|
REV KN ARTHRPLSTY WWOALLOGRAFT
|
Professional
|
Both
|
$3,600.00
|
|
|
Service Code
|
HCPCS 27486
|
| Hospital Charge Code |
761P0852
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,162.27 |
| Max. Negotiated Rate |
$2,286.70 |
| Rate for Payer: Aetna Commercial |
$2,117.10
|
| Rate for Payer: Ambetter Exchange |
$1,333.09
|
| Rate for Payer: Anthem Medicaid |
$1,162.27
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,333.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,333.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,599.71
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Cigna Commercial |
$2,286.70
|
| Rate for Payer: Healthspan PPO |
$1,917.64
|
| Rate for Payer: Humana Medicaid |
$1,162.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,770.37
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,333.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,333.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,185.52
|
| Rate for Payer: Molina Healthcare Passport |
$1,162.27
|
| Rate for Payer: Multiplan PHCS |
$2,160.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,733.02
|
| Rate for Payer: UHCCP Medicaid |
$1,260.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,173.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,333.09
|
|
|
REV KN ARTHRPLSTY WWOALLOGRAFT
|
Professional
|
Both
|
$5,600.00
|
|
|
Service Code
|
HCPCS 27487
|
| Hospital Charge Code |
761P0853
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,526.10 |
| Max. Negotiated Rate |
$3,360.00 |
| Rate for Payer: Aetna Commercial |
$2,679.11
|
| Rate for Payer: Ambetter Exchange |
$1,661.61
|
| Rate for Payer: Anthem Medicaid |
$1,526.10
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,661.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,661.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,993.93
|
| Rate for Payer: Cash Price |
$2,800.00
|
| Rate for Payer: Cash Price |
$2,800.00
|
| Rate for Payer: Cigna Commercial |
$2,892.50
|
| Rate for Payer: Healthspan PPO |
$2,426.71
|
| Rate for Payer: Humana Medicaid |
$1,526.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,224.92
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,661.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,661.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,556.62
|
| Rate for Payer: Molina Healthcare Passport |
$1,526.10
|
| Rate for Payer: Multiplan PHCS |
$3,360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,160.09
|
| Rate for Payer: UHCCP Medicaid |
$1,960.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,541.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,661.61
|
|
|
REV KN ARTHRPLSTY WWOALLOGRAFT
|
Facility
|
OP
|
$3,600.00
|
|
|
Service Code
|
HCPCS 27486
|
| Hospital Charge Code |
76100852
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,080.00 |
| Max. Negotiated Rate |
$3,456.00 |
| Rate for Payer: Aetna Commercial |
$2,772.00
|
| Rate for Payer: Anthem Medicaid |
$1,238.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,808.00
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Cigna Commercial |
$2,988.00
|
| Rate for Payer: First Health Commercial |
$3,420.00
|
| Rate for Payer: Humana Commercial |
$3,060.00
|
| Rate for Payer: Humana KY Medicaid |
$1,238.04
|
| Rate for Payer: Kentucky WC Medicaid |
$1,250.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,952.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,656.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,080.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,262.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,168.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,700.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,132.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,484.00
|
| Rate for Payer: PHCS Commercial |
$3,456.00
|
| Rate for Payer: United Healthcare All Payer |
$3,168.00
|
|
|
REV KN ARTHRPLSTY WWOALLOGRAFT
|
Facility
|
IP
|
$3,600.00
|
|
|
Service Code
|
HCPCS 27486
|
| Hospital Charge Code |
76100852
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,080.00 |
| Max. Negotiated Rate |
$3,456.00 |
| Rate for Payer: Aetna Commercial |
$2,772.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,808.00
|
| Rate for Payer: Cash Price |
$1,800.00
|
| Rate for Payer: Cigna Commercial |
$2,988.00
|
| Rate for Payer: First Health Commercial |
$3,420.00
|
| Rate for Payer: Humana Commercial |
$3,060.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,952.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,656.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,168.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,700.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,132.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,484.00
|
| Rate for Payer: PHCS Commercial |
$3,456.00
|
| Rate for Payer: United Healthcare All Payer |
$3,168.00
|
|
|
REV KN ARTHRPLSTY WWOALLOGRAFT
|
Facility
|
IP
|
$5,600.00
|
|
|
Service Code
|
