|
ANALYZE SPINE INFUS PUMP
|
Facility
|
IP
|
$784.65
|
|
|
Service Code
|
HCPCS 62367
|
| Hospital Charge Code |
76102301
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$753.26 |
| Rate for Payer: Aetna Commercial |
$604.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$612.03
|
| Rate for Payer: Cash Price |
$392.32
|
| Rate for Payer: Cigna Commercial |
$651.26
|
| Rate for Payer: First Health Commercial |
$745.42
|
| Rate for Payer: Humana Commercial |
$666.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$643.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$579.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$235.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$690.49
|
| Rate for Payer: Ohio Health Group HMO |
$588.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$243.24
|
| Rate for Payer: PHCS Commercial |
$753.26
|
| Rate for Payer: United Healthcare All Payer |
$690.49
|
|
|
ANALYZE SPINE INFUS PUMP
|
Professional
|
Both
|
$784.65
|
|
|
Service Code
|
HCPCS 62367
|
| Hospital Charge Code |
76102301
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$12.81 |
| Max. Negotiated Rate |
$784.65 |
| Rate for Payer: Aetna Commercial |
$39.18
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$12.81
|
| Rate for Payer: Anthem Medicaid |
$17.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$784.65
|
| Rate for Payer: Cash Price |
$392.32
|
| Rate for Payer: Cash Price |
$392.32
|
| Rate for Payer: Cigna Commercial |
$60.47
|
| Rate for Payer: Healthspan PPO |
$46.83
|
| Rate for Payer: Humana Medicaid |
$17.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$31.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$17.92
|
| Rate for Payer: Molina Healthcare Passport |
$17.57
|
| Rate for Payer: Multiplan PHCS |
$470.79
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$549.26
|
| Rate for Payer: UHCCP Medicaid |
$13.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$17.75
|
|
|
ANALYZE SPINE INFUS PUMP(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 62367
|
| Hospital Charge Code |
761P2301
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$12.81 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna Commercial |
$39.18
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$12.81
|
| Rate for Payer: Anthem Medicaid |
$17.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$150.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$60.47
|
| Rate for Payer: Healthspan PPO |
$46.83
|
| Rate for Payer: Humana Medicaid |
$17.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$31.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$17.92
|
| Rate for Payer: Molina Healthcare Passport |
$17.57
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.00
|
| Rate for Payer: UHCCP Medicaid |
$13.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$17.75
|
|
|
ANALYZE SPINE INFUS PUMP(T
|
Facility
|
OP
|
$634.65
|
|
|
Service Code
|
HCPCS 62367
|
| Hospital Charge Code |
761T2301
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.50 |
| Max. Negotiated Rate |
$609.26 |
| Rate for Payer: Aetna Commercial |
$488.68
|
| Rate for Payer: Anthem Medicaid |
$218.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$258.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$495.03
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$361.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$348.69
|
| Rate for Payer: Cash Price |
$317.32
|
| Rate for Payer: Cash Price |
$317.32
|
| Rate for Payer: Cigna Commercial |
$526.76
|
| Rate for Payer: First Health Commercial |
$602.92
|
| Rate for Payer: Humana Commercial |
$539.45
|
| Rate for Payer: Humana KY Medicaid |
$218.26
|
| Rate for Payer: Humana Medicare Advantage |
$258.29
|
| Rate for Payer: Kentucky WC Medicaid |
$220.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$520.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$468.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$309.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$222.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$558.49
|
| Rate for Payer: Ohio Health Group HMO |
$475.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$126.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$196.74
|
| Rate for Payer: PHCS Commercial |
$609.26
|
| Rate for Payer: United Healthcare All Payer |
$558.49
|
|
|
ANALYZE SPINE INFUS PUMP(T
|
Facility
|
IP
|
$634.65
|
|
|
Service Code
|
HCPCS 62367
|
| Hospital Charge Code |
761T2301
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.50 |
| Max. Negotiated Rate |
$609.26 |
| Rate for Payer: Aetna Commercial |
$488.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$495.03
|
| Rate for Payer: Cash Price |
$317.32
|
| Rate for Payer: Cigna Commercial |
$526.76
|
| Rate for Payer: First Health Commercial |
$602.92
|
| Rate for Payer: Humana Commercial |
$539.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$520.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$468.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$558.49
|
| Rate for Payer: Ohio Health Group HMO |
$475.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$126.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$196.74
|
| Rate for Payer: PHCS Commercial |
$609.26
|
| Rate for Payer: United Healthcare All Payer |
$558.49
|
|
|
ANALYZE SP INF PUMP W/REPROG
|
Facility
|
IP
|
$1,199.54
|
|
|
Service Code
|
HCPCS 62368
|
| Hospital Charge Code |
76102302
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$155.94 |
| Max. Negotiated Rate |
$1,151.56 |
| Rate for Payer: Aetna Commercial |
$923.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$935.64
|
| Rate for Payer: Cash Price |
$599.77
|
