|
SPECI GRAVITY SEROUS/BAL FLUID
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
HCPCS 84315
|
| Hospital Charge Code |
30000518
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.28 |
| Max. Negotiated Rate |
$30.72 |
| Rate for Payer: Aetna Commercial |
$24.64
|
| Rate for Payer: Anthem Medicaid |
$11.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.28
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cigna Commercial |
$26.56
|
| Rate for Payer: First Health Commercial |
$30.40
|
| Rate for Payer: Humana Commercial |
$27.20
|
| Rate for Payer: Humana KY Medicaid |
$11.00
|
| Rate for Payer: Humana Medicare Advantage |
$3.28
|
| Rate for Payer: Kentucky WC Medicaid |
$11.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$11.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$28.16
|
| Rate for Payer: Ohio Health Group HMO |
$24.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.92
|
| Rate for Payer: PHCS Commercial |
$30.72
|
| Rate for Payer: United Healthcare All Payer |
$28.16
|
|
|
SPECI GRAVITY SEROUS/BAL FLUID
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
HCPCS 84315
|
| Hospital Charge Code |
30000518
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$30.72 |
| Rate for Payer: Aetna Commercial |
$24.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25.70
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cigna Commercial |
$26.56
|
| Rate for Payer: First Health Commercial |
$30.40
|
| Rate for Payer: Humana Commercial |
$27.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$28.16
|
| Rate for Payer: Ohio Health Group HMO |
$24.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.92
|
| Rate for Payer: PHCS Commercial |
$30.72
|
| Rate for Payer: United Healthcare All Payer |
$28.16
|
|
|
SPECIMEN COLLECT COVID-19
|
Facility
|
OP
|
$26.00
|
|
| Hospital Charge Code |
30001833
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.38 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Anthem Medicaid |
$8.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.88
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cigna Commercial |
$21.58
|
| Rate for Payer: First Health Commercial |
$24.70
|
| Rate for Payer: Humana Commercial |
$22.10
|
| Rate for Payer: Humana KY Medicaid |
$8.94
|
| Rate for Payer: Kentucky WC Medicaid |
$9.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.88
|
| Rate for Payer: Ohio Health Group HMO |
$19.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.06
|
| Rate for Payer: PHCS Commercial |
$24.96
|
| Rate for Payer: United Healthcare All Payer |
$22.88
|
|
|
SPECIMEN COLLECT COVID-19
|
Facility
|
IP
|
$26.00
|
|
| Hospital Charge Code |
30001833
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.38 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20.88
|
| Rate for Payer: Cash Price |
$13.00
|
| Rate for Payer: Cigna Commercial |
$21.58
|
| Rate for Payer: First Health Commercial |
$24.70
|
| Rate for Payer: Humana Commercial |
$22.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.88
|
| Rate for Payer: Ohio Health Group HMO |
$19.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.06
|
| Rate for Payer: PHCS Commercial |
$24.96
|
| Rate for Payer: United Healthcare All Payer |
$22.88
|
|
|
SPECIMEN COLLECTION
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
HCPCS 99000
|
| Hospital Charge Code |
30001897
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.11 |
| Max. Negotiated Rate |
$45.12 |
| Rate for Payer: Aetna Commercial |
$36.19
|
| Rate for Payer: Anthem Medicaid |
$16.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$37.74
|
| Rate for Payer: Cash Price |
$23.50
|
| Rate for Payer: Cigna Commercial |
$39.01
|
| Rate for Payer: First Health Commercial |
$44.65
|
| Rate for Payer: Humana Commercial |
$39.95
|
| Rate for Payer: Humana KY Medicaid |
$16.16
|
| Rate for Payer: Kentucky WC Medicaid |
$16.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$38.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$34.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$16.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$41.36
|
| Rate for Payer: Ohio Health Group HMO |
$35.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14.57
|
| Rate for Payer: PHCS Commercial |
$45.12
|
| Rate for Payer: United Healthcare All Payer |
$41.36
|
|
|
SPECIMEN COLLECTION
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
HCPCS 99000
|
| Hospital Charge Code |
30001897
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.11 |
| Max. Negotiated Rate |
$45.12 |
| Rate for Payer: Aetna Commercial |
$36.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$37.74
|
| Rate for Payer: Cash Price |
$23.50
|
| Rate for Payer: Cigna Commercial |
$39.01
|
