|
SROM NRH TIB SLEEVE POR 45MM
|
Facility
|
IP
|
$8,664.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,126.40 |
| Max. Negotiated Rate |
$8,318.02 |
| Rate for Payer: Aetna Commercial |
$6,671.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,758.39
|
| Rate for Payer: Cash Price |
$4,332.30
|
| Rate for Payer: Cigna Commercial |
$7,191.62
|
| Rate for Payer: First Health Commercial |
$8,231.37
|
| Rate for Payer: Humana Commercial |
$7,364.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,104.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,394.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,599.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,624.85
|
| Rate for Payer: Ohio Health Group HMO |
$6,498.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,732.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,126.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,686.03
|
| Rate for Payer: PHCS Commercial |
$8,318.02
|
| Rate for Payer: United Healthcare All Payer |
$7,624.85
|
|
|
SROM NRH TIB SLEEVE POR 53MM
|
Facility
|
IP
|
$8,664.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,126.40 |
| Max. Negotiated Rate |
$8,318.02 |
| Rate for Payer: Aetna Commercial |
$6,671.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,758.39
|
| Rate for Payer: Cash Price |
$4,332.30
|
| Rate for Payer: Cigna Commercial |
$7,191.62
|
| Rate for Payer: First Health Commercial |
$8,231.37
|
| Rate for Payer: Humana Commercial |
$7,364.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,104.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,394.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,599.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,624.85
|
| Rate for Payer: Ohio Health Group HMO |
$6,498.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,732.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,126.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,686.03
|
| Rate for Payer: PHCS Commercial |
$8,318.02
|
| Rate for Payer: United Healthcare All Payer |
$7,624.85
|
|
|
SROM NRH TIB SLEEVE POR 53MM
|
Facility
|
OP
|
$8,664.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,126.40 |
| Max. Negotiated Rate |
$8,318.02 |
| Rate for Payer: Aetna Commercial |
$6,671.74
|
| Rate for Payer: Anthem Medicaid |
$2,979.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,758.39
|
| Rate for Payer: Cash Price |
$4,332.30
|
| Rate for Payer: Cigna Commercial |
$7,191.62
|
| Rate for Payer: First Health Commercial |
$8,231.37
|
| Rate for Payer: Humana Commercial |
$7,364.91
|
| Rate for Payer: Humana KY Medicaid |
$2,979.76
|
| Rate for Payer: Kentucky WC Medicaid |
$3,010.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,104.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,394.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,599.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,039.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,624.85
|
| Rate for Payer: Ohio Health Group HMO |
$6,498.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,732.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,126.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,686.03
|
| Rate for Payer: PHCS Commercial |
$8,318.02
|
| Rate for Payer: United Healthcare All Payer |
$7,624.85
|
|
|
SROM NRH TIB SLEEVE POR 61MM
|
Facility
|
IP
|
$8,664.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,126.40 |
| Max. Negotiated Rate |
$8,318.02 |
| Rate for Payer: Aetna Commercial |
$6,671.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,758.39
|
| Rate for Payer: Cash Price |
$4,332.30
|
| Rate for Payer: Cigna Commercial |
$7,191.62
|
| Rate for Payer: First Health Commercial |
$8,231.37
|
| Rate for Payer: Humana Commercial |
$7,364.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,104.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,394.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,599.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,624.85
|
| Rate for Payer: Ohio Health Group HMO |
$6,498.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,732.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,126.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,686.03
|
| Rate for Payer: PHCS Commercial |
$8,318.02
|
| Rate for Payer: United Healthcare All Payer |
$7,624.85
|
|
|
SROM NRH TIB SLEEVE POR 61MM
|
Facility
|
OP
|
$8,664.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,126.40 |
| Max. Negotiated Rate |
$8,318.02 |
| Rate for Payer: Aetna Commercial |
$6,671.74
|
| Rate for Payer: Anthem Medicaid |
$2,979.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,758.39
|
| Rate for Payer: Cash Price |
$4,332.30
|
| Rate for Payer: Cigna Commercial |
$7,191.62
|
| Rate for Payer: First Health Commercial |
$8,231.37
|
| Rate for Payer: Humana Commercial |
$7,364.91
|
| Rate for Payer: Humana KY Medicaid |
$2,979.76
|
| Rate for Payer: Kentucky WC Medicaid |
$3,010.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,104.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,394.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,599.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,039.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,624.85
|
| Rate for Payer: Ohio Health Group HMO |
