|
BF 40MM PEG GLENOD W/46MM SURF
|
Facility
|
OP
|
$9,159.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.77 |
| Max. Negotiated Rate |
$8,793.37 |
| Rate for Payer: Aetna Commercial |
$7,053.02
|
| Rate for Payer: Anthem Medicaid |
$3,150.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,144.61
|
| Rate for Payer: Cash Price |
$4,579.88
|
| Rate for Payer: Cigna Commercial |
$7,602.60
|
| Rate for Payer: First Health Commercial |
$8,701.77
|
| Rate for Payer: Humana Commercial |
$7,785.80
|
| Rate for Payer: Humana KY Medicaid |
$3,150.04
|
| Rate for Payer: Kentucky WC Medicaid |
$3,182.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,511.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,759.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,213.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,060.59
|
| Rate for Payer: Ohio Health Group HMO |
$6,869.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.53
|
| Rate for Payer: PHCS Commercial |
$8,793.37
|
| Rate for Payer: United Healthcare All Payer |
$8,060.59
|
|
|
BF 40MM PEG GLENOD W/46MM SURF
|
Facility
|
IP
|
$9,159.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.77 |
| Max. Negotiated Rate |
$8,793.37 |
| Rate for Payer: Aetna Commercial |
$7,053.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,144.61
|
| Rate for Payer: Cash Price |
$4,579.88
|
| Rate for Payer: Cigna Commercial |
$7,602.60
|
| Rate for Payer: First Health Commercial |
$8,701.77
|
| Rate for Payer: Humana Commercial |
$7,785.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,511.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,759.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,060.59
|
| Rate for Payer: Ohio Health Group HMO |
$6,869.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.53
|
| Rate for Payer: PHCS Commercial |
$8,793.37
|
| Rate for Payer: United Healthcare All Payer |
$8,060.59
|
|
|
BF 46MM KLD GLENOD W/40MM SURF
|
Facility
|
OP
|
$9,159.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.77 |
| Max. Negotiated Rate |
$8,793.37 |
| Rate for Payer: Aetna Commercial |
$7,053.02
|
| Rate for Payer: Anthem Medicaid |
$3,150.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,144.61
|
| Rate for Payer: Cash Price |
$4,579.88
|
| Rate for Payer: Cigna Commercial |
$7,602.60
|
| Rate for Payer: First Health Commercial |
$8,701.77
|
| Rate for Payer: Humana Commercial |
$7,785.80
|
| Rate for Payer: Humana KY Medicaid |
$3,150.04
|
| Rate for Payer: Kentucky WC Medicaid |
$3,182.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,511.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,759.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,213.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,060.59
|
| Rate for Payer: Ohio Health Group HMO |
$6,869.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.53
|
| Rate for Payer: PHCS Commercial |
$8,793.37
|
| Rate for Payer: United Healthcare All Payer |
$8,060.59
|
|
|
BF 46MM KLD GLENOD W/40MM SURF
|
Facility
|
IP
|
$9,159.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.77 |
| Max. Negotiated Rate |
$8,793.37 |
| Rate for Payer: Aetna Commercial |
$7,053.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,144.61
|
| Rate for Payer: Cash Price |
$4,579.88
|
| Rate for Payer: Cigna Commercial |
$7,602.60
|
| Rate for Payer: First Health Commercial |
$8,701.77
|
| Rate for Payer: Humana Commercial |
$7,785.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,511.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,759.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,060.59
|
| Rate for Payer: Ohio Health Group HMO |
$6,869.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.53
|
| Rate for Payer: PHCS Commercial |
$8,793.37
|
| Rate for Payer: United Healthcare All Payer |
$8,060.59
|
|
|
BF 46MM KLD GLENOD W/52MM SURF
|
Facility
|
IP
|
$9,159.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.77 |
| Max. Negotiated Rate |
$8,793.37 |
| Rate for Payer: Aetna Commercial |
$7,053.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,144.61
|
| Rate for Payer: Cash Price |
$4,579.88
|
| Rate for Payer: Cigna Commercial |
$7,602.60
|
| Rate for Payer: First Health Commercial |
$8,701.77
|
| Rate for Payer: Humana Commercial |
$7,785.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,511.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,759.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,060.59
|
| Rate for Payer: Ohio Health Group HMO |
$6,869.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.53
|
| Rate for Payer: PHCS Commercial |
$8,793.37
|
| Rate for Payer: United Healthcare All Payer |
$8,060.59
|
|
|
BF 46MM KLD GLENOD W/52MM SURF
|
Facility
|
