|
REV COLOSTOMY; SIMPLE (P
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 44340
|
| Hospital Charge Code |
761P1840
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$197.94 |
| Max. Negotiated Rate |
$856.55 |
| Rate for Payer: Aetna Commercial |
$856.55
|
| Rate for Payer: Anthem Medicaid |
$197.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$850.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$785.08
|
| Rate for Payer: Healthspan PPO |
$722.34
|
| Rate for Payer: Humana Medicaid |
$197.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$780.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$201.90
|
| Rate for Payer: Molina Healthcare Passport |
$197.94
|
| Rate for Payer: Multiplan PHCS |
$510.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$595.00
|
| Rate for Payer: UHCCP Medicaid |
$297.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$199.92
|
|
|
REVEAL DX ILR LOOP REC 9528
|
Facility
|
OP
|
$21,206.75
|
|
|
Service Code
|
HCPCS C1764
|
| Hospital Charge Code |
27000049
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,756.88 |
| Max. Negotiated Rate |
$20,358.48 |
| Rate for Payer: Aetna Commercial |
$16,329.20
|
| Rate for Payer: Anthem Medicaid |
$7,293.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,541.26
|
| Rate for Payer: Cash Price |
$10,603.38
|
| Rate for Payer: Cigna Commercial |
$17,601.60
|
| Rate for Payer: First Health Commercial |
$20,146.41
|
| Rate for Payer: Humana Commercial |
$18,025.74
|
| Rate for Payer: Humana KY Medicaid |
$7,293.00
|
| Rate for Payer: Kentucky WC Medicaid |
$7,367.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,389.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,650.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,362.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,439.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,661.94
|
| Rate for Payer: Ohio Health Group HMO |
$15,905.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,241.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,756.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,574.09
|
| Rate for Payer: PHCS Commercial |
$20,358.48
|
| Rate for Payer: United Healthcare All Payer |
$18,661.94
|
|
|
REVEAL DX ILR LOOP REC 9528
|
Facility
|
IP
|
$21,206.75
|
|
|
Service Code
|
HCPCS C1764
|
| Hospital Charge Code |
27000049
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,756.88 |
| Max. Negotiated Rate |
$20,358.48 |
| Rate for Payer: Aetna Commercial |
$16,329.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,541.26
|
| Rate for Payer: Cash Price |
$10,603.38
|
| Rate for Payer: Cigna Commercial |
$17,601.60
|
| Rate for Payer: First Health Commercial |
$20,146.41
|
| Rate for Payer: Humana Commercial |
$18,025.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,389.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,650.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,362.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,661.94
|
| Rate for Payer: Ohio Health Group HMO |
$15,905.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,241.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,756.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,574.09
|
| Rate for Payer: PHCS Commercial |
$20,358.48
|
| Rate for Payer: United Healthcare All Payer |
$18,661.94
|
|
|
REVERSAL ILEOSTOMY SIMPLE
|
Facility
|
OP
|
$796.00
|
|
|
Service Code
|
HCPCS 44312
|
| Hospital Charge Code |
76101837
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.48 |
| Max. Negotiated Rate |
$4,343.37 |
| Rate for Payer: Aetna Commercial |
$612.92
|
| Rate for Payer: Anthem Medicaid |
$273.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,102.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$620.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,343.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,188.25
|
| Rate for Payer: Cash Price |
$398.00
|
| Rate for Payer: Cash Price |
$398.00
|
| Rate for Payer: Cigna Commercial |
$660.68
|
| Rate for Payer: First Health Commercial |
$756.20
|
| Rate for Payer: Humana Commercial |
$676.60
|
| Rate for Payer: Humana KY Medicaid |
$273.74
|
| Rate for Payer: Humana Medicare Advantage |
$3,102.41
|
| Rate for Payer: Kentucky WC Medicaid |
$276.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$652.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$587.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,722.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$279.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$700.48
|
| Rate for Payer: Ohio Health Group HMO |
$597.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$159.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$103.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$246.76
