|
REV COLOSTOMY; SIMPLE
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 44340
|
| Hospital Charge Code |
76101840
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$197.94 |
| Max. Negotiated Rate |
$856.55 |
| Rate for Payer: Aetna Commercial |
$856.55
|
| Rate for Payer: Ambetter Exchange |
$594.75
|
| Rate for Payer: Anthem Medicaid |
$197.94
|
| Rate for Payer: Buckeye Individual/Medicaid |
$594.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$594.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$713.70
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$594.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$594.75
|
| 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 |
$773.17
|
| Rate for Payer: UHCCP Medicaid |
$297.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$199.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$594.75
|
|
|
REV COLOSTOMY; SIMPLE
|
Facility
|
IP
|
$850.00
|
|
|
Service Code
|
HCPCS 44340
|
| Hospital Charge Code |
76101840
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$255.00 |
| Max. Negotiated Rate |
$816.00 |
| Rate for Payer: Aetna Commercial |
$654.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$663.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$705.50
|
| Rate for Payer: First Health Commercial |
$807.50
|
| Rate for Payer: Humana Commercial |
$722.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$697.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$627.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$255.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$748.00
|
| Rate for Payer: Ohio Health Group HMO |
$637.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$739.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$586.50
|
| Rate for Payer: PHCS Commercial |
$816.00
|
| Rate for Payer: United Healthcare All Payer |
$748.00
|
|
|
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: Ambetter Exchange |
$594.75
|
| Rate for Payer: Anthem Medicaid |
$197.94
|
| Rate for Payer: Buckeye Individual/Medicaid |
$594.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$594.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$713.70
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$594.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$594.75
|
| 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 |
$773.17
|
| Rate for Payer: UHCCP Medicaid |
$297.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$199.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$594.75
|
|
|
REVEAL DX ILR LOOP REC 9528
|
Facility
|
IP
|
$21,856.25
|
|
|
Service Code
|
HCPCS C1764
|
| Hospital Charge Code |
27000049
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$6,556.88 |
| Max. Negotiated Rate |
$20,982.00 |
| Rate for Payer: Aetna Commercial |
$16,829.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,047.88
|
| Rate for Payer: Cash Price |
$10,928.12
|
| Rate for Payer: Cigna Commercial |
$18,140.69
|
| Rate for Payer: First Health Commercial |
$20,763.44
|
| Rate for Payer: Humana Commercial |
$18,577.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,922.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,129.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,556.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,233.50
|
| Rate for Payer: Ohio Health Group HMO |
$16,392.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,485.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,014.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,080.81
|
| Rate for Payer: PHCS Commercial |
$20,982.00
|
| Rate for Payer: United Healthcare All Payer |
$19,233.50
|
|
|
REVEAL DX ILR LOOP REC 9528
|
Facility
|
OP
|
$21,856.25
|
|
|
Service Code
|
HCPCS C1764
|
| Hospital Charge Code |
27000049
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$6,556.88 |
| Max. Negotiated Rate |
$20,982.00 |
| Rate for Payer: Aetna Commercial |
$16,829.31
|
| Rate for Payer: Anthem Medicaid |
$7,516.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,047.88
|
| Rate for Payer: Cash Price |
$10,928.12
|
| Rate for Payer: Cigna Commercial |
$18,140.69
|
| Rate for Payer: First Health Commercial |
$20,763.44
|
| Rate for Payer: Humana Commercial |
$18,577.81
|
| Rate for Payer: Humana KY Medicaid |
$7,516.36
|
| Rate for Payer: Kentucky WC Medicaid |
$7,592.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,922.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,129.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,556.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,667.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,233.50
|
| Rate for Payer: Ohio Health Group HMO |
$16,392.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,485.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,014.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,080.81
|
| Rate for Payer: PHCS Commercial |
$20,982.00
|
| Rate for Payer: United Healthcare All Payer |
$19,233.50
|
|
|
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: Ambetter Exchange |
$566.66
|
| Rate for Payer: Anthem Medicaid |
$250.24
|
| Rate for Payer: Buckeye Individual/Medicaid |
