|
FEMORAL STEM HIP 14MM*150MM
|
Facility
|
OP
|
$12,161.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,648.36 |
| Max. Negotiated Rate |
$11,674.75 |
| Rate for Payer: Aetna Commercial |
$9,364.12
|
| Rate for Payer: Anthem Medicaid |
$4,182.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,485.74
|
| Rate for Payer: Cash Price |
$6,080.60
|
| Rate for Payer: Cigna Commercial |
$10,093.80
|
| Rate for Payer: First Health Commercial |
$11,553.14
|
| Rate for Payer: Humana Commercial |
$10,337.02
|
| Rate for Payer: Humana KY Medicaid |
$4,182.24
|
| Rate for Payer: Kentucky WC Medicaid |
$4,224.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,972.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,974.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,648.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,266.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,701.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,120.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,728.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,580.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,391.23
|
| Rate for Payer: PHCS Commercial |
$11,674.75
|
| Rate for Payer: United Healthcare All Payer |
$10,701.86
|
|
|
FEMORAL STEM HIP 14MM*150MM
|
Facility
|
IP
|
$12,161.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,648.36 |
| Max. Negotiated Rate |
$11,674.75 |
| Rate for Payer: Aetna Commercial |
$9,364.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,485.74
|
| Rate for Payer: Cash Price |
$6,080.60
|
| Rate for Payer: Cigna Commercial |
$10,093.80
|
| Rate for Payer: First Health Commercial |
$11,553.14
|
| Rate for Payer: Humana Commercial |
$10,337.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,972.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,974.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,648.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,701.86
|
| Rate for Payer: Ohio Health Group HMO |
$9,120.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,728.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,580.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,391.23
|
| Rate for Payer: PHCS Commercial |
$11,674.75
|
| Rate for Payer: United Healthcare All Payer |
$10,701.86
|
|
|
FEMORAL STRUT FROZEN 2*20CM
|
Facility
|
IP
|
$4,840.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,452.03 |
| Max. Negotiated Rate |
$4,646.50 |
| Rate for Payer: Aetna Commercial |
$3,726.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,775.28
|
| Rate for Payer: Cash Price |
$2,420.05
|
| Rate for Payer: Cigna Commercial |
$4,017.28
|
| Rate for Payer: First Health Commercial |
$4,598.10
|
| Rate for Payer: Humana Commercial |
$4,114.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,968.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,571.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,452.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,259.29
|
| Rate for Payer: Ohio Health Group HMO |
$3,630.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,872.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,210.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,339.67
|
| Rate for Payer: PHCS Commercial |
$4,646.50
|
| Rate for Payer: United Healthcare All Payer |
$4,259.29
|
|
|
FEMORAL STRUT FROZEN 2*20CM
|
Facility
|
OP
|
$4,840.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,452.03 |
| Max. Negotiated Rate |
$4,646.50 |
| Rate for Payer: Aetna Commercial |
$3,726.88
|
| Rate for Payer: Anthem Medicaid |
$1,664.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,775.28
|
| Rate for Payer: Cash Price |
$2,420.05
|
| Rate for Payer: Cigna Commercial |
$4,017.28
|
| Rate for Payer: First Health Commercial |
$4,598.10
|
| Rate for Payer: Humana Commercial |
$4,114.09
|
| Rate for Payer: Humana KY Medicaid |
$1,664.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1,681.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,968.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,571.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,452.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,697.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,259.29
|
| Rate for Payer: Ohio Health Group HMO |
$3,630.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,872.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,210.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,339.67
|
| Rate for Payer: PHCS Commercial |
$4,646.50
|
| Rate for Payer: United Healthcare All Payer |
$4,259.29
|
|
|
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 |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
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 |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
FEM OSS RS 8.5CM SEG L
|
Facility
|
IP
|
$76,180.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,854.22 |
| Max. Negotiated Rate |
$73,133.49 |
| Rate for Payer: Aetna Commercial |
$58,659.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,420.96
|
| Rate for Payer: Cash Price |
$38,090.36
|
| Rate for Payer: Cigna Commercial |
$63,230.00
|
| Rate for Payer: First Health Commercial |
$72,371.68
|
| Rate for Payer: Humana Commercial |
$64,753.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,468.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,221.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,854.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$67,039.03
|
| Rate for Payer: Ohio Health Group HMO |
$57,135.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60,944.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66,277.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52,564.70
|
| Rate for Payer: PHCS Commercial |
$73,133.49
|
| Rate for Payer: United Healthcare All Payer |
$67,039.03
|
|
|
