SENTRY IVC FILTER
|
Facility
|
OP
|
$7,362.50
|
|
Service Code
|
HCPCS C1880
|
Hospital Charge Code |
27000050
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$957.12 |
Max. Negotiated Rate |
$7,068.00 |
Rate for Payer: Aetna Commercial |
$5,669.12
|
Rate for Payer: Anthem Medicaid |
$2,531.96
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
Rate for Payer: Cash Price |
$3,681.25
|
Rate for Payer: Cigna Commercial |
$6,110.88
|
Rate for Payer: First Health Commercial |
$6,994.38
|
Rate for Payer: Humana Commercial |
$6,258.12
|
Rate for Payer: Humana KY Medicaid |
$2,531.96
|
Rate for Payer: Kentucky WC Medicaid |
$2,557.73
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
Rate for Payer: Molina Healthcare Medicaid |
$2,582.76
|
Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
Rate for Payer: PHCS Commercial |
$7,068.00
|
Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
SEPARATOR 12
|
Facility
|
OP
|
$9,899.25
|
|
Service Code
|
HCPCS C1757
|
Hospital Charge Code |
27000008
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$1,286.90 |
Max. Negotiated Rate |
$9,503.28 |
Rate for Payer: Aetna Commercial |
$7,622.42
|
Rate for Payer: Anthem Medicaid |
$3,404.35
|
Rate for Payer: Anthem POS/PPO/Traditional |
$7,721.42
|
Rate for Payer: Cash Price |
$4,949.62
|
Rate for Payer: Cigna Commercial |
$8,216.38
|
Rate for Payer: First Health Commercial |
$9,404.29
|
Rate for Payer: Humana Commercial |
$8,414.36
|
Rate for Payer: Humana KY Medicaid |
$3,404.35
|
Rate for Payer: Kentucky WC Medicaid |
$3,439.00
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$8,117.38
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,305.65
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,969.78
|
Rate for Payer: Molina Healthcare Medicaid |
$3,472.66
|
Rate for Payer: Ohio Health Choice Commercial |
$8,711.34
|
Rate for Payer: Ohio Health Group HMO |
$7,424.44
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,979.85
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,286.90
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,068.77
|
Rate for Payer: PHCS Commercial |
$9,503.28
|
Rate for Payer: United Healthcare All Payer |
$8,711.34
|
|
SEPARATOR 12
|
Facility
|
IP
|
$9,899.25
|
|
Service Code
|
HCPCS C1757
|
Hospital Charge Code |
27000008
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$1,286.90 |
Max. Negotiated Rate |
$9,503.28 |
Rate for Payer: Aetna Commercial |
$7,622.42
|
Rate for Payer: Anthem POS/PPO/Traditional |
$7,721.42
|
Rate for Payer: Cash Price |
$4,949.62
|
Rate for Payer: Cigna Commercial |
$8,216.38
|
Rate for Payer: First Health Commercial |
$9,404.29
|
Rate for Payer: Humana Commercial |
$8,414.36
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$8,117.38
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,305.65
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,969.78
|
Rate for Payer: Ohio Health Choice Commercial |
$8,711.34
|
Rate for Payer: Ohio Health Group HMO |
$7,424.44
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,979.85
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,286.90
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,068.77
|
Rate for Payer: PHCS Commercial |
$9,503.28
|
Rate for Payer: United Healthcare All Payer |
$8,711.34
|
|
SEPARATOR 3
|
Facility
|
IP
|
$4,702.50
|
|
Service Code
|
HCPCS C1757
|
Hospital Charge Code |
27000008
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$611.32 |
Max. Negotiated Rate |
$4,514.40 |
Rate for Payer: Aetna Commercial |
$3,620.92
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,667.95
|
Rate for Payer: Cash Price |
$2,351.25
|
Rate for Payer: Cigna Commercial |
$3,903.08
|
Rate for Payer: First Health Commercial |
$4,467.38
|
Rate for Payer: Humana Commercial |
$3,997.12
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$3,856.05
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,470.44
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,410.75
|
Rate for Payer: Ohio Health Choice Commercial |
$4,138.20
|
Rate for Payer: Ohio Health Group HMO |
$3,526.88
|
Rate for Payer: Ohio Health Group PPO Differential |
$940.50
|
Rate for Payer: Ohio Health Group PPO No Differential |
$611.32
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,457.78
