|
SPECIMEN COLLECTION
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
HCPCS 99000
|
| Hospital Charge Code |
30001897
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.10 |
| 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 |
$37.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$32.43
|
| Rate for Payer: PHCS Commercial |
$45.12
|
| Rate for Payer: United Healthcare All Payer |
$41.36
|
|
|
SPECIMEN COLLECTION
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
HCPCS 99000
|
| Hospital Charge Code |
30001897
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.10 |
| 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 |
$37.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$32.43
|
| Rate for Payer: PHCS Commercial |
$45.12
|
| Rate for Payer: United Healthcare All Payer |
$41.36
|
|
|
SPECIMEN COLLECTION SKIN
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
HCPCS Q0111
|
| Hospital Charge Code |
30001589
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.49 |
| Max. Negotiated Rate |
$25.47 |
| Rate for Payer: Aetna Commercial |
$16.17
|
| Rate for Payer: Anthem Medicaid |
$18.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$18.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$25.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$18.19
|
| 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 |
$18.19
|
| Rate for Payer: Humana Medicare Advantage |
$18.19
|
| Rate for Payer: Kentucky WC Medicaid |
$18.37
|
| 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 |
$21.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.55
|
| 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 |
$16.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14.49
|
| Rate for Payer: PHCS Commercial |
$20.16
|
| Rate for Payer: United Healthcare All Payer |
$18.48
|
|
|
SPECIMEN COLLECTION SKIN
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
HCPCS Q0111
|
| Hospital Charge Code |
30001589
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.30 |
| 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 |
$16.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14.49
|
| Rate for Payer: PHCS Commercial |
$20.16
|
| Rate for Payer: United Healthcare All Payer |
$18.48
|
|
|
SPEC INVIS DIST CENT SZ 1
|
Facility
|
IP
|
$825.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$247.50 |
| Max. Negotiated Rate |
$792.00 |
| Rate for Payer: Aetna Commercial |
$635.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$643.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$684.75
|
| Rate for Payer: First Health Commercial |
$783.75
|
| Rate for Payer: Humana Commercial |
$701.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$676.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$608.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$247.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$726.00
|
| Rate for Payer: Ohio Health Group HMO |
$618.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$660.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$717.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$569.25
|
| Rate for Payer: PHCS Commercial |
$792.00
|
| Rate for Payer: United Healthcare All Payer |
$726.00
|
|
|
SPEC INVIS DIST CENT SZ 1
|
Facility
|
OP
|
$825.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$247.50 |
| Max. Negotiated Rate |
$792.00 |
| Rate for Payer: Aetna Commercial |
$635.25
|
| Rate for Payer: Anthem Medicaid |
$283.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$643.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$684.75
|
| Rate for Payer: First Health Commercial |
$783.75
|
| Rate for Payer: Humana Commercial |
$701.25
|
| Rate for Payer: Humana KY Medicaid |
$283.72
|
| Rate for Payer: Kentucky WC Medicaid |
$286.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$676.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$608.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$247.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$289.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$726.00
|
| Rate for Payer: Ohio Health Group HMO |
$618.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$660.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$717.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$569.25
|
| Rate for Payer: PHCS Commercial |
$792.00
|
| Rate for Payer: United Healthcare All Payer |
$726.00
|
|
|
SPEC INVIS DIST CENT SZ 2
|
Facility
|
IP
|
$825.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$247.50 |
| Max. Negotiated Rate |
$792.00 |
| Rate for Payer: Aetna Commercial |
$635.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$643.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$684.75
|
| Rate for Payer: First Health Commercial |
$783.75
|
| Rate for Payer: Humana Commercial |
$701.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$676.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$608.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$247.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$726.00
|
| Rate for Payer: Ohio Health Group HMO |
