|
23 SLV MD CONE 2 SPOU TALL SLT
|
Facility
IP
|
$13,317.97
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$10,254.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,388.02
|
| Rate for Payer: Cash Price |
$6,658.99
|
| Rate for Payer: Cigna Commercial |
$11,053.92
|
| Rate for Payer: First Health Commercial |
$12,652.07
|
| Rate for Payer: Humana Commercial |
$11,320.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,920.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,828.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,995.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,719.81
|
| Rate for Payer: Ohio Health Group HMO |
$9,988.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,663.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,731.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,128.57
|
| Rate for Payer: PHCS Commercial |
$12,785.25
|
|
|
23 SLV SM CONE 1 SPOU TALL SLT
|
Facility
OP
|
$13,317.97
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$10,254.84
|
| Rate for Payer: Anthem Medicaid |
$4,580.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,388.02
|
| Rate for Payer: Cash Price |
$6,658.99
|
| Rate for Payer: Cigna Commercial |
$11,053.92
|
| Rate for Payer: First Health Commercial |
$12,652.07
|
| Rate for Payer: Humana Commercial |
$11,320.27
|
| Rate for Payer: Humana KY Medicaid |
$4,580.05
|
| Rate for Payer: Kentucky WC Medicaid |
$4,626.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,920.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,828.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,995.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,671.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,719.81
|
| Rate for Payer: Ohio Health Group HMO |
$9,988.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,663.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,731.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,128.57
|
| Rate for Payer: PHCS Commercial |
$12,785.25
|
| Rate for Payer: United Healthcare All Payer |
$11,719.81
|
|
|
23 SLV SM CONE 1 SPOU TALL SLT
|
Facility
IP
|
$13,317.97
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$10,254.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,388.02
|
| Rate for Payer: Cash Price |
$6,658.99
|
| Rate for Payer: Cigna Commercial |
$11,053.92
|
| Rate for Payer: First Health Commercial |
$12,652.07
|
| Rate for Payer: Humana Commercial |
$11,320.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,920.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,828.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,995.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,719.81
|
| Rate for Payer: Ohio Health Group HMO |
$9,988.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,663.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,731.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,128.57
|
| Rate for Payer: PHCS Commercial |
$12,785.25
|
|
|
23 SLV SM CONE 2 SPOU TALL SLT
|
Facility
IP
|
$13,317.97
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$10,254.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,388.02
|
| Rate for Payer: Cash Price |
$6,658.99
|
| Rate for Payer: Cigna Commercial |
$11,053.92
|
| Rate for Payer: First Health Commercial |
$12,652.07
|
| Rate for Payer: Humana Commercial |
$11,320.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,920.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,828.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,995.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,719.81
|
| Rate for Payer: Ohio Health Group HMO |
$9,988.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,663.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,731.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,128.57
|
| Rate for Payer: PHCS Commercial |
$12,785.25
|
|
|
23 SLV SM CONE 2 SPOU TALL SLT
|
Facility
OP
|
$13,317.97
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$10,254.84
|
| Rate for Payer: Anthem Medicaid |
$4,580.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,388.02
|
| Rate for Payer: Cash Price |
$6,658.99
|
| Rate for Payer: Cigna Commercial |
$11,053.92
|
| Rate for Payer: First Health Commercial |
$12,652.07
|
| Rate for Payer: Humana Commercial |
$11,320.27
|
| Rate for Payer: Humana KY Medicaid |
$4,580.05
|
| Rate for Payer: Kentucky WC Medicaid |
$4,626.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,920.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,828.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,995.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,671.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,719.81
|
| Rate for Payer: Ohio Health Group HMO |
$9,988.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,663.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,731.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,128.57
|
| Rate for Payer: PHCS Commercial |
$12,785.25
|
| Rate for Payer: United Healthcare All Payer |
$11,719.81
|
|
|
25 HYDROXYVITAMIN D2&D3 OS
|
Facility
OP
|
$110.00
|
|
|
Service Code
|
HCPCS 82306
|
| Hospital Charge Code |
30000256
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$105.60 |
| Rate for Payer: Aetna Commercial |
$84.70
|
| Rate for Payer: Anthem Medicaid |
$29.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$29.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.33
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$41.44
|
| Rate for Payer: CareSource Just4Me Medicare |
$29.60
