|
3D REND W/O INDEPD WORKSTATION
|
Facility
OP
|
$887.00
|
|
|
Service Code
|
HCPCS 76376
|
| Hospital Charge Code |
402T0004
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$115.31 |
| Max. Negotiated Rate |
$851.52 |
| Rate for Payer: Aetna Commercial |
$682.99
|
| Rate for Payer: Anthem Medicaid |
$305.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$691.86
|
| Rate for Payer: Cash Price |
$443.50
|
| Rate for Payer: Cigna Commercial |
$736.21
|
| Rate for Payer: First Health Commercial |
$842.65
|
| Rate for Payer: Humana Commercial |
$753.95
|
| Rate for Payer: Humana KY Medicaid |
$305.04
|
| Rate for Payer: Kentucky WC Medicaid |
$308.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$727.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$654.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$266.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$311.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$780.56
|
| Rate for Payer: Ohio Health Group HMO |
$665.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$177.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$115.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$274.97
|
| Rate for Payer: PHCS Commercial |
$851.52
|
| Rate for Payer: United Healthcare All Payer |
$780.56
|
|
|
3D REND W/O INDEPD WORKSTATION
|
Facility
OP
|
$927.00
|
|
|
Service Code
|
HCPCS 76376
|
| Hospital Charge Code |
35000015
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$120.51 |
| Max. Negotiated Rate |
$889.92 |
| Rate for Payer: Aetna Commercial |
$713.79
|
| Rate for Payer: Anthem Medicaid |
$318.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$723.06
|
| Rate for Payer: Cash Price |
$463.50
|
| Rate for Payer: Cigna Commercial |
$769.41
|
| Rate for Payer: First Health Commercial |
$880.65
|
| Rate for Payer: Humana Commercial |
$787.95
|
| Rate for Payer: Humana KY Medicaid |
$318.80
|
| Rate for Payer: Kentucky WC Medicaid |
$322.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$760.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$684.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$278.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$325.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$815.76
|
| Rate for Payer: Ohio Health Group HMO |
$695.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$185.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$120.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$287.37
|
| Rate for Payer: PHCS Commercial |
$889.92
|
| Rate for Payer: United Healthcare All Payer |
$815.76
|
|
|
3D REND W/O INDEPD WORKSTATION
|
Facility
IP
|
$927.00
|
|
|
Service Code
|
HCPCS 76376
|
| Hospital Charge Code |
35000015
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$120.51 |
| Max. Negotiated Rate |
$889.92 |
| Rate for Payer: Aetna Commercial |
$713.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$723.06
|
| Rate for Payer: Cash Price |
$463.50
|
| Rate for Payer: Cigna Commercial |
$769.41
|
| Rate for Payer: First Health Commercial |
$880.65
|
| Rate for Payer: Humana Commercial |
$787.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$760.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$684.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$278.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$815.76
|
| Rate for Payer: Ohio Health Group HMO |
$695.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$185.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$120.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$287.37
|
| Rate for Payer: PHCS Commercial |
$889.92
|
|
|
3D REND W/O INDEPD WORKSTATION
|
Professional
|
$40.00
|
|
|
Service Code
|
HCPCS 76376
|
| Hospital Charge Code |
402P0004
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$12.95 |
| Max. Negotiated Rate |
$178.97 |
| Rate for Payer: Aetna Commercial |
$121.42
|
| Rate for Payer: Anthem Medicaid |
$97.83
|
| Rate for Payer: Buckeye Individual/Medicaid |
$22.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$40.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$27.54
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna Commercial |
$178.97
|
| Rate for Payer: Healthspan PPO |
$83.44
|
| Rate for Payer: Humana Medicaid |
$97.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$12.95
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$22.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$99.79
|
| Rate for Payer: Molina Healthcare Passport |
$97.83
|
| Rate for Payer: Multiplan PHCS |
$24.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$29.84
|
| Rate for Payer: UHCCP Medicaid |
$14.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$98.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$22.95
|
|
|
3D REND W/O INDEPD WORKSTATION
|
Facility
IP
|
$927.00
|
|
|
Service Code
|
HCPCS 76376
|
| Hospital Charge Code |
40200004
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$120.51 |
| Max. Negotiated Rate |
$889.92 |
| Rate for Payer: Aetna Commercial |
$713.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$723.06
|
| Rate for Payer: Cash Price |
$463.50
|
| Rate for Payer: Cigna Commercial |
$769.41
|
| Rate for Payer: First Health Commercial |
$880.65
|
| Rate for Payer: Humana Commercial |
$787.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$760.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$684.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$278.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$815.76
|
| Rate for Payer: Ohio Health Group HMO |
$695.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$185.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$120.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$287.37
