ARTCM 40M .1875 PST 10.5*10.5
|
Facility
|
IP
|
$23,860.30
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$3,101.84 |
Max. Negotiated Rate |
$22,905.89 |
Rate for Payer: Aetna Commercial |
$18,372.43
|
Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
Rate for Payer: Cash Price |
$11,930.15
|
Rate for Payer: Cigna Commercial |
$19,804.05
|
Rate for Payer: First Health Commercial |
$22,667.28
|
Rate for Payer: Humana Commercial |
$20,281.26
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
Rate for Payer: PHCS Commercial |
$22,905.89
|
Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
ARTCM 40M .1875 PST 10.5*10.5
|
Facility
|
OP
|
$23,860.30
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$3,101.84 |
Max. Negotiated Rate |
$22,905.89 |
Rate for Payer: Aetna Commercial |
$18,372.43
|
Rate for Payer: Anthem Medicaid |
$8,205.56
|
Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
Rate for Payer: Cash Price |
$11,930.15
|
Rate for Payer: Cigna Commercial |
$19,804.05
|
Rate for Payer: First Health Commercial |
$22,667.28
|
Rate for Payer: Humana Commercial |
$20,281.26
|
Rate for Payer: Humana KY Medicaid |
$8,205.56
|
Rate for Payer: Kentucky WC Medicaid |
$8,289.07
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
Rate for Payer: Molina Healthcare Medicaid |
$8,370.19
|
Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
Rate for Payer: PHCS Commercial |
$22,905.89
|
Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
ARTCM 40M .1875 PST 11.0*11.0
|
Facility
|
IP
|
$23,860.30
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$3,101.84 |
Max. Negotiated Rate |
$22,905.89 |
Rate for Payer: Aetna Commercial |
$18,372.43
|
Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
Rate for Payer: Cash Price |
$11,930.15
|
Rate for Payer: Cigna Commercial |
$19,804.05
|
Rate for Payer: First Health Commercial |
$22,667.28
|
Rate for Payer: Humana Commercial |
$20,281.26
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
Rate for Payer: PHCS Commercial |
$22,905.89
|
Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
ARTCM 40M .1875 PST 11.0*11.0
|
Facility
|
OP
|
$23,860.30
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$3,101.84 |
Max. Negotiated Rate |
$22,905.89 |
Rate for Payer: Aetna Commercial |
$18,372.43
|
Rate for Payer: Anthem Medicaid |
$8,205.56
|
Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
Rate for Payer: Cash Price |
$11,930.15
|
Rate for Payer: Cigna Commercial |
$19,804.05
|
Rate for Payer: First Health Commercial |
$22,667.28
|
Rate for Payer: Humana Commercial |
$20,281.26
|
Rate for Payer: Humana KY Medicaid |
$8,205.56
|
Rate for Payer: Kentucky WC Medicaid |
$8,289.07
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
Rate for Payer: Molina Healthcare Medicaid |
$8,370.19
|
Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
Rate for Payer: PHCS Commercial |
$22,905.89
|
Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
ARTCM 40M .1875 PST 11.0*12.0
|
Facility
|
IP
|
$23,860.30
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$3,101.84 |
Max. Negotiated Rate |
$22,905.89 |
Rate for Payer: Aetna Commercial |
$18,372.43
|
Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
Rate for Payer: Cash Price |
$11,930.15
|
Rate for Payer: Cigna Commercial |
$19,804.05
|
Rate for Payer: First Health Commercial |
$22,667.28
|
Rate for Payer: Humana Commercial |
$20,281.26
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
Rate for Payer: PHCS Commercial |
$22,905.89
|
Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
ARTCM 40M .1875 PST 11.0*12.0
|
Facility
|
OP
|
$23,860.30
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$3,101.84 |
Max. Negotiated Rate |
$22,905.89 |
Rate for Payer: Aetna Commercial |
$18,372.43
|
Rate for Payer: Anthem Medicaid |
$8,205.56
|
Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
Rate for Payer: Cash Price |
$11,930.15
|
Rate for Payer: Cigna Commercial |
$19,804.05
|
Rate for Payer: First Health Commercial |
