|
COONS DILATOR 12FR
|
Facility
|
IP
|
$478.10
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.15 |
| Max. Negotiated Rate |
$458.98 |
| Rate for Payer: Aetna Commercial |
$368.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$372.92
|
| Rate for Payer: Cash Price |
$239.05
|
| Rate for Payer: Cigna Commercial |
$396.82
|
| Rate for Payer: First Health Commercial |
$454.20
|
| Rate for Payer: Humana Commercial |
$406.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$392.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$352.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$143.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$420.73
|
| Rate for Payer: Ohio Health Group HMO |
$358.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$148.21
|
| Rate for Payer: PHCS Commercial |
$458.98
|
| Rate for Payer: United Healthcare All Payer |
$420.73
|
|
|
COONS DILATOR 14FR
|
Facility
|
IP
|
$478.10
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.15 |
| Max. Negotiated Rate |
$458.98 |
| Rate for Payer: Aetna Commercial |
$368.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$372.92
|
| Rate for Payer: Cash Price |
$239.05
|
| Rate for Payer: Cigna Commercial |
$396.82
|
| Rate for Payer: First Health Commercial |
$454.20
|
| Rate for Payer: Humana Commercial |
$406.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$392.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$352.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$143.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$420.73
|
| Rate for Payer: Ohio Health Group HMO |
$358.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$148.21
|
| Rate for Payer: PHCS Commercial |
$458.98
|
| Rate for Payer: United Healthcare All Payer |
$420.73
|
|
|
COONS DILATOR 14FR
|
Facility
|
OP
|
$478.10
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.15 |
| Max. Negotiated Rate |
$458.98 |
| Rate for Payer: Aetna Commercial |
$368.14
|
| Rate for Payer: Anthem Medicaid |
$164.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$372.92
|
| Rate for Payer: Cash Price |
$239.05
|
| Rate for Payer: Cigna Commercial |
$396.82
|
| Rate for Payer: First Health Commercial |
$454.20
|
| Rate for Payer: Humana Commercial |
$406.38
|
| Rate for Payer: Humana KY Medicaid |
$164.42
|
| Rate for Payer: Kentucky WC Medicaid |
$166.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$392.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$352.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$143.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$167.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$420.73
|
| Rate for Payer: Ohio Health Group HMO |
$358.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$148.21
|
| Rate for Payer: PHCS Commercial |
$458.98
|
| Rate for Payer: United Healthcare All Payer |
$420.73
|
|
|
COONS DILATOR 16FR
|
Facility
|
OP
|
$478.10
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.15 |
| Max. Negotiated Rate |
$458.98 |
| Rate for Payer: Aetna Commercial |
$368.14
|
| Rate for Payer: Anthem Medicaid |
$164.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$372.92
|
| Rate for Payer: Cash Price |
$239.05
|
| Rate for Payer: Cigna Commercial |
$396.82
|
| Rate for Payer: First Health Commercial |
$454.20
|
| Rate for Payer: Humana Commercial |
$406.38
|
| Rate for Payer: Humana KY Medicaid |
$164.42
|
| Rate for Payer: Kentucky WC Medicaid |
$166.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$392.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$352.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$143.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$167.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$420.73
|
| Rate for Payer: Ohio Health Group HMO |
$358.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$148.21
|
| Rate for Payer: PHCS Commercial |
$458.98
|
| Rate for Payer: United Healthcare All Payer |
$420.73
|
|
|
COONS DILATOR 16FR
|
Facility
|
IP
|
$478.10
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.15 |
| Max. Negotiated Rate |
$458.98 |
| Rate for Payer: Aetna Commercial |
$368.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$372.92
|
| Rate for Payer: Cash Price |
$239.05
|
| Rate for Payer: Cigna Commercial |
$396.82
|
| Rate for Payer: First Health Commercial |
$454.20
|
| Rate for Payer: Humana Commercial |
$406.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$392.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$352.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$143.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$420.73
|
| Rate for Payer: Ohio Health Group HMO |
$358.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$148.21
|
| Rate for Payer: PHCS Commercial |
$458.98
|
| Rate for Payer: United Healthcare All Payer |
$420.73
|
|
|
COONS DILATOR 18FR
|
Facility
|
OP
|
$478.10
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.15 |
| Max. Negotiated Rate |
$458.98 |
| Rate for Payer: Anthem Medicaid |
$164.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$372.92
|
| Rate for Payer: Cash Price |
$239.05
|
| Rate for Payer: Cigna Commercial |
$396.82
|
| Rate for Payer: First Health Commercial |
$454.20
|
| Rate for Payer: Humana Commercial |
$406.38
|
| Rate for Payer: Humana KY Medicaid |
