|
SROM NRH TIB SLEEVE POR 45MM
|
Facility
|
IP
|
$8,864.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,659.38 |
| Max. Negotiated Rate |
$8,510.02 |
| Rate for Payer: Aetna Commercial |
$6,825.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,914.39
|
| Rate for Payer: Cash Price |
$4,432.30
|
| Rate for Payer: Cigna Commercial |
$7,357.62
|
| Rate for Payer: First Health Commercial |
$8,421.37
|
| Rate for Payer: Humana Commercial |
$7,534.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,268.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,542.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,659.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,800.85
|
| Rate for Payer: Ohio Health Group HMO |
$6,648.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,091.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,712.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,116.57
|
| Rate for Payer: PHCS Commercial |
$8,510.02
|
| Rate for Payer: United Healthcare All Payer |
$7,800.85
|
|
|
SROM NRH TIB SLEEVE POR 45MM
|
Facility
|
OP
|
$8,864.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,659.38 |
| Max. Negotiated Rate |
$8,510.02 |
| Rate for Payer: Aetna Commercial |
$6,825.74
|
| Rate for Payer: Anthem Medicaid |
$3,048.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,914.39
|
| Rate for Payer: Cash Price |
$4,432.30
|
| Rate for Payer: Cigna Commercial |
$7,357.62
|
| Rate for Payer: First Health Commercial |
$8,421.37
|
| Rate for Payer: Humana Commercial |
$7,534.91
|
| Rate for Payer: Humana KY Medicaid |
$3,048.54
|
| Rate for Payer: Kentucky WC Medicaid |
$3,079.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,268.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,542.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,659.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,109.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,800.85
|
| Rate for Payer: Ohio Health Group HMO |
$6,648.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,091.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,712.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,116.57
|
| Rate for Payer: PHCS Commercial |
$8,510.02
|
| Rate for Payer: United Healthcare All Payer |
$7,800.85
|
|
|
SROM NRH TIB SLEEVE POR 53MM
|
Facility
|
IP
|
$8,864.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,659.38 |
| Max. Negotiated Rate |
$8,510.02 |
| Rate for Payer: Aetna Commercial |
$6,825.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,914.39
|
| Rate for Payer: Cash Price |
$4,432.30
|
| Rate for Payer: Cigna Commercial |
$7,357.62
|
| Rate for Payer: First Health Commercial |
$8,421.37
|
| Rate for Payer: Humana Commercial |
$7,534.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,268.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,542.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,659.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,800.85
|
| Rate for Payer: Ohio Health Group HMO |
$6,648.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,091.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,712.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,116.57
|
| Rate for Payer: PHCS Commercial |
$8,510.02
|
| Rate for Payer: United Healthcare All Payer |
$7,800.85
|
|
|
SROM NRH TIB SLEEVE POR 53MM
|
Facility
|
OP
|
$8,864.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,659.38 |
| Max. Negotiated Rate |
$8,510.02 |
| Rate for Payer: Aetna Commercial |
$6,825.74
|
| Rate for Payer: Anthem Medicaid |
$3,048.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,914.39
|
| Rate for Payer: Cash Price |
$4,432.30
|
| Rate for Payer: Cigna Commercial |
$7,357.62
|
| Rate for Payer: First Health Commercial |
$8,421.37
|
| Rate for Payer: Humana Commercial |
$7,534.91
|
| Rate for Payer: Humana KY Medicaid |
$3,048.54
|
| Rate for Payer: Kentucky WC Medicaid |
$3,079.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,268.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,542.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,659.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,109.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,800.85
|
| Rate for Payer: Ohio Health Group HMO |
$6,648.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,091.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,712.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,116.57
|
| Rate for Payer: PHCS Commercial |
$8,510.02
|
| Rate for Payer: United Healthcare All Payer |
$7,800.85
|
|
|
SROM NRH TIB SLEEVE POR 61MM
|
Facility
|
IP
|
$8,864.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,659.38 |
| Max. Negotiated Rate |
