|
LCCK 7D SZ6 5MM 41*34 CPL
|
Facility
|
OP
|
$27,219.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,165.79 |
| Max. Negotiated Rate |
$26,130.54 |
| Rate for Payer: Aetna Commercial |
$20,958.87
|
| Rate for Payer: Anthem Medicaid |
$9,360.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,231.06
|
| Rate for Payer: Cash Price |
$13,609.66
|
| Rate for Payer: Cigna Commercial |
$22,592.03
|
| Rate for Payer: First Health Commercial |
$25,858.34
|
| Rate for Payer: Humana Commercial |
$23,136.41
|
| Rate for Payer: Humana KY Medicaid |
$9,360.72
|
| Rate for Payer: Kentucky WC Medicaid |
$9,455.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,319.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,087.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,165.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,548.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,952.99
|
| Rate for Payer: Ohio Health Group HMO |
$20,414.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,775.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,680.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,781.32
|
| Rate for Payer: PHCS Commercial |
$26,130.54
|
| Rate for Payer: United Healthcare All Payer |
$23,952.99
|
|
|
LCCK 7D SZ6 5MM 41*34 CPL
|
Facility
|
IP
|
$27,219.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,165.79 |
| Max. Negotiated Rate |
$26,130.54 |
| Rate for Payer: Aetna Commercial |
$20,958.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,231.06
|
| Rate for Payer: Cash Price |
$13,609.66
|
| Rate for Payer: Cigna Commercial |
$22,592.03
|
| Rate for Payer: First Health Commercial |
$25,858.34
|
| Rate for Payer: Humana Commercial |
$23,136.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,319.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,087.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,165.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,952.99
|
| Rate for Payer: Ohio Health Group HMO |
$20,414.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,775.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,680.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,781.32
|
| Rate for Payer: PHCS Commercial |
$26,130.54
|
| Rate for Payer: United Healthcare All Payer |
$23,952.99
|
|
|
LCCK 7D SZ6 5MM 46*34 CPL
|
Facility
|
OP
|
$27,219.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,165.79 |
| Max. Negotiated Rate |
$26,130.54 |
| Rate for Payer: Aetna Commercial |
$20,958.87
|
| Rate for Payer: Anthem Medicaid |
$9,360.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,231.06
|
| Rate for Payer: Cash Price |
$13,609.66
|
| Rate for Payer: Cigna Commercial |
$22,592.03
|
| Rate for Payer: First Health Commercial |
$25,858.34
|
| Rate for Payer: Humana Commercial |
$23,136.41
|
| Rate for Payer: Humana KY Medicaid |
$9,360.72
|
| Rate for Payer: Kentucky WC Medicaid |
$9,455.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,319.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,087.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,165.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,548.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,952.99
|
| Rate for Payer: Ohio Health Group HMO |
$20,414.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,775.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,680.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,781.32
|
| Rate for Payer: PHCS Commercial |
$26,130.54
|
| Rate for Payer: United Healthcare All Payer |
$23,952.99
|
|
|
LCCK 7D SZ6 5MM 46*34 CPL
|
Facility
|
IP
|
$27,219.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,165.79 |
| Max. Negotiated Rate |
$26,130.54 |
| Rate for Payer: Aetna Commercial |
$20,958.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,231.06
|
| Rate for Payer: Cash Price |
$13,609.66
|
| Rate for Payer: Cigna Commercial |
$22,592.03
|
| Rate for Payer: First Health Commercial |
$25,858.34
|
| Rate for Payer: Humana Commercial |
$23,136.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,319.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,087.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,165.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,952.99
|
| Rate for Payer: Ohio Health Group HMO |
$20,414.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,775.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,680.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,781.32
|
| Rate for Payer: PHCS Commercial |
$26,130.54
|
| Rate for Payer: United Healthcare All Payer |
$23,952.99
|
|
|
LCCK 7D SZ7 5MM 46*34 CPL
|
Facility
|
OP
|
$27,219.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,165.79 |
| Max. Negotiated Rate |
$26,130.54 |
| Rate for Payer: Aetna Commercial |
$20,958.87
|
| Rate for Payer: Anthem Medicaid |
$9,360.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,231.06
|
| Rate for Payer: Cash Price |
$13,609.66
|
| Rate for Payer: Cigna Commercial |
$22,592.03
|
| Rate for Payer: First Health Commercial |
$25,858.34
|
| Rate for Payer: Humana Commercial |
$23,136.41
|
| Rate for Payer: Humana KY Medicaid |
$9,360.72
|
| Rate for Payer: Kentucky WC Medicaid |