|
Rate for Payer: PHCS Commercial |
$4,514.40
|
Rate for Payer: United Healthcare All Payer |
$4,138.20
|
|
SEPARATOR 3
|
Facility
|
OP
|
$4,702.50
|
|
Service Code
|
HCPCS C1757
|
Hospital Charge Code |
27000008
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$611.32 |
Max. Negotiated Rate |
$4,514.40 |
Rate for Payer: Aetna Commercial |
$3,620.92
|
Rate for Payer: Anthem Medicaid |
$1,617.19
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,667.95
|
Rate for Payer: Cash Price |
$2,351.25
|
Rate for Payer: Cigna Commercial |
$3,903.08
|
Rate for Payer: First Health Commercial |
$4,467.38
|
Rate for Payer: Humana Commercial |
$3,997.12
|
Rate for Payer: Humana KY Medicaid |
$1,617.19
|
Rate for Payer: Kentucky WC Medicaid |
$1,633.65
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$3,856.05
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,470.44
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,410.75
|
Rate for Payer: Molina Healthcare Medicaid |
$1,649.64
|
Rate for Payer: Ohio Health Choice Commercial |
$4,138.20
|
Rate for Payer: Ohio Health Group HMO |
$3,526.88
|
Rate for Payer: Ohio Health Group PPO Differential |
$940.50
|
Rate for Payer: Ohio Health Group PPO No Differential |
$611.32
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,457.78
|
Rate for Payer: PHCS Commercial |
$4,514.40
|
Rate for Payer: United Healthcare All Payer |
$4,138.20
|
|
SEPARATOR 4
|
Facility
|
IP
|
$5,280.00
|
|
Service Code
|
HCPCS C1757
|
Hospital Charge Code |
27000008
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$686.40 |
Max. Negotiated Rate |
$5,068.80 |
Rate for Payer: Aetna Commercial |
$4,065.60
|
Rate for Payer: Anthem POS/PPO/Traditional |
$4,118.40
|
Rate for Payer: Cash Price |
$2,640.00
|
Rate for Payer: Cigna Commercial |
$4,382.40
|
Rate for Payer: First Health Commercial |
$5,016.00
|
Rate for Payer: Humana Commercial |
$4,488.00
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,329.60
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,896.64
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,584.00
|
Rate for Payer: Ohio Health Choice Commercial |
$4,646.40
|
Rate for Payer: Ohio Health Group HMO |
$3,960.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,056.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$686.40
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,636.80
|
Rate for Payer: PHCS Commercial |
$5,068.80
|
Rate for Payer: United Healthcare All Payer |
$4,646.40
|
|
SEPARATOR 4
|
Facility
|
OP
|
$5,280.00
|
|
Service Code
|
HCPCS C1757
|
Hospital Charge Code |
27000008
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$686.40 |
Max. Negotiated Rate |
$5,068.80 |
Rate for Payer: Aetna Commercial |
$4,065.60
|
Rate for Payer: Anthem Medicaid |
$1,815.79
|
Rate for Payer: Anthem POS/PPO/Traditional |
$4,118.40
|
Rate for Payer: Cash Price |
$2,640.00
|
Rate for Payer: Cigna Commercial |
$4,382.40
|
Rate for Payer: First Health Commercial |
$5,016.00
|
Rate for Payer: Humana Commercial |
$4,488.00
|
Rate for Payer: Humana KY Medicaid |
$1,815.79
|
Rate for Payer: Kentucky WC Medicaid |
$1,834.27
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,329.60
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,896.64
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,584.00
|
Rate for Payer: Molina Healthcare Medicaid |
$1,852.22
|
Rate for Payer: Ohio Health Choice Commercial |
$4,646.40
|
Rate for Payer: Ohio Health Group HMO |
$3,960.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,056.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$686.40
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,636.80
|
Rate for Payer: PHCS Commercial |
$5,068.80
|
Rate for Payer: United Healthcare All Payer |
$4,646.40
|
|
SEPARATOR 5
|
Facility
|
OP
|
$4,702.50
|
|
Service Code
|
HCPCS C1757
|
Hospital Charge Code |
27000008
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$611.32 |
Max. Negotiated Rate |
$4,514.40 |
Rate for Payer: Aetna Commercial |
$3,620.92
|
Rate for Payer: Anthem Medicaid |
$1,617.19
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,667.95
|
Rate for Payer: Cash Price |
$2,351.25
|
Rate for Payer: Cigna Commercial |
$3,903.08
|
Rate for Payer: First Health Commercial |
