|
PLUS PROMOS HUM STEM 3.5
|
Facility
|
OP
|
$8,275.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.87 |
| Max. Negotiated Rate |
$7,944.87 |
| Rate for Payer: Aetna Commercial |
$6,372.45
|
| Rate for Payer: Anthem Medicaid |
$2,846.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,455.21
|
| Rate for Payer: Cash Price |
$4,137.96
|
| Rate for Payer: Cigna Commercial |
$6,869.01
|
| Rate for Payer: First Health Commercial |
$7,862.11
|
| Rate for Payer: Humana Commercial |
$7,034.52
|
| Rate for Payer: Humana KY Medicaid |
$2,846.09
|
| Rate for Payer: Kentucky WC Medicaid |
$2,875.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,786.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,107.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,903.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.53
|
| Rate for Payer: PHCS Commercial |
$7,944.87
|
| Rate for Payer: United Healthcare All Payer |
$7,282.80
|
|
|
PLUS PROMOS HUM STEM 3.5
|
Facility
|
IP
|
$8,275.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.87 |
| Max. Negotiated Rate |
$7,944.87 |
| Rate for Payer: Aetna Commercial |
$6,372.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,455.21
|
| Rate for Payer: Cash Price |
$4,137.96
|
| Rate for Payer: Cigna Commercial |
$6,869.01
|
| Rate for Payer: First Health Commercial |
$7,862.11
|
| Rate for Payer: Humana Commercial |
$7,034.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,786.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,107.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.53
|
| Rate for Payer: PHCS Commercial |
$7,944.87
|
| Rate for Payer: United Healthcare All Payer |
$7,282.80
|
|
|
PLUS PROMOS HUM STEM SZ 4
|
Facility
|
OP
|
$8,275.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.87 |
| Max. Negotiated Rate |
$7,944.87 |
| Rate for Payer: Aetna Commercial |
$6,372.45
|
| Rate for Payer: Anthem Medicaid |
$2,846.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,455.21
|
| Rate for Payer: Cash Price |
$4,137.96
|
| Rate for Payer: Cigna Commercial |
$6,869.01
|
| Rate for Payer: First Health Commercial |
$7,862.11
|
| Rate for Payer: Humana Commercial |
$7,034.52
|
| Rate for Payer: Humana KY Medicaid |
$2,846.09
|
| Rate for Payer: Kentucky WC Medicaid |
$2,875.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,786.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,107.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,903.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.53
|
| Rate for Payer: PHCS Commercial |
$7,944.87
|
| Rate for Payer: United Healthcare All Payer |
$7,282.80
|
|
|
PLUS PROMOS HUM STEM SZ 4
|
Facility
|
IP
|
$8,275.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.87 |
| Max. Negotiated Rate |
$7,944.87 |
| Rate for Payer: Aetna Commercial |
$6,372.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,455.21
|
| Rate for Payer: Cash Price |
$4,137.96
|
| Rate for Payer: Cigna Commercial |
$6,869.01
|
| Rate for Payer: First Health Commercial |
$7,862.11
|
| Rate for Payer: Humana Commercial |
$7,034.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,786.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,107.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.53
|
| Rate for Payer: PHCS Commercial |
$7,944.87
|
| Rate for Payer: United Healthcare All Payer |
$7,282.80
|
|
|
PLUS PROMOS REV. BODY 36/10MM
|
Facility
|
IP
|
$11,496.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,494.61 |
| Max. Negotiated Rate |
$11,037.11 |
| Rate for Payer: Aetna Commercial |
$8,852.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,967.65
|
| Rate for Payer: Cash Price |
$5,748.49
|
| Rate for Payer: Cigna Commercial |
$9,542.50
|
| Rate for Payer: First Health Commercial |
$10,922.14
|
| Rate for Payer: Humana Commercial |
$9,772.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,427.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,484.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,449.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,117.35
|
| Rate for Payer: Ohio Health Group HMO |
$8,622.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,299.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,494.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,564.07
|
| Rate for Payer: PHCS Commercial |
$11,037.11
|
| Rate for Payer: United Healthcare All Payer |
$10,117.35
|
|
|
PLUS PROMOS REV. BODY 36/10MM
|
Facility
|
OP
|
$11,496.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,494.61 |
| Max. Negotiated Rate |
$11,037.11 |
| Rate for Payer: Aetna Commercial |
$8,852.68
|
| Rate for Payer: Anthem Medicaid |
$3,953.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,967.65
|
| Rate for Payer: Cash Price |
$5,748.49
|
| Rate for Payer: Cigna Commercial |
$9,542.50
|
| Rate for Payer: First Health Commercial |
$10,922.14
|
| Rate for Payer: Humana Commercial |
$9,772.44
|
| Rate for Payer: Humana KY Medicaid |
