|
COMPR STEM 7MM STD
|
Facility
|
IP
|
$17,479.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,243.85 |
| Max. Negotiated Rate |
$16,780.32 |
| Rate for Payer: Aetna Commercial |
$13,459.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,634.01
|
| Rate for Payer: Cash Price |
$8,739.75
|
| Rate for Payer: Cigna Commercial |
$14,507.99
|
| Rate for Payer: First Health Commercial |
$16,605.53
|
| Rate for Payer: Humana Commercial |
$14,857.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,333.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,899.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,243.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,381.96
|
| Rate for Payer: Ohio Health Group HMO |
$13,109.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,983.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,207.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,060.85
|
| Rate for Payer: PHCS Commercial |
$16,780.32
|
| Rate for Payer: United Healthcare All Payer |
$15,381.96
|
|
|
COMPR STEM 8MM MICRO
|
Facility
|
IP
|
$20,078.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,023.62 |
| Max. Negotiated Rate |
$19,275.60 |
| Rate for Payer: Aetna Commercial |
$15,460.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,661.42
|
| Rate for Payer: Cash Price |
$10,039.38
|
| Rate for Payer: Cigna Commercial |
$16,665.36
|
| Rate for Payer: First Health Commercial |
$19,074.81
|
| Rate for Payer: Humana Commercial |
$17,066.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,464.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,818.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,023.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,669.30
|
| Rate for Payer: Ohio Health Group HMO |
$15,059.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,063.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,468.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,854.34
|
| Rate for Payer: PHCS Commercial |
$19,275.60
|
| Rate for Payer: United Healthcare All Payer |
$17,669.30
|
|
|
COMPR STEM 8MM MICRO
|
Facility
|
OP
|
$20,078.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,023.62 |
| Max. Negotiated Rate |
$19,275.60 |
| Rate for Payer: Aetna Commercial |
$15,460.64
|
| Rate for Payer: Anthem Medicaid |
$6,905.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,661.42
|
| Rate for Payer: Cash Price |
$10,039.38
|
| Rate for Payer: Cigna Commercial |
$16,665.36
|
| Rate for Payer: First Health Commercial |
$19,074.81
|
| Rate for Payer: Humana Commercial |
$17,066.94
|
| Rate for Payer: Humana KY Medicaid |
$6,905.08
|
| Rate for Payer: Kentucky WC Medicaid |
$6,975.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,464.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,818.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,023.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,043.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,669.30
|
| Rate for Payer: Ohio Health Group HMO |
$15,059.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,063.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,468.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,854.34
|
| Rate for Payer: PHCS Commercial |
$19,275.60
|
| Rate for Payer: United Healthcare All Payer |
$17,669.30
|
|
|
COMPR STEM 8MM MINI
|
Facility
|
IP
|
$20,078.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,023.62 |
| Max. Negotiated Rate |
$19,275.60 |
| Rate for Payer: Aetna Commercial |
$15,460.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,661.42
|
| Rate for Payer: Cash Price |
$10,039.38
|
| Rate for Payer: Cigna Commercial |
$16,665.36
|
| Rate for Payer: First Health Commercial |
$19,074.81
|
| Rate for Payer: Humana Commercial |
$17,066.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,464.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,818.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,023.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,669.30
|
| Rate for Payer: Ohio Health Group HMO |
$15,059.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,063.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,468.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,854.34
|
| Rate for Payer: PHCS Commercial |
$19,275.60
|
| Rate for Payer: United Healthcare All Payer |
$17,669.30
|
|
|
COMPR STEM 8MM MINI
|
Facility
|
OP
|
$20,078.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,023.62 |
| Max. Negotiated Rate |
$19,275.60 |
| Rate for Payer: Aetna Commercial |
$15,460.64
|
| Rate for Payer: Anthem Medicaid |
$6,905.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,661.42
|
| Rate for Payer: Cash Price |
$10,039.38
|