HCPCS 27487
|
| Hospital Charge Code |
76100853
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,680.00 |
| Max. Negotiated Rate |
$5,376.00 |
| Rate for Payer: Aetna Commercial |
$4,312.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,368.00
|
| Rate for Payer: Cash Price |
$2,800.00
|
| Rate for Payer: Cigna Commercial |
$4,648.00
|
| Rate for Payer: First Health Commercial |
$5,320.00
|
| Rate for Payer: Humana Commercial |
$4,760.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,592.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,132.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,680.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,928.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,480.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,872.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,864.00
|
| Rate for Payer: PHCS Commercial |
$5,376.00
|
| Rate for Payer: United Healthcare All Payer |
$4,928.00
|
|
|
REV LOWER EXT GRAFT PATCH
|
Professional
|
Both
|
$1,445.00
|
|
|
Service Code
|
HCPCS 35879
|
| Hospital Charge Code |
76101425
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$505.75 |
| Max. Negotiated Rate |
$1,633.14 |
| Rate for Payer: Aetna Commercial |
$1,633.14
|
| Rate for Payer: Ambetter Exchange |
$865.11
|
| Rate for Payer: Anthem Medicaid |
$727.03
|
| Rate for Payer: Buckeye Individual/Medicaid |
$865.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$865.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,038.13
|
| Rate for Payer: Cash Price |
$722.50
|
| Rate for Payer: Cash Price |
$722.50
|
| Rate for Payer: Cigna Commercial |
$1,575.26
|
| Rate for Payer: Healthspan PPO |
$1,605.70
|
| Rate for Payer: Humana Medicaid |
$727.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,275.30
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$865.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$865.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$741.57
|
| Rate for Payer: Molina Healthcare Passport |
$727.03
|
| Rate for Payer: Multiplan PHCS |
$867.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,124.64
|
| Rate for Payer: UHCCP Medicaid |
$505.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$734.30
|
| Rate for Payer: Wellcare Medicare Advantage |
$865.11
|
|
|
REV LOWER EXT GRAFT PATCH
|
Facility
|
IP
|
$1,445.00
|
|
|
Service Code
|
HCPCS 35879
|
| Hospital Charge Code |
76101425
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$433.50 |
| Max. Negotiated Rate |
$1,387.20 |
| Rate for Payer: Aetna Commercial |
$1,112.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,127.10
|
| Rate for Payer: Cash Price |
$722.50
|
| Rate for Payer: Cigna Commercial |
$1,199.35
|
| Rate for Payer: First Health Commercial |
$1,372.75
|
| Rate for Payer: Humana Commercial |
$1,228.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,184.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,066.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$433.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,271.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,083.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,257.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$997.05
|
| Rate for Payer: PHCS Commercial |
$1,387.20
|
| Rate for Payer: United Healthcare All Payer |
$1,271.60
|
|
|
REV LOWER EXT GRAFT PATCH
|
Facility
|
OP
|
$1,445.00
|
|
|
Service Code
|
HCPCS 35879
|
| Hospital Charge Code |
76101425
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$496.94 |
| Max. Negotiated Rate |
$6,992.66 |
| Rate for Payer: Aetna Commercial |
$1,112.65
|
| Rate for Payer: Anthem Medicaid |
$496.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,994.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,127.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,992.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,742.93
|
| Rate for Payer: Cash Price |
$722.50
|
| Rate for Payer: Cash Price |
$722.50
|
| Rate for Payer: Cigna Commercial |
$1,199.35
|
| Rate for Payer: First Health Commercial |
$1,372.75
|
| Rate for Payer: Humana Commercial |
$1,228.25
|
| Rate for Payer: Humana KY Medicaid |
$496.94
|
| Rate for Payer: Humana Medicare Advantage |
$4,994.76
|
| Rate for Payer: Kentucky WC Medicaid |
$501.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,184.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,066.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,993.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$506.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,271.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,083.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,257.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$997.05
|
| Rate for Payer: PHCS Commercial |
$1,387.20
|
| Rate for Payer: United Healthcare All Payer |
$1,271.60
|
|
|
REV LOWER EXT GRAFT PATCH(P
|
Professional
|
Both
|
$1,445.00
|
|
|
Service Code
|
HCPCS 35879
|
| Hospital Charge Code |
