|
SYN HA PF FEM COMP SZ 17
|
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 18
|
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 18
|
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 9
|
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 9
|
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
|
|
|
SYNOVECTOMY CARPOMETACRPL JNT
|
Facility
|
OP
|
$3,921.00
|
|
|
Service Code
|
HCPCS 26130
|
| Hospital Charge Code |
45000136
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$509.73 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$3,019.17
|
| Rate for Payer: Anthem Medicaid |
$1,348.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,058.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$1,960.50
|
| Rate for Payer: Cash Price |
$1,960.50
|
| Rate for Payer: Cigna Commercial |
$3,254.43
|
| Rate for Payer: First Health Commercial |
$3,724.95
|
| Rate for Payer: Humana Commercial |
$3,332.85
|
| Rate for Payer: Humana KY Medicaid |
$1,348.43
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,362.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,215.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,893.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,375.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,450.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,940.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$784.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$509.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,215.51
|
| Rate for Payer: PHCS Commercial |
$3,764.16
|
| Rate for Payer: United Healthcare All Payer |
$3,450.48
|
|
|
SYNOVECTOMY CARPOMETACRPL JNT
|
Facility
|
IP
|
$3,921.00
|
|
|
Service Code
|
HCPCS 26130
|
| Hospital Charge Code |
45000136
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$509.73 |
| Max. Negotiated Rate |
$3,764.16 |
| Rate for Payer: Aetna Commercial |
$3,019.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,058.38
|
| Rate for Payer: Cash Price |
$1,960.50
|
| Rate for Payer: Cigna Commercial |
$3,254.43
|
| Rate for Payer: First Health Commercial |
$3,724.95
|
| Rate for Payer: Humana Commercial |
$3,332.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,215.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,893.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,176.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,450.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,940.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$784.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$509.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,215.51
|
| Rate for Payer: PHCS Commercial |
$3,764.16
|
| Rate for Payer: United Healthcare All Payer |
$3,450.48
|
|
|
SYNOVECTOMY CARPOMETACRPL JNT
|
Facility
|
OP
|
$3,921.00
|
|
|
Service Code
|
HCPCS 26130
|
| Hospital Charge Code |
76100675
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$509.73 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$3,019.17
|
| Rate for Payer: Anthem Medicaid |
$1,348.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,058.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$1,960.50
|
| Rate for Payer: Cash Price |
$1,960.50
|
| Rate for Payer: Cigna Commercial |
$3,254.43
|
| Rate for Payer: First Health Commercial |
$3,724.95
|
| Rate for Payer: Humana Commercial |
$3,332.85
|
| Rate for Payer: Humana KY Medicaid |
$1,348.43
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,362.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,215.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,893.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,375.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,450.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,940.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$784.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$509.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,215.51
|
| Rate for Payer: PHCS Commercial |
$3,764.16
|
| Rate for Payer: United Healthcare All Payer |
$3,450.48
|
|
|
SYNOVECTOMY CARPOMETACRPL JNT
|
Facility
|
IP
|
$3,921.00
|
|
|
Service Code
|
HCPCS 26130
|
| Hospital Charge Code |
76100675
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$509.73 |
| Max. Negotiated Rate |
$3,764.16 |
| Rate for Payer: Aetna Commercial |
$3,019.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,058.38
|
| Rate for Payer: Cash Price |
$1,960.50
|
| Rate for Payer: Cigna Commercial |
$3,254.43
|
| Rate for Payer: First Health Commercial |
$3,724.95
|
| Rate for Payer: Humana Commercial |
$3,332.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,215.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,893.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,176.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,450.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,940.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$784.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$509.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,215.51
|
| Rate for Payer: PHCS Commercial |
$3,764.16
|
| Rate for Payer: United Healthcare All Payer |
$3,450.48
|
|
|
SYNOVIAL FL CELL CT/DIFF
|
Professional
|
Both
|
$92.00
|
|
|
Service Code
|
HCPCS 89051
|
| Hospital Charge Code |
30001543
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.11 |
| Max. Negotiated Rate |
$92.00 |
| Rate for Payer: Aetna Commercial |
$4.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$92.00
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cigna Commercial |
$4.80
|
| Rate for Payer: Healthspan PPO |
$5.77
|
| Rate for Payer: Multiplan PHCS |
$55.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$64.40
|
| Rate for Payer: UHCCP Medicaid |
$32.20
|
|
|
SYNOVIAL FL CELL CT/DIFF
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
HCPCS 89051
|
| Hospital Charge Code |
30001543
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.96 |
| Max. Negotiated Rate |
$88.32 |
| Rate for Payer: Aetna Commercial |
$70.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73.88
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: First Health Commercial |
$87.40
|
| Rate for Payer: Humana Commercial |
$78.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$75.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.96
|
| Rate for Payer: Ohio Health Group HMO |
$69.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.52
|
| Rate for Payer: PHCS Commercial |
$88.32
|
| Rate for Payer: United Healthcare All Payer |
$80.96
|
|
|
SYNOVIAL FL CELL CT/DIFF
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
HCPCS 89051
|
| Hospital Charge Code |
30001543
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$88.32 |
| Rate for Payer: Aetna Commercial |
$70.84
|
| Rate for Payer: Anthem Medicaid |
$31.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.60
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: First Health Commercial |
$87.40
|
| Rate for Payer: Humana Commercial |
$78.20
|
| Rate for Payer: Humana KY Medicaid |
$31.64
|
| Rate for Payer: Humana Medicare Advantage |
$5.60
|
| Rate for Payer: Kentucky WC Medicaid |
$31.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$75.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$32.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.96
|
| Rate for Payer: Ohio Health Group HMO |
$69.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.52
|
| Rate for Payer: PHCS Commercial |
$88.32
|
| Rate for Payer: United Healthcare All Payer |
$80.96
|
|
|
SYN POR 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 POR 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 POR 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 POR 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 POR 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 POR 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 POR 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 POR 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 POR 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 POR 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 POR 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 POR 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 POR 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
|
|
