|
POST FEM AUG BLOCK #5/5MM
|
Facility
|
IP
|
$5,576.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$724.98 |
| Max. Negotiated Rate |
$5,353.73 |
| Rate for Payer: Aetna Commercial |
$4,294.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,349.90
|
| Rate for Payer: Cash Price |
$2,788.40
|
| Rate for Payer: Cigna Commercial |
$4,628.74
|
| Rate for Payer: First Health Commercial |
$5,297.96
|
| Rate for Payer: Humana Commercial |
$4,740.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,572.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,115.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,673.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,907.58
|
| Rate for Payer: Ohio Health Group HMO |
$4,182.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,115.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$724.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,728.81
|
| Rate for Payer: PHCS Commercial |
$5,353.73
|
| Rate for Payer: United Healthcare All Payer |
$4,907.58
|
|
|
POST FEM AUG BLOCK #5/5MM
|
Facility
|
OP
|
$5,576.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$724.98 |
| Max. Negotiated Rate |
$5,353.73 |
| Rate for Payer: Aetna Commercial |
$4,294.14
|
| Rate for Payer: Anthem Medicaid |
$1,917.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,349.90
|
| Rate for Payer: Cash Price |
$2,788.40
|
| Rate for Payer: Cigna Commercial |
$4,628.74
|
| Rate for Payer: First Health Commercial |
$5,297.96
|
| Rate for Payer: Humana Commercial |
$4,740.28
|
| Rate for Payer: Humana KY Medicaid |
$1,917.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,937.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,572.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,115.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,673.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,956.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,907.58
|
| Rate for Payer: Ohio Health Group HMO |
$4,182.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,115.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$724.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,728.81
|
| Rate for Payer: PHCS Commercial |
$5,353.73
|
| Rate for Payer: United Healthcare All Payer |
$4,907.58
|
|
|
POST FEM AUG BLOCK #7/10MM
|
Facility
|
IP
|
$5,386.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$700.23 |
| Max. Negotiated Rate |
$5,170.94 |
| Rate for Payer: Aetna Commercial |
$4,147.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,201.39
|
| Rate for Payer: Cash Price |
$2,693.20
|
| Rate for Payer: Cigna Commercial |
$4,470.71
|
| Rate for Payer: First Health Commercial |
$5,117.08
|
| Rate for Payer: Humana Commercial |
$4,578.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,416.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,975.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,615.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,740.03
|
| Rate for Payer: Ohio Health Group HMO |
$4,039.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,077.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$700.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,669.78
|
| Rate for Payer: PHCS Commercial |
$5,170.94
|
| Rate for Payer: United Healthcare All Payer |
$4,740.03
|
|
|
POST FEM AUG BLOCK #7/10MM
|
Facility
|
OP
|
$5,386.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$700.23 |
| Max. Negotiated Rate |
$5,170.94 |
| Rate for Payer: Aetna Commercial |
$4,147.53
|
| Rate for Payer: Anthem Medicaid |
$1,852.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,201.39
|
| Rate for Payer: Cash Price |
$2,693.20
|
| Rate for Payer: Cigna Commercial |
$4,470.71
|
| Rate for Payer: First Health Commercial |
$5,117.08
|
| Rate for Payer: Humana Commercial |
$4,578.44
|
| Rate for Payer: Humana KY Medicaid |
$1,852.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,871.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,416.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,975.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,615.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,889.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,740.03
|
| Rate for Payer: Ohio Health Group HMO |
$4,039.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,077.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$700.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,669.78
|
| Rate for Payer: PHCS Commercial |
$5,170.94
|
| Rate for Payer: United Healthcare All Payer |
$4,740.03
|
|
|
POST FEM AUG BLOCK #7/5MM
|
Facility
|
IP
|
$5,576.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$724.98 |
| Max. Negotiated Rate |
$5,353.73 |
| Rate for Payer: Aetna Commercial |
$4,294.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,349.90
|
| Rate for Payer: Cash Price |
$2,788.40
|
| Rate for Payer: Cigna Commercial |
$4,628.74
|
| Rate for Payer: First Health Commercial |
