|
CENTRAL SCREW MODULAR 20MM
|
Facility
|
IP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$718.25 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,105.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$718.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,712.75
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
CENTRUM (MULTI VIT/MIN) T 1TAB
|
Facility
|
OP
|
$0.03
|
|
|
Service Code
|
NDC 904264172
|
| Hospital Charge Code |
25000405
|
|
Hospital Revenue Code
|
637
|
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna Commercial |
$0.02
|
| Rate for Payer: Anthem Medicaid |
$0.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.02
|
| Rate for Payer: First Health Commercial |
$0.03
|
| Rate for Payer: Humana Commercial |
$0.03
|
| Rate for Payer: Humana KY Medicaid |
$0.01
|
| Rate for Payer: Kentucky WC Medicaid |
$0.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.03
|
| Rate for Payer: Ohio Health Group HMO |
$0.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.01
|
| Rate for Payer: PHCS Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Payer |
$0.03
|
|
|
CENTRUM (MULTI VIT/MIN) T 1TAB
|
Facility
|
IP
|
$0.03
|
|
|
Service Code
|
NDC 904264172
|
| Hospital Charge Code |
25000405
|
|
Hospital Revenue Code
|
637
|
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Aetna Commercial |
$0.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.02
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cigna Commercial |
$0.02
|
| Rate for Payer: First Health Commercial |
$0.03
|
| Rate for Payer: Humana Commercial |
$0.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.03
|
| Rate for Payer: Ohio Health Group HMO |
$0.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.01
|
| Rate for Payer: PHCS Commercial |
$0.03
|
| Rate for Payer: United Healthcare All Payer |
$0.03
|
|
|
CENTRUM(MULTIVIT W/FE)15ML LIQ
|
Facility
|
OP
|
$4.61
|
|
|
Service Code
|
NDC 5434462
|
| Hospital Charge Code |
25000406
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$4.43 |
| Rate for Payer: Aetna Commercial |
$3.55
|
| Rate for Payer: Anthem Medicaid |
$1.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.60
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cigna Commercial |
$3.83
|
| Rate for Payer: First Health Commercial |
$4.38
|
| Rate for Payer: Humana Commercial |
$3.92
|
| Rate for Payer: Humana KY Medicaid |
$1.59
|
| Rate for Payer: Kentucky WC Medicaid |
$1.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.06
|
| Rate for Payer: Ohio Health Group HMO |
$3.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.43
|
| Rate for Payer: PHCS Commercial |
$4.43
|
| Rate for Payer: United Healthcare All Payer |
$4.06
|
|
|
CENTRUM(MULTIVIT W/FE)15ML LIQ
|
Facility
|
IP
|
$4.61
|
|
|
Service Code
|
NDC 5434462
|
| Hospital Charge Code |
25000406
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$4.43 |
| Rate for Payer: Aetna Commercial |
$3.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.60
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cigna Commercial |
$3.83
|
| Rate for Payer: First Health Commercial |
$4.38
|
| Rate for Payer: Humana Commercial |
$3.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.06
|
| Rate for Payer: Ohio Health Group HMO |
$3.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.43
|
| Rate for Payer: PHCS Commercial |
$4.43
|
| Rate for Payer: United Healthcare All Payer |
$4.06
|
|
|
CEPHULAC (LACTULOSE) SYRU 30ML
|
Facility
|
IP
|
$9.64
|
|
|
Service Code
|
NDC 121115440
|
| Hospital Charge Code |
25000408
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$9.25 |
| Rate for Payer: Aetna Commercial |
$7.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.52
|
| Rate for Payer: Cash Price |
$4.82
|
| Rate for Payer: Cigna Commercial |
$8.00
|
| Rate for Payer: First Health Commercial |
$9.16
|
| Rate for Payer: Humana Commercial |
$8.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.48
|
| Rate for Payer: Ohio Health Group HMO |
$7.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.99
|
| Rate for Payer: PHCS Commercial |
$9.25
|
| Rate for Payer: United Healthcare All Payer |
$8.48
|
|
|
CEPHULAC (LACTULOSE) SYRU 30ML
|
Facility
|
OP
|
$9.64
|
|
|
Service Code
|
NDC 121115440
|
| Hospital Charge Code |
25000408
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$9.25 |
| Rate for Payer: Aetna Commercial |
$7.42
|
| Rate for Payer: Anthem Medicaid |
$3.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.52
|
| Rate for Payer: Cash Price |
$4.82
|
| Rate for Payer: Cigna Commercial |
$8.00
|
| Rate for Payer: First Health Commercial |
$9.16
|
| Rate for Payer: Humana Commercial |
$8.19
|
| Rate for Payer: Humana KY Medicaid |
