|
SEC. ART M-THROMECT ADD-ON(P
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 37186
|
| Hospital Charge Code |
761P1527
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$188.24 |
| Max. Negotiated Rate |
$2,100.00 |
| Rate for Payer: Aetna Commercial |
$410.66
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$188.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,100.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cash Price |
$1,050.00
|
| Rate for Payer: Cigna Commercial |
$367.92
|
| Rate for Payer: Healthspan PPO |
$1,884.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$342.89
|
| Rate for Payer: Multiplan PHCS |
$1,260.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,470.00
|
| Rate for Payer: UHCCP Medicaid |
$197.65
|
|
|
SECONDARY CLOSURE OF SURGICAL WOUND OR DEHISCENCE, EXTENSIVE OR COMPLICATED
|
Facility
|
OP
|
$2,207.77
|
|
|
Service Code
|
CPT 13160
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,576.98 |
| Max. Negotiated Rate |
$2,207.77 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,576.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,207.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,128.92
|
| Rate for Payer: Humana Medicare Advantage |
$1,576.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,892.38
|
|
|
SECONDARY CLOSURE OF WOUND
|
Facility
|
OP
|
$7,679.50
|
|
|
Service Code
|
HCPCS 13160
|
| Hospital Charge Code |
76100161
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$998.34 |
| Max. Negotiated Rate |
$7,372.32 |
| Rate for Payer: Aetna Commercial |
$5,913.22
|
| Rate for Payer: Anthem Medicaid |
$2,640.98
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,576.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,990.01
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,207.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,128.92
|
| Rate for Payer: Cash Price |
$3,839.75
|
| Rate for Payer: Cash Price |
$3,839.75
|
| Rate for Payer: Cigna Commercial |
$6,373.98
|
| Rate for Payer: First Health Commercial |
$7,295.52
|
| Rate for Payer: Humana Commercial |
$6,527.58
|
| Rate for Payer: Humana KY Medicaid |
$2,640.98
|
| Rate for Payer: Humana Medicare Advantage |
$1,576.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,667.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,297.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,667.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,892.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,693.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,757.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,759.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,535.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$998.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,380.64
|
| Rate for Payer: PHCS Commercial |
$7,372.32
|
| Rate for Payer: United Healthcare All Payer |
$6,757.96
|
|
|
SECONDARY CLOSURE OF WOUND
|
Professional
|
Both
|
$7,679.50
|
|
|
Service Code
|
HCPCS 13160
|
| Hospital Charge Code |
76100161
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$383.05 |
| Max. Negotiated Rate |
$7,679.50 |
| Rate for Payer: Aetna Commercial |
$1,177.96
|
| Rate for Payer: Anthem Medicaid |
$383.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$7,679.50
|
| Rate for Payer: Cash Price |
$3,839.75
|
| Rate for Payer: Cash Price |
$3,839.75
|
| Rate for Payer: Cigna Commercial |
$1,110.34
|
| Rate for Payer: Healthspan PPO |
$941.89
|
| Rate for Payer: Humana Medicaid |
$383.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,010.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$390.71
|
| Rate for Payer: Molina Healthcare Passport |
$383.05
|
| Rate for Payer: Multiplan PHCS |
$4,607.70
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5,375.65
|
| Rate for Payer: UHCCP Medicaid |
$2,687.82
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$386.88
|
|
|
SECONDARY CLOSURE OF WOUND
|
Facility
|
IP
|
$7,679.50
|
|
|
Service Code
|
HCPCS 13160
|
| Hospital Charge Code |
76100161
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$998.34 |
| Max. Negotiated Rate |
$7,372.32 |
| Rate for Payer: Aetna Commercial |
$5,913.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,990.01
|
| Rate for Payer: Cash Price |
$3,839.75
|
| Rate for Payer: Cigna Commercial |
$6,373.98
|
| Rate for Payer: First Health Commercial |
$7,295.52
|
| Rate for Payer: Humana Commercial |
$6,527.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,297.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,667.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,303.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,757.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,759.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,535.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$998.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,380.64
|
| Rate for Payer: PHCS Commercial |
$7,372.32
|
| Rate for Payer: United Healthcare All Payer |
$6,757.96
|
|
|
SECONDARY CLOSURE OF WOUND(P
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 13160
|
| Hospital Charge Code |
761P0161
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$383.05 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$1,177.96
|
| Rate for Payer: Anthem Medicaid |
$383.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,500.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,110.34
|
| Rate for Payer: Healthspan PPO |
$941.89
|
| Rate for Payer: Humana Medicaid |
