|
DESTRUCT PREMAL LESIONS 15+
|
Facility
|
OP
|
$828.00
|
|
|
Service Code
|
HCPCS 17004
|
| Hospital Charge Code |
76100249
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$107.64 |
| Max. Negotiated Rate |
$794.88 |
| Rate for Payer: Aetna Commercial |
$637.56
|
| Rate for Payer: Anthem Medicaid |
$284.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$645.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$414.00
|
| Rate for Payer: Cash Price |
$414.00
|
| Rate for Payer: Cigna Commercial |
$687.24
|
| Rate for Payer: First Health Commercial |
$786.60
|
| Rate for Payer: Humana Commercial |
$703.80
|
| Rate for Payer: Humana KY Medicaid |
$284.75
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$287.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$678.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$611.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$290.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$728.64
|
| Rate for Payer: Ohio Health Group HMO |
$621.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$165.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$107.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$256.68
|
| Rate for Payer: PHCS Commercial |
$794.88
|
| Rate for Payer: United Healthcare All Payer |
$728.64
|
|
|
DESTRUCT PREMAL LESIONS 15+
|
Professional
|
Both
|
$828.00
|
|
|
Service Code
|
HCPCS 17004
|
| Hospital Charge Code |
76100249
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$88.51 |
| Max. Negotiated Rate |
$828.00 |
| Rate for Payer: Aetna Commercial |
$191.59
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$88.51
|
| Rate for Payer: Anthem Medicaid |
$143.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$828.00
|
| Rate for Payer: Cash Price |
$414.00
|
| Rate for Payer: Cash Price |
$414.00
|
| Rate for Payer: Cigna Commercial |
$231.55
|
| Rate for Payer: Healthspan PPO |
$193.84
|
| Rate for Payer: Humana Medicaid |
$143.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$167.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$146.22
|
| Rate for Payer: Molina Healthcare Passport |
$143.35
|
| Rate for Payer: Multiplan PHCS |
$496.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$579.60
|
| Rate for Payer: UHCCP Medicaid |
$92.94
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$144.78
|
|
|
DESTRUCT PREMAL LESIONS 15+
|
Facility
|
IP
|
$828.00
|
|
|
Service Code
|
HCPCS 17004
|
| Hospital Charge Code |
76100249
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$107.64 |
| Max. Negotiated Rate |
$794.88 |
| Rate for Payer: Aetna Commercial |
$637.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$645.84
|
| Rate for Payer: Cash Price |
$414.00
|
| Rate for Payer: Cigna Commercial |
$687.24
|
| Rate for Payer: First Health Commercial |
$786.60
|
| Rate for Payer: Humana Commercial |
$703.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$678.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$611.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$248.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$728.64
|
| Rate for Payer: Ohio Health Group HMO |
$621.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$165.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$107.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$256.68
|
| Rate for Payer: PHCS Commercial |
$794.88
|
| Rate for Payer: United Healthcare All Payer |
$728.64
|
|
|
DESYREL (TRAZODONE) 50MG/1TAB
|
Facility
|
IP
|
$4.32
|
|
|
Service Code
|
NDC 904686861
|
| Hospital Charge Code |
25000544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.15 |
| Rate for Payer: Aetna Commercial |
$3.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.37
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cigna Commercial |
$3.59
|
| Rate for Payer: First Health Commercial |
$4.10
|
| Rate for Payer: Humana Commercial |
$3.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.80
|
| Rate for Payer: Ohio Health Group HMO |
$3.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.34
|
| Rate for Payer: PHCS Commercial |
$4.15
|
| Rate for Payer: United Healthcare All Payer |
$3.80
|
|
|
DESYREL (TRAZODONE) 50MG/1TAB
|
Facility
|
OP
|
$4.32
|
|
|
Service Code
|
NDC 904686861
|
| Hospital Charge Code |
25000544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.15 |
| Rate for Payer: Aetna Commercial |
$3.33
|
| Rate for Payer: Anthem Medicaid |
$1.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.37
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cigna Commercial |
$3.59
|
| Rate for Payer: First Health Commercial |
$4.10
|
| Rate for Payer: Humana Commercial |
$3.67
|
| Rate for Payer: Humana KY Medicaid |
$1.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.80
|
| Rate for Payer: Ohio Health Group HMO |
$3.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.34
|
| Rate for Payer: PHCS Commercial |
$4.15
|
| Rate for Payer: United Healthcare All Payer |
$3.80
|
|
|
DETROL (TOLTERODINE TART)2MG
|
Facility
|
IP
|
$4.53
|
|
|
Service Code
|
NDC 31722080660
|
| Hospital Charge Code |
25000545
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.35 |
| Rate for Payer: Aetna Commercial |
$3.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.53
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Cigna Commercial |
$3.76
|
| Rate for Payer: First Health Commercial |
$4.30
|
| Rate for Payer: Humana Commercial |
