|
ANES COSMETI BIL REDU MAMMAPLA
|
Facility
|
OP
|
$420.00
|
|
| Hospital Charge Code |
37000210
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$403.20 |
| Rate for Payer: Aetna Commercial |
$323.40
|
| Rate for Payer: Anthem Medicaid |
$144.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$327.60
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cigna Commercial |
$348.60
|
| Rate for Payer: First Health Commercial |
$399.00
|
| Rate for Payer: Humana Commercial |
$357.00
|
| Rate for Payer: Humana KY Medicaid |
$144.44
|
| Rate for Payer: Kentucky WC Medicaid |
$145.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$344.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$309.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$126.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$147.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$369.60
|
| Rate for Payer: Ohio Health Group HMO |
$315.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$336.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$365.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$289.80
|
| Rate for Payer: PHCS Commercial |
$403.20
|
| Rate for Payer: United Healthcare All Payer |
$369.60
|
|
|
ANES COSMETI BIL REDU MAMMAPLA
|
Professional
|
Both
|
$420.00
|
|
| Hospital Charge Code |
37000210
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$147.00 |
| Max. Negotiated Rate |
$294.00 |
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Multiplan PHCS |
$252.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$294.00
|
| Rate for Payer: UHCCP Medicaid |
$147.00
|
|
|
ANES COSMETIC BIL BREAST AUGM
|
Professional
|
Both
|
$210.00
|
|
| Hospital Charge Code |
37000181
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$147.00 |
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Multiplan PHCS |
$126.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$147.00
|
| Rate for Payer: UHCCP Medicaid |
$73.50
|
|
|
ANES COSMETIC BIL BREAST AUGM
|
Facility
|
OP
|
$210.00
|
|
| Hospital Charge Code |
37000181
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: Aetna Commercial |
$161.70
|
| Rate for Payer: Anthem Medicaid |
$72.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$163.80
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$174.30
|
| Rate for Payer: First Health Commercial |
$199.50
|
| Rate for Payer: Humana Commercial |
$178.50
|
| Rate for Payer: Humana KY Medicaid |
$72.22
|
| Rate for Payer: Kentucky WC Medicaid |
$72.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$172.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$154.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$73.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$184.80
|
| Rate for Payer: Ohio Health Group HMO |
$157.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$168.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$182.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$144.90
|
| Rate for Payer: PHCS Commercial |
$201.60
|
| Rate for Payer: United Healthcare All Payer |
$184.80
|
|
|
ANES COSMETIC BIL BREAST AUGM
|
Facility
|
IP
|
$210.00
|
|
| Hospital Charge Code |
37000181
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: Aetna Commercial |
$161.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$163.80
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$174.30
|
| Rate for Payer: First Health Commercial |
$199.50
|
| Rate for Payer: Humana Commercial |
$178.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$172.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$154.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$184.80
|
| Rate for Payer: Ohio Health Group HMO |
$157.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$168.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$182.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$144.90
|
| Rate for Payer: PHCS Commercial |
$201.60
|
| Rate for Payer: United Healthcare All Payer |
$184.80
|
|
|
ANES COSMET RHINO - COMPLETE
|
Facility
|
OP
|
$640.00
|
|
| Hospital Charge Code |
37000201
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$192.00 |
| Max. Negotiated Rate |
$614.40 |
| Rate for Payer: Aetna Commercial |
$492.80
|
| Rate for Payer: Anthem Medicaid |
$220.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$499.20
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cigna Commercial |
$531.20
|
| Rate for Payer: First Health Commercial |
$608.00
|
| Rate for Payer: Humana Commercial |
$544.00
|
| Rate for Payer: Humana KY Medicaid |
$220.10
|
| Rate for Payer: Kentucky WC Medicaid |
$222.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$524.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$472.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$192.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$224.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$563.20
|
| Rate for Payer: Ohio Health Group HMO |
$480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$512.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$556.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$441.60
|
| Rate for Payer: PHCS Commercial |
$614.40
|
| Rate for Payer: United Healthcare All Payer |
$563.20
|
|
|
ANES COSMET RHINO - COMPLETE
|
Facility
|
IP
|
$640.00
|
|
| Hospital Charge Code |
37000201
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$192.00 |
| Max. Negotiated Rate |
$614.40 |
| Rate for Payer: Aetna Commercial |