$164.42
|
| Rate for Payer: Kentucky WC Medicaid |
$166.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$392.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$352.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$143.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$167.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$420.73
|
| Rate for Payer: Ohio Health Group HMO |
$358.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$148.21
|
| Rate for Payer: PHCS Commercial |
$458.98
|
| Rate for Payer: United Healthcare All Payer |
$420.73
|
| Rate for Payer: Aetna Commercial |
$368.14
|
|
|
COONS DILATOR 18FR
|
Facility
|
IP
|
$478.10
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.15 |
| Max. Negotiated Rate |
$458.98 |
| Rate for Payer: Aetna Commercial |
$368.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$372.92
|
| Rate for Payer: Cash Price |
$239.05
|
| Rate for Payer: Cigna Commercial |
$396.82
|
| Rate for Payer: First Health Commercial |
$454.20
|
| Rate for Payer: Humana Commercial |
$406.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$392.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$352.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$143.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$420.73
|
| Rate for Payer: Ohio Health Group HMO |
$358.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$148.21
|
| Rate for Payer: PHCS Commercial |
$458.98
|
| Rate for Payer: United Healthcare All Payer |
$420.73
|
|
|
COONS DILATOR 20FR
|
Facility
|
IP
|
$504.49
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.58 |
| Max. Negotiated Rate |
$484.31 |
| Rate for Payer: Aetna Commercial |
$388.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$393.50
|
| Rate for Payer: Cash Price |
$252.24
|
| Rate for Payer: Cigna Commercial |
$418.73
|
| Rate for Payer: First Health Commercial |
$479.27
|
| Rate for Payer: Humana Commercial |
$428.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$413.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$372.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$151.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$443.95
|
| Rate for Payer: Ohio Health Group HMO |
$378.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$100.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$156.39
|
| Rate for Payer: PHCS Commercial |
$484.31
|
| Rate for Payer: United Healthcare All Payer |
$443.95
|
|
|
COONS DILATOR 20FR
|
Facility
|
OP
|
$504.49
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.58 |
| Max. Negotiated Rate |
$484.31 |
| Rate for Payer: Aetna Commercial |
$388.46
|
| Rate for Payer: Anthem Medicaid |
$173.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$393.50
|
| Rate for Payer: Cash Price |
$252.24
|
| Rate for Payer: Cigna Commercial |
$418.73
|
| Rate for Payer: First Health Commercial |
$479.27
|
| Rate for Payer: Humana Commercial |
$428.82
|
| Rate for Payer: Humana KY Medicaid |
$173.49
|
| Rate for Payer: Kentucky WC Medicaid |
$175.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$413.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$372.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$151.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$176.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$443.95
|
| Rate for Payer: Ohio Health Group HMO |
$378.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$100.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$156.39
|
| Rate for Payer: PHCS Commercial |
$484.31
|
| Rate for Payer: United Healthcare All Payer |
$443.95
|
|
|
COONS DILATOR 22FR
|
Facility
|
OP
|
$493.57
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.16 |
| Max. Negotiated Rate |
$473.83 |
| Rate for Payer: Aetna Commercial |
$380.05
|
| Rate for Payer: Anthem Medicaid |
$169.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$384.98
|
| Rate for Payer: Cash Price |
$246.78
|
| Rate for Payer: Cigna Commercial |
$409.66
|
| Rate for Payer: First Health Commercial |
$468.89
|
| Rate for Payer: Humana Commercial |
$419.53
|
| Rate for Payer: Humana KY Medicaid |
$169.74
|
| Rate for Payer: Kentucky WC Medicaid |
$171.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$404.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$364.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$148.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$173.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$434.34
|
| Rate for Payer: Ohio Health Group HMO |
$370.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$98.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$153.01
|
| Rate for Payer: PHCS Commercial |
$473.83
|
| Rate for Payer: United Healthcare All Payer |
$434.34
|
|
|
COONS DILATOR 22FR
|
Facility
|
IP
|
$493.57
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.16 |
| Max. Negotiated Rate |
$473.83 |
| Rate for Payer: Aetna Commercial |
$380.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$384.98
|
| Rate for Payer: Cash Price |
$246.78
|
| Rate for Payer: Cigna Commercial |
$409.66
|
| Rate for Payer: First Health Commercial |
$468.89
|
| Rate for Payer: Humana Commercial |