$3,953.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,994.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,427.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,484.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,449.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,033.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,117.35
|
| Rate for Payer: Ohio Health Group HMO |
$8,622.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,299.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,494.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,564.07
|
| Rate for Payer: PHCS Commercial |
$11,037.11
|
| Rate for Payer: United Healthcare All Payer |
$10,117.35
|
|
|
PLUS PROMOS REV. BODY 36/15MM
|
Facility
|
IP
|
$11,496.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,494.61 |
| Max. Negotiated Rate |
$11,037.11 |
| Rate for Payer: Aetna Commercial |
$8,852.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,967.65
|
| Rate for Payer: Cash Price |
$5,748.49
|
| Rate for Payer: Cigna Commercial |
$9,542.50
|
| Rate for Payer: First Health Commercial |
$10,922.14
|
| Rate for Payer: Humana Commercial |
$9,772.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,427.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,484.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,449.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,117.35
|
| Rate for Payer: Ohio Health Group HMO |
$8,622.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,299.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,494.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,564.07
|
| Rate for Payer: PHCS Commercial |
$11,037.11
|
| Rate for Payer: United Healthcare All Payer |
$10,117.35
|
|
|
PLUS PROMOS REV. BODY 36/15MM
|
Facility
|
OP
|
$11,496.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,494.61 |
| Max. Negotiated Rate |
$11,037.11 |
| Rate for Payer: Aetna Commercial |
$8,852.68
|
| Rate for Payer: Anthem Medicaid |
$3,953.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,967.65
|
| Rate for Payer: Cash Price |
$5,748.49
|
| Rate for Payer: Cigna Commercial |
$9,542.50
|
| Rate for Payer: First Health Commercial |
$10,922.14
|
| Rate for Payer: Humana Commercial |
$9,772.44
|
| Rate for Payer: Humana KY Medicaid |
$3,953.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,994.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,427.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,484.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,449.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,033.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,117.35
|
| Rate for Payer: Ohio Health Group HMO |
$8,622.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,299.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,494.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,564.07
|
| Rate for Payer: PHCS Commercial |
$11,037.11
|
| Rate for Payer: United Healthcare All Payer |
$10,117.35
|
|
|
PLUS PROMOS REV. BODY 36/5MM
|
Facility
|
IP
|
$10,005.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,300.66 |
| Max. Negotiated Rate |
$9,604.90 |
| Rate for Payer: Aetna Commercial |
$7,703.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,803.98
|
| Rate for Payer: Cash Price |
$5,002.55
|
| Rate for Payer: Cigna Commercial |
$8,304.23
|
| Rate for Payer: First Health Commercial |
$9,504.84
|
| Rate for Payer: Humana Commercial |
$8,504.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,204.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,383.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,001.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,804.49
|
| Rate for Payer: Ohio Health Group HMO |
$7,503.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,001.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,300.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,101.58
|
| Rate for Payer: PHCS Commercial |
$9,604.90
|
| Rate for Payer: United Healthcare All Payer |
$8,804.49
|
|
|
PLUS PROMOS REV. BODY 36/5MM
|
Facility
|
OP
|
$10,005.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,300.66 |
| Max. Negotiated Rate |
$9,604.90 |
| Rate for Payer: Aetna Commercial |
$7,703.93
|
| Rate for Payer: Anthem Medicaid |
$3,440.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,803.98
|
| Rate for Payer: Cash Price |
$5,002.55
|
| Rate for Payer: Cigna Commercial |
$8,304.23
|
| Rate for Payer: First Health Commercial |
$9,504.84
|
| Rate for Payer: Humana Commercial |
$8,504.34
|
| Rate for Payer: Humana KY Medicaid |
$3,440.75
|
| Rate for Payer: Kentucky WC Medicaid |
$3,475.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,204.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,383.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,001.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,509.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,804.49
|
| Rate for Payer: Ohio Health Group HMO |
$7,503.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,001.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,300.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,101.58
|
| Rate for Payer: PHCS Commercial |
