|
TUNNELER SHEATH ON-Q 12
|
Facility
|
IP
|
$547.92
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$164.38 |
| Max. Negotiated Rate |
$526.00 |
| Rate for Payer: Aetna Commercial |
$421.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$427.38
|
| Rate for Payer: Cash Price |
$273.96
|
| Rate for Payer: Cigna Commercial |
$454.77
|
| Rate for Payer: First Health Commercial |
$520.52
|
| Rate for Payer: Humana Commercial |
$465.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$449.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$404.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$164.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$482.17
|
| Rate for Payer: Ohio Health Group HMO |
$410.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$438.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$476.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$378.06
|
| Rate for Payer: PHCS Commercial |
$526.00
|
| Rate for Payer: United Healthcare All Payer |
$482.17
|
|
|
TUNNELER SHEATH ON-Q 12
|
Facility
|
OP
|
$547.92
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$164.38 |
| Max. Negotiated Rate |
$526.00 |
| Rate for Payer: Aetna Commercial |
$421.90
|
| Rate for Payer: Anthem Medicaid |
$188.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$427.38
|
| Rate for Payer: Cash Price |
$273.96
|
| Rate for Payer: Cigna Commercial |
$454.77
|
| Rate for Payer: First Health Commercial |
$520.52
|
| Rate for Payer: Humana Commercial |
$465.73
|
| Rate for Payer: Humana KY Medicaid |
$188.43
|
| Rate for Payer: Kentucky WC Medicaid |
$190.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$449.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$404.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$164.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$192.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$482.17
|
| Rate for Payer: Ohio Health Group HMO |
$410.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$438.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$476.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$378.06
|
| Rate for Payer: PHCS Commercial |
$526.00
|
| Rate for Payer: United Healthcare All Payer |
$482.17
|
|
|
TUNNELER SHEATH ON-Q 8
|
Facility
|
IP
|
$560.08
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$168.02 |
| Max. Negotiated Rate |
$537.68 |
| Rate for Payer: Aetna Commercial |
$431.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$436.86
|
| Rate for Payer: Cash Price |
$280.04
|
| Rate for Payer: Cigna Commercial |
$464.87
|
| Rate for Payer: First Health Commercial |
$532.08
|
| Rate for Payer: Humana Commercial |
$476.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$459.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$413.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$168.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$492.87
|
| Rate for Payer: Ohio Health Group HMO |
$420.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$448.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$487.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$386.46
|
| Rate for Payer: PHCS Commercial |
$537.68
|
| Rate for Payer: United Healthcare All Payer |
$492.87
|
|
|
TUNNELER SHEATH ON-Q 8
|
Facility
|
OP
|
$560.08
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$168.02 |
| Max. Negotiated Rate |
$537.68 |
| Rate for Payer: Aetna Commercial |
$431.26
|
| Rate for Payer: Anthem Medicaid |
$192.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$436.86
|
| Rate for Payer: Cash Price |
$280.04
|
| Rate for Payer: Cigna Commercial |
$464.87
|
| Rate for Payer: First Health Commercial |
$532.08
|
| Rate for Payer: Humana Commercial |
$476.07
|
| Rate for Payer: Humana KY Medicaid |
$192.61
|
| Rate for Payer: Kentucky WC Medicaid |
$194.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$459.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$413.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$168.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$196.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$492.87
|
| Rate for Payer: Ohio Health Group HMO |
$420.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$448.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$487.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$386.46
|
| Rate for Payer: PHCS Commercial |
$537.68
|
| Rate for Payer: United Healthcare All Payer |
$492.87
|
|
|
TUNNLER/SHEATH 5 DISP
|
Facility
|
IP
|
$1,200.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$360.00 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$360.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$960.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,044.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$828.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
TUNNLER/SHEATH 5 DISP
|
Facility
|
OP
|
$1,200.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$360.00 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem Medicaid |
$412.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Humana KY Medicaid |
$412.68
|
| Rate for Payer: Kentucky WC Medicaid |
