|
C-TAPER HEAD LFIT 44MM +0
|
Facility
|
IP
|
$9,735.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,265.55 |
| Max. Negotiated Rate |
$9,345.60 |
| Rate for Payer: Aetna Commercial |
$7,495.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,593.30
|
| Rate for Payer: Cash Price |
$4,867.50
|
| Rate for Payer: Cigna Commercial |
$8,080.05
|
| Rate for Payer: First Health Commercial |
$9,248.25
|
| Rate for Payer: Humana Commercial |
$8,274.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,982.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,184.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,920.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,566.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,301.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,947.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,265.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,017.85
|
| Rate for Payer: PHCS Commercial |
$9,345.60
|
| Rate for Payer: United Healthcare All Payer |
$8,566.80
|
|
|
C-TAPER HEAD LFIT 44MM +0
|
Facility
|
OP
|
$9,735.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,265.55 |
| Max. Negotiated Rate |
$9,345.60 |
| Rate for Payer: Aetna Commercial |
$7,495.95
|
| Rate for Payer: Anthem Medicaid |
$3,347.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,593.30
|
| Rate for Payer: Cash Price |
$4,867.50
|
| Rate for Payer: Cigna Commercial |
$8,080.05
|
| Rate for Payer: First Health Commercial |
$9,248.25
|
| Rate for Payer: Humana Commercial |
$8,274.75
|
| Rate for Payer: Humana KY Medicaid |
$3,347.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,381.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,982.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,184.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,920.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,415.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,566.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,301.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,947.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,265.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,017.85
|
| Rate for Payer: PHCS Commercial |
$9,345.60
|
| Rate for Payer: United Healthcare All Payer |
$8,566.80
|
|
|
C-TAPER HEAD LFIT 44MM -5
|
Facility
|
IP
|
$9,735.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,265.55 |
| Max. Negotiated Rate |
$9,345.60 |
| Rate for Payer: Aetna Commercial |
$7,495.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,593.30
|
| Rate for Payer: Cash Price |
$4,867.50
|
| Rate for Payer: Cigna Commercial |
$8,080.05
|
| Rate for Payer: First Health Commercial |
$9,248.25
|
| Rate for Payer: Humana Commercial |
$8,274.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,982.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,184.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,920.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,566.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,301.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,947.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,265.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,017.85
|
| Rate for Payer: PHCS Commercial |
$9,345.60
|
| Rate for Payer: United Healthcare All Payer |
$8,566.80
|
|
|
C-TAPER HEAD LFIT 44MM -5
|
Facility
|
OP
|
$9,735.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,265.55 |
| Max. Negotiated Rate |
$9,345.60 |
| Rate for Payer: Aetna Commercial |
$7,495.95
|
| Rate for Payer: Anthem Medicaid |
$3,347.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,593.30
|
| Rate for Payer: Cash Price |
$4,867.50
|
| Rate for Payer: Cigna Commercial |
$8,080.05
|
| Rate for Payer: First Health Commercial |
$9,248.25
|
| Rate for Payer: Humana Commercial |
$8,274.75
|
| Rate for Payer: Humana KY Medicaid |
$3,347.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,381.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,982.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,184.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,920.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,415.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,566.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,301.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,947.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,265.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,017.85
|
| Rate for Payer: PHCS Commercial |
$9,345.60
|
| Rate for Payer: United Healthcare All Payer |
$8,566.80
|
|
|
C-TAPER NECK EXTENSION
|
Facility
|
IP
|
$1,938.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$251.94 |
| Max. Negotiated Rate |
$1,860.48 |
| Rate for Payer: Aetna Commercial |
