|
I CAST STENT 9*59
|
Facility
|
OP
|
$13,684.25
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,105.27 |
| Max. Negotiated Rate |
$13,136.88 |
| Rate for Payer: Aetna Commercial |
$10,536.87
|
| Rate for Payer: Anthem Medicaid |
$4,706.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,673.72
|
| Rate for Payer: Cash Price |
$6,842.12
|
| Rate for Payer: Cigna Commercial |
$11,357.93
|
| Rate for Payer: First Health Commercial |
$13,000.04
|
| Rate for Payer: Humana Commercial |
$11,631.61
|
| Rate for Payer: Humana KY Medicaid |
$4,706.01
|
| Rate for Payer: Kentucky WC Medicaid |
$4,753.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,221.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,098.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,105.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,800.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,042.14
|
| Rate for Payer: Ohio Health Group HMO |
$10,263.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,947.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,905.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,442.13
|
| Rate for Payer: PHCS Commercial |
$13,136.88
|
| Rate for Payer: United Healthcare All Payer |
$12,042.14
|
|
|
I CAST STENT 9*59
|
Facility
|
IP
|
$13,684.25
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,105.27 |
| Max. Negotiated Rate |
$13,136.88 |
| Rate for Payer: Aetna Commercial |
$10,536.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,673.72
|
| Rate for Payer: Cash Price |
$6,842.12
|
| Rate for Payer: Cigna Commercial |
$11,357.93
|
| Rate for Payer: First Health Commercial |
$13,000.04
|
| Rate for Payer: Humana Commercial |
$11,631.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,221.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,098.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,105.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,042.14
|
| Rate for Payer: Ohio Health Group HMO |
$10,263.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,947.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,905.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,442.13
|
| Rate for Payer: PHCS Commercial |
$13,136.88
|
| Rate for Payer: United Healthcare All Payer |
$12,042.14
|
|
|
ICD ANALYSIS W/OUT REPROG DC
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
HCPCS 93289
|
| Hospital Charge Code |
48000084
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$34.46 |
| Max. Negotiated Rate |
$143.04 |
| Rate for Payer: Aetna Commercial |
$114.73
|
| Rate for Payer: Anthem Medicaid |
$51.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$34.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$116.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$48.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$46.52
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cigna Commercial |
$123.67
|
| Rate for Payer: First Health Commercial |
$141.55
|
| Rate for Payer: Humana Commercial |
$126.65
|
| Rate for Payer: Humana KY Medicaid |
$51.24
|
| Rate for Payer: Humana Medicare Advantage |
$34.46
|
| Rate for Payer: Kentucky WC Medicaid |
$51.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$122.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$109.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$52.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$131.12
|
| Rate for Payer: Ohio Health Group HMO |
$111.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$119.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$129.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$102.81
|
| Rate for Payer: PHCS Commercial |
$143.04
|
| Rate for Payer: United Healthcare All Payer |
$131.12
|
|
|
ICD ANALYSIS W/OUT REPROG DC
|
Professional
|
Both
|
$149.00
|
|
|
Service Code
|
HCPCS 93289
|
| Hospital Charge Code |
48000084
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$52.15 |
| Max. Negotiated Rate |
$109.13 |
| Rate for Payer: Aetna Commercial |
$107.78
|
| Rate for Payer: Ambetter Exchange |
$64.79
|
| Rate for Payer: Anthem Medicaid |
$54.59
|
| Rate for Payer: Buckeye Individual/Medicaid |
$64.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$64.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$77.75
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cigna Commercial |
$109.13
|
| Rate for Payer: Healthspan PPO |
$101.31
|
| Rate for Payer: Humana Medicaid |
$54.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$62.04
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$64.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$64.79
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$55.68
|
| Rate for Payer: Molina Healthcare Passport |
$54.59
|
| Rate for Payer: Multiplan PHCS |
$89.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$84.23
|
| Rate for Payer: UHCCP Medicaid |
$52.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$55.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$64.79
|
|
|
