|
STERNAL TALON THRACIC MED 17MM
|
Facility
|
IP
|
$8,012.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,041.59 |
| Max. Negotiated Rate |
$7,691.71 |
| Rate for Payer: Aetna Commercial |
$6,169.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,249.52
|
| Rate for Payer: Cash Price |
$4,006.10
|
| Rate for Payer: Cigna Commercial |
$6,650.13
|
| Rate for Payer: First Health Commercial |
$7,611.59
|
| Rate for Payer: Humana Commercial |
$6,810.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,570.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,913.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,403.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,050.74
|
| Rate for Payer: Ohio Health Group HMO |
$6,009.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,602.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,041.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,483.78
|
| Rate for Payer: PHCS Commercial |
$7,691.71
|
| Rate for Payer: United Healthcare All Payer |
$7,050.74
|
|
|
STERNAL TALON THRACIC MED 17MM
|
Facility
|
OP
|
$8,012.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,041.59 |
| Max. Negotiated Rate |
$7,691.71 |
| Rate for Payer: Aetna Commercial |
$6,169.39
|
| Rate for Payer: Anthem Medicaid |
$2,755.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,249.52
|
| Rate for Payer: Cash Price |
$4,006.10
|
| Rate for Payer: Cigna Commercial |
$6,650.13
|
| Rate for Payer: First Health Commercial |
$7,611.59
|
| Rate for Payer: Humana Commercial |
$6,810.37
|
| Rate for Payer: Humana KY Medicaid |
$2,755.40
|
| Rate for Payer: Kentucky WC Medicaid |
$2,783.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,570.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,913.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,403.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,810.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,050.74
|
| Rate for Payer: Ohio Health Group HMO |
$6,009.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,602.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,041.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,483.78
|
| Rate for Payer: PHCS Commercial |
$7,691.71
|
| Rate for Payer: United Healthcare All Payer |
$7,050.74
|
|
|
STERNAL TALON THRACIC MED 20MM
|
Facility
|
OP
|
$8,012.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,041.59 |
| Max. Negotiated Rate |
$7,691.71 |
| Rate for Payer: Aetna Commercial |
$6,169.39
|
| Rate for Payer: Anthem Medicaid |
$2,755.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,249.52
|
| Rate for Payer: Cash Price |
$4,006.10
|
| Rate for Payer: Cigna Commercial |
$6,650.13
|
| Rate for Payer: First Health Commercial |
$7,611.59
|
| Rate for Payer: Humana Commercial |
$6,810.37
|
| Rate for Payer: Humana KY Medicaid |
$2,755.40
|
| Rate for Payer: Kentucky WC Medicaid |
$2,783.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,570.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,913.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,403.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,810.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,050.74
|
| Rate for Payer: Ohio Health Group HMO |
$6,009.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,602.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,041.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,483.78
|
| Rate for Payer: PHCS Commercial |
$7,691.71
|
| Rate for Payer: United Healthcare All Payer |
$7,050.74
|
|
|
STERNAL TALON THRACIC MED 20MM
|
Facility
|
IP
|
$8,012.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,041.59 |
| Max. Negotiated Rate |
$7,691.71 |
| Rate for Payer: Aetna Commercial |
$6,169.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,249.52
|
| Rate for Payer: Cash Price |
$4,006.10
|
| Rate for Payer: Cigna Commercial |
$6,650.13
|
| Rate for Payer: First Health Commercial |
$7,611.59
|
| Rate for Payer: Humana Commercial |
$6,810.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,570.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,913.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,403.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,050.74
|
| Rate for Payer: Ohio Health Group HMO |
$6,009.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,602.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,041.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,483.78
|
| Rate for Payer: PHCS Commercial |
$7,691.71
|
| Rate for Payer: United Healthcare All Payer |
$7,050.74
|
|
|
STERNAL TALON THRACIC XSM 11MM
|
Facility
|
IP
|
$7,764.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,009.32 |
| Max. Negotiated Rate |
$7,453.44 |
| Rate for Payer: Aetna Commercial |
$5,978.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,055.92
|
| Rate for Payer: Cash Price |
$3,882.00
|
| Rate for Payer: Cigna Commercial |
$6,444.12
|
| Rate for Payer: First Health Commercial |
$7,375.80
|
| Rate for Payer: Humana Commercial |
$6,599.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,366.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,729.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,329.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,832.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,823.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,009.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,406.84
|
| Rate for Payer: PHCS Commercial |
