|
NEW PT MID LEVEL 3
|
Professional
|
Both
|
$493.00
|
|
|
Service Code
|
HCPCS 99203
|
| Hospital Charge Code |
51000003
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.22 |
| Max. Negotiated Rate |
$27,517.35 |
| Rate for Payer: Aetna Commercial |
$108.39
|
| Rate for Payer: Ambetter Exchange |
$77.43
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$42.22
|
| Rate for Payer: Anthem Medicaid |
$79.04
|
| Rate for Payer: Buckeye Individual/Medicaid |
$77.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$77.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$92.92
|
| Rate for Payer: Cash Price |
$246.50
|
| Rate for Payer: Cash Price |
$246.50
|
| Rate for Payer: Cigna Commercial |
$138.86
|
| Rate for Payer: Healthspan PPO |
$106.83
|
| Rate for Payer: Humana Medicaid |
$79.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$100.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$77.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$77.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$80.62
|
| Rate for Payer: Molina Healthcare Passport |
$79.04
|
| Rate for Payer: Multiplan PHCS |
$295.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$100.66
|
| Rate for Payer: UHCCP Medicaid |
$44.33
|
| Rate for Payer: United Healthcare Non-Options |
$27,517.35
|
| Rate for Payer: United Healthcare Options |
$61.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$79.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$77.43
|
|
|
NEW PT MID LEVEL 3
|
Facility
|
IP
|
$493.00
|
|
|
Service Code
|
HCPCS 99203
|
| Hospital Charge Code |
51000003
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$147.90 |
| Max. Negotiated Rate |
$473.28 |
| Rate for Payer: Aetna Commercial |
$379.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$384.54
|
| Rate for Payer: Cash Price |
$246.50
|
| Rate for Payer: Cigna Commercial |
$409.19
|
| Rate for Payer: First Health Commercial |
$468.35
|
| Rate for Payer: Humana Commercial |
$419.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$404.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$363.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$147.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$433.84
|
| Rate for Payer: Ohio Health Group HMO |
$369.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$394.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$428.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$340.17
|
| Rate for Payer: PHCS Commercial |
$473.28
|
| Rate for Payer: United Healthcare All Payer |
$433.84
|
|
|
NEW PT MID LEVEL 3(P
|
Professional
|
Both
|
$160.00
|
|
|
Service Code
|
HCPCS 99203
|
| Hospital Charge Code |
510P0003
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.22 |
| Max. Negotiated Rate |
$27,517.35 |
| Rate for Payer: Aetna Commercial |
$108.39
|
| Rate for Payer: Ambetter Exchange |
$77.43
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$42.22
|
| Rate for Payer: Anthem Medicaid |
$79.04
|
| Rate for Payer: Buckeye Individual/Medicaid |
$77.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$77.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$92.92
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cigna Commercial |
$138.86
|
| Rate for Payer: Healthspan PPO |
$106.83
|
| Rate for Payer: Humana Medicaid |
$79.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$100.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$77.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$77.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$80.62
|
| Rate for Payer: Molina Healthcare Passport |
$79.04
|
| Rate for Payer: Multiplan PHCS |
$96.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$100.66
|
| Rate for Payer: UHCCP Medicaid |
$44.33
|
| Rate for Payer: United Healthcare Non-Options |
$27,517.35
|
| Rate for Payer: United Healthcare Options |
$61.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$79.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$77.43
|
|
|
NEW PT MID LEVEL 3(T
|
Facility
|
IP
|
$333.00
|
|
|
Service Code
|
HCPCS 99203
|
| Hospital Charge Code |
510T0003
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$99.90 |
| Max. Negotiated Rate |
$319.68 |
| Rate for Payer: Aetna Commercial |
$256.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$259.74
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cigna Commercial |
$276.39
|
| Rate for Payer: First Health Commercial |
$316.35
|
| Rate for Payer: Humana Commercial |
$283.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$273.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$245.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$99.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$293.04
|
| Rate for Payer: Ohio Health Group HMO |