$618.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$660.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$717.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$569.25
|
| Rate for Payer: PHCS Commercial |
$792.00
|
| Rate for Payer: United Healthcare All Payer |
$726.00
|
|
|
SPEC INVIS DIST CENT SZ 2
|
Facility
|
OP
|
$825.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$247.50 |
| Max. Negotiated Rate |
$792.00 |
| Rate for Payer: Aetna Commercial |
$635.25
|
| Rate for Payer: Anthem Medicaid |
$283.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$643.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$684.75
|
| Rate for Payer: First Health Commercial |
$783.75
|
| Rate for Payer: Humana Commercial |
$701.25
|
| Rate for Payer: Humana KY Medicaid |
$283.72
|
| Rate for Payer: Kentucky WC Medicaid |
$286.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$676.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$608.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$247.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$289.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$726.00
|
| Rate for Payer: Ohio Health Group HMO |
$618.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$660.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$717.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$569.25
|
| Rate for Payer: PHCS Commercial |
$792.00
|
| Rate for Payer: United Healthcare All Payer |
$726.00
|
|
|
SPEC INVIS DIST CENT SZ 3
|
Facility
|
OP
|
$825.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$247.50 |
| Max. Negotiated Rate |
$792.00 |
| Rate for Payer: Aetna Commercial |
$635.25
|
| Rate for Payer: Anthem Medicaid |
$283.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$643.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$684.75
|
| Rate for Payer: First Health Commercial |
$783.75
|
| Rate for Payer: Humana Commercial |
$701.25
|
| Rate for Payer: Humana KY Medicaid |
$283.72
|
| Rate for Payer: Kentucky WC Medicaid |
$286.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$676.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$608.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$247.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$289.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$726.00
|
| Rate for Payer: Ohio Health Group HMO |
$618.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$660.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$717.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$569.25
|
| Rate for Payer: PHCS Commercial |
$792.00
|
| Rate for Payer: United Healthcare All Payer |
$726.00
|
|
|
SPEC INVIS DIST CENT SZ 3
|
Facility
|
IP
|
$825.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$247.50 |
| Max. Negotiated Rate |
$792.00 |
| Rate for Payer: Aetna Commercial |
$635.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$643.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$684.75
|
| Rate for Payer: First Health Commercial |
$783.75
|
| Rate for Payer: Humana Commercial |
$701.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$676.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$608.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$247.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$726.00
|
| Rate for Payer: Ohio Health Group HMO |
$618.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$660.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$717.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$569.25
|
| Rate for Payer: PHCS Commercial |
$792.00
|
| Rate for Payer: United Healthcare All Payer |
$726.00
|
|
|
SPEC INVIS DIST CENT SZ 4
|
Facility
|
OP
|
$825.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$247.50 |
| Max. Negotiated Rate |
$792.00 |
| Rate for Payer: Aetna Commercial |
$635.25
|
| Rate for Payer: Anthem Medicaid |
$283.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$643.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$684.75
|
| Rate for Payer: First Health Commercial |
$783.75
|
| Rate for Payer: Humana Commercial |
$701.25
|
| Rate for Payer: Humana KY Medicaid |
$283.72
|
| Rate for Payer: Kentucky WC Medicaid |
$286.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$676.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$608.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$247.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$289.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$726.00
|
| Rate for Payer: Ohio Health Group HMO |
$618.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$660.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$717.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$569.25
|
| Rate for Payer: PHCS Commercial |
$792.00
|
| Rate for Payer: United Healthcare All Payer |
$726.00
|
|
|
SPEC INVIS DIST CENT SZ 4
|
Facility
|
IP
|
$825.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$247.50 |
| Max. Negotiated Rate |
$792.00 |
| Rate for Payer: Aetna Commercial |
$635.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$643.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$684.75
|
| Rate for Payer: First Health Commercial |
$783.75
|
| Rate for Payer: Humana Commercial |
