|
SCP ART INI 3RD> BRACH THOR(T
|
Facility
|
IP
|
$3,142.00
|
|
|
Service Code
|
HCPCS 36217
|
| Hospital Charge Code |
761T1441
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$408.46 |
| Max. Negotiated Rate |
$3,016.32 |
| Rate for Payer: Aetna Commercial |
$2,419.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,450.76
|
| Rate for Payer: Cash Price |
$1,571.00
|
| Rate for Payer: Cigna Commercial |
$2,607.86
|
| Rate for Payer: First Health Commercial |
$2,984.90
|
| Rate for Payer: Humana Commercial |
$2,670.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,576.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,318.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$942.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,764.96
|
| Rate for Payer: Ohio Health Group HMO |
$2,356.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$628.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$408.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$974.02
|
| Rate for Payer: PHCS Commercial |
$3,016.32
|
| Rate for Payer: United Healthcare All Payer |
$2,764.96
|
|
|
SCP COMP KNEE KIT-5CC END DEL
|
Facility
|
OP
|
$19,673.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,557.59 |
| Max. Negotiated Rate |
$18,886.80 |
| Rate for Payer: Aetna Commercial |
$15,148.79
|
| Rate for Payer: Anthem Medicaid |
$6,765.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,345.52
|
| Rate for Payer: Cash Price |
$9,836.88
|
| Rate for Payer: Cigna Commercial |
$16,329.21
|
| Rate for Payer: First Health Commercial |
$18,690.06
|
| Rate for Payer: Humana Commercial |
$16,722.69
|
| Rate for Payer: Humana KY Medicaid |
$6,765.80
|
| Rate for Payer: Kentucky WC Medicaid |
$6,834.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,132.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,519.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,902.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,901.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,312.90
|
| Rate for Payer: Ohio Health Group HMO |
$14,755.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,934.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,557.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,098.86
|
| Rate for Payer: PHCS Commercial |
$18,886.80
|
| Rate for Payer: United Healthcare All Payer |
$17,312.90
|
|
|
SCP COMP KNEE KIT-5CC END DEL
|
Facility
|
IP
|
$19,673.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,557.59 |
| Max. Negotiated Rate |
$18,886.80 |
| Rate for Payer: Aetna Commercial |
$15,148.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,345.52
|
| Rate for Payer: Cash Price |
$9,836.88
|
| Rate for Payer: Cigna Commercial |
$16,329.21
|
| Rate for Payer: First Health Commercial |
$18,690.06
|
| Rate for Payer: Humana Commercial |
$16,722.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,132.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,519.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,902.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,312.90
|
| Rate for Payer: Ohio Health Group HMO |
$14,755.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,934.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,557.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,098.86
|
| Rate for Payer: PHCS Commercial |
$18,886.80
|
| Rate for Payer: United Healthcare All Payer |
$17,312.90
|
|
|
SCP COMP KNEE KIT-5CC SIDE DEL
|
Facility
|
OP
|
$19,673.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,557.59 |
| Max. Negotiated Rate |
$18,886.80 |
| Rate for Payer: Aetna Commercial |
$15,148.79
|
| Rate for Payer: Anthem Medicaid |
$6,765.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,345.52
|
| Rate for Payer: Cash Price |
$9,836.88
|
| Rate for Payer: Cigna Commercial |
$16,329.21
|
| Rate for Payer: First Health Commercial |
$18,690.06
|
| Rate for Payer: Humana Commercial |
$16,722.69
|
| Rate for Payer: Humana KY Medicaid |
$6,765.80
|
| Rate for Payer: Kentucky WC Medicaid |
$6,834.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,132.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,519.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,902.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,901.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,312.90
|
| Rate for Payer: Ohio Health Group HMO |
$14,755.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,934.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,557.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,098.86
|
| Rate for Payer: PHCS Commercial |
$18,886.80
|
| Rate for Payer: United Healthcare All Payer |
$17,312.90
|
|
|
SCP COMP KNEE KIT-5CC SIDE DEL