| Rate for Payer: Cigna Commercial |
$16,665.36
|
| Rate for Payer: First Health Commercial |
$19,074.81
|
| Rate for Payer: Humana Commercial |
$17,066.94
|
| Rate for Payer: Humana KY Medicaid |
$6,905.08
|
| Rate for Payer: Kentucky WC Medicaid |
$6,975.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,464.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,818.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,023.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,043.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,669.30
|
| Rate for Payer: Ohio Health Group HMO |
$15,059.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,063.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,468.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,854.34
|
| Rate for Payer: PHCS Commercial |
$19,275.60
|
| Rate for Payer: United Healthcare All Payer |
$17,669.30
|
|
|
COMPR STEM 8MM STD
|
Facility
|
IP
|
$17,479.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,243.85 |
| Max. Negotiated Rate |
$16,780.32 |
| Rate for Payer: Aetna Commercial |
$13,459.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,634.01
|
| Rate for Payer: Cash Price |
$8,739.75
|
| Rate for Payer: Cigna Commercial |
$14,507.99
|
| Rate for Payer: First Health Commercial |
$16,605.53
|
| Rate for Payer: Humana Commercial |
$14,857.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,333.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,899.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,243.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,381.96
|
| Rate for Payer: Ohio Health Group HMO |
$13,109.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,983.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,207.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,060.85
|
| Rate for Payer: PHCS Commercial |
$16,780.32
|
| Rate for Payer: United Healthcare All Payer |
$15,381.96
|
|
|
COMPR STEM 8MM STD
|
Facility
|
OP
|
$17,479.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,243.85 |
| Max. Negotiated Rate |
$16,780.32 |
| Rate for Payer: Aetna Commercial |
$13,459.22
|
| Rate for Payer: Anthem Medicaid |
$6,011.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,634.01
|
| Rate for Payer: Cash Price |
$8,739.75
|
| Rate for Payer: Cigna Commercial |
$14,507.99
|
| Rate for Payer: First Health Commercial |
$16,605.53
|
| Rate for Payer: Humana Commercial |
$14,857.58
|
| Rate for Payer: Humana KY Medicaid |
$6,011.20
|
| Rate for Payer: Kentucky WC Medicaid |
$6,072.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,333.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,899.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,243.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,131.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,381.96
|
| Rate for Payer: Ohio Health Group HMO |
$13,109.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,983.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,207.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,060.85
|
| Rate for Payer: PHCS Commercial |
$16,780.32
|
| Rate for Payer: United Healthcare All Payer |
$15,381.96
|
|
|
COMPR STEM 9MM MICRO
|
Facility
|
OP
|
$20,078.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,023.62 |
| Max. Negotiated Rate |
$19,275.60 |
| Rate for Payer: Aetna Commercial |
$15,460.64
|
| Rate for Payer: Anthem Medicaid |
$6,905.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,661.42
|
| Rate for Payer: Cash Price |
$10,039.38
|
| Rate for Payer: Cigna Commercial |
$16,665.36
|
| Rate for Payer: First Health Commercial |
$19,074.81
|
| Rate for Payer: Humana Commercial |
$17,066.94
|
| Rate for Payer: Humana KY Medicaid |
$6,905.08
|
| Rate for Payer: Kentucky WC Medicaid |
$6,975.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,464.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,818.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,023.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,043.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,669.30
|
| Rate for Payer: Ohio Health Group HMO |
$15,059.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,063.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,468.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,854.34
|
| Rate for Payer: PHCS Commercial |
$19,275.60
|
| Rate for Payer: United Healthcare All Payer |
$17,669.30
|
|
|
COMPR STEM 9MM MICRO
|
Facility
|
IP
|
$20,078.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,023.62 |
| Max. Negotiated Rate |
$19,275.60 |
| Rate for Payer: Aetna Commercial |
$15,460.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,661.42
|
| Rate for Payer: Cash Price |
$10,039.38
|
