|
23 SLV SM CONE 1 SPOU TALL SLT
|
Facility
|
IP
|
$13,572.87
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,071.86 |
| Max. Negotiated Rate |
$13,029.96 |
| Rate for Payer: Aetna Commercial |
$10,451.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,586.84
|
| Rate for Payer: Cash Price |
$6,786.43
|
| Rate for Payer: Cigna Commercial |
$11,265.48
|
| Rate for Payer: First Health Commercial |
$12,894.23
|
| Rate for Payer: Humana Commercial |
$11,536.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,129.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,016.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,071.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,944.13
|
| Rate for Payer: Ohio Health Group HMO |
$10,179.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,858.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,808.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,365.28
|
| Rate for Payer: PHCS Commercial |
$13,029.96
|
| Rate for Payer: United Healthcare All Payer |
$11,944.13
|
|
|
23 SLV SM CONE 1 SPOU TALL SLT
|
Facility
|
OP
|
$13,572.87
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,071.86 |
| Max. Negotiated Rate |
$13,029.96 |
| Rate for Payer: Aetna Commercial |
$10,451.11
|
| Rate for Payer: Anthem Medicaid |
$4,667.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,586.84
|
| Rate for Payer: Cash Price |
$6,786.43
|
| Rate for Payer: Cigna Commercial |
$11,265.48
|
| Rate for Payer: First Health Commercial |
$12,894.23
|
| Rate for Payer: Humana Commercial |
$11,536.94
|
| Rate for Payer: Humana KY Medicaid |
$4,667.71
|
| Rate for Payer: Kentucky WC Medicaid |
$4,715.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,129.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,016.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,071.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,761.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,944.13
|
| Rate for Payer: Ohio Health Group HMO |
$10,179.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,858.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,808.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,365.28
|
| Rate for Payer: PHCS Commercial |
$13,029.96
|
| Rate for Payer: United Healthcare All Payer |
$11,944.13
|
|
|
23 SLV SM CONE 2 SPOU TALL SLT
|
Facility
|
OP
|
$13,572.87
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,071.86 |
| Max. Negotiated Rate |
$13,029.96 |
| Rate for Payer: Aetna Commercial |
$10,451.11
|
| Rate for Payer: Anthem Medicaid |
$4,667.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,586.84
|
| Rate for Payer: Cash Price |
$6,786.43
|
| Rate for Payer: Cigna Commercial |
$11,265.48
|
| Rate for Payer: First Health Commercial |
$12,894.23
|
| Rate for Payer: Humana Commercial |
$11,536.94
|
| Rate for Payer: Humana KY Medicaid |
$4,667.71
|
| Rate for Payer: Kentucky WC Medicaid |
$4,715.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,129.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,016.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,071.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,761.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,944.13
|
| Rate for Payer: Ohio Health Group HMO |
$10,179.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,858.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,808.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,365.28
|
| Rate for Payer: PHCS Commercial |
$13,029.96
|
| Rate for Payer: United Healthcare All Payer |
$11,944.13
|
|
|
23 SLV SM CONE 2 SPOU TALL SLT
|
Facility
|
IP
|
$13,572.87
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,071.86 |
| Max. Negotiated Rate |
$13,029.96 |
| Rate for Payer: Aetna Commercial |
$10,451.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,586.84
|
| Rate for Payer: Cash Price |
$6,786.43
|
| Rate for Payer: Cigna Commercial |
$11,265.48
|
| Rate for Payer: First Health Commercial |
$12,894.23
|
| Rate for Payer: Humana Commercial |
$11,536.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,129.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,016.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,071.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,944.13
|
| Rate for Payer: Ohio Health Group HMO |
$10,179.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,858.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,808.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,365.28
|
| Rate for Payer: PHCS Commercial |
$13,029.96
|
| Rate for Payer: United Healthcare All Payer |
$11,944.13
|
|
|
24MM BASEPLATE 10 FULL AUG O
|
Facility
|
OP
|
$16,240.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,872.00 |
| Max. Negotiated Rate |
$15,590.40 |
| Rate for Payer: Aetna Commercial |
$12,504.80
|
| Rate for Payer: Anthem Medicaid |
$5,584.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,667.20
|
| Rate for Payer: Cash Price |
$8,120.00
|
| Rate for Payer: Cigna Commercial |
$13,479.20
|
| Rate for Payer: First Health Commercial |
$15,428.00
|
| Rate for Payer: Humana Commercial |
$13,804.00
|
| Rate for Payer: Humana KY Medicaid |
$5,584.94
|
| Rate for Payer: Kentucky WC Medicaid |
$5,641.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,316.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,985.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,872.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,696.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,291.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,180.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,992.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,128.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,205.60