$383.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,010.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$390.71
|
| Rate for Payer: Molina Healthcare Passport |
$383.05
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,050.00
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$386.88
|
|
|
SECONDARY CLOSURE OF WOUND(T
|
Facility
|
OP
|
$6,179.50
|
|
|
Service Code
|
HCPCS 13160
|
| Hospital Charge Code |
761T0161
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$803.34 |
| Max. Negotiated Rate |
$5,932.32 |
| Rate for Payer: Aetna Commercial |
$4,758.22
|
| Rate for Payer: Anthem Medicaid |
$2,125.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,576.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,820.01
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,207.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,128.92
|
| Rate for Payer: Cash Price |
$3,089.75
|
| Rate for Payer: Cash Price |
$3,089.75
|
| Rate for Payer: Cigna Commercial |
$5,128.98
|
| Rate for Payer: First Health Commercial |
$5,870.52
|
| Rate for Payer: Humana Commercial |
$5,252.58
|
| Rate for Payer: Humana KY Medicaid |
$2,125.13
|
| Rate for Payer: Humana Medicare Advantage |
$1,576.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,146.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,067.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,560.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,892.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,167.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,437.96
|
| Rate for Payer: Ohio Health Group HMO |
$4,634.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,235.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$803.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,915.64
|
| Rate for Payer: PHCS Commercial |
$5,932.32
|
| Rate for Payer: United Healthcare All Payer |
$5,437.96
|
|
|
SECONDARY CLOSURE OF WOUND(T
|
Facility
|
IP
|
$6,179.50
|
|
|
Service Code
|
HCPCS 13160
|
| Hospital Charge Code |
761T0161
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$803.34 |
| Max. Negotiated Rate |
$5,932.32 |
| Rate for Payer: Aetna Commercial |
$4,758.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,820.01
|
| Rate for Payer: Cash Price |
$3,089.75
|
| Rate for Payer: Cigna Commercial |
$5,128.98
|
| Rate for Payer: First Health Commercial |
$5,870.52
|
| Rate for Payer: Humana Commercial |
$5,252.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,067.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,560.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,853.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,437.96
|
| Rate for Payer: Ohio Health Group HMO |
$4,634.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,235.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$803.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,915.64
|
| Rate for Payer: PHCS Commercial |
$5,932.32
|
| Rate for Payer: United Healthcare All Payer |
$5,437.96
|
|
|
SECOND LOOK PROCEDURE
|
Facility
|
IP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 58960
|
| Hospital Charge Code |
76102266
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$364.00 |
| Max. Negotiated Rate |
$2,688.00 |
| Rate for Payer: Aetna Commercial |
$2,156.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,184.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cigna Commercial |
$2,324.00
|
| Rate for Payer: First Health Commercial |
$2,660.00
|
| Rate for Payer: Humana Commercial |
$2,380.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,296.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,066.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$840.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,464.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,100.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$364.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$868.00
|
| Rate for Payer: PHCS Commercial |
$2,688.00
|
| Rate for Payer: United Healthcare All Payer |
$2,464.00
|
|
|
SECOND LOOK PROCEDURE
|
Facility
|
OP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 58960
|
| Hospital Charge Code |
76102266
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$364.00 |
| Max. Negotiated Rate |
$2,688.00 |
| Rate for Payer: Aetna Commercial |
$2,156.00
|
| Rate for Payer: Anthem Medicaid |
$962.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,184.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cigna Commercial |
$2,324.00
|
| Rate for Payer: First Health Commercial |
$2,660.00
|
| Rate for Payer: Humana Commercial |
$2,380.00
|
| Rate for Payer: Humana KY Medicaid |
$962.92
|
| Rate for Payer: Kentucky WC Medicaid |
$972.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,296.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,066.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$840.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$982.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,464.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,100.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$364.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$868.00
|
| Rate for Payer: PHCS Commercial |
$2,688.00
|
| Rate for Payer: United Healthcare All Payer |
$2,464.00
|
|
|
SECOND LOOK PROCEDURE
|
Professional
|
Both
|
$2,800.00
|
|
|
Service Code
|
HCPCS 58960
|
| Hospital Charge Code |
76102266
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$717.37 |
