|
PRESERVATN TIB TRAY LM/RL SZ 2
|
Facility
|
OP
|
$9,806.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,941.96 |
| Max. Negotiated Rate |
$9,414.26 |
| Rate for Payer: Aetna Commercial |
$7,551.02
|
| Rate for Payer: Anthem Medicaid |
$3,372.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,649.09
|
| Rate for Payer: Cash Price |
$4,903.26
|
| Rate for Payer: Cigna Commercial |
$8,139.41
|
| Rate for Payer: First Health Commercial |
$9,316.19
|
| Rate for Payer: Humana Commercial |
$8,335.54
|
| Rate for Payer: Humana KY Medicaid |
$3,372.46
|
| Rate for Payer: Kentucky WC Medicaid |
$3,406.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,041.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,237.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,941.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,440.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,629.74
|
| Rate for Payer: Ohio Health Group HMO |
$7,354.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,845.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,531.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,766.50
|
| Rate for Payer: PHCS Commercial |
$9,414.26
|
| Rate for Payer: United Healthcare All Payer |
$8,629.74
|
|
|
PRESERVATN TIB TRAY LM/RL SZ 2
|
Facility
|
IP
|
$9,806.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,941.96 |
| Max. Negotiated Rate |
$9,414.26 |
| Rate for Payer: Aetna Commercial |
$7,551.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,649.09
|
| Rate for Payer: Cash Price |
$4,903.26
|
| Rate for Payer: Cigna Commercial |
$8,139.41
|
| Rate for Payer: First Health Commercial |
$9,316.19
|
| Rate for Payer: Humana Commercial |
$8,335.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,041.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,237.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,941.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,629.74
|
| Rate for Payer: Ohio Health Group HMO |
$7,354.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,845.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,531.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,766.50
|
| Rate for Payer: PHCS Commercial |
$9,414.26
|
| Rate for Payer: United Healthcare All Payer |
$8,629.74
|
|
|
PRESERVATN TIB TRAY LM/RL SZ 3
|
Facility
|
OP
|
$9,806.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,941.96 |
| Max. Negotiated Rate |
$9,414.26 |
| Rate for Payer: Aetna Commercial |
$7,551.02
|
| Rate for Payer: Anthem Medicaid |
$3,372.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,649.09
|
| Rate for Payer: Cash Price |
$4,903.26
|
| Rate for Payer: Cigna Commercial |
$8,139.41
|
| Rate for Payer: First Health Commercial |
$9,316.19
|
| Rate for Payer: Humana Commercial |
$8,335.54
|
| Rate for Payer: Humana KY Medicaid |
$3,372.46
|
| Rate for Payer: Kentucky WC Medicaid |
$3,406.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,041.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,237.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,941.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,440.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,629.74
|
| Rate for Payer: Ohio Health Group HMO |
$7,354.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,845.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,531.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,766.50
|
| Rate for Payer: PHCS Commercial |
$9,414.26
|
| Rate for Payer: United Healthcare All Payer |
$8,629.74
|
|
|
PRESERVATN TIB TRAY LM/RL SZ 3
|
Facility
|
IP
|
$9,806.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,941.96 |
| Max. Negotiated Rate |
$9,414.26 |
| Rate for Payer: Aetna Commercial |
$7,551.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,649.09
|
| Rate for Payer: Cash Price |
$4,903.26
|
| Rate for Payer: Cigna Commercial |
$8,139.41
|
| Rate for Payer: First Health Commercial |
$9,316.19
|
| Rate for Payer: Humana Commercial |
$8,335.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,041.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,237.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,941.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,629.74
|
| Rate for Payer: Ohio Health Group HMO |
$7,354.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,845.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,531.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,766.50
|
| Rate for Payer: PHCS Commercial |
$9,414.26
|
| Rate for Payer: United Healthcare All Payer |
$8,629.74
|
|
|
PRESERVATN TIB TRAY LM/RL SZ 4
|
Facility
|
OP
|
$9,806.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,941.96 |
| Max. Negotiated Rate |
$9,414.26 |
