|
IMPLANT VENTRICULAR DEVICE
|
Facility
|
IP
|
$3,384.00
|
|
|
Service Code
|
HCPCS 33975
|
| Hospital Charge Code |
76101329
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$439.92 |
| Max. Negotiated Rate |
$3,248.64 |
| Rate for Payer: Aetna Commercial |
$2,605.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,639.52
|
| Rate for Payer: Cash Price |
$1,692.00
|
| Rate for Payer: Cigna Commercial |
$2,808.72
|
| Rate for Payer: First Health Commercial |
$3,214.80
|
| Rate for Payer: Humana Commercial |
$2,876.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,774.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,497.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,015.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,977.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,538.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$676.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$439.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,049.04
|
| Rate for Payer: PHCS Commercial |
$3,248.64
|
| Rate for Payer: United Healthcare All Payer |
$2,977.92
|
|
|
IMPLANT VENTRICULAR DEVICE
|
Facility
|
OP
|
$3,384.00
|
|
|
Service Code
|
HCPCS 33975
|
| Hospital Charge Code |
76101329
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$439.92 |
| Max. Negotiated Rate |
$3,248.64 |
| Rate for Payer: Aetna Commercial |
$2,605.68
|
| Rate for Payer: Anthem Medicaid |
$1,163.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,639.52
|
| Rate for Payer: Cash Price |
$1,692.00
|
| Rate for Payer: Cigna Commercial |
$2,808.72
|
| Rate for Payer: First Health Commercial |
$3,214.80
|
| Rate for Payer: Humana Commercial |
$2,876.40
|
| Rate for Payer: Humana KY Medicaid |
$1,163.76
|
| Rate for Payer: Kentucky WC Medicaid |
$1,175.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,774.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,497.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,015.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,187.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,977.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,538.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$676.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$439.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,049.04
|
| Rate for Payer: PHCS Commercial |
$3,248.64
|
| Rate for Payer: United Healthcare All Payer |
$2,977.92
|
|
|
IMPLANT VENTRICULAR DEVICE(P
|
Professional
|
Both
|
$3,384.00
|
|
|
Service Code
|
HCPCS 33975
|
| Hospital Charge Code |
761P1329
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,020.70 |
| Max. Negotiated Rate |
$3,384.00 |
| Rate for Payer: Aetna Commercial |
$1,939.00
|
| Rate for Payer: Anthem Medicaid |
$1,020.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,384.00
|
| Rate for Payer: Cash Price |
$1,692.00
|
| Rate for Payer: Cash Price |
$1,692.00
|
| Rate for Payer: Cigna Commercial |
$1,781.24
|
| Rate for Payer: Healthspan PPO |
$1,906.41
|
| Rate for Payer: Humana Medicaid |
$1,020.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,558.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,041.11
|
| Rate for Payer: Molina Healthcare Passport |
$1,020.70
|
| Rate for Payer: Multiplan PHCS |
$2,030.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,368.80
|
| Rate for Payer: UHCCP Medicaid |
$1,184.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,030.91
|
|
|
IMPL DELIVERY SYS DIST BICEPS
|
Facility
|
OP
|
$6,815.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$885.95 |
| Max. Negotiated Rate |
$6,542.40 |
| Rate for Payer: Aetna Commercial |
$5,247.55
|
| Rate for Payer: Anthem Medicaid |
$2,343.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,315.70
|
| Rate for Payer: Cash Price |
$3,407.50
|
| Rate for Payer: Cigna Commercial |
$5,656.45
|
| Rate for Payer: First Health Commercial |
$6,474.25
|
| Rate for Payer: Humana Commercial |
$5,792.75
|
| Rate for Payer: Humana KY Medicaid |
$2,343.68
|
| Rate for Payer: Kentucky WC Medicaid |
$2,367.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,588.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,029.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,044.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,390.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,997.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,111.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,363.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$885.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,112.65
|
| Rate for Payer: PHCS Commercial |
$6,542.40
|
| Rate for Payer: United Healthcare All Payer |
$5,997.20
|
|
|
IMPL DELIVERY SYS DIST BICEPS
|
Facility
|
IP
|
$6,815.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$885.95 |
| Max. Negotiated Rate |
$6,542.40 |
| Rate for Payer: Aetna Commercial |
$5,247.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,315.70
|
| Rate for Payer: Cash Price |
$3,407.50
|
| Rate for Payer: Cigna Commercial |
$5,656.45
|
| Rate for Payer: First Health Commercial |
$6,474.25
|
| Rate for Payer: Humana Commercial |
$5,792.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,588.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,029.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,044.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,997.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,111.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,363.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$885.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,112.65
