|
FEMORAL SIZE G RM/LL
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
FEMORAL STEM 13*32MM TEXTURED
|
Facility
|
OP
|
$9,329.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,212.88 |
| Max. Negotiated Rate |
$8,956.66 |
| Rate for Payer: Aetna Commercial |
$7,183.98
|
| Rate for Payer: Anthem Medicaid |
$3,208.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,277.28
|
| Rate for Payer: Cash Price |
$4,664.92
|
| Rate for Payer: Cigna Commercial |
$7,743.78
|
| Rate for Payer: First Health Commercial |
$8,863.36
|
| Rate for Payer: Humana Commercial |
$7,930.37
|
| Rate for Payer: Humana KY Medicaid |
$3,208.54
|
| Rate for Payer: Kentucky WC Medicaid |
$3,241.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,650.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,885.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,798.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,272.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,210.27
|
| Rate for Payer: Ohio Health Group HMO |
$6,997.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,865.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,212.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,892.25
|
| Rate for Payer: PHCS Commercial |
$8,956.66
|
| Rate for Payer: United Healthcare All Payer |
$8,210.27
|
|
|
FEMORAL STEM 13*32MM TEXTURED
|
Facility
|
IP
|
$9,329.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,212.88 |
| Max. Negotiated Rate |
$8,956.66 |
| Rate for Payer: Aetna Commercial |
$7,183.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,277.28
|
| Rate for Payer: Cash Price |
$4,664.92
|
| Rate for Payer: Cigna Commercial |
$7,743.78
|
| Rate for Payer: First Health Commercial |
$8,863.36
|
| Rate for Payer: Humana Commercial |
$7,930.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,650.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,885.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,798.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,210.27
|
| Rate for Payer: Ohio Health Group HMO |
$6,997.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,865.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,212.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,892.25
|
| Rate for Payer: PHCS Commercial |
$8,956.66
|
| Rate for Payer: United Healthcare All Payer |
$8,210.27
|
|
|
FEMORAL STEM HIP 14MM*150MM
|
Facility
|
OP
|
$11,914.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,548.82 |
| Max. Negotiated Rate |
$11,437.44 |
| Rate for Payer: Aetna Commercial |
$9,173.78
|
| Rate for Payer: Anthem Medicaid |
$4,097.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,292.92
|
| Rate for Payer: Cash Price |
$5,957.00
|
| Rate for Payer: Cigna Commercial |
$9,888.62
|
| Rate for Payer: First Health Commercial |
$11,318.30
|
| Rate for Payer: Humana Commercial |
$10,126.90
|
| Rate for Payer: Humana KY Medicaid |
$4,097.22
|
| Rate for Payer: Kentucky WC Medicaid |
$4,138.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,769.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,792.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,574.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,179.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,484.32
|
| Rate for Payer: Ohio Health Group HMO |
$8,935.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,382.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,548.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,693.34
|
| Rate for Payer: PHCS Commercial |
$11,437.44
|
| Rate for Payer: United Healthcare All Payer |
$10,484.32
|
|
|
FEMORAL STEM HIP 14MM*150MM
|
Facility
|
IP
|
$11,914.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,548.82 |
| Max. Negotiated Rate |
$11,437.44 |
| Rate for Payer: Aetna Commercial |
$9,173.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,292.92
|
| Rate for Payer: Cash Price |
$5,957.00
|
| Rate for Payer: Cigna Commercial |
$9,888.62
|
| Rate for Payer: First Health Commercial |
$11,318.30
|
| Rate for Payer: Humana Commercial |
$10,126.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,769.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,792.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,574.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,484.32
|
| Rate for Payer: Ohio Health Group HMO |
$8,935.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,382.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,548.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,693.34
|
| Rate for Payer: PHCS Commercial |
$11,437.44
|
| Rate for Payer: United Healthcare All Payer |
$10,484.32
|
|
|
FEMORAL STRUT FROZEN 2*20CM
|
Facility
|
IP
|
$4,850.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$630.60 |
| Max. Negotiated Rate |
$4,656.73 |
| Rate for Payer: Aetna Commercial |
$3,735.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,783.59
|
| Rate for Payer: Cash Price |
$2,425.38
|
| Rate for Payer: Cigna Commercial |
$4,026.13
|
| Rate for Payer: First Health Commercial |
$4,608.22
|
| Rate for Payer: Humana Commercial |
