|
BILIARY BALLOON DILATOR 8MM*4C
|
Facility
|
OP
|
$3,185.75
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$955.73 |
| Max. Negotiated Rate |
$3,058.32 |
| Rate for Payer: Aetna Commercial |
$2,453.03
|
| Rate for Payer: Anthem Medicaid |
$1,095.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,484.89
|
| Rate for Payer: Cash Price |
$1,592.88
|
| Rate for Payer: Cigna Commercial |
$2,644.17
|
| Rate for Payer: First Health Commercial |
$3,026.46
|
| Rate for Payer: Humana Commercial |
$2,707.89
|
| Rate for Payer: Humana KY Medicaid |
$1,095.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1,106.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,612.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,351.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$955.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,117.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,803.46
|
| Rate for Payer: Ohio Health Group HMO |
$2,389.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,548.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,771.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,198.17
|
| Rate for Payer: PHCS Commercial |
$3,058.32
|
| Rate for Payer: United Healthcare All Payer |
$2,803.46
|
|
|
BILIARY BALLOON DILATOR 8MM*4C
|
Facility
|
IP
|
$3,185.75
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$955.73 |
| Max. Negotiated Rate |
$3,058.32 |
| Rate for Payer: Aetna Commercial |
$2,453.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,484.89
|
| Rate for Payer: Cash Price |
$1,592.88
|
| Rate for Payer: Cigna Commercial |
$2,644.17
|
| Rate for Payer: First Health Commercial |
$3,026.46
|
| Rate for Payer: Humana Commercial |
$2,707.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,612.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,351.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$955.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,803.46
|
| Rate for Payer: Ohio Health Group HMO |
$2,389.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,548.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,771.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,198.17
|
| Rate for Payer: PHCS Commercial |
$3,058.32
|
| Rate for Payer: United Healthcare All Payer |
$2,803.46
|
|
|
BILILARY TREE BIOPSY
|
Professional
|
Both
|
$625.00
|
|
|
Service Code
|
HCPCS 47543
|
| Hospital Charge Code |
76102684
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$132.66 |
| Max. Negotiated Rate |
$1,004.79 |
| Rate for Payer: Ambetter Exchange |
$132.66
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$137.47
|
| Rate for Payer: Anthem Medicaid |
$985.09
|
| Rate for Payer: Buckeye Individual/Medicaid |
$132.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$132.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$159.19
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Cigna Commercial |
$281.41
|
| Rate for Payer: Humana Medicaid |
$985.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$238.15
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$132.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.66
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,004.79
|
| Rate for Payer: Molina Healthcare Passport |
$985.09
|
| Rate for Payer: Multiplan PHCS |
$375.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$172.46
|
| Rate for Payer: UHCCP Medicaid |
$144.34
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$994.94
|
| Rate for Payer: Wellcare Medicare Advantage |
$132.66
|
|
|
BILIRUBIN DIRECT
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
HCPCS 82248
|
| Hospital Charge Code |
30000249
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$81.60 |
| Rate for Payer: Aetna Commercial |
$65.45
|
| Rate for Payer: Anthem Medicaid |
$5.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$68.25
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.02
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cigna Commercial |
$70.55
|
| Rate for Payer: First Health Commercial |
$80.75
|
| Rate for Payer: Humana Commercial |
$72.25
|
| Rate for Payer: Humana KY Medicaid |
$5.02
|
| Rate for Payer: Humana Medicare Advantage |
$5.02
|
| Rate for Payer: Kentucky WC Medicaid |
$5.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$69.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$62.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$74.80
|
| Rate for Payer: Ohio Health Group HMO |
$63.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$58.65
|
| Rate for Payer: PHCS Commercial |
$81.60
|
| Rate for Payer: United Healthcare All Payer |
$74.80
|
|
|
BILIRUBIN DIRECT
|
Professional
|
Both
|
$85.00
|
|
|
Service Code
|
HCPCS 82248
|
| Hospital Charge Code |
30000249
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna Commercial |
$8.15
|
| Rate for Payer: Ambetter Exchange |
$5.02
|
| Rate for Payer: Buckeye Individual/Medicaid |
$5.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$5.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$6.02
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cigna Commercial |
$7.28
|
| Rate for Payer: Healthspan PPO |
$4.22
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$5.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.02
