|
AGC FEMORAL MOLD 60MM
|
Facility
|
IP
|
$12,498.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,624.74 |
| Max. Negotiated Rate |
$11,998.08 |
| Rate for Payer: Aetna Commercial |
$9,623.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,748.44
|
| Rate for Payer: Cash Price |
$6,249.00
|
| Rate for Payer: Cigna Commercial |
$10,373.34
|
| Rate for Payer: First Health Commercial |
$11,873.10
|
| Rate for Payer: Humana Commercial |
$10,623.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,248.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,223.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,749.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,998.24
|
| Rate for Payer: Ohio Health Group HMO |
$9,373.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,499.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,624.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,874.38
|
| Rate for Payer: PHCS Commercial |
$11,998.08
|
| Rate for Payer: United Healthcare All Payer |
$10,998.24
|
|
|
AGC FEMORAL MOLD 65MM
|
Facility
|
OP
|
$12,498.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,624.74 |
| Max. Negotiated Rate |
$11,998.08 |
| Rate for Payer: Aetna Commercial |
$9,623.46
|
| Rate for Payer: Anthem Medicaid |
$4,298.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,748.44
|
| Rate for Payer: Cash Price |
$6,249.00
|
| Rate for Payer: Cigna Commercial |
$10,373.34
|
| Rate for Payer: First Health Commercial |
$11,873.10
|
| Rate for Payer: Humana Commercial |
$10,623.30
|
| Rate for Payer: Humana KY Medicaid |
$4,298.06
|
| Rate for Payer: Kentucky WC Medicaid |
$4,341.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,248.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,223.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,749.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,384.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,998.24
|
| Rate for Payer: Ohio Health Group HMO |
$9,373.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,499.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,624.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,874.38
|
| Rate for Payer: PHCS Commercial |
$11,998.08
|
| Rate for Payer: United Healthcare All Payer |
$10,998.24
|
|
|
AGC FEMORAL MOLD 65MM
|
Facility
|
IP
|
$12,498.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,624.74 |
| Max. Negotiated Rate |
$11,998.08 |
| Rate for Payer: Aetna Commercial |
$9,623.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,748.44
|
| Rate for Payer: Cash Price |
$6,249.00
|
| Rate for Payer: Cigna Commercial |
$10,373.34
|
| Rate for Payer: First Health Commercial |
$11,873.10
|
| Rate for Payer: Humana Commercial |
$10,623.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,248.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,223.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,749.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,998.24
|
| Rate for Payer: Ohio Health Group HMO |
$9,373.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,499.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,624.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,874.38
|
| Rate for Payer: PHCS Commercial |
$11,998.08
|
| Rate for Payer: United Healthcare All Payer |
$10,998.24
|
|
|
AGC FEMORAL MOLD 70MM
|
Facility
|
OP
|
$12,498.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,624.74 |
| Max. Negotiated Rate |
$11,998.08 |
| Rate for Payer: Aetna Commercial |
$9,623.46
|
| Rate for Payer: Anthem Medicaid |
$4,298.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,748.44
|
| Rate for Payer: Cash Price |
$6,249.00
|
| Rate for Payer: Cigna Commercial |
$10,373.34
|
| Rate for Payer: First Health Commercial |
$11,873.10
|
| Rate for Payer: Humana Commercial |
$10,623.30
|
| Rate for Payer: Humana KY Medicaid |
$4,298.06
|
| Rate for Payer: Kentucky WC Medicaid |
$4,341.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,248.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,223.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,749.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,384.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,998.24
|
| Rate for Payer: Ohio Health Group HMO |
$9,373.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,499.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,624.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,874.38
|
| Rate for Payer: PHCS Commercial |
$11,998.08
|
| Rate for Payer: United Healthcare All Payer |
$10,998.24
|
|
|
AGC FEMORAL MOLD 70MM
|
Facility
|
IP
|
$12,498.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,624.74 |
| Max. Negotiated Rate |
$11,998.08 |
| Rate for Payer: Aetna Commercial |
$9,623.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,748.44
|
| Rate for Payer: Cash Price |
$6,249.00
|
| Rate for Payer: Cigna Commercial |
$10,373.34
|
| Rate for Payer: First Health Commercial |
$11,873.10
|
| Rate for Payer: Humana Commercial |
$10,623.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,248.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,223.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,749.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,998.24
|
