|
ACUTRAK 4.0 SOLID DRIVER TIP
|
Facility
|
OP
|
$1,512.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$196.62 |
| Max. Negotiated Rate |
$1,452.00 |
| Rate for Payer: Aetna Commercial |
$1,164.62
|
| Rate for Payer: Anthem Medicaid |
$520.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,179.75
|
| Rate for Payer: Cash Price |
$756.25
|
| Rate for Payer: Cigna Commercial |
$1,255.38
|
| Rate for Payer: First Health Commercial |
$1,436.88
|
| Rate for Payer: Humana Commercial |
$1,285.62
|
| Rate for Payer: Humana KY Medicaid |
$520.15
|
| Rate for Payer: Kentucky WC Medicaid |
$525.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,240.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,116.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$453.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$530.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,331.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,134.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$302.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$196.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$468.88
|
| Rate for Payer: PHCS Commercial |
$1,452.00
|
| Rate for Payer: United Healthcare All Payer |
$1,331.00
|
|
|
ACUTRAK 4.0 SOLID DRIVER TIP
|
Facility
|
IP
|
$1,512.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$196.62 |
| Max. Negotiated Rate |
$1,452.00 |
| Rate for Payer: Aetna Commercial |
$1,164.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,179.75
|
| Rate for Payer: Cash Price |
$756.25
|
| Rate for Payer: Cigna Commercial |
$1,255.38
|
| Rate for Payer: First Health Commercial |
$1,436.88
|
| Rate for Payer: Humana Commercial |
$1,285.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,240.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,116.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$453.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,331.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,134.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$302.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$196.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$468.88
|
| Rate for Payer: PHCS Commercial |
$1,452.00
|
| Rate for Payer: United Healthcare All Payer |
$1,331.00
|
|
|
ACUTRAK 6/7 X-RAY TEMPLATE
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$31.68 |
| Rate for Payer: Aetna Commercial |
$25.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25.74
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$27.39
|
| Rate for Payer: First Health Commercial |
$31.35
|
| Rate for Payer: Humana Commercial |
$28.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$29.04
|
| Rate for Payer: Ohio Health Group HMO |
$24.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10.23
|
| Rate for Payer: PHCS Commercial |
$31.68
|
| Rate for Payer: United Healthcare All Payer |
$29.04
|
|
|
ACUTRAK 6/7 X-RAY TEMPLATE
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$31.68 |
| Rate for Payer: Aetna Commercial |
$25.41
|
| Rate for Payer: Anthem Medicaid |
$11.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25.74
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$27.39
|
| Rate for Payer: First Health Commercial |
$31.35
|
| Rate for Payer: Humana Commercial |
$28.05
|
| Rate for Payer: Humana KY Medicaid |
$11.35
|
| Rate for Payer: Kentucky WC Medicaid |
$11.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$11.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$29.04
|
| Rate for Payer: Ohio Health Group HMO |
$24.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10.23
|
| Rate for Payer: PHCS Commercial |
$31.68
|
| Rate for Payer: United Healthcare All Payer |
$29.04
|
|
|
ACUTRAK GUIDE WIRES .045 SHORT
|
Facility
|
OP
|
$540.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.26 |
| Max. Negotiated Rate |
$518.88 |
| Rate for Payer: Aetna Commercial |
$416.18
|
| Rate for Payer: Anthem Medicaid |
$185.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$421.59
|
| Rate for Payer: Cash Price |
$270.25
|
| Rate for Payer: Cigna Commercial |
$448.62
|
| Rate for Payer: First Health Commercial |
$513.48
|
| Rate for Payer: Humana Commercial |
$459.42
|
| Rate for Payer: Humana KY Medicaid |
$185.88
|
| Rate for Payer: Kentucky WC Medicaid |
$187.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$443.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$398.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$189.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$475.64
|
| Rate for Payer: Ohio Health Group HMO |
$405.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$108.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$167.56
|
| Rate for Payer: PHCS Commercial |
$518.88
|
| Rate for Payer: United Healthcare All Payer |
$475.64
|
|
|
ACUTRAK GUIDE WIRES .045 SHORT
|
Facility
|
IP
|
$540.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.26 |
| Max. Negotiated Rate |
$518.88 |
| Rate for Payer: Aetna Commercial |
$416.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$421.59
|
| Rate for Payer: Cash Price |
$270.25
|
| Rate for Payer: Cigna Commercial |
$448.62
|
| Rate for Payer: First Health Commercial |
$513.48
|
| Rate for Payer: Humana Commercial |