| Max. Negotiated Rate |
$2,800.00 |
| Rate for Payer: Aetna Commercial |
$1,397.29
|
| Rate for Payer: Anthem Medicaid |
$717.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,800.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cigna Commercial |
$1,360.02
|
| Rate for Payer: Healthspan PPO |
$1,352.92
|
| Rate for Payer: Humana Medicaid |
$717.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,203.63
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$731.72
|
| Rate for Payer: Molina Healthcare Passport |
$717.37
|
| Rate for Payer: Multiplan PHCS |
$1,680.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,960.00
|
| Rate for Payer: UHCCP Medicaid |
$980.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$724.54
|
|
|
SECOND LOOK PROCEDURE(P
|
Professional
|
Both
|
$2,800.00
|
|
|
Service Code
|
HCPCS 58960
|
| Hospital Charge Code |
761P2266
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$717.37 |
| Max. Negotiated Rate |
$2,800.00 |
| Rate for Payer: Aetna Commercial |
$1,397.29
|
| Rate for Payer: Anthem Medicaid |
$717.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,800.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cigna Commercial |
$1,360.02
|
| Rate for Payer: Healthspan PPO |
$1,352.92
|
| Rate for Payer: Humana Medicaid |
$717.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,203.63
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$731.72
|
| Rate for Payer: Molina Healthcare Passport |
$717.37
|
| Rate for Payer: Multiplan PHCS |
$1,680.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,960.00
|
| Rate for Payer: UHCCP Medicaid |
$980.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$724.54
|
|
|
SECURFIT HASTEM #10 132^35*160
|
Facility
|
IP
|
$13,848.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,800.34 |
| Max. Negotiated Rate |
$13,294.84 |
| Rate for Payer: Aetna Commercial |
$10,663.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,802.06
|
| Rate for Payer: Cash Price |
$6,924.40
|
| Rate for Payer: Cigna Commercial |
$11,494.50
|
| Rate for Payer: First Health Commercial |
$13,156.35
|
| Rate for Payer: Humana Commercial |
$11,771.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,356.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,220.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,154.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,186.94
|
| Rate for Payer: Ohio Health Group HMO |
$10,386.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,769.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,800.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,293.12
|
| Rate for Payer: PHCS Commercial |
$13,294.84
|
| Rate for Payer: United Healthcare All Payer |
$12,186.94
|
|
|
SECURFIT HASTEM #10 132^35*160
|
Facility
|
OP
|
$13,848.79
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,800.34 |
| Max. Negotiated Rate |
$13,294.84 |
| Rate for Payer: Aetna Commercial |
$10,663.57
|
| Rate for Payer: Anthem Medicaid |
$4,762.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,802.06
|
| Rate for Payer: Cash Price |
$6,924.40
|
| Rate for Payer: Cigna Commercial |
$11,494.50
|
| Rate for Payer: First Health Commercial |
$13,156.35
|
| Rate for Payer: Humana Commercial |
$11,771.47
|
| Rate for Payer: Humana KY Medicaid |
$4,762.60
|
| Rate for Payer: Kentucky WC Medicaid |
$4,811.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,356.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,220.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,154.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,858.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,186.94
|
| Rate for Payer: Ohio Health Group HMO |
$10,386.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,769.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,800.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,293.12
|
| Rate for Payer: PHCS Commercial |
$13,294.84
|
| Rate for Payer: United Healthcare All Payer |
$12,186.94
|
|
|
SECURFIT HASTEM #11 132^40*170
|
Facility
|
IP
|
$19,874.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,583.68 |
| Max. Negotiated Rate |
$19,079.52 |
| Rate for Payer: Aetna Commercial |
$15,303.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,502.11
|
| Rate for Payer: Cash Price |
$9,937.25
|
| Rate for Payer: Cigna Commercial |
$16,495.84
|
| Rate for Payer: First Health Commercial |
$18,880.78
|
| Rate for Payer: Humana Commercial |
$16,893.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,297.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,667.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,962.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,489.56
|
| Rate for Payer: Ohio Health Group HMO |
$14,905.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,974.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,583.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,161.10
|
| Rate for Payer: PHCS Commercial |
$19,079.52
|
| Rate for Payer: United Healthcare All Payer |
$17,489.56
|
|
|
SECURFIT HASTEM #11 132^40*170
|
Facility
|
OP
|
$19,874.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,583.68 |
| Max. Negotiated Rate |
$19,079.52 |
| Rate for Payer: Aetna Commercial |
$15,303.36
|
| Rate for Payer: Anthem Medicaid |
$6,834.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,502.11
|
| Rate for Payer: Cash Price |
$9,937.25
|
| Rate for Payer: Cigna Commercial |
$16,495.84
|
| Rate for Payer: First Health Commercial |
$18,880.78
|
