|
ART TEST W/O TREADMILL EXER.(T
|
Facility
|
IP
|
$761.00
|
|
|
Service Code
|
HCPCS 93923
|
| Hospital Charge Code |
921T0005
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$228.30 |
| Max. Negotiated Rate |
$730.56 |
| Rate for Payer: Aetna Commercial |
$585.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$593.58
|
| Rate for Payer: Cash Price |
$380.50
|
| Rate for Payer: Cigna Commercial |
$631.63
|
| Rate for Payer: First Health Commercial |
$722.95
|
| Rate for Payer: Humana Commercial |
$646.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$624.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$561.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$228.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$669.68
|
| Rate for Payer: Ohio Health Group HMO |
$570.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$608.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$662.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$525.09
|
| Rate for Payer: PHCS Commercial |
$730.56
|
| Rate for Payer: United Healthcare All Payer |
$669.68
|
|
|
ART TEST W/O TREADMILL EXER.(T
|
Facility
|
OP
|
$761.00
|
|
|
Service Code
|
HCPCS 93923
|
| Hospital Charge Code |
921T0005
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$144.57 |
| Max. Negotiated Rate |
$730.56 |
| Rate for Payer: Aetna Commercial |
$585.97
|
| Rate for Payer: Anthem Medicaid |
$261.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$144.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$593.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$202.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$195.17
|
| Rate for Payer: Cash Price |
$380.50
|
| Rate for Payer: Cash Price |
$380.50
|
| Rate for Payer: Cigna Commercial |
$631.63
|
| Rate for Payer: First Health Commercial |
$722.95
|
| Rate for Payer: Humana Commercial |
$646.85
|
| Rate for Payer: Humana KY Medicaid |
$261.71
|
| Rate for Payer: Humana Medicare Advantage |
$144.57
|
| Rate for Payer: Kentucky WC Medicaid |
$264.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$624.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$561.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$173.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$266.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$669.68
|
| Rate for Payer: Ohio Health Group HMO |
$570.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$608.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$662.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$525.09
|
| Rate for Payer: PHCS Commercial |
$730.56
|
| Rate for Payer: United Healthcare All Payer |
$669.68
|
|
|
ARZERRA 10MG[1000MG/50MLVIAL]
|
Facility
|
OP
|
$32,883.67
|
|
|
Service Code
|
HCPCS J9302
|
| Hospital Charge Code |
25002669
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$62.23 |
| Max. Negotiated Rate |
$31,568.32 |
| Rate for Payer: Aetna Commercial |
$25,320.43
|
| Rate for Payer: Anthem Medicaid |
$11,308.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$62.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,649.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$87.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$84.01
|
| Rate for Payer: Cash Price |
$16,441.83
|
| Rate for Payer: Cash Price |
$16,441.83
|
| Rate for Payer: Cigna Commercial |
$27,293.45
|
| Rate for Payer: First Health Commercial |
$31,239.49
|
| Rate for Payer: Humana Commercial |
$27,951.12
|
| Rate for Payer: Humana KY Medicaid |
$11,308.69
|
| Rate for Payer: Humana Medicare Advantage |
$62.23
|
| Rate for Payer: Kentucky WC Medicaid |
$11,423.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,964.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,268.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$74.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,535.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,937.63
|
| Rate for Payer: Ohio Health Group HMO |
$24,662.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,306.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,608.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,689.73
|
| Rate for Payer: PHCS Commercial |
$31,568.32
|
| Rate for Payer: United Healthcare All Payer |
$28,937.63
|
|
|
ARZERRA 10MG[1000MG/50MLVIAL]
|
Facility
|
IP
|
$32,883.67
|
|
|
Service Code
|
HCPCS J9302
|
| Hospital Charge Code |
25002669
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9,865.10 |
| Max. Negotiated Rate |
$31,568.32 |
| Rate for Payer: Aetna Commercial |
$25,320.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,649.26
|
| Rate for Payer: Cash Price |
$16,441.83
|
| Rate for Payer: Cigna Commercial |
$27,293.45
|
| Rate for Payer: First Health Commercial |
$31,239.49
|
| Rate for Payer: Humana Commercial |
$27,951.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,964.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,268.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,865.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,937.63
