|
ART BYP POP-TIBL-PRL-OTHER
|
Facility
|
IP
|
$3,800.00
|
|
|
Service Code
|
HCPCS 35571
|
| Hospital Charge Code |
76101401
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,140.00 |
| Max. Negotiated Rate |
$3,648.00 |
| Rate for Payer: Aetna Commercial |
$2,926.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,964.00
|
| Rate for Payer: Cash Price |
$1,900.00
|
| Rate for Payer: Cigna Commercial |
$3,154.00
|
| Rate for Payer: First Health Commercial |
$3,610.00
|
| Rate for Payer: Humana Commercial |
$3,230.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,116.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,804.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,140.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,344.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,850.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,040.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,306.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,622.00
|
| Rate for Payer: PHCS Commercial |
$3,648.00
|
| Rate for Payer: United Healthcare All Payer |
$3,344.00
|
|
|
ART BYP POP-TIBL-PRL-OTHER
|
Facility
|
OP
|
$1,355.00
|
|
|
Service Code
|
HCPCS 35671
|
| Hospital Charge Code |
76101415
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$406.50 |
| Max. Negotiated Rate |
$1,300.80 |
| Rate for Payer: Aetna Commercial |
$1,043.35
|
| Rate for Payer: Anthem Medicaid |
$465.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,056.90
|
| Rate for Payer: Cash Price |
$677.50
|
| Rate for Payer: Cigna Commercial |
$1,124.65
|
| Rate for Payer: First Health Commercial |
$1,287.25
|
| Rate for Payer: Humana Commercial |
$1,151.75
|
| Rate for Payer: Humana KY Medicaid |
$465.98
|
| Rate for Payer: Kentucky WC Medicaid |
$470.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,111.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$999.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$406.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$475.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,192.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,016.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,084.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,178.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$934.95
|
| Rate for Payer: PHCS Commercial |
$1,300.80
|
| Rate for Payer: United Healthcare All Payer |
$1,192.40
|
|
|
ART BYP POP-TIBL-PRL-OTHER
|
Facility
|
IP
|
$1,355.00
|
|
|
Service Code
|
HCPCS 35671
|
| Hospital Charge Code |
76101415
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$406.50 |
| Max. Negotiated Rate |
$1,300.80 |
| Rate for Payer: Aetna Commercial |
$1,043.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,056.90
|
| Rate for Payer: Cash Price |
$677.50
|
| Rate for Payer: Cigna Commercial |
$1,124.65
|
| Rate for Payer: First Health Commercial |
$1,287.25
|
| Rate for Payer: Humana Commercial |
$1,151.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,111.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$999.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$406.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,192.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,016.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,084.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,178.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$934.95
|
| Rate for Payer: PHCS Commercial |
$1,300.80
|
| Rate for Payer: United Healthcare All Payer |
$1,192.40
|
|
|
ART BYP POP-TIBL-PRL-OTHER(P
|
Professional
|
Both
|
$3,800.00
|
|
|
Service Code
|
HCPCS 35571
|
| Hospital Charge Code |
761P1401
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,102.17 |
| Max. Negotiated Rate |
$2,374.67 |
| Rate for Payer: Aetna Commercial |
$2,374.67
|
| Rate for Payer: Ambetter Exchange |
$1,241.01
|
| Rate for Payer: Anthem Medicaid |
$1,102.17
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,241.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,241.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,489.21
|
| Rate for Payer: Cash Price |
$1,900.00
|
| Rate for Payer: Cash Price |
$1,900.00
|
| Rate for Payer: Cigna Commercial |
$2,290.19
|
| Rate for Payer: Healthspan PPO |
$2,334.76
|
| Rate for Payer: Humana Medicaid |
$1,102.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,839.44
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,241.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,241.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,124.21
|
| Rate for Payer: Molina Healthcare Passport |
$1,102.17
|
| Rate for Payer: Multiplan PHCS |
$2,280.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,613.31
|
| Rate for Payer: UHCCP Medicaid |
$1,330.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,113.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,241.01
|
|
|
ART BYP POP-TIBL-PRL-OTHER(P
|
Professional
|
Both
|
$1,355.00
|
|
|
Service Code
|
HCPCS 35671
|
| Hospital Charge Code |
761P1415
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$474.25 |
| Max. Negotiated Rate |
$1,980.53 |
| Rate for Payer: Aetna Commercial |
$1,980.53
|
| Rate for Payer: Ambetter Exchange |
$1,053.49
|
| Rate for Payer: Anthem Medicaid |
$874.97
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,053.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,053.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,264.19
