PKR INSERT X3 #6 LM/RL -12
|
Facility
|
OP
|
$6,669.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$866.97 |
Max. Negotiated Rate |
$6,402.24 |
Rate for Payer: Aetna Commercial |
$5,135.13
|
Rate for Payer: Anthem Medicaid |
$2,293.47
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,201.82
|
Rate for Payer: Cash Price |
$3,334.50
|
Rate for Payer: Cigna Commercial |
$5,535.27
|
Rate for Payer: First Health Commercial |
$6,335.55
|
Rate for Payer: Humana Commercial |
$5,668.65
|
Rate for Payer: Humana KY Medicaid |
$2,293.47
|
Rate for Payer: Kentucky WC Medicaid |
$2,316.81
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$5,468.58
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,921.72
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.70
|
Rate for Payer: Molina Healthcare Medicaid |
$2,339.49
|
Rate for Payer: Ohio Health Choice Commercial |
$5,868.72
|
Rate for Payer: Ohio Health Group HMO |
$5,001.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,333.80
|
Rate for Payer: Ohio Health Group PPO No Differential |
$866.97
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,067.39
|
Rate for Payer: PHCS Commercial |
$6,402.24
|
Rate for Payer: United Healthcare All Payer |
$5,868.72
|
|
PKR INSERT X3 #6 LM/RL-8
|
Facility
|
OP
|
$6,669.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$866.97 |
Max. Negotiated Rate |
$6,402.24 |
Rate for Payer: Aetna Commercial |
$5,135.13
|
Rate for Payer: Anthem Medicaid |
$2,293.47
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,201.82
|
Rate for Payer: Cash Price |
$3,334.50
|
Rate for Payer: Cigna Commercial |
$5,535.27
|
Rate for Payer: First Health Commercial |
$6,335.55
|
Rate for Payer: Humana Commercial |
$5,668.65
|
Rate for Payer: Humana KY Medicaid |
$2,293.47
|
Rate for Payer: Kentucky WC Medicaid |
$2,316.81
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$5,468.58
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,921.72
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.70
|
Rate for Payer: Molina Healthcare Medicaid |
$2,339.49
|
Rate for Payer: Ohio Health Choice Commercial |
$5,868.72
|
Rate for Payer: Ohio Health Group HMO |
$5,001.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,333.80
|
Rate for Payer: Ohio Health Group PPO No Differential |
$866.97
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,067.39
|
Rate for Payer: PHCS Commercial |
$6,402.24
|
Rate for Payer: United Healthcare All Payer |
$5,868.72
|
|
PKR INSERT X3 #6 LM/RL-8
|
Facility
|
IP
|
$6,669.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$866.97 |
Max. Negotiated Rate |
$6,402.24 |
Rate for Payer: Aetna Commercial |
$5,135.13
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,201.82
|
Rate for Payer: Cash Price |
$3,334.50
|
Rate for Payer: Cigna Commercial |
$5,535.27
|
Rate for Payer: First Health Commercial |
$6,335.55
|
Rate for Payer: Humana Commercial |
$5,668.65
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$5,468.58
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,921.72
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.70
|
Rate for Payer: Ohio Health Choice Commercial |
$5,868.72
|
Rate for Payer: Ohio Health Group HMO |
$5,001.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,333.80
|
Rate for Payer: Ohio Health Group PPO No Differential |
$866.97
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,067.39
|
Rate for Payer: PHCS Commercial |
$6,402.24
|
Rate for Payer: United Healthcare All Payer |
$5,868.72
|
|
PKR INSERT X3 #6 LM/RL-9
|
Facility
|
IP
|
$6,669.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$866.97 |
Max. Negotiated Rate |
$6,402.24 |
Rate for Payer: Aetna Commercial |
$5,135.13
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,201.82
|
Rate for Payer: Cash Price |
$3,334.50
|
Rate for Payer: Cigna Commercial |
$5,535.27
|
Rate for Payer: First Health Commercial |
$6,335.55
|
Rate for Payer: Humana Commercial |
$5,668.65
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$5,468.58
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,921.72
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.70
|
Rate for Payer: Ohio Health Choice Commercial |
