|
INSERT CATH PLEURA W/O IMAGE
|
Facility
|
IP
|
$3,091.00
|
|
|
Service Code
|
HCPCS 32556
|
| Hospital Charge Code |
76101202
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$401.83 |
| Max. Negotiated Rate |
$2,967.36 |
| Rate for Payer: Aetna Commercial |
$2,380.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,410.98
|
| Rate for Payer: Cash Price |
$1,545.50
|
| Rate for Payer: Cigna Commercial |
$2,565.53
|
| Rate for Payer: First Health Commercial |
$2,936.45
|
| Rate for Payer: Humana Commercial |
$2,627.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,534.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,281.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$927.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,720.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,318.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$618.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$401.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$958.21
|
| Rate for Payer: PHCS Commercial |
$2,967.36
|
| Rate for Payer: United Healthcare All Payer |
$2,720.08
|
|
|
INSERT CATH PLEURA W/O IMAGE
|
Facility
|
OP
|
$3,091.00
|
|
|
Service Code
|
HCPCS 32556
|
| Hospital Charge Code |
76101202
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$401.83 |
| Max. Negotiated Rate |
$2,967.36 |
| Rate for Payer: Aetna Commercial |
$2,380.07
|
| Rate for Payer: Anthem Medicaid |
$1,062.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,645.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,410.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,303.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,221.38
|
| Rate for Payer: Cash Price |
$1,545.50
|
| Rate for Payer: Cash Price |
$1,545.50
|
| Rate for Payer: Cigna Commercial |
$2,565.53
|
| Rate for Payer: First Health Commercial |
$2,936.45
|
| Rate for Payer: Humana Commercial |
$2,627.35
|
| Rate for Payer: Humana KY Medicaid |
$1,062.99
|
| Rate for Payer: Humana Medicare Advantage |
$1,645.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1,073.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,534.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,281.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,974.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,084.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,720.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,318.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$618.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$401.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$958.21
|
| Rate for Payer: PHCS Commercial |
$2,967.36
|
| Rate for Payer: United Healthcare All Payer |
$2,720.08
|
|
|
INSERT CATH PLEURA W/O IMAGE
|
Facility
|
OP
|
$2,326.00
|
|
|
Service Code
|
HCPCS 32556
|
| Hospital Charge Code |
45000226
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$302.38 |
| Max. Negotiated Rate |
$2,303.66 |
| Rate for Payer: Aetna Commercial |
$1,791.02
|
| Rate for Payer: Anthem Medicaid |
$799.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,645.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,814.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,303.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,221.38
|
| Rate for Payer: Cash Price |
$1,163.00
|
| Rate for Payer: Cash Price |
$1,163.00
|
| Rate for Payer: Cigna Commercial |
$1,930.58
|
| Rate for Payer: First Health Commercial |
$2,209.70
|
| Rate for Payer: Humana Commercial |
$1,977.10
|
| Rate for Payer: Humana KY Medicaid |
$799.91
|
| Rate for Payer: Humana Medicare Advantage |
$1,645.47
|
| Rate for Payer: Kentucky WC Medicaid |
$808.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,907.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,716.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,974.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$815.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,046.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,744.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$465.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$302.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$721.06
|
| Rate for Payer: PHCS Commercial |
$2,232.96
|
| Rate for Payer: United Healthcare All Payer |
$2,046.88
|
|
|
INSERT CATH PLEURA W/O IMAGE
|
Facility
|
IP
|
$2,326.00
|
|
|
Service Code
|
HCPCS 32556
|
| Hospital Charge Code |
45000226
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$302.38 |
| Max. Negotiated Rate |
$2,232.96 |
| Rate for Payer: Aetna Commercial |
$1,791.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,814.28
|
| Rate for Payer: Cash Price |
$1,163.00
|
| Rate for Payer: Cigna Commercial |
$1,930.58
|
| Rate for Payer: First Health Commercial |
$2,209.70
|
| Rate for Payer: Humana Commercial |
$1,977.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,907.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,716.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$697.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,046.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,744.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$465.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$302.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$721.06
|
| Rate for Payer: PHCS Commercial |
$2,232.96
|
| Rate for Payer: United Healthcare All Payer |
$2,046.88
|
|
|
INSERT CATH PLEURA W/O IMAGE
|
Professional
|
Both
|
$3,091.00
|
|
|
Service Code
|
HCPCS 32556
|
| Hospital Charge Code |
76101202
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$71.05 |
| Max. Negotiated Rate |
$3,091.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$71.05
|
| Rate for Payer: Anthem Medicaid |
$100.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,091.00
|
| Rate for Payer: Cash Price |
$1,545.50
|
| Rate for Payer: Cash Price |
$1,545.50
|
| Rate for Payer: Cigna Commercial |
$1,069.62
|
| Rate for Payer: Healthspan PPO |
$565.85
|
| Rate for Payer: Humana Medicaid |
$100.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$162.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$102.35