FEM OSS RS 8.5CM SEG L
|
Facility
|
OP
|
$76,180.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,854.22 |
| Max. Negotiated Rate |
$73,133.49 |
| Rate for Payer: Aetna Commercial |
$58,659.15
|
| Rate for Payer: Anthem Medicaid |
$26,198.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,420.96
|
| Rate for Payer: Cash Price |
$38,090.36
|
| Rate for Payer: Cigna Commercial |
$63,230.00
|
| Rate for Payer: First Health Commercial |
$72,371.68
|
| Rate for Payer: Humana Commercial |
$64,753.61
|
| Rate for Payer: Humana KY Medicaid |
$26,198.55
|
| Rate for Payer: Kentucky WC Medicaid |
$26,465.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,468.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,221.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,854.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,724.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$67,039.03
|
| Rate for Payer: Ohio Health Group HMO |
$57,135.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60,944.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66,277.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52,564.70
|
| Rate for Payer: PHCS Commercial |
$73,133.49
|
| Rate for Payer: United Healthcare All Payer |
$67,039.03
|
|
|
FEM OSS RS 8.5CM SEG R
|
Facility
|
IP
|
$76,180.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,854.22 |
| Max. Negotiated Rate |
$73,133.49 |
| Rate for Payer: Aetna Commercial |
$58,659.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,420.96
|
| Rate for Payer: Cash Price |
$38,090.36
|
| Rate for Payer: Cigna Commercial |
$63,230.00
|
| Rate for Payer: First Health Commercial |
$72,371.68
|
| Rate for Payer: Humana Commercial |
$64,753.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,468.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,221.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,854.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$67,039.03
|
| Rate for Payer: Ohio Health Group HMO |
$57,135.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60,944.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66,277.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52,564.70
|
| Rate for Payer: PHCS Commercial |
$73,133.49
|
| Rate for Payer: United Healthcare All Payer |
$67,039.03
|
|
|
FEM OSS RS 8.5CM SEG R
|
Facility
|
OP
|
$76,180.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,854.22 |
| Max. Negotiated Rate |
$73,133.49 |
| Rate for Payer: Aetna Commercial |
$58,659.15
|
| Rate for Payer: Anthem Medicaid |
$26,198.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$59,420.96
|
| Rate for Payer: Cash Price |
$38,090.36
|
| Rate for Payer: Cigna Commercial |
$63,230.00
|
| Rate for Payer: First Health Commercial |
$72,371.68
|
| Rate for Payer: Humana Commercial |
$64,753.61
|
| Rate for Payer: Humana KY Medicaid |
$26,198.55
|
| Rate for Payer: Kentucky WC Medicaid |
$26,465.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$62,468.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56,221.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,854.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,724.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$67,039.03
|
| Rate for Payer: Ohio Health Group HMO |
$57,135.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60,944.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66,277.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$52,564.70
|
| Rate for Payer: PHCS Commercial |
$73,133.49
|
| Rate for Payer: United Healthcare All Payer |
$67,039.03
|
|
|
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 |
$13,534.12 |
| Rate for Payer: Aetna Commercial |
$1,278.09
|
| Rate for Payer: Ambetter Exchange |
$667.72
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$385.85
|
| Rate for Payer: Anthem Medicaid |
$12,699.65
|
| Rate for Payer: Buckeye Individual/Medicaid |
$667.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$667.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$801.26
|
| 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 |
$12,699.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$996.33
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$667.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$667.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$12,953.64
|
| Rate for Payer: Molina Healthcare Passport |
$12,699.65
|
| Rate for Payer: Multiplan PHCS |
$8,726.11
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$868.04
|
| Rate for Payer: UHCCP Medicaid |
$405.14
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$12,826.65
|
| Rate for Payer: Wellcare Medicare Advantage |
$667.72
|
|
|
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 |
$5,001.51 |
| Max. Negotiated Rate |
$23,228.31 |
| Rate for Payer: Aetna Commercial |
$11,198.50
|
| Rate for Payer: Anthem Medicaid |
$5,001.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16,591.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,343.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$23,228.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$22,398.73
|
| 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 |
$16,591.65
|
| 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 |
$19,909.98
|
| 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 |
$11,634.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,652.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,035.02
|
| 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 |
$13,534.12 |
| Rate for Payer: Aetna Commercial |
$1,278.09
|
| Rate for Payer: Ambetter Exchange |
$667.72
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$385.85
|
| Rate for Payer: Anthem Medicaid |
$12,699.65
|
| Rate for Payer: Buckeye Individual/Medicaid |
$667.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$667.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$801.26