$419.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$404.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$364.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$148.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$434.34
|
| Rate for Payer: Ohio Health Group HMO |
$370.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$98.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$153.01
|
| Rate for Payer: PHCS Commercial |
$473.83
|
| Rate for Payer: United Healthcare All Payer |
$434.34
|
|
|
COPE MANDRIL WIRE GUIDE 18G*60
|
Facility
|
IP
|
$770.14
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.12 |
| Max. Negotiated Rate |
$739.33 |
| Rate for Payer: Aetna Commercial |
$593.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$600.71
|
| Rate for Payer: Cash Price |
$385.07
|
| Rate for Payer: Cigna Commercial |
$639.22
|
| Rate for Payer: First Health Commercial |
$731.63
|
| Rate for Payer: Humana Commercial |
$654.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$631.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$568.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$231.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$677.72
|
| Rate for Payer: Ohio Health Group HMO |
$577.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$154.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$238.74
|
| Rate for Payer: PHCS Commercial |
$739.33
|
| Rate for Payer: United Healthcare All Payer |
$677.72
|
|
|
COPE MANDRIL WIRE GUIDE 18G*60
|
Facility
|
OP
|
$770.14
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.12 |
| Max. Negotiated Rate |
$739.33 |
| Rate for Payer: Aetna Commercial |
$593.01
|
| Rate for Payer: Anthem Medicaid |
$264.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$600.71
|
| Rate for Payer: Cash Price |
$385.07
|
| Rate for Payer: Cigna Commercial |
$639.22
|
| Rate for Payer: First Health Commercial |
$731.63
|
| Rate for Payer: Humana Commercial |
$654.62
|
| Rate for Payer: Humana KY Medicaid |
$264.85
|
| Rate for Payer: Kentucky WC Medicaid |
$267.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$631.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$568.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$231.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$270.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$677.72
|
| Rate for Payer: Ohio Health Group HMO |
$577.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$154.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$238.74
|
| Rate for Payer: PHCS Commercial |
$739.33
|
| Rate for Payer: United Healthcare All Payer |
$677.72
|
|
|
[C]OPIUM & BELLADONNA SUP 1EA
|
Facility
|
OP
|
$86.76
|
|
|
Service Code
|
NDC 574704012
|
| Hospital Charge Code |
25002772
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.28 |
| Max. Negotiated Rate |
$83.29 |
| Rate for Payer: Aetna Commercial |
$66.81
|
| Rate for Payer: Anthem Medicaid |
$29.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67.67
|
| Rate for Payer: Cash Price |
$43.38
|
| Rate for Payer: Cigna Commercial |
$72.01
|
| Rate for Payer: First Health Commercial |
$82.42
|
| Rate for Payer: Humana Commercial |
$73.75
|
| Rate for Payer: Humana KY Medicaid |
$29.84
|
| Rate for Payer: Kentucky WC Medicaid |
$30.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$71.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$64.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$30.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$76.35
|
| Rate for Payer: Ohio Health Group HMO |
$65.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.90
|
| Rate for Payer: PHCS Commercial |
$83.29
|
| Rate for Payer: United Healthcare All Payer |
$76.35
|
|
|
[C]OPIUM & BELLADONNA SUP 1EA
|
Facility
|
IP
|
$86.76
|
|
|
Service Code
|
NDC 574704012
|
| Hospital Charge Code |
25002772
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.28 |
| Max. Negotiated Rate |
$83.29 |
| Rate for Payer: Aetna Commercial |
$66.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67.67
|
| Rate for Payer: Cash Price |
$43.38
|
| Rate for Payer: Cigna Commercial |
$72.01
|
| Rate for Payer: First Health Commercial |
$82.42
|
| Rate for Payer: Humana Commercial |
$73.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$71.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$64.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$76.35
|
| Rate for Payer: Ohio Health Group HMO |
$65.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.90
|
| Rate for Payer: PHCS Commercial |
$83.29
|
| Rate for Payer: United Healthcare All Payer |
$76.35
|
|
|
COPPER CHLORIDE 4MG/10ML VIAL
|
Facility
|
IP
|
$187.71
|
|
|
Service Code
|
NDC 409409201
|
| Hospital Charge Code |
25002963
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$180.20 |
| Rate for Payer: Aetna Commercial |
$144.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$146.41
|
| Rate for Payer: Cash Price |
$93.86
|
| Rate for Payer: Cigna Commercial |
$155.80
|
| Rate for Payer: First Health Commercial |
$178.32
|
| Rate for Payer: Humana Commercial |
$159.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$153.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$138.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$56.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$165.18
|
| Rate for Payer: Ohio Health Group HMO |
