|
AS CEM HUM STEM W/RMV HED9*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 STM W/REM HD 12*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 STM W/REM HD 12*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 STM W/REM HD 14*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 STM W/REM HD 14*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
|
|
|
ASCEND AORTA GRAFT W/CP BYPASS
|
Facility
|
IP
|
$6,670.00
|
|
|
Service Code
|
HCPCS 33863
|
| Hospital Charge Code |
76101319
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,001.00 |
| Max. Negotiated Rate |
$6,403.20 |
| Rate for Payer: Aetna Commercial |
$5,135.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,202.60
|
| Rate for Payer: Cash Price |
$3,335.00
|
| Rate for Payer: Cigna Commercial |
$5,536.10
|
| Rate for Payer: First Health Commercial |
$6,336.50
|
| Rate for Payer: Humana Commercial |
$5,669.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,469.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,922.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,001.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,869.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,002.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,336.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,802.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,602.30
|
| Rate for Payer: PHCS Commercial |
$6,403.20
|
| Rate for Payer: United Healthcare All Payer |
$5,869.60
|
|
|
ASCEND AORTA GRAFT W/CP BYPASS
|
Professional
|
Both
|
$6,670.00
|
|
|
Service Code
|
HCPCS 33863
|
| Hospital Charge Code |
76101319
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,112.29 |
| Max. Negotiated Rate |
$5,355.49 |
| Rate for Payer: Aetna Commercial |
$5,355.49
|
| Rate for Payer: Ambetter Exchange |
$2,949.01
|
| Rate for Payer: Anthem Medicaid |
$2,112.29
|
| Rate for Payer: Buckeye Individual/Medicaid |
$2,949.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,949.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,538.81
|
| Rate for Payer: Cash Price |
$3,335.00
|
| Rate for Payer: Cash Price |
$3,335.00
|
| Rate for Payer: Cigna Commercial |
$4,933.74
|
| Rate for Payer: Healthspan PPO |
$5,265.49
|
| Rate for Payer: Humana Medicaid |
$2,112.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$4,466.07
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$2,949.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,949.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$2,154.54
|
| Rate for Payer: Molina Healthcare Passport |
$2,112.29
|
| Rate for Payer: Multiplan PHCS |
$4,002.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,833.71
|
| Rate for Payer: UHCCP Medicaid |
$2,334.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$2,133.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,949.01
|
|
|
ASCEND AORTA GRAFT W/CP BYPASS
|
Facility
|
OP
|
$6,670.00
|
|
|
Service Code
|
HCPCS 33863
|
| Hospital Charge Code |
76101319
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,001.00 |
| Max. Negotiated Rate |
$6,403.20 |
| Rate for Payer: Aetna Commercial |
$5,135.90
|
| Rate for Payer: Anthem Medicaid |
$2,293.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,202.60
|
| Rate for Payer: Cash Price |
$3,335.00
|
| Rate for Payer: Cigna Commercial |
$5,536.10
|
| Rate for Payer: First Health Commercial |
$6,336.50
|
| Rate for Payer: Humana Commercial |
$5,669.50
|
| Rate for Payer: Humana KY Medicaid |
$2,293.81
|
| Rate for Payer: Kentucky WC Medicaid |
$2,317.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,469.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,922.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,001.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,339.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,869.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,002.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,336.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,802.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,602.30
|
| Rate for Payer: PHCS Commercial |
$6,403.20
|
| Rate for Payer: United Healthcare All Payer |
$5,869.60
|
|
|
ASCEND AORTA GRAFT W/CP BYPASS
|
Professional
|
Both
|
$6,670.00
|
|
|
Service Code
|
HCPCS 33863
|
| Hospital Charge Code |
761P1319
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,112.29 |
| Max. Negotiated Rate |
$5,355.49 |
| Rate for Payer: Aetna Commercial |
$5,355.49
|
| Rate for Payer: Ambetter Exchange |
$2,949.01
|
| Rate for Payer: Anthem Medicaid |
$2,112.29
|
| Rate for Payer: Buckeye Individual/Medicaid |
$2,949.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,949.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,538.81
|
| Rate for Payer: Cash Price |
$3,335.00
|
| Rate for Payer: Cash Price |