$701.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$676.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$608.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$247.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$726.00
|
| Rate for Payer: Ohio Health Group HMO |
$618.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$660.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$717.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$569.25
|
| Rate for Payer: PHCS Commercial |
$792.00
|
| Rate for Payer: United Healthcare All Payer |
$726.00
|
|
|
SPEC INVIS DIST CENT SZ 5
|
Facility
|
IP
|
$825.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$247.50 |
| Max. Negotiated Rate |
$792.00 |
| Rate for Payer: Aetna Commercial |
$635.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$643.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$684.75
|
| Rate for Payer: First Health Commercial |
$783.75
|
| Rate for Payer: Humana Commercial |
$701.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$676.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$608.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$247.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$726.00
|
| Rate for Payer: Ohio Health Group HMO |
$618.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$660.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$717.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$569.25
|
| Rate for Payer: PHCS Commercial |
$792.00
|
| Rate for Payer: United Healthcare All Payer |
$726.00
|
|
|
SPEC INVIS DIST CENT SZ 5
|
Facility
|
OP
|
$825.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$247.50 |
| Max. Negotiated Rate |
$792.00 |
| Rate for Payer: Aetna Commercial |
$635.25
|
| Rate for Payer: Anthem Medicaid |
$283.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$643.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$684.75
|
| Rate for Payer: First Health Commercial |
$783.75
|
| Rate for Payer: Humana Commercial |
$701.25
|
| Rate for Payer: Humana KY Medicaid |
$283.72
|
| Rate for Payer: Kentucky WC Medicaid |
$286.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$676.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$608.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$247.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$289.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$726.00
|
| Rate for Payer: Ohio Health Group HMO |
$618.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$660.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$717.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$569.25
|
| Rate for Payer: PHCS Commercial |
$792.00
|
| Rate for Payer: United Healthcare All Payer |
$726.00
|
|
|
SPEC MOD PROX ONE-THRD 120
|
Facility
|
IP
|
$20,698.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,209.53 |
| Max. Negotiated Rate |
$19,870.50 |
| Rate for Payer: Aetna Commercial |
$15,937.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,144.78
|
| Rate for Payer: Cash Price |
$10,349.22
|
| Rate for Payer: Cigna Commercial |
$17,179.71
|
| Rate for Payer: First Health Commercial |
$19,663.52
|
| Rate for Payer: Humana Commercial |
$17,593.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,972.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,275.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,209.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,214.63
|
| Rate for Payer: Ohio Health Group HMO |
$15,523.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,558.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,007.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,281.92
|
| Rate for Payer: PHCS Commercial |
$19,870.50
|
| Rate for Payer: United Healthcare All Payer |
$18,214.63
|
|
|
SPEC MOD PROX ONE-THRD 120
|
Facility
|
OP
|
$20,698.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,209.53 |
| Max. Negotiated Rate |
$19,870.50 |
| Rate for Payer: Aetna Commercial |
$15,937.80
|
| Rate for Payer: Anthem Medicaid |
$7,118.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,144.78
|
| Rate for Payer: Cash Price |
$10,349.22
|
| Rate for Payer: Cigna Commercial |
$17,179.71
|
| Rate for Payer: First Health Commercial |
$19,663.52
|
| Rate for Payer: Humana Commercial |
$17,593.67
|
| Rate for Payer: Humana KY Medicaid |
$7,118.19
|
| Rate for Payer: Kentucky WC Medicaid |
$7,190.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,972.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,275.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,209.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,261.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,214.63
|
| Rate for Payer: Ohio Health Group HMO |
$15,523.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,558.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,007.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,281.92
|
| Rate for Payer: PHCS Commercial |
$19,870.50
|
| Rate for Payer: United Healthcare All Payer |
$18,214.63
|
|
|
SPEC MOD PROX ONE-THRD 140
|
Facility
|
OP
|
$20,698.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,209.53 |
| Max. Negotiated Rate |