$566.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$566.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$679.99
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$566.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$566.66
|
| 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 |
$736.66
|
| Rate for Payer: UHCCP Medicaid |
$278.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$252.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$566.66
|
|
|
REVERSAL ILEOSTOMY SIMPLE
|
Facility
|
OP
|
$796.00
|
|
|
Service Code
|
HCPCS 44312
|
| Hospital Charge Code |
76101837
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$273.74 |
| Max. Negotiated Rate |
$4,735.72 |
| Rate for Payer: Aetna Commercial |
$612.92
|
| Rate for Payer: Anthem Medicaid |
$273.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,382.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$620.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,735.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,566.59
|
| 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 |
$3,382.66
|
| 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 |
$4,059.19
|
| 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 |
$636.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$692.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$549.24
|
| 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 |
$238.80 |
| 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 |
$636.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$692.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$549.24
|
| Rate for Payer: PHCS Commercial |
$764.16
|
| Rate for Payer: United Healthcare All Payer |
$700.48
|
|
|
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: Ambetter Exchange |
$566.66
|
| Rate for Payer: Anthem Medicaid |
$250.24
|
| Rate for Payer: Buckeye Individual/Medicaid |
$566.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$566.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$679.99
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$566.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$566.66
|
| 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 |
$736.66
|
| Rate for Payer: UHCCP Medicaid |
$278.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$252.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$566.66
|
|
|
REVERSE CUP SZ 36+2MM L
|
Facility
|
OP
|
$9,515.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,854.57 |
| Max. Negotiated Rate |
$9,134.64 |
| Rate for Payer: Aetna Commercial |
$7,326.74
|
| Rate for Payer: Anthem Medicaid |
$3,272.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,421.90
|
| Rate for Payer: Cash Price |
$4,757.62
|
| Rate for Payer: Cigna Commercial |
$7,897.66
|
| Rate for Payer: First Health Commercial |
$9,039.49
|
| Rate for Payer: Humana Commercial |
$8,087.96
|
| Rate for Payer: Humana KY Medicaid |
$3,272.29
|
| Rate for Payer: Kentucky WC Medicaid |
$3,305.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,802.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,022.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,854.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,337.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,373.42
|
| Rate for Payer: Ohio Health Group HMO |
$7,136.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,612.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,278.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,565.52
|
| Rate for Payer: PHCS Commercial |
$9,134.64
|
| Rate for Payer: United Healthcare All Payer |
$8,373.42
|
|
|
REVERSE CUP SZ 36+2MM L
|
Facility
|
IP
|
$9,515.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,854.57 |
| Max. Negotiated Rate |
$9,134.64 |
| Rate for Payer: Aetna Commercial |
$7,326.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,421.90
|
| Rate for Payer: Cash Price |
$4,757.62
|
| Rate for Payer: Cigna Commercial |
$7,897.66
|
| Rate for Payer: First Health Commercial |
$9,039.49
|
| Rate for Payer: Humana Commercial |
$8,087.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,802.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,022.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,854.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,373.42
|
| Rate for Payer: Ohio Health Group HMO |
$7,136.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,612.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,278.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,565.52
|
| Rate for Payer: PHCS Commercial |
$9,134.64
|
| Rate for Payer: United Healthcare All Payer |
$8,373.42
|
|
|
REVERSE CUP SZ 36+2MM R/H
|
Facility
|
IP
|
$9,515.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,854.57 |
| Max. Negotiated Rate |
$9,134.64 |
| Rate for Payer: Aetna Commercial |
$7,326.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,421.90
|
| Rate for Payer: Cash Price |
$4,757.62
|
| Rate for Payer: Cigna Commercial |
$7,897.66
|
| Rate for Payer: First Health Commercial |
$9,039.49
|
| Rate for Payer: Humana Commercial |
