|
COAPTITE 1ML SYRINGE
|
Facility
|
IP
|
$3,627.68
|
|
|
Service Code
|
HCPCS L8606
|
| Hospital Charge Code |
27000284
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$471.60 |
| Max. Negotiated Rate |
$3,482.57 |
| Rate for Payer: Aetna Commercial |
$2,793.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,829.59
|
| Rate for Payer: Cash Price |
$1,813.84
|
| Rate for Payer: Cigna Commercial |
$3,010.97
|
| Rate for Payer: First Health Commercial |
$3,446.30
|
| Rate for Payer: Humana Commercial |
$3,083.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,974.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,677.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,088.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,192.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,720.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$725.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$471.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,124.58
|
| Rate for Payer: PHCS Commercial |
$3,482.57
|
| Rate for Payer: United Healthcare All Payer |
$3,192.36
|
|
|
COAPTITE 1ML SYRINGE
|
Facility
|
OP
|
$3,627.68
|
|
|
Service Code
|
HCPCS L8606
|
| Hospital Charge Code |
27000284
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$471.60 |
| Max. Negotiated Rate |
$3,482.57 |
| Rate for Payer: Aetna Commercial |
$2,793.31
|
| Rate for Payer: Anthem Medicaid |
$1,247.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,829.59
|
| Rate for Payer: Cash Price |
$1,813.84
|
| Rate for Payer: Cigna Commercial |
$3,010.97
|
| Rate for Payer: First Health Commercial |
$3,446.30
|
| Rate for Payer: Humana Commercial |
$3,083.53
|
| Rate for Payer: Humana KY Medicaid |
$1,247.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1,260.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,974.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,677.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,088.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,272.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,192.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,720.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$725.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$471.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,124.58
|
| Rate for Payer: PHCS Commercial |
$3,482.57
|
| Rate for Payer: United Healthcare All Payer |
$3,192.36
|
|
|
COBALT HV BONE CEMENT 402432
|
Facility
|
OP
|
$1,731.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$225.10 |
| Max. Negotiated Rate |
$1,662.24 |
| Rate for Payer: Aetna Commercial |
$1,333.26
|
| Rate for Payer: Anthem Medicaid |
$595.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,350.57
|
| Rate for Payer: Cash Price |
$865.75
|
| Rate for Payer: Cigna Commercial |
$1,437.14
|
| Rate for Payer: First Health Commercial |
$1,644.92
|
| Rate for Payer: Humana Commercial |
$1,471.78
|
| Rate for Payer: Humana KY Medicaid |
$595.46
|
| Rate for Payer: Kentucky WC Medicaid |
$601.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,419.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,277.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$519.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$607.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,523.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,298.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$346.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$225.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$536.76
|
| Rate for Payer: PHCS Commercial |
$1,662.24
|
| Rate for Payer: United Healthcare All Payer |
$1,523.72
|
|
|
COBALT HV BONE CEMENT 402432
|
Facility
|
IP
|
$1,731.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$225.10 |
| Max. Negotiated Rate |
$1,662.24 |
| Rate for Payer: Aetna Commercial |
$1,333.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,350.57
|
| Rate for Payer: Cash Price |
$865.75
|
| Rate for Payer: Cigna Commercial |
$1,437.14
|
| Rate for Payer: First Health Commercial |
$1,644.92
|
| Rate for Payer: Humana Commercial |
$1,471.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,419.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,277.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$519.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,523.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,298.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$346.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$225.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$536.76
|
| Rate for Payer: PHCS Commercial |
$1,662.24
|
| Rate for Payer: United Healthcare All Payer |
$1,523.72
|
|
|
COBALT XT HF CRT
|
Facility
|
OP
|
$73,119.80
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,505.57 |
| Max. Negotiated Rate |
$70,195.01 |
| Rate for Payer: PHCS Commercial |
$70,195.01
|
| Rate for Payer: Aetna Commercial |
$56,302.25
|
| Rate for Payer: Anthem Medicaid |
$25,145.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57,033.44
|
| Rate for Payer: Cash Price |
$36,559.90
|
| Rate for Payer: Cigna Commercial |
$60,689.43
|
| Rate for Payer: First Health Commercial |
$69,463.81
|
| Rate for Payer: Humana Commercial |
$62,151.83
|
