|
GII PS INSERT SZ 7-8 18MM
|
Facility
|
OP
|
$5,140.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$668.20 |
| Max. Negotiated Rate |
$4,934.40 |
| Rate for Payer: Aetna Commercial |
$3,957.80
|
| Rate for Payer: Anthem Medicaid |
$1,767.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,009.20
|
| Rate for Payer: Cash Price |
$2,570.00
|
| Rate for Payer: Cigna Commercial |
$4,266.20
|
| Rate for Payer: First Health Commercial |
$4,883.00
|
| Rate for Payer: Humana Commercial |
$4,369.00
|
| Rate for Payer: Humana KY Medicaid |
$1,767.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,785.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,214.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,793.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,542.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,803.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,523.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,855.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,028.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$668.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,593.40
|
| Rate for Payer: PHCS Commercial |
$4,934.40
|
| Rate for Payer: United Healthcare All Payer |
$4,523.20
|
|
|
GII PS INSERT SZ 7-8 21MM
|
Facility
|
IP
|
$5,140.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$668.20 |
| Max. Negotiated Rate |
$4,934.40 |
| Rate for Payer: Aetna Commercial |
$3,957.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,009.20
|
| Rate for Payer: Cash Price |
$2,570.00
|
| Rate for Payer: Cigna Commercial |
$4,266.20
|
| Rate for Payer: First Health Commercial |
$4,883.00
|
| Rate for Payer: Humana Commercial |
$4,369.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,214.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,793.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,542.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,523.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,855.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,028.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$668.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,593.40
|
| Rate for Payer: PHCS Commercial |
$4,934.40
|
| Rate for Payer: United Healthcare All Payer |
$4,523.20
|
|
|
GII PS INSERT SZ 7-8 21MM
|
Facility
|
OP
|
$5,140.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$668.20 |
| Max. Negotiated Rate |
$4,934.40 |
| Rate for Payer: Aetna Commercial |
$3,957.80
|
| Rate for Payer: Anthem Medicaid |
$1,767.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,009.20
|
| Rate for Payer: Cash Price |
$2,570.00
|
| Rate for Payer: Cigna Commercial |
$4,266.20
|
| Rate for Payer: First Health Commercial |
$4,883.00
|
| Rate for Payer: Humana Commercial |
$4,369.00
|
| Rate for Payer: Humana KY Medicaid |
$1,767.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,785.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,214.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,793.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,542.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,803.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,523.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,855.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,028.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$668.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,593.40
|
| Rate for Payer: PHCS Commercial |
$4,934.40
|
| Rate for Payer: United Healthcare All Payer |
$4,523.20
|
|
|
GII PS INSERT SZ 7-8 25MM
|
Facility
|
OP
|
$5,140.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$668.20 |
| Max. Negotiated Rate |
$4,934.40 |
| Rate for Payer: Aetna Commercial |
$3,957.80
|
| Rate for Payer: Anthem Medicaid |
$1,767.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,009.20
|
| Rate for Payer: Cash Price |
$2,570.00
|
| Rate for Payer: Cigna Commercial |
$4,266.20
|
| Rate for Payer: First Health Commercial |
$4,883.00
|
| Rate for Payer: Humana Commercial |
$4,369.00
|
| Rate for Payer: Humana KY Medicaid |
$1,767.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,785.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,214.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,793.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,542.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,803.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,523.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,855.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,028.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$668.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,593.40
|
| Rate for Payer: PHCS Commercial |
$4,934.40
|
| Rate for Payer: United Healthcare All Payer |
$4,523.20
|
|
|
GII PS INSERT SZ 7-8 25MM
|
Facility
|
IP
|
$5,140.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$668.20 |
| Max. Negotiated Rate |
$4,934.40 |
| Rate for Payer: Aetna Commercial |
$3,957.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,009.20
|
| Rate for Payer: Cash Price |
$2,570.00
|
| Rate for Payer: Cigna Commercial |
$4,266.20
|
| Rate for Payer: First Health Commercial |
$4,883.00
|
| Rate for Payer: Humana Commercial |
$4,369.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,214.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,793.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,542.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,523.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,855.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,028.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$668.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,593.40
|
| Rate for Payer: PHCS Commercial |
$4,934.40
