|
PEEK PSHLCK 2.9*10.7 AR-1923PS
|
Facility
|
IP
|
$3,390.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$440.70 |
| Max. Negotiated Rate |
$3,254.40 |
| Rate for Payer: Aetna Commercial |
$2,610.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,644.20
|
| Rate for Payer: Cash Price |
$1,695.00
|
| Rate for Payer: Cigna Commercial |
$2,813.70
|
| Rate for Payer: First Health Commercial |
$3,220.50
|
| Rate for Payer: Humana Commercial |
$2,881.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,779.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,501.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,017.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,983.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,542.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$678.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$440.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,050.90
|
| Rate for Payer: PHCS Commercial |
$3,254.40
|
| Rate for Payer: United Healthcare All Payer |
$2,983.20
|
|
|
PEEK PSHLCK 2.9*10.7 AR-1923PS
|
Facility
|
OP
|
$3,390.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$440.70 |
| Max. Negotiated Rate |
$3,254.40 |
| Rate for Payer: Aetna Commercial |
$2,610.30
|
| Rate for Payer: Anthem Medicaid |
$1,165.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,644.20
|
| Rate for Payer: Cash Price |
$1,695.00
|
| Rate for Payer: Cigna Commercial |
$2,813.70
|
| Rate for Payer: First Health Commercial |
$3,220.50
|
| Rate for Payer: Humana Commercial |
$2,881.50
|
| Rate for Payer: Humana KY Medicaid |
$1,165.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,177.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,779.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,501.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,017.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,189.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,983.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,542.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$678.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$440.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,050.90
|
| Rate for Payer: PHCS Commercial |
$3,254.40
|
| Rate for Payer: United Healthcare All Payer |
$2,983.20
|
|
|
PEEL-AWAY INTRO KIT 7F
|
Facility
|
IP
|
$521.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.73 |
| Max. Negotiated Rate |
$500.16 |
| Rate for Payer: Aetna Commercial |
$401.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$406.38
|
| Rate for Payer: Cash Price |
$260.50
|
| Rate for Payer: Cigna Commercial |
$432.43
|
| Rate for Payer: First Health Commercial |
$494.95
|
| Rate for Payer: Humana Commercial |
$442.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$427.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$384.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$156.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$458.48
|
| Rate for Payer: Ohio Health Group HMO |
$390.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$161.51
|
| Rate for Payer: PHCS Commercial |
$500.16
|
| Rate for Payer: United Healthcare All Payer |
$458.48
|
|
|
PEEL-AWAY INTRO KIT 7F
|
Facility
|
OP
|
$521.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.73 |
| Max. Negotiated Rate |
$500.16 |
| Rate for Payer: Aetna Commercial |
$401.17
|
| Rate for Payer: Anthem Medicaid |
$179.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$406.38
|
| Rate for Payer: Cash Price |
$260.50
|
| Rate for Payer: Cigna Commercial |
$432.43
|
| Rate for Payer: First Health Commercial |
$494.95
|
| Rate for Payer: Humana Commercial |
$442.85
|
| Rate for Payer: Humana KY Medicaid |
$179.17
|
| Rate for Payer: Kentucky WC Medicaid |
$181.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$427.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$384.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$156.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$182.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$458.48
|
| Rate for Payer: Ohio Health Group HMO |
$390.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$161.51
|
| Rate for Payer: PHCS Commercial |
$500.16
|
| Rate for Payer: United Healthcare All Payer |
$458.48
|
|
|
PEEL-AWAY INTRO KIT 8F
|
Facility
|
IP
|
$1,065.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.45 |
| Max. Negotiated Rate |
$1,022.40 |
| Rate for Payer: Aetna Commercial |
$820.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$830.70
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$883.95
|
| Rate for Payer: First Health Commercial |
$1,011.75
|
| Rate for Payer: Humana Commercial |
$905.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$873.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$785.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$319.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$937.20
|
| Rate for Payer: Ohio Health Group HMO |
$798.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$213.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$138.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$330.15
|
| Rate for Payer: PHCS Commercial |
$1,022.40
|
| Rate for Payer: United Healthcare All Payer |
$937.20
|
|
|
PEEL-AWAY INTRO KIT 8F
|
Facility
|
OP
|
$1,065.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.45 |
| Max. Negotiated Rate |
$1,022.40 |
| Rate for Payer: Aetna Commercial |
$820.05
|
| Rate for Payer: Anthem Medicaid |
$366.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$830.70
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$883.95
|
| Rate for Payer: First Health Commercial |