|
| 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 |
$12,699.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$996.33
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$667.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$667.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$12,953.64
|
| Rate for Payer: Molina Healthcare Passport |
$12,699.65
|
| Rate for Payer: Multiplan PHCS |
$8,726.11
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$868.04
|
| Rate for Payer: UHCCP Medicaid |
$405.14
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$12,826.65
|
| Rate for Payer: Wellcare Medicare Advantage |
$667.72
|
|
|
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 |
$4,363.05 |
| 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 |
$11,634.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,652.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,035.02
|
| Rate for Payer: PHCS Commercial |
$13,961.77
|
| Rate for Payer: United Healthcare All Payer |
$12,798.29
|
|
|
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 |
$2,711.69 |
| 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 |
$6,779.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,231.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,863.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,236.90
|
| Rate for Payer: PHCS Commercial |
$8,677.42
|
| Rate for Payer: United Healthcare All Payer |
$7,954.30
|
|
|
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 |
$3,108.51 |
| Max. Negotiated Rate |
$14,669.84 |
| Rate for Payer: Aetna Commercial |
$6,960.01
|
| Rate for Payer: Anthem Medicaid |
$3,108.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10,478.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,050.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$14,669.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$14,145.92
|
| 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 |
$10,478.46
|
| 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 |
$12,574.15
|
| 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 |
$6,779.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,231.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,863.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,236.90
|
| 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 |
$8,375.95 |
| Rate for Payer: Aetna Commercial |
$861.22
|
| Rate for Payer: Ambetter Exchange |
$484.52
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$262.49
|
| Rate for Payer: Anthem Medicaid |
$7,862.85
|
| Rate for Payer: Buckeye Individual/Medicaid |
$484.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$484.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$581.42
|
| 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 |
$7,862.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$671.37
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$484.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$484.52
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$8,020.11
|
| Rate for Payer: Molina Healthcare Passport |
$7,862.85
|
| Rate for Payer: Multiplan PHCS |
$5,423.39
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$629.88
|
| Rate for Payer: UHCCP Medicaid |
$275.61
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$7,941.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$484.52
|
|
|
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 |
$8,375.95 |
| Rate for Payer: Aetna Commercial |
$861.22
|
| Rate for Payer: Ambetter Exchange |
$484.52
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$262.49
|
| Rate for Payer: Anthem Medicaid |
$7,862.85
|
| Rate for Payer: Buckeye Individual/Medicaid |
$484.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$484.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$581.42
|
| 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 |
$7,862.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$671.37
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$484.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$484.52
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$8,020.11
|
| Rate for Payer: Molina Healthcare Passport |
$7,862.85
|
| Rate for Payer: Multiplan PHCS |
$5,423.39
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$629.88
|
| Rate for Payer: UHCCP Medicaid |
$275.61
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$7,941.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$484.52
|
|
|
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: Ambetter Exchange |
$556.06
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$319.52
|
| Rate for Payer: Anthem Medicaid |
$9,393.82
|
| Rate for Payer: Buckeye Individual/Medicaid |
$556.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$556.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$667.27
|
| 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 |
$9,393.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$824.79
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$556.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$556.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$9,581.70
|
| Rate for Payer: Molina Healthcare Passport |
$9,393.82
|
| Rate for Payer: Multiplan PHCS |
$495.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$722.88
|
| Rate for Payer: UHCCP Medicaid |
$335.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$9,487.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$556.06
|
|
|
FEM/POPL REVAS W/ATHER
|
Facility
|
OP
|
$825.00
|
|
|
Service Code
|
HCPCS 37225
|
| Hospital Charge Code |
76101549
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$283.72 |
| Max. Negotiated Rate |
$23,228.31 |
| Rate for Payer: Aetna Commercial |
$635.25
|
| Rate for Payer: Anthem Medicaid |
$283.72
