|
GRANIX EAMCG(480MCG/0.8ML SYR)
|
Facility
|
OP
|
$2,179.40
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
25002059
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$2,092.22 |
| Rate for Payer: Aetna Commercial |
$1,678.14
|
| Rate for Payer: Anthem Medicaid |
$749.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$0.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,699.93
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$1.34
|
| Rate for Payer: Cash Price |
$1,089.70
|
| Rate for Payer: Cash Price |
$1,089.70
|
| Rate for Payer: Cigna Commercial |
$1,808.90
|
| Rate for Payer: First Health Commercial |
$2,070.43
|
| Rate for Payer: Humana Commercial |
$1,852.49
|
| Rate for Payer: Humana KY Medicaid |
$749.50
|
| Rate for Payer: Humana Medicare Advantage |
$0.99
|
| Rate for Payer: Kentucky WC Medicaid |
$757.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,787.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,608.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$764.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,917.87
|
| Rate for Payer: Ohio Health Group HMO |
$1,634.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,743.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,896.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,503.79
|
| Rate for Payer: PHCS Commercial |
$2,092.22
|
| Rate for Payer: United Healthcare All Payer |
$1,917.87
|
|
|
GREENFIELD CAVA FILTER JUGULAR
|
Facility
|
OP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C1880
|
| Hospital Charge Code |
27000050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,657.50 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem Medicaid |
$1,900.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Humana KY Medicaid |
$1,900.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,919.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,938.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,806.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,812.25
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
GREENFIELD CAVA FILTER JUGULAR
|
Facility
|
IP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C1880
|
| Hospital Charge Code |
27000050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,657.50 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,806.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,812.25
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
GREENFIELD VENA CAVA FEMORAL
|
Facility
|
IP
|
$5,566.25
|
|
|
Service Code
|
HCPCS C1880
|
| Hospital Charge Code |
27000050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,669.88 |
| Max. Negotiated Rate |
$5,343.60 |
| Rate for Payer: Aetna Commercial |
$4,286.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,341.68
|
| Rate for Payer: Cash Price |
$2,783.12
|
| Rate for Payer: Cigna Commercial |
$4,619.99
|
| Rate for Payer: First Health Commercial |
$5,287.94
|
| Rate for Payer: Humana Commercial |
$4,731.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,564.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,107.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,669.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,898.30
|
| Rate for Payer: Ohio Health Group HMO |
$4,174.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,453.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,842.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,840.71
|
| Rate for Payer: PHCS Commercial |
$5,343.60
|
| Rate for Payer: United Healthcare All Payer |
$4,898.30
|
|
|
GREENFIELD VENA CAVA FEMORAL
|
Facility
|
OP
|
$5,566.25
|
|
|
Service Code
|
HCPCS C1880
|
| Hospital Charge Code |
27000050
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,669.88 |
| Max. Negotiated Rate |
$5,343.60 |
| Rate for Payer: Aetna Commercial |
$4,286.01
|
| Rate for Payer: Anthem Medicaid |
$1,914.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,341.68
|
| Rate for Payer: Cash Price |
$2,783.12
|
| Rate for Payer: Cigna Commercial |
$4,619.99
|
| Rate for Payer: First Health Commercial |
$5,287.94
|
| Rate for Payer: Humana Commercial |
$4,731.31
|
| Rate for Payer: Humana KY Medicaid |
$1,914.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,933.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,564.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,107.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,669.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,952.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,898.30
|
| Rate for Payer: Ohio Health Group HMO |
$4,174.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,453.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,842.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,840.71
|
| Rate for Payer: PHCS Commercial |
$5,343.60
|
| Rate for Payer: United Healthcare All Payer |
$4,898.30
|
|
|
GRFG AUTOL FAT LIPO 25 CC/<
|
Facility
|
IP
|
$1,188.00
|
|
|
