|
INS VAG BRACHYTX DEVICE
|
Facility
|
IP
|
$3,517.00
|
|
|
Service Code
|
HCPCS 57156
|
| Hospital Charge Code |
76102176
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$457.21 |
| Max. Negotiated Rate |
$3,376.32 |
| Rate for Payer: Aetna Commercial |
$2,708.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,743.26
|
| Rate for Payer: Cash Price |
$1,758.50
|
| Rate for Payer: Cigna Commercial |
$2,919.11
|
| Rate for Payer: First Health Commercial |
$3,341.15
|
| Rate for Payer: Humana Commercial |
$2,989.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,883.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,595.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,055.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,094.96
|
| Rate for Payer: Ohio Health Group HMO |
$2,637.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$703.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$457.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,090.27
|
| Rate for Payer: PHCS Commercial |
$3,376.32
|
| Rate for Payer: United Healthcare All Payer |
$3,094.96
|
|
|
INS VAG BRACHYTX DEVICE
|
Professional
|
Both
|
$3,517.00
|
|
|
Service Code
|
HCPCS 57156
|
| Hospital Charge Code |
76102176
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$76.14 |
| Max. Negotiated Rate |
$3,517.00 |
| Rate for Payer: Aetna Commercial |
$164.16
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$76.14
|
| Rate for Payer: Anthem Medicaid |
$89.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,517.00
|
| Rate for Payer: Cash Price |
$1,758.50
|
| Rate for Payer: Cash Price |
$1,758.50
|
| Rate for Payer: Cigna Commercial |
$257.25
|
| Rate for Payer: Healthspan PPO |
$173.09
|
| Rate for Payer: Humana Medicaid |
$89.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$130.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$91.39
|
| Rate for Payer: Molina Healthcare Passport |
$89.60
|
| Rate for Payer: Multiplan PHCS |
$2,110.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,461.90
|
| Rate for Payer: UHCCP Medicaid |
$79.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$90.50
|
|
|
INS VAG BRACHYTX DEVICE
|
Facility
|
OP
|
$3,517.00
|
|
|
Service Code
|
HCPCS 57156
|
| Hospital Charge Code |
76102176
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$277.42 |
| Max. Negotiated Rate |
$3,376.32 |
| Rate for Payer: Aetna Commercial |
$2,708.09
|
| Rate for Payer: Anthem Medicaid |
$1,209.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$277.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,743.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$388.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$374.52
|
| Rate for Payer: Cash Price |
$1,758.50
|
| Rate for Payer: Cash Price |
$1,758.50
|
| Rate for Payer: Cigna Commercial |
$2,919.11
|
| Rate for Payer: First Health Commercial |
$3,341.15
|
| Rate for Payer: Humana Commercial |
$2,989.45
|
| Rate for Payer: Humana KY Medicaid |
$1,209.50
|
| Rate for Payer: Humana Medicare Advantage |
$277.42
|
| Rate for Payer: Kentucky WC Medicaid |
$1,221.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,883.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,595.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$332.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,233.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,094.96
|
| Rate for Payer: Ohio Health Group HMO |
$2,637.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$703.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$457.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,090.27
|
| Rate for Payer: PHCS Commercial |
$3,376.32
|
| Rate for Payer: United Healthcare All Payer |
$3,094.96
|
|
|
INS VAG BRACHYTX DEVICE(P
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 57156
|
| Hospital Charge Code |
761P2176
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$76.14 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna Commercial |
$164.16
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$76.14
|
| Rate for Payer: Anthem Medicaid |
$89.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$400.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$257.25
|
| Rate for Payer: Healthspan PPO |
$173.09
|
| Rate for Payer: Humana Medicaid |
$89.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$130.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$91.39
|
| Rate for Payer: Molina Healthcare Passport |
$89.60
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$280.00
|
| Rate for Payer: UHCCP Medicaid |
$79.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$90.50
|
|
|
INS VAG BRACHYTX DEVICE(T
|
Facility
|
OP
|
$3,117.00
|
|
|
Service Code
|
HCPCS 57156
|
| Hospital Charge Code |
761T2176
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$277.42 |
| Max. Negotiated Rate |
$2,992.32 |
| Rate for Payer: Aetna Commercial |
$2,400.09
|
| Rate for Payer: Anthem Medicaid |
$1,071.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$277.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,431.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$388.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$374.52
|
| 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 |
$277.42
|
| 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 |
$332.90
|
| 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
|
|
|
INS VAG BRACHYTX DEVICE(T
|
Facility
|