$3,335.00
|
| Rate for Payer: Cigna Commercial |
$4,933.74
|
| Rate for Payer: Healthspan PPO |
$5,265.49
|
| Rate for Payer: Humana Medicaid |
$2,112.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$4,466.07
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$2,949.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,949.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$2,154.54
|
| Rate for Payer: Molina Healthcare Passport |
$2,112.29
|
| Rate for Payer: Multiplan PHCS |
$4,002.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,833.71
|
| Rate for Payer: UHCCP Medicaid |
$2,334.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$2,133.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,949.01
|
|
|
AS COLS REV FEMCMP 62.5*56.5 R
|
Facility
|
OP
|
$29,738.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,921.62 |
| Max. Negotiated Rate |
$28,549.20 |
| Rate for Payer: Aetna Commercial |
$22,898.84
|
| Rate for Payer: Anthem Medicaid |
$10,227.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,196.22
|
| Rate for Payer: Cash Price |
$14,869.38
|
| Rate for Payer: Cigna Commercial |
$24,683.16
|
| Rate for Payer: First Health Commercial |
$28,251.81
|
| Rate for Payer: Humana Commercial |
$25,277.94
|
| Rate for Payer: Humana KY Medicaid |
$10,227.16
|
| Rate for Payer: Kentucky WC Medicaid |
$10,331.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,385.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,947.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,921.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,432.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,170.10
|
| Rate for Payer: Ohio Health Group HMO |
$22,304.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,791.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,872.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,519.74
|
| Rate for Payer: PHCS Commercial |
$28,549.20
|
| Rate for Payer: United Healthcare All Payer |
$26,170.10
|
|
|
AS COLS REV FEMCMP 62.5*56.5 R
|
Facility
|
IP
|
$29,738.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,921.62 |
| Max. Negotiated Rate |
$28,549.20 |
| Rate for Payer: Aetna Commercial |
$22,898.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,196.22
|
| Rate for Payer: Cash Price |
$14,869.38
|
| Rate for Payer: Cigna Commercial |
$24,683.16
|
| Rate for Payer: First Health Commercial |
$28,251.81
|
| Rate for Payer: Humana Commercial |
$25,277.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,385.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,947.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,921.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,170.10
|
| Rate for Payer: Ohio Health Group HMO |
$22,304.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,791.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,872.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,519.74
|
| Rate for Payer: PHCS Commercial |
$28,549.20
|
| Rate for Payer: United Healthcare All Payer |
$26,170.10
|
|
|
AS COLS REV FEM COMP 62.5*56.5
|
Facility
|
OP
|
$32,033.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,610.12 |
| Max. Negotiated Rate |
$30,752.40 |
| Rate for Payer: Aetna Commercial |
$24,665.99
|
| Rate for Payer: Anthem Medicaid |
$11,016.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,986.33
|
| Rate for Payer: Cash Price |
$16,016.88
|
| Rate for Payer: Cigna Commercial |
$26,588.01
|
| Rate for Payer: First Health Commercial |
$30,432.06
|
| Rate for Payer: Humana Commercial |
$27,228.69
|
| Rate for Payer: Humana KY Medicaid |
$11,016.41
|
| Rate for Payer: Kentucky WC Medicaid |
$11,128.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,267.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,640.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,610.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,237.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,189.70
|
| Rate for Payer: Ohio Health Group HMO |
$24,025.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,627.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,869.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,103.29
|
| Rate for Payer: PHCS Commercial |
$30,752.40
|
| Rate for Payer: United Healthcare All Payer |
$28,189.70
|
|
|
AS COLS REV FEM COMP 62.5*56.5
|
Facility
|
IP
|
$32,033.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,610.12 |
| Max. Negotiated Rate |
$30,752.40 |
| Rate for Payer: Aetna Commercial |
$24,665.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,986.33
|
| Rate for Payer: Cash Price |
$16,016.88
|
| Rate for Payer: Cigna Commercial |
$26,588.01
|
| Rate for Payer: First Health Commercial |
$30,432.06
|
| Rate for Payer: Humana Commercial |