Service Code
|
HCPCS 15773
|
| Hospital Charge Code |
76102947
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$356.40 |
| Max. Negotiated Rate |
$1,140.48 |
| Rate for Payer: Aetna Commercial |
$914.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$926.64
|
| Rate for Payer: Cash Price |
$594.00
|
| Rate for Payer: Cigna Commercial |
$986.04
|
| Rate for Payer: First Health Commercial |
$1,128.60
|
| Rate for Payer: Humana Commercial |
$1,009.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$974.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$876.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$356.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,045.44
|
| Rate for Payer: Ohio Health Group HMO |
$891.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$950.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,033.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$819.72
|
| Rate for Payer: PHCS Commercial |
$1,140.48
|
| Rate for Payer: United Healthcare All Payer |
$1,045.44
|
|
|
GRFG AUTOL FAT LIPO 25 CC/<
|
Facility
|
OP
|
$1,188.00
|
|
|
Service Code
|
HCPCS 15773
|
| Hospital Charge Code |
76102947
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$408.55 |
| Max. Negotiated Rate |
$2,366.24 |
| Rate for Payer: Aetna Commercial |
$914.76
|
| Rate for Payer: Anthem Medicaid |
$408.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,690.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$926.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,366.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,281.73
|
| Rate for Payer: Cash Price |
$594.00
|
| Rate for Payer: Cash Price |
$594.00
|
| Rate for Payer: Cigna Commercial |
$986.04
|
| Rate for Payer: First Health Commercial |
$1,128.60
|
| Rate for Payer: Humana Commercial |
$1,009.80
|
| Rate for Payer: Humana KY Medicaid |
$408.55
|
| Rate for Payer: Humana Medicare Advantage |
$1,690.17
|
| Rate for Payer: Kentucky WC Medicaid |
$412.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$974.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$876.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,028.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$416.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,045.44
|
| Rate for Payer: Ohio Health Group HMO |
$891.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$950.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,033.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$819.72
|
| Rate for Payer: PHCS Commercial |
$1,140.48
|
| Rate for Payer: United Healthcare All Payer |
$1,045.44
|
|
|
GRFG AUTOL FAT LIPO 25 CC/<
|
Professional
|
Both
|
$1,188.00
|
|
|
Service Code
|
HCPCS 15773
|
| Hospital Charge Code |
76102947
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$406.39 |
| Max. Negotiated Rate |
$712.80 |
| Rate for Payer: Ambetter Exchange |
$474.17
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$406.39
|
| Rate for Payer: Anthem Medicaid |
$453.88
|
| Rate for Payer: Buckeye Individual/Medicaid |
$474.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$474.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$569.00
|
| Rate for Payer: Cash Price |
$594.00
|
| Rate for Payer: Cash Price |
$594.00
|
| Rate for Payer: Humana Medicaid |
$453.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$626.96
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$474.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$474.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$462.96
|
| Rate for Payer: Molina Healthcare Passport |
$453.88
|
| Rate for Payer: Multiplan PHCS |
$712.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$616.42
|
| Rate for Payer: UHCCP Medicaid |
$426.71
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$458.42
|
| Rate for Payer: Wellcare Medicare Advantage |
$474.17
|
|
|
GRFG AUTOL FAT LIPO 50 CC/<
|
Professional
|
Both
|
$680.00
|
|
|
Service Code
|
HCPCS 15771
|
| Hospital Charge Code |
761P2620
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$382.86 |
| Max. Negotiated Rate |
$629.59 |
| Rate for Payer: Ambetter Exchange |
$484.30
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$382.86
|
| Rate for Payer: Anthem Medicaid |
$449.66
|
| Rate for Payer: Buckeye Individual/Medicaid |
$484.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$484.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$581.16
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Humana Medicaid |
$449.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$620.19
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$484.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$484.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$458.65
|
| Rate for Payer: Molina Healthcare Passport |
$449.66
|
| Rate for Payer: Multiplan PHCS |
$408.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$629.59
|
| Rate for Payer: UHCCP Medicaid |
