|
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
|
|
|
ADAPTER TM REV SHL W/BAY 60MM
|
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 60MM
|
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 62MM
|
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 62MM
|
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 64MM
|
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 64MM
|
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 66MM
|
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 66MM
|
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 68MM
|
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 68MM
|
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 70MM
|
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 70MM
|
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
|
|
|
ADAPTOR 3MM OFFSET
|
Facility
|
IP
|
$5,210.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,563.00 |
| Max. Negotiated Rate |
$5,001.60 |
| Rate for Payer: Aetna Commercial |
$4,011.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,063.80
|
| Rate for Payer: Cash Price |
$2,605.00
|
| Rate for Payer: Cigna Commercial |
$4,324.30
|
| Rate for Payer: First Health Commercial |
$4,949.50
|
| Rate for Payer: Humana Commercial |
$4,428.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,272.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,844.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,563.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,584.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,907.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,168.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,532.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,594.90
|
| Rate for Payer: PHCS Commercial |
$5,001.60
|
| Rate for Payer: United Healthcare All Payer |
$4,584.80
|
|
|
ADAPTOR 3MM OFFSET
|
Facility
|
OP
|
$5,210.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,563.00 |
| Max. Negotiated Rate |
$5,001.60 |
| Rate for Payer: Aetna Commercial |
$4,011.70
|
| Rate for Payer: Anthem Medicaid |
$1,791.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,063.80
|
| Rate for Payer: Cash Price |
$2,605.00
|
| Rate for Payer: Cigna Commercial |
$4,324.30
|
| Rate for Payer: First Health Commercial |
$4,949.50
|
| Rate for Payer: Humana Commercial |
$4,428.50
|
| Rate for Payer: Humana KY Medicaid |
$1,791.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1,809.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,272.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,844.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,563.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,827.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,584.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,907.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,168.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,532.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,594.90
|
| Rate for Payer: PHCS Commercial |
$5,001.60
|
| Rate for Payer: United Healthcare All Payer |
$4,584.80
|
|
|
ADAPTOR 4MM OFFSET
|
Facility
|
IP
|
$7,067.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,120.27 |
| Max. Negotiated Rate |
$6,784.86 |
| Rate for Payer: Aetna Commercial |
$5,442.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,512.70
|
| Rate for Payer: Cash Price |
$3,533.78
|
| Rate for Payer: Cigna Commercial |
$5,866.07
|
| Rate for Payer: First Health Commercial |
$6,714.18
|
| Rate for Payer: Humana Commercial |
$6,007.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,795.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,215.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,120.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,219.45
|
| Rate for Payer: Ohio Health Group HMO |
$5,300.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,654.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,148.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,876.62
|
| Rate for Payer: PHCS Commercial |
$6,784.86
|
| Rate for Payer: United Healthcare All Payer |
$6,219.45
|
|
|
ADAPTOR 4MM OFFSET
|
Facility
|
OP
|
$7,067.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,120.27 |
| Max. Negotiated Rate |
$6,784.86 |
| Rate for Payer: Aetna Commercial |
$5,442.02
|
| Rate for Payer: Anthem Medicaid |
$2,430.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,512.70
|
| Rate for Payer: Cash Price |
$3,533.78
|
| Rate for Payer: Cigna Commercial |
$5,866.07
|
| Rate for Payer: First Health Commercial |
$6,714.18
|
| Rate for Payer: Humana Commercial |
$6,007.43
|
| Rate for Payer: Humana KY Medicaid |
$2,430.53
|
| Rate for Payer: Kentucky WC Medicaid |
$2,455.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,795.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,215.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,120.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,479.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,219.45