|
| Rate for Payer: Ohio Health Group HMO |
$24,662.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,306.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28,608.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,689.73
|
| Rate for Payer: PHCS Commercial |
$31,568.32
|
| Rate for Payer: United Healthcare All Payer |
$28,937.63
|
|
|
ARZERRA 10MG [100MG/5ML VIAL
|
Facility
|
IP
|
$3,288.37
|
|
|
Service Code
|
HCPCS J9302
|
| Hospital Charge Code |
25002668
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$986.51 |
| Max. Negotiated Rate |
$3,156.84 |
| Rate for Payer: Aetna Commercial |
$2,532.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,564.93
|
| Rate for Payer: Cash Price |
$1,644.18
|
| Rate for Payer: Cigna Commercial |
$2,729.35
|
| Rate for Payer: First Health Commercial |
$3,123.95
|
| Rate for Payer: Humana Commercial |
$2,795.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,696.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,426.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$986.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,893.77
|
| Rate for Payer: Ohio Health Group HMO |
$2,466.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,630.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,860.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,268.98
|
| Rate for Payer: PHCS Commercial |
$3,156.84
|
| Rate for Payer: United Healthcare All Payer |
$2,893.77
|
|
|
ARZERRA 10MG [100MG/5ML VIAL
|
Facility
|
OP
|
$3,288.37
|
|
|
Service Code
|
HCPCS J9302
|
| Hospital Charge Code |
25002668
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$62.23 |
| Max. Negotiated Rate |
$3,156.84 |
| Rate for Payer: Aetna Commercial |
$2,532.04
|
| Rate for Payer: Anthem Medicaid |
$1,130.87
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$62.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,564.93
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$87.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$84.01
|
| Rate for Payer: Cash Price |
$1,644.18
|
| Rate for Payer: Cash Price |
$1,644.18
|
| Rate for Payer: Cigna Commercial |
$2,729.35
|
| Rate for Payer: First Health Commercial |
$3,123.95
|
| Rate for Payer: Humana Commercial |
$2,795.11
|
| Rate for Payer: Humana KY Medicaid |
$1,130.87
|
| Rate for Payer: Humana Medicare Advantage |
$62.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,142.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,696.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,426.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$74.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,153.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,893.77
|
| Rate for Payer: Ohio Health Group HMO |
$2,466.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,630.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,860.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,268.98
|
| Rate for Payer: PHCS Commercial |
$3,156.84
|
| Rate for Payer: United Healthcare All Payer |
$2,893.77
|
|
|
AS CEM HUM STEM RMV HD 12*210
|
Facility
|
IP
|
$22,127.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,638.10 |
| Max. Negotiated Rate |
$21,241.92 |
| Rate for Payer: Aetna Commercial |
$17,037.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,259.06
|
| Rate for Payer: Cash Price |
$11,063.50
|
| Rate for Payer: Cigna Commercial |
$18,365.41
|
| Rate for Payer: First Health Commercial |
$21,020.65
|
| Rate for Payer: Humana Commercial |
$18,807.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,144.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,329.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,638.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,471.76
|
| Rate for Payer: Ohio Health Group HMO |
$16,595.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,701.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,250.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,267.63
|
| Rate for Payer: PHCS Commercial |
$21,241.92
|
| Rate for Payer: United Healthcare All Payer |
$19,471.76
|
|
|
AS CEM HUM STEM RMV HD 12*210
|
Facility
|
OP
|
$22,127.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,638.10 |
| Max. Negotiated Rate |
$21,241.92 |
| Rate for Payer: Aetna Commercial |
$17,037.79
|
| Rate for Payer: Anthem Medicaid |
$7,609.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,259.06
|
| Rate for Payer: Cash Price |
$11,063.50
|
| Rate for Payer: Cigna Commercial |
$18,365.41
|
| Rate for Payer: First Health Commercial |
$21,020.65
|
| Rate for Payer: Humana Commercial |
$18,807.95
|
| Rate for Payer: Humana KY Medicaid |
$7,609.48
|
| Rate for Payer: Kentucky WC Medicaid |
$7,686.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,144.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,329.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,638.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,762.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,471.76