$3.32
|
| Rate for Payer: Kentucky WC Medicaid |
$3.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.48
|
| Rate for Payer: Ohio Health Group HMO |
$7.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.99
|
| Rate for Payer: PHCS Commercial |
$9.25
|
| Rate for Payer: United Healthcare All Payer |
$8.48
|
|
|
CERAMAX INSRT NEU 52MM 36MM ID
|
Facility
|
OP
|
$20,732.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,695.19 |
| Max. Negotiated Rate |
$19,902.96 |
| Rate for Payer: Aetna Commercial |
$15,963.83
|
| Rate for Payer: Anthem Medicaid |
$7,129.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,171.16
|
| Rate for Payer: Cash Price |
$10,366.12
|
| Rate for Payer: Cigna Commercial |
$17,207.77
|
| Rate for Payer: First Health Commercial |
$19,695.64
|
| Rate for Payer: Humana Commercial |
$17,622.41
|
| Rate for Payer: Humana KY Medicaid |
$7,129.82
|
| Rate for Payer: Kentucky WC Medicaid |
$7,202.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,000.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,300.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,219.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,272.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,244.38
|
| Rate for Payer: Ohio Health Group HMO |
$15,549.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,146.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,695.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,427.00
|
| Rate for Payer: PHCS Commercial |
$19,902.96
|
| Rate for Payer: United Healthcare All Payer |
$18,244.38
|
|
|
CERAMAX INSRT NEU 52MM 36MM ID
|
Facility
|
IP
|
$20,732.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,695.19 |
| Max. Negotiated Rate |
$19,902.96 |
| Rate for Payer: Aetna Commercial |
$15,963.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,171.16
|
| Rate for Payer: Cash Price |
$10,366.12
|
| Rate for Payer: Cigna Commercial |
$17,207.77
|
| Rate for Payer: First Health Commercial |
$19,695.64
|
| Rate for Payer: Humana Commercial |
$17,622.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,000.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,300.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,219.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,244.38
|
| Rate for Payer: Ohio Health Group HMO |
$15,549.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,146.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,695.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,427.00
|
| Rate for Payer: PHCS Commercial |
$19,902.96
|
| Rate for Payer: United Healthcare All Payer |
$18,244.38
|
|
|
CERAMAX INSRT NEU 54MM 36MM ID
|
Facility
|
OP
|
$20,732.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,695.19 |
| Max. Negotiated Rate |
$19,902.96 |
| Rate for Payer: Aetna Commercial |
$15,963.83
|
| Rate for Payer: Anthem Medicaid |
$7,129.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,171.16
|
| Rate for Payer: Cash Price |
$10,366.12
|
| Rate for Payer: Cigna Commercial |
$17,207.77
|
| Rate for Payer: First Health Commercial |
$19,695.64
|
| Rate for Payer: Humana Commercial |
$17,622.41
|
| Rate for Payer: Humana KY Medicaid |
$7,129.82
|
| Rate for Payer: Kentucky WC Medicaid |
$7,202.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,000.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,300.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,219.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,272.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,244.38
|
| Rate for Payer: Ohio Health Group HMO |
$15,549.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,146.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,695.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,427.00
|
| Rate for Payer: PHCS Commercial |
$19,902.96
|
| Rate for Payer: United Healthcare All Payer |
$18,244.38
|
|
|
CERAMAX INSRT NEU 54MM 36MM ID
|
Facility
|
IP
|
$20,732.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,695.19 |
| Max. Negotiated Rate |
$19,902.96 |
| Rate for Payer: Aetna Commercial |
$15,963.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,171.16
|
| Rate for Payer: Cash Price |
$10,366.12
|
| Rate for Payer: Cigna Commercial |
$17,207.77
|
| Rate for Payer: First Health Commercial |
$19,695.64
|
| Rate for Payer: Humana Commercial |
$17,622.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,000.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,300.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,219.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,244.38
|
| Rate for Payer: Ohio Health Group HMO |
$15,549.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,146.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,695.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,427.00