$27,228.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,267.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,640.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,610.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,189.70
|
| Rate for Payer: Ohio Health Group HMO |
$24,025.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,627.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,869.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,103.29
|
| Rate for Payer: PHCS Commercial |
$30,752.40
|
| Rate for Payer: United Healthcare All Payer |
$28,189.70
|
|
|
AS COLS REV FEM WEDGE DIS 5MM
|
Facility
|
OP
|
$16,143.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,843.14 |
| Max. Negotiated Rate |
$15,498.05 |
| Rate for Payer: Aetna Commercial |
$12,430.73
|
| Rate for Payer: Anthem Medicaid |
$5,551.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,592.16
|
| Rate for Payer: Cash Price |
$8,071.90
|
| Rate for Payer: Cigna Commercial |
$13,399.35
|
| Rate for Payer: First Health Commercial |
$15,336.61
|
| Rate for Payer: Humana Commercial |
$13,722.23
|
| Rate for Payer: Humana KY Medicaid |
$5,551.85
|
| Rate for Payer: Kentucky WC Medicaid |
$5,608.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,237.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,914.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,843.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,663.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,206.54
|
| Rate for Payer: Ohio Health Group HMO |
$12,107.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,915.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,045.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,139.22
|
| Rate for Payer: PHCS Commercial |
$15,498.05
|
| Rate for Payer: United Healthcare All Payer |
$14,206.54
|
|
|
AS COLS REV FEM WEDGE DIS 5MM
|
Facility
|
IP
|
$16,143.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,843.14 |
| Max. Negotiated Rate |
$15,498.05 |
| Rate for Payer: Aetna Commercial |
$12,430.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,592.16
|
| Rate for Payer: Cash Price |
$8,071.90
|
| Rate for Payer: Cigna Commercial |
$13,399.35
|
| Rate for Payer: First Health Commercial |
$15,336.61
|
| Rate for Payer: Humana Commercial |
$13,722.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,237.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,914.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,843.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,206.54
|
| Rate for Payer: Ohio Health Group HMO |
$12,107.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,915.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,045.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,139.22
|
| Rate for Payer: PHCS Commercial |
$15,498.05
|
| Rate for Payer: United Healthcare All Payer |
$14,206.54
|
|
|
AS COLS REV FEM WEDGE POS 5MM
|
Facility
|
OP
|
$13,897.11
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,169.13 |
| Max. Negotiated Rate |
$13,341.23 |
| Rate for Payer: Aetna Commercial |
$10,700.77
|
| Rate for Payer: Anthem Medicaid |
$4,779.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,839.75
|
| Rate for Payer: Cash Price |
$6,948.56
|
| Rate for Payer: Cigna Commercial |
$11,534.60
|
| Rate for Payer: First Health Commercial |
$13,202.25
|
| Rate for Payer: Humana Commercial |
$11,812.54
|
| Rate for Payer: Humana KY Medicaid |
$4,779.22
|
| Rate for Payer: Kentucky WC Medicaid |
$4,827.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,395.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,256.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,169.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,875.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,229.46
|
| Rate for Payer: Ohio Health Group HMO |
$10,422.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,117.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,090.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,589.01
|
| Rate for Payer: PHCS Commercial |
$13,341.23
|
| Rate for Payer: United Healthcare All Payer |
$12,229.46
|
|
|
AS COLS REV FEM WEDGE POS 5MM
|
Facility
|
IP
|
$13,897.11
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,169.13 |
| Max. Negotiated Rate |
$13,341.23 |
| Rate for Payer: Aetna Commercial |
$10,700.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,839.75
|
| Rate for Payer: Cash Price |
$6,948.56
|
| Rate for Payer: Cigna Commercial |
$11,534.60
|
| Rate for Payer: First Health Commercial |
$13,202.25
|
| Rate for Payer: Humana Commercial |
$11,812.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,395.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,256.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,169.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,229.46