|
| Rate for Payer: PHCS Commercial |
$15,590.40
|
| Rate for Payer: United Healthcare All Payer |
$14,291.20
|
|
|
24MM BASEPLATE 10 FULL AUG O
|
Facility
|
IP
|
$16,240.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,872.00 |
| Max. Negotiated Rate |
$15,590.40 |
| Rate for Payer: Aetna Commercial |
$12,504.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,667.20
|
| Rate for Payer: Cash Price |
$8,120.00
|
| Rate for Payer: Cigna Commercial |
$13,479.20
|
| Rate for Payer: First Health Commercial |
$15,428.00
|
| Rate for Payer: Humana Commercial |
$13,804.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,316.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,985.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,872.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,291.20
|
| Rate for Payer: Ohio Health Group HMO |
$12,180.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,992.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,128.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,205.60
|
| Rate for Payer: PHCS Commercial |
$15,590.40
|
| Rate for Payer: United Healthcare All Payer |
$14,291.20
|
|
|
25 HYDROXYVITAMIN D2&D3 OS
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
HCPCS 82306
|
| Hospital Charge Code |
30000256
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.80 |
| Max. Negotiated Rate |
$111.36 |
| Rate for Payer: Aetna Commercial |
$89.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93.15
|
| Rate for Payer: Cash Price |
$58.00
|
| Rate for Payer: Cigna Commercial |
$96.28
|
| Rate for Payer: First Health Commercial |
$110.20
|
| Rate for Payer: Humana Commercial |
$98.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$85.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.08
|
| Rate for Payer: Ohio Health Group HMO |
$87.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.04
|
| Rate for Payer: PHCS Commercial |
$111.36
|
| Rate for Payer: United Healthcare All Payer |
$102.08
|
|
|
25 HYDROXYVITAMIN D2&D3 OS
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
HCPCS 82306
|
| Hospital Charge Code |
30000256
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.60 |
| Max. Negotiated Rate |
$111.36 |
| Rate for Payer: Aetna Commercial |
$89.32
|
| Rate for Payer: Anthem Medicaid |
$29.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$29.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93.15
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$41.44
|
| Rate for Payer: CareSource Just4Me Medicare |
$29.60
|
| Rate for Payer: Cash Price |
$58.00
|
| Rate for Payer: Cash Price |
$58.00
|
| Rate for Payer: Cigna Commercial |
$96.28
|
| Rate for Payer: First Health Commercial |
$110.20
|
| Rate for Payer: Humana Commercial |
$98.60
|
| 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 |
$95.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$85.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$30.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.08
|
| Rate for Payer: Ohio Health Group HMO |
$87.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.04
|
| Rate for Payer: PHCS Commercial |
$111.36
|
| Rate for Payer: United Healthcare All Payer |
$102.08
|
|
|
25 HYDROXYVITAMIN D TOTAL
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
HCPCS 82306
|
| Hospital Charge Code |
30000257
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.60 |
| Max. Negotiated Rate |
$147.84 |
| Rate for Payer: Aetna Commercial |
$118.58
|
| Rate for Payer: Anthem Medicaid |
$29.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$29.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$123.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$41.44
|
| Rate for Payer: CareSource Just4Me Medicare |
$29.60
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cigna Commercial |
$127.82
|
| Rate for Payer: First Health Commercial |
$146.30
|
| Rate for Payer: Humana Commercial |
$130.90
|
| 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 |
$126.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$113.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$30.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$135.52
|
| Rate for Payer: Ohio Health Group HMO |
$115.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$123.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$133.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$106.26
|
| Rate for Payer: PHCS Commercial |
$147.84
|
| Rate for Payer: United Healthcare All Payer |
$135.52
|
|
|
25 HYDROXYVITAMIN D TOTAL
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
HCPCS 82306
|
| Hospital Charge Code |
30000257
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.20 |
| Max. Negotiated Rate |
$147.84 |
| Rate for Payer: Aetna Commercial |
$118.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$123.66
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cigna Commercial |
$127.82
|
| Rate for Payer: First Health Commercial |
$146.30
|
| Rate for Payer: Humana Commercial |
$130.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$126.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$113.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$135.52
|
| Rate for Payer: Ohio Health Group HMO |
$115.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$123.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$133.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$106.26
|
| Rate for Payer: PHCS Commercial |
$147.84
|
| Rate for Payer: United Healthcare All Payer |