|
| Rate for Payer: PHCS Commercial |
$19,902.96
|
| Rate for Payer: United Healthcare All Payer |
$18,244.38
|
|
|
CERAMAX INSRT NEU 58MM 36MM ID
|
Facility
|
IP
|
$20,732.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,695.19 |
| Max. Negotiated Rate |
$19,902.96 |
| Rate for Payer: Aetna Commercial |
$15,963.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,171.16
|
| Rate for Payer: Cash Price |
$10,366.12
|
| Rate for Payer: Cigna Commercial |
$17,207.77
|
| Rate for Payer: First Health Commercial |
$19,695.64
|
| Rate for Payer: Humana Commercial |
$17,622.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,000.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,300.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,219.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,244.38
|
| Rate for Payer: Ohio Health Group HMO |
$15,549.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,146.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,695.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,427.00
|
| Rate for Payer: PHCS Commercial |
$19,902.96
|
| Rate for Payer: United Healthcare All Payer |
$18,244.38
|
|
|
CERAMAX INSRT NEU 58MM 36MM ID
|
Facility
|
OP
|
$20,732.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,695.19 |
| Max. Negotiated Rate |
$19,902.96 |
| Rate for Payer: Aetna Commercial |
$15,963.83
|
| Rate for Payer: Anthem Medicaid |
$7,129.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,171.16
|
| Rate for Payer: Cash Price |
$10,366.12
|
| Rate for Payer: Cigna Commercial |
$17,207.77
|
| Rate for Payer: First Health Commercial |
$19,695.64
|
| Rate for Payer: Humana Commercial |
$17,622.41
|
| Rate for Payer: Humana KY Medicaid |
$7,129.82
|
| Rate for Payer: Kentucky WC Medicaid |
$7,202.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,000.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,300.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,219.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,272.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,244.38
|
| Rate for Payer: Ohio Health Group HMO |
$15,549.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,146.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,695.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,427.00
|
| Rate for Payer: PHCS Commercial |
$19,902.96
|
| Rate for Payer: United Healthcare All Payer |
$18,244.38
|
|
|
CERAMAX INSRT NEU 60MM 36MM ID
|
Facility
|
IP
|
$20,732.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,695.19 |
| Max. Negotiated Rate |
$19,902.96 |
| Rate for Payer: Aetna Commercial |
$15,963.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,171.16
|
| Rate for Payer: Cash Price |
$10,366.12
|
| Rate for Payer: Cigna Commercial |
$17,207.77
|
| Rate for Payer: First Health Commercial |
$19,695.64
|
| Rate for Payer: Humana Commercial |
$17,622.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,000.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,300.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,219.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,244.38
|
| Rate for Payer: Ohio Health Group HMO |
$15,549.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,146.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,695.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,427.00
|
| Rate for Payer: PHCS Commercial |
$19,902.96
|
| Rate for Payer: United Healthcare All Payer |
$18,244.38
|
|
|
CERAMAX INSRT NEU 60MM 36MM ID
|
Facility
|
OP
|
$20,732.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,695.19 |
| Max. Negotiated Rate |
$19,902.96 |
| Rate for Payer: Aetna Commercial |
$15,963.83
|
| Rate for Payer: Anthem Medicaid |
$7,129.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,171.16
|
| Rate for Payer: Cash Price |
$10,366.12
|
| Rate for Payer: Cigna Commercial |
$17,207.77
|
| Rate for Payer: First Health Commercial |
$19,695.64
|
| Rate for Payer: Humana Commercial |
$17,622.41
|
| Rate for Payer: Humana KY Medicaid |
$7,129.82
|
| Rate for Payer: Kentucky WC Medicaid |
$7,202.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,000.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,300.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,219.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,272.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,244.38
|
| Rate for Payer: Ohio Health Group HMO |
$15,549.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,146.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,695.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,427.00
|
| Rate for Payer: PHCS Commercial |