|
| Rate for Payer: PHCS Commercial |
$6,542.40
|
| Rate for Payer: United Healthcare All Payer |
$5,997.20
|
|
|
IMPLNT MAL 650 PENIL 16CM*13MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
IMPLNT MAL 650 PENIL 16CM*13MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
IMPLNT OS SEG DIST-FEM 8.5CM L
|
Facility
|
OP
|
$68,540.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,910.22 |
| Max. Negotiated Rate |
$65,798.55 |
| Rate for Payer: Aetna Commercial |
$52,775.92
|
| Rate for Payer: Anthem Medicaid |
$23,570.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,461.32
|
| Rate for Payer: Cash Price |
$34,270.08
|
| Rate for Payer: Cigna Commercial |
$56,888.33
|
| Rate for Payer: First Health Commercial |
$65,113.15
|
| Rate for Payer: Humana Commercial |
$58,259.14
|
| Rate for Payer: Humana KY Medicaid |
$23,570.96
|
| Rate for Payer: Kentucky WC Medicaid |
$23,810.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,202.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,582.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,562.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,043.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,315.34
|
| Rate for Payer: Ohio Health Group HMO |
$51,405.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,708.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,910.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,247.45
|
| Rate for Payer: PHCS Commercial |
$65,798.55
|
| Rate for Payer: United Healthcare All Payer |
$60,315.34
|
|
|
IMPLNT OS SEG DIST-FEM 8.5CM L
|
Facility
|
IP
|
$68,540.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,910.22 |
| Max. Negotiated Rate |
$65,798.55 |
| Rate for Payer: Aetna Commercial |
$52,775.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53,461.32
|
| Rate for Payer: Cash Price |
$34,270.08
|
| Rate for Payer: Cigna Commercial |
$56,888.33
|
| Rate for Payer: First Health Commercial |
$65,113.15
|
| Rate for Payer: Humana Commercial |
$58,259.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,202.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50,582.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,562.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,315.34
|
| Rate for Payer: Ohio Health Group HMO |
$51,405.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,708.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,910.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,247.45
|
| Rate for Payer: PHCS Commercial |
$65,798.55
|
| Rate for Payer: United Healthcare All Payer |
$60,315.34
|
|
|
IMPLNT OS SEG DIST-FEM 8.5CM R
|
Facility
|
OP
|
$75,508.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,816.04 |
| Max. Negotiated Rate |
$72,487.68 |
| Rate for Payer: Aetna Commercial |
$58,141.16
|
| Rate for Payer: Anthem Medicaid |
$25,967.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,896.24
|
| Rate for Payer: Cash Price |
$37,754.00
|
| Rate for Payer: Cigna Commercial |
$62,671.64
|
| Rate for Payer: First Health Commercial |
$71,732.60
|
| Rate for Payer: Humana Commercial |
$64,181.80
|
| Rate for Payer: Humana KY Medicaid |
$25,967.20
|
| Rate for Payer: Kentucky WC Medicaid |
$26,231.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,916.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,724.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,652.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,488.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,447.04
|
| Rate for Payer: Ohio Health Group HMO |
$56,631.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,101.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,816.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,407.48
|
| Rate for Payer: PHCS Commercial |
$72,487.68
|
| Rate for Payer: United Healthcare All Payer |
$66,447.04
|
|
|
IMPLNT OS SEG DIST-FEM 8.5CM R
|
Facility
|
IP
|
$75,508.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,816.04 |
| Max. Negotiated Rate |
$72,487.68 |
| Rate for Payer: Aetna Commercial |
$58,141.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58,896.24
|
| Rate for Payer: Cash Price |
$37,754.00
|
| Rate for Payer: Cigna Commercial |
$62,671.64
|
| Rate for Payer: First Health Commercial |
$71,732.60
|
| Rate for Payer: Humana Commercial |
$64,181.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61,916.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55,724.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,652.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$66,447.04
|
| Rate for Payer: Ohio Health Group HMO |
$56,631.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,101.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,816.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,407.48
|
| Rate for Payer: PHCS Commercial |
$72,487.68
|
| Rate for Payer: United Healthcare All Payer |
$66,447.04
|
|
|
IMPLNT OSS RESURF ANT FLNG 3CM
|
Facility
|
IP
|
$7,955.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,034.18 |
| Max. Negotiated Rate |
$7,637.05 |
| Rate for Payer: Aetna Commercial |
$6,125.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,205.10
