|
SET INTRODUCER 16FR
|
Facility
|
OP
|
$2,025.61
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$263.33 |
| Max. Negotiated Rate |
$1,944.59 |
| Rate for Payer: Aetna Commercial |
$1,559.72
|
| Rate for Payer: Anthem Medicaid |
$696.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,579.98
|
| Rate for Payer: Cash Price |
$1,012.80
|
| Rate for Payer: Cigna Commercial |
$1,681.26
|
| Rate for Payer: First Health Commercial |
$1,924.33
|
| Rate for Payer: Humana Commercial |
$1,721.77
|
| Rate for Payer: Humana KY Medicaid |
$696.61
|
| Rate for Payer: Kentucky WC Medicaid |
$703.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,661.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,494.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$607.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$710.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,782.54
|
| Rate for Payer: Ohio Health Group HMO |
$1,519.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$405.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$263.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$627.94
|
| Rate for Payer: PHCS Commercial |
$1,944.59
|
| Rate for Payer: United Healthcare All Payer |
$1,782.54
|
|
|
SET INTRODUCER 16FR
|
Facility
|
IP
|
$2,025.61
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$263.33 |
| Max. Negotiated Rate |
$1,944.59 |
| Rate for Payer: Aetna Commercial |
$1,559.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,579.98
|
| Rate for Payer: Cash Price |
$1,012.80
|
| Rate for Payer: Cigna Commercial |
$1,681.26
|
| Rate for Payer: First Health Commercial |
$1,924.33
|
| Rate for Payer: Humana Commercial |
$1,721.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,661.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,494.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$607.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,782.54
|
| Rate for Payer: Ohio Health Group HMO |
$1,519.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$405.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$263.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$627.94
|
| Rate for Payer: PHCS Commercial |
$1,944.59
|
| Rate for Payer: United Healthcare All Payer |
$1,782.54
|
|
|
SET RADIATION THPY FIELD
|
Facility
|
OP
|
$1,474.00
|
|
|
Service Code
|
HCPCS 77285
|
| Hospital Charge Code |
33300002
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$191.62 |
| Max. Negotiated Rate |
$1,415.04 |
| Rate for Payer: Aetna Commercial |
$1,134.98
|
| Rate for Payer: Anthem Medicaid |
$506.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$319.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,149.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$447.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$431.35
|
| Rate for Payer: Cash Price |
$737.00
|
| Rate for Payer: Cash Price |
$737.00
|
| Rate for Payer: Cigna Commercial |
$1,223.42
|
| Rate for Payer: First Health Commercial |
$1,400.30
|
| Rate for Payer: Humana Commercial |
$1,252.90
|
| Rate for Payer: Humana KY Medicaid |
$506.91
|
| Rate for Payer: Humana Medicare Advantage |
$319.52
|
| Rate for Payer: Kentucky WC Medicaid |
$512.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,208.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,087.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$383.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$517.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,297.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,105.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$294.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$191.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$456.94
|
| Rate for Payer: PHCS Commercial |
$1,415.04
|
| Rate for Payer: United Healthcare All Payer |
$1,297.12
|
|
|
SET RADIATION THPY FIELD
|
Facility
|
OP
|
$1,331.00
|
|
|
Service Code
|
HCPCS 77280
|
| Hospital Charge Code |
33300001
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$117.33 |
| Max. Negotiated Rate |
$1,277.76 |
| Rate for Payer: Aetna Commercial |
$1,024.87
|
| Rate for Payer: Anthem Medicaid |
$457.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$117.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,038.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$164.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$158.40
|
| Rate for Payer: Cash Price |
$665.50
|
| Rate for Payer: Cash Price |
$665.50
|
| Rate for Payer: Cigna Commercial |
$1,104.73
|
| Rate for Payer: First Health Commercial |
$1,264.45
|
| Rate for Payer: Humana Commercial |
$1,131.35
|
| Rate for Payer: Humana KY Medicaid |
$457.73
|
| Rate for Payer: Humana Medicare Advantage |
$117.33
|
| Rate for Payer: Kentucky WC Medicaid |
$462.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,091.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$982.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$140.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$466.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,171.28
|
| Rate for Payer: Ohio Health Group HMO |
$998.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$266.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$173.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$412.61