$5,297.96
|
| Rate for Payer: Humana Commercial |
$4,740.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,572.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,115.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,673.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,907.58
|
| Rate for Payer: Ohio Health Group HMO |
$4,182.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,115.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$724.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,728.81
|
| Rate for Payer: PHCS Commercial |
$5,353.73
|
| Rate for Payer: United Healthcare All Payer |
$4,907.58
|
|
|
POST FEM AUG BLOCK #7/5MM
|
Facility
|
OP
|
$5,576.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$724.98 |
| Max. Negotiated Rate |
$5,353.73 |
| Rate for Payer: Aetna Commercial |
$4,294.14
|
| Rate for Payer: Anthem Medicaid |
$1,917.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,349.90
|
| Rate for Payer: Cash Price |
$2,788.40
|
| Rate for Payer: Cigna Commercial |
$4,628.74
|
| Rate for Payer: First Health Commercial |
$5,297.96
|
| Rate for Payer: Humana Commercial |
$4,740.28
|
| Rate for Payer: Humana KY Medicaid |
$1,917.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,937.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,572.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,115.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,673.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,956.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,907.58
|
| Rate for Payer: Ohio Health Group HMO |
$4,182.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,115.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$724.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,728.81
|
| Rate for Payer: PHCS Commercial |
$5,353.73
|
| Rate for Payer: United Healthcare All Payer |
$4,907.58
|
|
|
POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC
|
Facility
|
IP
|
$21,548.09
|
|
|
Service Code
|
MSDRG 862
|
| Min. Negotiated Rate |
$14,621.92 |
| Max. Negotiated Rate |
$21,548.09 |
| Rate for Payer: Anthem Medicaid |
$14,621.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15,391.49
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21,548.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$20,778.51
|
| Rate for Payer: Humana KY Medicaid |
$14,621.92
|
| Rate for Payer: Humana Medicare Advantage |
$15,391.49
|
| Rate for Payer: Kentucky WC Medicaid |
$14,768.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18,469.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,914.35
|
|
|
POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC
|
Facility
|
IP
|
$11,762.55
|
|
|
Service Code
|
MSDRG 863
|
| Min. Negotiated Rate |
$7,981.73 |
| Max. Negotiated Rate |
$11,762.55 |
| Rate for Payer: Anthem Medicaid |
$7,981.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8,401.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$11,762.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$11,342.46
|
| Rate for Payer: Humana KY Medicaid |
$7,981.73
|
| Rate for Payer: Humana Medicare Advantage |
$8,401.82
|
| Rate for Payer: Kentucky WC Medicaid |
$8,061.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,082.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,141.36
|
|
|
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC
|
Facility
|
IP
|
$24,983.85
|
|
|
Service Code
|
MSDRG 857
|
| Min. Negotiated Rate |
$16,953.33 |
| Max. Negotiated Rate |
$24,983.85 |
| Rate for Payer: Anthem Medicaid |
$16,953.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17,845.61
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24,983.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$24,091.57
|
| Rate for Payer: Humana KY Medicaid |
$16,953.33
|
| Rate for Payer: Humana Medicare Advantage |
$17,845.61
|
| Rate for Payer: Kentucky WC Medicaid |
$17,122.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,414.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$17,292.40
|
|
|
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$51,804.33
|
|
|
Service Code
|
MSDRG 856
|
| Min. Negotiated Rate |
$35,152.94 |
| Max. Negotiated Rate |
$51,804.33 |
| Rate for Payer: Anthem Medicaid |
$35,152.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$37,003.09
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$51,804.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$49,954.17
|
| Rate for Payer: Humana KY Medicaid |
$35,152.94
|
| Rate for Payer: Humana Medicare Advantage |
$37,003.09
|
| Rate for Payer: Kentucky WC Medicaid |
$35,504.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$44,403.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$35,855.99
|
|
|
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$15,013.47
|
|
|
Service Code
|
MSDRG 858
|
| Min. Negotiated Rate |
$10,187.71 |
| Max. Negotiated Rate |
$15,013.47 |
| Rate for Payer: Anthem Medicaid |