|
| Rate for Payer: Cash Price |
$3,977.63
|
| Rate for Payer: Cigna Commercial |
$6,602.87
|
| Rate for Payer: First Health Commercial |
$7,557.50
|
| Rate for Payer: Humana Commercial |
$6,761.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,523.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,870.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,386.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,000.63
|
| Rate for Payer: Ohio Health Group HMO |
$5,966.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,591.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,034.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,466.13
|
| Rate for Payer: PHCS Commercial |
$7,637.05
|
| Rate for Payer: United Healthcare All Payer |
$7,000.63
|
|
|
IMPLNT OSS RESURF ANT FLNG 3CM
|
Facility
|
OP
|
$7,955.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,034.18 |
| Max. Negotiated Rate |
$7,637.05 |
| Rate for Payer: Aetna Commercial |
$6,125.55
|
| Rate for Payer: Anthem Medicaid |
$2,735.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,205.10
|
| Rate for Payer: Cash Price |
$3,977.63
|
| Rate for Payer: Cigna Commercial |
$6,602.87
|
| Rate for Payer: First Health Commercial |
$7,557.50
|
| Rate for Payer: Humana Commercial |
$6,761.97
|
| Rate for Payer: Humana KY Medicaid |
$2,735.81
|
| Rate for Payer: Kentucky WC Medicaid |
$2,763.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,523.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,870.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,386.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,790.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,000.63
|
| Rate for Payer: Ohio Health Group HMO |
$5,966.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,591.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,034.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,466.13
|
| Rate for Payer: PHCS Commercial |
$7,637.05
|
| Rate for Payer: United Healthcare All Payer |
$7,000.63
|
|
|
IMPLNT OSS SEG ELIPT FEM 8.5 L
|
Facility
|
IP
|
$76,380.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,929.48 |
| Max. Negotiated Rate |
$73,325.41 |
| Rate for Payer: Aetna Commercial |
$58,813.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,576.90
|
| Rate for Payer: Cash Price |
$38,190.32
|
| Rate for Payer: Cigna Commercial |
$63,395.93
|
| Rate for Payer: First Health Commercial |
$72,561.61
|
| Rate for Payer: Humana Commercial |
$64,923.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,632.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,368.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,914.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$67,214.96
|
| Rate for Payer: Ohio Health Group HMO |
$57,285.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,276.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,929.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,678.00
|
| Rate for Payer: PHCS Commercial |
$73,325.41
|
| Rate for Payer: United Healthcare All Payer |
$67,214.96
|
|
|
IMPLNT OSS SEG ELIPT FEM 8.5 L
|
Facility
|
OP
|
$76,380.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,929.48 |
| Max. Negotiated Rate |
$73,325.41 |
| Rate for Payer: Aetna Commercial |
$58,813.09
|
| Rate for Payer: Anthem Medicaid |
$26,267.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,576.90
|
| Rate for Payer: Cash Price |
$38,190.32
|
| Rate for Payer: Cigna Commercial |
$63,395.93
|
| Rate for Payer: First Health Commercial |
$72,561.61
|
| Rate for Payer: Humana Commercial |
$64,923.54
|
| Rate for Payer: Humana KY Medicaid |
$26,267.30
|
| Rate for Payer: Kentucky WC Medicaid |
$26,534.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,632.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,368.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,914.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,794.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$67,214.96
|
| Rate for Payer: Ohio Health Group HMO |
$57,285.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,276.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,929.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,678.00
|
| Rate for Payer: PHCS Commercial |
$73,325.41
|
| Rate for Payer: United Healthcare All Payer |
$67,214.96
|
|
|
IMPLNT OSS SEG ELIPT FEM 8.5 R
|
Facility
|
OP
|
$76,380.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,929.48 |
| Max. Negotiated Rate |
$73,325.41 |
| Rate for Payer: Aetna Commercial |
$58,813.09
|
| Rate for Payer: Anthem Medicaid |
$26,267.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,576.90
|
| Rate for Payer: Cash Price |
$38,190.32
|
| Rate for Payer: Cigna Commercial |
$63,395.93
|
| Rate for Payer: First Health Commercial |
$72,561.61
|
| Rate for Payer: Humana Commercial |
$64,923.54
|
| Rate for Payer: Humana KY Medicaid |
$26,267.30
|
| Rate for Payer: Kentucky WC Medicaid |
$26,534.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,632.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,368.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,914.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,794.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$67,214.96
|
| Rate for Payer: Ohio Health Group HMO |