$5,868.72
|
Rate for Payer: Ohio Health Group HMO |
$5,001.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,333.80
|
Rate for Payer: Ohio Health Group PPO No Differential |
$866.97
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,067.39
|
Rate for Payer: PHCS Commercial |
$6,402.24
|
Rate for Payer: United Healthcare All Payer |
$5,868.72
|
|
PKR INSERT X3 #6 LM/RL-9
|
Facility
|
OP
|
$6,669.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$866.97 |
Max. Negotiated Rate |
$6,402.24 |
Rate for Payer: Aetna Commercial |
$5,135.13
|
Rate for Payer: Anthem Medicaid |
$2,293.47
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,201.82
|
Rate for Payer: Cash Price |
$3,334.50
|
Rate for Payer: Cigna Commercial |
$5,535.27
|
Rate for Payer: First Health Commercial |
$6,335.55
|
Rate for Payer: Humana Commercial |
$5,668.65
|
Rate for Payer: Humana KY Medicaid |
$2,293.47
|
Rate for Payer: Kentucky WC Medicaid |
$2,316.81
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$5,468.58
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,921.72
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.70
|
Rate for Payer: Molina Healthcare Medicaid |
$2,339.49
|
Rate for Payer: Ohio Health Choice Commercial |
$5,868.72
|
Rate for Payer: Ohio Health Group HMO |
$5,001.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,333.80
|
Rate for Payer: Ohio Health Group PPO No Differential |
$866.97
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,067.39
|
Rate for Payer: PHCS Commercial |
$6,402.24
|
Rate for Payer: United Healthcare All Payer |
$5,868.72
|
|
PKR INSERT X3 #6 RM/LL-10
|
Facility
|
OP
|
$6,669.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$866.97 |
Max. Negotiated Rate |
$6,402.24 |
Rate for Payer: Aetna Commercial |
$5,135.13
|
Rate for Payer: Anthem Medicaid |
$2,293.47
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,201.82
|
Rate for Payer: Cash Price |
$3,334.50
|
Rate for Payer: Cigna Commercial |
$5,535.27
|
Rate for Payer: First Health Commercial |
$6,335.55
|
Rate for Payer: Humana Commercial |
$5,668.65
|
Rate for Payer: Humana KY Medicaid |
$2,293.47
|
Rate for Payer: Kentucky WC Medicaid |
$2,316.81
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$5,468.58
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,921.72
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.70
|
Rate for Payer: Molina Healthcare Medicaid |
$2,339.49
|
Rate for Payer: Ohio Health Choice Commercial |
$5,868.72
|
Rate for Payer: Ohio Health Group HMO |
$5,001.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,333.80
|
Rate for Payer: Ohio Health Group PPO No Differential |
$866.97
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,067.39
|
Rate for Payer: PHCS Commercial |
$6,402.24
|
Rate for Payer: United Healthcare All Payer |
$5,868.72
|
|
PKR INSERT X3 #6 RM/LL-10
|
Facility
|
IP
|
$6,669.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$866.97 |
Max. Negotiated Rate |
$6,402.24 |
Rate for Payer: Aetna Commercial |
$5,135.13
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,201.82
|
Rate for Payer: Cash Price |
$3,334.50
|
Rate for Payer: Cigna Commercial |
$5,535.27
|
Rate for Payer: First Health Commercial |
$6,335.55
|
Rate for Payer: Humana Commercial |
$5,668.65
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$5,468.58
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,921.72
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.70
|
Rate for Payer: Ohio Health Choice Commercial |
$5,868.72
|
Rate for Payer: Ohio Health Group HMO |
$5,001.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,333.80
|
Rate for Payer: Ohio Health Group PPO No Differential |
$866.97
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,067.39
|
Rate for Payer: PHCS Commercial |
$6,402.24
|
Rate for Payer: United Healthcare All Payer |
$5,868.72
|
|
PKR INSERT X3 #6 RM/LL-12
|
Facility
|
OP
|
$6,669.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$866.97 |
Max. Negotiated Rate |
$6,402.24 |
Rate for Payer: Aetna Commercial |
$5,135.13
|
Rate for Payer: Anthem Medicaid |
$2,293.47
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,201.82
|
Rate for Payer: Cash Price |