|
Facility
|
IP
|
$19,673.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,557.59 |
| Max. Negotiated Rate |
$18,886.80 |
| Rate for Payer: Aetna Commercial |
$15,148.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,345.52
|
| Rate for Payer: Cash Price |
$9,836.88
|
| Rate for Payer: Cigna Commercial |
$16,329.21
|
| Rate for Payer: First Health Commercial |
$18,690.06
|
| Rate for Payer: Humana Commercial |
$16,722.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,132.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,519.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,902.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,312.90
|
| Rate for Payer: Ohio Health Group HMO |
$14,755.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,934.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,557.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,098.86
|
| Rate for Payer: PHCS Commercial |
$18,886.80
|
| Rate for Payer: United Healthcare All Payer |
$17,312.90
|
|
|
SCP EA 1ST ABD PEL L EXT AR
|
Facility
|
OP
|
$1,424.00
|
|
|
Service Code
|
HCPCS 36245
|
| Hospital Charge Code |
48100021
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$185.12 |
| Max. Negotiated Rate |
$1,367.04 |
| Rate for Payer: Aetna Commercial |
$1,096.48
|
| Rate for Payer: Anthem Medicaid |
$489.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,110.72
|
| Rate for Payer: Cash Price |
$712.00
|
| Rate for Payer: Cigna Commercial |
$1,181.92
|
| Rate for Payer: First Health Commercial |
$1,352.80
|
| Rate for Payer: Humana Commercial |
$1,210.40
|
| Rate for Payer: Humana KY Medicaid |
$489.71
|
| Rate for Payer: Kentucky WC Medicaid |
$494.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,167.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,050.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$427.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$499.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,253.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,068.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$284.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$185.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$441.44
|
| Rate for Payer: PHCS Commercial |
$1,367.04
|
| Rate for Payer: United Healthcare All Payer |
$1,253.12
|
|
|
SCP EA 1ST ABD PEL L EXT AR
|
Professional
|
Both
|
$5,050.96
|
|
|
Service Code
|
HCPCS 36245
|
| Hospital Charge Code |
76101451
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$163.81 |
| Max. Negotiated Rate |
$5,050.96 |
| Rate for Payer: Aetna Commercial |
$434.13
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$163.81
|
| Rate for Payer: Anthem Medicaid |
$239.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,050.96
|
| Rate for Payer: Cash Price |
$2,525.48
|
| Rate for Payer: Cash Price |
$2,525.48
|
| Rate for Payer: Cigna Commercial |
$395.31
|
| Rate for Payer: Healthspan PPO |
$1,954.05
|
| Rate for Payer: Humana Medicaid |
$239.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$330.57
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$244.37
|
| Rate for Payer: Molina Healthcare Passport |
$239.58
|
| Rate for Payer: Multiplan PHCS |
$3,030.58
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,535.67
|
| Rate for Payer: UHCCP Medicaid |
$172.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$241.98
|
|
|
SCP EA 1ST ABD PEL L EXT AR
|
Facility
|
IP
|
$5,050.96
|
|
|
Service Code
|
HCPCS 36245
|
| Hospital Charge Code |
76101451
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$656.62 |
| Max. Negotiated Rate |
$4,848.92 |
| Rate for Payer: Aetna Commercial |
$3,889.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,939.75
|
| Rate for Payer: Cash Price |
$2,525.48
|
| Rate for Payer: Cigna Commercial |
$4,192.30
|
| Rate for Payer: First Health Commercial |
$4,798.41
|
| Rate for Payer: Humana Commercial |
$4,293.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,141.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,727.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,515.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,444.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,788.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,010.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$656.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,565.80
|
| Rate for Payer: PHCS Commercial |
$4,848.92
|
| Rate for Payer: United Healthcare All Payer |
$4,444.84
|
|
|
SCP EA 1ST ABD PEL L EXT AR
|
Facility
|
IP
|
$1,424.00
|
|
|
Service Code
|
HCPCS 36245
|
| Hospital Charge Code |
48100021
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$185.12 |