IP
|
$3,117.00
|
|
|
Service Code
|
HCPCS 57156
|
| Hospital Charge Code |
761T2176
|
|
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
|
|
|
INT ANASTOMSIS OF PAN CYST
|
Professional
|
Both
|
$1,850.00
|
|
|
Service Code
|
HCPCS 48520
|
| Hospital Charge Code |
76101972
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$647.50 |
| Max. Negotiated Rate |
$1,850.00 |
| Rate for Payer: Aetna Commercial |
$1,567.15
|
| Rate for Payer: Anthem Medicaid |
$742.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,850.00
|
| Rate for Payer: Cash Price |
$925.00
|
| Rate for Payer: Cash Price |
$925.00
|
| Rate for Payer: Cigna Commercial |
$1,446.70
|
| Rate for Payer: Healthspan PPO |
$1,321.61
|
| Rate for Payer: Humana Medicaid |
$742.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,393.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$757.57
|
| Rate for Payer: Molina Healthcare Passport |
$742.72
|
| Rate for Payer: Multiplan PHCS |
$1,110.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,295.00
|
| Rate for Payer: UHCCP Medicaid |
$647.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$750.15
|
|
|
INT ANASTOMSIS OF PAN CYST
|
Facility
|
IP
|
$1,850.00
|
|
|
Service Code
|
HCPCS 48520
|
| Hospital Charge Code |
76101972
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$240.50 |
| Max. Negotiated Rate |
$1,776.00 |
| Rate for Payer: Aetna Commercial |
$1,424.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,443.00
|
| Rate for Payer: Cash Price |
$925.00
|
| Rate for Payer: Cigna Commercial |
$1,535.50
|
| Rate for Payer: First Health Commercial |
$1,757.50
|
| Rate for Payer: Humana Commercial |
$1,572.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,517.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,365.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$555.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,628.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,387.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$370.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$573.50
|
| Rate for Payer: PHCS Commercial |
$1,776.00
|
| Rate for Payer: United Healthcare All Payer |
$1,628.00
|
|
|
INT ANASTOMSIS OF PAN CYST
|
Facility
|
OP
|
$1,850.00
|
|
|
Service Code
|
HCPCS 48520
|
| Hospital Charge Code |
76101972
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$240.50 |
| Max. Negotiated Rate |
$1,776.00 |
| Rate for Payer: Aetna Commercial |
$1,424.50
|
| Rate for Payer: Anthem Medicaid |
$636.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,443.00
|
| Rate for Payer: Cash Price |
$925.00
|
| Rate for Payer: Cigna Commercial |
$1,535.50
|
| Rate for Payer: First Health Commercial |
$1,757.50
|
| Rate for Payer: Humana Commercial |
$1,572.50
|
| Rate for Payer: Humana KY Medicaid |
$636.22
|
| Rate for Payer: Kentucky WC Medicaid |
$642.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,517.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,365.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$555.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$648.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,628.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,387.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$370.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$573.50
|
| Rate for Payer: PHCS Commercial |
$1,776.00
|
| Rate for Payer: United Healthcare All Payer |
$1,628.00
|
|
|
INT ANASTOMSIS OF PAN CYST(P
|
Professional
|
Both
|
$1,850.00
|
|
|
Service Code
|
HCPCS 48520
|
| Hospital Charge Code |
761P1972
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$647.50 |
| Max. Negotiated Rate |
$1,850.00 |
| Rate for Payer: Aetna Commercial |
$1,567.15
|
| Rate for Payer: Anthem Medicaid |
$742.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,850.00
|
| Rate for Payer: Cash Price |
$925.00
|
| Rate for Payer: Cash Price |
$925.00
|
| Rate for Payer: Cigna Commercial |
$1,446.70
|
| Rate for Payer: Healthspan PPO |
$1,321.61
|
| Rate for Payer: Humana Medicaid |
$742.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,393.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$757.57
|
| Rate for Payer: Molina Healthcare Passport |
$742.72
|
| Rate for Payer: Multiplan PHCS |
$1,110.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,295.00
|
| Rate for Payer: UHCCP Medicaid |
$647.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$750.15
|
|
|
INTEGRAL EXTD 4H GTR W/4 CBLS
|
Facility
|
IP
|
$24,911.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,238.50 |
| Max. Negotiated Rate |
$23,915.04 |
| Rate for Payer: Aetna Commercial |
$19,181.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,430.97
|
| Rate for Payer: Cash Price |
$12,455.75
|
| Rate for Payer: Cigna Commercial |
$20,676.54
|
| Rate for Payer: First Health Commercial |
$23,665.92
|
| Rate for Payer: Humana Commercial |
$21,174.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,427.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,384.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,473.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,922.12
|
| Rate for Payer: Ohio Health Group HMO |
$18,683.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,982.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,238.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,722.56
|
| Rate for Payer: PHCS Commercial |
$23,915.04
|
