|
INSERTION OR REPLACEMENT OF PERMANENT IMPLANTABLE DEFIBRILLATOR SYSTEM, WITH TRANSVENOUS LEAD(S), SINGLE OR DUAL CHAMBER
|
Facility
|
OP
|
$39,829.45
|
|
|
Service Code
|
CPT 33249
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$28,449.61 |
| Max. Negotiated Rate |
$39,829.45 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$28,449.61
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$39,829.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$38,406.97
|
| Rate for Payer: Humana Medicare Advantage |
$28,449.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34,139.53
|
|
|
INSERTION OR REPLACEMENT OF PERMANENT SUBCUTANEOUS IMPLANTABLE DEFIBRILLATOR SYSTEM, WITH SUBCUTANEOUS ELECTRODE, INCLUDING DEFIBRILLATION THRESHOLD EVALUATION, INDUCTION OF ARRHYTHMIA, EVALUATION OF SENSING FOR ARRHYTHMIA TERMINATION, AND PROGRAMMING OR REPROGRAMMING OF SENSING OR THERAPEUTIC PARAMETERS, WHEN PERFORMED
|
Facility
|
OP
|
$39,829.45
|
|
|
Service Code
|
CPT 33270
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$28,449.61 |
| Max. Negotiated Rate |
$39,829.45 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$28,449.61
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$39,829.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$38,406.97
|
| Rate for Payer: Humana Medicare Advantage |
$28,449.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34,139.53
|
|
|
INSERTION OR REPLACEMENT OF SPINAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER, REQUIRING POCKET CREATION AND CONNECTION BETWEEN ELECTRODE ARRAY AND PULSE GENERATOR OR RECEIVER
|
Facility
|
OP
|
$37,593.53
|
|
|
Service Code
|
CPT 63685
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$26,852.52 |
| Max. Negotiated Rate |
$37,593.53 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$26,852.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$37,593.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$36,250.90
|
| Rate for Payer: Humana Medicare Advantage |
$26,852.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32,223.02
|
|
|
INSERTION VAG TANDEM/OVOID HDR
|
Facility
|
IP
|
$3,117.00
|
|
|
Service Code
|
HCPCS 57155
|
| Hospital Charge Code |
76102175
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$405.21 |
| Max. Negotiated Rate |
$2,992.32 |
| Rate for Payer: Aetna Commercial |
$2,400.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,431.26
|
| Rate for Payer: Cash Price |
$1,558.50
|
| Rate for Payer: Cigna Commercial |
$2,587.11
|
| Rate for Payer: First Health Commercial |
$2,961.15
|
| Rate for Payer: Humana Commercial |
$2,649.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,555.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,300.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$935.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,742.96
|
| Rate for Payer: Ohio Health Group HMO |
$2,337.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$623.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$405.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$966.27
|
| Rate for Payer: PHCS Commercial |
$2,992.32
|
| Rate for Payer: United Healthcare All Payer |
$2,742.96
|
|
|
INSERTION VAG TANDEM/OVOID HDR
|
Facility
|
OP
|
$3,117.00
|
|
|
Service Code
|
HCPCS 57155
|
| Hospital Charge Code |
76102175
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$405.21 |
| Max. Negotiated Rate |
$6,021.69 |
| Rate for Payer: Aetna Commercial |
$2,400.09
|
| Rate for Payer: Anthem Medicaid |
$1,071.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,301.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,431.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,021.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$5,806.63
|
| Rate for Payer: Cash Price |
$1,558.50
|
| Rate for Payer: Cash Price |
$1,558.50
|
| Rate for Payer: Cigna Commercial |
