|
ENDO MODEL MODULAR STEM 240MM
|
Facility
|
OP
|
$13,019.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,905.99 |
| Max. Negotiated Rate |
$12,499.18 |
| Rate for Payer: Aetna Commercial |
$10,025.38
|
| Rate for Payer: Anthem Medicaid |
$4,477.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,155.58
|
| Rate for Payer: Cash Price |
$6,509.99
|
| Rate for Payer: Cigna Commercial |
$10,806.58
|
| Rate for Payer: First Health Commercial |
$12,368.98
|
| Rate for Payer: Humana Commercial |
$11,066.98
|
| Rate for Payer: Humana KY Medicaid |
$4,477.57
|
| Rate for Payer: Kentucky WC Medicaid |
$4,523.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,676.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,608.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,905.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,567.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,457.58
|
| Rate for Payer: Ohio Health Group HMO |
$9,764.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,415.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,327.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,983.79
|
| Rate for Payer: PHCS Commercial |
$12,499.18
|
| Rate for Payer: United Healthcare All Payer |
$11,457.58
|
|
|
ENDO MODEL MODULAR STEM 240MM
|
Facility
|
IP
|
$13,019.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,905.99 |
| Max. Negotiated Rate |
$12,499.18 |
| Rate for Payer: Aetna Commercial |
$10,025.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,155.58
|
| Rate for Payer: Cash Price |
$6,509.99
|
| Rate for Payer: Cigna Commercial |
$10,806.58
|
| Rate for Payer: First Health Commercial |
$12,368.98
|
| Rate for Payer: Humana Commercial |
$11,066.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,676.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,608.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,905.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,457.58
|
| Rate for Payer: Ohio Health Group HMO |
$9,764.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,415.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,327.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,983.79
|
| Rate for Payer: PHCS Commercial |
$12,499.18
|
| Rate for Payer: United Healthcare All Payer |
$11,457.58
|
|
|
ENDO MODEL MODULAR TIB LG
|
Facility
|
OP
|
$19,026.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,707.83 |
| Max. Negotiated Rate |
$18,265.06 |
| Rate for Payer: Aetna Commercial |
$14,650.10
|
| Rate for Payer: Anthem Medicaid |
$6,543.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,840.36
|
| Rate for Payer: Cash Price |
$9,513.05
|
| Rate for Payer: Cigna Commercial |
$15,791.66
|
| Rate for Payer: First Health Commercial |
$18,074.79
|
| Rate for Payer: Humana Commercial |
$16,172.18
|
| Rate for Payer: Humana KY Medicaid |
$6,543.08
|
| Rate for Payer: Kentucky WC Medicaid |
$6,609.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,601.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,041.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,707.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,674.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,742.97
|
| Rate for Payer: Ohio Health Group HMO |
$14,269.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,220.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,552.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,128.01
|
| Rate for Payer: PHCS Commercial |
$18,265.06
|
| Rate for Payer: United Healthcare All Payer |
$16,742.97
|
|
|
ENDO MODEL MODULAR TIB LG
|
Facility
|
IP
|
$19,026.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,707.83 |
| Max. Negotiated Rate |
$18,265.06 |
| Rate for Payer: Aetna Commercial |
$14,650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,840.36
|
| Rate for Payer: Cash Price |
$9,513.05
|
| Rate for Payer: Cigna Commercial |
$15,791.66
|
| Rate for Payer: First Health Commercial |
$18,074.79
|
| Rate for Payer: Humana Commercial |
$16,172.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,601.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,041.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,707.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,742.97
|
| Rate for Payer: Ohio Health Group HMO |
$14,269.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,220.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,552.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,128.01
|
| Rate for Payer: PHCS Commercial |
$18,265.06
|
| Rate for Payer: United Healthcare All Payer |
$16,742.97
|
|
|
ENDO MODEL MODUL FMR MD LFT
|
Facility
|
IP
|
$33,455.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,036.50 |
| Max. Negotiated Rate |
$32,116.80 |
| Rate for Payer: Aetna Commercial |
$25,760.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,094.90
|
| Rate for Payer: Cash Price |
$16,727.50
|
| Rate for Payer: Cigna Commercial |
$27,767.65
|
| Rate for Payer: First Health Commercial |
$31,782.25
|
| Rate for Payer: Humana Commercial |
$28,436.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,433.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,689.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,036.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,440.40
|
| Rate for Payer: Ohio Health Group HMO |
$25,091.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,764.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29,105.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,083.95
|
| Rate for Payer: PHCS Commercial |
$32,116.80
|
| Rate for Payer: United Healthcare All Payer |
$29,440.40
|
|
|
ENDO MODEL MODUL FMR MD LFT
|