| Rate for Payer: Aetna Commercial |
$7,551.02
|
| Rate for Payer: Anthem Medicaid |
$3,372.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,649.09
|
| Rate for Payer: Cash Price |
$4,903.26
|
| Rate for Payer: Cigna Commercial |
$8,139.41
|
| Rate for Payer: First Health Commercial |
$9,316.19
|
| Rate for Payer: Humana Commercial |
$8,335.54
|
| Rate for Payer: Humana KY Medicaid |
$3,372.46
|
| Rate for Payer: Kentucky WC Medicaid |
$3,406.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,041.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,237.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,941.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,440.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,629.74
|
| Rate for Payer: Ohio Health Group HMO |
$7,354.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,845.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,531.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,766.50
|
| Rate for Payer: PHCS Commercial |
$9,414.26
|
| Rate for Payer: United Healthcare All Payer |
$8,629.74
|
|
|
PRESERVATN TIB TRAY LM/RL SZ 4
|
Facility
|
IP
|
$9,806.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,941.96 |
| Max. Negotiated Rate |
$9,414.26 |
| Rate for Payer: Aetna Commercial |
$7,551.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,649.09
|
| Rate for Payer: Cash Price |
$4,903.26
|
| Rate for Payer: Cigna Commercial |
$8,139.41
|
| Rate for Payer: First Health Commercial |
$9,316.19
|
| Rate for Payer: Humana Commercial |
$8,335.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,041.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,237.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,941.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,629.74
|
| Rate for Payer: Ohio Health Group HMO |
$7,354.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,845.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,531.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,766.50
|
| Rate for Payer: PHCS Commercial |
$9,414.26
|
| Rate for Payer: United Healthcare All Payer |
$8,629.74
|
|
|
PRESERVATN TIB TRAY LM/RL SZ 5
|
Facility
|
IP
|
$9,806.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,941.96 |
| Max. Negotiated Rate |
$9,414.26 |
| Rate for Payer: Aetna Commercial |
$7,551.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,649.09
|
| Rate for Payer: Cash Price |
$4,903.26
|
| Rate for Payer: Cigna Commercial |
$8,139.41
|
| Rate for Payer: First Health Commercial |
$9,316.19
|
| Rate for Payer: Humana Commercial |
$8,335.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,041.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,237.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,941.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,629.74
|
| Rate for Payer: Ohio Health Group HMO |
$7,354.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,845.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,531.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,766.50
|
| Rate for Payer: PHCS Commercial |
$9,414.26
|
| Rate for Payer: United Healthcare All Payer |
$8,629.74
|
|
|
PRESERVATN TIB TRAY LM/RL SZ 5
|
Facility
|
OP
|
$9,806.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,941.96 |
| Max. Negotiated Rate |
$9,414.26 |
| Rate for Payer: Aetna Commercial |
$7,551.02
|
| Rate for Payer: Anthem Medicaid |
$3,372.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,649.09
|
| Rate for Payer: Cash Price |
$4,903.26
|
| Rate for Payer: Cigna Commercial |
$8,139.41
|
| Rate for Payer: First Health Commercial |
$9,316.19
|
| Rate for Payer: Humana Commercial |
$8,335.54
|
| Rate for Payer: Humana KY Medicaid |
$3,372.46
|
| Rate for Payer: Kentucky WC Medicaid |
$3,406.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,041.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,237.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,941.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,440.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,629.74
|
| Rate for Payer: Ohio Health Group HMO |
$7,354.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,845.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,531.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,766.50
|
| Rate for Payer: PHCS Commercial |
$9,414.26
|
| Rate for Payer: United Healthcare All Payer |
$8,629.74
|
|
|
PRESERVATN TIB TRAY RM/LL SZ 1
|
Facility
|
OP
|
$9,806.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,941.96 |
| Max. Negotiated Rate |
$9,414.26 |
| Rate for Payer: Aetna Commercial |
$7,551.02
|
| Rate for Payer: Anthem Medicaid |
$3,372.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,649.09
|