| Rate for Payer: United Healthcare All Payer |
$21,922.12
|
|
|
INTEGRAL EXTD 4H GTR W/4 CBLS
|
Facility
|
OP
|
$24,911.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,238.50 |
| Max. Negotiated Rate |
$23,915.04 |
| Rate for Payer: Aetna Commercial |
$19,181.86
|
| Rate for Payer: Anthem Medicaid |
$8,567.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,430.97
|
| Rate for Payer: Cash Price |
$12,455.75
|
| Rate for Payer: Cigna Commercial |
$20,676.54
|
| Rate for Payer: First Health Commercial |
$23,665.92
|
| Rate for Payer: Humana Commercial |
$21,174.78
|
| Rate for Payer: Humana KY Medicaid |
$8,567.06
|
| Rate for Payer: Kentucky WC Medicaid |
$8,654.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,427.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,384.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,473.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,738.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,922.12
|
| Rate for Payer: Ohio Health Group HMO |
$18,683.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,982.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,238.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,722.56
|
| Rate for Payer: PHCS Commercial |
$23,915.04
|
| Rate for Payer: United Healthcare All Payer |
$21,922.12
|
|
|
INTEGRAL EXTD 5H GTR W/4 CBLS
|
Facility
|
IP
|
$28,123.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,656.06 |
| Max. Negotiated Rate |
$26,998.56 |
| Rate for Payer: Aetna Commercial |
$21,655.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,936.33
|
| Rate for Payer: Cash Price |
$14,061.75
|
| Rate for Payer: Cigna Commercial |
$23,342.50
|
| Rate for Payer: First Health Commercial |
$26,717.32
|
| Rate for Payer: Humana Commercial |
$23,904.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,061.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,755.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,437.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,748.68
|
| Rate for Payer: Ohio Health Group HMO |
$21,092.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,624.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,656.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,718.28
|
| Rate for Payer: PHCS Commercial |
$26,998.56
|
| Rate for Payer: United Healthcare All Payer |
$24,748.68
|
|
|
INTEGRAL EXTD 5H GTR W/4 CBLS
|
Facility
|
OP
|
$28,123.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,656.06 |
| Max. Negotiated Rate |
$26,998.56 |
| Rate for Payer: Aetna Commercial |
$21,655.10
|
| Rate for Payer: Anthem Medicaid |
$9,671.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,936.33
|
| Rate for Payer: Cash Price |
$14,061.75
|
| Rate for Payer: Cigna Commercial |
$23,342.50
|
| Rate for Payer: First Health Commercial |
$26,717.32
|
| Rate for Payer: Humana Commercial |
$23,904.98
|
| Rate for Payer: Humana KY Medicaid |
$9,671.67
|
| Rate for Payer: Kentucky WC Medicaid |
$9,770.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,061.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,755.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,437.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,865.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,748.68
|
| Rate for Payer: Ohio Health Group HMO |
$21,092.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,624.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,656.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,718.28
|
| Rate for Payer: PHCS Commercial |
$26,998.56
|
| Rate for Payer: United Healthcare All Payer |
$24,748.68
|
|
|
INTEGRAL LG GTR W/4 CBL 23X121
|
Facility
|
OP
|
$11,154.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,450.12 |
| Max. Negotiated Rate |
$10,708.61 |
| Rate for Payer: Aetna Commercial |
$8,589.20
|
| Rate for Payer: Anthem Medicaid |
$3,836.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,700.74
|
| Rate for Payer: Cash Price |
$5,577.40
|
| Rate for Payer: Cigna Commercial |
$9,258.48
|
| Rate for Payer: First Health Commercial |
$10,597.06
|
| Rate for Payer: Humana Commercial |
$9,481.58
|
| Rate for Payer: Humana KY Medicaid |
$3,836.14
|
| Rate for Payer: Kentucky WC Medicaid |
$3,875.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,146.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,232.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,346.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,913.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,816.22
|
| Rate for Payer: Ohio Health Group HMO |
$8,366.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,230.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,450.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,457.99
|
| Rate for Payer: PHCS Commercial |
$10,708.61
|
| Rate for Payer: United Healthcare All Payer |
$9,816.22
|
|
|
INTEGRAL LG GTR W/4 CBL 23X121
|
Facility
|
IP
|
$11,154.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,450.12 |
| Max. Negotiated Rate |
$10,708.61 |
| Rate for Payer: Aetna Commercial |
$8,589.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,700.74
|
| Rate for Payer: Cash Price |
$5,577.40
|
| Rate for Payer: Cigna Commercial |
$9,258.48
|
| Rate for Payer: First Health Commercial |
$10,597.06
|
| Rate for Payer: Humana Commercial |