ICD ANALYSIS W/OUT REPROG DC
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
HCPCS 93289
|
| Hospital Charge Code |
48000084
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$44.70 |
| Max. Negotiated Rate |
$143.04 |
| Rate for Payer: Aetna Commercial |
$114.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$116.22
|
| Rate for Payer: Cash Price |
$74.50
|
| Rate for Payer: Cigna Commercial |
$123.67
|
| Rate for Payer: First Health Commercial |
$141.55
|
| Rate for Payer: Humana Commercial |
$126.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$122.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$109.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$44.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$131.12
|
| Rate for Payer: Ohio Health Group HMO |
$111.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$119.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$129.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$102.81
|
| Rate for Payer: PHCS Commercial |
$143.04
|
| Rate for Payer: United Healthcare All Payer |
$131.12
|
|
|
ICD ANALYSIS W/ REPROG DC
|
Professional
|
Both
|
$199.00
|
|
|
Service Code
|
HCPCS 93283
|
| Hospital Charge Code |
48000080
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$69.65 |
| Max. Negotiated Rate |
$143.07 |
| Rate for Payer: Aetna Commercial |
$141.56
|
| Rate for Payer: Ambetter Exchange |
$88.67
|
| Rate for Payer: Anthem Medicaid |
$71.50
|
| Rate for Payer: Buckeye Individual/Medicaid |
$88.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$88.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.40
|
| Rate for Payer: Cash Price |
$99.50
|
| Rate for Payer: Cash Price |
$99.50
|
| Rate for Payer: Cigna Commercial |
$143.07
|
| Rate for Payer: Healthspan PPO |
$133.07
|
| Rate for Payer: Humana Medicaid |
$71.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$79.12
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$88.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$88.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$72.93
|
| Rate for Payer: Molina Healthcare Passport |
$71.50
|
| Rate for Payer: Multiplan PHCS |
$119.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$115.27
|
| Rate for Payer: UHCCP Medicaid |
$69.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$72.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$88.67
|
|
|
ICD ANALYSIS W/ REPROG DC
|
Facility
|
IP
|
$199.00
|
|
|
Service Code
|
HCPCS 93283
|
| Hospital Charge Code |
48000080
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$59.70 |
| Max. Negotiated Rate |
$191.04 |
| Rate for Payer: Aetna Commercial |
$153.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$155.22
|
| Rate for Payer: Cash Price |
$99.50
|
| Rate for Payer: Cigna Commercial |
$165.17
|
| Rate for Payer: First Health Commercial |
$189.05
|
| Rate for Payer: Humana Commercial |
$169.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$163.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$146.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$175.12
|
| Rate for Payer: Ohio Health Group HMO |
$149.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$159.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$173.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$137.31
|
| Rate for Payer: PHCS Commercial |
$191.04
|
| Rate for Payer: United Healthcare All Payer |
$175.12
|
|
|
ICD ANALYSIS W/ REPROG DC
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
HCPCS 93283
|
| Hospital Charge Code |
48000080
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$34.46 |
| Max. Negotiated Rate |
$191.04 |
| Rate for Payer: Aetna Commercial |
$153.23
|
| Rate for Payer: Anthem Medicaid |
$68.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$34.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$155.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$48.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$46.52
|
| Rate for Payer: Cash Price |
$99.50
|
| Rate for Payer: Cash Price |
$99.50
|
| Rate for Payer: Cigna Commercial |
$165.17
|
| Rate for Payer: First Health Commercial |
$189.05
|
| Rate for Payer: Humana Commercial |
$169.15
|
| Rate for Payer: Humana KY Medicaid |
$68.44
|
| Rate for Payer: Humana Medicare Advantage |
$34.46
|
| Rate for Payer: Kentucky WC Medicaid |
$69.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$163.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$146.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$69.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$175.12
|
| Rate for Payer: Ohio Health Group HMO |
$149.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$159.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$173.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$137.31
|
| Rate for Payer: PHCS Commercial |
$191.04
|
| Rate for Payer: United Healthcare All Payer |
$175.12
|
|
|
ICD ANALYSIS W/ REPROG SC
|
Professional
|
Both
|
$183.00
|
|
|
Service Code
|
HCPCS 93282
|