$8,510.02 |
| Rate for Payer: Aetna Commercial |
$6,825.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,914.39
|
| Rate for Payer: Cash Price |
$4,432.30
|
| Rate for Payer: Cigna Commercial |
$7,357.62
|
| Rate for Payer: First Health Commercial |
$8,421.37
|
| Rate for Payer: Humana Commercial |
$7,534.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,268.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,542.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,659.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,800.85
|
| Rate for Payer: Ohio Health Group HMO |
$6,648.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,091.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,712.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,116.57
|
| Rate for Payer: PHCS Commercial |
$8,510.02
|
| Rate for Payer: United Healthcare All Payer |
$7,800.85
|
|
|
SROM NRH TIB SLEEVE POR 61MM
|
Facility
|
OP
|
$8,864.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,659.38 |
| Max. Negotiated Rate |
$8,510.02 |
| Rate for Payer: Aetna Commercial |
$6,825.74
|
| Rate for Payer: Anthem Medicaid |
$3,048.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,914.39
|
| Rate for Payer: Cash Price |
$4,432.30
|
| Rate for Payer: Cigna Commercial |
$7,357.62
|
| Rate for Payer: First Health Commercial |
$8,421.37
|
| Rate for Payer: Humana Commercial |
$7,534.91
|
| Rate for Payer: Humana KY Medicaid |
$3,048.54
|
| Rate for Payer: Kentucky WC Medicaid |
$3,079.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,268.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,542.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,659.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,109.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,800.85
|
| Rate for Payer: Ohio Health Group HMO |
$6,648.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,091.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,712.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,116.57
|
| Rate for Payer: PHCS Commercial |
$8,510.02
|
| Rate for Payer: United Healthcare All Payer |
$7,800.85
|
|
|
S-ROM PROX FEM SLEV ZTT 16B-LG
|
Facility
|
OP
|
$9,136.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,740.91 |
| Max. Negotiated Rate |
$8,770.92 |
| Rate for Payer: Aetna Commercial |
$7,035.01
|
| Rate for Payer: Anthem Medicaid |
$3,142.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,126.38
|
| Rate for Payer: Cash Price |
$4,568.19
|
| Rate for Payer: Cigna Commercial |
$7,583.20
|
| Rate for Payer: First Health Commercial |
$8,679.56
|
| Rate for Payer: Humana Commercial |
$7,765.92
|
| Rate for Payer: Humana KY Medicaid |
$3,142.00
|
| Rate for Payer: Kentucky WC Medicaid |
$3,173.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,491.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,742.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,740.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,205.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,040.01
|
| Rate for Payer: Ohio Health Group HMO |
$6,852.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,309.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,948.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,304.10
|
| Rate for Payer: PHCS Commercial |
$8,770.92
|
| Rate for Payer: United Healthcare All Payer |
$8,040.01
|
|
|
S-ROM PROX FEM SLEV ZTT 16B-LG
|
Facility
|
IP
|
$9,136.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,740.91 |
| Max. Negotiated Rate |
$8,770.92 |
| Rate for Payer: Aetna Commercial |
$7,035.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,126.38
|
| Rate for Payer: Cash Price |
$4,568.19
|
| Rate for Payer: Cigna Commercial |
$7,583.20
|
| Rate for Payer: First Health Commercial |
$8,679.56
|
| Rate for Payer: Humana Commercial |
$7,765.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,491.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,742.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,740.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,040.01
|
| Rate for Payer: Ohio Health Group HMO |
$6,852.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,309.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,948.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,304.10
|
| Rate for Payer: PHCS Commercial |
$8,770.92
|
| Rate for Payer: United Healthcare All Payer |
$8,040.01
|
|
|
S-ROM PROX FEM SLEV ZTT 16B-SM
|
Facility
|
OP
|
$9,136.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,740.91 |
| Max. Negotiated Rate |
$8,770.92 |
| Rate for Payer: Aetna Commercial |
$7,035.01
|
| Rate for Payer: Anthem Medicaid |
$3,142.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,126.38