| Rate for Payer: Humana KY Medicaid |
$25,145.90
|
| Rate for Payer: Kentucky WC Medicaid |
$25,401.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,958.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,962.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,935.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,650.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$64,345.42
|
| Rate for Payer: Ohio Health Group HMO |
$54,839.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,623.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,505.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,667.14
|
| Rate for Payer: United Healthcare All Payer |
$64,345.42
|
|
|
COBALT XT HF CRT
|
Facility
|
IP
|
$73,119.80
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,505.57 |
| Max. Negotiated Rate |
$70,195.01 |
| Rate for Payer: Aetna Commercial |
$56,302.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57,033.44
|
| Rate for Payer: Cash Price |
$36,559.90
|
| Rate for Payer: Cigna Commercial |
$60,689.43
|
| Rate for Payer: First Health Commercial |
$69,463.81
|
| Rate for Payer: Humana Commercial |
$62,151.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,958.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,962.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,935.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$64,345.42
|
| Rate for Payer: Ohio Health Group HMO |
$54,839.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,623.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,505.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,667.14
|
| Rate for Payer: PHCS Commercial |
$70,195.01
|
| Rate for Payer: United Healthcare All Payer |
$64,345.42
|
|
|
COBALT XT HF CRT SURE SCAN
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
COBALT XT HF CRT SURE SCAN
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
COBALT XT HF QUAD CRT-D
|
Facility
|
OP
|
$73,119.80
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,505.57 |
| Max. Negotiated Rate |
$70,195.01 |
| Rate for Payer: Aetna Commercial |
$56,302.25
|
| Rate for Payer: Anthem Medicaid |
$25,145.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57,033.44
|
| Rate for Payer: Cash Price |
$36,559.90
|
| Rate for Payer: Cigna Commercial |
$60,689.43
|
| Rate for Payer: First Health Commercial |
$69,463.81
|
| Rate for Payer: Humana Commercial |
$62,151.83
|
| Rate for Payer: Humana KY Medicaid |
$25,145.90
|
| Rate for Payer: Kentucky WC Medicaid |
$25,401.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,958.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,962.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,935.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,650.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$64,345.42
|
| Rate for Payer: Ohio Health Group HMO |
$54,839.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,623.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,505.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,667.14
|
| Rate for Payer: PHCS Commercial |
$70,195.01
|
| Rate for Payer: United Healthcare All Payer |
$64,345.42
|
|
|
COBALT XT HF QUAD CRT-D
|
Facility
|
IP
|
$73,119.80
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$9,505.57 |
| Max. Negotiated Rate |
$70,195.01 |
| Rate for Payer: Aetna Commercial |
$56,302.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57,033.44
|
| Rate for Payer: Cash Price |
$36,559.90
|
| Rate for Payer: Cigna Commercial |
$60,689.43
|
| Rate for Payer: First Health Commercial |
$69,463.81
|
| Rate for Payer: Humana Commercial |
$62,151.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,958.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,962.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,935.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$64,345.42
|
| Rate for Payer: Ohio Health Group HMO |
$54,839.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,623.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,505.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,667.14
|
| Rate for Payer: PHCS Commercial |
$70,195.01
|
| Rate for Payer: United Healthcare All Payer |
$64,345.42
|
|
|
COBRA PRIM SO 12/14 SZ 1
|
Facility
|
OP
|
$9,538.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,240.02 |
| Max. Negotiated Rate |
$9,157.08 |
| Rate for Payer: Aetna Commercial |
$7,344.75
|
| Rate for Payer: Anthem Medicaid |
$3,280.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,440.13
|
| Rate for Payer: Cash Price |
$4,769.31
|
| Rate for Payer: Cigna Commercial |
$7,917.06
|
| Rate for Payer: First Health Commercial |
$9,061.70
|
| Rate for Payer: Humana Commercial |
$8,107.84
|
| Rate for Payer: Humana KY Medicaid |
$3,280.33
|
| Rate for Payer: Kentucky WC Medicaid |
$3,313.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,821.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,039.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,861.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,346.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,393.99
|
| Rate for Payer: Ohio Health Group HMO |
$7,153.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,907.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,240.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,956.98