| Rate for Payer: First Health Commercial |
$44.65
|
| Rate for Payer: Humana Commercial |
$39.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$38.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$34.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$41.36
|
| Rate for Payer: Ohio Health Group HMO |
$35.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14.57
|
| Rate for Payer: PHCS Commercial |
$45.12
|
| Rate for Payer: United Healthcare All Payer |
$41.36
|
|
|
SPECIMEN COLLECTION
|
Professional
|
Both
|
$47.00
|
|
|
Service Code
|
HCPCS 99000
|
| Hospital Charge Code |
30001897
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.04 |
| Max. Negotiated Rate |
$47.00 |
| Rate for Payer: Aetna Commercial |
$9.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$47.00
|
| Rate for Payer: Cash Price |
$23.50
|
| Rate for Payer: Cash Price |
$23.50
|
| Rate for Payer: Cigna Commercial |
$6.87
|
| Rate for Payer: Healthspan PPO |
$7.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$4.04
|
| Rate for Payer: Multiplan PHCS |
$28.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$32.90
|
| Rate for Payer: UHCCP Medicaid |
$16.45
|
|
|
SPECIMEN COLLECTION SKIN
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
HCPCS Q0111
|
| Hospital Charge Code |
30001589
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$20.16 |
| Rate for Payer: Aetna Commercial |
$16.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16.86
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cigna Commercial |
$17.43
|
| Rate for Payer: First Health Commercial |
$19.95
|
| Rate for Payer: Humana Commercial |
$17.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$18.48
|
| Rate for Payer: Ohio Health Group HMO |
$15.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.51
|
| Rate for Payer: PHCS Commercial |
$20.16
|
| Rate for Payer: United Healthcare All Payer |
$18.48
|
|
|
SPECIMEN COLLECTION SKIN
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
HCPCS Q0111
|
| Hospital Charge Code |
30001589
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$24.23 |
| Rate for Payer: Aetna Commercial |
$16.17
|
| Rate for Payer: Anthem Medicaid |
$17.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$24.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.76
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cigna Commercial |
$17.43
|
| Rate for Payer: First Health Commercial |
$19.95
|
| Rate for Payer: Humana Commercial |
$17.85
|
| Rate for Payer: Humana KY Medicaid |
$17.76
|
| Rate for Payer: Humana Medicare Advantage |
$17.31
|
| Rate for Payer: Kentucky WC Medicaid |
$17.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$18.48
|
| Rate for Payer: Ohio Health Group HMO |
$15.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.51
|
| Rate for Payer: PHCS Commercial |
$20.16
|
| Rate for Payer: United Healthcare All Payer |
$18.48
|
|
|
SPEC INVIS DIST CENT SZ 1
|
Facility
|
IP
|
$802.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$104.32 |
| Max. Negotiated Rate |
$770.40 |
| Rate for Payer: Aetna Commercial |
$617.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$625.95
|
| Rate for Payer: Cash Price |
$401.25
|
| Rate for Payer: Cigna Commercial |
$666.08
|
| Rate for Payer: First Health Commercial |
$762.38
|
| Rate for Payer: Humana Commercial |
$682.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$658.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$592.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$706.20
|
| Rate for Payer: Ohio Health Group HMO |
$601.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.78
|
| Rate for Payer: PHCS Commercial |
$770.40
|
| Rate for Payer: United Healthcare All Payer |
$706.20
|
|
|
SPEC INVIS DIST CENT SZ 1
|
Facility
|
OP
|
$802.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$104.32 |
| Max. Negotiated Rate |
$770.40 |
| Rate for Payer: Aetna Commercial |
$617.92
|
| Rate for Payer: Anthem Medicaid |
$275.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$625.95
|
| Rate for Payer: Cash Price |
$401.25
|
| Rate for Payer: Cigna Commercial |
$666.08
|
| Rate for Payer: First Health Commercial |
$762.38
|
| Rate for Payer: Humana Commercial |
$682.12
|
| Rate for Payer: Humana KY Medicaid |
$275.98
|
| Rate for Payer: Kentucky WC Medicaid |
$278.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$658.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$592.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$281.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$706.20
|
| Rate for Payer: Ohio Health Group HMO |
$601.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.78
|
| Rate for Payer: PHCS Commercial |
$770.40
|
| Rate for Payer: United Healthcare All Payer |
$706.20
|
|
|
SPEC INVIS DIST CENT SZ 2