$4,123.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,977.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,579.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,455.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,268.67
|
| Rate for Payer: Ohio Health Group HMO |
$3,638.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$970.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$630.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,503.74
|
| Rate for Payer: PHCS Commercial |
$4,656.73
|
| Rate for Payer: United Healthcare All Payer |
$4,268.67
|
|
|
FEMORAL STRUT FROZEN 2*20CM
|
Facility
|
OP
|
$4,850.76
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$630.60 |
| Max. Negotiated Rate |
$4,656.73 |
| Rate for Payer: Aetna Commercial |
$3,735.09
|
| Rate for Payer: Anthem Medicaid |
$1,668.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,783.59
|
| Rate for Payer: Cash Price |
$2,425.38
|
| Rate for Payer: Cigna Commercial |
$4,026.13
|
| Rate for Payer: First Health Commercial |
$4,608.22
|
| Rate for Payer: Humana Commercial |
$4,123.15
|
| Rate for Payer: Humana KY Medicaid |
$1,668.18
|
| Rate for Payer: Kentucky WC Medicaid |
$1,685.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,977.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,579.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,455.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,701.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,268.67
|
| Rate for Payer: Ohio Health Group HMO |
$3,638.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$970.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$630.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,503.74
|
| Rate for Payer: PHCS Commercial |
$4,656.73
|
| Rate for Payer: United Healthcare All Payer |
$4,268.67
|
|
|
FEMORAL TOTAL ROD OSS IM 20CM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
FEMORAL TOTAL ROD OSS IM 20CM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
FEM OSS RS 8.5CM SEG L
|
Facility
|
IP
|
$73,723.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,584.10 |
| Max. Negotiated Rate |
$70,774.89 |
| Rate for Payer: Aetna Commercial |
$56,767.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57,504.60
|
| Rate for Payer: Cash Price |
$36,861.92
|
| Rate for Payer: Cigna Commercial |
$61,190.79
|
| Rate for Payer: First Health Commercial |
$70,037.65
|
| Rate for Payer: Humana Commercial |
$62,665.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60,453.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54,408.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,117.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$64,876.98
|
| Rate for Payer: Ohio Health Group HMO |
$55,292.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,744.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,584.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,854.39
|
| Rate for Payer: PHCS Commercial |
$70,774.89
|
| Rate for Payer: United Healthcare All Payer |
$64,876.98
|
|
|
FEM OSS RS 8.5CM SEG L
|
Facility
|
OP
|
$73,723.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,584.10 |
| Max. Negotiated Rate |
$70,774.89 |
| Rate for Payer: Aetna Commercial |
$56,767.36
|
| Rate for Payer: Anthem Medicaid |
$25,353.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57,504.60
|
| Rate for Payer: Cash Price |
$36,861.92
|
| Rate for Payer: Cigna Commercial |
$61,190.79
|
| Rate for Payer: First Health Commercial |
$70,037.65
|
| Rate for Payer: Humana Commercial |
$62,665.26
|
| Rate for Payer: Humana KY Medicaid |
$25,353.63
|
| Rate for Payer: Kentucky WC Medicaid |
$25,611.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60,453.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54,408.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,117.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,862.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$64,876.98
|
| Rate for Payer: Ohio Health Group HMO |
$55,292.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,744.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,584.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,854.39
|
| Rate for Payer: PHCS Commercial |
$70,774.89
|
| Rate for Payer: United Healthcare All Payer |
$64,876.98
|
|
|
FEM OSS RS 8.5CM SEG R
|
Facility
|
OP
|
$73,723.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,584.10 |
| Max. Negotiated Rate |
$70,774.89 |
| Rate for Payer: Aetna Commercial |
$56,767.36
|
| Rate for Payer: Anthem Medicaid |
$25,353.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57,504.60
|
| Rate for Payer: Cash Price |
$36,861.92
|
| Rate for Payer: Cigna Commercial |
$61,190.79
|
| Rate for Payer: First Health Commercial |
$70,037.65
|
| Rate for Payer: Humana Commercial |
$62,665.26
|
| Rate for Payer: Humana KY Medicaid |
$25,353.63
|
| Rate for Payer: Kentucky WC Medicaid |
$25,611.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60,453.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54,408.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,117.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,862.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$64,876.98
|
| Rate for Payer: Ohio Health Group HMO |
