|
RF ACET MH SZ 64H
|
Facility
|
IP
|
$14,330.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,299.05 |
| Max. Negotiated Rate |
$13,756.96 |
| Rate for Payer: Aetna Commercial |
$11,034.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,177.53
|
| Rate for Payer: Cash Price |
$7,165.08
|
| Rate for Payer: Cigna Commercial |
$11,894.04
|
| Rate for Payer: First Health Commercial |
$13,613.66
|
| Rate for Payer: Humana Commercial |
$12,180.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,750.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,575.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,299.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,610.55
|
| Rate for Payer: Ohio Health Group HMO |
$10,747.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,464.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,467.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,887.82
|
| Rate for Payer: PHCS Commercial |
$13,756.96
|
| Rate for Payer: United Healthcare All Payer |
$12,610.55
|
|
|
RF ACET MH SZ 64H
|
Facility
|
OP
|
$14,330.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,299.05 |
| Max. Negotiated Rate |
$13,756.96 |
| Rate for Payer: Aetna Commercial |
$11,034.23
|
| Rate for Payer: Anthem Medicaid |
$4,928.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,177.53
|
| Rate for Payer: Cash Price |
$7,165.08
|
| Rate for Payer: Cigna Commercial |
$11,894.04
|
| Rate for Payer: First Health Commercial |
$13,613.66
|
| Rate for Payer: Humana Commercial |
$12,180.64
|
| Rate for Payer: Humana KY Medicaid |
$4,928.15
|
| Rate for Payer: Kentucky WC Medicaid |
$4,978.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,750.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,575.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,299.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,027.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,610.55
|
| Rate for Payer: Ohio Health Group HMO |
$10,747.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,464.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,467.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,887.82
|
| Rate for Payer: PHCS Commercial |
$13,756.96
|
| Rate for Payer: United Healthcare All Payer |
$12,610.55
|
|
|
RF ACET MH SZ 66J
|
Facility
|
IP
|
$14,330.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,299.05 |
| Max. Negotiated Rate |
$13,756.96 |
| Rate for Payer: Aetna Commercial |
$11,034.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,177.53
|
| Rate for Payer: Cash Price |
$7,165.08
|
| Rate for Payer: Cigna Commercial |
$11,894.04
|
| Rate for Payer: First Health Commercial |
$13,613.66
|
| Rate for Payer: Humana Commercial |
$12,180.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,750.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,575.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,299.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,610.55
|
| Rate for Payer: Ohio Health Group HMO |
$10,747.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,464.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,467.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,887.82
|
| Rate for Payer: PHCS Commercial |
$13,756.96
|
| Rate for Payer: United Healthcare All Payer |
$12,610.55
|
|
|
RF ACET MH SZ 66J
|
Facility
|
OP
|
$14,330.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,299.05 |
| Max. Negotiated Rate |
$13,756.96 |
| Rate for Payer: Aetna Commercial |
$11,034.23
|
| Rate for Payer: Anthem Medicaid |
$4,928.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,177.53
|
| Rate for Payer: Cash Price |
$7,165.08
|
| Rate for Payer: Cigna Commercial |
$11,894.04
|
| Rate for Payer: First Health Commercial |
$13,613.66
|
| Rate for Payer: Humana Commercial |
$12,180.64
|
| Rate for Payer: Humana KY Medicaid |
$4,928.15
|
| Rate for Payer: Kentucky WC Medicaid |
$4,978.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,750.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,575.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,299.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,027.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,610.55
|
| Rate for Payer: Ohio Health Group HMO |
$10,747.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,464.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,467.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,887.82
|
| Rate for Payer: PHCS Commercial |
$13,756.96
|
| Rate for Payer: United Healthcare All Payer |
$12,610.55
|
|
|
RF ACET MH SZ 68J
|
Facility
|
IP
|
$14,330.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,299.05 |
| Max. Negotiated Rate |
$13,756.96 |
| Rate for Payer: Aetna Commercial |
$11,034.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,177.53
|
| Rate for Payer: Cash Price |
$7,165.08
|
| Rate for Payer: Cigna Commercial |
$11,894.04
|
| Rate for Payer: First Health Commercial |
$13,613.66
|
| Rate for Payer: Humana Commercial |
$12,180.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,750.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,575.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,299.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,610.55
