|
ART TEST W/O TREADMILL EXER.
|
Facility
|
IP
|
$815.00
|
|
|
Service Code
|
HCPCS 93923
|
| Hospital Charge Code |
92100005
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$105.95 |
| Max. Negotiated Rate |
$782.40 |
| Rate for Payer: Aetna Commercial |
$627.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$635.70
|
| Rate for Payer: Cash Price |
$407.50
|
| Rate for Payer: Cigna Commercial |
$676.45
|
| Rate for Payer: First Health Commercial |
$774.25
|
| Rate for Payer: Humana Commercial |
$692.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$668.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$601.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$717.20
|
| Rate for Payer: Ohio Health Group HMO |
$611.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$163.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$252.65
|
| Rate for Payer: PHCS Commercial |
$782.40
|
| Rate for Payer: United Healthcare All Payer |
$717.20
|
|
|
ART TEST W/O TREADMILL EXER.
|
Facility
|
IP
|
$715.00
|
|
|
Service Code
|
HCPCS 93923
|
| Hospital Charge Code |
48000104
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$92.95 |
| Max. Negotiated Rate |
$686.40 |
| Rate for Payer: Aetna Commercial |
$550.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$557.70
|
| Rate for Payer: Cash Price |
$357.50
|
| Rate for Payer: Cigna Commercial |
$593.45
|
| Rate for Payer: First Health Commercial |
$679.25
|
| Rate for Payer: Humana Commercial |
$607.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$586.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$527.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$214.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$629.20
|
| Rate for Payer: Ohio Health Group HMO |
$536.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$143.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$92.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$221.65
|
| Rate for Payer: PHCS Commercial |
$686.40
|
| Rate for Payer: United Healthcare All Payer |
$629.20
|
|
|
ART TEST W/O TREADMILL EXER.
|
Facility
|
OP
|
$715.00
|
|
|
Service Code
|
HCPCS 93923
|
| Hospital Charge Code |
48000104
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$92.95 |
| Max. Negotiated Rate |
$686.40 |
| Rate for Payer: Aetna Commercial |
$550.55
|
| Rate for Payer: Anthem Medicaid |
$245.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$135.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$557.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$189.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$182.36
|
| Rate for Payer: Cash Price |
$357.50
|
| Rate for Payer: Cash Price |
$357.50
|
| Rate for Payer: Cigna Commercial |
$593.45
|
| Rate for Payer: First Health Commercial |
$679.25
|
| Rate for Payer: Humana Commercial |
$607.75
|
| Rate for Payer: Humana KY Medicaid |
$245.89
|
| Rate for Payer: Humana Medicare Advantage |
$135.08
|
| Rate for Payer: Kentucky WC Medicaid |
$248.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$586.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$527.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$250.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$629.20
|
| Rate for Payer: Ohio Health Group HMO |
$536.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$143.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$92.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$221.65
|
| Rate for Payer: PHCS Commercial |
$686.40
|
| Rate for Payer: United Healthcare All Payer |
$629.20
|
|
|
ART TEST W/O TREADMILL EXER.
