|
CONRAY 60% 50ML
|
Facility
|
OP
|
$203.79
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
25003918
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.49 |
| Max. Negotiated Rate |
$195.64 |
| Rate for Payer: Kentucky WC Medicaid |
$70.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$167.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$150.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$71.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$179.34
|
| Rate for Payer: Ohio Health Group HMO |
$152.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.17
|
| Rate for Payer: PHCS Commercial |
$195.64
|
| Rate for Payer: United Healthcare All Payer |
$179.34
|
| Rate for Payer: Aetna Commercial |
$156.92
|
| Rate for Payer: Anthem Medicaid |
$70.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$158.96
|
| Rate for Payer: Cash Price |
$101.89
|
| Rate for Payer: Cigna Commercial |
$169.15
|
| Rate for Payer: First Health Commercial |
$193.60
|
| Rate for Payer: Humana Commercial |
$173.22
|
| Rate for Payer: Humana KY Medicaid |
$70.08
|
|
|
CONRAY 60% 50ML
|
Facility
|
IP
|
$203.79
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
25003918
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.49 |
| Max. Negotiated Rate |
$195.64 |
| Rate for Payer: Aetna Commercial |
$156.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$158.96
|
| Rate for Payer: Cash Price |
$101.89
|
| Rate for Payer: Cigna Commercial |
$169.15
|
| Rate for Payer: First Health Commercial |
$193.60
|
| Rate for Payer: Humana Commercial |
$173.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$167.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$150.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$179.34
|
| Rate for Payer: Ohio Health Group HMO |
$152.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.17
|
| Rate for Payer: PHCS Commercial |
$195.64
|
| Rate for Payer: United Healthcare All Payer |
$179.34
|
|
|
CONSERVE TOT A-CL FEM HED 36MM
|
Facility
|
OP
|
$7,362.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$957.12 |
| Max. Negotiated Rate |
$7,068.00 |
| Rate for Payer: Aetna Commercial |
$5,669.12
|
| Rate for Payer: Anthem Medicaid |
$2,531.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
| Rate for Payer: Cash Price |
$3,681.25
|
| Rate for Payer: Cigna Commercial |
$6,110.88
|
| Rate for Payer: First Health Commercial |
$6,994.38
|
| Rate for Payer: Humana Commercial |
$6,258.12
|
| Rate for Payer: Humana KY Medicaid |
$2,531.96
|
| Rate for Payer: Kentucky WC Medicaid |
$2,557.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,582.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
| Rate for Payer: PHCS Commercial |
$7,068.00
|
| Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
|
CONSERVE TOT A-CL FEM HED 36MM
|
Facility
|
IP
|
$7,362.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$957.12 |
| Max. Negotiated Rate |
$7,068.00 |
| Rate for Payer: Aetna Commercial |
$5,669.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
| Rate for Payer: Cash Price |
$3,681.25
|
| Rate for Payer: Cigna Commercial |
$6,110.88
|
| Rate for Payer: First Health Commercial |
$6,994.38
|
| Rate for Payer: Humana Commercial |
$6,258.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
| Rate for Payer: PHCS Commercial |
$7,068.00
|
| Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
|
CONSERVE TOT A-CL FEM HED 38MM
|
Facility
|
IP
|
$7,362.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$957.12 |
| Max. Negotiated Rate |
$7,068.00 |
| Rate for Payer: Aetna Commercial |
$5,669.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
| Rate for Payer: Cash Price |
$3,681.25
|
| Rate for Payer: Cigna Commercial |
$6,110.88
|
| Rate for Payer: First Health Commercial |
$6,994.38
|
| Rate for Payer: Humana Commercial |
$6,258.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
| Rate for Payer: PHCS Commercial |
$7,068.00
|
| Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
|
CONSERVE TOT A-CL FEM HED 38MM
|
Facility
|
OP
|
$7,362.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$957.12 |
| Max. Negotiated Rate |
$7,068.00 |
| Rate for Payer: Aetna Commercial |
$5,669.12
|
| Rate for Payer: Anthem Medicaid |
$2,531.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
| Rate for Payer: Cash Price |
$3,681.25
|
| Rate for Payer: Cigna Commercial |
$6,110.88
|
| Rate for Payer: First Health Commercial |