| Rate for Payer: Cigna Commercial |
$16,665.36
|
| Rate for Payer: First Health Commercial |
$19,074.81
|
| Rate for Payer: Humana Commercial |
$17,066.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,464.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,818.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,023.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,669.30
|
| Rate for Payer: Ohio Health Group HMO |
$15,059.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,063.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,468.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,854.34
|
| Rate for Payer: PHCS Commercial |
$19,275.60
|
| Rate for Payer: United Healthcare All Payer |
$17,669.30
|
|
|
COMPR STEM 9MM MINI
|
Facility
|
OP
|
$20,078.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,023.62 |
| Max. Negotiated Rate |
$19,275.60 |
| Rate for Payer: Aetna Commercial |
$15,460.64
|
| Rate for Payer: Anthem Medicaid |
$6,905.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,661.42
|
| Rate for Payer: Cash Price |
$10,039.38
|
| Rate for Payer: Cigna Commercial |
$16,665.36
|
| Rate for Payer: First Health Commercial |
$19,074.81
|
| Rate for Payer: Humana Commercial |
$17,066.94
|
| Rate for Payer: Humana KY Medicaid |
$6,905.08
|
| Rate for Payer: Kentucky WC Medicaid |
$6,975.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,464.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,818.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,023.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,043.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,669.30
|
| Rate for Payer: Ohio Health Group HMO |
$15,059.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,063.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,468.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,854.34
|
| Rate for Payer: PHCS Commercial |
$19,275.60
|
| Rate for Payer: United Healthcare All Payer |
$17,669.30
|
|
|
COMPR STEM 9MM MINI
|
Facility
|
IP
|
$20,078.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,023.62 |
| Max. Negotiated Rate |
$19,275.60 |
| Rate for Payer: Aetna Commercial |
$15,460.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,661.42
|
| Rate for Payer: Cash Price |
$10,039.38
|
| Rate for Payer: Cigna Commercial |
$16,665.36
|
| Rate for Payer: First Health Commercial |
$19,074.81
|
| Rate for Payer: Humana Commercial |
$17,066.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,464.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,818.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,023.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,669.30
|
| Rate for Payer: Ohio Health Group HMO |
$15,059.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,063.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,468.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,854.34
|
| Rate for Payer: PHCS Commercial |
$19,275.60
|
| Rate for Payer: United Healthcare All Payer |
$17,669.30
|
|
|
COMPR STEM 9MM STD
|
Facility
|
OP
|
$17,479.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,243.85 |
| Max. Negotiated Rate |
$16,780.32 |
| Rate for Payer: Aetna Commercial |
$13,459.22
|
| Rate for Payer: Anthem Medicaid |
$6,011.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,634.01
|
| Rate for Payer: Cash Price |
$8,739.75
|
| Rate for Payer: Cigna Commercial |
$14,507.99
|
| Rate for Payer: First Health Commercial |
$16,605.53
|
| Rate for Payer: Humana Commercial |
$14,857.58
|
| Rate for Payer: Humana KY Medicaid |
$6,011.20
|
| Rate for Payer: Kentucky WC Medicaid |
$6,072.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,333.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,899.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,243.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,131.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,381.96
|
| Rate for Payer: Ohio Health Group HMO |
$13,109.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,983.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,207.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,060.85
|
| Rate for Payer: PHCS Commercial |
$16,780.32
|
| Rate for Payer: United Healthcare All Payer |
$15,381.96
|
|
|
COMPR STEM 9MM STD
|
Facility
|
IP
|
$17,479.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,243.85 |
| Max. Negotiated Rate |
$16,780.32 |
| Rate for Payer: Aetna Commercial |
$13,459.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,634.01
|
| Rate for Payer: Cash Price |
$8,739.75
|
| Rate for Payer: Cigna Commercial |
$14,507.99
|
| Rate for Payer: First Health Commercial |
$16,605.53
|
| Rate for Payer: Humana Commercial |
