|
INSRT BLAD TMP INDWLCATH CMPLX
|
Facility
|
IP
|
$627.00
|
|
|
Service Code
|
HCPCS 51703
|
| Hospital Charge Code |
76102067
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$81.51 |
| Max. Negotiated Rate |
$601.92 |
| Rate for Payer: Aetna Commercial |
$482.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$489.06
|
| Rate for Payer: Cash Price |
$313.50
|
| Rate for Payer: Cigna Commercial |
$520.41
|
| Rate for Payer: First Health Commercial |
$595.65
|
| Rate for Payer: Humana Commercial |
$532.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$514.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$462.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$188.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$551.76
|
| Rate for Payer: Ohio Health Group HMO |
$470.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$125.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$81.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$194.37
|
| Rate for Payer: PHCS Commercial |
$601.92
|
| Rate for Payer: United Healthcare All Payer |
$551.76
|
|
|
INSRT BLAD TMP INDWLCATH CMPLX
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 51703
|
| Hospital Charge Code |
761P2067
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$44.11 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$133.73
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$44.11
|
| Rate for Payer: Anthem Medicaid |
$59.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$300.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$228.06
|
| Rate for Payer: Healthspan PPO |
$176.26
|
| Rate for Payer: Humana Medicaid |
$59.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$111.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$61.01
|
| Rate for Payer: Molina Healthcare Passport |
$59.81
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.00
|
| Rate for Payer: UHCCP Medicaid |
$46.32
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$60.41
|
|
|
INSRT BLAD TMP INDWLCATH CMPLX
|
Facility
|
OP
|
$627.00
|
|
|
Service Code
|
HCPCS 51703
|
| Hospital Charge Code |
76102067
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$81.51 |
| Max. Negotiated Rate |
$601.92 |
| Rate for Payer: Aetna Commercial |
$482.79
|
| Rate for Payer: Anthem Medicaid |
$215.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$135.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$489.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$189.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$182.36
|
| Rate for Payer: Cash Price |
$313.50
|
| Rate for Payer: Cash Price |
$313.50
|
| Rate for Payer: Cigna Commercial |
$520.41
|
| Rate for Payer: First Health Commercial |
$595.65
|
| Rate for Payer: Humana Commercial |
$532.95
|
| Rate for Payer: Humana KY Medicaid |
$215.63
|
| Rate for Payer: Humana Medicare Advantage |
$135.08
|
| Rate for Payer: Kentucky WC Medicaid |
$217.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$514.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$462.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$219.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$551.76
|
| Rate for Payer: Ohio Health Group HMO |
$470.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$125.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$81.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$194.37
|
| Rate for Payer: PHCS Commercial |
$601.92
|
| Rate for Payer: United Healthcare All Payer |
$551.76
|
|
|
INSRT BLAD TMP INDWLCATH CMPLX
|
Facility
|
IP
|
$327.00
|
|
|
Service Code
|
HCPCS 51703
|
| Hospital Charge Code |
45000281
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$42.51 |
| Max. Negotiated Rate |
$313.92 |
| Rate for Payer: Aetna Commercial |
$251.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$255.06
|
| Rate for Payer: Cash Price |
$163.50
|
| Rate for Payer: Cigna Commercial |
$271.41
|
| Rate for Payer: First Health Commercial |
$310.65
|
| Rate for Payer: Humana Commercial |
$277.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$268.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$241.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$98.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$287.76
|
| Rate for Payer: Ohio Health Group HMO |
$245.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$101.37
|
| Rate for Payer: PHCS Commercial |
$313.92
|
| Rate for Payer: United Healthcare All Payer |
$287.76
|
|
|
INSRT BLAD TMP INDWLCATH CMPLX
|
Professional
|
Both
|
$627.00
|
|
|
Service Code
|
HCPCS 51703
|
| Hospital Charge Code |
76102067
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$44.11 |
| Max. Negotiated Rate |
$627.00 |
| Rate for Payer: Aetna Commercial |
$133.73