$9,455.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,319.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,087.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,165.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,548.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,952.99
|
| Rate for Payer: Ohio Health Group HMO |
$20,414.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,775.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,680.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,781.32
|
| Rate for Payer: PHCS Commercial |
$26,130.54
|
| Rate for Payer: United Healthcare All Payer |
$23,952.99
|
|
|
LCCK 7D SZ7 5MM 46*34 CPL
|
Facility
|
IP
|
$27,219.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,165.79 |
| Max. Negotiated Rate |
$26,130.54 |
| Rate for Payer: Aetna Commercial |
$20,958.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,231.06
|
| Rate for Payer: Cash Price |
$13,609.66
|
| Rate for Payer: Cigna Commercial |
$22,592.03
|
| Rate for Payer: First Health Commercial |
$25,858.34
|
| Rate for Payer: Humana Commercial |
$23,136.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,319.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,087.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,165.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,952.99
|
| Rate for Payer: Ohio Health Group HMO |
$20,414.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,775.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,680.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,781.32
|
| Rate for Payer: PHCS Commercial |
$26,130.54
|
| Rate for Payer: United Healthcare All Payer |
$23,952.99
|
|
|
L COLECTOMY/COLOPROCTOSTOMY
|
Professional
|
Both
|
$4,765.00
|
|
|
Service Code
|
HCPCS 44208
|
| Hospital Charge Code |
76102969
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,323.02 |
| Max. Negotiated Rate |
$2,906.37 |
| Rate for Payer: Aetna Commercial |
$2,906.37
|
| Rate for Payer: Ambetter Exchange |
$1,854.65
|
| Rate for Payer: Anthem Medicaid |
$1,323.02
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,854.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,854.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,225.58
|
| Rate for Payer: Cash Price |
$2,382.50
|
| Rate for Payer: Cash Price |
$2,382.50
|
| Rate for Payer: Cigna Commercial |
$2,728.46
|
| Rate for Payer: Healthspan PPO |
$2,450.99
|
| Rate for Payer: Humana Medicaid |
$1,323.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,539.95
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,854.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,854.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,349.48
|
| Rate for Payer: Molina Healthcare Passport |
$1,323.02
|
| Rate for Payer: Multiplan PHCS |
$2,859.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,411.05
|
| Rate for Payer: UHCCP Medicaid |
$1,667.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,336.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,854.65
|
|
|
L COLECTOMY/COLOPROCTOSTOMY
|
Facility
|
IP
|
$4,765.00
|
|
|
Service Code
|
HCPCS 44208
|
| Hospital Charge Code |
76102969
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,429.50 |
| Max. Negotiated Rate |
$4,574.40 |
| Rate for Payer: Aetna Commercial |
$3,669.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,716.70
|
| Rate for Payer: Cash Price |
$2,382.50
|
| Rate for Payer: Cigna Commercial |
$3,954.95
|
| Rate for Payer: First Health Commercial |
$4,526.75
|
| Rate for Payer: Humana Commercial |
$4,050.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,907.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,516.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,429.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,193.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,573.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,812.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,145.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,287.85
|
| Rate for Payer: PHCS Commercial |
$4,574.40
|
| Rate for Payer: United Healthcare All Payer |
$4,193.20
|
|
|
L COLECTOMY/COLOPROCTOSTOMY
|
Facility
|
OP
|
$4,765.00
|
|
|
Service Code
|
HCPCS 44208
|
| Hospital Charge Code |
76102969
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,429.50 |
| Max. Negotiated Rate |
$4,574.40 |
| Rate for Payer: Aetna Commercial |
$3,669.05
|
| Rate for Payer: Anthem Medicaid |
$1,638.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,716.70
|
| Rate for Payer: Cash Price |
$2,382.50
|
| Rate for Payer: Cigna Commercial |
$3,954.95
|
| Rate for Payer: First Health Commercial |
$4,526.75
|
| Rate for Payer: Humana Commercial |
$4,050.25
|
| Rate for Payer: Humana KY Medicaid |
$1,638.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1,655.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,907.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,516.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,429.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,671.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,193.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,573.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,812.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,145.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,287.85