| Rate for Payer: Cash Price |
$4,903.26
|
| Rate for Payer: Cigna Commercial |
$8,139.41
|
| Rate for Payer: First Health Commercial |
$9,316.19
|
| Rate for Payer: Humana Commercial |
$8,335.54
|
| Rate for Payer: Humana KY Medicaid |
$3,372.46
|
| Rate for Payer: Kentucky WC Medicaid |
$3,406.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,041.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,237.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,941.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,440.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,629.74
|
| Rate for Payer: Ohio Health Group HMO |
$7,354.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,845.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,531.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,766.50
|
| Rate for Payer: PHCS Commercial |
$9,414.26
|
| Rate for Payer: United Healthcare All Payer |
$8,629.74
|
|
|
PRESERVATN TIB TRAY RM/LL SZ 1
|
Facility
|
IP
|
$9,806.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,941.96 |
| Max. Negotiated Rate |
$9,414.26 |
| Rate for Payer: Aetna Commercial |
$7,551.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,649.09
|
| Rate for Payer: Cash Price |
$4,903.26
|
| Rate for Payer: Cigna Commercial |
$8,139.41
|
| Rate for Payer: First Health Commercial |
$9,316.19
|
| Rate for Payer: Humana Commercial |
$8,335.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,041.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,237.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,941.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,629.74
|
| Rate for Payer: Ohio Health Group HMO |
$7,354.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,845.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,531.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,766.50
|
| Rate for Payer: PHCS Commercial |
$9,414.26
|
| Rate for Payer: United Healthcare All Payer |
$8,629.74
|
|
|
PRESERVATN TIB TRAY RM/LL SZ 2
|
Facility
|
IP
|
$9,806.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,941.96 |
| Max. Negotiated Rate |
$9,414.26 |
| Rate for Payer: Aetna Commercial |
$7,551.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,649.09
|
| Rate for Payer: Cash Price |
$4,903.26
|
| Rate for Payer: Cigna Commercial |
$8,139.41
|
| Rate for Payer: First Health Commercial |
$9,316.19
|
| Rate for Payer: Humana Commercial |
$8,335.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,041.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,237.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,941.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,629.74
|
| Rate for Payer: Ohio Health Group HMO |
$7,354.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,845.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,531.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,766.50
|
| Rate for Payer: PHCS Commercial |
$9,414.26
|
| Rate for Payer: United Healthcare All Payer |
$8,629.74
|
|
|
PRESERVATN TIB TRAY RM/LL SZ 2
|
Facility
|
OP
|
$9,806.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,941.96 |
| Max. Negotiated Rate |
$9,414.26 |
| Rate for Payer: Aetna Commercial |
$7,551.02
|
| Rate for Payer: Anthem Medicaid |
$3,372.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,649.09
|
| Rate for Payer: Cash Price |
$4,903.26
|
| Rate for Payer: Cigna Commercial |
$8,139.41
|
| Rate for Payer: First Health Commercial |
$9,316.19
|
| Rate for Payer: Humana Commercial |
$8,335.54
|
| Rate for Payer: Humana KY Medicaid |
$3,372.46
|
| Rate for Payer: Kentucky WC Medicaid |
$3,406.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,041.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,237.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,941.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,440.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,629.74
|
| Rate for Payer: Ohio Health Group HMO |
$7,354.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,845.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,531.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,766.50
|
| Rate for Payer: PHCS Commercial |
$9,414.26
|
| Rate for Payer: United Healthcare All Payer |
$8,629.74
|
|
|
PRESERVATN TIB TRAY RM/LL SZ 3
|
Facility
|
OP
|
$9,806.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,941.96 |
| Max. Negotiated Rate |
$9,414.26 |
| Rate for Payer: Aetna Commercial |
$7,551.02
|
| Rate for Payer: Anthem Medicaid |
$3,372.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,649.09
|
| Rate for Payer: Cash Price |
$4,903.26
|
| Rate for Payer: Cigna Commercial |
$8,139.41
|
| Rate for Payer: First Health Commercial |
$9,316.19
|
| Rate for Payer: Humana Commercial |