OP
|
$9,159.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.77 |
| Max. Negotiated Rate |
$8,793.37 |
| Rate for Payer: Aetna Commercial |
$7,053.02
|
| Rate for Payer: Anthem Medicaid |
$3,150.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,144.61
|
| Rate for Payer: Cash Price |
$4,579.88
|
| Rate for Payer: Cigna Commercial |
$7,602.60
|
| Rate for Payer: First Health Commercial |
$8,701.77
|
| Rate for Payer: Humana Commercial |
$7,785.80
|
| Rate for Payer: Humana KY Medicaid |
$3,150.04
|
| Rate for Payer: Kentucky WC Medicaid |
$3,182.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,511.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,759.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,213.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,060.59
|
| Rate for Payer: Ohio Health Group HMO |
$6,869.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.53
|
| Rate for Payer: PHCS Commercial |
$8,793.37
|
| Rate for Payer: United Healthcare All Payer |
$8,060.59
|
|
|
BF 46MM PEG GLENOD W/40MM SURF
|
Facility
|
IP
|
$9,159.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.77 |
| Max. Negotiated Rate |
$8,793.37 |
| Rate for Payer: Aetna Commercial |
$7,053.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,144.61
|
| Rate for Payer: Cash Price |
$4,579.88
|
| Rate for Payer: Cigna Commercial |
$7,602.60
|
| Rate for Payer: First Health Commercial |
$8,701.77
|
| Rate for Payer: Humana Commercial |
$7,785.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,511.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,759.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,060.59
|
| Rate for Payer: Ohio Health Group HMO |
$6,869.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.53
|
| Rate for Payer: PHCS Commercial |
$8,793.37
|
| Rate for Payer: United Healthcare All Payer |
$8,060.59
|
|
|
BF 46MM PEG GLENOD W/40MM SURF
|
Facility
|
OP
|
$9,159.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.77 |
| Max. Negotiated Rate |
$8,793.37 |
| Rate for Payer: Aetna Commercial |
$7,053.02
|
| Rate for Payer: Anthem Medicaid |
$3,150.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,144.61
|
| Rate for Payer: Cash Price |
$4,579.88
|
| Rate for Payer: Cigna Commercial |
$7,602.60
|
| Rate for Payer: First Health Commercial |
$8,701.77
|
| Rate for Payer: Humana Commercial |
$7,785.80
|
| Rate for Payer: Humana KY Medicaid |
$3,150.04
|
| Rate for Payer: Kentucky WC Medicaid |
$3,182.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,511.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,759.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,213.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,060.59
|
| Rate for Payer: Ohio Health Group HMO |
$6,869.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.53
|
| Rate for Payer: PHCS Commercial |
$8,793.37
|
| Rate for Payer: United Healthcare All Payer |
$8,060.59
|
|
|
BF 46MM PEG GLENOD W/52MM SURF
|
Facility
|
OP
|
$9,159.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.77 |
| Max. Negotiated Rate |
$8,793.37 |
| Rate for Payer: Aetna Commercial |
$7,053.02
|
| Rate for Payer: Anthem Medicaid |
$3,150.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,144.61
|
| Rate for Payer: Cash Price |
$4,579.88
|
| Rate for Payer: Cigna Commercial |
$7,602.60
|
| Rate for Payer: First Health Commercial |
$8,701.77
|
| Rate for Payer: Humana Commercial |
$7,785.80
|
| Rate for Payer: Humana KY Medicaid |
$3,150.04
|
| Rate for Payer: Kentucky WC Medicaid |
$3,182.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,511.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,759.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,213.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,060.59
|
| Rate for Payer: Ohio Health Group HMO |
$6,869.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.53
|
| Rate for Payer: PHCS Commercial |
$8,793.37
|
| Rate for Payer: United Healthcare All Payer |
$8,060.59
|
|
|
BF 46MM PEG GLENOD W/52MM SURF
|
Facility
|
IP
|
$9,159.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.77 |
| Max. Negotiated Rate |
$8,793.37 |
| Rate for Payer: Aetna Commercial |
$7,053.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,144.61
|
| Rate for Payer: Cash Price |
$4,579.88
|
| Rate for Payer: Cigna Commercial |
$7,602.60
|
| Rate for Payer: First Health Commercial |
$8,701.77
|
| Rate for Payer: Humana Commercial |
$7,785.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,511.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,759.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,060.59
|
| Rate for Payer: Ohio Health Group HMO |
$6,869.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.53