$3.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.99
|
| Rate for Payer: Ohio Health Group HMO |
$3.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.40
|
| Rate for Payer: PHCS Commercial |
$4.35
|
| Rate for Payer: United Healthcare All Payer |
$3.99
|
|
|
DETROL (TOLTERODINE TART)2MG
|
Facility
|
OP
|
$4.53
|
|
|
Service Code
|
NDC 31722080660
|
| Hospital Charge Code |
25000545
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.35 |
| Rate for Payer: Aetna Commercial |
$3.49
|
| Rate for Payer: Anthem Medicaid |
$1.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.53
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Cigna Commercial |
$3.76
|
| Rate for Payer: First Health Commercial |
$4.30
|
| Rate for Payer: Humana Commercial |
$3.85
|
| Rate for Payer: Humana KY Medicaid |
$1.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.99
|
| Rate for Payer: Ohio Health Group HMO |
$3.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.40
|
| Rate for Payer: PHCS Commercial |
$4.35
|
| Rate for Payer: United Healthcare All Payer |
$3.99
|
|
|
DEUCE FEM SZ 3 LT
|
Facility
|
OP
|
$15,282.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,986.69 |
| Max. Negotiated Rate |
$14,670.95 |
| Rate for Payer: Aetna Commercial |
$11,767.32
|
| Rate for Payer: Anthem Medicaid |
$5,255.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,920.15
|
| Rate for Payer: Cash Price |
$7,641.12
|
| Rate for Payer: Cigna Commercial |
$12,684.26
|
| Rate for Payer: First Health Commercial |
$14,518.13
|
| Rate for Payer: Humana Commercial |
$12,989.90
|
| Rate for Payer: Humana KY Medicaid |
$5,255.56
|
| Rate for Payer: Kentucky WC Medicaid |
$5,309.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,531.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,278.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,584.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,361.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,448.37
|
| Rate for Payer: Ohio Health Group HMO |
$11,461.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,056.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,986.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,737.49
|
| Rate for Payer: PHCS Commercial |
$14,670.95
|
| Rate for Payer: United Healthcare All Payer |
$13,448.37
|
|
|
DEUCE FEM SZ 3 LT
|
Facility
|
IP
|
$15,282.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,986.69 |
| Max. Negotiated Rate |
$14,670.95 |
| Rate for Payer: Aetna Commercial |
$11,767.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,920.15
|
| Rate for Payer: Cash Price |
$7,641.12
|
| Rate for Payer: Cigna Commercial |
$12,684.26
|
| Rate for Payer: First Health Commercial |
$14,518.13
|
| Rate for Payer: Humana Commercial |
$12,989.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,531.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,278.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,584.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,448.37
|
| Rate for Payer: Ohio Health Group HMO |
$11,461.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,056.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,986.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,737.49
|
| Rate for Payer: PHCS Commercial |
$14,670.95
|
| Rate for Payer: United Healthcare All Payer |
$13,448.37
|
|
|
DEUCE FEM SZ 3 RT
|
Facility
|
IP
|
$22,996.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,989.50 |
| Max. Negotiated Rate |
$22,076.31 |
| Rate for Payer: Aetna Commercial |
$17,707.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,937.00
|
| Rate for Payer: Cash Price |
$11,498.08
|
| Rate for Payer: Cigna Commercial |
$19,086.81
|
| Rate for Payer: First Health Commercial |
$21,846.35
|
| Rate for Payer: Humana Commercial |
$19,546.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,856.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,971.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,898.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,236.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,247.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,599.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,989.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,128.81
|
| Rate for Payer: PHCS Commercial |
$22,076.31
|
| Rate for Payer: United Healthcare All Payer |
$20,236.62
|
|
|
DEUCE FEM SZ 3 RT
|
Facility
|
OP
|
$22,996.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,989.50 |
| Max. Negotiated Rate |
$22,076.31 |
| Rate for Payer: Aetna Commercial |
$17,707.04
|
| Rate for Payer: Anthem Medicaid |
$7,908.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,937.00
|
| Rate for Payer: Cash Price |
$11,498.08
|
| Rate for Payer: Cigna Commercial |
$19,086.81
|
| Rate for Payer: First Health Commercial |
$21,846.35
|
| Rate for Payer: Humana Commercial |
$19,546.74
|
| Rate for Payer: Humana KY Medicaid |
$7,908.38
|
| Rate for Payer: Kentucky WC Medicaid |
$7,988.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,856.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,971.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,898.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,067.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,236.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,247.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,599.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,989.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,128.81
