|
TM HUM STEM 48 DEG 18*130
|
Facility
|
OP
|
$21,759.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,828.72 |
| Max. Negotiated Rate |
$20,888.99 |
| Rate for Payer: Aetna Commercial |
$16,754.71
|
| Rate for Payer: Anthem Medicaid |
$7,483.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,972.30
|
| Rate for Payer: Cash Price |
$10,879.68
|
| Rate for Payer: Cigna Commercial |
$18,060.27
|
| Rate for Payer: First Health Commercial |
$20,671.39
|
| Rate for Payer: Humana Commercial |
$18,495.46
|
| Rate for Payer: Humana KY Medicaid |
$7,483.04
|
| Rate for Payer: Kentucky WC Medicaid |
$7,559.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,842.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,058.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,527.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,633.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,148.24
|
| Rate for Payer: Ohio Health Group HMO |
$16,319.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,351.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,828.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,745.40
|
| Rate for Payer: PHCS Commercial |
$20,888.99
|
| Rate for Payer: United Healthcare All Payer |
$19,148.24
|
|
|
TM HUM STEM 48 DEG 6*130
|
Facility
|
OP
|
$21,759.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,828.72 |
| Max. Negotiated Rate |
$20,888.99 |
| Rate for Payer: Aetna Commercial |
$16,754.71
|
| Rate for Payer: Anthem Medicaid |
$7,483.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,972.30
|
| Rate for Payer: Cash Price |
$10,879.68
|
| Rate for Payer: Cigna Commercial |
$18,060.27
|
| Rate for Payer: First Health Commercial |
$20,671.39
|
| Rate for Payer: Humana Commercial |
$18,495.46
|
| Rate for Payer: Humana KY Medicaid |
$7,483.04
|
| Rate for Payer: Kentucky WC Medicaid |
$7,559.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,842.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,058.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,527.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,633.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,148.24
|
| Rate for Payer: Ohio Health Group HMO |
$16,319.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,351.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,828.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,745.40
|
| Rate for Payer: PHCS Commercial |
$20,888.99
|
| Rate for Payer: United Healthcare All Payer |
$19,148.24
|
|
|
TM HUM STEM 48 DEG 6*130
|
Facility
|
IP
|
$21,759.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,828.72 |
| Max. Negotiated Rate |
$20,888.99 |
| Rate for Payer: Aetna Commercial |
$16,754.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,972.30
|
| Rate for Payer: Cash Price |
$10,879.68
|
| Rate for Payer: Cigna Commercial |
$18,060.27
|
| Rate for Payer: First Health Commercial |
$20,671.39
|
| Rate for Payer: Humana Commercial |
$18,495.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,842.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,058.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,527.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,148.24
|
| Rate for Payer: Ohio Health Group HMO |
$16,319.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,351.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,828.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,745.40
|
| Rate for Payer: PHCS Commercial |
$20,888.99
|
| Rate for Payer: United Healthcare All Payer |
$19,148.24
|
|
|
TM HUM STEM 48 DEG 8*130
|
Facility
|
OP
|
$21,759.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,828.72 |
| Max. Negotiated Rate |
$20,888.99 |
| Rate for Payer: Aetna Commercial |
$16,754.71
|
| Rate for Payer: Anthem Medicaid |
$7,483.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,972.30
|
| Rate for Payer: Cash Price |
$10,879.68
|
| Rate for Payer: Cigna Commercial |
$18,060.27
|
| Rate for Payer: First Health Commercial |
$20,671.39
|
| Rate for Payer: Humana Commercial |
$18,495.46
|
| Rate for Payer: Humana KY Medicaid |
$7,483.04
|
| Rate for Payer: Kentucky WC Medicaid |
$7,559.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,842.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,058.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,527.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,633.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,148.24
|
| Rate for Payer: Ohio Health Group HMO |
$16,319.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,351.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,828.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,745.40
|
| Rate for Payer: PHCS Commercial |
$20,888.99
|
| Rate for Payer: United Healthcare All Payer |
$19,148.24
|
|
|