|
Facility
|
IP
|
$802.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$104.32 |
| Max. Negotiated Rate |
$770.40 |
| Rate for Payer: Aetna Commercial |
$617.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$625.95
|
| Rate for Payer: Cash Price |
$401.25
|
| Rate for Payer: Cigna Commercial |
$666.08
|
| Rate for Payer: First Health Commercial |
$762.38
|
| Rate for Payer: Humana Commercial |
$682.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$658.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$592.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$706.20
|
| Rate for Payer: Ohio Health Group HMO |
$601.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.78
|
| Rate for Payer: PHCS Commercial |
$770.40
|
| Rate for Payer: United Healthcare All Payer |
$706.20
|
|
|
SPEC INVIS DIST CENT SZ 2
|
Facility
|
OP
|
$802.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$104.32 |
| Max. Negotiated Rate |
$770.40 |
| Rate for Payer: Aetna Commercial |
$617.92
|
| Rate for Payer: Anthem Medicaid |
$275.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$625.95
|
| Rate for Payer: Cash Price |
$401.25
|
| Rate for Payer: Cigna Commercial |
$666.08
|
| Rate for Payer: First Health Commercial |
$762.38
|
| Rate for Payer: Humana Commercial |
$682.12
|
| Rate for Payer: Humana KY Medicaid |
$275.98
|
| Rate for Payer: Kentucky WC Medicaid |
$278.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$658.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$592.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$281.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$706.20
|
| Rate for Payer: Ohio Health Group HMO |
$601.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.78
|
| Rate for Payer: PHCS Commercial |
$770.40
|
| Rate for Payer: United Healthcare All Payer |
$706.20
|
|
|
SPEC INVIS DIST CENT SZ 3
|
Facility
|
IP
|
$802.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$104.32 |
| Max. Negotiated Rate |
$770.40 |
| Rate for Payer: Aetna Commercial |
$617.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$625.95
|
| Rate for Payer: Cash Price |
$401.25
|
| Rate for Payer: Cigna Commercial |
$666.08
|
| Rate for Payer: First Health Commercial |
$762.38
|
| Rate for Payer: Humana Commercial |
$682.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$658.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$592.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$706.20
|
| Rate for Payer: Ohio Health Group HMO |
$601.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.78
|
| Rate for Payer: PHCS Commercial |
$770.40
|
| Rate for Payer: United Healthcare All Payer |
$706.20
|
|
|
SPEC INVIS DIST CENT SZ 3
|
Facility
|
OP
|
$802.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$104.32 |
| Max. Negotiated Rate |
$770.40 |
| Rate for Payer: Aetna Commercial |
$617.92
|
| Rate for Payer: Anthem Medicaid |
$275.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$625.95
|
| Rate for Payer: Cash Price |
$401.25
|
| Rate for Payer: Cigna Commercial |
$666.08
|
| Rate for Payer: First Health Commercial |
$762.38
|
| Rate for Payer: Humana Commercial |
$682.12
|
| Rate for Payer: Humana KY Medicaid |
$275.98
|
| Rate for Payer: Kentucky WC Medicaid |
$278.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$658.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$592.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$281.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$706.20
|
| Rate for Payer: Ohio Health Group HMO |
$601.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.78
|
| Rate for Payer: PHCS Commercial |
$770.40
|
| Rate for Payer: United Healthcare All Payer |
$706.20
|
|
|
SPEC INVIS DIST CENT SZ 4
|
Facility
|
IP
|
$802.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$104.32 |
| Max. Negotiated Rate |
$770.40 |
| Rate for Payer: Aetna Commercial |
$617.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$625.95
|
| Rate for Payer: Cash Price |
$401.25
|
| Rate for Payer: Cigna Commercial |
$666.08
|
| Rate for Payer: First Health Commercial |
$762.38
|
| Rate for Payer: Humana Commercial |
$682.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$658.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$592.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$706.20
|
| Rate for Payer: Ohio Health Group HMO |
$601.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.78
|
| Rate for Payer: PHCS Commercial |
$770.40
|
| Rate for Payer: United Healthcare All Payer |
$706.20
|
|
|
SPEC INVIS DIST CENT SZ 4
|
Facility
|
OP
|
$802.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$104.32 |
| Max. Negotiated Rate |
$770.40 |
| Rate for Payer: Aetna Commercial |
$617.92
|
| Rate for Payer: Anthem Medicaid |