$7,453.44
|
| Rate for Payer: United Healthcare All Payer |
$6,832.32
|
|
|
STERNAL TALON THRACIC XSM 11MM
|
Facility
|
OP
|
$7,764.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,009.32 |
| Max. Negotiated Rate |
$7,453.44 |
| Rate for Payer: Aetna Commercial |
$5,978.28
|
| Rate for Payer: Anthem Medicaid |
$2,670.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,055.92
|
| Rate for Payer: Cash Price |
$3,882.00
|
| Rate for Payer: Cigna Commercial |
$6,444.12
|
| Rate for Payer: First Health Commercial |
$7,375.80
|
| Rate for Payer: Humana Commercial |
$6,599.40
|
| Rate for Payer: Humana KY Medicaid |
$2,670.04
|
| Rate for Payer: Kentucky WC Medicaid |
$2,697.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,366.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,729.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,329.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,723.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,832.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,823.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,009.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,406.84
|
| Rate for Payer: PHCS Commercial |
$7,453.44
|
| Rate for Payer: United Healthcare All Payer |
$6,832.32
|
|
|
STERNAL TALON THRACIC XSM 14MM
|
Facility
|
OP
|
$7,764.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,009.32 |
| Max. Negotiated Rate |
$7,453.44 |
| Rate for Payer: Aetna Commercial |
$5,978.28
|
| Rate for Payer: Anthem Medicaid |
$2,670.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,055.92
|
| Rate for Payer: Cash Price |
$3,882.00
|
| Rate for Payer: Cigna Commercial |
$6,444.12
|
| Rate for Payer: First Health Commercial |
$7,375.80
|
| Rate for Payer: Humana Commercial |
$6,599.40
|
| Rate for Payer: Humana KY Medicaid |
$2,670.04
|
| Rate for Payer: Kentucky WC Medicaid |
$2,697.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,366.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,729.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,329.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,723.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,832.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,823.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,009.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,406.84
|
| Rate for Payer: PHCS Commercial |
$7,453.44
|
| Rate for Payer: United Healthcare All Payer |
$6,832.32
|
|
|
STERNAL TALON THRACIC XSM 14MM
|
Facility
|
IP
|
$7,764.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,009.32 |
| Max. Negotiated Rate |
$7,453.44 |
| Rate for Payer: Aetna Commercial |
$5,978.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,055.92
|
| Rate for Payer: Cash Price |
$3,882.00
|
| Rate for Payer: Cigna Commercial |
$6,444.12
|
| Rate for Payer: First Health Commercial |
$7,375.80
|
| Rate for Payer: Humana Commercial |
$6,599.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,366.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,729.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,329.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,832.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,823.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,009.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,406.84
|
| Rate for Payer: PHCS Commercial |
$7,453.44
|
| Rate for Payer: United Healthcare All Payer |
$6,832.32
|
|
|
ST FLUSH CATH 65CM
|
Facility
|
OP
|
$780.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.40 |
| Max. Negotiated Rate |
$748.80 |
| Rate for Payer: Aetna Commercial |
$600.60
|
| Rate for Payer: Anthem Medicaid |
$268.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$608.40
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$647.40
|
| Rate for Payer: First Health Commercial |
$741.00
|
| Rate for Payer: Humana Commercial |
$663.00
|
| Rate for Payer: Humana KY Medicaid |
$268.24
|
| Rate for Payer: Kentucky WC Medicaid |
$270.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$639.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$575.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$234.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$273.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$686.40
|
| Rate for Payer: Ohio Health Group HMO |
$585.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.80
|
| Rate for Payer: PHCS Commercial |
$748.80
|
| Rate for Payer: United Healthcare All Payer |
$686.40
|
|
|
ST FLUSH CATH 65CM
|
Facility
|
IP
|
$780.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.40 |
| Max. Negotiated Rate |
$748.80 |
| Rate for Payer: Aetna Commercial |
$600.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$608.40
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$647.40
|
| Rate for Payer: First Health Commercial |
$741.00
|
| Rate for Payer: Humana Commercial |
$663.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$639.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$575.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$234.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$686.40
|
| Rate for Payer: Ohio Health Group HMO |
$585.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.80
|
| Rate for Payer: PHCS Commercial |
$748.80
|
| Rate for Payer: United Healthcare All Payer |
$686.40
|
|
|
ST FLUSH CATH 90CM
|
Facility
|
OP
|
$780.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.40 |
| Max. Negotiated Rate |