$459.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$443.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$398.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$475.64
|
| Rate for Payer: Ohio Health Group HMO |
$405.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$108.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$167.56
|
| Rate for Payer: PHCS Commercial |
$518.88
|
| Rate for Payer: United Healthcare All Payer |
$475.64
|
|
|
ACUTRAK GUIDE WIRES NITINOL
|
Facility
|
IP
|
$488.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.50 |
| Max. Negotiated Rate |
$468.96 |
| Rate for Payer: Aetna Commercial |
$376.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$381.03
|
| Rate for Payer: Cash Price |
$244.25
|
| Rate for Payer: Cigna Commercial |
$405.46
|
| Rate for Payer: First Health Commercial |
$464.08
|
| Rate for Payer: Humana Commercial |
$415.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$400.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$360.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$146.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$429.88
|
| Rate for Payer: Ohio Health Group HMO |
$366.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$97.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$151.44
|
| Rate for Payer: PHCS Commercial |
$468.96
|
| Rate for Payer: United Healthcare All Payer |
$429.88
|
|
|
ACUTRAK GUIDE WIRES NITINOL
|
Facility
|
OP
|
$488.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.50 |
| Max. Negotiated Rate |
$468.96 |
| Rate for Payer: Aetna Commercial |
$376.14
|
| Rate for Payer: Anthem Medicaid |
$168.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$381.03
|
| Rate for Payer: Cash Price |
$244.25
|
| Rate for Payer: Cigna Commercial |
$405.46
|
| Rate for Payer: First Health Commercial |
$464.08
|
| Rate for Payer: Humana Commercial |
$415.22
|
| Rate for Payer: Humana KY Medicaid |
$168.00
|
| Rate for Payer: Kentucky WC Medicaid |
$169.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$400.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$360.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$146.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$171.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$429.88
|
| Rate for Payer: Ohio Health Group HMO |
$366.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$97.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$151.44
|
| Rate for Payer: PHCS Commercial |
$468.96
|
| Rate for Payer: United Healthcare All Payer |
$429.88
|
|
|
ACYCLOVIR 5MG (500MG SDV)
|
Facility
|
IP
|
$118.25
|
|
|
Service Code
|
HCPCS J0133
|
| Hospital Charge Code |
25001824
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.37 |
| Max. Negotiated Rate |
$113.52 |
| Rate for Payer: Aetna Commercial |
$91.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.24
|
| Rate for Payer: Cash Price |
$59.12
|
| Rate for Payer: Cigna Commercial |
$98.15
|
| Rate for Payer: First Health Commercial |
$112.34
|
| Rate for Payer: Humana Commercial |
$100.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$96.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$104.06
|
| Rate for Payer: Ohio Health Group HMO |
$88.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.66
|
| Rate for Payer: PHCS Commercial |
$113.52
|
| Rate for Payer: United Healthcare All Payer |
$104.06
|
|
|
ACYCLOVIR 5MG (500MG SDV)
|
Facility
|
OP
|
$118.25
|
|
|
Service Code
|
HCPCS J0133
|
| Hospital Charge Code |
25001824
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.37 |
| Max. Negotiated Rate |
$113.52 |
| Rate for Payer: Aetna Commercial |
$91.05
|
| Rate for Payer: Anthem Medicaid |
$40.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.24
|
| Rate for Payer: Cash Price |
$59.12
|
| Rate for Payer: Cigna Commercial |
$98.15
|
| Rate for Payer: First Health Commercial |
$112.34
|
| Rate for Payer: Humana Commercial |
$100.51
|
| Rate for Payer: Humana KY Medicaid |
$40.67
|
| Rate for Payer: Kentucky WC Medicaid |
$41.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$96.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$41.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$104.06
|
| Rate for Payer: Ohio Health Group HMO |
$88.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.66
|
| Rate for Payer: PHCS Commercial |
$113.52
|
| Rate for Payer: United Healthcare All Payer |
$104.06
|
|
|
ADACEL (T-DAP) VACCINE EACH
|
Facility
|
OP
|
$201.58
|
|
|
Service Code
|
HCPCS 90715
|
| Hospital Charge Code |
25000039
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.21 |
| Max. Negotiated Rate |
$193.52 |
| Rate for Payer: Aetna Commercial |
$155.22
|
| Rate for Payer: Anthem Medicaid |
$69.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$157.23
|
| Rate for Payer: Cash Price |
$100.79
|
| Rate for Payer: Cigna Commercial |
$167.31
|
| Rate for Payer: First Health Commercial |
$191.50
|
| Rate for Payer: Humana Commercial |
$171.34
|
| Rate for Payer: Humana KY Medicaid |
$69.32
|
| Rate for Payer: Kentucky WC Medicaid |
$70.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$165.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$148.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$70.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$177.39