$22,667.28
|
Rate for Payer: Humana Commercial |
$20,281.26
|
Rate for Payer: Humana KY Medicaid |
$8,205.56
|
Rate for Payer: Kentucky WC Medicaid |
$8,289.07
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
Rate for Payer: Molina Healthcare Medicaid |
$8,370.19
|
Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
Rate for Payer: PHCS Commercial |
$22,905.89
|
Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
ARTCM 40M .1875 PST 11.5*11.5
|
Facility
|
OP
|
$23,860.30
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$3,101.84 |
Max. Negotiated Rate |
$22,905.89 |
Rate for Payer: Aetna Commercial |
$18,372.43
|
Rate for Payer: Anthem Medicaid |
$8,205.56
|
Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
Rate for Payer: Cash Price |
$11,930.15
|
Rate for Payer: Cigna Commercial |
$19,804.05
|
Rate for Payer: First Health Commercial |
$22,667.28
|
Rate for Payer: Humana Commercial |
$20,281.26
|
Rate for Payer: Humana KY Medicaid |
$8,205.56
|
Rate for Payer: Kentucky WC Medicaid |
$8,289.07
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
Rate for Payer: Molina Healthcare Medicaid |
$8,370.19
|
Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
Rate for Payer: PHCS Commercial |
$22,905.89
|
Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
ARTCM 40M .1875 PST 11.5*11.5
|
Facility
|
IP
|
$23,860.30
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$3,101.84 |
Max. Negotiated Rate |
$22,905.89 |
Rate for Payer: Aetna Commercial |
$18,372.43
|
Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
Rate for Payer: Cash Price |
$11,930.15
|
Rate for Payer: Cigna Commercial |
$19,804.05
|
Rate for Payer: First Health Commercial |
$22,667.28
|
Rate for Payer: Humana Commercial |
$20,281.26
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
Rate for Payer: PHCS Commercial |
$22,905.89
|
Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
ARTCM 40M .1875 PST 12.0*12.0
|
Facility
|
IP
|
$23,860.30
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$3,101.84 |
Max. Negotiated Rate |
$22,905.89 |
Rate for Payer: Aetna Commercial |
$18,372.43
|
Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
Rate for Payer: Cash Price |
$11,930.15
|
Rate for Payer: Cigna Commercial |
$19,804.05
|
Rate for Payer: First Health Commercial |
$22,667.28
|
Rate for Payer: Humana Commercial |
$20,281.26
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
Rate for Payer: PHCS Commercial |
$22,905.89
|
Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
ARTCM 40M .1875 PST 12.0*12.0
|
Facility
|
OP
|
$23,860.30
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$3,101.84 |
Max. Negotiated Rate |
$22,905.89 |
Rate for Payer: Aetna Commercial |
$18,372.43
|
Rate for Payer: Anthem Medicaid |
$8,205.56
|
Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
Rate for Payer: Cash Price |
$11,930.15
|
Rate for Payer: Cigna Commercial |
$19,804.05
|
Rate for Payer: First Health Commercial |
$22,667.28
|
Rate for Payer: Humana Commercial |
$20,281.26
|
Rate for Payer: Humana KY Medicaid |
$8,205.56
|
Rate for Payer: Kentucky WC Medicaid |
$8,289.07
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
Rate for Payer: Molina Healthcare Medicaid |
$8,370.19
|
Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
Rate for Payer: PHCS Commercial |
$22,905.89
|
Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
ART CMP 40M .1875 PST 9.0*10.0
|
Facility
|
OP
|
$23,860.30
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$3,101.84 |
Max. Negotiated Rate |
$22,905.89 |
Rate for Payer: Aetna Commercial |
$18,372.43
|
Rate for Payer: Anthem Medicaid |
$8,205.56
|
Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
Rate for Payer: Cash Price |
$11,930.15
|
Rate for Payer: Cigna Commercial |
$19,804.05
|
Rate for Payer: First Health Commercial |
$22,667.28
|
Rate for Payer: Humana Commercial |
$20,281.26
|
Rate for Payer: Humana KY Medicaid |
$8,205.56
|
Rate for Payer: Kentucky WC Medicaid |
$8,289.07