$402.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$454.16
|
| Rate for Payer: Wellcare Medicare Advantage |
$484.30
|
|
|
GRFG AUTOL FAT LIPO 50 CC/<
|
Facility
|
OP
|
$680.00
|
|
|
Service Code
|
HCPCS 15771
|
| Hospital Charge Code |
76102620
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$233.85 |
| Max. Negotiated Rate |
$4,735.72 |
| Rate for Payer: Aetna Commercial |
$523.60
|
| Rate for Payer: Anthem Medicaid |
$233.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,382.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$530.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,735.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,566.59
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cigna Commercial |
$564.40
|
| Rate for Payer: First Health Commercial |
$646.00
|
| Rate for Payer: Humana Commercial |
$578.00
|
| Rate for Payer: Humana KY Medicaid |
$233.85
|
| Rate for Payer: Humana Medicare Advantage |
$3,382.66
|
| Rate for Payer: Kentucky WC Medicaid |
$236.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$557.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$501.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,059.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$238.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$598.40
|
| Rate for Payer: Ohio Health Group HMO |
$510.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$544.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$591.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$469.20
|
| Rate for Payer: PHCS Commercial |
$652.80
|
| Rate for Payer: United Healthcare All Payer |
$598.40
|
|
|
GRFG AUTOL FAT LIPO 50 CC/<
|
Facility
|
IP
|
$680.00
|
|
|
Service Code
|
HCPCS 15771
|
| Hospital Charge Code |
76102620
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$204.00 |
| Max. Negotiated Rate |
$652.80 |
| Rate for Payer: Aetna Commercial |
$523.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$530.40
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cigna Commercial |
$564.40
|
| Rate for Payer: First Health Commercial |
$646.00
|
| Rate for Payer: Humana Commercial |
$578.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$557.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$501.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$204.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$598.40
|
| Rate for Payer: Ohio Health Group HMO |
$510.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$544.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$591.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$469.20
|
| Rate for Payer: PHCS Commercial |
$652.80
|
| Rate for Payer: United Healthcare All Payer |
$598.40
|
|
|
GRFG AUTOL FAT LIPO 50 CC/<
|
Professional
|
Both
|
$680.00
|
|
|
Service Code
|
HCPCS 15771
|
| Hospital Charge Code |
76102620
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$382.86 |
| Max. Negotiated Rate |
$629.59 |
| Rate for Payer: Ambetter Exchange |
$484.30
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$382.86
|
| Rate for Payer: Anthem Medicaid |
$449.66
|
| Rate for Payer: Buckeye Individual/Medicaid |
$484.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$484.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$581.16
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Humana Medicaid |
$449.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$620.19
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$484.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$484.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$458.65
|
| Rate for Payer: Molina Healthcare Passport |
$449.66
|
| Rate for Payer: Multiplan PHCS |
$408.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$629.59
|
| Rate for Payer: UHCCP Medicaid |
$402.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$454.16
|
| Rate for Payer: Wellcare Medicare Advantage |
$484.30
|
|
|
GRFG AUTOL FAT LIPO EA ADDL
|
Professional
|
Both
|
$345.00
|
|
|
Service Code
|
HCPCS 15772
|
| Hospital Charge Code |
761P2627
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$114.72 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Ambetter Exchange |
$140.81
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$114.72
|
| Rate for Payer: Anthem Medicaid |
$142.96
|
| Rate for Payer: Buckeye Individual/Medicaid |
$140.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$140.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$168.97
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Humana Medicaid |
$142.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$186.02
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$140.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$140.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$145.82
|
| Rate for Payer: Molina Healthcare Passport |
$142.96
|
| Rate for Payer: Multiplan PHCS |
$207.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$183.05
|