|
| Rate for Payer: PHCS Commercial |
$1,277.76
|
| Rate for Payer: United Healthcare All Payer |
$1,171.28
|
|
|
SET RADIATION THPY FIELD
|
Facility
|
IP
|
$1,474.00
|
|
|
Service Code
|
HCPCS 77285
|
| Hospital Charge Code |
33300002
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$191.62 |
| Max. Negotiated Rate |
$1,415.04 |
| Rate for Payer: Aetna Commercial |
$1,134.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,149.72
|
| Rate for Payer: Cash Price |
$737.00
|
| Rate for Payer: Cigna Commercial |
$1,223.42
|
| Rate for Payer: First Health Commercial |
$1,400.30
|
| Rate for Payer: Humana Commercial |
$1,252.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,208.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,087.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,297.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,105.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$294.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$191.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$456.94
|
| Rate for Payer: PHCS Commercial |
$1,415.04
|
| Rate for Payer: United Healthcare All Payer |
$1,297.12
|
|
|
SET RADIATION THPY FIELD
|
Facility
|
IP
|
$1,331.00
|
|
|
Service Code
|
HCPCS 77280
|
| Hospital Charge Code |
33300001
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$173.03 |
| Max. Negotiated Rate |
$1,277.76 |
| Rate for Payer: Aetna Commercial |
$1,024.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,038.18
|
| Rate for Payer: Cash Price |
$665.50
|
| Rate for Payer: Cigna Commercial |
$1,104.73
|
| Rate for Payer: First Health Commercial |
$1,264.45
|
| Rate for Payer: Humana Commercial |
$1,131.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,091.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$982.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,171.28
|
| Rate for Payer: Ohio Health Group HMO |
$998.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$266.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$173.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$412.61
|
| Rate for Payer: PHCS Commercial |
$1,277.76
|
| Rate for Payer: United Healthcare All Payer |
$1,171.28
|
|
|
SET RADIATION THPY FIELD
|
Professional
|
Both
|
$1,474.00
|
|
|
Service Code
|
HCPCS 77285
|
| Hospital Charge Code |
33300002
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$66.95 |
| Max. Negotiated Rate |
$1,474.00 |
| Rate for Payer: Aetna Commercial |
$481.57
|
| Rate for Payer: Anthem Medicaid |
$195.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,474.00
|
| Rate for Payer: Cash Price |
$737.00
|
| Rate for Payer: Cash Price |
$737.00
|
| Rate for Payer: Cigna Commercial |
$431.01
|
| Rate for Payer: Healthspan PPO |
$406.12
|
| Rate for Payer: Humana Medicaid |
$195.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$66.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$199.44
|
| Rate for Payer: Molina Healthcare Passport |
$195.53
|
| Rate for Payer: Multiplan PHCS |
$884.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,031.80
|
| Rate for Payer: UHCCP Medicaid |
$515.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$197.49
|
|
|
SET RADIATION THPY FIELD
|
Professional
|
Both
|
$1,331.00
|
|
|
Service Code
|
HCPCS 77280
|
| Hospital Charge Code |
33300001
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$44.44 |
| Max. Negotiated Rate |
$1,331.00 |
| Rate for Payer: Aetna Commercial |
$280.32
|
| Rate for Payer: Anthem Medicaid |
$124.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,331.00
|
| Rate for Payer: Cash Price |
$665.50
|
| Rate for Payer: Cash Price |
$665.50
|
| Rate for Payer: Cigna Commercial |
$264.17
|
| Rate for Payer: Healthspan PPO |
$236.40
|
| Rate for Payer: Humana Medicaid |
$124.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$44.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$126.70
|
| Rate for Payer: Molina Healthcare Passport |
$124.22
|
| Rate for Payer: Multiplan PHCS |
$798.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$931.70
|
| Rate for Payer: UHCCP Medicaid |
$465.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$125.46
|
|
|
SET RADIATION THPY FIELD(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 77280
|
| Hospital Charge Code |
333P0001
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$44.44 |
| Max. Negotiated Rate |
$280.32 |
| Rate for Payer: Aetna Commercial |
$280.32
|
| Rate for Payer: Anthem Medicaid |
$124.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$200.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$264.17
|
| Rate for Payer: Healthspan PPO |
$236.40
|
| Rate for Payer: Humana Medicaid |
$124.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$44.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$126.70
|
| Rate for Payer: Molina Healthcare Passport |
$124.22
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$140.00
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$125.46
|
|
|
SET RADIATION THPY FIELD(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 77285
|
| Hospital Charge Code |
333P0002
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$66.95 |
| Max. Negotiated Rate |