|
| Rate for Payer: Ohio Health Group HMO |
$10,747.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,464.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,467.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,887.82
|
| Rate for Payer: PHCS Commercial |
$13,756.96
|
| Rate for Payer: United Healthcare All Payer |
$12,610.55
|
|
|
RF ACET MH SZ 68J
|
Facility
|
OP
|
$14,330.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,299.05 |
| Max. Negotiated Rate |
$13,756.96 |
| Rate for Payer: Aetna Commercial |
$11,034.23
|
| Rate for Payer: Anthem Medicaid |
$4,928.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,177.53
|
| Rate for Payer: Cash Price |
$7,165.08
|
| Rate for Payer: Cigna Commercial |
$11,894.04
|
| Rate for Payer: First Health Commercial |
$13,613.66
|
| Rate for Payer: Humana Commercial |
$12,180.64
|
| Rate for Payer: Humana KY Medicaid |
$4,928.15
|
| Rate for Payer: Kentucky WC Medicaid |
$4,978.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,750.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,575.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,299.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,027.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,610.55
|
| Rate for Payer: Ohio Health Group HMO |
$10,747.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,464.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,467.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,887.82
|
| Rate for Payer: PHCS Commercial |
$13,756.96
|
| Rate for Payer: United Healthcare All Payer |
$12,610.55
|
|
|
RFB CONJNCTI EMBEDEDSUBCONJSCL
|
Facility
|
IP
|
$566.00
|
|
|
Service Code
|
HCPCS 65210
|
| Hospital Charge Code |
45000298
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$169.80 |
| Max. Negotiated Rate |
$543.36 |
| Rate for Payer: Aetna Commercial |
$435.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$441.48
|
| Rate for Payer: Cash Price |
$283.00
|
| Rate for Payer: Cigna Commercial |
$469.78
|
| Rate for Payer: First Health Commercial |
$537.70
|
| Rate for Payer: Humana Commercial |
$481.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$464.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$417.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$169.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$498.08
|
| Rate for Payer: Ohio Health Group HMO |
$424.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$452.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$492.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$390.54
|
| Rate for Payer: PHCS Commercial |
$543.36
|
| Rate for Payer: United Healthcare All Payer |
$498.08
|
|
|
RFB CONJNCTI EMBEDEDSUBCONJSCL
|
Facility
|
OP
|
$566.00
|
|
|
Service Code
|
HCPCS 65210
|
| Hospital Charge Code |
45000298
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$194.65 |
| Max. Negotiated Rate |
$543.36 |
| Rate for Payer: Aetna Commercial |
$435.82
|
| Rate for Payer: Anthem Medicaid |
$194.65
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$368.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$441.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$497.75
|
| Rate for Payer: Cash Price |
$283.00
|
| Rate for Payer: Cash Price |
$283.00
|
| Rate for Payer: Cigna Commercial |
$469.78
|
| Rate for Payer: First Health Commercial |
$537.70
|
| Rate for Payer: Humana Commercial |
$481.10
|
| Rate for Payer: Humana KY Medicaid |
$194.65
|
| Rate for Payer: Humana Medicare Advantage |
$368.70
|
| Rate for Payer: Kentucky WC Medicaid |
$196.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$464.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$417.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$198.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$498.08
|
| Rate for Payer: Ohio Health Group HMO |
$424.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$452.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$492.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$390.54
|
| Rate for Payer: PHCS Commercial |
$543.36
|
| Rate for Payer: United Healthcare All Payer |
$498.08
|
|
|
RFB CONJNCTI EMBEDEDSUBCONJSCL
|
Facility
|
IP
|
$521.00
|
|
|
Service Code
|
HCPCS 65210
|
| Hospital Charge Code |
76102574
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$156.30 |
| Max. Negotiated Rate |
$500.16 |
| Rate for Payer: Aetna Commercial |
$401.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$406.38
|
| Rate for Payer: Cash Price |
$260.50
|
| Rate for Payer: Cigna Commercial |
$432.43
|
| Rate for Payer: First Health Commercial |
$494.95
|
| Rate for Payer: Humana Commercial |
$442.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$427.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$384.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$156.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$458.48
|
| Rate for Payer: Ohio Health Group HMO |