| Max. Negotiated Rate |
$1,367.04 |
| Rate for Payer: Aetna Commercial |
$1,096.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,110.72
|
| Rate for Payer: Cash Price |
$712.00
|
| Rate for Payer: Cigna Commercial |
$1,181.92
|
| Rate for Payer: First Health Commercial |
$1,352.80
|
| Rate for Payer: Humana Commercial |
$1,210.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,167.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,050.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$427.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,253.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,068.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$284.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$185.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$441.44
|
| Rate for Payer: PHCS Commercial |
$1,367.04
|
| Rate for Payer: United Healthcare All Payer |
$1,253.12
|
|
|
SCP EA 1ST ABD PEL L EXT AR
|
Facility
|
OP
|
$5,050.96
|
|
|
Service Code
|
HCPCS 36245
|
| Hospital Charge Code |
76101451
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$656.62 |
| Max. Negotiated Rate |
$4,848.92 |
| Rate for Payer: Aetna Commercial |
$3,889.24
|
| Rate for Payer: Anthem Medicaid |
$1,737.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,939.75
|
| Rate for Payer: Cash Price |
$2,525.48
|
| Rate for Payer: Cigna Commercial |
$4,192.30
|
| Rate for Payer: First Health Commercial |
$4,798.41
|
| Rate for Payer: Humana Commercial |
$4,293.32
|
| Rate for Payer: Humana KY Medicaid |
$1,737.03
|
| Rate for Payer: Kentucky WC Medicaid |
$1,754.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,141.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,727.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,515.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,771.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,444.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,788.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,010.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$656.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,565.80
|
| Rate for Payer: PHCS Commercial |
$4,848.92
|
| Rate for Payer: United Healthcare All Payer |
$4,444.84
|
|
|
SCP EA 1ST ABD PEL L EXT AR(P
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
HCPCS 36245
|
| Hospital Charge Code |
761P1451
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$163.81 |
| Max. Negotiated Rate |
$1,954.05 |
| Rate for Payer: Aetna Commercial |
$434.13
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$163.81
|
| Rate for Payer: Anthem Medicaid |
$239.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,800.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$395.31
|
| Rate for Payer: Healthspan PPO |
$1,954.05
|
| Rate for Payer: Humana Medicaid |
$239.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$330.57
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$244.37
|
| Rate for Payer: Molina Healthcare Passport |
$239.58
|
| Rate for Payer: Multiplan PHCS |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,260.00
|
| Rate for Payer: UHCCP Medicaid |
$172.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$241.98
|
|
|
SCP EA 1ST ABD PEL L EXT AR(T
|
Facility
|
OP
|
$3,250.96
|
|
|
Service Code
|
HCPCS 36245
|
| Hospital Charge Code |
761T1451
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$422.62 |
| Max. Negotiated Rate |
$3,120.92 |
| Rate for Payer: Aetna Commercial |
$2,503.24
|
| Rate for Payer: Anthem Medicaid |
$1,118.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,535.75
|
| Rate for Payer: Cash Price |
$1,625.48
|
| Rate for Payer: Cigna Commercial |
$2,698.30
|
| Rate for Payer: First Health Commercial |
$3,088.41
|
| Rate for Payer: Humana Commercial |
$2,763.32
|
| Rate for Payer: Humana KY Medicaid |
$1,118.01
|
| Rate for Payer: Kentucky WC Medicaid |
$1,129.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,665.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,399.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$975.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,140.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,860.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,438.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$650.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$422.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,007.80
|
| Rate for Payer: PHCS Commercial |
$3,120.92
|
| Rate for Payer: United Healthcare All Payer |
$2,860.84
|
|
|
SCP EA 1ST ABD PEL L EXT AR(T
|
Facility
|
IP
|
$3,250.96
|
|
|
Service Code
|
HCPCS 36245
|
| Hospital Charge Code |
761T1451
