|
SLENDER SHEATH KIT 6F
|
Facility
|
IP
|
$1,086.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.24 |
| Max. Negotiated Rate |
$1,043.04 |
| Rate for Payer: Aetna Commercial |
$836.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$847.47
|
| Rate for Payer: Cash Price |
$543.25
|
| Rate for Payer: Cigna Commercial |
$901.80
|
| Rate for Payer: First Health Commercial |
$1,032.18
|
| Rate for Payer: Humana Commercial |
$923.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$890.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$801.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$956.12
|
| Rate for Payer: Ohio Health Group HMO |
$814.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$217.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$336.82
|
| Rate for Payer: PHCS Commercial |
$1,043.04
|
| Rate for Payer: United Healthcare All Payer |
$956.12
|
|
|
SLENDER SHEATH KIT 6F
|
Facility
|
OP
|
$1,086.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.24 |
| Max. Negotiated Rate |
$1,043.04 |
| Rate for Payer: Aetna Commercial |
$836.60
|
| Rate for Payer: Anthem Medicaid |
$373.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$847.47
|
| Rate for Payer: Cash Price |
$543.25
|
| Rate for Payer: Cigna Commercial |
$901.80
|
| Rate for Payer: First Health Commercial |
$1,032.18
|
| Rate for Payer: Humana Commercial |
$923.52
|
| Rate for Payer: Humana KY Medicaid |
$373.65
|
| Rate for Payer: Kentucky WC Medicaid |
$377.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$890.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$801.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$381.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$956.12
|
| Rate for Payer: Ohio Health Group HMO |
$814.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$217.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$336.82
|
| Rate for Payer: PHCS Commercial |
$1,043.04
|
| Rate for Payer: United Healthcare All Payer |
$956.12
|
|
|
SLING OPERATION FOR STRESS INCONTINENCE (EG, FASCIA OR SYNTHETIC)
|
Facility
|
OP
|
$6,021.69
|
|
|
Service Code
|
CPT 57288
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,301.21 |
| Max. Negotiated Rate |
$6,021.69 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,301.21
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,021.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$5,806.63
|
| Rate for Payer: Humana Medicare Advantage |
$4,301.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,161.45
|
|
|
SLITTER 6230UNI
|
Facility
|
OP
|
$547.00
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$71.11 |
| Max. Negotiated Rate |
$525.12 |
| Rate for Payer: Aetna Commercial |
$421.19
|
| Rate for Payer: Anthem Medicaid |
$188.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$426.66
|
| Rate for Payer: Cash Price |
$273.50
|
| Rate for Payer: Cigna Commercial |
$454.01
|
| Rate for Payer: First Health Commercial |
$519.65
|
| Rate for Payer: Humana Commercial |
$464.95
|
| Rate for Payer: Humana KY Medicaid |
$188.11
|
| Rate for Payer: Kentucky WC Medicaid |
$190.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$448.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$403.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$164.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$191.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$481.36
|
| Rate for Payer: Ohio Health Group HMO |
$410.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$109.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$169.57
|
| Rate for Payer: PHCS Commercial |
$525.12
|
| Rate for Payer: United Healthcare All Payer |
$481.36
|
|
|
SLITTER 6230UNI
|
Facility
|
IP
|
$547.00
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$71.11 |
| Max. Negotiated Rate |
$525.12 |
| Rate for Payer: Aetna Commercial |
$421.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$426.66
|
| Rate for Payer: Cash Price |
$273.50
|
| Rate for Payer: Cigna Commercial |
$454.01
|
| Rate for Payer: First Health Commercial |
$519.65
|
| Rate for Payer: Humana Commercial |
$464.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$448.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$403.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$164.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$481.36
|
| Rate for Payer: Ohio Health Group HMO |
$410.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$109.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$169.57
|
| Rate for Payer: PHCS Commercial |
$525.12
|
| Rate for Payer: United Healthcare All Payer |
$481.36
|
|
|
SLITTING OF PREPUCE
|
Professional
|
Both
|
$5,350.32
|
|
|
Service Code
|
HCPCS 54001
|
| Hospital Charge Code |
76102123
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.77 |
| Max. Negotiated Rate |
$5,350.32 |
| Rate for Payer: Aetna Commercial |
$222.29
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$70.77
|
| Rate for Payer: Anthem Medicaid |
$87.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,350.32
|
| Rate for Payer: Cash Price |
$2,675.16
|
| Rate for Payer: Cash Price |
$2,675.16
|
| Rate for Payer: Cigna Commercial |
$195.47
|
| Rate for Payer: Healthspan PPO |
$295.04
|
| Rate for Payer: Humana Medicaid |
$87.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$188.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$89.26
|
| Rate for Payer: Molina Healthcare Passport |
$87.51
|
| Rate for Payer: Multiplan PHCS |