|
Facility
|
OP
|
$815.00
|
|
|
Service Code
|
HCPCS 93923
|
| Hospital Charge Code |
92100005
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$105.95 |
| Max. Negotiated Rate |
$782.40 |
| Rate for Payer: Aetna Commercial |
$627.55
|
| Rate for Payer: Anthem Medicaid |
$280.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$135.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$635.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$189.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$182.36
|
| Rate for Payer: Cash Price |
$407.50
|
| Rate for Payer: Cash Price |
$407.50
|
| Rate for Payer: Cigna Commercial |
$676.45
|
| Rate for Payer: First Health Commercial |
$774.25
|
| Rate for Payer: Humana Commercial |
$692.75
|
| Rate for Payer: Humana KY Medicaid |
$280.28
|
| Rate for Payer: Humana Medicare Advantage |
$135.08
|
| Rate for Payer: Kentucky WC Medicaid |
$283.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$668.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$601.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$285.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$717.20
|
| Rate for Payer: Ohio Health Group HMO |
$611.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$163.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$252.65
|
| Rate for Payer: PHCS Commercial |
$782.40
|
| Rate for Payer: United Healthcare All Payer |
$717.20
|
|
|
ART TEST W/O TREADMILL EXER.(P
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 93923
|
| Hospital Charge Code |
921P0005
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$30.43 |
| Max. Negotiated Rate |
$301.92 |
| Rate for Payer: Aetna Commercial |
$282.64
|
| Rate for Payer: Anthem Medicaid |
$91.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$100.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$233.77
|
| Rate for Payer: Healthspan PPO |
$301.92
|
| Rate for Payer: Humana Medicaid |
$91.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$30.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$93.00
|
| Rate for Payer: Molina Healthcare Passport |
$91.18
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.00
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$92.09
|
|
|
ART TEST W/O TREADMILL EXER.(T
|
Facility
|
IP
|
$715.00
|
|
|
Service Code
|
HCPCS 93923
|
| Hospital Charge Code |
921T0005
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$92.95 |
| Max. Negotiated Rate |
$686.40 |
| Rate for Payer: Aetna Commercial |
$550.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$557.70
|
| Rate for Payer: Cash Price |
$357.50
|
| Rate for Payer: Cigna Commercial |
$593.45
|
| Rate for Payer: First Health Commercial |
$679.25
|
| Rate for Payer: Humana Commercial |
$607.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$586.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$527.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$214.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$629.20
|
| Rate for Payer: Ohio Health Group HMO |
$536.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$143.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$92.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$221.65
|
| Rate for Payer: PHCS Commercial |
$686.40
|
| Rate for Payer: United Healthcare All Payer |
$629.20
|
|
|
ART TEST W/O TREADMILL EXER.(T
|
Facility
|
OP
|
$715.00
|
|
|
Service Code
|
HCPCS 93923
|
| Hospital Charge Code |
921T0005
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$92.95 |
| Max. Negotiated Rate |
$686.40 |
| Rate for Payer: Aetna Commercial |
$550.55
|
| Rate for Payer: Anthem Medicaid |
$245.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$135.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$557.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$189.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$182.36
|
| Rate for Payer: Cash Price |
$357.50
|
| Rate for Payer: Cash Price |
$357.50
|
| Rate for Payer: Cigna Commercial |
$593.45
|
| Rate for Payer: First Health Commercial |
$679.25
|
| Rate for Payer: Humana Commercial |
$607.75
|
| Rate for Payer: Humana KY Medicaid |
$245.89
|
| Rate for Payer: Humana Medicare Advantage |
$135.08
|
| Rate for Payer: Kentucky WC Medicaid |
$248.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$586.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$527.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$250.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$629.20
|
| Rate for Payer: Ohio Health Group HMO |
$536.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$143.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$92.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$221.65
|
| Rate for Payer: PHCS Commercial |
$686.40
|
| Rate for Payer: United Healthcare All Payer |
$629.20
|
|
|
ARZERRA 10MG[1000MG/50MLVIAL]
|
Facility
|
OP
|
$32,883.67
|
|
|
Service Code
|
HCPCS J9302
|
| Hospital Charge Code |
25002669
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$63.96 |
| Max. Negotiated Rate |
$31,568.32 |
| Rate for Payer: Aetna Commercial |
$25,320.43
|
| Rate for Payer: Anthem Medicaid |
$11,308.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$63.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,649.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$89.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$86.34