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
Rate for Payer: Molina Healthcare Medicaid |
$8,370.19
|
Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
Rate for Payer: PHCS Commercial |
$22,905.89
|
Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
ART CMP 40M .1875 PST 9.0*10.0
|
Facility
|
IP
|
$23,860.30
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$3,101.84 |
Max. Negotiated Rate |
$22,905.89 |
Rate for Payer: Aetna Commercial |
$18,372.43
|
Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
Rate for Payer: Cash Price |
$11,930.15
|
Rate for Payer: Cigna Commercial |
$19,804.05
|
Rate for Payer: First Health Commercial |
$22,667.28
|
Rate for Payer: Humana Commercial |
$20,281.26
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
Rate for Payer: PHCS Commercial |
$22,905.89
|
Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
ART COMP 40M .1875 PST 8.0*8.0
|
Facility
|
IP
|
$23,860.30
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$3,101.84 |
Max. Negotiated Rate |
$22,905.89 |
Rate for Payer: Aetna Commercial |
$18,372.43
|
Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
Rate for Payer: Cash Price |
$11,930.15
|
Rate for Payer: Cigna Commercial |
$19,804.05
|
Rate for Payer: First Health Commercial |
$22,667.28
|
Rate for Payer: Humana Commercial |
$20,281.26
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
Rate for Payer: PHCS Commercial |
$22,905.89
|
Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
ART COMP 40M .1875 PST 8.0*8.0
|
Facility
|
OP
|
$23,860.30
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$3,101.84 |
Max. Negotiated Rate |
$22,905.89 |
Rate for Payer: Aetna Commercial |
$18,372.43
|
Rate for Payer: Anthem Medicaid |
$8,205.56
|
Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
Rate for Payer: Cash Price |
$11,930.15
|
Rate for Payer: Cigna Commercial |
$19,804.05
|
Rate for Payer: First Health Commercial |
$22,667.28
|
Rate for Payer: Humana Commercial |
$20,281.26
|
Rate for Payer: Humana KY Medicaid |
$8,205.56
|
Rate for Payer: Kentucky WC Medicaid |
$8,289.07
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
Rate for Payer: Molina Healthcare Medicaid |
$8,370.19
|
Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
Rate for Payer: PHCS Commercial |
$22,905.89
|
Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
ART COMP 40M .1875 PST 8.0*9.0
|
Facility
|
OP
|
$23,860.30
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$3,101.84 |
Max. Negotiated Rate |
$22,905.89 |
Rate for Payer: Aetna Commercial |
$18,372.43
|
Rate for Payer: Anthem Medicaid |
$8,205.56
|
Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
Rate for Payer: Cash Price |
$11,930.15
|
Rate for Payer: Cigna Commercial |
$19,804.05
|
Rate for Payer: First Health Commercial |
$22,667.28
|
Rate for Payer: Humana Commercial |
$20,281.26
|
Rate for Payer: Humana KY Medicaid |
$8,205.56
|
Rate for Payer: Kentucky WC Medicaid |
$8,289.07
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
Rate for Payer: Molina Healthcare Medicaid |
$8,370.19
|
Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
Rate for Payer: PHCS Commercial |
$22,905.89
|
Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
ART COMP 40M .1875 PST 8.0*9.0
|
Facility
|
IP
|
$23,860.30
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$3,101.84 |
Max. Negotiated Rate |
$22,905.89 |
Rate for Payer: Aetna Commercial |
$18,372.43
|
Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
Rate for Payer: Cash Price |
$11,930.15
|
Rate for Payer: Cigna Commercial |
$19,804.05
|
Rate for Payer: First Health Commercial |
$22,667.28
|
Rate for Payer: Humana Commercial |
$20,281.26
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
Rate for Payer: PHCS Commercial |
$22,905.89
|
Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
ART COMP 40M .1875 PST 8.5*8.5
|
Facility
|
IP
|
$23,860.30
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$3,101.84 |
Max. Negotiated Rate |
$22,905.89 |