|
| Rate for Payer: Molina Healthcare Passport |
$100.34
|
| Rate for Payer: Multiplan PHCS |
$1,854.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,163.70
|
| Rate for Payer: UHCCP Medicaid |
$74.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$101.34
|
|
|
INSERT CATH PLEURA W/O IMAG(P
|
Professional
|
Both
|
$860.00
|
|
|
Service Code
|
HCPCS 32556
|
| Hospital Charge Code |
761P1202
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$71.05 |
| Max. Negotiated Rate |
$1,069.62 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$71.05
|
| Rate for Payer: Anthem Medicaid |
$100.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$860.00
|
| Rate for Payer: Cash Price |
$430.00
|
| Rate for Payer: Cash Price |
$430.00
|
| Rate for Payer: Cigna Commercial |
$1,069.62
|
| Rate for Payer: Healthspan PPO |
$565.85
|
| Rate for Payer: Humana Medicaid |
$100.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$162.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$102.35
|
| Rate for Payer: Molina Healthcare Passport |
$100.34
|
| Rate for Payer: Multiplan PHCS |
$516.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$602.00
|
| Rate for Payer: UHCCP Medicaid |
$74.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$101.34
|
|
|
INSERT CATH PLEURA W/O IMAG(T
|
Facility
|
OP
|
$2,231.00
|
|
|
Service Code
|
HCPCS 32556
|
| Hospital Charge Code |
761T1202
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$290.03 |
| Max. Negotiated Rate |
$2,303.66 |
| Rate for Payer: Aetna Commercial |
$1,717.87
|
| Rate for Payer: Anthem Medicaid |
$767.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,645.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,740.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,303.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,221.38
|
| Rate for Payer: Cash Price |
$1,115.50
|
| Rate for Payer: Cash Price |
$1,115.50
|
| Rate for Payer: Cigna Commercial |
$1,851.73
|
| Rate for Payer: First Health Commercial |
$2,119.45
|
| Rate for Payer: Humana Commercial |
$1,896.35
|
| Rate for Payer: Humana KY Medicaid |
$767.24
|
| Rate for Payer: Humana Medicare Advantage |
$1,645.47
|
| Rate for Payer: Kentucky WC Medicaid |
$775.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,829.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,646.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,974.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$782.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,963.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,673.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$446.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$290.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$691.61
|
| Rate for Payer: PHCS Commercial |
$2,141.76
|
| Rate for Payer: United Healthcare All Payer |
$1,963.28
|
|
|
INSERT CATH PLEURA W/O IMAG(T
|
Facility
|
IP
|
$2,231.00
|
|
|
Service Code
|
HCPCS 32556
|
| Hospital Charge Code |
761T1202
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$290.03 |
| Max. Negotiated Rate |
$2,141.76 |
| Rate for Payer: Aetna Commercial |
$1,717.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,740.18
|
| Rate for Payer: Cash Price |
$1,115.50
|
| Rate for Payer: Cigna Commercial |
$1,851.73
|
| Rate for Payer: First Health Commercial |
$2,119.45
|
| Rate for Payer: Humana Commercial |
$1,896.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,829.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,646.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$669.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,963.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,673.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$446.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$290.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$691.61
|
| Rate for Payer: PHCS Commercial |
$2,141.76
|
| Rate for Payer: United Healthcare All Payer |
$1,963.28
|
|
|
INSERT CERVICAL DILATOR
|
Facility
|
OP
|
$836.00
|
|
|
Service Code
|
HCPCS 59200
|
| Hospital Charge Code |
72000012
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$108.68 |
| Max. Negotiated Rate |
$802.56 |
| Rate for Payer: Aetna Commercial |
$643.72
|
| Rate for Payer: Anthem Medicaid |
$287.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$277.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$652.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$388.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$374.52
|
| Rate for Payer: Cash Price |
$418.00
|
| Rate for Payer: Cash Price |
$418.00
|
| Rate for Payer: Cigna Commercial |
$693.88
|
| Rate for Payer: First Health Commercial |
$794.20
|
| Rate for Payer: Humana Commercial |
$710.60
|
| Rate for Payer: Humana KY Medicaid |
$287.50
|
| Rate for Payer: Humana Medicare Advantage |
$277.42
|
| Rate for Payer: Kentucky WC Medicaid |
$290.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$685.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$616.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$332.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$293.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$735.68
|
| Rate for Payer: Ohio Health Group HMO |
$627.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$167.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$108.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$259.16
|
| Rate for Payer: PHCS Commercial |
$802.56
|
| Rate for Payer: United Healthcare All Payer |
$735.68
|
|
|
INSERT CERVICAL DILATOR
|
Professional
|
Both
|
$836.00
|
|
|
Service Code
|
HCPCS 59200
|
| Hospital Charge Code |
72000012
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$22.67 |
| Max. Negotiated Rate |
$836.00 |
| Rate for Payer: Aetna Commercial |
$76.13
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$22.67
|
| Rate for Payer: Anthem Medicaid |
$33.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$836.00
|
| Rate for Payer: Cash Price |
$418.00
|
| Rate for Payer: Cash Price |
$418.00
|
| Rate for Payer: Cigna Commercial |