|
| Rate for Payer: Cash Price |
$16,441.83
|
| Rate for Payer: Cash Price |
$16,441.83
|
| Rate for Payer: Cigna Commercial |
$27,293.45
|
| Rate for Payer: First Health Commercial |
$31,239.49
|
| Rate for Payer: Humana Commercial |
$27,951.12
|
| Rate for Payer: Humana KY Medicaid |
$11,308.69
|
| Rate for Payer: Humana Medicare Advantage |
$63.96
|
| Rate for Payer: Kentucky WC Medicaid |
$11,423.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,964.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,268.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$76.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,535.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,937.63
|
| Rate for Payer: Ohio Health Group HMO |
$24,662.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,576.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,274.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,193.94
|
| Rate for Payer: PHCS Commercial |
$31,568.32
|
| Rate for Payer: United Healthcare All Payer |
$28,937.63
|
|
|
ARZERRA 10MG[1000MG/50MLVIAL]
|
Facility
|
IP
|
$32,883.67
|
|
|
Service Code
|
HCPCS J9302
|
| Hospital Charge Code |
25002669
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,274.88 |
| Max. Negotiated Rate |
$31,568.32 |
| Rate for Payer: Aetna Commercial |
$25,320.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,649.26
|
| Rate for Payer: Cash Price |
$16,441.83
|
| Rate for Payer: Cigna Commercial |
$27,293.45
|
| Rate for Payer: First Health Commercial |
$31,239.49
|
| Rate for Payer: Humana Commercial |
$27,951.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,964.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,268.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,865.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,937.63
|
| Rate for Payer: Ohio Health Group HMO |
$24,662.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,576.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,274.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,193.94
|
| Rate for Payer: PHCS Commercial |
$31,568.32
|
| Rate for Payer: United Healthcare All Payer |
$28,937.63
|
|
|
ARZERRA 10MG [100MG/5ML VIAL
|
Facility
|
OP
|
$3,288.37
|
|
|
Service Code
|
HCPCS J9302
|
| Hospital Charge Code |
25002668
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$63.96 |
| Max. Negotiated Rate |
$3,156.84 |
| Rate for Payer: Aetna Commercial |
$2,532.04
|
| Rate for Payer: Anthem Medicaid |
$1,130.87
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$63.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,564.93
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$89.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$86.34
|
| Rate for Payer: Cash Price |
$1,644.18
|
| Rate for Payer: Cash Price |
$1,644.18
|
| Rate for Payer: Cigna Commercial |
$2,729.35
|
| Rate for Payer: First Health Commercial |
$3,123.95
|
| Rate for Payer: Humana Commercial |
$2,795.11
|
| Rate for Payer: Humana KY Medicaid |
$1,130.87
|
| Rate for Payer: Humana Medicare Advantage |
$63.96
|
| Rate for Payer: Kentucky WC Medicaid |
$1,142.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,696.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,426.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$76.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,153.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,893.77
|
| Rate for Payer: Ohio Health Group HMO |
$2,466.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$657.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$427.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,019.39
|
| Rate for Payer: PHCS Commercial |
$3,156.84
|
| Rate for Payer: United Healthcare All Payer |
$2,893.77
|
|
|
ARZERRA 10MG [100MG/5ML VIAL
|
Facility
|
IP
|
$3,288.37
|
|
|
Service Code
|
HCPCS J9302
|
| Hospital Charge Code |
25002668
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$427.49 |
| Max. Negotiated Rate |
$3,156.84 |
| Rate for Payer: Aetna Commercial |
$2,532.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,564.93
|
| Rate for Payer: Cash Price |
$1,644.18
|
| Rate for Payer: Cigna Commercial |
$2,729.35
|
| Rate for Payer: First Health Commercial |
$3,123.95
|
| Rate for Payer: Humana Commercial |
$2,795.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,696.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,426.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$986.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,893.77
|
| Rate for Payer: Ohio Health Group HMO |
$2,466.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$657.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$427.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,019.39
|
| Rate for Payer: PHCS Commercial |
$3,156.84
|
| Rate for Payer: United Healthcare All Payer |
$2,893.77
|
|
|
AS CEM HUM STEM RMV HD 12*210
|
Facility
|
IP
|
$21,470.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,791.14 |
| Max. Negotiated Rate |
$20,611.47 |
| Rate for Payer: Aetna Commercial |
$16,532.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,746.82
|
| Rate for Payer: Cash Price |
