|
TRLUML PERIP ATHRC RENAL AR(P
|
Professional
|
Both
|
$2,200.00
|
|
|
Service Code
|
HCPCS 0234T
|
| Hospital Charge Code |
510P0023
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$770.00 |
| Max. Negotiated Rate |
$1,540.00 |
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Multiplan PHCS |
$1,320.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,540.00
|
| Rate for Payer: UHCCP Medicaid |
$770.00
|
|
|
TRLUML PERIP ATHRC RENAL AR(T
|
Facility
|
OP
|
$14,797.00
|
|
|
Service Code
|
HCPCS 0234T
|
| Hospital Charge Code |
510T0023
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$5,088.69 |
| Max. Negotiated Rate |
$14,669.84 |
| Rate for Payer: Aetna Commercial |
$11,393.69
|
| Rate for Payer: Anthem Medicaid |
$5,088.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10,478.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,541.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$14,669.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$14,145.92
|
| Rate for Payer: Cash Price |
$7,398.50
|
| Rate for Payer: Cash Price |
$7,398.50
|
| Rate for Payer: Cigna Commercial |
$12,281.51
|
| Rate for Payer: First Health Commercial |
$14,057.15
|
| Rate for Payer: Humana Commercial |
$12,577.45
|
| Rate for Payer: Humana KY Medicaid |
$5,088.69
|
| Rate for Payer: Humana Medicare Advantage |
$10,478.46
|
| Rate for Payer: Kentucky WC Medicaid |
$5,140.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,133.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,920.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,574.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,190.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,021.36
|
| Rate for Payer: Ohio Health Group HMO |
$11,097.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,837.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,873.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,209.93
|
| Rate for Payer: PHCS Commercial |
$14,205.12
|
| Rate for Payer: United Healthcare All Payer |
$13,021.36
|
|
|
TRLUML PERIP ATHRC RENAL AR(T
|
Facility
|
IP
|
$14,797.00
|
|
|
Service Code
|
HCPCS 0234T
|
| Hospital Charge Code |
510T0023
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$4,439.10 |
| Max. Negotiated Rate |
$14,205.12 |
| Rate for Payer: Aetna Commercial |
$11,393.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,541.66
|
| Rate for Payer: Cash Price |
$7,398.50
|
| Rate for Payer: Cigna Commercial |
$12,281.51
|
| Rate for Payer: First Health Commercial |
$14,057.15
|
| Rate for Payer: Humana Commercial |
$12,577.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,133.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,920.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,439.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,021.36
|
| Rate for Payer: Ohio Health Group HMO |
$11,097.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,837.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,873.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,209.93
|
| Rate for Payer: PHCS Commercial |
$14,205.12
|
| Rate for Payer: United Healthcare All Payer |
$13,021.36
|
|
|
TRLUML PERIP ATHRC RENAL ART
|
Facility
|
OP
|
$16,997.00
|
|
|
Service Code
|
HCPCS 0234T
|
| Hospital Charge Code |
50000001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$5,845.27 |
| Max. Negotiated Rate |
$16,317.12 |
| Rate for Payer: Aetna Commercial |
$13,087.69
|
| Rate for Payer: Anthem Medicaid |
$5,845.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10,478.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,257.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$14,669.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$14,145.92
|
| Rate for Payer: Cash Price |
$8,498.50
|
| Rate for Payer: Cash Price |
$8,498.50
|
| Rate for Payer: Cigna Commercial |
$14,107.51
|
| Rate for Payer: First Health Commercial |
$16,147.15
|
| Rate for Payer: Humana Commercial |
$14,447.45
|
| Rate for Payer: Humana KY Medicaid |
$5,845.27
|
| Rate for Payer: Humana Medicare Advantage |
$10,478.46
|
| Rate for Payer: Kentucky WC Medicaid |
$5,904.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,937.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,543.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,574.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,962.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,957.36
|
| Rate for Payer: Ohio Health Group HMO |
$12,747.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,597.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,787.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,727.93
|
| Rate for Payer: PHCS Commercial |
$16,317.12
|
| Rate for Payer: United Healthcare All Payer |
$14,957.36
|
|
|
TRLUML PERIP ATHRC RENAL ART
|
Facility
|
OP
|
$16,997.00
|
|
|
Service Code
|
HCPCS 0234T
|
| Hospital Charge Code |
51000023
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$5,845.27 |
