|
INNOVA 8*60*130 STENT
|
Facility
|
OP
|
$4,335.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$563.55 |
| Max. Negotiated Rate |
$4,161.60 |
| Rate for Payer: Aetna Commercial |
$3,337.95
|
| Rate for Payer: Anthem Medicaid |
$1,490.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,381.30
|
| Rate for Payer: Cash Price |
$2,167.50
|
| Rate for Payer: Cigna Commercial |
$3,598.05
|
| Rate for Payer: First Health Commercial |
$4,118.25
|
| Rate for Payer: Humana Commercial |
$3,684.75
|
| Rate for Payer: Humana KY Medicaid |
$1,490.81
|
| Rate for Payer: Kentucky WC Medicaid |
$1,505.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,554.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,199.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,300.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,520.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,814.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,251.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$867.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$563.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,343.85
|
| Rate for Payer: PHCS Commercial |
$4,161.60
|
| Rate for Payer: United Healthcare All Payer |
$3,814.80
|
|
|
INNOVA 8*60*130 STENT
|
Facility
|
IP
|
$4,335.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$563.55 |
| Max. Negotiated Rate |
$4,161.60 |
| Rate for Payer: Aetna Commercial |
$3,337.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,381.30
|
| Rate for Payer: Cash Price |
$2,167.50
|
| Rate for Payer: Cigna Commercial |
$3,598.05
|
| Rate for Payer: First Health Commercial |
$4,118.25
|
| Rate for Payer: Humana Commercial |
$3,684.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,554.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,199.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,300.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,814.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,251.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$867.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$563.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,343.85
|
| Rate for Payer: PHCS Commercial |
$4,161.60
|
| Rate for Payer: United Healthcare All Payer |
$3,814.80
|
|
|
INNOVA 8*80*130 STENT
|
Facility
|
OP
|
$5,332.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$693.22 |
| Max. Negotiated Rate |
$5,119.20 |
| Rate for Payer: Aetna Commercial |
$4,106.02
|
| Rate for Payer: Anthem Medicaid |
$1,833.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,159.35
|
| Rate for Payer: Cash Price |
$2,666.25
|
| Rate for Payer: Cigna Commercial |
$4,425.98
|
| Rate for Payer: First Health Commercial |
$5,065.88
|
| Rate for Payer: Humana Commercial |
$4,532.62
|
| Rate for Payer: Humana KY Medicaid |
$1,833.85
|
| Rate for Payer: Kentucky WC Medicaid |
$1,852.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,372.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,935.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,599.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,870.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,692.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,999.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,066.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$693.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,653.08
|
| Rate for Payer: PHCS Commercial |
$5,119.20
|
| Rate for Payer: United Healthcare All Payer |
$4,692.60
|
|
|
INNOVA 8*80*130 STENT
|
Facility
|
IP
|
$5,332.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$693.22 |
| Max. Negotiated Rate |
$5,119.20 |
| Rate for Payer: Aetna Commercial |
$4,106.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,159.35
|
| Rate for Payer: Cash Price |
$2,666.25
|
| Rate for Payer: Cigna Commercial |
$4,425.98
|
| Rate for Payer: First Health Commercial |
$5,065.88
|
| Rate for Payer: Humana Commercial |
$4,532.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,372.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,935.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,599.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,692.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,999.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,066.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$693.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,653.08
|
| Rate for Payer: PHCS Commercial |
$5,119.20
|
| Rate for Payer: United Healthcare All Payer |
$4,692.60
|
|
|
IN OFFICE 3 STEP PEEL
|
Professional
|
Both
|
$250.00
|
|
