|
AS CEM HUM STEM W/RMV HD14*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: Humana Commercial |
$15,283.68
|
| 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: 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
|
|
|
AS CEM HUM STEM W/RMV HD14*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 HED7*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 HED7*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
|
|
|
AS CEM HUM STEM W/RMV HED9*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 HED9*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
|
|
|
AS CEM HUM STM W/REM HD 12*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 STM W/REM HD 12*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 STM W/REM HD 14*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 STM W/REM HD 14*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
|
|
|
ASCEND AORTA GRAFT W/CP BYPASS
|
Professional
|
Both
|
$6,670.00
|
|
|
Service Code
|
HCPCS 33863
|
| Hospital Charge Code |
761P1319
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,112.29 |
| Max. Negotiated Rate |
$6,670.00 |
| Rate for Payer: Aetna Commercial |
$5,355.49
|
| Rate for Payer: Anthem Medicaid |
$2,112.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,670.00
|
| Rate for Payer: Cash Price |
$3,335.00
|
| Rate for Payer: Cash Price |
$3,335.00
|
| Rate for Payer: Cigna Commercial |
$4,933.74
|
| Rate for Payer: Healthspan PPO |
$5,265.50
|
| Rate for Payer: Humana Medicaid |
$2,112.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$4,466.07
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$2,154.54
|
| Rate for Payer: Molina Healthcare Passport |
$2,112.29
|
| Rate for Payer: Multiplan PHCS |
$4,002.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,669.00
|
| Rate for Payer: UHCCP Medicaid |
$2,334.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$2,133.41
|
|
|
ASCEND AORTA GRAFT W/CP BYPASS
|
Facility
|
OP
|
$6,670.00
|
|
|
Service Code
|
HCPCS 33863
|
| Hospital Charge Code |
76101319
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$867.10 |
| Max. Negotiated Rate |
$6,403.20 |
| Rate for Payer: Aetna Commercial |
$5,135.90
|
| Rate for Payer: Anthem Medicaid |
$2,293.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,202.60
|
| Rate for Payer: Cash Price |
$3,335.00
|
| Rate for Payer: Cigna Commercial |
$5,536.10
|
| Rate for Payer: First Health Commercial |
$6,336.50
|
| Rate for Payer: Humana Commercial |
$5,669.50
|
| Rate for Payer: Humana KY Medicaid |
$2,293.81
|
| Rate for Payer: Kentucky WC Medicaid |
$2,317.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,469.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,922.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,001.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,339.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,869.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,002.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,334.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$867.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,067.70
|
| Rate for Payer: PHCS Commercial |
$6,403.20
|
| Rate for Payer: United Healthcare All Payer |
$5,869.60
|
|
|
ASCEND AORTA GRAFT W/CP BYPASS
|
Professional
|
Both
|
$6,670.00
|
|
|
Service Code
|
HCPCS 33863
|
| Hospital Charge Code |
76101319
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,112.29 |
| Max. Negotiated Rate |
$6,670.00 |
| Rate for Payer: Aetna Commercial |
$5,355.49
|
| Rate for Payer: Anthem Medicaid |
$2,112.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,670.00
|
| Rate for Payer: Cash Price |
$3,335.00
|
| Rate for Payer: Cash Price |
$3,335.00
|
| Rate for Payer: Cigna Commercial |
$4,933.74
|
| Rate for Payer: Healthspan PPO |
$5,265.50
|
| Rate for Payer: Humana Medicaid |
$2,112.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$4,466.07
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$2,154.54
|
| Rate for Payer: Molina Healthcare Passport |
$2,112.29
|
| Rate for Payer: Multiplan PHCS |
$4,002.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,669.00
|
| Rate for Payer: UHCCP Medicaid |
$2,334.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$2,133.41
|
|
|
ASCEND AORTA GRAFT W/CP BYPASS
|
Facility
|
IP
|
$6,670.00
|
|
|
Service Code
|
HCPCS 33863
|
| Hospital Charge Code |
76101319
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$867.10 |
| Max. Negotiated Rate |
$6,403.20 |
| Rate for Payer: Aetna Commercial |
$5,135.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,202.60
|
| Rate for Payer: Cash Price |
$3,335.00
|
| Rate for Payer: Cigna Commercial |
$5,536.10
|
| Rate for Payer: First Health Commercial |
$6,336.50
|
| Rate for Payer: Humana Commercial |
$5,669.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,469.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,922.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,001.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,869.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,002.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,334.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$867.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,067.70
|
| Rate for Payer: PHCS Commercial |
$6,403.20
|
| Rate for Payer: United Healthcare All Payer |
$5,869.60
|
|
|
AS COLS REV FEMCMP 62.5*56.5 R
|
Facility
|
OP
|
$28,879.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,754.28 |
| Max. Negotiated Rate |
$27,723.89 |
| Rate for Payer: Aetna Commercial |
$22,236.87
|
| Rate for Payer: Anthem Medicaid |
$9,931.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,525.66
|
| Rate for Payer: Cash Price |
$14,439.52
|
| Rate for Payer: Cigna Commercial |
$23,969.61
|
| Rate for Payer: First Health Commercial |
$27,435.10
|
| Rate for Payer: Humana Commercial |
$24,547.19
|
| Rate for Payer: Humana KY Medicaid |
$9,931.51
|
| Rate for Payer: Kentucky WC Medicaid |
