8,953.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,685.95 |
| Max. Negotiated Rate |
$8,595.02 |
| Rate for Payer: Aetna Commercial |
$6,893.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,983.46
|
| Rate for Payer: Cash Price |
$4,476.58
|
| Rate for Payer: Cigna Commercial |
$7,431.11
|
| Rate for Payer: First Health Commercial |
$8,505.49
|
| Rate for Payer: Humana Commercial |
$7,610.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,341.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,607.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,685.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,878.77
|
| Rate for Payer: Ohio Health Group HMO |
$6,714.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,162.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,789.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,177.67
|
| Rate for Payer: PHCS Commercial |
$8,595.02
|
| Rate for Payer: United Healthcare All Payer |
$7,878.77
|
|
|
VERSA-DIAL 46*24*47MM HMRL HED
|
Facility
|
IP
|
$8,953.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,685.95 |
| Max. Negotiated Rate |
$8,595.02 |
| Rate for Payer: Aetna Commercial |
$6,893.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,983.46
|
| Rate for Payer: Cash Price |
$4,476.58
|
| Rate for Payer: Cigna Commercial |
$7,431.11
|
| Rate for Payer: First Health Commercial |
$8,505.49
|
| Rate for Payer: Humana Commercial |
$7,610.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,341.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,607.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,685.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,878.77
|
| Rate for Payer: Ohio Health Group HMO |
$6,714.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,162.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,789.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,177.67
|
| Rate for Payer: PHCS Commercial |
$8,595.02
|
| Rate for Payer: United Healthcare All Payer |
$7,878.77
|
|
|
VERSA-DIAL 46*24*47MM HMRL HED
|
Facility
|
OP
|
$8,953.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,685.95 |
| Max. Negotiated Rate |
$8,595.02 |
| Rate for Payer: Aetna Commercial |
$6,893.93
|
| Rate for Payer: Anthem Medicaid |
$3,078.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,983.46
|
| Rate for Payer: Cash Price |
$4,476.58
|
| Rate for Payer: Cigna Commercial |
$7,431.11
|
| Rate for Payer: First Health Commercial |
$8,505.49
|
| Rate for Payer: Humana Commercial |
$7,610.18
|
| Rate for Payer: Humana KY Medicaid |
$3,078.99
|
| Rate for Payer: Kentucky WC Medicaid |
$3,110.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,341.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,607.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,685.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,140.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,878.77
|
| Rate for Payer: Ohio Health Group HMO |
$6,714.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,162.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,789.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,177.67
|
| Rate for Payer: PHCS Commercial |
$8,595.02
|
| Rate for Payer: United Healthcare All Payer |
$7,878.77
|
|
|
VERSA-DIAL 46*27*46MM HMRL HED
|
Facility
|
IP
|
$8,953.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,685.95 |
| Max. Negotiated Rate |
$8,595.02 |
| Rate for Payer: Aetna Commercial |
$6,893.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,983.46
|
| Rate for Payer: Cash Price |
$4,476.58
|
| Rate for Payer: Cigna Commercial |
$7,431.11
|
| Rate for Payer: First Health Commercial |
$8,505.49
|
| Rate for Payer: Humana Commercial |
$7,610.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,341.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,607.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,685.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,878.77
|
| Rate for Payer: Ohio Health Group HMO |
$6,714.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,162.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,789.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,177.67
|
| Rate for Payer: PHCS Commercial |
$8,595.02
|
| Rate for Payer: United Healthcare All Payer |
$7,878.77
|
|
|
VERSA-DIAL 46*27*46MM HMRL HED
|
Facility
|
OP
|
$8,953.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,685.95 |
| Max. Negotiated Rate |
$8,595.02 |
| Rate for Payer: Aetna Commercial |
$6,893.93
|
| Rate for Payer: Anthem Medicaid |
$3,078.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,983.46
|
| Rate for Payer: Cash Price |
$4,476.58
|
| Rate for Payer: Cigna Commercial |
$7,431.11
|
| Rate for Payer: First Health Commercial |
$8,505.49
|
| Rate for Payer: Humana Commercial |
$7,610.18
|
| Rate for Payer: Humana KY Medicaid |
$3,078.99
|
| Rate for Payer: Kentucky WC Medicaid |
$3,110.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,341.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,607.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,685.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,140.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,878.77
|
| Rate for Payer: Ohio Health Group HMO |
$6,714.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,162.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,789.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,177.67
|
| Rate for Payer: PHCS Commercial |
$8,595.02
|
| Rate for Payer: United Healthcare All Payer |
$7,878.77
|
|
|
VERSA-DIAL 50*21*57MM HMRL HED
|
Facility
|
IP
|
$8,953.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,685.95 |
| Max. Negotiated Rate |
$8,595.02 |
| Rate for Payer: Aetna Commercial |
$6,893.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,983.46
|
| Rate for Payer: Cash Price |
$4,476.58
|
| Rate for Payer: Cigna Commercial |
$7,431.11
|
| Rate for Payer: First Health Commercial |
$8,505.49
|
| Rate for Payer: Humana Commercial |
$7,610.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,341.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,607.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,685.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,878.77
|
| Rate for Payer: Ohio Health Group HMO |
$6,714.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,162.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,789.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,177.67
|
| Rate for Payer: PHCS Commercial |
$8,595.02
|
| Rate for Payer: United Healthcare All Payer |
$7,878.77
|
|
|
VERSA-DIAL 50*21*57MM HMRL HED
|
Facility
|
OP
|
$8,953.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,685.95 |
| Max. Negotiated Rate |
$8,595.02 |
| Rate for Payer: Aetna Commercial |
$6,893.93
|
| Rate for Payer: Anthem Medicaid |
$3,078.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,983.46
|
| Rate for Payer: Cash Price |
$4,476.58
|
| Rate for Payer: Cigna Commercial |
$7,431.11
|
| Rate for Payer: First Health Commercial |
$8,505.49
|
| Rate for Payer: Humana Commercial |
$7,610.18
|
| Rate for Payer: Humana KY Medicaid |
$3,078.99
|
| Rate for Payer: Kentucky WC Medicaid |
$3,110.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,341.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,607.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,685.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,140.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,878.77
|
| Rate for Payer: Ohio Health Group HMO |
$6,714.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,162.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,789.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,177.67
|
| Rate for Payer: PHCS Commercial |
$8,595.02
|
| Rate for Payer: United Healthcare All Payer |
$7,878.77
|
|
|
VERSA-DIAL 50*24*52MM HMRL HED
|
Facility
|
IP
|
$8,953.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,685.95 |
| Max. Negotiated Rate |
$8,595.02 |
| Rate for Payer: Aetna Commercial |
$6,893.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,983.46
|
| Rate for Payer: Cash Price |
$4,476.58
|
| Rate for Payer: Cigna Commercial |
$7,431.11
|
| Rate for Payer: First Health Commercial |
$8,505.49
|
| Rate for Payer: Humana Commercial |
$7,610.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,341.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,607.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,685.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,878.77
|
| Rate for Payer: Ohio Health Group HMO |
$6,714.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,162.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,789.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,177.67
|
| Rate for Payer: PHCS Commercial |
$8,595.02
|
| Rate for Payer: United Healthcare All Payer |
$7,878.77
|
|