TM HUM STEM 48 DEG 8*130
|
Facility
|
IP
|
$21,759.36
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,828.72 |
| Max. Negotiated Rate |
$20,888.99 |
| Rate for Payer: Aetna Commercial |
$16,754.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,972.30
|
| Rate for Payer: Cash Price |
$10,879.68
|
| Rate for Payer: Cigna Commercial |
$18,060.27
|
| Rate for Payer: First Health Commercial |
$20,671.39
|
| Rate for Payer: Humana Commercial |
$18,495.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,842.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,058.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,527.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,148.24
|
| Rate for Payer: Ohio Health Group HMO |
$16,319.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,351.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,828.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,745.40
|
| Rate for Payer: PHCS Commercial |
$20,888.99
|
| Rate for Payer: United Healthcare All Payer |
$19,148.24
|
|
|
TM HUM STEM 48 DEG 8*170
|
Facility
|
IP
|
$23,461.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,050.02 |
| Max. Negotiated Rate |
$22,523.25 |
| Rate for Payer: Aetna Commercial |
$18,065.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,300.14
|
| Rate for Payer: Cash Price |
$11,730.86
|
| Rate for Payer: Cigna Commercial |
$19,473.23
|
| Rate for Payer: First Health Commercial |
$22,288.63
|
| Rate for Payer: Humana Commercial |
$19,942.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,238.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,314.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,038.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,646.31
|
| Rate for Payer: Ohio Health Group HMO |
$17,596.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,692.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,050.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,273.13
|
| Rate for Payer: PHCS Commercial |
$22,523.25
|
| Rate for Payer: United Healthcare All Payer |
$20,646.31
|
|
|
TM HUM STEM 48 DEG 8*170
|
Facility
|
OP
|
$23,461.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,050.02 |
| Max. Negotiated Rate |
$22,523.25 |
| Rate for Payer: Aetna Commercial |
$18,065.52
|
| Rate for Payer: Anthem Medicaid |
$8,068.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,300.14
|
| Rate for Payer: Cash Price |
$11,730.86
|
| Rate for Payer: Cigna Commercial |
$19,473.23
|
| Rate for Payer: First Health Commercial |
$22,288.63
|
| Rate for Payer: Humana Commercial |
$19,942.46
|
| Rate for Payer: Humana KY Medicaid |
$8,068.49
|
| Rate for Payer: Kentucky WC Medicaid |
$8,150.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,238.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,314.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,038.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,230.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,646.31
|
| Rate for Payer: Ohio Health Group HMO |
$17,596.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,692.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,050.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,273.13
|
| Rate for Payer: PHCS Commercial |
$22,523.25
|
| Rate for Payer: United Healthcare All Payer |
$20,646.31
|
|
|
TM HUM STEM 48 DEG 9*130
|
Facility
|
OP
|
$17,538.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.94 |
| Max. Negotiated Rate |
$16,836.48 |
| Rate for Payer: Aetna Commercial |
$13,504.26
|
| Rate for Payer: Anthem Medicaid |
$6,031.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,679.64
|
| Rate for Payer: Cash Price |
$8,769.00
|
| Rate for Payer: Cigna Commercial |
$14,556.54
|
| Rate for Payer: First Health Commercial |
$16,661.10
|
| Rate for Payer: Humana Commercial |
$14,907.30
|
| Rate for Payer: Humana KY Medicaid |
$6,031.32
|
| Rate for Payer: Kentucky WC Medicaid |
$6,092.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,381.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,943.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,261.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,152.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,433.44
|
| Rate for Payer: Ohio Health Group HMO |
$13,153.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,507.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,279.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,436.78
|
| Rate for Payer: PHCS Commercial |
$16,836.48
|
| Rate for Payer: United Healthcare All Payer |
$15,433.44
|
|
|
TM HUM STEM 48 DEG 9*130
|
Facility
|
IP
|
$17,538.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,279.94 |
| Max. Negotiated Rate |
$16,836.48 |
| Rate for Payer: Aetna Commercial |
$13,504.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,679.64