$4,467.38
|
Rate for Payer: Humana Commercial |
$3,997.12
|
Rate for Payer: Humana KY Medicaid |
$1,617.19
|
Rate for Payer: Kentucky WC Medicaid |
$1,633.65
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$3,856.05
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,470.44
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,410.75
|
Rate for Payer: Molina Healthcare Medicaid |
$1,649.64
|
Rate for Payer: Ohio Health Choice Commercial |
$4,138.20
|
Rate for Payer: Ohio Health Group HMO |
$3,526.88
|
Rate for Payer: Ohio Health Group PPO Differential |
$940.50
|
Rate for Payer: Ohio Health Group PPO No Differential |
$611.32
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,457.78
|
Rate for Payer: PHCS Commercial |
$4,514.40
|
Rate for Payer: United Healthcare All Payer |
$4,138.20
|
|
SEPARATOR 5
|
Facility
|
IP
|
$4,702.50
|
|
Service Code
|
HCPCS C1757
|
Hospital Charge Code |
27000008
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$611.32 |
Max. Negotiated Rate |
$4,514.40 |
Rate for Payer: Aetna Commercial |
$3,620.92
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,667.95
|
Rate for Payer: Cash Price |
$2,351.25
|
Rate for Payer: Cigna Commercial |
$3,903.08
|
Rate for Payer: First Health Commercial |
$4,467.38
|
Rate for Payer: Humana Commercial |
$3,997.12
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$3,856.05
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,470.44
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,410.75
|
Rate for Payer: Ohio Health Choice Commercial |
$4,138.20
|
Rate for Payer: Ohio Health Group HMO |
$3,526.88
|
Rate for Payer: Ohio Health Group PPO Differential |
$940.50
|
Rate for Payer: Ohio Health Group PPO No Differential |
$611.32
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,457.78
|
Rate for Payer: PHCS Commercial |
$4,514.40
|
Rate for Payer: United Healthcare All Payer |
$4,138.20
|
|
SEPARATOR 7
|
Facility
|
IP
|
$8,932.00
|
|
Service Code
|
HCPCS C1757
|
Hospital Charge Code |
27000008
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$1,161.16 |
Max. Negotiated Rate |
$8,574.72 |
Rate for Payer: Aetna Commercial |
$6,877.64
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.96
|
Rate for Payer: Cash Price |
$4,466.00
|
Rate for Payer: Cigna Commercial |
$7,413.56
|
Rate for Payer: First Health Commercial |
$8,485.40
|
Rate for Payer: Humana Commercial |
$7,592.20
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$7,324.24
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.82
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.60
|
Rate for Payer: Ohio Health Choice Commercial |
$7,860.16
|
Rate for Payer: Ohio Health Group HMO |
$6,699.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,786.40
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.16
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.92
|
Rate for Payer: PHCS Commercial |
$8,574.72
|
Rate for Payer: United Healthcare All Payer |
$7,860.16
|
|
SEPARATOR 7
|
Facility
|
OP
|
$8,932.00
|
|
Service Code
|
HCPCS C1757
|
Hospital Charge Code |
27000008
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$1,161.16 |
Max. Negotiated Rate |
$8,574.72 |
Rate for Payer: Aetna Commercial |
$6,877.64
|
Rate for Payer: Anthem Medicaid |
$3,071.71
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.96
|
Rate for Payer: Cash Price |
$4,466.00
|
Rate for Payer: Cigna Commercial |
$7,413.56
|
Rate for Payer: First Health Commercial |
$8,485.40
|
Rate for Payer: Humana Commercial |
$7,592.20
|
Rate for Payer: Humana KY Medicaid |
$3,071.71
|
Rate for Payer: Kentucky WC Medicaid |
$3,102.98
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$7,324.24
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.82
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.60
|
Rate for Payer: Molina Healthcare Medicaid |
$3,133.35
|
Rate for Payer: Ohio Health Choice Commercial |
$7,860.16
|
Rate for Payer: Ohio Health Group HMO |
$6,699.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,786.40
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.16
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.92
|
Rate for Payer: PHCS Commercial |
$8,574.72
|
Rate for Payer: United Healthcare All Payer |
$7,860.16
