|
SYMMETRY 3*4*135
|
Facility
|
IP
|
$3,335.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,000.50 |
| Max. Negotiated Rate |
$3,201.60 |
| Rate for Payer: Aetna Commercial |
$2,567.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,601.30
|
| Rate for Payer: Cash Price |
$1,667.50
|
| Rate for Payer: Cigna Commercial |
$2,768.05
|
| Rate for Payer: First Health Commercial |
$3,168.25
|
| Rate for Payer: Humana Commercial |
$2,834.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,734.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,461.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,000.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,934.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,501.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,668.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,901.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,301.15
|
| Rate for Payer: PHCS Commercial |
$3,201.60
|
| Rate for Payer: United Healthcare All Payer |
$2,934.80
|
|
|
SYNAGIS 50MG 0.5ML VIAL
|
Facility
|
OP
|
$3,570.66
|
|
|
Service Code
|
HCPCS 90378
|
| Hospital Charge Code |
25000009
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$719.87 |
| Max. Negotiated Rate |
$3,427.83 |
| Rate for Payer: Aetna Commercial |
$2,749.41
|
| Rate for Payer: Anthem Medicaid |
$1,227.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$719.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,785.11
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,007.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$971.82
|
| Rate for Payer: Cash Price |
$1,785.33
|
| Rate for Payer: Cash Price |
$1,785.33
|
| Rate for Payer: Cigna Commercial |
$2,963.65
|
| Rate for Payer: First Health Commercial |
$3,392.13
|
| Rate for Payer: Humana Commercial |
$3,035.06
|
| Rate for Payer: Humana KY Medicaid |
$1,227.95
|
| Rate for Payer: Humana Medicare Advantage |
$719.87
|
| Rate for Payer: Kentucky WC Medicaid |
$1,240.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,927.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,635.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$863.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,252.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,142.18
|
| Rate for Payer: Ohio Health Group HMO |
$2,677.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,856.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,106.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,463.76
|
| Rate for Payer: PHCS Commercial |
$3,427.83
|
| Rate for Payer: United Healthcare All Payer |
$3,142.18
|
|
|
SYNAGIS 50MG 0.5ML VIAL
|
Facility
|
IP
|
$3,570.66
|
|
|
Service Code
|
HCPCS 90378
|
| Hospital Charge Code |
25000009
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,071.20 |
| Max. Negotiated Rate |
$3,427.83 |
| Rate for Payer: Aetna Commercial |
$2,749.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,785.11
|
| Rate for Payer: Cash Price |
$1,785.33
|
| Rate for Payer: Cigna Commercial |
$2,963.65
|
| Rate for Payer: First Health Commercial |
$3,392.13
|
| Rate for Payer: Humana Commercial |
$3,035.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,927.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,635.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,071.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,142.18
|
| Rate for Payer: Ohio Health Group HMO |
$2,677.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,856.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,106.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,463.76
|
| Rate for Payer: PHCS Commercial |
$3,427.83
|
| Rate for Payer: United Healthcare All Payer |
$3,142.18
|
|
|
SYNALAR(FLUOCINOLONG).024 15GM
|
Facility
|
IP
|
$11.95
|
|
|
Service Code
|
NDC 713022415
|
| Hospital Charge Code |
25003507
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$11.47 |
| Rate for Payer: Aetna Commercial |
$9.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.32
|
| Rate for Payer: Cash Price |
$5.97
|
| Rate for Payer: Cigna Commercial |
$9.92
|
| Rate for Payer: First Health Commercial |
$11.35
|
| Rate for Payer: Humana Commercial |
$10.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$10.52
|
| Rate for Payer: Ohio Health Group HMO |
$8.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.25
|
| Rate for Payer: PHCS Commercial |
$11.47
|
| Rate for Payer: United Healthcare All Payer |
$10.52
|
|
|
SYNALAR(FLUOCINOLONG).024 15GM
|
Facility
|
OP
|
$11.95
|
|
|
Service Code
|
NDC 713022415
|
| Hospital Charge Code |
25003507
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$11.47 |
| Rate for Payer: Aetna Commercial |
$9.20
|
| Rate for Payer: Anthem Medicaid |
$4.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.32
|
| Rate for Payer: Cash Price |
$5.97
|
| Rate for Payer: Cigna Commercial |
$9.92
|
| Rate for Payer: First Health Commercial |
$11.35
|
| Rate for Payer: Humana Commercial |
$10.16
|
| Rate for Payer: Humana KY Medicaid |
$4.11
|
| Rate for Payer: Kentucky WC Medicaid |
$4.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$10.52
|
| Rate for Payer: Ohio Health Group HMO |
$8.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.25
|
| Rate for Payer: PHCS Commercial |
$11.47
|
| Rate for Payer: United Healthcare All Payer |
$10.52
|
|
|
SYNATOMIC VARIBLE FIT TIB CLIP
|
Facility
|
OP
|
$3,916.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,174.88 |