$3,210.19
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,745.22
|
| Rate for Payer: UHCCP Medicaid |
$74.31
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$88.39
|
|
|
SLITTING OF PREPUCE
|
Facility
|
OP
|
$5,350.32
|
|
|
Service Code
|
HCPCS 54001
|
| Hospital Charge Code |
76102123
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$695.54 |
| Max. Negotiated Rate |
$5,136.31 |
| Rate for Payer: Aetna Commercial |
$4,119.75
|
| Rate for Payer: Anthem Medicaid |
$1,839.98
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,761.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,173.25
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,465.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,377.81
|
| Rate for Payer: Cash Price |
$2,675.16
|
| Rate for Payer: Cash Price |
$2,675.16
|
| Rate for Payer: Cigna Commercial |
$4,440.77
|
| Rate for Payer: First Health Commercial |
$5,082.80
|
| Rate for Payer: Humana Commercial |
$4,547.77
|
| Rate for Payer: Humana KY Medicaid |
$1,839.98
|
| Rate for Payer: Humana Medicare Advantage |
$1,761.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,858.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,387.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,948.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,113.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,876.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,708.28
|
| Rate for Payer: Ohio Health Group HMO |
$4,012.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,070.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$695.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,658.60
|
| Rate for Payer: PHCS Commercial |
$5,136.31
|
| Rate for Payer: United Healthcare All Payer |
$4,708.28
|
|
|
SLITTING OF PREPUCE
|
Facility
|
IP
|
$5,350.32
|
|
|
Service Code
|
HCPCS 54001
|
| Hospital Charge Code |
76102123
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$695.54 |
| Max. Negotiated Rate |
$5,136.31 |
| Rate for Payer: Aetna Commercial |
$4,119.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,173.25
|
| Rate for Payer: Cash Price |
$2,675.16
|
| Rate for Payer: Cigna Commercial |
$4,440.77
|
| Rate for Payer: First Health Commercial |
$5,082.80
|
| Rate for Payer: Humana Commercial |
$4,547.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,387.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,948.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,605.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,708.28
|
| Rate for Payer: Ohio Health Group HMO |
$4,012.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,070.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$695.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,658.60
|
| Rate for Payer: PHCS Commercial |
$5,136.31
|
| Rate for Payer: United Healthcare All Payer |
$4,708.28
|
|
|
SLITTING OF PREPUCE, DORSAL OR LATERAL (SEPARATE PROCEDURE); EXCEPT NEWBORN
|
Facility
|
OP
|
$2,465.88
|
|
|
Service Code
|
CPT 54001
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,761.34 |
| Max. Negotiated Rate |
$2,465.88 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,761.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,465.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,377.81
|
| Rate for Payer: Humana Medicare Advantage |
$1,761.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,113.61
|
|
|
SLITTING OF PREPUCE(P
|
Professional
|
Both
|
$650.00
|
|
|
Service Code
|
HCPCS 54001
|
| Hospital Charge Code |
761P2123
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.77 |
| Max. Negotiated Rate |
$650.00 |
| Rate for Payer: Aetna Commercial |
$222.29
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$70.77
|
| Rate for Payer: Anthem Medicaid |
$87.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$650.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cigna Commercial |
$195.47
|
| Rate for Payer: Healthspan PPO |
$295.04
|
| Rate for Payer: Humana Medicaid |
$87.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$188.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$89.26
|
| Rate for Payer: Molina Healthcare Passport |
$87.51
|
| Rate for Payer: Multiplan PHCS |
$390.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$455.00
|
| Rate for Payer: UHCCP Medicaid |
$74.31
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$88.39
|
|
|
SLITTING OF PREPUCE(T
|
Facility
|
OP
|
$4,700.32
|
|
|
Service Code
|
HCPCS 54001
|
| Hospital Charge Code |
761T2123
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$611.04 |
| Max. Negotiated Rate |
$4,512.31 |
| Rate for Payer: Aetna Commercial |
$3,619.25
|
| Rate for Payer: Anthem Medicaid |
$1,616.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,761.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,666.25
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,465.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,377.81
|
| Rate for Payer: Cash Price |
$2,350.16
|
| Rate for Payer: Cash Price |
$2,350.16
|
| Rate for Payer: Cigna Commercial |
$3,901.27
|
| Rate for Payer: First Health Commercial |
$4,465.30
|
| Rate for Payer: Humana Commercial |
$3,995.27
|
| Rate for Payer: Humana KY Medicaid |
$1,616.44
|
| Rate for Payer: Humana Medicare Advantage |
$1,761.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,632.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,854.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,468.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,113.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,648.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,136.28