$57,285.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,276.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,929.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,678.00
|
| Rate for Payer: PHCS Commercial |
$73,325.41
|
| Rate for Payer: United Healthcare All Payer |
$67,214.96
|
|
|
IMPLNT OSS SEG ELIPT FEM 8.5 R
|
Facility
|
IP
|
$76,380.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,929.48 |
| Max. Negotiated Rate |
$73,325.41 |
| Rate for Payer: Aetna Commercial |
$58,813.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,576.90
|
| Rate for Payer: Cash Price |
$38,190.32
|
| Rate for Payer: Cigna Commercial |
$63,395.93
|
| Rate for Payer: First Health Commercial |
$72,561.61
|
| Rate for Payer: Humana Commercial |
$64,923.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,632.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,368.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,914.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$67,214.96
|
| Rate for Payer: Ohio Health Group HMO |
$57,285.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,276.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,929.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,678.00
|
| Rate for Payer: PHCS Commercial |
$73,325.41
|
| Rate for Payer: United Healthcare All Payer |
$67,214.96
|
|
|
IMPLSYS 2NDRY FIXATN BIOSWVLK
|
Facility
|
IP
|
$4,864.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$632.37 |
| Max. Negotiated Rate |
$4,669.80 |
| Rate for Payer: Aetna Commercial |
$3,745.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,794.22
|
| Rate for Payer: Cash Price |
$2,432.19
|
| Rate for Payer: Cigna Commercial |
$4,037.44
|
| Rate for Payer: First Health Commercial |
$4,621.16
|
| Rate for Payer: Humana Commercial |
$4,134.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,988.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,589.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,459.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,280.65
|
| Rate for Payer: Ohio Health Group HMO |
$3,648.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$972.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$632.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,507.96
|
| Rate for Payer: PHCS Commercial |
$4,669.80
|
| Rate for Payer: United Healthcare All Payer |
$4,280.65
|
|
|
IMPLSYS 2NDRY FIXATN BIOSWVLK
|
Facility
|
OP
|
$4,864.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$632.37 |
| Max. Negotiated Rate |
$4,669.80 |
| Rate for Payer: Aetna Commercial |
$3,745.57
|
| Rate for Payer: Anthem Medicaid |
$1,672.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,794.22
|
| Rate for Payer: Cash Price |
$2,432.19
|
| Rate for Payer: Cigna Commercial |
$4,037.44
|
| Rate for Payer: First Health Commercial |
$4,621.16
|
| Rate for Payer: Humana Commercial |
$4,134.72
|
| Rate for Payer: Humana KY Medicaid |
$1,672.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,689.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,988.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,589.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,459.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,706.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,280.65
|
| Rate for Payer: Ohio Health Group HMO |
$3,648.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$972.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$632.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,507.96
|
| Rate for Payer: PHCS Commercial |
$4,669.80
|
| Rate for Payer: United Healthcare All Payer |
$4,280.65
|
|
|
IMRT COMPLEX DELIVERY
|
Facility
|
OP
|
$1,640.00
|
|
|
Service Code
|
HCPCS 77386
|
| Hospital Charge Code |
33300022
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$213.20 |
| Max. Negotiated Rate |
$1,574.40 |
| Rate for Payer: Aetna Commercial |
$1,262.80
|
| Rate for Payer: Anthem Medicaid |
$564.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$509.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,279.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$712.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$687.22
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Cigna Commercial |
$1,361.20
|
| Rate for Payer: First Health Commercial |
$1,558.00
|
| Rate for Payer: Humana Commercial |
$1,394.00
|
| Rate for Payer: Humana KY Medicaid |
$564.00
|
| Rate for Payer: Humana Medicare Advantage |
$509.05
|
| Rate for Payer: Kentucky WC Medicaid |
$569.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,344.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,210.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$610.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$575.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,443.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,230.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$328.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$213.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$508.40
|
| Rate for Payer: PHCS Commercial |
$1,574.40
|
| Rate for Payer: United Healthcare All Payer |
$1,443.20
|
|
|
IMRT COMPLEX DELIVERY
|
Facility
|
IP
|
$1,640.00
|
|
|
Service Code
|
HCPCS 77386
|
| Hospital Charge Code |
33300022
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$213.20 |
| Max. Negotiated Rate |
$1,574.40 |
| Rate for Payer: Aetna Commercial |
$1,262.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,279.20