$390.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$416.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$453.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$359.49
|
| Rate for Payer: PHCS Commercial |
$500.16
|
| Rate for Payer: United Healthcare All Payer |
$458.48
|
|
|
RFB CONJNCTI EMBEDEDSUBCONJSCL
|
Facility
|
OP
|
$521.00
|
|
|
Service Code
|
HCPCS 65210
|
| Hospital Charge Code |
76102574
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$179.17 |
| Max. Negotiated Rate |
$516.18 |
| Rate for Payer: Aetna Commercial |
$401.17
|
| Rate for Payer: Anthem Medicaid |
$179.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$368.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$406.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$497.75
|
| Rate for Payer: Cash Price |
$260.50
|
| Rate for Payer: Cash Price |
$260.50
|
| Rate for Payer: Cigna Commercial |
$432.43
|
| Rate for Payer: First Health Commercial |
$494.95
|
| Rate for Payer: Humana Commercial |
$442.85
|
| Rate for Payer: Humana KY Medicaid |
$179.17
|
| Rate for Payer: Humana Medicare Advantage |
$368.70
|
| Rate for Payer: Kentucky WC Medicaid |
$181.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$427.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$384.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$182.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$458.48
|
| Rate for Payer: Ohio Health Group HMO |
$390.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$416.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$453.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$359.49
|
| Rate for Payer: PHCS Commercial |
$500.16
|
| Rate for Payer: United Healthcare All Payer |
$458.48
|
|
|
RFB EMBEDDED EYELID
|
Facility
|
OP
|
$435.00
|
|
|
Service Code
|
HCPCS 67938
|
| Hospital Charge Code |
45000304
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$149.60 |
| Max. Negotiated Rate |
$417.60 |
| Rate for Payer: Aetna Commercial |
$334.95
|
| Rate for Payer: Anthem Medicaid |
$149.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$276.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$339.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$386.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$372.88
|
| Rate for Payer: Cash Price |
$217.50
|
| Rate for Payer: Cash Price |
$217.50
|
| Rate for Payer: Cigna Commercial |
$361.05
|
| Rate for Payer: First Health Commercial |
$413.25
|
| Rate for Payer: Humana Commercial |
$369.75
|
| Rate for Payer: Humana KY Medicaid |
$149.60
|
| Rate for Payer: Humana Medicare Advantage |
$276.21
|
| Rate for Payer: Kentucky WC Medicaid |
$151.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$356.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$321.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$331.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$152.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$382.80
|
| Rate for Payer: Ohio Health Group HMO |
$326.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$348.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$378.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$300.15
|
| Rate for Payer: PHCS Commercial |
$417.60
|
| Rate for Payer: United Healthcare All Payer |
$382.80
|
|
|
RFB EMBEDDED EYELID
|
Facility
|
OP
|
$417.00
|
|
|
Service Code
|
HCPCS 67938
|
| Hospital Charge Code |
76102398
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$143.41 |
| Max. Negotiated Rate |
$400.32 |
| Rate for Payer: Aetna Commercial |
$321.09
|
| Rate for Payer: Anthem Medicaid |
$143.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$276.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$325.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$386.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$372.88
|
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: Cigna Commercial |
$346.11
|
| Rate for Payer: First Health Commercial |
$396.15
|
| Rate for Payer: Humana Commercial |
$354.45
|
| Rate for Payer: Humana KY Medicaid |
$143.41
|
| Rate for Payer: Humana Medicare Advantage |
$276.21
|
| Rate for Payer: Kentucky WC Medicaid |
$144.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$341.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$307.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$331.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$146.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$366.96
|
| Rate for Payer: Ohio Health Group HMO |
$312.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$333.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$362.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$287.73
|
| Rate for Payer: PHCS Commercial |
$400.32
|
| Rate for Payer: United Healthcare All Payer |
$366.96
|
|
|
RFB EMBEDDED EYELID
|
Facility
|
IP
|
$435.00
|
|
|
Service Code
|
HCPCS 67938
|
| Hospital Charge Code |
45000304
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$130.50 |
| Max. Negotiated Rate |
$417.60 |
| Rate for Payer: Aetna Commercial |
$334.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$339.30
|
| Rate for Payer: Cash Price |
$217.50
|
| Rate for Payer: Cigna Commercial |
$361.05
|