$10,187.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10,723.91
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15,013.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$14,477.28
|
| Rate for Payer: Humana KY Medicaid |
$10,187.71
|
| Rate for Payer: Humana Medicare Advantage |
$10,723.91
|
| Rate for Payer: Kentucky WC Medicaid |
$10,289.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,868.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,391.47
|
|
|
POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES
|
Facility
|
IP
|
$18,060.87
|
|
|
Service Code
|
MSDRG 769
|
| Min. Negotiated Rate |
$12,255.59 |
| Max. Negotiated Rate |
$18,060.87 |
| Rate for Payer: Anthem Medicaid |
$12,255.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12,900.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18,060.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$17,415.84
|
| Rate for Payer: Humana KY Medicaid |
$12,255.59
|
| Rate for Payer: Humana Medicare Advantage |
$12,900.62
|
| Rate for Payer: Kentucky WC Medicaid |
$12,378.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15,480.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,500.70
|
|
|
POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES
|
Facility
|
IP
|
$8,384.12
|
|
|
Service Code
|
MSDRG 776
|
| Min. Negotiated Rate |
$5,689.23 |
| Max. Negotiated Rate |
$8,384.12 |
| Rate for Payer: Anthem Medicaid |
$5,689.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,988.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,384.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,084.69
|
| Rate for Payer: Humana KY Medicaid |
$5,689.23
|
| Rate for Payer: Humana Medicare Advantage |
$5,988.66
|
| Rate for Payer: Kentucky WC Medicaid |
$5,746.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,186.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,803.01
|
|
|
POST RECOV DC EA 1/2HR ED
|
Facility
|
OP
|
$34.82
|
|
| Hospital Charge Code |
45000338
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$33.43 |
| Rate for Payer: Aetna Commercial |
$26.81
|
| Rate for Payer: Anthem Medicaid |
$11.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27.16
|
| Rate for Payer: Cash Price |
$17.41
|
| Rate for Payer: Cigna Commercial |
$28.90
|
| Rate for Payer: First Health Commercial |
$33.08
|
| Rate for Payer: Humana Commercial |
$29.60
|
| Rate for Payer: Humana KY Medicaid |
$11.97
|
| Rate for Payer: Kentucky WC Medicaid |
$12.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$30.64
|
| Rate for Payer: Ohio Health Group HMO |
$26.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10.79
|
| Rate for Payer: PHCS Commercial |
$33.43
|
| Rate for Payer: United Healthcare All Payer |
$30.64
|
|
|
POST RECOV DC EA 1/2HR ED
|
Facility
|
IP
|
$34.82
|
|
| Hospital Charge Code |
45000338
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$33.43 |
| Rate for Payer: Aetna Commercial |
$26.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27.16
|
| Rate for Payer: Cash Price |
$17.41
|
| Rate for Payer: Cigna Commercial |
$28.90
|
| Rate for Payer: First Health Commercial |
$33.08
|
| Rate for Payer: Humana Commercial |
$29.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$30.64
|
| Rate for Payer: Ohio Health Group HMO |
$26.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10.79
|
| Rate for Payer: PHCS Commercial |
$33.43
|
| Rate for Payer: United Healthcare All Payer |
$30.64
|
|
|
POST TAPER 12MM*32MM LG
|
Facility
|
OP
|
$4,797.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$623.61 |
| Max. Negotiated Rate |
$4,605.12 |
| Rate for Payer: Aetna Commercial |
$3,693.69
|
| Rate for Payer: Anthem Medicaid |
$1,649.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,741.66
|
| Rate for Payer: Cash Price |
$2,398.50
|
| Rate for Payer: Cigna Commercial |
$3,981.51
|
| Rate for Payer: First Health Commercial |
$4,557.15
|
| Rate for Payer: Humana Commercial |
$4,077.45
|
| Rate for Payer: Humana KY Medicaid |
$1,649.69
|
| Rate for Payer: Kentucky WC Medicaid |
$1,666.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,933.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,540.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,439.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,682.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,221.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,597.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$959.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$623.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,487.07
|
| Rate for Payer: PHCS Commercial |
$4,605.12
|
| Rate for Payer: United Healthcare All Payer |
$4,221.36
|
|
|
POST TAPER 12MM*32MM LG
|
Facility
|
IP
|
$4,797.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$623.61 |
| Max. Negotiated Rate |
$4,605.12 |
| Rate for Payer: Aetna Commercial |
$3,693.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,741.66
|