$1,492.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,511.64
|
| Rate for Payer: Cash Price |
$969.00
|
| Rate for Payer: Cigna Commercial |
$1,608.54
|
| Rate for Payer: First Health Commercial |
$1,841.10
|
| Rate for Payer: Humana Commercial |
$1,647.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,589.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,430.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$581.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,705.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,453.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$387.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$600.78
|
| Rate for Payer: PHCS Commercial |
$1,860.48
|
| Rate for Payer: United Healthcare All Payer |
$1,705.44
|
|
|
C-TAPER NECK EXTENSION
|
Facility
|
OP
|
$1,938.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$251.94 |
| Max. Negotiated Rate |
$1,860.48 |
| Rate for Payer: Aetna Commercial |
$1,492.26
|
| Rate for Payer: Anthem Medicaid |
$666.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,511.64
|
| Rate for Payer: Cash Price |
$969.00
|
| Rate for Payer: Cigna Commercial |
$1,608.54
|
| Rate for Payer: First Health Commercial |
$1,841.10
|
| Rate for Payer: Humana Commercial |
$1,647.30
|
| Rate for Payer: Humana KY Medicaid |
$666.48
|
| Rate for Payer: Kentucky WC Medicaid |
$673.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,589.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,430.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$581.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$679.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,705.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,453.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$387.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$600.78
|
| Rate for Payer: PHCS Commercial |
$1,860.48
|
| Rate for Payer: United Healthcare All Payer |
$1,705.44
|
|
|
C-TAPER UNITRAX SLEEVE +0
|
Facility
|
OP
|
$2,075.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$269.78 |
| Max. Negotiated Rate |
$1,992.19 |
| Rate for Payer: Aetna Commercial |
$1,597.90
|
| Rate for Payer: Anthem Medicaid |
$713.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,618.66
|
| Rate for Payer: Cash Price |
$1,037.60
|
| Rate for Payer: Cigna Commercial |
$1,722.42
|
| Rate for Payer: First Health Commercial |
$1,971.44
|
| Rate for Payer: Humana Commercial |
$1,763.92
|
| Rate for Payer: Humana KY Medicaid |
$713.66
|
| Rate for Payer: Kentucky WC Medicaid |
$720.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,701.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,531.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$622.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$727.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,826.18
|
| Rate for Payer: Ohio Health Group HMO |
$1,556.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$415.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$269.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$643.31
|
| Rate for Payer: PHCS Commercial |
$1,992.19
|
| Rate for Payer: United Healthcare All Payer |
$1,826.18
|
|
|
C-TAPER UNITRAX SLEEVE +0
|
Facility
|
IP
|
$2,075.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$269.78 |
| Max. Negotiated Rate |
$1,992.19 |
| Rate for Payer: Aetna Commercial |
$1,597.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,618.66
|
| Rate for Payer: Cash Price |
$1,037.60
|
| Rate for Payer: Cigna Commercial |
$1,722.42
|
| Rate for Payer: First Health Commercial |
$1,971.44
|
| Rate for Payer: Humana Commercial |
$1,763.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,701.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,531.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$622.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,826.18
|
| Rate for Payer: Ohio Health Group HMO |
$1,556.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$415.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$269.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$643.31
|
| Rate for Payer: PHCS Commercial |
$1,992.19
|
| Rate for Payer: United Healthcare All Payer |
$1,826.18
|
|
|
C-TAPER UNITRAX SLEEVE +10
|
Facility
|
IP
|
$2,075.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$269.78 |
| Max. Negotiated Rate |
$1,992.19 |
| Rate for Payer: Aetna Commercial |
$1,597.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,618.66
|
| Rate for Payer: Cash Price |
$1,037.60
|
| Rate for Payer: Cigna Commercial |
$1,722.42
|
| Rate for Payer: First Health Commercial |
$1,971.44
|
| Rate for Payer: Humana Commercial |