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$44.11
|
| Rate for Payer: Anthem Medicaid |
$59.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$627.00
|
| Rate for Payer: Cash Price |
$313.50
|
| Rate for Payer: Cash Price |
$313.50
|
| Rate for Payer: Cigna Commercial |
$228.06
|
| Rate for Payer: Healthspan PPO |
$176.26
|
| Rate for Payer: Humana Medicaid |
$59.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$111.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$61.01
|
| Rate for Payer: Molina Healthcare Passport |
$59.81
|
| Rate for Payer: Multiplan PHCS |
$376.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$438.90
|
| Rate for Payer: UHCCP Medicaid |
$46.32
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$60.41
|
|
|
INSRT BLAD TMP INDWLCATH CMPLX
|
Facility
|
IP
|
$327.00
|
|
|
Service Code
|
HCPCS 51703
|
| Hospital Charge Code |
48100042
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$42.51 |
| Max. Negotiated Rate |
$313.92 |
| Rate for Payer: Aetna Commercial |
$251.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$255.06
|
| Rate for Payer: Cash Price |
$163.50
|
| Rate for Payer: Cigna Commercial |
$271.41
|
| Rate for Payer: First Health Commercial |
$310.65
|
| Rate for Payer: Humana Commercial |
$277.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$268.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$241.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$98.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$287.76
|
| Rate for Payer: Ohio Health Group HMO |
$245.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$101.37
|
| Rate for Payer: PHCS Commercial |
$313.92
|
| Rate for Payer: United Healthcare All Payer |
$287.76
|
|
|
INSRT BLAD TMP INDWLCATH CMPLX
|
Facility
|
OP
|
$327.00
|
|
|
Service Code
|
HCPCS 51703
|
| Hospital Charge Code |
45000281
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$42.51 |
| Max. Negotiated Rate |
$313.92 |
| Rate for Payer: Aetna Commercial |
$251.79
|
| Rate for Payer: Anthem Medicaid |
$112.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$135.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$255.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$189.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$182.36
|
| Rate for Payer: Cash Price |
$163.50
|
| Rate for Payer: Cash Price |
$163.50
|
| Rate for Payer: Cigna Commercial |
$271.41
|
| Rate for Payer: First Health Commercial |
$310.65
|
| Rate for Payer: Humana Commercial |
$277.95
|
| Rate for Payer: Humana KY Medicaid |
$112.46
|
| Rate for Payer: Humana Medicare Advantage |
$135.08
|
| Rate for Payer: Kentucky WC Medicaid |
$113.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$268.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$241.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$114.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$287.76
|
| Rate for Payer: Ohio Health Group HMO |
$245.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$101.37
|
| Rate for Payer: PHCS Commercial |
$313.92
|
| Rate for Payer: United Healthcare All Payer |
$287.76
|
|
|
INSRT IABA VIA ASCENDING AORTA
|
Facility
|
OP
|
$2,159.00
|
|
|
Service Code
|
HCPCS 33973
|
| Hospital Charge Code |
48100006
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$280.67 |
| Max. Negotiated Rate |
$2,072.64 |
| Rate for Payer: Aetna Commercial |
$1,662.43
|
| Rate for Payer: Anthem Medicaid |
$742.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,684.02
|
| Rate for Payer: Cash Price |
$1,079.50
|
| Rate for Payer: Cigna Commercial |
$1,791.97
|
| Rate for Payer: First Health Commercial |
$2,051.05
|
| Rate for Payer: Humana Commercial |
$1,835.15
|
| Rate for Payer: Humana KY Medicaid |
$742.48
|
| Rate for Payer: Kentucky WC Medicaid |
$750.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,770.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,593.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$647.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$757.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,899.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,619.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$431.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$280.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$669.29
|
| Rate for Payer: PHCS Commercial |
$2,072.64
|
| Rate for Payer: United Healthcare All Payer |
$1,899.92
|
|
|
INSRT IABA VIA ASCENDING AORTA
|
Facility
|
OP
|
$2,071.00
|
|
|
Service Code
|
HCPCS 33973
|
| Hospital Charge Code |
76101328
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$269.23 |
| Max. Negotiated Rate |
$1,988.16 |
| Rate for Payer: Aetna Commercial |
$1,594.67
|
| Rate for Payer: Anthem Medicaid |