$9,481.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,146.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,232.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,346.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,816.22
|
| Rate for Payer: Ohio Health Group HMO |
$8,366.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,230.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,450.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,457.99
|
| Rate for Payer: PHCS Commercial |
$10,708.61
|
| Rate for Payer: United Healthcare All Payer |
$9,816.22
|
|
|
INTEGRAL LNG GTR W/4 CABLES
|
Facility
|
IP
|
$19,509.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,536.24 |
| Max. Negotiated Rate |
$18,729.12 |
| Rate for Payer: Aetna Commercial |
$15,022.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,217.41
|
| Rate for Payer: Cash Price |
$9,754.75
|
| Rate for Payer: Cigna Commercial |
$16,192.88
|
| Rate for Payer: First Health Commercial |
$18,534.02
|
| Rate for Payer: Humana Commercial |
$16,583.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,997.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,398.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,852.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,168.36
|
| Rate for Payer: Ohio Health Group HMO |
$14,632.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,901.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,536.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,047.94
|
| Rate for Payer: PHCS Commercial |
$18,729.12
|
| Rate for Payer: United Healthcare All Payer |
$17,168.36
|
|
|
INTEGRAL LNG GTR W/4 CABLES
|
Facility
|
OP
|
$19,509.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,536.24 |
| Max. Negotiated Rate |
$18,729.12 |
| Rate for Payer: Aetna Commercial |
$15,022.32
|
| Rate for Payer: Anthem Medicaid |
$6,709.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,217.41
|
| Rate for Payer: Cash Price |
$9,754.75
|
| Rate for Payer: Cigna Commercial |
$16,192.88
|
| Rate for Payer: First Health Commercial |
$18,534.02
|
| Rate for Payer: Humana Commercial |
$16,583.08
|
| Rate for Payer: Humana KY Medicaid |
$6,709.32
|
| Rate for Payer: Kentucky WC Medicaid |
$6,777.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,997.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,398.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,852.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,843.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,168.36
|
| Rate for Payer: Ohio Health Group HMO |
$14,632.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,901.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,536.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,047.94
|
| Rate for Payer: PHCS Commercial |
$18,729.12
|
| Rate for Payer: United Healthcare All Payer |
$17,168.36
|
|
|
INTEGRAL SH GTR W/2 CBLS 23X53
|
Facility
|
OP
|
$11,154.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,450.12 |
| Max. Negotiated Rate |
$10,708.61 |
| Rate for Payer: Aetna Commercial |
$8,589.20
|
| Rate for Payer: Anthem Medicaid |
$3,836.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,700.74
|
| Rate for Payer: Cash Price |
$5,577.40
|
| Rate for Payer: Cigna Commercial |
$9,258.48
|
| Rate for Payer: First Health Commercial |
$10,597.06
|
| Rate for Payer: Humana Commercial |
$9,481.58
|
| Rate for Payer: Humana KY Medicaid |
$3,836.14
|
| Rate for Payer: Kentucky WC Medicaid |
$3,875.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,146.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,232.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,346.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,913.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,816.22
|
| Rate for Payer: Ohio Health Group HMO |
$8,366.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,230.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,450.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,457.99
|
| Rate for Payer: PHCS Commercial |
$10,708.61
|
| Rate for Payer: United Healthcare All Payer |
$9,816.22
|
|
|
INTEGRAL SH GTR W/2 CBLS 23X53
|
Facility
|
IP
|
$11,154.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,450.12 |
| Max. Negotiated Rate |
$10,708.61 |
| Rate for Payer: Aetna Commercial |
$8,589.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,700.74
|
| Rate for Payer: Cash Price |
$5,577.40
|
| Rate for Payer: Cigna Commercial |
$9,258.48
|
| Rate for Payer: First Health Commercial |
$10,597.06
|
| Rate for Payer: Humana Commercial |
$9,481.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,146.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,232.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,346.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,816.22
|
| Rate for Payer: Ohio Health Group HMO |
$8,366.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,230.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,450.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,457.99
|
| Rate for Payer: PHCS Commercial |
$10,708.61
|
| Rate for Payer: United Healthcare All Payer |
$9,816.22
|
|
|
INTEGRAL SHRT GTR W/2 CABLES
|
Facility
|
IP
|
$12,534.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,629.48 |
| Max. Negotiated Rate |
$12,033.12 |
| Rate for Payer: Aetna Commercial |
$9,651.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,776.91
|
| Rate for Payer: Cash Price |
$6,267.25
|
| Rate for Payer: Cigna Commercial |
$10,403.64
|
| Rate for Payer: First Health Commercial |
