|
THYROIDECTOMY - TOTAL OR SUBT
|
Facility
|
IP
|
$3,500.00
|
|
|
Service Code
|
HCPCS 60252
|
| Hospital Charge Code |
76102276
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$455.00 |
| Max. Negotiated Rate |
$3,360.00 |
| Rate for Payer: Aetna Commercial |
$2,695.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,730.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cigna Commercial |
$2,905.00
|
| Rate for Payer: First Health Commercial |
$3,325.00
|
| Rate for Payer: Humana Commercial |
$2,975.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,870.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,583.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,050.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,080.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$455.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,085.00
|
| Rate for Payer: PHCS Commercial |
$3,360.00
|
| Rate for Payer: United Healthcare All Payer |
$3,080.00
|
|
|
THYROIDECTOMY - TOTAL OR SUBT
|
Professional
|
Both
|
$3,500.00
|
|
|
Service Code
|
HCPCS 60252
|
| Hospital Charge Code |
76102276
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$879.97 |
| Max. Negotiated Rate |
$3,500.00 |
| Rate for Payer: Aetna Commercial |
$1,933.71
|
| Rate for Payer: Anthem Medicaid |
$879.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,500.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cigna Commercial |
$1,826.04
|
| Rate for Payer: Healthspan PPO |
$1,630.73
|
| Rate for Payer: Humana Medicaid |
$879.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,697.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$897.57
|
| Rate for Payer: Molina Healthcare Passport |
$879.97
|
| Rate for Payer: Multiplan PHCS |
$2,100.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,450.00
|
| Rate for Payer: UHCCP Medicaid |
$1,225.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$888.77
|
|
|
THYROIDECTOMY, TOTAL OR SUBTOTAL FOR MALIGNANCY; WITH LIMITED NECK DISSECTION
|
Facility
|
OP
|
$7,089.80
|
|
|
Service Code
|
CPT 60252
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,064.14 |
| Max. Negotiated Rate |
$7,089.80 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,064.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,089.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,836.59
|
| Rate for Payer: Humana Medicare Advantage |
$5,064.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,076.97
|
|
|
THYROID IMAGING W/BLOOD FLO(P
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 78014
|
| Hospital Charge Code |
340P0002
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$26.83 |
| Max. Negotiated Rate |
$394.13 |
| Rate for Payer: Anthem Medicaid |
$186.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$125.00
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$394.13
|
| Rate for Payer: Healthspan PPO |
$268.05
|
| Rate for Payer: Humana Medicaid |
$186.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$26.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$190.29
|
| Rate for Payer: Molina Healthcare Passport |
$186.56
|
| Rate for Payer: Multiplan PHCS |
$75.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$87.50
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$188.43
|
|
|
THYROID IMAGING W/BLOOD FLO(T
|
Facility
|
IP
|
$1,173.00
|
|
|
Service Code
|
HCPCS 78014
|
| Hospital Charge Code |
340T0002
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$152.49 |
| Max. Negotiated Rate |
$1,126.08 |
| Rate for Payer: Aetna Commercial |
$903.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$914.94
|
| Rate for Payer: Cash Price |
$586.50
|
| Rate for Payer: Cigna Commercial |
$973.59
|
| Rate for Payer: First Health Commercial |
$1,114.35
|
| Rate for Payer: Humana Commercial |
$997.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$961.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$865.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$351.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,032.24
|
| Rate for Payer: Ohio Health Group HMO |
$879.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$234.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$152.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$363.63
|
| Rate for Payer: PHCS Commercial |
$1,126.08
|
| Rate for Payer: United Healthcare All Payer |
$1,032.24
|
|
|
THYROID IMAGING W/BLOOD FLO(T
|
Facility
|
OP
|
$1,173.00
|
|
|
Service Code
|
HCPCS 78014
|
| Hospital Charge Code |
340T0002
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$152.49 |
| Max. Negotiated Rate |
$1,126.08 |
| Rate for Payer: Aetna Commercial |
$903.21
|
| Rate for Payer: Anthem Medicaid |
$403.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$356.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$914.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$499.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$481.49
|
| Rate for Payer: Cash Price |
$586.50
|
| Rate for Payer: Cash Price |
$586.50
|
| Rate for Payer: Cigna Commercial |
$973.59
|
| Rate for Payer: First Health Commercial |
$1,114.35
|
| Rate for Payer: Humana Commercial |
$997.05
|
| Rate for Payer: Humana KY Medicaid |
$403.39
|
| Rate for Payer: Humana Medicare Advantage |
$356.66
|
| Rate for Payer: Kentucky WC Medicaid |
$407.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$961.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$865.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$427.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$411.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,032.24
|
| Rate for Payer: Ohio Health Group HMO |
$879.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$234.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$152.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$363.63
|
| Rate for Payer: PHCS Commercial |
$1,126.08
|
| Rate for Payer: United Healthcare All Payer |
$1,032.24
|
|
|
THYROID IMAGING W/BLOOD FLOW
|
Facility
|
OP
|
$1,298.00
|
|
|
Service Code
|
HCPCS 78014
|
| Hospital Charge Code |
34000002
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$168.74 |
| Max. Negotiated Rate |
$1,246.08 |
| Rate for Payer: Aetna Commercial |
$999.46
|
| Rate for Payer: Anthem Medicaid |
$446.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$356.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,012.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$499.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$481.49