| Max. Negotiated Rate |
$16,317.12 |
| Rate for Payer: Aetna Commercial |
$13,087.69
|
| Rate for Payer: Anthem Medicaid |
$5,845.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10,478.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,257.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$14,669.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$14,145.92
|
| Rate for Payer: Cash Price |
$8,498.50
|
| Rate for Payer: Cash Price |
$8,498.50
|
| Rate for Payer: Cigna Commercial |
$14,107.51
|
| Rate for Payer: First Health Commercial |
$16,147.15
|
| Rate for Payer: Humana Commercial |
$14,447.45
|
| Rate for Payer: Humana KY Medicaid |
$5,845.27
|
| Rate for Payer: Humana Medicare Advantage |
$10,478.46
|
| Rate for Payer: Kentucky WC Medicaid |
$5,904.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,937.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,543.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,574.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,962.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,957.36
|
| Rate for Payer: Ohio Health Group HMO |
$12,747.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,597.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,787.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,727.93
|
| Rate for Payer: PHCS Commercial |
$16,317.12
|
| Rate for Payer: United Healthcare All Payer |
$14,957.36
|
|
|
TRLUML PERIP ATHRC RENAL ART
|
Facility
|
IP
|
$16,997.00
|
|
|
Service Code
|
HCPCS 0234T
|
| Hospital Charge Code |
50000001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$5,099.10 |
| Max. Negotiated Rate |
$16,317.12 |
| Rate for Payer: Aetna Commercial |
$13,087.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,257.66
|
| Rate for Payer: Cash Price |
$8,498.50
|
| Rate for Payer: Cigna Commercial |
$14,107.51
|
| Rate for Payer: First Health Commercial |
$16,147.15
|
| Rate for Payer: Humana Commercial |
$14,447.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,937.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,543.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,099.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,957.36
|
| Rate for Payer: Ohio Health Group HMO |
$12,747.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,597.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,787.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,727.93
|
| Rate for Payer: PHCS Commercial |
$16,317.12
|
| Rate for Payer: United Healthcare All Payer |
$14,957.36
|
|
|
TRLUML PERIP ATHRC RENAL ART
|
Facility
|
IP
|
$16,997.00
|
|
|
Service Code
|
HCPCS 0234T
|
| Hospital Charge Code |
51000023
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$5,099.10 |
| Max. Negotiated Rate |
$16,317.12 |
| Rate for Payer: Aetna Commercial |
$13,087.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,257.66
|
| Rate for Payer: Cash Price |
$8,498.50
|
| Rate for Payer: Cigna Commercial |
$14,107.51
|
| Rate for Payer: First Health Commercial |
$16,147.15
|
| Rate for Payer: Humana Commercial |
$14,447.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,937.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,543.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,099.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,957.36
|
| Rate for Payer: Ohio Health Group HMO |
$12,747.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,597.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,787.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,727.93
|
| Rate for Payer: PHCS Commercial |
$16,317.12
|
| Rate for Payer: United Healthcare All Payer |
$14,957.36
|
|
|
TRLUML PERIP ATHRC RENAL ART
|
Professional
|
Both
|
$16,997.00
|
|
| Hospital Charge Code |
50000001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$5,948.95 |
| Max. Negotiated Rate |
$11,897.90 |
| Rate for Payer: Cash Price |
$8,498.50
|
| Rate for Payer: Multiplan PHCS |
$10,198.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$11,897.90
|
| Rate for Payer: UHCCP Medicaid |
$5,948.95
|
|
|
TRLUML PERIP ATHRC RENAL ART
|
Professional
|
Both
|
$16,997.00
|
|
|
Service Code
|
HCPCS 0234T
|
| Hospital Charge Code |
51000023
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$5,948.95 |
| Max. Negotiated Rate |
$11,897.90 |
| Rate for Payer: Cash Price |
$8,498.50
|
| Rate for Payer: Multiplan PHCS |
$10,198.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$11,897.90
|
| Rate for Payer: UHCCP Medicaid |
$5,948.95
|
|
|
TRLUML PERIP ATHRC VISCERAL
|
Facility
|
IP
|
$2,200.00
|
|
|
Service Code
|
HCPCS 0235T
|
| Hospital Charge Code |
51000024
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$660.00 |
| Max. Negotiated Rate |
$2,112.00 |
| Rate for Payer: Aetna Commercial |
$1,694.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,716.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,826.00
|
| Rate for Payer: First Health Commercial |
$2,090.00
|
| Rate for Payer: Humana Commercial |
