|
SYN HA HO PRESFIT FEM CMP SZ15
|
Facility
|
OP
|
$24,019.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,122.60 |
| Max. Negotiated Rate |
$23,059.19 |
| Rate for Payer: Aetna Commercial |
$18,495.39
|
| Rate for Payer: Anthem Medicaid |
$8,260.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,735.59
|
| Rate for Payer: Cash Price |
$12,009.99
|
| Rate for Payer: Cigna Commercial |
$19,936.59
|
| Rate for Payer: First Health Commercial |
$22,818.99
|
| Rate for Payer: Humana Commercial |
$20,416.99
|
| Rate for Payer: Humana KY Medicaid |
$8,260.47
|
| Rate for Payer: Kentucky WC Medicaid |
$8,344.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,696.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,726.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,206.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,426.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,137.59
|
| Rate for Payer: Ohio Health Group HMO |
$18,014.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,804.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,122.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,446.20
|
| Rate for Payer: PHCS Commercial |
$23,059.19
|
| Rate for Payer: United Healthcare All Payer |
$21,137.59
|
|
|
SYN HA HO PRESFIT FEM CMP SZ15
|
Facility
|
IP
|
$24,019.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,122.60 |
| Max. Negotiated Rate |
$23,059.19 |
| Rate for Payer: Aetna Commercial |
$18,495.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,735.59
|
| Rate for Payer: Cash Price |
$12,009.99
|
| Rate for Payer: Cigna Commercial |
$19,936.59
|
| Rate for Payer: First Health Commercial |
$22,818.99
|
| Rate for Payer: Humana Commercial |
$20,416.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,696.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,726.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,206.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,137.59
|
| Rate for Payer: Ohio Health Group HMO |
$18,014.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,804.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,122.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,446.20
|
| Rate for Payer: PHCS Commercial |
$23,059.19
|
| Rate for Payer: United Healthcare All Payer |
$21,137.59
|
|
|
SYN HA HO PRESFIT FEM CMP SZ16
|
Facility
|
IP
|
$24,019.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,122.60 |
| Max. Negotiated Rate |
$23,059.19 |
| Rate for Payer: Aetna Commercial |
$18,495.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,735.59
|
| Rate for Payer: Cash Price |
$12,009.99
|
| Rate for Payer: Cigna Commercial |
$19,936.59
|
| Rate for Payer: First Health Commercial |
$22,818.99
|
| Rate for Payer: Humana Commercial |
$20,416.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,696.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,726.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,206.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,137.59
|
| Rate for Payer: Ohio Health Group HMO |
$18,014.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,804.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,122.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,446.20
|
| Rate for Payer: PHCS Commercial |
$23,059.19
|
| Rate for Payer: United Healthcare All Payer |
$21,137.59
|
|
|
SYN HA HO PRESFIT FEM CMP SZ16
|
Facility
|
OP
|
$24,019.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,122.60 |
| Max. Negotiated Rate |
$23,059.19 |
| Rate for Payer: Aetna Commercial |
$18,495.39
|
| Rate for Payer: Anthem Medicaid |
$8,260.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,735.59
|
| Rate for Payer: Cash Price |
$12,009.99
|
| Rate for Payer: Cigna Commercial |
$19,936.59
|
| Rate for Payer: First Health Commercial |
$22,818.99
|
| Rate for Payer: Humana Commercial |
$20,416.99
|
| Rate for Payer: Humana KY Medicaid |
$8,260.47
|
| Rate for Payer: Kentucky WC Medicaid |
$8,344.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,696.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,726.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,206.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,426.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,137.59
|
| Rate for Payer: Ohio Health Group HMO |
$18,014.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,804.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,122.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,446.20
|
| Rate for Payer: PHCS Commercial |
$23,059.19
|
| Rate for Payer: United Healthcare All Payer |
$21,137.59
|
|
|
SYN HA HO PRESFIT FEM CMP SZ17
|
Facility
|
OP
|
$24,019.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,122.60 |
| Max. Negotiated Rate |
$23,059.19 |