$140.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$37.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$58.19
|
| Rate for Payer: PHCS Commercial |
$180.20
|
| Rate for Payer: United Healthcare All Payer |
$165.18
|
|
|
COPPER CHLORIDE 4MG/10ML VIAL
|
Facility
|
OP
|
$187.71
|
|
|
Service Code
|
NDC 409409201
|
| Hospital Charge Code |
25002963
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$180.20 |
| Rate for Payer: Aetna Commercial |
$144.54
|
| Rate for Payer: Anthem Medicaid |
$64.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$146.41
|
| Rate for Payer: Cash Price |
$93.86
|
| Rate for Payer: Cigna Commercial |
$155.80
|
| Rate for Payer: First Health Commercial |
$178.32
|
| Rate for Payer: Humana Commercial |
$159.55
|
| Rate for Payer: Humana KY Medicaid |
$64.55
|
| Rate for Payer: Kentucky WC Medicaid |
$65.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$153.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$138.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$56.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$65.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$165.18
|
| Rate for Payer: Ohio Health Group HMO |
$140.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$37.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$58.19
|
| Rate for Payer: PHCS Commercial |
$180.20
|
| Rate for Payer: United Healthcare All Payer |
$165.18
|
|
|
CORAIL2 LAT COXA VARA SIZE 10
|
Facility
|
OP
|
$22,498.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,924.85 |
| Max. Negotiated Rate |
$21,598.90 |
| Rate for Payer: Aetna Commercial |
$17,324.11
|
| Rate for Payer: Anthem Medicaid |
$7,737.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,549.10
|
| Rate for Payer: Cash Price |
$11,249.42
|
| Rate for Payer: Cigna Commercial |
$18,674.05
|
| Rate for Payer: First Health Commercial |
$21,373.91
|
| Rate for Payer: Humana Commercial |
$19,124.02
|
| Rate for Payer: Humana KY Medicaid |
$7,737.35
|
| Rate for Payer: Kentucky WC Medicaid |
$7,816.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,449.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,604.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,749.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,892.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,798.99
|
| Rate for Payer: Ohio Health Group HMO |
$16,874.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,499.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,924.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,974.64
|
| Rate for Payer: PHCS Commercial |
$21,598.90
|
| Rate for Payer: United Healthcare All Payer |
$19,798.99
|
|
|
CORAIL2 LAT COXA VARA SIZE 10
|
Facility
|
IP
|
$22,498.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,924.85 |
| Max. Negotiated Rate |
$21,598.90 |
| Rate for Payer: Aetna Commercial |
$17,324.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,549.10
|
| Rate for Payer: Cash Price |
$11,249.42
|
| Rate for Payer: Cigna Commercial |
$18,674.05
|
| Rate for Payer: First Health Commercial |
$21,373.91
|
| Rate for Payer: Humana Commercial |
$19,124.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,449.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,604.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,749.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,798.99
|
| Rate for Payer: Ohio Health Group HMO |
$16,874.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,499.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,924.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,974.64
|
| Rate for Payer: PHCS Commercial |
$21,598.90
|
| Rate for Payer: United Healthcare All Payer |
$19,798.99
|
|
|
CORAIL2 LAT COXA VARA SIZE 11
|
Facility
|
IP
|
$22,498.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,924.85 |
| Max. Negotiated Rate |
$21,598.90 |
| Rate for Payer: Aetna Commercial |
$17,324.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,549.10
|
| Rate for Payer: Cash Price |
$11,249.42
|
| Rate for Payer: Cigna Commercial |
$18,674.05
|
| Rate for Payer: First Health Commercial |
$21,373.91
|
| Rate for Payer: Humana Commercial |
$19,124.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,449.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,604.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,749.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,798.99
|
| Rate for Payer: Ohio Health Group HMO |
$16,874.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,499.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,924.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,974.64
|
| Rate for Payer: PHCS Commercial |
$21,598.90
|
| Rate for Payer: United Healthcare All Payer |
$19,798.99
|
|
|
CORAIL2 LAT COXA VARA SIZE 11
|
Facility
|
OP
|
$22,498.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,924.85 |
| Max. Negotiated Rate |
$21,598.90 |
| Rate for Payer: Aetna Commercial |
$17,324.11
|
| Rate for Payer: Anthem Medicaid |
$7,737.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,549.10
|
| Rate for Payer: Cash Price |
$11,249.42
|
| Rate for Payer: Cigna Commercial |
$18,674.05
|
| Rate for Payer: First Health Commercial |
$21,373.91
|
| Rate for Payer: Humana Commercial |
$19,124.02
|
| Rate for Payer: Humana KY Medicaid |