| Rate for Payer: UHCCP Medicaid |
$120.46
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$144.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$140.81
|
|
|
GRFG AUTOL FAT LIPO EA ADDL
|
Professional
|
Both
|
$345.00
|
|
|
Service Code
|
HCPCS 15772
|
| Hospital Charge Code |
76102627
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$114.72 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Ambetter Exchange |
$140.81
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$114.72
|
| Rate for Payer: Anthem Medicaid |
$142.96
|
| Rate for Payer: Buckeye Individual/Medicaid |
$140.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$140.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$168.97
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Humana Medicaid |
$142.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$186.02
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$140.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$140.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$145.82
|
| Rate for Payer: Molina Healthcare Passport |
$142.96
|
| Rate for Payer: Multiplan PHCS |
$207.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$183.05
|
| Rate for Payer: UHCCP Medicaid |
$120.46
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$144.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$140.81
|
|
|
GRFG AUTOL FAT LIPO EA ADDL
|
Facility
|
IP
|
$345.00
|
|
|
Service Code
|
HCPCS 15772
|
| Hospital Charge Code |
76102627
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.50 |
| Max. Negotiated Rate |
$331.20 |
| Rate for Payer: Aetna Commercial |
$265.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$269.10
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Cigna Commercial |
$286.35
|
| Rate for Payer: First Health Commercial |
$327.75
|
| Rate for Payer: Humana Commercial |
$293.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$282.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$254.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$103.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$303.60
|
| Rate for Payer: Ohio Health Group HMO |
$258.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$276.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$300.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$238.05
|
| Rate for Payer: PHCS Commercial |
$331.20
|
| Rate for Payer: United Healthcare All Payer |
$303.60
|
|
|
GRFG AUTOL FAT LIPO EA ADDL
|
Facility
|
OP
|
$345.00
|
|
|
Service Code
|
HCPCS 15772
|
| Hospital Charge Code |
76102627
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.50 |
| Max. Negotiated Rate |
$331.20 |
| Rate for Payer: Aetna Commercial |
$265.65
|
| Rate for Payer: Anthem Medicaid |
$118.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$269.10
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Cigna Commercial |
$286.35
|
| Rate for Payer: First Health Commercial |
$327.75
|
| Rate for Payer: Humana Commercial |
$293.25
|
| Rate for Payer: Humana KY Medicaid |
$118.65
|
| Rate for Payer: Kentucky WC Medicaid |
$119.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$282.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$254.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$103.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$121.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$303.60
|
| Rate for Payer: Ohio Health Group HMO |
$258.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$276.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$300.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$238.05
|
| Rate for Payer: PHCS Commercial |
$331.20
|
| Rate for Payer: United Healthcare All Payer |
$303.60
|
|
|
GRFG AUTOL SOFT TISS DIR EXC
|
Professional
|
Both
|
$6,547.00
|
|
|
Service Code
|
HCPCS 15769
|
| Hospital Charge Code |
76102710
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$379.72 |
| Max. Negotiated Rate |
$3,928.20 |
| Rate for Payer: Ambetter Exchange |
$454.06
|
| Rate for Payer: Anthem Medicaid |
$379.72
|
| Rate for Payer: Buckeye Individual/Medicaid |
$454.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$454.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$544.87
|
| Rate for Payer: Cash Price |
$3,273.50
|
| Rate for Payer: Cash Price |
$3,273.50
|
| Rate for Payer: Humana Medicaid |
$379.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$624.19
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$454.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$454.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$387.31
|
| Rate for Payer: Molina Healthcare Passport |
$379.72
|
| Rate for Payer: Multiplan PHCS |
$3,928.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$590.28
|
| Rate for Payer: UHCCP Medicaid |
$2,291.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$383.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$454.06
|
|
|
GRFG AUTOL SOFT TISS DIR EXC