$14,857.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,333.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,899.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,243.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,381.96
|
| Rate for Payer: Ohio Health Group HMO |
$13,109.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,983.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,207.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,060.85
|
| Rate for Payer: PHCS Commercial |
$16,780.32
|
| Rate for Payer: United Healthcare All Payer |
$15,381.96
|
|
|
COMPUTER-ASSIST SURG NAV PROC
|
Facility
|
IP
|
$9,101.00
|
|
|
Service Code
|
HCPCS 20985
|
| Hospital Charge Code |
76100360
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,730.30 |
| Max. Negotiated Rate |
$8,736.96 |
| Rate for Payer: Aetna Commercial |
$7,007.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,098.78
|
| Rate for Payer: Cash Price |
$4,550.50
|
| Rate for Payer: Cigna Commercial |
$7,553.83
|
| Rate for Payer: First Health Commercial |
$8,645.95
|
| Rate for Payer: Humana Commercial |
$7,735.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,462.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,716.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,730.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,008.88
|
| Rate for Payer: Ohio Health Group HMO |
$6,825.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,280.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,917.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,279.69
|
| Rate for Payer: PHCS Commercial |
$8,736.96
|
| Rate for Payer: United Healthcare All Payer |
$8,008.88
|
|
|
COMPUTER-ASSIST SURG NAV PROC
|
Professional
|
Both
|
$9,101.00
|
|
|
Service Code
|
HCPCS 20985
|
| Hospital Charge Code |
76100360
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$117.79 |
| Max. Negotiated Rate |
$5,460.60 |
| Rate for Payer: Aetna Commercial |
$235.21
|
| Rate for Payer: Ambetter Exchange |
$136.80
|
| Rate for Payer: Anthem Medicaid |
$117.79
|
| Rate for Payer: Buckeye Individual/Medicaid |
$136.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$136.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$164.16
|
| Rate for Payer: Cash Price |
$4,550.50
|
| Rate for Payer: Cash Price |
$4,550.50
|
| Rate for Payer: Cigna Commercial |
$239.29
|
| Rate for Payer: Healthspan PPO |
$213.05
|
| Rate for Payer: Humana Medicaid |
$117.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$188.18
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$136.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$136.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$120.15
|
| Rate for Payer: Molina Healthcare Passport |
$117.79
|
| Rate for Payer: Multiplan PHCS |
$5,460.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$177.84
|
| Rate for Payer: UHCCP Medicaid |
$3,185.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$118.97
|
| Rate for Payer: Wellcare Medicare Advantage |
$136.80
|
|
|
COMPUTER-ASSIST SURG NAV PROC
|
Facility
|
OP
|
$9,101.00
|
|
|
Service Code
|
HCPCS 20985
|
| Hospital Charge Code |
76100360
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,730.30 |
| Max. Negotiated Rate |
$8,736.96 |
| Rate for Payer: Aetna Commercial |
$7,007.77
|
| Rate for Payer: Anthem Medicaid |
$3,129.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,098.78
|
| Rate for Payer: Cash Price |
$4,550.50
|
| Rate for Payer: Cigna Commercial |
$7,553.83
|
| Rate for Payer: First Health Commercial |
$8,645.95
|
| Rate for Payer: Humana Commercial |
$7,735.85
|
| Rate for Payer: Humana KY Medicaid |
$3,129.83
|
| Rate for Payer: Kentucky WC Medicaid |
$3,161.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,462.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,716.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,730.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,192.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,008.88
|
| Rate for Payer: Ohio Health Group HMO |
$6,825.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,280.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,917.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,279.69
|
| Rate for Payer: PHCS Commercial |
$8,736.96
|
| Rate for Payer: United Healthcare All Payer |
$8,008.88
|
|
|
COMPUTER-ASSIST SURG NAV PRO(P
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 20985
|
| Hospital Charge Code |
761P0360
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$117.79 |
| Max. Negotiated Rate |
$239.29 |
| Rate for Payer: Aetna Commercial |
$235.21
|
| Rate for Payer: Ambetter Exchange |
$136.80
|
| Rate for Payer: Anthem Medicaid |
$117.79
|