$748.80 |
| Rate for Payer: Aetna Commercial |
$600.60
|
| Rate for Payer: Anthem Medicaid |
$268.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$608.40
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$647.40
|
| Rate for Payer: First Health Commercial |
$741.00
|
| Rate for Payer: Humana Commercial |
$663.00
|
| Rate for Payer: Humana KY Medicaid |
$268.24
|
| Rate for Payer: Kentucky WC Medicaid |
$270.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$639.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$575.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$234.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$273.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$686.40
|
| Rate for Payer: Ohio Health Group HMO |
$585.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.80
|
| Rate for Payer: PHCS Commercial |
$748.80
|
| Rate for Payer: United Healthcare All Payer |
$686.40
|
|
|
ST FLUSH CATH 90CM
|
Facility
|
IP
|
$780.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.40 |
| Max. Negotiated Rate |
$748.80 |
| Rate for Payer: Aetna Commercial |
$600.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$608.40
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$647.40
|
| Rate for Payer: First Health Commercial |
$741.00
|
| Rate for Payer: Humana Commercial |
$663.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$639.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$575.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$234.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$686.40
|
| Rate for Payer: Ohio Health Group HMO |
$585.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.80
|
| Rate for Payer: PHCS Commercial |
$748.80
|
| Rate for Payer: United Healthcare All Payer |
$686.40
|
|
|
STIMULATOR PERC IMPLANTATION
|
Professional
|
Both
|
$1,775.00
|
|
|
Service Code
|
HCPCS 63650
|
| Hospital Charge Code |
76102305
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$338.44 |
| Max. Negotiated Rate |
$1,775.00 |
| Rate for Payer: Aetna Commercial |
$650.19
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$338.44
|
| Rate for Payer: Anthem Medicaid |
$433.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,775.00
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cigna Commercial |
$629.85
|
| Rate for Payer: Healthspan PPO |
$507.65
|
| Rate for Payer: Humana Medicaid |
$433.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$528.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$441.92
|
| Rate for Payer: Molina Healthcare Passport |
$433.25
|
| Rate for Payer: Multiplan PHCS |
$1,065.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,242.50
|
| Rate for Payer: UHCCP Medicaid |
$355.36
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$437.58
|
|
|
STIMULATOR PERC IMPLANTATION
|
Facility
|
IP
|
$1,775.00
|
|
|
Service Code
|
HCPCS 63650
|
| Hospital Charge Code |
76102305
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$230.75 |
| Max. Negotiated Rate |
$1,704.00 |
| Rate for Payer: Aetna Commercial |
$1,366.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,384.50
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cigna Commercial |
$1,473.25
|
| Rate for Payer: First Health Commercial |
$1,686.25
|
| Rate for Payer: Humana Commercial |
$1,508.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,455.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,309.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$532.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,562.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,331.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$355.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$230.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$550.25
|
| Rate for Payer: PHCS Commercial |
$1,704.00
|
| Rate for Payer: United Healthcare All Payer |
$1,562.00
|
|
|
STIMULATOR PERC IMPLANTATION
|
Facility
|
OP
|
$1,775.00
|
|
|
Service Code
|
HCPCS 63650
|
| Hospital Charge Code |
76102305
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$230.75 |
| Max. Negotiated Rate |
$8,279.85 |
| Rate for Payer: Aetna Commercial |
$1,366.75
|
| Rate for Payer: Anthem Medicaid |
$610.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,914.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,384.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,279.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,984.14
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cigna Commercial |
$1,473.25
|
| Rate for Payer: First Health Commercial |
$1,686.25
|
| Rate for Payer: Humana Commercial |
$1,508.75
|
| Rate for Payer: Humana KY Medicaid |
$610.42
|
| Rate for Payer: Humana Medicare Advantage |
$5,914.18
|
| Rate for Payer: Kentucky WC Medicaid |
$616.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,455.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,309.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,097.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$622.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,562.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,331.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$355.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$230.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$550.25
|
| Rate for Payer: PHCS Commercial |
$1,704.00
|
| Rate for Payer: United Healthcare All Payer |
$1,562.00
|
|
|
STIMULATOR PERC IMPLANTATION(P
|