|
| Rate for Payer: Cash Price |
$8,769.00
|
| Rate for Payer: Cigna Commercial |
$14,556.54
|
| Rate for Payer: First Health Commercial |
$16,661.10
|
| Rate for Payer: Humana Commercial |
$14,907.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,381.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,943.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,261.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,433.44
|
| Rate for Payer: Ohio Health Group HMO |
$13,153.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,507.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,279.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,436.78
|
| Rate for Payer: PHCS Commercial |
$16,836.48
|
| Rate for Payer: United Healthcare All Payer |
$15,433.44
|
|
|
TMJ WITH ANESTH
|
Facility
|
OP
|
$1,933.00
|
|
|
Service Code
|
HCPCS 21073
|
| Hospital Charge Code |
76100372
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$251.29 |
| Max. Negotiated Rate |
$1,855.68 |
| Rate for Payer: Aetna Commercial |
$1,488.41
|
| Rate for Payer: Anthem Medicaid |
$664.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,318.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,507.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,846.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,780.37
|
| Rate for Payer: Cash Price |
$966.50
|
| Rate for Payer: Cash Price |
$966.50
|
| Rate for Payer: Cigna Commercial |
$1,604.39
|
| Rate for Payer: First Health Commercial |
$1,836.35
|
| Rate for Payer: Humana Commercial |
$1,643.05
|
| Rate for Payer: Humana KY Medicaid |
$664.76
|
| Rate for Payer: Humana Medicare Advantage |
$1,318.79
|
| Rate for Payer: Kentucky WC Medicaid |
$671.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,585.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,426.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,582.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$678.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,701.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,449.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$599.23
|
| Rate for Payer: PHCS Commercial |
$1,855.68
|
| Rate for Payer: United Healthcare All Payer |
$1,701.04
|
|
|
TMJ WITH ANESTH
|
Facility
|
IP
|
$1,933.00
|
|
|
Service Code
|
HCPCS 21073
|
| Hospital Charge Code |
76100372
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$251.29 |
| Max. Negotiated Rate |
$1,855.68 |
| Rate for Payer: Aetna Commercial |
$1,488.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,507.74
|
| Rate for Payer: Cash Price |
$966.50
|
| Rate for Payer: Cigna Commercial |
$1,604.39
|
| Rate for Payer: First Health Commercial |
$1,836.35
|
| Rate for Payer: Humana Commercial |
$1,643.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,585.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,426.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,701.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,449.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$599.23
|
| Rate for Payer: PHCS Commercial |
$1,855.68
|
| Rate for Payer: United Healthcare All Payer |
$1,701.04
|
|
|
TMJ WITH ANESTH
|
Facility
|
IP
|
$1,933.00
|
|
|
Service Code
|
HCPCS 21073
|
| Hospital Charge Code |
45000097
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$251.29 |
| Max. Negotiated Rate |
$1,855.68 |
| Rate for Payer: Aetna Commercial |
$1,488.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,507.74
|
| Rate for Payer: Cash Price |
$966.50
|
| Rate for Payer: Cigna Commercial |
$1,604.39
|
| Rate for Payer: First Health Commercial |
$1,836.35
|
| Rate for Payer: Humana Commercial |
$1,643.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,585.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,426.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,701.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,449.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$599.23
|
| Rate for Payer: PHCS Commercial |
$1,855.68
|
| Rate for Payer: United Healthcare All Payer |
$1,701.04
|
|
|
TMJ WITH ANESTH
|
Facility
|
OP
|
$1,933.00
|
|
|
Service Code
|
HCPCS 21073
|
| Hospital Charge Code |
45000097
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$251.29 |
| Max. Negotiated Rate |
$1,855.68 |
| Rate for Payer: Aetna Commercial |
$1,488.41
|
| Rate for Payer: Anthem Medicaid |
$664.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,318.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,507.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,846.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,780.37
|
| Rate for Payer: Cash Price |
$966.50
|
| Rate for Payer: Cash Price |
$966.50
|
| Rate for Payer: Cigna Commercial |
$1,604.39
|
