|
COONS DILATOR 10FR
|
Facility
|
IP
|
$482.45
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$144.74 |
| Max. Negotiated Rate |
$463.15 |
| Rate for Payer: Aetna Commercial |
$371.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$376.31
|
| Rate for Payer: Cash Price |
$241.22
|
| Rate for Payer: Cigna Commercial |
$400.43
|
| Rate for Payer: First Health Commercial |
$458.33
|
| Rate for Payer: Humana Commercial |
$410.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$395.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$356.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$144.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$424.56
|
| Rate for Payer: Ohio Health Group HMO |
$361.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$385.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$419.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$332.89
|
| Rate for Payer: PHCS Commercial |
$463.15
|
| Rate for Payer: United Healthcare All Payer |
$424.56
|
|
|
COONS DILATOR 10FR
|
Facility
|
OP
|
$482.45
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$144.74 |
| Max. Negotiated Rate |
$463.15 |
| Rate for Payer: Aetna Commercial |
$371.49
|
| Rate for Payer: Anthem Medicaid |
$165.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$376.31
|
| Rate for Payer: Cash Price |
$241.22
|
| Rate for Payer: Cigna Commercial |
$400.43
|
| Rate for Payer: First Health Commercial |
$458.33
|
| Rate for Payer: Humana Commercial |
$410.08
|
| Rate for Payer: Humana KY Medicaid |
$165.91
|
| Rate for Payer: Kentucky WC Medicaid |
$167.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$395.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$356.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$144.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$169.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$424.56
|
| Rate for Payer: Ohio Health Group HMO |
$361.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$385.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$419.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$332.89
|
| Rate for Payer: PHCS Commercial |
$463.15
|
| Rate for Payer: United Healthcare All Payer |
$424.56
|
|
|
COONS DILATOR 12FR
|
Facility
|
IP
|
$493.18
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$147.95 |
| Max. Negotiated Rate |
$473.45 |
| Rate for Payer: Aetna Commercial |
$379.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$384.68
|
| Rate for Payer: Cash Price |
$246.59
|
| Rate for Payer: Cigna Commercial |
$409.34
|
| Rate for Payer: First Health Commercial |
$468.52
|
| Rate for Payer: Humana Commercial |
$419.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$404.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$363.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$147.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$434.00
|
| Rate for Payer: Ohio Health Group HMO |
$369.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$394.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$429.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$340.29
|
| Rate for Payer: PHCS Commercial |
$473.45
|
| Rate for Payer: United Healthcare All Payer |
$434.00
|
|
|
COONS DILATOR 12FR
|
Facility
|
OP
|
$493.18
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$147.95 |
| Max. Negotiated Rate |
$473.45 |
| Rate for Payer: Aetna Commercial |
$379.75
|
| Rate for Payer: Anthem Medicaid |
$169.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$384.68
|
| Rate for Payer: Cash Price |
$246.59
|
| Rate for Payer: Cigna Commercial |
$409.34
|
| Rate for Payer: First Health Commercial |
$468.52
|
| Rate for Payer: Humana Commercial |
$419.20
|
| Rate for Payer: Humana KY Medicaid |
$169.60
|
| Rate for Payer: Kentucky WC Medicaid |
$171.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$404.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$363.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$147.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$173.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$434.00
|
| Rate for Payer: Ohio Health Group HMO |
$369.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$394.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$429.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$340.29
|
| Rate for Payer: PHCS Commercial |
$473.45
|
| Rate for Payer: United Healthcare All Payer |
$434.00
|
|
|
COONS DILATOR 14FR
|
Facility
|
IP
|
$482.45
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$144.74 |
| Max. Negotiated Rate |
$463.15 |
| Rate for Payer: Aetna Commercial |
$371.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$376.31
|
| Rate for Payer: Cash Price |
$241.22
|
| Rate for Payer: Cigna Commercial |
$400.43
|
| Rate for Payer: First Health Commercial |
$458.33
|
| Rate for Payer: Humana Commercial |
$410.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$395.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$356.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$144.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$424.56