$249.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$266.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$289.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$229.77
|
| Rate for Payer: PHCS Commercial |
$319.68
|
| Rate for Payer: United Healthcare All Payer |
$293.04
|
|
|
NEW PT MID LEVEL 3(T
|
Facility
|
IP
|
$333.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
510T0003
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$99.90 |
| Max. Negotiated Rate |
$319.68 |
| Rate for Payer: Aetna Commercial |
$256.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$259.74
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cigna Commercial |
$276.39
|
| Rate for Payer: First Health Commercial |
$316.35
|
| Rate for Payer: Humana Commercial |
$283.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$273.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$245.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$99.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$293.04
|
| Rate for Payer: Ohio Health Group HMO |
$249.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$266.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$289.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$229.77
|
| Rate for Payer: PHCS Commercial |
$319.68
|
| Rate for Payer: United Healthcare All Payer |
$293.04
|
|
|
NEW PT MID LEVEL 3(T
|
Facility
|
OP
|
$333.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
510T0003
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$114.52 |
| Max. Negotiated Rate |
$319.68 |
| Rate for Payer: Aetna Commercial |
$256.41
|
| Rate for Payer: Anthem Medicaid |
$114.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$259.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.74
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cigna Commercial |
$276.39
|
| Rate for Payer: First Health Commercial |
$316.35
|
| Rate for Payer: Humana Commercial |
$283.05
|
| Rate for Payer: Humana KY Medicaid |
$114.52
|
| Rate for Payer: Humana Medicare Advantage |
$119.07
|
| Rate for Payer: Kentucky WC Medicaid |
$115.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$273.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$245.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$293.04
|
| Rate for Payer: Ohio Health Group HMO |
$249.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$266.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$289.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$229.77
|
| Rate for Payer: PHCS Commercial |
$319.68
|
| Rate for Payer: United Healthcare All Payer |
$293.04
|
|
|
NEW PT MID LEVEL 3(T
|
Facility
|
OP
|
$333.00
|
|
|
Service Code
|
HCPCS 99203
|
| Hospital Charge Code |
510T0003
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$99.90 |
| Max. Negotiated Rate |
$319.68 |
| Rate for Payer: Aetna Commercial |
$256.41
|
| Rate for Payer: Anthem Medicaid |
$114.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$259.74
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cigna Commercial |
$276.39
|
| Rate for Payer: First Health Commercial |
$316.35
|
| Rate for Payer: Humana Commercial |
$283.05
|
| Rate for Payer: Humana KY Medicaid |
$114.52
|
| Rate for Payer: Kentucky WC Medicaid |
$115.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$273.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$245.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$99.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$293.04
|
| Rate for Payer: Ohio Health Group HMO |
$249.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$266.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$289.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$229.77
|
| Rate for Payer: PHCS Commercial |
$319.68
|
| Rate for Payer: United Healthcare All Payer |
$293.04
|
|
|
NEW SKIN (COMBINATION) SPR 1OZ
|
Facility
|
OP
|
$11.94
|
|
|
Service Code
|
NDC 16864044001
|
| Hospital Charge Code |
25001070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$11.46 |
| Rate for Payer: Aetna Commercial |
$9.19
|
| Rate for Payer: Anthem Medicaid |
$4.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.31
|
| Rate for Payer: Cash Price |
$5.97
|
| Rate for Payer: Cigna Commercial |
$9.91
|
| Rate for Payer: First Health Commercial |
$11.34
|
| Rate for Payer: Humana Commercial |
$10.15
|
| Rate for Payer: Humana KY Medicaid |
$4.11
|
| Rate for Payer: Kentucky WC Medicaid |
$4.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$10.51
|
| Rate for Payer: Ohio Health Group HMO |
$8.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.24
|
| Rate for Payer: PHCS Commercial |
$11.46
|
| Rate for Payer: United Healthcare All Payer |
$10.51
|
|
|
NEW SKIN (COMBINATION) SPR 1OZ
|
Facility
|
IP
|