| Hospital Charge Code |
48000079
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$58.86 |
| Max. Negotiated Rate |
$117.50 |
| Rate for Payer: Aetna Commercial |
$116.33
|
| Rate for Payer: Ambetter Exchange |
$71.85
|
| Rate for Payer: Anthem Medicaid |
$59.04
|
| Rate for Payer: Buckeye Individual/Medicaid |
$71.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$71.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$86.22
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cigna Commercial |
$117.50
|
| Rate for Payer: Healthspan PPO |
$109.35
|
| Rate for Payer: Humana Medicaid |
$59.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$58.86
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$71.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$71.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$60.22
|
| Rate for Payer: Molina Healthcare Passport |
$59.04
|
| Rate for Payer: Multiplan PHCS |
$109.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$93.41
|
| Rate for Payer: UHCCP Medicaid |
$64.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$59.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$71.85
|
|
|
ICD ANALYSIS W/ REPROG SC
|
Facility
|
IP
|
$183.00
|
|
|
Service Code
|
HCPCS 93282
|
| Hospital Charge Code |
48000079
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$54.90 |
| Max. Negotiated Rate |
$175.68 |
| Rate for Payer: Aetna Commercial |
$140.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$142.74
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cigna Commercial |
$151.89
|
| Rate for Payer: First Health Commercial |
$173.85
|
| Rate for Payer: Humana Commercial |
$155.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$150.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$135.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$161.04
|
| Rate for Payer: Ohio Health Group HMO |
$137.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$146.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$159.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$126.27
|
| Rate for Payer: PHCS Commercial |
$175.68
|
| Rate for Payer: United Healthcare All Payer |
$161.04
|
|
|
ICD ANALYSIS W/ REPROG SC
|
Facility
|
OP
|
$183.00
|
|
|
Service Code
|
HCPCS 93282
|
| Hospital Charge Code |
48000079
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$34.46 |
| Max. Negotiated Rate |
$175.68 |
| Rate for Payer: Aetna Commercial |
$140.91
|
| Rate for Payer: Anthem Medicaid |
$62.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$34.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$142.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$48.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$46.52
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cigna Commercial |
$151.89
|
| Rate for Payer: First Health Commercial |
$173.85
|
| Rate for Payer: Humana Commercial |
$155.55
|
| Rate for Payer: Humana KY Medicaid |
$62.93
|
| Rate for Payer: Humana Medicare Advantage |
$34.46
|
| Rate for Payer: Kentucky WC Medicaid |
$63.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$150.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$135.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$64.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$161.04
|
| Rate for Payer: Ohio Health Group HMO |
$137.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$146.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$159.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$126.27
|
| Rate for Payer: PHCS Commercial |
$175.68
|
| Rate for Payer: United Healthcare All Payer |
$161.04
|
|
|
ICONIX 1 ANCHOR 1.4MM 1 STRAND
|
Facility
|
IP
|
$3,320.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$996.00 |
| Max. Negotiated Rate |
$3,187.20 |
| Rate for Payer: Aetna Commercial |
$2,556.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,589.60
|
| Rate for Payer: Cash Price |
$1,660.00
|
| Rate for Payer: Cigna Commercial |
$2,755.60
|
| Rate for Payer: First Health Commercial |
$3,154.00
|
| Rate for Payer: Humana Commercial |
$2,822.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,722.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,450.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$996.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,921.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,490.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,656.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,888.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,290.80
|
| Rate for Payer: PHCS Commercial |
$3,187.20
|
| Rate for Payer: United Healthcare All Payer |
$2,921.60
|
|
|
ICONIX 1 ANCHOR 1.4MM 1 STRAND
|
Facility
|
OP
|
$3,320.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$996.00 |
| Max. Negotiated Rate |
$3,187.20 |
| Rate for Payer: Aetna Commercial |
$2,556.40
|
| Rate for Payer: Anthem Medicaid |
$1,141.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,589.60
|
| Rate for Payer: Cash Price |
