|
SYN HA HO PRESFIT FEM CMP SZ18
|
Facility
|
OP
|
$24,746.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,423.97 |
| Max. Negotiated Rate |
$23,756.70 |
| Rate for Payer: Aetna Commercial |
$19,054.85
|
| Rate for Payer: Anthem Medicaid |
$8,510.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,302.32
|
| Rate for Payer: Cash Price |
$12,373.28
|
| Rate for Payer: Cigna Commercial |
$20,539.64
|
| Rate for Payer: First Health Commercial |
$23,509.23
|
| Rate for Payer: Humana Commercial |
$21,034.58
|
| Rate for Payer: Humana KY Medicaid |
$8,510.34
|
| Rate for Payer: Kentucky WC Medicaid |
$8,596.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,292.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,262.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,681.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,776.97
|
| Rate for Payer: Ohio Health Group HMO |
$18,559.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,797.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,529.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,075.13
|
| Rate for Payer: PHCS Commercial |
$23,756.70
|
| Rate for Payer: United Healthcare All Payer |
$21,776.97
|
|
|
SYN HA HO PRESFIT FEM COMP SZ9
|
Facility
|
IP
|
$24,746.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,423.97 |
| Max. Negotiated Rate |
$23,756.70 |
| Rate for Payer: Aetna Commercial |
$19,054.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,302.32
|
| Rate for Payer: Cash Price |
$12,373.28
|
| Rate for Payer: Cigna Commercial |
$20,539.64
|
| Rate for Payer: First Health Commercial |
$23,509.23
|
| Rate for Payer: Humana Commercial |
$21,034.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,292.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,262.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,776.97
|
| Rate for Payer: Ohio Health Group HMO |
$18,559.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,797.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,529.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,075.13
|
| Rate for Payer: PHCS Commercial |
$23,756.70
|
| Rate for Payer: United Healthcare All Payer |
$21,776.97
|
|
|
SYN HA HO PRESFIT FEM COMP SZ9
|
Facility
|
OP
|
$24,746.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,423.97 |
| Max. Negotiated Rate |
$23,756.70 |
| Rate for Payer: Aetna Commercial |
$19,054.85
|
| Rate for Payer: Anthem Medicaid |
$8,510.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,302.32
|
| Rate for Payer: Cash Price |
$12,373.28
|
| Rate for Payer: Cigna Commercial |
$20,539.64
|
| Rate for Payer: First Health Commercial |
$23,509.23
|
| Rate for Payer: Humana Commercial |
$21,034.58
|
| Rate for Payer: Humana KY Medicaid |
$8,510.34
|
| Rate for Payer: Kentucky WC Medicaid |
$8,596.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,292.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,262.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,681.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,776.97
|
| Rate for Payer: Ohio Health Group HMO |
$18,559.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,797.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,529.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,075.13
|
| Rate for Payer: PHCS Commercial |
$23,756.70
|
| Rate for Payer: United Healthcare All Payer |
$21,776.97
|
|
|
SYN HA PF FEM COMP SZ 10
|
Facility
|
IP
|
$24,746.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,423.97 |
| Max. Negotiated Rate |
$23,756.70 |
| Rate for Payer: Aetna Commercial |
$19,054.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,302.32
|
| Rate for Payer: Cash Price |
$12,373.28
|
| Rate for Payer: Cigna Commercial |
$20,539.64
|
| Rate for Payer: First Health Commercial |
$23,509.23
|
| Rate for Payer: Humana Commercial |
$21,034.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,292.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,262.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,776.97
|
| Rate for Payer: Ohio Health Group HMO |
$18,559.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,797.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,529.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,075.13
|
| Rate for Payer: PHCS Commercial |
$23,756.70
|
| Rate for Payer: United Healthcare All Payer |
$21,776.97
|
|
|
SYN HA PF FEM COMP SZ 10
|
Facility
|
OP
|
$24,746.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,423.97 |
| Max. Negotiated Rate |
$23,756.70 |
| Rate for Payer: Aetna Commercial |