Professional
|
Both
|
$1,775.00
|
|
|
Service Code
|
HCPCS 63650
|
| Hospital Charge Code |
761P2305
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$338.44 |
| Max. Negotiated Rate |
$1,775.00 |
| Rate for Payer: Aetna Commercial |
$650.19
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$338.44
|
| Rate for Payer: Anthem Medicaid |
$433.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,775.00
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cigna Commercial |
$629.85
|
| Rate for Payer: Healthspan PPO |
$507.65
|
| Rate for Payer: Humana Medicaid |
$433.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$528.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$441.92
|
| Rate for Payer: Molina Healthcare Passport |
$433.25
|
| Rate for Payer: Multiplan PHCS |
$1,065.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,242.50
|
| Rate for Payer: UHCCP Medicaid |
$355.36
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$437.58
|
|
|
STIMULATOR WIRELESS EXT NEURO
|
Facility
|
OP
|
$8,019.50
|
|
|
Service Code
|
HCPCS C1767
|
| Hospital Charge Code |
27000081
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,042.54 |
| Max. Negotiated Rate |
$7,698.72 |
| Rate for Payer: Aetna Commercial |
$6,175.02
|
| Rate for Payer: Anthem Medicaid |
$2,757.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,255.21
|
| Rate for Payer: Cash Price |
$4,009.75
|
| Rate for Payer: Cigna Commercial |
$6,656.18
|
| Rate for Payer: First Health Commercial |
$7,618.52
|
| Rate for Payer: Humana Commercial |
$6,816.58
|
| Rate for Payer: Humana KY Medicaid |
$2,757.91
|
| Rate for Payer: Kentucky WC Medicaid |
$2,785.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,575.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,918.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,405.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,813.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,057.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,014.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,603.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,042.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,486.04
|
| Rate for Payer: PHCS Commercial |
$7,698.72
|
| Rate for Payer: United Healthcare All Payer |
$7,057.16
|
|
|
STIMULATOR WIRELESS EXT NEURO
|
Facility
|
IP
|
$8,019.50
|
|
|
Service Code
|
HCPCS C1767
|
| Hospital Charge Code |
27000081
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,042.54 |
| Max. Negotiated Rate |
$7,698.72 |
| Rate for Payer: Aetna Commercial |
$6,175.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,255.21
|
| Rate for Payer: Cash Price |
$4,009.75
|
| Rate for Payer: Cigna Commercial |
$6,656.18
|
| Rate for Payer: First Health Commercial |
$7,618.52
|
| Rate for Payer: Humana Commercial |
$6,816.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,575.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,918.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,405.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,057.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,014.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,603.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,042.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,486.04
|
| Rate for Payer: PHCS Commercial |
$7,698.72
|
| Rate for Payer: United Healthcare All Payer |
$7,057.16
|
|
|
STINGRAY BALLOON
|
Facility
|
IP
|
$7,595.63
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$987.43 |
| Max. Negotiated Rate |
$7,291.80 |
| Rate for Payer: Aetna Commercial |
$5,848.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,924.59
|
| Rate for Payer: Cash Price |
$3,797.81
|
| Rate for Payer: Cigna Commercial |
$6,304.37
|
| Rate for Payer: First Health Commercial |
$7,215.85
|
| Rate for Payer: Humana Commercial |
$6,456.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,228.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,605.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,278.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,684.15
|
| Rate for Payer: Ohio Health Group HMO |
$5,696.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,519.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$987.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,354.65
|
| Rate for Payer: PHCS Commercial |
$7,291.80
|
| Rate for Payer: United Healthcare All Payer |
$6,684.15
|
|
|
STINGRAY BALLOON
|
Facility
|
OP
|
$7,595.63
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$987.43 |
| Max. Negotiated Rate |
$7,291.80 |
| Rate for Payer: Aetna Commercial |
$5,848.64
|
| Rate for Payer: Anthem Medicaid |
$2,612.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,924.59
|
| Rate for Payer: Cash Price |
$3,797.81
|
| Rate for Payer: Cigna Commercial |
$6,304.37
|
| Rate for Payer: First Health Commercial |
$7,215.85
|
| Rate for Payer: Humana Commercial |
$6,456.29
|
| Rate for Payer: Humana KY Medicaid |
$2,612.14
|
| Rate for Payer: Kentucky WC Medicaid |
$2,638.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,228.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,605.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,278.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,664.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,684.15
|
| Rate for Payer: Ohio Health Group HMO |
$5,696.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,519.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$987.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,354.65
