|
SYN CEM HO 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 HO 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 HO FEM COMP SZ 11
|
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 HO FEM COMP SZ 11
|
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 HO 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 HO 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 HO 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 HO 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 HO 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 HO 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 HO FEM COMP SZ 15
|
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 HO FEM COMP SZ 15
|
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 HO 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 HO 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 HO 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 HO 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 HO FEM COMP SZ 9
|
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 HO FEM COMP SZ 9
|
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 SEL HO 11 10/12 SZ9
|
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 SEL HO 11 10/12 SZ9
|
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
|
|
|
SYNCH AUDIO-ONLY EST HIGH 40
|
Professional
|
Both
|
$315.00
|
|
|
Service Code
|
HCPCS 98015
|
| Hospital Charge Code |
96000049
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$110.25 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: Anthem Medicaid |
$111.77
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Humana Medicaid |
$111.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$114.01
|
| Rate for Payer: Molina Healthcare Passport |
$111.77
|
| Rate for Payer: Multiplan PHCS |
$189.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$220.50
|
| Rate for Payer: UHCCP Medicaid |
$110.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$112.89
|
|
|
SYNCH AUDIO-ONLY EST HIGH 40
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
HCPCS 98015
|
| Hospital Charge Code |
96000049
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$302.40 |
| Rate for Payer: Aetna Commercial |
$242.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$245.70
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna Commercial |
$261.45
|
| Rate for Payer: First Health Commercial |
$299.25
|
| Rate for Payer: Humana Commercial |
$267.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$258.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$232.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$277.20
|
| Rate for Payer: Ohio Health Group HMO |
$236.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$252.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$217.35
|
| Rate for Payer: PHCS Commercial |
$302.40
|
| Rate for Payer: United Healthcare All Payer |
$277.20
|
|
|
SYNCH AUDIO-ONLY EST HIGH 40
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 98015
|
| Hospital Charge Code |
96000049
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$302.40 |
| Rate for Payer: Aetna Commercial |
$242.55
|
| Rate for Payer: Anthem Medicaid |
$108.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$245.70
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna Commercial |
$261.45
|
| Rate for Payer: First Health Commercial |
$299.25
|
| Rate for Payer: Humana Commercial |
$267.75
|
| Rate for Payer: Humana KY Medicaid |
$108.33
|
| Rate for Payer: Kentucky WC Medicaid |
$109.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$258.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$232.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$110.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$277.20
|
| Rate for Payer: Ohio Health Group HMO |
$236.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$252.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$217.35
|
| Rate for Payer: PHCS Commercial |
$302.40
|
| Rate for Payer: United Healthcare All Payer |
$277.20
|
|
|
SYNCH AUDIO-ONLY EST LOW 20
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
HCPCS 98013
|
| Hospital Charge Code |
96000047
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$115.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$117.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$124.50
|
| Rate for Payer: First Health Commercial |
$142.50
|
| Rate for Payer: Humana Commercial |
$127.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$123.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$110.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$132.00
|
| Rate for Payer: Ohio Health Group HMO |
$112.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$103.50
|
| Rate for Payer: PHCS Commercial |
$144.00
|
| Rate for Payer: United Healthcare All Payer |
$132.00
|
|
|
SYNCH AUDIO-ONLY EST LOW 20
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 98013
|
| Hospital Charge Code |
96000047
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$52.49 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Anthem Medicaid |
$52.49
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Humana Medicaid |
$52.49
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$53.54
|
| Rate for Payer: Molina Healthcare Passport |
$52.49
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.00
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$53.01
|
|