| Rate for Payer: Cigna Commercial |
$995.62
|
| Rate for Payer: First Health Commercial |
$1,139.56
|
| Rate for Payer: Humana Commercial |
$1,019.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$983.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$359.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,055.60
|
| Rate for Payer: Ohio Health Group HMO |
$899.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$239.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$155.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$371.86
|
| Rate for Payer: PHCS Commercial |
$1,151.56
|
| Rate for Payer: United Healthcare All Payer |
$1,055.60
|
|
|
ANALYZE SP INF PUMP W/REPROG
|
Facility
|
OP
|
$1,199.54
|
|
|
Service Code
|
HCPCS 62368
|
| Hospital Charge Code |
76102302
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$155.94 |
| Max. Negotiated Rate |
$1,151.56 |
| Rate for Payer: Aetna Commercial |
$923.65
|
| Rate for Payer: Anthem Medicaid |
$412.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$258.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$935.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$361.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$348.69
|
| Rate for Payer: Cash Price |
$599.77
|
| Rate for Payer: Cash Price |
$599.77
|
| Rate for Payer: Cigna Commercial |
$995.62
|
| Rate for Payer: First Health Commercial |
$1,139.56
|
| Rate for Payer: Humana Commercial |
$1,019.61
|
| Rate for Payer: Humana KY Medicaid |
$412.52
|
| Rate for Payer: Humana Medicare Advantage |
$258.29
|
| Rate for Payer: Kentucky WC Medicaid |
$416.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$983.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$309.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$420.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,055.60
|
| Rate for Payer: Ohio Health Group HMO |
$899.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$239.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$155.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$371.86
|
| Rate for Payer: PHCS Commercial |
$1,151.56
|
| Rate for Payer: United Healthcare All Payer |
$1,055.60
|
|
|
ANALYZE SP INF PUMP W/REPROG
|
Professional
|
Both
|
$1,199.54
|
|
|
Service Code
|
HCPCS 62368
|
| Hospital Charge Code |
76102302
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$17.82 |
| Max. Negotiated Rate |
$1,199.54 |
| Rate for Payer: Aetna Commercial |
$61.78
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$17.82
|
| Rate for Payer: Anthem Medicaid |
$30.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,199.54
|
| Rate for Payer: Cash Price |
$599.77
|
| Rate for Payer: Cash Price |
$599.77
|
| Rate for Payer: Cigna Commercial |
$83.37
|
| Rate for Payer: Healthspan PPO |
$67.65
|
| Rate for Payer: Humana Medicaid |
$30.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$48.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$31.14
|
| Rate for Payer: Molina Healthcare Passport |
$30.53
|
| Rate for Payer: Multiplan PHCS |
$719.72
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$839.68
|
| Rate for Payer: UHCCP Medicaid |
$18.71
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$30.84
|
|
|
ANALYZE SP INF PUMP W/REPRO(P
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 62368
|
| Hospital Charge Code |
761P2302
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$17.82 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna Commercial |
$61.78
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$17.82
|
| Rate for Payer: Anthem Medicaid |
$30.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$500.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$83.37
|
| Rate for Payer: Healthspan PPO |
$67.65
|
| Rate for Payer: Humana Medicaid |
$30.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$48.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$31.14
|
| Rate for Payer: Molina Healthcare Passport |
$30.53
|
| Rate for Payer: Multiplan PHCS |
$300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$350.00
|
| Rate for Payer: UHCCP Medicaid |
$18.71
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$30.84
|
|
|
ANALYZE SP INF PUMP W/REPRO(T
|
Facility
|
IP
|
$699.54
|
|
|
Service Code
|
HCPCS 62368
|
| Hospital Charge Code |
761T2302
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$90.94 |
| Max. Negotiated Rate |
$671.56 |
| Rate for Payer: Aetna Commercial |
$538.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$545.64
|
| Rate for Payer: Cash Price |
$349.77
|
| Rate for Payer: Cigna Commercial |
$580.62
|
| Rate for Payer: First Health Commercial |
$664.56
|
| Rate for Payer: Humana Commercial |
$594.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$573.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$516.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$209.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$615.60
|
| Rate for Payer: Ohio Health Group HMO |
$524.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$139.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$90.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$216.86
|
| Rate for Payer: PHCS Commercial |
$671.56
|
| Rate for Payer: United Healthcare All Payer |
$615.60
|
|
|
ANALYZE SP INF PUMP W/REPRO(T
|
Facility
|
OP
|
$699.54
|
|
|
Service Code
|
HCPCS 62368
|
| Hospital Charge Code |
761T2302
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$90.94 |
| Max. Negotiated Rate |
$671.56 |
| Rate for Payer: Aetna Commercial |
$538.65
|
| Rate for Payer: Anthem Medicaid |
$240.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$258.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$545.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$361.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$348.69