761P1425
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$505.75 |
| Max. Negotiated Rate |
$1,633.14 |
| Rate for Payer: Aetna Commercial |
$1,633.14
|
| Rate for Payer: Ambetter Exchange |
$865.11
|
| Rate for Payer: Anthem Medicaid |
$727.03
|
| Rate for Payer: Buckeye Individual/Medicaid |
$865.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$865.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,038.13
|
| Rate for Payer: Cash Price |
$722.50
|
| Rate for Payer: Cash Price |
$722.50
|
| Rate for Payer: Cigna Commercial |
$1,575.26
|
| Rate for Payer: Healthspan PPO |
$1,605.70
|
| Rate for Payer: Humana Medicaid |
$727.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,275.30
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$865.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$865.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$741.57
|
| Rate for Payer: Molina Healthcare Passport |
$727.03
|
| Rate for Payer: Multiplan PHCS |
$867.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,124.64
|
| Rate for Payer: UHCCP Medicaid |
$505.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$734.30
|
| Rate for Payer: Wellcare Medicare Advantage |
$865.11
|
|
|
REV MASTOID; RSLT RAD MSTDCTMY
|
Professional
|
Both
|
$3,200.00
|
|
|
Service Code
|
HCPCS 69603
|
| Hospital Charge Code |
761P2426
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$909.84 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,805.48
|
| Rate for Payer: Ambetter Exchange |
$1,185.58
|
| Rate for Payer: Anthem Medicaid |
$909.84
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,185.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,185.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,422.70
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cigna Commercial |
$1,827.37
|
| Rate for Payer: Healthspan PPO |
$1,601.55
|
| Rate for Payer: Humana Medicaid |
$909.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,612.95
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,185.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,185.58
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$928.04
|
| Rate for Payer: Molina Healthcare Passport |
$909.84
|
| Rate for Payer: Multiplan PHCS |
$1,920.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,541.25
|
| Rate for Payer: UHCCP Medicaid |
$1,120.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$918.94
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,185.58
|
|
|
REV MASTOID; RSLT RAD MSTDCTMY
|
Professional
|
Both
|
$3,200.00
|
|
|
Service Code
|
HCPCS 69603
|
| Hospital Charge Code |
76102426
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$909.84 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,805.48
|
| Rate for Payer: Ambetter Exchange |
$1,185.58
|
| Rate for Payer: Anthem Medicaid |
$909.84
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,185.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,185.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,422.70
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cigna Commercial |
$1,827.37
|
| Rate for Payer: Healthspan PPO |
$1,601.55
|
| Rate for Payer: Humana Medicaid |
$909.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,612.95
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,185.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,185.58
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$928.04
|
| Rate for Payer: Molina Healthcare Passport |
$909.84
|
| Rate for Payer: Multiplan PHCS |
$1,920.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,541.25
|
| Rate for Payer: UHCCP Medicaid |
$1,120.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$918.94
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,185.58
|
|
|
REV MASTOID; RSLT RAD MSTDCTMY
|
Facility
|
IP
|
$3,200.00
|
|
|
Service Code
|
HCPCS 69603
|
| Hospital Charge Code |
76102426
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$960.00 |
| Max. Negotiated Rate |
$3,072.00 |
| Rate for Payer: Aetna Commercial |
$2,464.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,496.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cigna Commercial |
$2,656.00
|
| Rate for Payer: First Health Commercial |
$3,040.00
|
| Rate for Payer: Humana Commercial |
$2,720.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,624.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,361.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$960.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,816.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,400.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,784.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,208.00
|
| Rate for Payer: PHCS Commercial |
$3,072.00
|
| Rate for Payer: United Healthcare All Payer |
$2,816.00
|
|
|
REV MASTOID; RSLT RAD MSTDCTMY
|
Facility
|
OP
|
$3,200.00
|
|
|
Service Code
|
HCPCS 69603
|
| Hospital Charge Code |
76102426
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,100.48 |
