|
S P CONSULT PREP AT SOMC
|
Facility
|
IP
|
$567.00
|
|
|
Service Code
|
HCPCS 88323
|
| Hospital Charge Code |
30002035
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$73.71 |
| Max. Negotiated Rate |
$544.32 |
| Rate for Payer: Aetna Commercial |
$436.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$455.30
|
| Rate for Payer: Cash Price |
$283.50
|
| Rate for Payer: Cigna Commercial |
$470.61
|
| Rate for Payer: First Health Commercial |
$538.65
|
| Rate for Payer: Humana Commercial |
$481.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$464.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$418.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$170.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$498.96
|
| Rate for Payer: Ohio Health Group HMO |
$425.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$113.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$175.77
|
| Rate for Payer: PHCS Commercial |
$544.32
|
| Rate for Payer: United Healthcare All Payer |
$498.96
|
|
|
S P CONSULT PREP AT SOMC
|
Professional
|
Both
|
$567.00
|
|
|
Service Code
|
HCPCS 88323
|
| Hospital Charge Code |
30002035
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$44.95 |
| Max. Negotiated Rate |
$567.00 |
| Rate for Payer: Aetna Commercial |
$218.75
|
| Rate for Payer: Anthem Medicaid |
$88.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$567.00
|
| Rate for Payer: Cash Price |
$283.50
|
| Rate for Payer: Cash Price |
$283.50
|
| Rate for Payer: Cigna Commercial |
$89.15
|
| Rate for Payer: Healthspan PPO |
$207.71
|
| Rate for Payer: Humana Medicaid |
$88.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$44.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$89.86
|
| Rate for Payer: Molina Healthcare Passport |
$88.10
|
| Rate for Payer: Multiplan PHCS |
$340.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$396.90
|
| Rate for Payer: UHCCP Medicaid |
$198.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$88.98
|
|
|
S P CONSULT PREP AT SOMC
|
Facility
|
OP
|
$567.00
|
|
|
Service Code
|
HCPCS 88323
|
| Hospital Charge Code |
30002035
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$46.86 |
| Max. Negotiated Rate |
$544.32 |
| Rate for Payer: Aetna Commercial |
$436.59
|
| Rate for Payer: Anthem Medicaid |
$194.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$46.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$455.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$65.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$63.26
|
| Rate for Payer: Cash Price |
$283.50
|
| Rate for Payer: Cash Price |
$283.50
|
| Rate for Payer: Cigna Commercial |
$470.61
|
| Rate for Payer: First Health Commercial |
$538.65
|
| Rate for Payer: Humana Commercial |
$481.95
|
| Rate for Payer: Humana KY Medicaid |
$194.99
|
| Rate for Payer: Humana Medicare Advantage |
$46.86
|
| Rate for Payer: Kentucky WC Medicaid |
$196.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$464.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$418.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$56.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$198.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$498.96
|
| Rate for Payer: Ohio Health Group HMO |
$425.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$113.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$175.77
|
| Rate for Payer: PHCS Commercial |
$544.32
|
| Rate for Payer: United Healthcare All Payer |
$498.96
|
|
|
S P CONSULT PREP AT SOMC (P
|
Professional
|
Both
|
$110.00
|
|
|
Service Code
|
HCPCS 88323
|
| Hospital Charge Code |
300P2035
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$38.50 |
| Max. Negotiated Rate |
$218.75 |
| Rate for Payer: Aetna Commercial |
$218.75
|
| Rate for Payer: Anthem Medicaid |
$88.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$110.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cigna Commercial |
$89.15
|
| Rate for Payer: Healthspan PPO |
$207.71
|
| Rate for Payer: Humana Medicaid |
$88.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$44.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$89.86
|
| Rate for Payer: Molina Healthcare Passport |
$88.10
|
| Rate for Payer: Multiplan PHCS |
$66.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$77.00
|
| Rate for Payer: UHCCP Medicaid |
$38.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$88.98
|
|
|
S P CONSULT PREP AT SOMC (T
|
Facility
|
OP
|
$457.00
|
|
|
Service Code
|
HCPCS 88323
|
| Hospital Charge Code |
300T2035
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$46.86 |
| Max. Negotiated Rate |
$438.72 |
| Rate for Payer: Aetna Commercial |
$351.89
|
| Rate for Payer: Anthem Medicaid |
$157.16
