|
SLENDER SHEATH KIT 6F
|
Facility
|
IP
|
$1,494.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$448.35 |
| Max. Negotiated Rate |
$1,434.72 |
| Rate for Payer: Aetna Commercial |
$1,150.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,165.71
|
| Rate for Payer: Cash Price |
$747.25
|
| Rate for Payer: Cigna Commercial |
$1,240.43
|
| Rate for Payer: First Health Commercial |
$1,419.78
|
| Rate for Payer: Humana Commercial |
$1,270.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,225.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,102.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$448.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,315.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,120.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,195.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,300.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,031.20
|
| Rate for Payer: PHCS Commercial |
$1,434.72
|
| Rate for Payer: United Healthcare All Payer |
$1,315.16
|
|
|
SLENDER SHEATH KIT 6F
|
Facility
|
OP
|
$1,494.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$448.35 |
| Max. Negotiated Rate |
$1,434.72 |
| Rate for Payer: Aetna Commercial |
$1,150.77
|
| Rate for Payer: Anthem Medicaid |
$513.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,165.71
|
| Rate for Payer: Cash Price |
$747.25
|
| Rate for Payer: Cigna Commercial |
$1,240.43
|
| Rate for Payer: First Health Commercial |
$1,419.78
|
| Rate for Payer: Humana Commercial |
$1,270.33
|
| Rate for Payer: Humana KY Medicaid |
$513.96
|
| Rate for Payer: Kentucky WC Medicaid |
$519.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,225.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,102.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$448.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$524.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,315.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,120.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,195.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,300.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,031.20
|
| Rate for Payer: PHCS Commercial |
$1,434.72
|
| Rate for Payer: United Healthcare All Payer |
$1,315.16
|
|
|
SLIDE ON ENDOSHEATH
|
Facility
|
IP
|
$550.96
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$165.29 |
| Max. Negotiated Rate |
$528.92 |
| Rate for Payer: Aetna Commercial |
$424.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$429.75
|
| Rate for Payer: Cash Price |
$275.48
|
| Rate for Payer: Cigna Commercial |
$457.30
|
| Rate for Payer: First Health Commercial |
$523.41
|
| Rate for Payer: Humana Commercial |
$468.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$451.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$406.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$484.84
|
| Rate for Payer: Ohio Health Group HMO |
$413.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$440.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$479.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$380.16
|
| Rate for Payer: PHCS Commercial |
$528.92
|
| Rate for Payer: United Healthcare All Payer |
$484.84
|
|
|
SLIDE ON ENDOSHEATH
|
Facility
|
OP
|
$550.96
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$165.29 |
| Max. Negotiated Rate |
$528.92 |
| Rate for Payer: Aetna Commercial |
$424.24
|
| Rate for Payer: Anthem Medicaid |
$189.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$429.75
|
| Rate for Payer: Cash Price |
$275.48
|
| Rate for Payer: Cigna Commercial |
$457.30
|
| Rate for Payer: First Health Commercial |
$523.41
|
| Rate for Payer: Humana Commercial |
$468.32
|
| Rate for Payer: Humana KY Medicaid |
$189.48
|
| Rate for Payer: Kentucky WC Medicaid |
$191.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$451.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$406.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$193.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$484.84
|
| Rate for Payer: Ohio Health Group HMO |
$413.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$440.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$479.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$380.16
|
| Rate for Payer: PHCS Commercial |
$528.92
|
| Rate for Payer: United Healthcare All Payer |
$484.84
|
|
|
SLIDE ON ENDOSHEATH/ENT 1000
|
Facility
|
IP
|
$550.96
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$165.29 |
| Max. Negotiated Rate |
$528.92 |
| Rate for Payer: Aetna Commercial |
$424.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$429.75
|
| Rate for Payer: Cash Price |
$275.48
|
| Rate for Payer: Cigna Commercial |
$457.30
|
| Rate for Payer: First Health Commercial |
$523.41
|
| Rate for Payer: Humana Commercial |
$468.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$451.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$406.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$484.84
|
| Rate for Payer: Ohio Health Group HMO |
$413.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$440.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$479.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$380.16
|
| Rate for Payer: PHCS Commercial |
$528.92
|
| Rate for Payer: United Healthcare All Payer |
$484.84
|
|
|
SLIDE ON ENDOSHEATH/ENT 1000
|
Facility
|
OP
|
$550.96
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$165.29 |
| Max. Negotiated Rate |
$528.92 |
| Rate for Payer: Aetna Commercial |
$424.24
|
| Rate for Payer: Anthem Medicaid |
$189.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$429.75
|
| Rate for Payer: Cash Price |
$275.48
|
| Rate for Payer: Cigna Commercial |
$457.30
|
| Rate for Payer: First Health Commercial |
$523.41
|
| Rate for Payer: Humana Commercial |
$468.32
|
| Rate for Payer: Humana KY Medicaid |
$189.48
|
| Rate for Payer: Kentucky WC Medicaid |