|
| Rate for Payer: United Healthcare All Payer |
$4,523.20
|
|
|
GII PS INSERT SZ 7-8 9MM
|
Facility
|
IP
|
$4,776.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$620.88 |
| Max. Negotiated Rate |
$4,584.96 |
| Rate for Payer: Aetna Commercial |
$3,677.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,725.28
|
| Rate for Payer: Cash Price |
$2,388.00
|
| Rate for Payer: Cigna Commercial |
$3,964.08
|
| Rate for Payer: First Health Commercial |
$4,537.20
|
| Rate for Payer: Humana Commercial |
$4,059.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,916.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,524.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,432.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,202.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,582.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$955.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$620.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,480.56
|
| Rate for Payer: PHCS Commercial |
$4,584.96
|
| Rate for Payer: United Healthcare All Payer |
$4,202.88
|
|
|
GII PS INSERT SZ 7-8 9MM
|
Facility
|
OP
|
$4,776.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$620.88 |
| Max. Negotiated Rate |
$4,584.96 |
| Rate for Payer: Aetna Commercial |
$3,677.52
|
| Rate for Payer: Anthem Medicaid |
$1,642.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,725.28
|
| Rate for Payer: Cash Price |
$2,388.00
|
| Rate for Payer: Cigna Commercial |
$3,964.08
|
| Rate for Payer: First Health Commercial |
$4,537.20
|
| Rate for Payer: Humana Commercial |
$4,059.60
|
| Rate for Payer: Humana KY Medicaid |
$1,642.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1,659.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,916.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,524.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,432.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,675.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,202.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,582.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$955.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$620.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,480.56
|
| Rate for Payer: PHCS Commercial |
$4,584.96
|
| Rate for Payer: United Healthcare All Payer |
$4,202.88
|
|
|
GI LEVEL 1
|
Facility
|
OP
|
$1,594.00
|
|
| Hospital Charge Code |
36001238
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$207.22 |
| Max. Negotiated Rate |
$1,530.24 |
| Rate for Payer: Aetna Commercial |
$1,227.38
|
| Rate for Payer: Anthem Medicaid |
$548.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,243.32
|
| Rate for Payer: Cash Price |
$797.00
|
| Rate for Payer: Cigna Commercial |
$1,323.02
|
| Rate for Payer: First Health Commercial |
$1,514.30
|
| Rate for Payer: Humana Commercial |
$1,354.90
|
| Rate for Payer: Humana KY Medicaid |
$548.18
|
| Rate for Payer: Kentucky WC Medicaid |
$553.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,307.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,176.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$478.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$559.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,402.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,195.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$318.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$207.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$494.14
|
| Rate for Payer: PHCS Commercial |
$1,530.24
|
| Rate for Payer: United Healthcare All Payer |
$1,402.72
|
|
|
GI LEVEL 1
|
Facility
|
IP
|
$1,594.00
|
|
| Hospital Charge Code |
36001238
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$207.22 |
| Max. Negotiated Rate |
$1,530.24 |
| Rate for Payer: Aetna Commercial |
$1,227.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,243.32
|
| Rate for Payer: Cash Price |
$797.00
|
| Rate for Payer: Cigna Commercial |
$1,323.02
|
| Rate for Payer: First Health Commercial |
$1,514.30
|
| Rate for Payer: Humana Commercial |
$1,354.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,307.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,176.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$478.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,402.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,195.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$318.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$207.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$494.14
|
| Rate for Payer: PHCS Commercial |
$1,530.24
|
| Rate for Payer: United Healthcare All Payer |
$1,402.72
|
|
|
GI LEVEL 2
|
Facility
|
OP
|
$2,359.00
|
|
| Hospital Charge Code |
36001239
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$306.67 |
| Max. Negotiated Rate |
$2,264.64 |
| Rate for Payer: Aetna Commercial |
$1,816.43
|
| Rate for Payer: Anthem Medicaid |
$811.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,840.02
|
| Rate for Payer: Cash Price |
$1,179.50
|
| Rate for Payer: Cigna Commercial |
$1,957.97
|
| Rate for Payer: First Health Commercial |
$2,241.05
|
| Rate for Payer: Humana Commercial |
$2,005.15
|
| Rate for Payer: Humana KY Medicaid |
$811.26
|
| Rate for Payer: Kentucky WC Medicaid |
$819.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,934.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,740.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$707.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$827.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,075.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,769.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$471.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$306.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$731.29