$11.94
|
|
|
Service Code
|
NDC 16864044001
|
| Hospital Charge Code |
25001070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$11.46 |
| Rate for Payer: Aetna Commercial |
$9.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.31
|
| Rate for Payer: Cash Price |
$5.97
|
| Rate for Payer: Cigna Commercial |
$9.91
|
| Rate for Payer: First Health Commercial |
$11.34
|
| Rate for Payer: Humana Commercial |
$10.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$10.51
|
| Rate for Payer: Ohio Health Group HMO |
$8.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.24
|
| Rate for Payer: PHCS Commercial |
$11.46
|
| Rate for Payer: United Healthcare All Payer |
$10.51
|
|
|
NEXEL TOTELB HMSTM SZ5 150M LG
|
Facility
|
OP
|
$26,937.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,081.25 |
| Max. Negotiated Rate |
$25,860.00 |
| Rate for Payer: Aetna Commercial |
$20,741.88
|
| Rate for Payer: Anthem Medicaid |
$9,263.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,011.25
|
| Rate for Payer: Cash Price |
$13,468.75
|
| Rate for Payer: Cigna Commercial |
$22,358.12
|
| Rate for Payer: First Health Commercial |
$25,590.62
|
| Rate for Payer: Humana Commercial |
$22,896.88
|
| Rate for Payer: Humana KY Medicaid |
$9,263.81
|
| Rate for Payer: Kentucky WC Medicaid |
$9,358.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,088.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,879.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,081.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,449.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,705.00
|
| Rate for Payer: Ohio Health Group HMO |
$20,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,550.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,435.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,586.88
|
| Rate for Payer: PHCS Commercial |
$25,860.00
|
| Rate for Payer: United Healthcare All Payer |
$23,705.00
|
|
|
NEXEL TOTELB HMSTM SZ5 150M LG
|
Facility
|
IP
|
$26,937.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,081.25 |
| Max. Negotiated Rate |
$25,860.00 |
| Rate for Payer: Aetna Commercial |
$20,741.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,011.25
|
| Rate for Payer: Cash Price |
$13,468.75
|
| Rate for Payer: Cigna Commercial |
$22,358.12
|
| Rate for Payer: First Health Commercial |
$25,590.62
|
| Rate for Payer: Humana Commercial |
$22,896.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,088.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,879.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,081.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,705.00
|
| Rate for Payer: Ohio Health Group HMO |
$20,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,550.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,435.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,586.88
|
| Rate for Payer: PHCS Commercial |
$25,860.00
|
| Rate for Payer: United Healthcare All Payer |
$23,705.00
|
|
|
NEXEL TOTELB HMSTM SZ5 200M LG
|
Facility
|
IP
|
$26,937.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,081.25 |
| Max. Negotiated Rate |
$25,860.00 |
| Rate for Payer: Aetna Commercial |
$20,741.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,011.25
|
| Rate for Payer: Cash Price |
$13,468.75
|
| Rate for Payer: Cigna Commercial |
$22,358.12
|
| Rate for Payer: First Health Commercial |
$25,590.62
|
| Rate for Payer: Humana Commercial |
$22,896.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,088.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,879.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,081.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,705.00
|
| Rate for Payer: Ohio Health Group HMO |
$20,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,550.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,435.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,586.88
|
| Rate for Payer: PHCS Commercial |
$25,860.00
|
| Rate for Payer: United Healthcare All Payer |
$23,705.00
|
|
|
NEXEL TOTELB HMSTM SZ5 200M LG
|
Facility
|
OP
|
$26,937.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,081.25 |
| Max. Negotiated Rate |
$25,860.00 |
| Rate for Payer: Aetna Commercial |
$20,741.88
|
| Rate for Payer: Anthem Medicaid |
$9,263.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,011.25
|
| Rate for Payer: Cash Price |
$13,468.75
|
| Rate for Payer: Cigna Commercial |
$22,358.12
|
| Rate for Payer: First Health Commercial |
$25,590.62
|
| Rate for Payer: Humana Commercial |
$22,896.88
|
| Rate for Payer: Humana KY Medicaid |
$9,263.81
|
| Rate for Payer: Kentucky WC Medicaid |