| Rate for Payer: First Health Commercial |
$413.25
|
| Rate for Payer: Humana Commercial |
$369.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$356.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$321.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$130.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$382.80
|
| Rate for Payer: Ohio Health Group HMO |
$326.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$348.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$378.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$300.15
|
| Rate for Payer: PHCS Commercial |
$417.60
|
| Rate for Payer: United Healthcare All Payer |
$382.80
|
|
|
RFB EMBEDDED EYELID
|
Facility
|
IP
|
$417.00
|
|
|
Service Code
|
HCPCS 67938
|
| Hospital Charge Code |
76102398
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$125.10 |
| Max. Negotiated Rate |
$400.32 |
| Rate for Payer: Aetna Commercial |
$321.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$325.26
|
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: Cigna Commercial |
$346.11
|
| Rate for Payer: First Health Commercial |
$396.15
|
| Rate for Payer: Humana Commercial |
$354.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$341.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$307.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$125.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$366.96
|
| Rate for Payer: Ohio Health Group HMO |
$312.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$333.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$362.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$287.73
|
| Rate for Payer: PHCS Commercial |
$400.32
|
| Rate for Payer: United Healthcare All Payer |
$366.96
|
|
|
RFB EXTRN EYECORNEA W SLITLAMP
|
Facility
|
IP
|
$388.00
|
|
|
Service Code
|
HCPCS 65222
|
| Hospital Charge Code |
45000300
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$116.40 |
| Max. Negotiated Rate |
$372.48 |
| Rate for Payer: Aetna Commercial |
$298.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$302.64
|
| Rate for Payer: Cash Price |
$194.00
|
| Rate for Payer: Cigna Commercial |
$322.04
|
| Rate for Payer: First Health Commercial |
$368.60
|
| Rate for Payer: Humana Commercial |
$329.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$318.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$286.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$116.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$341.44
|
| Rate for Payer: Ohio Health Group HMO |
$291.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$310.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$337.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$267.72
|
| Rate for Payer: PHCS Commercial |
$372.48
|
| Rate for Payer: United Healthcare All Payer |
$341.44
|
|
|
RFB EXTRN EYECORNEA W SLITLAMP
|
Facility
|
OP
|
$388.00
|
|
|
Service Code
|
HCPCS 65222
|
| Hospital Charge Code |
45000300
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$119.10 |
| Max. Negotiated Rate |
$372.48 |
| Rate for Payer: Aetna Commercial |
$298.76
|
| Rate for Payer: Anthem Medicaid |
$133.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$302.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.78
|
| Rate for Payer: Cash Price |
$194.00
|
| Rate for Payer: Cash Price |
$194.00
|
| Rate for Payer: Cigna Commercial |
$322.04
|
| Rate for Payer: First Health Commercial |
$368.60
|
| Rate for Payer: Humana Commercial |
$329.80
|
| Rate for Payer: Humana KY Medicaid |
$133.43
|
| Rate for Payer: Humana Medicare Advantage |
$119.10
|
| Rate for Payer: Kentucky WC Medicaid |
$134.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$318.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$286.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$136.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$341.44
|
| Rate for Payer: Ohio Health Group HMO |
$291.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$310.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$337.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$267.72
|
| Rate for Payer: PHCS Commercial |
$372.48
|
| Rate for Payer: United Healthcare All Payer |
$341.44
|
|
|
RFB EXTRN EYECORNEA W SLITLAMP
|
Facility
|
IP
|
$335.00
|
|
|
Service Code
|
HCPCS 65222
|
| Hospital Charge Code |
76102384
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$100.50 |
| Max. Negotiated Rate |
$321.60 |
| Rate for Payer: Aetna Commercial |
$257.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$261.30
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cigna Commercial |
$278.05
|
| Rate for Payer: First Health Commercial |
$318.25
|
| Rate for Payer: Humana Commercial |
$284.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$274.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$247.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$100.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$294.80
|
| Rate for Payer: Ohio Health Group HMO |
$251.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$268.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$291.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$231.15