|
| Rate for Payer: PHCS Commercial |
$2,264.64
|
| Rate for Payer: United Healthcare All Payer |
$2,075.92
|
|
|
GI LEVEL 2
|
Facility
|
IP
|
$2,359.00
|
|
| Hospital Charge Code |
36001239
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$306.67 |
| Max. Negotiated Rate |
$2,264.64 |
| Rate for Payer: Aetna Commercial |
$1,816.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,840.02
|
| Rate for Payer: Cash Price |
$1,179.50
|
| Rate for Payer: Cigna Commercial |
$1,957.97
|
| Rate for Payer: First Health Commercial |
$2,241.05
|
| Rate for Payer: Humana Commercial |
$2,005.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,934.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,740.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$707.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,075.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,769.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$471.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$306.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$731.29
|
| Rate for Payer: PHCS Commercial |
$2,264.64
|
| Rate for Payer: United Healthcare All Payer |
$2,075.92
|
|
|
GI LEVEL 3
|
Facility
|
OP
|
$3,009.00
|
|
| Hospital Charge Code |
36001240
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$391.17 |
| Max. Negotiated Rate |
$2,888.64 |
| Rate for Payer: Aetna Commercial |
$2,316.93
|
| Rate for Payer: Anthem Medicaid |
$1,034.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,347.02
|
| Rate for Payer: Cash Price |
$1,504.50
|
| Rate for Payer: Cigna Commercial |
$2,497.47
|
| Rate for Payer: First Health Commercial |
$2,858.55
|
| Rate for Payer: Humana Commercial |
$2,557.65
|
| Rate for Payer: Humana KY Medicaid |
$1,034.80
|
| Rate for Payer: Kentucky WC Medicaid |
$1,045.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,467.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,220.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$902.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,055.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,647.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,256.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$601.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$391.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$932.79
|
| Rate for Payer: PHCS Commercial |
$2,888.64
|
| Rate for Payer: United Healthcare All Payer |
$2,647.92
|
|
|
GI LEVEL 3
|
Facility
|
IP
|
$3,009.00
|
|
| Hospital Charge Code |
36001240
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$391.17 |
| Max. Negotiated Rate |
$2,888.64 |
| Rate for Payer: Aetna Commercial |
$2,316.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,347.02
|
| Rate for Payer: Cash Price |
$1,504.50
|
| Rate for Payer: Cigna Commercial |
$2,497.47
|
| Rate for Payer: First Health Commercial |
$2,858.55
|
| Rate for Payer: Humana Commercial |
$2,557.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,467.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,220.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$902.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,647.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,256.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$601.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$391.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$932.79
|
| Rate for Payer: PHCS Commercial |
$2,888.64
|
| Rate for Payer: United Healthcare All Payer |
$2,647.92
|
|
|
GI LEVEL 4
|
Facility
|
OP
|
$3,462.00
|
|
| Hospital Charge Code |
36001241
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$450.06 |
| Max. Negotiated Rate |
$3,323.52 |
| Rate for Payer: Aetna Commercial |
$2,665.74
|
| Rate for Payer: Anthem Medicaid |
$1,190.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,700.36
|
| Rate for Payer: Cash Price |
$1,731.00
|
| Rate for Payer: Cigna Commercial |
$2,873.46
|
| Rate for Payer: First Health Commercial |
$3,288.90
|
| Rate for Payer: Humana Commercial |
$2,942.70
|
| Rate for Payer: Humana KY Medicaid |
$1,190.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1,202.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,838.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,554.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,038.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,214.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,046.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,596.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$450.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,073.22
|
| Rate for Payer: PHCS Commercial |
$3,323.52
|
| Rate for Payer: United Healthcare All Payer |
$3,046.56
|
|
|
GI LEVEL 4
|
Facility
|
IP
|
$3,462.00
|
|
| Hospital Charge Code |
36001241
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$450.06 |
| Max. Negotiated Rate |
$3,323.52 |
| Rate for Payer: Aetna Commercial |
$2,665.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,700.36
|
| Rate for Payer: Cash Price |
$1,731.00
|
| Rate for Payer: Cigna Commercial |
$2,873.46
|
| Rate for Payer: First Health Commercial |
$3,288.90
|
| Rate for Payer: Humana Commercial |
$2,942.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,838.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,554.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,038.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,046.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,596.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$692.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$450.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,073.22
|