$481.57 |
| Rate for Payer: Aetna Commercial |
$481.57
|
| Rate for Payer: Anthem Medicaid |
$195.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$250.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$431.01
|
| Rate for Payer: Healthspan PPO |
$406.12
|
| Rate for Payer: Humana Medicaid |
$195.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$66.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$199.44
|
| Rate for Payer: Molina Healthcare Passport |
$195.53
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$197.49
|
|
|
SET RADIATION THPY FIELD(T
|
Facility
|
OP
|
$1,131.00
|
|
|
Service Code
|
HCPCS 77280
|
| Hospital Charge Code |
333T0001
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$117.33 |
| Max. Negotiated Rate |
$1,085.76 |
| Rate for Payer: Aetna Commercial |
$870.87
|
| Rate for Payer: Anthem Medicaid |
$388.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$117.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$882.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$164.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$158.40
|
| Rate for Payer: Cash Price |
$565.50
|
| Rate for Payer: Cash Price |
$565.50
|
| Rate for Payer: Cigna Commercial |
$938.73
|
| Rate for Payer: First Health Commercial |
$1,074.45
|
| Rate for Payer: Humana Commercial |
$961.35
|
| Rate for Payer: Humana KY Medicaid |
$388.95
|
| Rate for Payer: Humana Medicare Advantage |
$117.33
|
| Rate for Payer: Kentucky WC Medicaid |
$392.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$927.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$834.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$140.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$396.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$995.28
|
| Rate for Payer: Ohio Health Group HMO |
$848.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$226.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$147.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$350.61
|
| Rate for Payer: PHCS Commercial |
$1,085.76
|
| Rate for Payer: United Healthcare All Payer |
$995.28
|
|
|
SET RADIATION THPY FIELD(T
|
Facility
|
OP
|
$1,224.00
|
|
|
Service Code
|
HCPCS 77285
|
| Hospital Charge Code |
333T0002
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$159.12 |
| Max. Negotiated Rate |
$1,175.04 |
| Rate for Payer: Aetna Commercial |
$942.48
|
| Rate for Payer: Anthem Medicaid |
$420.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$319.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$954.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$447.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$431.35
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cigna Commercial |
$1,015.92
|
| Rate for Payer: First Health Commercial |
$1,162.80
|
| Rate for Payer: Humana Commercial |
$1,040.40
|
| Rate for Payer: Humana KY Medicaid |
$420.93
|
| Rate for Payer: Humana Medicare Advantage |
$319.52
|
| Rate for Payer: Kentucky WC Medicaid |
$425.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,003.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$903.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$383.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$429.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,077.12
|
| Rate for Payer: Ohio Health Group HMO |
$918.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$244.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$159.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$379.44
|
| Rate for Payer: PHCS Commercial |
$1,175.04
|
| Rate for Payer: United Healthcare All Payer |
$1,077.12
|
|
|
SET RADIATION THPY FIELD(T
|
Facility
|
IP
|
$1,224.00
|
|
|
Service Code
|
HCPCS 77285
|
| Hospital Charge Code |
333T0002
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$159.12 |
| Max. Negotiated Rate |
$1,175.04 |
| Rate for Payer: Aetna Commercial |
$942.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$954.72
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cigna Commercial |
$1,015.92
|
| Rate for Payer: First Health Commercial |
$1,162.80
|
| Rate for Payer: Humana Commercial |
$1,040.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,003.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$903.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$367.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,077.12
|
| Rate for Payer: Ohio Health Group HMO |
$918.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$244.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$159.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$379.44
|
| Rate for Payer: PHCS Commercial |
$1,175.04
|
| Rate for Payer: United Healthcare All Payer |
$1,077.12
|
|
|
SET RADIATION THPY FIELD(T
|
Facility
|
IP
|
$1,131.00
|
|
|
Service Code
|
HCPCS 77280
|
| Hospital Charge Code |
333T0001
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$147.03 |
| Max. Negotiated Rate |
$1,085.76 |
| Rate for Payer: Aetna Commercial |
$870.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$882.18
|
| Rate for Payer: Cash Price |
$565.50
|
| Rate for Payer: Cigna Commercial |
$938.73
|
| Rate for Payer: First Health Commercial |
$1,074.45
|
| Rate for Payer: Humana Commercial |