$19,902.96
|
| Rate for Payer: United Healthcare All Payer |
$18,244.38
|
|
|
CERAMENT G 10ML
|
Facility
|
OP
|
$31,948.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,153.33 |
| Max. Negotiated Rate |
$30,670.75 |
| Rate for Payer: Aetna Commercial |
$24,600.50
|
| Rate for Payer: Anthem Medicaid |
$10,987.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,919.99
|
| Rate for Payer: Cash Price |
$15,974.35
|
| Rate for Payer: Cigna Commercial |
$26,517.42
|
| Rate for Payer: First Health Commercial |
$30,351.26
|
| Rate for Payer: Humana Commercial |
$27,156.40
|
| Rate for Payer: Humana KY Medicaid |
$10,987.16
|
| Rate for Payer: Kentucky WC Medicaid |
$11,098.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,197.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,578.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,584.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,207.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,114.86
|
| Rate for Payer: Ohio Health Group HMO |
$23,961.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,389.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,153.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,904.10
|
| Rate for Payer: PHCS Commercial |
$30,670.75
|
| Rate for Payer: United Healthcare All Payer |
$28,114.86
|
|
|
CERAMENT G 10ML
|
Facility
|
IP
|
$31,948.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,153.33 |
| Max. Negotiated Rate |
$30,670.75 |
| Rate for Payer: Aetna Commercial |
$24,600.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,919.99
|
| Rate for Payer: Cash Price |
$15,974.35
|
| Rate for Payer: Cigna Commercial |
$26,517.42
|
| Rate for Payer: First Health Commercial |
$30,351.26
|
| Rate for Payer: Humana Commercial |
$27,156.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,197.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,578.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,584.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,114.86
|
| Rate for Payer: Ohio Health Group HMO |
$23,961.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,389.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,153.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,904.10
|
| Rate for Payer: PHCS Commercial |
$30,670.75
|
| Rate for Payer: United Healthcare All Payer |
$28,114.86
|
|
|
CERAMENT G 5ML
|
Facility
|
OP
|
$19,848.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,580.36 |
| Max. Negotiated Rate |
$19,054.99 |
| Rate for Payer: First Health Commercial |
$18,856.50
|
| Rate for Payer: Humana Commercial |
$16,871.61
|
| Rate for Payer: Humana KY Medicaid |
$6,826.05
|
| Rate for Payer: Kentucky WC Medicaid |
$6,895.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,276.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,648.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,954.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,963.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,467.08
|
| Rate for Payer: Ohio Health Group HMO |
$14,886.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,969.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,580.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,153.17
|
| Rate for Payer: PHCS Commercial |
$19,054.99
|
| Rate for Payer: United Healthcare All Payer |
$17,467.08
|
| Rate for Payer: Aetna Commercial |
$15,283.69
|
| Rate for Payer: Anthem Medicaid |
$6,826.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,482.18
|
| Rate for Payer: Cash Price |
$9,924.48
|
| Rate for Payer: Cigna Commercial |
$16,474.63
|
|
|
CERAMENT G 5ML
|
Facility
|
IP
|
$19,848.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,580.36 |
| Max. Negotiated Rate |
$19,054.99 |
| Rate for Payer: Aetna Commercial |
$15,283.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,482.18
|
| Rate for Payer: Cash Price |
$9,924.48
|
| Rate for Payer: Cigna Commercial |
$16,474.63
|
| Rate for Payer: First Health Commercial |
$18,856.50
|
| Rate for Payer: Humana Commercial |
$16,871.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,276.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,648.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,954.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,467.08
|
| Rate for Payer: Ohio Health Group HMO |
$14,886.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,969.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,580.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,153.17
|
| Rate for Payer: PHCS Commercial |
$19,054.99
|
| Rate for Payer: United Healthcare All Payer |
$17,467.08
|
|
|
CERCLAGE OF CERVIX NONOBSTET
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 57700
|
| Hospital Charge Code |