|
| Rate for Payer: Ohio Health Group HMO |
$3,525.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$940.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$611.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,457.10
|
| Rate for Payer: PHCS Commercial |
$4,512.31
|
| Rate for Payer: United Healthcare All Payer |
$4,136.28
|
|
|
SLITTING OF PREPUCE(T
|
Facility
|
IP
|
$4,700.32
|
|
|
Service Code
|
HCPCS 54001
|
| Hospital Charge Code |
761T2123
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$611.04 |
| Max. Negotiated Rate |
$4,512.31 |
| Rate for Payer: Aetna Commercial |
$3,619.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,666.25
|
| Rate for Payer: Cash Price |
$2,350.16
|
| Rate for Payer: Cigna Commercial |
$3,901.27
|
| Rate for Payer: First Health Commercial |
$4,465.30
|
| Rate for Payer: Humana Commercial |
$3,995.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,854.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,468.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,410.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,136.28
|
| Rate for Payer: Ohio Health Group HMO |
$3,525.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$940.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$611.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,457.10
|
| Rate for Payer: PHCS Commercial |
$4,512.31
|
| Rate for Payer: United Healthcare All Payer |
$4,136.28
|
|
|
SLOTTED DRILL GUIDE/1.9MM DRIL
|
Facility
|
OP
|
$4,496.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$584.59 |
| Max. Negotiated Rate |
$4,317.00 |
| Rate for Payer: Aetna Commercial |
$3,462.60
|
| Rate for Payer: Anthem Medicaid |
$1,546.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,507.57
|
| Rate for Payer: Cash Price |
$2,248.44
|
| Rate for Payer: Cigna Commercial |
$3,732.41
|
| Rate for Payer: First Health Commercial |
$4,272.04
|
| Rate for Payer: Humana Commercial |
$3,822.35
|
| Rate for Payer: Humana KY Medicaid |
$1,546.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,562.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,687.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,318.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,349.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,577.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,957.25
|
| Rate for Payer: Ohio Health Group HMO |
$3,372.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$899.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$584.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,394.03
|
| Rate for Payer: PHCS Commercial |
$4,317.00
|
| Rate for Payer: United Healthcare All Payer |
$3,957.25
|
|
|
SLOTTED DRILL GUIDE/1.9MM DRIL
|
Facility
|
IP
|
$4,496.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$584.59 |
| Max. Negotiated Rate |
$4,317.00 |
| Rate for Payer: Aetna Commercial |
$3,462.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,507.57
|
| Rate for Payer: Cash Price |
$2,248.44
|
| Rate for Payer: Cigna Commercial |
$3,732.41
|
| Rate for Payer: First Health Commercial |
$4,272.04
|
| Rate for Payer: Humana Commercial |
$3,822.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,687.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,318.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,349.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,957.25
|
| Rate for Payer: Ohio Health Group HMO |
$3,372.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$899.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$584.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,394.03
|
| Rate for Payer: PHCS Commercial |
$4,317.00
|
| Rate for Payer: United Healthcare All Payer |
$3,957.25
|
|
|
SL-PLUS SDP W/ANTEVRTD HOLE 4
|
Facility
|
OP
|
$25,500.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,315.01 |
| Max. Negotiated Rate |
$24,480.06 |
| Rate for Payer: Aetna Commercial |
$19,635.05
|
| Rate for Payer: Anthem Medicaid |
$8,769.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,890.05
|
| Rate for Payer: Cash Price |
$12,750.03
|
| Rate for Payer: Cigna Commercial |
$21,165.05
|
| Rate for Payer: First Health Commercial |
$24,225.06
|
| Rate for Payer: Humana Commercial |
$21,675.05
|
| Rate for Payer: Humana KY Medicaid |
$8,769.47
|
| Rate for Payer: Kentucky WC Medicaid |
$8,858.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,910.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,819.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,650.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,945.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,440.05
|
| Rate for Payer: Ohio Health Group HMO |
$19,125.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,100.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,315.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,905.02
|
| Rate for Payer: PHCS Commercial |
$24,480.06
|
| Rate for Payer: United Healthcare All Payer |
$22,440.05
|
|
|
SL-PLUS SDP W/ANTEVRTD HOLE 4
|
Facility
|
IP
|
$25,500.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,315.01 |
| Max. Negotiated Rate |
$24,480.06 |
| Rate for Payer: Aetna Commercial |
$19,635.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,890.05
|
| Rate for Payer: Cash Price |
$12,750.03
|