| Rate for Payer: PHCS Commercial |
$3,323.52
|
| Rate for Payer: United Healthcare All Payer |
$3,046.56
|
|
|
GI LEVEL MOD TO COMPLEX
|
Facility
|
IP
|
$8,163.00
|
|
| Hospital Charge Code |
36001261
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,061.19 |
| Max. Negotiated Rate |
$7,836.48 |
| Rate for Payer: Aetna Commercial |
$6,285.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,367.14
|
| Rate for Payer: Cash Price |
$4,081.50
|
| Rate for Payer: Cigna Commercial |
$6,775.29
|
| Rate for Payer: First Health Commercial |
$7,754.85
|
| Rate for Payer: Humana Commercial |
$6,938.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,693.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,024.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,448.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,183.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,122.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,632.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,061.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,530.53
|
| Rate for Payer: PHCS Commercial |
$7,836.48
|
| Rate for Payer: United Healthcare All Payer |
$7,183.44
|
|
|
GI LEVEL MOD TO COMPLEX
|
Facility
|
OP
|
$8,163.00
|
|
| Hospital Charge Code |
36001261
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,061.19 |
| Max. Negotiated Rate |
$7,836.48 |
| Rate for Payer: Aetna Commercial |
$6,285.51
|
| Rate for Payer: Anthem Medicaid |
$2,807.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,367.14
|
| Rate for Payer: Cash Price |
$4,081.50
|
| Rate for Payer: Cigna Commercial |
$6,775.29
|
| Rate for Payer: First Health Commercial |
$7,754.85
|
| Rate for Payer: Humana Commercial |
$6,938.55
|
| Rate for Payer: Humana KY Medicaid |
$2,807.26
|
| Rate for Payer: Kentucky WC Medicaid |
$2,835.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,693.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,024.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,448.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,863.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,183.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,122.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,632.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,061.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,530.53
|
| Rate for Payer: PHCS Commercial |
$7,836.48
|
| Rate for Payer: United Healthcare All Payer |
$7,183.44
|
|
|
GI TRC IMG INTRAL COLON I&R
|
Facility
|
OP
|
$3,311.00
|
|
|
Service Code
|
HCPCS 91113
|
| Hospital Charge Code |
75000009
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$430.43 |
| Max. Negotiated Rate |
$3,178.56 |
| Rate for Payer: Aetna Commercial |
$2,549.47
|
| Rate for Payer: Anthem Medicaid |
$1,138.65
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$790.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,582.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,106.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,066.97
|
| Rate for Payer: Cash Price |
$1,655.50
|
| Rate for Payer: Cash Price |
$1,655.50
|
| Rate for Payer: Cigna Commercial |
$2,748.13
|
| Rate for Payer: First Health Commercial |
$3,145.45
|
| Rate for Payer: Humana Commercial |
$2,814.35
|
| Rate for Payer: Humana KY Medicaid |
$1,138.65
|
| Rate for Payer: Humana Medicare Advantage |
$790.35
|
| Rate for Payer: Kentucky WC Medicaid |
$1,150.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,715.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,443.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$948.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,161.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,913.68
|
| Rate for Payer: Ohio Health Group HMO |
$2,483.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$662.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$430.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,026.41
|
| Rate for Payer: PHCS Commercial |
$3,178.56
|
| Rate for Payer: United Healthcare All Payer |
$2,913.68
|
|
|
GI TRC IMG INTRAL COLON I&R
|
Facility
|
IP
|
$3,311.00
|
|
|
Service Code
|
HCPCS 91113
|
| Hospital Charge Code |
75000009
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$430.43 |
| Max. Negotiated Rate |
$3,178.56 |
| Rate for Payer: Aetna Commercial |
$2,549.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,582.58
|
| Rate for Payer: Cash Price |
$1,655.50
|
| Rate for Payer: Cigna Commercial |
$2,748.13
|
| Rate for Payer: First Health Commercial |
$3,145.45
|
| Rate for Payer: Humana Commercial |
$2,814.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,715.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,443.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$993.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,913.68
|
| Rate for Payer: Ohio Health Group HMO |
$2,483.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$662.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$430.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,026.41
|
| Rate for Payer: PHCS Commercial |
$3,178.56
|
| Rate for Payer: United Healthcare All Payer |
$2,913.68
|
|
|
GI TRC IMG INTRAL COLON I&R
|
Professional
|
Both
|
$3,311.00
|
|
|
Service Code
|
HCPCS 91113
|
| Hospital Charge Code |
75000009
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$733.25 |
| Max. Negotiated Rate |
$3,311.00 |
| Rate for Payer: Anthem Medicaid |
$733.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,311.00
|
| Rate for Payer: Cash Price |
$1,655.50
|
| Rate for Payer: Cash Price |
$1,655.50
|
| Rate for Payer: Humana Medicaid |
$733.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$747.92
|
| Rate for Payer: Molina Healthcare Passport |
$733.25
|
