|
REV MASTOID; RSLT RAD MSTDCTMY
|
Facility
|
OP
|
$3,200.00
|
|
|
Service Code
|
HCPCS 69603
|
| Hospital Charge Code |
76102426
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$416.00 |
| Max. Negotiated Rate |
$7,089.80 |
| Rate for Payer: Aetna Commercial |
$2,464.00
|
| Rate for Payer: Anthem Medicaid |
$1,100.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,064.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,496.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,089.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,836.59
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cigna Commercial |
$2,656.00
|
| Rate for Payer: First Health Commercial |
$3,040.00
|
| Rate for Payer: Humana Commercial |
$2,720.00
|
| Rate for Payer: Humana KY Medicaid |
$1,100.48
|
| Rate for Payer: Humana Medicare Advantage |
$5,064.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,111.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,624.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,361.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,076.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,122.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,816.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,400.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$416.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$992.00
|
| Rate for Payer: PHCS Commercial |
$3,072.00
|
| Rate for Payer: United Healthcare All Payer |
$2,816.00
|
|
|
REV MASTOID; RSLT RAD MSTDCTMY
|
Facility
|
IP
|
$3,200.00
|
|
|
Service Code
|
HCPCS 69603
|
| Hospital Charge Code |
76102426
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$416.00 |
| Max. Negotiated Rate |
$3,072.00 |
| Rate for Payer: Aetna Commercial |
$2,464.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,496.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cigna Commercial |
$2,656.00
|
| Rate for Payer: First Health Commercial |
$3,040.00
|
| Rate for Payer: Humana Commercial |
$2,720.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,624.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,361.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$960.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,816.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,400.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$416.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$992.00
|
| Rate for Payer: PHCS Commercial |
$3,072.00
|
| Rate for Payer: United Healthcare All Payer |
$2,816.00
|
|
|
REV OF GASTROJEJUNAL ANAST
|
Facility
|
OP
|
$2,100.00
|
|
|
Service Code
|
HCPCS 43860
|
| Hospital Charge Code |
76101799
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$273.00 |
| Max. Negotiated Rate |
$2,016.00 |
| Rate for Payer: Aetna Commercial |
$1,617.00
|
| Rate for Payer: Anthem Medicaid |
$722.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,638.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,743.00
|
| Rate for Payer: First Health Commercial |
$1,995.00
|
| Rate for Payer: Humana Commercial |
$1,785.00
|
| Rate for Payer: Humana KY Medicaid |
$722.19
|
| Rate for Payer: Kentucky WC Medicaid |
$729.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,722.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,549.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$736.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,848.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$651.00
|
| Rate for Payer: PHCS Commercial |
$2,016.00
|
| Rate for Payer: United Healthcare All Payer |
$1,848.00
|
|
|
REV OF GASTROJEJUNAL ANAST
|
Facility
|
IP
|
$2,100.00
|
|
|
Service Code
|
HCPCS 43860
|
| Hospital Charge Code |
76101799
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$273.00 |
| Max. Negotiated Rate |
$2,016.00 |
| Rate for Payer: Aetna Commercial |
$1,617.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,638.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$1,743.00
|
| Rate for Payer: First Health Commercial |
$1,995.00
|
| Rate for Payer: Humana Commercial |
$1,785.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,722.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,549.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,848.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,575.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$651.00
|
| Rate for Payer: PHCS Commercial |
$2,016.00
|
| Rate for Payer: United Healthcare All Payer |
$1,848.00
|
|
|
REV OF GASTROJEJUNAL ANAST
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 43860
|
| Hospital Charge Code |
76101799
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$735.00 |
| Max. Negotiated Rate |
$2,371.81 |
| Rate for Payer: Aetna Commercial |
$2,371.81
|
| Rate for Payer: Anthem Medicaid |
$900.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,100.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$2,204.98
|
| Rate for Payer: Healthspan PPO |
$2,000.19
|
| Rate for Payer: Humana Medicaid |
$900.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,091.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$918.67
|
| Rate for Payer: Molina Healthcare Passport |
$900.66
|
| Rate for Payer: Multiplan PHCS |
$1,260.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,470.00
|
| Rate for Payer: UHCCP Medicaid |
$735.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$909.67
|
|
|
REV OF GASTROJEJUNAL ANAST(P
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 43860
|
| Hospital Charge Code |
761P1799
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$735.00 |
| Max. Negotiated Rate |
$2,371.81 |