|
|
SEPARATOR 7D
|
Facility
|
OP
|
$8,932.00
|
|
Service Code
|
HCPCS C1757
|
Hospital Charge Code |
27000008
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$1,161.16 |
Max. Negotiated Rate |
$8,574.72 |
Rate for Payer: Aetna Commercial |
$6,877.64
|
Rate for Payer: Anthem Medicaid |
$3,071.71
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.96
|
Rate for Payer: Cash Price |
$4,466.00
|
Rate for Payer: Cigna Commercial |
$7,413.56
|
Rate for Payer: First Health Commercial |
$8,485.40
|
Rate for Payer: Humana Commercial |
$7,592.20
|
Rate for Payer: Humana KY Medicaid |
$3,071.71
|
Rate for Payer: Kentucky WC Medicaid |
$3,102.98
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$7,324.24
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.82
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.60
|
Rate for Payer: Molina Healthcare Medicaid |
$3,133.35
|
Rate for Payer: Ohio Health Choice Commercial |
$7,860.16
|
Rate for Payer: Ohio Health Group HMO |
$6,699.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,786.40
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.16
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.92
|
Rate for Payer: PHCS Commercial |
$8,574.72
|
Rate for Payer: United Healthcare All Payer |
$7,860.16
|
|
SEPARATOR 7D
|
Facility
|
IP
|
$8,932.00
|
|
Service Code
|
HCPCS C1757
|
Hospital Charge Code |
27000008
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$1,161.16 |
Max. Negotiated Rate |
$8,574.72 |
Rate for Payer: Aetna Commercial |
$6,877.64
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.96
|
Rate for Payer: Cash Price |
$4,466.00
|
Rate for Payer: Cigna Commercial |
$7,413.56
|
Rate for Payer: First Health Commercial |
$8,485.40
|
Rate for Payer: Humana Commercial |
$7,592.20
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$7,324.24
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.82
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.60
|
Rate for Payer: Ohio Health Choice Commercial |
$7,860.16
|
Rate for Payer: Ohio Health Group HMO |
$6,699.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,786.40
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.16
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.92
|
Rate for Payer: PHCS Commercial |
$8,574.72
|
Rate for Payer: United Healthcare All Payer |
$7,860.16
|
|
SEP D
|
Facility
|
IP
|
$8,932.00
|
|
Service Code
|
HCPCS C1757
|
Hospital Charge Code |
27000008
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$1,161.16 |
Max. Negotiated Rate |
$8,574.72 |
Rate for Payer: Aetna Commercial |
$6,877.64
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.96
|
Rate for Payer: Cash Price |
$4,466.00
|
Rate for Payer: Cigna Commercial |
$7,413.56
|
Rate for Payer: First Health Commercial |
$8,485.40
|
Rate for Payer: Humana Commercial |
$7,592.20
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$7,324.24
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.82
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.60
|
Rate for Payer: Ohio Health Choice Commercial |
$7,860.16
|
Rate for Payer: Ohio Health Group HMO |
$6,699.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,786.40
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.16
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.92
|
Rate for Payer: PHCS Commercial |
$8,574.72
|
Rate for Payer: United Healthcare All Payer |
$7,860.16
|
|
SEP D
|
Facility
|
OP
|
$8,932.00
|
|
Service Code
|
HCPCS C1757
|
Hospital Charge Code |
27000008
|
Hospital Revenue Code
|
272
|
Min. Negotiated Rate |
$1,161.16 |
Max. Negotiated Rate |
$8,574.72 |
Rate for Payer: Aetna Commercial |
$6,877.64
|
Rate for Payer: Anthem Medicaid |
$3,071.71
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.96
|
Rate for Payer: Cash Price |
$4,466.00
|
Rate for Payer: Cigna Commercial |
$7,413.56
|
Rate for Payer: First Health Commercial |
$8,485.40
|
Rate for Payer: Humana Commercial |
$7,592.20
|
Rate for Payer: Humana KY Medicaid |
$3,071.71
|
Rate for Payer: Kentucky WC Medicaid |
$3,102.98
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$7,324.24
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.82
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.60
|
Rate for Payer: Molina Healthcare Medicaid |