$3,334.50
|
Rate for Payer: Cigna Commercial |
$5,535.27
|
Rate for Payer: First Health Commercial |
$6,335.55
|
Rate for Payer: Humana Commercial |
$5,668.65
|
Rate for Payer: Humana KY Medicaid |
$2,293.47
|
Rate for Payer: Kentucky WC Medicaid |
$2,316.81
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$5,468.58
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,921.72
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.70
|
Rate for Payer: Molina Healthcare Medicaid |
$2,339.49
|
Rate for Payer: Ohio Health Choice Commercial |
$5,868.72
|
Rate for Payer: Ohio Health Group HMO |
$5,001.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,333.80
|
Rate for Payer: Ohio Health Group PPO No Differential |
$866.97
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,067.39
|
Rate for Payer: PHCS Commercial |
$6,402.24
|
Rate for Payer: United Healthcare All Payer |
$5,868.72
|
|
PKR INSERT X3 #6 RM/LL-12
|
Facility
|
IP
|
$6,669.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$866.97 |
Max. Negotiated Rate |
$6,402.24 |
Rate for Payer: Aetna Commercial |
$5,135.13
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,201.82
|
Rate for Payer: Cash Price |
$3,334.50
|
Rate for Payer: Cigna Commercial |
$5,535.27
|
Rate for Payer: First Health Commercial |
$6,335.55
|
Rate for Payer: Humana Commercial |
$5,668.65
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$5,468.58
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,921.72
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.70
|
Rate for Payer: Ohio Health Choice Commercial |
$5,868.72
|
Rate for Payer: Ohio Health Group HMO |
$5,001.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,333.80
|
Rate for Payer: Ohio Health Group PPO No Differential |
$866.97
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,067.39
|
Rate for Payer: PHCS Commercial |
$6,402.24
|
Rate for Payer: United Healthcare All Payer |
$5,868.72
|
|
PKR INSERT X3 #6 RM/LL-8
|
Facility
|
IP
|
$6,669.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$866.97 |
Max. Negotiated Rate |
$6,402.24 |
Rate for Payer: Aetna Commercial |
$5,135.13
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,201.82
|
Rate for Payer: Cash Price |
$3,334.50
|
Rate for Payer: Cigna Commercial |
$5,535.27
|
Rate for Payer: First Health Commercial |
$6,335.55
|
Rate for Payer: Humana Commercial |
$5,668.65
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$5,468.58
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,921.72
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.70
|
Rate for Payer: Ohio Health Choice Commercial |
$5,868.72
|
Rate for Payer: Ohio Health Group HMO |
$5,001.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,333.80
|
Rate for Payer: Ohio Health Group PPO No Differential |
$866.97
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,067.39
|
Rate for Payer: PHCS Commercial |
$6,402.24
|
Rate for Payer: United Healthcare All Payer |
$5,868.72
|
|
PKR INSERT X3 #6 RM/LL-8
|
Facility
|
OP
|
$6,669.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$866.97 |
Max. Negotiated Rate |
$6,402.24 |
Rate for Payer: Aetna Commercial |
$5,135.13
|
Rate for Payer: Anthem Medicaid |
$2,293.47
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,201.82
|
Rate for Payer: Cash Price |
$3,334.50
|
Rate for Payer: Cigna Commercial |
$5,535.27
|
Rate for Payer: First Health Commercial |
$6,335.55
|
Rate for Payer: Humana Commercial |
$5,668.65
|
Rate for Payer: Humana KY Medicaid |
$2,293.47
|
Rate for Payer: Kentucky WC Medicaid |
$2,316.81
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$5,468.58
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,921.72
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.70
|
Rate for Payer: Molina Healthcare Medicaid |
$2,339.49
|
Rate for Payer: Ohio Health Choice Commercial |
$5,868.72
|
Rate for Payer: Ohio Health Group HMO |
$5,001.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,333.80
|
Rate for Payer: Ohio Health Group PPO No Differential |
$866.97
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,067.39
|
Rate for Payer: PHCS Commercial |
$6,402.24
|
Rate for Payer: United Healthcare All Payer |