|
| Rate for Payer: PHCS Commercial |
$22,076.31
|
| Rate for Payer: United Healthcare All Payer |
$20,236.62
|
|
|
DEUCE FEM SZ 4 LT
|
Facility
|
OP
|
$22,996.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,989.50 |
| Max. Negotiated Rate |
$22,076.31 |
| Rate for Payer: Aetna Commercial |
$17,707.04
|
| Rate for Payer: Anthem Medicaid |
$7,908.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,937.00
|
| Rate for Payer: Cash Price |
$11,498.08
|
| Rate for Payer: Cigna Commercial |
$19,086.81
|
| Rate for Payer: First Health Commercial |
$21,846.35
|
| Rate for Payer: Humana Commercial |
$19,546.74
|
| Rate for Payer: Humana KY Medicaid |
$7,908.38
|
| Rate for Payer: Kentucky WC Medicaid |
$7,988.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,856.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,971.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,898.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,067.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,236.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,247.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,599.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,989.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,128.81
|
| Rate for Payer: PHCS Commercial |
$22,076.31
|
| Rate for Payer: United Healthcare All Payer |
$20,236.62
|
|
|
DEUCE FEM SZ 4 LT
|
Facility
|
IP
|
$22,996.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,989.50 |
| Max. Negotiated Rate |
$22,076.31 |
| Rate for Payer: Aetna Commercial |
$17,707.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,937.00
|
| Rate for Payer: Cash Price |
$11,498.08
|
| Rate for Payer: Cigna Commercial |
$19,086.81
|
| Rate for Payer: First Health Commercial |
$21,846.35
|
| Rate for Payer: Humana Commercial |
$19,546.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,856.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,971.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,898.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,236.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,247.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,599.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,989.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,128.81
|
| Rate for Payer: PHCS Commercial |
$22,076.31
|
| Rate for Payer: United Healthcare All Payer |
$20,236.62
|
|
|
DEUCE FEM SZ 4 RT
|
Facility
|
OP
|
$18,077.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,350.02 |
| Max. Negotiated Rate |
$17,354.02 |
| Rate for Payer: Aetna Commercial |
$13,919.37
|
| Rate for Payer: Anthem Medicaid |
$6,216.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,100.14
|
| Rate for Payer: Cash Price |
$9,038.55
|
| Rate for Payer: Cigna Commercial |
$15,003.99
|
| Rate for Payer: First Health Commercial |
$17,173.24
|
| Rate for Payer: Humana Commercial |
$15,365.54
|
| Rate for Payer: Humana KY Medicaid |
$6,216.71
|
| Rate for Payer: Kentucky WC Medicaid |
$6,279.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,823.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,340.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,423.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,341.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,907.85
|
| Rate for Payer: Ohio Health Group HMO |
$13,557.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,615.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,350.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,603.90
|
| Rate for Payer: PHCS Commercial |
$17,354.02
|
| Rate for Payer: United Healthcare All Payer |
$15,907.85
|
|
|
DEUCE FEM SZ 4 RT
|
Facility
|
IP
|
$18,077.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,350.02 |
| Max. Negotiated Rate |
$17,354.02 |
| Rate for Payer: Aetna Commercial |
$13,919.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,100.14
|
| Rate for Payer: Cash Price |
$9,038.55
|
| Rate for Payer: Cigna Commercial |
$15,003.99
|
| Rate for Payer: First Health Commercial |
$17,173.24
|
| Rate for Payer: Humana Commercial |
$15,365.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,823.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,340.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,423.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,907.85
|
| Rate for Payer: Ohio Health Group HMO |
$13,557.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,615.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,350.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,603.90
|
| Rate for Payer: PHCS Commercial |
$17,354.02
|
| Rate for Payer: United Healthcare All Payer |
$15,907.85
|
|
|
DEUCE FEM SZ 5 LT
|
Facility
|
OP
|
$22,996.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,989.50 |
| Max. Negotiated Rate |
$22,076.31 |
| Rate for Payer: Aetna Commercial |
$17,707.04
|
| Rate for Payer: Anthem Medicaid |
$7,908.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,937.00
|
| Rate for Payer: Cash Price |
$11,498.08
|
| Rate for Payer: Cigna Commercial |
$19,086.81
|
| Rate for Payer: First Health Commercial |
$21,846.35
|
| Rate for Payer: Humana Commercial |
$19,546.74
|
| Rate for Payer: Humana KY Medicaid |
$7,908.38
|
| Rate for Payer: Kentucky WC Medicaid |