|
| Rate for Payer: Ohio Health Group HMO |
$5,300.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,654.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,148.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,876.62
|
| Rate for Payer: PHCS Commercial |
$6,784.86
|
| Rate for Payer: United Healthcare All Payer |
$6,219.45
|
|
|
ADAPTOR 8MM OFFSET
|
Facility
|
IP
|
$5,435.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,630.50 |
| Max. Negotiated Rate |
$5,217.60 |
| Rate for Payer: Aetna Commercial |
$4,184.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,239.30
|
| Rate for Payer: Cash Price |
$2,717.50
|
| Rate for Payer: Cigna Commercial |
$4,511.05
|
| Rate for Payer: First Health Commercial |
$5,163.25
|
| Rate for Payer: Humana Commercial |
$4,619.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,456.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,011.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,630.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,782.80
|
| Rate for Payer: Ohio Health Group HMO |
$4,076.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,348.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,728.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,750.15
|
| Rate for Payer: PHCS Commercial |
$5,217.60
|
| Rate for Payer: United Healthcare All Payer |
$4,782.80
|
|
|
ADAPTOR 8MM OFFSET
|
Facility
|
OP
|
$5,435.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,630.50 |
| Max. Negotiated Rate |
$5,217.60 |
| Rate for Payer: Aetna Commercial |
$4,184.95
|
| Rate for Payer: Anthem Medicaid |
$1,869.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,239.30
|
| Rate for Payer: Cash Price |
$2,717.50
|
| Rate for Payer: Cigna Commercial |
$4,511.05
|
| Rate for Payer: First Health Commercial |
$5,163.25
|
| Rate for Payer: Humana Commercial |
$4,619.75
|
| Rate for Payer: Humana KY Medicaid |
$1,869.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,888.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,456.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,011.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,630.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,906.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,782.80
|
| Rate for Payer: Ohio Health Group HMO |
$4,076.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,348.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,728.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,750.15
|
| Rate for Payer: PHCS Commercial |
$5,217.60
|
| Rate for Payer: United Healthcare All Payer |
$4,782.80
|
|
|
ADAPTOR NON-LOCKING
|
Facility
|
OP
|
$1,816.53
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$544.96 |
| Max. Negotiated Rate |
$1,743.87 |
| Rate for Payer: Aetna Commercial |
$1,398.73
|
| Rate for Payer: Anthem Medicaid |
$624.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,416.89
|
| Rate for Payer: Cash Price |
$908.27
|
| Rate for Payer: Cigna Commercial |
$1,507.72
|
| Rate for Payer: First Health Commercial |
$1,725.70
|
| Rate for Payer: Humana Commercial |
$1,544.05
|
| Rate for Payer: Humana KY Medicaid |
$624.70
|
| Rate for Payer: Kentucky WC Medicaid |
$631.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,489.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,340.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$544.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$637.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,598.55
|
| Rate for Payer: Ohio Health Group HMO |
$1,362.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,453.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,580.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,253.41
|
| Rate for Payer: PHCS Commercial |
$1,743.87
|
| Rate for Payer: United Healthcare All Payer |
$1,598.55
|
|
|
ADAPTOR NON-LOCKING
|
Facility
|
IP
|
$1,816.53
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$544.96 |
| Max. Negotiated Rate |
$1,743.87 |
| Rate for Payer: Aetna Commercial |
$1,398.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,416.89
|
| Rate for Payer: Cash Price |
$908.27
|
| Rate for Payer: Cigna Commercial |
$1,507.72
|
| Rate for Payer: First Health Commercial |
$1,725.70
|
| Rate for Payer: Humana Commercial |
$1,544.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,489.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,340.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$544.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,598.55
|
| Rate for Payer: Ohio Health Group HMO |
$1,362.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,453.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,580.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,253.41
|
| Rate for Payer: PHCS Commercial |
$1,743.87
|
| Rate for Payer: United Healthcare All Payer |
$1,598.55
|
|
|
ADAPTOR PIGTAIL G05297
|
Facility
|
OP
|
$1,509.93
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27000036