$1,011.75
|
| Rate for Payer: Humana Commercial |
$905.25
|
| Rate for Payer: Humana KY Medicaid |
$366.25
|
| Rate for Payer: Kentucky WC Medicaid |
$369.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$873.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$785.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$319.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$373.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$937.20
|
| Rate for Payer: Ohio Health Group HMO |
$798.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$213.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$138.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$330.15
|
| Rate for Payer: PHCS Commercial |
$1,022.40
|
| Rate for Payer: United Healthcare All Payer |
$937.20
|
|
|
PEG 1 SER A PAT W/WR STD 25
|
Facility
|
IP
|
$3,880.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$504.40 |
| Max. Negotiated Rate |
$3,724.80 |
| Rate for Payer: Aetna Commercial |
$2,987.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,026.40
|
| Rate for Payer: Cash Price |
$1,940.00
|
| Rate for Payer: Cigna Commercial |
$3,220.40
|
| Rate for Payer: First Health Commercial |
$3,686.00
|
| Rate for Payer: Humana Commercial |
$3,298.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,181.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,863.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,164.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,414.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,910.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$776.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$504.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,202.80
|
| Rate for Payer: PHCS Commercial |
$3,724.80
|
| Rate for Payer: United Healthcare All Payer |
$3,414.40
|
|
|
PEG 1 SER A PAT W/WR STD 25
|
Facility
|
OP
|
$3,880.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$504.40 |
| Max. Negotiated Rate |
$3,724.80 |
| Rate for Payer: Aetna Commercial |
$2,987.60
|
| Rate for Payer: Anthem Medicaid |
$1,334.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,026.40
|
| Rate for Payer: Cash Price |
$1,940.00
|
| Rate for Payer: Cigna Commercial |
$3,220.40
|
| Rate for Payer: First Health Commercial |
$3,686.00
|
| Rate for Payer: Humana Commercial |
$3,298.00
|
| Rate for Payer: Humana KY Medicaid |
$1,334.33
|
| Rate for Payer: Kentucky WC Medicaid |
$1,347.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,181.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,863.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,164.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,361.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,414.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,910.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$776.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$504.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,202.80
|
| Rate for Payer: PHCS Commercial |
$3,724.80
|
| Rate for Payer: United Healthcare All Payer |
$3,414.40
|
|
|
PEG 1 SER A PAT W/WR STD 28
|
Facility
|
OP
|
$3,880.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$504.40 |
| Max. Negotiated Rate |
$3,724.80 |
| Rate for Payer: Aetna Commercial |
$2,987.60
|
| Rate for Payer: Anthem Medicaid |
$1,334.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,026.40
|
| Rate for Payer: Cash Price |
$1,940.00
|
| Rate for Payer: Cigna Commercial |
$3,220.40
|
| Rate for Payer: First Health Commercial |
$3,686.00
|
| Rate for Payer: Humana Commercial |
$3,298.00
|
| Rate for Payer: Humana KY Medicaid |
$1,334.33
|
| Rate for Payer: Kentucky WC Medicaid |
$1,347.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,181.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,863.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,164.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,361.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,414.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,910.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$776.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$504.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,202.80
|
| Rate for Payer: PHCS Commercial |
$3,724.80
|
| Rate for Payer: United Healthcare All Payer |
$3,414.40
|
|
|
PEG 1 SER A PAT W/WR STD 28
|
Facility
|
IP
|
$3,880.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$504.40 |
| Max. Negotiated Rate |
$3,724.80 |
| Rate for Payer: Aetna Commercial |
$2,987.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,026.40
|
| Rate for Payer: Cash Price |
$1,940.00
|
| Rate for Payer: Cigna Commercial |
$3,220.40
|
| Rate for Payer: First Health Commercial |
$3,686.00
|
| Rate for Payer: Humana Commercial |
$3,298.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,181.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,863.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,164.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,414.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,910.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$776.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$504.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,202.80
|
| Rate for Payer: PHCS Commercial |
$3,724.80
|
| Rate for Payer: United Healthcare All Payer |
$3,414.40
|
|
|
PEG 1 SER A PAT W/WR STD 31
|
Facility
|
OP
|
$3,880.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$504.40 |
| Max. Negotiated Rate |
$3,724.80 |
| Rate for Payer: Aetna Commercial |
$2,987.60
|
| Rate for Payer: Anthem Medicaid |
$1,334.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,026.40