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$422.62 |
| Max. Negotiated Rate |
$3,120.92 |
| Rate for Payer: Aetna Commercial |
$2,503.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,535.75
|
| Rate for Payer: Cash Price |
$1,625.48
|
| Rate for Payer: Cigna Commercial |
$2,698.30
|
| Rate for Payer: First Health Commercial |
$3,088.41
|
| Rate for Payer: Humana Commercial |
$2,763.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,665.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,399.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$975.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,860.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,438.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$650.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$422.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,007.80
|
| Rate for Payer: PHCS Commercial |
$3,120.92
|
| Rate for Payer: United Healthcare All Payer |
$2,860.84
|
|
|
SCP INIT 2ND ABDPELL EXT AR
|
Facility
|
IP
|
$3,133.00
|
|
|
Service Code
|
HCPCS 36246
|
| Hospital Charge Code |
76101452
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$407.29 |
| Max. Negotiated Rate |
$3,007.68 |
| Rate for Payer: Aetna Commercial |
$2,412.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,443.74
|
| Rate for Payer: Cash Price |
$1,566.50
|
| Rate for Payer: Cigna Commercial |
$2,600.39
|
| Rate for Payer: First Health Commercial |
$2,976.35
|
| Rate for Payer: Humana Commercial |
$2,663.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,569.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,312.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$939.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,757.04
|
| Rate for Payer: Ohio Health Group HMO |
$2,349.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$626.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$407.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$971.23
|
| Rate for Payer: PHCS Commercial |
$3,007.68
|
| Rate for Payer: United Healthcare All Payer |
$2,757.04
|
|
|
SCP INIT 2ND ABDPELL EXT AR
|
Facility
|
IP
|
$1,424.00
|
|
|
Service Code
|
HCPCS 36246
|
| Hospital Charge Code |
48100022
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$185.12 |
| Max. Negotiated Rate |
$1,367.04 |
| Rate for Payer: Aetna Commercial |
$1,096.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,110.72
|
| Rate for Payer: Cash Price |
$712.00
|
| Rate for Payer: Cigna Commercial |
$1,181.92
|
| Rate for Payer: First Health Commercial |
$1,352.80
|
| Rate for Payer: Humana Commercial |
$1,210.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,167.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,050.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$427.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,253.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,068.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$284.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$185.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$441.44
|
| Rate for Payer: PHCS Commercial |
$1,367.04
|
| Rate for Payer: United Healthcare All Payer |
$1,253.12
|
|
|
SCP INIT 2ND ABDPELL EXT AR
|
Facility
|
OP
|
$1,424.00
|
|
|
Service Code
|
HCPCS 36246
|
| Hospital Charge Code |
48100022
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$185.12 |
| Max. Negotiated Rate |
$1,367.04 |
| Rate for Payer: Aetna Commercial |
$1,096.48
|
| Rate for Payer: Anthem Medicaid |
$489.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,110.72
|
| Rate for Payer: Cash Price |
$712.00
|
| Rate for Payer: Cigna Commercial |
$1,181.92
|
| Rate for Payer: First Health Commercial |
$1,352.80
|
| Rate for Payer: Humana Commercial |
$1,210.40
|
| Rate for Payer: Humana KY Medicaid |
$489.71
|
| Rate for Payer: Kentucky WC Medicaid |
$494.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,167.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,050.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$427.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$499.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,253.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,068.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$284.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$185.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$441.44
|
| Rate for Payer: PHCS Commercial |
$1,367.04
|
| Rate for Payer: United Healthcare All Payer |
$1,253.12
|
|
|
SCP INIT 2ND ABDPELL EXT AR
|
Facility
|
OP
|
$3,133.00
|
|
|
Service Code
|
HCPCS 36246
|
| Hospital Charge Code |
76101452
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$407.29 |
| Max. Negotiated Rate |