$55,292.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,744.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,584.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,854.39
|
| Rate for Payer: PHCS Commercial |
$70,774.89
|
| Rate for Payer: United Healthcare All Payer |
$64,876.98
|
|
|
FEM OSS RS 8.5CM SEG R
|
Facility
|
IP
|
$73,723.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,584.10 |
| Max. Negotiated Rate |
$70,774.89 |
| Rate for Payer: Aetna Commercial |
$56,767.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57,504.60
|
| Rate for Payer: Cash Price |
$36,861.92
|
| Rate for Payer: Cigna Commercial |
$61,190.79
|
| Rate for Payer: First Health Commercial |
$70,037.65
|
| Rate for Payer: Humana Commercial |
$62,665.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$60,453.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$54,408.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,117.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$64,876.98
|
| Rate for Payer: Ohio Health Group HMO |
$55,292.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,744.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,584.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,854.39
|
| Rate for Payer: PHCS Commercial |
$70,774.89
|
| Rate for Payer: United Healthcare All Payer |
$64,876.98
|
|
|
FEM/POPL REVASC STNT & ATHE(P
|
Professional
|
Both
|
$14,543.51
|
|
|
Service Code
|
HCPCS 37227
|
| Hospital Charge Code |
761P1551
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$385.85 |
| Max. Negotiated Rate |
$14,543.51 |
| Rate for Payer: Aetna Commercial |
$1,278.09
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$385.85
|
| Rate for Payer: Anthem Medicaid |
$682.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$14,543.51
|
| Rate for Payer: Cash Price |
$7,271.76
|
| Rate for Payer: Cash Price |
$7,271.76
|
| Rate for Payer: Cigna Commercial |
$1,445.68
|
| Rate for Payer: Healthspan PPO |
$13,534.12
|
| Rate for Payer: Humana Medicaid |
$682.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$996.33
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$696.36
|
| Rate for Payer: Molina Healthcare Passport |
$682.71
|
| Rate for Payer: Multiplan PHCS |
$8,726.11
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$10,180.46
|
| Rate for Payer: UHCCP Medicaid |
$405.14
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$689.54
|
|
|
FEM/POPL REVASC STNT & ATHER
|
Facility
|
OP
|
$14,543.51
|
|
|
Service Code
|
HCPCS 37227
|
| Hospital Charge Code |
76101551
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,890.66 |
| Max. Negotiated Rate |
$21,228.97 |
| Rate for Payer: Aetna Commercial |
$11,198.50
|
| Rate for Payer: Anthem Medicaid |
$5,001.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15,163.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,343.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21,228.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$20,470.79
|
| Rate for Payer: Cash Price |
$7,271.76
|
| Rate for Payer: Cash Price |
$7,271.76
|
| Rate for Payer: Cigna Commercial |
$12,071.11
|
| Rate for Payer: First Health Commercial |
$13,816.33
|
| Rate for Payer: Humana Commercial |
$12,361.98
|
| Rate for Payer: Humana KY Medicaid |
$5,001.51
|
| Rate for Payer: Humana Medicare Advantage |
$15,163.55
|
| Rate for Payer: Kentucky WC Medicaid |
$5,052.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,925.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,733.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18,196.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,101.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,798.29
|
| Rate for Payer: Ohio Health Group HMO |
$10,907.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,908.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,890.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,508.49
|
| Rate for Payer: PHCS Commercial |
$13,961.77
|
| Rate for Payer: United Healthcare All Payer |
$12,798.29
|
|
|
FEM/POPL REVASC STNT & ATHER
|
Facility
|
IP
|
$14,543.51
|
|
|
Service Code
|
HCPCS 37227
|
| Hospital Charge Code |
76101551
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,890.66 |
| Max. Negotiated Rate |
$13,961.77 |
| Rate for Payer: Aetna Commercial |
$11,198.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,343.94
|
| Rate for Payer: Cash Price |
$7,271.76
|
| Rate for Payer: Cigna Commercial |
$12,071.11
|
| Rate for Payer: First Health Commercial |
$13,816.33
|
| Rate for Payer: Humana Commercial |
$12,361.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,925.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,733.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,363.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,798.29
|
| Rate for Payer: Ohio Health Group HMO |
$10,907.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,908.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,890.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,508.49
|
| Rate for Payer: PHCS Commercial |
$13,961.77
|
| Rate for Payer: United Healthcare All Payer |
$12,798.29
|
|
|
FEM/POPL REVASC STNT & ATHER
|
Professional
|
Both
|