|
| Rate for Payer: Cash Price |
$1,940.00
|
| Rate for Payer: Cigna Commercial |
$3,220.40
|
| Rate for Payer: First Health Commercial |
$3,686.00
|
| Rate for Payer: Humana Commercial |
$3,298.00
|
| Rate for Payer: Humana KY Medicaid |
$1,334.33
|
| Rate for Payer: Kentucky WC Medicaid |
$1,347.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,181.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,863.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,164.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,361.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,414.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,910.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$776.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$504.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,202.80
|
| Rate for Payer: PHCS Commercial |
$3,724.80
|
| Rate for Payer: United Healthcare All Payer |
$3,414.40
|
|
|
PEG 1 SER A PAT W/WR STD 31
|
Facility
|
IP
|
$3,880.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$504.40 |
| Max. Negotiated Rate |
$3,724.80 |
| Rate for Payer: Aetna Commercial |
$2,987.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,026.40
|
| Rate for Payer: Cash Price |
$1,940.00
|
| Rate for Payer: Cigna Commercial |
$3,220.40
|
| Rate for Payer: First Health Commercial |
$3,686.00
|
| Rate for Payer: Humana Commercial |
$3,298.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,181.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,863.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,164.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,414.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,910.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$776.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$504.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,202.80
|
| Rate for Payer: PHCS Commercial |
$3,724.80
|
| Rate for Payer: United Healthcare All Payer |
$3,414.40
|
|
|
PEG 1 SER A PAT W/WR STD 34
|
Facility
|
IP
|
$3,880.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$504.40 |
| Max. Negotiated Rate |
$3,724.80 |
| Rate for Payer: Aetna Commercial |
$2,987.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,026.40
|
| Rate for Payer: Cash Price |
$1,940.00
|
| Rate for Payer: Cigna Commercial |
$3,220.40
|
| Rate for Payer: First Health Commercial |
$3,686.00
|
| Rate for Payer: Humana Commercial |
$3,298.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,181.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,863.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,164.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,414.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,910.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$776.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$504.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,202.80
|
| Rate for Payer: PHCS Commercial |
$3,724.80
|
| Rate for Payer: United Healthcare All Payer |
$3,414.40
|
|
|
PEG 1 SER A PAT W/WR STD 34
|
Facility
|
OP
|
$3,880.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$504.40 |
| Max. Negotiated Rate |
$3,724.80 |
| Rate for Payer: Aetna Commercial |
$2,987.60
|
| Rate for Payer: Anthem Medicaid |
$1,334.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,026.40
|
| Rate for Payer: Cash Price |
$1,940.00
|
| Rate for Payer: Cigna Commercial |
$3,220.40
|
| Rate for Payer: First Health Commercial |
$3,686.00
|
| Rate for Payer: Humana Commercial |
$3,298.00
|
| Rate for Payer: Humana KY Medicaid |
$1,334.33
|
| Rate for Payer: Kentucky WC Medicaid |
$1,347.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,181.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,863.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,164.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,361.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,414.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,910.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$776.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$504.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,202.80
|
| Rate for Payer: PHCS Commercial |
$3,724.80
|
| Rate for Payer: United Healthcare All Payer |
$3,414.40
|
|
|
PEG 1 SER A PAT W/WR STD 37
|
Facility
|
IP
|
$3,880.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$504.40 |
| Max. Negotiated Rate |
$3,724.80 |
| Rate for Payer: Aetna Commercial |
$2,987.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,026.40
|
| Rate for Payer: Cash Price |
$1,940.00
|
| Rate for Payer: Cigna Commercial |
$3,220.40
|
| Rate for Payer: First Health Commercial |
$3,686.00
|
| Rate for Payer: Humana Commercial |
$3,298.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,181.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,863.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,164.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,414.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,910.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$776.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$504.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,202.80
|
| Rate for Payer: PHCS Commercial |
$3,724.80
|
| Rate for Payer: United Healthcare All Payer |
$3,414.40
|
|
|
PEG 1 SER A PAT W/WR STD 37
|
Facility
|
OP
|
$3,880.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$504.40 |
| Max. Negotiated Rate |
$3,724.80 |
| Rate for Payer: Aetna Commercial |
$2,987.60
|
| Rate for Payer: Anthem Medicaid |
$1,334.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,026.40
|
| Rate for Payer: Cash Price |