76102206
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$169.20 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$453.18
|
| Rate for Payer: Anthem Medicaid |
$169.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,500.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$431.71
|
| Rate for Payer: Healthspan PPO |
$438.79
|
| Rate for Payer: Humana Medicaid |
$169.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$399.97
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$172.58
|
| Rate for Payer: Molina Healthcare Passport |
$169.20
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,050.00
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$170.89
|
|
|
CERCLAGE OF CERVIX NONOBSTET
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 57700
|
| Hospital Charge Code |
76102206
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$450.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$195.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$465.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
CERCLAGE OF CERVIX NONOBSTET
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 57700
|
| Hospital Charge Code |
76102206
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$3,784.94 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem Medicaid |
$515.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,784.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,649.77
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Humana KY Medicaid |
$515.85
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Kentucky WC Medicaid |
$521.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$526.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$195.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$465.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
CERCLAGE OF CERVIX NONOBSTET(P
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 57700
|
| Hospital Charge Code |
761P2206
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$169.20 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$453.18
|
| Rate for Payer: Anthem Medicaid |
$169.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,500.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$431.71
|
| Rate for Payer: Healthspan PPO |
$438.79
|
| Rate for Payer: Humana Medicaid |
$169.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$399.97
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$172.58
|
| Rate for Payer: Molina Healthcare Passport |
$169.20
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,050.00
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$170.89
|
|
|
CERCLAGE OF CERVIX - PREG -
|
Professional
|
Both
|
$6,709.00
|
|
|
Service Code
|
HCPCS 59320
|
| Hospital Charge Code |
72000014
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$130.48 |
| Max. Negotiated Rate |
$6,709.00 |
| Rate for Payer: Aetna Commercial |
$255.67
|
| Rate for Payer: Anthem Medicaid |
$130.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,709.00
|
| Rate for Payer: Cash Price |
$3,354.50
|
| Rate for Payer: Cash Price |
$3,354.50
|
| Rate for Payer: Cigna Commercial |
$236.17
|
| Rate for Payer: Healthspan PPO |
$185.56
|
| Rate for Payer: Humana Medicaid |
$130.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$202.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$133.09
|
| Rate for Payer: Molina Healthcare Passport |
$130.48
|
| Rate for Payer: Multiplan PHCS |
$4,025.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,696.30
|
| Rate for Payer: UHCCP Medicaid |
$2,348.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$131.78
|
|
|
CERCLAGE OF CERVIX - PREG -
|
Facility
|
IP
|
$6,709.00
|
|
|
Service Code
|
HCPCS 59320
|
| Hospital Charge Code |
72000014
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$872.17 |
| Max. Negotiated Rate |
$6,440.64 |
| Rate for Payer: Aetna Commercial |
$5,165.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,233.02
|
| Rate for Payer: Cash Price |
$3,354.50
|
| Rate for Payer: Cigna Commercial |
$5,568.47
|
| Rate for Payer: First Health Commercial |
$6,373.55
|
| Rate for Payer: Humana Commercial |
$5,702.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,501.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,951.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,012.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,903.92
|
| Rate for Payer: Ohio Health Group HMO |
$5,031.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,341.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$872.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,079.79
|
| Rate for Payer: PHCS Commercial |
$6,440.64
|
| Rate for Payer: United Healthcare All Payer |
$5,903.92
|
|