$8,335.54
|
| Rate for Payer: Humana KY Medicaid |
$3,372.46
|
| Rate for Payer: Kentucky WC Medicaid |
$3,406.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,041.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,237.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,941.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,440.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,629.74
|
| Rate for Payer: Ohio Health Group HMO |
$7,354.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,845.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,531.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,766.50
|
| Rate for Payer: PHCS Commercial |
$9,414.26
|
| Rate for Payer: United Healthcare All Payer |
$8,629.74
|
|
|
PRESERVATN TIB TRAY RM/LL SZ 3
|
Facility
|
IP
|
$9,806.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,941.96 |
| Max. Negotiated Rate |
$9,414.26 |
| Rate for Payer: Aetna Commercial |
$7,551.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,649.09
|
| Rate for Payer: Cash Price |
$4,903.26
|
| Rate for Payer: Cigna Commercial |
$8,139.41
|
| Rate for Payer: First Health Commercial |
$9,316.19
|
| Rate for Payer: Humana Commercial |
$8,335.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,041.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,237.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,941.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,629.74
|
| Rate for Payer: Ohio Health Group HMO |
$7,354.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,845.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,531.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,766.50
|
| Rate for Payer: PHCS Commercial |
$9,414.26
|
| Rate for Payer: United Healthcare All Payer |
$8,629.74
|
|
|
PRESERVATN TIB TRAY RM/LL SZ 4
|
Facility
|
OP
|
$9,806.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,941.96 |
| Max. Negotiated Rate |
$9,414.26 |
| Rate for Payer: Aetna Commercial |
$7,551.02
|
| Rate for Payer: Anthem Medicaid |
$3,372.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,649.09
|
| Rate for Payer: Cash Price |
$4,903.26
|
| Rate for Payer: Cigna Commercial |
$8,139.41
|
| Rate for Payer: First Health Commercial |
$9,316.19
|
| Rate for Payer: Humana Commercial |
$8,335.54
|
| Rate for Payer: Humana KY Medicaid |
$3,372.46
|
| Rate for Payer: Kentucky WC Medicaid |
$3,406.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,041.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,237.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,941.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,440.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,629.74
|
| Rate for Payer: Ohio Health Group HMO |
$7,354.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,845.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,531.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,766.50
|
| Rate for Payer: PHCS Commercial |
$9,414.26
|
| Rate for Payer: United Healthcare All Payer |
$8,629.74
|
|
|
PRESERVATN TIB TRAY RM/LL SZ 4
|
Facility
|
IP
|
$9,806.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,941.96 |
| Max. Negotiated Rate |
$9,414.26 |
| Rate for Payer: Aetna Commercial |
$7,551.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,649.09
|
| Rate for Payer: Cash Price |
$4,903.26
|
| Rate for Payer: Cigna Commercial |
$8,139.41
|
| Rate for Payer: First Health Commercial |
$9,316.19
|
| Rate for Payer: Humana Commercial |
$8,335.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,041.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,237.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,941.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,629.74
|
| Rate for Payer: Ohio Health Group HMO |
$7,354.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,845.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,531.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,766.50
|
| Rate for Payer: PHCS Commercial |
$9,414.26
|
| Rate for Payer: United Healthcare All Payer |
$8,629.74
|
|
|
PRESERVATN TIB TRAY RM/LL SZ 5
|
Facility
|
IP
|
$9,806.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,941.96 |
| Max. Negotiated Rate |
$9,414.26 |
| Rate for Payer: Aetna Commercial |
$7,551.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,649.09
|
| Rate for Payer: Cash Price |
$4,903.26
|
| Rate for Payer: Cigna Commercial |
$8,139.41
|
| Rate for Payer: First Health Commercial |
$9,316.19
|
| Rate for Payer: Humana Commercial |
$8,335.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,041.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,237.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,941.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,629.74