| Rate for Payer: Ohio Health Group HMO |
$9,373.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,499.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,624.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,874.38
|
| Rate for Payer: PHCS Commercial |
$11,998.08
|
| Rate for Payer: United Healthcare All Payer |
$10,998.24
|
|
|
AGC FEMORAL MOLD 75MM
|
Facility
|
IP
|
$12,498.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,624.74 |
| Max. Negotiated Rate |
$11,998.08 |
| Rate for Payer: Aetna Commercial |
$9,623.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,748.44
|
| Rate for Payer: Cash Price |
$6,249.00
|
| Rate for Payer: Cigna Commercial |
$10,373.34
|
| Rate for Payer: First Health Commercial |
$11,873.10
|
| Rate for Payer: Humana Commercial |
$10,623.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,248.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,223.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,749.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,998.24
|
| Rate for Payer: Ohio Health Group HMO |
$9,373.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,499.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,624.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,874.38
|
| Rate for Payer: PHCS Commercial |
$11,998.08
|
| Rate for Payer: United Healthcare All Payer |
$10,998.24
|
|
|
AGC FEMORAL MOLD 75MM
|
Facility
|
OP
|
$12,498.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,624.74 |
| Max. Negotiated Rate |
$11,998.08 |
| Rate for Payer: Aetna Commercial |
$9,623.46
|
| Rate for Payer: Anthem Medicaid |
$4,298.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,748.44
|
| Rate for Payer: Cash Price |
$6,249.00
|
| Rate for Payer: Cigna Commercial |
$10,373.34
|
| Rate for Payer: First Health Commercial |
$11,873.10
|
| Rate for Payer: Humana Commercial |
$10,623.30
|
| Rate for Payer: Humana KY Medicaid |
$4,298.06
|
| Rate for Payer: Kentucky WC Medicaid |
$4,341.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,248.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,223.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,749.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,384.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,998.24
|
| Rate for Payer: Ohio Health Group HMO |
$9,373.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,499.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,624.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,874.38
|
| Rate for Payer: PHCS Commercial |
$11,998.08
|
| Rate for Payer: United Healthcare All Payer |
$10,998.24
|
|
|
AGC TIBIAL MOLD 65MM
|
Facility
|
IP
|
$7,209.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.20 |
| Max. Negotiated Rate |
$6,920.83 |
| Rate for Payer: Aetna Commercial |
$5,551.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,623.18
|
| Rate for Payer: Cash Price |
$3,604.60
|
| Rate for Payer: Cigna Commercial |
$5,983.64
|
| Rate for Payer: First Health Commercial |
$6,848.74
|
| Rate for Payer: Humana Commercial |
$6,127.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,911.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,320.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,162.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,344.10
|
| Rate for Payer: Ohio Health Group HMO |
$5,406.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,441.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$937.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,234.85
|
| Rate for Payer: PHCS Commercial |
$6,920.83
|
| Rate for Payer: United Healthcare All Payer |
$6,344.10
|
|
|
AGC TIBIAL MOLD 65MM
|
Facility
|
OP
|
$7,209.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.20 |
| Max. Negotiated Rate |
$6,920.83 |
| Rate for Payer: Aetna Commercial |
$5,551.08
|
| Rate for Payer: Anthem Medicaid |
$2,479.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,623.18
|
| Rate for Payer: Cash Price |
$3,604.60
|
| Rate for Payer: Cigna Commercial |
$5,983.64
|
| Rate for Payer: First Health Commercial |
$6,848.74
|
| Rate for Payer: Humana Commercial |
$6,127.82
|
| Rate for Payer: Humana KY Medicaid |
$2,479.24
|
| Rate for Payer: Kentucky WC Medicaid |
$2,504.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,911.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,320.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,162.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,528.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,344.10
|
| Rate for Payer: Ohio Health Group HMO |
$5,406.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,441.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$937.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,234.85
|
| Rate for Payer: PHCS Commercial |
$6,920.83
|
| Rate for Payer: United Healthcare All Payer |
$6,344.10
|
|
|
AGC TIBIAL MOLD 70MM
|
Facility
|
IP
|
$7,209.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.20 |
| Max. Negotiated Rate |
$6,920.83 |
| Rate for Payer: Aetna Commercial |
$5,551.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,623.18
|
| Rate for Payer: Cash Price |
$3,604.60
|
| Rate for Payer: Cigna Commercial |
$5,983.64
|
| Rate for Payer: First Health Commercial |
$6,848.74
|