|
| Rate for Payer: Cash Price |
$677.50
|
| Rate for Payer: Cash Price |
$677.50
|
| Rate for Payer: Cigna Commercial |
$1,902.36
|
| Rate for Payer: Healthspan PPO |
$1,947.25
|
| Rate for Payer: Humana Medicaid |
$874.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,539.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,053.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,053.49
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$892.47
|
| Rate for Payer: Molina Healthcare Passport |
$874.97
|
| Rate for Payer: Multiplan PHCS |
$813.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,369.54
|
| Rate for Payer: UHCCP Medicaid |
$474.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$883.72
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,053.49
|
|
|
ARTCM 40M .1875 PST 10.0*10.0
|
Facility
|
OP
|
$24,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,374.75 |
| Max. Negotiated Rate |
$23,599.20 |
| Rate for Payer: Aetna Commercial |
$18,928.53
|
| Rate for Payer: Anthem Medicaid |
$8,453.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,174.35
|
| Rate for Payer: Cash Price |
$12,291.25
|
| Rate for Payer: Cigna Commercial |
$20,403.47
|
| Rate for Payer: First Health Commercial |
$23,353.38
|
| Rate for Payer: Humana Commercial |
$20,895.12
|
| Rate for Payer: Humana KY Medicaid |
$8,453.92
|
| Rate for Payer: Kentucky WC Medicaid |
$8,539.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,157.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,141.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,374.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,623.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,632.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,436.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,961.92
|
| Rate for Payer: PHCS Commercial |
$23,599.20
|
| Rate for Payer: United Healthcare All Payer |
$21,632.60
|
|
|
ARTCM 40M .1875 PST 10.0*10.0
|
Facility
|
IP
|
$24,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,374.75 |
| Max. Negotiated Rate |
$23,599.20 |
| Rate for Payer: Aetna Commercial |
$18,928.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,174.35
|
| Rate for Payer: Cash Price |
$12,291.25
|
| Rate for Payer: Cigna Commercial |
$20,403.47
|
| Rate for Payer: First Health Commercial |
$23,353.38
|
| Rate for Payer: Humana Commercial |
$20,895.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,157.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,141.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,374.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,632.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,436.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,961.92
|
| Rate for Payer: PHCS Commercial |
$23,599.20
|
| Rate for Payer: United Healthcare All Payer |
$21,632.60
|
|
|
ARTCM 40M .1875 PST 10.0*11.0
|
Facility
|
IP
|
$24,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,374.75 |
| Max. Negotiated Rate |
$23,599.20 |
| Rate for Payer: Aetna Commercial |
$18,928.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,174.35
|
| Rate for Payer: Cash Price |
$12,291.25
|
| Rate for Payer: Cigna Commercial |
$20,403.47
|
| Rate for Payer: First Health Commercial |
$23,353.38
|
| Rate for Payer: Humana Commercial |
$20,895.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,157.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,141.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,374.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,632.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,436.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,961.92
|
| Rate for Payer: PHCS Commercial |
$23,599.20
|
| Rate for Payer: United Healthcare All Payer |
$21,632.60
|
|
|
ARTCM 40M .1875 PST 10.0*11.0
|
Facility
|
OP
|
$24,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,374.75 |
| Max. Negotiated Rate |
$23,599.20 |
| Rate for Payer: Aetna Commercial |
$18,928.53
|
| Rate for Payer: Anthem Medicaid |
$8,453.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,174.35
|
| Rate for Payer: Cash Price |
$12,291.25
|
| Rate for Payer: Cigna Commercial |
$20,403.47
|
| Rate for Payer: First Health Commercial |
$23,353.38
|
| Rate for Payer: Humana Commercial |
$20,895.12
|
| Rate for Payer: Humana KY Medicaid |
$8,453.92
|
| Rate for Payer: Kentucky WC Medicaid |
$8,539.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,157.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,141.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,374.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,623.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,632.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,436.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,961.92
|
| Rate for Payer: PHCS Commercial |
$23,599.20
|
| Rate for Payer: United Healthcare All Payer |
$21,632.60
|
|
|
ARTCM 40M .1875 PST 10.5*10.5
|
Facility
|
IP
|
$24,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,374.75 |
| Max. Negotiated Rate |
$23,599.20 |
| Rate for Payer: Aetna Commercial |
$18,928.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,174.35
|
| Rate for Payer: Cash Price |
$12,291.25
|
| Rate for Payer: Cigna Commercial |
$20,403.47
|
| Rate for Payer: First Health Commercial |
$23,353.38
|
| Rate for Payer: Humana Commercial |