$10,032.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,680.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,312.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,663.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,130.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,413.56
|
| Rate for Payer: Ohio Health Group HMO |
$21,659.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,775.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,754.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,952.51
|
| Rate for Payer: PHCS Commercial |
$27,723.89
|
| Rate for Payer: United Healthcare All Payer |
$25,413.56
|
|
|
AS COLS REV FEMCMP 62.5*56.5 R
|
Facility
|
IP
|
$28,879.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,754.28 |
| Max. Negotiated Rate |
$27,723.89 |
| Rate for Payer: Aetna Commercial |
$22,236.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,525.66
|
| Rate for Payer: Cash Price |
$14,439.52
|
| Rate for Payer: Cigna Commercial |
$23,969.61
|
| Rate for Payer: First Health Commercial |
$27,435.10
|
| Rate for Payer: Humana Commercial |
$24,547.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,680.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,312.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,663.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,413.56
|
| Rate for Payer: Ohio Health Group HMO |
$21,659.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,775.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,754.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,952.51
|
| Rate for Payer: PHCS Commercial |
$27,723.89
|
| Rate for Payer: United Healthcare All Payer |
$25,413.56
|
|
|
AS COLS REV FEM COMP 62.5*56.5
|
Facility
|
OP
|
$31,112.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,044.67 |
| Max. Negotiated Rate |
$29,868.34 |
| Rate for Payer: Aetna Commercial |
$23,956.89
|
| Rate for Payer: Anthem Medicaid |
$10,699.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,268.02
|
| Rate for Payer: Cash Price |
$15,556.42
|
| Rate for Payer: Cigna Commercial |
$25,823.67
|
| Rate for Payer: First Health Commercial |
$29,557.21
|
| Rate for Payer: Humana Commercial |
$26,445.92
|
| Rate for Payer: Humana KY Medicaid |
$10,699.71
|
| Rate for Payer: Kentucky WC Medicaid |
$10,808.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,512.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,961.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,333.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,914.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,379.31
|
| Rate for Payer: Ohio Health Group HMO |
$23,334.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,222.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,044.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,644.98
|
| Rate for Payer: PHCS Commercial |
$29,868.34
|
| Rate for Payer: United Healthcare All Payer |
$27,379.31
|
|
|
AS COLS REV FEM COMP 62.5*56.5
|
Facility
|
IP
|
$31,112.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,044.67 |
| Max. Negotiated Rate |
$29,868.34 |
| Rate for Payer: Aetna Commercial |
$23,956.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,268.02
|
| Rate for Payer: Cash Price |
$15,556.42
|
| Rate for Payer: Cigna Commercial |
$25,823.67
|
| Rate for Payer: First Health Commercial |
$29,557.21
|
| Rate for Payer: Humana Commercial |
$26,445.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,512.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,961.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,333.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,379.31
|
| Rate for Payer: Ohio Health Group HMO |
$23,334.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,222.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,044.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,644.98
|
| Rate for Payer: PHCS Commercial |
$29,868.34
|
| Rate for Payer: United Healthcare All Payer |
$27,379.31
|
|
|
AS COLS REV FEM WEDGE DIS 5MM
|
Facility
|
OP
|
$15,626.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,031.43 |
| Max. Negotiated Rate |
$15,001.34 |
| Rate for Payer: Aetna Commercial |
$12,032.33
|
| Rate for Payer: Anthem Medicaid |
$5,373.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,188.59
|
| Rate for Payer: Cash Price |
$7,813.20
|
| Rate for Payer: Cigna Commercial |
$12,969.91
|
| Rate for Payer: First Health Commercial |
$14,845.08
|
| Rate for Payer: Humana Commercial |
$13,282.44
|
| Rate for Payer: Humana KY Medicaid |
$5,373.92
|
| Rate for Payer: Kentucky WC Medicaid |
$5,428.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,813.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,532.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,687.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,481.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,751.23
|
| Rate for Payer: Ohio Health Group HMO |
$11,719.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,125.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,031.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,844.18
|
| Rate for Payer: PHCS Commercial |
$15,001.34
|
| Rate for Payer: United Healthcare All Payer |
$13,751.23
|
|
|
AS COLS REV FEM WEDGE DIS 5MM
|
Facility
|
IP
|
$15,626.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,031.43 |
| Max. Negotiated Rate |
$15,001.34 |
| Rate for Payer: Aetna Commercial |
$12,032.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,188.59
|
| Rate for Payer: Cash Price |
$7,813.20
|
| Rate for Payer: Cigna Commercial |
$12,969.91
|
| Rate for Payer: First Health Commercial |
$14,845.08
|
| Rate for Payer: Humana Commercial |
$13,282.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,813.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,532.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,687.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,751.23
|