$6,498.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,732.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,126.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,686.03
|
| Rate for Payer: PHCS Commercial |
$8,318.02
|
| Rate for Payer: United Healthcare All Payer |
$7,624.85
|
|
|
S-ROM PROX FEM SLEV ZTT 16B-LG
|
Facility
|
OP
|
$8,936.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.73 |
| Max. Negotiated Rate |
$8,578.92 |
| Rate for Payer: Aetna Commercial |
$6,881.01
|
| Rate for Payer: Anthem Medicaid |
$3,073.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,970.38
|
| Rate for Payer: Cash Price |
$4,468.19
|
| Rate for Payer: Cigna Commercial |
$7,417.20
|
| Rate for Payer: First Health Commercial |
$8,489.56
|
| Rate for Payer: Humana Commercial |
$7,595.92
|
| Rate for Payer: Humana KY Medicaid |
$3,073.22
|
| Rate for Payer: Kentucky WC Medicaid |
$3,104.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,327.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,595.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,680.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,134.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,864.01
|
| Rate for Payer: Ohio Health Group HMO |
$6,702.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,787.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,770.28
|
| Rate for Payer: PHCS Commercial |
$8,578.92
|
| Rate for Payer: United Healthcare All Payer |
$7,864.01
|
|
|
S-ROM PROX FEM SLEV ZTT 16B-LG
|
Facility
|
IP
|
$8,936.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.73 |
| Max. Negotiated Rate |
$8,578.92 |
| Rate for Payer: Aetna Commercial |
$6,881.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,970.38
|
| Rate for Payer: Cash Price |
$4,468.19
|
| Rate for Payer: Cigna Commercial |
$7,417.20
|
| Rate for Payer: First Health Commercial |
$8,489.56
|
| Rate for Payer: Humana Commercial |
$7,595.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,327.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,595.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,680.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,864.01
|
| Rate for Payer: Ohio Health Group HMO |
$6,702.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,787.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,770.28
|
| Rate for Payer: PHCS Commercial |
$8,578.92
|
| Rate for Payer: United Healthcare All Payer |
$7,864.01
|
|
|
S-ROM PROX FEM SLEV ZTT 16B-SM
|
Facility
|
OP
|
$8,936.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.73 |
| Max. Negotiated Rate |
$8,578.92 |
| Rate for Payer: Aetna Commercial |
$6,881.01
|
| Rate for Payer: Anthem Medicaid |
$3,073.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,970.38
|
| Rate for Payer: Cash Price |
$4,468.19
|
| Rate for Payer: Cigna Commercial |
$7,417.20
|
| Rate for Payer: First Health Commercial |
$8,489.56
|
| Rate for Payer: Humana Commercial |
$7,595.92
|
| Rate for Payer: Humana KY Medicaid |
$3,073.22
|
| Rate for Payer: Kentucky WC Medicaid |
$3,104.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,327.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,595.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,680.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,134.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,864.01
|
| Rate for Payer: Ohio Health Group HMO |
$6,702.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,787.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,770.28
|
| Rate for Payer: PHCS Commercial |
$8,578.92
|
| Rate for Payer: United Healthcare All Payer |
$7,864.01
|
|
|
S-ROM PROX FEM SLEV ZTT 16B-SM
|
Facility
|
IP
|
$8,936.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.73 |
| Max. Negotiated Rate |
$8,578.92 |
| Rate for Payer: Aetna Commercial |
$6,881.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,970.38
|
| Rate for Payer: Cash Price |
$4,468.19
|
| Rate for Payer: Cigna Commercial |
$7,417.20
|
| Rate for Payer: First Health Commercial |
$8,489.56
|
| Rate for Payer: Humana Commercial |
$7,595.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,327.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,595.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,680.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,864.01
|
| Rate for Payer: Ohio Health Group HMO |
$6,702.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,787.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,770.28
|
| Rate for Payer: PHCS Commercial |
$8,578.92
|
| Rate for Payer: United Healthcare All Payer |
$7,864.01
|
|
|
S-ROM PROX FEM SLEV ZTT 18B-LG
|
Facility
|
OP
|
$8,936.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.73 |
| Max. Negotiated Rate |
$8,578.92 |
| Rate for Payer: Aetna Commercial |
$6,881.01
|
| Rate for Payer: Anthem Medicaid |
$3,073.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,970.38
|
| Rate for Payer: Cash Price |
$4,468.19
|
| Rate for Payer: Cigna Commercial |
$7,417.20
|
| Rate for Payer: First Health Commercial |
$8,489.56
|
| Rate for Payer: Humana Commercial |
$7,595.92
|
| Rate for Payer: Humana KY Medicaid |
$3,073.22
|
| Rate for Payer: Kentucky WC Medicaid |
