|
BIO-MOD 48*19MM EAS HD
|
Facility
|
OP
|
$9,848.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,280.26 |
| Max. Negotiated Rate |
$9,454.22 |
| Rate for Payer: Aetna Commercial |
$7,583.08
|
| Rate for Payer: Anthem Medicaid |
$3,386.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,681.56
|
| Rate for Payer: Cash Price |
$4,924.08
|
| Rate for Payer: Cigna Commercial |
$8,173.96
|
| Rate for Payer: First Health Commercial |
$9,355.74
|
| Rate for Payer: Humana Commercial |
$8,370.93
|
| Rate for Payer: Humana KY Medicaid |
$3,386.78
|
| Rate for Payer: Kentucky WC Medicaid |
$3,421.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,075.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,267.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,954.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,454.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,666.37
|
| Rate for Payer: Ohio Health Group HMO |
$7,386.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,969.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,280.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,052.93
|
| Rate for Payer: PHCS Commercial |
$9,454.22
|
| Rate for Payer: United Healthcare All Payer |
$8,666.37
|
|
|
BIO-MOD 48*24MM EAS HD
|
Facility
|
IP
|
$9,848.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,280.26 |
| Max. Negotiated Rate |
$9,454.22 |
| Rate for Payer: Aetna Commercial |
$7,583.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,681.56
|
| Rate for Payer: Cash Price |
$4,924.08
|
| Rate for Payer: Cigna Commercial |
$8,173.96
|
| Rate for Payer: First Health Commercial |
$9,355.74
|
| Rate for Payer: Humana Commercial |
$8,370.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,075.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,267.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,954.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,666.37
|
| Rate for Payer: Ohio Health Group HMO |
$7,386.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,969.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,280.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,052.93
|
| Rate for Payer: PHCS Commercial |
$9,454.22
|
| Rate for Payer: United Healthcare All Payer |
$8,666.37
|
|
|
BIO-MOD 48*24MM EAS HD
|
Facility
|
OP
|
$9,848.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,280.26 |
| Max. Negotiated Rate |
$9,454.22 |
| Rate for Payer: Aetna Commercial |
$7,583.08
|
| Rate for Payer: Anthem Medicaid |
$3,386.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,681.56
|
| Rate for Payer: Cash Price |
$4,924.08
|
| Rate for Payer: Cigna Commercial |
$8,173.96
|
| Rate for Payer: First Health Commercial |
$9,355.74
|
| Rate for Payer: Humana Commercial |
$8,370.93
|
| Rate for Payer: Humana KY Medicaid |
$3,386.78
|
| Rate for Payer: Kentucky WC Medicaid |
$3,421.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,075.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,267.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,954.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,454.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,666.37
|
| Rate for Payer: Ohio Health Group HMO |
$7,386.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,969.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,280.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,052.93
|
| Rate for Payer: PHCS Commercial |
$9,454.22
|
| Rate for Payer: United Healthcare All Payer |
$8,666.37
|
|
|
BIO-MOD 54*22MM EAS HD
|
Facility
|
IP
|
$9,848.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,280.26 |
| Max. Negotiated Rate |
$9,454.22 |
| Rate for Payer: Aetna Commercial |
$7,583.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,681.56
|
| Rate for Payer: Cash Price |
$4,924.08
|
| Rate for Payer: Cigna Commercial |
$8,173.96
|
| Rate for Payer: First Health Commercial |
$9,355.74
|
| Rate for Payer: Humana Commercial |
$8,370.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,075.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,267.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,954.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,666.37
|
| Rate for Payer: Ohio Health Group HMO |
$7,386.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,969.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,280.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,052.93
|
| Rate for Payer: PHCS Commercial |
$9,454.22
|
| Rate for Payer: United Healthcare All Payer |
$8,666.37
|
|
|
BIO-MOD 54*22MM EAS HD
|
Facility
|
OP
|
$9,848.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,280.26 |
| Max. Negotiated Rate |
$9,454.22 |
| Rate for Payer: Aetna Commercial |
$7,583.08
|
| Rate for Payer: Anthem Medicaid |
$3,386.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,681.56
|
| Rate for Payer: Cash Price |
$4,924.08
|
| Rate for Payer: Cigna Commercial |
$8,173.96
|
| Rate for Payer: First Health Commercial |
$9,355.74
|
| Rate for Payer: Humana Commercial |
$8,370.93
|
| Rate for Payer: Humana KY Medicaid |
$3,386.78
|
| Rate for Payer: Kentucky WC Medicaid |
$3,421.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,075.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,267.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,954.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,454.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,666.37
|
| Rate for Payer: Ohio Health Group HMO |