|
| Rate for Payer: Multiplan PHCS |
$51.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$6.53
|
| Rate for Payer: UHCCP Medicaid |
$29.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$3.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.02
|
|
|
BILIRUBIN DIRECT
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
HCPCS 82248
|
| Hospital Charge Code |
30000249
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.50 |
| Max. Negotiated Rate |
$81.60 |
| Rate for Payer: Aetna Commercial |
$65.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$68.25
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cigna Commercial |
$70.55
|
| Rate for Payer: First Health Commercial |
$80.75
|
| Rate for Payer: Humana Commercial |
$72.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$69.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$62.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$74.80
|
| Rate for Payer: Ohio Health Group HMO |
$63.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$58.65
|
| Rate for Payer: PHCS Commercial |
$81.60
|
| Rate for Payer: United Healthcare All Payer |
$74.80
|
|
|
BILIRUBIN (TOTAL)
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
HCPCS 82247
|
| Hospital Charge Code |
30000248
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.45 |
| Max. Negotiated Rate |
$7.03 |
| Rate for Payer: Aetna Commercial |
$3.85
|
| Rate for Payer: Anthem Medicaid |
$5.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.01
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.02
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cigna Commercial |
$4.15
|
| Rate for Payer: First Health Commercial |
$4.75
|
| Rate for Payer: Humana Commercial |
$4.25
|
| Rate for Payer: Humana KY Medicaid |
$5.02
|
| Rate for Payer: Humana Medicare Advantage |
$5.02
|
| Rate for Payer: Kentucky WC Medicaid |
$5.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.40
|
| Rate for Payer: Ohio Health Group HMO |
$3.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.45
|
| Rate for Payer: PHCS Commercial |
$4.80
|
| Rate for Payer: United Healthcare All Payer |
$4.40
|
|
|
BILIRUBIN (TOTAL)
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
HCPCS 82247
|
| Hospital Charge Code |
30000248
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: Aetna Commercial |
$3.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4.01
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cigna Commercial |
$4.15
|
| Rate for Payer: First Health Commercial |
$4.75
|
| Rate for Payer: Humana Commercial |
$4.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.40
|
| Rate for Payer: Ohio Health Group HMO |
$3.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.45
|
| Rate for Payer: PHCS Commercial |
$4.80
|
| Rate for Payer: United Healthcare All Payer |
$4.40
|
|
|
BILIRUBIN TOTAL
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
HCPCS 82247
|
| Hospital Charge Code |
30000246
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.80 |
| Max. Negotiated Rate |
$82.56 |
| Rate for Payer: Aetna Commercial |
$66.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$69.06
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cigna Commercial |
$71.38
|
| Rate for Payer: First Health Commercial |
$81.70
|
| Rate for Payer: Humana Commercial |
$73.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$75.68
|
| Rate for Payer: Ohio Health Group HMO |
$64.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$74.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59.34
|
| Rate for Payer: PHCS Commercial |
$82.56
|
| Rate for Payer: United Healthcare All Payer |
$75.68
|
|
|
BILIRUBIN TOTAL
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
HCPCS 82247
|
| Hospital Charge Code |
30000246
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$82.56 |
| Rate for Payer: Aetna Commercial |
$66.22
|
| Rate for Payer: Anthem Medicaid |
$5.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$69.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.02
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cigna Commercial |
$71.38
|
| Rate for Payer: First Health Commercial |
$81.70
|
| Rate for Payer: Humana Commercial |
$73.10
|
| Rate for Payer: Humana KY Medicaid |
$5.02
|
| Rate for Payer: Humana Medicare Advantage |
$5.02
|
| Rate for Payer: Kentucky WC Medicaid |
$5.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$75.68
|
| Rate for Payer: Ohio Health Group HMO |
$64.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$74.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59.34
|
| Rate for Payer: PHCS Commercial |
$82.56
|
| Rate for Payer: United Healthcare All Payer |
$75.68
|
|
|
BILIRUBINTOTALTRANSCUTANEOUS
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS 88720
|
| Hospital Charge Code |
30001536
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$19.80 |
| Rate for Payer: Aetna Commercial |
$8.15
|
| Rate for Payer: Ambetter Exchange |
$5.02
|
| Rate for Payer: Buckeye Individual/Medicaid |
$5.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$5.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$6.02
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$10.79