|
| Rate for Payer: PHCS Commercial |
$764.16
|
| Rate for Payer: United Healthcare All Payer |
$700.48
|
|
|
REVERSAL ILEOSTOMY SIMPLE
|
Facility
|
IP
|
$796.00
|
|
|
Service Code
|
HCPCS 44312
|
| Hospital Charge Code |
76101837
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.48 |
| Max. Negotiated Rate |
$764.16 |
| Rate for Payer: Aetna Commercial |
$612.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$620.88
|
| Rate for Payer: Cash Price |
$398.00
|
| Rate for Payer: Cigna Commercial |
$660.68
|
| Rate for Payer: First Health Commercial |
$756.20
|
| Rate for Payer: Humana Commercial |
$676.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$652.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$587.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$238.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$700.48
|
| Rate for Payer: Ohio Health Group HMO |
$597.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$159.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$103.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$246.76
|
| Rate for Payer: PHCS Commercial |
$764.16
|
| Rate for Payer: United Healthcare All Payer |
$700.48
|
|
|
REVERSAL ILEOSTOMY SIMPLE
|
Professional
|
Both
|
$796.00
|
|
|
Service Code
|
HCPCS 44312
|
| Hospital Charge Code |
76101837
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$250.24 |
| Max. Negotiated Rate |
$849.78 |
| Rate for Payer: Aetna Commercial |
$849.78
|
| Rate for Payer: Anthem Medicaid |
$250.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$796.00
|
| Rate for Payer: Cash Price |
$398.00
|
| Rate for Payer: Cash Price |
$398.00
|
| Rate for Payer: Cigna Commercial |
$776.89
|
| Rate for Payer: Healthspan PPO |
$716.63
|
| Rate for Payer: Humana Medicaid |
$250.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$751.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$255.24
|
| Rate for Payer: Molina Healthcare Passport |
$250.24
|
| Rate for Payer: Multiplan PHCS |
$477.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$557.20
|
| Rate for Payer: UHCCP Medicaid |
$278.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$252.74
|
|
|
REVERSAL ILEOSTOMY SIMPLE(P
|
Professional
|
Both
|
$796.00
|
|
|
Service Code
|
HCPCS 44312
|
| Hospital Charge Code |
761P1837
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$250.24 |
| Max. Negotiated Rate |
$849.78 |
| Rate for Payer: Aetna Commercial |
$849.78
|
| Rate for Payer: Anthem Medicaid |
$250.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$796.00
|
| Rate for Payer: Cash Price |
$398.00
|
| Rate for Payer: Cash Price |
$398.00
|
| Rate for Payer: Cigna Commercial |
$776.89
|
| Rate for Payer: Healthspan PPO |
$716.63
|
| Rate for Payer: Humana Medicaid |
$250.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$751.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$255.24
|
| Rate for Payer: Molina Healthcare Passport |
$250.24
|
| Rate for Payer: Multiplan PHCS |
$477.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$557.20
|
| Rate for Payer: UHCCP Medicaid |
$278.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$252.74
|
|
|
REVERSE CUP SZ 36+2MM L
|
Facility
|
IP
|
$9,315.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,210.98 |
| Max. Negotiated Rate |
$8,942.64 |
| Rate for Payer: Aetna Commercial |
$7,172.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,265.90
|
| Rate for Payer: Cash Price |
$4,657.62
|
| Rate for Payer: Cigna Commercial |
$7,731.66
|
| Rate for Payer: First Health Commercial |
$8,849.49
|
| Rate for Payer: Humana Commercial |
$7,917.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,638.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,874.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,794.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,197.42
|
| Rate for Payer: Ohio Health Group HMO |
$6,986.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,863.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,210.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,887.73
|
| Rate for Payer: PHCS Commercial |
$8,942.64
|
| Rate for Payer: United Healthcare All Payer |
$8,197.42
|
|
|
REVERSE CUP SZ 36+2MM L
|
Facility
|
OP
|
$9,315.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,210.98 |
| Max. Negotiated Rate |
$8,942.64 |
| Rate for Payer: Aetna Commercial |
$7,172.74
|
| Rate for Payer: Anthem Medicaid |
$3,203.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,265.90
|
| Rate for Payer: Cash Price |
$4,657.62
|
| Rate for Payer: Cigna Commercial |
$7,731.66
|
| Rate for Payer: First Health Commercial |
$8,849.49
|
| Rate for Payer: Humana Commercial |