$9,604.90
|
| Rate for Payer: United Healthcare All Payer |
$8,804.49
|
|
|
PLUS PROMOS REV. BODY 42/10MM
|
Facility
|
IP
|
$10,005.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,300.66 |
| Max. Negotiated Rate |
$9,604.90 |
| Rate for Payer: Aetna Commercial |
$7,703.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,803.98
|
| Rate for Payer: Cash Price |
$5,002.55
|
| Rate for Payer: Cigna Commercial |
$8,304.23
|
| Rate for Payer: First Health Commercial |
$9,504.84
|
| Rate for Payer: Humana Commercial |
$8,504.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,204.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,383.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,001.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,804.49
|
| Rate for Payer: Ohio Health Group HMO |
$7,503.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,001.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,300.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,101.58
|
| Rate for Payer: PHCS Commercial |
$9,604.90
|
| Rate for Payer: United Healthcare All Payer |
$8,804.49
|
|
|
PLUS PROMOS REV. BODY 42/10MM
|
Facility
|
OP
|
$10,005.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,300.66 |
| Max. Negotiated Rate |
$9,604.90 |
| Rate for Payer: Aetna Commercial |
$7,703.93
|
| Rate for Payer: Anthem Medicaid |
$3,440.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,803.98
|
| Rate for Payer: Cash Price |
$5,002.55
|
| Rate for Payer: Cigna Commercial |
$8,304.23
|
| Rate for Payer: First Health Commercial |
$9,504.84
|
| Rate for Payer: Humana Commercial |
$8,504.34
|
| Rate for Payer: Humana KY Medicaid |
$3,440.75
|
| Rate for Payer: Kentucky WC Medicaid |
$3,475.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,204.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,383.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,001.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,509.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,804.49
|
| Rate for Payer: Ohio Health Group HMO |
$7,503.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,001.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,300.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,101.58
|
| Rate for Payer: PHCS Commercial |
$9,604.90
|
| Rate for Payer: United Healthcare All Payer |
$8,804.49
|
|
|
PLUS PROMOS REV. BODY 42/15MM
|
Facility
|
IP
|
$7,675.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$997.81 |
| Max. Negotiated Rate |
$7,368.47 |
| Rate for Payer: Aetna Commercial |
$5,910.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,986.88
|
| Rate for Payer: Cash Price |
$3,837.74
|
| Rate for Payer: Cigna Commercial |
$6,370.66
|
| Rate for Payer: First Health Commercial |
$7,291.72
|
| Rate for Payer: Humana Commercial |
$6,524.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,293.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,664.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,302.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,754.43
|
| Rate for Payer: Ohio Health Group HMO |
$5,756.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,535.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$997.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,379.40
|
| Rate for Payer: PHCS Commercial |
$7,368.47
|
| Rate for Payer: United Healthcare All Payer |
$6,754.43
|
|
|
PLUS PROMOS REV. BODY 42/15MM
|
Facility
|
OP
|
$7,675.49
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$997.81 |
| Max. Negotiated Rate |
$7,368.47 |
| Rate for Payer: Aetna Commercial |
$5,910.13
|
| Rate for Payer: Anthem Medicaid |
$2,639.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,986.88
|
| Rate for Payer: Cash Price |
$3,837.74
|
| Rate for Payer: Cigna Commercial |
$6,370.66
|
| Rate for Payer: First Health Commercial |
$7,291.72
|
| Rate for Payer: Humana Commercial |
$6,524.17
|
| Rate for Payer: Humana KY Medicaid |
$2,639.60
|
| Rate for Payer: Kentucky WC Medicaid |
$2,666.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,293.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,664.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,302.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,692.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,754.43
|
| Rate for Payer: Ohio Health Group HMO |
$5,756.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,535.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$997.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,379.40
|
| Rate for Payer: PHCS Commercial |
$7,368.47
|
| Rate for Payer: United Healthcare All Payer |
$6,754.43
|
|
|
PLUS PROMOS REV. BODY 42/5MM
|
Facility
|
IP
|
$13,885.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,805.05 |
| Max. Negotiated Rate |
$13,329.60 |
| Rate for Payer: Aetna Commercial |
$10,691.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,830.30
|
| Rate for Payer: Cash Price |
$6,942.50
|
| Rate for Payer: Cigna Commercial |
$11,524.55
|
| Rate for Payer: First Health Commercial |
$13,190.75
|