$8,087.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,802.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,022.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,854.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,373.42
|
| Rate for Payer: Ohio Health Group HMO |
$7,136.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,612.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,278.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,565.52
|
| Rate for Payer: PHCS Commercial |
$9,134.64
|
| Rate for Payer: United Healthcare All Payer |
$8,373.42
|
|
|
REVERSE CUP SZ 36+2MM R/H
|
Facility
|
OP
|
$9,515.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,854.57 |
| Max. Negotiated Rate |
$9,134.64 |
| Rate for Payer: Aetna Commercial |
$7,326.74
|
| Rate for Payer: Anthem Medicaid |
$3,272.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,421.90
|
| Rate for Payer: Cash Price |
$4,757.62
|
| Rate for Payer: Cigna Commercial |
$7,897.66
|
| Rate for Payer: First Health Commercial |
$9,039.49
|
| Rate for Payer: Humana Commercial |
$8,087.96
|
| Rate for Payer: Humana KY Medicaid |
$3,272.29
|
| Rate for Payer: Kentucky WC Medicaid |
$3,305.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,802.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,022.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,854.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,337.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,373.42
|
| Rate for Payer: Ohio Health Group HMO |
$7,136.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,612.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,278.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,565.52
|
| Rate for Payer: PHCS Commercial |
$9,134.64
|
| Rate for Payer: United Healthcare All Payer |
$8,373.42
|
|
|
REVERSE CUP SZ 36 NEUTRAL
|
Facility
|
OP
|
$9,515.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,854.57 |
| Max. Negotiated Rate |
$9,134.64 |
| Rate for Payer: Aetna Commercial |
$7,326.74
|
| Rate for Payer: Anthem Medicaid |
$3,272.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,421.90
|
| Rate for Payer: Cash Price |
$4,757.62
|
| Rate for Payer: Cigna Commercial |
$7,897.66
|
| Rate for Payer: First Health Commercial |
$9,039.49
|
| Rate for Payer: Humana Commercial |
$8,087.96
|
| Rate for Payer: Humana KY Medicaid |
$3,272.29
|
| Rate for Payer: Kentucky WC Medicaid |
$3,305.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,802.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,022.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,854.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,337.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,373.42
|
| Rate for Payer: Ohio Health Group HMO |
$7,136.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,612.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,278.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,565.52
|
| Rate for Payer: PHCS Commercial |
$9,134.64
|
| Rate for Payer: United Healthcare All Payer |
$8,373.42
|
|
|
REVERSE CUP SZ 36 NEUTRAL
|
Facility
|
IP
|
$9,515.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,854.57 |
| Max. Negotiated Rate |
$9,134.64 |
| Rate for Payer: Aetna Commercial |
$7,326.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,421.90
|
| Rate for Payer: Cash Price |
$4,757.62
|
| Rate for Payer: Cigna Commercial |
$7,897.66
|
| Rate for Payer: First Health Commercial |
$9,039.49
|
| Rate for Payer: Humana Commercial |
$8,087.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,802.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,022.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,854.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,373.42
|
| Rate for Payer: Ohio Health Group HMO |
$7,136.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,612.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,278.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,565.52
|
| Rate for Payer: PHCS Commercial |
$9,134.64
|
| Rate for Payer: United Healthcare All Payer |
$8,373.42
|
|
|
REVERSE CUP SZ 39+2MM L/H
|
Facility
|
OP
|
$9,515.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,854.57 |
| Max. Negotiated Rate |
$9,134.64 |
| Rate for Payer: Aetna Commercial |
$7,326.74
|
| Rate for Payer: Anthem Medicaid |
$3,272.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,421.90
|
| Rate for Payer: Cash Price |
$4,757.62
|
| Rate for Payer: Cigna Commercial |
$7,897.66
|
| Rate for Payer: First Health Commercial |
$9,039.49
|
| Rate for Payer: Humana Commercial |
$8,087.96
|
| Rate for Payer: Humana KY Medicaid |
$3,272.29
|
| Rate for Payer: Kentucky WC Medicaid |
$3,305.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,802.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,022.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,854.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,337.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,373.42
|
| Rate for Payer: Ohio Health Group HMO |
$7,136.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,612.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,278.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,565.52