$7,917.96
|
| Rate for Payer: Humana KY Medicaid |
$3,203.51
|
| Rate for Payer: Kentucky WC Medicaid |
$3,236.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,638.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,874.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,794.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,267.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,197.42
|
| Rate for Payer: Ohio Health Group HMO |
$6,986.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,863.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,210.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,887.73
|
| Rate for Payer: PHCS Commercial |
$8,942.64
|
| Rate for Payer: United Healthcare All Payer |
$8,197.42
|
|
|
REVERSE CUP SZ 36+2MM R/H
|
Facility
|
IP
|
$9,315.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,210.98 |
| Max. Negotiated Rate |
$8,942.64 |
| Rate for Payer: Aetna Commercial |
$7,172.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,265.90
|
| Rate for Payer: Cash Price |
$4,657.62
|
| Rate for Payer: Cigna Commercial |
$7,731.66
|
| Rate for Payer: First Health Commercial |
$8,849.49
|
| Rate for Payer: Humana Commercial |
$7,917.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,638.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,874.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,794.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,197.42
|
| Rate for Payer: Ohio Health Group HMO |
$6,986.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,863.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,210.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,887.73
|
| Rate for Payer: PHCS Commercial |
$8,942.64
|
| Rate for Payer: United Healthcare All Payer |
$8,197.42
|
|
|
REVERSE CUP SZ 36+2MM R/H
|
Facility
|
OP
|
$9,315.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,210.98 |
| Max. Negotiated Rate |
$8,942.64 |
| Rate for Payer: Aetna Commercial |
$7,172.74
|
| Rate for Payer: Anthem Medicaid |
$3,203.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,265.90
|
| Rate for Payer: Cash Price |
$4,657.62
|
| Rate for Payer: Cigna Commercial |
$7,731.66
|
| Rate for Payer: First Health Commercial |
$8,849.49
|
| Rate for Payer: Humana Commercial |
$7,917.96
|
| Rate for Payer: Humana KY Medicaid |
$3,203.51
|
| Rate for Payer: Kentucky WC Medicaid |
$3,236.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,638.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,874.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,794.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,267.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,197.42
|
| Rate for Payer: Ohio Health Group HMO |
$6,986.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,863.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,210.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,887.73
|
| Rate for Payer: PHCS Commercial |
$8,942.64
|
| Rate for Payer: United Healthcare All Payer |
$8,197.42
|
|
|
REVERSE CUP SZ 36 NEUTRAL
|
Facility
|
OP
|
$9,315.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,210.98 |
| Max. Negotiated Rate |
$8,942.64 |
| Rate for Payer: Aetna Commercial |
$7,172.74
|
| Rate for Payer: Anthem Medicaid |
$3,203.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,265.90
|
| Rate for Payer: Cash Price |
$4,657.62
|
| Rate for Payer: Cigna Commercial |
$7,731.66
|
| Rate for Payer: First Health Commercial |
$8,849.49
|
| Rate for Payer: Humana Commercial |
$7,917.96
|
| Rate for Payer: Humana KY Medicaid |
$3,203.51
|
| Rate for Payer: Kentucky WC Medicaid |
$3,236.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,638.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,874.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,794.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,267.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,197.42
|
| Rate for Payer: Ohio Health Group HMO |
$6,986.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,863.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,210.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,887.73
|
| Rate for Payer: PHCS Commercial |
$8,942.64
|
| Rate for Payer: United Healthcare All Payer |
$8,197.42
|
|
|
REVERSE CUP SZ 36 NEUTRAL
|
Facility
|
IP
|
$9,315.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,210.98 |
| Max. Negotiated Rate |
$8,942.64 |
| Rate for Payer: Aetna Commercial |
$7,172.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,265.90
|
| Rate for Payer: Cash Price |
$4,657.62
|
| Rate for Payer: Cigna Commercial |
$7,731.66
|
| Rate for Payer: First Health Commercial |
$8,849.49
|
| Rate for Payer: Humana Commercial |