|
| Rate for Payer: PHCS Commercial |
$9,157.08
|
| Rate for Payer: United Healthcare All Payer |
$8,393.99
|
|
|
COBRA PRIM SO 12/14 SZ 1
|
Facility
|
IP
|
$9,538.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,240.02 |
| Max. Negotiated Rate |
$9,157.08 |
| Rate for Payer: Aetna Commercial |
$7,344.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,440.13
|
| Rate for Payer: Cash Price |
$4,769.31
|
| Rate for Payer: Cigna Commercial |
$7,917.06
|
| Rate for Payer: First Health Commercial |
$9,061.70
|
| Rate for Payer: Humana Commercial |
$8,107.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,821.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,039.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,861.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,393.99
|
| Rate for Payer: Ohio Health Group HMO |
$7,153.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,907.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,240.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,956.98
|
| Rate for Payer: PHCS Commercial |
$9,157.08
|
| Rate for Payer: United Healthcare All Payer |
$8,393.99
|
|
|
COBRA PRIM SO 12/14 SZ 2
|
Facility
|
IP
|
$9,538.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,240.02 |
| Max. Negotiated Rate |
$9,157.08 |
| Rate for Payer: Aetna Commercial |
$7,344.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,440.13
|
| Rate for Payer: Cash Price |
$4,769.31
|
| Rate for Payer: Cigna Commercial |
$7,917.06
|
| Rate for Payer: First Health Commercial |
$9,061.70
|
| Rate for Payer: Humana Commercial |
$8,107.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,821.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,039.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,861.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,393.99
|
| Rate for Payer: Ohio Health Group HMO |
$7,153.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,907.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,240.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,956.98
|
| Rate for Payer: PHCS Commercial |
$9,157.08
|
| Rate for Payer: United Healthcare All Payer |
$8,393.99
|
|
|
COBRA PRIM SO 12/14 SZ 2
|
Facility
|
OP
|
$9,538.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,240.02 |
| Max. Negotiated Rate |
$9,157.08 |
| Rate for Payer: Aetna Commercial |
$7,344.75
|
| Rate for Payer: Anthem Medicaid |
$3,280.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,440.13
|
| Rate for Payer: Cash Price |
$4,769.31
|
| Rate for Payer: Cigna Commercial |
$7,917.06
|
| Rate for Payer: First Health Commercial |
$9,061.70
|
| Rate for Payer: Humana Commercial |
$8,107.84
|
| Rate for Payer: Humana KY Medicaid |
$3,280.33
|
| Rate for Payer: Kentucky WC Medicaid |
$3,313.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,821.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,039.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,861.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,346.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,393.99
|
| Rate for Payer: Ohio Health Group HMO |
$7,153.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,907.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,240.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,956.98
|
| Rate for Payer: PHCS Commercial |
$9,157.08
|
| Rate for Payer: United Healthcare All Payer |
$8,393.99
|
|
|
COBRA PRIM SO 12/14 SZ 3
|
Facility
|
OP
|
$9,538.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,240.02 |
| Max. Negotiated Rate |
$9,157.08 |
| Rate for Payer: Aetna Commercial |
$7,344.75
|
| Rate for Payer: Anthem Medicaid |
$3,280.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,440.13
|
| Rate for Payer: Cash Price |
$4,769.31
|
| Rate for Payer: Cigna Commercial |
$7,917.06
|
| Rate for Payer: First Health Commercial |
$9,061.70
|
| Rate for Payer: Humana Commercial |
$8,107.84
|
| Rate for Payer: Humana KY Medicaid |
$3,280.33
|
| Rate for Payer: Kentucky WC Medicaid |
$3,313.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,821.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,039.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,861.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,346.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,393.99
|
| Rate for Payer: Ohio Health Group HMO |
$7,153.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,907.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,240.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,956.98
|
| Rate for Payer: PHCS Commercial |
$9,157.08
|
| Rate for Payer: United Healthcare All Payer |
$8,393.99
|
|
|
COBRA PRIM SO 12/14 SZ 3
|
Facility
|
IP
|
$9,538.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,240.02 |
| Max. Negotiated Rate |
$9,157.08 |
| Rate for Payer: Aetna Commercial |
$7,344.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,440.13
|
| Rate for Payer: Cash Price |
$4,769.31
|
| Rate for Payer: Cigna Commercial |
$7,917.06
|
| Rate for Payer: First Health Commercial |
$9,061.70
|
| Rate for Payer: Humana Commercial |
$8,107.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,821.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,039.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,861.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,393.99
