|
ACUTRAK GUIDE WIRES NITINOL
|
Facility
|
OP
|
$493.25
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$147.97 |
| Max. Negotiated Rate |
$473.52 |
| Rate for Payer: Aetna Commercial |
$379.80
|
| Rate for Payer: Anthem Medicaid |
$169.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$384.74
|
| Rate for Payer: Cash Price |
$246.62
|
| Rate for Payer: Cigna Commercial |
$409.40
|
| Rate for Payer: First Health Commercial |
$468.59
|
| Rate for Payer: Humana Commercial |
$419.26
|
| Rate for Payer: Humana KY Medicaid |
$169.63
|
| Rate for Payer: Kentucky WC Medicaid |
$171.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$404.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$364.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$147.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$173.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$434.06
|
| Rate for Payer: Ohio Health Group HMO |
$369.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$394.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$429.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$340.34
|
| Rate for Payer: PHCS Commercial |
$473.52
|
| Rate for Payer: United Healthcare All Payer |
$434.06
|
|
|
ACUTRAK GUIDE WIRES NITINOL
|
Facility
|
IP
|
$493.25
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$147.97 |
| Max. Negotiated Rate |
$473.52 |
| Rate for Payer: Aetna Commercial |
$379.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$384.74
|
| Rate for Payer: Cash Price |
$246.62
|
| Rate for Payer: Cigna Commercial |
$409.40
|
| Rate for Payer: First Health Commercial |
$468.59
|
| Rate for Payer: Humana Commercial |
$419.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$404.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$364.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$147.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$434.06
|
| Rate for Payer: Ohio Health Group HMO |
$369.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$394.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$429.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$340.34
|
| Rate for Payer: PHCS Commercial |
$473.52
|
| Rate for Payer: United Healthcare All Payer |
$434.06
|
|
|
ACYCLOVIR 5MG (500MG SDV)
|
Facility
|
IP
|
$118.25
|
|
|
Service Code
|
HCPCS J0133
|
| Hospital Charge Code |
25001824
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.48 |
| Max. Negotiated Rate |
$113.52 |
| Rate for Payer: Aetna Commercial |
$91.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.23
|
| 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 |
$96.97
|
| 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 |
$94.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$81.59
|
| 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 |
$35.48 |
| 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 |
$92.23
|
| 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 |
$96.97
|
| 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 |
$94.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$81.59
|
| Rate for Payer: PHCS Commercial |
$113.52
|
| Rate for Payer: United Healthcare All Payer |
$104.06
|
|
|
ADACEL (T-DAP) VACCINE EACH
|
Facility
|
OP
|
$202.95
|
|
|
Service Code
|
HCPCS 90715
|
| Hospital Charge Code |
25000039
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.88 |
| Max. Negotiated Rate |
$194.83 |
| Rate for Payer: Aetna Commercial |
$156.27
|
| Rate for Payer: Anthem Medicaid |
$69.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$158.30
|
| Rate for Payer: Cash Price |
$101.47
|
| Rate for Payer: Cigna Commercial |
$168.45
|
| Rate for Payer: First Health Commercial |
$192.80
|
| Rate for Payer: Humana Commercial |
$172.51
|
| Rate for Payer: Humana KY Medicaid |
$69.79
|
| Rate for Payer: Kentucky WC Medicaid |
$70.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$166.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$149.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$71.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$178.60
|
| Rate for Payer: Ohio Health Group HMO |
$152.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$162.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$176.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$140.04
|
| Rate for Payer: PHCS Commercial |
$194.83
|
| Rate for Payer: United Healthcare All Payer |
$178.60
|
|
|
ADACEL (T-DAP) VACCINE EACH
|
Facility
|
IP
|
$202.95
|
|
|
Service Code
|
HCPCS 90715
|
| Hospital Charge Code |
25000039
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.88 |
| Max. Negotiated Rate |
$194.83 |
| Rate for Payer: Aetna Commercial |
$156.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$158.30
|
| Rate for Payer: Cash Price |
$101.47
|
| Rate for Payer: Cigna Commercial |
$168.45
|
| Rate for Payer: First Health Commercial |
$192.80
|
| Rate for Payer: Humana Commercial |
$172.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$166.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$149.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$178.60
|
| Rate for Payer: Ohio Health Group HMO |
$152.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$162.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$176.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$140.04
|
| Rate for Payer: PHCS Commercial |
$194.83
|
| Rate for Payer: United Healthcare All Payer |
$178.60
|
|
|
ADACEL TDAP VIAL O.5 ML
