|
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 |
$281.07 |
| 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 |
$281.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,431.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$393.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$379.44
|
| 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 |
$281.07
|
| 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 |
$337.28
|
| 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 |
$2,493.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,711.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,150.73
|
| 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 |
$935.10 |
| 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 |
$2,493.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,711.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,150.73
|
| Rate for Payer: PHCS Commercial |
$2,992.32
|
| Rate for Payer: United Healthcare All Payer |
$2,742.96
|
|
|
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 |
$555.00 |
| 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 |
$1,480.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,609.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,276.50
|
| Rate for Payer: PHCS Commercial |
$1,776.00
|
| Rate for Payer: United Healthcare All Payer |
$1,628.00
|
|
|
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 |
$1,567.15 |
| Rate for Payer: Aetna Commercial |
$1,567.15
|
| Rate for Payer: Ambetter Exchange |
$1,048.47
|
| Rate for Payer: Anthem Medicaid |
$742.72
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,048.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,048.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,258.16
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,048.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,048.47
|
| 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 |
$1,363.01
|
| Rate for Payer: UHCCP Medicaid |
$647.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$750.15
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,048.47
|
|
|
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 |
$555.00 |
| 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 |
$1,480.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,609.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,276.50
|
| 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 |
$1,567.15 |
| Rate for Payer: Aetna Commercial |
$1,567.15
|
| Rate for Payer: Ambetter Exchange |
$1,048.47
|
| Rate for Payer: Anthem Medicaid |
$742.72
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,048.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,048.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,258.16
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,048.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,048.47
|
| 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 |
$1,363.01
|
| Rate for Payer: UHCCP Medicaid |
$647.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$750.15
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,048.47
|
|
|
INTEGRAL EXTD 4H GTR W/4 CBLS
|
Facility
|
IP
|
$25,662.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,698.75 |
| Max. Negotiated Rate |
$24,636.00 |
| Rate for Payer: Aetna Commercial |
$19,760.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,016.75
|
| Rate for Payer: Cash Price |
$12,831.25
|
| Rate for Payer: Cigna Commercial |
$21,299.88
|
| Rate for Payer: First Health Commercial |
$24,379.38
|
| Rate for Payer: Humana Commercial |
$21,813.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,043.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,938.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,698.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,583.00
|
| Rate for Payer: Ohio Health Group HMO |
$19,246.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,530.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,326.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,707.12
|
| Rate for Payer: PHCS Commercial |
$24,636.00
|
| Rate for Payer: United Healthcare All Payer |
$22,583.00
|
|
|
INTEGRAL EXTD 4H GTR W/4 CBLS
|
Facility
|
OP
|
$25,662.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,698.75 |
| Max. Negotiated Rate |
$24,636.00 |
| Rate for Payer: Aetna Commercial |
$19,760.12
|
| Rate for Payer: Anthem Medicaid |
$8,825.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,016.75
|
| Rate for Payer: Cash Price |
$12,831.25
|
| Rate for Payer: Cigna Commercial |
$21,299.88
|
| Rate for Payer: First Health Commercial |
$24,379.38
|
| Rate for Payer: Humana Commercial |
$21,813.12
|
| Rate for Payer: Humana KY Medicaid |
$8,825.33
|
| Rate for Payer: Kentucky WC Medicaid |
$8,915.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,043.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,938.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,698.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,002.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,583.00
|
| Rate for Payer: Ohio Health Group HMO |
$19,246.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,530.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,326.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,707.12
|
| Rate for Payer: PHCS Commercial |
$24,636.00
|
| Rate for Payer: United Healthcare All Payer |
$22,583.00
|
|
|
INTEGRAL EXTD 5H GTR W/4 CBLS
|
Facility
|
OP
|
$28,962.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,688.75 |
| Max. Negotiated Rate |
$27,804.00 |
| Rate for Payer: Aetna Commercial |
$22,301.12
|
| Rate for Payer: Anthem Medicaid |
$9,960.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,590.75
|
| Rate for Payer: Cash Price |
$14,481.25
|
| Rate for Payer: Cigna Commercial |
$24,038.88
|
| Rate for Payer: First Health Commercial |
$27,514.38
|
| Rate for Payer: Humana Commercial |
$24,618.12
|
| Rate for Payer: Humana KY Medicaid |
$9,960.20
|
| Rate for Payer: Kentucky WC Medicaid |
$10,061.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,749.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,374.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,688.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,160.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,487.00