|
| Rate for Payer: Ohio Health Group HMO |
$7,354.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,845.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,531.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,766.50
|
| Rate for Payer: PHCS Commercial |
$9,414.26
|
| Rate for Payer: United Healthcare All Payer |
$8,629.74
|
|
|
PRESERVATN TIB TRAY RM/LL SZ 5
|
Facility
|
OP
|
$9,806.52
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,941.96 |
| Max. Negotiated Rate |
$9,414.26 |
| Rate for Payer: Aetna Commercial |
$7,551.02
|
| Rate for Payer: Anthem Medicaid |
$3,372.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,649.09
|
| Rate for Payer: Cash Price |
$4,903.26
|
| Rate for Payer: Cigna Commercial |
$8,139.41
|
| Rate for Payer: First Health Commercial |
$9,316.19
|
| Rate for Payer: Humana Commercial |
$8,335.54
|
| Rate for Payer: Humana KY Medicaid |
$3,372.46
|
| Rate for Payer: Kentucky WC Medicaid |
$3,406.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,041.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,237.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,941.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,440.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,629.74
|
| Rate for Payer: Ohio Health Group HMO |
$7,354.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,845.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,531.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,766.50
|
| Rate for Payer: PHCS Commercial |
$9,414.26
|
| Rate for Payer: United Healthcare All Payer |
$8,629.74
|
|
|
PRESERVISION AREDS 2 CAP
|
Facility
|
IP
|
$4.29
|
|
|
Service Code
|
NDC 24208043272
|
| Hospital Charge Code |
25003746
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$4.12 |
| Rate for Payer: Aetna Commercial |
$3.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.35
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cigna Commercial |
$3.56
|
| Rate for Payer: First Health Commercial |
$4.08
|
| Rate for Payer: Humana Commercial |
$3.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.78
|
| Rate for Payer: Ohio Health Group HMO |
$3.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.96
|
| Rate for Payer: PHCS Commercial |
$4.12
|
| Rate for Payer: United Healthcare All Payer |
$3.78
|
|
|
PRESERVISION AREDS 2 CAP
|
Facility
|
OP
|
$4.29
|
|
|
Service Code
|
NDC 24208043272
|
| Hospital Charge Code |
25003746
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$4.12 |
| Rate for Payer: Aetna Commercial |
$3.30
|
| Rate for Payer: Anthem Medicaid |
$1.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.35
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cigna Commercial |
$3.56
|
| Rate for Payer: First Health Commercial |
$4.08
|
| Rate for Payer: Humana Commercial |
$3.65
|
| Rate for Payer: Humana KY Medicaid |
$1.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.78
|
| Rate for Payer: Ohio Health Group HMO |
$3.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.96
|
| Rate for Payer: PHCS Commercial |
$4.12
|
| Rate for Payer: United Healthcare All Payer |
$3.78
|
|
|
PRESSURE TREATMENT ESOPHAGU(P
|
Professional
|
Both
|
$755.00
|
|
|
Service Code
|
HCPCS 43460
|
| Hospital Charge Code |
761P1777
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.94 |
| Max. Negotiated Rate |
$453.00 |
| Rate for Payer: Aetna Commercial |
$336.67
|
| Rate for Payer: Ambetter Exchange |
$198.41
|
| Rate for Payer: Anthem Medicaid |
$159.94
|
| Rate for Payer: Buckeye Individual/Medicaid |
$198.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$198.41
|
| Rate for Payer: CareSource Just4Me Medicare |
$238.09
|
| Rate for Payer: Cash Price |
$377.50
|
| Rate for Payer: Cash Price |
$377.50
|
| Rate for Payer: Cigna Commercial |
$304.37
|
| Rate for Payer: Healthspan PPO |
$283.92
|
| Rate for Payer: Humana Medicaid |
$159.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$289.40
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$198.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$198.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$163.14
|
| Rate for Payer: Molina Healthcare Passport |
$159.94
|
| Rate for Payer: Multiplan PHCS |
$453.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$257.93
|
| Rate for Payer: UHCCP Medicaid |
$264.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$161.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$198.41
|
|
|
PRESSURE TREATMENT ESOPHAGUS
|
Facility
|
OP
|
$755.00
|
|
|
Service Code
|
HCPCS 43460
|
| Hospital Charge Code |
76101777
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$226.50 |
| Max. Negotiated Rate |
$724.80 |