|
| Rate for Payer: PHCS Commercial |
$889.92
|
|
|
3D REND W/O INDEPD WORKSTATION
|
Facility
IP
|
$887.00
|
|
|
Service Code
|
HCPCS 76376
|
| Hospital Charge Code |
402T0004
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$115.31 |
| Max. Negotiated Rate |
$851.52 |
| Rate for Payer: Aetna Commercial |
$682.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$691.86
|
| Rate for Payer: Cash Price |
$443.50
|
| Rate for Payer: Cigna Commercial |
$736.21
|
| Rate for Payer: First Health Commercial |
$842.65
|
| Rate for Payer: Humana Commercial |
$753.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$727.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$654.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$266.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$780.56
|
| Rate for Payer: Ohio Health Group HMO |
$665.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$177.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$115.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$274.97
|
| Rate for Payer: PHCS Commercial |
$851.52
|
|
|
3D REND W/O INDEPD WORKSTATION
|
Professional
|
$927.00
|
|
|
Service Code
|
HCPCS 76376
|
| Hospital Charge Code |
35000015
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$12.95 |
| Max. Negotiated Rate |
$927.00 |
| Rate for Payer: Aetna Commercial |
$121.42
|
| Rate for Payer: Anthem Medicaid |
$97.83
|
| Rate for Payer: Buckeye Individual/Medicaid |
$22.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$927.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$27.54
|
| Rate for Payer: Cash Price |
$463.50
|
| Rate for Payer: Cash Price |
$463.50
|
| Rate for Payer: Cigna Commercial |
$178.97
|
| Rate for Payer: Healthspan PPO |
$83.44
|
| Rate for Payer: Humana Medicaid |
$97.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$12.95
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$22.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$99.79
|
| Rate for Payer: Molina Healthcare Passport |
$97.83
|
| Rate for Payer: Multiplan PHCS |
$556.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$29.84
|
| Rate for Payer: UHCCP Medicaid |
$324.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$98.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$22.95
|
|
|
3D REND W/O INDEPD WORKSTATION
|
Facility
OP
|
$887.00
|
|
|
Service Code
|
HCPCS 76376
|
| Hospital Charge Code |
350T0015
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$115.31 |
| Max. Negotiated Rate |
$851.52 |
| Rate for Payer: Aetna Commercial |
$682.99
|
| Rate for Payer: Anthem Medicaid |
$305.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$691.86
|
| Rate for Payer: Cash Price |
$443.50
|
| Rate for Payer: Cigna Commercial |
$736.21
|
| Rate for Payer: First Health Commercial |
$842.65
|
| Rate for Payer: Humana Commercial |
$753.95
|
| Rate for Payer: Humana KY Medicaid |
$305.04
|
| Rate for Payer: Kentucky WC Medicaid |
$308.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$727.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$654.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$266.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$311.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$780.56
|
| Rate for Payer: Ohio Health Group HMO |
$665.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$177.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$115.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$274.97
|
| Rate for Payer: PHCS Commercial |
$851.52
|
| Rate for Payer: United Healthcare All Payer |
$780.56
|
|
|
3D REND W/O INDEPD WORKSTATION
|
Professional
|
$40.00
|
|
|
Service Code
|
HCPCS 76376
|
| Hospital Charge Code |
350P0015
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$12.95 |
| Max. Negotiated Rate |
$178.97 |
| Rate for Payer: Aetna Commercial |
$121.42
|
| Rate for Payer: Anthem Medicaid |
$97.83
|
| Rate for Payer: Buckeye Individual/Medicaid |
$22.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$40.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$27.54
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna Commercial |
$178.97
|
| Rate for Payer: Healthspan PPO |
$83.44
|
| Rate for Payer: Humana Medicaid |
$97.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$12.95
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$22.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$99.79
|
| Rate for Payer: Molina Healthcare Passport |
$97.83
|
| Rate for Payer: Multiplan PHCS |
$24.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$29.84
|
| Rate for Payer: UHCCP Medicaid |
$14.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$98.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$22.95
|
|
|
3D RIGHT GUIDE 6FR
|
Facility
OP
|
$1,090.80
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$4,507.68 |
| Rate for Payer: Aetna Commercial |
$839.92
|
| Rate for Payer: Anthem Medicaid |
$375.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$850.82
|
| Rate for Payer: Cash Price |
$545.40
|
| Rate for Payer: Cigna Commercial |
$905.36
|
| Rate for Payer: First Health Commercial |
$1,036.26
|
| Rate for Payer: Humana Commercial |
$927.18
|
| Rate for Payer: Humana KY Medicaid |
$375.13
|
| Rate for Payer: Kentucky WC Medicaid |
$378.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$894.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$805.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$382.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$959.90
|
| Rate for Payer: Ohio Health Group HMO |