|
| Rate for Payer: Ohio Health Group HMO |
$16,595.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,701.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,250.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,267.63
|
| Rate for Payer: PHCS Commercial |
$21,241.92
|
| Rate for Payer: United Healthcare All Payer |
$19,471.76
|
|
|
AS CEM HUM STEM RMV HD 14*210
|
Facility
|
OP
|
$22,127.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,638.10 |
| Max. Negotiated Rate |
$21,241.92 |
| Rate for Payer: Aetna Commercial |
$17,037.79
|
| Rate for Payer: Anthem Medicaid |
$7,609.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,259.06
|
| Rate for Payer: Cash Price |
$11,063.50
|
| Rate for Payer: Cigna Commercial |
$18,365.41
|
| Rate for Payer: First Health Commercial |
$21,020.65
|
| Rate for Payer: Humana Commercial |
$18,807.95
|
| Rate for Payer: Humana KY Medicaid |
$7,609.48
|
| Rate for Payer: Kentucky WC Medicaid |
$7,686.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,144.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,329.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,638.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,762.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,471.76
|
| Rate for Payer: Ohio Health Group HMO |
$16,595.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,701.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,250.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,267.63
|
| Rate for Payer: PHCS Commercial |
$21,241.92
|
| Rate for Payer: United Healthcare All Payer |
$19,471.76
|
|
|
AS CEM HUM STEM RMV HD 14*210
|
Facility
|
IP
|
$22,127.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,638.10 |
| Max. Negotiated Rate |
$21,241.92 |
| Rate for Payer: Aetna Commercial |
$17,037.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,259.06
|
| Rate for Payer: Cash Price |
$11,063.50
|
| Rate for Payer: Cigna Commercial |
$18,365.41
|
| Rate for Payer: First Health Commercial |
$21,020.65
|
| Rate for Payer: Humana Commercial |
$18,807.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,144.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,329.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,638.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,471.76
|
| Rate for Payer: Ohio Health Group HMO |
$16,595.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,701.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,250.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,267.63
|
| Rate for Payer: PHCS Commercial |
$21,241.92
|
| Rate for Payer: United Healthcare All Payer |
$19,471.76
|
|
|
AS CEM HUM STEM RMV HD 7*200
|
Facility
|
IP
|
$22,127.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,638.10 |
| Max. Negotiated Rate |
$21,241.92 |
| Rate for Payer: Aetna Commercial |
$17,037.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,259.06
|
| Rate for Payer: Cash Price |
$11,063.50
|
| Rate for Payer: Cigna Commercial |
$18,365.41
|
| Rate for Payer: First Health Commercial |
$21,020.65
|
| Rate for Payer: Humana Commercial |
$18,807.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,144.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,329.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,638.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,471.76
|
| Rate for Payer: Ohio Health Group HMO |
$16,595.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,701.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,250.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,267.63
|
| Rate for Payer: PHCS Commercial |
$21,241.92
|
| Rate for Payer: United Healthcare All Payer |
$19,471.76
|
|
|
AS CEM HUM STEM RMV HD 7*200
|
Facility
|
OP
|
$22,127.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,638.10 |
| Max. Negotiated Rate |
$21,241.92 |
| Rate for Payer: Aetna Commercial |
$17,037.79
|
| Rate for Payer: Anthem Medicaid |
$7,609.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,259.06
|
| Rate for Payer: Cash Price |
$11,063.50
|
| Rate for Payer: Cigna Commercial |
$18,365.41
|
| Rate for Payer: First Health Commercial |
$21,020.65
|
| Rate for Payer: Humana Commercial |
$18,807.95
|
| Rate for Payer: Humana KY Medicaid |
$7,609.48
|
| Rate for Payer: Kentucky WC Medicaid |
$7,686.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,144.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,329.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,638.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,762.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,471.76
|
| Rate for Payer: Ohio Health Group HMO |
$16,595.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,701.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,250.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,267.63
|
| Rate for Payer: PHCS Commercial |
$21,241.92
|
| Rate for Payer: United Healthcare All Payer |
$19,471.76
|
|
|
AS CEM HUM STEM RMV HD 9*210
|
Facility