$3,007.68 |
| Rate for Payer: Aetna Commercial |
$2,412.41
|
| Rate for Payer: Anthem Medicaid |
$1,077.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,443.74
|
| Rate for Payer: Cash Price |
$1,566.50
|
| Rate for Payer: Cigna Commercial |
$2,600.39
|
| Rate for Payer: First Health Commercial |
$2,976.35
|
| Rate for Payer: Humana Commercial |
$2,663.05
|
| Rate for Payer: Humana KY Medicaid |
$1,077.44
|
| Rate for Payer: Kentucky WC Medicaid |
$1,088.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,569.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,312.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$939.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,099.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,757.04
|
| Rate for Payer: Ohio Health Group HMO |
$2,349.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$626.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$407.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$971.23
|
| Rate for Payer: PHCS Commercial |
$3,007.68
|
| Rate for Payer: United Healthcare All Payer |
$2,757.04
|
|
|
SCP INIT 2ND ABDPELL EXT AR
|
Professional
|
Both
|
$3,133.00
|
|
|
Service Code
|
HCPCS 36246
|
| Hospital Charge Code |
76101452
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$179.16 |
| Max. Negotiated Rate |
$3,133.00 |
| Rate for Payer: Aetna Commercial |
$475.77
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$179.16
|
| Rate for Payer: Anthem Medicaid |
$249.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,133.00
|
| Rate for Payer: Cash Price |
$1,566.50
|
| Rate for Payer: Cash Price |
$1,566.50
|
| Rate for Payer: Cigna Commercial |
$437.88
|
| Rate for Payer: Healthspan PPO |
$1,925.66
|
| Rate for Payer: Humana Medicaid |
$249.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$364.59
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$254.73
|
| Rate for Payer: Molina Healthcare Passport |
$249.74
|
| Rate for Payer: Multiplan PHCS |
$1,879.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,193.10
|
| Rate for Payer: UHCCP Medicaid |
$188.12
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$252.24
|
|
|
SCP INIT 2ND ABDPELL EXT AR(P
|
Professional
|
Both
|
$1,839.00
|
|
|
Service Code
|
HCPCS 36246
|
| Hospital Charge Code |
761P1452
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$179.16 |
| Max. Negotiated Rate |
$1,925.66 |
| Rate for Payer: Aetna Commercial |
$475.77
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$179.16
|
| Rate for Payer: Anthem Medicaid |
$249.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,839.00
|
| Rate for Payer: Cash Price |
$919.50
|
| Rate for Payer: Cash Price |
$919.50
|
| Rate for Payer: Cigna Commercial |
$437.88
|
| Rate for Payer: Healthspan PPO |
$1,925.66
|
| Rate for Payer: Humana Medicaid |
$249.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$364.59
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$254.73
|
| Rate for Payer: Molina Healthcare Passport |
$249.74
|
| Rate for Payer: Multiplan PHCS |
$1,103.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,287.30
|
| Rate for Payer: UHCCP Medicaid |
$188.12
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$252.24
|
|
|
SCP INIT 2ND ABDPELL EXT AR(T
|
Facility
|
OP
|
$1,294.00
|
|
|
Service Code
|
HCPCS 36246
|
| Hospital Charge Code |
761T1452
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$168.22 |
| Max. Negotiated Rate |
$1,242.24 |
| Rate for Payer: Aetna Commercial |
$996.38
|
| Rate for Payer: Anthem Medicaid |
$445.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,009.32
|
| Rate for Payer: Cash Price |
$647.00
|
| Rate for Payer: Cigna Commercial |
$1,074.02
|
| Rate for Payer: First Health Commercial |
$1,229.30
|
| Rate for Payer: Humana Commercial |
$1,099.90
|
| Rate for Payer: Humana KY Medicaid |
$445.01
|
| Rate for Payer: Kentucky WC Medicaid |
$449.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,061.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$954.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$388.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$453.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,138.72
|
| Rate for Payer: Ohio Health Group HMO |
$970.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$258.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$168.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$401.14
|
| Rate for Payer: PHCS Commercial |
$1,242.24
|
| Rate for Payer: United Healthcare All Payer |
$1,138.72
|
|
|
SCP INIT 2ND ABDPELL EXT AR(T
|
Facility
|
IP
|
$1,294.00
|
|
|
Service Code
|
HCPCS 36246
|
| Hospital Charge Code |
761T1452