$818.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$218.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$338.15
|
| Rate for Payer: PHCS Commercial |
$1,047.17
|
| Rate for Payer: United Healthcare All Payer |
$959.90
|
|
|
3D RIGHT GUIDE 6FR
|
Facility
IP
|
$1,090.80
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$4,507.68 |
| Rate for Payer: Aetna Commercial |
$839.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$850.82
|
| Rate for Payer: Cash Price |
$545.40
|
| Rate for Payer: Cigna Commercial |
$905.36
|
| Rate for Payer: First Health Commercial |
$1,036.26
|
| Rate for Payer: Humana Commercial |
$927.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$894.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$805.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$959.90
|
| Rate for Payer: Ohio Health Group HMO |
$818.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$218.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$338.15
|
| Rate for Payer: PHCS Commercial |
$1,047.17
|
|
|
3 D SIMULATION FIELD SETTING
|
Professional
|
$6,301.00
|
|
|
Service Code
|
HCPCS 77295
|
| Hospital Charge Code |
33300005
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$291.79 |
| Max. Negotiated Rate |
$6,301.00 |
| Rate for Payer: Aetna Commercial |
$1,075.33
|
| Rate for Payer: Anthem Medicaid |
$950.24
|
| Rate for Payer: Buckeye Individual/Medicaid |
$455.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,301.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$546.85
|
| Rate for Payer: Cash Price |
$3,150.50
|
| Rate for Payer: Cash Price |
$3,150.50
|
| Rate for Payer: Cigna Commercial |
$1,657.98
|
| Rate for Payer: Healthspan PPO |
$906.85
|
| Rate for Payer: Humana Medicaid |
$950.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$291.79
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$455.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$455.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$969.24
|
| Rate for Payer: Molina Healthcare Passport |
$950.24
|
| Rate for Payer: Multiplan PHCS |
$3,780.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$592.42
|
| Rate for Payer: UHCCP Medicaid |
$2,205.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$959.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$455.71
|
|
|
3 D SIMULATION FIELD SETTING
|
Facility
IP
|
$6,301.00
|
|
|
Service Code
|
HCPCS 77295
|
| Hospital Charge Code |
33300005
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$819.13 |
| Max. Negotiated Rate |
$6,048.96 |
| Rate for Payer: Aetna Commercial |
$4,851.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,914.78
|
| Rate for Payer: Cash Price |
$3,150.50
|
| Rate for Payer: Cigna Commercial |
$5,229.83
|
| Rate for Payer: First Health Commercial |
$5,985.95
|
| Rate for Payer: Humana Commercial |
$5,355.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,166.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,650.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,890.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,544.88
|
| Rate for Payer: Ohio Health Group HMO |
$4,725.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,260.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$819.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,953.31
|
| Rate for Payer: PHCS Commercial |
$6,048.96
|
|
|
3 D SIMULATION FIELD SETTING
|
Facility
OP
|
$6,301.00
|
|
|
Service Code
|
HCPCS 77295
|
| Hospital Charge Code |
33300005
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$819.13 |
| Max. Negotiated Rate |
$6,048.96 |
| Rate for Payer: Aetna Commercial |
$4,851.77
|
| Rate for Payer: Anthem Medicaid |
$2,166.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,198.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,914.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,677.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,617.60
|
| Rate for Payer: Cash Price |
$3,150.50
|
| Rate for Payer: Cash Price |
$3,150.50
|
| Rate for Payer: Cigna Commercial |
$5,229.83
|
| Rate for Payer: First Health Commercial |
$5,985.95
|
| Rate for Payer: Humana Commercial |
$5,355.85
|
| Rate for Payer: Humana KY Medicaid |
$2,166.91
|
| Rate for Payer: Humana Medicare Advantage |
$1,198.22
|
| Rate for Payer: Kentucky WC Medicaid |
$2,188.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,166.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,650.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,437.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,210.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,544.88
|
| Rate for Payer: Ohio Health Group HMO |
$4,725.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,260.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$819.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,953.31
|
| Rate for Payer: PHCS Commercial |
$6,048.96
|
| Rate for Payer: United Healthcare All Payer |
$5,544.88
|
|
|
3 D SIMULATION FIELD SETTING(P
|
Professional
|
$425.00
|
|
|
Service Code
|
HCPCS 77295
|
| Hospital Charge Code |
333P0005
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$148.75 |
| Max. Negotiated Rate |
$1,657.98 |
| Rate for Payer: Aetna Commercial |
$1,075.33
|
| Rate for Payer: Anthem Medicaid |
$950.24
|
| Rate for Payer: Buckeye Individual/Medicaid |
$455.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$425.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$546.85
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cigna Commercial |
$1,657.98
|
| Rate for Payer: Healthspan PPO |
$906.85
|
| Rate for Payer: Humana Medicaid |
$950.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$291.79