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$46.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$366.97
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$65.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$63.26
|
| Rate for Payer: Cash Price |
$228.50
|
| Rate for Payer: Cash Price |
$228.50
|
| Rate for Payer: Cigna Commercial |
$379.31
|
| Rate for Payer: First Health Commercial |
$434.15
|
| Rate for Payer: Humana Commercial |
$388.45
|
| Rate for Payer: Humana KY Medicaid |
$157.16
|
| Rate for Payer: Humana Medicare Advantage |
$46.86
|
| Rate for Payer: Kentucky WC Medicaid |
$158.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$374.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$337.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$56.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$160.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$402.16
|
| Rate for Payer: Ohio Health Group HMO |
$342.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$91.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$59.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$141.67
|
| Rate for Payer: PHCS Commercial |
$438.72
|
| Rate for Payer: United Healthcare All Payer |
$402.16
|
|
|
S P CONSULT PREP AT SOMC (T
|
Facility
|
IP
|
$457.00
|
|
|
Service Code
|
HCPCS 88323
|
| Hospital Charge Code |
300T2035
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$59.41 |
| Max. Negotiated Rate |
$438.72 |
| Rate for Payer: Aetna Commercial |
$351.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$366.97
|
| Rate for Payer: Cash Price |
$228.50
|
| Rate for Payer: Cigna Commercial |
$379.31
|
| Rate for Payer: First Health Commercial |
$434.15
|
| Rate for Payer: Humana Commercial |
$388.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$374.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$337.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$402.16
|
| Rate for Payer: Ohio Health Group HMO |
$342.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$91.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$59.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$141.67
|
| Rate for Payer: PHCS Commercial |
$438.72
|
| Rate for Payer: United Healthcare All Payer |
$402.16
|
|
|
SPEC COLL SNF/LAB COVID-19
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
HCPCS G2024
|
| Hospital Charge Code |
30001835
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.59 |
| Max. Negotiated Rate |
$41.28 |
| Rate for Payer: Aetna Commercial |
$33.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$34.53
|
| Rate for Payer: Cash Price |
$21.50
|
| Rate for Payer: Cigna Commercial |
$35.69
|
| Rate for Payer: First Health Commercial |
$40.85
|
| Rate for Payer: Humana Commercial |
$36.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$35.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$31.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$37.84
|
| Rate for Payer: Ohio Health Group HMO |
$32.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13.33
|
| Rate for Payer: PHCS Commercial |
$41.28
|
| Rate for Payer: United Healthcare All Payer |
$37.84
|
|
|
SPEC COLL SNF/LAB COVID-19
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
HCPCS G2024
|
| Hospital Charge Code |
30001835
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.59 |
| Max. Negotiated Rate |
$41.28 |
| Rate for Payer: Aetna Commercial |
$33.11
|
| Rate for Payer: Anthem Medicaid |
$25.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$34.53
|
| Rate for Payer: Cash Price |
$21.50
|
| Rate for Payer: Cash Price |
$21.50
|
| Rate for Payer: Cigna Commercial |
$35.69
|
| Rate for Payer: First Health Commercial |
$40.85
|
| Rate for Payer: Humana Commercial |
$36.55
|
| Rate for Payer: Humana KY Medicaid |
$25.46
|
| Rate for Payer: Kentucky WC Medicaid |
$25.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$35.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$31.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$25.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$37.84
|
| Rate for Payer: Ohio Health Group HMO |
$32.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13.33
|
| Rate for Payer: PHCS Commercial |
$41.28
|
| Rate for Payer: United Healthcare All Payer |
$37.84
|
|
|
SPEC EF 12/14 LS 165MM L
|
Facility
|
OP
|
$23,523.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,058.07 |
| Max. Negotiated Rate |
$22,582.65 |
| Rate for Payer: Aetna Commercial |
$18,113.16
|
| Rate for Payer: Anthem Medicaid |
$8,089.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,348.40
|
| Rate for Payer: Cash Price |
$11,761.79
|
| Rate for Payer: Cigna Commercial |
$19,524.58
|
| Rate for Payer: First Health Commercial |
$22,347.41
|
| Rate for Payer: Humana Commercial |
$19,995.05