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$5.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.02
|
| Rate for Payer: Multiplan PHCS |
$19.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$6.53
|
| Rate for Payer: UHCCP Medicaid |
$11.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$3.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.02
|
|
|
BILIRUBINTOTALTRANSCUTANEOUS
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
HCPCS 88720
|
| Hospital Charge Code |
30001536
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$31.68 |
| Rate for Payer: Aetna Commercial |
$25.41
|
| Rate for Payer: Anthem Medicaid |
$5.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.02
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$27.39
|
| Rate for Payer: First Health Commercial |
$31.35
|
| Rate for Payer: Humana Commercial |
$28.05
|
| Rate for Payer: Humana KY Medicaid |
$5.02
|
| Rate for Payer: Humana Medicare Advantage |
$5.02
|
| Rate for Payer: Kentucky WC Medicaid |
$5.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$29.04
|
| Rate for Payer: Ohio Health Group HMO |
$24.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.77
|
| Rate for Payer: PHCS Commercial |
$31.68
|
| Rate for Payer: United Healthcare All Payer |
$29.04
|
|
|
BILIRUBINTOTALTRANSCUTANEOUS
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
HCPCS 88720
|
| Hospital Charge Code |
30001536
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.90 |
| Max. Negotiated Rate |
$31.68 |
| Rate for Payer: Aetna Commercial |
$25.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26.50
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$27.39
|
| Rate for Payer: First Health Commercial |
$31.35
|
| Rate for Payer: Humana Commercial |
$28.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$29.04
|
| Rate for Payer: Ohio Health Group HMO |
$24.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.77
|
| Rate for Payer: PHCS Commercial |
$31.68
|
| Rate for Payer: United Healthcare All Payer |
$29.04
|
|
|
BI-METRIC FEMORAL COMP 10*130
|
Facility
|
IP
|
$22,677.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,803.25 |
| Max. Negotiated Rate |
$21,770.40 |
| Rate for Payer: Aetna Commercial |
$17,461.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,688.45
|
| Rate for Payer: Cash Price |
$11,338.75
|
| Rate for Payer: Cigna Commercial |
$18,822.33
|
| Rate for Payer: First Health Commercial |
$21,543.62
|
| Rate for Payer: Humana Commercial |
$19,275.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,595.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,735.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,803.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,956.20
|
| Rate for Payer: Ohio Health Group HMO |
$17,008.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,142.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,729.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,647.48
|
| Rate for Payer: PHCS Commercial |
$21,770.40
|
| Rate for Payer: United Healthcare All Payer |
$19,956.20
|
|
|
BI-METRIC FEMORAL COMP 10*130
|
Facility
|
OP
|
$22,677.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,803.25 |
| Max. Negotiated Rate |
$21,770.40 |
| Rate for Payer: Aetna Commercial |
$17,461.67
|
| Rate for Payer: Anthem Medicaid |
$7,798.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,688.45
|
| Rate for Payer: Cash Price |
$11,338.75
|
| Rate for Payer: Cigna Commercial |
$18,822.33
|
| Rate for Payer: First Health Commercial |
$21,543.62
|
| Rate for Payer: Humana Commercial |
$19,275.88
|
| Rate for Payer: Humana KY Medicaid |
$7,798.79
|
| Rate for Payer: Kentucky WC Medicaid |
$7,878.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,595.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,735.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,803.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,955.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,956.20
|
| Rate for Payer: Ohio Health Group HMO |
$17,008.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,142.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,729.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,647.48
|
| Rate for Payer: PHCS Commercial |
$21,770.40
|
| Rate for Payer: United Healthcare All Payer |
$19,956.20
|
|
|
BI-METRIC FEMORAL COMP 11*135
|
Facility
|
IP
|
$22,677.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,803.25 |
| Max. Negotiated Rate |
$21,770.40 |
| Rate for Payer: Aetna Commercial |
$17,461.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,688.45
|
| Rate for Payer: Cash Price |
$11,338.75
|
| Rate for Payer: Cigna Commercial |
$18,822.33
|
| Rate for Payer: First Health Commercial |
$21,543.62
|
| Rate for Payer: Humana Commercial |
$19,275.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,595.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,735.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,803.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,956.20
|
| Rate for Payer: Ohio Health Group HMO |
$17,008.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,142.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,729.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,647.48
|
| Rate for Payer: PHCS Commercial |