|
Facility
|
OP
|
$202.95
|
|
|
Service Code
|
HCPCS 90715
|
| Hospital Charge Code |
25003898
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.88 |
| Max. Negotiated Rate |
$194.83 |
| Rate for Payer: Aetna Commercial |
$156.27
|
| Rate for Payer: Anthem Medicaid |
$69.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$158.30
|
| Rate for Payer: Cash Price |
$101.47
|
| Rate for Payer: Cigna Commercial |
$168.45
|
| Rate for Payer: First Health Commercial |
$192.80
|
| Rate for Payer: Humana Commercial |
$172.51
|
| Rate for Payer: Humana KY Medicaid |
$69.79
|
| Rate for Payer: Kentucky WC Medicaid |
$70.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$166.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$149.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$71.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$178.60
|
| Rate for Payer: Ohio Health Group HMO |
$152.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$162.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$176.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$140.04
|
| Rate for Payer: PHCS Commercial |
$194.83
|
| Rate for Payer: United Healthcare All Payer |
$178.60
|
|
|
ADACEL TDAP VIAL O.5 ML
|
Facility
|
IP
|
$202.95
|
|
|
Service Code
|
HCPCS 90715
|
| Hospital Charge Code |
25003898
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.88 |
| Max. Negotiated Rate |
$194.83 |
| Rate for Payer: Aetna Commercial |
$156.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$158.30
|
| Rate for Payer: Cash Price |
$101.47
|
| Rate for Payer: Cigna Commercial |
$168.45
|
| Rate for Payer: First Health Commercial |
$192.80
|
| Rate for Payer: Humana Commercial |
$172.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$166.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$149.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$178.60
|
| Rate for Payer: Ohio Health Group HMO |
$152.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$162.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$176.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$140.04
|
| Rate for Payer: PHCS Commercial |
$194.83
|
| Rate for Payer: United Healthcare All Payer |
$178.60
|
|
|
ADAPTER HIP NECK LENGTH +6MM
|
Facility
|
IP
|
$3,470.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,041.00 |
| Max. Negotiated Rate |
$3,331.20 |
| Rate for Payer: Aetna Commercial |
$2,671.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,706.60
|
| Rate for Payer: Cash Price |
$1,735.00
|
| Rate for Payer: Cigna Commercial |
$2,880.10
|
| Rate for Payer: First Health Commercial |
$3,296.50
|
| Rate for Payer: Humana Commercial |
$2,949.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,845.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,560.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,041.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,053.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,602.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,776.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,018.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,394.30
|
| Rate for Payer: PHCS Commercial |
$3,331.20
|
| Rate for Payer: United Healthcare All Payer |
$3,053.60
|
|
|
ADAPTER HIP NECK LENGTH +6MM
|
Facility
|
OP
|
$3,470.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,041.00 |
| Max. Negotiated Rate |
$3,331.20 |
| Rate for Payer: Aetna Commercial |
$2,671.90
|
| Rate for Payer: Anthem Medicaid |
$1,193.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,706.60
|
| Rate for Payer: Cash Price |
$1,735.00
|
| Rate for Payer: Cigna Commercial |
$2,880.10
|
| Rate for Payer: First Health Commercial |
$3,296.50
|
| Rate for Payer: Humana Commercial |
$2,949.50
|
| Rate for Payer: Humana KY Medicaid |
$1,193.33
|
| Rate for Payer: Kentucky WC Medicaid |
$1,205.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,845.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,560.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,041.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,217.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,053.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,602.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,776.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,018.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,394.30
|
| Rate for Payer: PHCS Commercial |
$3,331.20
|
| Rate for Payer: United Healthcare All Payer |
$3,053.60
|
|
|
ADAPTER HIP NECK LENGTH -6MM
|
Facility
|
OP
|
$3,470.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,041.00 |
| Max. Negotiated Rate |
$3,331.20 |
| Rate for Payer: Aetna Commercial |
$2,671.90
|
| Rate for Payer: Anthem Medicaid |
$1,193.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,706.60
|
| Rate for Payer: Cash Price |
$1,735.00
|
| Rate for Payer: Cigna Commercial |
$2,880.10
|
| Rate for Payer: First Health Commercial |
$3,296.50
|
| Rate for Payer: Humana Commercial |
$2,949.50
|
| Rate for Payer: Humana KY Medicaid |
$1,193.33
|
| Rate for Payer: Kentucky WC Medicaid |
$1,205.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,845.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,560.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,041.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,217.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,053.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,602.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,776.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,018.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,394.30