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cigna Commercial |
$91.30
|
| Rate for Payer: First Health Commercial |
$104.50
|
| Rate for Payer: Humana Commercial |
$93.50
|
| Rate for Payer: Humana KY Medicaid |
$29.60
|
| Rate for Payer: Humana Medicare Advantage |
$29.60
|
| Rate for Payer: Kentucky WC Medicaid |
$29.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$90.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$81.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$30.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$96.80
|
| Rate for Payer: Ohio Health Group HMO |
$82.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.10
|
| Rate for Payer: PHCS Commercial |
$105.60
|
| Rate for Payer: United Healthcare All Payer |
$96.80
|
|
|
25 HYDROXYVITAMIN D2&D3 OS
|
Facility
IP
|
$110.00
|
|
|
Service Code
|
HCPCS 82306
|
| Hospital Charge Code |
30000256
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$105.60 |
| Rate for Payer: Aetna Commercial |
$84.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$88.33
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cigna Commercial |
$91.30
|
| Rate for Payer: First Health Commercial |
$104.50
|
| Rate for Payer: Humana Commercial |
$93.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$90.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$81.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$96.80
|
| Rate for Payer: Ohio Health Group HMO |
$82.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.10
|
| Rate for Payer: PHCS Commercial |
$105.60
|
|
|
25 HYDROXYVITAMIN D TOTAL
|
Professional
|
$146.00
|
|
|
Service Code
|
HCPCS 82306
|
| Hospital Charge Code |
30000257
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.76 |
| Max. Negotiated Rate |
$146.00 |
| Rate for Payer: Aetna Commercial |
$54.12
|
| Rate for Payer: Buckeye Individual/Medicaid |
$29.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$146.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.52
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: Cigna Commercial |
$26.13
|
| Rate for Payer: Healthspan PPO |
$31.02
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$29.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.60
|
| Rate for Payer: Multiplan PHCS |
$87.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$38.48
|
| Rate for Payer: UHCCP Medicaid |
$51.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$17.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$29.60
|
|
|
25 HYDROXYVITAMIN D TOTAL
|
Facility
IP
|
$146.00
|
|
|
Service Code
|
HCPCS 82306
|
| Hospital Charge Code |
30000257
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.98 |
| Max. Negotiated Rate |
$140.16 |
| Rate for Payer: Aetna Commercial |
$112.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$117.24
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: Cigna Commercial |
$121.18
|
| Rate for Payer: First Health Commercial |
$138.70
|
| Rate for Payer: Humana Commercial |
$124.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$119.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$107.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$43.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$128.48
|
| Rate for Payer: Ohio Health Group HMO |
$109.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$45.26
|
| Rate for Payer: PHCS Commercial |
$140.16
|
|
|
25 HYDROXYVITAMIN D TOTAL
|
Facility
OP
|
$146.00
|
|
|
Service Code
|
HCPCS 82306
|
| Hospital Charge Code |
30000257
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.98 |
| Max. Negotiated Rate |
$140.16 |
| Rate for Payer: Aetna Commercial |
$112.42
|
| Rate for Payer: Anthem Medicaid |
$29.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$29.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$117.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$41.44
|
| Rate for Payer: CareSource Just4Me Medicare |
$29.60
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: Cigna Commercial |
$121.18
|
| Rate for Payer: First Health Commercial |
$138.70
|
| Rate for Payer: Humana Commercial |
$124.10
|
| Rate for Payer: Humana KY Medicaid |
$29.60
|
| Rate for Payer: Humana Medicare Advantage |
$29.60
|
| Rate for Payer: Kentucky WC Medicaid |
$29.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$119.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$107.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$30.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$128.48
|
| Rate for Payer: Ohio Health Group HMO |
$109.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$29.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$45.26
|
| Rate for Payer: PHCS Commercial |
$140.16
|
| Rate for Payer: United Healthcare All Payer |
$128.48
|
|
|
2.7 MM LOCKING SCREW 10 MM
|
Facility
IP
|
$1,805.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$36,566.41 |
| Rate for Payer: Aetna Commercial |
$1,389.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,407.90
|
| Rate for Payer: Cash Price |
$902.50
|
| Rate for Payer: Cigna Commercial |
$1,498.15
|
| Rate for Payer: First Health Commercial |
$1,714.75
|
| Rate for Payer: Humana Commercial |
$1,534.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,480.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,332.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$541.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,588.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,353.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$361.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$559.55