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Cigna Commercial |
$1,361.20
|
| Rate for Payer: First Health Commercial |
$1,558.00
|
| Rate for Payer: Humana Commercial |
$1,394.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,344.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,210.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$492.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,443.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,230.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$328.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$213.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$508.40
|
| Rate for Payer: PHCS Commercial |
$1,574.40
|
| Rate for Payer: United Healthcare All Payer |
$1,443.20
|
|
|
IMRT PLAN
|
Professional
|
Both
|
$6,585.00
|
|
|
Service Code
|
HCPCS 77301
|
| Hospital Charge Code |
33300007
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$510.85 |
| Max. Negotiated Rate |
$6,585.00 |
| Rate for Payer: Healthspan PPO |
$2,755.42
|
| Rate for Payer: Aetna Commercial |
$3,267.35
|
| Rate for Payer: Anthem Medicaid |
$1,032.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,585.00
|
| Rate for Payer: Cash Price |
$3,292.50
|
| Rate for Payer: Cash Price |
$3,292.50
|
| Rate for Payer: Cigna Commercial |
$2,585.13
|
| Rate for Payer: Humana Medicaid |
$1,032.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$510.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,053.27
|
| Rate for Payer: Molina Healthcare Passport |
$1,032.62
|
| Rate for Payer: Multiplan PHCS |
$3,951.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,609.50
|
| Rate for Payer: UHCCP Medicaid |
$2,304.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,042.95
|
|
|
IMRT PLAN
|
Facility
|
OP
|
$6,585.00
|
|
|
Service Code
|
HCPCS 77301
|
| Hospital Charge Code |
33300007
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$856.05 |
| Max. Negotiated Rate |
$6,321.60 |
| Rate for Payer: Aetna Commercial |
$5,070.45
|
| Rate for Payer: Anthem Medicaid |
$2,264.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,198.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,136.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,677.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,617.60
|
| Rate for Payer: Cash Price |
$3,292.50
|
| Rate for Payer: Cash Price |
$3,292.50
|
| Rate for Payer: Cigna Commercial |
$5,465.55
|
| Rate for Payer: First Health Commercial |
$6,255.75
|
| Rate for Payer: Humana Commercial |
$5,597.25
|
| Rate for Payer: Humana KY Medicaid |
$2,264.58
|
| Rate for Payer: Humana Medicare Advantage |
$1,198.22
|
| Rate for Payer: Kentucky WC Medicaid |
$2,287.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,399.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,859.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,437.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,310.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,794.80
|
| Rate for Payer: Ohio Health Group HMO |
$4,938.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,317.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$856.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,041.35
|
| Rate for Payer: PHCS Commercial |
$6,321.60
|
| Rate for Payer: United Healthcare All Payer |
$5,794.80
|
|
|
IMRT PLAN
|
Facility
|
IP
|
$6,585.00
|
|
|
Service Code
|
HCPCS 77301
|
| Hospital Charge Code |
33300007
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$856.05 |
| Max. Negotiated Rate |
$6,321.60 |
| Rate for Payer: Aetna Commercial |
$5,070.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,136.30
|
| Rate for Payer: Cash Price |
$3,292.50
|
| Rate for Payer: Cigna Commercial |
$5,465.55
|
| Rate for Payer: First Health Commercial |
$6,255.75
|
| Rate for Payer: Humana Commercial |
$5,597.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,399.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,859.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,975.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,794.80
|
| Rate for Payer: Ohio Health Group HMO |
$4,938.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,317.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$856.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,041.35
|
| Rate for Payer: PHCS Commercial |
$6,321.60
|
| Rate for Payer: United Healthcare All Payer |
$5,794.80
|
|
|
IMRT PLAN(P
|
Professional
|
Both
|
$735.00
|
|
|
Service Code
|
HCPCS 77301
|
| Hospital Charge Code |
333P0007
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$257.25 |
| Max. Negotiated Rate |
$3,267.35 |
| Rate for Payer: Aetna Commercial |
$3,267.35
|
| Rate for Payer: Anthem Medicaid |
$1,032.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$735.00
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: Cigna Commercial |
$2,585.13
|
| Rate for Payer: Healthspan PPO |
$2,755.42
|
| Rate for Payer: Humana Medicaid |
$1,032.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$510.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,053.27
|
| Rate for Payer: Molina Healthcare Passport |
$1,032.62
|
| Rate for Payer: Multiplan PHCS |
$441.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$514.50
|
| Rate for Payer: UHCCP Medicaid |
$257.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,042.95
|
|