| Max. Negotiated Rate |
$7,652.33 |
| Rate for Payer: Aetna Commercial |
$2,464.00
|
| Rate for Payer: Anthem Medicaid |
$1,100.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,465.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,496.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,652.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,379.03
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cigna Commercial |
$2,656.00
|
| Rate for Payer: First Health Commercial |
$3,040.00
|
| Rate for Payer: Humana Commercial |
$2,720.00
|
| Rate for Payer: Humana KY Medicaid |
$1,100.48
|
| Rate for Payer: Humana Medicare Advantage |
$5,465.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,111.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,624.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,361.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,559.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,122.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,816.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,400.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,784.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,208.00
|
| Rate for Payer: PHCS Commercial |
$3,072.00
|
| Rate for Payer: United Healthcare All Payer |
$2,816.00
|
|
|
REV OF GASTROJEJUNAL ANAST
|
Facility
|
IP
|
$2,100.00
|
|
|
Service Code
|
HCPCS 43860
|
| Hospital Charge Code |
76101799
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$630.00 |
| Max. Negotiated Rate |
$2,016.00 |
| Rate for Payer: Aetna Commercial |
$1,617.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,638.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,743.00
|
| Rate for Payer: First Health Commercial |
$1,995.00
|
| Rate for Payer: Humana Commercial |
$1,785.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,722.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,549.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,848.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,827.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,449.00
|
| Rate for Payer: PHCS Commercial |
$2,016.00
|
| Rate for Payer: United Healthcare All Payer |
$1,848.00
|
|
|
REV OF GASTROJEJUNAL ANAST
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 43860
|
| Hospital Charge Code |
76101799
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$735.00 |
| Max. Negotiated Rate |
$2,371.81 |
| Rate for Payer: Aetna Commercial |
$2,371.81
|
| Rate for Payer: Ambetter Exchange |
$1,560.16
|
| Rate for Payer: Anthem Medicaid |
$900.66
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,560.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,560.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,872.19
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$2,204.98
|
| Rate for Payer: Healthspan PPO |
$2,000.19
|
| Rate for Payer: Humana Medicaid |
$900.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,091.44
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,560.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,560.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$918.67
|
| Rate for Payer: Molina Healthcare Passport |
$900.66
|
| Rate for Payer: Multiplan PHCS |
$1,260.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,028.21
|
| Rate for Payer: UHCCP Medicaid |
$735.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$909.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,560.16
|
|
|
REV OF GASTROJEJUNAL ANAST
|
Facility
|
OP
|
$2,100.00
|
|
|
Service Code
|
HCPCS 43860
|
| Hospital Charge Code |
76101799
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$630.00 |
| Max. Negotiated Rate |
$2,016.00 |
| Rate for Payer: Aetna Commercial |
$1,617.00
|
| Rate for Payer: Anthem Medicaid |
$722.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,638.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,743.00
|
| Rate for Payer: First Health Commercial |
$1,995.00
|
| Rate for Payer: Humana Commercial |
$1,785.00
|
| Rate for Payer: Humana KY Medicaid |
$722.19
|
| Rate for Payer: Kentucky WC Medicaid |
$729.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,722.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,549.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$736.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,848.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,827.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,449.00
|
| Rate for Payer: PHCS Commercial |
$2,016.00
|
| Rate for Payer: United Healthcare All Payer |
$1,848.00
|
|
|
REV OF GASTROJEJUNAL ANAST(P
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 43860
|
| Hospital Charge Code |
761P1799
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$735.00 |
| Max. Negotiated Rate |
$2,371.81 |
| Rate for Payer: Aetna Commercial |
$2,371.81
|
| Rate for Payer: Ambetter Exchange |
$1,560.16
|
| Rate for Payer: Anthem Medicaid |
$900.66
