|
LCCK 7D SZ6 5MM 31*31 CPL
|
Facility
|
OP
|
$26,426.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,435.48 |
| Max. Negotiated Rate |
$25,369.73 |
| Rate for Payer: Cigna Commercial |
$21,934.24
|
| Rate for Payer: Aetna Commercial |
$20,348.64
|
| Rate for Payer: Anthem Medicaid |
$9,088.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,612.90
|
| Rate for Payer: Cash Price |
$13,213.40
|
| Rate for Payer: First Health Commercial |
$25,105.46
|
| Rate for Payer: Humana Commercial |
$22,462.78
|
| Rate for Payer: Humana KY Medicaid |
$9,088.18
|
| Rate for Payer: Kentucky WC Medicaid |
$9,180.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,669.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,502.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,928.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,270.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,255.58
|
| Rate for Payer: Ohio Health Group HMO |
$19,820.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,285.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,435.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,192.31
|
| Rate for Payer: PHCS Commercial |
$25,369.73
|
| Rate for Payer: United Healthcare All Payer |
$23,255.58
|
|
|
LCCK 7D SZ6 5MM 31*31 CPL
|
Facility
|
IP
|
$26,426.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,435.48 |
| Max. Negotiated Rate |
$25,369.73 |
| Rate for Payer: Aetna Commercial |
$20,348.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,612.90
|
| Rate for Payer: Cash Price |
$13,213.40
|
| Rate for Payer: Cigna Commercial |
$21,934.24
|
| Rate for Payer: First Health Commercial |
$25,105.46
|
| Rate for Payer: Humana Commercial |
$22,462.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,669.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,502.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,928.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,255.58
|
| Rate for Payer: Ohio Health Group HMO |
$19,820.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,285.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,435.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,192.31
|
| Rate for Payer: PHCS Commercial |
$25,369.73
|
| Rate for Payer: United Healthcare All Payer |
$23,255.58
|
|
|
LCCK 7D SZ6 5MM 36*31 CPL
|
Facility
|
OP
|
$26,426.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,435.48 |
| Max. Negotiated Rate |
$25,369.73 |
| Rate for Payer: Aetna Commercial |
$20,348.64
|
| Rate for Payer: Anthem Medicaid |
$9,088.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,612.90
|
| Rate for Payer: Cash Price |
$13,213.40
|
| Rate for Payer: Cigna Commercial |
$21,934.24
|
| Rate for Payer: First Health Commercial |
$25,105.46
|
| Rate for Payer: Humana Commercial |
$22,462.78
|
| Rate for Payer: Humana KY Medicaid |
$9,088.18
|
| Rate for Payer: Kentucky WC Medicaid |
$9,180.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,669.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,502.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,928.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,270.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,255.58
|
| Rate for Payer: Ohio Health Group HMO |
$19,820.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,285.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,435.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,192.31
|
| Rate for Payer: PHCS Commercial |
$25,369.73
|
| Rate for Payer: United Healthcare All Payer |
$23,255.58
|
|
|
LCCK 7D SZ6 5MM 36*31 CPL
|
Facility
|
IP
|
$26,426.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,435.48 |
| Max. Negotiated Rate |
$25,369.73 |
| Rate for Payer: Aetna Commercial |
$20,348.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,612.90
|
| Rate for Payer: Cash Price |
$13,213.40
|
| Rate for Payer: Cigna Commercial |
$21,934.24
|
| Rate for Payer: First Health Commercial |
$25,105.46
|
| Rate for Payer: Humana Commercial |
$22,462.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,669.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,502.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,928.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,255.58
|
| Rate for Payer: Ohio Health Group HMO |
$19,820.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,285.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,435.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,192.31
|
| Rate for Payer: PHCS Commercial |
$25,369.73
|
| Rate for Payer: United Healthcare All Payer |
$23,255.58
|
|
|
LCCK 7D SZ6 5MM 41*34 CPL
|
Facility
|
OP
|
$26,426.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,435.48 |
| Max. Negotiated Rate |
$25,369.73 |
| Rate for Payer: Aetna Commercial |
$20,348.64
|
| Rate for Payer: Anthem Medicaid |
$9,088.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,612.90
|
| Rate for Payer: Cash Price |
$13,213.40
|
| Rate for Payer: Cigna Commercial |
$21,934.24
|
| Rate for Payer: First Health Commercial |