$2,587.11
|
| Rate for Payer: First Health Commercial |
$2,961.15
|
| Rate for Payer: Humana Commercial |
$2,649.45
|
| Rate for Payer: Humana KY Medicaid |
$1,071.94
|
| Rate for Payer: Humana Medicare Advantage |
$4,301.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,082.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,555.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,300.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,161.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,093.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,742.96
|
| Rate for Payer: Ohio Health Group HMO |
$2,337.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$623.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$405.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$966.27
|
| Rate for Payer: PHCS Commercial |
$2,992.32
|
| Rate for Payer: United Healthcare All Payer |
$2,742.96
|
|
|
INSERT JOURNEY REV STD 3-4 L 9
|
Facility
|
OP
|
$9,158.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.58 |
| Max. Negotiated Rate |
$8,791.97 |
| Rate for Payer: Aetna Commercial |
$7,051.89
|
| Rate for Payer: Anthem Medicaid |
$3,149.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.47
|
| Rate for Payer: Cash Price |
$4,579.15
|
| Rate for Payer: Cigna Commercial |
$7,601.39
|
| Rate for Payer: First Health Commercial |
$8,700.38
|
| Rate for Payer: Humana Commercial |
$7,784.56
|
| Rate for Payer: Humana KY Medicaid |
$3,149.54
|
| Rate for Payer: Kentucky WC Medicaid |
$3,181.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,212.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.07
|
| Rate for Payer: PHCS Commercial |
$8,791.97
|
| Rate for Payer: United Healthcare All Payer |
$8,059.30
|
|
|
INSERT JOURNEY REV STD 3-4 L 9
|
Facility
|
IP
|
$9,158.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.58 |
| Max. Negotiated Rate |
$8,791.97 |
| Rate for Payer: Aetna Commercial |
$7,051.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.47
|
| Rate for Payer: Cash Price |
$4,579.15
|
| Rate for Payer: Cigna Commercial |
$7,601.39
|
| Rate for Payer: First Health Commercial |
$8,700.38
|
| Rate for Payer: Humana Commercial |
$7,784.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.07
|
| Rate for Payer: PHCS Commercial |
$8,791.97
|
| Rate for Payer: United Healthcare All Payer |
$8,059.30
|
|
|
INSERT JOURNEY REV STD 5-6 R 9
|
Facility
|
OP
|
$9,158.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.58 |
| Max. Negotiated Rate |
$8,791.97 |
| Rate for Payer: Aetna Commercial |
$7,051.89
|
| Rate for Payer: Anthem Medicaid |
$3,149.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.47
|
| Rate for Payer: Cash Price |
$4,579.15
|
| Rate for Payer: Cigna Commercial |
$7,601.39
|
| Rate for Payer: First Health Commercial |
$8,700.38
|
| Rate for Payer: Humana Commercial |
$7,784.56
|
| Rate for Payer: Humana KY Medicaid |
$3,149.54
|
| Rate for Payer: Kentucky WC Medicaid |
$3,181.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,212.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.07
|
| Rate for Payer: PHCS Commercial |
$8,791.97
|
| Rate for Payer: United Healthcare All Payer |
$8,059.30
|
|
|
INSERT JOURNEY REV STD 5-6 R 9
|
Facility
|
IP
|
$9,158.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.58 |
| Max. Negotiated Rate |
$8,791.97 |
| Rate for Payer: Aetna Commercial |
$7,051.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.47
|
| Rate for Payer: Cash Price |
$4,579.15
|
| Rate for Payer: Cigna Commercial |
$7,601.39
|
| Rate for Payer: First Health Commercial |
$8,700.38
|
| Rate for Payer: Humana Commercial |
$7,784.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.07
|
| Rate for Payer: PHCS Commercial |
$8,791.97
|
| Rate for Payer: United Healthcare All Payer |
$8,059.30
|
|
|
INSERT JRNY REV STD 3-4 L 10