| Rate for Payer: First Health Commercial |
$1,836.35
|
| Rate for Payer: Humana Commercial |
$1,643.05
|
| Rate for Payer: Humana KY Medicaid |
$664.76
|
| Rate for Payer: Humana Medicare Advantage |
$1,318.79
|
| Rate for Payer: Kentucky WC Medicaid |
$671.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,585.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,426.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,582.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$678.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,701.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,449.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$599.23
|
| Rate for Payer: PHCS Commercial |
$1,855.68
|
| Rate for Payer: United Healthcare All Payer |
$1,701.04
|
|
|
TM KEEL GLEN 40MM W/46MM SRFC
|
Facility
|
IP
|
$9,800.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,274.09 |
| Max. Negotiated Rate |
$9,408.67 |
| Rate for Payer: Aetna Commercial |
$7,546.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,644.55
|
| Rate for Payer: Cash Price |
$4,900.35
|
| Rate for Payer: Cigna Commercial |
$8,134.58
|
| Rate for Payer: First Health Commercial |
$9,310.66
|
| Rate for Payer: Humana Commercial |
$8,330.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,036.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,232.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,940.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,624.62
|
| Rate for Payer: Ohio Health Group HMO |
$7,350.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,960.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,274.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,038.22
|
| Rate for Payer: PHCS Commercial |
$9,408.67
|
| Rate for Payer: United Healthcare All Payer |
$8,624.62
|
|
|
TM KEEL GLEN 40MM W/46MM SRFC
|
Facility
|
OP
|
$9,800.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,274.09 |
| Max. Negotiated Rate |
$9,408.67 |
| Rate for Payer: Aetna Commercial |
$7,546.54
|
| Rate for Payer: Anthem Medicaid |
$3,370.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,644.55
|
| Rate for Payer: Cash Price |
$4,900.35
|
| Rate for Payer: Cigna Commercial |
$8,134.58
|
| Rate for Payer: First Health Commercial |
$9,310.66
|
| Rate for Payer: Humana Commercial |
$8,330.60
|
| Rate for Payer: Humana KY Medicaid |
$3,370.46
|
| Rate for Payer: Kentucky WC Medicaid |
$3,404.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,036.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,232.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,940.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,438.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,624.62
|
| Rate for Payer: Ohio Health Group HMO |
$7,350.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,960.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,274.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,038.22
|
| Rate for Payer: PHCS Commercial |
$9,408.67
|
| Rate for Payer: United Healthcare All Payer |
$8,624.62
|
|
|
TM KEEL GLEN 46MM
|
Facility
|
IP
|
$9,800.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,274.09 |
| Max. Negotiated Rate |
$9,408.67 |
| Rate for Payer: Aetna Commercial |
$7,546.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,644.55
|
| Rate for Payer: Cash Price |
$4,900.35
|
| Rate for Payer: Cigna Commercial |
$8,134.58
|
| Rate for Payer: First Health Commercial |
$9,310.66
|
| Rate for Payer: Humana Commercial |
$8,330.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,036.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,232.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,940.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,624.62
|
| Rate for Payer: Ohio Health Group HMO |
$7,350.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,960.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,274.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,038.22
|
| Rate for Payer: PHCS Commercial |
$9,408.67
|
| Rate for Payer: United Healthcare All Payer |
$8,624.62
|
|
|
TM KEEL GLEN 46MM
|
Facility
|
OP
|
$9,800.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,274.09 |
| Max. Negotiated Rate |
$9,408.67 |
| Rate for Payer: Aetna Commercial |
$7,546.54
|
| Rate for Payer: Anthem Medicaid |
$3,370.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,644.55
|
| Rate for Payer: Cash Price |
$4,900.35
|
| Rate for Payer: Cigna Commercial |
$8,134.58
|
| Rate for Payer: First Health Commercial |
$9,310.66
|
| Rate for Payer: Humana Commercial |
$8,330.60
|
| Rate for Payer: Humana KY Medicaid |
$3,370.46
|
| Rate for Payer: Kentucky WC Medicaid |