|
| Rate for Payer: PHCS Commercial |
$8,793.37
|
| Rate for Payer: United Healthcare All Payer |
$8,060.59
|
|
|
BF 52MM KLD GLENOD W/46MM SURF
|
Facility
|
IP
|
$9,159.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.77 |
| Max. Negotiated Rate |
$8,793.37 |
| Rate for Payer: Aetna Commercial |
$7,053.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,144.61
|
| Rate for Payer: Cash Price |
$4,579.88
|
| Rate for Payer: Cigna Commercial |
$7,602.60
|
| Rate for Payer: First Health Commercial |
$8,701.77
|
| Rate for Payer: Humana Commercial |
$7,785.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,511.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,759.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,060.59
|
| Rate for Payer: Ohio Health Group HMO |
$6,869.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.53
|
| Rate for Payer: PHCS Commercial |
$8,793.37
|
| Rate for Payer: United Healthcare All Payer |
$8,060.59
|
|
|
BF 52MM KLD GLENOD W/46MM SURF
|
Facility
|
OP
|
$9,159.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.77 |
| Max. Negotiated Rate |
$8,793.37 |
| Rate for Payer: Aetna Commercial |
$7,053.02
|
| Rate for Payer: Anthem Medicaid |
$3,150.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,144.61
|
| Rate for Payer: Cash Price |
$4,579.88
|
| Rate for Payer: Cigna Commercial |
$7,602.60
|
| Rate for Payer: First Health Commercial |
$8,701.77
|
| Rate for Payer: Humana Commercial |
$7,785.80
|
| Rate for Payer: Humana KY Medicaid |
$3,150.04
|
| Rate for Payer: Kentucky WC Medicaid |
$3,182.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,511.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,759.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,213.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,060.59
|
| Rate for Payer: Ohio Health Group HMO |
$6,869.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.53
|
| Rate for Payer: PHCS Commercial |
$8,793.37
|
| Rate for Payer: United Healthcare All Payer |
$8,060.59
|
|
|
BF 52MM KLD GLENOD W/56MM SURF
|
Facility
|
OP
|
$9,159.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.77 |
| Max. Negotiated Rate |
$8,793.37 |
| Rate for Payer: Aetna Commercial |
$7,053.02
|
| Rate for Payer: Anthem Medicaid |
$3,150.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,144.61
|
| Rate for Payer: Cash Price |
$4,579.88
|
| Rate for Payer: Cigna Commercial |
$7,602.60
|
| Rate for Payer: First Health Commercial |
$8,701.77
|
| Rate for Payer: Humana Commercial |
$7,785.80
|
| Rate for Payer: Humana KY Medicaid |
$3,150.04
|
| Rate for Payer: Kentucky WC Medicaid |
$3,182.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,511.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,759.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,213.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,060.59
|
| Rate for Payer: Ohio Health Group HMO |
$6,869.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.53
|
| Rate for Payer: PHCS Commercial |
$8,793.37
|
| Rate for Payer: United Healthcare All Payer |
$8,060.59
|
|
|
BF 52MM KLD GLENOD W/56MM SURF
|
Facility
|
IP
|
$9,159.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.77 |
| Max. Negotiated Rate |
$8,793.37 |
| Rate for Payer: Aetna Commercial |
$7,053.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,144.61
|
| Rate for Payer: Cash Price |
$4,579.88
|
| Rate for Payer: Cigna Commercial |
$7,602.60
|
| Rate for Payer: First Health Commercial |
$8,701.77
|
| Rate for Payer: Humana Commercial |
$7,785.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,511.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,759.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,060.59
|
| Rate for Payer: Ohio Health Group HMO |
$6,869.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.53
|
| Rate for Payer: PHCS Commercial |
$8,793.37
|
| Rate for Payer: United Healthcare All Payer |
$8,060.59
|
|
|
BF 52MM PEG GLENOD W/46MM SURF
|
Facility
|
OP
|
$9,159.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.77 |
| Max. Negotiated Rate |
$8,793.37 |
| Rate for Payer: Aetna Commercial |
$7,053.02
|
| Rate for Payer: Anthem Medicaid |
$3,150.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,144.61
|
| Rate for Payer: Cash Price |
$4,579.88
|
| Rate for Payer: Cigna Commercial |
$7,602.60
|
| Rate for Payer: First Health Commercial |
$8,701.77
|
| Rate for Payer: Humana Commercial |
$7,785.80
|
| Rate for Payer: Humana KY Medicaid |
$3,150.04
|
| Rate for Payer: Kentucky WC Medicaid |
$3,182.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,511.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,759.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,213.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,060.59