| Max. Negotiated Rate |
$3,759.60 |
| Rate for Payer: Aetna Commercial |
$3,015.51
|
| Rate for Payer: Anthem Medicaid |
$1,346.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,054.68
|
| Rate for Payer: Cash Price |
$1,958.12
|
| Rate for Payer: Cigna Commercial |
$3,250.49
|
| Rate for Payer: First Health Commercial |
$3,720.44
|
| Rate for Payer: Humana Commercial |
$3,328.81
|
| Rate for Payer: Humana KY Medicaid |
$1,346.80
|
| Rate for Payer: Kentucky WC Medicaid |
$1,360.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,211.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,890.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,174.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,373.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,446.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,937.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,133.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,407.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,702.21
|
| Rate for Payer: PHCS Commercial |
$3,759.60
|
| Rate for Payer: United Healthcare All Payer |
$3,446.30
|
|
|
SYNATOMIC VARIBLE FIT TIB CLIP
|
Facility
|
IP
|
$3,916.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,174.88 |
| Max. Negotiated Rate |
$3,759.60 |
| Rate for Payer: Aetna Commercial |
$3,015.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,054.68
|
| Rate for Payer: Cash Price |
$1,958.12
|
| Rate for Payer: Cigna Commercial |
$3,250.49
|
| Rate for Payer: First Health Commercial |
$3,720.44
|
| Rate for Payer: Humana Commercial |
$3,328.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,211.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,890.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,174.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,446.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,937.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,133.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,407.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,702.21
|
| Rate for Payer: PHCS Commercial |
$3,759.60
|
| Rate for Payer: United Healthcare All Payer |
$3,446.30
|
|
|
SYN CEM FEM COMP SZ 10
|
Facility
|
IP
|
$7,745.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,323.50 |
| Max. Negotiated Rate |
$7,435.20 |
| Rate for Payer: Aetna Commercial |
$5,963.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,041.10
|
| Rate for Payer: Cash Price |
$3,872.50
|
| Rate for Payer: Cigna Commercial |
$6,428.35
|
| Rate for Payer: First Health Commercial |
$7,357.75
|
| Rate for Payer: Humana Commercial |
$6,583.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,350.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,715.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,323.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,815.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,808.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,738.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,344.05
|
| Rate for Payer: PHCS Commercial |
$7,435.20
|
| Rate for Payer: United Healthcare All Payer |
$6,815.60
|
|
|
SYN CEM FEM COMP SZ 10
|
Facility
|
OP
|
$7,745.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,323.50 |
| Max. Negotiated Rate |
$7,435.20 |
| Rate for Payer: Aetna Commercial |
$5,963.65
|
| Rate for Payer: Anthem Medicaid |
$2,663.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,041.10
|
| Rate for Payer: Cash Price |
$3,872.50
|
| Rate for Payer: Cigna Commercial |
$6,428.35
|
| Rate for Payer: First Health Commercial |
$7,357.75
|
| Rate for Payer: Humana Commercial |
$6,583.25
|
| Rate for Payer: Humana KY Medicaid |
$2,663.51
|
| Rate for Payer: Kentucky WC Medicaid |
$2,690.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,350.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,715.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,323.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,716.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,815.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,808.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,738.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,344.05
|
| Rate for Payer: PHCS Commercial |
$7,435.20
|
| Rate for Payer: United Healthcare All Payer |
$6,815.60
|
|
|
SYN CEM FEM COMP SZ 11
|
Facility
|
OP
|
$8,556.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,566.84 |
| Max. Negotiated Rate |
$8,213.89 |
| Rate for Payer: Aetna Commercial |
$6,588.23
|
| Rate for Payer: Anthem Medicaid |
$2,942.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,673.79
|
| Rate for Payer: Cash Price |
$4,278.07
|
| Rate for Payer: Cigna Commercial |
$7,101.60
|
| Rate for Payer: First Health Commercial |
$8,128.33
|
| Rate for Payer: Humana Commercial |
$7,272.72
|
| Rate for Payer: Humana KY Medicaid |
$2,942.46
|
| Rate for Payer: Kentucky WC Medicaid |
$2,972.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,016.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,314.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,566.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,001.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,529.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,417.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,844.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,443.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,903.74
|