$19,054.85
|
| Rate for Payer: Anthem Medicaid |
$8,510.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,302.32
|
| Rate for Payer: Cash Price |
$12,373.28
|
| Rate for Payer: Cigna Commercial |
$20,539.64
|
| Rate for Payer: First Health Commercial |
$23,509.23
|
| Rate for Payer: Humana Commercial |
$21,034.58
|
| Rate for Payer: Humana KY Medicaid |
$8,510.34
|
| Rate for Payer: Kentucky WC Medicaid |
$8,596.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,292.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,262.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,681.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,776.97
|
| Rate for Payer: Ohio Health Group HMO |
$18,559.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,797.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,529.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,075.13
|
| Rate for Payer: PHCS Commercial |
$23,756.70
|
| Rate for Payer: United Healthcare All Payer |
$21,776.97
|
|
|
SYN HA PF FEM COMP SZ 11
|
Facility
|
OP
|
$24,746.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,423.97 |
| Max. Negotiated Rate |
$23,756.70 |
| Rate for Payer: Aetna Commercial |
$19,054.85
|
| Rate for Payer: Anthem Medicaid |
$8,510.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,302.32
|
| Rate for Payer: Cash Price |
$12,373.28
|
| Rate for Payer: Cigna Commercial |
$20,539.64
|
| Rate for Payer: First Health Commercial |
$23,509.23
|
| Rate for Payer: Humana Commercial |
$21,034.58
|
| Rate for Payer: Humana KY Medicaid |
$8,510.34
|
| Rate for Payer: Kentucky WC Medicaid |
$8,596.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,292.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,262.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,681.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,776.97
|
| Rate for Payer: Ohio Health Group HMO |
$18,559.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,797.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,529.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,075.13
|
| Rate for Payer: PHCS Commercial |
$23,756.70
|
| Rate for Payer: United Healthcare All Payer |
$21,776.97
|
|
|
SYN HA PF FEM COMP SZ 11
|
Facility
|
IP
|
$24,746.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,423.97 |
| Max. Negotiated Rate |
$23,756.70 |
| Rate for Payer: Aetna Commercial |
$19,054.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,302.32
|
| Rate for Payer: Cash Price |
$12,373.28
|
| Rate for Payer: Cigna Commercial |
$20,539.64
|
| Rate for Payer: First Health Commercial |
$23,509.23
|
| Rate for Payer: Humana Commercial |
$21,034.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,292.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,262.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,776.97
|
| Rate for Payer: Ohio Health Group HMO |
$18,559.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,797.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,529.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,075.13
|
| Rate for Payer: PHCS Commercial |
$23,756.70
|
| Rate for Payer: United Healthcare All Payer |
$21,776.97
|
|
|
SYN HA PF FEM COMP SZ 12
|
Facility
|
OP
|
$24,746.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,423.97 |
| Max. Negotiated Rate |
$23,756.70 |
| Rate for Payer: Aetna Commercial |
$19,054.85
|
| Rate for Payer: Anthem Medicaid |
$8,510.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,302.32
|
| Rate for Payer: Cash Price |
$12,373.28
|
| Rate for Payer: Cigna Commercial |
$20,539.64
|
| Rate for Payer: First Health Commercial |
$23,509.23
|
| Rate for Payer: Humana Commercial |
$21,034.58
|
| Rate for Payer: Humana KY Medicaid |
$8,510.34
|
| Rate for Payer: Kentucky WC Medicaid |
$8,596.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,292.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,262.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,681.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,776.97
|
| Rate for Payer: Ohio Health Group HMO |
$18,559.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,797.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,529.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,075.13
|
| Rate for Payer: PHCS Commercial |
$23,756.70
|
| Rate for Payer: United Healthcare All Payer |
$21,776.97
|
|
|
SYN HA PF FEM COMP SZ 12
|
Facility
|
IP
|
$24,746.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,423.97 |
| Max. Negotiated Rate |
$23,756.70 |
| Rate for Payer: Aetna Commercial |