$5,868.72
|
|
PKR INSERT X3 #6 RM/LL-9
|
Facility
|
OP
|
$6,669.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$866.97 |
Max. Negotiated Rate |
$6,402.24 |
Rate for Payer: Aetna Commercial |
$5,135.13
|
Rate for Payer: Anthem Medicaid |
$2,293.47
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,201.82
|
Rate for Payer: Cash Price |
$3,334.50
|
Rate for Payer: Cigna Commercial |
$5,535.27
|
Rate for Payer: First Health Commercial |
$6,335.55
|
Rate for Payer: Humana Commercial |
$5,668.65
|
Rate for Payer: Humana KY Medicaid |
$2,293.47
|
Rate for Payer: Kentucky WC Medicaid |
$2,316.81
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$5,468.58
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,921.72
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.70
|
Rate for Payer: Molina Healthcare Medicaid |
$2,339.49
|
Rate for Payer: Ohio Health Choice Commercial |
$5,868.72
|
Rate for Payer: Ohio Health Group HMO |
$5,001.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,333.80
|
Rate for Payer: Ohio Health Group PPO No Differential |
$866.97
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,067.39
|
Rate for Payer: PHCS Commercial |
$6,402.24
|
Rate for Payer: United Healthcare All Payer |
$5,868.72
|
|
PKR INSERT X3 #6 RM/LL-9
|
Facility
|
IP
|
$6,669.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$866.97 |
Max. Negotiated Rate |
$6,402.24 |
Rate for Payer: Aetna Commercial |
$5,135.13
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,201.82
|
Rate for Payer: Cash Price |
$3,334.50
|
Rate for Payer: Cigna Commercial |
$5,535.27
|
Rate for Payer: First Health Commercial |
$6,335.55
|
Rate for Payer: Humana Commercial |
$5,668.65
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$5,468.58
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,921.72
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.70
|
Rate for Payer: Ohio Health Choice Commercial |
$5,868.72
|
Rate for Payer: Ohio Health Group HMO |
$5,001.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,333.80
|
Rate for Payer: Ohio Health Group PPO No Differential |
$866.97
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,067.39
|
Rate for Payer: PHCS Commercial |
$6,402.24
|
Rate for Payer: United Healthcare All Payer |
$5,868.72
|
|
PKR X3 #1 RM/LL12MM
|
Facility
|
IP
|
$6,669.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$866.97 |
Max. Negotiated Rate |
$6,402.24 |
Rate for Payer: Aetna Commercial |
$5,135.13
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,201.82
|
Rate for Payer: Cash Price |
$3,334.50
|
Rate for Payer: Cigna Commercial |
$5,535.27
|
Rate for Payer: First Health Commercial |
$6,335.55
|
Rate for Payer: Humana Commercial |
$5,668.65
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$5,468.58
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,921.72
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.70
|
Rate for Payer: Ohio Health Choice Commercial |
$5,868.72
|
Rate for Payer: Ohio Health Group HMO |
$5,001.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,333.80
|
Rate for Payer: Ohio Health Group PPO No Differential |
$866.97
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,067.39
|
Rate for Payer: PHCS Commercial |
$6,402.24
|
Rate for Payer: United Healthcare All Payer |
$5,868.72
|
|
PKR X3 #1 RM/LL12MM
|
Facility
|
OP
|
$6,669.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$866.97 |
Max. Negotiated Rate |
$6,402.24 |
Rate for Payer: Aetna Commercial |
$5,135.13
|
Rate for Payer: Anthem Medicaid |
$2,293.47
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,201.82
|
Rate for Payer: Cash Price |
$3,334.50
|
Rate for Payer: Cigna Commercial |
$5,535.27
|
Rate for Payer: First Health Commercial |
$6,335.55
|
Rate for Payer: Humana Commercial |
$5,668.65
|
Rate for Payer: Humana KY Medicaid |
$2,293.47
|
Rate for Payer: Kentucky WC Medicaid |
$2,316.81
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$5,468.58
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,921.72
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,000.70
|
Rate for Payer: Molina Healthcare Medicaid |
$2,339.49
|