$3,104.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,327.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,595.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,680.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,134.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,864.01
|
| Rate for Payer: Ohio Health Group HMO |
$6,702.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,787.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,770.28
|
| Rate for Payer: PHCS Commercial |
$8,578.92
|
| Rate for Payer: United Healthcare All Payer |
$7,864.01
|
|
|
S-ROM PROX FEM SLEV ZTT 18B-LG
|
Facility
|
IP
|
$8,936.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.73 |
| Max. Negotiated Rate |
$8,578.92 |
| Rate for Payer: Aetna Commercial |
$6,881.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,970.38
|
| Rate for Payer: Cash Price |
$4,468.19
|
| Rate for Payer: Cigna Commercial |
$7,417.20
|
| Rate for Payer: First Health Commercial |
$8,489.56
|
| Rate for Payer: Humana Commercial |
$7,595.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,327.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,595.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,680.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,864.01
|
| Rate for Payer: Ohio Health Group HMO |
$6,702.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,787.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,770.28
|
| Rate for Payer: PHCS Commercial |
$8,578.92
|
| Rate for Payer: United Healthcare All Payer |
$7,864.01
|
|
|
S-ROM PROX FEM SLEV ZTT 18B-SM
|
Facility
|
IP
|
$8,936.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.73 |
| Max. Negotiated Rate |
$8,578.92 |
| Rate for Payer: Aetna Commercial |
$6,881.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,970.38
|
| Rate for Payer: Cash Price |
$4,468.19
|
| Rate for Payer: Cigna Commercial |
$7,417.20
|
| Rate for Payer: First Health Commercial |
$8,489.56
|
| Rate for Payer: Humana Commercial |
$7,595.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,327.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,595.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,680.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,864.01
|
| Rate for Payer: Ohio Health Group HMO |
$6,702.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,787.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,770.28
|
| Rate for Payer: PHCS Commercial |
$8,578.92
|
| Rate for Payer: United Healthcare All Payer |
$7,864.01
|
|
|
S-ROM PROX FEM SLEV ZTT 18B-SM
|
Facility
|
OP
|
$8,936.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.73 |
| Max. Negotiated Rate |
$8,578.92 |
| Rate for Payer: Aetna Commercial |
$6,881.01
|
| Rate for Payer: Anthem Medicaid |
$3,073.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,970.38
|
| Rate for Payer: Cash Price |
$4,468.19
|
| Rate for Payer: Cigna Commercial |
$7,417.20
|
| Rate for Payer: First Health Commercial |
$8,489.56
|
| Rate for Payer: Humana Commercial |
$7,595.92
|
| Rate for Payer: Humana KY Medicaid |
$3,073.22
|
| Rate for Payer: Kentucky WC Medicaid |
$3,104.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,327.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,595.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,680.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,134.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,864.01
|
| Rate for Payer: Ohio Health Group HMO |
$6,702.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,787.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,770.28
|
| Rate for Payer: PHCS Commercial |
$8,578.92
|
| Rate for Payer: United Healthcare All Payer |
$7,864.01
|
|
|
S-ROM PROX FEM SLEV ZTT 20B-LG
|
Facility
|
IP
|
$8,936.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.73 |
| Max. Negotiated Rate |
$8,578.92 |
| Rate for Payer: Aetna Commercial |
$6,881.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,970.38
|
| Rate for Payer: Cash Price |
$4,468.19
|
| Rate for Payer: Cigna Commercial |
$7,417.20
|
| Rate for Payer: First Health Commercial |
$8,489.56
|
| Rate for Payer: Humana Commercial |
$7,595.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,327.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,595.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,680.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,864.01
|
| Rate for Payer: Ohio Health Group HMO |
$6,702.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,787.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,770.28
|
| Rate for Payer: PHCS Commercial |
$8,578.92
|
| Rate for Payer: United Healthcare All Payer |
$7,864.01
|
|
|
S-ROM PROX FEM SLEV ZTT 20B-LG
|
Facility
|
OP
|
$8,936.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.73 |
| Max. Negotiated Rate |
$8,578.92 |
| Rate for Payer: Aetna Commercial |
$6,881.01
|
| Rate for Payer: Anthem Medicaid |
$3,073.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,970.38
|
| Rate for Payer: Cash Price |
$4,468.19
|
| Rate for Payer: Cigna Commercial |
$7,417.20
|
| Rate for Payer: First Health Commercial |
$8,489.56
|
| Rate for Payer: Humana Commercial |
$7,595.92
|
| Rate for Payer: Humana KY Medicaid |
$3,073.22
|
| Rate for Payer: Kentucky WC Medicaid |