|
| Rate for Payer: Humana KY Medicaid |
$8,089.76
|
| Rate for Payer: Kentucky WC Medicaid |
$8,172.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,289.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,360.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,057.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,252.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,700.76
|
| Rate for Payer: Ohio Health Group HMO |
$17,642.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,704.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,058.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,292.31
|
| Rate for Payer: PHCS Commercial |
$22,582.65
|
| Rate for Payer: United Healthcare All Payer |
$20,700.76
|
|
|
SPEC EF 12/14 LS 165MM L
|
Facility
|
IP
|
$23,523.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,058.07 |
| Max. Negotiated Rate |
$22,582.65 |
| Rate for Payer: Aetna Commercial |
$18,113.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,348.40
|
| Rate for Payer: Cash Price |
$11,761.79
|
| Rate for Payer: Cigna Commercial |
$19,524.58
|
| Rate for Payer: First Health Commercial |
$22,347.41
|
| Rate for Payer: Humana Commercial |
$19,995.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,289.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,360.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,057.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,700.76
|
| Rate for Payer: Ohio Health Group HMO |
$17,642.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,704.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,058.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,292.31
|
| Rate for Payer: PHCS Commercial |
$22,582.65
|
| Rate for Payer: United Healthcare All Payer |
$20,700.76
|
|
|
SPEC EF 12/14 LS 165MM M
|
Facility
|
IP
|
$23,523.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,058.07 |
| Max. Negotiated Rate |
$22,582.65 |
| Rate for Payer: Aetna Commercial |
$18,113.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,348.40
|
| Rate for Payer: Cash Price |
$11,761.79
|
| Rate for Payer: Cigna Commercial |
$19,524.58
|
| Rate for Payer: First Health Commercial |
$22,347.41
|
| Rate for Payer: Humana Commercial |
$19,995.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,289.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,360.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,057.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,700.76
|
| Rate for Payer: Ohio Health Group HMO |
$17,642.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,704.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,058.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,292.31
|
| Rate for Payer: PHCS Commercial |
$22,582.65
|
| Rate for Payer: United Healthcare All Payer |
$20,700.76
|
|
|
SPEC EF 12/14 LS 165MM M
|
Facility
|
OP
|
$23,523.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,058.07 |
| Max. Negotiated Rate |
$22,582.65 |
| Rate for Payer: Aetna Commercial |
$18,113.16
|
| Rate for Payer: Anthem Medicaid |
$8,089.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,348.40
|
| Rate for Payer: Cash Price |
$11,761.79
|
| Rate for Payer: Cigna Commercial |
$19,524.58
|
| Rate for Payer: First Health Commercial |
$22,347.41
|
| Rate for Payer: Humana Commercial |
$19,995.05
|
| Rate for Payer: Humana KY Medicaid |
$8,089.76
|
| Rate for Payer: Kentucky WC Medicaid |
$8,172.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,289.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,360.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,057.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,252.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,700.76
|
| Rate for Payer: Ohio Health Group HMO |
$17,642.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,704.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,058.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,292.31
|
| Rate for Payer: PHCS Commercial |
$22,582.65
|
| Rate for Payer: United Healthcare All Payer |
$20,700.76
|
|
|
SPEC EF 12/14 LS 165MM S
|
Facility
|
IP
|
$23,523.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,058.07 |
| Max. Negotiated Rate |
$22,582.65 |
| Rate for Payer: Aetna Commercial |
$18,113.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,348.40
|
| Rate for Payer: Cash Price |
$11,761.79
|
| Rate for Payer: Cigna Commercial |
$19,524.58
|
| Rate for Payer: First Health Commercial |
$22,347.41
|
| Rate for Payer: Humana Commercial |
$19,995.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,289.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,360.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,057.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,700.76