$7,737.35
|
| Rate for Payer: Kentucky WC Medicaid |
$7,816.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,449.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,604.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,749.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,892.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,798.99
|
| Rate for Payer: Ohio Health Group HMO |
$16,874.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,499.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,924.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,974.64
|
| Rate for Payer: PHCS Commercial |
$21,598.90
|
| Rate for Payer: United Healthcare All Payer |
$19,798.99
|
|
|
CORAIL2 LAT COXA VARA SIZE 12
|
Facility
|
IP
|
$22,498.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,924.85 |
| Max. Negotiated Rate |
$21,598.90 |
| Rate for Payer: Aetna Commercial |
$17,324.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,549.10
|
| Rate for Payer: Cash Price |
$11,249.42
|
| Rate for Payer: Cigna Commercial |
$18,674.05
|
| Rate for Payer: First Health Commercial |
$21,373.91
|
| Rate for Payer: Humana Commercial |
$19,124.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,449.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,604.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,749.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,798.99
|
| Rate for Payer: Ohio Health Group HMO |
$16,874.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,499.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,924.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,974.64
|
| Rate for Payer: PHCS Commercial |
$21,598.90
|
| Rate for Payer: United Healthcare All Payer |
$19,798.99
|
|
|
CORAIL2 LAT COXA VARA SIZE 12
|
Facility
|
OP
|
$22,498.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,924.85 |
| Max. Negotiated Rate |
$21,598.90 |
| Rate for Payer: Aetna Commercial |
$17,324.11
|
| Rate for Payer: Anthem Medicaid |
$7,737.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,549.10
|
| Rate for Payer: Cash Price |
$11,249.42
|
| Rate for Payer: Cigna Commercial |
$18,674.05
|
| Rate for Payer: First Health Commercial |
$21,373.91
|
| Rate for Payer: Humana Commercial |
$19,124.02
|
| Rate for Payer: Humana KY Medicaid |
$7,737.35
|
| Rate for Payer: Kentucky WC Medicaid |
$7,816.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,449.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,604.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,749.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,892.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,798.99
|
| Rate for Payer: Ohio Health Group HMO |
$16,874.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,499.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,924.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,974.64
|
| Rate for Payer: PHCS Commercial |
$21,598.90
|
| Rate for Payer: United Healthcare All Payer |
$19,798.99
|
|
|
CORAIL2 LAT COXA VARA SIZE 13
|
Facility
|
OP
|
$21,499.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,794.92 |
| Max. Negotiated Rate |
$20,639.40 |
| Rate for Payer: Aetna Commercial |
$16,554.51
|
| Rate for Payer: Anthem Medicaid |
$7,393.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,769.51
|
| Rate for Payer: Cash Price |
$10,749.69
|
| Rate for Payer: Cigna Commercial |
$17,844.48
|
| Rate for Payer: First Health Commercial |
$20,424.40
|
| Rate for Payer: Humana Commercial |
$18,274.46
|
| Rate for Payer: Humana KY Medicaid |
$7,393.63
|
| Rate for Payer: Kentucky WC Medicaid |
$7,468.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,629.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,866.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,449.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,541.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,919.45
|
| Rate for Payer: Ohio Health Group HMO |
$16,124.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,299.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,794.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,664.80
|
| Rate for Payer: PHCS Commercial |
$20,639.40
|
| Rate for Payer: United Healthcare All Payer |
$18,919.45
|
|
|
CORAIL2 LAT COXA VARA SIZE 13
|
Facility
|
IP
|
$21,499.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,794.92 |
| Max. Negotiated Rate |
$20,639.40 |
| Rate for Payer: Aetna Commercial |
$16,554.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,769.51
|
| Rate for Payer: Cash Price |
$10,749.69
|
| Rate for Payer: Cigna Commercial |
$17,844.48
|
| Rate for Payer: First Health Commercial |
$20,424.40
|
| Rate for Payer: Humana Commercial |
$18,274.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,629.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,866.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,449.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,919.45
|
| Rate for Payer: Ohio Health Group HMO |
$16,124.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,299.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,794.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,664.80
|
| Rate for Payer: PHCS Commercial |
$20,639.40
|
| Rate for Payer: United Healthcare All Payer |
$18,919.45
|
|