$191.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$451.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$406.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$193.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$484.84
|
| Rate for Payer: Ohio Health Group HMO |
$413.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$440.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$479.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$380.16
|
| Rate for Payer: PHCS Commercial |
$528.92
|
| Rate for Payer: United Healthcare All Payer |
$484.84
|
|
|
SLING OPERATION FOR STRESS INCONTINENCE (EG, FASCIA OR SYNTHETIC)
|
Facility
|
OP
|
$6,385.65
|
|
|
Service Code
|
CPT 57288
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,561.18 |
| Max. Negotiated Rate |
$6,385.65 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,561.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,385.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,157.59
|
| Rate for Payer: Humana Medicare Advantage |
$4,561.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,473.42
|
|
|
SLITTER 6230UNI
|
Facility
|
OP
|
$554.00
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$166.20 |
| Max. Negotiated Rate |
$531.84 |
| Rate for Payer: Aetna Commercial |
$426.58
|
| Rate for Payer: Anthem Medicaid |
$190.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$432.12
|
| Rate for Payer: Cash Price |
$277.00
|
| Rate for Payer: Cigna Commercial |
$459.82
|
| Rate for Payer: First Health Commercial |
$526.30
|
| Rate for Payer: Humana Commercial |
$470.90
|
| Rate for Payer: Humana KY Medicaid |
$190.52
|
| Rate for Payer: Kentucky WC Medicaid |
$192.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$454.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$408.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$166.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$194.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$487.52
|
| Rate for Payer: Ohio Health Group HMO |
$415.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$443.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$481.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$382.26
|
| Rate for Payer: PHCS Commercial |
$531.84
|
| Rate for Payer: United Healthcare All Payer |
$487.52
|
|
|
SLITTER 6230UNI
|
Facility
|
IP
|
$554.00
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$166.20 |
| Max. Negotiated Rate |
$531.84 |
| Rate for Payer: Aetna Commercial |
$426.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$432.12
|
| Rate for Payer: Cash Price |
$277.00
|
| Rate for Payer: Cigna Commercial |
$459.82
|
| Rate for Payer: First Health Commercial |
$526.30
|
| Rate for Payer: Humana Commercial |
$470.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$454.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$408.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$166.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$487.52
|
| Rate for Payer: Ohio Health Group HMO |
$415.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$443.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$481.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$382.26
|
| Rate for Payer: PHCS Commercial |
$531.84
|
| Rate for Payer: United Healthcare All Payer |
$487.52
|
|
|
SLITTING OF PREPUCE
|
Facility
|
OP
|
$5,350.32
|
|
|
Service Code
|
HCPCS 54001
|
| Hospital Charge Code |
76102123
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,839.98 |
| 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 |
$1,892.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,173.25
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,649.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,555.25
|
| 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 |
$1,892.78
|
| 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 |
$2,271.34
|
| 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 |
$4,280.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,654.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,691.72
|
| Rate for Payer: PHCS Commercial |
$5,136.31
|
| Rate for Payer: United Healthcare All Payer |
$4,708.28
|
|
|
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 |
$3,210.19 |
| Rate for Payer: Aetna Commercial |
$222.29
|
| Rate for Payer: Ambetter Exchange |
$133.38
|
| 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 Individual/Medicaid |
$133.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$133.38
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.06
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$133.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$133.38
|
| 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 |
$173.39
|
| Rate for Payer: UHCCP Medicaid |
$74.31
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$88.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$133.38
|
|
|
SLITTING OF PREPUCE
|
Facility
|
IP
|
$5,350.32
|
|
|
Service Code
|
HCPCS 54001
|
| Hospital Charge Code |
76102123
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,605.10 |
| 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 |
$4,280.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,654.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,691.72
|
| 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
|
$2,649.89
|
|
|
Service Code
|
CPT 54001
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,892.78 |
| Max. Negotiated Rate |
$2,649.89 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,892.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,649.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,555.25
|
| Rate for Payer: Humana Medicare Advantage |
$1,892.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,271.34
|
|
|
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 |
$390.00 |
| Rate for Payer: Aetna Commercial |
$222.29
|
| Rate for Payer: Ambetter Exchange |
$133.38
|
| 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 Individual/Medicaid |