|
| Rate for Payer: Ohio Health Group HMO |
$6,869.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.53
|
| Rate for Payer: PHCS Commercial |
$8,793.37
|
| Rate for Payer: United Healthcare All Payer |
$8,060.59
|
|
|
BF 52MM PEG GLENOD W/46MM SURF
|
Facility
|
IP
|
$9,159.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.77 |
| Max. Negotiated Rate |
$8,793.37 |
| Rate for Payer: Aetna Commercial |
$7,053.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,144.61
|
| Rate for Payer: Cash Price |
$4,579.88
|
| Rate for Payer: Cigna Commercial |
$7,602.60
|
| Rate for Payer: First Health Commercial |
$8,701.77
|
| Rate for Payer: Humana Commercial |
$7,785.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,511.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,759.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,060.59
|
| Rate for Payer: Ohio Health Group HMO |
$6,869.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.53
|
| Rate for Payer: PHCS Commercial |
$8,793.37
|
| Rate for Payer: United Healthcare All Payer |
$8,060.59
|
|
|
BF 52MM PEG GLENOD W/56MM SURF
|
Facility
|
OP
|
$9,159.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.77 |
| Max. Negotiated Rate |
$8,793.37 |
| Rate for Payer: Aetna Commercial |
$7,053.02
|
| Rate for Payer: Anthem Medicaid |
$3,150.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,144.61
|
| Rate for Payer: Cash Price |
$4,579.88
|
| Rate for Payer: Cigna Commercial |
$7,602.60
|
| Rate for Payer: First Health Commercial |
$8,701.77
|
| Rate for Payer: Humana Commercial |
$7,785.80
|
| Rate for Payer: Humana KY Medicaid |
$3,150.04
|
| Rate for Payer: Kentucky WC Medicaid |
$3,182.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,511.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,759.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,213.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,060.59
|
| Rate for Payer: Ohio Health Group HMO |
$6,869.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.53
|
| Rate for Payer: PHCS Commercial |
$8,793.37
|
| Rate for Payer: United Healthcare All Payer |
$8,060.59
|
|
|
BF 52MM PEG GLENOD W/56MM SURF
|
Facility
|
IP
|
$9,159.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.77 |
| Max. Negotiated Rate |
$8,793.37 |
| Rate for Payer: Aetna Commercial |
$7,053.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,144.61
|
| Rate for Payer: Cash Price |
$4,579.88
|
| Rate for Payer: Cigna Commercial |
$7,602.60
|
| Rate for Payer: First Health Commercial |
$8,701.77
|
| Rate for Payer: Humana Commercial |
$7,785.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,511.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,759.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,060.59
|
| Rate for Payer: Ohio Health Group HMO |
$6,869.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.53
|
| Rate for Payer: PHCS Commercial |
$8,793.37
|
| Rate for Payer: United Healthcare All Payer |
$8,060.59
|
|
|
BF ANAT SHOULDR ADAPTOR 42 DEG
|
Facility
|
IP
|
$8,129.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,056.77 |
| Max. Negotiated Rate |
$7,803.84 |
| Rate for Payer: Aetna Commercial |
$6,259.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,340.62
|
| Rate for Payer: Cash Price |
$4,064.50
|
| Rate for Payer: Cigna Commercial |
$6,747.07
|
| Rate for Payer: First Health Commercial |
$7,722.55
|
| Rate for Payer: Humana Commercial |
$6,909.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,665.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,999.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,438.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,153.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,096.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,625.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,056.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,519.99
|
| Rate for Payer: PHCS Commercial |
$7,803.84
|
| Rate for Payer: United Healthcare All Payer |
$7,153.52
|
|
|
BF ANAT SHOULDR ADAPTOR 42 DEG
|
Facility
|
OP
|
$8,129.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,056.77 |
| Max. Negotiated Rate |
$7,803.84 |
| Rate for Payer: Aetna Commercial |
$6,259.33
|
| Rate for Payer: Anthem Medicaid |
$2,795.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,340.62
|
| Rate for Payer: Cash Price |
$4,064.50
|
| Rate for Payer: Cigna Commercial |
$6,747.07
|
| Rate for Payer: First Health Commercial |
$7,722.55
|
| Rate for Payer: Humana Commercial |
$6,909.65
|
| Rate for Payer: Humana KY Medicaid |
$2,795.56
|
| Rate for Payer: Kentucky WC Medicaid |