|
| Rate for Payer: PHCS Commercial |
$3,331.20
|
| Rate for Payer: United Healthcare All Payer |
$3,053.60
|
|
|
ADAPTER HIP NECK LENGTH -6MM
|
Facility
|
IP
|
$3,470.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,041.00 |
| Max. Negotiated Rate |
$3,331.20 |
| Rate for Payer: Aetna Commercial |
$2,671.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,706.60
|
| Rate for Payer: Cash Price |
$1,735.00
|
| Rate for Payer: Cigna Commercial |
$2,880.10
|
| Rate for Payer: First Health Commercial |
$3,296.50
|
| Rate for Payer: Humana Commercial |
$2,949.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,845.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,560.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,041.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,053.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,602.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,776.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,018.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,394.30
|
| Rate for Payer: PHCS Commercial |
$3,331.20
|
| Rate for Payer: United Healthcare All Payer |
$3,053.60
|
|
|
ADAPTER HIP NECK LENGTH STD
|
Facility
|
IP
|
$3,470.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,041.00 |
| Max. Negotiated Rate |
$3,331.20 |
| Rate for Payer: Aetna Commercial |
$2,671.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,706.60
|
| Rate for Payer: Cash Price |
$1,735.00
|
| Rate for Payer: Cigna Commercial |
$2,880.10
|
| Rate for Payer: First Health Commercial |
$3,296.50
|
| Rate for Payer: Humana Commercial |
$2,949.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,845.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,560.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,041.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,053.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,602.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,776.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,018.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,394.30
|
| Rate for Payer: PHCS Commercial |
$3,331.20
|
| Rate for Payer: United Healthcare All Payer |
$3,053.60
|
|
|
ADAPTER HIP NECK LENGTH STD
|
Facility
|
OP
|
$3,470.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,041.00 |
| Max. Negotiated Rate |
$3,331.20 |
| Rate for Payer: Aetna Commercial |
$2,671.90
|
| Rate for Payer: Anthem Medicaid |
$1,193.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,706.60
|
| Rate for Payer: Cash Price |
$1,735.00
|
| Rate for Payer: Cigna Commercial |
$2,880.10
|
| Rate for Payer: First Health Commercial |
$3,296.50
|
| Rate for Payer: Humana Commercial |
$2,949.50
|
| Rate for Payer: Humana KY Medicaid |
$1,193.33
|
| Rate for Payer: Kentucky WC Medicaid |
$1,205.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,845.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,560.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,041.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,217.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,053.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,602.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,776.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,018.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,394.30
|
| Rate for Payer: PHCS Commercial |
$3,331.20
|
| Rate for Payer: United Healthcare All Payer |
$3,053.60
|
|
|
ADAPTER TM REV SHL W/BAY 48MM
|
Facility
|
OP
|
$8,956.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,687.04 |
| Max. Negotiated Rate |
$8,598.53 |
| Rate for Payer: Aetna Commercial |
$6,896.74
|
| Rate for Payer: Anthem Medicaid |
$3,080.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,986.30
|
| Rate for Payer: Cash Price |
$4,478.40
|
| Rate for Payer: Cigna Commercial |
$7,434.14
|
| Rate for Payer: First Health Commercial |
$8,508.96
|
| Rate for Payer: Humana Commercial |
$7,613.28
|
| Rate for Payer: Humana KY Medicaid |
$3,080.24
|
| Rate for Payer: Kentucky WC Medicaid |
$3,111.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,344.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,610.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,687.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,142.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,881.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,717.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,165.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,792.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,180.19
|
| Rate for Payer: PHCS Commercial |
$8,598.53
|
| Rate for Payer: United Healthcare All Payer |
$7,881.98
|
|
|
ADAPTER TM REV SHL W/BAY 48MM
|
Facility
|
IP
|
$8,956.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,687.04 |
| Max. Negotiated Rate |
$8,598.53 |
| Rate for Payer: Aetna Commercial |
$6,896.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,986.30
|
| Rate for Payer: Cash Price |
$4,478.40
|
| Rate for Payer: Cigna Commercial |
$7,434.14
|
| Rate for Payer: First Health Commercial |
$8,508.96
|
| Rate for Payer: Humana Commercial |