$3,404.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,036.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,232.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,940.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,438.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,624.62
|
| Rate for Payer: Ohio Health Group HMO |
$7,350.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,960.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,274.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,038.22
|
| Rate for Payer: PHCS Commercial |
$9,408.67
|
| Rate for Payer: United Healthcare All Payer |
$8,624.62
|
|
|
TM KEEL GLEN 46MM W/40MM SRFC
|
Facility
|
IP
|
$9,800.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,274.09 |
| Max. Negotiated Rate |
$9,408.67 |
| Rate for Payer: Aetna Commercial |
$7,546.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,644.55
|
| Rate for Payer: Cash Price |
$4,900.35
|
| Rate for Payer: Cigna Commercial |
$8,134.58
|
| Rate for Payer: First Health Commercial |
$9,310.66
|
| Rate for Payer: Humana Commercial |
$8,330.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,036.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,232.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,940.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,624.62
|
| Rate for Payer: Ohio Health Group HMO |
$7,350.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,960.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,274.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,038.22
|
| Rate for Payer: PHCS Commercial |
$9,408.67
|
| Rate for Payer: United Healthcare All Payer |
$8,624.62
|
|
|
TM KEEL GLEN 46MM W/40MM SRFC
|
Facility
|
OP
|
$9,800.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,274.09 |
| Max. Negotiated Rate |
$9,408.67 |
| Rate for Payer: Aetna Commercial |
$7,546.54
|
| Rate for Payer: Anthem Medicaid |
$3,370.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,644.55
|
| Rate for Payer: Cash Price |
$4,900.35
|
| Rate for Payer: Cigna Commercial |
$8,134.58
|
| Rate for Payer: First Health Commercial |
$9,310.66
|
| Rate for Payer: Humana Commercial |
$8,330.60
|
| Rate for Payer: Humana KY Medicaid |
$3,370.46
|
| Rate for Payer: Kentucky WC Medicaid |
$3,404.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,036.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,232.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,940.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,438.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,624.62
|
| Rate for Payer: Ohio Health Group HMO |
$7,350.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,960.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,274.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,038.22
|
| Rate for Payer: PHCS Commercial |
$9,408.67
|
| Rate for Payer: United Healthcare All Payer |
$8,624.62
|
|
|
TM KEEL GLEN 46MM W/52MM SRFC
|
Facility
|
OP
|
$9,800.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,274.09 |
| Max. Negotiated Rate |
$9,408.67 |
| Rate for Payer: Aetna Commercial |
$7,546.54
|
| Rate for Payer: Anthem Medicaid |
$3,370.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,644.55
|
| Rate for Payer: Cash Price |
$4,900.35
|
| Rate for Payer: Cigna Commercial |
$8,134.58
|
| Rate for Payer: First Health Commercial |
$9,310.66
|
| Rate for Payer: Humana Commercial |
$8,330.60
|
| Rate for Payer: Humana KY Medicaid |
$3,370.46
|
| Rate for Payer: Kentucky WC Medicaid |
$3,404.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,036.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,232.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,940.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,438.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,624.62
|
| Rate for Payer: Ohio Health Group HMO |
$7,350.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,960.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,274.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,038.22
|
| Rate for Payer: PHCS Commercial |
$9,408.67
|
| Rate for Payer: United Healthcare All Payer |
$8,624.62
|
|
|
TM KEEL GLEN 46MM W/52MM SRFC
|
Facility
|
IP
|
$9,800.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,274.09 |
| Max. Negotiated Rate |
$9,408.67 |
| Rate for Payer: Aetna Commercial |
$7,546.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,644.55
|
| Rate for Payer: Cash Price |
$4,900.35
|
| Rate for Payer: Cigna Commercial |
$8,134.58
|
| Rate for Payer: First Health Commercial |
$9,310.66
|
| Rate for Payer: Humana Commercial |
$8,330.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,036.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,232.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,940.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,624.62
|
| Rate for Payer: Ohio Health Group HMO |