$10,735.14
|
| Rate for Payer: Cigna Commercial |
$17,820.33
|
| Rate for Payer: First Health Commercial |
$20,396.77
|
| Rate for Payer: Humana Commercial |
$18,249.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,605.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,845.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,441.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,893.85
|
| Rate for Payer: Ohio Health Group HMO |
$16,102.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,294.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,791.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,655.79
|
| Rate for Payer: PHCS Commercial |
$20,611.47
|
| Rate for Payer: United Healthcare All Payer |
$18,893.85
|
|
|
AS CEM HUM STEM RMV HD 12*210
|
Facility
|
OP
|
$21,470.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,791.14 |
| Max. Negotiated Rate |
$20,611.47 |
| Rate for Payer: Aetna Commercial |
$16,532.12
|
| Rate for Payer: Anthem Medicaid |
$7,383.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,746.82
|
| Rate for Payer: Cash Price |
$10,735.14
|
| Rate for Payer: Cigna Commercial |
$17,820.33
|
| Rate for Payer: First Health Commercial |
$20,396.77
|
| Rate for Payer: Humana Commercial |
$18,249.74
|
| Rate for Payer: Humana KY Medicaid |
$7,383.63
|
| Rate for Payer: Kentucky WC Medicaid |
$7,458.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,605.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,845.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,441.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,531.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,893.85
|
| Rate for Payer: Ohio Health Group HMO |
$16,102.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,294.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,791.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,655.79
|
| Rate for Payer: PHCS Commercial |
$20,611.47
|
| Rate for Payer: United Healthcare All Payer |
$18,893.85
|
|
|
AS CEM HUM STEM RMV HD 14*210
|
Facility
|
OP
|
$21,470.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,791.14 |
| Max. Negotiated Rate |
$20,611.47 |
| Rate for Payer: Aetna Commercial |
$16,532.12
|
| Rate for Payer: Anthem Medicaid |
$7,383.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,746.82
|
| Rate for Payer: Cash Price |
$10,735.14
|
| Rate for Payer: Cigna Commercial |
$17,820.33
|
| Rate for Payer: First Health Commercial |
$20,396.77
|
| Rate for Payer: Humana Commercial |
$18,249.74
|
| Rate for Payer: Humana KY Medicaid |
$7,383.63
|
| Rate for Payer: Kentucky WC Medicaid |
$7,458.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,605.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,845.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,441.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,531.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,893.85
|
| Rate for Payer: Ohio Health Group HMO |
$16,102.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,294.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,791.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,655.79
|
| Rate for Payer: PHCS Commercial |
$20,611.47
|
| Rate for Payer: United Healthcare All Payer |
$18,893.85
|
|
|
AS CEM HUM STEM RMV HD 14*210
|
Facility
|
IP
|
$21,470.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,791.14 |
| Max. Negotiated Rate |
$20,611.47 |
| Rate for Payer: Aetna Commercial |
$16,532.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,746.82
|
| Rate for Payer: Cash Price |
$10,735.14
|
| Rate for Payer: Cigna Commercial |
$17,820.33
|
| Rate for Payer: First Health Commercial |
$20,396.77
|
| Rate for Payer: Humana Commercial |
$18,249.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,605.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,845.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,441.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,893.85
|
| Rate for Payer: Ohio Health Group HMO |
$16,102.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,294.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,791.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,655.79
|
| Rate for Payer: PHCS Commercial |
$20,611.47
|
| Rate for Payer: United Healthcare All Payer |
$18,893.85
|
|
|
AS CEM HUM STEM RMV HD 7*200
|
Facility
|
OP
|
$21,470.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,791.14 |
| Max. Negotiated Rate |
$20,611.47 |
| Rate for Payer: Aetna Commercial |
$16,532.12
|
| Rate for Payer: Anthem Medicaid |
$7,383.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,746.82
|
| Rate for Payer: Cash Price |
$10,735.14
|
| Rate for Payer: Cigna Commercial |
$17,820.33
|
| Rate for Payer: First Health Commercial |
$20,396.77
|
| Rate for Payer: Humana Commercial |
$18,249.74
|
| Rate for Payer: Humana KY Medicaid |
$7,383.63
|
| Rate for Payer: Kentucky WC Medicaid |
$7,458.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,605.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,845.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,441.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,531.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,893.85
|
| Rate for Payer: Ohio Health Group HMO |