$3,133.35
|
Rate for Payer: Ohio Health Choice Commercial |
$7,860.16
|
Rate for Payer: Ohio Health Group HMO |
$6,699.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,786.40
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.16
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.92
|
Rate for Payer: PHCS Commercial |
$8,574.72
|
Rate for Payer: United Healthcare All Payer |
$7,860.16
|
|
SEPTIC ARTHRITIS WITH CC
|
Facility
|
IP
|
$14,110.36
|
|
Service Code
|
MSDRG 549
|
Min. Negotiated Rate |
$9,574.89 |
Max. Negotiated Rate |
$14,110.36 |
Rate for Payer: Anthem Medicaid |
$9,574.89
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$10,078.83
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$14,110.36
|
Rate for Payer: CareSource Just4Me Medicare |
$13,606.42
|
Rate for Payer: Humana KY Medicaid |
$9,574.89
|
Rate for Payer: Humana Medicare Advantage |
$10,078.83
|
Rate for Payer: Kentucky WC Medicaid |
$9,670.64
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$12,094.60
|
Rate for Payer: Molina Healthcare Medicaid |
$9,766.39
|
|
SEPTIC ARTHRITIS WITH MCC
|
Facility
|
IP
|
$22,809.15
|
|
Service Code
|
MSDRG 548
|
Min. Negotiated Rate |
$15,477.64 |
Max. Negotiated Rate |
$22,809.15 |
Rate for Payer: Anthem Medicaid |
$15,477.64
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$16,292.25
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$22,809.15
|
Rate for Payer: CareSource Just4Me Medicare |
$21,994.54
|
Rate for Payer: Humana KY Medicaid |
$15,477.64
|
Rate for Payer: Humana Medicare Advantage |
$16,292.25
|
Rate for Payer: Kentucky WC Medicaid |
$15,632.41
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$19,550.70
|
Rate for Payer: Molina Healthcare Medicaid |
$15,787.19
|
|
SEPTIC ARTHRITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$11,037.25
|
|
Service Code
|
MSDRG 550
|
Min. Negotiated Rate |
$7,489.56 |
Max. Negotiated Rate |
$11,037.25 |
Rate for Payer: Anthem Medicaid |
$7,489.56
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$7,883.75
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$11,037.25
|
Rate for Payer: CareSource Just4Me Medicare |
$10,643.06
|
Rate for Payer: Humana KY Medicaid |
$7,489.56
|
Rate for Payer: Humana Medicare Advantage |
$7,883.75
|
Rate for Payer: Kentucky WC Medicaid |
$7,564.46
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$9,460.50
|
Rate for Payer: Molina Healthcare Medicaid |
$7,639.35
|
|
SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS
|
Facility
|
IP
|
$81,476.82
|
|
Service Code
|
MSDRG 870
|
Min. Negotiated Rate |
$55,287.84 |
Max. Negotiated Rate |
$81,476.82 |
Rate for Payer: Anthem Medicaid |
$55,287.84
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$58,197.73
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$81,476.82
|
Rate for Payer: CareSource Just4Me Medicare |
$78,566.94
|
Rate for Payer: Humana KY Medicaid |
$55,287.84
|
Rate for Payer: Humana Medicare Advantage |
$58,197.73
|
Rate for Payer: Kentucky WC Medicaid |
$55,840.72
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$69,837.28
|
Rate for Payer: Molina Healthcare Medicaid |
$56,393.60
|
|
SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC
|
Facility
|
IP
|
$23,192.88
|
|
Service Code
|
MSDRG 871
|
Min. Negotiated Rate |
$15,738.02 |
Max. Negotiated Rate |
$23,192.88 |
Rate for Payer: Anthem Medicaid |
$15,738.02
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$16,566.34
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$23,192.88
|
Rate for Payer: CareSource Just4Me Medicare |
$22,364.56
|
Rate for Payer: Humana KY Medicaid |
$15,738.02
|
Rate for Payer: Humana Medicare Advantage |
$16,566.34
|
Rate for Payer: Kentucky WC Medicaid |
$15,895.40
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$19,879.61
|
Rate for Payer: Molina Healthcare Medicaid |
$16,052.78
|
|
SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC
|
Facility
|
IP
|
$12,047.98
|
|
Service Code
|
MSDRG 872
|
Min. Negotiated Rate |
$8,175.42 |
Max. Negotiated Rate |
$12,047.98 |
Rate for Payer: Anthem Medicaid |
$8,175.42
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$8,605.70
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12,047.98
|
Rate for Payer: CareSource Just4Me Medicare |