$133.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$133.38
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.06
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$133.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$133.38
|
| 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 |
$173.39
|
| Rate for Payer: UHCCP Medicaid |
$74.31
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$88.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$133.38
|
|
|
SLITTING OF PREPUCE(T
|
Facility
|
IP
|
$4,700.32
|
|
|
Service Code
|
HCPCS 54001
|
| Hospital Charge Code |
761T2123
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,410.10 |
| 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 |
$3,760.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,089.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,243.22
|
| Rate for Payer: PHCS Commercial |
$4,512.31
|
| Rate for Payer: United Healthcare All Payer |
$4,136.28
|
|
|
SLITTING OF PREPUCE(T
|
Facility
|
OP
|
$4,700.32
|
|
|
Service Code
|
HCPCS 54001
|
| Hospital Charge Code |
761T2123
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,616.44 |
| 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 |
$1,892.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,666.25
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,649.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,555.25
|
| 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 |
$1,892.78
|
| 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 |
$2,271.34
|
| 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 |
$3,760.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,089.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,243.22
|
| 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
|
$4,460.94
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,338.28 |
| Max. Negotiated Rate |
$4,282.50 |
| Rate for Payer: Aetna Commercial |
$3,434.92
|
| Rate for Payer: Anthem Medicaid |
$1,534.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,479.53
|
| Rate for Payer: Cash Price |
$2,230.47
|
| Rate for Payer: Cigna Commercial |
$3,702.58
|
| Rate for Payer: First Health Commercial |
$4,237.89
|
| Rate for Payer: Humana Commercial |
$3,791.80
|
| Rate for Payer: Humana KY Medicaid |
$1,534.12
|
| Rate for Payer: Kentucky WC Medicaid |
$1,549.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,657.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,292.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,338.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,564.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,925.63
|
| Rate for Payer: Ohio Health Group HMO |
$3,345.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,568.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,881.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,078.05
|
| Rate for Payer: PHCS Commercial |
$4,282.50
|
| Rate for Payer: United Healthcare All Payer |
$3,925.63
|
|
|
SLOTTED DRILL GUIDE/1.9MM DRIL
|
Facility
|
IP
|
$4,460.94
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,338.28 |
| Max. Negotiated Rate |
$4,282.50 |
| Rate for Payer: Aetna Commercial |
$3,434.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,479.53
|
| Rate for Payer: Cash Price |
$2,230.47
|
| Rate for Payer: Cigna Commercial |
$3,702.58
|
| Rate for Payer: First Health Commercial |
$4,237.89
|
| Rate for Payer: Humana Commercial |
$3,791.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,657.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,292.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,338.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,925.63
|
| Rate for Payer: Ohio Health Group HMO |
$3,345.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,568.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,881.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,078.05
|
| Rate for Payer: PHCS Commercial |
$4,282.50
|
| Rate for Payer: United Healthcare All Payer |
$3,925.63
|
|
|
SL-PLUS SDP W/ANTEVRTD HOLE 4
|
Facility
|
IP
|
$26,267.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,880.16 |
| Max. Negotiated Rate |
$25,216.50 |
| Rate for Payer: Aetna Commercial |
$20,225.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,488.41
|
| Rate for Payer: Cash Price |
$13,133.59
|
| Rate for Payer: Cigna Commercial |
$21,801.77
|
| Rate for Payer: First Health Commercial |
$24,953.83
|
| Rate for Payer: Humana Commercial |
$22,327.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,539.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,385.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,880.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,115.13
|
| Rate for Payer: Ohio Health Group HMO |
$19,700.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,013.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,852.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,124.36
|
| Rate for Payer: PHCS Commercial |
$25,216.50
|
| Rate for Payer: United Healthcare All Payer |
$23,115.13
|
|
|
SL-PLUS SDP W/ANTEVRTD HOLE 4
|
Facility
|
OP
|
$26,267.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,880.16 |
| Max. Negotiated Rate |
$25,216.50 |
| Rate for Payer: Aetna Commercial |
$20,225.74
|
| Rate for Payer: Anthem Medicaid |
$9,033.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,488.41
|
| Rate for Payer: Cash Price |
$13,133.59
|
| Rate for Payer: Cigna Commercial |
$21,801.77
|
| Rate for Payer: First Health Commercial |
$24,953.83
|
| Rate for Payer: Humana Commercial |
$22,327.11
|
| Rate for Payer: Humana KY Medicaid |
$9,033.29
|
| Rate for Payer: Kentucky WC Medicaid |
$9,125.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,539.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,385.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,880.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,214.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,115.13
|