|
| Rate for Payer: Ohio Health Group HMO |
$361.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$385.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$419.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$332.89
|
| Rate for Payer: PHCS Commercial |
$463.15
|
| Rate for Payer: United Healthcare All Payer |
$424.56
|
|
|
COONS DILATOR 14FR
|
Facility
|
OP
|
$482.45
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$144.74 |
| Max. Negotiated Rate |
$463.15 |
| Rate for Payer: Aetna Commercial |
$371.49
|
| Rate for Payer: Anthem Medicaid |
$165.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$376.31
|
| Rate for Payer: Cash Price |
$241.22
|
| Rate for Payer: Cigna Commercial |
$400.43
|
| Rate for Payer: First Health Commercial |
$458.33
|
| Rate for Payer: Humana Commercial |
$410.08
|
| Rate for Payer: Humana KY Medicaid |
$165.91
|
| Rate for Payer: Kentucky WC Medicaid |
$167.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$395.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$356.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$144.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$169.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$424.56
|
| Rate for Payer: Ohio Health Group HMO |
$361.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$385.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$419.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$332.89
|
| Rate for Payer: PHCS Commercial |
$463.15
|
| Rate for Payer: United Healthcare All Payer |
$424.56
|
|
|
COONS DILATOR 16FR
|
Facility
|
IP
|
$482.45
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$144.74 |
| Max. Negotiated Rate |
$463.15 |
| Rate for Payer: Aetna Commercial |
$371.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$376.31
|
| Rate for Payer: Cash Price |
$241.22
|
| Rate for Payer: Cigna Commercial |
$400.43
|
| Rate for Payer: First Health Commercial |
$458.33
|
| Rate for Payer: Humana Commercial |
$410.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$395.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$356.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$144.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$424.56
|
| Rate for Payer: Ohio Health Group HMO |
$361.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$385.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$419.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$332.89
|
| Rate for Payer: PHCS Commercial |
$463.15
|
| Rate for Payer: United Healthcare All Payer |
$424.56
|
|
|
COONS DILATOR 16FR
|
Facility
|
OP
|
$482.45
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$144.74 |
| Max. Negotiated Rate |
$463.15 |
| Rate for Payer: Aetna Commercial |
$371.49
|
| Rate for Payer: Anthem Medicaid |
$165.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$376.31
|
| Rate for Payer: Cash Price |
$241.22
|
| Rate for Payer: Cigna Commercial |
$400.43
|
| Rate for Payer: First Health Commercial |
$458.33
|
| Rate for Payer: Humana Commercial |
$410.08
|
| Rate for Payer: Humana KY Medicaid |
$165.91
|
| Rate for Payer: Kentucky WC Medicaid |
$167.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$395.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$356.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$144.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$169.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$424.56
|
| Rate for Payer: Ohio Health Group HMO |
$361.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$385.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$419.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$332.89
|
| Rate for Payer: PHCS Commercial |
$463.15
|
| Rate for Payer: United Healthcare All Payer |
$424.56
|
|
|
COONS DILATOR 18FR
|
Facility
|
OP
|
$482.45
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$144.74 |
| Max. Negotiated Rate |
$463.15 |
| Rate for Payer: Aetna Commercial |
$371.49
|
| Rate for Payer: Anthem Medicaid |
$165.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$376.31
|
| Rate for Payer: Cash Price |
$241.22
|
| Rate for Payer: Cigna Commercial |
$400.43
|
| Rate for Payer: First Health Commercial |
$458.33
|
| Rate for Payer: Humana Commercial |
$410.08
|
| Rate for Payer: Humana KY Medicaid |
$165.91
|
| Rate for Payer: Kentucky WC Medicaid |
$167.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$395.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$356.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$144.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$169.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$424.56
|
| Rate for Payer: Ohio Health Group HMO |
$361.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$385.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$419.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$332.89
|