$275.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$625.95
|
| Rate for Payer: Cash Price |
$401.25
|
| Rate for Payer: Cigna Commercial |
$666.08
|
| Rate for Payer: First Health Commercial |
$762.38
|
| Rate for Payer: Humana Commercial |
$682.12
|
| Rate for Payer: Humana KY Medicaid |
$275.98
|
| Rate for Payer: Kentucky WC Medicaid |
$278.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$658.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$592.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$281.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$706.20
|
| Rate for Payer: Ohio Health Group HMO |
$601.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.78
|
| Rate for Payer: PHCS Commercial |
$770.40
|
| Rate for Payer: United Healthcare All Payer |
$706.20
|
|
|
SPEC INVIS DIST CENT SZ 5
|
Facility
|
OP
|
$802.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$104.32 |
| Max. Negotiated Rate |
$770.40 |
| Rate for Payer: Aetna Commercial |
$617.92
|
| Rate for Payer: Anthem Medicaid |
$275.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$625.95
|
| Rate for Payer: Cash Price |
$401.25
|
| Rate for Payer: Cigna Commercial |
$666.08
|
| Rate for Payer: First Health Commercial |
$762.38
|
| Rate for Payer: Humana Commercial |
$682.12
|
| Rate for Payer: Humana KY Medicaid |
$275.98
|
| Rate for Payer: Kentucky WC Medicaid |
$278.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$658.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$592.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$281.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$706.20
|
| Rate for Payer: Ohio Health Group HMO |
$601.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.78
|
| Rate for Payer: PHCS Commercial |
$770.40
|
| Rate for Payer: United Healthcare All Payer |
$706.20
|
|
|
SPEC INVIS DIST CENT SZ 5
|
Facility
|
IP
|
$802.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$104.32 |
| Max. Negotiated Rate |
$770.40 |
| Rate for Payer: Aetna Commercial |
$617.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$625.95
|
| Rate for Payer: Cash Price |
$401.25
|
| Rate for Payer: Cigna Commercial |
$666.08
|
| Rate for Payer: First Health Commercial |
$762.38
|
| Rate for Payer: Humana Commercial |
$682.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$658.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$592.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$706.20
|
| Rate for Payer: Ohio Health Group HMO |
$601.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.78
|
| Rate for Payer: PHCS Commercial |
$770.40
|
| Rate for Payer: United Healthcare All Payer |
$706.20
|
|
|
SPEC MOD PROX ONE-THRD 120
|
Facility
|
IP
|
$20,079.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,610.38 |
| Max. Negotiated Rate |
$19,276.62 |
| Rate for Payer: Aetna Commercial |
$15,461.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,662.25
|
| Rate for Payer: Cash Price |
$10,039.91
|
| Rate for Payer: Cigna Commercial |
$16,666.24
|
| Rate for Payer: First Health Commercial |
$19,075.82
|
| Rate for Payer: Humana Commercial |
$17,067.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,465.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,818.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,023.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,670.23
|
| Rate for Payer: Ohio Health Group HMO |
$15,059.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,015.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,610.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,224.74
|
| Rate for Payer: PHCS Commercial |
$19,276.62
|
| Rate for Payer: United Healthcare All Payer |
$17,670.23
|
|
|
SPEC MOD PROX ONE-THRD 120
|
Facility
|
OP
|
$20,079.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,610.38 |
| Max. Negotiated Rate |
$19,276.62 |
| Rate for Payer: Aetna Commercial |
$15,461.45
|
| Rate for Payer: Anthem Medicaid |
$6,905.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,662.25
|
| Rate for Payer: Cash Price |
$10,039.91
|
| Rate for Payer: Cigna Commercial |
$16,666.24
|
| Rate for Payer: First Health Commercial |
$19,075.82
|
| Rate for Payer: Humana Commercial |
$17,067.84
|
| Rate for Payer: Humana KY Medicaid |
$6,905.45
|
| Rate for Payer: Kentucky WC Medicaid |
$6,975.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,465.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,818.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,023.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,044.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,670.23
|
| Rate for Payer: Ohio Health Group HMO |