$19,870.50 |
| Rate for Payer: Aetna Commercial |
$15,937.80
|
| Rate for Payer: Anthem Medicaid |
$7,118.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,144.78
|
| Rate for Payer: Cash Price |
$10,349.22
|
| Rate for Payer: Cigna Commercial |
$17,179.71
|
| Rate for Payer: First Health Commercial |
$19,663.52
|
| Rate for Payer: Humana Commercial |
$17,593.67
|
| Rate for Payer: Humana KY Medicaid |
$7,118.19
|
| Rate for Payer: Kentucky WC Medicaid |
$7,190.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,972.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,275.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,209.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,261.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,214.63
|
| Rate for Payer: Ohio Health Group HMO |
$15,523.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,558.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,007.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,281.92
|
| Rate for Payer: PHCS Commercial |
$19,870.50
|
| Rate for Payer: United Healthcare All Payer |
$18,214.63
|
|
|
SPEC MOD PROX ONE-THRD 140
|
Facility
|
IP
|
$20,698.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,209.53 |
| Max. Negotiated Rate |
$19,870.50 |
| Rate for Payer: Aetna Commercial |
$15,937.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,144.78
|
| Rate for Payer: Cash Price |
$10,349.22
|
| Rate for Payer: Cigna Commercial |
$17,179.71
|
| Rate for Payer: First Health Commercial |
$19,663.52
|
| Rate for Payer: Humana Commercial |
$17,593.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,972.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,275.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,209.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,214.63
|
| Rate for Payer: Ohio Health Group HMO |
$15,523.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,558.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,007.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,281.92
|
| Rate for Payer: PHCS Commercial |
$19,870.50
|
| Rate for Payer: United Healthcare All Payer |
$18,214.63
|
|
|
SPEC REV 12/14 LS/NR DST CN 12
|
Facility
|
OP
|
$1,821.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$546.35 |
| Max. Negotiated Rate |
$1,748.32 |
| Rate for Payer: Aetna Commercial |
$1,402.30
|
| Rate for Payer: Anthem Medicaid |
$626.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,420.51
|
| Rate for Payer: Cash Price |
$910.58
|
| Rate for Payer: Cigna Commercial |
$1,511.57
|
| Rate for Payer: First Health Commercial |
$1,730.11
|
| Rate for Payer: Humana Commercial |
$1,547.99
|
| Rate for Payer: Humana KY Medicaid |
$626.30
|
| Rate for Payer: Kentucky WC Medicaid |
$632.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,493.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,344.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$546.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$638.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,602.63
|
| Rate for Payer: Ohio Health Group HMO |
$1,365.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,456.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,584.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,256.61
|
| Rate for Payer: PHCS Commercial |
$1,748.32
|
| Rate for Payer: United Healthcare All Payer |
$1,602.63
|
|
|
SPEC REV 12/14 LS/NR DST CN 12
|
Facility
|
IP
|
$1,821.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$546.35 |
| Max. Negotiated Rate |
$1,748.32 |
| Rate for Payer: Aetna Commercial |
$1,402.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,420.51
|
| Rate for Payer: Cash Price |
$910.58
|
| Rate for Payer: Cigna Commercial |
$1,511.57
|
| Rate for Payer: First Health Commercial |
$1,730.11
|
| Rate for Payer: Humana Commercial |
$1,547.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,493.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,344.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$546.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,602.63
|
| Rate for Payer: Ohio Health Group HMO |
$1,365.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,456.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,584.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,256.61
|
| Rate for Payer: PHCS Commercial |
$1,748.32
|
| Rate for Payer: United Healthcare All Payer |
$1,602.63
|
|
|
SPEC REV 12/14 LS/NR DST CN 14
|
Facility
|
OP
|
$1,821.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$546.35 |
| Max. Negotiated Rate |
$1,748.32 |
| Rate for Payer: Aetna Commercial |
$1,402.30
|
| Rate for Payer: Anthem Medicaid |
$626.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,420.51
|
| Rate for Payer: Cash Price |
$910.58
|
| Rate for Payer: Cigna Commercial |
$1,511.57
|
| Rate for Payer: First Health Commercial |
$1,730.11
|
| Rate for Payer: Humana Commercial |
$1,547.99
|
| Rate for Payer: Humana KY Medicaid |
$626.30
|
| Rate for Payer: Kentucky WC Medicaid |
