|
SLEEP LATENCY
|
Facility
|
IP
|
$3,460.00
|
|
|
Service Code
|
HCPCS 95805
|
| Hospital Charge Code |
74000002
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,038.00 |
| Max. Negotiated Rate |
$3,321.60 |
| Rate for Payer: Aetna Commercial |
$2,664.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,698.80
|
| Rate for Payer: Cash Price |
$1,730.00
|
| Rate for Payer: Cigna Commercial |
$2,871.80
|
| Rate for Payer: First Health Commercial |
$3,287.00
|
| Rate for Payer: Humana Commercial |
$2,941.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,837.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,553.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,038.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,044.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,595.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,768.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,010.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,387.40
|
| Rate for Payer: PHCS Commercial |
$3,321.60
|
| Rate for Payer: United Healthcare All Payer |
$3,044.80
|
|
|
SLEEP LATENCY(P
|
Professional
|
Both
|
$185.00
|
|
|
Service Code
|
HCPCS 95805
|
| Hospital Charge Code |
740P0002
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$64.75 |
| Max. Negotiated Rate |
$959.14 |
| Rate for Payer: Aetna Commercial |
$641.16
|
| Rate for Payer: Ambetter Exchange |
$391.92
|
| Rate for Payer: Anthem Medicaid |
$213.89
|
| Rate for Payer: Buckeye Individual/Medicaid |
$391.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$391.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$470.30
|
| Rate for Payer: Cash Price |
$92.50
|
| Rate for Payer: Cash Price |
$92.50
|
| Rate for Payer: Cigna Commercial |
$959.14
|
| Rate for Payer: Healthspan PPO |
$560.73
|
| Rate for Payer: Humana Medicaid |
$213.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$73.98
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$391.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$391.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$218.17
|
| Rate for Payer: Molina Healthcare Passport |
$213.89
|
| Rate for Payer: Multiplan PHCS |
$111.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$509.50
|
| Rate for Payer: UHCCP Medicaid |
$64.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$216.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$391.92
|
|
|
SLEEP LATENCY(T
|
Facility
|
IP
|
$3,275.00
|
|
|
Service Code
|
HCPCS 95805
|
| Hospital Charge Code |
740T0002
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$982.50 |
| Max. Negotiated Rate |
$3,144.00 |
| Rate for Payer: Aetna Commercial |
$2,521.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,554.50
|
| Rate for Payer: Cash Price |
$1,637.50
|
| Rate for Payer: Cigna Commercial |
$2,718.25
|
| Rate for Payer: First Health Commercial |
$3,111.25
|
| Rate for Payer: Humana Commercial |
$2,783.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,685.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,416.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$982.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,882.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,456.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,620.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,849.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,259.75
|
| Rate for Payer: PHCS Commercial |
$3,144.00
|
| Rate for Payer: United Healthcare All Payer |
$2,882.00
|
|
|
SLEEP LATENCY(T
|
Facility
|
OP
|
$3,275.00
|
|
|
Service Code
|
HCPCS 95805
|
| Hospital Charge Code |
740T0002
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$490.26 |
| Max. Negotiated Rate |
$3,144.00 |
| Rate for Payer: Aetna Commercial |
$2,521.75
|
| Rate for Payer: Anthem Medicaid |
$1,126.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$490.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,554.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$686.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$661.85
|
| Rate for Payer: Cash Price |
$1,637.50
|
| Rate for Payer: Cash Price |
$1,637.50
|
| Rate for Payer: Cigna Commercial |
$2,718.25
|
| Rate for Payer: First Health Commercial |
$3,111.25
|
| Rate for Payer: Humana Commercial |
$2,783.75
|
| Rate for Payer: Humana KY Medicaid |
$1,126.27
|
| Rate for Payer: Humana Medicare Advantage |
$490.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,137.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,685.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,416.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$588.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,148.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,882.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,456.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,620.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,849.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,259.75
|
| Rate for Payer: PHCS Commercial |
$3,144.00
|
| Rate for Payer: United Healthcare All Payer |
$2,882.00
|
|
|