$712.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,615.38
|
| Rate for Payer: Cash Price |
$1,035.50
|
| Rate for Payer: Cigna Commercial |
$1,718.93
|
| Rate for Payer: First Health Commercial |
$1,967.45
|
| Rate for Payer: Humana Commercial |
$1,760.35
|
| Rate for Payer: Humana KY Medicaid |
$712.22
|
| Rate for Payer: Kentucky WC Medicaid |
$719.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,698.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,528.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$621.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$726.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,822.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,553.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$414.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$269.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$642.01
|
| Rate for Payer: PHCS Commercial |
$1,988.16
|
| Rate for Payer: United Healthcare All Payer |
$1,822.48
|
|
|
INSRT IABA VIA ASCENDING AORTA
|
Facility
|
IP
|
$2,159.00
|
|
|
Service Code
|
HCPCS 33973
|
| Hospital Charge Code |
48100006
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$280.67 |
| Max. Negotiated Rate |
$2,072.64 |
| Rate for Payer: Aetna Commercial |
$1,662.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,684.02
|
| Rate for Payer: Cash Price |
$1,079.50
|
| Rate for Payer: Cigna Commercial |
$1,791.97
|
| Rate for Payer: First Health Commercial |
$2,051.05
|
| Rate for Payer: Humana Commercial |
$1,835.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,770.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,593.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$647.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,899.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,619.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$431.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$280.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$669.29
|
| Rate for Payer: PHCS Commercial |
$2,072.64
|
| Rate for Payer: United Healthcare All Payer |
$1,899.92
|
|
|
INSRT IABA VIA ASCENDING AORTA
|
Facility
|
IP
|
$2,071.00
|
|
|
Service Code
|
HCPCS 33973
|
| Hospital Charge Code |
76101328
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$269.23 |
| Max. Negotiated Rate |
$1,988.16 |
| Rate for Payer: Aetna Commercial |
$1,594.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,615.38
|
| Rate for Payer: Cash Price |
$1,035.50
|
| Rate for Payer: Cigna Commercial |
$1,718.93
|
| Rate for Payer: First Health Commercial |
$1,967.45
|
| Rate for Payer: Humana Commercial |
$1,760.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,698.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,528.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$621.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,822.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,553.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$414.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$269.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$642.01
|
| Rate for Payer: PHCS Commercial |
$1,988.16
|
| Rate for Payer: United Healthcare All Payer |
$1,822.48
|
|
|
INSRT JOURNEY REV STD SZ 3-4 L
|
Facility
|
IP
|
$12,498.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,624.74 |
| Max. Negotiated Rate |
$11,998.08 |
| Rate for Payer: Aetna Commercial |
$9,623.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,748.44
|
| Rate for Payer: Cash Price |
$6,249.00
|
| Rate for Payer: Cigna Commercial |
$10,373.34
|
| Rate for Payer: First Health Commercial |
$11,873.10
|
| Rate for Payer: Humana Commercial |
$10,623.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,248.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,223.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,749.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,998.24
|
| Rate for Payer: Ohio Health Group HMO |
$9,373.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,499.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,624.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,874.38
|
| Rate for Payer: PHCS Commercial |
$11,998.08
|
| Rate for Payer: United Healthcare All Payer |
$10,998.24
|
|
|
INSRT JOURNEY REV STD SZ 3-4 L
|
Facility
|
OP
|
$12,498.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,624.74 |
| Max. Negotiated Rate |
$11,998.08 |
| Rate for Payer: Aetna Commercial |
$9,623.46
|
| Rate for Payer: Anthem Medicaid |
$4,298.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,748.44
|
| Rate for Payer: Cash Price |
$6,249.00
|
| Rate for Payer: Cigna Commercial |
$10,373.34
|
| Rate for Payer: First Health Commercial |
$11,873.10
|
| Rate for Payer: Humana Commercial |