|
| Rate for Payer: Ohio Health Group HMO |
$10,422.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,117.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,090.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,589.01
|
| Rate for Payer: PHCS Commercial |
$13,341.23
|
| Rate for Payer: United Healthcare All Payer |
$12,229.46
|
|
|
AS COLS REV TIB COMP SZ70*45MM
|
Facility
|
IP
|
$26,851.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,055.38 |
| Max. Negotiated Rate |
$25,777.20 |
| Rate for Payer: Aetna Commercial |
$20,675.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,943.97
|
| Rate for Payer: Cash Price |
$13,425.62
|
| Rate for Payer: Cigna Commercial |
$22,286.54
|
| Rate for Payer: First Health Commercial |
$25,508.69
|
| Rate for Payer: Humana Commercial |
$22,823.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,018.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,816.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,055.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,629.10
|
| Rate for Payer: Ohio Health Group HMO |
$20,138.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,481.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,360.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,527.36
|
| Rate for Payer: PHCS Commercial |
$25,777.20
|
| Rate for Payer: United Healthcare All Payer |
$23,629.10
|
|
|
AS COLS REV TIB COMP SZ70*45MM
|
Facility
|
OP
|
$26,851.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,055.38 |
| Max. Negotiated Rate |
$25,777.20 |
| Rate for Payer: Aetna Commercial |
$20,675.46
|
| Rate for Payer: Anthem Medicaid |
$9,234.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,943.97
|
| Rate for Payer: Cash Price |
$13,425.62
|
| Rate for Payer: Cigna Commercial |
$22,286.54
|
| Rate for Payer: First Health Commercial |
$25,508.69
|
| Rate for Payer: Humana Commercial |
$22,823.56
|
| Rate for Payer: Humana KY Medicaid |
$9,234.14
|
| Rate for Payer: Kentucky WC Medicaid |
$9,328.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,018.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,816.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,055.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,419.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,629.10
|
| Rate for Payer: Ohio Health Group HMO |
$20,138.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,481.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,360.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,527.36
|
| Rate for Payer: PHCS Commercial |
$25,777.20
|
| Rate for Payer: United Healthcare All Payer |
$23,629.10
|
|
|
AS COLS REV TIB COMP SZ 70*49M
|
Facility
|
IP
|
$28,872.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,661.75 |
| Max. Negotiated Rate |
$27,717.60 |
| Rate for Payer: Aetna Commercial |
$22,231.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,520.55
|
| Rate for Payer: Cash Price |
$14,436.25
|
| Rate for Payer: Cigna Commercial |
$23,964.17
|
| Rate for Payer: First Health Commercial |
$27,428.88
|
| Rate for Payer: Humana Commercial |
$24,541.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,675.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,307.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,661.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,407.80
|
| Rate for Payer: Ohio Health Group HMO |
$21,654.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,098.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,119.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,922.03
|
| Rate for Payer: PHCS Commercial |
$27,717.60
|
| Rate for Payer: United Healthcare All Payer |
$25,407.80
|
|
|
AS COLS REV TIB COMP SZ 70*49M
|
Facility
|
OP
|
$28,872.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,661.75 |
| Max. Negotiated Rate |
$27,717.60 |
| Rate for Payer: Aetna Commercial |
$22,231.83
|
| Rate for Payer: Anthem Medicaid |
$9,929.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,520.55
|
| Rate for Payer: Cash Price |
$14,436.25
|
| Rate for Payer: Cigna Commercial |
$23,964.17
|
| Rate for Payer: First Health Commercial |
$27,428.88
|
| Rate for Payer: Humana Commercial |
$24,541.62
|
| Rate for Payer: Humana KY Medicaid |
$9,929.25
|
| Rate for Payer: Kentucky WC Medicaid |
$10,030.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,675.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,307.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,661.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,128.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,407.80
|
| Rate for Payer: Ohio Health Group HMO |
$21,654.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,098.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,119.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,922.03