SLEEP STUDY ATTENDED
|
Facility
|
IP
|
$2,390.00
|
|
|
Service Code
|
HCPCS 95807
|
| Hospital Charge Code |
51000035
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$717.00 |
| Max. Negotiated Rate |
$2,294.40 |
| Rate for Payer: Aetna Commercial |
$1,840.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,864.20
|
| Rate for Payer: Cash Price |
$1,195.00
|
| Rate for Payer: Cigna Commercial |
$1,983.70
|
| Rate for Payer: First Health Commercial |
$2,270.50
|
| Rate for Payer: Humana Commercial |
$2,031.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,959.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,763.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$717.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,103.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,792.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,912.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,079.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,649.10
|
| Rate for Payer: PHCS Commercial |
$2,294.40
|
| Rate for Payer: United Healthcare All Payer |
$2,103.20
|
|
|
SLEEP STUDY ATTENDED
|
Facility
|
OP
|
$2,390.00
|
|
|
Service Code
|
HCPCS 95807
|
| Hospital Charge Code |
51000035
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$490.26 |
| Max. Negotiated Rate |
$2,294.40 |
| Rate for Payer: Aetna Commercial |
$1,840.30
|
| Rate for Payer: Anthem Medicaid |
$821.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$490.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,864.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$686.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$661.85
|
| Rate for Payer: Cash Price |
$1,195.00
|
| Rate for Payer: Cash Price |
$1,195.00
|
| Rate for Payer: Cigna Commercial |
$1,983.70
|
| Rate for Payer: First Health Commercial |
$2,270.50
|
| Rate for Payer: Humana Commercial |
$2,031.50
|
| Rate for Payer: Humana KY Medicaid |
$821.92
|
| Rate for Payer: Humana Medicare Advantage |
$490.26
|
| Rate for Payer: Kentucky WC Medicaid |
$830.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,959.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,763.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$588.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$838.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,103.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,792.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,912.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,079.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,649.10
|
| Rate for Payer: PHCS Commercial |
$2,294.40
|
| Rate for Payer: United Healthcare All Payer |
$2,103.20
|
|
|
SLEEP STUDY ATTENDED
|
Professional
|
Both
|
$2,390.00
|
|
|
Service Code
|
HCPCS 95807
|
| Hospital Charge Code |
51000035
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$75.78 |
| Max. Negotiated Rate |
$1,434.00 |
| Rate for Payer: Aetna Commercial |
$747.97
|
| Rate for Payer: Ambetter Exchange |
$370.30
|
| Rate for Payer: Anthem Medicaid |
$299.68
|
| Rate for Payer: Buckeye Individual/Medicaid |
$370.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$370.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$444.36
|
| Rate for Payer: Cash Price |
$1,195.00
|
| Rate for Payer: Cash Price |
$1,195.00
|
| Rate for Payer: Cigna Commercial |
$788.13
|
| Rate for Payer: Healthspan PPO |
$654.14
|
| Rate for Payer: Humana Medicaid |
$299.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$75.78
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$370.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$370.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$305.67
|
| Rate for Payer: Molina Healthcare Passport |
$299.68
|
| Rate for Payer: Multiplan PHCS |
$1,434.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$481.39
|
| Rate for Payer: UHCCP Medicaid |
$836.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$302.68
|
| Rate for Payer: Wellcare Medicare Advantage |
$370.30
|
|
|
SLEEP STUDY ATTENDED(P
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 95807
|
| Hospital Charge Code |
510P0035
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$75.78 |
| Max. Negotiated Rate |
$788.13 |
| Rate for Payer: Aetna Commercial |
$747.97
|
| Rate for Payer: Ambetter Exchange |
$370.30
|
| Rate for Payer: Anthem Medicaid |
$299.68
|
| Rate for Payer: Buckeye Individual/Medicaid |
$370.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$370.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$444.36
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$788.13
|
| Rate for Payer: Healthspan PPO |
$654.14
|
| Rate for Payer: Humana Medicaid |
$299.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$75.78
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$370.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$370.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$305.67
|
| Rate for Payer: Molina Healthcare Passport |
$299.68
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$481.39
|
| Rate for Payer: UHCCP Medicaid |