| Rate for Payer: PHCS Commercial |
$463.15
|
| Rate for Payer: United Healthcare All Payer |
$424.56
|
|
|
COONS DILATOR 18FR
|
Facility
|
IP
|
$482.45
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$144.74 |
| Max. Negotiated Rate |
$463.15 |
| Rate for Payer: Aetna Commercial |
$371.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$376.31
|
| Rate for Payer: Cash Price |
$241.22
|
| Rate for Payer: Cigna Commercial |
$400.43
|
| Rate for Payer: First Health Commercial |
$458.33
|
| Rate for Payer: Humana Commercial |
$410.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$395.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$356.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$144.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$424.56
|
| Rate for Payer: Ohio Health Group HMO |
$361.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$385.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$419.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$332.89
|
| Rate for Payer: PHCS Commercial |
$463.15
|
| Rate for Payer: United Healthcare All Payer |
$424.56
|
|
|
COONS DILATOR 20FR
|
Facility
|
OP
|
$509.86
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$152.96 |
| Max. Negotiated Rate |
$489.47 |
| Rate for Payer: Aetna Commercial |
$392.59
|
| Rate for Payer: Anthem Medicaid |
$175.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$397.69
|
| Rate for Payer: Cash Price |
$254.93
|
| Rate for Payer: Cigna Commercial |
$423.18
|
| Rate for Payer: First Health Commercial |
$484.37
|
| Rate for Payer: Humana Commercial |
$433.38
|
| Rate for Payer: Humana KY Medicaid |
$175.34
|
| Rate for Payer: Kentucky WC Medicaid |
$177.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$418.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$376.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$152.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$178.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$448.68
|
| Rate for Payer: Ohio Health Group HMO |
$382.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$407.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$443.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$351.80
|
| Rate for Payer: PHCS Commercial |
$489.47
|
| Rate for Payer: United Healthcare All Payer |
$448.68
|
|
|
COONS DILATOR 20FR
|
Facility
|
IP
|
$509.86
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$152.96 |
| Max. Negotiated Rate |
$489.47 |
| Rate for Payer: Aetna Commercial |
$392.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$397.69
|
| Rate for Payer: Cash Price |
$254.93
|
| Rate for Payer: Cigna Commercial |
$423.18
|
| Rate for Payer: First Health Commercial |
$484.37
|
| Rate for Payer: Humana Commercial |
$433.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$418.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$376.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$152.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$448.68
|
| Rate for Payer: Ohio Health Group HMO |
$382.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$407.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$443.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$351.80
|
| Rate for Payer: PHCS Commercial |
$489.47
|
| Rate for Payer: United Healthcare All Payer |
$448.68
|
|
|
COONS DILATOR 22FR
|
Facility
|
OP
|
$498.52
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.56 |
| Max. Negotiated Rate |
$478.58 |
| Rate for Payer: Aetna Commercial |
$383.86
|
| Rate for Payer: Anthem Medicaid |
$171.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$388.85
|
| Rate for Payer: Cash Price |
$249.26
|
| Rate for Payer: Cigna Commercial |
$413.77
|
| Rate for Payer: First Health Commercial |
$473.59
|
| Rate for Payer: Humana Commercial |
$423.74
|
| Rate for Payer: Humana KY Medicaid |
$171.44
|
| Rate for Payer: Kentucky WC Medicaid |
$173.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$408.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$367.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$149.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$174.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$438.70
|
| Rate for Payer: Ohio Health Group HMO |
$373.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$398.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$433.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$343.98
|
| Rate for Payer: PHCS Commercial |
$478.58
|
| Rate for Payer: United Healthcare All Payer |
$438.70
|
|
|
COONS DILATOR 22FR
|
Facility
|
IP
|
$498.52
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.56 |
| Max. Negotiated Rate |
$478.58 |
| Rate for Payer: Aetna Commercial |
$383.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$388.85
|
| Rate for Payer: Cash Price |
$249.26
|
| Rate for Payer: Cigna Commercial |
$413.77
|
| Rate for Payer: First Health Commercial |
$473.59
|
| Rate for Payer: Humana Commercial |