| Rate for Payer: PHCS Commercial |
$8,213.89
|
| Rate for Payer: United Healthcare All Payer |
$7,529.40
|
|
|
SYN CEM FEM COMP SZ 11
|
Facility
|
IP
|
$8,556.14
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,566.84 |
| Max. Negotiated Rate |
$8,213.89 |
| Rate for Payer: Aetna Commercial |
$6,588.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,673.79
|
| Rate for Payer: Cash Price |
$4,278.07
|
| Rate for Payer: Cigna Commercial |
$7,101.60
|
| Rate for Payer: First Health Commercial |
$8,128.33
|
| Rate for Payer: Humana Commercial |
$7,272.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,016.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,314.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,566.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,529.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,417.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,844.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,443.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,903.74
|
| Rate for Payer: PHCS Commercial |
$8,213.89
|
| Rate for Payer: United Healthcare All Payer |
$7,529.40
|
|
|
SYN CEM FEM COMP SZ 12
|
Facility
|
OP
|
$7,745.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,323.50 |
| Max. Negotiated Rate |
$7,435.20 |
| Rate for Payer: Aetna Commercial |
$5,963.65
|
| Rate for Payer: Anthem Medicaid |
$2,663.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,041.10
|
| Rate for Payer: Cash Price |
$3,872.50
|
| Rate for Payer: Cigna Commercial |
$6,428.35
|
| Rate for Payer: First Health Commercial |
$7,357.75
|
| Rate for Payer: Humana Commercial |
$6,583.25
|
| Rate for Payer: Humana KY Medicaid |
$2,663.51
|
| Rate for Payer: Kentucky WC Medicaid |
$2,690.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,350.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,715.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,323.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,716.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,815.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,808.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,738.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,344.05
|
| Rate for Payer: PHCS Commercial |
$7,435.20
|
| Rate for Payer: United Healthcare All Payer |
$6,815.60
|
|
|
SYN CEM FEM COMP SZ 12
|
Facility
|
IP
|
$7,745.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,323.50 |
| Max. Negotiated Rate |
$7,435.20 |
| Rate for Payer: Aetna Commercial |
$5,963.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,041.10
|
| Rate for Payer: Cash Price |
$3,872.50
|
| Rate for Payer: Cigna Commercial |
$6,428.35
|
| Rate for Payer: First Health Commercial |
$7,357.75
|
| Rate for Payer: Humana Commercial |
$6,583.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,350.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,715.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,323.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,815.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,808.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,738.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,344.05
|
| Rate for Payer: PHCS Commercial |
$7,435.20
|
| Rate for Payer: United Healthcare All Payer |
$6,815.60
|
|
|
SYN CEM FEM COMP SZ 13
|
Facility
|
IP
|
$7,745.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,323.50 |
| Max. Negotiated Rate |
$7,435.20 |
| Rate for Payer: Aetna Commercial |
$5,963.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,041.10
|
| Rate for Payer: Cash Price |
$3,872.50
|
| Rate for Payer: Cigna Commercial |
$6,428.35
|
| Rate for Payer: First Health Commercial |
$7,357.75
|
| Rate for Payer: Humana Commercial |
$6,583.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,350.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,715.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,323.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,815.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,808.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,738.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,344.05
|
| Rate for Payer: PHCS Commercial |
$7,435.20
|
| Rate for Payer: United Healthcare All Payer |
$6,815.60
|
|
|
SYN CEM FEM COMP SZ 13
|
Facility
|
OP
|
$7,745.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,323.50 |
| Max. Negotiated Rate |
$7,435.20 |
| Rate for Payer: Aetna Commercial |
$5,963.65
|
| Rate for Payer: Anthem Medicaid |
$2,663.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,041.10
|
| Rate for Payer: Cash Price |
$3,872.50
|
| Rate for Payer: Cigna Commercial |
$6,428.35
|
| Rate for Payer: First Health Commercial |
$7,357.75
|
| Rate for Payer: Humana Commercial |
$6,583.25
|
| Rate for Payer: Humana KY Medicaid |
$2,663.51
|
| Rate for Payer: Kentucky WC Medicaid |
$2,690.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,350.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,715.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,323.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,716.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,815.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,808.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,738.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,344.05
|
| Rate for Payer: PHCS Commercial |
$7,435.20
|
| Rate for Payer: United Healthcare All Payer |
$6,815.60
|