$492.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$499.20
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cigna Commercial |
$531.20
|
| Rate for Payer: First Health Commercial |
$608.00
|
| Rate for Payer: Humana Commercial |
$544.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$524.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$472.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$192.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$563.20
|
| Rate for Payer: Ohio Health Group HMO |
$480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$512.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$556.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$441.60
|
| Rate for Payer: PHCS Commercial |
$614.40
|
| Rate for Payer: United Healthcare All Payer |
$563.20
|
|
|
ANES COSMET RHINO - COMPLETE
|
Professional
|
Both
|
$640.00
|
|
| Hospital Charge Code |
37000201
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$224.00 |
| Max. Negotiated Rate |
$448.00 |
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Multiplan PHCS |
$384.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$448.00
|
| Rate for Payer: UHCCP Medicaid |
$224.00
|
|
|
ANESCOSM GALAFLEXSLINGINSRT(B)
|
Facility
|
OP
|
$210.00
|
|
| Hospital Charge Code |
37000258
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: Aetna Commercial |
$161.70
|
| Rate for Payer: Anthem Medicaid |
$72.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$163.80
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$174.30
|
| Rate for Payer: First Health Commercial |
$199.50
|
| Rate for Payer: Humana Commercial |
$178.50
|
| Rate for Payer: Humana KY Medicaid |
$72.22
|
| Rate for Payer: Kentucky WC Medicaid |
$72.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$172.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$154.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$73.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$184.80
|
| Rate for Payer: Ohio Health Group HMO |
$157.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$168.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$182.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$144.90
|
| Rate for Payer: PHCS Commercial |
$201.60
|
| Rate for Payer: United Healthcare All Payer |
$184.80
|
|
|
ANESCOSM GALAFLEXSLINGINSRT(B)
|
Facility
|
IP
|
$210.00
|
|
| Hospital Charge Code |
37000258
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: Aetna Commercial |
$161.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$163.80
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$174.30
|
| Rate for Payer: First Health Commercial |
$199.50
|
| Rate for Payer: Humana Commercial |
$178.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$172.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$154.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$184.80
|
| Rate for Payer: Ohio Health Group HMO |
$157.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$168.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$182.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$144.90
|
| Rate for Payer: PHCS Commercial |
$201.60
|
| Rate for Payer: United Healthcare All Payer |
$184.80
|
|
|
ANESCOSM GALAFLEXSLINGINSRT(U)
|
Facility
|
OP
|
$105.00
|
|
| Hospital Charge Code |
37000257
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$100.80 |
| Rate for Payer: Aetna Commercial |
$80.85
|
| Rate for Payer: Anthem Medicaid |
$36.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$81.90
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$87.15
|
| Rate for Payer: First Health Commercial |
$99.75
|
| Rate for Payer: Humana Commercial |
$89.25
|
| Rate for Payer: Humana KY Medicaid |
$36.11
|
| Rate for Payer: Kentucky WC Medicaid |
$36.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$86.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$77.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$31.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$36.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$92.40
|
| Rate for Payer: Ohio Health Group HMO |
$78.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$84.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$91.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$72.45
|
| Rate for Payer: PHCS Commercial |
$100.80
|
| Rate for Payer: United Healthcare All Payer |
$92.40
|
|
|
ANESCOSM GALAFLEXSLINGINSRT(U)
|
Facility
|
IP
|
$105.00
|
|
| Hospital Charge Code |
37000257
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$100.80 |
| Rate for Payer: Aetna Commercial |
$80.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$81.90
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$87.15
|
| Rate for Payer: First Health Commercial |
$99.75
|
| Rate for Payer: Humana Commercial |
$89.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$86.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$77.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$31.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$92.40
|
| Rate for Payer: Ohio Health Group HMO |
$78.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$84.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$91.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$72.45
|
| Rate for Payer: PHCS Commercial |
$100.80
|
| Rate for Payer: United Healthcare All Payer |
$92.40
|
|
|
ANESCOSMMSTPXYBILBRSTFATGRFT
|
Facility
|
IP
|
$1,060.00
|
|