$140.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$302.68
|
| Rate for Payer: Wellcare Medicare Advantage |
$370.30
|
|
|
SLEEP STUDY ATTENDED(T
|
Facility
|
OP
|
$1,990.00
|
|
|
Service Code
|
HCPCS 95807
|
| Hospital Charge Code |
510T0035
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$490.26 |
| Max. Negotiated Rate |
$1,910.40 |
| Rate for Payer: Aetna Commercial |
$1,532.30
|
| Rate for Payer: Anthem Medicaid |
$684.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$490.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,552.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$686.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$661.85
|
| Rate for Payer: Cash Price |
$995.00
|
| Rate for Payer: Cash Price |
$995.00
|
| Rate for Payer: Cigna Commercial |
$1,651.70
|
| Rate for Payer: First Health Commercial |
$1,890.50
|
| Rate for Payer: Humana Commercial |
$1,691.50
|
| Rate for Payer: Humana KY Medicaid |
$684.36
|
| Rate for Payer: Humana Medicare Advantage |
$490.26
|
| Rate for Payer: Kentucky WC Medicaid |
$691.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,631.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,468.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$588.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$698.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,751.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,492.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,592.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,731.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,373.10
|
| Rate for Payer: PHCS Commercial |
$1,910.40
|
| Rate for Payer: United Healthcare All Payer |
$1,751.20
|
|
|
SLEEP STUDY ATTENDED(T
|
Facility
|
IP
|
$1,990.00
|
|
|
Service Code
|
HCPCS 95807
|
| Hospital Charge Code |
510T0035
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$597.00 |
| Max. Negotiated Rate |
$1,910.40 |
| Rate for Payer: Aetna Commercial |
$1,532.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,552.20
|
| Rate for Payer: Cash Price |
$995.00
|
| Rate for Payer: Cigna Commercial |
$1,651.70
|
| Rate for Payer: First Health Commercial |
$1,890.50
|
| Rate for Payer: Humana Commercial |
$1,691.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,631.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,468.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$597.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,751.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,492.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,592.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,731.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,373.10
|
| Rate for Payer: PHCS Commercial |
$1,910.40
|
| Rate for Payer: United Healthcare All Payer |
$1,751.20
|
|
|
SLEEVE LOBECTOMY
|
Facility
|
OP
|
$5,700.00
|
|
|
Service Code
|
HCPCS 32486
|
| Hospital Charge Code |
76101192
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,710.00 |
| Max. Negotiated Rate |
$5,472.00 |
| Rate for Payer: Aetna Commercial |
$4,389.00
|
| Rate for Payer: Anthem Medicaid |
$1,960.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,446.00
|
| Rate for Payer: Cash Price |
$2,850.00
|
| Rate for Payer: Cigna Commercial |
$4,731.00
|
| Rate for Payer: First Health Commercial |
$5,415.00
|
| Rate for Payer: Humana Commercial |
$4,845.00
|
| Rate for Payer: Humana KY Medicaid |
$1,960.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,980.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,674.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,206.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,710.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,999.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,016.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,959.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,933.00
|
| Rate for Payer: PHCS Commercial |
$5,472.00
|
| Rate for Payer: United Healthcare All Payer |
$5,016.00
|
|
|
SLEEVE LOBECTOMY
|
Professional
|
Both
|
$5,700.00
|
|
|
Service Code
|
HCPCS 32486
|
| Hospital Charge Code |
76101192
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,189.69 |
| Max. Negotiated Rate |
$3,815.30 |
| Rate for Payer: Aetna Commercial |
$3,815.30
|
| Rate for Payer: Ambetter Exchange |
$2,200.80
|
| Rate for Payer: Anthem Medicaid |
$1,189.69
|
| Rate for Payer: Buckeye Individual/Medicaid |
$2,200.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,200.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,640.96
|
| Rate for Payer: Cash Price |
$2,850.00
|
| Rate for Payer: Cash Price |
$2,850.00
|
| Rate for Payer: Cigna Commercial |
$3,509.82
|
| Rate for Payer: Healthspan PPO |
$2,978.88
|
| Rate for Payer: Humana Medicaid |
$1,189.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$3,279.91
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$2,200.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,200.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,213.48
|
| Rate for Payer: Molina Healthcare Passport |
$1,189.69
|
| Rate for Payer: Multiplan PHCS |