|
| Rate for Payer: PHCS Commercial |
$1,732.80
|
|
|
2.7 MM LOCKING SCREW 10 MM
|
Facility
OP
|
$1,805.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$36,566.41 |
| Rate for Payer: First Health Commercial |
$1,714.75
|
| Rate for Payer: Aetna Commercial |
$1,389.85
|
| Rate for Payer: Anthem Medicaid |
$620.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,407.90
|
| Rate for Payer: Cash Price |
$902.50
|
| Rate for Payer: Cigna Commercial |
$1,498.15
|
| Rate for Payer: Humana Commercial |
$1,534.25
|
| Rate for Payer: Humana KY Medicaid |
$620.74
|
| Rate for Payer: Kentucky WC Medicaid |
$627.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,480.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,332.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$541.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$633.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,588.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,353.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$361.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$559.55
|
| Rate for Payer: PHCS Commercial |
$1,732.80
|
| Rate for Payer: United Healthcare All Payer |
$1,588.40
|
|
|
2.7 MM LOCKING SCREW 16 MM
|
Facility
IP
|
$1,805.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$36,566.41 |
| Rate for Payer: Aetna Commercial |
$1,389.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,407.90
|
| Rate for Payer: Cash Price |
$902.50
|
| Rate for Payer: Cigna Commercial |
$1,498.15
|
| Rate for Payer: First Health Commercial |
$1,714.75
|
| Rate for Payer: Humana Commercial |
$1,534.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,480.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,332.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$541.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,588.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,353.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$361.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$559.55
|
| Rate for Payer: PHCS Commercial |
$1,732.80
|
|
|
2.7 MM LOCKING SCREW 16 MM
|
Facility
OP
|
$1,805.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$36,566.41 |
| Rate for Payer: Aetna Commercial |
$1,389.85
|
| Rate for Payer: Anthem Medicaid |
$620.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,407.90
|
| Rate for Payer: Cash Price |
$902.50
|
| Rate for Payer: Cigna Commercial |
$1,498.15
|
| Rate for Payer: First Health Commercial |
$1,714.75
|
| Rate for Payer: Humana Commercial |
$1,534.25
|
| Rate for Payer: Humana KY Medicaid |
$620.74
|
| Rate for Payer: Kentucky WC Medicaid |
$627.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,480.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,332.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$541.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$633.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,588.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,353.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$361.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$559.55
|
| Rate for Payer: PHCS Commercial |
$1,732.80
|
| Rate for Payer: United Healthcare All Payer |
$1,588.40
|
|
|
2+HEAD STEM 496-S 265
|
Facility
OP
|
$11,092.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$8,541.42
|
| Rate for Payer: Anthem Medicaid |
$3,814.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,652.34
|
| Rate for Payer: Cash Price |
$5,546.38
|
| Rate for Payer: Cigna Commercial |
$9,206.98
|
| Rate for Payer: First Health Commercial |
$10,538.11
|
| Rate for Payer: Humana Commercial |
$9,428.84
|
| Rate for Payer: Humana KY Medicaid |
$3,814.80
|
| Rate for Payer: Kentucky WC Medicaid |
$3,853.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,096.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,186.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,327.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,891.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,761.62
|
| Rate for Payer: Ohio Health Group HMO |
$8,319.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,218.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,442.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,438.75
|
| Rate for Payer: PHCS Commercial |
$10,649.04
|
| Rate for Payer: United Healthcare All Payer |
$9,761.62
|
|
|
2+HEAD STEM 496-S 265
|
Facility
IP
|
$11,092.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$8,541.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,652.34
|
| Rate for Payer: Cash Price |
$5,546.38
|
| Rate for Payer: Cigna Commercial |
$9,206.98
|
| Rate for Payer: First Health Commercial |
$10,538.11
|
| Rate for Payer: Humana Commercial |
$9,428.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,096.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,186.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,327.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,761.62
|
| Rate for Payer: Ohio Health Group HMO |
$8,319.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,218.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,442.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,438.75
|
| Rate for Payer: PHCS Commercial |
$10,649.04
|
|
|
2ND/3RD STAGE LABOR EA 15 MIN
|
Facility
OP
|
$120.00
|
|
| Hospital Charge Code |
76102548
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: Aetna Commercial |
$92.40
|
| Rate for Payer: Anthem Medicaid |
$41.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93.60