$7,613.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,344.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,610.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,687.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,881.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,717.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,165.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,792.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,180.19
|
| Rate for Payer: PHCS Commercial |
$8,598.53
|
| Rate for Payer: United Healthcare All Payer |
$7,881.98
|
|
|
ADAPTER TM REV SHL W/BAY 50MM
|
Facility
|
IP
|
$8,956.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,687.04 |
| Max. Negotiated Rate |
$8,598.53 |
| Rate for Payer: Aetna Commercial |
$6,896.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,986.30
|
| Rate for Payer: Cash Price |
$4,478.40
|
| Rate for Payer: Cigna Commercial |
$7,434.14
|
| Rate for Payer: First Health Commercial |
$8,508.96
|
| Rate for Payer: Humana Commercial |
$7,613.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,344.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,610.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,687.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,881.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,717.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,165.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,792.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,180.19
|
| Rate for Payer: PHCS Commercial |
$8,598.53
|
| Rate for Payer: United Healthcare All Payer |
$7,881.98
|
|
|
ADAPTER TM REV SHL W/BAY 50MM
|
Facility
|
OP
|
$8,956.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,687.04 |
| Max. Negotiated Rate |
$8,598.53 |
| Rate for Payer: Aetna Commercial |
$6,896.74
|
| Rate for Payer: Anthem Medicaid |
$3,080.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,986.30
|
| Rate for Payer: Cash Price |
$4,478.40
|
| Rate for Payer: Cigna Commercial |
$7,434.14
|
| Rate for Payer: First Health Commercial |
$8,508.96
|
| Rate for Payer: Humana Commercial |
$7,613.28
|
| Rate for Payer: Humana KY Medicaid |
$3,080.24
|
| Rate for Payer: Kentucky WC Medicaid |
$3,111.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,344.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,610.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,687.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,142.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,881.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,717.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,165.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,792.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,180.19
|
| Rate for Payer: PHCS Commercial |
$8,598.53
|
| Rate for Payer: United Healthcare All Payer |
$7,881.98
|
|
|
ADAPTER TM REV SHL W/BAY 52MM
|
Facility
|
IP
|
$8,956.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,687.04 |
| Max. Negotiated Rate |
$8,598.53 |
| Rate for Payer: Aetna Commercial |
$6,896.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,986.30
|
| Rate for Payer: Cash Price |
$4,478.40
|
| Rate for Payer: Cigna Commercial |
$7,434.14
|
| Rate for Payer: First Health Commercial |
$8,508.96
|
| Rate for Payer: Humana Commercial |
$7,613.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,344.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,610.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,687.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,881.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,717.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,165.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,792.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,180.19
|
| Rate for Payer: PHCS Commercial |
$8,598.53
|
| Rate for Payer: United Healthcare All Payer |
$7,881.98
|
|
|
ADAPTER TM REV SHL W/BAY 52MM
|
Facility
|
OP
|
$8,956.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,687.04 |
| Max. Negotiated Rate |
$8,598.53 |
| Rate for Payer: Aetna Commercial |
$6,896.74
|
| Rate for Payer: Anthem Medicaid |
$3,080.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,986.30
|
| Rate for Payer: Cash Price |
$4,478.40
|
| Rate for Payer: Cigna Commercial |
$7,434.14
|
| Rate for Payer: First Health Commercial |
$8,508.96
|
| Rate for Payer: Humana Commercial |
$7,613.28
|
| Rate for Payer: Humana KY Medicaid |
$3,080.24
|
| Rate for Payer: Kentucky WC Medicaid |
$3,111.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,344.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,610.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,687.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,142.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,881.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,717.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,165.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,792.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,180.19
|
| Rate for Payer: PHCS Commercial |
$8,598.53
|
| Rate for Payer: United Healthcare All Payer |
$7,881.98
|
|
|
ADAPTER TM REV SHL W/BAY 54MM
|
Facility
|
OP
|
$8,956.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,687.04 |
| Max. Negotiated Rate |
$8,598.53 |
| Rate for Payer: Aetna Commercial |
$6,896.74
|
| Rate for Payer: Anthem Medicaid |
$3,080.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,986.30
|
| Rate for Payer: Cash Price |
$4,478.40
|
| Rate for Payer: Cigna Commercial |