$21,770.40
|
| Rate for Payer: United Healthcare All Payer |
$19,956.20
|
|
|
BI-METRIC FEMORAL COMP 11*135
|
Facility
|
OP
|
$22,677.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,803.25 |
| Max. Negotiated Rate |
$21,770.40 |
| Rate for Payer: Aetna Commercial |
$17,461.67
|
| Rate for Payer: Anthem Medicaid |
$7,798.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,688.45
|
| Rate for Payer: Cash Price |
$11,338.75
|
| Rate for Payer: Cigna Commercial |
$18,822.33
|
| Rate for Payer: First Health Commercial |
$21,543.62
|
| Rate for Payer: Humana Commercial |
$19,275.88
|
| Rate for Payer: Humana KY Medicaid |
$7,798.79
|
| Rate for Payer: Kentucky WC Medicaid |
$7,878.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,595.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,735.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,803.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,955.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,956.20
|
| Rate for Payer: Ohio Health Group HMO |
$17,008.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,142.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,729.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,647.48
|
| Rate for Payer: PHCS Commercial |
$21,770.40
|
| Rate for Payer: United Healthcare All Payer |
$19,956.20
|
|
|
BI-METRIC FEMORAL COMP 12*140
|
Facility
|
OP
|
$22,677.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,803.25 |
| Max. Negotiated Rate |
$21,770.40 |
| Rate for Payer: Aetna Commercial |
$17,461.67
|
| Rate for Payer: Anthem Medicaid |
$7,798.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,688.45
|
| Rate for Payer: Cash Price |
$11,338.75
|
| Rate for Payer: Cigna Commercial |
$18,822.33
|
| Rate for Payer: First Health Commercial |
$21,543.62
|
| Rate for Payer: Humana Commercial |
$19,275.88
|
| Rate for Payer: Humana KY Medicaid |
$7,798.79
|
| Rate for Payer: Kentucky WC Medicaid |
$7,878.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,595.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,735.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,803.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,955.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,956.20
|
| Rate for Payer: Ohio Health Group HMO |
$17,008.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,142.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,729.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,647.48
|
| Rate for Payer: PHCS Commercial |
$21,770.40
|
| Rate for Payer: United Healthcare All Payer |
$19,956.20
|
|
|
BI-METRIC FEMORAL COMP 12*140
|
Facility
|
IP
|
$22,677.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,803.25 |
| Max. Negotiated Rate |
$21,770.40 |
| Rate for Payer: Aetna Commercial |
$17,461.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,688.45
|
| Rate for Payer: Cash Price |
$11,338.75
|
| Rate for Payer: Cigna Commercial |
$18,822.33
|
| Rate for Payer: First Health Commercial |
$21,543.62
|
| Rate for Payer: Humana Commercial |
$19,275.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,595.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,735.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,803.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,956.20
|
| Rate for Payer: Ohio Health Group HMO |
$17,008.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,142.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,729.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,647.48
|
| Rate for Payer: PHCS Commercial |
$21,770.40
|
| Rate for Payer: United Healthcare All Payer |
$19,956.20
|
|
|
BI-METRIC FEMORAL COMP 13*145
|
Facility
|
OP
|
$22,677.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,803.25 |
| Max. Negotiated Rate |
$21,770.40 |
| Rate for Payer: Aetna Commercial |
$17,461.67
|
| Rate for Payer: Anthem Medicaid |
$7,798.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,688.45
|
| Rate for Payer: Cash Price |
$11,338.75
|
| Rate for Payer: Cigna Commercial |
$18,822.33
|
| Rate for Payer: First Health Commercial |
$21,543.62
|
| Rate for Payer: Humana Commercial |
$19,275.88
|
| Rate for Payer: Humana KY Medicaid |
$7,798.79
|
| Rate for Payer: Kentucky WC Medicaid |
$7,878.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,595.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,735.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,803.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,955.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,956.20
|
| Rate for Payer: Ohio Health Group HMO |
$17,008.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,142.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,729.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,647.48
|
| Rate for Payer: PHCS Commercial |
$21,770.40
|
| Rate for Payer: United Healthcare All Payer |
$19,956.20
|
|
|
BI-METRIC FEMORAL COMP 13*145
|
Facility
|
IP
|
$22,677.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,803.25 |
| Max. Negotiated Rate |
$21,770.40 |
| Rate for Payer: Aetna Commercial |
$17,461.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,688.45
|
| Rate for Payer: Cash Price |
$11,338.75
|
| Rate for Payer: Cigna Commercial |
$18,822.33
|