| Rate for Payer: Cash Price |
$2,398.50
|
| Rate for Payer: Cigna Commercial |
$3,981.51
|
| Rate for Payer: First Health Commercial |
$4,557.15
|
| Rate for Payer: Humana Commercial |
$4,077.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,933.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,540.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,439.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,221.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,597.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$959.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$623.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,487.07
|
| Rate for Payer: PHCS Commercial |
$4,605.12
|
| Rate for Payer: United Healthcare All Payer |
$4,221.36
|
|
|
POST TAPER 15.6MM*32MM LG
|
Facility
|
IP
|
$4,797.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$623.61 |
| Max. Negotiated Rate |
$4,605.12 |
| Rate for Payer: Aetna Commercial |
$3,693.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,741.66
|
| Rate for Payer: Cash Price |
$2,398.50
|
| Rate for Payer: Cigna Commercial |
$3,981.51
|
| Rate for Payer: First Health Commercial |
$4,557.15
|
| Rate for Payer: Humana Commercial |
$4,077.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,933.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,540.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,439.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,221.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,597.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$959.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$623.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,487.07
|
| Rate for Payer: PHCS Commercial |
$4,605.12
|
| Rate for Payer: United Healthcare All Payer |
$4,221.36
|
|
|
POST TAPER 15.6MM*32MM LG
|
Facility
|
OP
|
$4,797.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$623.61 |
| Max. Negotiated Rate |
$4,605.12 |
| Rate for Payer: Aetna Commercial |
$3,693.69
|
| Rate for Payer: Anthem Medicaid |
$1,649.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,741.66
|
| Rate for Payer: Cash Price |
$2,398.50
|
| Rate for Payer: Cigna Commercial |
$3,981.51
|
| Rate for Payer: First Health Commercial |
$4,557.15
|
| Rate for Payer: Humana Commercial |
$4,077.45
|
| Rate for Payer: Humana KY Medicaid |
$1,649.69
|
| Rate for Payer: Kentucky WC Medicaid |
$1,666.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,933.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,540.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,439.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,682.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,221.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,597.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$959.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$623.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,487.07
|
| Rate for Payer: PHCS Commercial |
$4,605.12
|
| Rate for Payer: United Healthcare All Payer |
$4,221.36
|
|
|
POST TAPER 8.5MM*25MM LG
|
Facility
|
OP
|
$4,797.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$623.61 |
| Max. Negotiated Rate |
$4,605.12 |
| Rate for Payer: Aetna Commercial |
$3,693.69
|
| Rate for Payer: Anthem Medicaid |
$1,649.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,741.66
|
| Rate for Payer: Cash Price |
$2,398.50
|
| Rate for Payer: Cigna Commercial |
$3,981.51
|
| Rate for Payer: First Health Commercial |
$4,557.15
|
| Rate for Payer: Humana Commercial |
$4,077.45
|
| Rate for Payer: Humana KY Medicaid |
$1,649.69
|
| Rate for Payer: Kentucky WC Medicaid |
$1,666.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,933.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,540.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,439.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,682.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,221.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,597.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$959.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$623.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,487.07
|
| Rate for Payer: PHCS Commercial |
$4,605.12
|
| Rate for Payer: United Healthcare All Payer |
$4,221.36
|
|
|
POST TAPER 8.5MM*25MM LG
|
Facility
|
IP
|
$4,797.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$623.61 |
| Max. Negotiated Rate |
$4,605.12 |
| Rate for Payer: Aetna Commercial |
$3,693.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,741.66
|
| Rate for Payer: Cash Price |
$2,398.50
|
| Rate for Payer: Cigna Commercial |
$3,981.51
|
| Rate for Payer: First Health Commercial |
$4,557.15
|
| Rate for Payer: Humana Commercial |