$11,617.70
|
Rate for Payer: Humana KY Medicaid |
$8,175.42
|
Rate for Payer: Humana Medicare Advantage |
$8,605.70
|
Rate for Payer: Kentucky WC Medicaid |
$8,257.17
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$10,326.84
|
Rate for Payer: Molina Healthcare Medicaid |
$8,338.92
|
|
SEPTOPLASTY
|
Facility
|
IP
|
$1,800.00
|
|
Service Code
|
HCPCS 30520
|
Hospital Charge Code |
76101132
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$234.00 |
Max. Negotiated Rate |
$1,728.00 |
Rate for Payer: Aetna Commercial |
$1,386.00
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,404.00
|
Rate for Payer: Cash Price |
$900.00
|
Rate for Payer: Cigna Commercial |
$1,494.00
|
Rate for Payer: First Health Commercial |
$1,710.00
|
Rate for Payer: Humana Commercial |
$1,530.00
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,476.00
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,328.40
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$540.00
|
Rate for Payer: Ohio Health Choice Commercial |
$1,584.00
|
Rate for Payer: Ohio Health Group HMO |
$1,350.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$360.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$234.00
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$558.00
|
Rate for Payer: PHCS Commercial |
$1,728.00
|
Rate for Payer: United Healthcare All Payer |
$1,584.00
|
|
SEPTOPLASTY
|
Facility
|
OP
|
$1,800.00
|
|
Service Code
|
HCPCS 30520
|
Hospital Charge Code |
76101132
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$234.00 |
Max. Negotiated Rate |
$3,897.84 |
Rate for Payer: Aetna Commercial |
$1,386.00
|
Rate for Payer: Anthem Medicaid |
$619.02
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,404.00
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,897.84
|
Rate for Payer: CareSource Just4Me Medicare |
$3,758.63
|
Rate for Payer: Cash Price |
$900.00
|
Rate for Payer: Cash Price |
$900.00
|
Rate for Payer: Cigna Commercial |
$1,494.00
|
Rate for Payer: First Health Commercial |
$1,710.00
|
Rate for Payer: Humana Commercial |
$1,530.00
|
Rate for Payer: Humana KY Medicaid |
$619.02
|
Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
Rate for Payer: Kentucky WC Medicaid |
$625.32
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,476.00
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,328.40
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
Rate for Payer: Molina Healthcare Medicaid |
$631.44
|
Rate for Payer: Ohio Health Choice Commercial |
$1,584.00
|
Rate for Payer: Ohio Health Group HMO |
$1,350.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$360.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$234.00
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$558.00
|
Rate for Payer: PHCS Commercial |
$1,728.00
|
Rate for Payer: United Healthcare All Payer |
$1,584.00
|
|
SEPTOPLASTY
|
Professional
|
Both
|
$1,800.00
|
|
Service Code
|
HCPCS 30520
|
Hospital Charge Code |
76101132
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$376.62 |
Max. Negotiated Rate |
$1,800.00 |
Rate for Payer: Aetna Commercial |
$841.39
|
Rate for Payer: Anthem Medicaid |
$376.62
|
Rate for Payer: Buckeye Medicare Advantage |
$1,800.00
|
Rate for Payer: Cash Price |
$900.00
|
Rate for Payer: Cash Price |
$900.00
|
Rate for Payer: Cigna Commercial |
$787.50
|
Rate for Payer: Healthspan PPO |
$709.56
|
Rate for Payer: Humana Medicaid |
$376.62
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$777.45
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$384.15
|
Rate for Payer: Molina Healthcare Passport |
$376.62
|
Rate for Payer: Multiplan PHCS |
$1,080.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,260.00
|
Rate for Payer: UHCCP Medicaid |
$630.00
|
Rate for Payer: Wellcare CHIP/Medicaid |
$380.39
|
|
SEPTOPLASTY OR SUBMUCOUS RESECTION, WITH OR WITHOUT CARTILAGE SCORING, CONTOURING OR REPLACEMENT WITH GRAFT
|
Facility
|
OP
|
$3,897.84
|
|
Service Code
|
CPT 30520
|
Hospital Revenue Code
|
360
|
Min. Negotiated Rate |
$2,784.17 |
Max. Negotiated Rate |
$3,897.84 |
Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,897.84
|
Rate for Payer: CareSource Just4Me Medicare |
$3,758.63
|
Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
|