| Hospital Charge Code |
22200324
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$250.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
|
|
IN OFFICE STIMULATOR PEEL
|
Professional
|
Both
|
$100.00
|
|
| Hospital Charge Code |
22200323
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$100.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.00
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
|
|
IN PACT ADMIRAL 12*40*80
|
Facility
|
IP
|
$12,771.75
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,660.33 |
| Max. Negotiated Rate |
$12,260.88 |
| Rate for Payer: Aetna Commercial |
$9,834.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,961.96
|
| Rate for Payer: Cash Price |
$6,385.88
|
| Rate for Payer: Cigna Commercial |
$10,600.55
|
| Rate for Payer: First Health Commercial |
$12,133.16
|
| Rate for Payer: Humana Commercial |
$10,855.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,472.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,425.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,831.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,239.14
|
| Rate for Payer: Ohio Health Group HMO |
$9,578.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,554.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,660.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,959.24
|
| Rate for Payer: PHCS Commercial |
$12,260.88
|
| Rate for Payer: United Healthcare All Payer |
$11,239.14
|
|
|
IN PACT ADMIRAL 12*40*80
|
Facility
|
OP
|
$12,771.75
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,660.33 |
| Max. Negotiated Rate |
$12,260.88 |
| Rate for Payer: Aetna Commercial |
$9,834.25
|
| Rate for Payer: Anthem Medicaid |
$4,392.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,961.96
|
| Rate for Payer: Cash Price |
$6,385.88
|
| Rate for Payer: Cigna Commercial |
$10,600.55
|
| Rate for Payer: First Health Commercial |
$12,133.16
|
| Rate for Payer: Humana Commercial |
$10,855.99
|
| Rate for Payer: Humana KY Medicaid |
$4,392.20
|
| Rate for Payer: Kentucky WC Medicaid |
$4,436.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,472.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,425.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,831.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,480.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,239.14
|
| Rate for Payer: Ohio Health Group HMO |
$9,578.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,554.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,660.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,959.24
|
| Rate for Payer: PHCS Commercial |
$12,260.88
|
| Rate for Payer: United Healthcare All Payer |
$11,239.14
|
|
|
IN PACT ADMIRAL 4*120*130
|
Facility
|
IP
|
$7,362.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$957.12 |
| Max. Negotiated Rate |
$7,068.00 |
| Rate for Payer: Aetna Commercial |
$5,669.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
| Rate for Payer: Cash Price |
$3,681.25
|
| Rate for Payer: Cigna Commercial |
$6,110.88
|
| Rate for Payer: First Health Commercial |
$6,994.38
|
| Rate for Payer: Humana Commercial |
$6,258.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
| Rate for Payer: PHCS Commercial |
$7,068.00
|
| Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
|
IN PACT ADMIRAL 4*120*130
|
Facility
|
OP
|
$7,362.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$957.12 |
| Max. Negotiated Rate |
$7,068.00 |
| Rate for Payer: Aetna Commercial |
$5,669.12
|
| Rate for Payer: Anthem Medicaid |
$2,531.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
| Rate for Payer: Cash Price |
$3,681.25
|
| Rate for Payer: Cigna Commercial |
$6,110.88
|
| Rate for Payer: First Health Commercial |
$6,994.38
|
| Rate for Payer: Humana Commercial |
$6,258.12
|
| Rate for Payer: Humana KY Medicaid |
$2,531.96
|
| Rate for Payer: Kentucky WC Medicaid |
$2,557.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,582.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
| Rate for Payer: PHCS Commercial |
$7,068.00
|
| Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
|
IN PACT ADMIRAL 4*150*130
|
Facility
|
IP
|
$8,530.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,108.96 |
| Max. Negotiated Rate |
$8,189.28 |
| Rate for Payer: Aetna Commercial |
$6,568.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,653.79
|
| Rate for Payer: Cash Price |
$4,265.25
|
| Rate for Payer: Cigna Commercial |
$7,080.32
|
| Rate for Payer: First Health Commercial |
$8,103.98
|
| Rate for Payer: Humana Commercial |