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$455.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$455.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$969.24
|
| Rate for Payer: Molina Healthcare Passport |
$950.24
|
| Rate for Payer: Multiplan PHCS |
$255.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$592.42
|
| Rate for Payer: UHCCP Medicaid |
$148.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$959.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$455.71
|
|
|
3 D SIMULATION FIELD SETTING(T
|
Facility
IP
|
$5,876.00
|
|
|
Service Code
|
HCPCS 77295
|
| Hospital Charge Code |
333T0005
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$763.88 |
| Max. Negotiated Rate |
$5,640.96 |
| Rate for Payer: Aetna Commercial |
$4,524.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,583.28
|
| Rate for Payer: Cash Price |
$2,938.00
|
| Rate for Payer: Cigna Commercial |
$4,877.08
|
| Rate for Payer: First Health Commercial |
$5,582.20
|
| Rate for Payer: Humana Commercial |
$4,994.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,818.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,336.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,762.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,170.88
|
| Rate for Payer: Ohio Health Group HMO |
$4,407.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,175.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$763.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,821.56
|
| Rate for Payer: PHCS Commercial |
$5,640.96
|
|
|
3 D SIMULATION FIELD SETTING(T
|
Facility
OP
|
$5,876.00
|
|
|
Service Code
|
HCPCS 77295
|
| Hospital Charge Code |
333T0005
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$763.88 |
| Max. Negotiated Rate |
$5,640.96 |
| Rate for Payer: Aetna Commercial |
$4,524.52
|
| Rate for Payer: Anthem Medicaid |
$2,020.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,198.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,583.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,677.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,617.60
|
| Rate for Payer: Cash Price |
$2,938.00
|
| Rate for Payer: Cash Price |
$2,938.00
|
| Rate for Payer: Cigna Commercial |
$4,877.08
|
| Rate for Payer: First Health Commercial |
$5,582.20
|
| Rate for Payer: Humana Commercial |
$4,994.60
|
| Rate for Payer: Humana KY Medicaid |
$2,020.76
|
| Rate for Payer: Humana Medicare Advantage |
$1,198.22
|
| Rate for Payer: Kentucky WC Medicaid |
$2,041.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,818.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,336.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,437.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,061.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,170.88
|
| Rate for Payer: Ohio Health Group HMO |
$4,407.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,175.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$763.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,821.56
|
| Rate for Payer: PHCS Commercial |
$5,640.96
|
| Rate for Payer: United Healthcare All Payer |
$5,170.88
|
|
|
40MM GLNOD W/46MM SURFC KEEL
|
Facility
OP
|
$8,607.15
|
|
|
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 |
$6,627.51
|
| Rate for Payer: Anthem Medicaid |
$2,960.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,713.58
|
| Rate for Payer: Cash Price |
$4,303.58
|
| Rate for Payer: Cigna Commercial |
$7,143.93
|
| Rate for Payer: First Health Commercial |
$8,176.79
|
| Rate for Payer: Humana Commercial |
$7,316.08
|
| Rate for Payer: Humana KY Medicaid |
$2,960.00
|
| Rate for Payer: Kentucky WC Medicaid |
$2,990.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,057.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,352.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,582.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,019.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,574.29
|
| Rate for Payer: Ohio Health Group HMO |
$6,455.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,721.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,118.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,668.22
|
| Rate for Payer: PHCS Commercial |
$8,262.86
|
| Rate for Payer: United Healthcare All Payer |
$7,574.29
|
|
|
40MM GLNOD W/46MM SURFC KEEL
|
Facility
IP
|
$8,607.15
|
|
|
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 |
$6,627.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,713.58
|
| Rate for Payer: Cash Price |
$4,303.58
|
| Rate for Payer: Cigna Commercial |
$7,143.93
|
| Rate for Payer: First Health Commercial |
$8,176.79
|
| Rate for Payer: Humana Commercial |
$7,316.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,057.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,352.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,582.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,574.29
|
| Rate for Payer: Ohio Health Group HMO |
$6,455.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,721.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,118.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,668.22
|
| Rate for Payer: PHCS Commercial |
$8,262.86
|
|
|
42/24 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
|
|
|
42/24 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
|
|
|
42 +2.5 INF/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
|
|
|
42 +2.5 INF/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
|
|
|
42 +2.5 INF/28 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
|
|
|
42 +2.5 INF/28 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
|
|