|
| Rate for Payer: Ohio Health Group HMO |
$7,153.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,907.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,240.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,956.98
|
| Rate for Payer: PHCS Commercial |
$9,157.08
|
| Rate for Payer: United Healthcare All Payer |
$8,393.99
|
|
|
COBRA PRIM SO 12/14 SZ 4
|
Facility
|
OP
|
$9,538.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,240.02 |
| Max. Negotiated Rate |
$9,157.08 |
| Rate for Payer: Aetna Commercial |
$7,344.75
|
| Rate for Payer: Anthem Medicaid |
$3,280.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,440.13
|
| Rate for Payer: Cash Price |
$4,769.31
|
| Rate for Payer: Cigna Commercial |
$7,917.06
|
| Rate for Payer: First Health Commercial |
$9,061.70
|
| Rate for Payer: Humana Commercial |
$8,107.84
|
| Rate for Payer: Humana KY Medicaid |
$3,280.33
|
| Rate for Payer: Kentucky WC Medicaid |
$3,313.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,821.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,039.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,861.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,346.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,393.99
|
| Rate for Payer: Ohio Health Group HMO |
$7,153.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,907.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,240.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,956.98
|
| Rate for Payer: PHCS Commercial |
$9,157.08
|
| Rate for Payer: United Healthcare All Payer |
$8,393.99
|
|
|
COBRA PRIM SO 12/14 SZ 4
|
Facility
|
IP
|
$9,538.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,240.02 |
| Max. Negotiated Rate |
$9,157.08 |
| Rate for Payer: Aetna Commercial |
$7,344.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,440.13
|
| Rate for Payer: Cash Price |
$4,769.31
|
| Rate for Payer: Cigna Commercial |
$7,917.06
|
| Rate for Payer: First Health Commercial |
$9,061.70
|
| Rate for Payer: Humana Commercial |
$8,107.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,821.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,039.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,861.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,393.99
|
| Rate for Payer: Ohio Health Group HMO |
$7,153.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,907.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,240.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,956.98
|
| Rate for Payer: PHCS Commercial |
$9,157.08
|
| Rate for Payer: United Healthcare All Payer |
$8,393.99
|
|
|
COBRA PRIM SO 12/14 SZ 5
|
Facility
|
OP
|
$9,538.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,240.02 |
| Max. Negotiated Rate |
$9,157.08 |
| Rate for Payer: Aetna Commercial |
$7,344.75
|
| Rate for Payer: Anthem Medicaid |
$3,280.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,440.13
|
| Rate for Payer: Cash Price |
$4,769.31
|
| Rate for Payer: Cigna Commercial |
$7,917.06
|
| Rate for Payer: First Health Commercial |
$9,061.70
|
| Rate for Payer: Humana Commercial |
$8,107.84
|
| Rate for Payer: Humana KY Medicaid |
$3,280.33
|
| Rate for Payer: Kentucky WC Medicaid |
$3,313.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,821.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,039.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,861.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,346.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,393.99
|
| Rate for Payer: Ohio Health Group HMO |
$7,153.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,907.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,240.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,956.98
|
| Rate for Payer: PHCS Commercial |
$9,157.08
|
| Rate for Payer: United Healthcare All Payer |
$8,393.99
|
|
|
COBRA PRIM SO 12/14 SZ 5
|
Facility
|
IP
|
$9,538.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,240.02 |
| Max. Negotiated Rate |
$9,157.08 |
| Rate for Payer: Aetna Commercial |
$7,344.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,440.13
|
| Rate for Payer: Cash Price |
$4,769.31
|
| Rate for Payer: Cigna Commercial |
$7,917.06
|
| Rate for Payer: First Health Commercial |
$9,061.70
|
| Rate for Payer: Humana Commercial |
$8,107.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,821.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,039.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,861.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,393.99
|
| Rate for Payer: Ohio Health Group HMO |
$7,153.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,907.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,240.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,956.98
|
| Rate for Payer: PHCS Commercial |
$9,157.08
|
| Rate for Payer: United Healthcare All Payer |
$8,393.99
|
|
|
COBRA PZF 2.50*12
|
Facility
|
IP
|
$4,825.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$627.25 |
| Max. Negotiated Rate |
$4,632.00 |
| Rate for Payer: Aetna Commercial |
$3,715.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,763.50
|
| Rate for Payer: Cash Price |