$1,660.00
|
| Rate for Payer: Cigna Commercial |
$2,755.60
|
| Rate for Payer: First Health Commercial |
$3,154.00
|
| Rate for Payer: Humana Commercial |
$2,822.00
|
| Rate for Payer: Humana KY Medicaid |
$1,141.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,153.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,722.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,450.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$996.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,164.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,921.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,490.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,656.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,888.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,290.80
|
| Rate for Payer: PHCS Commercial |
$3,187.20
|
| Rate for Payer: United Healthcare All Payer |
$2,921.60
|
|
|
ICONIX 25 ANCHOR 2.3MM 2 STRAN
|
Facility
|
IP
|
$3,320.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$996.00 |
| Max. Negotiated Rate |
$3,187.20 |
| Rate for Payer: Aetna Commercial |
$2,556.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,589.60
|
| Rate for Payer: Cash Price |
$1,660.00
|
| Rate for Payer: Cigna Commercial |
$2,755.60
|
| Rate for Payer: First Health Commercial |
$3,154.00
|
| Rate for Payer: Humana Commercial |
$2,822.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,722.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,450.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$996.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,921.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,490.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,656.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,888.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,290.80
|
| Rate for Payer: PHCS Commercial |
$3,187.20
|
| Rate for Payer: United Healthcare All Payer |
$2,921.60
|
|
|
ICONIX 25 ANCHOR 2.3MM 2 STRAN
|
Facility
|
OP
|
$3,320.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$996.00 |
| Max. Negotiated Rate |
$3,187.20 |
| Rate for Payer: Aetna Commercial |
$2,556.40
|
| Rate for Payer: Anthem Medicaid |
$1,141.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,589.60
|
| Rate for Payer: Cash Price |
$1,660.00
|
| Rate for Payer: Cigna Commercial |
$2,755.60
|
| Rate for Payer: First Health Commercial |
$3,154.00
|
| Rate for Payer: Humana Commercial |
$2,822.00
|
| Rate for Payer: Humana KY Medicaid |
$1,141.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,153.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,722.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,450.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$996.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,164.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,921.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,490.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,656.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,888.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,290.80
|
| Rate for Payer: PHCS Commercial |
$3,187.20
|
| Rate for Payer: United Healthcare All Payer |
$2,921.60
|
|
|
ICONIX 2 ANCHOR 2.3MM 2 STRAND
|
Facility
|
OP
|
$3,320.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$996.00 |
| Max. Negotiated Rate |
$3,187.20 |
| Rate for Payer: Aetna Commercial |
$2,556.40
|
| Rate for Payer: Anthem Medicaid |
$1,141.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,589.60
|
| Rate for Payer: Cash Price |
$1,660.00
|
| Rate for Payer: Cigna Commercial |
$2,755.60
|
| Rate for Payer: First Health Commercial |
$3,154.00
|
| Rate for Payer: Humana Commercial |
$2,822.00
|
| Rate for Payer: Humana KY Medicaid |
$1,141.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,153.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,722.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,450.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$996.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,164.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,921.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,490.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,656.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,888.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,290.80
|
| Rate for Payer: PHCS Commercial |
$3,187.20
|
| Rate for Payer: United Healthcare All Payer |
$2,921.60
|
|
|
ICONIX 2 ANCHOR 2.3MM 2 STRAND
|
Facility
|
IP
|
$3,320.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$996.00 |
| Max. Negotiated Rate |
$3,187.20 |
| Rate for Payer: Aetna Commercial |
$2,556.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,589.60
|
| Rate for Payer: Cash Price |
$1,660.00
|
| Rate for Payer: Cigna Commercial |
$2,755.60
|
| Rate for Payer: First Health Commercial |
$3,154.00
|
| Rate for Payer: Humana Commercial |