$7,250.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,995.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,295.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,559.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,506.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,397.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,706.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,108.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,644.46
|
| Rate for Payer: PHCS Commercial |
$8,189.28
|
| Rate for Payer: United Healthcare All Payer |
$7,506.84
|
|
|
IN PACT ADMIRAL 4*150*130
|
Facility
|
OP
|
$8,530.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,108.96 |
| Max. Negotiated Rate |
$8,189.28 |
| Rate for Payer: Aetna Commercial |
$6,568.48
|
| Rate for Payer: Anthem Medicaid |
$2,933.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,653.79
|
| Rate for Payer: Cash Price |
$4,265.25
|
| Rate for Payer: Cigna Commercial |
$7,080.32
|
| Rate for Payer: First Health Commercial |
$8,103.98
|
| Rate for Payer: Humana Commercial |
$7,250.92
|
| Rate for Payer: Humana KY Medicaid |
$2,933.64
|
| Rate for Payer: Kentucky WC Medicaid |
$2,963.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,995.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,295.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,559.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,992.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,506.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,397.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,706.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,108.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,644.46
|
| Rate for Payer: PHCS Commercial |
$8,189.28
|
| Rate for Payer: United Healthcare All Payer |
$7,506.84
|
|
|
IN PACT ADMIRAL 4*200*130
|
Facility
|
IP
|
$10,764.25
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,399.35 |
| Max. Negotiated Rate |
$10,333.68 |
| Rate for Payer: Aetna Commercial |
$8,288.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,396.12
|
| Rate for Payer: Cash Price |
$5,382.12
|
| Rate for Payer: Cigna Commercial |
$8,934.33
|
| Rate for Payer: First Health Commercial |
$10,226.04
|
| Rate for Payer: Humana Commercial |
$9,149.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,826.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,944.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,229.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,472.54
|
| Rate for Payer: Ohio Health Group HMO |
$8,073.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,152.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,399.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,336.92
|
| Rate for Payer: PHCS Commercial |
$10,333.68
|
| Rate for Payer: United Healthcare All Payer |
$9,472.54
|
|
|
IN PACT ADMIRAL 4*200*130
|
Facility
|
OP
|
$10,764.25
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,399.35 |
| Max. Negotiated Rate |
$10,333.68 |
| Rate for Payer: Aetna Commercial |
$8,288.47
|
| Rate for Payer: Anthem Medicaid |
$3,701.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,396.12
|
| Rate for Payer: Cash Price |
$5,382.12
|
| Rate for Payer: Cigna Commercial |
$8,934.33
|
| Rate for Payer: First Health Commercial |
$10,226.04
|
| Rate for Payer: Humana Commercial |
$9,149.61
|
| Rate for Payer: Humana KY Medicaid |
$3,701.83
|
| Rate for Payer: Kentucky WC Medicaid |
$3,739.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,826.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,944.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,229.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,776.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,472.54
|
| Rate for Payer: Ohio Health Group HMO |
$8,073.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,152.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,399.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,336.92
|
| Rate for Payer: PHCS Commercial |
$10,333.68
|
| Rate for Payer: United Healthcare All Payer |
$9,472.54
|
|
|
IN PACT ADMIRAL 4*250*130
|
Facility
|
OP
|
$11,512.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,496.62 |
| Max. Negotiated Rate |
$11,052.00 |
| Rate for Payer: Aetna Commercial |
$8,864.62
|
| Rate for Payer: Anthem Medicaid |
$3,959.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,979.75
|
| Rate for Payer: Cash Price |
$5,756.25
|
| Rate for Payer: Cigna Commercial |
$9,555.38
|
| Rate for Payer: First Health Commercial |
$10,936.88
|
| Rate for Payer: Humana Commercial |
$9,785.62
|