$7,917.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,638.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,874.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,794.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,197.42
|
| Rate for Payer: Ohio Health Group HMO |
$6,986.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,863.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,210.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,887.73
|
| Rate for Payer: PHCS Commercial |
$8,942.64
|
| Rate for Payer: United Healthcare All Payer |
$8,197.42
|
|
|
REVERSE CUP SZ 39+2MM L/H
|
Facility
|
IP
|
$9,315.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,210.98 |
| Max. Negotiated Rate |
$8,942.64 |
| Rate for Payer: Aetna Commercial |
$7,172.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,265.90
|
| Rate for Payer: Cash Price |
$4,657.62
|
| Rate for Payer: Cigna Commercial |
$7,731.66
|
| Rate for Payer: First Health Commercial |
$8,849.49
|
| Rate for Payer: Humana Commercial |
$7,917.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,638.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,874.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,794.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,197.42
|
| Rate for Payer: Ohio Health Group HMO |
$6,986.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,863.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,210.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,887.73
|
| Rate for Payer: PHCS Commercial |
$8,942.64
|
| Rate for Payer: United Healthcare All Payer |
$8,197.42
|
|
|
REVERSE CUP SZ 39+2MM L/H
|
Facility
|
OP
|
$9,315.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,210.98 |
| Max. Negotiated Rate |
$8,942.64 |
| Rate for Payer: Aetna Commercial |
$7,172.74
|
| Rate for Payer: Anthem Medicaid |
$3,203.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,265.90
|
| Rate for Payer: Cash Price |
$4,657.62
|
| Rate for Payer: Cigna Commercial |
$7,731.66
|
| Rate for Payer: First Health Commercial |
$8,849.49
|
| Rate for Payer: Humana Commercial |
$7,917.96
|
| Rate for Payer: Humana KY Medicaid |
$3,203.51
|
| Rate for Payer: Kentucky WC Medicaid |
$3,236.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,638.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,874.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,794.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,267.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,197.42
|
| Rate for Payer: Ohio Health Group HMO |
$6,986.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,863.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,210.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,887.73
|
| Rate for Payer: PHCS Commercial |
$8,942.64
|
| Rate for Payer: United Healthcare All Payer |
$8,197.42
|
|
|
REVERSE CUP SZ 39+2MM R/H
|
Facility
|
IP
|
$9,315.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,210.98 |
| Max. Negotiated Rate |
$8,942.64 |
| Rate for Payer: Aetna Commercial |
$7,172.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,265.90
|
| Rate for Payer: Cash Price |
$4,657.62
|
| Rate for Payer: Cigna Commercial |
$7,731.66
|
| Rate for Payer: First Health Commercial |
$8,849.49
|
| Rate for Payer: Humana Commercial |
$7,917.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,638.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,874.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,794.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,197.42
|
| Rate for Payer: Ohio Health Group HMO |
$6,986.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,863.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,210.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,887.73
|
| Rate for Payer: PHCS Commercial |
$8,942.64
|
| Rate for Payer: United Healthcare All Payer |
$8,197.42
|
|
|
REVERSE CUP SZ 39+2MM R/H
|
Facility
|
OP
|
$9,315.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,210.98 |
| Max. Negotiated Rate |
$8,942.64 |
| Rate for Payer: Aetna Commercial |
$7,172.74
|
| Rate for Payer: Anthem Medicaid |
$3,203.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,265.90
|
| Rate for Payer: Cash Price |
$4,657.62
|
| Rate for Payer: Cigna Commercial |
$7,731.66
|
| Rate for Payer: First Health Commercial |
$8,849.49
|
| Rate for Payer: Humana Commercial |
$7,917.96
|
| Rate for Payer: Humana KY Medicaid |
$3,203.51
|
| Rate for Payer: Kentucky WC Medicaid |
$3,236.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,638.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,874.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,794.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,267.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,197.42