$135.52
|
|
|
25 HYDROXYVITAMIN D TOTAL
|
Professional
|
Both
|
$154.00
|
|
|
Service Code
|
HCPCS 82306
|
| Hospital Charge Code |
30000257
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.76 |
| Max. Negotiated Rate |
$92.40 |
| Rate for Payer: Aetna Commercial |
$54.12
|
| Rate for Payer: Ambetter Exchange |
$29.60
|
| Rate for Payer: Buckeye Individual/Medicaid |
$29.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$29.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.52
|
| Rate for Payer: Cash Price |
$77.00
|
| Rate for Payer: Cash Price |
$77.00
|
| 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 |
$92.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$38.48
|
| Rate for Payer: UHCCP Medicaid |
$53.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$17.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$29.60
|
|
|
2.6 FIBERTAK KNOTLES FIBERTAPE
|
Facility
|
OP
|
$13,711.77
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,113.53 |
| Max. Negotiated Rate |
$13,163.30 |
| Rate for Payer: Aetna Commercial |
$10,558.06
|
| Rate for Payer: Anthem Medicaid |
$4,715.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,695.18
|
| Rate for Payer: Cash Price |
$6,855.89
|
| Rate for Payer: Cigna Commercial |
$11,380.77
|
| Rate for Payer: First Health Commercial |
$13,026.18
|
| Rate for Payer: Humana Commercial |
$11,655.00
|
| Rate for Payer: Humana KY Medicaid |
$4,715.48
|
| Rate for Payer: Kentucky WC Medicaid |
$4,763.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,243.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,119.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,113.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,810.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,066.36
|
| Rate for Payer: Ohio Health Group HMO |
$10,283.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,969.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,929.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,461.12
|
| Rate for Payer: PHCS Commercial |
$13,163.30
|
| Rate for Payer: United Healthcare All Payer |
$12,066.36
|
|
|
2.6 FIBERTAK KNOTLES FIBERTAPE
|
Facility
|
IP
|
$13,711.77
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,113.53 |
| Max. Negotiated Rate |
$13,163.30 |
| Rate for Payer: Aetna Commercial |
$10,558.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,695.18
|
| Rate for Payer: Cash Price |
$6,855.89
|
| Rate for Payer: Cigna Commercial |
$11,380.77
|
| Rate for Payer: First Health Commercial |
$13,026.18
|
| Rate for Payer: Humana Commercial |
$11,655.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,243.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,119.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,113.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,066.36
|
| Rate for Payer: Ohio Health Group HMO |
$10,283.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,969.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,929.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,461.12
|
| Rate for Payer: PHCS Commercial |
$13,163.30
|
| Rate for Payer: United Healthcare All Payer |
$12,066.36
|
|
|
2.6 FIBERTAK RC SP FIBERTAPE
|
Facility
|
IP
|
$12,555.73
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,766.72 |
| Max. Negotiated Rate |
$12,053.50 |
| Rate for Payer: Aetna Commercial |
$9,667.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,793.47
|
| Rate for Payer: Cash Price |
$6,277.86
|
| Rate for Payer: Cigna Commercial |
$10,421.26
|
| Rate for Payer: First Health Commercial |
$11,927.94
|
| Rate for Payer: Humana Commercial |
$10,672.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,295.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,266.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,766.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,049.04
|
| Rate for Payer: Ohio Health Group HMO |
$9,416.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,044.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,923.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,663.45
|
| Rate for Payer: PHCS Commercial |
$12,053.50
|
| Rate for Payer: United Healthcare All Payer |
$11,049.04
|
|
|
2.6 FIBERTAK RC SP FIBERTAPE
|
Facility
|
OP
|
$12,555.73
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,766.72 |
| Max. Negotiated Rate |
$12,053.50 |
| Rate for Payer: Aetna Commercial |
$9,667.91
|
| Rate for Payer: Anthem Medicaid |
$4,317.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,793.47
|
| Rate for Payer: Cash Price |
$6,277.86
|
| Rate for Payer: Cigna Commercial |
$10,421.26
|
| Rate for Payer: First Health Commercial |
$11,927.94
|
| Rate for Payer: Humana Commercial |
$10,672.37
|
| Rate for Payer: Humana KY Medicaid |
$4,317.92
|
| Rate for Payer: Kentucky WC Medicaid |
$4,361.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,295.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,266.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,766.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,404.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,049.04
|
| Rate for Payer: Ohio Health Group HMO |
$9,416.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,044.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,923.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,663.45
|
| Rate for Payer: PHCS Commercial |
$12,053.50
|
| Rate for Payer: United Healthcare All Payer |
$11,049.04
|
|
|
2.6 FIBERTAK RC SP FIBERTAPE ���
|
Facility
|
OP
|
$12,555.73
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,766.72 |
| Max. Negotiated Rate |
$12,053.50 |