$16,102.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,294.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,791.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,655.79
|
| Rate for Payer: PHCS Commercial |
$20,611.47
|
| Rate for Payer: United Healthcare All Payer |
$18,893.85
|
|
|
AS CEM HUM STEM RMV HD 7*200
|
Facility
|
IP
|
$21,470.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,791.14 |
| Max. Negotiated Rate |
$20,611.47 |
| Rate for Payer: Aetna Commercial |
$16,532.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,746.82
|
| Rate for Payer: Cash Price |
$10,735.14
|
| Rate for Payer: Cigna Commercial |
$17,820.33
|
| Rate for Payer: First Health Commercial |
$20,396.77
|
| Rate for Payer: Humana Commercial |
$18,249.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,605.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,845.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,441.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,893.85
|
| Rate for Payer: Ohio Health Group HMO |
$16,102.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,294.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,791.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,655.79
|
| Rate for Payer: PHCS Commercial |
$20,611.47
|
| Rate for Payer: United Healthcare All Payer |
$18,893.85
|
|
|
AS CEM HUM STEM RMV HD 9*210
|
Facility
|
OP
|
$21,470.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,791.14 |
| Max. Negotiated Rate |
$20,611.47 |
| Rate for Payer: Aetna Commercial |
$16,532.12
|
| Rate for Payer: Anthem Medicaid |
$7,383.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,746.82
|
| Rate for Payer: Cash Price |
$10,735.14
|
| Rate for Payer: Cigna Commercial |
$17,820.33
|
| Rate for Payer: First Health Commercial |
$20,396.77
|
| Rate for Payer: Humana Commercial |
$18,249.74
|
| Rate for Payer: Humana KY Medicaid |
$7,383.63
|
| Rate for Payer: Kentucky WC Medicaid |
$7,458.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,605.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,845.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,441.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,531.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,893.85
|
| Rate for Payer: Ohio Health Group HMO |
$16,102.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,294.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,791.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,655.79
|
| Rate for Payer: PHCS Commercial |
$20,611.47
|
| Rate for Payer: United Healthcare All Payer |
$18,893.85
|
|
|
AS CEM HUM STEM RMV HD 9*210
|
Facility
|
IP
|
$21,470.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,791.14 |
| Max. Negotiated Rate |
$20,611.47 |
| Rate for Payer: Aetna Commercial |
$16,532.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,746.82
|
| Rate for Payer: Cash Price |
$10,735.14
|
| Rate for Payer: Cigna Commercial |
$17,820.33
|
| Rate for Payer: First Health Commercial |
$20,396.77
|
| Rate for Payer: Humana Commercial |
$18,249.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,605.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,845.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,441.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,893.85
|
| Rate for Payer: Ohio Health Group HMO |
$16,102.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,294.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,791.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,655.79
|
| Rate for Payer: PHCS Commercial |
$20,611.47
|
| Rate for Payer: United Healthcare All Payer |
$18,893.85
|
|
|
AS CEM HUM STEM W/REM HD 7*100
|
Facility
|
OP
|
$17,649.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,294.45 |
| Max. Negotiated Rate |
$16,943.62 |
| Rate for Payer: Aetna Commercial |
$13,590.19
|
| Rate for Payer: Anthem Medicaid |
$6,069.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,766.69
|
| Rate for Payer: Cash Price |
$8,824.80
|
| Rate for Payer: Cigna Commercial |
$14,649.17
|
| Rate for Payer: First Health Commercial |
$16,767.12
|
| Rate for Payer: Humana Commercial |
$15,002.16
|
| Rate for Payer: Humana KY Medicaid |
$6,069.70
|
| Rate for Payer: Kentucky WC Medicaid |
$6,131.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,472.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,025.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,294.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,191.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,531.65
|
| Rate for Payer: Ohio Health Group HMO |
$13,237.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,529.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,294.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,471.38
|
| Rate for Payer: PHCS Commercial |
$16,943.62
|
| Rate for Payer: United Healthcare All Payer |
$15,531.65
|
|
|
AS CEM HUM STEM W/REM HD 7*100
|
Facility
|
IP
|
$17,649.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,294.45 |
| Max. Negotiated Rate |
$16,943.62 |
| Rate for Payer: Aetna Commercial |
$13,590.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,766.69
|
| Rate for Payer: Cash Price |
$8,824.80
|
| Rate for Payer: Cigna Commercial |
$14,649.17
|