$7,386.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,969.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,280.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,052.93
|
| Rate for Payer: PHCS Commercial |
$9,454.22
|
| Rate for Payer: United Healthcare All Payer |
$8,666.37
|
|
|
BIO-MOD 54*24MM EAS HD
|
Facility
|
OP
|
$9,848.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,280.26 |
| Max. Negotiated Rate |
$9,454.22 |
| Rate for Payer: Aetna Commercial |
$7,583.08
|
| Rate for Payer: Anthem Medicaid |
$3,386.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,681.56
|
| Rate for Payer: Cash Price |
$4,924.08
|
| Rate for Payer: Cigna Commercial |
$8,173.96
|
| Rate for Payer: First Health Commercial |
$9,355.74
|
| Rate for Payer: Humana Commercial |
$8,370.93
|
| Rate for Payer: Humana KY Medicaid |
$3,386.78
|
| Rate for Payer: Kentucky WC Medicaid |
$3,421.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,075.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,267.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,954.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,454.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,666.37
|
| Rate for Payer: Ohio Health Group HMO |
$7,386.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,969.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,280.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,052.93
|
| Rate for Payer: PHCS Commercial |
$9,454.22
|
| Rate for Payer: United Healthcare All Payer |
$8,666.37
|
|
|
BIO-MOD 54*24MM EAS HD
|
Facility
|
IP
|
$9,848.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,280.26 |
| Max. Negotiated Rate |
$9,454.22 |
| Rate for Payer: Aetna Commercial |
$7,583.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,681.56
|
| Rate for Payer: Cash Price |
$4,924.08
|
| Rate for Payer: Cigna Commercial |
$8,173.96
|
| Rate for Payer: First Health Commercial |
$9,355.74
|
| Rate for Payer: Humana Commercial |
$8,370.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,075.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,267.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,954.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,666.37
|
| Rate for Payer: Ohio Health Group HMO |
$7,386.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,969.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,280.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,052.93
|
| Rate for Payer: PHCS Commercial |
$9,454.22
|
| Rate for Payer: United Healthcare All Payer |
$8,666.37
|
|
|
BIO-MOD GLEN KEEL ALLPLY LG 4M
|
Facility
|
OP
|
$8,150.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,059.62 |
| Max. Negotiated Rate |
$7,824.86 |
| Rate for Payer: Aetna Commercial |
$6,276.19
|
| Rate for Payer: Anthem Medicaid |
$2,803.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,357.70
|
| Rate for Payer: Cash Price |
$4,075.45
|
| Rate for Payer: Cigna Commercial |
$6,765.25
|
| Rate for Payer: First Health Commercial |
$7,743.36
|
| Rate for Payer: Humana Commercial |
$6,928.26
|
| Rate for Payer: Humana KY Medicaid |
$2,803.09
|
| Rate for Payer: Kentucky WC Medicaid |
$2,831.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,683.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,015.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,445.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,859.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,172.79
|
| Rate for Payer: Ohio Health Group HMO |
$6,113.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,630.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,059.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,526.78
|
| Rate for Payer: PHCS Commercial |
$7,824.86
|
| Rate for Payer: United Healthcare All Payer |
$7,172.79
|
|
|
BIO-MOD GLEN KEEL ALLPLY LG 4M
|
Facility
|
IP
|
$8,150.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,059.62 |
| Max. Negotiated Rate |
$7,824.86 |
| Rate for Payer: Aetna Commercial |
$6,276.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,357.70
|
| Rate for Payer: Cash Price |
$4,075.45
|
| Rate for Payer: Cigna Commercial |
$6,765.25
|
| Rate for Payer: First Health Commercial |
$7,743.36
|
| Rate for Payer: Humana Commercial |
$6,928.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,683.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,015.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,445.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,172.79
|
| Rate for Payer: Ohio Health Group HMO |
$6,113.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,630.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,059.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,526.78
|
| Rate for Payer: PHCS Commercial |
$7,824.86
|
| Rate for Payer: United Healthcare All Payer |
$7,172.79
|
|
|
BIO-MOD GLEN KEEL ALLPLY LG 7M
|
Facility
|
IP
|
$8,150.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,059.62 |
| Max. Negotiated Rate |
$7,824.86 |
| Rate for Payer: Aetna Commercial |
$6,276.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,357.70
|
| Rate for Payer: Cash Price |
$4,075.45
|
| Rate for Payer: Cigna Commercial |
$6,765.25
|
| Rate for Payer: First Health Commercial |
$7,743.36
|
| Rate for Payer: Humana Commercial |
$6,928.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,683.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,015.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,445.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,172.79