$25,105.46
|
| Rate for Payer: Humana Commercial |
$22,462.78
|
| Rate for Payer: Humana KY Medicaid |
$9,088.18
|
| Rate for Payer: Kentucky WC Medicaid |
$9,180.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,669.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,502.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,928.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,270.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,255.58
|
| Rate for Payer: Ohio Health Group HMO |
$19,820.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,285.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,435.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,192.31
|
| Rate for Payer: PHCS Commercial |
$25,369.73
|
| Rate for Payer: United Healthcare All Payer |
$23,255.58
|
|
|
LCCK 7D SZ6 5MM 41*34 CPL
|
Facility
|
IP
|
$26,426.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,435.48 |
| Max. Negotiated Rate |
$25,369.73 |
| Rate for Payer: Aetna Commercial |
$20,348.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,612.90
|
| Rate for Payer: Cash Price |
$13,213.40
|
| Rate for Payer: Cigna Commercial |
$21,934.24
|
| Rate for Payer: First Health Commercial |
$25,105.46
|
| Rate for Payer: Humana Commercial |
$22,462.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,669.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,502.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,928.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,255.58
|
| Rate for Payer: Ohio Health Group HMO |
$19,820.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,285.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,435.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,192.31
|
| Rate for Payer: PHCS Commercial |
$25,369.73
|
| Rate for Payer: United Healthcare All Payer |
$23,255.58
|
|
|
LCCK 7D SZ6 5MM 46*34 CPL
|
Facility
|
IP
|
$26,426.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,435.48 |
| Max. Negotiated Rate |
$25,369.73 |
| Rate for Payer: Aetna Commercial |
$20,348.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,612.90
|
| Rate for Payer: Cash Price |
$13,213.40
|
| Rate for Payer: Cigna Commercial |
$21,934.24
|
| Rate for Payer: First Health Commercial |
$25,105.46
|
| Rate for Payer: Humana Commercial |
$22,462.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,669.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,502.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,928.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,255.58
|
| Rate for Payer: Ohio Health Group HMO |
$19,820.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,285.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,435.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,192.31
|
| Rate for Payer: PHCS Commercial |
$25,369.73
|
| Rate for Payer: United Healthcare All Payer |
$23,255.58
|
|
|
LCCK 7D SZ6 5MM 46*34 CPL
|
Facility
|
OP
|
$26,426.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,435.48 |
| Max. Negotiated Rate |
$25,369.73 |
| Rate for Payer: Aetna Commercial |
$20,348.64
|
| Rate for Payer: Anthem Medicaid |
$9,088.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,612.90
|
| Rate for Payer: Cash Price |
$13,213.40
|
| Rate for Payer: Cigna Commercial |
$21,934.24
|
| Rate for Payer: First Health Commercial |
$25,105.46
|
| Rate for Payer: Humana Commercial |
$22,462.78
|
| Rate for Payer: Humana KY Medicaid |
$9,088.18
|
| Rate for Payer: Kentucky WC Medicaid |
$9,180.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,669.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,502.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,928.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,270.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,255.58
|
| Rate for Payer: Ohio Health Group HMO |
$19,820.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,285.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,435.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,192.31
|
| Rate for Payer: PHCS Commercial |
$25,369.73
|
| Rate for Payer: United Healthcare All Payer |
$23,255.58
|
|
|
LCCK 7D SZ7 5MM 46*34 CPL
|
Facility
|
OP
|
$26,426.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,435.48 |
| Max. Negotiated Rate |
$25,369.73 |
| Rate for Payer: Aetna Commercial |
$20,348.64
|
| Rate for Payer: Anthem Medicaid |
$9,088.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,612.90
|
| Rate for Payer: Cash Price |
$13,213.40
|
| Rate for Payer: Cigna Commercial |
$21,934.24
|
| Rate for Payer: First Health Commercial |
$25,105.46
|
| Rate for Payer: Humana Commercial |
$22,462.78
|
| Rate for Payer: Humana KY Medicaid |
$9,088.18
|
| Rate for Payer: Kentucky WC Medicaid |
$9,180.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,669.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,502.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,928.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,270.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,255.58