$1,763.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,701.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,531.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$622.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,826.18
|
| Rate for Payer: Ohio Health Group HMO |
$1,556.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$415.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$269.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$643.31
|
| Rate for Payer: PHCS Commercial |
$1,992.19
|
| Rate for Payer: United Healthcare All Payer |
$1,826.18
|
|
|
C-TAPER UNITRAX SLEEVE +10
|
Facility
|
OP
|
$2,075.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$269.78 |
| Max. Negotiated Rate |
$1,992.19 |
| Rate for Payer: Aetna Commercial |
$1,597.90
|
| Rate for Payer: Anthem Medicaid |
$713.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,618.66
|
| Rate for Payer: Cash Price |
$1,037.60
|
| Rate for Payer: Cigna Commercial |
$1,722.42
|
| Rate for Payer: First Health Commercial |
$1,971.44
|
| Rate for Payer: Humana Commercial |
$1,763.92
|
| Rate for Payer: Humana KY Medicaid |
$713.66
|
| Rate for Payer: Kentucky WC Medicaid |
$720.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,701.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,531.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$622.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$727.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,826.18
|
| Rate for Payer: Ohio Health Group HMO |
$1,556.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$415.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$269.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$643.31
|
| Rate for Payer: PHCS Commercial |
$1,992.19
|
| Rate for Payer: United Healthcare All Payer |
$1,826.18
|
|
|
C-TAPER UNITRAX SLEEVE -3
|
Facility
|
IP
|
$2,075.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$269.78 |
| Max. Negotiated Rate |
$1,992.19 |
| Rate for Payer: Aetna Commercial |
$1,597.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,618.66
|
| Rate for Payer: Cash Price |
$1,037.60
|
| Rate for Payer: Cigna Commercial |
$1,722.42
|
| Rate for Payer: First Health Commercial |
$1,971.44
|
| Rate for Payer: Humana Commercial |
$1,763.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,701.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,531.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$622.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,826.18
|
| Rate for Payer: Ohio Health Group HMO |
$1,556.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$415.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$269.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$643.31
|
| Rate for Payer: PHCS Commercial |
$1,992.19
|
| Rate for Payer: United Healthcare All Payer |
$1,826.18
|
|
|
C-TAPER UNITRAX SLEEVE -3
|
Facility
|
OP
|
$2,075.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$269.78 |
| Max. Negotiated Rate |
$1,992.19 |
| Rate for Payer: Aetna Commercial |
$1,597.90
|
| Rate for Payer: Anthem Medicaid |
$713.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,618.66
|
| Rate for Payer: Cash Price |
$1,037.60
|
| Rate for Payer: Cigna Commercial |
$1,722.42
|
| Rate for Payer: First Health Commercial |
$1,971.44
|
| Rate for Payer: Humana Commercial |
$1,763.92
|
| Rate for Payer: Humana KY Medicaid |
$713.66
|
| Rate for Payer: Kentucky WC Medicaid |
$720.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,701.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,531.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$622.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$727.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,826.18
|
| Rate for Payer: Ohio Health Group HMO |
$1,556.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$415.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$269.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$643.31
|
| Rate for Payer: PHCS Commercial |
$1,992.19
|
| Rate for Payer: United Healthcare All Payer |
$1,826.18
|
|
|
C-TAPER UNITRAX SLEEVE +5
|
Facility
|
IP
|
$2,075.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$269.78 |
| Max. Negotiated Rate |
$1,992.19 |
| Rate for Payer: Aetna Commercial |
$1,597.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,618.66
|
| Rate for Payer: Cash Price |
$1,037.60
|
| Rate for Payer: Cigna Commercial |
$1,722.42
|
| Rate for Payer: First Health Commercial |
$1,971.44
|
| Rate for Payer: Humana Commercial |
$1,763.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,701.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,531.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$622.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,826.18
|
| Rate for Payer: Ohio Health Group HMO |