Facility
|
OP
|
$33,455.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,036.50 |
| Max. Negotiated Rate |
$32,116.80 |
| Rate for Payer: Aetna Commercial |
$25,760.35
|
| Rate for Payer: Anthem Medicaid |
$11,505.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,094.90
|
| Rate for Payer: Cash Price |
$16,727.50
|
| Rate for Payer: Cigna Commercial |
$27,767.65
|
| Rate for Payer: First Health Commercial |
$31,782.25
|
| Rate for Payer: Humana Commercial |
$28,436.75
|
| Rate for Payer: Humana KY Medicaid |
$11,505.17
|
| Rate for Payer: Kentucky WC Medicaid |
$11,622.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,433.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,689.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,036.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,736.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,440.40
|
| Rate for Payer: Ohio Health Group HMO |
$25,091.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,764.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29,105.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,083.95
|
| Rate for Payer: PHCS Commercial |
$32,116.80
|
| Rate for Payer: United Healthcare All Payer |
$29,440.40
|
|
|
ENDO MODULAR STEM 120MM*14MM
|
Facility
|
IP
|
$13,019.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,905.99 |
| Max. Negotiated Rate |
$12,499.18 |
| Rate for Payer: Aetna Commercial |
$10,025.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,155.58
|
| Rate for Payer: Cash Price |
$6,509.99
|
| Rate for Payer: Cigna Commercial |
$10,806.58
|
| Rate for Payer: First Health Commercial |
$12,368.98
|
| Rate for Payer: Humana Commercial |
$11,066.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,676.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,608.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,905.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,457.58
|
| Rate for Payer: Ohio Health Group HMO |
$9,764.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,415.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,327.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,983.79
|
| Rate for Payer: PHCS Commercial |
$12,499.18
|
| Rate for Payer: United Healthcare All Payer |
$11,457.58
|
|
|
ENDO MODULAR STEM 120MM*14MM
|
Facility
|
OP
|
$13,019.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,905.99 |
| Max. Negotiated Rate |
$12,499.18 |
| Rate for Payer: Aetna Commercial |
$10,025.38
|
| Rate for Payer: Anthem Medicaid |
$4,477.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,155.58
|
| Rate for Payer: Cash Price |
$6,509.99
|
| Rate for Payer: Cigna Commercial |
$10,806.58
|
| Rate for Payer: First Health Commercial |
$12,368.98
|
| Rate for Payer: Humana Commercial |
$11,066.98
|
| Rate for Payer: Humana KY Medicaid |
$4,477.57
|
| Rate for Payer: Kentucky WC Medicaid |
$4,523.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,676.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,608.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,905.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,567.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,457.58
|
| Rate for Payer: Ohio Health Group HMO |
$9,764.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,415.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,327.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,983.79
|
| Rate for Payer: PHCS Commercial |
$12,499.18
|
| Rate for Payer: United Healthcare All Payer |
$11,457.58
|
|
|
ENDO MODULAR STEM 120MM*16MM
|
Facility
|
IP
|
$13,019.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,905.99 |
| Max. Negotiated Rate |
$12,499.18 |
| Rate for Payer: Aetna Commercial |
$10,025.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,155.58
|
| Rate for Payer: Cash Price |
$6,509.99
|
| Rate for Payer: Cigna Commercial |
$10,806.58
|
| Rate for Payer: First Health Commercial |
$12,368.98
|
| Rate for Payer: Humana Commercial |
$11,066.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,676.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,608.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,905.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,457.58
|
| Rate for Payer: Ohio Health Group HMO |
$9,764.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,415.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,327.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,983.79
|
| Rate for Payer: PHCS Commercial |
$12,499.18
|
| Rate for Payer: United Healthcare All Payer |
$11,457.58
|
|
|
ENDO MODULAR STEM 120MM*16MM
|
Facility
|
OP
|
$13,019.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,905.99 |
| Max. Negotiated Rate |
$12,499.18 |
| Rate for Payer: Aetna Commercial |
$10,025.38
|
| Rate for Payer: Anthem Medicaid |
$4,477.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,155.58
|
| Rate for Payer: Cash Price |
$6,509.99
|
| Rate for Payer: Cigna Commercial |
$10,806.58
|
| Rate for Payer: First Health Commercial |
$12,368.98
|
| Rate for Payer: Humana Commercial |
$11,066.98
|
| Rate for Payer: Humana KY Medicaid |
$4,477.57
|
| Rate for Payer: Kentucky WC Medicaid |
$4,523.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,676.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,608.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,905.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,567.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,457.58
|
| Rate for Payer: Ohio Health Group HMO |
$9,764.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,415.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,327.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,983.79