|
| Rate for Payer: Ohio Health Group HMO |
$19,820.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,285.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,435.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,192.31
|
| Rate for Payer: PHCS Commercial |
$25,369.73
|
| Rate for Payer: United Healthcare All Payer |
$23,255.58
|
|
|
LCCK 7D SZ7 5MM 46*34 CPL
|
Facility
|
IP
|
$26,426.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,435.48 |
| Max. Negotiated Rate |
$25,369.73 |
| Rate for Payer: Aetna Commercial |
$20,348.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,612.90
|
| Rate for Payer: Cash Price |
$13,213.40
|
| Rate for Payer: Cigna Commercial |
$21,934.24
|
| Rate for Payer: First Health Commercial |
$25,105.46
|
| Rate for Payer: Humana Commercial |
$22,462.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,669.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,502.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,928.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,255.58
|
| Rate for Payer: Ohio Health Group HMO |
$19,820.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,285.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,435.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,192.31
|
| Rate for Payer: PHCS Commercial |
$25,369.73
|
| Rate for Payer: United Healthcare All Payer |
$23,255.58
|
|
|
LDL CHOLESTEROL
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
HCPCS 83721
|
| Hospital Charge Code |
30000446
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.38 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Anthem Medicaid |
$10.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$14.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$10.50
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cigna Commercial |
$21.58
|
| Rate for Payer: First Health Commercial |
$24.70
|
| Rate for Payer: Humana Commercial |
$22.10
|
| Rate for Payer: Humana KY Medicaid |
$10.50
|
| Rate for Payer: Humana Medicare Advantage |
$10.50
|
| Rate for Payer: Kentucky WC Medicaid |
$10.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.88
|
| Rate for Payer: Ohio Health Group HMO |
$19.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.06
|
| Rate for Payer: PHCS Commercial |
$24.96
|
| Rate for Payer: United Healthcare All Payer |
$22.88
|
|
|
LDL CHOLESTEROL
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS 83721
|
| Hospital Charge Code |
30000446
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: Aetna Commercial |
$16.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$26.00
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cigna Commercial |
$8.38
|
| Rate for Payer: Healthspan PPO |
$10.00
|
| Rate for Payer: Multiplan PHCS |
$15.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$18.20
|
| Rate for Payer: UHCCP Medicaid |
$9.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$6.30
|
|
|
LDL CHOLESTEROL
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
HCPCS 83721
|
| Hospital Charge Code |
30000446
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.38 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.88
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cigna Commercial |
$21.58
|
| Rate for Payer: First Health Commercial |
$24.70
|
| Rate for Payer: Humana Commercial |
$22.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.88
|
| Rate for Payer: Ohio Health Group HMO |
$19.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.06
|
| Rate for Payer: PHCS Commercial |
$24.96
|
| Rate for Payer: United Healthcare All Payer |
$22.88
|
|
|
LEAD
|
Facility
|
OP
|
$96.00
|
|
|
Service Code
|
HCPCS 83655
|
| Hospital Charge Code |
30001806
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.11 |
| Max. Negotiated Rate |
$92.16 |
| Rate for Payer: Aetna Commercial |
$73.92
|
| Rate for Payer: Anthem Medicaid |
$12.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$77.09
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.11
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$79.68
|
| Rate for Payer: First Health Commercial |
$91.20
|
| Rate for Payer: Humana Commercial |
$81.60
|
| Rate for Payer: Humana KY Medicaid |
$12.11
|
| Rate for Payer: Humana Medicare Advantage |
$12.11
|
| Rate for Payer: Kentucky WC Medicaid |
$12.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$78.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$70.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$84.48
|
| Rate for Payer: Ohio Health Group HMO |
$72.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29.76
|
| Rate for Payer: PHCS Commercial |
$92.16
|
| Rate for Payer: United Healthcare All Payer |
$84.48
|
|
|
LEAD
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
HCPCS 83655
|
| Hospital Charge Code |
30001806
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.48 |
| Max. Negotiated Rate |
$92.16 |
| Rate for Payer: Aetna Commercial |
$73.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$77.09