| Hospital Charge Code |
37000206
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$318.00 |
| Max. Negotiated Rate |
$1,017.60 |
| Rate for Payer: Aetna Commercial |
$816.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$826.80
|
| Rate for Payer: Cash Price |
$530.00
|
| Rate for Payer: Cigna Commercial |
$879.80
|
| Rate for Payer: First Health Commercial |
$1,007.00
|
| Rate for Payer: Humana Commercial |
$901.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$869.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$782.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$318.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$932.80
|
| Rate for Payer: Ohio Health Group HMO |
$795.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$848.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$922.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$731.40
|
| Rate for Payer: PHCS Commercial |
$1,017.60
|
| Rate for Payer: United Healthcare All Payer |
$932.80
|
|
|
ANESCOSMMSTPXYBILBRSTFATGRFT
|
Professional
|
Both
|
$1,060.00
|
|
| Hospital Charge Code |
37000206
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$371.00 |
| Max. Negotiated Rate |
$742.00 |
| Rate for Payer: Cash Price |
$530.00
|
| Rate for Payer: Multiplan PHCS |
$636.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$742.00
|
| Rate for Payer: UHCCP Medicaid |
$371.00
|
|
|
ANESCOSMMSTPXYBILBRSTFATGRFT
|
Facility
|
OP
|
$1,060.00
|
|
| Hospital Charge Code |
37000206
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$318.00 |
| Max. Negotiated Rate |
$1,017.60 |
| Rate for Payer: Aetna Commercial |
$816.20
|
| Rate for Payer: Anthem Medicaid |
$364.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$826.80
|
| Rate for Payer: Cash Price |
$530.00
|
| Rate for Payer: Cigna Commercial |
$879.80
|
| Rate for Payer: First Health Commercial |
$1,007.00
|
| Rate for Payer: Humana Commercial |
$901.00
|
| Rate for Payer: Humana KY Medicaid |
$364.53
|
| Rate for Payer: Kentucky WC Medicaid |
$368.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$869.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$782.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$318.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$371.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$932.80
|
| Rate for Payer: Ohio Health Group HMO |
$795.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$848.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$922.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$731.40
|
| Rate for Payer: PHCS Commercial |
$1,017.60
|
| Rate for Payer: United Healthcare All Payer |
$932.80
|
|
|
ANES COSM REML IMPT W/CAP
|
Professional
|
Both
|
$350.00
|
|
| Hospital Charge Code |
37000192
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$122.50 |
| Max. Negotiated Rate |
$245.00 |
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$245.00
|
| Rate for Payer: UHCCP Medicaid |
$122.50
|
|
|
ANES COSM REML IMPT W/CAP
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
37000192
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: Aetna Commercial |
$269.50
|
| Rate for Payer: Anthem Medicaid |
$120.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$273.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$290.50
|
| Rate for Payer: First Health Commercial |
$332.50
|
| Rate for Payer: Humana Commercial |
$297.50
|
| Rate for Payer: Humana KY Medicaid |
$120.36
|
| Rate for Payer: Kentucky WC Medicaid |
$121.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$287.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$258.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$105.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$122.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$308.00
|
| Rate for Payer: Ohio Health Group HMO |
$262.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$304.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.50
|
| Rate for Payer: PHCS Commercial |
$336.00
|
| Rate for Payer: United Healthcare All Payer |
$308.00
|
|
|
ANES COSM REML IMPT W/CAP
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
37000192
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: Aetna Commercial |
$269.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$273.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$290.50
|
| Rate for Payer: First Health Commercial |
$332.50
|
| Rate for Payer: Humana Commercial |
$297.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$287.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$258.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$105.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$308.00
|
| Rate for Payer: Ohio Health Group HMO |
$262.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$304.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.50
|
| Rate for Payer: PHCS Commercial |
$336.00
|
| Rate for Payer: United Healthcare All Payer |
$308.00
|
|
|
ANES COSM REMOV IMPLANW/O CAPS
|
Facility
|
OP
|
$210.00
|
|
| Hospital Charge Code |
37000191
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: Aetna Commercial |
$161.70
|
| Rate for Payer: Anthem Medicaid |
$72.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$163.80
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$174.30
|
| Rate for Payer: First Health Commercial |
$199.50
|
| Rate for Payer: Humana Commercial |
$178.50
|
| Rate for Payer: Humana KY Medicaid |
