|
VERSA-DIAL 50*24*52MM 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*27*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 50*27*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 54*21*64MM 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 54*21*64MM 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 54*24*58MM 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 54*24*58MM 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 54*27*55MM 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 54*27*55MM 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 58*24*64MM 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 58*24*64MM 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 58*27*61MM 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 58*27*61MM 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 COMP TI STD TAPER
|
Facility
|
OP
|
$1,961.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$588.36 |
| Max. Negotiated Rate |
$1,882.75 |
| Rate for Payer: Aetna Commercial |
$1,510.12
|
| Rate for Payer: Anthem Medicaid |
$674.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,529.74
|
| Rate for Payer: Cash Price |
$980.60
|
| Rate for Payer: Cigna Commercial |
$1,627.80
|
| Rate for Payer: First Health Commercial |
$1,863.14
|
| Rate for Payer: Humana Commercial |
$1,667.02
|
| Rate for Payer: Humana KY Medicaid |
$674.46
|
| Rate for Payer: Kentucky WC Medicaid |
$681.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,608.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,447.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$588.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$687.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,725.86
|
| Rate for Payer: Ohio Health Group HMO |
$1,470.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,568.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,706.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,353.23
|
| Rate for Payer: PHCS Commercial |
$1,882.75
|
| Rate for Payer: United Healthcare All Payer |
$1,725.86
|
|
|
VERSA-DIAL COMP TI STD TAPER
|
Facility
|
IP
|
$1,961.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$588.36 |
| Max. Negotiated Rate |
$1,882.75 |
| Rate for Payer: Aetna Commercial |
$1,510.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,529.74
|
| Rate for Payer: Cash Price |
$980.60
|
| Rate for Payer: Cigna Commercial |
$1,627.80
|
| Rate for Payer: First Health Commercial |
$1,863.14
|
| Rate for Payer: Humana Commercial |
$1,667.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,608.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,447.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$588.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,725.86
|
| Rate for Payer: Ohio Health Group HMO |
$1,470.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,568.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,706.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,353.23
|
| Rate for Payer: PHCS Commercial |
$1,882.75
|
| Rate for Payer: United Healthcare All Payer |
$1,725.86
|
|
|
VERSALOK ANCHOR W/ORTHOCORD
|
Facility
|
IP
|
$3,320.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$996.00 |
| Max. Negotiated Rate |
$3,187.20 |
| Rate for Payer: Aetna Commercial |
$2,556.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,589.60
|
| Rate for Payer: Cash Price |
$1,660.00
|
| Rate for Payer: Cigna Commercial |
$2,755.60
|
| Rate for Payer: First Health Commercial |
$3,154.00
|
| Rate for Payer: Humana Commercial |
$2,822.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,722.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,450.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$996.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,921.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,490.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,656.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,888.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,290.80
|
| Rate for Payer: PHCS Commercial |
$3,187.20
|
| Rate for Payer: United Healthcare All Payer |
$2,921.60
|
|
|
VERSALOK ANCHOR W/ORTHOCORD
|
Facility
|
OP
|
$3,320.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$996.00 |
| Max. Negotiated Rate |
$3,187.20 |
| Rate for Payer: Aetna Commercial |
$2,556.40
|
| Rate for Payer: Anthem Medicaid |
$1,141.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,589.60