$3,420.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,861.04
|
| Rate for Payer: UHCCP Medicaid |
$1,995.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,201.59
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,200.80
|
|
|
SLEEVE LOBECTOMY
|
Facility
|
IP
|
$5,700.00
|
|
|
Service Code
|
HCPCS 32486
|
| Hospital Charge Code |
76101192
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,710.00 |
| Max. Negotiated Rate |
$5,472.00 |
| Rate for Payer: Aetna Commercial |
$4,389.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,446.00
|
| Rate for Payer: Cash Price |
$2,850.00
|
| Rate for Payer: Cigna Commercial |
$4,731.00
|
| Rate for Payer: First Health Commercial |
$5,415.00
|
| Rate for Payer: Humana Commercial |
$4,845.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,674.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,206.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,710.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,016.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,959.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,933.00
|
| Rate for Payer: PHCS Commercial |
$5,472.00
|
| Rate for Payer: United Healthcare All Payer |
$5,016.00
|
|
|
SLEEVE LOBECTOMY(P
|
Professional
|
Both
|
$5,700.00
|
|
|
Service Code
|
HCPCS 32486
|
| Hospital Charge Code |
761P1192
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,189.69 |
| Max. Negotiated Rate |
$3,815.30 |
| Rate for Payer: Aetna Commercial |
$3,815.30
|
| Rate for Payer: Ambetter Exchange |
$2,200.80
|
| Rate for Payer: Anthem Medicaid |
$1,189.69
|
| Rate for Payer: Buckeye Individual/Medicaid |
$2,200.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,200.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,640.96
|
| Rate for Payer: Cash Price |
$2,850.00
|
| Rate for Payer: Cash Price |
$2,850.00
|
| Rate for Payer: Cigna Commercial |
$3,509.82
|
| Rate for Payer: Healthspan PPO |
$2,978.88
|
| Rate for Payer: Humana Medicaid |
$1,189.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$3,279.91
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$2,200.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,200.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,213.48
|
| Rate for Payer: Molina Healthcare Passport |
$1,189.69
|
| Rate for Payer: Multiplan PHCS |
$3,420.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,861.04
|
| Rate for Payer: UHCCP Medicaid |
$1,995.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,201.59
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,200.80
|
|
|
SLEEVE MODSTIKTITEW/HA LG26/27
|
Facility
|
IP
|
$15,870.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,761.00 |
| Max. Negotiated Rate |
$15,235.20 |
| Rate for Payer: Aetna Commercial |
$12,219.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,378.60
|
| Rate for Payer: Cash Price |
$7,935.00
|
| Rate for Payer: Cigna Commercial |
$13,172.10
|
| Rate for Payer: First Health Commercial |
$15,076.50
|
| Rate for Payer: Humana Commercial |
$13,489.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,013.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,712.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,761.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,965.60
|
| Rate for Payer: Ohio Health Group HMO |
$11,902.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,696.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,806.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,950.30
|
| Rate for Payer: PHCS Commercial |
$15,235.20
|
| Rate for Payer: United Healthcare All Payer |
$13,965.60
|
|
|
SLEEVE MODSTIKTITEW/HA LG26/27
|
Facility
|
OP
|
$15,870.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,761.00 |
| Max. Negotiated Rate |
$15,235.20 |
| Rate for Payer: Aetna Commercial |
$12,219.90
|
| Rate for Payer: Anthem Medicaid |
$5,457.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,378.60
|
| Rate for Payer: Cash Price |
$7,935.00
|
| Rate for Payer: Cigna Commercial |
$13,172.10
|
| Rate for Payer: First Health Commercial |
$15,076.50
|
| Rate for Payer: Humana Commercial |
$13,489.50
|
| Rate for Payer: Humana KY Medicaid |
$5,457.69
|
| Rate for Payer: Kentucky WC Medicaid |
$5,513.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,013.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,712.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,761.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,567.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,965.60
|
| Rate for Payer: Ohio Health Group HMO |
$11,902.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,696.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,806.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,950.30
|
| Rate for Payer: PHCS Commercial |
$15,235.20
|
| Rate for Payer: United Healthcare All Payer |
$13,965.60
|
|
|
SLEEVE MODSTIKTITEW/HA MD26/27
|
Facility
|
OP
|
$15,870.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,761.00 |
| Max. Negotiated Rate |
$15,235.20 |
| Rate for Payer: Aetna Commercial |
$12,219.90
|
| Rate for Payer: Anthem Medicaid |