|
| Rate for Payer: Cash Price |
$349.77
|
| Rate for Payer: Cash Price |
$349.77
|
| Rate for Payer: Cigna Commercial |
$580.62
|
| Rate for Payer: First Health Commercial |
$664.56
|
| Rate for Payer: Humana Commercial |
$594.61
|
| Rate for Payer: Humana KY Medicaid |
$240.57
|
| Rate for Payer: Humana Medicare Advantage |
$258.29
|
| Rate for Payer: Kentucky WC Medicaid |
$243.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$573.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$516.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$309.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$245.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$615.60
|
| Rate for Payer: Ohio Health Group HMO |
$524.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$139.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$90.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$216.86
|
| Rate for Payer: PHCS Commercial |
$671.56
|
| Rate for Payer: United Healthcare All Payer |
$615.60
|
|
|
ANATOMICAL SHLD PEG GLND LG
|
Facility
|
IP
|
$8,103.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,053.45 |
| Max. Negotiated Rate |
$7,779.31 |
| Rate for Payer: Aetna Commercial |
$6,239.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,320.69
|
| Rate for Payer: Cash Price |
$4,051.72
|
| Rate for Payer: Cigna Commercial |
$6,725.86
|
| Rate for Payer: First Health Commercial |
$7,698.28
|
| Rate for Payer: Humana Commercial |
$6,887.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,644.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,980.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,431.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,131.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,077.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,620.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,053.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,512.07
|
| Rate for Payer: PHCS Commercial |
$7,779.31
|
| Rate for Payer: United Healthcare All Payer |
$7,131.04
|
|
|
ANATOMICAL SHLD PEG GLND LG
|
Facility
|
OP
|
$8,103.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,053.45 |
| Max. Negotiated Rate |
$7,779.31 |
| Rate for Payer: Aetna Commercial |
$6,239.66
|
| Rate for Payer: Anthem Medicaid |
$2,786.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,320.69
|
| Rate for Payer: Cash Price |
$4,051.72
|
| Rate for Payer: Cigna Commercial |
$6,725.86
|
| Rate for Payer: First Health Commercial |
$7,698.28
|
| Rate for Payer: Humana Commercial |
$6,887.93
|
| Rate for Payer: Humana KY Medicaid |
$2,786.78
|
| Rate for Payer: Kentucky WC Medicaid |
$2,815.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,644.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,980.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,431.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,842.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,131.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,077.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,620.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,053.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,512.07
|
| Rate for Payer: PHCS Commercial |
$7,779.31
|
| Rate for Payer: United Healthcare All Payer |
$7,131.04
|
|
|
ANATOMICAL SHLDR KEEL GLND LG
|
Facility
|
IP
|
$5,637.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$732.81 |
| Max. Negotiated Rate |
$5,411.52 |
| Rate for Payer: Aetna Commercial |
$4,340.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,396.86
|
| Rate for Payer: Cash Price |
$2,818.50
|
| Rate for Payer: Cigna Commercial |
$4,678.71
|
| Rate for Payer: First Health Commercial |
$5,355.15
|
| Rate for Payer: Humana Commercial |
$4,791.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,622.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,160.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,691.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,960.56
|
| Rate for Payer: Ohio Health Group HMO |
$4,227.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,127.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$732.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,747.47
|
| Rate for Payer: PHCS Commercial |
$5,411.52
|
| Rate for Payer: United Healthcare All Payer |
$4,960.56
|
|
|
ANATOMICAL SHLDR KEEL GLND LG
|
Facility
|
OP
|
$5,637.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$732.81 |
| Max. Negotiated Rate |
$5,411.52 |
| Rate for Payer: Aetna Commercial |
$4,340.49
|
| Rate for Payer: Anthem Medicaid |
$1,938.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,396.86
|
| Rate for Payer: Cash Price |
$2,818.50
|
| Rate for Payer: Cigna Commercial |
$4,678.71
|
| Rate for Payer: First Health Commercial |
$5,355.15
|
| Rate for Payer: Humana Commercial |
$4,791.45
|
| Rate for Payer: Humana KY Medicaid |
$1,938.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1,958.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,622.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,160.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,691.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,977.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,960.56
|
| Rate for Payer: Ohio Health Group HMO |
$4,227.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,127.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$732.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,747.47
|
| Rate for Payer: PHCS Commercial |
$5,411.52
|
| Rate for Payer: United Healthcare All Payer |
$4,960.56
|
|
|
ANATOMICAL SHLDR KEEL GLND SM
|