$118.00
|
| Rate for Payer: Healthspan PPO |
$85.85
|
| Rate for Payer: Humana Medicaid |
$33.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$60.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$33.76
|
| Rate for Payer: Molina Healthcare Passport |
$33.10
|
| Rate for Payer: Multiplan PHCS |
$501.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$585.20
|
| Rate for Payer: UHCCP Medicaid |
$23.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$33.43
|
|
|
INSERT CERVICAL DILATOR
|
Facility
|
IP
|
$836.00
|
|
|
Service Code
|
HCPCS 59200
|
| Hospital Charge Code |
72000012
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$108.68 |
| Max. Negotiated Rate |
$802.56 |
| Rate for Payer: Aetna Commercial |
$643.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$652.08
|
| Rate for Payer: Cash Price |
$418.00
|
| Rate for Payer: Cigna Commercial |
$693.88
|
| Rate for Payer: First Health Commercial |
$794.20
|
| Rate for Payer: Humana Commercial |
$710.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$685.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$616.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$250.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$735.68
|
| Rate for Payer: Ohio Health Group HMO |
$627.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$167.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$108.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$259.16
|
| Rate for Payer: PHCS Commercial |
$802.56
|
| Rate for Payer: United Healthcare All Payer |
$735.68
|
|
|
INSERT CERVICAL DILATOR(P
|
Professional
|
Both
|
$245.00
|
|
|
Service Code
|
HCPCS 59200
|
| Hospital Charge Code |
720P0012
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$22.67 |
| Max. Negotiated Rate |
$245.00 |
| Rate for Payer: Aetna Commercial |
$76.13
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$22.67
|
| Rate for Payer: Anthem Medicaid |
$33.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$245.00
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cigna Commercial |
$118.00
|
| Rate for Payer: Healthspan PPO |
$85.85
|
| Rate for Payer: Humana Medicaid |
$33.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$60.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$33.76
|
| Rate for Payer: Molina Healthcare Passport |
$33.10
|
| Rate for Payer: Multiplan PHCS |
$147.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$171.50
|
| Rate for Payer: UHCCP Medicaid |
$23.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$33.43
|
|
|
INSERT CERVICAL DILATOR(T
|
Facility
|
IP
|
$591.00
|
|
|
Service Code
|
HCPCS 59200
|
| Hospital Charge Code |
720T0012
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$76.83 |
| Max. Negotiated Rate |
$567.36 |
| Rate for Payer: Aetna Commercial |
$455.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$460.98
|
| Rate for Payer: Cash Price |
$295.50
|
| Rate for Payer: Cigna Commercial |
$490.53
|
| Rate for Payer: First Health Commercial |
$561.45
|
| Rate for Payer: Humana Commercial |
$502.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$484.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$436.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$177.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$520.08
|
| Rate for Payer: Ohio Health Group HMO |
$443.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$118.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$76.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$183.21
|
| Rate for Payer: PHCS Commercial |
$567.36
|
| Rate for Payer: United Healthcare All Payer |
$520.08
|
|
|
INSERT CERVICAL DILATOR(T
|
Facility
|
OP
|
$591.00
|
|
|
Service Code
|
HCPCS 59200
|
| Hospital Charge Code |
720T0012
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$76.83 |
| Max. Negotiated Rate |
$567.36 |
| Rate for Payer: Aetna Commercial |
$455.07
|
| Rate for Payer: Anthem Medicaid |
$203.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$277.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$460.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$388.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$374.52
|
| Rate for Payer: Cash Price |
$295.50
|
| Rate for Payer: Cash Price |
$295.50
|
| Rate for Payer: Cigna Commercial |
$490.53
|
| Rate for Payer: First Health Commercial |
$561.45
|
| Rate for Payer: Humana Commercial |
$502.35
|
| Rate for Payer: Humana KY Medicaid |
$203.24
|
| Rate for Payer: Humana Medicare Advantage |
$277.42
|
| Rate for Payer: Kentucky WC Medicaid |
$205.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$484.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$436.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$332.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$207.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$520.08
|
| Rate for Payer: Ohio Health Group HMO |
$443.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$118.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$76.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$183.21
|
| Rate for Payer: PHCS Commercial |
$567.36
|
| Rate for Payer: United Healthcare All Payer |
$520.08
|
|
|
INSERT DEEP FLEX C/R S 1-2 9MM
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
INSERT DEEP FLEX C/R S 1-2 9MM
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
INSERT DEEP FLEX C/R S 3-4 9MM
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
INSERT DEEP FLEX C/R S 3-4 9MM
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
INSERT DEEP FLEX C/R S 5-6 9MM
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
INSERT DEEP FLEX C/R S 5-6 9MM
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
INSERT DEEP FLEX C/R S 7-8 9MM
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
INSERT DEEP FLEX C/R S 7-8 9MM
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
INSERT DEEPFLX C/R S 1-2 11MM
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
INSERT DEEPFLX C/R S 1-2 11MM
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
INSERT DEEPFLX C/R S 1-2 13MM
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