$7,988.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,856.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,971.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,898.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,067.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,236.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,247.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,599.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,989.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,128.81
|
| Rate for Payer: PHCS Commercial |
$22,076.31
|
| Rate for Payer: United Healthcare All Payer |
$20,236.62
|
|
|
DEUCE FEM SZ 5 LT
|
Facility
|
IP
|
$22,996.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,989.50 |
| Max. Negotiated Rate |
$22,076.31 |
| Rate for Payer: Aetna Commercial |
$17,707.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,937.00
|
| Rate for Payer: Cash Price |
$11,498.08
|
| Rate for Payer: Cigna Commercial |
$19,086.81
|
| Rate for Payer: First Health Commercial |
$21,846.35
|
| Rate for Payer: Humana Commercial |
$19,546.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,856.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,971.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,898.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,236.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,247.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,599.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,989.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,128.81
|
| Rate for Payer: PHCS Commercial |
$22,076.31
|
| Rate for Payer: United Healthcare All Payer |
$20,236.62
|
|
|
DEUCE FEM SZ 5 RT
|
Facility
|
OP
|
$22,996.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,989.50 |
| Max. Negotiated Rate |
$22,076.31 |
| Rate for Payer: Aetna Commercial |
$17,707.04
|
| Rate for Payer: Anthem Medicaid |
$7,908.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,937.00
|
| Rate for Payer: Cash Price |
$11,498.08
|
| Rate for Payer: Cigna Commercial |
$19,086.81
|
| Rate for Payer: First Health Commercial |
$21,846.35
|
| Rate for Payer: Humana Commercial |
$19,546.74
|
| Rate for Payer: Humana KY Medicaid |
$7,908.38
|
| Rate for Payer: Kentucky WC Medicaid |
$7,988.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,856.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,971.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,898.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,067.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,236.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,247.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,599.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,989.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,128.81
|
| Rate for Payer: PHCS Commercial |
$22,076.31
|
| Rate for Payer: United Healthcare All Payer |
$20,236.62
|
|
|
DEUCE FEM SZ 5 RT
|
Facility
|
IP
|
$22,996.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,989.50 |
| Max. Negotiated Rate |
$22,076.31 |
| Rate for Payer: Aetna Commercial |
$17,707.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,937.00
|
| Rate for Payer: Cash Price |
$11,498.08
|
| Rate for Payer: Cigna Commercial |
$19,086.81
|
| Rate for Payer: First Health Commercial |
$21,846.35
|
| Rate for Payer: Humana Commercial |
$19,546.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,856.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,971.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,898.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,236.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,247.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,599.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,989.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,128.81
|
| Rate for Payer: PHCS Commercial |
$22,076.31
|
| Rate for Payer: United Healthcare All Payer |
$20,236.62
|
|
|
DEUCE FEM SZ 6 LT
|
Facility
|
IP
|
$22,996.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,989.50 |
| Max. Negotiated Rate |
$22,076.31 |
| Rate for Payer: Humana Commercial |
$19,546.74
|
| Rate for Payer: Aetna Commercial |
$17,707.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,937.00
|
| Rate for Payer: Cash Price |
$11,498.08
|
| Rate for Payer: Cigna Commercial |
$19,086.81
|
| Rate for Payer: First Health Commercial |
$21,846.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,856.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,971.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,898.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,236.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,247.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,599.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,989.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,128.81
|
| Rate for Payer: PHCS Commercial |
$22,076.31
|
| Rate for Payer: United Healthcare All Payer |
$20,236.62
|
|
|
DEUCE FEM SZ 6 LT
|
Facility
|
OP
|
$22,996.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,989.50 |
| Max. Negotiated Rate |
$22,076.31 |
| Rate for Payer: Aetna Commercial |
$17,707.04
|
| Rate for Payer: Anthem Medicaid |
$7,908.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,937.00
|
| Rate for Payer: Cash Price |
$11,498.08
|
| Rate for Payer: Cigna Commercial |
$19,086.81
|
