|
SYN POR HO FEM COM 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 POR HO FEM COM 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 POR HO FEM COM 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 POR HO FEM COM 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
|
|
|
SYN POR PLUS HA HO STEM SZ 10
|
Facility
|
IP
|
$18,402.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,392.26 |
| Max. Negotiated Rate |
$17,665.92 |
| Rate for Payer: Aetna Commercial |
$14,169.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,353.56
|
| Rate for Payer: Cash Price |
$9,201.00
|
| Rate for Payer: Cigna Commercial |
$15,273.66
|
| Rate for Payer: First Health Commercial |
$17,481.90
|
| Rate for Payer: Humana Commercial |
$15,641.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,089.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,580.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,520.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,193.76
|
| Rate for Payer: Ohio Health Group HMO |
$13,801.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,680.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,392.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,704.62
|
| Rate for Payer: PHCS Commercial |
$17,665.92
|
| Rate for Payer: United Healthcare All Payer |
$16,193.76
|
|
|
SYN POR PLUS HA HO STEM SZ 10
|
Facility
|
OP
|
$18,402.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,392.26 |
| Max. Negotiated Rate |
$17,665.92 |
| Rate for Payer: Aetna Commercial |
$14,169.54
|
| Rate for Payer: Anthem Medicaid |
$6,328.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,353.56
|
| Rate for Payer: Cash Price |
$9,201.00
|
| Rate for Payer: Cigna Commercial |
$15,273.66
|
| Rate for Payer: First Health Commercial |
$17,481.90
|
| Rate for Payer: Humana Commercial |
$15,641.70
|
| Rate for Payer: Humana KY Medicaid |
$6,328.45
|
| Rate for Payer: Kentucky WC Medicaid |
$6,392.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,089.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,580.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,520.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,455.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,193.76
|
| Rate for Payer: Ohio Health Group HMO |
$13,801.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,680.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,392.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,704.62
|
| Rate for Payer: PHCS Commercial |
$17,665.92
|
| Rate for Payer: United Healthcare All Payer |
$16,193.76
|
|
|
SYN POR PLUS HA HO STEM SZ 11
|
Facility
|
IP
|
$22,613.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,939.73 |
| Max. Negotiated Rate |
$21,708.75 |
| Rate for Payer: Aetna Commercial |
$17,412.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,638.36
|
| Rate for Payer: Cash Price |
$11,306.64
|
| Rate for Payer: Cigna Commercial |
$18,769.02
|
| Rate for Payer: First Health Commercial |
$21,482.62
|
| Rate for Payer: Humana Commercial |
$19,221.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,542.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,688.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,783.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,899.69
|
| Rate for Payer: Ohio Health Group HMO |
$16,959.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,522.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,939.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,010.12
|
| Rate for Payer: PHCS Commercial |
$21,708.75
|
| Rate for Payer: United Healthcare All Payer |
$19,899.69
|
|
|
SYN POR PLUS HA HO STEM SZ 11
|
Facility
|
OP
|
$22,613.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,939.73 |
| Max. Negotiated Rate |
$21,708.75 |
| Rate for Payer: Aetna Commercial |
$17,412.23
|
| Rate for Payer: Anthem Medicaid |
$7,776.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,638.36
|
| Rate for Payer: Cash Price |
$11,306.64
|
| Rate for Payer: Cigna Commercial |
$18,769.02
|
| Rate for Payer: First Health Commercial |
$21,482.62
|
| Rate for Payer: Humana Commercial |
$19,221.29
|
| Rate for Payer: Humana KY Medicaid |
$7,776.71
|
| Rate for Payer: Kentucky WC Medicaid |
$7,855.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,542.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,688.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,783.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,932.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,899.69
|
| Rate for Payer: Ohio Health Group HMO |
$16,959.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,522.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,939.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,010.12
|
| Rate for Payer: PHCS Commercial |
$21,708.75
|
| Rate for Payer: United Healthcare All Payer |
$19,899.69
|
|
|
SYN POR PLUS HA HO STEM SZ 12
|
Facility
|
IP
|
$9,735.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,265.55 |
| Max. Negotiated Rate |
$9,345.60 |
| Rate for Payer: Aetna Commercial |
$7,495.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,593.30
|
| Rate for Payer: Cash Price |
$4,867.50
|
| Rate for Payer: Cigna Commercial |
$8,080.05
|
| Rate for Payer: First Health Commercial |
$9,248.25
|
| Rate for Payer: Humana Commercial |
$8,274.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,982.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,184.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,920.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,566.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,301.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,947.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,265.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,017.85
|
| Rate for Payer: PHCS Commercial |
$9,345.60
|
| Rate for Payer: United Healthcare All Payer |
$8,566.80
|
|
|
SYN POR PLUS HA HO STEM SZ 12
|
Facility
|
OP
|
$9,735.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,265.55 |
| Max. Negotiated Rate |
$9,345.60 |
| Rate for Payer: Aetna Commercial |
$7,495.95