|
| Rate for Payer: Cash Price |
$649.00
|
| Rate for Payer: Cash Price |
$649.00
|
| Rate for Payer: Cigna Commercial |
$1,077.34
|
| Rate for Payer: First Health Commercial |
$1,233.10
|
| Rate for Payer: Humana Commercial |
$1,103.30
|
| Rate for Payer: Humana KY Medicaid |
$446.38
|
| Rate for Payer: Humana Medicare Advantage |
$356.66
|
| Rate for Payer: Kentucky WC Medicaid |
$450.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,064.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$957.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$427.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$455.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,142.24
|
| Rate for Payer: Ohio Health Group HMO |
$973.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$259.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$168.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$402.38
|
| Rate for Payer: PHCS Commercial |
$1,246.08
|
| Rate for Payer: United Healthcare All Payer |
$1,142.24
|
|
|
THYROID IMAGING W/BLOOD FLOW
|
Professional
|
Both
|
$1,298.00
|
|
|
Service Code
|
HCPCS 78014
|
| Hospital Charge Code |
34000002
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$26.83 |
| Max. Negotiated Rate |
$1,298.00 |
| Rate for Payer: Anthem Medicaid |
$186.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,298.00
|
| Rate for Payer: Cash Price |
$649.00
|
| Rate for Payer: Cash Price |
$649.00
|
| Rate for Payer: Cigna Commercial |
$394.13
|
| Rate for Payer: Healthspan PPO |
$268.05
|
| Rate for Payer: Humana Medicaid |
$186.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$26.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$190.29
|
| Rate for Payer: Molina Healthcare Passport |
$186.56
|
| Rate for Payer: Multiplan PHCS |
$778.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$908.60
|
| Rate for Payer: UHCCP Medicaid |
$454.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$188.43
|
|
|
THYROID IMAGING W/BLOOD FLOW
|
Facility
|
IP
|
$1,298.00
|
|
|
Service Code
|
HCPCS 78014
|
| Hospital Charge Code |
34000002
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$168.74 |
| Max. Negotiated Rate |
$1,246.08 |
| Rate for Payer: Aetna Commercial |
$999.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,012.44
|
| Rate for Payer: Cash Price |
$649.00
|
| Rate for Payer: Cigna Commercial |
$1,077.34
|
| Rate for Payer: First Health Commercial |
$1,233.10
|
| Rate for Payer: Humana Commercial |
$1,103.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,064.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$957.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$389.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,142.24
|
| Rate for Payer: Ohio Health Group HMO |
$973.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$259.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$168.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$402.38
|
| Rate for Payer: PHCS Commercial |
$1,246.08
|
| Rate for Payer: United Healthcare All Payer |
$1,142.24
|
|
|
THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC
|
Facility
|
IP
|
$17,452.57
|
|
|
Service Code
|
MSDRG 626
|
| Min. Negotiated Rate |
$11,842.81 |
| Max. Negotiated Rate |
$17,452.57 |
| Rate for Payer: Anthem Medicaid |
$11,842.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12,466.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17,452.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$16,829.26
|
| Rate for Payer: Humana KY Medicaid |
$11,842.81
|
| Rate for Payer: Humana Medicare Advantage |
$12,466.12
|
| Rate for Payer: Kentucky WC Medicaid |
$11,961.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14,959.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,079.67
|
|
|
THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC
|
Facility
|
IP
|
$34,172.80
|
|
|
Service Code
|
MSDRG 625
|
| Min. Negotiated Rate |
$23,188.68 |
| Max. Negotiated Rate |
$34,172.80 |
| Rate for Payer: Anthem Medicaid |
$23,188.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$24,409.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$34,172.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$32,952.34
|
| Rate for Payer: Humana KY Medicaid |
$23,188.68
|
| Rate for Payer: Humana Medicare Advantage |
$24,409.14
|
| Rate for Payer: Kentucky WC Medicaid |
$23,420.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29,290.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$23,652.46
|
|
|
THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$14,458.99
|
|
|
Service Code
|
MSDRG 627
|
| Min. Negotiated Rate |
$9,811.46 |
| Max. Negotiated Rate |
$14,458.99 |
| Rate for Payer: Anthem Medicaid |
$9,811.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10,327.85
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$14,458.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$13,942.60
|
| Rate for Payer: Humana KY Medicaid |
$9,811.46
|
| Rate for Payer: Humana Medicare Advantage |
$10,327.85
|
| Rate for Payer: Kentucky WC Medicaid |
$9,909.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,393.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,007.69
|
|
|
TIB ALL PLY GII P/S SZ 11MM RT
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
TIB ALL PLY GII P/S SZ 11MM RT
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
TIB ALL PLY GII P/S SZ 13MM RT
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
TIB ALL PLY GII P/S SZ 13MM RT
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
TIB ALL PLY GII P/S SZ 15MM RT
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
TIB ALL PLY GII P/S SZ 15MM RT
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
TIB ALL PLY GII P/S SZ3 11MM R
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
TIB ALL PLY GII P/S SZ3 11MM R
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
TIB ALL PLY GII P/S SZ3 13MM R
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
TIB ALL PLY GII P/S SZ3 13MM R
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
TIB ALL PLY GII P/S SZ3 15MM R
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
TIB ALL PLY GII P/S SZ3 15MM R
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
TIB ALL PLY GII P/S SZ3 9MM RT
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