$1,556.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$415.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$269.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$643.31
|
| Rate for Payer: PHCS Commercial |
$1,992.19
|
| Rate for Payer: United Healthcare All Payer |
$1,826.18
|
|
|
C-TAPER UNITRAX SLEEVE +5
|
Facility
|
OP
|
$2,075.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$269.78 |
| Max. Negotiated Rate |
$1,992.19 |
| Rate for Payer: Aetna Commercial |
$1,597.90
|
| Rate for Payer: Anthem Medicaid |
$713.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,618.66
|
| Rate for Payer: Cash Price |
$1,037.60
|
| Rate for Payer: Cigna Commercial |
$1,722.42
|
| Rate for Payer: First Health Commercial |
$1,971.44
|
| Rate for Payer: Humana Commercial |
$1,763.92
|
| Rate for Payer: Humana KY Medicaid |
$713.66
|
| Rate for Payer: Kentucky WC Medicaid |
$720.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,701.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,531.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$622.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$727.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,826.18
|
| Rate for Payer: Ohio Health Group HMO |
$1,556.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$415.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$269.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$643.31
|
| Rate for Payer: PHCS Commercial |
$1,992.19
|
| Rate for Payer: United Healthcare All Payer |
$1,826.18
|
|
|
CTA UPPER EXTREMITY
|
Facility
|
IP
|
$2,666.00
|
|
|
Service Code
|
HCPCS 73206
|
| Hospital Charge Code |
35000005
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$346.58 |
| Max. Negotiated Rate |
$2,559.36 |
| Rate for Payer: Aetna Commercial |
$2,052.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,079.48
|
| Rate for Payer: Cash Price |
$1,333.00
|
| Rate for Payer: Cigna Commercial |
$2,212.78
|
| Rate for Payer: First Health Commercial |
$2,532.70
|
| Rate for Payer: Humana Commercial |
$2,266.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,186.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,967.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$799.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,346.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,999.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$533.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$346.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$826.46
|
| Rate for Payer: PHCS Commercial |
$2,559.36
|
| Rate for Payer: United Healthcare All Payer |
$2,346.08
|
|
|
CTA UPPER EXTREMITY
|
Facility
|
OP
|
$2,666.00
|
|
|
Service Code
|
HCPCS 73206
|
| Hospital Charge Code |
35000005
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$158.88 |
| Max. Negotiated Rate |
$2,559.36 |
| Rate for Payer: Aetna Commercial |
$2,052.82
|
| Rate for Payer: Anthem Medicaid |
$916.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$158.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,079.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$222.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$214.49
|
| Rate for Payer: Cash Price |
$1,333.00
|
| Rate for Payer: Cash Price |
$1,333.00
|
| Rate for Payer: Cigna Commercial |
$2,212.78
|
| Rate for Payer: First Health Commercial |
$2,532.70
|
| Rate for Payer: Humana Commercial |
$2,266.10
|
| Rate for Payer: Humana KY Medicaid |
$916.84
|
| Rate for Payer: Humana Medicare Advantage |
$158.88
|
| Rate for Payer: Kentucky WC Medicaid |
$926.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,186.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,967.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$935.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,346.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,999.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$533.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$346.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$826.46
|
| Rate for Payer: PHCS Commercial |
$2,559.36
|
| Rate for Payer: United Healthcare All Payer |
$2,346.08
|
|
|
CTA UPPER EXTREMITY
|
Facility
|
IP
|
$2,956.00
|
|
|
Service Code
|
HCPCS 73206
|
| Hospital Charge Code |
35000091
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$384.28 |
| Max. Negotiated Rate |
$2,837.76 |
| Rate for Payer: Aetna Commercial |
$2,276.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,305.68
|
| Rate for Payer: Cash Price |
$1,478.00
|
| Rate for Payer: Cigna Commercial |
$2,453.48
|
| Rate for Payer: First Health Commercial |
$2,808.20
|
| Rate for Payer: Humana Commercial |