$9,358.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,088.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,879.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,081.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,449.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,705.00
|
| Rate for Payer: Ohio Health Group HMO |
$20,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,550.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,435.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,586.88
|
| Rate for Payer: PHCS Commercial |
$25,860.00
|
| Rate for Payer: United Healthcare All Payer |
$23,705.00
|
|
|
NEXEL TOTELB HMSTM SZ6 150M LG
|
Facility
|
IP
|
$26,937.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,081.25 |
| Max. Negotiated Rate |
$25,860.00 |
| Rate for Payer: Aetna Commercial |
$20,741.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,011.25
|
| Rate for Payer: Cash Price |
$13,468.75
|
| Rate for Payer: Cigna Commercial |
$22,358.12
|
| Rate for Payer: First Health Commercial |
$25,590.62
|
| Rate for Payer: Humana Commercial |
$22,896.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,088.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,879.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,081.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,705.00
|
| Rate for Payer: Ohio Health Group HMO |
$20,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,550.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,435.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,586.88
|
| Rate for Payer: PHCS Commercial |
$25,860.00
|
| Rate for Payer: United Healthcare All Payer |
$23,705.00
|
|
|
NEXEL TOTELB HMSTM SZ6 150M LG
|
Facility
|
OP
|
$26,937.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,081.25 |
| Max. Negotiated Rate |
$25,860.00 |
| Rate for Payer: Aetna Commercial |
$20,741.88
|
| Rate for Payer: Anthem Medicaid |
$9,263.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,011.25
|
| Rate for Payer: Cash Price |
$13,468.75
|
| Rate for Payer: Cigna Commercial |
$22,358.12
|
| Rate for Payer: First Health Commercial |
$25,590.62
|
| Rate for Payer: Humana Commercial |
$22,896.88
|
| Rate for Payer: Humana KY Medicaid |
$9,263.81
|
| Rate for Payer: Kentucky WC Medicaid |
$9,358.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,088.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,879.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,081.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,449.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,705.00
|
| Rate for Payer: Ohio Health Group HMO |
$20,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,550.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,435.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,586.88
|
| Rate for Payer: PHCS Commercial |
$25,860.00
|
| Rate for Payer: United Healthcare All Payer |
$23,705.00
|
|
|
NEXEL TOT ELB HUM STEM SZ 4 10
|
Facility
|
OP
|
$26,937.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,081.25 |
| Max. Negotiated Rate |
$25,860.00 |
| Rate for Payer: Aetna Commercial |
$20,741.88
|
| Rate for Payer: Anthem Medicaid |
$9,263.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,011.25
|
| Rate for Payer: Cash Price |
$13,468.75
|
| Rate for Payer: Cigna Commercial |
$22,358.12
|
| Rate for Payer: First Health Commercial |
$25,590.62
|
| Rate for Payer: Humana Commercial |
$22,896.88
|
| Rate for Payer: Humana KY Medicaid |
$9,263.81
|
| Rate for Payer: Kentucky WC Medicaid |
$9,358.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,088.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,879.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,081.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,449.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,705.00
|
| Rate for Payer: Ohio Health Group HMO |
$20,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,550.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,435.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,586.88
|
| Rate for Payer: PHCS Commercial |
$25,860.00
|
| Rate for Payer: United Healthcare All Payer |
$23,705.00
|
|
|
NEXEL TOT ELB HUM STEM SZ 4 10
|
Facility
|
IP
|
$26,937.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,081.25 |
| Max. Negotiated Rate |
$25,860.00 |
| Rate for Payer: Aetna Commercial |
$20,741.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,011.25
|
| Rate for Payer: Cash Price |
$13,468.75
|
| Rate for Payer: Cigna Commercial |
$22,358.12
|
| Rate for Payer: First Health Commercial |
$25,590.62
|
| Rate for Payer: Humana Commercial |
$22,896.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,088.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,879.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,081.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,705.00