$20,895.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,157.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,141.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,374.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,632.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,436.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,961.92
|
| Rate for Payer: PHCS Commercial |
$23,599.20
|
| Rate for Payer: United Healthcare All Payer |
$21,632.60
|
|
|
ARTCM 40M .1875 PST 10.5*10.5
|
Facility
|
OP
|
$24,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,374.75 |
| Max. Negotiated Rate |
$23,599.20 |
| Rate for Payer: Aetna Commercial |
$18,928.53
|
| Rate for Payer: Anthem Medicaid |
$8,453.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,174.35
|
| Rate for Payer: Cash Price |
$12,291.25
|
| Rate for Payer: Cigna Commercial |
$20,403.47
|
| Rate for Payer: First Health Commercial |
$23,353.38
|
| Rate for Payer: Humana Commercial |
$20,895.12
|
| Rate for Payer: Humana KY Medicaid |
$8,453.92
|
| Rate for Payer: Kentucky WC Medicaid |
$8,539.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,157.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,141.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,374.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,623.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,632.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,436.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,961.92
|
| Rate for Payer: PHCS Commercial |
$23,599.20
|
| Rate for Payer: United Healthcare All Payer |
$21,632.60
|
|
|
ARTCM 40M .1875 PST 11.0*11.0
|
Facility
|
OP
|
$24,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,374.75 |
| Max. Negotiated Rate |
$23,599.20 |
| Rate for Payer: Aetna Commercial |
$18,928.53
|
| Rate for Payer: Anthem Medicaid |
$8,453.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,174.35
|
| Rate for Payer: Cash Price |
$12,291.25
|
| Rate for Payer: Cigna Commercial |
$20,403.47
|
| Rate for Payer: First Health Commercial |
$23,353.38
|
| Rate for Payer: Humana Commercial |
$20,895.12
|
| Rate for Payer: Humana KY Medicaid |
$8,453.92
|
| Rate for Payer: Kentucky WC Medicaid |
$8,539.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,157.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,141.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,374.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,623.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,632.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,436.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,961.92
|
| Rate for Payer: PHCS Commercial |
$23,599.20
|
| Rate for Payer: United Healthcare All Payer |
$21,632.60
|
|
|
ARTCM 40M .1875 PST 11.0*11.0
|
Facility
|
IP
|
$24,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,374.75 |
| Max. Negotiated Rate |
$23,599.20 |
| Rate for Payer: Aetna Commercial |
$18,928.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,174.35
|
| Rate for Payer: Cash Price |
$12,291.25
|
| Rate for Payer: Cigna Commercial |
$20,403.47
|
| Rate for Payer: First Health Commercial |
$23,353.38
|
| Rate for Payer: Humana Commercial |
$20,895.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,157.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,141.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,374.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,632.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,436.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,961.92
|
| Rate for Payer: PHCS Commercial |
$23,599.20
|
| Rate for Payer: United Healthcare All Payer |
$21,632.60
|
|
|
ARTCM 40M .1875 PST 11.0*12.0
|
Facility
|
IP
|
$24,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,374.75 |
| Max. Negotiated Rate |
$23,599.20 |
| Rate for Payer: Aetna Commercial |
$18,928.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,174.35
|
| Rate for Payer: Cash Price |
$12,291.25
|
| Rate for Payer: Cigna Commercial |
$20,403.47
|
| Rate for Payer: First Health Commercial |
$23,353.38
|
| Rate for Payer: Humana Commercial |
$20,895.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,157.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,141.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,374.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,632.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,436.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,961.92
|
| Rate for Payer: PHCS Commercial |
$23,599.20
|
| Rate for Payer: United Healthcare All Payer |
$21,632.60
|
|
|
ARTCM 40M .1875 PST 11.0*12.0
|
Facility
|
OP
|
$24,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,374.75 |
| Max. Negotiated Rate |
$23,599.20 |
| Rate for Payer: Aetna Commercial |
$18,928.53
|
| Rate for Payer: Anthem Medicaid |
$8,453.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,174.35
|
| Rate for Payer: Cash Price |
$12,291.25
|
| Rate for Payer: Cigna Commercial |
$20,403.47
|
| Rate for Payer: First Health Commercial |
$23,353.38
|
| Rate for Payer: Humana Commercial |
$20,895.12
|
| Rate for Payer: Humana KY Medicaid |
$8,453.92
|
| Rate for Payer: Kentucky WC Medicaid |