|
| Rate for Payer: Ohio Health Group HMO |
$17,642.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,704.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,058.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,292.31
|
| Rate for Payer: PHCS Commercial |
$22,582.65
|
| Rate for Payer: United Healthcare All Payer |
$20,700.76
|
|
|
SPEC EF 12/14 LS 165MM S
|
Facility
|
OP
|
$23,523.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,058.07 |
| Max. Negotiated Rate |
$22,582.65 |
| Rate for Payer: Aetna Commercial |
$18,113.16
|
| Rate for Payer: Anthem Medicaid |
$8,089.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,348.40
|
| Rate for Payer: Cash Price |
$11,761.79
|
| Rate for Payer: Cigna Commercial |
$19,524.58
|
| Rate for Payer: First Health Commercial |
$22,347.41
|
| Rate for Payer: Humana Commercial |
$19,995.05
|
| Rate for Payer: Humana KY Medicaid |
$8,089.76
|
| Rate for Payer: Kentucky WC Medicaid |
$8,172.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,289.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,360.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,057.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,252.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,700.76
|
| Rate for Payer: Ohio Health Group HMO |
$17,642.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,704.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,058.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,292.31
|
| Rate for Payer: PHCS Commercial |
$22,582.65
|
| Rate for Payer: United Healthcare All Payer |
$20,700.76
|
|
|
SPEC EF 12/14 LS 195MM L
|
Facility
|
OP
|
$23,523.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,058.07 |
| Max. Negotiated Rate |
$22,582.65 |
| Rate for Payer: Aetna Commercial |
$18,113.16
|
| Rate for Payer: Anthem Medicaid |
$8,089.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,348.40
|
| Rate for Payer: Cash Price |
$11,761.79
|
| Rate for Payer: Cigna Commercial |
$19,524.58
|
| Rate for Payer: First Health Commercial |
$22,347.41
|
| Rate for Payer: Humana Commercial |
$19,995.05
|
| Rate for Payer: Humana KY Medicaid |
$8,089.76
|
| Rate for Payer: Kentucky WC Medicaid |
$8,172.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,289.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,360.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,057.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,252.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,700.76
|
| Rate for Payer: Ohio Health Group HMO |
$17,642.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,704.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,058.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,292.31
|
| Rate for Payer: PHCS Commercial |
$22,582.65
|
| Rate for Payer: United Healthcare All Payer |
$20,700.76
|
|
|
SPEC EF 12/14 LS 195MM L
|
Facility
|
IP
|
$23,523.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,058.07 |
| Max. Negotiated Rate |
$22,582.65 |
| Rate for Payer: Aetna Commercial |
$18,113.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,348.40
|
| Rate for Payer: Cash Price |
$11,761.79
|
| Rate for Payer: Cigna Commercial |
$19,524.58
|
| Rate for Payer: First Health Commercial |
$22,347.41
|
| Rate for Payer: Humana Commercial |
$19,995.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,289.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,360.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,057.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,700.76
|
| Rate for Payer: Ohio Health Group HMO |
$17,642.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,704.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,058.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,292.31
|
| Rate for Payer: PHCS Commercial |
$22,582.65
|
| Rate for Payer: United Healthcare All Payer |
$20,700.76
|
|
|
SPEC EF 12/14 LS 195MM M
|
Facility
|
IP
|
$23,523.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,058.07 |
| Max. Negotiated Rate |
$22,582.65 |
| Rate for Payer: Aetna Commercial |
$18,113.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,348.40
|
| Rate for Payer: Cash Price |
$11,761.79
|
| Rate for Payer: Cigna Commercial |
$19,524.58
|
| Rate for Payer: First Health Commercial |
$22,347.41
|
| Rate for Payer: Humana Commercial |
$19,995.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,289.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,360.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,057.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,700.76
|
| Rate for Payer: Ohio Health Group HMO |
$17,642.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,704.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,058.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,292.31