|
Facility
|
OP
|
$9,158.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.58 |
| Max. Negotiated Rate |
$8,791.97 |
| Rate for Payer: Aetna Commercial |
$7,051.89
|
| Rate for Payer: Anthem Medicaid |
$3,149.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.47
|
| Rate for Payer: Cash Price |
$4,579.15
|
| Rate for Payer: Cigna Commercial |
$7,601.39
|
| Rate for Payer: First Health Commercial |
$8,700.38
|
| Rate for Payer: Humana Commercial |
$7,784.56
|
| Rate for Payer: Humana KY Medicaid |
$3,149.54
|
| Rate for Payer: Kentucky WC Medicaid |
$3,181.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,212.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.07
|
| Rate for Payer: PHCS Commercial |
$8,791.97
|
| Rate for Payer: United Healthcare All Payer |
$8,059.30
|
|
|
INSERT JRNY REV STD 3-4 L 10
|
Facility
|
IP
|
$9,158.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.58 |
| Max. Negotiated Rate |
$8,791.97 |
| Rate for Payer: Aetna Commercial |
$7,051.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.47
|
| Rate for Payer: Cash Price |
$4,579.15
|
| Rate for Payer: Cigna Commercial |
$7,601.39
|
| Rate for Payer: First Health Commercial |
$8,700.38
|
| Rate for Payer: Humana Commercial |
$7,784.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.07
|
| Rate for Payer: PHCS Commercial |
$8,791.97
|
| Rate for Payer: United Healthcare All Payer |
$8,059.30
|
|
|
INSERT JRNY REV STD 3-4 L 11
|
Facility
|
IP
|
$9,158.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.58 |
| Max. Negotiated Rate |
$8,791.97 |
| Rate for Payer: Aetna Commercial |
$7,051.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.47
|
| Rate for Payer: Cash Price |
$4,579.15
|
| Rate for Payer: Cigna Commercial |
$7,601.39
|
| Rate for Payer: First Health Commercial |
$8,700.38
|
| Rate for Payer: Humana Commercial |
$7,784.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.07
|
| Rate for Payer: PHCS Commercial |
$8,791.97
|
| Rate for Payer: United Healthcare All Payer |
$8,059.30
|
|
|
INSERT JRNY REV STD 3-4 L 11
|
Facility
|
OP
|
$9,158.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.58 |
| Max. Negotiated Rate |
$8,791.97 |
| Rate for Payer: Aetna Commercial |
$7,051.89
|
| Rate for Payer: Anthem Medicaid |
$3,149.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.47
|
| Rate for Payer: Cash Price |
$4,579.15
|
| Rate for Payer: Cigna Commercial |
$7,601.39
|
| Rate for Payer: First Health Commercial |
$8,700.38
|
| Rate for Payer: Humana Commercial |
$7,784.56
|
| Rate for Payer: Humana KY Medicaid |
$3,149.54
|
| Rate for Payer: Kentucky WC Medicaid |
$3,181.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,212.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.07
|
| Rate for Payer: PHCS Commercial |
$8,791.97
|
| Rate for Payer: United Healthcare All Payer |
$8,059.30
|
|
|
INSERT JRNY REV STD 3-4 L 15
|
Facility
|
IP
|
$9,158.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.58 |
| Max. Negotiated Rate |
$8,791.97 |
| Rate for Payer: Aetna Commercial |
$7,051.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.47
|
| Rate for Payer: Cash Price |
$4,579.15
|
| Rate for Payer: Cigna Commercial |
$7,601.39
|
| Rate for Payer: First Health Commercial |
$8,700.38
|
| Rate for Payer: Humana Commercial |
$7,784.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.07
|
| Rate for Payer: PHCS Commercial |
$8,791.97
|
| Rate for Payer: United Healthcare All Payer |
$8,059.30
|
|
|
INSERT JRNY REV STD 3-4 L 15
|
Facility
|
OP
|
$9,158.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.58 |
| Max. Negotiated Rate |
$8,791.97 |
| Rate for Payer: Aetna Commercial |
$7,051.89
|
| Rate for Payer: Anthem Medicaid |
$3,149.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.47
|
| Rate for Payer: Cash Price |
$4,579.15
|
| Rate for Payer: Cigna Commercial |