| Rate for Payer: Humana Commercial |
$6,127.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,911.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,320.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,162.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,344.10
|
| Rate for Payer: Ohio Health Group HMO |
$5,406.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,441.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$937.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,234.85
|
| Rate for Payer: PHCS Commercial |
$6,920.83
|
| Rate for Payer: United Healthcare All Payer |
$6,344.10
|
|
|
AGC TIBIAL MOLD 70MM
|
Facility
|
OP
|
$7,209.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.20 |
| Max. Negotiated Rate |
$6,920.83 |
| Rate for Payer: Aetna Commercial |
$5,551.08
|
| Rate for Payer: Anthem Medicaid |
$2,479.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,623.18
|
| Rate for Payer: Cash Price |
$3,604.60
|
| Rate for Payer: Cigna Commercial |
$5,983.64
|
| Rate for Payer: First Health Commercial |
$6,848.74
|
| Rate for Payer: Humana Commercial |
$6,127.82
|
| Rate for Payer: Humana KY Medicaid |
$2,479.24
|
| Rate for Payer: Kentucky WC Medicaid |
$2,504.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,911.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,320.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,162.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,528.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,344.10
|
| Rate for Payer: Ohio Health Group HMO |
$5,406.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,441.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$937.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,234.85
|
| Rate for Payer: PHCS Commercial |
$6,920.83
|
| Rate for Payer: United Healthcare All Payer |
$6,344.10
|
|
|
AGC TIBIAL MOLD 75MM
|
Facility
|
OP
|
$7,209.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.20 |
| Max. Negotiated Rate |
$6,920.83 |
| Rate for Payer: Aetna Commercial |
$5,551.08
|
| Rate for Payer: Anthem Medicaid |
$2,479.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,623.18
|
| Rate for Payer: Cash Price |
$3,604.60
|
| Rate for Payer: Cigna Commercial |
$5,983.64
|
| Rate for Payer: First Health Commercial |
$6,848.74
|
| Rate for Payer: Humana Commercial |
$6,127.82
|
| Rate for Payer: Humana KY Medicaid |
$2,479.24
|
| Rate for Payer: Kentucky WC Medicaid |
$2,504.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,911.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,320.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,162.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,528.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,344.10
|
| Rate for Payer: Ohio Health Group HMO |
$5,406.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,441.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$937.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,234.85
|
| Rate for Payer: PHCS Commercial |
$6,920.83
|
| Rate for Payer: United Healthcare All Payer |
$6,344.10
|
|
|
AGC TIBIAL MOLD 75MM
|
Facility
|
IP
|
$7,209.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.20 |
| Max. Negotiated Rate |
$6,920.83 |
| Rate for Payer: Aetna Commercial |
$5,551.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,623.18
|
| Rate for Payer: Cash Price |
$3,604.60
|
| Rate for Payer: Cigna Commercial |
$5,983.64
|
| Rate for Payer: First Health Commercial |
$6,848.74
|
| Rate for Payer: Humana Commercial |
$6,127.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,911.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,320.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,162.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,344.10
|
| Rate for Payer: Ohio Health Group HMO |
$5,406.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,441.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$937.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,234.85
|
| Rate for Payer: PHCS Commercial |
$6,920.83
|
| Rate for Payer: United Healthcare All Payer |
$6,344.10
|
|
|
AGC TIBIAL MOLD 80MM
|
Facility
|
IP
|
$7,209.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.20 |
| Max. Negotiated Rate |
$6,920.83 |
| Rate for Payer: Aetna Commercial |
$5,551.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,623.18
|
| Rate for Payer: Cash Price |
$3,604.60
|
| Rate for Payer: Cigna Commercial |
$5,983.64
|
| Rate for Payer: First Health Commercial |
$6,848.74
|
| Rate for Payer: Humana Commercial |
$6,127.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,911.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,320.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,162.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,344.10
|
| Rate for Payer: Ohio Health Group HMO |
$5,406.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,441.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$937.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,234.85
|
| Rate for Payer: PHCS Commercial |
$6,920.83
|
| Rate for Payer: United Healthcare All Payer |
$6,344.10
|
|
|
AGC TIBIAL MOLD 80MM
|
Facility
|
OP
|
$7,209.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.20 |
| Max. Negotiated Rate |
$6,920.83 |