|
| Rate for Payer: Anthem Medicaid |
$3,347.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,593.30
|
| Rate for Payer: Cash Price |
$4,867.50
|
| Rate for Payer: Cigna Commercial |
$8,080.05
|
| Rate for Payer: First Health Commercial |
$9,248.25
|
| Rate for Payer: Humana Commercial |
$8,274.75
|
| Rate for Payer: Humana KY Medicaid |
$3,347.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,381.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,982.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,184.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,920.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,415.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,566.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,301.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,947.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,265.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,017.85
|
| Rate for Payer: PHCS Commercial |
$9,345.60
|
| Rate for Payer: United Healthcare All Payer |
$8,566.80
|
|
|
SYN POR PLUS HA HO STEM SZ 13
|
Facility
|
OP
|
$22,613.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,939.73 |
| Max. Negotiated Rate |
$21,708.75 |
| Rate for Payer: Aetna Commercial |
$17,412.23
|
| Rate for Payer: Anthem Medicaid |
$7,776.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,638.36
|
| Rate for Payer: Cash Price |
$11,306.64
|
| Rate for Payer: Cigna Commercial |
$18,769.02
|
| Rate for Payer: First Health Commercial |
$21,482.62
|
| Rate for Payer: Humana Commercial |
$19,221.29
|
| Rate for Payer: Humana KY Medicaid |
$7,776.71
|
| Rate for Payer: Kentucky WC Medicaid |
$7,855.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,542.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,688.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,783.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,932.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,899.69
|
| Rate for Payer: Ohio Health Group HMO |
$16,959.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,522.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,939.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,010.12
|
| Rate for Payer: PHCS Commercial |
$21,708.75
|
| Rate for Payer: United Healthcare All Payer |
$19,899.69
|
|
|
SYN POR PLUS HA HO STEM SZ 13
|
Facility
|
IP
|
$22,613.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,939.73 |
| Max. Negotiated Rate |
$21,708.75 |
| Rate for Payer: Aetna Commercial |
$17,412.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,638.36
|
| Rate for Payer: Cash Price |
$11,306.64
|
| Rate for Payer: Cigna Commercial |
$18,769.02
|
| Rate for Payer: First Health Commercial |
$21,482.62
|
| Rate for Payer: Humana Commercial |
$19,221.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,542.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,688.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,783.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,899.69
|
| Rate for Payer: Ohio Health Group HMO |
$16,959.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,522.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,939.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,010.12
|
| Rate for Payer: PHCS Commercial |
$21,708.75
|
| Rate for Payer: United Healthcare All Payer |
$19,899.69
|
|
|
SYN POR PLUS HA HO STEM SZ 14
|
Facility
|
OP
|
$9,735.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,265.55 |
| Max. Negotiated Rate |
$9,345.60 |
| Rate for Payer: Aetna Commercial |
$7,495.95
|
| Rate for Payer: Anthem Medicaid |
$3,347.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,593.30
|
| Rate for Payer: Cash Price |
$4,867.50
|
| Rate for Payer: Cigna Commercial |
$8,080.05
|
| Rate for Payer: First Health Commercial |
$9,248.25
|
| Rate for Payer: Humana Commercial |
$8,274.75
|
| Rate for Payer: Humana KY Medicaid |
$3,347.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,381.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,982.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,184.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,920.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,415.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,566.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,301.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,947.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,265.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,017.85
|
| Rate for Payer: PHCS Commercial |
$9,345.60
|
| Rate for Payer: United Healthcare All Payer |
$8,566.80
|
|
|
SYN POR PLUS HA HO STEM SZ 14
|
Facility
|
IP
|
$9,735.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,265.55 |
| Max. Negotiated Rate |
$9,345.60 |
| Rate for Payer: Aetna Commercial |
$7,495.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,593.30
|
| Rate for Payer: Cash Price |
$4,867.50
|
| Rate for Payer: Cigna Commercial |
$8,080.05
|
| Rate for Payer: First Health Commercial |
$9,248.25
|
| Rate for Payer: Humana Commercial |
$8,274.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,982.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,184.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,920.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,566.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,301.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,947.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,265.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,017.85
|
| Rate for Payer: PHCS Commercial |
$9,345.60
|
| Rate for Payer: United Healthcare All Payer |
$8,566.80
|
|
|
SYN POR PLUS HA HO STEM SZ 15
|
Facility
|
OP
|
$9,735.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,265.55 |
| Max. Negotiated Rate |
$9,345.60 |
| Rate for Payer: Aetna Commercial |
$7,495.95
|
| Rate for Payer: Anthem Medicaid |
$3,347.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,593.30
|
| Rate for Payer: Cash Price |
$4,867.50
|
| Rate for Payer: Cigna Commercial |
$8,080.05
|
| Rate for Payer: First Health Commercial |
$9,248.25
|