|
Facility
|
IP
|
$6,547.00
|
|
|
Service Code
|
HCPCS 15769
|
| Hospital Charge Code |
76102710
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,964.10 |
| Max. Negotiated Rate |
$6,285.12 |
| Rate for Payer: Aetna Commercial |
$5,041.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,106.66
|
| Rate for Payer: Cash Price |
$3,273.50
|
| Rate for Payer: Cigna Commercial |
$5,434.01
|
| Rate for Payer: First Health Commercial |
$6,219.65
|
| Rate for Payer: Humana Commercial |
$5,564.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,368.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,831.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,964.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,761.36
|
| Rate for Payer: Ohio Health Group HMO |
$4,910.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,237.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,695.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,517.43
|
| Rate for Payer: PHCS Commercial |
$6,285.12
|
| Rate for Payer: United Healthcare All Payer |
$5,761.36
|
|
|
GRFG AUTOL SOFT TISS DIR EXC
|
Facility
|
OP
|
$6,547.00
|
|
|
Service Code
|
HCPCS 15769
|
| Hospital Charge Code |
76102710
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,251.51 |
| Max. Negotiated Rate |
$6,285.12 |
| Rate for Payer: Aetna Commercial |
$5,041.19
|
| Rate for Payer: Anthem Medicaid |
$2,251.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,382.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,106.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,735.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,566.59
|
| Rate for Payer: Cash Price |
$3,273.50
|
| Rate for Payer: Cash Price |
$3,273.50
|
| Rate for Payer: Cigna Commercial |
$5,434.01
|
| Rate for Payer: First Health Commercial |
$6,219.65
|
| Rate for Payer: Humana Commercial |
$5,564.95
|
| Rate for Payer: Humana KY Medicaid |
$2,251.51
|
| Rate for Payer: Humana Medicare Advantage |
$3,382.66
|
| Rate for Payer: Kentucky WC Medicaid |
$2,274.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,368.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,831.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,059.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,296.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,761.36
|
| Rate for Payer: Ohio Health Group HMO |
$4,910.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,237.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,695.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,517.43
|
| Rate for Payer: PHCS Commercial |
$6,285.12
|
| Rate for Payer: United Healthcare All Payer |
$5,761.36
|
|
|
GRFG AUTOL SOFT TISS DIR EXC(P
|
Professional
|
Both
|
$675.00
|
|
|
Service Code
|
HCPCS 15769
|
| Hospital Charge Code |
761P2710
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$236.25 |
| Max. Negotiated Rate |
$624.19 |
| Rate for Payer: Ambetter Exchange |
$454.06
|
| Rate for Payer: Anthem Medicaid |
$379.72
|
| Rate for Payer: Buckeye Individual/Medicaid |
$454.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$454.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$544.87
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Humana Medicaid |
$379.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$624.19
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$454.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$454.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$387.31
|
| Rate for Payer: Molina Healthcare Passport |
$379.72
|
| Rate for Payer: Multiplan PHCS |
$405.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$590.28
|
| Rate for Payer: UHCCP Medicaid |
$236.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$383.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$454.06
|
|
|
GRFG AUTOL SOFT TISS DIR EXC(T
|
Facility
|
OP
|
$5,872.00
|
|
|
Service Code
|
HCPCS 15769
|
| Hospital Charge Code |
761T2710
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,019.38 |
| Max. Negotiated Rate |
$5,637.12 |
| Rate for Payer: Aetna Commercial |
$4,521.44
|
| Rate for Payer: Anthem Medicaid |
$2,019.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,382.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,580.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,735.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,566.59
|
| Rate for Payer: Cash Price |
$2,936.00
|
| Rate for Payer: Cash Price |
$2,936.00
|
| Rate for Payer: Cigna Commercial |
$4,873.76
|
| Rate for Payer: First Health Commercial |
$5,578.40
|
| Rate for Payer: Humana Commercial |
$4,991.20
|
| Rate for Payer: Humana KY Medicaid |
$2,019.38
|
| Rate for Payer: Humana Medicare Advantage |
$3,382.66
|
| Rate for Payer: Kentucky WC Medicaid |
$2,039.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,815.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,333.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,059.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,059.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,167.36