| Rate for Payer: Aetna Commercial |
$5,551.08
|
| Rate for Payer: Anthem Medicaid |
$2,479.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,623.18
|
| Rate for Payer: Cash Price |
$3,604.60
|
| Rate for Payer: Cigna Commercial |
$5,983.64
|
| Rate for Payer: First Health Commercial |
$6,848.74
|
| Rate for Payer: Humana Commercial |
$6,127.82
|
| Rate for Payer: Humana KY Medicaid |
$2,479.24
|
| Rate for Payer: Kentucky WC Medicaid |
$2,504.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,911.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,320.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,162.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,528.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,344.10
|
| Rate for Payer: Ohio Health Group HMO |
$5,406.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,441.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$937.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,234.85
|
| Rate for Payer: PHCS Commercial |
$6,920.83
|
| Rate for Payer: United Healthcare All Payer |
$6,344.10
|
|
|
AGGRASTAT 0.25MG 12.5 MG/250ML
|
Facility
|
IP
|
$655.05
|
|
|
Service Code
|
HCPCS J3246
|
| Hospital Charge Code |
25002388
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$85.16 |
| Max. Negotiated Rate |
$628.85 |
| Rate for Payer: Aetna Commercial |
$504.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$510.94
|
| Rate for Payer: Cash Price |
$327.52
|
| Rate for Payer: Cigna Commercial |
$543.69
|
| Rate for Payer: First Health Commercial |
$622.30
|
| Rate for Payer: Humana Commercial |
$556.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$537.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$483.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$196.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$576.44
|
| Rate for Payer: Ohio Health Group HMO |
$491.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$131.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$85.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$203.07
|
| Rate for Payer: PHCS Commercial |
$628.85
|
| Rate for Payer: United Healthcare All Payer |
$576.44
|
|
|
AGGRASTAT 0.25MG 12.5 MG/250ML
|
Facility
|
OP
|
$655.05
|
|
|
Service Code
|
HCPCS J3246
|
| Hospital Charge Code |
25002388
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.32 |
| Max. Negotiated Rate |
$628.85 |
| Rate for Payer: Aetna Commercial |
$504.39
|
| Rate for Payer: Anthem Medicaid |
$225.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$510.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.83
|
| Rate for Payer: Cash Price |
$327.52
|
| Rate for Payer: Cash Price |
$327.52
|
| Rate for Payer: Cigna Commercial |
$543.69
|
| Rate for Payer: First Health Commercial |
$622.30
|
| Rate for Payer: Humana Commercial |
$556.79
|
| Rate for Payer: Humana KY Medicaid |
$225.27
|
| Rate for Payer: Humana Medicare Advantage |
$4.32
|
| Rate for Payer: Kentucky WC Medicaid |
$227.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$537.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$483.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$229.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$576.44
|
| Rate for Payer: Ohio Health Group HMO |
$491.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$131.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$85.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$203.07
|
| Rate for Payer: PHCS Commercial |
$628.85
|
| Rate for Payer: United Healthcare All Payer |
$576.44
|
|
|
AGGRENOX 200/25MG CAPSULE
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
NDC 43598033960
|
| Hospital Charge Code |
25000173
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$8.64 |
| Rate for Payer: Aetna Commercial |
$6.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.02
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cigna Commercial |
$7.47
|
| Rate for Payer: First Health Commercial |
$8.55
|
| Rate for Payer: Humana Commercial |
$7.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.92
|
| Rate for Payer: Ohio Health Group HMO |
$6.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.79
|
| Rate for Payer: PHCS Commercial |
$8.64
|
| Rate for Payer: United Healthcare All Payer |
$7.92
|
|
|
AGGRENOX 200/25MG CAPSULE
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
NDC 43598033960
|
| Hospital Charge Code |
25000173
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$8.64 |
| Rate for Payer: Aetna Commercial |
$6.93
|
| Rate for Payer: Anthem Medicaid |
$3.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.02
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cigna Commercial |
$7.47
|
| Rate for Payer: First Health Commercial |
$8.55
|
| Rate for Payer: Humana Commercial |
$7.65
|
| Rate for Payer: Humana KY Medicaid |
$3.10
|
| Rate for Payer: Kentucky WC Medicaid |
$3.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.92
|
| Rate for Payer: Ohio Health Group HMO |
$6.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.79
|
| Rate for Payer: PHCS Commercial |
$8.64
|
| Rate for Payer: United Healthcare All Payer |
$7.92
|
|
|
AGGRESV ANTIAGE PRGRM KIT GBL
|
Professional
|
Both
|
$263.00
|
|
| Hospital Charge Code |
22200151