|
| Rate for Payer: Cash Price |
$4,568.19
|
| Rate for Payer: Cigna Commercial |
$7,583.20
|
| Rate for Payer: First Health Commercial |
$8,679.56
|
| Rate for Payer: Humana Commercial |
$7,765.92
|
| Rate for Payer: Humana KY Medicaid |
$3,142.00
|
| Rate for Payer: Kentucky WC Medicaid |
$3,173.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,491.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,742.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,740.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,205.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,040.01
|
| Rate for Payer: Ohio Health Group HMO |
$6,852.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,309.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,948.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,304.10
|
| Rate for Payer: PHCS Commercial |
$8,770.92
|
| Rate for Payer: United Healthcare All Payer |
$8,040.01
|
|
|
S-ROM PROX FEM SLEV ZTT 16B-SM
|
Facility
|
IP
|
$9,136.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,740.91 |
| Max. Negotiated Rate |
$8,770.92 |
| Rate for Payer: Aetna Commercial |
$7,035.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,126.38
|
| Rate for Payer: Cash Price |
$4,568.19
|
| Rate for Payer: Cigna Commercial |
$7,583.20
|
| Rate for Payer: First Health Commercial |
$8,679.56
|
| Rate for Payer: Humana Commercial |
$7,765.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,491.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,742.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,740.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,040.01
|
| Rate for Payer: Ohio Health Group HMO |
$6,852.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,309.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,948.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,304.10
|
| Rate for Payer: PHCS Commercial |
$8,770.92
|
| Rate for Payer: United Healthcare All Payer |
$8,040.01
|
|
|
S-ROM PROX FEM SLEV ZTT 18B-LG
|
Facility
|
IP
|
$9,136.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,740.91 |
| Max. Negotiated Rate |
$8,770.92 |
| Rate for Payer: Aetna Commercial |
$7,035.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,126.38
|
| Rate for Payer: Cash Price |
$4,568.19
|
| Rate for Payer: Cigna Commercial |
$7,583.20
|
| Rate for Payer: First Health Commercial |
$8,679.56
|
| Rate for Payer: Humana Commercial |
$7,765.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,491.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,742.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,740.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,040.01
|
| Rate for Payer: Ohio Health Group HMO |
$6,852.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,309.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,948.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,304.10
|
| Rate for Payer: PHCS Commercial |
$8,770.92
|
| Rate for Payer: United Healthcare All Payer |
$8,040.01
|
|
|
S-ROM PROX FEM SLEV ZTT 18B-LG
|
Facility
|
OP
|
$9,136.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,740.91 |
| Max. Negotiated Rate |
$8,770.92 |
| Rate for Payer: Aetna Commercial |
$7,035.01
|
| Rate for Payer: Anthem Medicaid |
$3,142.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,126.38
|
| Rate for Payer: Cash Price |
$4,568.19
|
| Rate for Payer: Cigna Commercial |
$7,583.20
|
| Rate for Payer: First Health Commercial |
$8,679.56
|
| Rate for Payer: Humana Commercial |
$7,765.92
|
| Rate for Payer: Humana KY Medicaid |
$3,142.00
|
| Rate for Payer: Kentucky WC Medicaid |
$3,173.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,491.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,742.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,740.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,205.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,040.01
|
| Rate for Payer: Ohio Health Group HMO |
$6,852.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,309.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,948.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,304.10
|
| Rate for Payer: PHCS Commercial |
$8,770.92
|
| Rate for Payer: United Healthcare All Payer |
$8,040.01
|
|
|
S-ROM PROX FEM SLEV ZTT 18B-SM
|
Facility
|
OP
|
$9,136.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,740.91 |
| Max. Negotiated Rate |
$8,770.92 |
| Rate for Payer: Aetna Commercial |
$7,035.01
|
| Rate for Payer: Anthem Medicaid |
$3,142.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,126.38
|
| Rate for Payer: Cash Price |
$4,568.19
|
| Rate for Payer: Cigna Commercial |
$7,583.20
|
| Rate for Payer: First Health Commercial |