| Rate for Payer: Multiplan PHCS |
$1,986.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,317.70
|
| Rate for Payer: UHCCP Medicaid |
$1,158.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$740.58
|
|
|
GI TRC IMG INTRAL COLON I&R (P
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 91113
|
| Hospital Charge Code |
750P0009
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$50.75 |
| Max. Negotiated Rate |
$747.92 |
| Rate for Payer: Anthem Medicaid |
$733.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$145.00
|
| Rate for Payer: Cash Price |
$72.50
|
| Rate for Payer: Cash Price |
$72.50
|
| Rate for Payer: Humana Medicaid |
$733.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$747.92
|
| Rate for Payer: Molina Healthcare Passport |
$733.25
|
| Rate for Payer: Multiplan PHCS |
$87.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$101.50
|
| Rate for Payer: UHCCP Medicaid |
$50.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$740.58
|
|
|
GI TRC IMG INTRAL COLON I&R (T
|
Facility
|
IP
|
$3,021.00
|
|
|
Service Code
|
HCPCS 91113
|
| Hospital Charge Code |
750T0009
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$392.73 |
| Max. Negotiated Rate |
$2,900.16 |
| Rate for Payer: Aetna Commercial |
$2,326.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,356.38
|
| Rate for Payer: Cash Price |
$1,510.50
|
| Rate for Payer: Cigna Commercial |
$2,507.43
|
| Rate for Payer: First Health Commercial |
$2,869.95
|
| Rate for Payer: Humana Commercial |
$2,567.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,477.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,229.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$906.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,658.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,265.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$604.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$392.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$936.51
|
| Rate for Payer: PHCS Commercial |
$2,900.16
|
| Rate for Payer: United Healthcare All Payer |
$2,658.48
|
|
|
GI TRC IMG INTRAL COLON I&R (T
|
Facility
|
OP
|
$3,021.00
|
|
|
Service Code
|
HCPCS 91113
|
| Hospital Charge Code |
750T0009
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$392.73 |
| Max. Negotiated Rate |
$2,900.16 |
| Rate for Payer: Aetna Commercial |
$2,326.17
|
| Rate for Payer: Anthem Medicaid |
$1,038.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$790.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,356.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,106.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,066.97
|
| Rate for Payer: Cash Price |
$1,510.50
|
| Rate for Payer: Cash Price |
$1,510.50
|
| Rate for Payer: Cigna Commercial |
$2,507.43
|
| Rate for Payer: First Health Commercial |
$2,869.95
|
| Rate for Payer: Humana Commercial |
$2,567.85
|
| Rate for Payer: Humana KY Medicaid |
$1,038.92
|
| Rate for Payer: Humana Medicare Advantage |
$790.35
|
| Rate for Payer: Kentucky WC Medicaid |
$1,049.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,477.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,229.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$948.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,059.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,658.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,265.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$604.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$392.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$936.51
|
| Rate for Payer: PHCS Commercial |
$2,900.16
|
| Rate for Payer: United Healthcare All Payer |
$2,658.48
|
|
|
GI: UPPER W/AIR CONTRAST
|
Professional
|
Both
|
$940.00
|
|
|
Service Code
|
HCPCS 74246
|
| Hospital Charge Code |
32000133
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$44.13 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: Aetna Commercial |
$186.10
|
| Rate for Payer: Anthem Medicaid |
$104.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$940.00
|
| Rate for Payer: Cash Price |
$470.00
|
| Rate for Payer: Cash Price |
$470.00
|
| Rate for Payer: Cigna Commercial |
$157.57
|
| Rate for Payer: Healthspan PPO |
$174.38
|
| Rate for Payer: Humana Medicaid |
$104.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$44.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$106.11
|
| Rate for Payer: Molina Healthcare Passport |
$104.03
|
| Rate for Payer: Multiplan PHCS |
$564.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$658.00
|
| Rate for Payer: UHCCP Medicaid |
$329.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$105.07
|
|
|
GI: UPPER W/AIR CONTRAST
|
Facility
|
IP
|
$940.00
|
|
|
Service Code
|
HCPCS 74246
|
| Hospital Charge Code |
32000133
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$122.20 |
| Max. Negotiated Rate |
$902.40 |
| Rate for Payer: Aetna Commercial |
$723.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$733.20
|
| Rate for Payer: Cash Price |
$470.00
|
| Rate for Payer: Cigna Commercial |
$780.20
|
| Rate for Payer: First Health Commercial |
$893.00
|
| Rate for Payer: Humana Commercial |
$799.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$770.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$693.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$282.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$827.20
|
| Rate for Payer: Ohio Health Group HMO |
$705.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$188.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$122.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$291.40
|
| Rate for Payer: PHCS Commercial |
$902.40
|
| Rate for Payer: United Healthcare All Payer |
$827.20
|
|