| Rate for Payer: First Health Commercial |
$21,846.35
|
| Rate for Payer: Humana Commercial |
$19,546.74
|
| Rate for Payer: Humana KY Medicaid |
$7,908.38
|
| Rate for Payer: Kentucky WC Medicaid |
$7,988.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,856.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,971.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,898.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,067.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,236.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,247.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,599.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,989.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,128.81
|
| Rate for Payer: PHCS Commercial |
$22,076.31
|
| Rate for Payer: United Healthcare All Payer |
$20,236.62
|
|
|
DEUCE FEM SZ 6 RT
|
Facility
|
OP
|
$22,996.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,989.50 |
| Max. Negotiated Rate |
$22,076.31 |
| Rate for Payer: Aetna Commercial |
$17,707.04
|
| Rate for Payer: Anthem Medicaid |
$7,908.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,937.00
|
| Rate for Payer: Cash Price |
$11,498.08
|
| Rate for Payer: Cigna Commercial |
$19,086.81
|
| Rate for Payer: First Health Commercial |
$21,846.35
|
| Rate for Payer: Humana Commercial |
$19,546.74
|
| Rate for Payer: Humana KY Medicaid |
$7,908.38
|
| Rate for Payer: Kentucky WC Medicaid |
$7,988.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,856.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,971.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,898.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,067.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,236.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,247.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,599.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,989.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,128.81
|
| Rate for Payer: PHCS Commercial |
$22,076.31
|
| Rate for Payer: United Healthcare All Payer |
$20,236.62
|
|
|
DEUCE FEM SZ 6 RT
|
Facility
|
IP
|
$22,996.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,989.50 |
| Max. Negotiated Rate |
$22,076.31 |
| Rate for Payer: Aetna Commercial |
$17,707.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,937.00
|
| Rate for Payer: Cash Price |
$11,498.08
|
| Rate for Payer: Cigna Commercial |
$19,086.81
|
| Rate for Payer: First Health Commercial |
$21,846.35
|
| Rate for Payer: Humana Commercial |
$19,546.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,856.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,971.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,898.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,236.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,247.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,599.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,989.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,128.81
|
| Rate for Payer: PHCS Commercial |
$22,076.31
|
| Rate for Payer: United Healthcare All Payer |
$20,236.62
|
|
|
DEUCE FEM SZ 7 LT
|
Facility
|
IP
|
$22,996.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,989.50 |
| Max. Negotiated Rate |
$22,076.31 |
| Rate for Payer: Aetna Commercial |
$17,707.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,937.00
|
| Rate for Payer: Cash Price |
$11,498.08
|
| Rate for Payer: Cigna Commercial |
$19,086.81
|
| Rate for Payer: First Health Commercial |
$21,846.35
|
| Rate for Payer: Humana Commercial |
$19,546.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,856.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,971.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,898.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,236.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,247.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,599.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,989.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,128.81
|
| Rate for Payer: PHCS Commercial |
$22,076.31
|
| Rate for Payer: United Healthcare All Payer |
$20,236.62
|
|
|
DEUCE FEM SZ 7 LT
|
Facility
|
OP
|
$22,996.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,989.50 |
| Max. Negotiated Rate |
$22,076.31 |
| Rate for Payer: Aetna Commercial |
$17,707.04
|
| Rate for Payer: Anthem Medicaid |
$7,908.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,937.00
|
| Rate for Payer: Cash Price |
$11,498.08
|
| Rate for Payer: Cigna Commercial |
$19,086.81
|
| Rate for Payer: First Health Commercial |
$21,846.35
|
| Rate for Payer: Humana Commercial |
$19,546.74
|
| Rate for Payer: Humana KY Medicaid |
$7,908.38
|
| Rate for Payer: Kentucky WC Medicaid |
$7,988.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,856.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,971.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,898.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,067.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,236.62
|
| Rate for Payer: Ohio Health Group HMO |
$17,247.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,599.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,989.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,128.81
|
| Rate for Payer: PHCS Commercial |
$22,076.31
|
| Rate for Payer: United Healthcare All Payer |
$20,236.62
|
|