$10,623.30
|
| Rate for Payer: Humana KY Medicaid |
$4,298.06
|
| Rate for Payer: Kentucky WC Medicaid |
$4,341.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,248.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,223.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,749.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,384.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,998.24
|
| Rate for Payer: Ohio Health Group HMO |
$9,373.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,499.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,624.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,874.38
|
| Rate for Payer: PHCS Commercial |
$11,998.08
|
| Rate for Payer: United Healthcare All Payer |
$10,998.24
|
|
|
INSRT JRNY ARTBCS STD 1-2 10 L
|
Facility
|
IP
|
$9,158.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.58 |
| Max. Negotiated Rate |
$8,791.97 |
| Rate for Payer: Aetna Commercial |
$7,051.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.47
|
| Rate for Payer: Cash Price |
$4,579.15
|
| Rate for Payer: Cigna Commercial |
$7,601.39
|
| Rate for Payer: First Health Commercial |
$8,700.38
|
| Rate for Payer: Humana Commercial |
$7,784.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.07
|
| Rate for Payer: PHCS Commercial |
$8,791.97
|
| Rate for Payer: United Healthcare All Payer |
$8,059.30
|
|
|
INSRT JRNY ARTBCS STD 1-2 10 L
|
Facility
|
OP
|
$9,158.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.58 |
| Max. Negotiated Rate |
$8,791.97 |
| Rate for Payer: Aetna Commercial |
$7,051.89
|
| Rate for Payer: Anthem Medicaid |
$3,149.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.47
|
| Rate for Payer: Cash Price |
$4,579.15
|
| Rate for Payer: Cigna Commercial |
$7,601.39
|
| Rate for Payer: First Health Commercial |
$8,700.38
|
| Rate for Payer: Humana Commercial |
$7,784.56
|
| Rate for Payer: Humana KY Medicaid |
$3,149.54
|
| Rate for Payer: Kentucky WC Medicaid |
$3,181.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,212.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.07
|
| Rate for Payer: PHCS Commercial |
$8,791.97
|
| Rate for Payer: United Healthcare All Payer |
$8,059.30
|
|
|
INSRT JRNY ARTBCS STD 1-2 10 R
|
Facility
|
IP
|
$9,158.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.58 |
| Max. Negotiated Rate |
$8,791.97 |
| Rate for Payer: Aetna Commercial |
$7,051.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.47
|
| Rate for Payer: Cash Price |
$4,579.15
|
| Rate for Payer: Cigna Commercial |
$7,601.39
|
| Rate for Payer: First Health Commercial |
$8,700.38
|
| Rate for Payer: Humana Commercial |
$7,784.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.07
|
| Rate for Payer: PHCS Commercial |
$8,791.97
|
| Rate for Payer: United Healthcare All Payer |
$8,059.30
|
|
|
INSRT JRNY ARTBCS STD 1-2 10 R
|
Facility
|
OP
|
$9,158.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.58 |
| Max. Negotiated Rate |
$8,791.97 |
| Rate for Payer: Aetna Commercial |
$7,051.89
|
| Rate for Payer: Anthem Medicaid |
$3,149.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.47
|
| Rate for Payer: Cash Price |
$4,579.15
|
| Rate for Payer: Cigna Commercial |
$7,601.39
|
| Rate for Payer: First Health Commercial |
$8,700.38
|
| Rate for Payer: Humana Commercial |
$7,784.56
|
| Rate for Payer: Humana KY Medicaid |
$3,149.54
|
| Rate for Payer: Kentucky WC Medicaid |
$3,181.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,212.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.07
|
| Rate for Payer: PHCS Commercial |
$8,791.97
|
| Rate for Payer: United Healthcare All Payer |
$8,059.30
|
|
|
INSRT JRNY ARTBCS STD 1-2 11 L
|
Facility
|
IP
|
$9,158.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.58 |
| Max. Negotiated Rate |
$8,791.97 |
| Rate for Payer: Aetna Commercial |
$7,051.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.47
|
| Rate for Payer: Cash Price |
$4,579.15
|
| Rate for Payer: Cigna Commercial |
$7,601.39
|
| Rate for Payer: First Health Commercial |
$8,700.38
|
| Rate for Payer: Humana Commercial |
$7,784.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.07
|
| Rate for Payer: PHCS Commercial |
$8,791.97
|
| Rate for Payer: United Healthcare All Payer |
$8,059.30
|
|
|
INSRT JRNY ARTBCS STD 1-2 11 L
|
Facility
|
OP
|
$9,158.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.58 |
| Max. Negotiated Rate |
$8,791.97 |
| Rate for Payer: Aetna Commercial |
$7,051.89
|
| Rate for Payer: Anthem Medicaid |
$3,149.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.47
|
| Rate for Payer: Cash Price |
$4,579.15
|
| Rate for Payer: Cigna Commercial |
$7,601.39
|
| Rate for Payer: First Health Commercial |
$8,700.38
|
| Rate for Payer: Humana Commercial |