Facility
|
OP
|
$5,637.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$732.81 |
| Max. Negotiated Rate |
$5,411.52 |
| Rate for Payer: Aetna Commercial |
$4,340.49
|
| Rate for Payer: Anthem Medicaid |
$1,938.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,396.86
|
| Rate for Payer: Cash Price |
$2,818.50
|
| Rate for Payer: Cigna Commercial |
$4,678.71
|
| Rate for Payer: First Health Commercial |
$5,355.15
|
| Rate for Payer: Humana Commercial |
$4,791.45
|
| Rate for Payer: Humana KY Medicaid |
$1,938.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1,958.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,622.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,160.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,691.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,977.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,960.56
|
| Rate for Payer: Ohio Health Group HMO |
$4,227.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,127.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$732.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,747.47
|
| Rate for Payer: PHCS Commercial |
$5,411.52
|
| Rate for Payer: United Healthcare All Payer |
$4,960.56
|
|
|
ANATOMICAL SHLDR KEEL GLND SM
|
Facility
|
IP
|
$5,637.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$732.81 |
| Max. Negotiated Rate |
$5,411.52 |
| Rate for Payer: Aetna Commercial |
$4,340.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,396.86
|
| Rate for Payer: Cash Price |
$2,818.50
|
| Rate for Payer: Cigna Commercial |
$4,678.71
|
| Rate for Payer: First Health Commercial |
$5,355.15
|
| Rate for Payer: Humana Commercial |
$4,791.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,622.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,160.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,691.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,960.56
|
| Rate for Payer: Ohio Health Group HMO |
$4,227.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,127.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$732.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,747.47
|
| Rate for Payer: PHCS Commercial |
$5,411.52
|
| Rate for Payer: United Healthcare All Payer |
$4,960.56
|
|
|
ANATOMICAL SHLDR KELL GLND MED
|
Facility
|
IP
|
$5,637.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$732.81 |
| Max. Negotiated Rate |
$5,411.52 |
| Rate for Payer: Aetna Commercial |
$4,340.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,396.86
|
| Rate for Payer: Cash Price |
$2,818.50
|
| Rate for Payer: Cigna Commercial |
$4,678.71
|
| Rate for Payer: First Health Commercial |
$5,355.15
|
| Rate for Payer: Humana Commercial |
$4,791.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,622.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,160.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,691.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,960.56
|
| Rate for Payer: Ohio Health Group HMO |
$4,227.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,127.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$732.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,747.47
|
| Rate for Payer: PHCS Commercial |
$5,411.52
|
| Rate for Payer: United Healthcare All Payer |
$4,960.56
|
|
|
ANATOMICAL SHLDR KELL GLND MED
|
Facility
|
OP
|
$5,637.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$732.81 |
| Max. Negotiated Rate |
$5,411.52 |
| Rate for Payer: Aetna Commercial |
$4,340.49
|
| Rate for Payer: Anthem Medicaid |
$1,938.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,396.86
|
| Rate for Payer: Cash Price |
$2,818.50
|
| Rate for Payer: Cigna Commercial |
$4,678.71
|
| Rate for Payer: First Health Commercial |
$5,355.15
|
| Rate for Payer: Humana Commercial |
$4,791.45
|
| Rate for Payer: Humana KY Medicaid |
$1,938.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1,958.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,622.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,160.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,691.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,977.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,960.56
|
| Rate for Payer: Ohio Health Group HMO |
$4,227.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,127.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$732.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,747.47
|
| Rate for Payer: PHCS Commercial |
$5,411.52
|
| Rate for Payer: United Healthcare All Payer |
$4,960.56
|
|
|
ANATOMICAL SHLDR PEG GLENOID L
|
Facility
|
OP
|
$8,517.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,107.26 |
| Max. Negotiated Rate |
$8,176.67 |
| Rate for Payer: Aetna Commercial |
$6,558.37
|
| Rate for Payer: Anthem Medicaid |
$2,929.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,643.54
|
| Rate for Payer: Cash Price |
$4,258.68
|
| Rate for Payer: Cigna Commercial |
$7,069.41
|
| Rate for Payer: First Health Commercial |
$8,091.49
|
| Rate for Payer: Humana Commercial |
$7,239.76
|
| Rate for Payer: Humana KY Medicaid |
$2,929.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,958.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,984.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,285.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,555.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,987.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,495.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,388.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,703.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,107.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,640.38
|
| Rate for Payer: PHCS Commercial |