Rate for Payer: Aetna Commercial |
$18,372.43
|
Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
Rate for Payer: Cash Price |
$11,930.15
|
Rate for Payer: Cigna Commercial |
$19,804.05
|
Rate for Payer: First Health Commercial |
$22,667.28
|
Rate for Payer: Humana Commercial |
$20,281.26
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
Rate for Payer: PHCS Commercial |
$22,905.89
|
Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
ART COMP 40M .1875 PST 8.5*8.5
|
Facility
|
OP
|
$23,860.30
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$3,101.84 |
Max. Negotiated Rate |
$22,905.89 |
Rate for Payer: Aetna Commercial |
$18,372.43
|
Rate for Payer: Anthem Medicaid |
$8,205.56
|
Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
Rate for Payer: Cash Price |
$11,930.15
|
Rate for Payer: Cigna Commercial |
$19,804.05
|
Rate for Payer: First Health Commercial |
$22,667.28
|
Rate for Payer: Humana Commercial |
$20,281.26
|
Rate for Payer: Humana KY Medicaid |
$8,205.56
|
Rate for Payer: Kentucky WC Medicaid |
$8,289.07
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
Rate for Payer: Molina Healthcare Medicaid |
$8,370.19
|
Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
Rate for Payer: PHCS Commercial |
$22,905.89
|
Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
ART COMP 40M .1875 PST 9.0*9.0
|
Facility
|
OP
|
$23,860.30
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$3,101.84 |
Max. Negotiated Rate |
$22,905.89 |
Rate for Payer: Aetna Commercial |
$18,372.43
|
Rate for Payer: Anthem Medicaid |
$8,205.56
|
Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
Rate for Payer: Cash Price |
$11,930.15
|
Rate for Payer: Cigna Commercial |
$19,804.05
|
Rate for Payer: First Health Commercial |
$22,667.28
|
Rate for Payer: Humana Commercial |
$20,281.26
|
Rate for Payer: Humana KY Medicaid |
$8,205.56
|
Rate for Payer: Kentucky WC Medicaid |
$8,289.07
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
Rate for Payer: Molina Healthcare Medicaid |
$8,370.19
|
Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
Rate for Payer: PHCS Commercial |
$22,905.89
|
Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
ART COMP 40M .1875 PST 9.0*9.0
|
Facility
|
IP
|
$23,860.30
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$3,101.84 |
Max. Negotiated Rate |
$22,905.89 |
Rate for Payer: Aetna Commercial |
$18,372.43
|
Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
Rate for Payer: Cash Price |
$11,930.15
|
Rate for Payer: Cigna Commercial |
$19,804.05
|
Rate for Payer: First Health Commercial |
$22,667.28
|
Rate for Payer: Humana Commercial |
$20,281.26
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
Rate for Payer: PHCS Commercial |
$22,905.89
|
Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
ART COMP 40M .1875 PST 9.5*9.5
|
Facility
|
OP
|
$23,860.30
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$3,101.84 |
Max. Negotiated Rate |
$22,905.89 |
Rate for Payer: Aetna Commercial |
$18,372.43
|
Rate for Payer: Anthem Medicaid |
$8,205.56
|
Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
Rate for Payer: Cash Price |
$11,930.15
|
Rate for Payer: Cigna Commercial |
$19,804.05
|
Rate for Payer: First Health Commercial |
$22,667.28
|
Rate for Payer: Humana Commercial |
$20,281.26
|
Rate for Payer: Humana KY Medicaid |
$8,205.56
|
Rate for Payer: Kentucky WC Medicaid |
$8,289.07
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
Rate for Payer: Molina Healthcare Medicaid |
$8,370.19
|
Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
Rate for Payer: PHCS Commercial |
$22,905.89
|
Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
ART COMP 40M .1875 PST 9.5*9.5
|
Facility
|
IP
|
$23,860.30
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$3,101.84 |
Max. Negotiated Rate |
$22,905.89 |
Rate for Payer: Aetna Commercial |
$18,372.43
|
Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
Rate for Payer: Cash Price |
$11,930.15
|
Rate for Payer: Cigna Commercial |