|
| Rate for Payer: PHCS Commercial |
$321.60
|
| Rate for Payer: United Healthcare All Payer |
$294.80
|
|
|
RFB EXTRN EYECORNEA W SLITLAMP
|
Facility
|
OP
|
$335.00
|
|
|
Service Code
|
HCPCS 65222
|
| Hospital Charge Code |
76102384
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$115.21 |
| Max. Negotiated Rate |
$321.60 |
| Rate for Payer: Aetna Commercial |
$257.95
|
| Rate for Payer: Anthem Medicaid |
$115.21
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$261.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.78
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cigna Commercial |
$278.05
|
| Rate for Payer: First Health Commercial |
$318.25
|
| Rate for Payer: Humana Commercial |
$284.75
|
| Rate for Payer: Humana KY Medicaid |
$115.21
|
| Rate for Payer: Humana Medicare Advantage |
$119.10
|
| Rate for Payer: Kentucky WC Medicaid |
$116.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$274.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$247.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$117.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$294.80
|
| Rate for Payer: Ohio Health Group HMO |
$251.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$268.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$291.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$231.15
|
| Rate for Payer: PHCS Commercial |
$321.60
|
| Rate for Payer: United Healthcare All Payer |
$294.80
|
|
|
RFB INTRAOCUL ANTIORCHMBR LENS
|
Facility
|
OP
|
$3,020.00
|
|
|
Service Code
|
HCPCS 65235
|
| Hospital Charge Code |
45000301
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,038.58 |
| Max. Negotiated Rate |
$2,950.29 |
| Rate for Payer: Aetna Commercial |
$2,325.40
|
| Rate for Payer: Anthem Medicaid |
$1,038.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,107.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,355.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,950.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,844.92
|
| Rate for Payer: Cash Price |
$1,510.00
|
| Rate for Payer: Cash Price |
$1,510.00
|
| Rate for Payer: Cigna Commercial |
$2,506.60
|
| Rate for Payer: First Health Commercial |
$2,869.00
|
| Rate for Payer: Humana Commercial |
$2,567.00
|
| Rate for Payer: Humana KY Medicaid |
$1,038.58
|
| Rate for Payer: Humana Medicare Advantage |
$2,107.35
|
| Rate for Payer: Kentucky WC Medicaid |
$1,049.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,476.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,228.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,528.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,059.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,657.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,265.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,416.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,627.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,083.80
|
| Rate for Payer: PHCS Commercial |
$2,899.20
|
| Rate for Payer: United Healthcare All Payer |
$2,657.60
|
|
|
RFB INTRAOCUL ANTIORCHMBR LENS
|
Facility
|
IP
|
$2,896.00
|
|
|
Service Code
|
HCPCS 65235
|
| Hospital Charge Code |
76102385
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$868.80 |
| Max. Negotiated Rate |
$2,780.16 |
| Rate for Payer: Aetna Commercial |
$2,229.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,258.88
|
| Rate for Payer: Cash Price |
$1,448.00
|
| Rate for Payer: Cigna Commercial |
$2,403.68
|
| Rate for Payer: First Health Commercial |
$2,751.20
|
| Rate for Payer: Humana Commercial |
$2,461.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,374.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,137.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$868.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,548.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,172.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,316.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,519.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,998.24
|
| Rate for Payer: PHCS Commercial |
$2,780.16
|
| Rate for Payer: United Healthcare All Payer |
$2,548.48
|
|
|
RFB INTRAOCUL ANTIORCHMBR LENS
|
Facility
|
IP
|
$3,020.00
|
|
|
Service Code
|
HCPCS 65235
|
| Hospital Charge Code |
45000301
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$906.00 |
| Max. Negotiated Rate |
$2,899.20 |
| Rate for Payer: Aetna Commercial |
$2,325.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,355.60
|
| Rate for Payer: Cash Price |
$1,510.00
|
| Rate for Payer: Cigna Commercial |
$2,506.60
|
| Rate for Payer: First Health Commercial |
$2,869.00
|
| Rate for Payer: Humana Commercial |
$2,567.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,476.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,228.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$906.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,657.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,265.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,416.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,627.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,083.80