$8,679.56
|
| Rate for Payer: Humana Commercial |
$7,765.92
|
| Rate for Payer: Humana KY Medicaid |
$3,142.00
|
| Rate for Payer: Kentucky WC Medicaid |
$3,173.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,491.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,742.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,740.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,205.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,040.01
|
| Rate for Payer: Ohio Health Group HMO |
$6,852.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,309.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,948.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,304.10
|
| Rate for Payer: PHCS Commercial |
$8,770.92
|
| Rate for Payer: United Healthcare All Payer |
$8,040.01
|
|
|
S-ROM PROX FEM SLEV ZTT 18B-SM
|
Facility
|
IP
|
$9,136.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,740.91 |
| Max. Negotiated Rate |
$8,770.92 |
| Rate for Payer: Aetna Commercial |
$7,035.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,126.38
|
| Rate for Payer: Cash Price |
$4,568.19
|
| Rate for Payer: Cigna Commercial |
$7,583.20
|
| Rate for Payer: First Health Commercial |
$8,679.56
|
| Rate for Payer: Humana Commercial |
$7,765.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,491.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,742.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,740.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,040.01
|
| Rate for Payer: Ohio Health Group HMO |
$6,852.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,309.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,948.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,304.10
|
| Rate for Payer: PHCS Commercial |
$8,770.92
|
| Rate for Payer: United Healthcare All Payer |
$8,040.01
|
|
|
S-ROM PROX FEM SLEV ZTT 20B-LG
|
Facility
|
IP
|
$9,136.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,740.91 |
| Max. Negotiated Rate |
$8,770.92 |
| Rate for Payer: Aetna Commercial |
$7,035.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,126.38
|
| Rate for Payer: Cash Price |
$4,568.19
|
| Rate for Payer: Cigna Commercial |
$7,583.20
|
| Rate for Payer: First Health Commercial |
$8,679.56
|
| Rate for Payer: Humana Commercial |
$7,765.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,491.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,742.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,740.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,040.01
|
| Rate for Payer: Ohio Health Group HMO |
$6,852.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,309.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,948.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,304.10
|
| Rate for Payer: PHCS Commercial |
$8,770.92
|
| Rate for Payer: United Healthcare All Payer |
$8,040.01
|
|
|
S-ROM PROX FEM SLEV ZTT 20B-LG
|
Facility
|
OP
|
$9,136.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,740.91 |
| Max. Negotiated Rate |
$8,770.92 |
| Rate for Payer: Aetna Commercial |
$7,035.01
|
| Rate for Payer: Anthem Medicaid |
$3,142.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,126.38
|
| Rate for Payer: Cash Price |
$4,568.19
|
| Rate for Payer: Cigna Commercial |
$7,583.20
|
| Rate for Payer: First Health Commercial |
$8,679.56
|
| Rate for Payer: Humana Commercial |
$7,765.92
|
| Rate for Payer: Humana KY Medicaid |
$3,142.00
|
| Rate for Payer: Kentucky WC Medicaid |
$3,173.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,491.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,742.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,740.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,205.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,040.01
|
| Rate for Payer: Ohio Health Group HMO |
$6,852.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,309.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,948.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,304.10
|
| Rate for Payer: PHCS Commercial |
$8,770.92
|
| Rate for Payer: United Healthcare All Payer |
$8,040.01
|
|
|
S-ROM PROX FEM SLEV ZTT 20B-SM
|
Facility
|
OP
|
$9,136.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,740.91 |
| Max. Negotiated Rate |
$8,770.92 |
| Rate for Payer: Aetna Commercial |
$7,035.01
|
| Rate for Payer: Anthem Medicaid |
$3,142.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,126.38
|
| Rate for Payer: Cash Price |
$4,568.19
|
| Rate for Payer: Cigna Commercial |
$7,583.20
|
| Rate for Payer: First Health Commercial |
$8,679.56
|
| Rate for Payer: Humana Commercial |
$7,765.92
|
| Rate for Payer: Humana KY Medicaid |
$3,142.00
|