$1,870.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,804.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,623.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$660.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,936.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,650.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,914.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,518.00
|
| Rate for Payer: PHCS Commercial |
$2,112.00
|
| Rate for Payer: United Healthcare All Payer |
$1,936.00
|
|
|
TRLUML PERIP ATHRC VISCERAL
|
Facility
|
OP
|
$2,200.00
|
|
|
Service Code
|
HCPCS 0235T
|
| Hospital Charge Code |
51000024
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$660.00 |
| Max. Negotiated Rate |
$2,112.00 |
| Rate for Payer: Aetna Commercial |
$1,694.00
|
| Rate for Payer: Anthem Medicaid |
$756.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,716.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,826.00
|
| Rate for Payer: First Health Commercial |
$2,090.00
|
| Rate for Payer: Humana Commercial |
$1,870.00
|
| Rate for Payer: Humana KY Medicaid |
$756.58
|
| Rate for Payer: Kentucky WC Medicaid |
$764.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,804.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,623.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$660.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$771.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,936.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,650.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,914.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,518.00
|
| Rate for Payer: PHCS Commercial |
$2,112.00
|
| Rate for Payer: United Healthcare All Payer |
$1,936.00
|
|
|
TRLUML PERIP ATHRC VISCERAL
|
Professional
|
Both
|
$2,200.00
|
|
| Hospital Charge Code |
50000002
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$770.00 |
| Max. Negotiated Rate |
$1,540.00 |
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Multiplan PHCS |
$1,320.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,540.00
|
| Rate for Payer: UHCCP Medicaid |
$770.00
|
|
|
TRLUML PERIP ATHRC VISCERAL
|
Facility
|
IP
|
$2,200.00
|
|
|
Service Code
|
HCPCS 0235T
|
| Hospital Charge Code |
50000002
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$660.00 |
| Max. Negotiated Rate |
$2,112.00 |
| Rate for Payer: Aetna Commercial |
$1,694.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,716.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,826.00
|
| Rate for Payer: First Health Commercial |
$2,090.00
|
| Rate for Payer: Humana Commercial |
$1,870.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,804.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,623.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$660.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,936.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,650.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,914.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,518.00
|
| Rate for Payer: PHCS Commercial |
$2,112.00
|
| Rate for Payer: United Healthcare All Payer |
$1,936.00
|
|
|
TRLUML PERIP ATHRC VISCERAL
|
Professional
|
Both
|
$2,200.00
|
|
|
Service Code
|
HCPCS 0235T
|
| Hospital Charge Code |
51000024
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$770.00 |
| Max. Negotiated Rate |
$1,540.00 |
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Multiplan PHCS |
$1,320.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,540.00
|
| Rate for Payer: UHCCP Medicaid |
$770.00
|
|
|
TRLUML PERIP ATHRC VISCERAL
|
Facility
|
OP
|
$2,200.00
|
|
|
Service Code
|
HCPCS 0235T
|
| Hospital Charge Code |
50000002
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$660.00 |
| Max. Negotiated Rate |
$2,112.00 |
| Rate for Payer: Aetna Commercial |
$1,694.00
|
| Rate for Payer: Anthem Medicaid |
$756.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,716.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,826.00
|
| Rate for Payer: First Health Commercial |
$2,090.00
|
| Rate for Payer: Humana Commercial |
$1,870.00
|
| Rate for Payer: Humana KY Medicaid |
$756.58
|
| Rate for Payer: Kentucky WC Medicaid |
$764.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,804.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,623.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$660.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$771.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,936.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,650.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,914.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,518.00
|
| Rate for Payer: PHCS Commercial |
$2,112.00
|
| Rate for Payer: United Healthcare All Payer |
$1,936.00
|
|
|
TRLUML PERIP ATHRC VISCERAL(P
|
Professional
|
Both
|
$2,200.00
|
|
|
Service Code
|
HCPCS 0235T
|
| Hospital Charge Code |
510P0024