|
| Rate for Payer: PHCS Commercial |
$12,499.18
|
| Rate for Payer: United Healthcare All Payer |
$11,457.58
|
|
|
ENDO MODULAR STEM 160MM*16MM
|
Facility
|
IP
|
$13,019.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,905.99 |
| Max. Negotiated Rate |
$12,499.18 |
| Rate for Payer: Aetna Commercial |
$10,025.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,155.58
|
| Rate for Payer: Cash Price |
$6,509.99
|
| Rate for Payer: Cigna Commercial |
$10,806.58
|
| Rate for Payer: First Health Commercial |
$12,368.98
|
| Rate for Payer: Humana Commercial |
$11,066.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,676.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,608.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,905.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,457.58
|
| Rate for Payer: Ohio Health Group HMO |
$9,764.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,415.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,327.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,983.79
|
| Rate for Payer: PHCS Commercial |
$12,499.18
|
| Rate for Payer: United Healthcare All Payer |
$11,457.58
|
|
|
ENDO MODULAR STEM 160MM*16MM
|
Facility
|
OP
|
$13,019.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,905.99 |
| Max. Negotiated Rate |
$12,499.18 |
| Rate for Payer: Aetna Commercial |
$10,025.38
|
| Rate for Payer: Anthem Medicaid |
$4,477.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,155.58
|
| Rate for Payer: Cash Price |
$6,509.99
|
| Rate for Payer: Cigna Commercial |
$10,806.58
|
| Rate for Payer: First Health Commercial |
$12,368.98
|
| Rate for Payer: Humana Commercial |
$11,066.98
|
| Rate for Payer: Humana KY Medicaid |
$4,477.57
|
| Rate for Payer: Kentucky WC Medicaid |
$4,523.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,676.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,608.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,905.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,567.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,457.58
|
| Rate for Payer: Ohio Health Group HMO |
$9,764.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,415.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,327.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,983.79
|
| Rate for Payer: PHCS Commercial |
$12,499.18
|
| Rate for Payer: United Healthcare All Payer |
$11,457.58
|
|
|
ENDOMYOCARDIAL BIOPSY
|
Facility
|
IP
|
$1,108.00
|
|
|
Service Code
|
HCPCS 93505
|
| Hospital Charge Code |
48000096
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$332.40 |
| Max. Negotiated Rate |
$1,063.68 |
| Rate for Payer: Aetna Commercial |
$853.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$864.24
|
| Rate for Payer: Cash Price |
$554.00
|
| Rate for Payer: Cigna Commercial |
$919.64
|
| Rate for Payer: First Health Commercial |
$1,052.60
|
| Rate for Payer: Humana Commercial |
$941.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$908.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$817.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$332.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$975.04
|
| Rate for Payer: Ohio Health Group HMO |
$831.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$886.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$963.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$764.52
|
| Rate for Payer: PHCS Commercial |
$1,063.68
|
| Rate for Payer: United Healthcare All Payer |
$975.04
|
|
|
ENDOMYOCARDIAL BIOPSY
|
Facility
|
OP
|
$1,108.00
|
|
|
Service Code
|
HCPCS 93505
|
| Hospital Charge Code |
48000096
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$381.04 |
| Max. Negotiated Rate |
$4,071.52 |
| Rate for Payer: Aetna Commercial |
$853.16
|
| Rate for Payer: Anthem Medicaid |
$381.04
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$864.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| Rate for Payer: Cash Price |
$554.00
|
| Rate for Payer: Cash Price |
$554.00
|
| Rate for Payer: Cigna Commercial |
$919.64
|
| Rate for Payer: First Health Commercial |
$1,052.60
|
| Rate for Payer: Humana Commercial |
$941.80
|
| Rate for Payer: Humana KY Medicaid |
$381.04
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Kentucky WC Medicaid |
$384.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$908.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$817.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$388.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$975.04
|
| Rate for Payer: Ohio Health Group HMO |
$831.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$886.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$963.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$764.52
|
| Rate for Payer: PHCS Commercial |
$1,063.68
|
| Rate for Payer: United Healthcare All Payer |
$975.04
|
|
|
ENDOPLEDGE COR SINUS CATHETER
|
Facility
|
IP
|
$11,115.25
|
|
|
Service Code
|
HCPCS C2628
|
| Hospital Charge Code |
27000014
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,334.57 |
| Max. Negotiated Rate |
$10,670.64 |
| Rate for Payer: Aetna Commercial |
$8,558.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,669.90
|
| Rate for Payer: Cash Price |
$5,557.62
|
| Rate for Payer: Cigna Commercial |
$9,225.66
|
| Rate for Payer: First Health Commercial |
$10,559.49
|
| Rate for Payer: Humana Commercial |
$9,447.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,114.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,203.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,334.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,781.42
|