|
| Rate for Payer: Ohio Health Group HMO |
$151.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.49
|
| Rate for Payer: PHCS Commercial |
$193.52
|
| Rate for Payer: United Healthcare All Payer |
$177.39
|
|
|
ADACEL (T-DAP) VACCINE EACH
|
Facility
|
IP
|
$201.58
|
|
|
Service Code
|
HCPCS 90715
|
| Hospital Charge Code |
25000039
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.21 |
| Max. Negotiated Rate |
$193.52 |
| Rate for Payer: Aetna Commercial |
$155.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$157.23
|
| Rate for Payer: Cash Price |
$100.79
|
| Rate for Payer: Cigna Commercial |
$167.31
|
| Rate for Payer: First Health Commercial |
$191.50
|
| Rate for Payer: Humana Commercial |
$171.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$165.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$148.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$177.39
|
| Rate for Payer: Ohio Health Group HMO |
$151.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.49
|
| Rate for Payer: PHCS Commercial |
$193.52
|
| Rate for Payer: United Healthcare All Payer |
$177.39
|
|
|
ADACEL TDAP VIAL O.5 ML
|
Facility
|
IP
|
$201.58
|
|
|
Service Code
|
HCPCS 90715
|
| Hospital Charge Code |
25003898
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.21 |
| Max. Negotiated Rate |
$193.52 |
| Rate for Payer: Aetna Commercial |
$155.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$157.23
|
| Rate for Payer: Cash Price |
$100.79
|
| Rate for Payer: Cigna Commercial |
$167.31
|
| Rate for Payer: First Health Commercial |
$191.50
|
| Rate for Payer: Humana Commercial |
$171.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$165.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$148.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$177.39
|
| Rate for Payer: Ohio Health Group HMO |
$151.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.49
|
| Rate for Payer: PHCS Commercial |
$193.52
|
| Rate for Payer: United Healthcare All Payer |
$177.39
|
|
|
ADACEL TDAP VIAL O.5 ML
|
Facility
|
OP
|
$201.58
|
|
|
Service Code
|
HCPCS 90715
|
| Hospital Charge Code |
25003898
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.21 |
| Max. Negotiated Rate |
$193.52 |
| Rate for Payer: Aetna Commercial |
$155.22
|
| Rate for Payer: Anthem Medicaid |
$69.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$157.23
|
| Rate for Payer: Cash Price |
$100.79
|
| Rate for Payer: Cigna Commercial |
$167.31
|
| Rate for Payer: First Health Commercial |
$191.50
|
| Rate for Payer: Humana Commercial |
$171.34
|
| Rate for Payer: Humana KY Medicaid |
$69.32
|
| Rate for Payer: Kentucky WC Medicaid |
$70.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$165.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$148.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$70.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$177.39
|
| Rate for Payer: Ohio Health Group HMO |
$151.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.49
|
| Rate for Payer: PHCS Commercial |
$193.52
|
| Rate for Payer: United Healthcare All Payer |
$177.39
|
|
|
ADAPTER HIP NECK LENGTH +6MM
|
Facility
|
OP
|
$3,572.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$464.36 |
| Max. Negotiated Rate |
$3,429.12 |
| Rate for Payer: Aetna Commercial |
$2,750.44
|
| Rate for Payer: Anthem Medicaid |
$1,228.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,786.16
|
| Rate for Payer: Cash Price |
$1,786.00
|
| Rate for Payer: Cigna Commercial |
$2,964.76
|
| Rate for Payer: First Health Commercial |
$3,393.40
|
| Rate for Payer: Humana Commercial |
$3,036.20
|
| Rate for Payer: Humana KY Medicaid |
$1,228.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,240.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,929.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,636.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,071.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,253.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,143.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,679.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$714.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$464.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,107.32
|
| Rate for Payer: PHCS Commercial |
$3,429.12
|
| Rate for Payer: United Healthcare All Payer |
$3,143.36
|
|
|
ADAPTER HIP NECK LENGTH +6MM
|
Facility
|
IP
|
$3,572.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$464.36 |
| Max. Negotiated Rate |
$3,429.12 |
| Rate for Payer: Aetna Commercial |
$2,750.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,786.16
|
| Rate for Payer: Cash Price |
$1,786.00
|
| Rate for Payer: Cigna Commercial |
$2,964.76
|
| Rate for Payer: First Health Commercial |
$3,393.40
|
| Rate for Payer: Humana Commercial |
$3,036.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,929.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,636.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,071.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,143.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,679.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$714.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$464.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,107.32