|
| Rate for Payer: Ohio Health Group HMO |
$6,986.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,863.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,210.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,887.73
|
| Rate for Payer: PHCS Commercial |
$8,942.64
|
| Rate for Payer: United Healthcare All Payer |
$8,197.42
|
|
|
REVERSE CUP SZ 39 NEUTRAL
|
Facility
|
OP
|
$9,315.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,210.98 |
| Max. Negotiated Rate |
$8,942.64 |
| Rate for Payer: Aetna Commercial |
$7,172.74
|
| Rate for Payer: Anthem Medicaid |
$3,203.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,265.90
|
| Rate for Payer: Cash Price |
$4,657.62
|
| Rate for Payer: Cigna Commercial |
$7,731.66
|
| Rate for Payer: First Health Commercial |
$8,849.49
|
| Rate for Payer: Humana Commercial |
$7,917.96
|
| Rate for Payer: Humana KY Medicaid |
$3,203.51
|
| Rate for Payer: Kentucky WC Medicaid |
$3,236.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,638.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,874.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,794.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,267.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,197.42
|
| Rate for Payer: Ohio Health Group HMO |
$6,986.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,863.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,210.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,887.73
|
| Rate for Payer: PHCS Commercial |
$8,942.64
|
| Rate for Payer: United Healthcare All Payer |
$8,197.42
|
|
|
REVERSE CUP SZ 39 NEUTRAL
|
Facility
|
IP
|
$9,315.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,210.98 |
| Max. Negotiated Rate |
$8,942.64 |
| Rate for Payer: Aetna Commercial |
$7,172.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,265.90
|
| Rate for Payer: Cash Price |
$4,657.62
|
| Rate for Payer: Cigna Commercial |
$7,731.66
|
| Rate for Payer: First Health Commercial |
$8,849.49
|
| Rate for Payer: Humana Commercial |
$7,917.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,638.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,874.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,794.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,197.42
|
| Rate for Payer: Ohio Health Group HMO |
$6,986.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,863.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,210.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,887.73
|
| Rate for Payer: PHCS Commercial |
$8,942.64
|
| Rate for Payer: United Healthcare All Payer |
$8,197.42
|
|
|
REVERSE CUP SZ 42+2MM L/H
|
Facility
|
OP
|
$9,315.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,210.98 |
| Max. Negotiated Rate |
$8,942.64 |
| Rate for Payer: Aetna Commercial |
$7,172.74
|
| Rate for Payer: Anthem Medicaid |
$3,203.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,265.90
|
| Rate for Payer: Cash Price |
$4,657.62
|
| Rate for Payer: Cigna Commercial |
$7,731.66
|
| Rate for Payer: First Health Commercial |
$8,849.49
|
| Rate for Payer: Humana Commercial |
$7,917.96
|
| Rate for Payer: Humana KY Medicaid |
$3,203.51
|
| Rate for Payer: Kentucky WC Medicaid |
$3,236.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,638.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,874.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,794.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,267.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,197.42
|
| Rate for Payer: Ohio Health Group HMO |
$6,986.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,863.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,210.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,887.73
|
| Rate for Payer: PHCS Commercial |
$8,942.64
|
| Rate for Payer: United Healthcare All Payer |
$8,197.42
|
|
|
REVERSE CUP SZ 42+2MM L/H
|
Facility
|
IP
|
$9,315.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,210.98 |
| Max. Negotiated Rate |
$8,942.64 |
| Rate for Payer: Aetna Commercial |
$7,172.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,265.90
|
| Rate for Payer: Cash Price |
$4,657.62
|
| Rate for Payer: Cigna Commercial |
$7,731.66
|
| Rate for Payer: First Health Commercial |
$8,849.49
|
| Rate for Payer: Humana Commercial |
$7,917.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,638.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,874.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,794.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,197.42
|
| Rate for Payer: Ohio Health Group HMO |
$6,986.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,863.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,210.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,887.73