$5,457.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,378.60
|
| Rate for Payer: Cash Price |
$7,935.00
|
| Rate for Payer: Cigna Commercial |
$13,172.10
|
| Rate for Payer: First Health Commercial |
$15,076.50
|
| Rate for Payer: Humana Commercial |
$13,489.50
|
| Rate for Payer: Humana KY Medicaid |
$5,457.69
|
| Rate for Payer: Kentucky WC Medicaid |
$5,513.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,013.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,712.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,761.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,567.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,965.60
|
| Rate for Payer: Ohio Health Group HMO |
$11,902.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,696.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,806.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,950.30
|
| Rate for Payer: PHCS Commercial |
$15,235.20
|
| Rate for Payer: United Healthcare All Payer |
$13,965.60
|
|
|
SLEEVE MODSTIKTITEW/HA MD26/27
|
Facility
|
IP
|
$15,870.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,761.00 |
| Max. Negotiated Rate |
$15,235.20 |
| Rate for Payer: Aetna Commercial |
$12,219.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,378.60
|
| Rate for Payer: Cash Price |
$7,935.00
|
| Rate for Payer: Cigna Commercial |
$13,172.10
|
| Rate for Payer: First Health Commercial |
$15,076.50
|
| Rate for Payer: Humana Commercial |
$13,489.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,013.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,712.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,761.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,965.60
|
| Rate for Payer: Ohio Health Group HMO |
$11,902.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,696.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,806.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,950.30
|
| Rate for Payer: PHCS Commercial |
$15,235.20
|
| Rate for Payer: United Healthcare All Payer |
$13,965.60
|
|
|
SLEEVE MODSTIKTITEW/HA SM12-13
|
Facility
|
OP
|
$15,648.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,694.40 |
| Max. Negotiated Rate |
$15,022.08 |
| Rate for Payer: Aetna Commercial |
$12,048.96
|
| Rate for Payer: Anthem Medicaid |
$5,381.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,205.44
|
| Rate for Payer: Cash Price |
$7,824.00
|
| Rate for Payer: Cigna Commercial |
$12,987.84
|
| Rate for Payer: First Health Commercial |
$14,865.60
|
| Rate for Payer: Humana Commercial |
$13,300.80
|
| Rate for Payer: Humana KY Medicaid |
$5,381.35
|
| Rate for Payer: Kentucky WC Medicaid |
$5,436.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,831.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,548.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,694.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,489.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,770.24
|
| Rate for Payer: Ohio Health Group HMO |
$11,736.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,518.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,613.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,797.12
|
| Rate for Payer: PHCS Commercial |
$15,022.08
|
| Rate for Payer: United Healthcare All Payer |
$13,770.24
|
|
|
SLEEVE MODSTIKTITEW/HA SM12-13
|
Facility
|
IP
|
$15,648.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,694.40 |
| Max. Negotiated Rate |
$15,022.08 |
| Rate for Payer: Aetna Commercial |
$12,048.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,205.44
|
| Rate for Payer: Cash Price |
$7,824.00
|
| Rate for Payer: Cigna Commercial |
$12,987.84
|
| Rate for Payer: First Health Commercial |
$14,865.60
|
| Rate for Payer: Humana Commercial |
$13,300.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,831.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,548.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,694.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,770.24
|
| Rate for Payer: Ohio Health Group HMO |
$11,736.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,518.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,613.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,797.12
|
| Rate for Payer: PHCS Commercial |
$15,022.08
|
| Rate for Payer: United Healthcare All Payer |
$13,770.24
|
|
|
SLEEVE MODSTIKTITEW/HA SM26/27
|
Facility
|
OP
|
$15,870.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,761.00 |
| Max. Negotiated Rate |
$15,235.20 |
| Rate for Payer: Aetna Commercial |
$12,219.90
|
| Rate for Payer: Anthem Medicaid |
$5,457.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,378.60
|
| Rate for Payer: Cash Price |
$7,935.00
|
| Rate for Payer: Cigna Commercial |
$13,172.10
|
| Rate for Payer: First Health Commercial |
$15,076.50
|
| Rate for Payer: Humana Commercial |
$13,489.50
|
| Rate for Payer: Humana KY Medicaid |
$5,457.69
|
| Rate for Payer: Kentucky WC Medicaid |