|
| Rate for Payer: PHCS Commercial |
$3,429.12
|
| Rate for Payer: United Healthcare All Payer |
$3,143.36
|
|
|
ADAPTER HIP NECK LENGTH -6MM
|
Facility
|
OP
|
$3,572.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$464.36 |
| Max. Negotiated Rate |
$3,429.12 |
| Rate for Payer: Aetna Commercial |
$2,750.44
|
| Rate for Payer: Anthem Medicaid |
$1,228.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,786.16
|
| Rate for Payer: Cash Price |
$1,786.00
|
| Rate for Payer: Cigna Commercial |
$2,964.76
|
| Rate for Payer: First Health Commercial |
$3,393.40
|
| Rate for Payer: Humana Commercial |
$3,036.20
|
| Rate for Payer: Humana KY Medicaid |
$1,228.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,240.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,929.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,636.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,071.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,253.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,143.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,679.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$714.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$464.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,107.32
|
| Rate for Payer: PHCS Commercial |
$3,429.12
|
| Rate for Payer: United Healthcare All Payer |
$3,143.36
|
|
|
ADAPTER HIP NECK LENGTH -6MM
|
Facility
|
IP
|
$3,572.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$464.36 |
| Max. Negotiated Rate |
$3,429.12 |
| Rate for Payer: Aetna Commercial |
$2,750.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,786.16
|
| Rate for Payer: Cash Price |
$1,786.00
|
| Rate for Payer: Cigna Commercial |
$2,964.76
|
| Rate for Payer: First Health Commercial |
$3,393.40
|
| Rate for Payer: Humana Commercial |
$3,036.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,929.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,636.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,071.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,143.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,679.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$714.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$464.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,107.32
|
| Rate for Payer: PHCS Commercial |
$3,429.12
|
| Rate for Payer: United Healthcare All Payer |
$3,143.36
|
|
|
ADAPTER HIP NECK LENGTH STD
|
Facility
|
IP
|
$3,572.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$464.36 |
| Max. Negotiated Rate |
$3,429.12 |
| Rate for Payer: Aetna Commercial |
$2,750.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,786.16
|
| Rate for Payer: Cash Price |
$1,786.00
|
| Rate for Payer: Cigna Commercial |
$2,964.76
|
| Rate for Payer: First Health Commercial |
$3,393.40
|
| Rate for Payer: Humana Commercial |
$3,036.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,929.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,636.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,071.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,143.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,679.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$714.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$464.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,107.32
|
| Rate for Payer: PHCS Commercial |
$3,429.12
|
| Rate for Payer: United Healthcare All Payer |
$3,143.36
|
|
|
ADAPTER HIP NECK LENGTH STD
|
Facility
|
OP
|
$3,572.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$464.36 |
| Max. Negotiated Rate |
$3,429.12 |
| Rate for Payer: Aetna Commercial |
$2,750.44
|
| Rate for Payer: Anthem Medicaid |
$1,228.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,786.16
|
| Rate for Payer: Cash Price |
$1,786.00
|
| Rate for Payer: Cigna Commercial |
$2,964.76
|
| Rate for Payer: First Health Commercial |
$3,393.40
|
| Rate for Payer: Humana Commercial |
$3,036.20
|
| Rate for Payer: Humana KY Medicaid |
$1,228.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,240.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,929.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,636.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,071.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,253.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,143.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,679.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$714.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$464.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,107.32
|
| Rate for Payer: PHCS Commercial |
$3,429.12
|
| Rate for Payer: United Healthcare All Payer |
$3,143.36
|
|
|
ADAPTER TM REV SHL W/BAY 48MM
|
Facility
|
OP
|
$8,756.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,138.38 |
| Max. Negotiated Rate |
$8,406.53 |
| Rate for Payer: Aetna Commercial |
$6,742.74
|
| Rate for Payer: Anthem Medicaid |
$3,011.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,830.30
|
| Rate for Payer: Cash Price |
$4,378.40
|
| Rate for Payer: Cigna Commercial |
$7,268.14
|
| Rate for Payer: First Health Commercial |
$8,318.96
|
| Rate for Payer: Humana Commercial |
$7,443.28
|
| Rate for Payer: Humana KY Medicaid |