$7,350.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,960.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,274.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,038.22
|
| Rate for Payer: PHCS Commercial |
$9,408.67
|
| Rate for Payer: United Healthcare All Payer |
$8,624.62
|
|
|
TM KEEL GLEN 52MM
|
Facility
|
OP
|
$9,800.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,274.09 |
| Max. Negotiated Rate |
$9,408.67 |
| Rate for Payer: Aetna Commercial |
$7,546.54
|
| Rate for Payer: Anthem Medicaid |
$3,370.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,644.55
|
| Rate for Payer: Cash Price |
$4,900.35
|
| Rate for Payer: Cigna Commercial |
$8,134.58
|
| Rate for Payer: First Health Commercial |
$9,310.66
|
| Rate for Payer: Humana Commercial |
$8,330.60
|
| Rate for Payer: Humana KY Medicaid |
$3,370.46
|
| Rate for Payer: Kentucky WC Medicaid |
$3,404.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,036.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,232.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,940.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,438.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,624.62
|
| Rate for Payer: Ohio Health Group HMO |
$7,350.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,960.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,274.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,038.22
|
| Rate for Payer: PHCS Commercial |
$9,408.67
|
| Rate for Payer: United Healthcare All Payer |
$8,624.62
|
|
|
TM KEEL GLEN 52MM
|
Facility
|
IP
|
$9,800.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,274.09 |
| Max. Negotiated Rate |
$9,408.67 |
| Rate for Payer: Aetna Commercial |
$7,546.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,644.55
|
| Rate for Payer: Cash Price |
$4,900.35
|
| Rate for Payer: Cigna Commercial |
$8,134.58
|
| Rate for Payer: First Health Commercial |
$9,310.66
|
| Rate for Payer: Humana Commercial |
$8,330.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,036.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,232.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,940.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,624.62
|
| Rate for Payer: Ohio Health Group HMO |
$7,350.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,960.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,274.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,038.22
|
| Rate for Payer: PHCS Commercial |
$9,408.67
|
| Rate for Payer: United Healthcare All Payer |
$8,624.62
|
|
|
TM KEEL GLEN 52MM W/46MM SRFC
|
Facility
|
OP
|
$9,800.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,274.09 |
| Max. Negotiated Rate |
$9,408.67 |
| Rate for Payer: Aetna Commercial |
$7,546.54
|
| Rate for Payer: Anthem Medicaid |
$3,370.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,644.55
|
| Rate for Payer: Cash Price |
$4,900.35
|
| Rate for Payer: Cigna Commercial |
$8,134.58
|
| Rate for Payer: First Health Commercial |
$9,310.66
|
| Rate for Payer: Humana Commercial |
$8,330.60
|
| Rate for Payer: Humana KY Medicaid |
$3,370.46
|
| Rate for Payer: Kentucky WC Medicaid |
$3,404.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,036.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,232.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,940.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,438.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,624.62
|
| Rate for Payer: Ohio Health Group HMO |
$7,350.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,960.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,274.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,038.22
|
| Rate for Payer: PHCS Commercial |
$9,408.67
|
| Rate for Payer: United Healthcare All Payer |
$8,624.62
|
|
|
TM KEEL GLEN 52MM W/46MM SRFC
|
Facility
|
IP
|
$9,800.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,274.09 |
| Max. Negotiated Rate |
$9,408.67 |
| Rate for Payer: Aetna Commercial |
$7,546.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,644.55
|
| Rate for Payer: Cash Price |
$4,900.35
|
| Rate for Payer: Cigna Commercial |
$8,134.58
|
| Rate for Payer: First Health Commercial |
$9,310.66
|
| Rate for Payer: Humana Commercial |
$8,330.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,036.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,232.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,940.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,624.62
|
| Rate for Payer: Ohio Health Group HMO |
$7,350.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,960.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,274.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,038.22
|
| Rate for Payer: PHCS Commercial |
$9,408.67
|
| Rate for Payer: United Healthcare All Payer |
$8,624.62
|
|