$4,077.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,933.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,540.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,439.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,221.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,597.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$959.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$623.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,487.07
|
| Rate for Payer: PHCS Commercial |
$4,605.12
|
| Rate for Payer: United Healthcare All Payer |
$4,221.36
|
|
|
POST TAPER 8.5MM*25MM LG CE
|
Facility
|
IP
|
$4,797.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$623.61 |
| Max. Negotiated Rate |
$4,605.12 |
| Rate for Payer: Aetna Commercial |
$3,693.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,741.66
|
| Rate for Payer: Cash Price |
$2,398.50
|
| Rate for Payer: Cigna Commercial |
$3,981.51
|
| Rate for Payer: First Health Commercial |
$4,557.15
|
| Rate for Payer: Humana Commercial |
$4,077.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,933.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,540.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,439.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,221.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,597.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$959.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$623.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,487.07
|
| Rate for Payer: PHCS Commercial |
$4,605.12
|
| Rate for Payer: United Healthcare All Payer |
$4,221.36
|
|
|
POST TAPER 8.5MM*25MM LG CE
|
Facility
|
OP
|
$4,797.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$623.61 |
| Max. Negotiated Rate |
$4,605.12 |
| Rate for Payer: Aetna Commercial |
$3,693.69
|
| Rate for Payer: Anthem Medicaid |
$1,649.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,741.66
|
| Rate for Payer: Cash Price |
$2,398.50
|
| Rate for Payer: Cigna Commercial |
$3,981.51
|
| Rate for Payer: First Health Commercial |
$4,557.15
|
| Rate for Payer: Humana Commercial |
$4,077.45
|
| Rate for Payer: Humana KY Medicaid |
$1,649.69
|
| Rate for Payer: Kentucky WC Medicaid |
$1,666.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,933.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,540.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,439.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,682.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,221.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,597.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$959.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$623.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,487.07
|
| Rate for Payer: PHCS Commercial |
$4,605.12
|
| Rate for Payer: United Healthcare All Payer |
$4,221.36
|
|
|
POST TAPER HUM HEAD 13.5*31 CE
|
Facility
|
IP
|
$4,797.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$623.61 |
| Max. Negotiated Rate |
$4,605.12 |
| Rate for Payer: Aetna Commercial |
$3,693.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,741.66
|
| Rate for Payer: Cash Price |
$2,398.50
|
| Rate for Payer: Cigna Commercial |
$3,981.51
|
| Rate for Payer: First Health Commercial |
$4,557.15
|
| Rate for Payer: Humana Commercial |
$4,077.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,933.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,540.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,439.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,221.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,597.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$959.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$623.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,487.07
|
| Rate for Payer: PHCS Commercial |
$4,605.12
|
| Rate for Payer: United Healthcare All Payer |
$4,221.36
|
|
|
POST TAPER HUM HEAD 13.5*31 CE
|
Facility
|
OP
|
$4,797.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$623.61 |
| Max. Negotiated Rate |
$4,605.12 |
| Rate for Payer: Aetna Commercial |
$3,693.69
|
| Rate for Payer: Anthem Medicaid |
$1,649.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,741.66
|
| Rate for Payer: Cash Price |
$2,398.50
|
| Rate for Payer: Cigna Commercial |
$3,981.51
|
| Rate for Payer: First Health Commercial |
$4,557.15
|
| Rate for Payer: Humana Commercial |
$4,077.45
|
| Rate for Payer: Humana KY Medicaid |
$1,649.69
|
| Rate for Payer: Kentucky WC Medicaid |
$1,666.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,933.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,540.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,439.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,682.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,221.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,597.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$959.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$623.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,487.07
|
| Rate for Payer: PHCS Commercial |
$4,605.12
|
| Rate for Payer: United Healthcare All Payer |
$4,221.36
|
|