|
| Rate for Payer: PHCS Commercial |
$22,582.65
|
| Rate for Payer: United Healthcare All Payer |
$20,700.76
|
|
|
SPEC EF 12/14 LS 195MM M
|
Facility
|
OP
|
$23,523.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,058.07 |
| Max. Negotiated Rate |
$22,582.65 |
| Rate for Payer: Aetna Commercial |
$18,113.16
|
| Rate for Payer: Anthem Medicaid |
$8,089.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,348.40
|
| Rate for Payer: Cash Price |
$11,761.79
|
| Rate for Payer: Cigna Commercial |
$19,524.58
|
| Rate for Payer: First Health Commercial |
$22,347.41
|
| Rate for Payer: Humana Commercial |
$19,995.05
|
| Rate for Payer: Humana KY Medicaid |
$8,089.76
|
| Rate for Payer: Kentucky WC Medicaid |
$8,172.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,289.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,360.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,057.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,252.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,700.76
|
| Rate for Payer: Ohio Health Group HMO |
$17,642.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,704.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,058.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,292.31
|
| Rate for Payer: PHCS Commercial |
$22,582.65
|
| Rate for Payer: United Healthcare All Payer |
$20,700.76
|
|
|
SPEC EF 12/14 LS 195MM S
|
Facility
|
IP
|
$23,523.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,058.07 |
| Max. Negotiated Rate |
$22,582.65 |
| Rate for Payer: Aetna Commercial |
$18,113.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,348.40
|
| Rate for Payer: Cash Price |
$11,761.79
|
| Rate for Payer: Cigna Commercial |
$19,524.58
|
| Rate for Payer: First Health Commercial |
$22,347.41
|
| Rate for Payer: Humana Commercial |
$19,995.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,289.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,360.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,057.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,700.76
|
| Rate for Payer: Ohio Health Group HMO |
$17,642.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,704.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,058.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,292.31
|
| Rate for Payer: PHCS Commercial |
$22,582.65
|
| Rate for Payer: United Healthcare All Payer |
$20,700.76
|
|
|
SPEC EF 12/14 LS 195MM S
|
Facility
|
OP
|
$23,523.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,058.07 |
| Max. Negotiated Rate |
$22,582.65 |
| Rate for Payer: Aetna Commercial |
$18,113.16
|
| Rate for Payer: Anthem Medicaid |
$8,089.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,348.40
|
| Rate for Payer: Cash Price |
$11,761.79
|
| Rate for Payer: Cigna Commercial |
$19,524.58
|
| Rate for Payer: First Health Commercial |
$22,347.41
|
| Rate for Payer: Humana Commercial |
$19,995.05
|
| Rate for Payer: Humana KY Medicaid |
$8,089.76
|
| Rate for Payer: Kentucky WC Medicaid |
$8,172.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,289.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,360.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,057.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,252.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,700.76
|
| Rate for Payer: Ohio Health Group HMO |
$17,642.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,704.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,058.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,292.31
|
| Rate for Payer: PHCS Commercial |
$22,582.65
|
| Rate for Payer: United Healthcare All Payer |
$20,700.76
|
|
|
SPEC EF 12/14 LS 225MM L
|
Facility
|
IP
|
$24,271.29
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,155.27 |
| Max. Negotiated Rate |
$23,300.44 |
| Rate for Payer: Aetna Commercial |
$18,688.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,931.61
|
| Rate for Payer: Cash Price |
$12,135.65
|
| Rate for Payer: Cigna Commercial |
$20,145.17
|
| Rate for Payer: First Health Commercial |
$23,057.73
|
| Rate for Payer: Humana Commercial |
$20,630.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,902.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,912.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,281.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,358.74
|
| Rate for Payer: Ohio Health Group HMO |
$18,203.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,854.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,155.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,524.10
|
| Rate for Payer: PHCS Commercial |
$23,300.44
|
| Rate for Payer: United Healthcare All Payer |
$21,358.74
|
|
|
SPEC EF 12/14 LS 225MM L
