|
COCR HEMI HEAD 55M OD SHT NECK
|
Facility
|
IP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
COCR HEMI HEAD 55M OD SHT NECK
|
Facility
|
OP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem Medicaid |
$2,218.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Humana KY Medicaid |
$2,218.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,240.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,262.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
COCR HEMI HEAD 56M OD MED NECK
|
Facility
|
OP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem Medicaid |
$2,218.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Humana KY Medicaid |
$2,218.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,240.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,262.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
COCR HEMI HEAD 56M OD MED NECK
|
Facility
|
IP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
COCR HEMI HEAD 56M OD SHT NECK
|
Facility
|
IP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
COCR HEMI HEAD 56M OD SHT NECK
|
Facility
|
OP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem Medicaid |
$2,218.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Humana KY Medicaid |
$2,218.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,240.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,262.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
COCR HEMI HEAD 58M OD MED NECK
|
Facility
|
OP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem Medicaid |
$2,218.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Humana KY Medicaid |
$2,218.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,240.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,262.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
COCR HEMI HEAD 58M OD MED NECK
|
Facility
|
IP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
COCR HEMI HEAD 58M OD SHT NECK
|
Facility
|
IP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
COCR HEMI HEAD 58M OD SHT NECK
|
Facility
|
OP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem Medicaid |
$2,218.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Humana KY Medicaid |
$2,218.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,240.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,262.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
COCR HEMI HEAD 60M OD MED NECK
|
Facility
|
OP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem Medicaid |
$2,218.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Humana KY Medicaid |
$2,218.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,240.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,262.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
COCR HEMI HEAD 60M OD MED NECK
|
Facility
|
IP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
COCR HEMI HEAD 60M OD SHT NECK
|
Facility
|
OP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem Medicaid |
$2,218.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Humana KY Medicaid |
$2,218.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,240.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,262.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
COCR HEMI HEAD 60M OD SHT NECK
|
Facility
|
IP
|
$6,450.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.50 |
| Max. Negotiated Rate |
$6,192.00 |
| Rate for Payer: Aetna Commercial |
$4,966.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,031.00
|
| Rate for Payer: Cash Price |
$3,225.00
|
| Rate for Payer: Cigna Commercial |
$5,353.50
|
| Rate for Payer: First Health Commercial |
$6,127.50
|
| Rate for Payer: Humana Commercial |
$5,482.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,289.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,760.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,935.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,676.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$838.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,999.50
|
| Rate for Payer: PHCS Commercial |
$6,192.00
|
| Rate for Payer: United Healthcare All Payer |
$5,676.00
|
|
|
CODA BALLOON CATH 10.0-35-120-
|
Facility
|
IP
|
$3,659.50
|
|
|
Service Code
|
HCPCS C2628
|
| Hospital Charge Code |
27000014
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$475.74 |
| Max. Negotiated Rate |
$3,513.12 |
| Rate for Payer: Aetna Commercial |
$2,817.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,854.41
|
| Rate for Payer: Cash Price |
$1,829.75
|
| Rate for Payer: Cigna Commercial |
$3,037.38
|
| Rate for Payer: First Health Commercial |
$3,476.52
|
| Rate for Payer: Humana Commercial |
$3,110.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,000.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,700.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,097.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,220.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,744.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$731.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$475.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,134.44
|
| Rate for Payer: PHCS Commercial |
$3,513.12
|
| Rate for Payer: United Healthcare All Payer |
$3,220.36
|
|
|
CODA BALLOON CATH 10.0-35-120-
|
Facility
|
OP
|
$3,659.50
|
|
|
Service Code
|
HCPCS C2628
|
| Hospital Charge Code |
27000014
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$475.74 |
| Max. Negotiated Rate |
$3,513.12 |
| Rate for Payer: Aetna Commercial |
$2,817.82
|
| Rate for Payer: Anthem Medicaid |
$1,258.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,854.41
|
| Rate for Payer: Cash Price |
$1,829.75
|
| Rate for Payer: Cigna Commercial |
$3,037.38
|
| Rate for Payer: First Health Commercial |
$3,476.52
|
| Rate for Payer: Humana Commercial |
$3,110.58
|
| Rate for Payer: Humana KY Medicaid |
$1,258.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,271.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,000.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,700.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,097.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,283.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,220.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,744.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$731.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$475.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,134.44
|
| Rate for Payer: PHCS Commercial |
$3,513.12
|
| Rate for Payer: United Healthcare All Payer |
$3,220.36
|
|
|
CODA BALLOON CATH 10.0-35-140-
|
Facility
|
IP
|
$4,121.50
|
|
|
Service Code
|
HCPCS C2628
|
| Hospital Charge Code |
27000014
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$535.80 |
| Max. Negotiated Rate |
$3,956.64 |
| Rate for Payer: Aetna Commercial |
$3,173.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,214.77
|
| Rate for Payer: Cash Price |
$2,060.75
|
| Rate for Payer: Cigna Commercial |
$3,420.84
|
| Rate for Payer: First Health Commercial |
$3,915.42
|
| Rate for Payer: Humana Commercial |