$3,104.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,327.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,595.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,680.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,134.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,864.01
|
| Rate for Payer: Ohio Health Group HMO |
$6,702.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,787.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,770.28
|
| Rate for Payer: PHCS Commercial |
$8,578.92
|
| Rate for Payer: United Healthcare All Payer |
$7,864.01
|
|
|
S-ROM PROX FEM SLEV ZTT 20B-SM
|
Facility
|
OP
|
$8,936.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.73 |
| Max. Negotiated Rate |
$8,578.92 |
| Rate for Payer: Aetna Commercial |
$6,881.01
|
| Rate for Payer: Anthem Medicaid |
$3,073.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,970.38
|
| Rate for Payer: Cash Price |
$4,468.19
|
| Rate for Payer: Cigna Commercial |
$7,417.20
|
| Rate for Payer: First Health Commercial |
$8,489.56
|
| Rate for Payer: Humana Commercial |
$7,595.92
|
| Rate for Payer: Humana KY Medicaid |
$3,073.22
|
| Rate for Payer: Kentucky WC Medicaid |
$3,104.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,327.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,595.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,680.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,134.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,864.01
|
| Rate for Payer: Ohio Health Group HMO |
$6,702.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,787.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,770.28
|
| Rate for Payer: PHCS Commercial |
$8,578.92
|
| Rate for Payer: United Healthcare All Payer |
$7,864.01
|
|
|
S-ROM PROX FEM SLEV ZTT 20B-SM
|
Facility
|
IP
|
$8,936.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.73 |
| Max. Negotiated Rate |
$8,578.92 |
| Rate for Payer: Aetna Commercial |
$6,881.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,970.38
|
| Rate for Payer: Cash Price |
$4,468.19
|
| Rate for Payer: Cigna Commercial |
$7,417.20
|
| Rate for Payer: First Health Commercial |
$8,489.56
|
| Rate for Payer: Humana Commercial |
$7,595.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,327.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,595.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,680.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,864.01
|
| Rate for Payer: Ohio Health Group HMO |
$6,702.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,787.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,770.28
|
| Rate for Payer: PHCS Commercial |
$8,578.92
|
| Rate for Payer: United Healthcare All Payer |
$7,864.01
|
|
|
S-ROM PROX FEM SLEV ZTT 22B-LG
|
Facility
|
IP
|
$8,936.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.73 |
| Max. Negotiated Rate |
$8,578.92 |
| Rate for Payer: Aetna Commercial |
$6,881.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,970.38
|
| Rate for Payer: Cash Price |
$4,468.19
|
| Rate for Payer: Cigna Commercial |
$7,417.20
|
| Rate for Payer: First Health Commercial |
$8,489.56
|
| Rate for Payer: Humana Commercial |
$7,595.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,327.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,595.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,680.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,864.01
|
| Rate for Payer: Ohio Health Group HMO |
$6,702.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,787.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,770.28
|
| Rate for Payer: PHCS Commercial |
$8,578.92
|
| Rate for Payer: United Healthcare All Payer |
$7,864.01
|
|
|
S-ROM PROX FEM SLEV ZTT 22B-LG
|
Facility
|
OP
|
$8,936.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.73 |
| Max. Negotiated Rate |
$8,578.92 |
| Rate for Payer: Aetna Commercial |
$6,881.01
|
| Rate for Payer: Anthem Medicaid |
$3,073.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,970.38
|
| Rate for Payer: Cash Price |
$4,468.19
|
| Rate for Payer: Cigna Commercial |
$7,417.20
|
| Rate for Payer: First Health Commercial |
$8,489.56
|
| Rate for Payer: Humana Commercial |
$7,595.92
|
| Rate for Payer: Humana KY Medicaid |
$3,073.22
|
| Rate for Payer: Kentucky WC Medicaid |
$3,104.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,327.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,595.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,680.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,134.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,864.01
|
| Rate for Payer: Ohio Health Group HMO |
$6,702.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,787.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,770.28
|
| Rate for Payer: PHCS Commercial |
$8,578.92
|
| Rate for Payer: United Healthcare All Payer |
$7,864.01
|
|
|
S-ROM PROX FEM SLEV ZTT 22B-SM
|
Facility
|
OP
|
$8,936.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.73 |
| Max. Negotiated Rate |
$8,578.92 |
| Rate for Payer: Aetna Commercial |
$6,881.01
|
| Rate for Payer: Anthem Medicaid |
$3,073.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,970.38
|
| Rate for Payer: Cash Price |
$4,468.19
|
| Rate for Payer: Cigna Commercial |
$7,417.20
|
| Rate for Payer: First Health Commercial |