$2,822.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,722.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,450.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$996.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,921.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,490.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,656.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,888.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,290.80
|
| Rate for Payer: PHCS Commercial |
$3,187.20
|
| Rate for Payer: United Healthcare All Payer |
$2,921.60
|
|
|
ICONIX 3 ANCHOR 2.3MM 3 STRAND
|
Facility
|
IP
|
$3,320.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$996.00 |
| Max. Negotiated Rate |
$3,187.20 |
| Rate for Payer: Aetna Commercial |
$2,556.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,589.60
|
| Rate for Payer: Cash Price |
$1,660.00
|
| Rate for Payer: Cigna Commercial |
$2,755.60
|
| Rate for Payer: First Health Commercial |
$3,154.00
|
| Rate for Payer: Humana Commercial |
$2,822.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,722.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,450.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$996.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,921.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,490.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,656.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,888.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,290.80
|
| Rate for Payer: PHCS Commercial |
$3,187.20
|
| Rate for Payer: United Healthcare All Payer |
$2,921.60
|
|
|
ICONIX 3 ANCHOR 2.3MM 3 STRAND
|
Facility
|
OP
|
$3,320.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$996.00 |
| Max. Negotiated Rate |
$3,187.20 |
| Rate for Payer: Aetna Commercial |
$2,556.40
|
| Rate for Payer: Anthem Medicaid |
$1,141.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,589.60
|
| Rate for Payer: Cash Price |
$1,660.00
|
| Rate for Payer: Cigna Commercial |
$2,755.60
|
| Rate for Payer: First Health Commercial |
$3,154.00
|
| Rate for Payer: Humana Commercial |
$2,822.00
|
| Rate for Payer: Humana KY Medicaid |
$1,141.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,153.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,722.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,450.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$996.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,164.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,921.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,490.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,656.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,888.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,290.80
|
| Rate for Payer: PHCS Commercial |
$3,187.20
|
| Rate for Payer: United Healthcare All Payer |
$2,921.60
|
|
|
ICU ROOM RATE
|
Facility
|
IP
|
$3,658.00
|
|
| Hospital Charge Code |
20000001
|
|
Hospital Revenue Code
|
200
|
| Min. Negotiated Rate |
$1,097.40 |
| Max. Negotiated Rate |
$3,511.68 |
| Rate for Payer: Aetna Commercial |
$2,816.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,853.24
|
| Rate for Payer: Cash Price |
$1,829.00
|
| Rate for Payer: Cigna Commercial |
$3,036.14
|
| Rate for Payer: First Health Commercial |
$3,475.10
|
| Rate for Payer: Humana Commercial |
$3,109.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,999.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,699.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,097.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,219.04
|
| Rate for Payer: Ohio Health Group HMO |
$2,743.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,926.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,182.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,524.02
|
| Rate for Payer: PHCS Commercial |
$3,511.68
|
| Rate for Payer: United Healthcare All Payer |
$3,219.04
|
|
|
I&D ABCESS COMPLICATED
|
Facility
|
IP
|
$781.00
|
|
|
Service Code
|
HCPCS 10061
|
| Hospital Charge Code |
76100009
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$234.30 |
| Max. Negotiated Rate |
$749.76 |
| Rate for Payer: Aetna Commercial |
$601.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$609.18
|
| Rate for Payer: Cash Price |
$390.50
|
| Rate for Payer: Cigna Commercial |
$648.23
|
| Rate for Payer: First Health Commercial |
$741.95
|
| Rate for Payer: Humana Commercial |
$663.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$640.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$576.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$234.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$687.28
|
| Rate for Payer: Ohio Health Group HMO |
$585.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$624.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$679.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$538.89
|
| Rate for Payer: PHCS Commercial |
$749.76
|
| Rate for Payer: United Healthcare All Payer |
$687.28
|
|
|
I&D ABCESS COMPLICATED
|
Facility
|
OP
|
$531.00
|
|