Rate for Payer: Ohio Health Choice Commercial |
$5,868.72
|
Rate for Payer: Ohio Health Group HMO |
$5,001.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,333.80
|
Rate for Payer: Ohio Health Group PPO No Differential |
$866.97
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,067.39
|
Rate for Payer: PHCS Commercial |
$6,402.24
|
Rate for Payer: United Healthcare All Payer |
$5,868.72
|
|
PLACE CECOSTOMY TUBE PERC
|
Facility
|
OP
|
$4,317.00
|
|
Service Code
|
HCPCS 49442
|
Hospital Charge Code |
76102006
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$561.21 |
Max. Negotiated Rate |
$4,144.32 |
Rate for Payer: Aetna Commercial |
$3,324.09
|
Rate for Payer: Anthem Medicaid |
$1,484.62
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$1,020.47
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,367.26
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,428.66
|
Rate for Payer: CareSource Just4Me Medicare |
$1,377.63
|
Rate for Payer: Cash Price |
$2,158.50
|
Rate for Payer: Cash Price |
$2,158.50
|
Rate for Payer: Cigna Commercial |
$3,583.11
|
Rate for Payer: First Health Commercial |
$4,101.15
|
Rate for Payer: Humana Commercial |
$3,669.45
|
Rate for Payer: Humana KY Medicaid |
$1,484.62
|
Rate for Payer: Humana Medicare Advantage |
$1,020.47
|
Rate for Payer: Kentucky WC Medicaid |
$1,499.73
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$3,539.94
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,185.95
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,224.56
|
Rate for Payer: Molina Healthcare Medicaid |
$1,514.40
|
Rate for Payer: Ohio Health Choice Commercial |
$3,798.96
|
Rate for Payer: Ohio Health Group HMO |
$3,237.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$863.40
|
Rate for Payer: Ohio Health Group PPO No Differential |
$561.21
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,338.27
|
Rate for Payer: PHCS Commercial |
$4,144.32
|
Rate for Payer: United Healthcare All Payer |
$3,798.96
|
|
PLACE CECOSTOMY TUBE PERC
|
Facility
|
IP
|
$4,317.00
|
|
Service Code
|
HCPCS 49442
|
Hospital Charge Code |
76102006
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$561.21 |
Max. Negotiated Rate |
$4,144.32 |
Rate for Payer: Aetna Commercial |
$3,324.09
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,367.26
|
Rate for Payer: Cash Price |
$2,158.50
|
Rate for Payer: Cigna Commercial |
$3,583.11
|
Rate for Payer: First Health Commercial |
$4,101.15
|
Rate for Payer: Humana Commercial |
$3,669.45
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$3,539.94
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,185.95
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,295.10
|
Rate for Payer: Ohio Health Choice Commercial |
$3,798.96
|
Rate for Payer: Ohio Health Group HMO |
$3,237.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$863.40
|
Rate for Payer: Ohio Health Group PPO No Differential |
$561.21
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,338.27
|
Rate for Payer: PHCS Commercial |
$4,144.32
|
Rate for Payer: United Healthcare All Payer |
$3,798.96
|
|
PLACE CECOSTOMY TUBE PERC
|
Professional
|
Both
|
$4,317.00
|
|
Service Code
|
HCPCS 49442
|
Hospital Charge Code |
76102006
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$174.16 |
Max. Negotiated Rate |
$4,317.00 |
Rate for Payer: Aetna Commercial |
$338.46
|
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$190.29
|
Rate for Payer: Anthem Medicaid |
$174.16
|
Rate for Payer: Buckeye Medicare Advantage |
$4,317.00
|
Rate for Payer: Cash Price |
$2,158.50
|
Rate for Payer: Cash Price |
$2,158.50
|
Rate for Payer: Cigna Commercial |
$311.30
|
Rate for Payer: Healthspan PPO |
$1,291.96
|
Rate for Payer: Humana Medicaid |
$174.16
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$278.20
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$177.64
|
Rate for Payer: Molina Healthcare Passport |
$174.16
|
Rate for Payer: Multiplan PHCS |
$2,590.20
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,021.90
|
Rate for Payer: UHCCP Medicaid |
$199.80
|
Rate for Payer: Wellcare CHIP/Medicaid |
$175.90
|
|
PLACE CECOSTOMY TUBE PERC(P
|
Professional
|
Both
|
$1,500.00
|
|
Service Code