|
| Rate for Payer: Ohio Health Group HMO |
$21,721.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,170.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,197.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,984.12
|
| Rate for Payer: PHCS Commercial |
$27,804.00
|
| Rate for Payer: United Healthcare All Payer |
$25,487.00
|
|
|
INTEGRAL EXTD 5H GTR W/4 CBLS
|
Facility
|
IP
|
$28,962.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,688.75 |
| Max. Negotiated Rate |
$27,804.00 |
| Rate for Payer: Aetna Commercial |
$22,301.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,590.75
|
| Rate for Payer: Cash Price |
$14,481.25
|
| Rate for Payer: Cigna Commercial |
$24,038.88
|
| Rate for Payer: First Health Commercial |
$27,514.38
|
| Rate for Payer: Humana Commercial |
$24,618.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,749.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,374.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,688.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,487.00
|
| Rate for Payer: Ohio Health Group HMO |
$21,721.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,170.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,197.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,984.12
|
| Rate for Payer: PHCS Commercial |
$27,804.00
|
| Rate for Payer: United Healthcare All Payer |
$25,487.00
|
|
|
INTEGRAL LG GTR W/4 CBL 23X121
|
Facility
|
IP
|
$11,397.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,419.35 |
| Max. Negotiated Rate |
$10,941.93 |
| Rate for Payer: Aetna Commercial |
$8,776.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,890.32
|
| Rate for Payer: Cash Price |
$5,698.92
|
| Rate for Payer: Cigna Commercial |
$9,460.21
|
| Rate for Payer: First Health Commercial |
$10,827.95
|
| Rate for Payer: Humana Commercial |
$9,688.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,346.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,411.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,419.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,030.10
|
| Rate for Payer: Ohio Health Group HMO |
$8,548.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,118.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,916.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,864.51
|
| Rate for Payer: PHCS Commercial |
$10,941.93
|
| Rate for Payer: United Healthcare All Payer |
$10,030.10
|
|
|
INTEGRAL LG GTR W/4 CBL 23X121
|
Facility
|
OP
|
$11,397.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,419.35 |
| Max. Negotiated Rate |
$10,941.93 |
| Rate for Payer: Aetna Commercial |
$8,776.34
|
| Rate for Payer: Anthem Medicaid |
$3,919.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,890.32
|
| Rate for Payer: Cash Price |
$5,698.92
|
| Rate for Payer: Cigna Commercial |
$9,460.21
|
| Rate for Payer: First Health Commercial |
$10,827.95
|
| Rate for Payer: Humana Commercial |
$9,688.16
|
| Rate for Payer: Humana KY Medicaid |
$3,919.72
|
| Rate for Payer: Kentucky WC Medicaid |
$3,959.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,346.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,411.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,419.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,998.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,030.10
|
| Rate for Payer: Ohio Health Group HMO |
$8,548.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,118.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,916.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,864.51
|
| Rate for Payer: PHCS Commercial |
$10,941.93
|
| Rate for Payer: United Healthcare All Payer |
$10,030.10
|
|
|
INTEGRAL LNG GTR W/4 CABLES
|
Facility
|
IP
|
$20,112.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,033.75 |
| Max. Negotiated Rate |
$19,308.00 |
| Rate for Payer: Aetna Commercial |
$15,486.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,687.75
|
| Rate for Payer: Cash Price |
$10,056.25
|
| Rate for Payer: Cigna Commercial |
$16,693.38
|
| Rate for Payer: First Health Commercial |
$19,106.88
|
| Rate for Payer: Humana Commercial |
$17,095.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,492.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,843.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,033.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,699.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,084.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,090.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,497.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,877.62
|
| Rate for Payer: PHCS Commercial |
$19,308.00
|
| Rate for Payer: United Healthcare All Payer |
$17,699.00
|
|
|
INTEGRAL LNG GTR W/4 CABLES
|
Facility
|
OP
|
$20,112.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,033.75 |
| Max. Negotiated Rate |
$19,308.00 |
| Rate for Payer: Aetna Commercial |
$15,486.62
|
| Rate for Payer: Anthem Medicaid |
$6,916.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,687.75
|
| Rate for Payer: Cash Price |
$10,056.25
|
| Rate for Payer: Cigna Commercial |
$16,693.38
|
| Rate for Payer: First Health Commercial |
$19,106.88
|
| Rate for Payer: Humana Commercial |
$17,095.62
|
| Rate for Payer: Humana KY Medicaid |
$6,916.69
|
| Rate for Payer: Kentucky WC Medicaid |
$6,987.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,492.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,843.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,033.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,055.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,699.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,084.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,090.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,497.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,877.62
|
| Rate for Payer: PHCS Commercial |
$19,308.00
|
| Rate for Payer: United Healthcare All Payer |
$17,699.00
|
|
|
INTEGRAL SH GTR W/2 CBLS 23X53
|
Facility
|
OP
|
$11,397.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,419.35 |
| Max. Negotiated Rate |
$10,941.93 |