$8,539.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,157.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,141.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,374.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,623.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,632.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,436.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,961.92
|
| Rate for Payer: PHCS Commercial |
$23,599.20
|
| Rate for Payer: United Healthcare All Payer |
$21,632.60
|
|
|
ARTCM 40M .1875 PST 11.5*11.5
|
Facility
|
OP
|
$24,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,374.75 |
| Max. Negotiated Rate |
$23,599.20 |
| Rate for Payer: Aetna Commercial |
$18,928.53
|
| Rate for Payer: Anthem Medicaid |
$8,453.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,174.35
|
| Rate for Payer: Cash Price |
$12,291.25
|
| Rate for Payer: Cigna Commercial |
$20,403.47
|
| Rate for Payer: First Health Commercial |
$23,353.38
|
| Rate for Payer: Humana Commercial |
$20,895.12
|
| Rate for Payer: Humana KY Medicaid |
$8,453.92
|
| Rate for Payer: Kentucky WC Medicaid |
$8,539.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,157.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,141.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,374.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,623.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,632.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,436.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,961.92
|
| Rate for Payer: PHCS Commercial |
$23,599.20
|
| Rate for Payer: United Healthcare All Payer |
$21,632.60
|
|
|
ARTCM 40M .1875 PST 11.5*11.5
|
Facility
|
IP
|
$24,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,374.75 |
| Max. Negotiated Rate |
$23,599.20 |
| Rate for Payer: Aetna Commercial |
$18,928.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,174.35
|
| Rate for Payer: Cash Price |
$12,291.25
|
| Rate for Payer: Cigna Commercial |
$20,403.47
|
| Rate for Payer: First Health Commercial |
$23,353.38
|
| Rate for Payer: Humana Commercial |
$20,895.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,157.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,141.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,374.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,632.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,436.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,961.92
|
| Rate for Payer: PHCS Commercial |
$23,599.20
|
| Rate for Payer: United Healthcare All Payer |
$21,632.60
|
|
|
ARTCM 40M .1875 PST 12.0*12.0
|
Facility
|
IP
|
$24,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,374.75 |
| Max. Negotiated Rate |
$23,599.20 |
| Rate for Payer: Aetna Commercial |
$18,928.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,174.35
|
| Rate for Payer: Cash Price |
$12,291.25
|
| Rate for Payer: Cigna Commercial |
$20,403.47
|
| Rate for Payer: First Health Commercial |
$23,353.38
|
| Rate for Payer: Humana Commercial |
$20,895.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,157.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,141.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,374.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,632.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,436.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,961.92
|
| Rate for Payer: PHCS Commercial |
$23,599.20
|
| Rate for Payer: United Healthcare All Payer |
$21,632.60
|
|
|
ARTCM 40M .1875 PST 12.0*12.0
|
Facility
|
OP
|
$24,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,374.75 |
| Max. Negotiated Rate |
$23,599.20 |
| Rate for Payer: Aetna Commercial |
$18,928.53
|
| Rate for Payer: Anthem Medicaid |
$8,453.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,174.35
|
| Rate for Payer: Cash Price |
$12,291.25
|
| Rate for Payer: Cigna Commercial |
$20,403.47
|
| Rate for Payer: First Health Commercial |
$23,353.38
|
| Rate for Payer: Humana Commercial |
$20,895.12
|
| Rate for Payer: Humana KY Medicaid |
$8,453.92
|
| Rate for Payer: Kentucky WC Medicaid |
$8,539.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,157.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,141.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,374.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,623.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,632.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,436.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,961.92
|
| Rate for Payer: PHCS Commercial |
$23,599.20
|
| Rate for Payer: United Healthcare All Payer |
$21,632.60
|
|
|
ART CMP 40M .1875 PST 9.0*10.0
|
Facility
|
IP
|
$24,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,374.75 |
| Max. Negotiated Rate |
$23,599.20 |
| Rate for Payer: Aetna Commercial |
$18,928.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,174.35
|
| Rate for Payer: Cash Price |
$12,291.25
|
| Rate for Payer: Cigna Commercial |
$20,403.47
|
| Rate for Payer: First Health Commercial |
$23,353.38
|
| Rate for Payer: Humana Commercial |
$20,895.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,157.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,141.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,374.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,632.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,436.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,961.92
|
| Rate for Payer: PHCS Commercial |
$23,599.20
|
| Rate for Payer: United Healthcare All Payer |
$21,632.60