$961.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$927.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$834.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$339.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$995.28
|
| Rate for Payer: Ohio Health Group HMO |
$848.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$226.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$147.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$350.61
|
| Rate for Payer: PHCS Commercial |
$1,085.76
|
| Rate for Payer: United Healthcare All Payer |
$995.28
|
|
|
SGMDSC W/BAND LIGATION
|
Professional
|
Both
|
$305.00
|
|
|
Service Code
|
HCPCS 45350
|
| Hospital Charge Code |
76101890
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$86.37 |
| Max. Negotiated Rate |
$305.00 |
| Rate for Payer: Anthem Medicaid |
$86.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$305.00
|
| Rate for Payer: Cash Price |
$152.50
|
| Rate for Payer: Cash Price |
$152.50
|
| Rate for Payer: Humana Medicaid |
$86.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$149.84
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$88.10
|
| Rate for Payer: Molina Healthcare Passport |
$86.37
|
| Rate for Payer: Multiplan PHCS |
$183.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$213.50
|
| Rate for Payer: UHCCP Medicaid |
$106.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$87.23
|
|
|
SGMDSC W/BAND LIGATION
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
HCPCS 45350
|
| Hospital Charge Code |
76101890
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$39.65 |
| Max. Negotiated Rate |
$1,428.66 |
| Rate for Payer: Aetna Commercial |
$234.85
|
| Rate for Payer: Anthem Medicaid |
$104.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,020.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$237.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,428.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,377.63
|
| Rate for Payer: Cash Price |
$152.50
|
| Rate for Payer: Cash Price |
$152.50
|
| Rate for Payer: Cigna Commercial |
$253.15
|
| Rate for Payer: First Health Commercial |
$289.75
|
| Rate for Payer: Humana Commercial |
$259.25
|
| Rate for Payer: Humana KY Medicaid |
$104.89
|
| Rate for Payer: Humana Medicare Advantage |
$1,020.47
|
| Rate for Payer: Kentucky WC Medicaid |
$105.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$250.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$225.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,224.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$106.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$268.40
|
| Rate for Payer: Ohio Health Group HMO |
$228.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$94.55
|
| Rate for Payer: PHCS Commercial |
$292.80
|
| Rate for Payer: United Healthcare All Payer |
$268.40
|
|
|
SGMDSC W/BAND LIGATION
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
HCPCS 45350
|
| Hospital Charge Code |
76101890
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$39.65 |
| Max. Negotiated Rate |
$292.80 |
| Rate for Payer: Aetna Commercial |
$234.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$237.90
|
| Rate for Payer: Cash Price |
$152.50
|
| Rate for Payer: Cigna Commercial |
$253.15
|
| Rate for Payer: First Health Commercial |
$289.75
|
| Rate for Payer: Humana Commercial |
$259.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$250.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$225.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$91.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$268.40
|
| Rate for Payer: Ohio Health Group HMO |
$228.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$94.55
|
| Rate for Payer: PHCS Commercial |
$292.80
|
| Rate for Payer: United Healthcare All Payer |
$268.40
|
|
|
SGMDSC W/BAND LIGATION(P
|
Professional
|
Both
|
$305.00
|
|
|
Service Code
|
HCPCS 45350
|
| Hospital Charge Code |
761P1890
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$86.37 |
| Max. Negotiated Rate |
$305.00 |
| Rate for Payer: Anthem Medicaid |
$86.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$305.00
|
| Rate for Payer: Cash Price |
$152.50
|
| Rate for Payer: Cash Price |
$152.50
|
| Rate for Payer: Humana Medicaid |
$86.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$149.84
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$88.10
|
| Rate for Payer: Molina Healthcare Passport |
$86.37
|
| Rate for Payer: Multiplan PHCS |
$183.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$213.50
|
| Rate for Payer: UHCCP Medicaid |
$106.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$87.23
|
|
|
SGMNTL FEM/TIB MALE-MALE 200MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
SGMNTL FEM/TIB MALE-MALE 200MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
SGMNTL FEM/TIB MALE-MALE 80MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
SGMNTL FEM/TIB MALE-MALE 80MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
SGMNTL FEM/TIB MALE-MALE 90MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
SGMNTL FEM/TIB MALE-MALE 90MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
SGMNTL FEM/TIB MAL-FEM 100MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