| Rate for Payer: Aetna Commercial |
$18,495.39
|
| Rate for Payer: Anthem Medicaid |
$8,260.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,735.59
|
| Rate for Payer: Cash Price |
$12,009.99
|
| Rate for Payer: Cigna Commercial |
$19,936.59
|
| Rate for Payer: First Health Commercial |
$22,818.99
|
| Rate for Payer: Humana Commercial |
$20,416.99
|
| Rate for Payer: Humana KY Medicaid |
$8,260.47
|
| Rate for Payer: Kentucky WC Medicaid |
$8,344.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,696.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,726.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,206.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,426.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,137.59
|
| Rate for Payer: Ohio Health Group HMO |
$18,014.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,804.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,122.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,446.20
|
| Rate for Payer: PHCS Commercial |
$23,059.19
|
| Rate for Payer: United Healthcare All Payer |
$21,137.59
|
|
|
SYN HA HO PRESFIT FEM CMP SZ17
|
Facility
|
IP
|
$24,019.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,122.60 |
| Max. Negotiated Rate |
$23,059.19 |
| Rate for Payer: Aetna Commercial |
$18,495.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,735.59
|
| Rate for Payer: Cash Price |
$12,009.99
|
| Rate for Payer: Cigna Commercial |
$19,936.59
|
| Rate for Payer: First Health Commercial |
$22,818.99
|
| Rate for Payer: Humana Commercial |
$20,416.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,696.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,726.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,206.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,137.59
|
| Rate for Payer: Ohio Health Group HMO |
$18,014.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,804.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,122.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,446.20
|
| Rate for Payer: PHCS Commercial |
$23,059.19
|
| Rate for Payer: United Healthcare All Payer |
$21,137.59
|
|
|
SYN HA HO PRESFIT FEM CMP SZ18
|
Facility
|
IP
|
$24,019.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,122.60 |
| Max. Negotiated Rate |
$23,059.19 |
| Rate for Payer: Aetna Commercial |
$18,495.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,735.59
|
| Rate for Payer: Cash Price |
$12,009.99
|
| Rate for Payer: Cigna Commercial |
$19,936.59
|
| Rate for Payer: First Health Commercial |
$22,818.99
|
| Rate for Payer: Humana Commercial |
$20,416.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,696.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,726.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,206.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,137.59
|
| Rate for Payer: Ohio Health Group HMO |
$18,014.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,804.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,122.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,446.20
|
| Rate for Payer: PHCS Commercial |
$23,059.19
|
| Rate for Payer: United Healthcare All Payer |
$21,137.59
|
|
|
SYN HA HO PRESFIT FEM CMP SZ18
|
Facility
|
OP
|
$24,019.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,122.60 |
| Max. Negotiated Rate |
$23,059.19 |
| Rate for Payer: Aetna Commercial |
$18,495.39
|
| Rate for Payer: Anthem Medicaid |
$8,260.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,735.59
|
| Rate for Payer: Cash Price |
$12,009.99
|
| Rate for Payer: Cigna Commercial |
$19,936.59
|
| Rate for Payer: First Health Commercial |
$22,818.99
|
| Rate for Payer: Humana Commercial |
$20,416.99
|
| Rate for Payer: Humana KY Medicaid |
$8,260.47
|
| Rate for Payer: Kentucky WC Medicaid |
$8,344.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,696.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,726.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,206.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,426.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,137.59
|
| Rate for Payer: Ohio Health Group HMO |
$18,014.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,804.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,122.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,446.20
|
| Rate for Payer: PHCS Commercial |
$23,059.19
|
| Rate for Payer: United Healthcare All Payer |
$21,137.59
|
|
|
SYN HA HO PRESFIT FEM COMP SZ9
|
Facility
|
IP
|
$24,019.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,122.60 |
| Max. Negotiated Rate |
$23,059.19 |
| Rate for Payer: Aetna Commercial |
$18,495.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,735.59
|
| Rate for Payer: Cash Price |
$12,009.99
|