|
Facility
|
OP
|
$24,271.29
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,155.27 |
| Max. Negotiated Rate |
$23,300.44 |
| Rate for Payer: Aetna Commercial |
$18,688.89
|
| Rate for Payer: Anthem Medicaid |
$8,346.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,931.61
|
| Rate for Payer: Cash Price |
$12,135.65
|
| Rate for Payer: Cigna Commercial |
$20,145.17
|
| Rate for Payer: First Health Commercial |
$23,057.73
|
| Rate for Payer: Humana Commercial |
$20,630.60
|
| Rate for Payer: Humana KY Medicaid |
$8,346.90
|
| Rate for Payer: Kentucky WC Medicaid |
$8,431.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,902.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,912.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,281.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,514.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,358.74
|
| Rate for Payer: Ohio Health Group HMO |
$18,203.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,854.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,155.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,524.10
|
| Rate for Payer: PHCS Commercial |
$23,300.44
|
| Rate for Payer: United Healthcare All Payer |
$21,358.74
|
|
|
SPEC EF 12/14 LS 225MM M
|
Facility
|
OP
|
$23,523.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,058.07 |
| Max. Negotiated Rate |
$22,582.65 |
| Rate for Payer: Aetna Commercial |
$18,113.16
|
| Rate for Payer: Anthem Medicaid |
$8,089.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,348.40
|
| Rate for Payer: Cash Price |
$11,761.79
|
| Rate for Payer: Cigna Commercial |
$19,524.58
|
| Rate for Payer: First Health Commercial |
$22,347.41
|
| Rate for Payer: Humana Commercial |
$19,995.05
|
| Rate for Payer: Humana KY Medicaid |
$8,089.76
|
| Rate for Payer: Kentucky WC Medicaid |
$8,172.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,289.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,360.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,057.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,252.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,700.76
|
| Rate for Payer: Ohio Health Group HMO |
$17,642.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,704.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,058.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,292.31
|
| Rate for Payer: PHCS Commercial |
$22,582.65
|
| Rate for Payer: United Healthcare All Payer |
$20,700.76
|
|
|
SPEC EF 12/14 LS 225MM M
|
Facility
|
IP
|
$23,523.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,058.07 |
| Max. Negotiated Rate |
$22,582.65 |
| Rate for Payer: Aetna Commercial |
$18,113.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,348.40
|
| Rate for Payer: Cash Price |
$11,761.79
|
| Rate for Payer: Cigna Commercial |
$19,524.58
|
| Rate for Payer: First Health Commercial |
$22,347.41
|
| Rate for Payer: Humana Commercial |
$19,995.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,289.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,360.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,057.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,700.76
|
| Rate for Payer: Ohio Health Group HMO |
$17,642.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,704.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,058.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,292.31
|
| Rate for Payer: PHCS Commercial |
$22,582.65
|
| Rate for Payer: United Healthcare All Payer |
$20,700.76
|
|
|
SPEC EF 12/14 LS 225MM S
|
Facility
|
OP
|
$23,523.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,058.07 |
| Max. Negotiated Rate |
$22,582.65 |
| Rate for Payer: Aetna Commercial |
$18,113.16
|
| Rate for Payer: Anthem Medicaid |
$8,089.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,348.40
|
| Rate for Payer: Cash Price |
$11,761.79
|
| Rate for Payer: Cigna Commercial |
$19,524.58
|
| Rate for Payer: First Health Commercial |
$22,347.41
|
| Rate for Payer: Humana Commercial |
$19,995.05
|
| Rate for Payer: Humana KY Medicaid |
$8,089.76
|
| Rate for Payer: Kentucky WC Medicaid |
$8,172.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,289.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,360.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,057.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,252.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,700.76
|
| Rate for Payer: Ohio Health Group HMO |
$17,642.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,704.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,058.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,292.31
|
| Rate for Payer: PHCS Commercial |
$22,582.65
|
| Rate for Payer: United Healthcare All Payer |
$20,700.76
|
|