$6,994.38
|
| Rate for Payer: Humana Commercial |
$6,258.12
|
| Rate for Payer: Humana KY Medicaid |
$2,531.96
|
| Rate for Payer: Kentucky WC Medicaid |
$2,557.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,582.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
| Rate for Payer: PHCS Commercial |
$7,068.00
|
| Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
|
CONSERVE TOT A-CL FEM HED 40MM
|
Facility
|
OP
|
$7,362.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$957.12 |
| Max. Negotiated Rate |
$7,068.00 |
| Rate for Payer: Aetna Commercial |
$5,669.12
|
| Rate for Payer: Anthem Medicaid |
$2,531.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
| Rate for Payer: Cash Price |
$3,681.25
|
| Rate for Payer: Cigna Commercial |
$6,110.88
|
| Rate for Payer: First Health Commercial |
$6,994.38
|
| Rate for Payer: Humana Commercial |
$6,258.12
|
| Rate for Payer: Humana KY Medicaid |
$2,531.96
|
| Rate for Payer: Kentucky WC Medicaid |
$2,557.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,582.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
| Rate for Payer: PHCS Commercial |
$7,068.00
|
| Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
|
CONSERVE TOT A-CL FEM HED 40MM
|
Facility
|
IP
|
$7,362.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$957.12 |
| Max. Negotiated Rate |
$7,068.00 |
| Rate for Payer: Aetna Commercial |
$5,669.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
| Rate for Payer: Cash Price |
$3,681.25
|
| Rate for Payer: Cigna Commercial |
$6,110.88
|
| Rate for Payer: First Health Commercial |
$6,994.38
|
| Rate for Payer: Humana Commercial |
$6,258.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
| Rate for Payer: PHCS Commercial |
$7,068.00
|
| Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
|
CONSERVE TOT A-CL FEM HED 42MM
|
Facility
|
OP
|
$7,362.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$957.12 |
| Max. Negotiated Rate |
$7,068.00 |
| Rate for Payer: Aetna Commercial |
$5,669.12
|
| Rate for Payer: Anthem Medicaid |
$2,531.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
| Rate for Payer: Cash Price |
$3,681.25
|
| Rate for Payer: Cigna Commercial |
$6,110.88
|
| Rate for Payer: First Health Commercial |
$6,994.38
|
| Rate for Payer: Humana Commercial |
$6,258.12
|
| Rate for Payer: Humana KY Medicaid |
$2,531.96
|
| Rate for Payer: Kentucky WC Medicaid |
$2,557.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,582.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
| Rate for Payer: PHCS Commercial |
$7,068.00
|
| Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
|
CONSERVE TOT A-CL FEM HED 42MM
|
Facility
|
IP
|
$7,362.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$957.12 |
| Max. Negotiated Rate |
$7,068.00 |
| Rate for Payer: Aetna Commercial |
$5,669.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
| Rate for Payer: Cash Price |
$3,681.25
|
| Rate for Payer: Cigna Commercial |
$6,110.88
|
| Rate for Payer: First Health Commercial |
$6,994.38
|
| Rate for Payer: Humana Commercial |
$6,258.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
| Rate for Payer: PHCS Commercial |
$7,068.00
|
| Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
|
CONSERVE TOT A-CL FEM HED 44MM
|
Facility
|
IP
|
$7,362.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$957.12 |
| Max. Negotiated Rate |
$7,068.00 |
| Rate for Payer: Aetna Commercial |
$5,669.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
| Rate for Payer: Cash Price |
$3,681.25
|
| Rate for Payer: Cigna Commercial |
$6,110.88
|
| Rate for Payer: First Health Commercial |
$6,994.38
|
| Rate for Payer: Humana Commercial |
$6,258.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
| Rate for Payer: PHCS Commercial |
$7,068.00
|
| Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
|
CONSERVE TOT A-CL FEM HED 44MM
|
Facility
|
OP
|
$7,362.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$957.12 |
| Max. Negotiated Rate |
$7,068.00 |
| Rate for Payer: Aetna Commercial |
$5,669.12
|
| Rate for Payer: Anthem Medicaid |
$2,531.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
| Rate for Payer: Cash Price |
$3,681.25
|
| Rate for Payer: Cigna Commercial |
$6,110.88
|
| Rate for Payer: First Health Commercial |
$6,994.38
|
| Rate for Payer: Humana Commercial |
$6,258.12
|
| Rate for Payer: Humana KY Medicaid |
$2,531.96
|
| Rate for Payer: Kentucky WC Medicaid |