$7,601.39
|
| Rate for Payer: First Health Commercial |
$8,700.38
|
| Rate for Payer: Humana Commercial |
$7,784.56
|
| Rate for Payer: Humana KY Medicaid |
$3,149.54
|
| Rate for Payer: Kentucky WC Medicaid |
$3,181.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,212.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.07
|
| Rate for Payer: PHCS Commercial |
$8,791.97
|
| Rate for Payer: United Healthcare All Payer |
$8,059.30
|
|
|
INSERT JRNY REV STD 3-4 L 18
|
Facility
|
IP
|
$9,158.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.58 |
| Max. Negotiated Rate |
$8,791.97 |
| Rate for Payer: Aetna Commercial |
$7,051.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.47
|
| Rate for Payer: Cash Price |
$4,579.15
|
| Rate for Payer: Cigna Commercial |
$7,601.39
|
| Rate for Payer: First Health Commercial |
$8,700.38
|
| Rate for Payer: Humana Commercial |
$7,784.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.07
|
| Rate for Payer: PHCS Commercial |
$8,791.97
|
| Rate for Payer: United Healthcare All Payer |
$8,059.30
|
|
|
INSERT JRNY REV STD 3-4 L 18
|
Facility
|
OP
|
$9,158.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.58 |
| Max. Negotiated Rate |
$8,791.97 |
| Rate for Payer: Aetna Commercial |
$7,051.89
|
| Rate for Payer: Anthem Medicaid |
$3,149.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.47
|
| Rate for Payer: Cash Price |
$4,579.15
|
| Rate for Payer: Cigna Commercial |
$7,601.39
|
| Rate for Payer: First Health Commercial |
$8,700.38
|
| Rate for Payer: Humana Commercial |
$7,784.56
|
| Rate for Payer: Humana KY Medicaid |
$3,149.54
|
| Rate for Payer: Kentucky WC Medicaid |
$3,181.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,212.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.07
|
| Rate for Payer: PHCS Commercial |
$8,791.97
|
| Rate for Payer: United Healthcare All Payer |
$8,059.30
|
|
|
INSERT JRNY REV STD 3-4 R 15
|
Facility
|
OP
|
$9,158.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.58 |
| Max. Negotiated Rate |
$8,791.97 |
| Rate for Payer: Aetna Commercial |
$7,051.89
|
| Rate for Payer: Anthem Medicaid |
$3,149.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.47
|
| Rate for Payer: Cash Price |
$4,579.15
|
| Rate for Payer: Cigna Commercial |
$7,601.39
|
| Rate for Payer: First Health Commercial |
$8,700.38
|
| Rate for Payer: Humana Commercial |
$7,784.56
|
| Rate for Payer: Humana KY Medicaid |
$3,149.54
|
| Rate for Payer: Kentucky WC Medicaid |
$3,181.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,212.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.07
|
| Rate for Payer: PHCS Commercial |
$8,791.97
|
| Rate for Payer: United Healthcare All Payer |
$8,059.30
|
|
|
INSERT JRNY REV STD 3-4 R 15
|
Facility
|
IP
|
$9,158.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.58 |
| Max. Negotiated Rate |
$8,791.97 |
| Rate for Payer: Aetna Commercial |
$7,051.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.47
|
| Rate for Payer: Cash Price |
$4,579.15
|
| Rate for Payer: Cigna Commercial |
$7,601.39
|
| Rate for Payer: First Health Commercial |
$8,700.38
|
| Rate for Payer: Humana Commercial |
$7,784.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.07
|
| Rate for Payer: PHCS Commercial |
$8,791.97
|
| Rate for Payer: United Healthcare All Payer |
$8,059.30
|
|
|
INSERT JRNY REV STD 3-4 R 18
|
Facility
|
OP
|
$9,158.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.58 |
| Max. Negotiated Rate |
$8,791.97 |
| Rate for Payer: Aetna Commercial |
$7,051.89
|
| Rate for Payer: Anthem Medicaid |
$3,149.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.47
|
| Rate for Payer: Cash Price |
$4,579.15
|
| Rate for Payer: Cigna Commercial |
$7,601.39
|
| Rate for Payer: First Health Commercial |
$8,700.38
|
| Rate for Payer: Humana Commercial |