| Rate for Payer: Buckeye Individual/Medicaid |
$136.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$136.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$164.16
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$239.29
|
| Rate for Payer: Healthspan PPO |
$213.05
|
| Rate for Payer: Humana Medicaid |
$117.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$188.18
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$136.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$136.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$120.15
|
| Rate for Payer: Molina Healthcare Passport |
$117.79
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$177.84
|
| Rate for Payer: UHCCP Medicaid |
$122.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$118.97
|
| Rate for Payer: Wellcare Medicare Advantage |
$136.80
|
|
|
COMPUTER-ASSIST SURG NAV PRO(T
|
Facility
|
IP
|
$8,751.00
|
|
|
Service Code
|
HCPCS 20985
|
| Hospital Charge Code |
761T0360
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,625.30 |
| Max. Negotiated Rate |
$8,400.96 |
| Rate for Payer: Aetna Commercial |
$6,738.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,825.78
|
| Rate for Payer: Cash Price |
$4,375.50
|
| Rate for Payer: Cigna Commercial |
$7,263.33
|
| Rate for Payer: First Health Commercial |
$8,313.45
|
| Rate for Payer: Humana Commercial |
$7,438.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,175.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,458.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,625.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,700.88
|
| Rate for Payer: Ohio Health Group HMO |
$6,563.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,000.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,613.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,038.19
|
| Rate for Payer: PHCS Commercial |
$8,400.96
|
| Rate for Payer: United Healthcare All Payer |
$7,700.88
|
|
|
COMPUTER-ASSIST SURG NAV PRO(T
|
Facility
|
OP
|
$8,751.00
|
|
|
Service Code
|
HCPCS 20985
|
| Hospital Charge Code |
761T0360
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,625.30 |
| Max. Negotiated Rate |
$8,400.96 |
| Rate for Payer: Aetna Commercial |
$6,738.27
|
| Rate for Payer: Anthem Medicaid |
$3,009.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,825.78
|
| Rate for Payer: Cash Price |
$4,375.50
|
| Rate for Payer: Cigna Commercial |
$7,263.33
|
| Rate for Payer: First Health Commercial |
$8,313.45
|
| Rate for Payer: Humana Commercial |
$7,438.35
|
| Rate for Payer: Humana KY Medicaid |
$3,009.47
|
| Rate for Payer: Kentucky WC Medicaid |
$3,040.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,175.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,458.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,625.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,069.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,700.88
|
| Rate for Payer: Ohio Health Group HMO |
$6,563.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,000.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,613.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,038.19
|
| Rate for Payer: PHCS Commercial |
$8,400.96
|
| Rate for Payer: United Healthcare All Payer |
$7,700.88
|
|
|
COMTAN(ENTACAPONE)200 MG TAB
|
Facility
|
OP
|
$4.82
|
|
|
Service Code
|
NDC 65862065401
|
| Hospital Charge Code |
25000454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$4.63 |
| Rate for Payer: Aetna Commercial |
$3.71
|
| Rate for Payer: Anthem Medicaid |
$1.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.76
|
| Rate for Payer: Cash Price |
$2.41
|
| Rate for Payer: Cigna Commercial |
$4.00
|
| Rate for Payer: First Health Commercial |
$4.58
|
| Rate for Payer: Humana Commercial |
$4.10
|
| Rate for Payer: Humana KY Medicaid |
$1.66
|
| Rate for Payer: Kentucky WC Medicaid |
$1.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.24
|
| Rate for Payer: Ohio Health Group HMO |
$3.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.33
|
| Rate for Payer: PHCS Commercial |
$4.63
|
| Rate for Payer: United Healthcare All Payer |
$4.24
|
|
|
COMTAN(ENTACAPONE)200 MG TAB
|
Facility
|
IP
|
$4.82
|
|
|
Service Code
|
NDC 65862065401
|
| Hospital Charge Code |
25000454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$4.63 |
| Rate for Payer: Aetna Commercial |
$3.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.76
|
| Rate for Payer: Cash Price |
$2.41
|
| Rate for Payer: Cigna Commercial |
$4.00
|
| Rate for Payer: First Health Commercial |
$4.58
|
| Rate for Payer: Humana Commercial |
$4.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.24
|
| Rate for Payer: Ohio Health Group HMO |