| Rate for Payer: Cigna Commercial |
$19,936.59
|
| Rate for Payer: First Health Commercial |
$22,818.99
|
| Rate for Payer: Humana Commercial |
$20,416.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,696.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,726.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,206.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,137.59
|
| Rate for Payer: Ohio Health Group HMO |
$18,014.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,804.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,122.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,446.20
|
| Rate for Payer: PHCS Commercial |
$23,059.19
|
| Rate for Payer: United Healthcare All Payer |
$21,137.59
|
|
|
SYN HA HO PRESFIT FEM COMP SZ9
|
Facility
|
OP
|
$24,019.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,122.60 |
| Max. Negotiated Rate |
$23,059.19 |
| Rate for Payer: Aetna Commercial |
$18,495.39
|
| Rate for Payer: Anthem Medicaid |
$8,260.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,735.59
|
| Rate for Payer: Cash Price |
$12,009.99
|
| Rate for Payer: Cigna Commercial |
$19,936.59
|
| Rate for Payer: First Health Commercial |
$22,818.99
|
| Rate for Payer: Humana Commercial |
$20,416.99
|
| Rate for Payer: Humana KY Medicaid |
$8,260.47
|
| Rate for Payer: Kentucky WC Medicaid |
$8,344.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,696.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,726.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,206.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,426.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,137.59
|
| Rate for Payer: Ohio Health Group HMO |
$18,014.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,804.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,122.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,446.20
|
| Rate for Payer: PHCS Commercial |
$23,059.19
|
| Rate for Payer: United Healthcare All Payer |
$21,137.59
|
|
|
SYN HA PF FEM COMP SZ 10
|
Facility
|
IP
|
$24,019.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,122.60 |
| Max. Negotiated Rate |
$23,059.19 |
| Rate for Payer: Aetna Commercial |
$18,495.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,735.59
|
| Rate for Payer: Cash Price |
$12,009.99
|
| Rate for Payer: Cigna Commercial |
$19,936.59
|
| Rate for Payer: First Health Commercial |
$22,818.99
|
| Rate for Payer: Humana Commercial |
$20,416.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,696.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,726.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,206.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,137.59
|
| Rate for Payer: Ohio Health Group HMO |
$18,014.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,804.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,122.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,446.20
|
| Rate for Payer: PHCS Commercial |
$23,059.19
|
| Rate for Payer: United Healthcare All Payer |
$21,137.59
|
|
|
SYN HA PF FEM COMP SZ 10
|
Facility
|
OP
|
$24,019.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,122.60 |
| Max. Negotiated Rate |
$23,059.19 |
| Rate for Payer: Aetna Commercial |
$18,495.39
|
| Rate for Payer: Anthem Medicaid |
$8,260.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,735.59
|
| Rate for Payer: Cash Price |
$12,009.99
|
| Rate for Payer: Cigna Commercial |
$19,936.59
|
| Rate for Payer: First Health Commercial |
$22,818.99
|
| Rate for Payer: Humana Commercial |
$20,416.99
|
| Rate for Payer: Humana KY Medicaid |
$8,260.47
|
| Rate for Payer: Kentucky WC Medicaid |
$8,344.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,696.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,726.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,206.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,426.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,137.59
|
| Rate for Payer: Ohio Health Group HMO |
$18,014.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,804.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,122.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,446.20
|
| Rate for Payer: PHCS Commercial |
$23,059.19
|
| Rate for Payer: United Healthcare All Payer |
$21,137.59
|
|
|
SYN HA PF FEM COMP SZ 11
|
Facility
|
OP
|
$24,019.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,122.60 |
| Max. Negotiated Rate |
$23,059.19 |
| Rate for Payer: Aetna Commercial |
$18,495.39
|
| Rate for Payer: Anthem Medicaid |
$8,260.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,735.59
|
| Rate for Payer: Cash Price |
$12,009.99
|
| Rate for Payer: Cigna Commercial |
$19,936.59
|
| Rate for Payer: First Health Commercial |
$22,818.99
|
| Rate for Payer: Humana Commercial |