$2,512.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,423.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,181.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$886.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,601.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,217.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$591.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$384.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$916.36
|
| Rate for Payer: PHCS Commercial |
$2,837.76
|
| Rate for Payer: United Healthcare All Payer |
$2,601.28
|
|
|
CTA UPPER EXTREMITY
|
Facility
|
OP
|
$2,956.00
|
|
|
Service Code
|
HCPCS 73206
|
| Hospital Charge Code |
35000091
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$158.88 |
| Max. Negotiated Rate |
$2,837.76 |
| Rate for Payer: Aetna Commercial |
$2,276.12
|
| Rate for Payer: Anthem Medicaid |
$1,016.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$158.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,305.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$222.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$214.49
|
| Rate for Payer: Cash Price |
$1,478.00
|
| Rate for Payer: Cash Price |
$1,478.00
|
| Rate for Payer: Cigna Commercial |
$2,453.48
|
| Rate for Payer: First Health Commercial |
$2,808.20
|
| Rate for Payer: Humana Commercial |
$2,512.60
|
| Rate for Payer: Humana KY Medicaid |
$1,016.57
|
| Rate for Payer: Humana Medicare Advantage |
$158.88
|
| Rate for Payer: Kentucky WC Medicaid |
$1,026.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,423.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,181.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,036.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,601.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,217.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$591.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$384.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$916.36
|
| Rate for Payer: PHCS Commercial |
$2,837.76
|
| Rate for Payer: United Healthcare All Payer |
$2,601.28
|
|
|
CTA UPPER EXTREMITY
|
Professional
|
Both
|
$2,956.00
|
|
|
Service Code
|
HCPCS 73206
|
| Hospital Charge Code |
35000091
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$114.43 |
| Max. Negotiated Rate |
$2,956.00 |
| Rate for Payer: Aetna Commercial |
$676.36
|
| Rate for Payer: Anthem Medicaid |
$246.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,956.00
|
| Rate for Payer: Cash Price |
$1,478.00
|
| Rate for Payer: Cash Price |
$1,478.00
|
| Rate for Payer: Cigna Commercial |
$741.57
|
| Rate for Payer: Healthspan PPO |
$464.76
|
| Rate for Payer: Humana Medicaid |
$246.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$114.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$251.34
|
| Rate for Payer: Molina Healthcare Passport |
$246.41
|
| Rate for Payer: Multiplan PHCS |
$1,773.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,069.20
|
| Rate for Payer: UHCCP Medicaid |
$1,034.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$248.87
|
|
|
CTA UPPER EXTREMITY(P
|
Professional
|
Both
|
$290.00
|
|
|
Service Code
|
HCPCS 73206
|
| Hospital Charge Code |
350P0091
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$101.50 |
| Max. Negotiated Rate |
$741.57 |
| Rate for Payer: Aetna Commercial |
$676.36
|
| Rate for Payer: Anthem Medicaid |
$246.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$290.00
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: Cigna Commercial |
$741.57
|
| Rate for Payer: Healthspan PPO |
$464.76
|
| Rate for Payer: Humana Medicaid |
$246.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$114.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$251.34
|
| Rate for Payer: Molina Healthcare Passport |
$246.41
|
| Rate for Payer: Multiplan PHCS |
$174.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$203.00
|
| Rate for Payer: UHCCP Medicaid |
$101.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$248.87
|
|
|
CTA UPPER EXTREMITY(T
|
Facility
|
IP
|
$2,666.00
|
|
|
Service Code
|
HCPCS 73206
|
| Hospital Charge Code |
350T0091
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$346.58 |
| Max. Negotiated Rate |
$2,559.36 |
| Rate for Payer: Aetna Commercial |
$2,052.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,079.48
|
| Rate for Payer: Cash Price |
$1,333.00
|
| Rate for Payer: Cigna Commercial |
$2,212.78
|
| Rate for Payer: First Health Commercial |
$2,532.70
|
| Rate for Payer: Humana Commercial |
$2,266.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,186.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,967.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$799.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,346.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,999.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$533.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$346.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$826.46