|
IP
|
$22,127.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,638.10 |
| Max. Negotiated Rate |
$21,241.92 |
| Rate for Payer: Aetna Commercial |
$17,037.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,259.06
|
| Rate for Payer: Cash Price |
$11,063.50
|
| Rate for Payer: Cigna Commercial |
$18,365.41
|
| Rate for Payer: First Health Commercial |
$21,020.65
|
| Rate for Payer: Humana Commercial |
$18,807.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,144.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,329.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,638.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,471.76
|
| Rate for Payer: Ohio Health Group HMO |
$16,595.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,701.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,250.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,267.63
|
| Rate for Payer: PHCS Commercial |
$21,241.92
|
| Rate for Payer: United Healthcare All Payer |
$19,471.76
|
|
|
AS CEM HUM STEM RMV HD 9*210
|
Facility
|
OP
|
$22,127.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,638.10 |
| Max. Negotiated Rate |
$21,241.92 |
| Rate for Payer: Aetna Commercial |
$17,037.79
|
| Rate for Payer: Anthem Medicaid |
$7,609.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,259.06
|
| Rate for Payer: Cash Price |
$11,063.50
|
| Rate for Payer: Cigna Commercial |
$18,365.41
|
| Rate for Payer: First Health Commercial |
$21,020.65
|
| Rate for Payer: Humana Commercial |
$18,807.95
|
| Rate for Payer: Humana KY Medicaid |
$7,609.48
|
| Rate for Payer: Kentucky WC Medicaid |
$7,686.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,144.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,329.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,638.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,762.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,471.76
|
| Rate for Payer: Ohio Health Group HMO |
$16,595.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,701.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,250.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,267.63
|
| Rate for Payer: PHCS Commercial |
$21,241.92
|
| Rate for Payer: United Healthcare All Payer |
$19,471.76
|
|
|
AS CEM HUM STEM W/REM HD 7*100
|
Facility
|
OP
|
$18,223.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,466.96 |
| Max. Negotiated Rate |
$17,494.27 |
| Rate for Payer: Aetna Commercial |
$14,031.86
|
| Rate for Payer: Anthem Medicaid |
$6,266.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,214.10
|
| Rate for Payer: Cash Price |
$9,111.60
|
| Rate for Payer: Cigna Commercial |
$15,125.26
|
| Rate for Payer: First Health Commercial |
$17,312.04
|
| Rate for Payer: Humana Commercial |
$15,489.72
|
| Rate for Payer: Humana KY Medicaid |
$6,266.96
|
| Rate for Payer: Kentucky WC Medicaid |
$6,330.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,943.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,448.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,466.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,392.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,036.42
|
| Rate for Payer: Ohio Health Group HMO |
$13,667.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,578.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,854.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,574.01
|
| Rate for Payer: PHCS Commercial |
$17,494.27
|
| Rate for Payer: United Healthcare All Payer |
$16,036.42
|
|
|
AS CEM HUM STEM W/REM HD 7*100
|
Facility
|
IP
|
$18,223.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,466.96 |
| Max. Negotiated Rate |
$17,494.27 |
| Rate for Payer: Aetna Commercial |
$14,031.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,214.10
|
| Rate for Payer: Cash Price |
$9,111.60
|
| Rate for Payer: Cigna Commercial |
$15,125.26
|
| Rate for Payer: First Health Commercial |
$17,312.04
|
| Rate for Payer: Humana Commercial |
$15,489.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,943.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,448.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,466.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,036.42
|
| Rate for Payer: Ohio Health Group HMO |
$13,667.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,578.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,854.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,574.01
|
| Rate for Payer: PHCS Commercial |
$17,494.27
|
| Rate for Payer: United Healthcare All Payer |
$16,036.42
|
|
|
AS CEM HUM STEM W/REM HD 9*110
|
Facility
|
IP
|
$18,223.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,466.96 |
| Max. Negotiated Rate |
$17,494.27 |
| Rate for Payer: Aetna Commercial |
$14,031.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,214.10
|
| Rate for Payer: Cash Price |
$9,111.60
|
| Rate for Payer: Cigna Commercial |
$15,125.26
|
| Rate for Payer: First Health Commercial |
$17,312.04
|
| Rate for Payer: Humana Commercial |