$416.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$360.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$420.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$960.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,044.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$828.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
TUTOPLAST PROCESS PERICARD 6*6
|
Facility
|
OP
|
$12,487.83
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
27000051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,746.35 |
| Max. Negotiated Rate |
$11,988.32 |
| Rate for Payer: Aetna Commercial |
$9,615.63
|
| Rate for Payer: Anthem Medicaid |
$4,294.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,740.51
|
| Rate for Payer: Cash Price |
$6,243.92
|
| Rate for Payer: Cigna Commercial |
$10,364.90
|
| Rate for Payer: First Health Commercial |
$11,863.44
|
| Rate for Payer: Humana Commercial |
$10,614.66
|
| Rate for Payer: Humana KY Medicaid |
$4,294.56
|
| Rate for Payer: Kentucky WC Medicaid |
$4,338.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,240.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,216.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,746.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,380.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,989.29
|
| Rate for Payer: Ohio Health Group HMO |
$9,365.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,990.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,864.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,616.60
|
| Rate for Payer: PHCS Commercial |
$11,988.32
|
| Rate for Payer: United Healthcare All Payer |
$10,989.29
|
|
|
TUTOPLAST PROCESS PERICARD 6*6
|
Facility
|
IP
|
$12,487.83
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
27000051
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,746.35 |
| Max. Negotiated Rate |
$11,988.32 |
| Rate for Payer: Aetna Commercial |
$9,615.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,740.51
|
| Rate for Payer: Cash Price |
$6,243.92
|
| Rate for Payer: Cigna Commercial |
$10,364.90
|
| Rate for Payer: First Health Commercial |
$11,863.44
|
| Rate for Payer: Humana Commercial |
$10,614.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,240.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,216.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,746.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,989.29
|
| Rate for Payer: Ohio Health Group HMO |
$9,365.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,990.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,864.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,616.60
|
| Rate for Payer: PHCS Commercial |
$11,988.32
|
| Rate for Payer: United Healthcare All Payer |
$10,989.29
|
|
|
TV CONNECTOR (HEARING AID ACC)
|
Professional
|
Both
|
$250.00
|
|
| Hospital Charge Code |
22200665
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
|
|
TWIN SITE SET 1EA
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TWIN SITE SET 1EA
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TX ATRIAL FIB PULM VEIN ISOL
|
Professional
|
Both
|
$1,335.00
|
|
|
Service Code
|
HCPCS 93656
|
| Hospital Charge Code |
48000099
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$467.25 |
| Max. Negotiated Rate |
$1,949.65 |
| Rate for Payer: Ambetter Exchange |
$880.82
|
| Rate for Payer: Anthem Medicaid |
$877.43
|
| Rate for Payer: Buckeye Individual/Medicaid |
$880.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$880.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,056.98
|
| Rate for Payer: Cash Price |
$667.50
|
| Rate for Payer: Cash Price |
$667.50
|
| Rate for Payer: Cigna Commercial |
$1,949.65
|
| Rate for Payer: Healthspan PPO |
$1,290.97
|
| Rate for Payer: Humana Medicaid |
$877.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,573.06
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$880.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$880.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$894.98
|
| Rate for Payer: Molina Healthcare Passport |
$877.43
|
| Rate for Payer: Multiplan PHCS |
$801.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,145.07
|
| Rate for Payer: UHCCP Medicaid |
$467.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$886.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$880.82
|
|
|
TX CLSDELBOWDISLOCATWITHANES
|
Facility
|
IP
|
$2,172.00
|
|
|
Service Code
|
HCPCS 24605
|
| Hospital Charge Code |
45000123
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$651.60 |
| Max. Negotiated Rate |
$2,085.12 |
| Rate for Payer: Aetna Commercial |
$1,672.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,694.16
|
| Rate for Payer: Cash Price |
$1,086.00
|
| Rate for Payer: Cigna Commercial |
$1,802.76
|
| Rate for Payer: First Health Commercial |
$2,063.40
|
| Rate for Payer: Humana Commercial |
$1,846.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,781.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,602.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,911.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,629.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,737.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,889.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,498.68
|
| Rate for Payer: PHCS Commercial |
$2,085.12