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$168.22 |
| Max. Negotiated Rate |
$1,242.24 |
| Rate for Payer: Aetna Commercial |
$996.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,009.32
|
| Rate for Payer: Cash Price |
$647.00
|
| Rate for Payer: Cigna Commercial |
$1,074.02
|
| Rate for Payer: First Health Commercial |
$1,229.30
|
| Rate for Payer: Humana Commercial |
$1,099.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,061.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$954.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$388.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,138.72
|
| Rate for Payer: Ohio Health Group HMO |
$970.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$258.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$168.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$401.14
|
| Rate for Payer: PHCS Commercial |
$1,242.24
|
| Rate for Payer: United Healthcare All Payer |
$1,138.72
|
|
|
SCR C/V CYTO,AUTOSYS AND MD
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
HCPCS G0141
|
| Hospital Charge Code |
51000137
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$29.90 |
| Max. Negotiated Rate |
$220.80 |
| Rate for Payer: Aetna Commercial |
$177.10
|
| Rate for Payer: Anthem Medicaid |
$79.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$179.40
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cigna Commercial |
$190.90
|
| Rate for Payer: First Health Commercial |
$218.50
|
| Rate for Payer: Humana Commercial |
$195.50
|
| Rate for Payer: Humana KY Medicaid |
$79.10
|
| Rate for Payer: Kentucky WC Medicaid |
$79.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$188.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$169.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$69.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$80.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$202.40
|
| Rate for Payer: Ohio Health Group HMO |
$172.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$46.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$71.30
|
| Rate for Payer: PHCS Commercial |
$220.80
|
| Rate for Payer: United Healthcare All Payer |
$202.40
|
|
|
SCR C/V CYTO,AUTOSYS AND MD
|
Professional
|
Both
|
$230.00
|
|
|
Service Code
|
HCPCS G0141
|
| Hospital Charge Code |
51000137
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$230.00 |
| Rate for Payer: Aetna Commercial |
$42.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$230.00
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$15.40
|
| Rate for Payer: Multiplan PHCS |
$138.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$161.00
|
| Rate for Payer: UHCCP Medicaid |
$80.50
|
|
|
SCR C/V CYTO,AUTOSYS AND MD
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
HCPCS G0141
|
| Hospital Charge Code |
51000137
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$29.90 |
| Max. Negotiated Rate |
$220.80 |
| Rate for Payer: Aetna Commercial |
$177.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$179.40
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cigna Commercial |
$190.90
|
| Rate for Payer: First Health Commercial |
$218.50
|
| Rate for Payer: Humana Commercial |
$195.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$188.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$169.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$69.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$202.40
|
| Rate for Payer: Ohio Health Group HMO |
$172.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$46.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$71.30
|
| Rate for Payer: PHCS Commercial |
$220.80
|
| Rate for Payer: United Healthcare All Payer |
$202.40
|
|
|
SCREEN BREAST TOMOSYNTESIS BI
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
HCPCS 77063
|
| Hospital Charge Code |
401T0012
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$10.66 |
| Max. Negotiated Rate |
$78.72 |
| Rate for Payer: Aetna Commercial |
$63.14
|
| Rate for Payer: Anthem Medicaid |
$28.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63.96
|
| Rate for Payer: Cash Price |
$41.00
|
| Rate for Payer: Cigna Commercial |
$68.06
|
| Rate for Payer: First Health Commercial |
$77.90
|
| Rate for Payer: Humana Commercial |
$69.70
|
| Rate for Payer: Humana KY Medicaid |
$28.20
|
| Rate for Payer: Kentucky WC Medicaid |
$28.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$28.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$72.16
|
| Rate for Payer: Ohio Health Group HMO |
$61.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25.42
|
| Rate for Payer: PHCS Commercial |
$78.72
|
| Rate for Payer: United Healthcare All Payer |
$72.16
|
|