$5,513.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,013.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,712.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,761.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,567.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,965.60
|
| Rate for Payer: Ohio Health Group HMO |
$11,902.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,696.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,806.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,950.30
|
| Rate for Payer: PHCS Commercial |
$15,235.20
|
| Rate for Payer: United Healthcare All Payer |
$13,965.60
|
|
|
SLEEVE MODSTIKTITEW/HA SM26/27
|
Facility
|
IP
|
$15,870.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,761.00 |
| Max. Negotiated Rate |
$15,235.20 |
| Rate for Payer: Aetna Commercial |
$12,219.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,378.60
|
| Rate for Payer: Cash Price |
$7,935.00
|
| Rate for Payer: Cigna Commercial |
$13,172.10
|
| Rate for Payer: First Health Commercial |
$15,076.50
|
| Rate for Payer: Humana Commercial |
$13,489.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,013.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,712.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,761.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,965.60
|
| Rate for Payer: Ohio Health Group HMO |
$11,902.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,696.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,806.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,950.30
|
| Rate for Payer: PHCS Commercial |
$15,235.20
|
| Rate for Payer: United Healthcare All Payer |
$13,965.60
|
|
|
SLEEVE MODULAR GRIT XS 26/27
|
Facility
|
IP
|
$15,870.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,761.00 |
| Max. Negotiated Rate |
$15,235.20 |
| Rate for Payer: Aetna Commercial |
$12,219.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,378.60
|
| Rate for Payer: Cash Price |
$7,935.00
|
| Rate for Payer: Cigna Commercial |
$13,172.10
|
| Rate for Payer: First Health Commercial |
$15,076.50
|
| Rate for Payer: Humana Commercial |
$13,489.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,013.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,712.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,761.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,965.60
|
| Rate for Payer: Ohio Health Group HMO |
$11,902.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,696.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,806.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,950.30
|
| Rate for Payer: PHCS Commercial |
$15,235.20
|
| Rate for Payer: United Healthcare All Payer |
$13,965.60
|
|
|
SLEEVE MODULAR GRIT XS 26/27
|
Facility
|
OP
|
$15,870.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,761.00 |
| Max. Negotiated Rate |
$15,235.20 |
| Rate for Payer: Aetna Commercial |
$12,219.90
|
| Rate for Payer: Anthem Medicaid |
$5,457.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,378.60
|
| Rate for Payer: Cash Price |
$7,935.00
|
| Rate for Payer: Cigna Commercial |
$13,172.10
|
| Rate for Payer: First Health Commercial |
$15,076.50
|
| Rate for Payer: Humana Commercial |
$13,489.50
|
| Rate for Payer: Humana KY Medicaid |
$5,457.69
|
| Rate for Payer: Kentucky WC Medicaid |
$5,513.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,013.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,712.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,761.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,567.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,965.60
|
| Rate for Payer: Ohio Health Group HMO |
$11,902.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,696.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,806.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,950.30
|
| Rate for Payer: PHCS Commercial |
$15,235.20
|
| Rate for Payer: United Healthcare All Payer |
$13,965.60
|
|
|
SLEEVE TI MOD HEAD 12/14 TPR +
|
Facility
|
OP
|
$1,737.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$521.10 |
| Max. Negotiated Rate |
$1,667.52 |
| Rate for Payer: Aetna Commercial |
$1,337.49
|
| Rate for Payer: Anthem Medicaid |
$597.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,354.86
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Cigna Commercial |
$1,441.71
|
| Rate for Payer: First Health Commercial |
$1,650.15
|
| Rate for Payer: Humana Commercial |
$1,476.45
|
| Rate for Payer: Humana KY Medicaid |
$597.35
|
| Rate for Payer: Kentucky WC Medicaid |
$603.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,424.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,281.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$521.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$609.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,528.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,302.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,389.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,511.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,198.53
|
| Rate for Payer: PHCS Commercial |
$1,667.52
|
| Rate for Payer: United Healthcare All Payer |
$1,528.56
|
|