|
| Rate for Payer: United Healthcare All Payer |
$1,911.36
|
|
|
TX CLSDELBOWDISLOCATWITHANES
|
Facility
|
OP
|
$2,172.00
|
|
|
Service Code
|
HCPCS 24605
|
| Hospital Charge Code |
45000123
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$746.95 |
| Max. Negotiated Rate |
$2,085.12 |
| Rate for Payer: Aetna Commercial |
$1,672.44
|
| Rate for Payer: Anthem Medicaid |
$746.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,694.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| Rate for Payer: Cash Price |
$1,086.00
|
| Rate for Payer: Cash Price |
$1,086.00
|
| Rate for Payer: Cigna Commercial |
$1,802.76
|
| Rate for Payer: First Health Commercial |
$2,063.40
|
| Rate for Payer: Humana Commercial |
$1,846.20
|
| Rate for Payer: Humana KY Medicaid |
$746.95
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$754.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,781.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,602.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$761.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,911.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,629.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,737.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,889.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,498.68
|
| Rate for Payer: PHCS Commercial |
$2,085.12
|
| Rate for Payer: United Healthcare All Payer |
$1,911.36
|
|
|
TX CONTOUR DEFECTS >10.0 CC
|
Facility
|
IP
|
$4,806.68
|
|
|
Service Code
|
HCPCS 11954
|
| Hospital Charge Code |
76100112
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,442.00 |
| Max. Negotiated Rate |
$4,614.41 |
| Rate for Payer: Aetna Commercial |
$3,701.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,749.21
|
| Rate for Payer: Cash Price |
$2,403.34
|
| Rate for Payer: Cigna Commercial |
$3,989.54
|
| Rate for Payer: First Health Commercial |
$4,566.35
|
| Rate for Payer: Humana Commercial |
$4,085.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,941.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,547.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,442.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,229.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,605.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,845.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,181.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,316.61
|
| Rate for Payer: PHCS Commercial |
$4,614.41
|
| Rate for Payer: United Healthcare All Payer |
$4,229.88
|
|
|
TX CONTOUR DEFECTS >10.0 CC
|
Professional
|
Both
|
$4,806.68
|
|
|
Service Code
|
HCPCS 11954
|
| Hospital Charge Code |
76100112
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$88.88 |
| Max. Negotiated Rate |
$2,884.01 |
| Rate for Payer: Aetna Commercial |
$171.69
|
| Rate for Payer: Ambetter Exchange |
$105.97
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$91.79
|
| Rate for Payer: Anthem Medicaid |
$88.88
|
| Rate for Payer: Buckeye Individual/Medicaid |
$105.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$105.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$127.16
|
| Rate for Payer: Cash Price |
$2,403.34
|
| Rate for Payer: Cash Price |
$2,403.34
|
| Rate for Payer: Cigna Commercial |
$237.35
|
| Rate for Payer: Healthspan PPO |
$184.36
|
| Rate for Payer: Humana Medicaid |
$88.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$146.80
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$105.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$105.97
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$90.66
|
| Rate for Payer: Molina Healthcare Passport |
$88.88
|
| Rate for Payer: Multiplan PHCS |
$2,884.01
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$137.76
|
| Rate for Payer: UHCCP Medicaid |
$96.38
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$89.77
|
| Rate for Payer: Wellcare Medicare Advantage |
$105.97
|
|
|
TX CONTOUR DEFECTS >10.0 CC
|
Facility
|
OP
|
$4,806.68
|
|
|
Service Code
|
HCPCS 11954
|
| Hospital Charge Code |
76100112
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$565.60 |
| Max. Negotiated Rate |
$4,614.41 |
| Rate for Payer: Aetna Commercial |
$3,701.14
|
| Rate for Payer: Anthem Medicaid |
$1,653.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$565.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,749.21
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$791.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$763.56
|
| Rate for Payer: Cash Price |
$2,403.34
|
| Rate for Payer: Cash Price |
$2,403.34
|
| Rate for Payer: Cigna Commercial |
$3,989.54
|
| Rate for Payer: First Health Commercial |
$4,566.35
|
| Rate for Payer: Humana Commercial |
$4,085.68
|
| Rate for Payer: Humana KY Medicaid |
$1,653.02
|
| Rate for Payer: Humana Medicare Advantage |
$565.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1,669.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,941.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,547.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$678.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,686.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,229.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,605.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,845.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,181.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,316.61