$72.22
|
| Rate for Payer: Kentucky WC Medicaid |
$72.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$172.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$154.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$73.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$184.80
|
| Rate for Payer: Ohio Health Group HMO |
$157.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$168.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$182.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$144.90
|
| Rate for Payer: PHCS Commercial |
$201.60
|
| Rate for Payer: United Healthcare All Payer |
$184.80
|
|
|
ANES COSM REMOV IMPLANW/O CAPS
|
Professional
|
Both
|
$210.00
|
|
| Hospital Charge Code |
37000191
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$147.00 |
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Multiplan PHCS |
$126.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$147.00
|
| Rate for Payer: UHCCP Medicaid |
$73.50
|
|
|
ANES COSM REMOV IMPLANW/O CAPS
|
Facility
|
IP
|
$210.00
|
|
| Hospital Charge Code |
37000191
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: Aetna Commercial |
$161.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$163.80
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$174.30
|
| Rate for Payer: First Health Commercial |
$199.50
|
| Rate for Payer: Humana Commercial |
$178.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$172.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$154.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$184.80
|
| Rate for Payer: Ohio Health Group HMO |
$157.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$168.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$182.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$144.90
|
| Rate for Payer: PHCS Commercial |
$201.60
|
| Rate for Payer: United Healthcare All Payer |
$184.80
|
|
|
ANES COSM UNLI 60 MIN PX
|
Facility
|
IP
|
$210.00
|
|
| Hospital Charge Code |
37000251
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: Aetna Commercial |
$161.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$163.80
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$174.30
|
| Rate for Payer: First Health Commercial |
$199.50
|
| Rate for Payer: Humana Commercial |
$178.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$172.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$154.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$184.80
|
| Rate for Payer: Ohio Health Group HMO |
$157.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$168.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$182.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$144.90
|
| Rate for Payer: PHCS Commercial |
$201.60
|
| Rate for Payer: United Healthcare All Payer |
$184.80
|
|
|
ANES COSM UNLI 60 MIN PX
|
Professional
|
Both
|
$210.00
|
|
| Hospital Charge Code |
37000251
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$147.00 |
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Multiplan PHCS |
$126.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$147.00
|
| Rate for Payer: UHCCP Medicaid |
$73.50
|
|
|
ANES COSM UNLI 60 MIN PX
|
Facility
|
OP
|
$210.00
|
|
| Hospital Charge Code |
37000251
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: Aetna Commercial |
$161.70
|
| Rate for Payer: Anthem Medicaid |
$72.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$163.80
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$174.30
|
| Rate for Payer: First Health Commercial |
$199.50
|
| Rate for Payer: Humana Commercial |
$178.50
|
| Rate for Payer: Humana KY Medicaid |
$72.22
|
| Rate for Payer: Kentucky WC Medicaid |
$72.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$172.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$154.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$73.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$184.80
|
| Rate for Payer: Ohio Health Group HMO |
$157.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$168.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$182.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$144.90
|
| Rate for Payer: PHCS Commercial |
$201.60
|
| Rate for Payer: United Healthcare All Payer |
$184.80
|
|
|
ANES COSM UNLIST 120 MIN PX
|
Facility
|
OP
|
$420.00
|
|
| Hospital Charge Code |
37000253
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$403.20 |
| Rate for Payer: Aetna Commercial |
$323.40
|
| Rate for Payer: Anthem Medicaid |
$144.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$327.60
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cigna Commercial |
$348.60
|
| Rate for Payer: First Health Commercial |
$399.00
|
| Rate for Payer: Humana Commercial |
$357.00
|
| Rate for Payer: Humana KY Medicaid |
$144.44
|
| Rate for Payer: Kentucky WC Medicaid |
$145.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$344.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$309.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$126.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$147.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$369.60
|
| Rate for Payer: Ohio Health Group HMO |
$315.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$336.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$365.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$289.80
|
| Rate for Payer: PHCS Commercial |
$403.20
|
| Rate for Payer: United Healthcare All Payer |
$369.60
|
|