| Rate for Payer: First Health Commercial |
$21,543.62
|
| Rate for Payer: Humana Commercial |
$19,275.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,595.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,735.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,803.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,956.20
|
| Rate for Payer: Ohio Health Group HMO |
$17,008.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,142.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,729.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,647.48
|
| Rate for Payer: PHCS Commercial |
$21,770.40
|
| Rate for Payer: United Healthcare All Payer |
$19,956.20
|
|
|
BI-METRIC FEMORAL COMP 14*150
|
Facility
|
OP
|
$22,677.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,803.25 |
| Max. Negotiated Rate |
$21,770.40 |
| Rate for Payer: Aetna Commercial |
$17,461.67
|
| Rate for Payer: Anthem Medicaid |
$7,798.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,688.45
|
| Rate for Payer: Cash Price |
$11,338.75
|
| Rate for Payer: Cigna Commercial |
$18,822.33
|
| Rate for Payer: First Health Commercial |
$21,543.62
|
| Rate for Payer: Humana Commercial |
$19,275.88
|
| Rate for Payer: Humana KY Medicaid |
$7,798.79
|
| Rate for Payer: Kentucky WC Medicaid |
$7,878.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,595.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,735.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,803.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,955.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,956.20
|
| Rate for Payer: Ohio Health Group HMO |
$17,008.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,142.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,729.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,647.48
|
| Rate for Payer: PHCS Commercial |
$21,770.40
|
| Rate for Payer: United Healthcare All Payer |
$19,956.20
|
|
|
BI-METRIC FEMORAL COMP 14*150
|
Facility
|
IP
|
$22,677.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,803.25 |
| Max. Negotiated Rate |
$21,770.40 |
| Rate for Payer: Aetna Commercial |
$17,461.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,688.45
|
| Rate for Payer: Cash Price |
$11,338.75
|
| Rate for Payer: Cigna Commercial |
$18,822.33
|
| Rate for Payer: First Health Commercial |
$21,543.62
|
| Rate for Payer: Humana Commercial |
$19,275.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,595.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,735.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,803.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,956.20
|
| Rate for Payer: Ohio Health Group HMO |
$17,008.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,142.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,729.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,647.48
|
| Rate for Payer: PHCS Commercial |
$21,770.40
|
| Rate for Payer: United Healthcare All Payer |
$19,956.20
|
|
|
BI-METRIC FEMORAL COMP 15*155
|
Facility
|
OP
|
$22,677.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,803.25 |
| Max. Negotiated Rate |
$21,770.40 |
| Rate for Payer: Aetna Commercial |
$17,461.67
|
| Rate for Payer: Anthem Medicaid |
$7,798.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,688.45
|
| Rate for Payer: Cash Price |
$11,338.75
|
| Rate for Payer: Cigna Commercial |
$18,822.33
|
| Rate for Payer: First Health Commercial |
$21,543.62
|
| Rate for Payer: Humana Commercial |
$19,275.88
|
| Rate for Payer: Humana KY Medicaid |
$7,798.79
|
| Rate for Payer: Kentucky WC Medicaid |
$7,878.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,595.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,735.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,803.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,955.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,956.20
|
| Rate for Payer: Ohio Health Group HMO |
$17,008.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,142.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,729.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,647.48
|
| Rate for Payer: PHCS Commercial |
$21,770.40
|
| Rate for Payer: United Healthcare All Payer |
$19,956.20
|
|
|
BI-METRIC FEMORAL COMP 15*155
|
Facility
|
IP
|
$22,677.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,803.25 |
| Max. Negotiated Rate |
$21,770.40 |
| Rate for Payer: Aetna Commercial |
$17,461.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,688.45
|
| Rate for Payer: Cash Price |
$11,338.75
|
| Rate for Payer: Cigna Commercial |
$18,822.33
|
| Rate for Payer: First Health Commercial |
$21,543.62
|
| Rate for Payer: Humana Commercial |
$19,275.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,595.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,735.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,803.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,956.20
|
| Rate for Payer: Ohio Health Group HMO |
$17,008.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,142.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,729.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,647.48
|
| Rate for Payer: PHCS Commercial |
$21,770.40
|
| Rate for Payer: United Healthcare All Payer |
$19,956.20
|
|