|
| Rate for Payer: Cash Price |
$1,660.00
|
| Rate for Payer: Cigna Commercial |
$2,755.60
|
| Rate for Payer: First Health Commercial |
$3,154.00
|
| Rate for Payer: Humana Commercial |
$2,822.00
|
| Rate for Payer: Humana KY Medicaid |
$1,141.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,153.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,722.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,450.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$996.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,164.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,921.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,490.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,656.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,888.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,290.80
|
| Rate for Payer: PHCS Commercial |
$3,187.20
|
| Rate for Payer: United Healthcare All Payer |
$2,921.60
|
|
|
VERSED 1mg (100mg/100mL Drip)
|
Facility
|
IP
|
$82.08
|
|
|
Service Code
|
HCPCS J2250
|
| Hospital Charge Code |
25004464
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.62 |
| Max. Negotiated Rate |
$78.80 |
| Rate for Payer: Aetna Commercial |
$63.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64.02
|
| Rate for Payer: Cash Price |
$41.04
|
| Rate for Payer: Cigna Commercial |
$68.13
|
| Rate for Payer: First Health Commercial |
$77.98
|
| Rate for Payer: Humana Commercial |
$69.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$72.23
|
| Rate for Payer: Ohio Health Group HMO |
$61.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56.64
|
| Rate for Payer: PHCS Commercial |
$78.80
|
| Rate for Payer: United Healthcare All Payer |
$72.23
|
|
|
VERSED 1mg (100mg/100mL Drip)
|
Facility
|
OP
|
$82.08
|
|
|
Service Code
|
HCPCS J2250
|
| Hospital Charge Code |
25004464
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.62 |
| Max. Negotiated Rate |
$78.80 |
| Rate for Payer: Aetna Commercial |
$63.20
|
| Rate for Payer: Anthem Medicaid |
$28.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64.02
|
| Rate for Payer: Cash Price |
$41.04
|
| Rate for Payer: Cigna Commercial |
$68.13
|
| Rate for Payer: First Health Commercial |
$77.98
|
| Rate for Payer: Humana Commercial |
$69.77
|
| Rate for Payer: Humana KY Medicaid |
$28.23
|
| Rate for Payer: Kentucky WC Medicaid |
$28.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$28.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$72.23
|
| Rate for Payer: Ohio Health Group HMO |
$61.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56.64
|
| Rate for Payer: PHCS Commercial |
$78.80
|
| Rate for Payer: United Healthcare All Payer |
$72.23
|
|
|
VERSED 1 MG[10MG/10ML VIAL]
|
Facility
|
OP
|
$77.27
|
|
|
Service Code
|
HCPCS J2250
|
| Hospital Charge Code |
25002236
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.18 |
| Max. Negotiated Rate |
$74.18 |
| Rate for Payer: Aetna Commercial |
$59.50
|
| Rate for Payer: Anthem Medicaid |
$26.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.27
|
| Rate for Payer: Cash Price |
$38.63
|
| Rate for Payer: Cigna Commercial |
$64.13
|
| Rate for Payer: First Health Commercial |
$73.41
|
| Rate for Payer: Humana Commercial |
$65.68
|
| Rate for Payer: Humana KY Medicaid |
$26.57
|
| Rate for Payer: Kentucky WC Medicaid |
$26.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.00
|
| Rate for Payer: Ohio Health Group HMO |
$57.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.32
|
| Rate for Payer: PHCS Commercial |
$74.18
|
| Rate for Payer: United Healthcare All Payer |
$68.00
|
|
|
VERSED 1 MG[10MG/10ML VIAL]
|
Facility
|
IP
|
$77.27
|
|
|
Service Code
|
HCPCS J2250
|
| Hospital Charge Code |
25002236
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.18 |
| Max. Negotiated Rate |
$74.18 |
| Rate for Payer: Aetna Commercial |
$59.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.27
|
| Rate for Payer: Cash Price |
$38.63
|
| Rate for Payer: Cigna Commercial |
$64.13
|
| Rate for Payer: First Health Commercial |
$73.41
|
| Rate for Payer: Humana Commercial |
$65.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.00
|
| Rate for Payer: Ohio Health Group HMO |
$57.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.32
|
| Rate for Payer: PHCS Commercial |
$74.18
|
| Rate for Payer: United Healthcare All Payer |
$68.00
|
|
|
VERSED 1MG (2mg PF VIAL)
|
Facility
|
IP
|
$73.97
|
|
|