|
| Rate for Payer: PHCS Commercial |
$9,134.64
|
| Rate for Payer: United Healthcare All Payer |
$8,373.42
|
|
|
REVERSE CUP SZ 39+2MM L/H
|
Facility
|
IP
|
$9,515.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,854.57 |
| Max. Negotiated Rate |
$9,134.64 |
| Rate for Payer: Aetna Commercial |
$7,326.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,421.90
|
| Rate for Payer: Cash Price |
$4,757.62
|
| Rate for Payer: Cigna Commercial |
$7,897.66
|
| Rate for Payer: First Health Commercial |
$9,039.49
|
| Rate for Payer: Humana Commercial |
$8,087.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,802.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,022.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,854.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,373.42
|
| Rate for Payer: Ohio Health Group HMO |
$7,136.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,612.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,278.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,565.52
|
| Rate for Payer: PHCS Commercial |
$9,134.64
|
| Rate for Payer: United Healthcare All Payer |
$8,373.42
|
|
|
REVERSE CUP SZ 39+2MM R/H
|
Facility
|
OP
|
$9,515.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,854.57 |
| Max. Negotiated Rate |
$9,134.64 |
| Rate for Payer: Aetna Commercial |
$7,326.74
|
| Rate for Payer: Anthem Medicaid |
$3,272.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,421.90
|
| Rate for Payer: Cash Price |
$4,757.62
|
| Rate for Payer: Cigna Commercial |
$7,897.66
|
| Rate for Payer: First Health Commercial |
$9,039.49
|
| Rate for Payer: Humana Commercial |
$8,087.96
|
| Rate for Payer: Humana KY Medicaid |
$3,272.29
|
| Rate for Payer: Kentucky WC Medicaid |
$3,305.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,802.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,022.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,854.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,337.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,373.42
|
| Rate for Payer: Ohio Health Group HMO |
$7,136.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,612.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,278.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,565.52
|
| Rate for Payer: PHCS Commercial |
$9,134.64
|
| Rate for Payer: United Healthcare All Payer |
$8,373.42
|
|
|
REVERSE CUP SZ 39+2MM R/H
|
Facility
|
IP
|
$9,515.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,854.57 |
| Max. Negotiated Rate |
$9,134.64 |
| Rate for Payer: Aetna Commercial |
$7,326.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,421.90
|
| Rate for Payer: Cash Price |
$4,757.62
|
| Rate for Payer: Cigna Commercial |
$7,897.66
|
| Rate for Payer: First Health Commercial |
$9,039.49
|
| Rate for Payer: Humana Commercial |
$8,087.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,802.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,022.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,854.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,373.42
|
| Rate for Payer: Ohio Health Group HMO |
$7,136.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,612.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,278.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,565.52
|
| Rate for Payer: PHCS Commercial |
$9,134.64
|
| Rate for Payer: United Healthcare All Payer |
$8,373.42
|
|
|
REVERSE CUP SZ 39 NEUTRAL
|
Facility
|
IP
|
$9,515.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,854.57 |
| Max. Negotiated Rate |
$9,134.64 |
| Rate for Payer: Aetna Commercial |
$7,326.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,421.90
|
| Rate for Payer: Cash Price |
$4,757.62
|
| Rate for Payer: Cigna Commercial |
$7,897.66
|
| Rate for Payer: First Health Commercial |
$9,039.49
|
| Rate for Payer: Humana Commercial |
$8,087.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,802.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,022.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,854.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,373.42
|
| Rate for Payer: Ohio Health Group HMO |
$7,136.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,612.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,278.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,565.52
|
| Rate for Payer: PHCS Commercial |
$9,134.64
|
| Rate for Payer: United Healthcare All Payer |
$8,373.42
|
|
|
REVERSE CUP SZ 39 NEUTRAL
|
Facility
|
OP
|
$9,515.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,854.57 |
| Max. Negotiated Rate |
$9,134.64 |
| Rate for Payer: Aetna Commercial |
$7,326.74
|
| Rate for Payer: Anthem Medicaid |
$3,272.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,421.90
|
| Rate for Payer: Cash Price |
$4,757.62
|
| Rate for Payer: Cigna Commercial |
$7,897.66
|
| Rate for Payer: First Health Commercial |
$9,039.49
|
| Rate for Payer: Humana Commercial |
$8,087.96
|
| Rate for Payer: Humana KY Medicaid |
$3,272.29
|
| Rate for Payer: Kentucky WC Medicaid |