| Rate for Payer: Cigna Commercial |
$21,165.05
|
| Rate for Payer: First Health Commercial |
$24,225.06
|
| Rate for Payer: Humana Commercial |
$21,675.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,910.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,819.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,650.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,440.05
|
| Rate for Payer: Ohio Health Group HMO |
$19,125.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,100.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,315.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,905.02
|
| Rate for Payer: PHCS Commercial |
$24,480.06
|
| Rate for Payer: United Healthcare All Payer |
$22,440.05
|
|
|
SL-PLUS SDP W/ANTEVRTD HOLE 5
|
Facility
|
OP
|
$25,500.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,315.01 |
| Max. Negotiated Rate |
$24,480.06 |
| Rate for Payer: Aetna Commercial |
$19,635.05
|
| Rate for Payer: Anthem Medicaid |
$8,769.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,890.05
|
| Rate for Payer: Cash Price |
$12,750.03
|
| Rate for Payer: Cigna Commercial |
$21,165.05
|
| Rate for Payer: First Health Commercial |
$24,225.06
|
| Rate for Payer: Humana Commercial |
$21,675.05
|
| Rate for Payer: Humana KY Medicaid |
$8,769.47
|
| Rate for Payer: Kentucky WC Medicaid |
$8,858.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,910.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,819.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,650.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,945.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,440.05
|
| Rate for Payer: Ohio Health Group HMO |
$19,125.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,100.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,315.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,905.02
|
| Rate for Payer: PHCS Commercial |
$24,480.06
|
| Rate for Payer: United Healthcare All Payer |
$22,440.05
|
|
|
SL-PLUS SDP W/ANTEVRTD HOLE 5
|
Facility
|
IP
|
$25,500.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,315.01 |
| Max. Negotiated Rate |
$24,480.06 |
| Rate for Payer: Aetna Commercial |
$19,635.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,890.05
|
| Rate for Payer: Cash Price |
$12,750.03
|
| Rate for Payer: Cigna Commercial |
$21,165.05
|
| Rate for Payer: First Health Commercial |
$24,225.06
|
| Rate for Payer: Humana Commercial |
$21,675.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,910.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,819.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,650.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,440.05
|
| Rate for Payer: Ohio Health Group HMO |
$19,125.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,100.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,315.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,905.02
|
| Rate for Payer: PHCS Commercial |
$24,480.06
|
| Rate for Payer: United Healthcare All Payer |
$22,440.05
|
|
|
SL-PLUS SDP W/ANTEVRTD HOLE 6
|
Facility
|
OP
|
$25,500.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,315.01 |
| Max. Negotiated Rate |
$24,480.06 |
| Rate for Payer: Aetna Commercial |
$19,635.05
|
| Rate for Payer: Anthem Medicaid |
$8,769.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,890.05
|
| Rate for Payer: Cash Price |
$12,750.03
|
| Rate for Payer: Cigna Commercial |
$21,165.05
|
| Rate for Payer: First Health Commercial |
$24,225.06
|
| Rate for Payer: Humana Commercial |
$21,675.05
|
| Rate for Payer: Humana KY Medicaid |
$8,769.47
|
| Rate for Payer: Kentucky WC Medicaid |
$8,858.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,910.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,819.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,650.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,945.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,440.05
|
| Rate for Payer: Ohio Health Group HMO |
$19,125.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,100.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,315.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,905.02
|
| Rate for Payer: PHCS Commercial |
$24,480.06
|
| Rate for Payer: United Healthcare All Payer |
$22,440.05
|
|
|
SL-PLUS SDP W/ANTEVRTD HOLE 6
|
Facility
|
IP
|
$25,500.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,315.01 |
| Max. Negotiated Rate |
$24,480.06 |
| Rate for Payer: Aetna Commercial |
$19,635.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,890.05
|
| Rate for Payer: Cash Price |
$12,750.03
|
| Rate for Payer: Cigna Commercial |
$21,165.05
|
| Rate for Payer: First Health Commercial |
$24,225.06
|
| Rate for Payer: Humana Commercial |
$21,675.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,910.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,819.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,650.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,440.05
|
| Rate for Payer: Ohio Health Group HMO |
$19,125.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,100.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,315.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,905.02
|
| Rate for Payer: PHCS Commercial |
$24,480.06
|
| Rate for Payer: United Healthcare All Payer |
$22,440.05
|
|
|
SL-PLUS SDP W/ANTEVRTD HOLE 7
|
Facility
|
OP
|
$25,500.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,315.01 |
| Max. Negotiated Rate |