|
HCPCS 49442
|
Hospital Charge Code |
761P2006
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$174.16 |
Max. Negotiated Rate |
$1,500.00 |
Rate for Payer: Aetna Commercial |
$338.46
|
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$190.29
|
Rate for Payer: Anthem Medicaid |
$174.16
|
Rate for Payer: Buckeye Medicare Advantage |
$1,500.00
|
Rate for Payer: Cash Price |
$750.00
|
Rate for Payer: Cash Price |
$750.00
|
Rate for Payer: Cigna Commercial |
$311.30
|
Rate for Payer: Healthspan PPO |
$1,291.96
|
Rate for Payer: Humana Medicaid |
$174.16
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$278.20
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$177.64
|
Rate for Payer: Molina Healthcare Passport |
$174.16
|
Rate for Payer: Multiplan PHCS |
$900.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,050.00
|
Rate for Payer: UHCCP Medicaid |
$199.80
|
Rate for Payer: Wellcare CHIP/Medicaid |
$175.90
|
|
PLACE CECOSTOMY TUBE PERC(T
|
Facility
|
OP
|
$2,817.00
|
|
Service Code
|
HCPCS 49442
|
Hospital Charge Code |
761T2006
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$366.21 |
Max. Negotiated Rate |
$2,704.32 |
Rate for Payer: Aetna Commercial |
$2,169.09
|
Rate for Payer: Anthem Medicaid |
$968.77
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$1,020.47
|
Rate for Payer: Anthem POS/PPO/Traditional |
$2,197.26
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,428.66
|
Rate for Payer: CareSource Just4Me Medicare |
$1,377.63
|
Rate for Payer: Cash Price |
$1,408.50
|
Rate for Payer: Cash Price |
$1,408.50
|
Rate for Payer: Cigna Commercial |
$2,338.11
|
Rate for Payer: First Health Commercial |
$2,676.15
|
Rate for Payer: Humana Commercial |
$2,394.45
|
Rate for Payer: Humana KY Medicaid |
$968.77
|
Rate for Payer: Humana Medicare Advantage |
$1,020.47
|
Rate for Payer: Kentucky WC Medicaid |
$978.63
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$2,309.94
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,078.95
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,224.56
|
Rate for Payer: Molina Healthcare Medicaid |
$988.20
|
Rate for Payer: Ohio Health Choice Commercial |
$2,478.96
|
Rate for Payer: Ohio Health Group HMO |
$2,112.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$563.40
|
Rate for Payer: Ohio Health Group PPO No Differential |
$366.21
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$873.27
|
Rate for Payer: PHCS Commercial |
$2,704.32
|
Rate for Payer: United Healthcare All Payer |
$2,478.96
|
|
PLACE CECOSTOMY TUBE PERC(T
|
Facility
|
IP
|
$2,817.00
|
|
Service Code
|
HCPCS 49442
|
Hospital Charge Code |
761T2006
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$366.21 |
Max. Negotiated Rate |
$2,704.32 |
Rate for Payer: Aetna Commercial |
$2,169.09
|
Rate for Payer: Anthem POS/PPO/Traditional |
$2,197.26
|
Rate for Payer: Cash Price |
$1,408.50
|
Rate for Payer: Cigna Commercial |
$2,338.11
|
Rate for Payer: First Health Commercial |
$2,676.15
|
Rate for Payer: Humana Commercial |
$2,394.45
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$2,309.94
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,078.95
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$845.10
|
Rate for Payer: Ohio Health Choice Commercial |
$2,478.96
|
Rate for Payer: Ohio Health Group HMO |
$2,112.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$563.40
|
Rate for Payer: Ohio Health Group PPO No Differential |
$366.21
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$873.27
|
Rate for Payer: PHCS Commercial |
$2,704.32
|
Rate for Payer: United Healthcare All Payer |
$2,478.96
|
|
PLACE DUOD/JEJ TUBE PERC
|
Professional
|
Both
|
$3,406.24
|
|
Service Code
|
HCPCS 49441
|
Hospital Charge Code |
76102005
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$209.77 |
Max. Negotiated Rate |
$3,406.24 |
Rate for Payer: Aetna Commercial |
$409.49
|
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$240.51
|
Rate for Payer: Anthem Medicaid |
$209.77
|
Rate for Payer: Buckeye Medicare Advantage |
$3,406.24
|
Rate for Payer: Cash Price |
$1,703.12
|
Rate for Payer: Cash Price |
$1,703.12
|
Rate for Payer: Cigna Commercial |
$375.25