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$99.60
|
| Rate for Payer: First Health Commercial |
$114.00
|
| Rate for Payer: Humana Commercial |
$102.00
|
| Rate for Payer: Humana KY Medicaid |
$41.27
|
| Rate for Payer: Kentucky WC Medicaid |
$41.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$98.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$88.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$42.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$105.60
|
| Rate for Payer: Ohio Health Group HMO |
$90.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.20
|
| Rate for Payer: PHCS Commercial |
$115.20
|
| Rate for Payer: United Healthcare All Payer |
$105.60
|
|
|
2ND/3RD STAGE LABOR EA 15 MIN
|
Facility
IP
|
$120.00
|
|
| Hospital Charge Code |
76102548
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: Aetna Commercial |
$92.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93.60
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$99.60
|
| Rate for Payer: First Health Commercial |
$114.00
|
| Rate for Payer: Humana Commercial |
$102.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$98.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$88.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$105.60
|
| Rate for Payer: Ohio Health Group HMO |
$90.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.20
|
| Rate for Payer: PHCS Commercial |
$115.20
|
|
|
300 CM .018 SV-8 WIRE
|
Facility
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$9,415.68 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
300 CM .018 SV-8 WIRE
|
Facility
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$9,415.68 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
|
|
30 Minutes of OR
|
Professional
|
$395.00
|
|
| Hospital Charge Code |
22200548
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$138.25 |
| Max. Negotiated Rate |
$395.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$395.00
|
| Rate for Payer: Cash Price |
$197.50
|
| Rate for Payer: Multiplan PHCS |
$237.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$276.50
|
| Rate for Payer: UHCCP Medicaid |
$138.25
|
|
|
30 MINUTES OF OR -80
|
Professional
|
$197.50
|
|
| Hospital Charge Code |
22200663
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$69.12 |
| Max. Negotiated Rate |
$197.50 |
| Rate for Payer: Buckeye Medicare Advantage |
$197.50
|
| Rate for Payer: Cash Price |
$98.75
|
| Rate for Payer: Multiplan PHCS |
$118.50
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$138.25
|
| Rate for Payer: UHCCP Medicaid |
$69.12
|
|
|
33/24 TI GLENOSPHERE
|
Facility
IP
|
$13,520.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$10,410.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,545.60
|
| Rate for Payer: Cash Price |
$6,760.00
|
| Rate for Payer: Cigna Commercial |
$11,221.60
|
| Rate for Payer: First Health Commercial |
$12,844.00
|
| Rate for Payer: Humana Commercial |
$11,492.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,086.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,977.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,056.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,897.60
|
| Rate for Payer: Ohio Health Group HMO |
$10,140.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,704.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,757.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,191.20
|
| Rate for Payer: PHCS Commercial |
$12,979.20
|
|
|
33/24 TI GLENOSPHERE
|
Facility
OP
|
$13,520.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$10,410.40
|
| Rate for Payer: Anthem Medicaid |
$4,649.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,545.60
|
| Rate for Payer: Cash Price |
$6,760.00
|
| Rate for Payer: Cigna Commercial |
$11,221.60
|
| Rate for Payer: First Health Commercial |
$12,844.00
|
| Rate for Payer: Humana Commercial |
$11,492.00
|
| Rate for Payer: Humana KY Medicaid |
$4,649.53
|
| Rate for Payer: Kentucky WC Medicaid |
$4,696.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,086.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,977.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,056.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,742.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,897.60
|
| Rate for Payer: Ohio Health Group HMO |
$10,140.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,704.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,757.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,191.20
|
| Rate for Payer: PHCS Commercial |
$12,979.20
|
| Rate for Payer: United Healthcare All Payer |
$11,897.60
|
|
|
33 +4 LAT/24 TI GLENOSPHERE
|
Facility
IP
|
$13,520.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$10,410.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,545.60
|
| Rate for Payer: Cash Price |
$6,760.00
|
| Rate for Payer: Cigna Commercial |
$11,221.60
|
| Rate for Payer: First Health Commercial |
$12,844.00
|
| Rate for Payer: Humana Commercial |
$11,492.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,086.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,977.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,056.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,897.60
|
| Rate for Payer: Ohio Health Group HMO |
$10,140.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,704.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,757.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,191.20
|
| Rate for Payer: PHCS Commercial |
$12,979.20
|
|