$11,907.78
|
| Rate for Payer: Humana Commercial |
$10,654.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,278.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,250.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,760.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,030.36
|
| Rate for Payer: Ohio Health Group HMO |
$9,400.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,506.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,629.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,885.70
|
| Rate for Payer: PHCS Commercial |
$12,033.12
|
| Rate for Payer: United Healthcare All Payer |
$11,030.36
|
|
|
INTEGRAL SHRT GTR W/2 CABLES
|
Facility
|
OP
|
$12,534.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,629.48 |
| Max. Negotiated Rate |
$12,033.12 |
| Rate for Payer: Aetna Commercial |
$9,651.56
|
| Rate for Payer: Anthem Medicaid |
$4,310.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,776.91
|
| Rate for Payer: Cash Price |
$6,267.25
|
| Rate for Payer: Cigna Commercial |
$10,403.64
|
| Rate for Payer: First Health Commercial |
$11,907.78
|
| Rate for Payer: Humana Commercial |
$10,654.32
|
| Rate for Payer: Humana KY Medicaid |
$4,310.61
|
| Rate for Payer: Kentucky WC Medicaid |
$4,354.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,278.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,250.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,760.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,397.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,030.36
|
| Rate for Payer: Ohio Health Group HMO |
$9,400.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,506.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,629.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,885.70
|
| Rate for Payer: PHCS Commercial |
$12,033.12
|
| Rate for Payer: United Healthcare All Payer |
$11,030.36
|
|
|
INTEGRITY STENT 2.25 * 12
|
Facility
|
IP
|
$3,862.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$502.12 |
| Max. Negotiated Rate |
$3,708.00 |
| Rate for Payer: Aetna Commercial |
$2,974.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,012.75
|
| Rate for Payer: Cash Price |
$1,931.25
|
| Rate for Payer: Cigna Commercial |
$3,205.88
|
| Rate for Payer: First Health Commercial |
$3,669.38
|
| Rate for Payer: Humana Commercial |
$3,283.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,167.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,850.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,158.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,399.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,896.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$772.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$502.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,197.38
|
| Rate for Payer: PHCS Commercial |
$3,708.00
|
| Rate for Payer: United Healthcare All Payer |
$3,399.00
|
|
|
INTEGRITY STENT 2.25 * 12
|
Facility
|
OP
|
$3,862.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$502.12 |
| Max. Negotiated Rate |
$3,708.00 |
| Rate for Payer: Aetna Commercial |
$2,974.12
|
| Rate for Payer: Anthem Medicaid |
$1,328.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,012.75
|
| Rate for Payer: Cash Price |
$1,931.25
|
| Rate for Payer: Cigna Commercial |
$3,205.88
|
| Rate for Payer: First Health Commercial |
$3,669.38
|
| Rate for Payer: Humana Commercial |
$3,283.12
|
| Rate for Payer: Humana KY Medicaid |
$1,328.31
|
| Rate for Payer: Kentucky WC Medicaid |
$1,341.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,167.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,850.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,158.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,354.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,399.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,896.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$772.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$502.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,197.38
|
| Rate for Payer: PHCS Commercial |
$3,708.00
|
| Rate for Payer: United Healthcare All Payer |
$3,399.00
|
|
|
INTEGRITY STENT 2.25 * 14
|
Facility
|
OP
|
$3,862.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$502.12 |
| Max. Negotiated Rate |
$3,708.00 |
| Rate for Payer: Aetna Commercial |
$2,974.12
|
| Rate for Payer: Anthem Medicaid |
$1,328.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,012.75
|
| Rate for Payer: Cash Price |
$1,931.25
|
| Rate for Payer: Cigna Commercial |
$3,205.88
|
| Rate for Payer: First Health Commercial |
$3,669.38
|
| Rate for Payer: Humana Commercial |
$3,283.12
|
| Rate for Payer: Humana KY Medicaid |
$1,328.31
|
| Rate for Payer: Kentucky WC Medicaid |
$1,341.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,167.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,850.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,158.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,354.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,399.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,896.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$772.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$502.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,197.38
|
| Rate for Payer: PHCS Commercial |
$3,708.00
|
| Rate for Payer: United Healthcare All Payer |
$3,399.00
|
|