$2,824.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,665.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,999.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,438.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,851.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,153.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,096.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,625.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,056.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,519.99
|
| Rate for Payer: PHCS Commercial |
$7,803.84
|
| Rate for Payer: United Healthcare All Payer |
$7,153.52
|
|
|
BFB TRAINING 1ST 15 MINS OT
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
HCPCS 90912
|
| Hospital Charge Code |
43000036
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$15.47 |
| Max. Negotiated Rate |
$114.24 |
| Rate for Payer: Aetna Commercial |
$91.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.82
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: Cigna Commercial |
$98.77
|
| Rate for Payer: First Health Commercial |
$113.05
|
| Rate for Payer: Humana Commercial |
$101.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$97.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$104.72
|
| Rate for Payer: Ohio Health Group HMO |
$89.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.89
|
| Rate for Payer: PHCS Commercial |
$114.24
|
| Rate for Payer: United Healthcare All Payer |
$104.72
|
|
|
BFB TRAINING 1ST 15 MINS OT
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
HCPCS 90912
|
| Hospital Charge Code |
43000036
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$15.47 |
| Max. Negotiated Rate |
$114.24 |
| Rate for Payer: Aetna Commercial |
$91.63
|
| Rate for Payer: Anthem Medicaid |
$40.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.82
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: Cigna Commercial |
$98.77
|
| Rate for Payer: First Health Commercial |
$113.05
|
| Rate for Payer: Humana Commercial |
$101.15
|
| Rate for Payer: Humana KY Medicaid |
$40.92
|
| Rate for Payer: Kentucky WC Medicaid |
$41.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$97.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$41.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$104.72
|
| Rate for Payer: Ohio Health Group HMO |
$89.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.89
|
| Rate for Payer: PHCS Commercial |
$114.24
|
| Rate for Payer: United Healthcare All Payer |
$104.72
|
|
|
BFB TRAINING 1ST 15 MINS PT
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
HCPCS 90912
|
| Hospital Charge Code |
42000067
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$15.47 |
| Max. Negotiated Rate |
$114.24 |
| Rate for Payer: Aetna Commercial |
$91.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.82
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: Cigna Commercial |
$98.77
|
| Rate for Payer: First Health Commercial |
$113.05
|
| Rate for Payer: Humana Commercial |
$101.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$97.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$104.72
|
| Rate for Payer: Ohio Health Group HMO |
$89.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.89
|
| Rate for Payer: PHCS Commercial |
$114.24
|
| Rate for Payer: United Healthcare All Payer |
$104.72
|
|
|
BFB TRAINING 1ST 15 MINS PT
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
HCPCS 90912
|
| Hospital Charge Code |
42000067
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$15.47 |
| Max. Negotiated Rate |
$114.24 |
| Rate for Payer: Aetna Commercial |
$91.63
|
| Rate for Payer: Anthem Medicaid |
$40.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.82
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: Cigna Commercial |
$98.77
|
| Rate for Payer: First Health Commercial |
$113.05
|
| Rate for Payer: Humana Commercial |
$101.15
|
| Rate for Payer: Humana KY Medicaid |
$40.92
|
| Rate for Payer: Kentucky WC Medicaid |
$41.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$97.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$41.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$104.72
|
| Rate for Payer: Ohio Health Group HMO |
$89.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.89
|
| Rate for Payer: PHCS Commercial |
$114.24
|
| Rate for Payer: United Healthcare All Payer |
$104.72
|
|
|
BFB TRAINING EA ADDL 15 MIN OT
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 90913
|
| Hospital Charge Code |
43000037
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$8.97 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53.82
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.39
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