$3.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.33
|
| Rate for Payer: PHCS Commercial |
$4.63
|
| Rate for Payer: United Healthcare All Payer |
$4.24
|
|
|
CONFIANZA PRO 12 PTCA GW 180CM
|
Facility
|
OP
|
$1,824.40
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$547.32 |
| Max. Negotiated Rate |
$1,751.42 |
| Rate for Payer: Aetna Commercial |
$1,404.79
|
| Rate for Payer: Anthem Medicaid |
$627.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,423.03
|
| Rate for Payer: Cash Price |
$912.20
|
| Rate for Payer: Cigna Commercial |
$1,514.25
|
| Rate for Payer: First Health Commercial |
$1,733.18
|
| Rate for Payer: Humana Commercial |
$1,550.74
|
| Rate for Payer: Humana KY Medicaid |
$627.41
|
| Rate for Payer: Kentucky WC Medicaid |
$633.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,496.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,346.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$547.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$640.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,605.47
|
| Rate for Payer: Ohio Health Group HMO |
$1,368.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,459.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,587.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,258.84
|
| Rate for Payer: PHCS Commercial |
$1,751.42
|
| Rate for Payer: United Healthcare All Payer |
$1,605.47
|
|
|
CONFIANZA PRO 12 PTCA GW 180CM
|
Facility
|
IP
|
$1,824.40
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$547.32 |
| Max. Negotiated Rate |
$1,751.42 |
| Rate for Payer: Aetna Commercial |
$1,404.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,423.03
|
| Rate for Payer: Cash Price |
$912.20
|
| Rate for Payer: Cigna Commercial |
$1,514.25
|
| Rate for Payer: First Health Commercial |
$1,733.18
|
| Rate for Payer: Humana Commercial |
$1,550.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,496.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,346.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$547.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,605.47
|
| Rate for Payer: Ohio Health Group HMO |
$1,368.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,459.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,587.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,258.84
|
| Rate for Payer: PHCS Commercial |
$1,751.42
|
| Rate for Payer: United Healthcare All Payer |
$1,605.47
|
|
|
CONFIANZA PRO 12 PTCA GW 300CM
|
Facility
|
OP
|
$1,756.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$526.80 |
| Max. Negotiated Rate |
$1,685.76 |
| Rate for Payer: Aetna Commercial |
$1,352.12
|
| Rate for Payer: Anthem Medicaid |
$603.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,369.68
|
| Rate for Payer: Cash Price |
$878.00
|
| Rate for Payer: Cigna Commercial |
$1,457.48
|
| Rate for Payer: First Health Commercial |
$1,668.20
|
| Rate for Payer: Humana Commercial |
$1,492.60
|
| Rate for Payer: Humana KY Medicaid |
$603.89
|
| Rate for Payer: Kentucky WC Medicaid |
$610.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,439.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,295.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$526.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$616.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,545.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,317.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,404.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,527.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,211.64
|
| Rate for Payer: PHCS Commercial |
$1,685.76
|
| Rate for Payer: United Healthcare All Payer |
$1,545.28
|
|
|
CONFIANZA PRO 12 PTCA GW 300CM
|
Facility
|
IP
|
$1,756.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$526.80 |
| Max. Negotiated Rate |
$1,685.76 |
| Rate for Payer: Aetna Commercial |
$1,352.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,369.68
|
| Rate for Payer: Cash Price |
$878.00
|
| Rate for Payer: Cigna Commercial |
$1,457.48
|
| Rate for Payer: First Health Commercial |
$1,668.20
|
| Rate for Payer: Humana Commercial |
$1,492.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,439.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,295.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$526.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,545.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,317.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,404.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,527.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,211.64
|
| Rate for Payer: PHCS Commercial |
$1,685.76
|
| Rate for Payer: United Healthcare All Payer |
$1,545.28
|
|