|
| Rate for Payer: PHCS Commercial |
$4,614.41
|
| Rate for Payer: United Healthcare All Payer |
$4,229.88
|
|
|
TX CONTOUR DEFECTS >10.0 CC(P
|
Professional
|
Both
|
$430.00
|
|
|
Service Code
|
HCPCS 11954
|
| Hospital Charge Code |
761P0112
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$88.88 |
| Max. Negotiated Rate |
$258.00 |
| Rate for Payer: Aetna Commercial |
$171.69
|
| Rate for Payer: Ambetter Exchange |
$105.97
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$91.79
|
| Rate for Payer: Anthem Medicaid |
$88.88
|
| Rate for Payer: Buckeye Individual/Medicaid |
$105.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$105.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$127.16
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Cigna Commercial |
$237.35
|
| Rate for Payer: Healthspan PPO |
$184.36
|
| Rate for Payer: Humana Medicaid |
$88.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$146.80
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$105.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$105.97
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$90.66
|
| Rate for Payer: Molina Healthcare Passport |
$88.88
|
| Rate for Payer: Multiplan PHCS |
$258.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$137.76
|
| Rate for Payer: UHCCP Medicaid |
$96.38
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$89.77
|
| Rate for Payer: Wellcare Medicare Advantage |
$105.97
|
|
|
TX CONTOUR DEFECTS >10.0 CC(T
|
Facility
|
OP
|
$4,376.68
|
|
|
Service Code
|
HCPCS 11954
|
| Hospital Charge Code |
761T0112
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$565.60 |
| Max. Negotiated Rate |
$4,201.61 |
| Rate for Payer: Aetna Commercial |
$3,370.04
|
| Rate for Payer: Anthem Medicaid |
$1,505.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$565.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,413.81
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$791.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$763.56
|
| Rate for Payer: Cash Price |
$2,188.34
|
| Rate for Payer: Cash Price |
$2,188.34
|
| Rate for Payer: Cigna Commercial |
$3,632.64
|
| Rate for Payer: First Health Commercial |
$4,157.85
|
| Rate for Payer: Humana Commercial |
$3,720.18
|
| Rate for Payer: Humana KY Medicaid |
$1,505.14
|
| Rate for Payer: Humana Medicare Advantage |
$565.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1,520.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,588.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,229.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$678.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,535.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,851.48
|
| Rate for Payer: Ohio Health Group HMO |
$3,282.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,501.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,807.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,019.91
|
| Rate for Payer: PHCS Commercial |
$4,201.61
|
| Rate for Payer: United Healthcare All Payer |
$3,851.48
|
|
|
TX CONTOUR DEFECTS >10.0 CC(T
|
Facility
|
IP
|
$4,376.68
|
|
|
Service Code
|
HCPCS 11954
|
| Hospital Charge Code |
761T0112
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,313.00 |
| Max. Negotiated Rate |
$4,201.61 |
| Rate for Payer: Aetna Commercial |
$3,370.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,413.81
|
| Rate for Payer: Cash Price |
$2,188.34
|
| Rate for Payer: Cigna Commercial |
$3,632.64
|
| Rate for Payer: First Health Commercial |
$4,157.85
|
| Rate for Payer: Humana Commercial |
$3,720.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,588.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,229.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,313.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,851.48
|
| Rate for Payer: Ohio Health Group HMO |
$3,282.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,501.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,807.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,019.91
|
| Rate for Payer: PHCS Commercial |
$4,201.61
|
| Rate for Payer: United Healthcare All Payer |
$3,851.48
|
|
|
TX CONTOUR DEFECTS 5.1-10CC
|
Facility
|
OP
|
$1,062.00
|
|
|
Service Code
|
HCPCS 11952
|
| Hospital Charge Code |
76100111
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$365.22 |
| Max. Negotiated Rate |
$1,019.52 |
| Rate for Payer: Aetna Commercial |
$817.74
|
| Rate for Payer: Anthem Medicaid |
$365.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$565.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$828.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$791.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$763.56
|
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Cigna Commercial |
$881.46
|
| Rate for Payer: First Health Commercial |
$1,008.90
|
| Rate for Payer: Humana Commercial |
$902.70
|
| Rate for Payer: Humana KY Medicaid |
$365.22
|
| Rate for Payer: Humana Medicare Advantage |
$565.60
|
| Rate for Payer: Kentucky WC Medicaid |