$7,784.56
|
| Rate for Payer: Humana KY Medicaid |
$3,149.54
|
| Rate for Payer: Kentucky WC Medicaid |
$3,181.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,212.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.07
|
| Rate for Payer: PHCS Commercial |
$8,791.97
|
| Rate for Payer: United Healthcare All Payer |
$8,059.30
|
|
|
INSRT JRNY ARTBCS STD 1-2 11 R
|
Facility
|
OP
|
$9,158.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.58 |
| Max. Negotiated Rate |
$8,791.97 |
| Rate for Payer: Aetna Commercial |
$7,051.89
|
| Rate for Payer: Anthem Medicaid |
$3,149.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.47
|
| Rate for Payer: Cash Price |
$4,579.15
|
| Rate for Payer: Cigna Commercial |
$7,601.39
|
| Rate for Payer: First Health Commercial |
$8,700.38
|
| Rate for Payer: Humana Commercial |
$7,784.56
|
| Rate for Payer: Humana KY Medicaid |
$3,149.54
|
| Rate for Payer: Kentucky WC Medicaid |
$3,181.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,212.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.07
|
| Rate for Payer: PHCS Commercial |
$8,791.97
|
| Rate for Payer: United Healthcare All Payer |
$8,059.30
|
|
|
INSRT JRNY ARTBCS STD 1-2 11 R
|
Facility
|
IP
|
$9,158.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.58 |
| Max. Negotiated Rate |
$8,791.97 |
| Rate for Payer: Aetna Commercial |
$7,051.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.47
|
| Rate for Payer: Cash Price |
$4,579.15
|
| Rate for Payer: Cigna Commercial |
$7,601.39
|
| Rate for Payer: First Health Commercial |
$8,700.38
|
| Rate for Payer: Humana Commercial |
$7,784.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.07
|
| Rate for Payer: PHCS Commercial |
$8,791.97
|
| Rate for Payer: United Healthcare All Payer |
$8,059.30
|
|
|
INSRT JRNY ARTBCS STD 1-2 13 L
|
Facility
|
OP
|
$9,158.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.58 |
| Max. Negotiated Rate |
$8,791.97 |
| Rate for Payer: Aetna Commercial |
$7,051.89
|
| Rate for Payer: Anthem Medicaid |
$3,149.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.47
|
| Rate for Payer: Cash Price |
$4,579.15
|
| Rate for Payer: Cigna Commercial |
$7,601.39
|
| Rate for Payer: First Health Commercial |
$8,700.38
|
| Rate for Payer: Humana Commercial |
$7,784.56
|
| Rate for Payer: Humana KY Medicaid |
$3,149.54
|
| Rate for Payer: Kentucky WC Medicaid |
$3,181.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,212.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.07
|
| Rate for Payer: PHCS Commercial |
$8,791.97
|
| Rate for Payer: United Healthcare All Payer |
$8,059.30
|
|
|
INSRT JRNY ARTBCS STD 1-2 13 L
|
Facility
|
IP
|
$9,158.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.58 |
| Max. Negotiated Rate |
$8,791.97 |
| Rate for Payer: Aetna Commercial |
$7,051.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.47
|
| Rate for Payer: Cash Price |
$4,579.15
|
| Rate for Payer: Cigna Commercial |
$7,601.39
|
| Rate for Payer: First Health Commercial |
$8,700.38
|
| Rate for Payer: Humana Commercial |
$7,784.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.07
|
| Rate for Payer: PHCS Commercial |
$8,791.97
|
| Rate for Payer: United Healthcare All Payer |
$8,059.30
|
|
|
INSRT JRNY ARTBCS STD 1-2 13 R
|
Facility
|
IP
|
$9,158.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.58 |
| Max. Negotiated Rate |
$8,791.97 |
| Rate for Payer: Aetna Commercial |
$7,051.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.47
|
| Rate for Payer: Cash Price |
$4,579.15
|
| Rate for Payer: Cigna Commercial |
$7,601.39
|
| Rate for Payer: First Health Commercial |
$8,700.38
|
| Rate for Payer: Humana Commercial |
$7,784.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.07
|
| Rate for Payer: PHCS Commercial |
$8,791.97
|
| Rate for Payer: United Healthcare All Payer |
$8,059.30
|
|
|
INSRT JRNY ARTBCS STD 1-2 13 R
|
Facility
|
OP
|
$9,158.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.58 |
| Max. Negotiated Rate |
$8,791.97 |
| Rate for Payer: Aetna Commercial |
$7,051.89
|
| Rate for Payer: Anthem Medicaid |
$3,149.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.47
|
| Rate for Payer: Cash Price |
$4,579.15
|
| Rate for Payer: Cigna Commercial |
$7,601.39
|
| Rate for Payer: First Health Commercial |
$8,700.38
|
| Rate for Payer: Humana Commercial |
$7,784.56
|
| Rate for Payer: Humana KY Medicaid |
$3,149.54
|
| Rate for Payer: Kentucky WC Medicaid |
$3,181.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,212.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.30
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.07
|
| Rate for Payer: PHCS Commercial |
$8,791.97
|
| Rate for Payer: United Healthcare All Payer |
$8,059.30
|
|