|
| Rate for Payer: PHCS Commercial |
$2,559.36
|
| Rate for Payer: United Healthcare All Payer |
$2,346.08
|
|
|
CTA UPPER EXTREMITY(T
|
Facility
|
OP
|
$2,666.00
|
|
|
Service Code
|
HCPCS 73206
|
| Hospital Charge Code |
350T0091
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$158.88 |
| Max. Negotiated Rate |
$2,559.36 |
| Rate for Payer: Aetna Commercial |
$2,052.82
|
| Rate for Payer: Anthem Medicaid |
$916.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$158.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,079.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$222.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$214.49
|
| Rate for Payer: Cash Price |
$1,333.00
|
| Rate for Payer: Cash Price |
$1,333.00
|
| Rate for Payer: Cigna Commercial |
$2,212.78
|
| Rate for Payer: First Health Commercial |
$2,532.70
|
| Rate for Payer: Humana Commercial |
$2,266.10
|
| Rate for Payer: Humana KY Medicaid |
$916.84
|
| Rate for Payer: Humana Medicare Advantage |
$158.88
|
| Rate for Payer: Kentucky WC Medicaid |
$926.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,186.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,967.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$935.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,346.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,999.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$533.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$346.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$826.46
|
| Rate for Payer: PHCS Commercial |
$2,559.36
|
| Rate for Payer: United Healthcare All Payer |
$2,346.08
|
|
|
CT BRAIN ANGIOGRAPHY
|
Facility
|
IP
|
$1,983.00
|
|
|
Service Code
|
HCPCS 0042T
|
| Hospital Charge Code |
32000995
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$257.79 |
| Max. Negotiated Rate |
$1,903.68 |
| Rate for Payer: Aetna Commercial |
$1,526.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,546.74
|
| Rate for Payer: Cash Price |
$991.50
|
| Rate for Payer: Cigna Commercial |
$1,645.89
|
| Rate for Payer: First Health Commercial |
$1,883.85
|
| Rate for Payer: Humana Commercial |
$1,685.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,626.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,463.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$594.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,745.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,487.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$396.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$257.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$614.73
|
| Rate for Payer: PHCS Commercial |
$1,903.68
|
| Rate for Payer: United Healthcare All Payer |
$1,745.04
|
|
|
CT BRAIN ANGIOGRAPHY
|
Professional
|
Both
|
$1,983.00
|
|
|
Service Code
|
HCPCS 0042T
|
| Hospital Charge Code |
32000995
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$694.05 |
| Max. Negotiated Rate |
$1,983.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$1,983.00
|
| Rate for Payer: Cash Price |
$991.50
|
| Rate for Payer: Multiplan PHCS |
$1,189.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,388.10
|
| Rate for Payer: UHCCP Medicaid |
$694.05
|
|
|
CT BRAIN ANGIOGRAPHY
|
Facility
|
OP
|
$1,983.00
|
|
|
Service Code
|
HCPCS 0042T
|
| Hospital Charge Code |
32000995
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$257.79 |
| Max. Negotiated Rate |
$1,903.68 |
| Rate for Payer: Aetna Commercial |
$1,526.91
|
| Rate for Payer: Anthem Medicaid |
$681.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,546.74
|
| Rate for Payer: Cash Price |
$991.50
|
| Rate for Payer: Cigna Commercial |
$1,645.89
|
| Rate for Payer: First Health Commercial |
$1,883.85
|
| Rate for Payer: Humana Commercial |
$1,685.55
|
| Rate for Payer: Humana KY Medicaid |
$681.95
|
| Rate for Payer: Kentucky WC Medicaid |
$688.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,626.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,463.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$594.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$695.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,745.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,487.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$396.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$257.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$614.73
|
| Rate for Payer: PHCS Commercial |
$1,903.68
|
| Rate for Payer: United Healthcare All Payer |
$1,745.04
|
|