|
| Rate for Payer: PHCS Commercial |
$8,942.64
|
| Rate for Payer: United Healthcare All Payer |
$8,197.42
|
|
|
REVERSE CUP SZ 42+2MM R/H
|
Facility
|
IP
|
$9,315.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,210.98 |
| Max. Negotiated Rate |
$8,942.64 |
| Rate for Payer: Aetna Commercial |
$7,172.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,265.90
|
| Rate for Payer: Cash Price |
$4,657.62
|
| Rate for Payer: Cigna Commercial |
$7,731.66
|
| Rate for Payer: First Health Commercial |
$8,849.49
|
| Rate for Payer: Humana Commercial |
$7,917.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,638.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,874.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,794.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,197.42
|
| Rate for Payer: Ohio Health Group HMO |
$6,986.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,863.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,210.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,887.73
|
| Rate for Payer: PHCS Commercial |
$8,942.64
|
| Rate for Payer: United Healthcare All Payer |
$8,197.42
|
|
|
REVERSE CUP SZ 42+2MM R/H
|
Facility
|
OP
|
$9,315.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,210.98 |
| Max. Negotiated Rate |
$8,942.64 |
| Rate for Payer: Aetna Commercial |
$7,172.74
|
| Rate for Payer: Anthem Medicaid |
$3,203.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,265.90
|
| Rate for Payer: Cash Price |
$4,657.62
|
| Rate for Payer: Cigna Commercial |
$7,731.66
|
| Rate for Payer: First Health Commercial |
$8,849.49
|
| Rate for Payer: Humana Commercial |
$7,917.96
|
| Rate for Payer: Humana KY Medicaid |
$3,203.51
|
| Rate for Payer: Kentucky WC Medicaid |
$3,236.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,638.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,874.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,794.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,267.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,197.42
|
| Rate for Payer: Ohio Health Group HMO |
$6,986.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,863.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,210.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,887.73
|
| Rate for Payer: PHCS Commercial |
$8,942.64
|
| Rate for Payer: United Healthcare All Payer |
$8,197.42
|
|
|
REVERSE CUP SZ 42 NEUTRAL
|
Facility
|
OP
|
$9,315.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,210.98 |
| Max. Negotiated Rate |
$8,942.64 |
| Rate for Payer: Aetna Commercial |
$7,172.74
|
| Rate for Payer: Anthem Medicaid |
$3,203.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,265.90
|
| Rate for Payer: Cash Price |
$4,657.62
|
| Rate for Payer: Cigna Commercial |
$7,731.66
|
| Rate for Payer: First Health Commercial |
$8,849.49
|
| Rate for Payer: Humana Commercial |
$7,917.96
|
| Rate for Payer: Humana KY Medicaid |
$3,203.51
|
| Rate for Payer: Kentucky WC Medicaid |
$3,236.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,638.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,874.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,794.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,267.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,197.42
|
| Rate for Payer: Ohio Health Group HMO |
$6,986.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,863.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,210.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,887.73
|
| Rate for Payer: PHCS Commercial |
$8,942.64
|
| Rate for Payer: United Healthcare All Payer |
$8,197.42
|
|
|
REVERSE CUP SZ 42 NEUTRAL
|
Facility
|
IP
|
$9,315.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,210.98 |
| Max. Negotiated Rate |
$8,942.64 |
| Rate for Payer: Aetna Commercial |
$7,172.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,265.90
|
| Rate for Payer: Cash Price |
$4,657.62
|
| Rate for Payer: Cigna Commercial |
$7,731.66
|
| Rate for Payer: First Health Commercial |
$8,849.49
|
| Rate for Payer: Humana Commercial |
$7,917.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,638.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,874.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,794.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,197.42
|
| Rate for Payer: Ohio Health Group HMO |
$6,986.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,863.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,210.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,887.73
|
| Rate for Payer: PHCS Commercial |
$8,942.64
|
| Rate for Payer: United Healthcare All Payer |
$8,197.42
|
|