| Rate for Payer: Humana Commercial |
$8,274.75
|
| Rate for Payer: Humana KY Medicaid |
$3,347.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,381.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,982.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,184.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,920.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,415.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,566.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,301.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,947.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,265.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,017.85
|
| Rate for Payer: PHCS Commercial |
$9,345.60
|
| Rate for Payer: United Healthcare All Payer |
$8,566.80
|
|
|
SYN POR PLUS HA HO STEM SZ 15
|
Facility
|
IP
|
$9,735.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,265.55 |
| Max. Negotiated Rate |
$9,345.60 |
| Rate for Payer: Aetna Commercial |
$7,495.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,593.30
|
| Rate for Payer: Cash Price |
$4,867.50
|
| Rate for Payer: Cigna Commercial |
$8,080.05
|
| Rate for Payer: First Health Commercial |
$9,248.25
|
| Rate for Payer: Humana Commercial |
$8,274.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,982.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,184.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,920.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,566.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,301.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,947.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,265.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,017.85
|
| Rate for Payer: PHCS Commercial |
$9,345.60
|
| Rate for Payer: United Healthcare All Payer |
$8,566.80
|
|
|
SYN POR PLUS HA HO STEM SZ 16
|
Facility
|
OP
|
$9,735.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,265.55 |
| Max. Negotiated Rate |
$9,345.60 |
| Rate for Payer: Aetna Commercial |
$7,495.95
|
| Rate for Payer: Anthem Medicaid |
$3,347.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,593.30
|
| Rate for Payer: Cash Price |
$4,867.50
|
| Rate for Payer: Cigna Commercial |
$8,080.05
|
| Rate for Payer: First Health Commercial |
$9,248.25
|
| Rate for Payer: Humana Commercial |
$8,274.75
|
| Rate for Payer: Humana KY Medicaid |
$3,347.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,381.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,982.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,184.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,920.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,415.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,566.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,301.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,947.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,265.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,017.85
|
| Rate for Payer: PHCS Commercial |
$9,345.60
|
| Rate for Payer: United Healthcare All Payer |
$8,566.80
|
|
|
SYN POR PLUS HA HO STEM SZ 16
|
Facility
|
IP
|
$9,735.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,265.55 |
| Max. Negotiated Rate |
$9,345.60 |
| Rate for Payer: Aetna Commercial |
$7,495.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,593.30
|
| Rate for Payer: Cash Price |
$4,867.50
|
| Rate for Payer: Cigna Commercial |
$8,080.05
|
| Rate for Payer: First Health Commercial |
$9,248.25
|
| Rate for Payer: Humana Commercial |
$8,274.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,982.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,184.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,920.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,566.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,301.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,947.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,265.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,017.85
|
| Rate for Payer: PHCS Commercial |
$9,345.60
|
| Rate for Payer: United Healthcare All Payer |
$8,566.80
|
|
|
SYN POR PLUS HA HO STEM SZ 17
|
Facility
|
IP
|
$22,613.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,939.73 |
| Max. Negotiated Rate |
$21,708.75 |
| Rate for Payer: Aetna Commercial |
$17,412.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,638.36
|
| Rate for Payer: Cash Price |
$11,306.64
|
| Rate for Payer: Cigna Commercial |
$18,769.02
|
| Rate for Payer: First Health Commercial |
$21,482.62
|
| Rate for Payer: Humana Commercial |
$19,221.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,542.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,688.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,783.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,899.69
|
| Rate for Payer: Ohio Health Group HMO |
$16,959.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,522.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,939.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,010.12
|
| Rate for Payer: PHCS Commercial |
$21,708.75
|
| Rate for Payer: United Healthcare All Payer |
$19,899.69
|
|
|
SYN POR PLUS HA HO STEM SZ 17
|
Facility
|
OP
|
$22,613.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,939.73 |
| Max. Negotiated Rate |
$21,708.75 |
| Rate for Payer: Aetna Commercial |
$17,412.23
|
| Rate for Payer: Anthem Medicaid |
$7,776.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,638.36
|
| Rate for Payer: Cash Price |
$11,306.64
|
| Rate for Payer: Cigna Commercial |
$18,769.02
|
| Rate for Payer: First Health Commercial |
$21,482.62
|
| Rate for Payer: Humana Commercial |
$19,221.29
|
| Rate for Payer: Humana KY Medicaid |
$7,776.71
|
| Rate for Payer: Kentucky WC Medicaid |
$7,855.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,542.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,688.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,783.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,932.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,899.69
|
| Rate for Payer: Ohio Health Group HMO |