| Rate for Payer: Aetna Commercial |
$8,776.34
|
| Rate for Payer: Anthem Medicaid |
$3,919.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,890.32
|
| Rate for Payer: Cash Price |
$5,698.92
|
| Rate for Payer: Cigna Commercial |
$9,460.21
|
| Rate for Payer: First Health Commercial |
$10,827.95
|
| Rate for Payer: Humana Commercial |
$9,688.16
|
| Rate for Payer: Humana KY Medicaid |
$3,919.72
|
| Rate for Payer: Kentucky WC Medicaid |
$3,959.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,346.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,411.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,419.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,998.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,030.10
|
| Rate for Payer: Ohio Health Group HMO |
$8,548.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,118.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,916.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,864.51
|
| Rate for Payer: PHCS Commercial |
$10,941.93
|
| Rate for Payer: United Healthcare All Payer |
$10,030.10
|
|
|
INTEGRAL SH GTR W/2 CBLS 23X53
|
Facility
|
IP
|
$11,397.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,419.35 |
| Max. Negotiated Rate |
$10,941.93 |
| Rate for Payer: Aetna Commercial |
$8,776.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,890.32
|
| Rate for Payer: Cash Price |
$5,698.92
|
| Rate for Payer: Cigna Commercial |
$9,460.21
|
| Rate for Payer: First Health Commercial |
$10,827.95
|
| Rate for Payer: Humana Commercial |
$9,688.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,346.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,411.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,419.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,030.10
|
| Rate for Payer: Ohio Health Group HMO |
$8,548.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,118.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,916.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,864.51
|
| Rate for Payer: PHCS Commercial |
$10,941.93
|
| Rate for Payer: United Healthcare All Payer |
$10,030.10
|
|
|
INTEGRAL SHRT GTR W/2 CABLES
|
Facility
|
IP
|
$12,785.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,835.53 |
| Max. Negotiated Rate |
$12,273.70 |
| Rate for Payer: Aetna Commercial |
$9,844.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,972.38
|
| Rate for Payer: Cash Price |
$6,392.55
|
| Rate for Payer: Cigna Commercial |
$10,611.63
|
| Rate for Payer: First Health Commercial |
$12,145.84
|
| Rate for Payer: Humana Commercial |
$10,867.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,483.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,435.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,835.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,250.89
|
| Rate for Payer: Ohio Health Group HMO |
$9,588.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,228.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,123.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,821.72
|
| Rate for Payer: PHCS Commercial |
$12,273.70
|
| Rate for Payer: United Healthcare All Payer |
$11,250.89
|
|
|
INTEGRAL SHRT GTR W/2 CABLES
|
Facility
|
OP
|
$12,785.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,835.53 |
| Max. Negotiated Rate |
$12,273.70 |
| Rate for Payer: Aetna Commercial |
$9,844.53
|
| Rate for Payer: Anthem Medicaid |
$4,396.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,972.38
|
| Rate for Payer: Cash Price |
$6,392.55
|
| Rate for Payer: Cigna Commercial |
$10,611.63
|
| Rate for Payer: First Health Commercial |
$12,145.84
|
| Rate for Payer: Humana Commercial |
$10,867.33
|
| Rate for Payer: Humana KY Medicaid |
$4,396.80
|
| Rate for Payer: Kentucky WC Medicaid |
$4,441.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,483.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,435.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,835.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,485.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,250.89
|
| Rate for Payer: Ohio Health Group HMO |
$9,588.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,228.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,123.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,821.72
|
| Rate for Payer: PHCS Commercial |
$12,273.70
|
| Rate for Payer: United Healthcare All Payer |
$11,250.89
|
|
|
INTEGRITY STENT 2.25 * 12
|
Facility
|
OP
|
$3,781.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,134.38 |
| Max. Negotiated Rate |
$3,630.00 |
| Rate for Payer: Aetna Commercial |
$2,911.56
|
| Rate for Payer: Anthem Medicaid |
$1,300.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,949.38
|
| Rate for Payer: Cash Price |
$1,890.62
|
| Rate for Payer: Cigna Commercial |
$3,138.44
|
| Rate for Payer: First Health Commercial |
$3,592.19
|
| Rate for Payer: Humana Commercial |
$3,214.06
|
| Rate for Payer: Humana KY Medicaid |
$1,300.37
|
| Rate for Payer: Kentucky WC Medicaid |
$1,313.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,100.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,790.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,134.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,326.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,327.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,835.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,025.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,289.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,609.06
|
| Rate for Payer: PHCS Commercial |
$3,630.00
|
| Rate for Payer: United Healthcare All Payer |
$3,327.50
|
|
|
INTEGRITY STENT 2.25 * 12
|
Facility
|
IP
|
$3,781.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,134.38 |
| Max. Negotiated Rate |
$3,630.00 |
| Rate for Payer: Aetna Commercial |
$2,911.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,949.38
|
| Rate for Payer: Cash Price |
$1,890.62
|
| Rate for Payer: Cigna Commercial |
$3,138.44
|
| Rate for Payer: First Health Commercial |
$3,592.19
|
| Rate for Payer: Humana Commercial |