| Rate for Payer: Aetna Commercial |
$2,371.81
|
| Rate for Payer: Anthem Medicaid |
$900.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,100.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$2,204.98
|
| Rate for Payer: Healthspan PPO |
$2,000.19
|
| Rate for Payer: Humana Medicaid |
$900.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,091.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$918.67
|
| Rate for Payer: Molina Healthcare Passport |
$900.66
|
| Rate for Payer: Multiplan PHCS |
$1,260.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,470.00
|
| Rate for Payer: UHCCP Medicaid |
$735.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$909.67
|
|
|
REV POR 170MM STR SZ 11
|
Facility
|
IP
|
$15,102.78
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,963.36 |
| Max. Negotiated Rate |
$14,498.67 |
| Rate for Payer: Aetna Commercial |
$11,629.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,780.17
|
| Rate for Payer: Cash Price |
$7,551.39
|
| Rate for Payer: Cigna Commercial |
$12,535.31
|
| Rate for Payer: First Health Commercial |
$14,347.64
|
| Rate for Payer: Humana Commercial |
$12,837.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,384.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,145.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,530.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,290.45
|
| Rate for Payer: Ohio Health Group HMO |
$11,327.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,020.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,963.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,681.86
|
| Rate for Payer: PHCS Commercial |
$14,498.67
|
| Rate for Payer: United Healthcare All Payer |
$13,290.45
|
|
|
REV POR 170MM STR SZ 11
|
Facility
|
OP
|
$15,102.78
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,963.36 |
| Max. Negotiated Rate |
$14,498.67 |
| Rate for Payer: Aetna Commercial |
$11,629.14
|
| Rate for Payer: Anthem Medicaid |
$5,193.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,780.17
|
| Rate for Payer: Cash Price |
$7,551.39
|
| Rate for Payer: Cigna Commercial |
$12,535.31
|
| Rate for Payer: First Health Commercial |
$14,347.64
|
| Rate for Payer: Humana Commercial |
$12,837.36
|
| Rate for Payer: Humana KY Medicaid |
$5,193.85
|
| Rate for Payer: Kentucky WC Medicaid |
$5,246.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,384.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,145.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,530.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,298.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,290.45
|
| Rate for Payer: Ohio Health Group HMO |
$11,327.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,020.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,963.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,681.86
|
| Rate for Payer: PHCS Commercial |
$14,498.67
|
| Rate for Payer: United Healthcare All Payer |
$13,290.45
|
|
|
REV POR 170MM STR SZ 12
|
Facility
|
IP
|
$15,102.78
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,963.36 |
| Max. Negotiated Rate |
$14,498.67 |
| Rate for Payer: Aetna Commercial |
$11,629.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,780.17
|
| Rate for Payer: Cash Price |
$7,551.39
|
| Rate for Payer: Cigna Commercial |
$12,535.31
|
| Rate for Payer: First Health Commercial |
$14,347.64
|
| Rate for Payer: Humana Commercial |
$12,837.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,384.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,145.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,530.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,290.45
|
| Rate for Payer: Ohio Health Group HMO |
$11,327.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,020.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,963.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,681.86
|
| Rate for Payer: PHCS Commercial |
$14,498.67
|
| Rate for Payer: United Healthcare All Payer |
$13,290.45
|
|
|
REV POR 170MM STR SZ 12
|
Facility
|
OP
|
$15,102.78
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,963.36 |
| Max. Negotiated Rate |
$14,498.67 |
| Rate for Payer: Aetna Commercial |
$11,629.14
|
| Rate for Payer: Anthem Medicaid |
$5,193.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,780.17
|
| Rate for Payer: Cash Price |
$7,551.39
|
| Rate for Payer: Cigna Commercial |
$12,535.31
|
| Rate for Payer: First Health Commercial |
$14,347.64
|
| Rate for Payer: Humana Commercial |
$12,837.36
|
| Rate for Payer: Humana KY Medicaid |
$5,193.85
|
| Rate for Payer: Kentucky WC Medicaid |
$5,246.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,384.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,145.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,530.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,298.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,290.45
|
| Rate for Payer: Ohio Health Group HMO |
$11,327.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,020.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,963.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,681.86
|
| Rate for Payer: PHCS Commercial |
$14,498.67
|
| Rate for Payer: United Healthcare All Payer |
$13,290.45
|
|
|
REV POR 170MM STR SZ 13
|
Facility
|
IP
|
$15,102.78
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,963.36 |
| Max. Negotiated Rate |
$14,498.67 |
| Rate for Payer: Aetna Commercial |
$11,629.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,780.17
|
| Rate for Payer: Cash Price |
$7,551.39
|
| Rate for Payer: Cigna Commercial |
$12,535.31
|