$2,557.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,582.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
| Rate for Payer: PHCS Commercial |
$7,068.00
|
| Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
|
CONSERVE TOT A-CL FEM HED 46MM
|
Facility
|
IP
|
$7,362.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$957.12 |
| Max. Negotiated Rate |
$7,068.00 |
| Rate for Payer: Aetna Commercial |
$5,669.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
| Rate for Payer: Cash Price |
$3,681.25
|
| Rate for Payer: Cigna Commercial |
$6,110.88
|
| Rate for Payer: First Health Commercial |
$6,994.38
|
| Rate for Payer: Humana Commercial |
$6,258.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
| Rate for Payer: PHCS Commercial |
$7,068.00
|
| Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
|
CONSERVE TOT A-CL FEM HED 46MM
|
Facility
|
OP
|
$7,362.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$957.12 |
| Max. Negotiated Rate |
$7,068.00 |
| Rate for Payer: Aetna Commercial |
$5,669.12
|
| Rate for Payer: Anthem Medicaid |
$2,531.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
| Rate for Payer: Cash Price |
$3,681.25
|
| Rate for Payer: Cigna Commercial |
$6,110.88
|
| Rate for Payer: First Health Commercial |
$6,994.38
|
| Rate for Payer: Humana Commercial |
$6,258.12
|
| Rate for Payer: Humana KY Medicaid |
$2,531.96
|
| Rate for Payer: Kentucky WC Medicaid |
$2,557.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,582.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
| Rate for Payer: PHCS Commercial |
$7,068.00
|
| Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
|
CONSERVE TOT A-CL FEM HED 48MM
|
Facility
|
IP
|
$7,362.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$957.12 |
| Max. Negotiated Rate |
$7,068.00 |
| Rate for Payer: Aetna Commercial |
$5,669.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
| Rate for Payer: Cash Price |
$3,681.25
|
| Rate for Payer: Cigna Commercial |
$6,110.88
|
| Rate for Payer: First Health Commercial |
$6,994.38
|
| Rate for Payer: Humana Commercial |
$6,258.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
| Rate for Payer: PHCS Commercial |
$7,068.00
|
| Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
|
CONSERVE TOT A-CL FEM HED 48MM
|
Facility
|
OP
|
$7,362.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$957.12 |
| Max. Negotiated Rate |
$7,068.00 |
| Rate for Payer: Aetna Commercial |
$5,669.12
|
| Rate for Payer: Anthem Medicaid |
$2,531.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
| Rate for Payer: Cash Price |
$3,681.25
|
| Rate for Payer: Cigna Commercial |
$6,110.88
|
| Rate for Payer: First Health Commercial |
$6,994.38
|
| Rate for Payer: Humana Commercial |
$6,258.12
|
| Rate for Payer: Humana KY Medicaid |
$2,531.96
|
| Rate for Payer: Kentucky WC Medicaid |
$2,557.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,582.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
| Rate for Payer: PHCS Commercial |
$7,068.00
|
| Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
|
CONSERVE TOT A-CL FEM HED 50MM
|
Facility
|
OP
|
$7,362.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$957.12 |
| Max. Negotiated Rate |
$7,068.00 |
| Rate for Payer: Aetna Commercial |
$5,669.12
|
| Rate for Payer: Anthem Medicaid |
$2,531.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
| Rate for Payer: Cash Price |
$3,681.25
|
| Rate for Payer: Cigna Commercial |
$6,110.88
|
| Rate for Payer: First Health Commercial |
$6,994.38
|
| Rate for Payer: Humana Commercial |
$6,258.12
|
| Rate for Payer: Humana KY Medicaid |
$2,531.96
|
| Rate for Payer: Kentucky WC Medicaid |
$2,557.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,582.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
| Rate for Payer: PHCS Commercial |
$7,068.00
|
| Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
|
CONSERVE TOT A-CL FEM HED 50MM
|
Facility
|
IP
|
$7,362.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$957.12 |
| Max. Negotiated Rate |
$7,068.00 |
| Rate for Payer: Aetna Commercial |
$5,669.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
| Rate for Payer: Cash Price |
$3,681.25
|
| Rate for Payer: Cigna Commercial |
$6,110.88
|
| Rate for Payer: First Health Commercial |
$6,994.38
|
| Rate for Payer: Humana Commercial |
$6,258.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
| Rate for Payer: PHCS Commercial |
$7,068.00
|
| Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
|
CONSERVE TOT A-CL FEM HED 52MM
|
Facility
|
IP
|
$7,362.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$957.12 |
| Max. Negotiated Rate |
$7,068.00 |
| Rate for Payer: Aetna Commercial |
$5,669.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
| Rate for Payer: Cash Price |
$3,681.25
|
| Rate for Payer: Cigna Commercial |
$6,110.88
|
| Rate for Payer: First Health Commercial |
$6,994.38
|
| Rate for Payer: Humana Commercial |
$6,258.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
| Rate for Payer: PHCS Commercial |
$7,068.00
|
| Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
|
CONSERVE TOT A-CL FEM HED 52MM
|
Facility
|
OP
|
$7,362.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$957.12 |
| Max. Negotiated Rate |
$7,068.00 |
| Rate for Payer: Aetna Commercial |
$5,669.12
|
| Rate for Payer: Anthem Medicaid |
$2,531.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
| Rate for Payer: Cash Price |
$3,681.25
|
| Rate for Payer: Cigna Commercial |
$6,110.88
|
| Rate for Payer: First Health Commercial |
$6,994.38
|
| Rate for Payer: Humana Commercial |
$6,258.12
|
| Rate for Payer: Humana KY Medicaid |
$2,531.96
|
| Rate for Payer: Kentucky WC Medicaid |
$2,557.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,582.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
| Rate for Payer: PHCS Commercial |
$7,068.00
|
| Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
|
CONSERVE TOT A-CL FEM HED 54MM
|
Facility
|
IP
|
$7,362.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$957.12 |
| Max. Negotiated Rate |
$7,068.00 |
| Rate for Payer: Aetna Commercial |
$5,669.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
| Rate for Payer: Cash Price |
$3,681.25
|
| Rate for Payer: Cigna Commercial |
$6,110.88
|
| Rate for Payer: First Health Commercial |
$6,994.38
|
| Rate for Payer: Humana Commercial |
$6,258.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
| Rate for Payer: PHCS Commercial |
$7,068.00
|
| Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
|
CONSERVE TOT A-CL FEM HED 54MM
|
Facility
|
OP
|
$7,362.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$957.12 |
| Max. Negotiated Rate |
$7,068.00 |
| Rate for Payer: Aetna Commercial |
$5,669.12
|
| Rate for Payer: Anthem Medicaid |
$2,531.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
| Rate for Payer: Cash Price |
$3,681.25
|
| Rate for Payer: Cigna Commercial |
$6,110.88
|
| Rate for Payer: First Health Commercial |
$6,994.38
|
| Rate for Payer: Humana Commercial |
$6,258.12
|
| Rate for Payer: Humana KY Medicaid |
$2,531.96
|
| Rate for Payer: Kentucky WC Medicaid |
$2,557.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,582.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
| Rate for Payer: PHCS Commercial |
$7,068.00
|
| Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
|
CONSERVE TOT A-CL FEM HED 56MM
|
Facility
|
OP
|
$7,362.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$957.12 |
| Max. Negotiated Rate |
$7,068.00 |
| Rate for Payer: Aetna Commercial |
$5,669.12
|
| Rate for Payer: Anthem Medicaid |
$2,531.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
| Rate for Payer: Cash Price |
$3,681.25
|
| Rate for Payer: Cigna Commercial |
$6,110.88
|
| Rate for Payer: First Health Commercial |
$6,994.38
|
| Rate for Payer: Humana Commercial |
$6,258.12
|
| Rate for Payer: Humana KY Medicaid |
$2,531.96
|
| Rate for Payer: Kentucky WC Medicaid |
$2,557.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,582.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
| Rate for Payer: PHCS Commercial |
$7,068.00
|
| Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
|
CONSERVE TOT A-CL FEM HED 56MM
|
Facility
|
IP
|
$7,362.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$957.12 |
| Max. Negotiated Rate |
$7,068.00 |
| Rate for Payer: Aetna Commercial |
$5,669.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
| Rate for Payer: Cash Price |
$3,681.25
|
| Rate for Payer: Cigna Commercial |
$6,110.88
|
| Rate for Payer: First Health Commercial |
$6,994.38
|
| Rate for Payer: Humana Commercial |
$6,258.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
| Rate for Payer: PHCS Commercial |
$7,068.00
|
| Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
|
CONSERVE TOT NECK SLEEVE XLG
|
Facility
|
IP
|
$2,050.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