$15,489.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,943.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,448.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,466.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,036.42
|
| Rate for Payer: Ohio Health Group HMO |
$13,667.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,578.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,854.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,574.01
|
| Rate for Payer: PHCS Commercial |
$17,494.27
|
| Rate for Payer: United Healthcare All Payer |
$16,036.42
|
|
|
AS CEM HUM STEM W/REM HD 9*110
|
Facility
|
OP
|
$18,223.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,466.96 |
| Max. Negotiated Rate |
$17,494.27 |
| Rate for Payer: Aetna Commercial |
$14,031.86
|
| Rate for Payer: Anthem Medicaid |
$6,266.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,214.10
|
| Rate for Payer: Cash Price |
$9,111.60
|
| Rate for Payer: Cigna Commercial |
$15,125.26
|
| Rate for Payer: First Health Commercial |
$17,312.04
|
| Rate for Payer: Humana Commercial |
$15,489.72
|
| Rate for Payer: Humana KY Medicaid |
$6,266.96
|
| Rate for Payer: Kentucky WC Medicaid |
$6,330.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,943.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,448.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,466.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,392.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,036.42
|
| Rate for Payer: Ohio Health Group HMO |
$13,667.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,578.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,854.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,574.01
|
| Rate for Payer: PHCS Commercial |
$17,494.27
|
| Rate for Payer: United Healthcare All Payer |
$16,036.42
|
|
|
AS CEM HUM STEM W/RMV HD12*100
|
Facility
|
IP
|
$18,563.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,569.08 |
| Max. Negotiated Rate |
$17,821.06 |
| Rate for Payer: Aetna Commercial |
$14,293.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,479.61
|
| Rate for Payer: Cash Price |
$9,281.80
|
| Rate for Payer: Cigna Commercial |
$15,407.79
|
| Rate for Payer: First Health Commercial |
$17,635.42
|
| Rate for Payer: Humana Commercial |
$15,779.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,222.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,699.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,569.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,335.97
|
| Rate for Payer: Ohio Health Group HMO |
$13,922.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,850.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,150.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,808.88
|
| Rate for Payer: PHCS Commercial |
$17,821.06
|
| Rate for Payer: United Healthcare All Payer |
$16,335.97
|
|
|
AS CEM HUM STEM W/RMV HD12*100
|
Facility
|
OP
|
$18,563.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,569.08 |
| Max. Negotiated Rate |
$17,821.06 |
| Rate for Payer: Aetna Commercial |
$14,293.97
|
| Rate for Payer: Anthem Medicaid |
$6,384.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,479.61
|
| Rate for Payer: Cash Price |
$9,281.80
|
| Rate for Payer: Cigna Commercial |
$15,407.79
|
| Rate for Payer: First Health Commercial |
$17,635.42
|
| Rate for Payer: Humana Commercial |
$15,779.06
|
| Rate for Payer: Humana KY Medicaid |
$6,384.02
|
| Rate for Payer: Kentucky WC Medicaid |
$6,448.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,222.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,699.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,569.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,512.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,335.97
|
| Rate for Payer: Ohio Health Group HMO |
$13,922.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,850.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,150.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,808.88
|
| Rate for Payer: PHCS Commercial |
$17,821.06
|
| Rate for Payer: United Healthcare All Payer |
$16,335.97
|
|
|
AS CEM HUM STEM W/RMV HD14*100
|
Facility
|
IP
|
$18,563.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,569.08 |
| Max. Negotiated Rate |
$17,821.06 |
| Rate for Payer: Aetna Commercial |
$14,293.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,479.61
|
| Rate for Payer: Cash Price |
$9,281.80
|
| Rate for Payer: Cigna Commercial |
$15,407.79
|
| Rate for Payer: First Health Commercial |
$17,635.42
|
| Rate for Payer: Humana Commercial |
$15,779.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,222.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,699.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,569.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,335.97
|
| Rate for Payer: Ohio Health Group HMO |
$13,922.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,850.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,150.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,808.88