| Rate for Payer: Ohio Health Group HMO |
$11,719.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,125.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,031.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,844.18
|
| Rate for Payer: PHCS Commercial |
$15,001.34
|
| Rate for Payer: United Healthcare All Payer |
$13,751.23
|
|
|
AS COLS REV FEM WEDGE POS 5MM
|
Facility
|
OP
|
$13,640.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,773.26 |
| Max. Negotiated Rate |
$13,094.83 |
| Rate for Payer: Aetna Commercial |
$10,503.15
|
| Rate for Payer: Anthem Medicaid |
$4,690.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,639.55
|
| Rate for Payer: Cash Price |
$6,820.23
|
| Rate for Payer: Cigna Commercial |
$11,321.57
|
| Rate for Payer: First Health Commercial |
$12,958.43
|
| Rate for Payer: Humana Commercial |
$11,594.38
|
| Rate for Payer: Humana KY Medicaid |
$4,690.95
|
| Rate for Payer: Kentucky WC Medicaid |
$4,738.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,185.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,066.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,092.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,785.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,003.60
|
| Rate for Payer: Ohio Health Group HMO |
$10,230.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,728.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,773.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,228.54
|
| Rate for Payer: PHCS Commercial |
$13,094.83
|
| Rate for Payer: United Healthcare All Payer |
$12,003.60
|
|
|
AS COLS REV FEM WEDGE POS 5MM
|
Facility
|
IP
|
$13,640.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,773.26 |
| Max. Negotiated Rate |
$13,094.83 |
| Rate for Payer: Aetna Commercial |
$10,503.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,639.55
|
| Rate for Payer: Cash Price |
$6,820.23
|
| Rate for Payer: Cigna Commercial |
$11,321.57
|
| Rate for Payer: First Health Commercial |
$12,958.43
|
| Rate for Payer: Humana Commercial |
$11,594.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,185.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,066.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,092.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,003.60
|
| Rate for Payer: Ohio Health Group HMO |
$10,230.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,728.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,773.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,228.54
|
| Rate for Payer: PHCS Commercial |
$13,094.83
|
| Rate for Payer: United Healthcare All Payer |
$12,003.60
|
|
|
AS COLS REV TIB COMP SZ70*45MM
|
Facility
|
IP
|
$26,068.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,388.91 |
| Max. Negotiated Rate |
$25,025.81 |
| Rate for Payer: Aetna Commercial |
$20,072.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,333.47
|
| Rate for Payer: Cash Price |
$13,034.27
|
| Rate for Payer: Cigna Commercial |
$21,636.90
|
| Rate for Payer: First Health Commercial |
$24,765.12
|
| Rate for Payer: Humana Commercial |
$22,158.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,376.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,238.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,820.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,940.32
|
| Rate for Payer: Ohio Health Group HMO |
$19,551.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,213.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,388.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,081.25
|
| Rate for Payer: PHCS Commercial |
$25,025.81
|
| Rate for Payer: United Healthcare All Payer |
$22,940.32
|
|
|
AS COLS REV TIB COMP SZ70*45MM
|
Facility
|
OP
|
$26,068.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,388.91 |
| Max. Negotiated Rate |
$25,025.81 |
| Rate for Payer: Aetna Commercial |
$20,072.78
|
| Rate for Payer: Anthem Medicaid |
$8,964.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,333.47
|
| Rate for Payer: Cash Price |
$13,034.27
|
| Rate for Payer: Cigna Commercial |
$21,636.90
|
| Rate for Payer: First Health Commercial |
$24,765.12
|
| Rate for Payer: Humana Commercial |
$22,158.27
|
| Rate for Payer: Humana KY Medicaid |
$8,964.97
|
| Rate for Payer: Kentucky WC Medicaid |
$9,056.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,376.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,238.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,820.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,144.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,940.32
|
| Rate for Payer: Ohio Health Group HMO |
$19,551.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,213.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,388.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,081.25
|
| Rate for Payer: PHCS Commercial |
$25,025.81
|
| Rate for Payer: United Healthcare All Payer |
$22,940.32
|
|
|
AS COLS REV TIB COMP SZ 70*49M
|
Facility
|
IP
|
$28,035.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,644.67 |
| Max. Negotiated Rate |
$26,914.46 |
| Rate for Payer: Aetna Commercial |
$21,587.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,868.00
|
| Rate for Payer: Cash Price |
$14,017.95
|
| Rate for Payer: Cigna Commercial |
$23,269.80
|
| Rate for Payer: First Health Commercial |
$26,634.10
|
| Rate for Payer: Humana Commercial |
$23,830.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,989.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,690.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,410.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,671.59
|
| Rate for Payer: Ohio Health Group HMO |
$21,026.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,607.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,644.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,691.13
|
| Rate for Payer: PHCS Commercial |
$26,914.46
|
| Rate for Payer: United Healthcare All Payer |
$24,671.59
|
|