$2,412.50
|
| Rate for Payer: Cigna Commercial |
$4,004.75
|
| Rate for Payer: First Health Commercial |
$4,583.75
|
| Rate for Payer: Humana Commercial |
$4,101.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,956.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,560.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,447.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,246.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,618.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$965.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$627.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,495.75
|
| Rate for Payer: PHCS Commercial |
$4,632.00
|
| Rate for Payer: United Healthcare All Payer |
$4,246.00
|
|
|
COBRA PZF 2.50*12
|
Facility
|
OP
|
$4,825.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$627.25 |
| Max. Negotiated Rate |
$4,632.00 |
| Rate for Payer: Aetna Commercial |
$3,715.25
|
| Rate for Payer: Anthem Medicaid |
$1,659.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,763.50
|
| Rate for Payer: Cash Price |
$2,412.50
|
| Rate for Payer: Cigna Commercial |
$4,004.75
|
| Rate for Payer: First Health Commercial |
$4,583.75
|
| Rate for Payer: Humana Commercial |
$4,101.25
|
| Rate for Payer: Humana KY Medicaid |
$1,659.32
|
| Rate for Payer: Kentucky WC Medicaid |
$1,676.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,956.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,560.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,447.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,692.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,246.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,618.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$965.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$627.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,495.75
|
| Rate for Payer: PHCS Commercial |
$4,632.00
|
| Rate for Payer: United Healthcare All Payer |
$4,246.00
|
|
|
COBRA PZF 2.50*15
|
Facility
|
OP
|
$4,825.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$627.25 |
| Max. Negotiated Rate |
$4,632.00 |
| Rate for Payer: Aetna Commercial |
$3,715.25
|
| Rate for Payer: Anthem Medicaid |
$1,659.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,763.50
|
| Rate for Payer: Cash Price |
$2,412.50
|
| Rate for Payer: Cigna Commercial |
$4,004.75
|
| Rate for Payer: First Health Commercial |
$4,583.75
|
| Rate for Payer: Humana Commercial |
$4,101.25
|
| Rate for Payer: Humana KY Medicaid |
$1,659.32
|
| Rate for Payer: Kentucky WC Medicaid |
$1,676.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,956.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,560.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,447.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,692.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,246.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,618.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$965.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$627.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,495.75
|
| Rate for Payer: PHCS Commercial |
$4,632.00
|
| Rate for Payer: United Healthcare All Payer |
$4,246.00
|
|
|
COBRA PZF 2.50*15
|
Facility
|
IP
|
$4,825.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$627.25 |
| Max. Negotiated Rate |
$4,632.00 |
| Rate for Payer: Aetna Commercial |
$3,715.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,763.50
|
| Rate for Payer: Cash Price |
$2,412.50
|
| Rate for Payer: Cigna Commercial |
$4,004.75
|
| Rate for Payer: First Health Commercial |
$4,583.75
|
| Rate for Payer: Humana Commercial |
$4,101.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,956.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,560.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,447.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,246.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,618.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$965.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$627.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,495.75
|
| Rate for Payer: PHCS Commercial |
$4,632.00
|
| Rate for Payer: United Healthcare All Payer |
$4,246.00
|
|
|
COBRA PZF 2.50*18
|
Facility
|
IP
|
$4,825.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$627.25 |
| Max. Negotiated Rate |
$4,632.00 |
| Rate for Payer: Aetna Commercial |
$3,715.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,763.50
|
| Rate for Payer: Cash Price |
$2,412.50
|
| Rate for Payer: Cigna Commercial |
$4,004.75
|
| Rate for Payer: First Health Commercial |
$4,583.75
|
| Rate for Payer: Humana Commercial |
$4,101.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,956.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,560.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,447.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,246.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,618.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$965.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$627.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,495.75
|
| Rate for Payer: PHCS Commercial |
$4,632.00
|
| Rate for Payer: United Healthcare All Payer |
$4,246.00
|
|