| Rate for Payer: Humana KY Medicaid |
$3,959.15
|
| Rate for Payer: Kentucky WC Medicaid |
$3,999.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,440.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,496.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,453.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,038.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,131.00
|
| Rate for Payer: Ohio Health Group HMO |
$8,634.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,302.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,496.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,568.88
|
| Rate for Payer: PHCS Commercial |
$11,052.00
|
| Rate for Payer: United Healthcare All Payer |
$10,131.00
|
|
|
IN PACT ADMIRAL 4*250*130
|
Facility
|
IP
|
$11,512.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,496.62 |
| Max. Negotiated Rate |
$11,052.00 |
| Rate for Payer: Aetna Commercial |
$8,864.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,979.75
|
| Rate for Payer: Cash Price |
$5,756.25
|
| Rate for Payer: Cigna Commercial |
$9,555.38
|
| Rate for Payer: First Health Commercial |
$10,936.88
|
| Rate for Payer: Humana Commercial |
$9,785.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,440.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,496.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,453.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,131.00
|
| Rate for Payer: Ohio Health Group HMO |
$8,634.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,302.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,496.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,568.88
|
| Rate for Payer: PHCS Commercial |
$11,052.00
|
| Rate for Payer: United Healthcare All Payer |
$10,131.00
|
|
|
IN PACT ADMIRAL 4*40*130
|
Facility
|
OP
|
$7,362.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$957.12 |
| Max. Negotiated Rate |
$7,068.00 |
| Rate for Payer: Aetna Commercial |
$5,669.12
|
| Rate for Payer: Anthem Medicaid |
$2,531.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
| Rate for Payer: Cash Price |
$3,681.25
|
| Rate for Payer: Cigna Commercial |
$6,110.88
|
| Rate for Payer: First Health Commercial |
$6,994.38
|
| Rate for Payer: Humana Commercial |
$6,258.12
|
| Rate for Payer: Humana KY Medicaid |
$2,531.96
|
| Rate for Payer: Kentucky WC Medicaid |
$2,557.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,582.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
| Rate for Payer: PHCS Commercial |
$7,068.00
|
| Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
|
IN PACT ADMIRAL 4*40*130
|
Facility
|
IP
|
$7,362.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$957.12 |
| Max. Negotiated Rate |
$7,068.00 |
| Rate for Payer: Aetna Commercial |
$5,669.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
| Rate for Payer: Cash Price |
$3,681.25
|
| Rate for Payer: Cigna Commercial |
$6,110.88
|
| Rate for Payer: First Health Commercial |
$6,994.38
|
| Rate for Payer: Humana Commercial |
$6,258.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
| Rate for Payer: PHCS Commercial |
$7,068.00
|
| Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
|
IN PACT ADMIRAL 4*80*130
|
Facility
|
IP
|
$7,362.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$957.12 |
| Max. Negotiated Rate |
$7,068.00 |
| Rate for Payer: Aetna Commercial |
$5,669.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
| Rate for Payer: Cash Price |
$3,681.25
|
| Rate for Payer: Cigna Commercial |
$6,110.88
|
| Rate for Payer: First Health Commercial |
$6,994.38
|
| Rate for Payer: Humana Commercial |
$6,258.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
| Rate for Payer: PHCS Commercial |
$7,068.00
|
| Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
|
IN PACT ADMIRAL 4*80*130
|
Facility
|
OP
|
$7,362.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$957.12 |
| Max. Negotiated Rate |
$7,068.00 |
| Rate for Payer: Aetna Commercial |
$5,669.12
|
| Rate for Payer: Anthem Medicaid |
$2,531.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
| Rate for Payer: Cash Price |
$3,681.25
|
| Rate for Payer: Cigna Commercial |
$6,110.88
|
| Rate for Payer: First Health Commercial |
$6,994.38
|
| Rate for Payer: Humana Commercial |
$6,258.12
|
| Rate for Payer: Humana KY Medicaid |
$2,531.96
|
| Rate for Payer: Kentucky WC Medicaid |
$2,557.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,582.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
| Rate for Payer: PHCS Commercial |
$7,068.00
|
| Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
|