$24,480.06 |
| Rate for Payer: Aetna Commercial |
$19,635.05
|
| Rate for Payer: Anthem Medicaid |
$8,769.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,890.05
|
| Rate for Payer: Cash Price |
$12,750.03
|
| Rate for Payer: Cigna Commercial |
$21,165.05
|
| Rate for Payer: First Health Commercial |
$24,225.06
|
| Rate for Payer: Humana Commercial |
$21,675.05
|
| Rate for Payer: Humana KY Medicaid |
$8,769.47
|
| Rate for Payer: Kentucky WC Medicaid |
$8,858.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,910.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,819.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,650.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,945.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,440.05
|
| Rate for Payer: Ohio Health Group HMO |
$19,125.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,100.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,315.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,905.02
|
| Rate for Payer: PHCS Commercial |
$24,480.06
|
| Rate for Payer: United Healthcare All Payer |
$22,440.05
|
|
|
SL-PLUS SDP W/ANTEVRTD HOLE 7
|
Facility
|
IP
|
$25,500.06
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,315.01 |
| Max. Negotiated Rate |
$24,480.06 |
| Rate for Payer: Aetna Commercial |
$19,635.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,890.05
|
| Rate for Payer: Cash Price |
$12,750.03
|
| Rate for Payer: Cigna Commercial |
$21,165.05
|
| Rate for Payer: First Health Commercial |
$24,225.06
|
| Rate for Payer: Humana Commercial |
$21,675.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,910.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,819.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,650.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,440.05
|
| Rate for Payer: Ohio Health Group HMO |
$19,125.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,100.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,315.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,905.02
|
| Rate for Payer: PHCS Commercial |
$24,480.06
|
| Rate for Payer: United Healthcare All Payer |
$22,440.05
|
|
|
SMALL BOWEL ENDOSCOPY
|
Facility
|
IP
|
$775.00
|
|
|
Service Code
|
HCPCS 44360
|
| Hospital Charge Code |
76101843
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$100.75 |
| Max. Negotiated Rate |
$744.00 |
| Rate for Payer: Aetna Commercial |
$596.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$604.50
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cigna Commercial |
$643.25
|
| Rate for Payer: First Health Commercial |
$736.25
|
| Rate for Payer: Humana Commercial |
$658.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$635.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$571.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$232.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$682.00
|
| Rate for Payer: Ohio Health Group HMO |
$581.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$155.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$240.25
|
| Rate for Payer: PHCS Commercial |
$744.00
|
| Rate for Payer: United Healthcare All Payer |
$682.00
|
|
|
SMALL BOWEL ENDOSCOPY
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 44369
|
| Hospital Charge Code |
76102623
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$157.50 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$406.96
|
| Rate for Payer: Anthem Medicaid |
$336.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$450.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$363.73
|
| Rate for Payer: Healthspan PPO |
$343.20
|
| Rate for Payer: Humana Medicaid |
$336.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$347.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$343.12
|
| Rate for Payer: Molina Healthcare Passport |
$336.39
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$315.00
|
| Rate for Payer: UHCCP Medicaid |
$157.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$339.75
|
|
|
SMALL BOWEL ENDOSCOPY
|
Facility
|
OP
|
$775.00
|
|
|
Service Code
|
HCPCS 44360
|
| Hospital Charge Code |
76101843
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$100.75 |
| Max. Negotiated Rate |
$2,303.66 |
| Rate for Payer: Aetna Commercial |
$596.75
|
| Rate for Payer: Anthem Medicaid |
$266.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,645.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$604.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,303.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,221.38
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cigna Commercial |
$643.25
|
| Rate for Payer: First Health Commercial |
$736.25
|
| Rate for Payer: Humana Commercial |
$658.75
|
| Rate for Payer: Humana KY Medicaid |
$266.52
|
| Rate for Payer: Humana Medicare Advantage |
$1,645.47
|
| Rate for Payer: Kentucky WC Medicaid |
$269.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$635.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$571.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,974.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$271.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$682.00
|
| Rate for Payer: Ohio Health Group HMO |
$581.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$155.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$240.25
|
| Rate for Payer: PHCS Commercial |
$744.00
|
| Rate for Payer: United Healthcare All Payer |
$682.00
|
|