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$79.68
|
| Rate for Payer: First Health Commercial |
$91.20
|
| Rate for Payer: Humana Commercial |
$81.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$78.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$70.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$84.48
|
| Rate for Payer: Ohio Health Group HMO |
$72.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29.76
|
| Rate for Payer: PHCS Commercial |
$92.16
|
| Rate for Payer: United Healthcare All Payer |
$84.48
|
|
|
LEAD
|
Professional
|
Both
|
$96.00
|
|
|
Service Code
|
HCPCS 83655
|
| Hospital Charge Code |
30001806
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.27 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Aetna Commercial |
$11.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$96.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$10.79
|
| Rate for Payer: Healthspan PPO |
$12.68
|
| Rate for Payer: Multiplan PHCS |
$57.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$67.20
|
| Rate for Payer: UHCCP Medicaid |
$33.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$7.27
|
|
|
LEAD 130 050
|
Facility
|
IP
|
$3,950.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$513.50 |
| Max. Negotiated Rate |
$3,792.00 |
| Rate for Payer: Aetna Commercial |
$3,041.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,081.00
|
| Rate for Payer: Cash Price |
$1,975.00
|
| Rate for Payer: Cigna Commercial |
$3,278.50
|
| Rate for Payer: First Health Commercial |
$3,752.50
|
| Rate for Payer: Humana Commercial |
$3,357.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,239.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,915.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,185.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,476.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,962.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$790.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$513.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.50
|
| Rate for Payer: PHCS Commercial |
$3,792.00
|
| Rate for Payer: United Healthcare All Payer |
$3,476.00
|
|
|
LEAD 130 050
|
Facility
|
OP
|
$3,950.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$513.50 |
| Max. Negotiated Rate |
$3,792.00 |
| Rate for Payer: Aetna Commercial |
$3,041.50
|
| Rate for Payer: Anthem Medicaid |
$1,358.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,081.00
|
| Rate for Payer: Cash Price |
$1,975.00
|
| Rate for Payer: Cigna Commercial |
$3,278.50
|
| Rate for Payer: First Health Commercial |
$3,752.50
|
| Rate for Payer: Humana Commercial |
$3,357.50
|
| Rate for Payer: Humana KY Medicaid |
$1,358.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,372.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,239.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,915.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,185.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,385.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,476.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,962.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$790.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$513.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.50
|
| Rate for Payer: PHCS Commercial |
$3,792.00
|
| Rate for Payer: United Healthcare All Payer |
$3,476.00
|
|
|
LEAD 1388T
|
Facility
|
OP
|
$4,125.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$536.25 |
| Max. Negotiated Rate |
$3,960.00 |
| Rate for Payer: Aetna Commercial |
$3,176.25
|
| Rate for Payer: Anthem Medicaid |
$1,418.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,217.50
|
| Rate for Payer: Cash Price |
$2,062.50
|
| Rate for Payer: Cigna Commercial |
$3,423.75
|
| Rate for Payer: First Health Commercial |
$3,918.75
|
| Rate for Payer: Humana Commercial |
$3,506.25
|
| Rate for Payer: Humana KY Medicaid |
$1,418.59
|
| Rate for Payer: Kentucky WC Medicaid |
$1,433.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,382.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,044.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,237.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,447.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,630.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,093.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$825.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$536.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,278.75
|
| Rate for Payer: PHCS Commercial |
$3,960.00
|
| Rate for Payer: United Healthcare All Payer |
$3,630.00
|
|
|
LEAD 1388T
|
Facility
|
IP
|
$4,125.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$536.25 |
| Max. Negotiated Rate |
$3,960.00 |
| Rate for Payer: Aetna Commercial |
$3,176.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,217.50
|
| Rate for Payer: Cash Price |
$2,062.50
|
| Rate for Payer: Cigna Commercial |
$3,423.75
|
| Rate for Payer: First Health Commercial |
$3,918.75