|
| Rate for Payer: Ohio Health Group HMO |
$4,404.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,697.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,108.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,051.68
|
| Rate for Payer: PHCS Commercial |
$5,637.12
|
| Rate for Payer: United Healthcare All Payer |
$5,167.36
|
|
|
GRFG AUTOL SOFT TISS DIR EXC(T
|
Facility
|
IP
|
$5,872.00
|
|
|
Service Code
|
HCPCS 15769
|
| Hospital Charge Code |
761T2710
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,761.60 |
| Max. Negotiated Rate |
$5,637.12 |
| Rate for Payer: Aetna Commercial |
$4,521.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,580.16
|
| Rate for Payer: Cash Price |
$2,936.00
|
| Rate for Payer: Cigna Commercial |
$4,873.76
|
| Rate for Payer: First Health Commercial |
$5,578.40
|
| Rate for Payer: Humana Commercial |
$4,991.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,815.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,333.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,761.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,167.36
|
| Rate for Payer: Ohio Health Group HMO |
$4,404.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,697.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,108.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,051.68
|
| Rate for Payer: PHCS Commercial |
$5,637.12
|
| Rate for Payer: United Healthcare All Payer |
$5,167.36
|
|
|
GRFT AX-BYFEM STD W/RING 90*40
|
Facility
|
OP
|
$12,594.26
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,778.28 |
| Max. Negotiated Rate |
$12,090.49 |
| Rate for Payer: Aetna Commercial |
$9,697.58
|
| Rate for Payer: Anthem Medicaid |
$4,331.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,823.52
|
| Rate for Payer: Cash Price |
$6,297.13
|
| Rate for Payer: Cigna Commercial |
$10,453.24
|
| Rate for Payer: First Health Commercial |
$11,964.55
|
| Rate for Payer: Humana Commercial |
$10,705.12
|
| Rate for Payer: Humana KY Medicaid |
$4,331.17
|
| Rate for Payer: Kentucky WC Medicaid |
$4,375.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,327.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,294.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,778.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,418.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,082.95
|
| Rate for Payer: Ohio Health Group HMO |
$9,445.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,075.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,957.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,690.04
|
| Rate for Payer: PHCS Commercial |
$12,090.49
|
| Rate for Payer: United Healthcare All Payer |
$11,082.95
|
|
|
GRFT AX-BYFEM STD W/RING 90*40
|
Facility
|
IP
|
$12,594.26
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,778.28 |
| Max. Negotiated Rate |
$12,090.49 |
| Rate for Payer: Aetna Commercial |
$9,697.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,823.52
|
| Rate for Payer: Cash Price |
$6,297.13
|
| Rate for Payer: Cigna Commercial |
$10,453.24
|
| Rate for Payer: First Health Commercial |
$11,964.55
|
| Rate for Payer: Humana Commercial |
$10,705.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,327.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,294.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,778.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,082.95
|
| Rate for Payer: Ohio Health Group HMO |
$9,445.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,075.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,957.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,690.04
|
| Rate for Payer: PHCS Commercial |
$12,090.49
|
| Rate for Payer: United Healthcare All Payer |
$11,082.95
|
|
|
GRFT ENDURNT BIFUR 3 PIECE BUN
|
Facility
|
IP
|
$90,300.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$27,090.00 |
| Max. Negotiated Rate |
$86,688.00 |
| Rate for Payer: Aetna Commercial |
$69,531.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$70,434.00
|
| Rate for Payer: Cash Price |
$45,150.00
|
| Rate for Payer: Cigna Commercial |
$74,949.00
|
| Rate for Payer: First Health Commercial |
$85,785.00
|
| Rate for Payer: Humana Commercial |
$76,755.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$74,046.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$66,641.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27,090.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$79,464.00
|
| Rate for Payer: Ohio Health Group HMO |
$67,725.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$72,240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78,561.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62,307.00
|
| Rate for Payer: PHCS Commercial |
$86,688.00
|
| Rate for Payer: United Healthcare All Payer |
$79,464.00
|
|