$423.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$408.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$367.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$149.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$438.70
|
| Rate for Payer: Ohio Health Group HMO |
$373.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$398.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$433.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$343.98
|
| Rate for Payer: PHCS Commercial |
$478.58
|
| Rate for Payer: United Healthcare All Payer |
$438.70
|
|
|
COPE MANDRIL WIRE GUIDE 18G*60
|
Facility
|
IP
|
$807.45
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$242.24 |
| Max. Negotiated Rate |
$775.15 |
| Rate for Payer: Aetna Commercial |
$621.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$629.81
|
| Rate for Payer: Cash Price |
$403.72
|
| Rate for Payer: Cigna Commercial |
$670.18
|
| Rate for Payer: First Health Commercial |
$767.08
|
| Rate for Payer: Humana Commercial |
$686.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$662.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$595.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$242.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$710.56
|
| Rate for Payer: Ohio Health Group HMO |
$605.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$645.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$702.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$557.14
|
| Rate for Payer: PHCS Commercial |
$775.15
|
| Rate for Payer: United Healthcare All Payer |
$710.56
|
|
|
COPE MANDRIL WIRE GUIDE 18G*60
|
Facility
|
OP
|
$807.45
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$242.24 |
| Max. Negotiated Rate |
$775.15 |
| Rate for Payer: Aetna Commercial |
$621.74
|
| Rate for Payer: Anthem Medicaid |
$277.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$629.81
|
| Rate for Payer: Cash Price |
$403.72
|
| Rate for Payer: Cigna Commercial |
$670.18
|
| Rate for Payer: First Health Commercial |
$767.08
|
| Rate for Payer: Humana Commercial |
$686.33
|
| Rate for Payer: Humana KY Medicaid |
$277.68
|
| Rate for Payer: Kentucky WC Medicaid |
$280.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$662.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$595.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$242.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$283.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$710.56
|
| Rate for Payer: Ohio Health Group HMO |
$605.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$645.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$702.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$557.14
|
| Rate for Payer: PHCS Commercial |
$775.15
|
| Rate for Payer: United Healthcare All Payer |
$710.56
|
|
|
[C]OPIUM & BELLADONNA SUP 1EA
|
Facility
|
OP
|
$86.76
|
|
|
Service Code
|
NDC 574704012
|
| Hospital Charge Code |
25002772
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.03 |
| 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 |
$69.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59.86
|
| 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 |
$26.03 |
| 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 |
$69.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59.86
|
| Rate for Payer: PHCS Commercial |
$83.29
|
| Rate for Payer: United Healthcare All Payer |
$76.35
|
|
|
COPPER CHLORIDE 4MG/10ML VIAL
|
Facility
|
OP
|
$187.71
|
|
|
Service Code
|
NDC 409409201
|
| Hospital Charge Code |
25002963
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$56.31 |
| 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 |
$150.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$163.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$129.52
|
| Rate for Payer: PHCS Commercial |
$180.20
|
| Rate for Payer: United Healthcare All Payer |
$165.18
|
|
|
COPPER CHLORIDE 4MG/10ML VIAL
|
Facility
|
IP
|
$187.71
|
|
|
Service Code
|
NDC 409409201
|
| Hospital Charge Code |
25002963
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$56.31 |
| 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 |
$150.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$163.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$129.52
|
| Rate for Payer: PHCS Commercial |
$180.20
|
| Rate for Payer: United Healthcare All Payer |
$165.18
|
|
|
CORAIL2 LAT COXA VARA SIZE 10
|
Facility
|
IP
|
$23,183.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,955.12 |
| Max. Negotiated Rate |
$22,256.40 |
| Rate for Payer: Aetna Commercial |
$17,851.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,083.33
|
| Rate for Payer: Cash Price |
$11,591.88
|
| Rate for Payer: Cigna Commercial |
$19,242.51
|
| Rate for Payer: First Health Commercial |
$22,024.56
|
| Rate for Payer: Humana Commercial |
$19,706.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,010.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,109.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,955.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,401.70