|
| Rate for Payer: Ohio Health Group HMO |
$20,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,550.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,435.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,586.88
|
| Rate for Payer: PHCS Commercial |
$25,860.00
|
| Rate for Payer: United Healthcare All Payer |
$23,705.00
|
|
|
NEXEL TOTELB HUM STEM SZ4 150M
|
Facility
|
IP
|
$26,937.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,081.25 |
| Max. Negotiated Rate |
$25,860.00 |
| Rate for Payer: Aetna Commercial |
$20,741.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,011.25
|
| Rate for Payer: Cash Price |
$13,468.75
|
| Rate for Payer: Cigna Commercial |
$22,358.12
|
| Rate for Payer: First Health Commercial |
$25,590.62
|
| Rate for Payer: Humana Commercial |
$22,896.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,088.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,879.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,081.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,705.00
|
| Rate for Payer: Ohio Health Group HMO |
$20,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,550.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,435.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,586.88
|
| Rate for Payer: PHCS Commercial |
$25,860.00
|
| Rate for Payer: United Healthcare All Payer |
$23,705.00
|
|
|
NEXEL TOTELB HUM STEM SZ4 150M
|
Facility
|
OP
|
$26,937.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,081.25 |
| Max. Negotiated Rate |
$25,860.00 |
| Rate for Payer: Aetna Commercial |
$20,741.88
|
| Rate for Payer: Anthem Medicaid |
$9,263.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,011.25
|
| Rate for Payer: Cash Price |
$13,468.75
|
| Rate for Payer: Cigna Commercial |
$22,358.12
|
| Rate for Payer: First Health Commercial |
$25,590.62
|
| Rate for Payer: Humana Commercial |
$22,896.88
|
| Rate for Payer: Humana KY Medicaid |
$9,263.81
|
| Rate for Payer: Kentucky WC Medicaid |
$9,358.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,088.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,879.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,081.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,449.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,705.00
|
| Rate for Payer: Ohio Health Group HMO |
$20,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,550.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,435.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,586.88
|
| Rate for Payer: PHCS Commercial |
$25,860.00
|
| Rate for Payer: United Healthcare All Payer |
$23,705.00
|
|
|
NEXEL TOTELB HUM STEM SZ5 100M
|
Facility
|
OP
|
$26,937.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,081.25 |
| Max. Negotiated Rate |
$25,860.00 |
| Rate for Payer: Aetna Commercial |
$20,741.88
|
| Rate for Payer: Anthem Medicaid |
$9,263.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,011.25
|
| Rate for Payer: Cash Price |
$13,468.75
|
| Rate for Payer: Cigna Commercial |
$22,358.12
|
| Rate for Payer: First Health Commercial |
$25,590.62
|
| Rate for Payer: Humana Commercial |
$22,896.88
|
| Rate for Payer: Humana KY Medicaid |
$9,263.81
|
| Rate for Payer: Kentucky WC Medicaid |
$9,358.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,088.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,879.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,081.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,449.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,705.00
|
| Rate for Payer: Ohio Health Group HMO |
$20,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,550.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,435.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,586.88
|
| Rate for Payer: PHCS Commercial |
$25,860.00
|
| Rate for Payer: United Healthcare All Payer |
$23,705.00
|
|
|
NEXEL TOTELB HUM STEM SZ5 100M
|
Facility
|
IP
|
$26,937.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,081.25 |
| Max. Negotiated Rate |
$25,860.00 |
| Rate for Payer: Aetna Commercial |
$20,741.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,011.25
|
| Rate for Payer: Cash Price |
$13,468.75
|
| Rate for Payer: Cigna Commercial |
$22,358.12
|
| Rate for Payer: First Health Commercial |
$25,590.62
|
| Rate for Payer: Humana Commercial |
$22,896.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,088.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,879.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,081.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,705.00
|
| Rate for Payer: Ohio Health Group HMO |
$20,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,550.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,435.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,586.88