| Rate for Payer: Humana Commercial |
$11,802.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,385.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,247.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,165.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,218.80
|
| Rate for Payer: Ohio Health Group HMO |
$10,413.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,777.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,805.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,304.35
|
| Rate for Payer: PHCS Commercial |
$13,329.60
|
| Rate for Payer: United Healthcare All Payer |
$12,218.80
|
|
|
PLUS PROMOS REV. BODY 42/5MM
|
Facility
|
OP
|
$13,885.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,805.05 |
| Max. Negotiated Rate |
$13,329.60 |
| Rate for Payer: Aetna Commercial |
$10,691.45
|
| Rate for Payer: Anthem Medicaid |
$4,775.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,830.30
|
| Rate for Payer: Cash Price |
$6,942.50
|
| Rate for Payer: Cigna Commercial |
$11,524.55
|
| Rate for Payer: First Health Commercial |
$13,190.75
|
| Rate for Payer: Humana Commercial |
$11,802.25
|
| Rate for Payer: Humana KY Medicaid |
$4,775.05
|
| Rate for Payer: Kentucky WC Medicaid |
$4,823.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,385.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,247.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,165.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,870.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,218.80
|
| Rate for Payer: Ohio Health Group HMO |
$10,413.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,777.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,805.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,304.35
|
| Rate for Payer: PHCS Commercial |
$13,329.60
|
| Rate for Payer: United Healthcare All Payer |
$12,218.80
|
|
|
PM DEVICE PROGR EVAL MULTI
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 93281
|
| Hospital Charge Code |
48000078
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$62.88 |
| Max. Negotiated Rate |
$255.00 |
| Rate for Payer: Aetna Commercial |
$125.36
|
| Rate for Payer: Anthem Medicaid |
$63.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$255.00
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cigna Commercial |
$126.90
|
| Rate for Payer: Healthspan PPO |
$117.84
|
| Rate for Payer: Humana Medicaid |
$63.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$62.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$64.76
|
| Rate for Payer: Molina Healthcare Passport |
$63.49
|
| Rate for Payer: Multiplan PHCS |
$153.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$178.50
|
| Rate for Payer: UHCCP Medicaid |
$89.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$64.12
|
|
|
PM DEVICE PROGR EVAL MULTI
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
HCPCS 93281
|
| Hospital Charge Code |
48000078
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$32.61 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Aetna Commercial |
$196.35
|
| Rate for Payer: Anthem Medicaid |
$87.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$32.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$198.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$45.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$44.02
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cigna Commercial |
$211.65
|
| Rate for Payer: First Health Commercial |
$242.25
|
| Rate for Payer: Humana Commercial |
$216.75
|
| Rate for Payer: Humana KY Medicaid |
$87.69
|
| Rate for Payer: Humana Medicare Advantage |
$32.61
|
| Rate for Payer: Kentucky WC Medicaid |
$88.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$209.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$188.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$89.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$224.40
|
| Rate for Payer: Ohio Health Group HMO |
$191.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$51.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$79.05
|
| Rate for Payer: PHCS Commercial |
$244.80
|
| Rate for Payer: United Healthcare All Payer |
$224.40
|
|
|
PM DEVICE PROGR EVAL MULTI
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
HCPCS 93281
|
| Hospital Charge Code |
48000078
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$33.15 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Aetna Commercial |
$196.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$198.90
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cigna Commercial |
$211.65
|
| Rate for Payer: First Health Commercial |
$242.25
|
| Rate for Payer: Humana Commercial |
$216.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$209.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$188.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$76.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$224.40
|
| Rate for Payer: Ohio Health Group HMO |
$191.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$51.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$79.05