$20,416.99
|
| Rate for Payer: Humana KY Medicaid |
$8,260.47
|
| Rate for Payer: Kentucky WC Medicaid |
$8,344.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,696.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,726.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,206.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,426.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,137.59
|
| Rate for Payer: Ohio Health Group HMO |
$18,014.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,804.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,122.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,446.20
|
| Rate for Payer: PHCS Commercial |
$23,059.19
|
| Rate for Payer: United Healthcare All Payer |
$21,137.59
|
|
|
SYN HA PF FEM COMP SZ 11
|
Facility
|
IP
|
$24,019.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,122.60 |
| Max. Negotiated Rate |
$23,059.19 |
| Rate for Payer: Aetna Commercial |
$18,495.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,735.59
|
| Rate for Payer: Cash Price |
$12,009.99
|
| Rate for Payer: Cigna Commercial |
$19,936.59
|
| Rate for Payer: First Health Commercial |
$22,818.99
|
| Rate for Payer: Humana Commercial |
$20,416.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,696.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,726.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,206.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,137.59
|
| Rate for Payer: Ohio Health Group HMO |
$18,014.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,804.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,122.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,446.20
|
| Rate for Payer: PHCS Commercial |
$23,059.19
|
| Rate for Payer: United Healthcare All Payer |
$21,137.59
|
|
|
SYN HA PF FEM COMP SZ 12
|
Facility
|
IP
|
$24,019.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,122.60 |
| Max. Negotiated Rate |
$23,059.19 |
| Rate for Payer: Aetna Commercial |
$18,495.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,735.59
|
| Rate for Payer: Cash Price |
$12,009.99
|
| Rate for Payer: Cigna Commercial |
$19,936.59
|
| Rate for Payer: First Health Commercial |
$22,818.99
|
| Rate for Payer: Humana Commercial |
$20,416.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,696.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,726.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,206.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,137.59
|
| Rate for Payer: Ohio Health Group HMO |
$18,014.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,804.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,122.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,446.20
|
| Rate for Payer: PHCS Commercial |
$23,059.19
|
| Rate for Payer: United Healthcare All Payer |
$21,137.59
|
|
|
SYN HA PF FEM COMP SZ 12
|
Facility
|
OP
|
$24,019.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,122.60 |
| Max. Negotiated Rate |
$23,059.19 |
| Rate for Payer: Aetna Commercial |
$18,495.39
|
| Rate for Payer: Anthem Medicaid |
$8,260.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,735.59
|
| Rate for Payer: Cash Price |
$12,009.99
|
| Rate for Payer: Cigna Commercial |
$19,936.59
|
| Rate for Payer: First Health Commercial |
$22,818.99
|
| Rate for Payer: Humana Commercial |
$20,416.99
|
| Rate for Payer: Humana KY Medicaid |
$8,260.47
|
| Rate for Payer: Kentucky WC Medicaid |
$8,344.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,696.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,726.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,206.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,426.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,137.59
|
| Rate for Payer: Ohio Health Group HMO |
$18,014.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,804.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,122.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,446.20
|
| Rate for Payer: PHCS Commercial |
$23,059.19
|
| Rate for Payer: United Healthcare All Payer |
$21,137.59
|
|
|
SYN HA PF FEM COMP SZ 13
|
Facility
|
OP
|
$24,019.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,122.60 |
| Max. Negotiated Rate |
$23,059.19 |
| Rate for Payer: Aetna Commercial |
$18,495.39
|
| Rate for Payer: Anthem Medicaid |
$8,260.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,735.59
|
| Rate for Payer: Cash Price |
$12,009.99
|
| Rate for Payer: Cigna Commercial |
$19,936.59
|
| Rate for Payer: First Health Commercial |
$22,818.99
|
| Rate for Payer: Humana Commercial |
$20,416.99
|
| Rate for Payer: Humana KY Medicaid |
$8,260.47
|
| Rate for Payer: Kentucky WC Medicaid |