$1,940.00
|
| Rate for Payer: Cigna Commercial |
$3,220.40
|
| Rate for Payer: First Health Commercial |
$3,686.00
|
| Rate for Payer: Humana Commercial |
$3,298.00
|
| Rate for Payer: Humana KY Medicaid |
$1,334.33
|
| Rate for Payer: Kentucky WC Medicaid |
$1,347.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,181.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,863.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,164.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,361.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,414.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,910.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$776.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$504.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,202.80
|
| Rate for Payer: PHCS Commercial |
$3,724.80
|
| Rate for Payer: United Healthcare All Payer |
$3,414.40
|
|
|
PEG 1 SER A PAT W/WR STD 40
|
Facility
|
IP
|
$3,880.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$504.40 |
| Max. Negotiated Rate |
$3,724.80 |
| Rate for Payer: Aetna Commercial |
$2,987.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,026.40
|
| Rate for Payer: Cash Price |
$1,940.00
|
| Rate for Payer: Cigna Commercial |
$3,220.40
|
| Rate for Payer: First Health Commercial |
$3,686.00
|
| Rate for Payer: Humana Commercial |
$3,298.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,181.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,863.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,164.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,414.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,910.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$776.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$504.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,202.80
|
| Rate for Payer: PHCS Commercial |
$3,724.80
|
| Rate for Payer: United Healthcare All Payer |
$3,414.40
|
|
|
PEG 1 SER A PAT W/WR STD 40
|
Facility
|
OP
|
$3,880.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$504.40 |
| Max. Negotiated Rate |
$3,724.80 |
| Rate for Payer: Aetna Commercial |
$2,987.60
|
| Rate for Payer: Anthem Medicaid |
$1,334.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,026.40
|
| Rate for Payer: Cash Price |
$1,940.00
|
| Rate for Payer: Cigna Commercial |
$3,220.40
|
| Rate for Payer: First Health Commercial |
$3,686.00
|
| Rate for Payer: Humana Commercial |
$3,298.00
|
| Rate for Payer: Humana KY Medicaid |
$1,334.33
|
| Rate for Payer: Kentucky WC Medicaid |
$1,347.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,181.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,863.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,164.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,361.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,414.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,910.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$776.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$504.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,202.80
|
| Rate for Payer: PHCS Commercial |
$3,724.80
|
| Rate for Payer: United Healthcare All Payer |
$3,414.40
|
|
|
PEG 1 SER A PAT W/WR THN 25
|
Facility
|
OP
|
$3,880.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$504.40 |
| Max. Negotiated Rate |
$3,724.80 |
| Rate for Payer: Aetna Commercial |
$2,987.60
|
| Rate for Payer: Anthem Medicaid |
$1,334.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,026.40
|
| Rate for Payer: Cash Price |
$1,940.00
|
| Rate for Payer: Cigna Commercial |
$3,220.40
|
| Rate for Payer: First Health Commercial |
$3,686.00
|
| Rate for Payer: Humana Commercial |
$3,298.00
|
| Rate for Payer: Humana KY Medicaid |
$1,334.33
|
| Rate for Payer: Kentucky WC Medicaid |
$1,347.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,181.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,863.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,164.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,361.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,414.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,910.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$776.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$504.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,202.80
|
| Rate for Payer: PHCS Commercial |
$3,724.80
|
| Rate for Payer: United Healthcare All Payer |
$3,414.40
|
|
|
PEG 1 SER A PAT W/WR THN 25
|
Facility
|
IP
|
$3,880.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$504.40 |
| Max. Negotiated Rate |
$3,724.80 |
| Rate for Payer: Aetna Commercial |
$2,987.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,026.40
|
| Rate for Payer: Cash Price |
$1,940.00
|
| Rate for Payer: Cigna Commercial |
$3,220.40
|
| Rate for Payer: First Health Commercial |
$3,686.00
|
| Rate for Payer: Humana Commercial |
$3,298.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,181.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,863.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,164.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,414.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,910.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$776.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$504.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,202.80
|
| Rate for Payer: PHCS Commercial |
$3,724.80
|
| Rate for Payer: United Healthcare All Payer |
$3,414.40
|
|
|
PEG 1 SER A PAT W/WR THN 28
|
Facility
|
OP
|
$3,880.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$504.40 |
| Max. Negotiated Rate |
$3,724.80 |