$632.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,493.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,344.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$546.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$638.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,602.63
|
| Rate for Payer: Ohio Health Group HMO |
$1,365.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,456.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,584.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,256.61
|
| Rate for Payer: PHCS Commercial |
$1,748.32
|
| Rate for Payer: United Healthcare All Payer |
$1,602.63
|
|
|
SPEC REV 12/14 LS/NR DST CN 14
|
Facility
|
IP
|
$1,821.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$546.35 |
| Max. Negotiated Rate |
$1,748.32 |
| Rate for Payer: Aetna Commercial |
$1,402.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,420.51
|
| Rate for Payer: Cash Price |
$910.58
|
| Rate for Payer: Cigna Commercial |
$1,511.57
|
| Rate for Payer: First Health Commercial |
$1,730.11
|
| Rate for Payer: Humana Commercial |
$1,547.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,493.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,344.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$546.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,602.63
|
| Rate for Payer: Ohio Health Group HMO |
$1,365.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,456.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,584.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,256.61
|
| Rate for Payer: PHCS Commercial |
$1,748.32
|
| Rate for Payer: United Healthcare All Payer |
$1,602.63
|
|
|
SPEC REV 12/14 LS/NR DST CN 16
|
Facility
|
OP
|
$1,821.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$546.35 |
| Max. Negotiated Rate |
$1,748.32 |
| Rate for Payer: Aetna Commercial |
$1,402.30
|
| Rate for Payer: Anthem Medicaid |
$626.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,420.51
|
| Rate for Payer: Cash Price |
$910.58
|
| Rate for Payer: Cigna Commercial |
$1,511.57
|
| Rate for Payer: First Health Commercial |
$1,730.11
|
| Rate for Payer: Humana Commercial |
$1,547.99
|
| Rate for Payer: Humana KY Medicaid |
$626.30
|
| Rate for Payer: Kentucky WC Medicaid |
$632.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,493.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,344.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$546.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$638.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,602.63
|
| Rate for Payer: Ohio Health Group HMO |
$1,365.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,456.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,584.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,256.61
|
| Rate for Payer: PHCS Commercial |
$1,748.32
|
| Rate for Payer: United Healthcare All Payer |
$1,602.63
|
|
|
SPEC REV 12/14 LS/NR DST CN 16
|
Facility
|
IP
|
$1,821.17
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$546.35 |
| Max. Negotiated Rate |
$1,748.32 |
| Rate for Payer: Aetna Commercial |
$1,402.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,420.51
|
| Rate for Payer: Cash Price |
$910.58
|
| Rate for Payer: Cigna Commercial |
$1,511.57
|
| Rate for Payer: First Health Commercial |
$1,730.11
|
| Rate for Payer: Humana Commercial |
$1,547.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,493.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,344.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$546.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,602.63
|
| Rate for Payer: Ohio Health Group HMO |
$1,365.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,456.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,584.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,256.61
|
| Rate for Payer: PHCS Commercial |
$1,748.32
|
| Rate for Payer: United Healthcare All Payer |
$1,602.63
|
|
|
SPECTRA IMP PULS GEN KIT
|
Facility
|
OP
|
$91,440.00
|
|
|
Service Code
|
HCPCS C1820
|
| Hospital Charge Code |
27000082
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$27,432.00 |
| Max. Negotiated Rate |
$87,782.40 |
| Rate for Payer: Aetna Commercial |
$70,408.80
|
| Rate for Payer: Anthem Medicaid |
$31,446.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$71,323.20
|
| Rate for Payer: Cash Price |
$45,720.00
|
| Rate for Payer: Cigna Commercial |
$75,895.20
|
| Rate for Payer: First Health Commercial |
$86,868.00
|
| Rate for Payer: Humana Commercial |
$77,724.00
|
| Rate for Payer: Humana KY Medicaid |
$31,446.22
|
| Rate for Payer: Kentucky WC Medicaid |
$31,766.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$74,980.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67,482.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27,432.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$32,077.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$80,467.20
|
| Rate for Payer: Ohio Health Group HMO |
$68,580.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$73,152.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$79,552.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63,093.60
|
| Rate for Payer: PHCS Commercial |
$87,782.40
|
| Rate for Payer: United Healthcare All Payer |
$80,467.20
|
|