|
|
SYN CEM FEM COMP SZ 14
|
Facility
|
OP
|
$7,745.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,323.50 |
| Max. Negotiated Rate |
$7,435.20 |
| Rate for Payer: Aetna Commercial |
$5,963.65
|
| Rate for Payer: Anthem Medicaid |
$2,663.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,041.10
|
| Rate for Payer: Cash Price |
$3,872.50
|
| Rate for Payer: Cigna Commercial |
$6,428.35
|
| Rate for Payer: First Health Commercial |
$7,357.75
|
| Rate for Payer: Humana Commercial |
$6,583.25
|
| Rate for Payer: Humana KY Medicaid |
$2,663.51
|
| Rate for Payer: Kentucky WC Medicaid |
$2,690.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,350.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,715.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,323.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,716.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,815.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,808.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,738.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,344.05
|
| Rate for Payer: PHCS Commercial |
$7,435.20
|
| Rate for Payer: United Healthcare All Payer |
$6,815.60
|
|
|
SYN CEM FEM COMP SZ 14
|
Facility
|
IP
|
$7,745.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,323.50 |
| Max. Negotiated Rate |
$7,435.20 |
| Rate for Payer: Aetna Commercial |
$5,963.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,041.10
|
| Rate for Payer: Cash Price |
$3,872.50
|
| Rate for Payer: Cigna Commercial |
$6,428.35
|
| Rate for Payer: First Health Commercial |
$7,357.75
|
| Rate for Payer: Humana Commercial |
$6,583.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,350.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,715.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,323.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,815.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,808.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,738.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,344.05
|
| Rate for Payer: PHCS Commercial |
$7,435.20
|
| Rate for Payer: United Healthcare All Payer |
$6,815.60
|
|
|
SYN CEM FEM COMP SZ 15
|
Facility
|
IP
|
$7,745.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,323.50 |
| Max. Negotiated Rate |
$7,435.20 |
| Rate for Payer: Aetna Commercial |
$5,963.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,041.10
|
| Rate for Payer: Cash Price |
$3,872.50
|
| Rate for Payer: Cigna Commercial |
$6,428.35
|
| Rate for Payer: First Health Commercial |
$7,357.75
|
| Rate for Payer: Humana Commercial |
$6,583.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,350.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,715.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,323.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,815.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,808.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,738.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,344.05
|
| Rate for Payer: PHCS Commercial |
$7,435.20
|
| Rate for Payer: United Healthcare All Payer |
$6,815.60
|
|
|
SYN CEM FEM COMP SZ 15
|
Facility
|
OP
|
$7,745.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,323.50 |
| Max. Negotiated Rate |
$7,435.20 |
| Rate for Payer: Aetna Commercial |
$5,963.65
|
| Rate for Payer: Anthem Medicaid |
$2,663.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,041.10
|
| Rate for Payer: Cash Price |
$3,872.50
|
| Rate for Payer: Cigna Commercial |
$6,428.35
|
| Rate for Payer: First Health Commercial |
$7,357.75
|
| Rate for Payer: Humana Commercial |
$6,583.25
|
| Rate for Payer: Humana KY Medicaid |
$2,663.51
|
| Rate for Payer: Kentucky WC Medicaid |
$2,690.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,350.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,715.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,323.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,716.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,815.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,808.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,738.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,344.05
|
| Rate for Payer: PHCS Commercial |
$7,435.20
|
| Rate for Payer: United Healthcare All Payer |
$6,815.60
|
|
|
SYN CEM FEM COMP SZ 16
|
Facility
|
IP
|
$7,745.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,323.50 |
| Max. Negotiated Rate |
$7,435.20 |
| Rate for Payer: Aetna Commercial |
$5,963.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,041.10
|
| Rate for Payer: Cash Price |
$3,872.50
|
| Rate for Payer: Cigna Commercial |
$6,428.35
|
| Rate for Payer: First Health Commercial |
$7,357.75
|
| Rate for Payer: Humana Commercial |
$6,583.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,350.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,715.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,323.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,815.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,808.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,738.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,344.05
|
| Rate for Payer: PHCS Commercial |
$7,435.20
|
| Rate for Payer: United Healthcare All Payer |
$6,815.60
|
|
|
SYN CEM FEM COMP SZ 16
|
Facility
|
OP
|
$7,745.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,323.50 |
| Max. Negotiated Rate |
$7,435.20 |