$368.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$870.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$783.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$678.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$372.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$934.56
|
| Rate for Payer: Ohio Health Group HMO |
$796.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$849.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$923.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$732.78
|
| Rate for Payer: PHCS Commercial |
$1,019.52
|
| Rate for Payer: United Healthcare All Payer |
$934.56
|
|
|
TX CONTOUR DEFECTS 5.1-10CC
|
Professional
|
Both
|
$1,062.00
|
|
|
Service Code
|
HCPCS 11952
|
| Hospital Charge Code |
76100111
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$71.34 |
| Max. Negotiated Rate |
$637.20 |
| Rate for Payer: Aetna Commercial |
$150.70
|
| Rate for Payer: Ambetter Exchange |
$96.18
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$71.34
|
| Rate for Payer: Buckeye Individual/Medicaid |
$96.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$96.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$115.42
|
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Cigna Commercial |
$199.73
|
| Rate for Payer: Healthspan PPO |
$159.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$120.01
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$96.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$96.18
|
| Rate for Payer: Multiplan PHCS |
$637.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$125.03
|
| Rate for Payer: UHCCP Medicaid |
$74.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$96.18
|
|
|
TX CONTOUR DEFECTS 5.1-10CC
|
Facility
|
IP
|
$1,062.00
|
|
|
Service Code
|
HCPCS 11952
|
| Hospital Charge Code |
76100111
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$318.60 |
| Max. Negotiated Rate |
$1,019.52 |
| Rate for Payer: Aetna Commercial |
$817.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$828.36
|
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Cigna Commercial |
$881.46
|
| Rate for Payer: First Health Commercial |
$1,008.90
|
| Rate for Payer: Humana Commercial |
$902.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$870.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$783.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$318.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$934.56
|
| Rate for Payer: Ohio Health Group HMO |
$796.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$849.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$923.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$732.78
|
| Rate for Payer: PHCS Commercial |
$1,019.52
|
| Rate for Payer: United Healthcare All Payer |
$934.56
|
|
|
TX CONTOUR DEFECTS 5.1-10CC(P
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 11952
|
| Hospital Charge Code |
761P0111
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$71.34 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Aetna Commercial |
$150.70
|
| Rate for Payer: Ambetter Exchange |
$96.18
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$71.34
|
| Rate for Payer: Buckeye Individual/Medicaid |
$96.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$96.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$115.42
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$199.73
|
| Rate for Payer: Healthspan PPO |
$159.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$120.01
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$96.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$96.18
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$125.03
|
| Rate for Payer: UHCCP Medicaid |
$74.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$96.18
|
|
|
TX CONTOUR DEFECTS 5.1-10CC(T
|
Facility
|
OP
|
$712.00
|
|
|
Service Code
|
HCPCS 11952
|
| Hospital Charge Code |
761T0111
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$244.86 |
| Max. Negotiated Rate |
$791.84 |
| Rate for Payer: Aetna Commercial |
$548.24
|
| Rate for Payer: Anthem Medicaid |
$244.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$565.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$555.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$791.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$763.56
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cigna Commercial |
$590.96
|
| Rate for Payer: First Health Commercial |
$676.40
|
| Rate for Payer: Humana Commercial |
$605.20
|
| Rate for Payer: Humana KY Medicaid |
$244.86
|
| Rate for Payer: Humana Medicare Advantage |
$565.60
|
| Rate for Payer: Kentucky WC Medicaid |
$247.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$583.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$525.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$678.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$249.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$626.56
|
| Rate for Payer: Ohio Health Group HMO |
$534.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$569.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$619.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$491.28
|
| Rate for Payer: PHCS Commercial |
$683.52
|
| Rate for Payer: United Healthcare All Payer |
$626.56
|
|