$14,543.51
|
|
|
Service Code
|
HCPCS 37227
|
| Hospital Charge Code |
76101551
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$385.85 |
| Max. Negotiated Rate |
$14,543.51 |
| Rate for Payer: Aetna Commercial |
$1,278.09
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$385.85
|
| Rate for Payer: Anthem Medicaid |
$682.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$14,543.51
|
| Rate for Payer: Cash Price |
$7,271.76
|
| Rate for Payer: Cash Price |
$7,271.76
|
| Rate for Payer: Cigna Commercial |
$1,445.68
|
| Rate for Payer: Healthspan PPO |
$13,534.12
|
| Rate for Payer: Humana Medicaid |
$682.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$996.33
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$696.36
|
| Rate for Payer: Molina Healthcare Passport |
$682.71
|
| Rate for Payer: Multiplan PHCS |
$8,726.11
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$10,180.46
|
| Rate for Payer: UHCCP Medicaid |
$405.14
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$689.54
|
|
|
FEM/POPL REVASC W/STENT
|
Facility
|
OP
|
$9,038.98
|
|
|
Service Code
|
HCPCS 37226
|
| Hospital Charge Code |
76101550
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,175.07 |
| Max. Negotiated Rate |
$13,318.61 |
| Rate for Payer: Aetna Commercial |
$6,960.01
|
| Rate for Payer: Anthem Medicaid |
$3,108.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,513.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,050.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13,318.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$12,842.94
|
| Rate for Payer: Cash Price |
$4,519.49
|
| Rate for Payer: Cash Price |
$4,519.49
|
| Rate for Payer: Cigna Commercial |
$7,502.35
|
| Rate for Payer: First Health Commercial |
$8,587.03
|
| Rate for Payer: Humana Commercial |
$7,683.13
|
| Rate for Payer: Humana KY Medicaid |
$3,108.51
|
| Rate for Payer: Humana Medicare Advantage |
$9,513.29
|
| Rate for Payer: Kentucky WC Medicaid |
$3,140.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,411.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,670.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,415.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,170.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,954.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,779.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,807.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,175.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,802.08
|
| Rate for Payer: PHCS Commercial |
$8,677.42
|
| Rate for Payer: United Healthcare All Payer |
$7,954.30
|
|
|
FEM/POPL REVASC W/STENT
|
Professional
|
Both
|
$9,038.98
|
|
|
Service Code
|
HCPCS 37226
|
| Hospital Charge Code |
76101550
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$262.49 |
| Max. Negotiated Rate |
$9,038.98 |
| Rate for Payer: Aetna Commercial |
$861.22
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$262.49
|
| Rate for Payer: Anthem Medicaid |
$465.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$9,038.98
|
| Rate for Payer: Cash Price |
$4,519.49
|
| Rate for Payer: Cash Price |
$4,519.49
|
| Rate for Payer: Cigna Commercial |
$987.01
|
| Rate for Payer: Healthspan PPO |
$8,375.95
|
| Rate for Payer: Humana Medicaid |
$465.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$671.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$474.83
|
| Rate for Payer: Molina Healthcare Passport |
$465.52
|
| Rate for Payer: Multiplan PHCS |
$5,423.39
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$6,327.29
|
| Rate for Payer: UHCCP Medicaid |
$275.61
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$470.18
|
|
|
FEM/POPL REVASC W/STENT
|
Facility
|
IP
|
$9,038.98
|
|
|
Service Code
|
HCPCS 37226
|
| Hospital Charge Code |
76101550
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,175.07 |
| Max. Negotiated Rate |
$8,677.42 |
| Rate for Payer: Aetna Commercial |
$6,960.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,050.40
|
| Rate for Payer: Cash Price |
$4,519.49
|
| Rate for Payer: Cigna Commercial |
$7,502.35
|
| Rate for Payer: First Health Commercial |
$8,587.03
|
| Rate for Payer: Humana Commercial |
$7,683.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,411.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,670.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,711.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,954.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,779.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,807.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,175.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,802.08
|
| Rate for Payer: PHCS Commercial |
$8,677.42
|
| Rate for Payer: United Healthcare All Payer |
$7,954.30
|
|
|
FEM/POPL REVASC W/STENT(P
|
Professional
|
Both
|
$9,038.98
|
|
|
Service Code
|
HCPCS 37226
|
| Hospital Charge Code |
761P1550
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$262.49 |
| Max. Negotiated Rate |
$9,038.98 |
| Rate for Payer: Aetna Commercial |
$861.22
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$262.49
|
| Rate for Payer: Anthem Medicaid |