$19,054.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,302.32
|
| Rate for Payer: Cash Price |
$12,373.28
|
| Rate for Payer: Cigna Commercial |
$20,539.64
|
| Rate for Payer: First Health Commercial |
$23,509.23
|
| Rate for Payer: Humana Commercial |
$21,034.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,292.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,262.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,776.97
|
| Rate for Payer: Ohio Health Group HMO |
$18,559.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,797.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,529.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,075.13
|
| Rate for Payer: PHCS Commercial |
$23,756.70
|
| Rate for Payer: United Healthcare All Payer |
$21,776.97
|
|
|
SYN HA PF FEM COMP SZ 13
|
Facility
|
OP
|
$24,746.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,423.97 |
| Max. Negotiated Rate |
$23,756.70 |
| Rate for Payer: Aetna Commercial |
$19,054.85
|
| Rate for Payer: Anthem Medicaid |
$8,510.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,302.32
|
| Rate for Payer: Cash Price |
$12,373.28
|
| Rate for Payer: Cigna Commercial |
$20,539.64
|
| Rate for Payer: First Health Commercial |
$23,509.23
|
| Rate for Payer: Humana Commercial |
$21,034.58
|
| Rate for Payer: Humana KY Medicaid |
$8,510.34
|
| Rate for Payer: Kentucky WC Medicaid |
$8,596.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,292.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,262.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,681.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,776.97
|
| Rate for Payer: Ohio Health Group HMO |
$18,559.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,797.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,529.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,075.13
|
| Rate for Payer: PHCS Commercial |
$23,756.70
|
| Rate for Payer: United Healthcare All Payer |
$21,776.97
|
|
|
SYN HA PF FEM COMP SZ 13
|
Facility
|
IP
|
$24,746.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,423.97 |
| Max. Negotiated Rate |
$23,756.70 |
| Rate for Payer: Aetna Commercial |
$19,054.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,302.32
|
| Rate for Payer: Cash Price |
$12,373.28
|
| Rate for Payer: Cigna Commercial |
$20,539.64
|
| Rate for Payer: First Health Commercial |
$23,509.23
|
| Rate for Payer: Humana Commercial |
$21,034.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,292.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,262.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,776.97
|
| Rate for Payer: Ohio Health Group HMO |
$18,559.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,797.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,529.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,075.13
|
| Rate for Payer: PHCS Commercial |
$23,756.70
|
| Rate for Payer: United Healthcare All Payer |
$21,776.97
|
|
|
SYN HA PF FEM COMP SZ 14
|
Facility
|
OP
|
$24,746.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,423.97 |
| Max. Negotiated Rate |
$23,756.70 |
| Rate for Payer: Aetna Commercial |
$19,054.85
|
| Rate for Payer: Anthem Medicaid |
$8,510.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,302.32
|
| Rate for Payer: Cash Price |
$12,373.28
|
| Rate for Payer: Cigna Commercial |
$20,539.64
|
| Rate for Payer: First Health Commercial |
$23,509.23
|
| Rate for Payer: Humana Commercial |
$21,034.58
|
| Rate for Payer: Humana KY Medicaid |
$8,510.34
|
| Rate for Payer: Kentucky WC Medicaid |
$8,596.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,292.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,262.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,681.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,776.97
|
| Rate for Payer: Ohio Health Group HMO |
$18,559.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,797.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,529.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,075.13
|
| Rate for Payer: PHCS Commercial |
$23,756.70
|
| Rate for Payer: United Healthcare All Payer |
$21,776.97
|
|
|
SYN HA PF FEM COMP SZ 14
|
Facility
|
IP
|
$24,746.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,423.97 |
| Max. Negotiated Rate |
$23,756.70 |
| Rate for Payer: Aetna Commercial |
$19,054.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,302.32
|
| Rate for Payer: Cash Price |
$12,373.28
|
| Rate for Payer: Cigna Commercial |
$20,539.64
|
| Rate for Payer: First Health Commercial |