|
| Rate for Payer: PHCS Commercial |
$4,574.40
|
| Rate for Payer: United Healthcare All Payer |
$4,193.20
|
|
|
LDL CHOLESTEROL
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
HCPCS 83721
|
| Hospital Charge Code |
30000446
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.50 |
| 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 |
$10.61
|
| 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 |
$20.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.94
|
| Rate for Payer: PHCS Commercial |
$24.96
|
| Rate for Payer: United Healthcare All Payer |
$22.88
|
|
|
LDL CHOLESTEROL
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
HCPCS 83721
|
| Hospital Charge Code |
30000446
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.80 |
| 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 |
$20.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.94
|
| 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 |
$16.06 |
| Rate for Payer: Aetna Commercial |
$16.06
|
| Rate for Payer: Ambetter Exchange |
$10.50
|
| Rate for Payer: Buckeye Individual/Medicaid |
$10.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$10.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.60
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$10.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.50
|
| Rate for Payer: Multiplan PHCS |
$15.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$13.65
|
| Rate for Payer: UHCCP Medicaid |
$9.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$6.30
|
| Rate for Payer: Wellcare Medicare Advantage |
$10.50
|
|
|
LEAD
|
Professional
|
Both
|
$101.00
|
|
|
Service Code
|
HCPCS 83655
|
| Hospital Charge Code |
30001806
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.27 |
| Max. Negotiated Rate |
$60.60 |
| Rate for Payer: Aetna Commercial |
$11.69
|
| Rate for Payer: Ambetter Exchange |
$12.11
|
| Rate for Payer: Buckeye Individual/Medicaid |
$12.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$12.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.53
|
| Rate for Payer: Cash Price |
$50.50
|
| Rate for Payer: Cash Price |
$50.50
|
| Rate for Payer: Cigna Commercial |
$10.79
|
| Rate for Payer: Healthspan PPO |
$12.68
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$12.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.11
|
| Rate for Payer: Multiplan PHCS |
$60.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$15.74
|
| Rate for Payer: UHCCP Medicaid |
$35.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$7.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$12.11
|
|
|
LEAD
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
HCPCS 83655
|
| Hospital Charge Code |
30001806
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.11 |
| Max. Negotiated Rate |
$96.96 |
| Rate for Payer: Aetna Commercial |
$77.77
|
| Rate for Payer: Anthem Medicaid |
$12.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$81.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.11
|
| Rate for Payer: Cash Price |
$50.50
|
| Rate for Payer: Cash Price |
$50.50
|
| Rate for Payer: Cigna Commercial |
$83.83
|
| Rate for Payer: First Health Commercial |
$95.95
|
| Rate for Payer: Humana Commercial |
$85.85
|
| 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 |
$82.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$74.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$88.88
|
| Rate for Payer: Ohio Health Group HMO |
$75.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$87.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$69.69
|
| Rate for Payer: PHCS Commercial |
$96.96
|
| Rate for Payer: United Healthcare All Payer |
$88.88
|
|
|
LEAD
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
HCPCS 83655
|
| Hospital Charge Code |
30001806
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.30 |
| Max. Negotiated Rate |
$96.96 |
| Rate for Payer: Aetna Commercial |
$77.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$81.10
|
| Rate for Payer: Cash Price |
$50.50
|
| Rate for Payer: Cigna Commercial |
$83.83
|
| Rate for Payer: First Health Commercial |
$95.95
|
| Rate for Payer: Humana Commercial |
$85.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$82.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$74.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$88.88
|
| Rate for Payer: Ohio Health Group HMO |
$75.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$87.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$69.69
|
| Rate for Payer: PHCS Commercial |
$96.96
|
| Rate for Payer: United Healthcare All Payer |
$88.88
|
|
|
LEAD 130 050
|
Facility
|
OP
|
$3,875.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,162.50 |
| Max. Negotiated Rate |
$3,720.00 |
| Rate for Payer: Aetna Commercial |
$2,983.75
|
| Rate for Payer: Anthem Medicaid |
$1,332.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,022.50
|
| Rate for Payer: Cash Price |
$1,937.50
|
| Rate for Payer: Cigna Commercial |
$3,216.25