|
| Rate for Payer: PHCS Commercial |
$27,717.60
|
| Rate for Payer: United Healthcare All Payer |
$25,407.80
|
|
|
AS COLS REV TIB WDGE RL/LM 5MM
|
Facility
|
IP
|
$14,113.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,234.09 |
| Max. Negotiated Rate |
$13,549.09 |
| Rate for Payer: Aetna Commercial |
$10,867.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,008.64
|
| Rate for Payer: Cash Price |
$7,056.82
|
| Rate for Payer: Cigna Commercial |
$11,714.32
|
| Rate for Payer: First Health Commercial |
$13,407.96
|
| Rate for Payer: Humana Commercial |
$11,996.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,573.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,415.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,234.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,420.00
|
| Rate for Payer: Ohio Health Group HMO |
$10,585.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,290.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,278.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,738.41
|
| Rate for Payer: PHCS Commercial |
$13,549.09
|
| Rate for Payer: United Healthcare All Payer |
$12,420.00
|
|
|
AS COLS REV TIB WDGE RL/LM 5MM
|
Facility
|
OP
|
$14,113.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,234.09 |
| Max. Negotiated Rate |
$13,549.09 |
| Rate for Payer: Aetna Commercial |
$10,867.50
|
| Rate for Payer: Anthem Medicaid |
$4,853.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,008.64
|
| Rate for Payer: Cash Price |
$7,056.82
|
| Rate for Payer: Cigna Commercial |
$11,714.32
|
| Rate for Payer: First Health Commercial |
$13,407.96
|
| Rate for Payer: Humana Commercial |
$11,996.59
|
| Rate for Payer: Humana KY Medicaid |
$4,853.68
|
| Rate for Payer: Kentucky WC Medicaid |
$4,903.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,573.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,415.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,234.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,951.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,420.00
|
| Rate for Payer: Ohio Health Group HMO |
$10,585.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,290.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,278.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,738.41
|
| Rate for Payer: PHCS Commercial |
$13,549.09
|
| Rate for Payer: United Healthcare All Payer |
$12,420.00
|
|
|
AS COLS REV TIB WDGE RM/LL 5MM
|
Facility
|
IP
|
$14,109.97
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,232.99 |
| Max. Negotiated Rate |
$13,545.57 |
| Rate for Payer: Aetna Commercial |
$10,864.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,005.78
|
| Rate for Payer: Cash Price |
$7,054.98
|
| Rate for Payer: Cigna Commercial |
$11,711.28
|
| Rate for Payer: First Health Commercial |
$13,404.47
|
| Rate for Payer: Humana Commercial |
$11,993.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,570.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,413.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,232.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,416.77
|
| Rate for Payer: Ohio Health Group HMO |
$10,582.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,287.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,275.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,735.88
|
| Rate for Payer: PHCS Commercial |
$13,545.57
|
| Rate for Payer: United Healthcare All Payer |
$12,416.77
|
|
|
AS COLS REV TIB WDGE RM/LL 5MM
|
Facility
|
OP
|
$14,109.97
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,232.99 |
| Max. Negotiated Rate |
$13,545.57 |
| Rate for Payer: Aetna Commercial |
$10,864.68
|
| Rate for Payer: Anthem Medicaid |
$4,852.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,005.78
|
| Rate for Payer: Cash Price |
$7,054.98
|
| Rate for Payer: Cigna Commercial |
$11,711.28
|
| Rate for Payer: First Health Commercial |
$13,404.47
|
| Rate for Payer: Humana Commercial |
$11,993.47
|
| Rate for Payer: Humana KY Medicaid |
$4,852.42
|
| Rate for Payer: Kentucky WC Medicaid |
$4,901.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,570.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,413.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,232.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,949.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,416.77
|
| Rate for Payer: Ohio Health Group HMO |
$10,582.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,287.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,275.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,735.88
|
| Rate for Payer: PHCS Commercial |
$13,545.57
|
| Rate for Payer: United Healthcare All Payer |
$12,416.77
|
|