$3,503.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,379.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,041.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,236.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,626.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,091.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$824.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$535.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,277.66
|
| Rate for Payer: PHCS Commercial |
$3,956.64
|
| Rate for Payer: United Healthcare All Payer |
$3,626.92
|
|
|
CODA BALLOON CATH 10.0-35-140-
|
Facility
|
OP
|
$4,121.50
|
|
|
Service Code
|
HCPCS C2628
|
| Hospital Charge Code |
27000014
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$535.80 |
| Max. Negotiated Rate |
$3,956.64 |
| Rate for Payer: Aetna Commercial |
$3,173.56
|
| Rate for Payer: Anthem Medicaid |
$1,417.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,214.77
|
| Rate for Payer: Cash Price |
$2,060.75
|
| Rate for Payer: Cigna Commercial |
$3,420.84
|
| Rate for Payer: First Health Commercial |
$3,915.42
|
| Rate for Payer: Humana Commercial |
$3,503.28
|
| Rate for Payer: Humana KY Medicaid |
$1,417.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,431.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,379.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,041.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,236.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,445.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,626.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,091.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$824.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$535.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,277.66
|
| Rate for Payer: PHCS Commercial |
$3,956.64
|
| Rate for Payer: United Healthcare All Payer |
$3,626.92
|
|
|
CODA BALLOON CATH 32 120 SHAFT
|
Facility
|
OP
|
$4,181.00
|
|
|
Service Code
|
HCPCS C2628
|
| Hospital Charge Code |
27000014
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$543.53 |
| Max. Negotiated Rate |
$4,013.76 |
| Rate for Payer: Aetna Commercial |
$3,219.37
|
| Rate for Payer: Anthem Medicaid |
$1,437.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,261.18
|
| Rate for Payer: Cash Price |
$2,090.50
|
| Rate for Payer: Cigna Commercial |
$3,470.23
|
| Rate for Payer: First Health Commercial |
$3,971.95
|
| Rate for Payer: Humana Commercial |
$3,553.85
|
| Rate for Payer: Humana KY Medicaid |
$1,437.85
|
| Rate for Payer: Kentucky WC Medicaid |
$1,452.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,428.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,085.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,254.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,466.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,679.28
|
| Rate for Payer: Ohio Health Group HMO |
$3,135.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$836.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$543.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,296.11
|
| Rate for Payer: PHCS Commercial |
$4,013.76
|
| Rate for Payer: United Healthcare All Payer |
$3,679.28
|
|
|
CODA BALLOON CATH 32 120 SHAFT
|
Facility
|
IP
|
$4,181.00
|
|
|
Service Code
|
HCPCS C2628
|
| Hospital Charge Code |
27000014
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$543.53 |
| Max. Negotiated Rate |
$4,013.76 |
| Rate for Payer: Aetna Commercial |
$3,219.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,261.18
|
| Rate for Payer: Cash Price |
$2,090.50
|
| Rate for Payer: Cigna Commercial |
$3,470.23
|
| Rate for Payer: First Health Commercial |
$3,971.95
|
| Rate for Payer: Humana Commercial |
$3,553.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,428.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,085.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,254.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,679.28
|
| Rate for Payer: Ohio Health Group HMO |
$3,135.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$836.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$543.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,296.11
|
| Rate for Payer: PHCS Commercial |
$4,013.76
|
| Rate for Payer: United Healthcare All Payer |
$3,679.28
|
|
|
CODEINE 15mg Tablet
|
Facility
|
OP
|
$60.72
|
|
|
Service Code
|
NDC 54024324
|
| Hospital Charge Code |
25004184
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.89 |
| Max. Negotiated Rate |
$58.29 |
| Rate for Payer: Aetna Commercial |
$46.75
|
| Rate for Payer: Anthem Medicaid |
$20.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.36
|
| Rate for Payer: Cash Price |
$30.36
|
| Rate for Payer: Cigna Commercial |
$50.40
|
| Rate for Payer: First Health Commercial |
$57.68
|
| Rate for Payer: Humana Commercial |
$51.61
|
| Rate for Payer: Humana KY Medicaid |
$20.88
|
| Rate for Payer: Kentucky WC Medicaid |
$21.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.43
|
| Rate for Payer: Ohio Health Group HMO |
$45.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.82
|
| Rate for Payer: PHCS Commercial |
$58.29
|
| Rate for Payer: United Healthcare All Payer |
$53.43
|
|
|
CODEINE 15mg Tablet
|
Facility
|
IP
|
$60.72
|
|
|
Service Code
|
NDC 54024324
|
| Hospital Charge Code |
25004184
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.89 |
| Max. Negotiated Rate |
$58.29 |
| Rate for Payer: Aetna Commercial |
$46.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.36
|
| Rate for Payer: Cash Price |
$30.36
|
| Rate for Payer: Cigna Commercial |
$50.40
|
| Rate for Payer: First Health Commercial |
$57.68
|
| Rate for Payer: Humana Commercial |
$51.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.43
|
| Rate for Payer: Ohio Health Group HMO |
$45.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.82
|
| Rate for Payer: PHCS Commercial |
$58.29
|
| Rate for Payer: United Healthcare All Payer |
$53.43
|
|
|
CODFISH IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000734
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Humana KY Medicaid |
$5.22
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Kentucky WC Medicaid |
$5.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
CODFISH IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000734
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
COENZYME Q10 100MG CAPSULE
|
Facility
|
OP
|
$4.39
|
|
|
Service Code
|
NDC 87701040816
|
| Hospital Charge Code |
25000439
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.21 |
| Rate for Payer: Aetna Commercial |
$3.38
|
| Rate for Payer: Anthem Medicaid |
$1.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.42
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cigna Commercial |
$3.64
|
| Rate for Payer: First Health Commercial |
$4.17
|
| Rate for Payer: Humana Commercial |
$3.73
|
| Rate for Payer: Humana KY Medicaid |
$1.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.86
|
| Rate for Payer: Ohio Health Group HMO |
$3.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.36
|
| Rate for Payer: PHCS Commercial |
$4.21
|
| Rate for Payer: United Healthcare All Payer |
$3.86
|
|