$3,011.46
|
| Rate for Payer: Kentucky WC Medicaid |
$3,042.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,180.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,462.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,627.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,071.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,705.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,567.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,751.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,138.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,714.61
|
| Rate for Payer: PHCS Commercial |
$8,406.53
|
| Rate for Payer: United Healthcare All Payer |
$7,705.98
|
|
|
ADAPTER TM REV SHL W/BAY 48MM
|
Facility
|
IP
|
$8,756.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,138.38 |
| Max. Negotiated Rate |
$8,406.53 |
| Rate for Payer: Aetna Commercial |
$6,742.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,830.30
|
| Rate for Payer: Cash Price |
$4,378.40
|
| Rate for Payer: Cigna Commercial |
$7,268.14
|
| Rate for Payer: First Health Commercial |
$8,318.96
|
| Rate for Payer: Humana Commercial |
$7,443.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,180.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,462.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,627.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,705.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,567.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,751.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,138.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,714.61
|
| Rate for Payer: PHCS Commercial |
$8,406.53
|
| Rate for Payer: United Healthcare All Payer |
$7,705.98
|
|
|
ADAPTER TM REV SHL W/BAY 50MM
|
Facility
|
IP
|
$8,756.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,138.38 |
| Max. Negotiated Rate |
$8,406.53 |
| Rate for Payer: Aetna Commercial |
$6,742.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,830.30
|
| Rate for Payer: Cash Price |
$4,378.40
|
| Rate for Payer: Cigna Commercial |
$7,268.14
|
| Rate for Payer: First Health Commercial |
$8,318.96
|
| Rate for Payer: Humana Commercial |
$7,443.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,180.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,462.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,627.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,705.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,567.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,751.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,138.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,714.61
|
| Rate for Payer: PHCS Commercial |
$8,406.53
|
| Rate for Payer: United Healthcare All Payer |
$7,705.98
|
|
|
ADAPTER TM REV SHL W/BAY 50MM
|
Facility
|
OP
|
$8,756.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,138.38 |
| Max. Negotiated Rate |
$8,406.53 |
| Rate for Payer: Aetna Commercial |
$6,742.74
|
| Rate for Payer: Anthem Medicaid |
$3,011.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,830.30
|
| Rate for Payer: Cash Price |
$4,378.40
|
| Rate for Payer: Cigna Commercial |
$7,268.14
|
| Rate for Payer: First Health Commercial |
$8,318.96
|
| Rate for Payer: Humana Commercial |
$7,443.28
|
| Rate for Payer: Humana KY Medicaid |
$3,011.46
|
| Rate for Payer: Kentucky WC Medicaid |
$3,042.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,180.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,462.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,627.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,071.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,705.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,567.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,751.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,138.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,714.61
|
| Rate for Payer: PHCS Commercial |
$8,406.53
|
| Rate for Payer: United Healthcare All Payer |
$7,705.98
|
|
|
ADAPTER TM REV SHL W/BAY 52MM
|
Facility
|
OP
|
$8,756.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,138.38 |
| Max. Negotiated Rate |
$8,406.53 |
| Rate for Payer: Aetna Commercial |
$6,742.74
|
| Rate for Payer: Anthem Medicaid |
$3,011.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,830.30
|
| Rate for Payer: Cash Price |
$4,378.40
|
| Rate for Payer: Cigna Commercial |
$7,268.14
|
| Rate for Payer: First Health Commercial |
$8,318.96
|
| Rate for Payer: Humana Commercial |
$7,443.28
|
| Rate for Payer: Humana KY Medicaid |
$3,011.46
|
| Rate for Payer: Kentucky WC Medicaid |
$3,042.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,180.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,462.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,627.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,071.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,705.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,567.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,751.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,138.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,714.61
|
| Rate for Payer: PHCS Commercial |
$8,406.53
|
| Rate for Payer: United Healthcare All Payer |
$7,705.98
|
|