|
| Rate for Payer: First Health Commercial |
$3,681.25
|
| Rate for Payer: Humana Commercial |
$3,293.75
|
| Rate for Payer: Humana KY Medicaid |
$1,332.61
|
| Rate for Payer: Kentucky WC Medicaid |
$1,346.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,177.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,859.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,162.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,359.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,410.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,906.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,371.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,673.75
|
| Rate for Payer: PHCS Commercial |
$3,720.00
|
| Rate for Payer: United Healthcare All Payer |
$3,410.00
|
|
|
LEAD 130 050
|
Facility
|
IP
|
$3,875.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,162.50 |
| Max. Negotiated Rate |
$3,720.00 |
| Rate for Payer: Aetna Commercial |
$2,983.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,022.50
|
| Rate for Payer: Cash Price |
$1,937.50
|
| Rate for Payer: Cigna Commercial |
$3,216.25
|
| Rate for Payer: First Health Commercial |
$3,681.25
|
| Rate for Payer: Humana Commercial |
$3,293.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,177.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,859.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,162.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,410.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,906.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,371.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,673.75
|
| Rate for Payer: PHCS Commercial |
$3,720.00
|
| Rate for Payer: United Healthcare All Payer |
$3,410.00
|
|
|
LEAD 1388T
|
Facility
|
IP
|
$4,062.50
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,218.75 |
| Max. Negotiated Rate |
$3,900.00 |
| Rate for Payer: Aetna Commercial |
$3,128.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,168.75
|
| Rate for Payer: Cash Price |
$2,031.25
|
| Rate for Payer: Cigna Commercial |
$3,371.88
|
| Rate for Payer: First Health Commercial |
$3,859.38
|
| Rate for Payer: Humana Commercial |
$3,453.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,331.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,998.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,218.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,575.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,046.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,250.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,534.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,803.12
|
| Rate for Payer: PHCS Commercial |
$3,900.00
|
| Rate for Payer: United Healthcare All Payer |
$3,575.00
|
|
|
LEAD 1388T
|
Facility
|
OP
|
$4,062.50
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,218.75 |
| Max. Negotiated Rate |
$3,900.00 |
| Rate for Payer: Aetna Commercial |
$3,128.12
|
| Rate for Payer: Anthem Medicaid |
$1,397.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,168.75
|
| Rate for Payer: Cash Price |
$2,031.25
|
| Rate for Payer: Cigna Commercial |
$3,371.88
|
| Rate for Payer: First Health Commercial |
$3,859.38
|
| Rate for Payer: Humana Commercial |
$3,453.12
|
| Rate for Payer: Humana KY Medicaid |
$1,397.09
|
| Rate for Payer: Kentucky WC Medicaid |
$1,411.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,331.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,998.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,218.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,425.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,575.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,046.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,250.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,534.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,803.12
|
| Rate for Payer: PHCS Commercial |
$3,900.00
|
| Rate for Payer: United Healthcare All Payer |
$3,575.00
|
|
|
LEAD 1648T
|
Facility
|
OP
|
$5,562.50
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$5,340.00 |
| Rate for Payer: Aetna Commercial |
$4,283.12
|
| Rate for Payer: Anthem Medicaid |
$1,912.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,338.75
|
| Rate for Payer: Cash Price |
$2,781.25
|
| Rate for Payer: Cigna Commercial |
$4,616.88
|
| Rate for Payer: First Health Commercial |
$5,284.38
|
| Rate for Payer: Humana Commercial |
$4,728.12
|
| Rate for Payer: Humana KY Medicaid |
$1,912.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,932.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,561.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,105.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,951.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,895.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,171.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,839.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,838.12
|
| Rate for Payer: PHCS Commercial |
$5,340.00
|
| Rate for Payer: United Healthcare All Payer |
$4,895.00
|
|
|
LEAD 1648T
|
Facility
|
IP
|
$5,562.50
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$5,340.00 |