Service Code
|
HCPCS J2250
|
| Hospital Charge Code |
25002238
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.19 |
| Max. Negotiated Rate |
$71.01 |
| Rate for Payer: Aetna Commercial |
$56.96
|
| Rate for Payer: Aetna Commercial |
$58.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59.26
|
| Rate for Payer: Cash Price |
$36.98
|
| Rate for Payer: Cash Price |
$37.98
|
| Rate for Payer: Cigna Commercial |
$61.40
|
| Rate for Payer: Cigna Commercial |
$63.06
|
| Rate for Payer: First Health Commercial |
$72.17
|
| Rate for Payer: First Health Commercial |
$70.27
|
| Rate for Payer: Humana Commercial |
$64.57
|
| Rate for Payer: Humana Commercial |
$62.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$65.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.85
|
| Rate for Payer: Ohio Health Group HMO |
$55.48
|
| Rate for Payer: Ohio Health Group HMO |
$56.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.04
|
| Rate for Payer: PHCS Commercial |
$71.01
|
| Rate for Payer: PHCS Commercial |
$72.93
|
| Rate for Payer: United Healthcare All Payer |
$65.09
|
| Rate for Payer: United Healthcare All Payer |
$66.85
|
|
|
VERSED 1MG (2mg PF VIAL)
|
Facility
|
OP
|
$73.97
|
|
|
Service Code
|
HCPCS J2250
|
| Hospital Charge Code |
25002238
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.19 |
| Max. Negotiated Rate |
$71.01 |
| Rate for Payer: Aetna Commercial |
$56.96
|
| Rate for Payer: Aetna Commercial |
$58.50
|
| Rate for Payer: Anthem Medicaid |
$25.44
|
| Rate for Payer: Anthem Medicaid |
$26.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59.26
|
| Rate for Payer: Cash Price |
$36.98
|
| Rate for Payer: Cash Price |
$37.98
|
| Rate for Payer: Cigna Commercial |
$63.06
|
| Rate for Payer: Cigna Commercial |
$61.40
|
| Rate for Payer: First Health Commercial |
$72.17
|
| Rate for Payer: First Health Commercial |
$70.27
|
| Rate for Payer: Humana Commercial |
$62.87
|
| Rate for Payer: Humana Commercial |
$64.57
|
| Rate for Payer: Humana KY Medicaid |
$25.44
|
| Rate for Payer: Humana KY Medicaid |
$26.13
|
| Rate for Payer: Kentucky WC Medicaid |
$26.39
|
| Rate for Payer: Kentucky WC Medicaid |
$25.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$25.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$65.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.85
|
| Rate for Payer: Ohio Health Group HMO |
$55.48
|
| Rate for Payer: Ohio Health Group HMO |
$56.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52.42
|
| Rate for Payer: PHCS Commercial |
$72.93
|
| Rate for Payer: PHCS Commercial |
$71.01
|
| Rate for Payer: United Healthcare All Payer |
$66.85
|
| Rate for Payer: United Healthcare All Payer |
$65.09
|
|
|
VERSED 1 MG [50MG/10ML]
|
Facility
|
OP
|
$82.52
|
|
|
Service Code
|
HCPCS J2250
|
| Hospital Charge Code |
25002234
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.76 |
| Max. Negotiated Rate |
$79.22 |
| Rate for Payer: Aetna Commercial |
$63.54
|
| Rate for Payer: Anthem Medicaid |
$28.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64.37
|
| Rate for Payer: Cash Price |
$41.26
|
| Rate for Payer: Cigna Commercial |
$68.49
|
| Rate for Payer: First Health Commercial |
$78.39
|
| Rate for Payer: Humana Commercial |
$70.14
|
| Rate for Payer: Humana KY Medicaid |
$28.38
|
| Rate for Payer: Kentucky WC Medicaid |
$28.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$28.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$72.62
|
| Rate for Payer: Ohio Health Group HMO |
$61.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56.94
|
| Rate for Payer: PHCS Commercial |
$79.22
|
| Rate for Payer: United Healthcare All Payer |
$72.62
|
|
|
VERSED 1 MG [50MG/10ML]
|
Facility
|
IP
|
$82.52
|
|
|
Service Code
|
HCPCS J2250
|
| Hospital Charge Code |
25002234
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.76 |
| Max. Negotiated Rate |
$79.22 |
| Rate for Payer: Aetna Commercial |
$63.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64.37
|
| Rate for Payer: Cash Price |
$41.26
|
| Rate for Payer: Cigna Commercial |
$68.49
|
| Rate for Payer: First Health Commercial |
$78.39
|
| Rate for Payer: Humana Commercial |
$70.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$72.62
|
| Rate for Payer: Ohio Health Group HMO |
$61.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56.94
|
| Rate for Payer: PHCS Commercial |
$79.22
|
| Rate for Payer: United Healthcare All Payer |
$72.62
|
|