$23,509.23
|
| Rate for Payer: Humana Commercial |
$21,034.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,292.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,262.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,776.97
|
| Rate for Payer: Ohio Health Group HMO |
$18,559.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,797.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,529.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,075.13
|
| Rate for Payer: PHCS Commercial |
$23,756.70
|
| Rate for Payer: United Healthcare All Payer |
$21,776.97
|
|
|
SYN HA PF FEM COMP SZ 15
|
Facility
|
IP
|
$24,746.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,423.97 |
| Max. Negotiated Rate |
$23,756.70 |
| Rate for Payer: Aetna Commercial |
$19,054.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,302.32
|
| Rate for Payer: Cash Price |
$12,373.28
|
| Rate for Payer: Cigna Commercial |
$20,539.64
|
| Rate for Payer: First Health Commercial |
$23,509.23
|
| Rate for Payer: Humana Commercial |
$21,034.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,292.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,262.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,776.97
|
| Rate for Payer: Ohio Health Group HMO |
$18,559.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,797.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,529.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,075.13
|
| Rate for Payer: PHCS Commercial |
$23,756.70
|
| Rate for Payer: United Healthcare All Payer |
$21,776.97
|
|
|
SYN HA PF FEM COMP SZ 15
|
Facility
|
OP
|
$24,746.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,423.97 |
| Max. Negotiated Rate |
$23,756.70 |
| Rate for Payer: Aetna Commercial |
$19,054.85
|
| Rate for Payer: Anthem Medicaid |
$8,510.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,302.32
|
| Rate for Payer: Cash Price |
$12,373.28
|
| Rate for Payer: Cigna Commercial |
$20,539.64
|
| Rate for Payer: First Health Commercial |
$23,509.23
|
| Rate for Payer: Humana Commercial |
$21,034.58
|
| Rate for Payer: Humana KY Medicaid |
$8,510.34
|
| Rate for Payer: Kentucky WC Medicaid |
$8,596.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,292.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,262.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,681.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,776.97
|
| Rate for Payer: Ohio Health Group HMO |
$18,559.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,797.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,529.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,075.13
|
| Rate for Payer: PHCS Commercial |
$23,756.70
|
| Rate for Payer: United Healthcare All Payer |
$21,776.97
|
|
|
SYN HA PF FEM COMP SZ 16
|
Facility
|
OP
|
$24,746.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,423.97 |
| Max. Negotiated Rate |
$23,756.70 |
| Rate for Payer: Aetna Commercial |
$19,054.85
|
| Rate for Payer: Anthem Medicaid |
$8,510.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,302.32
|
| Rate for Payer: Cash Price |
$12,373.28
|
| Rate for Payer: Cigna Commercial |
$20,539.64
|
| Rate for Payer: First Health Commercial |
$23,509.23
|
| Rate for Payer: Humana Commercial |
$21,034.58
|
| Rate for Payer: Humana KY Medicaid |
$8,510.34
|
| Rate for Payer: Kentucky WC Medicaid |
$8,596.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,292.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,262.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,681.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,776.97
|
| Rate for Payer: Ohio Health Group HMO |
$18,559.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,797.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,529.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,075.13
|
| Rate for Payer: PHCS Commercial |
$23,756.70
|
| Rate for Payer: United Healthcare All Payer |
$21,776.97
|
|
|
SYN HA PF FEM COMP SZ 16
|
Facility
|
IP
|
$24,746.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,423.97 |
| Max. Negotiated Rate |
$23,756.70 |
| Rate for Payer: Aetna Commercial |
$19,054.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,302.32
|
| Rate for Payer: Cash Price |
$12,373.28
|
| Rate for Payer: Cigna Commercial |
$20,539.64
|
| Rate for Payer: First Health Commercial |
$23,509.23
|
| Rate for Payer: Humana Commercial |
$21,034.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,292.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,262.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,776.97