| Rate for Payer: Ohio Health Group HMO |
$8,336.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,892.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,670.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,669.52
|
| Rate for Payer: PHCS Commercial |
$10,670.64
|
| Rate for Payer: United Healthcare All Payer |
$9,781.42
|
|
|
ENDOPLEDGE COR SINUS CATHETER
|
Facility
|
OP
|
$11,115.25
|
|
|
Service Code
|
HCPCS C2628
|
| Hospital Charge Code |
27000014
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,334.57 |
| Max. Negotiated Rate |
$10,670.64 |
| Rate for Payer: Aetna Commercial |
$8,558.74
|
| Rate for Payer: Anthem Medicaid |
$3,822.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,669.90
|
| Rate for Payer: Cash Price |
$5,557.62
|
| Rate for Payer: Cigna Commercial |
$9,225.66
|
| Rate for Payer: First Health Commercial |
$10,559.49
|
| Rate for Payer: Humana Commercial |
$9,447.96
|
| Rate for Payer: Humana KY Medicaid |
$3,822.53
|
| Rate for Payer: Kentucky WC Medicaid |
$3,861.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,114.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,203.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,334.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,899.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,781.42
|
| Rate for Payer: Ohio Health Group HMO |
$8,336.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,892.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,670.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,669.52
|
| Rate for Payer: PHCS Commercial |
$10,670.64
|
| Rate for Payer: United Healthcare All Payer |
$9,781.42
|
|
|
ENDOSCOPIC INJECTION/IMPLANT
|
Facility
|
OP
|
$900.00
|
|
|
Service Code
|
HCPCS 51715
|
| Hospital Charge Code |
76102872
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$309.51 |
| Max. Negotiated Rate |
$4,461.49 |
| Rate for Payer: Aetna Commercial |
$693.00
|
| Rate for Payer: Anthem Medicaid |
$309.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,186.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$702.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,461.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,302.15
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$747.00
|
| Rate for Payer: First Health Commercial |
$855.00
|
| Rate for Payer: Humana Commercial |
$765.00
|
| Rate for Payer: Humana KY Medicaid |
$309.51
|
| Rate for Payer: Humana Medicare Advantage |
$3,186.78
|
| Rate for Payer: Kentucky WC Medicaid |
$312.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$738.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$664.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,824.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$315.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$792.00
|
| Rate for Payer: Ohio Health Group HMO |
$675.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$720.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$783.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$621.00
|
| Rate for Payer: PHCS Commercial |
$864.00
|
| Rate for Payer: United Healthcare All Payer |
$792.00
|
|
|
ENDOSCOPIC INJECTION/IMPLANT
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 51715
|
| Hospital Charge Code |
76102872
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$109.27 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: Aetna Commercial |
$328.04
|
| Rate for Payer: Ambetter Exchange |
$188.08
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$109.27
|
| Rate for Payer: Anthem Medicaid |
$187.38
|
| Rate for Payer: Buckeye Individual/Medicaid |
$188.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$188.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$225.70
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$294.71
|
| Rate for Payer: Healthspan PPO |
$373.99
|
| Rate for Payer: Humana Medicaid |
$187.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$272.16
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$188.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$188.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$191.13
|
| Rate for Payer: Molina Healthcare Passport |
$187.38
|
| Rate for Payer: Multiplan PHCS |
$540.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$244.50
|
| Rate for Payer: UHCCP Medicaid |
$114.73
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$189.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$188.08
|
|
|
ENDOSCOPIC INJECTION/IMPLANT
|
Facility
|
IP
|
$900.00
|
|
|
Service Code
|
HCPCS 51715
|
| Hospital Charge Code |
76102872
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$864.00 |
| Rate for Payer: Aetna Commercial |
$693.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$702.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$747.00
|
| Rate for Payer: First Health Commercial |
$855.00
|
| Rate for Payer: Humana Commercial |
$765.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$738.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$664.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$270.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$792.00
|
| Rate for Payer: Ohio Health Group HMO |
$675.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$720.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$783.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$621.00
|
| Rate for Payer: PHCS Commercial |
$864.00
|
| Rate for Payer: United Healthcare All Payer |
$792.00
|
|
|
ENDOSCOPIC INJECTION OF IMPLANT MATERIAL INTO THE SUBMUCOSAL TISSUES OF THE URETHRA AND/OR BLADDER NECK
|
Facility
|
OP
|
$4,461.49
|
|
|
Service Code
|
CPT 51715