| Rate for Payer: First Health Commercial |
$14,347.64
|
| Rate for Payer: Humana Commercial |
$12,837.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,384.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,145.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,530.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,290.45
|
| Rate for Payer: Ohio Health Group HMO |
$11,327.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,020.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,963.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,681.86
|
| Rate for Payer: PHCS Commercial |
$14,498.67
|
| Rate for Payer: United Healthcare All Payer |
$13,290.45
|
|
|
REV POR 170MM STR SZ 13
|
Facility
|
OP
|
$15,102.78
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,963.36 |
| Max. Negotiated Rate |
$14,498.67 |
| Rate for Payer: Aetna Commercial |
$11,629.14
|
| Rate for Payer: Anthem Medicaid |
$5,193.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,780.17
|
| Rate for Payer: Cash Price |
$7,551.39
|
| Rate for Payer: Cigna Commercial |
$12,535.31
|
| Rate for Payer: First Health Commercial |
$14,347.64
|
| Rate for Payer: Humana Commercial |
$12,837.36
|
| Rate for Payer: Humana KY Medicaid |
$5,193.85
|
| Rate for Payer: Kentucky WC Medicaid |
$5,246.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,384.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,145.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,530.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,298.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,290.45
|
| Rate for Payer: Ohio Health Group HMO |
$11,327.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,020.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,963.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,681.86
|
| Rate for Payer: PHCS Commercial |
$14,498.67
|
| Rate for Payer: United Healthcare All Payer |
$13,290.45
|
|
|
REV POR 170MM STR SZ 14
|
Facility
|
OP
|
$15,102.78
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,963.36 |
| Max. Negotiated Rate |
$14,498.67 |
| Rate for Payer: Aetna Commercial |
$11,629.14
|
| Rate for Payer: Anthem Medicaid |
$5,193.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,780.17
|
| Rate for Payer: Cash Price |
$7,551.39
|
| Rate for Payer: Cigna Commercial |
$12,535.31
|
| Rate for Payer: First Health Commercial |
$14,347.64
|
| Rate for Payer: Humana Commercial |
$12,837.36
|
| Rate for Payer: Humana KY Medicaid |
$5,193.85
|
| Rate for Payer: Kentucky WC Medicaid |
$5,246.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,384.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,145.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,530.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,298.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,290.45
|
| Rate for Payer: Ohio Health Group HMO |
$11,327.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,020.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,963.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,681.86
|
| Rate for Payer: PHCS Commercial |
$14,498.67
|
| Rate for Payer: United Healthcare All Payer |
$13,290.45
|
|
|
REV POR 170MM STR SZ 14
|
Facility
|
IP
|
$15,102.78
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,963.36 |
| Max. Negotiated Rate |
$14,498.67 |
| Rate for Payer: Aetna Commercial |
$11,629.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,780.17
|
| Rate for Payer: Cash Price |
$7,551.39
|
| Rate for Payer: Cigna Commercial |
$12,535.31
|
| Rate for Payer: First Health Commercial |
$14,347.64
|
| Rate for Payer: Humana Commercial |
$12,837.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,384.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,145.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,530.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,290.45
|
| Rate for Payer: Ohio Health Group HMO |
$11,327.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,020.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,963.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,681.86
|
| Rate for Payer: PHCS Commercial |
$14,498.67
|
| Rate for Payer: United Healthcare All Payer |
$13,290.45
|
|
|
REV POR 170MM STR SZ 15
|
Facility
|
IP
|
$15,102.78
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,963.36 |
| Max. Negotiated Rate |
$14,498.67 |
| Rate for Payer: Aetna Commercial |
$11,629.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,780.17
|
| Rate for Payer: Cash Price |
$7,551.39
|
| Rate for Payer: Cigna Commercial |
$12,535.31
|
| Rate for Payer: First Health Commercial |
$14,347.64
|
| Rate for Payer: Humana Commercial |
$12,837.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,384.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,145.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,530.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,290.45
|
| Rate for Payer: Ohio Health Group HMO |
$11,327.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,020.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,963.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,681.86
|
| Rate for Payer: PHCS Commercial |
$14,498.67
|
| Rate for Payer: United Healthcare All Payer |
$13,290.45
|
|
|
REV POR 170MM STR SZ 15
|
Facility
|
OP
|
$15,102.78
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,963.36 |
| Max. Negotiated Rate |
$14,498.67 |
| Rate for Payer: Aetna Commercial |
$11,629.14
|
| Rate for Payer: Anthem Medicaid |
$5,193.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,780.17
|
| Rate for Payer: Cash Price |
$7,551.39
|
| Rate for Payer: Cigna Commercial |