| Rate for Payer: Aetna Commercial |
$4,283.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,338.75
|
| Rate for Payer: Cash Price |
$2,781.25
|
| Rate for Payer: Cigna Commercial |
$4,616.88
|
| Rate for Payer: First Health Commercial |
$5,284.38
|
| Rate for Payer: Humana Commercial |
$4,728.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,561.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,105.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,895.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,171.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,839.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,838.12
|
| Rate for Payer: PHCS Commercial |
$5,340.00
|
| Rate for Payer: United Healthcare All Payer |
$4,895.00
|
|
|
LEAD 1788TC
|
Facility
|
OP
|
$3,875.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,162.50 |
| Max. Negotiated Rate |
$3,720.00 |
| Rate for Payer: Aetna Commercial |
$2,983.75
|
| Rate for Payer: Anthem Medicaid |
$1,332.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,022.50
|
| Rate for Payer: Cash Price |
$1,937.50
|
| Rate for Payer: Cigna Commercial |
$3,216.25
|
| Rate for Payer: First Health Commercial |
$3,681.25
|
| Rate for Payer: Humana Commercial |
$3,293.75
|
| Rate for Payer: Humana KY Medicaid |
$1,332.61
|
| Rate for Payer: Kentucky WC Medicaid |
$1,346.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,177.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,859.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,162.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,359.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,410.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,906.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,371.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,673.75
|
| Rate for Payer: PHCS Commercial |
$3,720.00
|
| Rate for Payer: United Healthcare All Payer |
$3,410.00
|
|
|
LEAD 1788TC
|
Facility
|
IP
|
$3,875.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,162.50 |
| Max. Negotiated Rate |
$3,720.00 |
| Rate for Payer: Aetna Commercial |
$2,983.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,022.50
|
| Rate for Payer: Cash Price |
$1,937.50
|
| Rate for Payer: Cigna Commercial |
$3,216.25
|
| Rate for Payer: First Health Commercial |
$3,681.25
|
| Rate for Payer: Humana Commercial |
$3,293.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,177.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,859.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,162.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,410.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,906.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,371.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,673.75
|
| Rate for Payer: PHCS Commercial |
$3,720.00
|
| Rate for Payer: United Healthcare All Payer |
$3,410.00
|
|
|
LEAD 4068-45
|
Facility
|
IP
|
$3,425.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,027.50 |
| Max. Negotiated Rate |
$3,288.00 |
| Rate for Payer: Aetna Commercial |
$2,637.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,671.50
|
| Rate for Payer: Cash Price |
$1,712.50
|
| Rate for Payer: Cigna Commercial |
$2,842.75
|
| Rate for Payer: First Health Commercial |
$3,253.75
|
| Rate for Payer: Humana Commercial |
$2,911.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,808.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,527.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,027.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,014.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,568.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,740.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,979.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,363.25
|
| Rate for Payer: PHCS Commercial |
$3,288.00
|
| Rate for Payer: United Healthcare All Payer |
$3,014.00
|
|
|
LEAD 4068-45
|
Facility
|
OP
|
$3,425.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,027.50 |
| Max. Negotiated Rate |
$3,288.00 |
| Rate for Payer: Aetna Commercial |
$2,637.25
|
| Rate for Payer: Anthem Medicaid |
$1,177.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,671.50
|
| Rate for Payer: Cash Price |
$1,712.50
|
| Rate for Payer: Cigna Commercial |
$2,842.75
|
| Rate for Payer: First Health Commercial |
$3,253.75
|
| Rate for Payer: Humana Commercial |
$2,911.25
|
| Rate for Payer: Humana KY Medicaid |
$1,177.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,189.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,808.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,527.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,027.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,201.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,014.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,568.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,740.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,979.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,363.25
|
| Rate for Payer: PHCS Commercial |
$3,288.00
|
| Rate for Payer: United Healthcare All Payer |
$3,014.00
|
|