| Rate for Payer: Aetna Commercial |
$9,667.91
|
| Rate for Payer: Anthem Medicaid |
$4,317.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,793.47
|
| Rate for Payer: Cash Price |
$6,277.86
|
| Rate for Payer: Cigna Commercial |
$10,421.26
|
| Rate for Payer: First Health Commercial |
$11,927.94
|
| Rate for Payer: Humana Commercial |
$10,672.37
|
| Rate for Payer: Humana KY Medicaid |
$4,317.92
|
| Rate for Payer: Kentucky WC Medicaid |
$4,361.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,295.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,266.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,766.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,404.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,049.04
|
| Rate for Payer: Ohio Health Group HMO |
$9,416.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,044.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,923.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,663.45
|
| Rate for Payer: PHCS Commercial |
$12,053.50
|
| Rate for Payer: United Healthcare All Payer |
$11,049.04
|
|
|
2.6 FIBERTAK RC SP FIBERTAPE ���
|
Facility
|
IP
|
$12,555.73
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,766.72 |
| Max. Negotiated Rate |
$12,053.50 |
| Rate for Payer: Aetna Commercial |
$9,667.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,793.47
|
| Rate for Payer: Cash Price |
$6,277.86
|
| Rate for Payer: Cigna Commercial |
$10,421.26
|
| Rate for Payer: First Health Commercial |
$11,927.94
|
| Rate for Payer: Humana Commercial |
$10,672.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,295.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,266.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,766.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,049.04
|
| Rate for Payer: Ohio Health Group HMO |
$9,416.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,044.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,923.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,663.45
|
| Rate for Payer: PHCS Commercial |
$12,053.50
|
| Rate for Payer: United Healthcare All Payer |
$11,049.04
|
|
|
2.6 RC KNOTLESS FIBERTAPE B/B
|
Facility
|
IP
|
$13,711.77
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,113.53 |
| Max. Negotiated Rate |
$13,163.30 |
| Rate for Payer: Aetna Commercial |
$10,558.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,695.18
|
| Rate for Payer: Cash Price |
$6,855.89
|
| Rate for Payer: Cigna Commercial |
$11,380.77
|
| Rate for Payer: First Health Commercial |
$13,026.18
|
| Rate for Payer: Humana Commercial |
$11,655.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,243.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,119.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,113.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,066.36
|
| Rate for Payer: Ohio Health Group HMO |
$10,283.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,969.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,929.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,461.12
|
| Rate for Payer: PHCS Commercial |
$13,163.30
|
| Rate for Payer: United Healthcare All Payer |
$12,066.36
|
|
|
2.6 RC KNOTLESS FIBERTAPE B/B
|
Facility
|
OP
|
$13,711.77
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,113.53 |
| Max. Negotiated Rate |
$13,163.30 |
| Rate for Payer: Aetna Commercial |
$10,558.06
|
| Rate for Payer: Anthem Medicaid |
$4,715.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,695.18
|
| Rate for Payer: Cash Price |
$6,855.89
|
| Rate for Payer: Cigna Commercial |
$11,380.77
|
| Rate for Payer: First Health Commercial |
$13,026.18
|
| Rate for Payer: Humana Commercial |
$11,655.00
|
| Rate for Payer: Humana KY Medicaid |
$4,715.48
|
| Rate for Payer: Kentucky WC Medicaid |
$4,763.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,243.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,119.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,113.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,810.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,066.36
|
| Rate for Payer: Ohio Health Group HMO |
$10,283.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,969.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,929.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,461.12
|
| Rate for Payer: PHCS Commercial |
$13,163.30
|
| Rate for Payer: United Healthcare All Payer |
$12,066.36
|
|
|
2.7 MM LOCKING SCREW 10 MM
|
Facility
|
OP
|
$1,794.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$538.20 |
| Max. Negotiated Rate |
$1,722.24 |
| Rate for Payer: Aetna Commercial |
$1,381.38
|
| Rate for Payer: Anthem Medicaid |
$616.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,399.32
|
| Rate for Payer: Cash Price |
$897.00
|
| Rate for Payer: Cigna Commercial |
$1,489.02
|
| Rate for Payer: First Health Commercial |
$1,704.30
|
| Rate for Payer: Humana Commercial |
$1,524.90
|
| Rate for Payer: Humana KY Medicaid |
$616.96
|
| Rate for Payer: Kentucky WC Medicaid |
$623.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,471.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,323.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$538.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$629.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,578.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,345.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,435.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,560.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,237.86
|
| Rate for Payer: PHCS Commercial |
$1,722.24
|