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$92.05 |
| Max. Negotiated Rate |
$263.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$263.00
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Multiplan PHCS |
$157.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$184.10
|
| Rate for Payer: UHCCP Medicaid |
$92.05
|
|
|
AICD GENERATOR PROCEDURES
|
Facility
|
IP
|
$53,009.24
|
|
|
Service Code
|
MSDRG 245
|
| Min. Negotiated Rate |
$35,970.55 |
| Max. Negotiated Rate |
$53,009.24 |
| Rate for Payer: Anthem Medicaid |
$35,970.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$37,863.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$53,009.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$51,116.05
|
| Rate for Payer: Humana KY Medicaid |
$35,970.55
|
| Rate for Payer: Humana Medicare Advantage |
$37,863.74
|
| Rate for Payer: Kentucky WC Medicaid |
$36,330.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45,436.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$36,689.96
|
|
|
AICD LEAD PROCEDURES
|
Facility
|
IP
|
$41,342.62
|
|
|
Service Code
|
MSDRG 265
|
| Min. Negotiated Rate |
$28,053.92 |
| Max. Negotiated Rate |
$41,342.62 |
| Rate for Payer: Anthem Medicaid |
$28,053.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$29,530.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$41,342.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$39,866.09
|
| Rate for Payer: Humana KY Medicaid |
$28,053.92
|
| Rate for Payer: Humana Medicare Advantage |
$29,530.44
|
| Rate for Payer: Kentucky WC Medicaid |
$28,334.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35,436.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,615.00
|
|
|
AIR CONTRAST ENEMA W/WO KUB
|
Facility
|
IP
|
$863.00
|
|
|
Service Code
|
HCPCS 74280
|
| Hospital Charge Code |
32000138
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$112.19 |
| Max. Negotiated Rate |
$828.48 |
| Rate for Payer: Aetna Commercial |
$664.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$673.14
|
| Rate for Payer: Cash Price |
$431.50
|
| Rate for Payer: Cigna Commercial |
$716.29
|
| Rate for Payer: First Health Commercial |
$819.85
|
| Rate for Payer: Humana Commercial |
$733.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$707.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$636.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$258.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$759.44
|
| Rate for Payer: Ohio Health Group HMO |
$647.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$172.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$112.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$267.53
|
| Rate for Payer: PHCS Commercial |
$828.48
|
| Rate for Payer: United Healthcare All Payer |
$759.44
|
|
|
AIR CONTRAST ENEMA W/WO KUB
|
Professional
|
Both
|
$863.00
|
|
|
Service Code
|
HCPCS 74280
|
| Hospital Charge Code |
32000138
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$62.67 |
| Max. Negotiated Rate |
$863.00 |
| Rate for Payer: Aetna Commercial |
$294.04
|
| Rate for Payer: Anthem Medicaid |
$165.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$863.00
|
| Rate for Payer: Cash Price |
$431.50
|
| Rate for Payer: Cash Price |
$431.50
|
| Rate for Payer: Cigna Commercial |
$231.47
|
| Rate for Payer: Healthspan PPO |
$275.52
|
| Rate for Payer: Humana Medicaid |
$165.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$62.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$169.22
|
| Rate for Payer: Molina Healthcare Passport |
$165.90
|
| Rate for Payer: Multiplan PHCS |
$517.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$604.10
|
| Rate for Payer: UHCCP Medicaid |
$302.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$167.56
|
|
|
AIR CONTRAST ENEMA W/WO KUB
|
Facility
|
OP
|
$863.00
|
|
|
Service Code
|
HCPCS 74280
|
| Hospital Charge Code |
32000138
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$112.19 |
| Max. Negotiated Rate |
$828.48 |
| Rate for Payer: Aetna Commercial |
$664.51
|
| Rate for Payer: Anthem Medicaid |
$296.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$158.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$673.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$222.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$214.49
|
| Rate for Payer: Cash Price |
$431.50
|
| Rate for Payer: Cash Price |
$431.50
|
| Rate for Payer: Cigna Commercial |
$716.29
|
| Rate for Payer: First Health Commercial |
$819.85
|
| Rate for Payer: Humana Commercial |
$733.55
|
| Rate for Payer: Humana KY Medicaid |
$296.79
|
| Rate for Payer: Humana Medicare Advantage |
$158.88
|
| Rate for Payer: Kentucky WC Medicaid |
$299.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$707.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$636.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$302.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$759.44
|
| Rate for Payer: Ohio Health Group HMO |
$647.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$172.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$112.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$267.53
|
| Rate for Payer: PHCS Commercial |
$828.48
|
| Rate for Payer: United Healthcare All Payer |
$759.44
|
|