|
| Rate for Payer: PHCS Commercial |
$25,860.00
|
| Rate for Payer: United Healthcare All Payer |
$23,705.00
|
|
|
NEXEL TOTELB HUM STEM SZ5 150M
|
Facility
|
IP
|
$26,937.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,081.25 |
| Max. Negotiated Rate |
$25,860.00 |
| Rate for Payer: Aetna Commercial |
$20,741.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,011.25
|
| Rate for Payer: Cash Price |
$13,468.75
|
| Rate for Payer: Cigna Commercial |
$22,358.12
|
| Rate for Payer: First Health Commercial |
$25,590.62
|
| Rate for Payer: Humana Commercial |
$22,896.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,088.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,879.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,081.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,705.00
|
| Rate for Payer: Ohio Health Group HMO |
$20,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,550.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,435.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,586.88
|
| Rate for Payer: PHCS Commercial |
$25,860.00
|
| Rate for Payer: United Healthcare All Payer |
$23,705.00
|
|
|
NEXEL TOTELB HUM STEM SZ5 150M
|
Facility
|
OP
|
$26,937.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,081.25 |
| Max. Negotiated Rate |
$25,860.00 |
| Rate for Payer: Aetna Commercial |
$20,741.88
|
| Rate for Payer: Anthem Medicaid |
$9,263.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,011.25
|
| Rate for Payer: Cash Price |
$13,468.75
|
| Rate for Payer: Cigna Commercial |
$22,358.12
|
| Rate for Payer: First Health Commercial |
$25,590.62
|
| Rate for Payer: Humana Commercial |
$22,896.88
|
| Rate for Payer: Humana KY Medicaid |
$9,263.81
|
| Rate for Payer: Kentucky WC Medicaid |
$9,358.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,088.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,879.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,081.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,449.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,705.00
|
| Rate for Payer: Ohio Health Group HMO |
$20,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,550.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,435.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,586.88
|
| Rate for Payer: PHCS Commercial |
$25,860.00
|
| Rate for Payer: United Healthcare All Payer |
$23,705.00
|
|
|
NEXEL TOTELB HUM STEM SZ6 200M
|
Facility
|
IP
|
$26,937.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,081.25 |
| Max. Negotiated Rate |
$25,860.00 |
| Rate for Payer: Aetna Commercial |
$20,741.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,011.25
|
| Rate for Payer: Cash Price |
$13,468.75
|
| Rate for Payer: Cigna Commercial |
$22,358.12
|
| Rate for Payer: First Health Commercial |
$25,590.62
|
| Rate for Payer: Humana Commercial |
$22,896.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,088.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,879.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,081.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,705.00
|
| Rate for Payer: Ohio Health Group HMO |
$20,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,550.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,435.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,586.88
|
| Rate for Payer: PHCS Commercial |
$25,860.00
|
| Rate for Payer: United Healthcare All Payer |
$23,705.00
|
|
|
NEXEL TOTELB HUM STEM SZ6 200M
|
Facility
|
OP
|
$26,937.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,081.25 |
| Max. Negotiated Rate |
$25,860.00 |
| Rate for Payer: Aetna Commercial |
$20,741.88
|
| Rate for Payer: Anthem Medicaid |
$9,263.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,011.25
|
| Rate for Payer: Cash Price |
$13,468.75
|
| Rate for Payer: Cigna Commercial |
$22,358.12
|
| Rate for Payer: First Health Commercial |
$25,590.62
|
| Rate for Payer: Humana Commercial |
$22,896.88
|
| Rate for Payer: Humana KY Medicaid |
$9,263.81
|
| Rate for Payer: Kentucky WC Medicaid |
$9,358.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,088.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,879.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,081.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,449.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,705.00
|
| Rate for Payer: Ohio Health Group HMO |
$20,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,550.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,435.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,586.88
|
| Rate for Payer: PHCS Commercial |
$25,860.00
|
| Rate for Payer: United Healthcare All Payer |
$23,705.00
|
|