| Rate for Payer: United Healthcare All Payer |
$1,578.72
|
|
|
2.7 MM LOCKING SCREW 10 MM
|
Facility
|
IP
|
$1,794.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$538.20 |
| Max. Negotiated Rate |
$1,722.24 |
| Rate for Payer: Aetna Commercial |
$1,381.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,399.32
|
| Rate for Payer: Cash Price |
$897.00
|
| Rate for Payer: Cigna Commercial |
$1,489.02
|
| Rate for Payer: First Health Commercial |
$1,704.30
|
| Rate for Payer: Humana Commercial |
$1,524.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,471.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,323.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$538.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,578.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,345.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,435.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,560.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,237.86
|
| Rate for Payer: PHCS Commercial |
$1,722.24
|
| Rate for Payer: United Healthcare All Payer |
$1,578.72
|
|
|
2.7 MM LOCKING SCREW 16 MM
|
Facility
|
OP
|
$1,794.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$538.20 |
| Max. Negotiated Rate |
$1,722.24 |
| Rate for Payer: Aetna Commercial |
$1,381.38
|
| Rate for Payer: Anthem Medicaid |
$616.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,399.32
|
| Rate for Payer: Cash Price |
$897.00
|
| Rate for Payer: Cigna Commercial |
$1,489.02
|
| Rate for Payer: First Health Commercial |
$1,704.30
|
| Rate for Payer: Humana Commercial |
$1,524.90
|
| Rate for Payer: Humana KY Medicaid |
$616.96
|
| Rate for Payer: Kentucky WC Medicaid |
$623.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,471.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,323.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$538.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$629.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,578.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,345.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,435.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,560.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,237.86
|
| Rate for Payer: PHCS Commercial |
$1,722.24
|
| Rate for Payer: United Healthcare All Payer |
$1,578.72
|
|
|
2.7 MM LOCKING SCREW 16 MM
|
Facility
|
IP
|
$1,794.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$538.20 |
| Max. Negotiated Rate |
$1,722.24 |
| Rate for Payer: Aetna Commercial |
$1,381.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,399.32
|
| Rate for Payer: Cash Price |
$897.00
|
| Rate for Payer: Cigna Commercial |
$1,489.02
|
| Rate for Payer: First Health Commercial |
$1,704.30
|
| Rate for Payer: Humana Commercial |
$1,524.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,471.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,323.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$538.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,578.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,345.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,435.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,560.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,237.86
|
| Rate for Payer: PHCS Commercial |
$1,722.24
|
| Rate for Payer: United Healthcare All Payer |
$1,578.72
|
|
|
2+HEAD STEM 496-S 265
|
Facility
|
OP
|
$11,335.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,400.64 |
| Max. Negotiated Rate |
$10,882.03 |
| Rate for Payer: Aetna Commercial |
$8,728.30
|
| Rate for Payer: Anthem Medicaid |
$3,898.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,841.65
|
| Rate for Payer: Cash Price |
$5,667.73
|
| Rate for Payer: Cigna Commercial |
$9,408.42
|
| Rate for Payer: First Health Commercial |
$10,768.68
|
| Rate for Payer: Humana Commercial |
$9,635.13
|
| Rate for Payer: Humana KY Medicaid |
$3,898.26
|
| Rate for Payer: Kentucky WC Medicaid |
$3,937.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,295.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,365.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,400.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,976.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,975.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,501.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,068.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,861.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,821.46
|
| Rate for Payer: PHCS Commercial |
$10,882.03
|
| Rate for Payer: United Healthcare All Payer |
$9,975.20
|
|
|
2+HEAD STEM 496-S 265
|
Facility
|
IP
|
$11,335.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,400.64 |
| Max. Negotiated Rate |
$10,882.03 |
| Rate for Payer: Aetna Commercial |
$8,728.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,841.65
|
| Rate for Payer: Cash Price |
$5,667.73
|
| Rate for Payer: Cigna Commercial |
$9,408.42
|
| Rate for Payer: First Health Commercial |
$10,768.68
|
| Rate for Payer: Humana Commercial |
$9,635.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,295.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,365.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,400.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,975.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,501.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,068.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,861.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,821.46
|
| Rate for Payer: PHCS Commercial |
$10,882.03
|
| Rate for Payer: United Healthcare All Payer |
$9,975.20
|
|