| Rate for Payer: First Health Commercial |
$16,767.12
|
| Rate for Payer: Humana Commercial |
$15,002.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,472.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,025.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,294.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,531.65
|
| Rate for Payer: Ohio Health Group HMO |
$13,237.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,529.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,294.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,471.38
|
| Rate for Payer: PHCS Commercial |
$16,943.62
|
| Rate for Payer: United Healthcare All Payer |
$15,531.65
|
|
|
AS CEM HUM STEM W/REM HD 9*110
|
Facility
|
IP
|
$17,649.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,294.45 |
| Max. Negotiated Rate |
$16,943.62 |
| Rate for Payer: Aetna Commercial |
$13,590.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,766.69
|
| Rate for Payer: Cash Price |
$8,824.80
|
| Rate for Payer: Cigna Commercial |
$14,649.17
|
| Rate for Payer: First Health Commercial |
$16,767.12
|
| Rate for Payer: Humana Commercial |
$15,002.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,472.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,025.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,294.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,531.65
|
| Rate for Payer: Ohio Health Group HMO |
$13,237.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,529.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,294.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,471.38
|
| Rate for Payer: PHCS Commercial |
$16,943.62
|
| Rate for Payer: United Healthcare All Payer |
$15,531.65
|
|
|
AS CEM HUM STEM W/REM HD 9*110
|
Facility
|
OP
|
$17,649.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,294.45 |
| Max. Negotiated Rate |
$16,943.62 |
| Rate for Payer: Aetna Commercial |
$13,590.19
|
| Rate for Payer: Anthem Medicaid |
$6,069.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,766.69
|
| Rate for Payer: Cash Price |
$8,824.80
|
| Rate for Payer: Cigna Commercial |
$14,649.17
|
| Rate for Payer: First Health Commercial |
$16,767.12
|
| Rate for Payer: Humana Commercial |
$15,002.16
|
| Rate for Payer: Humana KY Medicaid |
$6,069.70
|
| Rate for Payer: Kentucky WC Medicaid |
$6,131.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,472.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,025.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,294.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,191.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,531.65
|
| Rate for Payer: Ohio Health Group HMO |
$13,237.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,529.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,294.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,471.38
|
| Rate for Payer: PHCS Commercial |
$16,943.62
|
| Rate for Payer: United Healthcare All Payer |
$15,531.65
|
|
|
AS CEM HUM STEM W/RMV HD12*100
|
Facility
|
OP
|
$17,980.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,337.50 |
| Max. Negotiated Rate |
$17,261.57 |
| Rate for Payer: Aetna Commercial |
$13,845.22
|
| Rate for Payer: Anthem Medicaid |
$6,183.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,025.02
|
| Rate for Payer: Cash Price |
$8,990.40
|
| Rate for Payer: Cigna Commercial |
$14,924.06
|
| Rate for Payer: First Health Commercial |
$17,081.76
|
| Rate for Payer: Humana Commercial |
$15,283.68
|
| Rate for Payer: Humana KY Medicaid |
$6,183.60
|
| Rate for Payer: Kentucky WC Medicaid |
$6,246.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,744.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,269.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,394.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,307.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,823.10
|
| Rate for Payer: Ohio Health Group HMO |
$13,485.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,596.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,337.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,574.05
|
| Rate for Payer: PHCS Commercial |
$17,261.57
|
| Rate for Payer: United Healthcare All Payer |
$15,823.10
|
|
|
AS CEM HUM STEM W/RMV HD12*100
|
Facility
|
IP
|
$17,980.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,337.50 |
| Max. Negotiated Rate |
$17,261.57 |
| Rate for Payer: Aetna Commercial |
$13,845.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,025.02
|
| Rate for Payer: Cash Price |
$8,990.40
|
| Rate for Payer: Cigna Commercial |
$14,924.06
|
| Rate for Payer: First Health Commercial |
$17,081.76
|
| Rate for Payer: Humana Commercial |
$15,283.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,744.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,269.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,394.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,823.10
|
| Rate for Payer: Ohio Health Group HMO |
$13,485.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,596.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,337.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,574.05
|
| Rate for Payer: PHCS Commercial |
$17,261.57
|
| Rate for Payer: United Healthcare All Payer |
$15,823.10
|
|