|
| Rate for Payer: Ohio Health Group HMO |
$6,113.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,630.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,059.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,526.78
|
| Rate for Payer: PHCS Commercial |
$7,824.86
|
| Rate for Payer: United Healthcare All Payer |
$7,172.79
|
|
|
BIO-MOD GLEN KEEL ALLPLY LG 7M
|
Facility
|
OP
|
$8,150.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,059.62 |
| Max. Negotiated Rate |
$7,824.86 |
| Rate for Payer: Aetna Commercial |
$6,276.19
|
| Rate for Payer: Anthem Medicaid |
$2,803.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,357.70
|
| Rate for Payer: Cash Price |
$4,075.45
|
| Rate for Payer: Cigna Commercial |
$6,765.25
|
| Rate for Payer: First Health Commercial |
$7,743.36
|
| Rate for Payer: Humana Commercial |
$6,928.26
|
| Rate for Payer: Humana KY Medicaid |
$2,803.09
|
| Rate for Payer: Kentucky WC Medicaid |
$2,831.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,683.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,015.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,445.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,859.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,172.79
|
| Rate for Payer: Ohio Health Group HMO |
$6,113.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,630.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,059.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,526.78
|
| Rate for Payer: PHCS Commercial |
$7,824.86
|
| Rate for Payer: United Healthcare All Payer |
$7,172.79
|
|
|
BIO-MOD GLEN KEEL ALLPLY MD 4M
|
Facility
|
IP
|
$8,150.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,059.62 |
| Max. Negotiated Rate |
$7,824.86 |
| Rate for Payer: Aetna Commercial |
$6,276.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,357.70
|
| Rate for Payer: Cash Price |
$4,075.45
|
| Rate for Payer: Cigna Commercial |
$6,765.25
|
| Rate for Payer: First Health Commercial |
$7,743.36
|
| Rate for Payer: Humana Commercial |
$6,928.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,683.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,015.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,445.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,172.79
|
| Rate for Payer: Ohio Health Group HMO |
$6,113.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,630.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,059.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,526.78
|
| Rate for Payer: PHCS Commercial |
$7,824.86
|
| Rate for Payer: United Healthcare All Payer |
$7,172.79
|
|
|
BIO-MOD GLEN KEEL ALLPLY MD 4M
|
Facility
|
OP
|
$8,150.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,059.62 |
| Max. Negotiated Rate |
$7,824.86 |
| Rate for Payer: Aetna Commercial |
$6,276.19
|
| Rate for Payer: Anthem Medicaid |
$2,803.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,357.70
|
| Rate for Payer: Cash Price |
$4,075.45
|
| Rate for Payer: Cigna Commercial |
$6,765.25
|
| Rate for Payer: First Health Commercial |
$7,743.36
|
| Rate for Payer: Humana Commercial |
$6,928.26
|
| Rate for Payer: Humana KY Medicaid |
$2,803.09
|
| Rate for Payer: Kentucky WC Medicaid |
$2,831.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,683.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,015.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,445.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,859.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,172.79
|
| Rate for Payer: Ohio Health Group HMO |
$6,113.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,630.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,059.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,526.78
|
| Rate for Payer: PHCS Commercial |
$7,824.86
|
| Rate for Payer: United Healthcare All Payer |
$7,172.79
|
|
|
BIO-MOD GLEN KEEL ALLPLY MD 7M
|
Facility
|
IP
|
$8,150.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,059.62 |
| Max. Negotiated Rate |
$7,824.86 |
| Rate for Payer: Aetna Commercial |
$6,276.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,357.70
|
| Rate for Payer: Cash Price |
$4,075.45
|
| Rate for Payer: Cigna Commercial |
$6,765.25
|
| Rate for Payer: First Health Commercial |
$7,743.36
|
| Rate for Payer: Humana Commercial |
$6,928.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,683.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,015.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,445.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,172.79
|
| Rate for Payer: Ohio Health Group HMO |
$6,113.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,630.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,059.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,526.78
|
| Rate for Payer: PHCS Commercial |
$7,824.86
|
| Rate for Payer: United Healthcare All Payer |
$7,172.79
|
|
|
BIO-MOD GLEN KEEL ALLPLY MD 7M
|
Facility
|
OP
|
$8,150.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,059.62 |
| Max. Negotiated Rate |
$7,824.86 |
| Rate for Payer: Aetna Commercial |
$6,276.19
|
| Rate for Payer: Anthem Medicaid |
$2,803.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,357.70
|
| Rate for Payer: Cash Price |
$4,075.45
|
| Rate for Payer: Cigna Commercial |
$6,765.25
|
| Rate for Payer: First Health Commercial |
$7,743.36
|
| Rate for Payer: Humana Commercial |
$6,928.26
|