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$770.00 |
| Max. Negotiated Rate |
$1,540.00 |
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Multiplan PHCS |
$1,320.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,540.00
|
| Rate for Payer: UHCCP Medicaid |
$770.00
|
|
|
TRNSCND FEM HD 28M TPR MED NCK
|
Facility
|
OP
|
$3,875.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,162.50 |
| Max. Negotiated Rate |
$3,720.00 |
| Rate for Payer: Aetna Commercial |
$2,983.75
|
| Rate for Payer: Anthem Medicaid |
$1,332.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,022.50
|
| Rate for Payer: Cash Price |
$1,937.50
|
| Rate for Payer: Cigna Commercial |
$3,216.25
|
| Rate for Payer: First Health Commercial |
$3,681.25
|
| Rate for Payer: Humana Commercial |
$3,293.75
|
| Rate for Payer: Humana KY Medicaid |
$1,332.61
|
| Rate for Payer: Kentucky WC Medicaid |
$1,346.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,177.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,859.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,162.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,359.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,410.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,906.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,371.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,673.75
|
| Rate for Payer: PHCS Commercial |
$3,720.00
|
| Rate for Payer: United Healthcare All Payer |
$3,410.00
|
|
|
TRNSCND FEM HD 28M TPR MED NCK
|
Facility
|
IP
|
$3,875.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,162.50 |
| Max. Negotiated Rate |
$3,720.00 |
| Rate for Payer: Aetna Commercial |
$2,983.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,022.50
|
| Rate for Payer: Cash Price |
$1,937.50
|
| Rate for Payer: Cigna Commercial |
$3,216.25
|
| Rate for Payer: First Health Commercial |
$3,681.25
|
| Rate for Payer: Humana Commercial |
$3,293.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,177.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,859.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,162.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,410.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,906.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,371.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,673.75
|
| Rate for Payer: PHCS Commercial |
$3,720.00
|
| Rate for Payer: United Healthcare All Payer |
$3,410.00
|
|
|
TRNSCND FEM HD 28M TPR XLG NCK
|
Facility
|
OP
|
$3,875.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,162.50 |
| Max. Negotiated Rate |
$3,720.00 |
| Rate for Payer: Aetna Commercial |
$2,983.75
|
| Rate for Payer: Anthem Medicaid |
$1,332.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,022.50
|
| Rate for Payer: Cash Price |
$1,937.50
|
| Rate for Payer: Cigna Commercial |
$3,216.25
|
| Rate for Payer: First Health Commercial |
$3,681.25
|
| Rate for Payer: Humana Commercial |
$3,293.75
|
| Rate for Payer: Humana KY Medicaid |
$1,332.61
|
| Rate for Payer: Kentucky WC Medicaid |
$1,346.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,177.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,859.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,162.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,359.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,410.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,906.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,371.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,673.75
|
| Rate for Payer: PHCS Commercial |
$3,720.00
|
| Rate for Payer: United Healthcare All Payer |
$3,410.00
|
|
|
TRNSCND FEM HD 28M TPR XLG NCK
|
Facility
|
IP
|
$3,875.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,162.50 |
| Max. Negotiated Rate |
$3,720.00 |
| Rate for Payer: Aetna Commercial |
$2,983.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,022.50
|
| Rate for Payer: Cash Price |
$1,937.50
|
| Rate for Payer: Cigna Commercial |
$3,216.25
|
| Rate for Payer: First Health Commercial |
$3,681.25
|
| Rate for Payer: Humana Commercial |
$3,293.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,177.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,859.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,162.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,410.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,906.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,371.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,673.75
|
| Rate for Payer: PHCS Commercial |
$3,720.00
|
| Rate for Payer: United Healthcare All Payer |
$3,410.00
|
|
|
TRNSCND FEM HD 32M TPR MED NCK
|
Facility
|
IP
|
$3,875.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,162.50 |
| Max. Negotiated Rate |
$3,720.00 |
| Rate for Payer: Aetna Commercial |
$2,983.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,022.50
|
| Rate for Payer: Cash Price |
$1,937.50
|
| Rate for Payer: Cigna Commercial |
$3,216.25
|