| Rate for Payer: Kentucky WC Medicaid |
$3,173.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,491.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,742.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,740.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,205.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,040.01
|
| Rate for Payer: Ohio Health Group HMO |
$6,852.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,309.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,948.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,304.10
|
| Rate for Payer: PHCS Commercial |
$8,770.92
|
| Rate for Payer: United Healthcare All Payer |
$8,040.01
|
|
|
S-ROM PROX FEM SLEV ZTT 20B-SM
|
Facility
|
IP
|
$9,136.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,740.91 |
| Max. Negotiated Rate |
$8,770.92 |
| Rate for Payer: Aetna Commercial |
$7,035.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,126.38
|
| Rate for Payer: Cash Price |
$4,568.19
|
| Rate for Payer: Cigna Commercial |
$7,583.20
|
| Rate for Payer: First Health Commercial |
$8,679.56
|
| Rate for Payer: Humana Commercial |
$7,765.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,491.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,742.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,740.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,040.01
|
| Rate for Payer: Ohio Health Group HMO |
$6,852.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,309.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,948.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,304.10
|
| Rate for Payer: PHCS Commercial |
$8,770.92
|
| Rate for Payer: United Healthcare All Payer |
$8,040.01
|
|
|
S-ROM PROX FEM SLEV ZTT 22B-LG
|
Facility
|
OP
|
$9,136.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,740.91 |
| Max. Negotiated Rate |
$8,770.92 |
| Rate for Payer: Aetna Commercial |
$7,035.01
|
| Rate for Payer: Anthem Medicaid |
$3,142.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,126.38
|
| Rate for Payer: Cash Price |
$4,568.19
|
| Rate for Payer: Cigna Commercial |
$7,583.20
|
| Rate for Payer: First Health Commercial |
$8,679.56
|
| Rate for Payer: Humana Commercial |
$7,765.92
|
| Rate for Payer: Humana KY Medicaid |
$3,142.00
|
| Rate for Payer: Kentucky WC Medicaid |
$3,173.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,491.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,742.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,740.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,205.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,040.01
|
| Rate for Payer: Ohio Health Group HMO |
$6,852.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,309.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,948.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,304.10
|
| Rate for Payer: PHCS Commercial |
$8,770.92
|
| Rate for Payer: United Healthcare All Payer |
$8,040.01
|
|
|
S-ROM PROX FEM SLEV ZTT 22B-LG
|
Facility
|
IP
|
$9,136.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,740.91 |
| Max. Negotiated Rate |
$8,770.92 |
| Rate for Payer: Aetna Commercial |
$7,035.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,126.38
|
| Rate for Payer: Cash Price |
$4,568.19
|
| Rate for Payer: Cigna Commercial |
$7,583.20
|
| Rate for Payer: First Health Commercial |
$8,679.56
|
| Rate for Payer: Humana Commercial |
$7,765.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,491.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,742.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,740.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,040.01
|
| Rate for Payer: Ohio Health Group HMO |
$6,852.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,309.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,948.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,304.10
|
| Rate for Payer: PHCS Commercial |
$8,770.92
|
| Rate for Payer: United Healthcare All Payer |
$8,040.01
|
|
|
S-ROM PROX FEM SLEV ZTT 22B-SM
|
Facility
|
OP
|
$9,136.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,740.91 |
| Max. Negotiated Rate |
$8,770.92 |
| Rate for Payer: Aetna Commercial |
$7,035.01
|
| Rate for Payer: Anthem Medicaid |
$3,142.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,126.38
|
| Rate for Payer: Cash Price |
$4,568.19
|
| Rate for Payer: Cigna Commercial |
$7,583.20
|
| Rate for Payer: First Health Commercial |
$8,679.56
|
| Rate for Payer: Humana Commercial |
$7,765.92
|
| Rate for Payer: Humana KY Medicaid |
$3,142.00
|
| Rate for Payer: Kentucky WC Medicaid |