|
| Rate for Payer: Ohio Health Group HMO |
$18,559.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,797.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,529.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,075.13
|
| Rate for Payer: PHCS Commercial |
$23,756.70
|
| Rate for Payer: United Healthcare All Payer |
$21,776.97
|
|
|
SYN HA PF FEM COMP SZ 17
|
Facility
|
OP
|
$24,746.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,423.97 |
| Max. Negotiated Rate |
$23,756.70 |
| Rate for Payer: Aetna Commercial |
$19,054.85
|
| Rate for Payer: Anthem Medicaid |
$8,510.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,302.32
|
| Rate for Payer: Cash Price |
$12,373.28
|
| Rate for Payer: Cigna Commercial |
$20,539.64
|
| Rate for Payer: First Health Commercial |
$23,509.23
|
| Rate for Payer: Humana Commercial |
$21,034.58
|
| Rate for Payer: Humana KY Medicaid |
$8,510.34
|
| Rate for Payer: Kentucky WC Medicaid |
$8,596.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,292.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,262.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,681.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,776.97
|
| Rate for Payer: Ohio Health Group HMO |
$18,559.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,797.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,529.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,075.13
|
| Rate for Payer: PHCS Commercial |
$23,756.70
|
| Rate for Payer: United Healthcare All Payer |
$21,776.97
|
|
|
SYN HA PF FEM COMP SZ 17
|
Facility
|
IP
|
$24,746.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,423.97 |
| Max. Negotiated Rate |
$23,756.70 |
| Rate for Payer: Aetna Commercial |
$19,054.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,302.32
|
| Rate for Payer: Cash Price |
$12,373.28
|
| Rate for Payer: Cigna Commercial |
$20,539.64
|
| Rate for Payer: First Health Commercial |
$23,509.23
|
| Rate for Payer: Humana Commercial |
$21,034.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,292.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,262.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,776.97
|
| Rate for Payer: Ohio Health Group HMO |
$18,559.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,797.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,529.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,075.13
|
| Rate for Payer: PHCS Commercial |
$23,756.70
|
| Rate for Payer: United Healthcare All Payer |
$21,776.97
|
|
|
SYN HA PF FEM COMP SZ 18
|
Facility
|
IP
|
$24,746.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,423.97 |
| Max. Negotiated Rate |
$23,756.70 |
| Rate for Payer: Aetna Commercial |
$19,054.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,302.32
|
| Rate for Payer: Cash Price |
$12,373.28
|
| Rate for Payer: Cigna Commercial |
$20,539.64
|
| Rate for Payer: First Health Commercial |
$23,509.23
|
| Rate for Payer: Humana Commercial |
$21,034.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,292.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,262.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,776.97
|
| Rate for Payer: Ohio Health Group HMO |
$18,559.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,797.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,529.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,075.13
|
| Rate for Payer: PHCS Commercial |
$23,756.70
|
| Rate for Payer: United Healthcare All Payer |
$21,776.97
|
|
|
SYN HA PF FEM COMP SZ 18
|
Facility
|
OP
|
$24,746.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,423.97 |
| Max. Negotiated Rate |
$23,756.70 |
| Rate for Payer: Aetna Commercial |
$19,054.85
|
| Rate for Payer: Anthem Medicaid |
$8,510.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,302.32
|
| Rate for Payer: Cash Price |
$12,373.28
|
| Rate for Payer: Cigna Commercial |
$20,539.64
|
| Rate for Payer: First Health Commercial |
$23,509.23
|
| Rate for Payer: Humana Commercial |
$21,034.58
|
| Rate for Payer: Humana KY Medicaid |
$8,510.34
|
| Rate for Payer: Kentucky WC Medicaid |
$8,596.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,292.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,262.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,681.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,776.97
|
| Rate for Payer: Ohio Health Group HMO |
$18,559.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,797.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,529.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,075.13