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,560.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,560.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,872.19
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$2,204.98
|
| Rate for Payer: Healthspan PPO |
$2,000.19
|
| Rate for Payer: Humana Medicaid |
$900.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,091.44
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,560.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,560.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$918.67
|
| Rate for Payer: Molina Healthcare Passport |
$900.66
|
| Rate for Payer: Multiplan PHCS |
$1,260.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,028.21
|
| Rate for Payer: UHCCP Medicaid |
$735.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$909.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,560.16
|
|
|
REV POR 170MM STR SZ 11
|
Facility
|
OP
|
$15,605.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,681.69 |
| Max. Negotiated Rate |
$14,981.41 |
| Rate for Payer: Aetna Commercial |
$12,016.34
|
| Rate for Payer: Anthem Medicaid |
$5,366.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,172.40
|
| Rate for Payer: Cash Price |
$7,802.82
|
| Rate for Payer: Cigna Commercial |
$12,952.68
|
| Rate for Payer: First Health Commercial |
$14,825.36
|
| Rate for Payer: Humana Commercial |
$13,264.79
|
| Rate for Payer: Humana KY Medicaid |
$5,366.78
|
| Rate for Payer: Kentucky WC Medicaid |
$5,421.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,796.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,516.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,681.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,474.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,732.96
|
| Rate for Payer: Ohio Health Group HMO |
$11,704.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,484.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,576.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,767.89
|
| Rate for Payer: PHCS Commercial |
$14,981.41
|
| Rate for Payer: United Healthcare All Payer |
$13,732.96
|
|
|
REV POR 170MM STR SZ 11
|
Facility
|
IP
|
$15,605.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,681.69 |
| Max. Negotiated Rate |
$14,981.41 |
| Rate for Payer: Aetna Commercial |
$12,016.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,172.40
|
| Rate for Payer: Cash Price |
$7,802.82
|
| Rate for Payer: Cigna Commercial |
$12,952.68
|
| Rate for Payer: First Health Commercial |
$14,825.36
|
| Rate for Payer: Humana Commercial |
$13,264.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,796.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,516.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,681.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,732.96
|
| Rate for Payer: Ohio Health Group HMO |
$11,704.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,484.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,576.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,767.89
|
| Rate for Payer: PHCS Commercial |
$14,981.41
|
| Rate for Payer: United Healthcare All Payer |
$13,732.96
|
|
|
REV POR 170MM STR SZ 12
|
Facility
|
IP
|
$15,605.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,681.69 |
| Max. Negotiated Rate |
$14,981.41 |
| Rate for Payer: Aetna Commercial |
$12,016.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,172.40
|
| Rate for Payer: Cash Price |
$7,802.82
|
| Rate for Payer: Cigna Commercial |
$12,952.68
|
| Rate for Payer: First Health Commercial |
$14,825.36
|
| Rate for Payer: Humana Commercial |
$13,264.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,796.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,516.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,681.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,732.96
|
| Rate for Payer: Ohio Health Group HMO |
$11,704.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,484.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,576.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,767.89
|
| Rate for Payer: PHCS Commercial |
$14,981.41
|
| Rate for Payer: United Healthcare All Payer |
$13,732.96
|
|
|
REV POR 170MM STR SZ 12
|
Facility
|
OP
|
$15,605.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,681.69 |
| Max. Negotiated Rate |
$14,981.41 |
| Rate for Payer: Aetna Commercial |
$12,016.34
|
| Rate for Payer: Anthem Medicaid |
$5,366.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,172.40
|
| Rate for Payer: Cash Price |
$7,802.82
|
| Rate for Payer: Cigna Commercial |
$12,952.68
|
| Rate for Payer: First Health Commercial |
$14,825.36
|
| Rate for Payer: Humana Commercial |
$13,264.79
|
| Rate for Payer: Humana KY Medicaid |
$5,366.78
|
| Rate for Payer: Kentucky WC Medicaid |
$5,421.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,796.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,516.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,681.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,474.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,732.96