|
| Rate for Payer: PHCS Commercial |
$17,821.06
|
| Rate for Payer: United Healthcare All Payer |
$16,335.97
|
|
|
AS CEM HUM STEM W/RMV HD14*100
|
Facility
|
OP
|
$18,563.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,569.08 |
| Max. Negotiated Rate |
$17,821.06 |
| Rate for Payer: Aetna Commercial |
$14,293.97
|
| Rate for Payer: Anthem Medicaid |
$6,384.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,479.61
|
| Rate for Payer: Cash Price |
$9,281.80
|
| Rate for Payer: Cigna Commercial |
$15,407.79
|
| Rate for Payer: First Health Commercial |
$17,635.42
|
| Rate for Payer: Humana Commercial |
$15,779.06
|
| Rate for Payer: Humana KY Medicaid |
$6,384.02
|
| Rate for Payer: Kentucky WC Medicaid |
$6,448.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,222.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,699.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,569.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,512.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,335.97
|
| Rate for Payer: Ohio Health Group HMO |
$13,922.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,850.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,150.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,808.88
|
| Rate for Payer: PHCS Commercial |
$17,821.06
|
| Rate for Payer: United Healthcare All Payer |
$16,335.97
|
|
|
AS CEM HUM STEM W/RMV HED7*100
|
Facility
|
OP
|
$18,563.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,569.08 |
| Max. Negotiated Rate |
$17,821.06 |
| Rate for Payer: Aetna Commercial |
$14,293.97
|
| Rate for Payer: Anthem Medicaid |
$6,384.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,479.61
|
| Rate for Payer: Cash Price |
$9,281.80
|
| Rate for Payer: Cigna Commercial |
$15,407.79
|
| Rate for Payer: First Health Commercial |
$17,635.42
|
| Rate for Payer: Humana Commercial |
$15,779.06
|
| Rate for Payer: Humana KY Medicaid |
$6,384.02
|
| Rate for Payer: Kentucky WC Medicaid |
$6,448.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,222.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,699.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,569.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,512.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,335.97
|
| Rate for Payer: Ohio Health Group HMO |
$13,922.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,850.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,150.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,808.88
|
| Rate for Payer: PHCS Commercial |
$17,821.06
|
| Rate for Payer: United Healthcare All Payer |
$16,335.97
|
|
|
AS CEM HUM STEM W/RMV HED7*100
|
Facility
|
IP
|
$18,563.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,569.08 |
| Max. Negotiated Rate |
$17,821.06 |
| Rate for Payer: Aetna Commercial |
$14,293.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,479.61
|
| Rate for Payer: Cash Price |
$9,281.80
|
| Rate for Payer: Cigna Commercial |
$15,407.79
|
| Rate for Payer: First Health Commercial |
$17,635.42
|
| Rate for Payer: Humana Commercial |
$15,779.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,222.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,699.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,569.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,335.97
|
| Rate for Payer: Ohio Health Group HMO |
$13,922.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,850.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,150.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,808.88
|
| Rate for Payer: PHCS Commercial |
$17,821.06
|
| Rate for Payer: United Healthcare All Payer |
$16,335.97
|
|
|
AS CEM HUM STEM W/RMV HED9*100
|
Facility
|
OP
|
$18,563.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,569.08 |
| Max. Negotiated Rate |
$17,821.06 |
| Rate for Payer: Aetna Commercial |
$14,293.97
|
| Rate for Payer: Anthem Medicaid |
$6,384.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,479.61
|
| Rate for Payer: Cash Price |
$9,281.80
|
| Rate for Payer: Cigna Commercial |
$15,407.79
|
| Rate for Payer: First Health Commercial |
$17,635.42
|
| Rate for Payer: Humana Commercial |
$15,779.06
|
| Rate for Payer: Humana KY Medicaid |
$6,384.02
|
| Rate for Payer: Kentucky WC Medicaid |
$6,448.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,222.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,699.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,569.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,512.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,335.97
|
| Rate for Payer: Ohio Health Group HMO |
$13,922.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,850.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,150.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,808.88
|
| Rate for Payer: PHCS Commercial |
$17,821.06
|
| Rate for Payer: United Healthcare All Payer |
$16,335.97
|
|