|
| Rate for Payer: Ohio Health Group HMO |
$17,387.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,547.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,169.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,996.79
|
| Rate for Payer: PHCS Commercial |
$22,256.40
|
| Rate for Payer: United Healthcare All Payer |
$20,401.70
|
|
|
CORAIL2 LAT COXA VARA SIZE 10
|
Facility
|
OP
|
$23,183.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,955.12 |
| Max. Negotiated Rate |
$22,256.40 |
| Rate for Payer: Aetna Commercial |
$17,851.49
|
| Rate for Payer: Anthem Medicaid |
$7,972.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,083.33
|
| Rate for Payer: Cash Price |
$11,591.88
|
| Rate for Payer: Cigna Commercial |
$19,242.51
|
| Rate for Payer: First Health Commercial |
$22,024.56
|
| Rate for Payer: Humana Commercial |
$19,706.19
|
| Rate for Payer: Humana KY Medicaid |
$7,972.89
|
| Rate for Payer: Kentucky WC Medicaid |
$8,054.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,010.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,109.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,955.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,132.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,401.70
|
| Rate for Payer: Ohio Health Group HMO |
$17,387.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,547.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,169.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,996.79
|
| Rate for Payer: PHCS Commercial |
$22,256.40
|
| Rate for Payer: United Healthcare All Payer |
$20,401.70
|
|
|
CORAIL2 LAT COXA VARA SIZE 11
|
Facility
|
OP
|
$23,183.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,955.12 |
| Max. Negotiated Rate |
$22,256.40 |
| Rate for Payer: Aetna Commercial |
$17,851.49
|
| Rate for Payer: Anthem Medicaid |
$7,972.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,083.33
|
| Rate for Payer: Cash Price |
$11,591.88
|
| Rate for Payer: Cigna Commercial |
$19,242.51
|
| Rate for Payer: First Health Commercial |
$22,024.56
|
| Rate for Payer: Humana Commercial |
$19,706.19
|
| Rate for Payer: Humana KY Medicaid |
$7,972.89
|
| Rate for Payer: Kentucky WC Medicaid |
$8,054.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,010.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,109.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,955.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,132.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,401.70
|
| Rate for Payer: Ohio Health Group HMO |
$17,387.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,547.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,169.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,996.79
|
| Rate for Payer: PHCS Commercial |
$22,256.40
|
| Rate for Payer: United Healthcare All Payer |
$20,401.70
|
|
|
CORAIL2 LAT COXA VARA SIZE 11
|
Facility
|
IP
|
$23,183.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,955.12 |
| Max. Negotiated Rate |
$22,256.40 |
| Rate for Payer: Aetna Commercial |
$17,851.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,083.33
|
| Rate for Payer: Cash Price |
$11,591.88
|
| Rate for Payer: Cigna Commercial |
$19,242.51
|
| Rate for Payer: First Health Commercial |
$22,024.56
|
| Rate for Payer: Humana Commercial |
$19,706.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,010.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,109.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,955.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,401.70
|
| Rate for Payer: Ohio Health Group HMO |
$17,387.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,547.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,169.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,996.79
|
| Rate for Payer: PHCS Commercial |
$22,256.40
|
| Rate for Payer: United Healthcare All Payer |
$20,401.70
|
|
|
CORAIL2 LAT COXA VARA SIZE 12
|
Facility
|
IP
|
$23,183.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,955.12 |
| Max. Negotiated Rate |
$22,256.40 |
| Rate for Payer: Aetna Commercial |
$17,851.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,083.33
|
| Rate for Payer: Cash Price |
$11,591.88
|
| Rate for Payer: Cigna Commercial |
$19,242.51
|
| Rate for Payer: First Health Commercial |
$22,024.56
|
| Rate for Payer: Humana Commercial |
$19,706.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,010.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,109.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,955.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,401.70
|
| Rate for Payer: Ohio Health Group HMO |
$17,387.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,547.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,169.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,996.79
|
| Rate for Payer: PHCS Commercial |
$22,256.40
|
| Rate for Payer: United Healthcare All Payer |
$20,401.70
|
|