| Rate for Payer: Ohio Health Group HMO |
$19,700.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,013.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,852.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,124.36
|
| Rate for Payer: PHCS Commercial |
$25,216.50
|
| Rate for Payer: United Healthcare All Payer |
$23,115.13
|
|
|
SL-PLUS SDP W/ANTEVRTD HOLE 5
|
Facility
|
OP
|
$26,267.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,880.16 |
| Max. Negotiated Rate |
$25,216.50 |
| Rate for Payer: Aetna Commercial |
$20,225.74
|
| Rate for Payer: Anthem Medicaid |
$9,033.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,488.41
|
| Rate for Payer: Cash Price |
$13,133.59
|
| Rate for Payer: Cigna Commercial |
$21,801.77
|
| Rate for Payer: First Health Commercial |
$24,953.83
|
| Rate for Payer: Humana Commercial |
$22,327.11
|
| Rate for Payer: Humana KY Medicaid |
$9,033.29
|
| Rate for Payer: Kentucky WC Medicaid |
$9,125.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,539.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,385.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,880.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,214.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,115.13
|
| Rate for Payer: Ohio Health Group HMO |
$19,700.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,013.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,852.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,124.36
|
| Rate for Payer: PHCS Commercial |
$25,216.50
|
| Rate for Payer: United Healthcare All Payer |
$23,115.13
|
|
|
SL-PLUS SDP W/ANTEVRTD HOLE 5
|
Facility
|
IP
|
$26,267.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,880.16 |
| Max. Negotiated Rate |
$25,216.50 |
| Rate for Payer: Aetna Commercial |
$20,225.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,488.41
|
| Rate for Payer: Cash Price |
$13,133.59
|
| Rate for Payer: Cigna Commercial |
$21,801.77
|
| Rate for Payer: First Health Commercial |
$24,953.83
|
| Rate for Payer: Humana Commercial |
$22,327.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,539.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,385.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,880.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,115.13
|
| Rate for Payer: Ohio Health Group HMO |
$19,700.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,013.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,852.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,124.36
|
| Rate for Payer: PHCS Commercial |
$25,216.50
|
| Rate for Payer: United Healthcare All Payer |
$23,115.13
|
|
|
SL-PLUS SDP W/ANTEVRTD HOLE 6
|
Facility
|
OP
|
$26,267.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,880.16 |
| Max. Negotiated Rate |
$25,216.50 |
| Rate for Payer: Aetna Commercial |
$20,225.74
|
| Rate for Payer: Anthem Medicaid |
$9,033.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,488.41
|
| Rate for Payer: Cash Price |
$13,133.59
|
| Rate for Payer: Cigna Commercial |
$21,801.77
|
| Rate for Payer: First Health Commercial |
$24,953.83
|
| Rate for Payer: Humana Commercial |
$22,327.11
|
| Rate for Payer: Humana KY Medicaid |
$9,033.29
|
| Rate for Payer: Kentucky WC Medicaid |
$9,125.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,539.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,385.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,880.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,214.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,115.13
|
| Rate for Payer: Ohio Health Group HMO |
$19,700.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,013.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,852.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,124.36
|
| Rate for Payer: PHCS Commercial |
$25,216.50
|
| Rate for Payer: United Healthcare All Payer |
$23,115.13
|
|
|
SL-PLUS SDP W/ANTEVRTD HOLE 6
|
Facility
|
IP
|
$26,267.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,880.16 |
| Max. Negotiated Rate |
$25,216.50 |
| Rate for Payer: Aetna Commercial |
$20,225.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,488.41
|
| Rate for Payer: Cash Price |
$13,133.59
|
| Rate for Payer: Cigna Commercial |
$21,801.77
|
| Rate for Payer: First Health Commercial |
$24,953.83
|
| Rate for Payer: Humana Commercial |
$22,327.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,539.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,385.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,880.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,115.13
|
| Rate for Payer: Ohio Health Group HMO |
$19,700.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,013.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,852.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,124.36
|
| Rate for Payer: PHCS Commercial |
$25,216.50
|
| Rate for Payer: United Healthcare All Payer |
$23,115.13
|
|
|
SL-PLUS SDP W/ANTEVRTD HOLE 7
|
Facility
|
IP
|
$26,267.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,880.16 |
| Max. Negotiated Rate |
$25,216.50 |
| Rate for Payer: Aetna Commercial |
$20,225.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,488.41
|
| Rate for Payer: Cash Price |
$13,133.59
|
| Rate for Payer: Cigna Commercial |
$21,801.77
|
| Rate for Payer: First Health Commercial |
$24,953.83
|
| Rate for Payer: Humana Commercial |
$22,327.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,539.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,385.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,880.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,115.13
|
| Rate for Payer: Ohio Health Group HMO |
$19,700.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,013.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,852.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,124.36
|
| Rate for Payer: PHCS Commercial |
$25,216.50
|
| Rate for Payer: United Healthcare All Payer |
$23,115.13
|
|