$8,489.56
|
| Rate for Payer: Humana Commercial |
$7,595.92
|
| Rate for Payer: Humana KY Medicaid |
$3,073.22
|
| Rate for Payer: Kentucky WC Medicaid |
$3,104.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,327.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,595.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,680.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,134.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,864.01
|
| Rate for Payer: Ohio Health Group HMO |
$6,702.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,787.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,770.28
|
| Rate for Payer: PHCS Commercial |
$8,578.92
|
| Rate for Payer: United Healthcare All Payer |
$7,864.01
|
|
|
S-ROM PROX FEM SLEV ZTT 22B-SM
|
Facility
|
IP
|
$8,936.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.73 |
| Max. Negotiated Rate |
$8,578.92 |
| Rate for Payer: Aetna Commercial |
$6,881.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,970.38
|
| Rate for Payer: Cash Price |
$4,468.19
|
| Rate for Payer: Cigna Commercial |
$7,417.20
|
| Rate for Payer: First Health Commercial |
$8,489.56
|
| Rate for Payer: Humana Commercial |
$7,595.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,327.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,595.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,680.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,864.01
|
| Rate for Payer: Ohio Health Group HMO |
$6,702.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,787.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,770.28
|
| Rate for Payer: PHCS Commercial |
$8,578.92
|
| Rate for Payer: United Healthcare All Payer |
$7,864.01
|
|
|
STAB PHLEBECTOMY 10-20
|
Facility
|
IP
|
$6,881.00
|
|
|
Service Code
|
HCPCS 37799
|
| Hospital Charge Code |
76102688
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$894.53 |
| Max. Negotiated Rate |
$6,605.76 |
| Rate for Payer: Aetna Commercial |
$5,298.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,367.18
|
| Rate for Payer: Cash Price |
$3,440.50
|
| Rate for Payer: Cigna Commercial |
$5,711.23
|
| Rate for Payer: First Health Commercial |
$6,536.95
|
| Rate for Payer: Humana Commercial |
$5,848.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,642.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,078.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,064.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,055.28
|
| Rate for Payer: Ohio Health Group HMO |
$5,160.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,376.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$894.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,133.11
|
| Rate for Payer: PHCS Commercial |
$6,605.76
|
| Rate for Payer: United Healthcare All Payer |
$6,055.28
|
|
|
STAB PHLEBECTOMY 10-20
|
Facility
|
OP
|
$6,881.00
|
|
|
Service Code
|
HCPCS 37799
|
| Hospital Charge Code |
76102688
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$543.24 |
| Max. Negotiated Rate |
$6,605.76 |
| Rate for Payer: Aetna Commercial |
$5,298.37
|
| Rate for Payer: Anthem Medicaid |
$2,366.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$543.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,367.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$760.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.37
|
| Rate for Payer: Cash Price |
$3,440.50
|
| Rate for Payer: Cash Price |
$3,440.50
|
| Rate for Payer: Cigna Commercial |
$5,711.23
|
| Rate for Payer: First Health Commercial |
$6,536.95
|
| Rate for Payer: Humana Commercial |
$5,848.85
|
| Rate for Payer: Humana KY Medicaid |
$2,366.38
|
| Rate for Payer: Humana Medicare Advantage |
$543.24
|
| Rate for Payer: Kentucky WC Medicaid |
$2,390.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,642.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,078.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,413.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,055.28
|
| Rate for Payer: Ohio Health Group HMO |
$5,160.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,376.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$894.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,133.11
|
| Rate for Payer: PHCS Commercial |
$6,605.76
|
| Rate for Payer: United Healthcare All Payer |
$6,055.28
|
|
|
STAB PHLEBECTOMY 10-20
|
Professional
|
Both
|
$6,881.00
|
|
|
Service Code
|
HCPCS 37799
|
| Hospital Charge Code |
76102688
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$6,881.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$6,881.00
|
| Rate for Payer: Cash Price |
$3,440.50
|
| Rate for Payer: Cash Price |
$3,440.50
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$4,128.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,816.70
|
| Rate for Payer: UHCCP Medicaid |
$2,408.35
|
|
|
STAB PHLEBECTOMY 10-20 (P
|
Professional
|
Both
|
$640.00
|
|
|
Service Code
|
HCPCS 37799
|
| Hospital Charge Code |
761P2688
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$640.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$640.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$384.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$448.00
|
| Rate for Payer: UHCCP Medicaid |
$224.00
|
|