|
Service Code
|
HCPCS 10061
|
| Hospital Charge Code |
45000018
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$182.61 |
| Max. Negotiated Rate |
$516.82 |
| Rate for Payer: Aetna Commercial |
$408.87
|
| Rate for Payer: Anthem Medicaid |
$182.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$414.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cigna Commercial |
$440.73
|
| Rate for Payer: First Health Commercial |
$504.45
|
| Rate for Payer: Humana Commercial |
$451.35
|
| Rate for Payer: Humana KY Medicaid |
$182.61
|
| Rate for Payer: Humana Medicare Advantage |
$369.16
|
| Rate for Payer: Kentucky WC Medicaid |
$184.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$435.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$391.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$186.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$467.28
|
| Rate for Payer: Ohio Health Group HMO |
$398.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$424.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$461.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$366.39
|
| Rate for Payer: PHCS Commercial |
$509.76
|
| Rate for Payer: United Healthcare All Payer |
$467.28
|
|
|
I&D ABCESS COMPLICATED
|
Facility
|
IP
|
$531.00
|
|
|
Service Code
|
HCPCS 10061
|
| Hospital Charge Code |
45000018
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$159.30 |
| Max. Negotiated Rate |
$509.76 |
| Rate for Payer: Aetna Commercial |
$408.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$414.18
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cigna Commercial |
$440.73
|
| Rate for Payer: First Health Commercial |
$504.45
|
| Rate for Payer: Humana Commercial |
$451.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$435.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$391.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$159.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$467.28
|
| Rate for Payer: Ohio Health Group HMO |
$398.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$424.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$461.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$366.39
|
| Rate for Payer: PHCS Commercial |
$509.76
|
| Rate for Payer: United Healthcare All Payer |
$467.28
|
|
|
I&D ABCESS COMPLICATED
|
Facility
|
OP
|
$781.00
|
|
|
Service Code
|
HCPCS 10061
|
| Hospital Charge Code |
76100009
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$268.59 |
| Max. Negotiated Rate |
$749.76 |
| Rate for Payer: Aetna Commercial |
$601.37
|
| Rate for Payer: Anthem Medicaid |
$268.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$609.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| Rate for Payer: Cash Price |
$390.50
|
| Rate for Payer: Cash Price |
$390.50
|
| Rate for Payer: Cigna Commercial |
$648.23
|
| Rate for Payer: First Health Commercial |
$741.95
|
| Rate for Payer: Humana Commercial |
$663.85
|
| Rate for Payer: Humana KY Medicaid |
$268.59
|
| Rate for Payer: Humana Medicare Advantage |
$369.16
|
| Rate for Payer: Kentucky WC Medicaid |
$271.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$640.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$576.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$273.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$687.28
|
| Rate for Payer: Ohio Health Group HMO |
$585.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$624.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$679.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$538.89
|
| Rate for Payer: PHCS Commercial |
$749.76
|
| Rate for Payer: United Healthcare All Payer |
$687.28
|
|
|
I&D ABCESS COMPLICATED
|
Professional
|
Both
|
$781.00
|
|
|
Service Code
|
HCPCS 10061
|
| Hospital Charge Code |
76100009
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$468.60 |
| Rate for Payer: Aetna Commercial |
$238.49
|
| Rate for Payer: Ambetter Exchange |
$172.08
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$93.44
|
| Rate for Payer: Anthem Medicaid |
$91.40
|
| Rate for Payer: Buckeye Individual/Medicaid |
$172.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$172.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$206.50
|
| Rate for Payer: Cash Price |
$390.50
|
| Rate for Payer: Cash Price |
$390.50
|
| Rate for Payer: Cigna Commercial |
$247.65
|
| Rate for Payer: Healthspan PPO |
$211.67
|
| Rate for Payer: Humana Medicaid |
$91.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$198.16
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$172.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$172.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$93.23
|
| Rate for Payer: Molina Healthcare Passport |
$91.40
|
| Rate for Payer: Multiplan PHCS |
$468.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$223.70
|
| Rate for Payer: UHCCP Medicaid |
$98.11
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$92.31
|
| Rate for Payer: Wellcare Medicare Advantage |
$172.08
|
|