$8,344.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,696.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,726.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,206.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,426.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,137.59
|
| Rate for Payer: Ohio Health Group HMO |
$18,014.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,804.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,122.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,446.20
|
| Rate for Payer: PHCS Commercial |
$23,059.19
|
| Rate for Payer: United Healthcare All Payer |
$21,137.59
|
|
|
SYN HA PF FEM COMP SZ 13
|
Facility
|
IP
|
$24,019.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,122.60 |
| Max. Negotiated Rate |
$23,059.19 |
| Rate for Payer: Aetna Commercial |
$18,495.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,735.59
|
| Rate for Payer: Cash Price |
$12,009.99
|
| Rate for Payer: Cigna Commercial |
$19,936.59
|
| Rate for Payer: First Health Commercial |
$22,818.99
|
| Rate for Payer: Humana Commercial |
$20,416.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,696.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,726.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,206.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,137.59
|
| Rate for Payer: Ohio Health Group HMO |
$18,014.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,804.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,122.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,446.20
|
| Rate for Payer: PHCS Commercial |
$23,059.19
|
| Rate for Payer: United Healthcare All Payer |
$21,137.59
|
|
|
SYN HA PF FEM COMP SZ 14
|
Facility
|
IP
|
$24,019.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,122.60 |
| Max. Negotiated Rate |
$23,059.19 |
| Rate for Payer: Aetna Commercial |
$18,495.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,735.59
|
| Rate for Payer: Cash Price |
$12,009.99
|
| Rate for Payer: Cigna Commercial |
$19,936.59
|
| Rate for Payer: First Health Commercial |
$22,818.99
|
| Rate for Payer: Humana Commercial |
$20,416.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,696.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,726.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,206.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,137.59
|
| Rate for Payer: Ohio Health Group HMO |
$18,014.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,804.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,122.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,446.20
|
| Rate for Payer: PHCS Commercial |
$23,059.19
|
| Rate for Payer: United Healthcare All Payer |
$21,137.59
|
|
|
SYN HA PF FEM COMP SZ 14
|
Facility
|
OP
|
$24,019.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,122.60 |
| Max. Negotiated Rate |
$23,059.19 |
| Rate for Payer: Aetna Commercial |
$18,495.39
|
| Rate for Payer: Anthem Medicaid |
$8,260.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,735.59
|
| Rate for Payer: Cash Price |
$12,009.99
|
| Rate for Payer: Cigna Commercial |
$19,936.59
|
| Rate for Payer: First Health Commercial |
$22,818.99
|
| Rate for Payer: Humana Commercial |
$20,416.99
|
| Rate for Payer: Humana KY Medicaid |
$8,260.47
|
| Rate for Payer: Kentucky WC Medicaid |
$8,344.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,696.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,726.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,206.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,426.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,137.59
|
| Rate for Payer: Ohio Health Group HMO |
$18,014.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,804.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,122.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,446.20
|
| Rate for Payer: PHCS Commercial |
$23,059.19
|
| Rate for Payer: United Healthcare All Payer |
$21,137.59
|
|
|
SYN HA PF FEM COMP SZ 15
|
Facility
|
IP
|
$24,019.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,122.60 |
| Max. Negotiated Rate |
$23,059.19 |
| Rate for Payer: Aetna Commercial |
$18,495.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,735.59
|
| Rate for Payer: Cash Price |
$12,009.99
|
| Rate for Payer: Cigna Commercial |
$19,936.59
|
| Rate for Payer: First Health Commercial |
$22,818.99
|
| Rate for Payer: Humana Commercial |
$20,416.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,696.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,726.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,206.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,137.59
|
| Rate for Payer: Ohio Health Group HMO |
$18,014.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,804.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,122.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,446.20