$12,535.31
|
| Rate for Payer: First Health Commercial |
$14,347.64
|
| Rate for Payer: Humana Commercial |
$12,837.36
|
| Rate for Payer: Humana KY Medicaid |
$5,193.85
|
| Rate for Payer: Kentucky WC Medicaid |
$5,246.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,384.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,145.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,530.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,298.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,290.45
|
| Rate for Payer: Ohio Health Group HMO |
$11,327.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,020.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,963.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,681.86
|
| Rate for Payer: PHCS Commercial |
$14,498.67
|
| Rate for Payer: United Healthcare All Payer |
$13,290.45
|
|
|
REV POR 170MM STR SZ 16
|
Facility
|
OP
|
$15,102.78
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,963.36 |
| Max. Negotiated Rate |
$14,498.67 |
| Rate for Payer: Aetna Commercial |
$11,629.14
|
| Rate for Payer: Anthem Medicaid |
$5,193.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,780.17
|
| Rate for Payer: Cash Price |
$7,551.39
|
| Rate for Payer: Cigna Commercial |
$12,535.31
|
| Rate for Payer: First Health Commercial |
$14,347.64
|
| Rate for Payer: Humana Commercial |
$12,837.36
|
| Rate for Payer: Humana KY Medicaid |
$5,193.85
|
| Rate for Payer: Kentucky WC Medicaid |
$5,246.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,384.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,145.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,530.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,298.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,290.45
|
| Rate for Payer: Ohio Health Group HMO |
$11,327.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,020.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,963.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,681.86
|
| Rate for Payer: PHCS Commercial |
$14,498.67
|
| Rate for Payer: United Healthcare All Payer |
$13,290.45
|
|
|
REV POR 170MM STR SZ 16
|
Facility
|
IP
|
$15,102.78
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,963.36 |
| Max. Negotiated Rate |
$14,498.67 |
| Rate for Payer: Aetna Commercial |
$11,629.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,780.17
|
| Rate for Payer: Cash Price |
$7,551.39
|
| Rate for Payer: Cigna Commercial |
$12,535.31
|
| Rate for Payer: First Health Commercial |
$14,347.64
|
| Rate for Payer: Humana Commercial |
$12,837.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,384.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,145.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,530.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,290.45
|
| Rate for Payer: Ohio Health Group HMO |
$11,327.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,020.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,963.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,681.86
|
| Rate for Payer: PHCS Commercial |
$14,498.67
|
| Rate for Payer: United Healthcare All Payer |
$13,290.45
|
|
|
REV POR 170MM STR SZ 17
|
Facility
|
IP
|
$15,102.78
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,963.36 |
| Max. Negotiated Rate |
$14,498.67 |
| Rate for Payer: Aetna Commercial |
$11,629.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,780.17
|
| Rate for Payer: Cash Price |
$7,551.39
|
| Rate for Payer: Cigna Commercial |
$12,535.31
|
| Rate for Payer: First Health Commercial |
$14,347.64
|
| Rate for Payer: Humana Commercial |
$12,837.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,384.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,145.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,530.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,290.45
|
| Rate for Payer: Ohio Health Group HMO |
$11,327.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,020.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,963.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,681.86
|
| Rate for Payer: PHCS Commercial |
$14,498.67
|
| Rate for Payer: United Healthcare All Payer |
$13,290.45
|
|
|
REV POR 170MM STR SZ 17
|
Facility
|
OP
|
$15,102.78
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,963.36 |
| Max. Negotiated Rate |
$14,498.67 |
| Rate for Payer: Aetna Commercial |
$11,629.14
|
| Rate for Payer: Anthem Medicaid |
$5,193.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,780.17
|
| Rate for Payer: Cash Price |
$7,551.39
|
| Rate for Payer: Cigna Commercial |
$12,535.31
|
| Rate for Payer: First Health Commercial |
$14,347.64
|
| Rate for Payer: Humana Commercial |
$12,837.36
|
| Rate for Payer: Humana KY Medicaid |
$5,193.85
|
| Rate for Payer: Kentucky WC Medicaid |
$5,246.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,384.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,145.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,530.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,298.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,290.45
|
| Rate for Payer: Ohio Health Group HMO |
$11,327.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,020.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,963.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,681.86
|
| Rate for Payer: PHCS Commercial |
$14,498.67
|
| Rate for Payer: United Healthcare All Payer |
$13,290.45
|
|
|
REV POR 170MM STR SZ 18
|
Facility
|
IP
|
$15,102.78
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,963.36 |
| Max. Negotiated Rate |
$14,498.67 |
| Rate for Payer: Aetna Commercial |