| Rate for Payer: Humana Commercial |
$16,893.32
|
| Rate for Payer: Humana KY Medicaid |
$6,834.84
|
| Rate for Payer: Kentucky WC Medicaid |
$6,904.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,297.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,667.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,962.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,971.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,489.56
|
| Rate for Payer: Ohio Health Group HMO |
$14,905.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,974.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,583.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,161.10
|
| Rate for Payer: PHCS Commercial |
$19,079.52
|
| Rate for Payer: United Healthcare All Payer |
$17,489.56
|
|
|
SECURFIT HA STEM #7 132^30*130
|
Facility
|
IP
|
$19,874.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,583.68 |
| Max. Negotiated Rate |
$19,079.52 |
| Rate for Payer: Aetna Commercial |
$15,303.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,502.11
|
| Rate for Payer: Cash Price |
$9,937.25
|
| Rate for Payer: Cigna Commercial |
$16,495.84
|
| Rate for Payer: First Health Commercial |
$18,880.78
|
| Rate for Payer: Humana Commercial |
$16,893.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,297.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,667.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,962.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,489.56
|
| Rate for Payer: Ohio Health Group HMO |
$14,905.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,974.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,583.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,161.10
|
| Rate for Payer: PHCS Commercial |
$19,079.52
|
| Rate for Payer: United Healthcare All Payer |
$17,489.56
|
|
|
SECURFIT HA STEM #7 132^30*130
|
Facility
|
OP
|
$19,874.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,583.68 |
| Max. Negotiated Rate |
$19,079.52 |
| Rate for Payer: Aetna Commercial |
$15,303.36
|
| Rate for Payer: Anthem Medicaid |
$6,834.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,502.11
|
| Rate for Payer: Cash Price |
$9,937.25
|
| Rate for Payer: Cigna Commercial |
$16,495.84
|
| Rate for Payer: First Health Commercial |
$18,880.78
|
| Rate for Payer: Humana Commercial |
$16,893.32
|
| Rate for Payer: Humana KY Medicaid |
$6,834.84
|
| Rate for Payer: Kentucky WC Medicaid |
$6,904.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,297.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,667.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,962.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,971.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,489.56
|
| Rate for Payer: Ohio Health Group HMO |
$14,905.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,974.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,583.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,161.10
|
| Rate for Payer: PHCS Commercial |
$19,079.52
|
| Rate for Payer: United Healthcare All Payer |
$17,489.56
|
|
|
SECURFIT HA STEM #8 132^30*140
|
Facility
|
IP
|
$19,874.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,583.68 |
| Max. Negotiated Rate |
$19,079.52 |
| Rate for Payer: Aetna Commercial |
$15,303.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,502.11
|
| Rate for Payer: Cash Price |
$9,937.25
|
| Rate for Payer: Cigna Commercial |
$16,495.84
|
| Rate for Payer: First Health Commercial |
$18,880.78
|
| Rate for Payer: Humana Commercial |
$16,893.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,297.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,667.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,962.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,489.56
|
| Rate for Payer: Ohio Health Group HMO |
$14,905.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,974.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,583.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,161.10
|
| Rate for Payer: PHCS Commercial |
$19,079.52
|
| Rate for Payer: United Healthcare All Payer |
$17,489.56
|
|
|
SECURFIT HA STEM #8 132^30*140
|
Facility
|
OP
|
$19,874.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,583.68 |
| Max. Negotiated Rate |
$19,079.52 |
| Rate for Payer: Aetna Commercial |
$15,303.36
|
| Rate for Payer: Anthem Medicaid |
$6,834.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,502.11
|
| Rate for Payer: Cash Price |
$9,937.25
|
| Rate for Payer: Cigna Commercial |
$16,495.84
|
| Rate for Payer: First Health Commercial |
$18,880.78
|
| Rate for Payer: Humana Commercial |
$16,893.32
|
| Rate for Payer: Humana KY Medicaid |
$6,834.84
|
| Rate for Payer: Kentucky WC Medicaid |
$6,904.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,297.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,667.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,962.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,971.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,489.56
|
| Rate for Payer: Ohio Health Group HMO |
$14,905.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,974.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,583.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,161.10
|
| Rate for Payer: PHCS Commercial |
$19,079.52
|
| Rate for Payer: United Healthcare All Payer |
$17,489.56
|
|
|
SECURFIT HA STEM #9 132^35*150
|
Facility
|
IP
|
$19,874.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,583.68 |