|
| Rate for Payer: Humana Commercial |
$3,506.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,382.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,044.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,237.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,630.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,093.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$825.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$536.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,278.75
|
| Rate for Payer: PHCS Commercial |
$3,960.00
|
| Rate for Payer: United Healthcare All Payer |
$3,630.00
|
|
|
LEAD 1648T
|
Facility
|
OP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$718.25 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem Medicaid |
$1,900.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Humana KY Medicaid |
$1,900.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,919.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,938.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,105.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$718.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,712.75
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
LEAD 1648T
|
Facility
|
IP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$718.25 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,105.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$718.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,712.75
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
LEAD 1788TC
|
Facility
|
IP
|
$3,950.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$513.50 |
| Max. Negotiated Rate |
$3,792.00 |
| Rate for Payer: Aetna Commercial |
$3,041.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,081.00
|
| Rate for Payer: Cash Price |
$1,975.00
|
| Rate for Payer: Cigna Commercial |
$3,278.50
|
| Rate for Payer: First Health Commercial |
$3,752.50
|
| Rate for Payer: Humana Commercial |
$3,357.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,239.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,915.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,185.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,476.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,962.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$790.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$513.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.50
|
| Rate for Payer: PHCS Commercial |
$3,792.00
|
| Rate for Payer: United Healthcare All Payer |
$3,476.00
|
|
|
LEAD 1788TC
|
Facility
|
OP
|
$3,950.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$513.50 |
| Max. Negotiated Rate |
$3,792.00 |
| Rate for Payer: Aetna Commercial |
$3,041.50
|
| Rate for Payer: Anthem Medicaid |
$1,358.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,081.00
|
| Rate for Payer: Cash Price |
$1,975.00
|
| Rate for Payer: Cigna Commercial |
$3,278.50
|
| Rate for Payer: First Health Commercial |
$3,752.50
|
| Rate for Payer: Humana Commercial |
$3,357.50
|
| Rate for Payer: Humana KY Medicaid |
$1,358.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,372.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,239.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,915.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,185.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,385.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,476.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,962.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$790.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$513.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.50
|
| Rate for Payer: PHCS Commercial |
$3,792.00
|
| Rate for Payer: United Healthcare All Payer |
$3,476.00
|
|
|
LEAD 4068-45
|
Facility
|
OP
|
$3,530.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$458.90 |
| Max. Negotiated Rate |
$3,388.80 |
| Rate for Payer: Aetna Commercial |
$2,718.10
|
| Rate for Payer: Anthem Medicaid |
$1,213.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,753.40
|
| Rate for Payer: Cash Price |
$1,765.00
|
| Rate for Payer: Cigna Commercial |
$2,929.90
|
| Rate for Payer: First Health Commercial |
$3,353.50
|
| Rate for Payer: Humana Commercial |
$3,000.50
|
| Rate for Payer: Humana KY Medicaid |
$1,213.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,226.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,894.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,605.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,059.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,238.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,106.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,647.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$706.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$458.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,094.30
|
| Rate for Payer: PHCS Commercial |
$3,388.80
|
| Rate for Payer: United Healthcare All Payer |
$3,106.40
|
|