$7,784.56
|
| Rate for Payer: Humana KY Medicaid |
$3,149.54
|
| Rate for Payer: Kentucky WC Medicaid |
$3,181.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,212.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.07
|
| Rate for Payer: PHCS Commercial |
$8,791.97
|
| Rate for Payer: United Healthcare All Payer |
$8,059.30
|
|
|
INSERT JRNY REV STD 3-4 R 18
|
Facility
|
IP
|
$9,158.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.58 |
| Max. Negotiated Rate |
$8,791.97 |
| Rate for Payer: Aetna Commercial |
$7,051.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.47
|
| Rate for Payer: Cash Price |
$4,579.15
|
| Rate for Payer: Cigna Commercial |
$7,601.39
|
| Rate for Payer: First Health Commercial |
$8,700.38
|
| Rate for Payer: Humana Commercial |
$7,784.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.07
|
| Rate for Payer: PHCS Commercial |
$8,791.97
|
| Rate for Payer: United Healthcare All Payer |
$8,059.30
|
|
|
INSERT JRNY REV STD 5-6 L 10
|
Facility
|
OP
|
$9,158.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.58 |
| Max. Negotiated Rate |
$8,791.97 |
| Rate for Payer: Aetna Commercial |
$7,051.89
|
| Rate for Payer: Anthem Medicaid |
$3,149.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.47
|
| Rate for Payer: Cash Price |
$4,579.15
|
| Rate for Payer: Cigna Commercial |
$7,601.39
|
| Rate for Payer: First Health Commercial |
$8,700.38
|
| Rate for Payer: Humana Commercial |
$7,784.56
|
| Rate for Payer: Humana KY Medicaid |
$3,149.54
|
| Rate for Payer: Kentucky WC Medicaid |
$3,181.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,212.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.07
|
| Rate for Payer: PHCS Commercial |
$8,791.97
|
| Rate for Payer: United Healthcare All Payer |
$8,059.30
|
|
|
INSERT JRNY REV STD 5-6 L 10
|
Facility
|
IP
|
$9,158.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.58 |
| Max. Negotiated Rate |
$8,791.97 |
| Rate for Payer: Aetna Commercial |
$7,051.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.47
|
| Rate for Payer: Cash Price |
$4,579.15
|
| Rate for Payer: Cigna Commercial |
$7,601.39
|
| Rate for Payer: First Health Commercial |
$8,700.38
|
| Rate for Payer: Humana Commercial |
$7,784.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.07
|
| Rate for Payer: PHCS Commercial |
$8,791.97
|
| Rate for Payer: United Healthcare All Payer |
$8,059.30
|
|
|
INSERT JRNY REV STD 5-6 L 11
|
Facility
|
OP
|
$9,158.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.58 |
| Max. Negotiated Rate |
$8,791.97 |
| Rate for Payer: Aetna Commercial |
$7,051.89
|
| Rate for Payer: Anthem Medicaid |
$3,149.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.47
|
| Rate for Payer: Cash Price |
$4,579.15
|
| Rate for Payer: Cigna Commercial |
$7,601.39
|
| Rate for Payer: First Health Commercial |
$8,700.38
|
| Rate for Payer: Humana Commercial |
$7,784.56
|
| Rate for Payer: Humana KY Medicaid |
$3,149.54
|
| Rate for Payer: Kentucky WC Medicaid |
$3,181.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,212.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.07
|
| Rate for Payer: PHCS Commercial |
$8,791.97
|
| Rate for Payer: United Healthcare All Payer |
$8,059.30
|
|
|
INSERT JRNY REV STD 5-6 L 11
|
Facility
|
IP
|
$9,158.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.58 |
| Max. Negotiated Rate |
$8,791.97 |
| Rate for Payer: Aetna Commercial |
$7,051.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.47
|
| Rate for Payer: Cash Price |
$4,579.15
|
| Rate for Payer: Cigna Commercial |
$7,601.39
|
| Rate for Payer: First Health Commercial |
$8,700.38
|
| Rate for Payer: Humana Commercial |
$7,784.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.07
|
| Rate for Payer: PHCS Commercial |
$8,791.97
|
| Rate for Payer: United Healthcare All Payer |
$8,059.30
|
|