$3,305.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,802.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,022.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,854.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,337.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,373.42
|
| Rate for Payer: Ohio Health Group HMO |
$7,136.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,612.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,278.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,565.52
|
| Rate for Payer: PHCS Commercial |
$9,134.64
|
| Rate for Payer: United Healthcare All Payer |
$8,373.42
|
|
|
REVERSE CUP SZ 42+2MM L/H
|
Facility
|
IP
|
$9,515.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,854.57 |
| Max. Negotiated Rate |
$9,134.64 |
| Rate for Payer: Aetna Commercial |
$7,326.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,421.90
|
| Rate for Payer: Cash Price |
$4,757.62
|
| Rate for Payer: Cigna Commercial |
$7,897.66
|
| Rate for Payer: First Health Commercial |
$9,039.49
|
| Rate for Payer: Humana Commercial |
$8,087.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,802.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,022.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,854.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,373.42
|
| Rate for Payer: Ohio Health Group HMO |
$7,136.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,612.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,278.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,565.52
|
| Rate for Payer: PHCS Commercial |
$9,134.64
|
| Rate for Payer: United Healthcare All Payer |
$8,373.42
|
|
|
REVERSE CUP SZ 42+2MM L/H
|
Facility
|
OP
|
$9,515.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,854.57 |
| Max. Negotiated Rate |
$9,134.64 |
| Rate for Payer: Aetna Commercial |
$7,326.74
|
| Rate for Payer: Anthem Medicaid |
$3,272.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,421.90
|
| Rate for Payer: Cash Price |
$4,757.62
|
| Rate for Payer: Cigna Commercial |
$7,897.66
|
| Rate for Payer: First Health Commercial |
$9,039.49
|
| Rate for Payer: Humana Commercial |
$8,087.96
|
| Rate for Payer: Humana KY Medicaid |
$3,272.29
|
| Rate for Payer: Kentucky WC Medicaid |
$3,305.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,802.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,022.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,854.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,337.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,373.42
|
| Rate for Payer: Ohio Health Group HMO |
$7,136.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,612.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,278.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,565.52
|
| Rate for Payer: PHCS Commercial |
$9,134.64
|
| Rate for Payer: United Healthcare All Payer |
$8,373.42
|
|
|
REVERSE CUP SZ 42+2MM R/H
|
Facility
|
OP
|
$9,515.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,854.57 |
| Max. Negotiated Rate |
$9,134.64 |
| Rate for Payer: Aetna Commercial |
$7,326.74
|
| Rate for Payer: Anthem Medicaid |
$3,272.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,421.90
|
| Rate for Payer: Cash Price |
$4,757.62
|
| Rate for Payer: Cigna Commercial |
$7,897.66
|
| Rate for Payer: First Health Commercial |
$9,039.49
|
| Rate for Payer: Humana Commercial |
$8,087.96
|
| Rate for Payer: Humana KY Medicaid |
$3,272.29
|
| Rate for Payer: Kentucky WC Medicaid |
$3,305.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,802.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,022.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,854.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,337.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,373.42
|
| Rate for Payer: Ohio Health Group HMO |
$7,136.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,612.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,278.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,565.52
|
| Rate for Payer: PHCS Commercial |
$9,134.64
|
| Rate for Payer: United Healthcare All Payer |
$8,373.42
|
|
|
REVERSE CUP SZ 42+2MM R/H
|
Facility
|
IP
|
$9,515.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,854.57 |
| Max. Negotiated Rate |
$9,134.64 |
| Rate for Payer: Aetna Commercial |
$7,326.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,421.90
|
| Rate for Payer: Cash Price |
$4,757.62
|
| Rate for Payer: Cigna Commercial |
$7,897.66
|
| Rate for Payer: First Health Commercial |
$9,039.49
|
| Rate for Payer: Humana Commercial |
$8,087.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,802.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,022.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,854.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,373.42
|
| Rate for Payer: Ohio Health Group HMO |
$7,136.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,612.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,278.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,565.52
|
| Rate for Payer: PHCS Commercial |
$9,134.64
|
| Rate for Payer: United Healthcare All Payer |
$8,373.42
|
|