| Max. Negotiated Rate |
$19,079.52 |
| Rate for Payer: Aetna Commercial |
$15,303.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,502.11
|
| Rate for Payer: Cash Price |
$9,937.25
|
| Rate for Payer: Cigna Commercial |
$16,495.84
|
| Rate for Payer: First Health Commercial |
$18,880.78
|
| Rate for Payer: Humana Commercial |
$16,893.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,297.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,667.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,962.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,489.56
|
| Rate for Payer: Ohio Health Group HMO |
$14,905.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,974.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,583.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,161.10
|
| Rate for Payer: PHCS Commercial |
$19,079.52
|
| Rate for Payer: United Healthcare All Payer |
$17,489.56
|
|
|
SECURFIT HA STEM #9 132^35*150
|
Facility
|
OP
|
$19,874.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,583.68 |
| Max. Negotiated Rate |
$19,079.52 |
| Rate for Payer: Aetna Commercial |
$15,303.36
|
| Rate for Payer: Anthem Medicaid |
$6,834.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,502.11
|
| Rate for Payer: Cash Price |
$9,937.25
|
| Rate for Payer: Cigna Commercial |
$16,495.84
|
| Rate for Payer: First Health Commercial |
$18,880.78
|
| Rate for Payer: Humana Commercial |
$16,893.32
|
| Rate for Payer: Humana KY Medicaid |
$6,834.84
|
| Rate for Payer: Kentucky WC Medicaid |
$6,904.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,297.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,667.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,962.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,971.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,489.56
|
| Rate for Payer: Ohio Health Group HMO |
$14,905.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,974.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,583.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,161.10
|
| Rate for Payer: PHCS Commercial |
$19,079.52
|
| Rate for Payer: United Healthcare All Payer |
$17,489.56
|
|
|
SECUR-FIT STEM #10 14MM*35MM
|
Facility
|
IP
|
$22,623.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,941.08 |
| Max. Negotiated Rate |
$21,718.73 |
| Rate for Payer: Aetna Commercial |
$17,420.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,646.47
|
| Rate for Payer: Cash Price |
$11,311.84
|
| Rate for Payer: Cigna Commercial |
$18,777.65
|
| Rate for Payer: First Health Commercial |
$21,492.50
|
| Rate for Payer: Humana Commercial |
$19,230.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,551.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,696.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,787.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,908.84
|
| Rate for Payer: Ohio Health Group HMO |
$16,967.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,524.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,941.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,013.34
|
| Rate for Payer: PHCS Commercial |
$21,718.73
|
| Rate for Payer: United Healthcare All Payer |
$19,908.84
|
|
|
SECUR-FIT STEM #10 14MM*35MM
|
Facility
|
OP
|
$22,623.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,941.08 |
| Max. Negotiated Rate |
$21,718.73 |
| Rate for Payer: Aetna Commercial |
$17,420.23
|
| Rate for Payer: Anthem Medicaid |
$7,780.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,646.47
|
| Rate for Payer: Cash Price |
$11,311.84
|
| Rate for Payer: Cigna Commercial |
$18,777.65
|
| Rate for Payer: First Health Commercial |
$21,492.50
|
| Rate for Payer: Humana Commercial |
$19,230.13
|
| Rate for Payer: Humana KY Medicaid |
$7,780.28
|
| Rate for Payer: Kentucky WC Medicaid |
$7,859.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,551.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,696.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,787.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,936.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,908.84
|
| Rate for Payer: Ohio Health Group HMO |
$16,967.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,524.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,941.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,013.34
|
| Rate for Payer: PHCS Commercial |
$21,718.73
|
| Rate for Payer: United Healthcare All Payer |
$19,908.84
|
|
|
SECUR-FIT STEM #10 16MM*35MM
|
Facility
|
IP
|
$22,623.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,941.08 |
| Max. Negotiated Rate |
$21,718.73 |
| Rate for Payer: Aetna Commercial |
$17,420.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,646.47
|
| Rate for Payer: Cash Price |
$11,311.84
|
| Rate for Payer: Cigna Commercial |
$18,777.65
|
| Rate for Payer: First Health Commercial |
$21,492.50
|
| Rate for Payer: Humana Commercial |
$19,230.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,551.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,696.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,787.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,908.84
|
| Rate for Payer: Ohio Health Group HMO |
$16,967.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,524.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,941.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,013.34
|
| Rate for Payer: PHCS Commercial |
$21,718.73
|
| Rate for Payer: United Healthcare All Payer |
$19,908.84
|
|