$15,059.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,015.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,610.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,224.74
|
| Rate for Payer: PHCS Commercial |
$19,276.62
|
| Rate for Payer: United Healthcare All Payer |
$17,670.23
|
|
|
SPEC MOD PROX ONE-THRD 140
|
Facility
|
IP
|
$20,079.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,610.38 |
| Max. Negotiated Rate |
$19,276.62 |
| Rate for Payer: Aetna Commercial |
$15,461.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,662.25
|
| Rate for Payer: Cash Price |
$10,039.91
|
| Rate for Payer: Cigna Commercial |
$16,666.24
|
| Rate for Payer: First Health Commercial |
$19,075.82
|
| Rate for Payer: Humana Commercial |
$17,067.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,465.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,818.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,023.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,670.23
|
| Rate for Payer: Ohio Health Group HMO |
$15,059.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,015.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,610.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,224.74
|
| Rate for Payer: PHCS Commercial |
$19,276.62
|
| Rate for Payer: United Healthcare All Payer |
$17,670.23
|
|
|
SPEC MOD PROX ONE-THRD 140
|
Facility
|
OP
|
$20,079.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,610.38 |
| Max. Negotiated Rate |
$19,276.62 |
| Rate for Payer: Aetna Commercial |
$15,461.45
|
| Rate for Payer: Anthem Medicaid |
$6,905.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,662.25
|
| Rate for Payer: Cash Price |
$10,039.91
|
| Rate for Payer: Cigna Commercial |
$16,666.24
|
| Rate for Payer: First Health Commercial |
$19,075.82
|
| Rate for Payer: Humana Commercial |
$17,067.84
|
| Rate for Payer: Humana KY Medicaid |
$6,905.45
|
| Rate for Payer: Kentucky WC Medicaid |
$6,975.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,465.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,818.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,023.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,044.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,670.23
|
| Rate for Payer: Ohio Health Group HMO |
$15,059.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,015.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,610.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,224.74
|
| Rate for Payer: PHCS Commercial |
$19,276.62
|
| Rate for Payer: United Healthcare All Payer |
$17,670.23
|
|
|
SPEC REV 12/14 LS/NR DST CN 12
|
Facility
|
OP
|
$1,830.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$237.90 |
| Max. Negotiated Rate |
$1,756.83 |
| Rate for Payer: Aetna Commercial |
$1,409.12
|
| Rate for Payer: Anthem Medicaid |
$629.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,427.42
|
| Rate for Payer: Cash Price |
$915.01
|
| Rate for Payer: Cigna Commercial |
$1,518.92
|
| Rate for Payer: First Health Commercial |
$1,738.53
|
| Rate for Payer: Humana Commercial |
$1,555.53
|
| Rate for Payer: Humana KY Medicaid |
$629.35
|
| Rate for Payer: Kentucky WC Medicaid |
$635.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,500.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,350.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$549.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$641.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,610.43
|
| Rate for Payer: Ohio Health Group HMO |
$1,372.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$366.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$237.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$567.31
|
| Rate for Payer: PHCS Commercial |
$1,756.83
|
| Rate for Payer: United Healthcare All Payer |
$1,610.43
|
|
|
SPEC REV 12/14 LS/NR DST CN 12
|
Facility
|
IP
|
$1,830.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$237.90 |
| Max. Negotiated Rate |
$1,756.83 |
| Rate for Payer: Aetna Commercial |
$1,409.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,427.42
|
| Rate for Payer: Cash Price |
$915.01
|
| Rate for Payer: Cigna Commercial |
$1,518.92
|
| Rate for Payer: First Health Commercial |
$1,738.53
|
| Rate for Payer: Humana Commercial |
$1,555.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,500.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,350.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$549.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,610.43
|
| Rate for Payer: Ohio Health Group HMO |
$1,372.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$366.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$237.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$567.31
|
| Rate for Payer: PHCS Commercial |
$1,756.83
|
| Rate for Payer: United Healthcare All Payer |
$1,610.43
|
|