|
Rate for Payer: Healthspan PPO |
$1,443.03
|
Rate for Payer: Humana Medicaid |
$209.77
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$337.32
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$213.97
|
Rate for Payer: Molina Healthcare Passport |
$209.77
|
Rate for Payer: Multiplan PHCS |
$2,043.74
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,384.37
|
Rate for Payer: UHCCP Medicaid |
$252.54
|
Rate for Payer: Wellcare CHIP/Medicaid |
$211.87
|
|
PLACE DUOD/JEJ TUBE PERC
|
Facility
|
IP
|
$3,406.24
|
|
Service Code
|
HCPCS 49441
|
Hospital Charge Code |
76102005
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$442.81 |
Max. Negotiated Rate |
$3,269.99 |
Rate for Payer: Aetna Commercial |
$2,622.80
|
Rate for Payer: Anthem POS/PPO/Traditional |
$2,656.87
|
Rate for Payer: Cash Price |
$1,703.12
|
Rate for Payer: Cigna Commercial |
$2,827.18
|
Rate for Payer: First Health Commercial |
$3,235.93
|
Rate for Payer: Humana Commercial |
$2,895.30
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$2,793.12
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,513.81
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,021.87
|
Rate for Payer: Ohio Health Choice Commercial |
$2,997.49
|
Rate for Payer: Ohio Health Group HMO |
$2,554.68
|
Rate for Payer: Ohio Health Group PPO Differential |
$681.25
|
Rate for Payer: Ohio Health Group PPO No Differential |
$442.81
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,055.93
|
Rate for Payer: PHCS Commercial |
$3,269.99
|
Rate for Payer: United Healthcare All Payer |
$2,997.49
|
|
PLACE DUOD/JEJ TUBE PERC
|
Facility
|
OP
|
$3,406.24
|
|
Service Code
|
HCPCS 49441
|
Hospital Charge Code |
76102005
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$442.81 |
Max. Negotiated Rate |
$3,269.99 |
Rate for Payer: Aetna Commercial |
$2,622.80
|
Rate for Payer: Anthem Medicaid |
$1,171.41
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$1,645.47
|
Rate for Payer: Anthem POS/PPO/Traditional |
$2,656.87
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,303.66
|
Rate for Payer: CareSource Just4Me Medicare |
$2,221.38
|
Rate for Payer: Cash Price |
$1,703.12
|
Rate for Payer: Cash Price |
$1,703.12
|
Rate for Payer: Cigna Commercial |
$2,827.18
|
Rate for Payer: First Health Commercial |
$3,235.93
|
Rate for Payer: Humana Commercial |
$2,895.30
|
Rate for Payer: Humana KY Medicaid |
$1,171.41
|
Rate for Payer: Humana Medicare Advantage |
$1,645.47
|
Rate for Payer: Kentucky WC Medicaid |
$1,183.33
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$2,793.12
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,513.81
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,974.56
|
Rate for Payer: Molina Healthcare Medicaid |
$1,194.91
|
Rate for Payer: Ohio Health Choice Commercial |
$2,997.49
|
Rate for Payer: Ohio Health Group HMO |
$2,554.68
|
Rate for Payer: Ohio Health Group PPO Differential |
$681.25
|
Rate for Payer: Ohio Health Group PPO No Differential |
$442.81
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,055.93
|
Rate for Payer: PHCS Commercial |
$3,269.99
|
Rate for Payer: United Healthcare All Payer |
$2,997.49
|
|
PLACE DUOD/JEJ TUBE PERC(P
|
Professional
|
Both
|
$445.00
|
|
Service Code
|
HCPCS 49441
|
Hospital Charge Code |
761P2005
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$209.77 |
Max. Negotiated Rate |
$1,443.03 |
Rate for Payer: Aetna Commercial |
$409.49
|
Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$240.51
|
Rate for Payer: Anthem Medicaid |
$209.77
|
Rate for Payer: Buckeye Medicare Advantage |
$445.00
|
Rate for Payer: Cash Price |
$222.50
|
Rate for Payer: Cash Price |
$222.50
|
Rate for Payer: Cigna Commercial |
$375.25
|
Rate for Payer: Healthspan PPO |
$1,443.03
|
Rate for Payer: Humana Medicaid |
$209.77
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$337.32
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$213.97
|
Rate for Payer: Molina Healthcare Passport |
$209.77
|
Rate for Payer: Multiplan PHCS |
$267.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$311.50
|
Rate for Payer: UHCCP Medicaid |
$252.54
|
Rate for Payer: Wellcare CHIP/Medicaid |
$211.87
|
|