|
| Rate for Payer: PHCS Commercial |
$7,291.80
|
| Rate for Payer: United Healthcare All Payer |
$6,684.15
|
|
|
STINGRAY GUIDEWIRE 185CM
|
Facility
|
IP
|
$3,440.33
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$447.24 |
| Max. Negotiated Rate |
$3,302.72 |
| Rate for Payer: Aetna Commercial |
$2,649.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,683.46
|
| Rate for Payer: Cash Price |
$1,720.16
|
| Rate for Payer: Cigna Commercial |
$2,855.47
|
| Rate for Payer: First Health Commercial |
$3,268.31
|
| Rate for Payer: Humana Commercial |
$2,924.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,821.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,538.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,032.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,027.49
|
| Rate for Payer: Ohio Health Group HMO |
$2,580.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$688.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$447.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,066.50
|
| Rate for Payer: PHCS Commercial |
$3,302.72
|
| Rate for Payer: United Healthcare All Payer |
$3,027.49
|
|
|
STINGRAY GUIDEWIRE 185CM
|
Facility
|
OP
|
$3,440.33
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$447.24 |
| Max. Negotiated Rate |
$3,302.72 |
| Rate for Payer: Aetna Commercial |
$2,649.05
|
| Rate for Payer: Anthem Medicaid |
$1,183.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,683.46
|
| Rate for Payer: Cash Price |
$1,720.16
|
| Rate for Payer: Cigna Commercial |
$2,855.47
|
| Rate for Payer: First Health Commercial |
$3,268.31
|
| Rate for Payer: Humana Commercial |
$2,924.28
|
| Rate for Payer: Humana KY Medicaid |
$1,183.13
|
| Rate for Payer: Kentucky WC Medicaid |
$1,195.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,821.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,538.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,032.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,206.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,027.49
|
| Rate for Payer: Ohio Health Group HMO |
$2,580.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$688.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$447.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,066.50
|
| Rate for Payer: PHCS Commercial |
$3,302.72
|
| Rate for Payer: United Healthcare All Payer |
$3,027.49
|
|
|
STINGRAY GUIDEWIRE 300CM
|
Facility
|
OP
|
$3,440.33
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$447.24 |
| Max. Negotiated Rate |
$3,302.72 |
| Rate for Payer: Aetna Commercial |
$2,649.05
|
| Rate for Payer: Anthem Medicaid |
$1,183.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,683.46
|
| Rate for Payer: Cash Price |
$1,720.16
|
| Rate for Payer: Cigna Commercial |
$2,855.47
|
| Rate for Payer: First Health Commercial |
$3,268.31
|
| Rate for Payer: Humana Commercial |
$2,924.28
|
| Rate for Payer: Humana KY Medicaid |
$1,183.13
|
| Rate for Payer: Kentucky WC Medicaid |
$1,195.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,821.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,538.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,032.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,206.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,027.49
|
| Rate for Payer: Ohio Health Group HMO |
$2,580.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$688.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$447.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,066.50
|
| Rate for Payer: PHCS Commercial |
$3,302.72
|
| Rate for Payer: United Healthcare All Payer |
$3,027.49
|
|
|
STINGRAY GUIDEWIRE 300CM
|
Facility
|
IP
|
$3,440.33
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$447.24 |
| Max. Negotiated Rate |
$3,302.72 |
| Rate for Payer: Aetna Commercial |
$2,649.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,683.46
|
| Rate for Payer: Cash Price |
$1,720.16
|
| Rate for Payer: Cigna Commercial |
$2,855.47
|
| Rate for Payer: First Health Commercial |
$3,268.31
|
| Rate for Payer: Humana Commercial |
$2,924.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,821.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,538.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,032.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,027.49
|
| Rate for Payer: Ohio Health Group HMO |
$2,580.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$688.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$447.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,066.50
|
| Rate for Payer: PHCS Commercial |
$3,302.72
|
| Rate for Payer: United Healthcare All Payer |
$3,027.49
|
|
|
STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC
|
Facility
|
IP
|
$29,215.10
|
|
|
Service Code
|
MSDRG 327
|
| Min. Negotiated Rate |
$19,824.53 |
| Max. Negotiated Rate |
$29,215.10 |
| Rate for Payer: Anthem Medicaid |
$19,824.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$20,867.93
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$29,215.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$28,171.71
|
| Rate for Payer: Humana KY Medicaid |
$19,824.53
|
| Rate for Payer: Humana Medicare Advantage |
$20,867.93
|
| Rate for Payer: Kentucky WC Medicaid |
$20,022.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,041.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$20,221.02
|
|