$8,176.67
|
| Rate for Payer: United Healthcare All Payer |
$7,495.28
|
|
|
ANATOMICAL SHLDR PEG GLENOID L
|
Facility
|
IP
|
$8,517.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,107.26 |
| Max. Negotiated Rate |
$8,176.67 |
| Rate for Payer: Aetna Commercial |
$6,558.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,643.54
|
| Rate for Payer: Cash Price |
$4,258.68
|
| Rate for Payer: Cigna Commercial |
$7,069.41
|
| Rate for Payer: First Health Commercial |
$8,091.49
|
| Rate for Payer: Humana Commercial |
$7,239.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,984.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,285.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,555.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,495.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,388.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,703.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,107.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,640.38
|
| Rate for Payer: PHCS Commercial |
$8,176.67
|
| Rate for Payer: United Healthcare All Payer |
$7,495.28
|
|
|
ANATOMICAL SHLDR PEG GLENOID M
|
Facility
|
IP
|
$8,517.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,107.26 |
| Max. Negotiated Rate |
$8,176.67 |
| Rate for Payer: Aetna Commercial |
$6,558.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,643.54
|
| Rate for Payer: Cash Price |
$4,258.68
|
| Rate for Payer: Cigna Commercial |
$7,069.41
|
| Rate for Payer: First Health Commercial |
$8,091.49
|
| Rate for Payer: Humana Commercial |
$7,239.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,984.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,285.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,555.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,495.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,388.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,703.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,107.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,640.38
|
| Rate for Payer: PHCS Commercial |
$8,176.67
|
| Rate for Payer: United Healthcare All Payer |
$7,495.28
|
|
|
ANATOMICAL SHLDR PEG GLENOID M
|
Facility
|
OP
|
$8,517.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,107.26 |
| Max. Negotiated Rate |
$8,176.67 |
| Rate for Payer: Aetna Commercial |
$6,558.37
|
| Rate for Payer: Anthem Medicaid |
$2,929.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,643.54
|
| Rate for Payer: Cash Price |
$4,258.68
|
| Rate for Payer: Cigna Commercial |
$7,069.41
|
| Rate for Payer: First Health Commercial |
$8,091.49
|
| Rate for Payer: Humana Commercial |
$7,239.76
|
| Rate for Payer: Humana KY Medicaid |
$2,929.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,958.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,984.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,285.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,555.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,987.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,495.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,388.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,703.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,107.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,640.38
|
| Rate for Payer: PHCS Commercial |
$8,176.67
|
| Rate for Payer: United Healthcare All Payer |
$7,495.28
|
|
|
ANATOMICAL SHLDR PEG GLENOID S
|
Facility
|
OP
|
$8,517.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,107.26 |
| Max. Negotiated Rate |
$8,176.67 |
| Rate for Payer: Aetna Commercial |
$6,558.37
|
| Rate for Payer: Anthem Medicaid |
$2,929.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,643.54
|
| Rate for Payer: Cash Price |
$4,258.68
|
| Rate for Payer: Cigna Commercial |
$7,069.41
|
| Rate for Payer: First Health Commercial |
$8,091.49
|
| Rate for Payer: Humana Commercial |
$7,239.76
|
| Rate for Payer: Humana KY Medicaid |
$2,929.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,958.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,984.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,285.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,555.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,987.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,495.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,388.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,703.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,107.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,640.38
|
| Rate for Payer: PHCS Commercial |
$8,176.67
|
| Rate for Payer: United Healthcare All Payer |
$7,495.28
|
|
|
ANATOMICAL SHLDR PEG GLENOID S
|
Facility
|
IP
|
$8,517.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,107.26 |
| Max. Negotiated Rate |
$8,176.67 |
| Rate for Payer: Aetna Commercial |
$6,558.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,643.54
|
| Rate for Payer: Cash Price |
$4,258.68
|
| Rate for Payer: Cigna Commercial |
$7,069.41
|
| Rate for Payer: First Health Commercial |
$8,091.49
|
| Rate for Payer: Humana Commercial |
$7,239.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,984.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,285.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,555.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,495.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,388.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,703.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,107.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,640.38
|
| Rate for Payer: PHCS Commercial |
$8,176.67
|
| Rate for Payer: United Healthcare All Payer |
$7,495.28
|
|