$16,959.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,522.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,939.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,010.12
|
| Rate for Payer: PHCS Commercial |
$21,708.75
|
| Rate for Payer: United Healthcare All Payer |
$19,899.69
|
|
|
SYN POR PLUS HA HO STEM SZ 18
|
Facility
|
OP
|
$9,735.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,265.55 |
| Max. Negotiated Rate |
$9,345.60 |
| Rate for Payer: Aetna Commercial |
$7,495.95
|
| Rate for Payer: Anthem Medicaid |
$3,347.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,593.30
|
| Rate for Payer: Cash Price |
$4,867.50
|
| Rate for Payer: Cigna Commercial |
$8,080.05
|
| Rate for Payer: First Health Commercial |
$9,248.25
|
| Rate for Payer: Humana Commercial |
$8,274.75
|
| Rate for Payer: Humana KY Medicaid |
$3,347.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,381.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,982.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,184.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,920.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,415.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,566.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,301.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,947.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,265.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,017.85
|
| Rate for Payer: PHCS Commercial |
$9,345.60
|
| Rate for Payer: United Healthcare All Payer |
$8,566.80
|
|
|
SYN POR PLUS HA HO STEM SZ 18
|
Facility
|
IP
|
$9,735.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,265.55 |
| Max. Negotiated Rate |
$9,345.60 |
| Rate for Payer: Aetna Commercial |
$7,495.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,593.30
|
| Rate for Payer: Cash Price |
$4,867.50
|
| Rate for Payer: Cigna Commercial |
$8,080.05
|
| Rate for Payer: First Health Commercial |
$9,248.25
|
| Rate for Payer: Humana Commercial |
$8,274.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,982.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,184.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,920.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,566.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,301.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,947.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,265.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,017.85
|
| Rate for Payer: PHCS Commercial |
$9,345.60
|
| Rate for Payer: United Healthcare All Payer |
$8,566.80
|
|
|
SYN POR PLUS HA HO STEM SZ 9
|
Facility
|
IP
|
$18,402.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,392.26 |
| Max. Negotiated Rate |
$17,665.92 |
| Rate for Payer: Aetna Commercial |
$14,169.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,353.56
|
| Rate for Payer: Cash Price |
$9,201.00
|
| Rate for Payer: Cigna Commercial |
$15,273.66
|
| Rate for Payer: First Health Commercial |
$17,481.90
|
| Rate for Payer: Humana Commercial |
$15,641.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,089.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,580.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,520.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,193.76
|
| Rate for Payer: Ohio Health Group HMO |
$13,801.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,680.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,392.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,704.62
|
| Rate for Payer: PHCS Commercial |
$17,665.92
|
| Rate for Payer: United Healthcare All Payer |
$16,193.76
|
|
|
SYN POR PLUS HA HO STEM SZ 9
|
Facility
|
OP
|
$18,402.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,392.26 |
| Max. Negotiated Rate |
$17,665.92 |
| Rate for Payer: Aetna Commercial |
$14,169.54
|
| Rate for Payer: Anthem Medicaid |
$6,328.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,353.56
|
| Rate for Payer: Cash Price |
$9,201.00
|
| Rate for Payer: Cigna Commercial |
$15,273.66
|
| Rate for Payer: First Health Commercial |
$17,481.90
|
| Rate for Payer: Humana Commercial |
$15,641.70
|
| Rate for Payer: Humana KY Medicaid |
$6,328.45
|
| Rate for Payer: Kentucky WC Medicaid |
$6,392.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,089.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,580.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,520.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,455.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,193.76
|
| Rate for Payer: Ohio Health Group HMO |
$13,801.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,680.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,392.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,704.62
|
| Rate for Payer: PHCS Commercial |
$17,665.92
|
| Rate for Payer: United Healthcare All Payer |
$16,193.76
|
|
|
SYN POR PLUS HA SO STEM SZ 10
|
Facility
|
OP
|
$9,735.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,265.55 |
| Max. Negotiated Rate |
$9,345.60 |
| Rate for Payer: Aetna Commercial |
$7,495.95
|
| Rate for Payer: Anthem Medicaid |
$3,347.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,593.30
|
| Rate for Payer: Cash Price |
$4,867.50
|
| Rate for Payer: Cigna Commercial |
$8,080.05
|
| Rate for Payer: First Health Commercial |
$9,248.25
|
| Rate for Payer: Humana Commercial |
$8,274.75
|
| Rate for Payer: Humana KY Medicaid |
$3,347.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,381.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,982.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,184.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,920.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,415.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,566.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,301.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,947.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,265.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,017.85
|
| Rate for Payer: PHCS Commercial |
$9,345.60
|
| Rate for Payer: United Healthcare All Payer |
$8,566.80
|
|