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16,591.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$643.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$23,228.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$22,398.73
|
| 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 |
$16,591.65
|
| Rate for Payer: Kentucky WC Medicaid |
$286.61
|
| 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 |
$19,909.98
|
| 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 |
$660.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$717.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$569.25
|
| 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 |
$247.50 |
| 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 |
$660.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$717.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$569.25
|
| 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: Ambetter Exchange |
$556.06
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$319.52
|
| Rate for Payer: Anthem Medicaid |
$9,393.82
|
| Rate for Payer: Buckeye Individual/Medicaid |
$556.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$556.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$667.27
|
| 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 |
$9,393.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$824.79
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$556.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$556.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$9,581.70
|
| Rate for Payer: Molina Healthcare Passport |
$9,393.82
|
| Rate for Payer: Multiplan PHCS |
$495.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$722.88
|
| Rate for Payer: UHCCP Medicaid |
$335.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$9,487.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$556.06
|
|
|
FEM/POPL REVAS W/TLA
|
Professional
|
Both
|
$3,900.00
|
|
|
Service Code
|
HCPCS 37224
|
| Hospital Charge Code |
76101548
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$236.33 |
| Max. Negotiated Rate |
$3,560.19 |
| Rate for Payer: Aetna Commercial |
$784.66
|
| Rate for Payer: Ambetter Exchange |
$414.90
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$236.33
|
| Rate for Payer: Anthem Medicaid |
$3,327.49
|
| Rate for Payer: Buckeye Individual/Medicaid |
$414.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$414.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$497.88
|
| Rate for Payer: Cash Price |
$1,950.00
|
| Rate for Payer: Cash Price |
$1,950.00
|
| Rate for Payer: Cigna Commercial |
$888.66
|
| Rate for Payer: Healthspan PPO |
$3,560.19
|
| Rate for Payer: Humana Medicaid |
$3,327.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$611.68
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$414.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$414.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$3,394.04
|
| Rate for Payer: Molina Healthcare Passport |
$3,327.49
|
| Rate for Payer: Multiplan PHCS |
$2,340.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$539.37
|
| Rate for Payer: UHCCP Medicaid |
$248.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$3,360.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$414.90
|
|
|
FEM/POPL REVAS W/TLA
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
HCPCS 37224
|
| Hospital Charge Code |
76101548
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,341.21 |
| Max. Negotiated Rate |
$7,375.33 |
| Rate for Payer: Aetna Commercial |
$3,003.00
|
| Rate for Payer: Anthem Medicaid |
$1,341.21
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,268.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,042.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,375.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,111.92
|
| Rate for Payer: Cash Price |
$1,950.00
|
| Rate for Payer: Cash Price |
$1,950.00
|
| Rate for Payer: Cigna Commercial |
$3,237.00
|
| Rate for Payer: First Health Commercial |
$3,705.00
|
| Rate for Payer: Humana Commercial |
$3,315.00
|
| Rate for Payer: Humana KY Medicaid |
$1,341.21
|
| Rate for Payer: Humana Medicare Advantage |
$5,268.09
|
| Rate for Payer: Kentucky WC Medicaid |
$1,354.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,198.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,878.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,321.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,368.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,432.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,925.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,393.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,691.00
|
| Rate for Payer: PHCS Commercial |
$3,744.00
|
| Rate for Payer: United Healthcare All Payer |
$3,432.00
|
|
|
FEM/POPL REVAS W/TLA
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
HCPCS 37224
|
| Hospital Charge Code |
76101548
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,170.00 |
| Max. Negotiated Rate |
$3,744.00 |
| Rate for Payer: Aetna Commercial |
$3,003.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,042.00
|
| Rate for Payer: Cash Price |
$1,950.00
|
| Rate for Payer: Cigna Commercial |
$3,237.00
|
| Rate for Payer: First Health Commercial |
$3,705.00
|
| Rate for Payer: Humana Commercial |
$3,315.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,198.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,878.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,170.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,432.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,925.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,393.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,691.00
|
| Rate for Payer: PHCS Commercial |
$3,744.00
|
| Rate for Payer: United Healthcare All Payer |
$3,432.00
|
|