$3,173.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,491.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,742.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,740.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,205.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,040.01
|
| Rate for Payer: Ohio Health Group HMO |
$6,852.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,309.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,948.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,304.10
|
| Rate for Payer: PHCS Commercial |
$8,770.92
|
| Rate for Payer: United Healthcare All Payer |
$8,040.01
|
|
|
S-ROM PROX FEM SLEV ZTT 22B-SM
|
Facility
|
IP
|
$9,136.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,740.91 |
| Max. Negotiated Rate |
$8,770.92 |
| Rate for Payer: Aetna Commercial |
$7,035.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,126.38
|
| Rate for Payer: Cash Price |
$4,568.19
|
| Rate for Payer: Cigna Commercial |
$7,583.20
|
| Rate for Payer: First Health Commercial |
$8,679.56
|
| Rate for Payer: Humana Commercial |
$7,765.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,491.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,742.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,740.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,040.01
|
| Rate for Payer: Ohio Health Group HMO |
$6,852.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,309.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,948.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,304.10
|
| Rate for Payer: PHCS Commercial |
$8,770.92
|
| Rate for Payer: United Healthcare All Payer |
$8,040.01
|
|
|
STAB PHLEBECTOMY 10-20
|
Facility
|
OP
|
$7,062.00
|
|
|
Service Code
|
HCPCS 37799
|
| Hospital Charge Code |
76102688
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$571.26 |
| Max. Negotiated Rate |
$6,779.52 |
| Rate for Payer: Aetna Commercial |
$5,437.74
|
| Rate for Payer: Anthem Medicaid |
$2,428.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$571.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,508.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$799.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$771.20
|
| Rate for Payer: Cash Price |
$3,531.00
|
| Rate for Payer: Cash Price |
$3,531.00
|
| Rate for Payer: Cigna Commercial |
$5,861.46
|
| Rate for Payer: First Health Commercial |
$6,708.90
|
| Rate for Payer: Humana Commercial |
$6,002.70
|
| Rate for Payer: Humana KY Medicaid |
$2,428.62
|
| Rate for Payer: Humana Medicare Advantage |
$571.26
|
| Rate for Payer: Kentucky WC Medicaid |
$2,453.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,790.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,211.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$685.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,477.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,214.56
|
| Rate for Payer: Ohio Health Group HMO |
$5,296.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,649.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,143.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,872.78
|
| Rate for Payer: PHCS Commercial |
$6,779.52
|
| Rate for Payer: United Healthcare All Payer |
$6,214.56
|
|
|
STAB PHLEBECTOMY 10-20
|
Professional
|
Both
|
$7,062.00
|
|
|
Service Code
|
HCPCS 37799
|
| Hospital Charge Code |
76102688
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$4,943.40 |
| Rate for Payer: Cash Price |
$3,531.00
|
| Rate for Payer: Cash Price |
$3,531.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$4,237.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,943.40
|
| Rate for Payer: UHCCP Medicaid |
$2,471.70
|
|
|
STAB PHLEBECTOMY 10-20
|
Facility
|
IP
|
$7,062.00
|
|
|
Service Code
|
HCPCS 37799
|
| Hospital Charge Code |
76102688
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,118.60 |
| Max. Negotiated Rate |
$6,779.52 |
| Rate for Payer: Aetna Commercial |
$5,437.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,508.36
|
| Rate for Payer: Cash Price |
$3,531.00
|
| Rate for Payer: Cigna Commercial |
$5,861.46
|
| Rate for Payer: First Health Commercial |
$6,708.90
|
| Rate for Payer: Humana Commercial |
$6,002.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,790.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,211.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,118.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,214.56
|
| Rate for Payer: Ohio Health Group HMO |
$5,296.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,649.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,143.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,872.78
|
| Rate for Payer: PHCS Commercial |
$6,779.52
|
| Rate for Payer: United Healthcare All Payer |
$6,214.56
|
|