$19,804.05
|
Rate for Payer: First Health Commercial |
$22,667.28
|
Rate for Payer: Humana Commercial |
$20,281.26
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
Rate for Payer: PHCS Commercial |
$22,905.89
|
Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
ARTEGRAFT BOVINE 5MM*15CM
|
Facility
|
OP
|
$8,234.85
|
|
Service Code
|
HCPCS C1768
|
Hospital Charge Code |
27000052
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,070.53 |
Max. Negotiated Rate |
$7,905.46 |
Rate for Payer: Aetna Commercial |
$6,340.83
|
Rate for Payer: Anthem Medicaid |
$2,831.96
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,423.18
|
Rate for Payer: Cash Price |
$4,117.42
|
Rate for Payer: Cigna Commercial |
$6,834.93
|
Rate for Payer: First Health Commercial |
$7,823.11
|
Rate for Payer: Humana Commercial |
$6,999.62
|
Rate for Payer: Humana KY Medicaid |
$2,831.96
|
Rate for Payer: Kentucky WC Medicaid |
$2,860.79
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$6,752.58
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,077.32
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,470.46
|
Rate for Payer: Molina Healthcare Medicaid |
$2,888.79
|
Rate for Payer: Ohio Health Choice Commercial |
$7,246.67
|
Rate for Payer: Ohio Health Group HMO |
$6,176.14
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,646.97
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,070.53
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,552.80
|
Rate for Payer: PHCS Commercial |
$7,905.46
|
Rate for Payer: United Healthcare All Payer |
$7,246.67
|
|
ARTEGRAFT BOVINE 5MM*15CM
|
Facility
|
IP
|
$8,234.85
|
|
Service Code
|
HCPCS C1768
|
Hospital Charge Code |
27000052
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,070.53 |
Max. Negotiated Rate |
$7,905.46 |
Rate for Payer: Aetna Commercial |
$6,340.83
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,423.18
|
Rate for Payer: Cash Price |
$4,117.42
|
Rate for Payer: Cigna Commercial |
$6,834.93
|
Rate for Payer: First Health Commercial |
$7,823.11
|
Rate for Payer: Humana Commercial |
$6,999.62
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$6,752.58
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,077.32
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,470.46
|
Rate for Payer: Ohio Health Choice Commercial |
$7,246.67
|
Rate for Payer: Ohio Health Group HMO |
$6,176.14
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,646.97
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,070.53
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,552.80
|
Rate for Payer: PHCS Commercial |
$7,905.46
|
Rate for Payer: United Healthcare All Payer |
$7,246.67
|
|
ARTEGRAFT BOVINE 5MM*30CM
|
Facility
|
OP
|
$7,212.85
|
|
Service Code
|
HCPCS C1768
|
Hospital Charge Code |
27000052
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$937.67 |
Max. Negotiated Rate |
$6,924.34 |
Rate for Payer: Aetna Commercial |
$5,553.89
|
Rate for Payer: Anthem Medicaid |
$2,480.50
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,626.02
|
Rate for Payer: Cash Price |
$3,606.43
|
Rate for Payer: Cigna Commercial |
$5,986.67
|
Rate for Payer: First Health Commercial |
$6,852.21
|
Rate for Payer: Humana Commercial |
$6,130.92
|
Rate for Payer: Humana KY Medicaid |
$2,480.50
|
Rate for Payer: Kentucky WC Medicaid |
$2,505.74
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$5,914.54
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,323.08
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,163.86
|
Rate for Payer: Molina Healthcare Medicaid |
$2,530.27
|
Rate for Payer: Ohio Health Choice Commercial |
$6,347.31
|
Rate for Payer: Ohio Health Group HMO |
$5,409.64
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,442.57
|
Rate for Payer: Ohio Health Group PPO No Differential |
$937.67
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,235.98
|
Rate for Payer: PHCS Commercial |
$6,924.34
|
Rate for Payer: United Healthcare All Payer |
$6,347.31
|
|