|
| Rate for Payer: PHCS Commercial |
$23,756.70
|
| Rate for Payer: United Healthcare All Payer |
$21,776.97
|
|
|
SYN HA PF FEM COMP SZ 9
|
Facility
|
OP
|
$24,746.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,423.97 |
| Max. Negotiated Rate |
$23,756.70 |
| Rate for Payer: Aetna Commercial |
$19,054.85
|
| Rate for Payer: Anthem Medicaid |
$8,510.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,302.32
|
| Rate for Payer: Cash Price |
$12,373.28
|
| Rate for Payer: Cigna Commercial |
$20,539.64
|
| Rate for Payer: First Health Commercial |
$23,509.23
|
| Rate for Payer: Humana Commercial |
$21,034.58
|
| Rate for Payer: Humana KY Medicaid |
$8,510.34
|
| Rate for Payer: Kentucky WC Medicaid |
$8,596.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,292.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,262.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,681.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,776.97
|
| Rate for Payer: Ohio Health Group HMO |
$18,559.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,797.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,529.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,075.13
|
| Rate for Payer: PHCS Commercial |
$23,756.70
|
| Rate for Payer: United Healthcare All Payer |
$21,776.97
|
|
|
SYN HA PF FEM COMP SZ 9
|
Facility
|
IP
|
$24,746.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,423.97 |
| Max. Negotiated Rate |
$23,756.70 |
| Rate for Payer: Aetna Commercial |
$19,054.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,302.32
|
| Rate for Payer: Cash Price |
$12,373.28
|
| Rate for Payer: Cigna Commercial |
$20,539.64
|
| Rate for Payer: First Health Commercial |
$23,509.23
|
| Rate for Payer: Humana Commercial |
$21,034.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,292.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,262.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,776.97
|
| Rate for Payer: Ohio Health Group HMO |
$18,559.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,797.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,529.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,075.13
|
| Rate for Payer: PHCS Commercial |
$23,756.70
|
| Rate for Payer: United Healthcare All Payer |
$21,776.97
|
|
|
SYNOVECTOMY CARPOMETACRPL JNT
|
Facility
|
IP
|
$3,921.00
|
|
|
Service Code
|
HCPCS 26130
|
| Hospital Charge Code |
45000136
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,176.30 |
| Max. Negotiated Rate |
$3,764.16 |
| Rate for Payer: Aetna Commercial |
$3,019.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,058.38
|
| Rate for Payer: Cash Price |
$1,960.50
|
| Rate for Payer: Cigna Commercial |
$3,254.43
|
| Rate for Payer: First Health Commercial |
$3,724.95
|
| Rate for Payer: Humana Commercial |
$3,332.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,215.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,893.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,176.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,450.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,940.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,136.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,411.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,705.49
|
| Rate for Payer: PHCS Commercial |
$3,764.16
|
| Rate for Payer: United Healthcare All Payer |
$3,450.48
|
|
|
SYNOVECTOMY CARPOMETACRPL JNT
|
Facility
|
IP
|
$3,921.00
|
|
|
Service Code
|
HCPCS 26130
|
| Hospital Charge Code |
76100675
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,176.30 |
| Max. Negotiated Rate |
$3,764.16 |
| Rate for Payer: Aetna Commercial |
$3,019.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,058.38
|
| Rate for Payer: Cash Price |
$1,960.50
|
| Rate for Payer: Cigna Commercial |
$3,254.43
|
| Rate for Payer: First Health Commercial |
$3,724.95
|
| Rate for Payer: Humana Commercial |
$3,332.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,215.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,893.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,176.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,450.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,940.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,136.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,411.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,705.49
|
| Rate for Payer: PHCS Commercial |
$3,764.16
|
| Rate for Payer: United Healthcare All Payer |
$3,450.48
|
|