|
| Rate for Payer: PHCS Commercial |
$244.80
|
| Rate for Payer: United Healthcare All Payer |
$224.40
|
|
|
PNEUMOTHORAX WITH CC
|
Facility
|
IP
|
$12,598.99
|
|
|
Service Code
|
MSDRG 200
|
| Min. Negotiated Rate |
$8,549.32 |
| Max. Negotiated Rate |
$12,598.99 |
| Rate for Payer: Anthem Medicaid |
$8,549.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8,999.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12,598.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$12,149.03
|
| Rate for Payer: Humana KY Medicaid |
$8,549.32
|
| Rate for Payer: Humana Medicare Advantage |
$8,999.28
|
| Rate for Payer: Kentucky WC Medicaid |
$8,634.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,799.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,720.30
|
|
|
PNEUMOTHORAX WITH MCC
|
Facility
|
IP
|
$20,753.78
|
|
|
Service Code
|
MSDRG 199
|
| Min. Negotiated Rate |
$14,082.92 |
| Max. Negotiated Rate |
$20,753.78 |
| Rate for Payer: Anthem Medicaid |
$14,082.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14,824.13
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20,753.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$20,012.58
|
| Rate for Payer: Humana KY Medicaid |
$14,082.92
|
| Rate for Payer: Humana Medicare Advantage |
$14,824.13
|
| Rate for Payer: Kentucky WC Medicaid |
$14,223.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17,788.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,364.58
|
|
|
PNEUMOTHORAX WITHOUT CC/MCC
|
Facility
|
IP
|
$8,260.10
|
|
|
Service Code
|
MSDRG 201
|
| Min. Negotiated Rate |
$5,605.07 |
| Max. Negotiated Rate |
$8,260.10 |
| Rate for Payer: Anthem Medicaid |
$5,605.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,900.07
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,260.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,965.09
|
| Rate for Payer: Humana KY Medicaid |
$5,605.07
|
| Rate for Payer: Humana Medicare Advantage |
$5,900.07
|
| Rate for Payer: Kentucky WC Medicaid |
$5,661.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,080.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,717.17
|
|
|
PNU-IMUNE 23 (PNEUMOCOCCA0.5ML
|
Facility
|
IP
|
$545.08
|
|
|
Service Code
|
HCPCS 90732
|
| Hospital Charge Code |
25000043
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.86 |
| Max. Negotiated Rate |
$523.28 |
| Rate for Payer: Aetna Commercial |
$419.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$425.16
|
| Rate for Payer: Cash Price |
$272.54
|
| Rate for Payer: Cigna Commercial |
$452.42
|
| Rate for Payer: First Health Commercial |
$517.83
|
| Rate for Payer: Humana Commercial |
$463.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$446.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$402.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$163.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$479.67
|
| Rate for Payer: Ohio Health Group HMO |
$408.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$109.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$168.97
|
| Rate for Payer: PHCS Commercial |
$523.28
|
| Rate for Payer: United Healthcare All Payer |
$479.67
|
|
|
PNU-IMUNE 23 (PNEUMOCOCCA0.5ML
|
Facility
|
OP
|
$545.08
|
|
|
Service Code
|
HCPCS 90732
|
| Hospital Charge Code |
25000043
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.86 |
| Max. Negotiated Rate |
$523.28 |
| Rate for Payer: Aetna Commercial |
$419.71
|
| Rate for Payer: Anthem Medicaid |
$187.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$425.16
|
| Rate for Payer: Cash Price |
$272.54
|
| Rate for Payer: Cigna Commercial |
$452.42
|
| Rate for Payer: First Health Commercial |
$517.83
|
| Rate for Payer: Humana Commercial |
$463.32
|
| Rate for Payer: Humana KY Medicaid |
$187.45
|
| Rate for Payer: Kentucky WC Medicaid |
$189.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$446.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$402.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$163.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$191.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$479.67
|
| Rate for Payer: Ohio Health Group HMO |
$408.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$109.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$168.97
|
| Rate for Payer: PHCS Commercial |
$523.28
|
| Rate for Payer: United Healthcare All Payer |
$479.67
|
|
|
POC MONO TEST
|
Professional
|
Both
|
$47.00
|
|
|
Service Code
|
HCPCS 86308
|
| Hospital Charge Code |
30001938
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.11 |
| Max. Negotiated Rate |
$47.00 |
| Rate for Payer: Aetna Commercial |
$8.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$47.00
|
| Rate for Payer: Cash Price |
$23.50
|
| Rate for Payer: Cash Price |
$23.50
|
| Rate for Payer: Cigna Commercial |
$7.28
|
| Rate for Payer: Healthspan PPO |
$5.42
|
| Rate for Payer: Multiplan PHCS |
$28.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$32.90
|
| Rate for Payer: UHCCP Medicaid |
$16.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$3.11
|
|