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,186.78 |
| Max. Negotiated Rate |
$4,461.49 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,186.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,461.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,302.15
|
| Rate for Payer: Humana Medicare Advantage |
$3,186.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,824.14
|
|
|
ENDOSCOPIC PANCREATOSCOPY
|
Professional
|
Both
|
$525.00
|
|
|
Service Code
|
HCPCS 43273
|
| Hospital Charge Code |
76101758
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.25 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna Commercial |
$198.52
|
| Rate for Payer: Ambetter Exchange |
$110.95
|
| Rate for Payer: Anthem Medicaid |
$103.25
|
| Rate for Payer: Buckeye Individual/Medicaid |
$110.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$110.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$133.14
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cigna Commercial |
$200.88
|
| Rate for Payer: Healthspan PPO |
$167.41
|
| Rate for Payer: Humana Medicaid |
$103.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$168.07
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$110.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$110.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$105.31
|
| Rate for Payer: Molina Healthcare Passport |
$103.25
|
| Rate for Payer: Multiplan PHCS |
$315.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$144.24
|
| Rate for Payer: UHCCP Medicaid |
$183.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$104.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$110.95
|
|
|
ENDOSCOPIC PANCREATOSCOPY
|
Facility
|
IP
|
$525.00
|
|
|
Service Code
|
HCPCS 43273
|
| Hospital Charge Code |
76101758
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$157.50 |
| Max. Negotiated Rate |
$504.00 |
| Rate for Payer: Aetna Commercial |
$404.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$409.50
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cigna Commercial |
$435.75
|
| Rate for Payer: First Health Commercial |
$498.75
|
| Rate for Payer: Humana Commercial |
$446.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$430.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$387.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$157.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$462.00
|
| Rate for Payer: Ohio Health Group HMO |
$393.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$456.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$362.25
|
| Rate for Payer: PHCS Commercial |
$504.00
|
| Rate for Payer: United Healthcare All Payer |
$462.00
|
|
|
ENDOSCOPIC PANCREATOSCOPY
|
Facility
|
OP
|
$525.00
|
|
|
Service Code
|
HCPCS 43273
|
| Hospital Charge Code |
76101758
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$157.50 |
| Max. Negotiated Rate |
$504.00 |
| Rate for Payer: Aetna Commercial |
$404.25
|
| Rate for Payer: Anthem Medicaid |
$180.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$409.50
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cigna Commercial |
$435.75
|
| Rate for Payer: First Health Commercial |
$498.75
|
| Rate for Payer: Humana Commercial |
$446.25
|
| Rate for Payer: Humana KY Medicaid |
$180.55
|
| Rate for Payer: Kentucky WC Medicaid |
$182.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$430.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$387.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$157.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$184.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$462.00
|
| Rate for Payer: Ohio Health Group HMO |
$393.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$456.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$362.25
|
| Rate for Payer: PHCS Commercial |
$504.00
|
| Rate for Payer: United Healthcare All Payer |
$462.00
|
|
|
ENDOSCOPIC PANCREATOSCOPY(P
|
Professional
|
Both
|
$525.00
|
|
|
Service Code
|
HCPCS 43273
|
| Hospital Charge Code |
761P1758
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.25 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna Commercial |
$198.52
|
| Rate for Payer: Ambetter Exchange |
$110.95
|
| Rate for Payer: Anthem Medicaid |
$103.25
|
| Rate for Payer: Buckeye Individual/Medicaid |
$110.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$110.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$133.14
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cigna Commercial |
$200.88
|
| Rate for Payer: Healthspan PPO |
$167.41
|
| Rate for Payer: Humana Medicaid |
$103.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$168.07
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$110.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$110.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$105.31
|
| Rate for Payer: Molina Healthcare Passport |
$103.25
|
| Rate for Payer: Multiplan PHCS |
$315.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$144.24
|
| Rate for Payer: UHCCP Medicaid |
$183.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$104.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$110.95
|
|
|
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$4,921.43
|
|
|
Service Code
|
CPT 43260
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,515.31 |
| Max. Negotiated Rate |
$4,921.43 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,515.31
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,921.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,745.67
|
| Rate for Payer: Humana Medicare Advantage |
$3,515.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,218.37
|
|