| Rate for Payer: Humana KY Medicaid |
$2,803.09
|
| Rate for Payer: Kentucky WC Medicaid |
$2,831.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,683.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,015.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,445.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,859.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,172.79
|
| Rate for Payer: Ohio Health Group HMO |
$6,113.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,630.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,059.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,526.78
|
| Rate for Payer: PHCS Commercial |
$7,824.86
|
| Rate for Payer: United Healthcare All Payer |
$7,172.79
|
|
|
BIO-MOD GLEN KEEL ALLPLY SM 4M
|
Facility
|
OP
|
$8,150.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,059.62 |
| Max. Negotiated Rate |
$7,824.86 |
| Rate for Payer: Aetna Commercial |
$6,276.19
|
| Rate for Payer: Anthem Medicaid |
$2,803.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,357.70
|
| Rate for Payer: Cash Price |
$4,075.45
|
| Rate for Payer: Cigna Commercial |
$6,765.25
|
| Rate for Payer: First Health Commercial |
$7,743.36
|
| Rate for Payer: Humana Commercial |
$6,928.26
|
| Rate for Payer: Humana KY Medicaid |
$2,803.09
|
| Rate for Payer: Kentucky WC Medicaid |
$2,831.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,683.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,015.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,445.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,859.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,172.79
|
| Rate for Payer: Ohio Health Group HMO |
$6,113.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,630.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,059.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,526.78
|
| Rate for Payer: PHCS Commercial |
$7,824.86
|
| Rate for Payer: United Healthcare All Payer |
$7,172.79
|
|
|
BIO-MOD GLEN KEEL ALLPLY SM 4M
|
Facility
|
IP
|
$8,150.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,059.62 |
| Max. Negotiated Rate |
$7,824.86 |
| Rate for Payer: Aetna Commercial |
$6,276.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,357.70
|
| Rate for Payer: Cash Price |
$4,075.45
|
| Rate for Payer: Cigna Commercial |
$6,765.25
|
| Rate for Payer: First Health Commercial |
$7,743.36
|
| Rate for Payer: Humana Commercial |
$6,928.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,683.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,015.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,445.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,172.79
|
| Rate for Payer: Ohio Health Group HMO |
$6,113.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,630.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,059.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,526.78
|
| Rate for Payer: PHCS Commercial |
$7,824.86
|
| Rate for Payer: United Healthcare All Payer |
$7,172.79
|
|
|
BIO-MOD GLEN KEEL ALLPLY SM 7M
|
Facility
|
IP
|
$8,150.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,059.62 |
| Max. Negotiated Rate |
$7,824.86 |
| Rate for Payer: Aetna Commercial |
$6,276.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,357.70
|
| Rate for Payer: Cash Price |
$4,075.45
|
| Rate for Payer: Cigna Commercial |
$6,765.25
|
| Rate for Payer: First Health Commercial |
$7,743.36
|
| Rate for Payer: Humana Commercial |
$6,928.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,683.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,015.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,445.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,172.79
|
| Rate for Payer: Ohio Health Group HMO |
$6,113.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,630.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,059.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,526.78
|
| Rate for Payer: PHCS Commercial |
$7,824.86
|
| Rate for Payer: United Healthcare All Payer |
$7,172.79
|
|
|
BIO-MOD GLEN KEEL ALLPLY SM 7M
|
Facility
|
OP
|
$8,150.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,059.62 |
| Max. Negotiated Rate |
$7,824.86 |
| Rate for Payer: Aetna Commercial |
$6,276.19
|
| Rate for Payer: Anthem Medicaid |
$2,803.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,357.70
|
| Rate for Payer: Cash Price |
$4,075.45
|
| Rate for Payer: Cigna Commercial |
$6,765.25
|
| Rate for Payer: First Health Commercial |
$7,743.36
|
| Rate for Payer: Humana Commercial |
$6,928.26
|
| Rate for Payer: Humana KY Medicaid |
$2,803.09
|
| Rate for Payer: Kentucky WC Medicaid |
$2,831.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,683.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,015.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,445.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,859.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,172.79
|
| Rate for Payer: Ohio Health Group HMO |
$6,113.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,630.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,059.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,526.78
|
| Rate for Payer: PHCS Commercial |
$7,824.86
|
| Rate for Payer: United Healthcare All Payer |
$7,172.79
|
|
|
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC
|
Facility
|
IP
|
$27,884.99
|
|
|
Service Code
|
MSDRG 478
|
| Min. Negotiated Rate |
$18,921.96 |
| Max. Negotiated Rate |