| Rate for Payer: Aetna Commercial |
$2,987.60
|
| Rate for Payer: Anthem Medicaid |
$1,334.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,026.40
|
| Rate for Payer: Cash Price |
$1,940.00
|
| Rate for Payer: Cigna Commercial |
$3,220.40
|
| Rate for Payer: First Health Commercial |
$3,686.00
|
| Rate for Payer: Humana Commercial |
$3,298.00
|
| Rate for Payer: Humana KY Medicaid |
$1,334.33
|
| Rate for Payer: Kentucky WC Medicaid |
$1,347.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,181.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,863.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,164.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,361.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,414.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,910.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$776.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$504.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,202.80
|
| Rate for Payer: PHCS Commercial |
$3,724.80
|
| Rate for Payer: United Healthcare All Payer |
$3,414.40
|
|
|
PEG 1 SER A PAT W/WR THN 28
|
Facility
|
IP
|
$3,880.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$504.40 |
| Max. Negotiated Rate |
$3,724.80 |
| Rate for Payer: Aetna Commercial |
$2,987.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,026.40
|
| Rate for Payer: Cash Price |
$1,940.00
|
| Rate for Payer: Cigna Commercial |
$3,220.40
|
| Rate for Payer: First Health Commercial |
$3,686.00
|
| Rate for Payer: Humana Commercial |
$3,298.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,181.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,863.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,164.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,414.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,910.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$776.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$504.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,202.80
|
| Rate for Payer: PHCS Commercial |
$3,724.80
|
| Rate for Payer: United Healthcare All Payer |
$3,414.40
|
|
|
PEG 1 SER A PAT W/WR THN 31
|
Facility
|
OP
|
$3,880.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$504.40 |
| Max. Negotiated Rate |
$3,724.80 |
| Rate for Payer: Aetna Commercial |
$2,987.60
|
| Rate for Payer: Anthem Medicaid |
$1,334.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,026.40
|
| Rate for Payer: Cash Price |
$1,940.00
|
| Rate for Payer: Cigna Commercial |
$3,220.40
|
| Rate for Payer: First Health Commercial |
$3,686.00
|
| Rate for Payer: Humana Commercial |
$3,298.00
|
| Rate for Payer: Humana KY Medicaid |
$1,334.33
|
| Rate for Payer: Kentucky WC Medicaid |
$1,347.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,181.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,863.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,164.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,361.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,414.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,910.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$776.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$504.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,202.80
|
| Rate for Payer: PHCS Commercial |
$3,724.80
|
| Rate for Payer: United Healthcare All Payer |
$3,414.40
|
|
|
PEG 1 SER A PAT W/WR THN 31
|
Facility
|
IP
|
$3,880.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$504.40 |
| Max. Negotiated Rate |
$3,724.80 |
| Rate for Payer: Aetna Commercial |
$2,987.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,026.40
|
| Rate for Payer: Cash Price |
$1,940.00
|
| Rate for Payer: Cigna Commercial |
$3,220.40
|
| Rate for Payer: First Health Commercial |
$3,686.00
|
| Rate for Payer: Humana Commercial |
$3,298.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,181.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,863.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,164.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,414.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,910.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$776.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$504.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,202.80
|
| Rate for Payer: PHCS Commercial |
$3,724.80
|
| Rate for Payer: United Healthcare All Payer |
$3,414.40
|
|
|
PEG 1 SER A PAT W/WR THN 34
|
Facility
|
OP
|
$3,880.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$504.40 |
| Max. Negotiated Rate |
$3,724.80 |
| Rate for Payer: Aetna Commercial |
$2,987.60
|
| Rate for Payer: Anthem Medicaid |
$1,334.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,026.40
|
| Rate for Payer: Cash Price |
$1,940.00
|
| Rate for Payer: Cigna Commercial |
$3,220.40
|
| Rate for Payer: First Health Commercial |
$3,686.00
|
| Rate for Payer: Humana Commercial |
$3,298.00
|
| Rate for Payer: Humana KY Medicaid |
$1,334.33
|
| Rate for Payer: Kentucky WC Medicaid |
$1,347.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,181.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,863.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,164.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,361.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,414.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,910.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$776.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$504.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,202.80
|
| Rate for Payer: PHCS Commercial |
$3,724.80
|
| Rate for Payer: United Healthcare All Payer |
$3,414.40
|
|