|
|
|
ART CMP 40M .1875 PST 9.0*10.0
|
Facility
|
OP
|
$24,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,374.75 |
| Max. Negotiated Rate |
$23,599.20 |
| Rate for Payer: Aetna Commercial |
$18,928.53
|
| Rate for Payer: Anthem Medicaid |
$8,453.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,174.35
|
| Rate for Payer: Cash Price |
$12,291.25
|
| Rate for Payer: Cigna Commercial |
$20,403.47
|
| Rate for Payer: First Health Commercial |
$23,353.38
|
| Rate for Payer: Humana Commercial |
$20,895.12
|
| Rate for Payer: Humana KY Medicaid |
$8,453.92
|
| Rate for Payer: Kentucky WC Medicaid |
$8,539.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,157.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,141.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,374.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,623.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,632.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,436.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,961.92
|
| Rate for Payer: PHCS Commercial |
$23,599.20
|
| Rate for Payer: United Healthcare All Payer |
$21,632.60
|
|
|
ART COMP 40M .1875 PST 8.0*8.0
|
Facility
|
IP
|
$24,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,374.75 |
| Max. Negotiated Rate |
$23,599.20 |
| Rate for Payer: Aetna Commercial |
$18,928.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,174.35
|
| Rate for Payer: Cash Price |
$12,291.25
|
| Rate for Payer: Cigna Commercial |
$20,403.47
|
| Rate for Payer: First Health Commercial |
$23,353.38
|
| Rate for Payer: Humana Commercial |
$20,895.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,157.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,141.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,374.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,632.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,436.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,961.92
|
| Rate for Payer: PHCS Commercial |
$23,599.20
|
| Rate for Payer: United Healthcare All Payer |
$21,632.60
|
|
|
ART COMP 40M .1875 PST 8.0*8.0
|
Facility
|
OP
|
$24,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,374.75 |
| Max. Negotiated Rate |
$23,599.20 |
| Rate for Payer: Aetna Commercial |
$18,928.53
|
| Rate for Payer: Anthem Medicaid |
$8,453.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,174.35
|
| Rate for Payer: Cash Price |
$12,291.25
|
| Rate for Payer: Cigna Commercial |
$20,403.47
|
| Rate for Payer: First Health Commercial |
$23,353.38
|
| Rate for Payer: Humana Commercial |
$20,895.12
|
| Rate for Payer: Humana KY Medicaid |
$8,453.92
|
| Rate for Payer: Kentucky WC Medicaid |
$8,539.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,157.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,141.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,374.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,623.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,632.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,436.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,961.92
|
| Rate for Payer: PHCS Commercial |
$23,599.20
|
| Rate for Payer: United Healthcare All Payer |
$21,632.60
|
|
|
ART COMP 40M .1875 PST 8.0*9.0
|
Facility
|
IP
|
$24,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,374.75 |
| Max. Negotiated Rate |
$23,599.20 |
| Rate for Payer: Aetna Commercial |
$18,928.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,174.35
|
| Rate for Payer: Cash Price |
$12,291.25
|
| Rate for Payer: Cigna Commercial |
$20,403.47
|
| Rate for Payer: First Health Commercial |
$23,353.38
|
| Rate for Payer: Humana Commercial |
$20,895.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,157.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,141.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,374.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,632.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,436.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,961.92
|
| Rate for Payer: PHCS Commercial |
$23,599.20
|
| Rate for Payer: United Healthcare All Payer |
$21,632.60
|
|
|
ART COMP 40M .1875 PST 8.0*9.0
|
Facility
|
OP
|
$24,582.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,374.75 |
| Max. Negotiated Rate |
$23,599.20 |
| Rate for Payer: Aetna Commercial |
$18,928.53
|
| Rate for Payer: Anthem Medicaid |
$8,453.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,174.35
|
| Rate for Payer: Cash Price |
$12,291.25
|
| Rate for Payer: Cigna Commercial |
$20,403.47
|
| Rate for Payer: First Health Commercial |
$23,353.38
|
| Rate for Payer: Humana Commercial |
$20,895.12
|
| Rate for Payer: Humana KY Medicaid |
$8,453.92
|
| Rate for Payer: Kentucky WC Medicaid |
$8,539.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,157.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,141.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,374.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,623.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,632.60
|
| Rate for Payer: Ohio Health Group HMO |
$18,436.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,666.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,386.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,961.92
|
| Rate for Payer: PHCS Commercial |
$23,599.20
|
| Rate for Payer: United Healthcare All Payer |
$21,632.60
|
|