$3,214.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,100.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,790.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,134.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,327.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,835.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,025.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,289.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,609.06
|
| Rate for Payer: PHCS Commercial |
$3,630.00
|
| Rate for Payer: United Healthcare All Payer |
$3,327.50
|
|
|
INTEGRITY STENT 2.25 * 14
|
Facility
|
OP
|
$3,781.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,134.38 |
| Max. Negotiated Rate |
$3,630.00 |
| Rate for Payer: Aetna Commercial |
$2,911.56
|
| Rate for Payer: Anthem Medicaid |
$1,300.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,949.38
|
| Rate for Payer: Cash Price |
$1,890.62
|
| Rate for Payer: Cigna Commercial |
$3,138.44
|
| Rate for Payer: First Health Commercial |
$3,592.19
|
| Rate for Payer: Humana Commercial |
$3,214.06
|
| Rate for Payer: Humana KY Medicaid |
$1,300.37
|
| Rate for Payer: Kentucky WC Medicaid |
$1,313.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,100.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,790.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,134.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,326.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,327.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,835.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,025.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,289.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,609.06
|
| Rate for Payer: PHCS Commercial |
$3,630.00
|
| Rate for Payer: United Healthcare All Payer |
$3,327.50
|
|
|
INTEGRITY STENT 2.25 * 14
|
Facility
|
IP
|
$3,781.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,134.38 |
| Max. Negotiated Rate |
$3,630.00 |
| Rate for Payer: Aetna Commercial |
$2,911.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,949.38
|
| Rate for Payer: Cash Price |
$1,890.62
|
| Rate for Payer: Cigna Commercial |
$3,138.44
|
| Rate for Payer: First Health Commercial |
$3,592.19
|
| Rate for Payer: Humana Commercial |
$3,214.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,100.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,790.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,134.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,327.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,835.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,025.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,289.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,609.06
|
| Rate for Payer: PHCS Commercial |
$3,630.00
|
| Rate for Payer: United Healthcare All Payer |
$3,327.50
|
|
|
INTEGRITY STENT 2.25 * 18
|
Facility
|
IP
|
$3,781.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,134.38 |
| Max. Negotiated Rate |
$3,630.00 |
| Rate for Payer: Aetna Commercial |
$2,911.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,949.38
|
| Rate for Payer: Cash Price |
$1,890.62
|
| Rate for Payer: Cigna Commercial |
$3,138.44
|
| Rate for Payer: First Health Commercial |
$3,592.19
|
| Rate for Payer: Humana Commercial |
$3,214.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,100.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,790.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,134.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,327.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,835.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,025.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,289.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,609.06
|
| Rate for Payer: PHCS Commercial |
$3,630.00
|
| Rate for Payer: United Healthcare All Payer |
$3,327.50
|
|
|
INTEGRITY STENT 2.25 * 18
|
Facility
|
OP
|
$3,781.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,134.38 |
| Max. Negotiated Rate |
$3,630.00 |
| Rate for Payer: Aetna Commercial |
$2,911.56
|
| Rate for Payer: Anthem Medicaid |
$1,300.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,949.38
|
| Rate for Payer: Cash Price |
$1,890.62
|
| Rate for Payer: Cigna Commercial |
$3,138.44
|
| Rate for Payer: First Health Commercial |
$3,592.19
|
| Rate for Payer: Humana Commercial |
$3,214.06
|
| Rate for Payer: Humana KY Medicaid |
$1,300.37
|
| Rate for Payer: Kentucky WC Medicaid |
$1,313.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,100.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,790.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,134.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,326.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,327.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,835.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,025.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,289.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,609.06
|
| Rate for Payer: PHCS Commercial |
$3,630.00
|
| Rate for Payer: United Healthcare All Payer |
$3,327.50
|
|
|
INTEGRITY STENT 2.25 * 22
|
Facility
|
OP
|
$3,781.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,134.38 |
| Max. Negotiated Rate |
$3,630.00 |
| Rate for Payer: Aetna Commercial |
$2,911.56
|
| Rate for Payer: Anthem Medicaid |
$1,300.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,949.38
|
| Rate for Payer: Cash Price |
$1,890.62
|
| Rate for Payer: Cigna Commercial |
$3,138.44
|
| Rate for Payer: First Health Commercial |
$3,592.19
|
| Rate for Payer: Humana Commercial |
$3,214.06
|
| Rate for Payer: Humana KY Medicaid |
$1,300.37
|
| Rate for Payer: Kentucky WC Medicaid |
$1,313.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,100.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,790.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,134.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,326.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,327.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,835.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,025.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,289.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,609.06
|
| Rate for Payer: PHCS Commercial |
$3,630.00
|
| Rate for Payer: United Healthcare All Payer |
$3,327.50
|
|