|
| Rate for Payer: PHCS Commercial |
$2,899.20
|
| Rate for Payer: United Healthcare All Payer |
$2,657.60
|
|
|
RFB INTRAOCUL ANTIORCHMBR LENS
|
Facility
|
OP
|
$2,896.00
|
|
|
Service Code
|
HCPCS 65235
|
| Hospital Charge Code |
76102385
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$995.93 |
| Max. Negotiated Rate |
$2,950.29 |
| Rate for Payer: Aetna Commercial |
$2,229.92
|
| Rate for Payer: Anthem Medicaid |
$995.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,107.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,258.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,950.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,844.92
|
| Rate for Payer: Cash Price |
$1,448.00
|
| Rate for Payer: Cash Price |
$1,448.00
|
| Rate for Payer: Cigna Commercial |
$2,403.68
|
| Rate for Payer: First Health Commercial |
$2,751.20
|
| Rate for Payer: Humana Commercial |
$2,461.60
|
| Rate for Payer: Humana KY Medicaid |
$995.93
|
| Rate for Payer: Humana Medicare Advantage |
$2,107.35
|
| Rate for Payer: Kentucky WC Medicaid |
$1,006.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,374.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,137.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,528.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,015.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,548.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,172.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,316.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,519.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,998.24
|
| Rate for Payer: PHCS Commercial |
$2,780.16
|
| Rate for Payer: United Healthcare All Payer |
$2,548.48
|
|
|
RF FSO 5 POR HA ACET 42MM
|
Facility
|
IP
|
$11,411.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,423.32 |
| Max. Negotiated Rate |
$10,954.61 |
| Rate for Payer: Aetna Commercial |
$8,786.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,900.62
|
| Rate for Payer: Cash Price |
$5,705.53
|
| Rate for Payer: Cigna Commercial |
$9,471.17
|
| Rate for Payer: First Health Commercial |
$10,840.50
|
| Rate for Payer: Humana Commercial |
$9,699.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,357.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,421.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,423.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,041.72
|
| Rate for Payer: Ohio Health Group HMO |
$8,558.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,128.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,927.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,873.62
|
| Rate for Payer: PHCS Commercial |
$10,954.61
|
| Rate for Payer: United Healthcare All Payer |
$10,041.72
|
|
|
RF FSO 5 POR HA ACET 42MM
|
Facility
|
OP
|
$11,411.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,423.32 |
| Max. Negotiated Rate |
$10,954.61 |
| Rate for Payer: Aetna Commercial |
$8,786.51
|
| Rate for Payer: Anthem Medicaid |
$3,924.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,900.62
|
| Rate for Payer: Cash Price |
$5,705.53
|
| Rate for Payer: Cigna Commercial |
$9,471.17
|
| Rate for Payer: First Health Commercial |
$10,840.50
|
| Rate for Payer: Humana Commercial |
$9,699.39
|
| Rate for Payer: Humana KY Medicaid |
$3,924.26
|
| Rate for Payer: Kentucky WC Medicaid |
$3,964.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,357.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,421.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,423.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,003.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,041.72
|
| Rate for Payer: Ohio Health Group HMO |
$8,558.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,128.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,927.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,873.62
|
| Rate for Payer: PHCS Commercial |
$10,954.61
|
| Rate for Payer: United Healthcare All Payer |
$10,041.72
|
|
|
RF FSO 5 POR HA ACET 46MM
|
Facility
|
IP
|
$11,411.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,423.32 |
| Max. Negotiated Rate |
$10,954.61 |
| Rate for Payer: Aetna Commercial |
$8,786.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,900.62
|
| Rate for Payer: Cash Price |
$5,705.53
|
| Rate for Payer: Cigna Commercial |
$9,471.17
|
| Rate for Payer: First Health Commercial |
$10,840.50
|
| Rate for Payer: Humana Commercial |
$9,699.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,357.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,421.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,423.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,041.72
|
| Rate for Payer: Ohio Health Group HMO |
$8,558.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,128.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,927.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,873.62
|
| Rate for Payer: PHCS Commercial |
$10,954.61
|
| Rate for Payer: United Healthcare All Payer |
$10,041.72
|
|