|
| Rate for Payer: PHCS Commercial |
$23,059.19
|
| Rate for Payer: United Healthcare All Payer |
$21,137.59
|
|
|
SYN HA PF FEM COMP SZ 15
|
Facility
|
OP
|
$24,019.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,122.60 |
| Max. Negotiated Rate |
$23,059.19 |
| Rate for Payer: Aetna Commercial |
$18,495.39
|
| Rate for Payer: Anthem Medicaid |
$8,260.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,735.59
|
| Rate for Payer: Cash Price |
$12,009.99
|
| Rate for Payer: Cigna Commercial |
$19,936.59
|
| Rate for Payer: First Health Commercial |
$22,818.99
|
| Rate for Payer: Humana Commercial |
$20,416.99
|
| Rate for Payer: Humana KY Medicaid |
$8,260.47
|
| Rate for Payer: Kentucky WC Medicaid |
$8,344.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,696.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,726.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,206.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,426.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,137.59
|
| Rate for Payer: Ohio Health Group HMO |
$18,014.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,804.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,122.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,446.20
|
| Rate for Payer: PHCS Commercial |
$23,059.19
|
| Rate for Payer: United Healthcare All Payer |
$21,137.59
|
|
|
SYN HA PF FEM COMP SZ 16
|
Facility
|
OP
|
$24,019.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,122.60 |
| Max. Negotiated Rate |
$23,059.19 |
| Rate for Payer: Aetna Commercial |
$18,495.39
|
| Rate for Payer: Anthem Medicaid |
$8,260.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,735.59
|
| Rate for Payer: Cash Price |
$12,009.99
|
| Rate for Payer: Cigna Commercial |
$19,936.59
|
| Rate for Payer: First Health Commercial |
$22,818.99
|
| Rate for Payer: Humana Commercial |
$20,416.99
|
| Rate for Payer: Humana KY Medicaid |
$8,260.47
|
| Rate for Payer: Kentucky WC Medicaid |
$8,344.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,696.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,726.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,206.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,426.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,137.59
|
| Rate for Payer: Ohio Health Group HMO |
$18,014.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,804.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,122.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,446.20
|
| Rate for Payer: PHCS Commercial |
$23,059.19
|
| Rate for Payer: United Healthcare All Payer |
$21,137.59
|
|
|
SYN HA PF FEM COMP SZ 16
|
Facility
|
IP
|
$24,019.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,122.60 |
| Max. Negotiated Rate |
$23,059.19 |
| Rate for Payer: Aetna Commercial |
$18,495.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,735.59
|
| Rate for Payer: Cash Price |
$12,009.99
|
| Rate for Payer: Cigna Commercial |
$19,936.59
|
| Rate for Payer: First Health Commercial |
$22,818.99
|
| Rate for Payer: Humana Commercial |
$20,416.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,696.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,726.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,206.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,137.59
|
| Rate for Payer: Ohio Health Group HMO |
$18,014.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,804.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,122.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,446.20
|
| Rate for Payer: PHCS Commercial |
$23,059.19
|
| Rate for Payer: United Healthcare All Payer |
$21,137.59
|
|
|
SYN HA PF FEM COMP SZ 17
|
Facility
|
IP
|
$24,019.99
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,122.60 |
| Max. Negotiated Rate |
$23,059.19 |
| Rate for Payer: Aetna Commercial |
$18,495.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,735.59
|
| Rate for Payer: Cash Price |
$12,009.99
|
| Rate for Payer: Cigna Commercial |
$19,936.59
|
| Rate for Payer: First Health Commercial |
$22,818.99
|
| Rate for Payer: Humana Commercial |
$20,416.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,696.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,726.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,206.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,137.59
|
| Rate for Payer: Ohio Health Group HMO |
$18,014.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,804.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,122.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,446.20
|
| Rate for Payer: PHCS Commercial |
$23,059.19
|
| Rate for Payer: United Healthcare All Payer |
$21,137.59
|
|