$465.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$9,038.98
|
| Rate for Payer: Cash Price |
$4,519.49
|
| Rate for Payer: Cash Price |
$4,519.49
|
| Rate for Payer: Cigna Commercial |
$987.01
|
| Rate for Payer: Healthspan PPO |
$8,375.95
|
| Rate for Payer: Humana Medicaid |
$465.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$671.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$474.83
|
| Rate for Payer: Molina Healthcare Passport |
$465.52
|
| Rate for Payer: Multiplan PHCS |
$5,423.39
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$6,327.29
|
| Rate for Payer: UHCCP Medicaid |
$275.61
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$470.18
|
|
|
FEM/POPL REVAS W/ATHER
|
Professional
|
Both
|
$825.00
|
|
|
Service Code
|
HCPCS 37225
|
| Hospital Charge Code |
76101549
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$319.52 |
| Max. Negotiated Rate |
$10,014.27 |
| Rate for Payer: Aetna Commercial |
$1,058.05
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$319.52
|
| Rate for Payer: Anthem Medicaid |
$565.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$825.00
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$1,196.84
|
| Rate for Payer: Healthspan PPO |
$10,014.27
|
| Rate for Payer: Humana Medicaid |
$565.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$824.79
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$576.51
|
| Rate for Payer: Molina Healthcare Passport |
$565.21
|
| Rate for Payer: Multiplan PHCS |
$495.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$577.50
|
| Rate for Payer: UHCCP Medicaid |
$335.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$570.86
|
|
|
FEM/POPL REVAS W/ATHER
|
Facility
|
OP
|
$825.00
|
|
|
Service Code
|
HCPCS 37225
|
| Hospital Charge Code |
76101549
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$107.25 |
| Max. Negotiated Rate |
$21,228.97 |
| Rate for Payer: Aetna Commercial |
$635.25
|
| Rate for Payer: Anthem Medicaid |
$283.72
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15,163.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$643.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21,228.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$20,470.79
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$684.75
|
| Rate for Payer: First Health Commercial |
$783.75
|
| Rate for Payer: Humana Commercial |
$701.25
|
| Rate for Payer: Humana KY Medicaid |
$283.72
|
| Rate for Payer: Humana Medicare Advantage |
$15,163.55
|
| Rate for Payer: Kentucky WC Medicaid |
$286.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$676.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$608.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18,196.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$289.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$726.00
|
| Rate for Payer: Ohio Health Group HMO |
$618.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$165.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$107.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$255.75
|
| Rate for Payer: PHCS Commercial |
$792.00
|
| Rate for Payer: United Healthcare All Payer |
$726.00
|
|
|
FEM/POPL REVAS W/ATHER
|
Facility
|
IP
|
$825.00
|
|
|
Service Code
|
HCPCS 37225
|
| Hospital Charge Code |
76101549
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$107.25 |
| Max. Negotiated Rate |
$792.00 |
| Rate for Payer: Aetna Commercial |
$635.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$643.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$684.75
|
| Rate for Payer: First Health Commercial |
$783.75
|
| Rate for Payer: Humana Commercial |
$701.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$676.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$608.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$247.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$726.00
|
| Rate for Payer: Ohio Health Group HMO |
$618.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$165.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$107.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$255.75
|
| Rate for Payer: PHCS Commercial |
$792.00
|
| Rate for Payer: United Healthcare All Payer |
$726.00
|
|
|
FEM/POPL REVAS W/ATHER(P
|
Professional
|
Both
|
$825.00
|
|
|
Service Code
|
HCPCS 37225
|
| Hospital Charge Code |
761P1549
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$319.52 |
| Max. Negotiated Rate |
$10,014.27 |
| Rate for Payer: Aetna Commercial |
$1,058.05
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$319.52
|
| Rate for Payer: Anthem Medicaid |
$565.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$825.00
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$1,196.84
|
| Rate for Payer: Healthspan PPO |
$10,014.27
|
| Rate for Payer: Humana Medicaid |
$565.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$824.79
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$576.51
|
| Rate for Payer: Molina Healthcare Passport |
$565.21
|
| Rate for Payer: Multiplan PHCS |
$495.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$577.50
|
| Rate for Payer: UHCCP Medicaid |
$335.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$570.86
|
|