$7,434.14
|
| Rate for Payer: First Health Commercial |
$8,508.96
|
| Rate for Payer: Humana Commercial |
$7,613.28
|
| Rate for Payer: Humana KY Medicaid |
$3,080.24
|
| Rate for Payer: Kentucky WC Medicaid |
$3,111.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,344.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,610.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,687.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,142.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,881.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,717.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,165.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,792.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,180.19
|
| Rate for Payer: PHCS Commercial |
$8,598.53
|
| Rate for Payer: United Healthcare All Payer |
$7,881.98
|
|
|
ADAPTER TM REV SHL W/BAY 54MM
|
Facility
|
IP
|
$8,956.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,687.04 |
| Max. Negotiated Rate |
$8,598.53 |
| Rate for Payer: Aetna Commercial |
$6,896.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,986.30
|
| Rate for Payer: Cash Price |
$4,478.40
|
| Rate for Payer: Cigna Commercial |
$7,434.14
|
| Rate for Payer: First Health Commercial |
$8,508.96
|
| Rate for Payer: Humana Commercial |
$7,613.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,344.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,610.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,687.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,881.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,717.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,165.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,792.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,180.19
|
| Rate for Payer: PHCS Commercial |
$8,598.53
|
| Rate for Payer: United Healthcare All Payer |
$7,881.98
|
|
|
ADAPTER TM REV SHL W/BAY 56MM
|
Facility
|
OP
|
$8,956.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,687.04 |
| Max. Negotiated Rate |
$8,598.53 |
| Rate for Payer: Aetna Commercial |
$6,896.74
|
| Rate for Payer: Anthem Medicaid |
$3,080.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,986.30
|
| Rate for Payer: Cash Price |
$4,478.40
|
| Rate for Payer: Cigna Commercial |
$7,434.14
|
| Rate for Payer: First Health Commercial |
$8,508.96
|
| Rate for Payer: Humana Commercial |
$7,613.28
|
| Rate for Payer: Humana KY Medicaid |
$3,080.24
|
| Rate for Payer: Kentucky WC Medicaid |
$3,111.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,344.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,610.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,687.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,142.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,881.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,717.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,165.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,792.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,180.19
|
| Rate for Payer: PHCS Commercial |
$8,598.53
|
| Rate for Payer: United Healthcare All Payer |
$7,881.98
|
|
|
ADAPTER TM REV SHL W/BAY 56MM
|
Facility
|
IP
|
$8,956.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,687.04 |
| Max. Negotiated Rate |
$8,598.53 |
| Rate for Payer: Aetna Commercial |
$6,896.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,986.30
|
| Rate for Payer: Cash Price |
$4,478.40
|
| Rate for Payer: Cigna Commercial |
$7,434.14
|
| Rate for Payer: First Health Commercial |
$8,508.96
|
| Rate for Payer: Humana Commercial |
$7,613.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,344.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,610.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,687.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,881.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,717.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,165.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,792.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,180.19
|
| Rate for Payer: PHCS Commercial |
$8,598.53
|
| Rate for Payer: United Healthcare All Payer |
$7,881.98
|
|
|
ADAPTER TM REV SHL W/BAY 58MM
|
Facility
|
OP
|
$8,956.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,687.04 |
| Max. Negotiated Rate |
$8,598.53 |
| Rate for Payer: Aetna Commercial |
$6,896.74
|
| Rate for Payer: Anthem Medicaid |
$3,080.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,986.30
|
| Rate for Payer: Cash Price |
$4,478.40
|
| Rate for Payer: Cigna Commercial |
$7,434.14
|
| Rate for Payer: First Health Commercial |
$8,508.96
|
| Rate for Payer: Humana Commercial |
$7,613.28
|
| Rate for Payer: Humana KY Medicaid |
$3,080.24
|
| Rate for Payer: Kentucky WC Medicaid |
$3,111.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,344.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,610.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,687.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,142.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,881.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,717.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,165.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,792.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,180.19
|
| Rate for Payer: PHCS Commercial |
$8,598.53
|
| Rate for Payer: United Healthcare All Payer |
$7,881.98
|
|