$27,884.99 |
| Rate for Payer: Anthem Medicaid |
$18,921.96
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$19,917.85
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$27,884.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$26,889.10
|
| Rate for Payer: Humana KY Medicaid |
$18,921.96
|
| Rate for Payer: Humana Medicare Advantage |
$19,917.85
|
| Rate for Payer: Kentucky WC Medicaid |
$19,111.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,901.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$19,300.40
|
|
|
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC
|
Facility
|
IP
|
$39,411.25
|
|
|
Service Code
|
MSDRG 477
|
| Min. Negotiated Rate |
$26,743.35 |
| Max. Negotiated Rate |
$39,411.25 |
| Rate for Payer: Anthem Medicaid |
$26,743.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$28,150.89
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$39,411.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$38,003.70
|
| Rate for Payer: Humana KY Medicaid |
$26,743.35
|
| Rate for Payer: Humana Medicare Advantage |
$28,150.89
|
| Rate for Payer: Kentucky WC Medicaid |
$27,010.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33,781.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,278.21
|
|
|
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC
|
Facility
|
IP
|
$21,805.43
|
|
|
Service Code
|
MSDRG 479
|
| Min. Negotiated Rate |
$14,796.54 |
| Max. Negotiated Rate |
$21,805.43 |
| Rate for Payer: Anthem Medicaid |
$14,796.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15,575.31
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21,805.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$21,026.67
|
| Rate for Payer: Humana KY Medicaid |
$14,796.54
|
| Rate for Payer: Humana Medicare Advantage |
$15,575.31
|
| Rate for Payer: Kentucky WC Medicaid |
$14,944.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18,690.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$15,092.48
|
|
|
BIOPSY - ABD. MASS - PERCU.NEE
|
Facility
|
IP
|
$1,966.00
|
|
|
Service Code
|
HCPCS 49180
|
| Hospital Charge Code |
761T1981
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$255.58 |
| Max. Negotiated Rate |
$1,887.36 |
| Rate for Payer: Aetna Commercial |
$1,513.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,533.48
|
| Rate for Payer: Cash Price |
$983.00
|
| Rate for Payer: Cigna Commercial |
$1,631.78
|
| Rate for Payer: First Health Commercial |
$1,867.70
|
| Rate for Payer: Humana Commercial |
$1,671.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,612.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,450.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$589.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,730.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,474.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$393.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$255.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$609.46
|
| Rate for Payer: PHCS Commercial |
$1,887.36
|
| Rate for Payer: United Healthcare All Payer |
$1,730.08
|
|
|
BIOPSY - ABD. MASS - PERCU.NEE
|
Facility
|
OP
|
$2,466.00
|
|
|
Service Code
|
HCPCS 49180
|
| Hospital Charge Code |
76101981
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$320.58 |
| Max. Negotiated Rate |
$2,367.36 |
| Rate for Payer: Aetna Commercial |
$1,898.82
|
| Rate for Payer: Anthem Medicaid |
$848.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,923.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Cash Price |
$1,233.00
|
| Rate for Payer: Cash Price |
$1,233.00
|
| Rate for Payer: Cigna Commercial |
$2,046.78
|
| Rate for Payer: First Health Commercial |
$2,342.70
|
| Rate for Payer: Humana Commercial |
$2,096.10
|
| Rate for Payer: Humana KY Medicaid |
$848.06
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$856.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,022.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,819.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$865.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,170.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,849.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$493.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$320.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$764.46
|
| Rate for Payer: PHCS Commercial |
$2,367.36
|
| Rate for Payer: United Healthcare All Payer |
$2,170.08
|
|
|
BIOPSY - ABD. MASS - PERCU.NEE
|
Professional
|
Both
|
$2,466.00
|
|
|
Service Code
|
HCPCS 49180
|
| Hospital Charge Code |
76101981
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$80.01 |
| Max. Negotiated Rate |
$2,466.00 |
| Rate for Payer: Aetna Commercial |
$142.31
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$80.01
|
| Rate for Payer: Anthem Medicaid |
$97.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,466.00
|
| Rate for Payer: Cash Price |
$1,233.00
|
| Rate for Payer: Cash Price |
$1,233.00
|
| Rate for Payer: Cigna Commercial |
$128.09
|
| Rate for Payer: Healthspan PPO |
$210.75
|
| Rate for Payer: Humana Medicaid |
$97.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$113.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$99.35
|
| Rate for Payer: Molina Healthcare Passport |
$97.40
|
| Rate for Payer: Multiplan PHCS |
$1,479.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,726.20
|
| Rate for Payer: UHCCP Medicaid |
$84.01
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$98.37
|
|