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$452.98 |
| Max. Negotiated Rate |
$1,449.53 |
| Rate for Payer: Aetna Commercial |
$1,162.65
|
| Rate for Payer: Anthem Medicaid |
$519.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,177.75
|
| Rate for Payer: Cash Price |
$754.96
|
| Rate for Payer: Cigna Commercial |
$1,253.24
|
| Rate for Payer: First Health Commercial |
$1,434.43
|
| Rate for Payer: Humana Commercial |
$1,283.44
|
| Rate for Payer: Humana KY Medicaid |
$519.26
|
| Rate for Payer: Kentucky WC Medicaid |
$524.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,238.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,114.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$452.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$529.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,328.74
|
| Rate for Payer: Ohio Health Group HMO |
$1,132.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,207.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,313.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,041.85
|
| Rate for Payer: PHCS Commercial |
$1,449.53
|
| Rate for Payer: United Healthcare All Payer |
$1,328.74
|
|
|
ADAPTOR PIGTAIL G05297
|
Facility
|
IP
|
$1,509.93
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27000036
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$452.98 |
| Max. Negotiated Rate |
$1,449.53 |
| Rate for Payer: Aetna Commercial |
$1,162.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,177.75
|
| Rate for Payer: Cash Price |
$754.96
|
| Rate for Payer: Cigna Commercial |
$1,253.24
|
| Rate for Payer: First Health Commercial |
$1,434.43
|
| Rate for Payer: Humana Commercial |
$1,283.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,238.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,114.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$452.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,328.74
|
| Rate for Payer: Ohio Health Group HMO |
$1,132.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,207.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,313.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,041.85
|
| Rate for Payer: PHCS Commercial |
$1,449.53
|
| Rate for Payer: United Healthcare All Payer |
$1,328.74
|
|
|
ADCETRIS 50 MG/10 ML VIAL
|
Facility
|
IP
|
$69,083.11
|
|
|
Service Code
|
HCPCS J9042
|
| Hospital Charge Code |
25004006
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20,724.93 |
| Max. Negotiated Rate |
$66,319.79 |
| Rate for Payer: Aetna Commercial |
$53,193.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,884.83
|
| Rate for Payer: Cash Price |
$34,541.56
|
| Rate for Payer: Cigna Commercial |
$57,338.98
|
| Rate for Payer: First Health Commercial |
$65,628.95
|
| Rate for Payer: Humana Commercial |
$58,720.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,648.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,983.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,724.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,793.14
|
| Rate for Payer: Ohio Health Group HMO |
$51,812.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55,266.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60,102.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47,667.35
|
| Rate for Payer: PHCS Commercial |
$66,319.79
|
| Rate for Payer: United Healthcare All Payer |
$60,793.14
|
|
|
ADCETRIS 50 MG/10 ML VIAL
|
Facility
|
OP
|
$69,083.11
|
|
|
Service Code
|
HCPCS J9042
|
| Hospital Charge Code |
25004006
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$258.52 |
| Max. Negotiated Rate |
$66,319.79 |
| Rate for Payer: Aetna Commercial |
$53,193.99
|
| Rate for Payer: Anthem Medicaid |
$23,757.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$258.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,884.83
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$361.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$349.00
|
| Rate for Payer: Cash Price |
$34,541.56
|
| Rate for Payer: Cash Price |
$34,541.56
|
| Rate for Payer: Cigna Commercial |
$57,338.98
|
| Rate for Payer: First Health Commercial |
$65,628.95
|
| Rate for Payer: Humana Commercial |
$58,720.64
|
| Rate for Payer: Humana KY Medicaid |
$23,757.68
|
| Rate for Payer: Humana Medicare Advantage |
$258.52
|
| Rate for Payer: Kentucky WC Medicaid |
$23,999.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,648.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,983.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$310.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,234.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,793.14
|
| Rate for Payer: Ohio Health Group HMO |
$51,812.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55,266.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60,102.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47,667.35
|
| Rate for Payer: PHCS Commercial |
$66,319.79
|
| Rate for Payer: United Healthcare All Payer |
$60,793.14
|
|