|
| Rate for Payer: Ohio Health Group HMO |
$11,704.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,484.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,576.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,767.89
|
| Rate for Payer: PHCS Commercial |
$14,981.41
|
| Rate for Payer: United Healthcare All Payer |
$13,732.96
|
|
|
REV POR 170MM STR SZ 13
|
Facility
|
IP
|
$15,605.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,681.69 |
| Max. Negotiated Rate |
$14,981.41 |
| Rate for Payer: Aetna Commercial |
$12,016.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,172.40
|
| Rate for Payer: Cash Price |
$7,802.82
|
| Rate for Payer: Cigna Commercial |
$12,952.68
|
| Rate for Payer: First Health Commercial |
$14,825.36
|
| Rate for Payer: Humana Commercial |
$13,264.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,796.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,516.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,681.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,732.96
|
| Rate for Payer: Ohio Health Group HMO |
$11,704.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,484.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,576.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,767.89
|
| Rate for Payer: PHCS Commercial |
$14,981.41
|
| Rate for Payer: United Healthcare All Payer |
$13,732.96
|
|
|
REV POR 170MM STR SZ 13
|
Facility
|
OP
|
$15,605.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,681.69 |
| Max. Negotiated Rate |
$14,981.41 |
| Rate for Payer: Aetna Commercial |
$12,016.34
|
| Rate for Payer: Anthem Medicaid |
$5,366.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,172.40
|
| Rate for Payer: Cash Price |
$7,802.82
|
| Rate for Payer: Cigna Commercial |
$12,952.68
|
| Rate for Payer: First Health Commercial |
$14,825.36
|
| Rate for Payer: Humana Commercial |
$13,264.79
|
| Rate for Payer: Humana KY Medicaid |
$5,366.78
|
| Rate for Payer: Kentucky WC Medicaid |
$5,421.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,796.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,516.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,681.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,474.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,732.96
|
| Rate for Payer: Ohio Health Group HMO |
$11,704.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,484.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,576.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,767.89
|
| Rate for Payer: PHCS Commercial |
$14,981.41
|
| Rate for Payer: United Healthcare All Payer |
$13,732.96
|
|
|
REV POR 170MM STR SZ 14
|
Facility
|
OP
|
$15,605.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,681.69 |
| Max. Negotiated Rate |
$14,981.41 |
| Rate for Payer: Aetna Commercial |
$12,016.34
|
| Rate for Payer: Anthem Medicaid |
$5,366.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,172.40
|
| Rate for Payer: Cash Price |
$7,802.82
|
| Rate for Payer: Cigna Commercial |
$12,952.68
|
| Rate for Payer: First Health Commercial |
$14,825.36
|
| Rate for Payer: Humana Commercial |
$13,264.79
|
| Rate for Payer: Humana KY Medicaid |
$5,366.78
|
| Rate for Payer: Kentucky WC Medicaid |
$5,421.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,796.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,516.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,681.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,474.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,732.96
|
| Rate for Payer: Ohio Health Group HMO |
$11,704.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,484.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,576.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,767.89
|
| Rate for Payer: PHCS Commercial |
$14,981.41
|
| Rate for Payer: United Healthcare All Payer |
$13,732.96
|
|
|
REV POR 170MM STR SZ 14
|
Facility
|
IP
|
$15,605.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,681.69 |
| Max. Negotiated Rate |
$14,981.41 |
| Rate for Payer: Aetna Commercial |
$12,016.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,172.40
|
| Rate for Payer: Cash Price |
$7,802.82
|
| Rate for Payer: Cigna Commercial |
$12,952.68
|
| Rate for Payer: First Health Commercial |
$14,825.36
|
| Rate for Payer: Humana Commercial |
$13,264.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,796.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,516.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,681.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,732.96
|
| Rate for Payer: Ohio Health Group HMO |
$11,704.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,484.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,576.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,767.89
|
| Rate for Payer: PHCS Commercial |
$14,981.41
|
| Rate for Payer: United Healthcare All Payer |
$13,732.96
|
|