| Rate for Payer: First Health Commercial |
$3,681.25
|
| Rate for Payer: Humana Commercial |
$3,293.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,177.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,859.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,162.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,410.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,906.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,371.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,673.75
|
| Rate for Payer: PHCS Commercial |
$3,720.00
|
| Rate for Payer: United Healthcare All Payer |
$3,410.00
|
|
|
TRNSCND FEM HD 32M TPR MED NCK
|
Facility
|
OP
|
$3,875.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,162.50 |
| Max. Negotiated Rate |
$3,720.00 |
| Rate for Payer: Aetna Commercial |
$2,983.75
|
| Rate for Payer: Anthem Medicaid |
$1,332.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,022.50
|
| Rate for Payer: Cash Price |
$1,937.50
|
| Rate for Payer: Cigna Commercial |
$3,216.25
|
| Rate for Payer: First Health Commercial |
$3,681.25
|
| Rate for Payer: Humana Commercial |
$3,293.75
|
| Rate for Payer: Humana KY Medicaid |
$1,332.61
|
| Rate for Payer: Kentucky WC Medicaid |
$1,346.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,177.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,859.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,162.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,359.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,410.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,906.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,371.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,673.75
|
| Rate for Payer: PHCS Commercial |
$3,720.00
|
| Rate for Payer: United Healthcare All Payer |
$3,410.00
|
|
|
TRNSCND FEM HD 36M TPR MED NCK
|
Facility
|
IP
|
$3,875.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,162.50 |
| Max. Negotiated Rate |
$3,720.00 |
| Rate for Payer: Aetna Commercial |
$2,983.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,022.50
|
| Rate for Payer: Cash Price |
$1,937.50
|
| Rate for Payer: Cigna Commercial |
$3,216.25
|
| Rate for Payer: First Health Commercial |
$3,681.25
|
| Rate for Payer: Humana Commercial |
$3,293.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,177.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,859.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,162.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,410.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,906.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,371.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,673.75
|
| Rate for Payer: PHCS Commercial |
$3,720.00
|
| Rate for Payer: United Healthcare All Payer |
$3,410.00
|
|
|
TRNSCND FEM HD 36M TPR MED NCK
|
Facility
|
OP
|
$3,875.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,162.50 |
| Max. Negotiated Rate |
$3,720.00 |
| Rate for Payer: Aetna Commercial |
$2,983.75
|
| Rate for Payer: Anthem Medicaid |
$1,332.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,022.50
|
| Rate for Payer: Cash Price |
$1,937.50
|
| Rate for Payer: Cigna Commercial |
$3,216.25
|
| Rate for Payer: First Health Commercial |
$3,681.25
|
| Rate for Payer: Humana Commercial |
$3,293.75
|
| Rate for Payer: Humana KY Medicaid |
$1,332.61
|
| Rate for Payer: Kentucky WC Medicaid |
$1,346.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,177.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,859.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,162.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,359.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,410.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,906.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,371.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,673.75
|
| Rate for Payer: PHCS Commercial |
$3,720.00
|
| Rate for Payer: United Healthcare All Payer |
$3,410.00
|
|
|
TRNSCND FEM HD 36M TPR XLG NCK
|
Facility
|
IP
|
$3,875.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,162.50 |
| Max. Negotiated Rate |
$3,720.00 |
| Rate for Payer: Aetna Commercial |
$2,983.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,022.50
|
| Rate for Payer: Cash Price |
$1,937.50
|
| Rate for Payer: Cigna Commercial |
$3,216.25
|
| Rate for Payer: First Health Commercial |
$3,681.25
|
| Rate for Payer: Humana Commercial |
$3,293.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,177.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,859.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,162.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,410.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,906.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,371.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,673.75
|
| Rate for Payer: PHCS Commercial |
$3,720.00
|
| Rate for Payer: United Healthcare All Payer |
$3,410.00
|
|