| Rate for Payer: Aetna Commercial |
$5,963.65
|
| Rate for Payer: Anthem Medicaid |
$2,663.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,041.10
|
| Rate for Payer: Cash Price |
$3,872.50
|
| Rate for Payer: Cigna Commercial |
$6,428.35
|
| Rate for Payer: First Health Commercial |
$7,357.75
|
| Rate for Payer: Humana Commercial |
$6,583.25
|
| Rate for Payer: Humana KY Medicaid |
$2,663.51
|
| Rate for Payer: Kentucky WC Medicaid |
$2,690.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,350.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,715.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,323.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,716.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,815.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,808.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,738.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,344.05
|
| Rate for Payer: PHCS Commercial |
$7,435.20
|
| Rate for Payer: United Healthcare All Payer |
$6,815.60
|
|
|
SYN CEM FEM COMP SZ 17
|
Facility
|
OP
|
$7,745.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,323.50 |
| Max. Negotiated Rate |
$7,435.20 |
| Rate for Payer: Aetna Commercial |
$5,963.65
|
| Rate for Payer: Anthem Medicaid |
$2,663.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,041.10
|
| Rate for Payer: Cash Price |
$3,872.50
|
| Rate for Payer: Cigna Commercial |
$6,428.35
|
| Rate for Payer: First Health Commercial |
$7,357.75
|
| Rate for Payer: Humana Commercial |
$6,583.25
|
| Rate for Payer: Humana KY Medicaid |
$2,663.51
|
| Rate for Payer: Kentucky WC Medicaid |
$2,690.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,350.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,715.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,323.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,716.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,815.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,808.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,738.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,344.05
|
| Rate for Payer: PHCS Commercial |
$7,435.20
|
| Rate for Payer: United Healthcare All Payer |
$6,815.60
|
|
|
SYN CEM FEM COMP SZ 17
|
Facility
|
IP
|
$7,745.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,323.50 |
| Max. Negotiated Rate |
$7,435.20 |
| Rate for Payer: Aetna Commercial |
$5,963.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,041.10
|
| Rate for Payer: Cash Price |
$3,872.50
|
| Rate for Payer: Cigna Commercial |
$6,428.35
|
| Rate for Payer: First Health Commercial |
$7,357.75
|
| Rate for Payer: Humana Commercial |
$6,583.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,350.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,715.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,323.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,815.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,808.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,738.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,344.05
|
| Rate for Payer: PHCS Commercial |
$7,435.20
|
| Rate for Payer: United Healthcare All Payer |
$6,815.60
|
|
|
SYN CEM FEM COMP SZ 9
|
Facility
|
OP
|
$12,382.87
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,714.86 |
| Max. Negotiated Rate |
$11,887.56 |
| Rate for Payer: Aetna Commercial |
$9,534.81
|
| Rate for Payer: Anthem Medicaid |
$4,258.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,658.64
|
| Rate for Payer: Cash Price |
$6,191.43
|
| Rate for Payer: Cigna Commercial |
$10,277.78
|
| Rate for Payer: First Health Commercial |
$11,763.73
|
| Rate for Payer: Humana Commercial |
$10,525.44
|
| Rate for Payer: Humana KY Medicaid |
$4,258.47
|
| Rate for Payer: Kentucky WC Medicaid |
$4,301.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,153.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,138.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,714.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,343.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,896.93
|
| Rate for Payer: Ohio Health Group HMO |
$9,287.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,906.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,773.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,544.18
|
| Rate for Payer: PHCS Commercial |
$11,887.56
|
| Rate for Payer: United Healthcare All Payer |
$10,896.93
|
|
|
SYN CEM FEM COMP SZ 9
|
Facility
|
IP
|
$12,382.87
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,714.86 |
| Max. Negotiated Rate |
$11,887.56 |
| Rate for Payer: Aetna Commercial |
$9,534.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,658.64
|
| Rate for Payer: Cash Price |
$6,191.43
|
| Rate for Payer: Cigna Commercial |
$10,277.78
|
| Rate for Payer: First Health Commercial |
$11,763.73
|
| Rate for Payer: Humana Commercial |
$10,525.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,153.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,138.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,714.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,896.93
|
| Rate for Payer: Ohio Health Group HMO |
$9,287.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,906.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,773.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,544.18
|
| Rate for Payer: PHCS Commercial |
$11,887.56
|
| Rate for Payer: United Healthcare All Payer |
$10,896.93
|
|