| Rate for Payer: Aetna Commercial |
$581.35
|
| Rate for Payer: Anthem Medicaid |
$259.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$588.90
|
| Rate for Payer: Cash Price |
$377.50
|
| Rate for Payer: Cigna Commercial |
$626.65
|
| Rate for Payer: First Health Commercial |
$717.25
|
| Rate for Payer: Humana Commercial |
$641.75
|
| Rate for Payer: Humana KY Medicaid |
$259.64
|
| Rate for Payer: Kentucky WC Medicaid |
$262.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$619.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$557.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$226.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$264.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$664.40
|
| Rate for Payer: Ohio Health Group HMO |
$566.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$604.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$656.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$520.95
|
| Rate for Payer: PHCS Commercial |
$724.80
|
| Rate for Payer: United Healthcare All Payer |
$664.40
|
|
|
PRESSURE TREATMENT ESOPHAGUS
|
Facility
|
IP
|
$755.00
|
|
|
Service Code
|
HCPCS 43460
|
| Hospital Charge Code |
76101777
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$226.50 |
| Max. Negotiated Rate |
$724.80 |
| Rate for Payer: Aetna Commercial |
$581.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$588.90
|
| Rate for Payer: Cash Price |
$377.50
|
| Rate for Payer: Cigna Commercial |
$626.65
|
| Rate for Payer: First Health Commercial |
$717.25
|
| Rate for Payer: Humana Commercial |
$641.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$619.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$557.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$226.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$664.40
|
| Rate for Payer: Ohio Health Group HMO |
$566.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$604.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$656.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$520.95
|
| Rate for Payer: PHCS Commercial |
$724.80
|
| Rate for Payer: United Healthcare All Payer |
$664.40
|
|
|
PRESSURE TREATMENT ESOPHAGUS
|
Professional
|
Both
|
$755.00
|
|
|
Service Code
|
HCPCS 43460
|
| Hospital Charge Code |
76101777
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.94 |
| Max. Negotiated Rate |
$453.00 |
| Rate for Payer: Aetna Commercial |
$336.67
|
| Rate for Payer: Ambetter Exchange |
$198.41
|
| Rate for Payer: Anthem Medicaid |
$159.94
|
| Rate for Payer: Buckeye Individual/Medicaid |
$198.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$198.41
|
| Rate for Payer: CareSource Just4Me Medicare |
$238.09
|
| Rate for Payer: Cash Price |
$377.50
|
| Rate for Payer: Cash Price |
$377.50
|
| Rate for Payer: Cigna Commercial |
$304.37
|
| Rate for Payer: Healthspan PPO |
$283.92
|
| Rate for Payer: Humana Medicaid |
$159.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$289.40
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$198.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$198.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$163.14
|
| Rate for Payer: Molina Healthcare Passport |
$159.94
|
| Rate for Payer: Multiplan PHCS |
$453.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$257.93
|
| Rate for Payer: UHCCP Medicaid |
$264.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$161.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$198.41
|
|
|
PRESSURE WIRE X GUIDE WIRE
|
Facility
|
OP
|
$4,411.25
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,323.38 |
| Max. Negotiated Rate |
$4,234.80 |
| Rate for Payer: Aetna Commercial |
$3,396.66
|
| Rate for Payer: Anthem Medicaid |
$1,517.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,440.78
|
| Rate for Payer: Cash Price |
$2,205.62
|
| Rate for Payer: Cigna Commercial |
$3,661.34
|
| Rate for Payer: First Health Commercial |
$4,190.69
|
| Rate for Payer: Humana Commercial |
$3,749.56
|
| Rate for Payer: Humana KY Medicaid |
$1,517.03
|
| Rate for Payer: Kentucky WC Medicaid |
$1,532.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,617.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,255.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,323.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,547.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,881.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,308.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,529.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,837.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,043.76
|
| Rate for Payer: PHCS Commercial |
$4,234.80
|
| Rate for Payer: United Healthcare All Payer |
$3,881.90
|
|