$11,629.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,780.17
|
| Rate for Payer: Cash Price |
$7,551.39
|
| Rate for Payer: Cigna Commercial |
$12,535.31
|
| Rate for Payer: First Health Commercial |
$14,347.64
|
| Rate for Payer: Humana Commercial |
$12,837.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,384.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,145.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,530.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,290.45
|
| Rate for Payer: Ohio Health Group HMO |
$11,327.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,020.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,963.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,681.86
|
| Rate for Payer: PHCS Commercial |
$14,498.67
|
| Rate for Payer: United Healthcare All Payer |
$13,290.45
|
|
|
REV POR 170MM STR SZ 18
|
Facility
|
OP
|
$15,102.78
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,963.36 |
| Max. Negotiated Rate |
$14,498.67 |
| Rate for Payer: Aetna Commercial |
$11,629.14
|
| Rate for Payer: Anthem Medicaid |
$5,193.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,780.17
|
| Rate for Payer: Cash Price |
$7,551.39
|
| Rate for Payer: Cigna Commercial |
$12,535.31
|
| Rate for Payer: First Health Commercial |
$14,347.64
|
| Rate for Payer: Humana Commercial |
$12,837.36
|
| Rate for Payer: Humana KY Medicaid |
$5,193.85
|
| Rate for Payer: Kentucky WC Medicaid |
$5,246.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,384.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,145.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,530.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,298.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,290.45
|
| Rate for Payer: Ohio Health Group HMO |
$11,327.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,020.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,963.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,681.86
|
| Rate for Payer: PHCS Commercial |
$14,498.67
|
| Rate for Payer: United Healthcare All Payer |
$13,290.45
|
|
|
REV POR 170MM STR SZ 19
|
Facility
|
IP
|
$15,102.78
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,963.36 |
| Max. Negotiated Rate |
$14,498.67 |
| Rate for Payer: Aetna Commercial |
$11,629.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,780.17
|
| Rate for Payer: Cash Price |
$7,551.39
|
| Rate for Payer: Cigna Commercial |
$12,535.31
|
| Rate for Payer: First Health Commercial |
$14,347.64
|
| Rate for Payer: Humana Commercial |
$12,837.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,384.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,145.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,530.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,290.45
|
| Rate for Payer: Ohio Health Group HMO |
$11,327.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,020.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,963.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,681.86
|
| Rate for Payer: PHCS Commercial |
$14,498.67
|
| Rate for Payer: United Healthcare All Payer |
$13,290.45
|
|
|
REV POR 170MM STR SZ 19
|
Facility
|
OP
|
$15,102.78
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,963.36 |
| Max. Negotiated Rate |
$14,498.67 |
| Rate for Payer: Aetna Commercial |
$11,629.14
|
| Rate for Payer: Anthem Medicaid |
$5,193.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,780.17
|
| Rate for Payer: Cash Price |
$7,551.39
|
| Rate for Payer: Cigna Commercial |
$12,535.31
|
| Rate for Payer: First Health Commercial |
$14,347.64
|
| Rate for Payer: Humana Commercial |
$12,837.36
|
| Rate for Payer: Humana KY Medicaid |
$5,193.85
|
| Rate for Payer: Kentucky WC Medicaid |
$5,246.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,384.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,145.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,530.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,298.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,290.45
|
| Rate for Payer: Ohio Health Group HMO |
$11,327.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,020.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,963.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,681.86
|
| Rate for Payer: PHCS Commercial |
$14,498.67
|
| Rate for Payer: United Healthcare All Payer |
$13,290.45
|
|
|
REV POR 170MM STR SZ 20
|
Facility
|
OP
|
$15,102.78
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,963.36 |
| Max. Negotiated Rate |
$14,498.67 |
| Rate for Payer: Aetna Commercial |
$11,629.14
|
| Rate for Payer: Anthem Medicaid |
$5,193.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,780.17
|
| Rate for Payer: Cash Price |
$7,551.39
|
| Rate for Payer: Cigna Commercial |
$12,535.31
|
| Rate for Payer: First Health Commercial |
$14,347.64
|
| Rate for Payer: Humana Commercial |
$12,837.36
|
| Rate for Payer: Humana KY Medicaid |
$5,193.85
|
| Rate for Payer: Kentucky WC Medicaid |
$5,246.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,384.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,145.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,530.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,298.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,290.45
|
| Rate for Payer: Ohio Health Group HMO |
$11,327.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,020.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,963.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,681.86
|
| Rate for Payer: PHCS Commercial |
$14,498.67
|
| Rate for Payer: United Healthcare All Payer |
$13,290.45
|
|