IN PACT ADMIRAL 5*120*130
|
Facility
|
OP
|
$7,362.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$957.12 |
| Max. Negotiated Rate |
$7,068.00 |
| Rate for Payer: Aetna Commercial |
$5,669.12
|
| Rate for Payer: Anthem Medicaid |
$2,531.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
| Rate for Payer: Cash Price |
$3,681.25
|
| Rate for Payer: Cigna Commercial |
$6,110.88
|
| Rate for Payer: First Health Commercial |
$6,994.38
|
| Rate for Payer: Humana Commercial |
$6,258.12
|
| Rate for Payer: Humana KY Medicaid |
$2,531.96
|
| Rate for Payer: Kentucky WC Medicaid |
$2,557.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,582.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
| Rate for Payer: PHCS Commercial |
$7,068.00
|
| Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
|
IN PACT ADMIRAL 5*120*130
|
Facility
|
IP
|
$7,362.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$957.12 |
| Max. Negotiated Rate |
$7,068.00 |
| Rate for Payer: Aetna Commercial |
$5,669.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
| Rate for Payer: Cash Price |
$3,681.25
|
| Rate for Payer: Cigna Commercial |
$6,110.88
|
| Rate for Payer: First Health Commercial |
$6,994.38
|
| Rate for Payer: Humana Commercial |
$6,258.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
| Rate for Payer: PHCS Commercial |
$7,068.00
|
| Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
|
IN PACT ADMIRAL 5*150*130
|
Facility
|
OP
|
$6,997.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$909.68 |
| Max. Negotiated Rate |
$6,717.60 |
| Rate for Payer: Aetna Commercial |
$5,388.08
|
| Rate for Payer: Anthem Medicaid |
$2,406.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,458.05
|
| Rate for Payer: Cash Price |
$3,498.75
|
| Rate for Payer: Cigna Commercial |
$5,807.92
|
| Rate for Payer: First Health Commercial |
$6,647.62
|
| Rate for Payer: Humana Commercial |
$5,947.88
|
| Rate for Payer: Humana KY Medicaid |
$2,406.44
|
| Rate for Payer: Kentucky WC Medicaid |
$2,430.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,737.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,164.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,099.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,454.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,157.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,248.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$909.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,169.22
|
| Rate for Payer: PHCS Commercial |
$6,717.60
|
| Rate for Payer: United Healthcare All Payer |
$6,157.80
|
|
|
IN PACT ADMIRAL 5*150*130
|
Facility
|
IP
|
$6,997.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$909.68 |
| Max. Negotiated Rate |
$6,717.60 |
| Rate for Payer: Aetna Commercial |
$5,388.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,458.05
|
| Rate for Payer: Cash Price |
$3,498.75
|
| Rate for Payer: Cigna Commercial |
$5,807.92
|
| Rate for Payer: First Health Commercial |
$6,647.62
|
| Rate for Payer: Humana Commercial |
$5,947.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,737.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,164.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,099.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,157.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,248.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$909.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,169.22
|
| Rate for Payer: PHCS Commercial |
$6,717.60
|
| Rate for Payer: United Healthcare All Payer |
$6,157.80
|
|
|
IN PACT ADMIRAL 5*200*130
|
Facility
|
IP
|
$10,764.25
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,399.35 |
| Max. Negotiated Rate |
$10,333.68 |
| Rate for Payer: Aetna Commercial |
$8,288.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,396.12
|
| Rate for Payer: Cash Price |
$5,382.12
|
| Rate for Payer: Cigna Commercial |
$8,934.33
|
| Rate for Payer: First Health Commercial |
$10,226.04
|
| Rate for Payer: Humana Commercial |
$9,149.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,826.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,944.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,229.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,472.54
|
| Rate for Payer: Ohio Health Group HMO |
$8,073.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,152.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,399.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,336.92
|
| Rate for Payer: PHCS Commercial |
$10,333.68
|
| Rate for Payer: United Healthcare All Payer |
$9,472.54
|
|
