|
COMPOSITE SKIN GRAFT(T
|
Facility
|
IP
|
$4,525.46
|
|
|
Service Code
|
HCPCS 15760
|
| Hospital Charge Code |
761T0208
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$588.31 |
| Max. Negotiated Rate |
$4,344.44 |
| Rate for Payer: Aetna Commercial |
$3,484.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,529.86
|
| Rate for Payer: Cash Price |
$2,262.73
|
| Rate for Payer: Cigna Commercial |
$3,756.13
|
| Rate for Payer: First Health Commercial |
$4,299.19
|
| Rate for Payer: Humana Commercial |
$3,846.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,710.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,339.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,357.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,982.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,394.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$905.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$588.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,402.89
|
| Rate for Payer: PHCS Commercial |
$4,344.44
|
| Rate for Payer: United Healthcare All Payer |
$3,982.40
|
|
|
COMPREHEN METABOLIC PANEL
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
HCPCS 80053
|
| Hospital Charge Code |
30000008
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.18 |
| Max. Negotiated Rate |
$82.56 |
| Rate for Payer: Aetna Commercial |
$66.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$69.06
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cigna Commercial |
$71.38
|
| Rate for Payer: First Health Commercial |
$81.70
|
| Rate for Payer: Humana Commercial |
$73.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$75.68
|
| Rate for Payer: Ohio Health Group HMO |
$64.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.66
|
| Rate for Payer: PHCS Commercial |
$82.56
|
| Rate for Payer: United Healthcare All Payer |
$75.68
|
|
|
COMPREHEN METABOLIC PANEL
|
Professional
|
Both
|
$86.00
|
|
|
Service Code
|
HCPCS 80053
|
| Hospital Charge Code |
30000008
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.34 |
| Max. Negotiated Rate |
$86.00 |
| Rate for Payer: Aetna Commercial |
$19.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$86.00
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cigna Commercial |
$9.35
|
| Rate for Payer: Healthspan PPO |
$11.08
|
| Rate for Payer: Multiplan PHCS |
$51.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$60.20
|
| Rate for Payer: UHCCP Medicaid |
$30.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$6.34
|
|
|
COMPREHEN METABOLIC PANEL
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
HCPCS 80053
|
| Hospital Charge Code |
30000008
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.56 |
| Max. Negotiated Rate |
$82.56 |
| Rate for Payer: Aetna Commercial |
$66.22
|
| Rate for Payer: Anthem Medicaid |
$10.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$69.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$14.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$10.56
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cigna Commercial |
$71.38
|
| Rate for Payer: First Health Commercial |
$81.70
|
| Rate for Payer: Humana Commercial |
$73.10
|
| Rate for Payer: Humana KY Medicaid |
$10.56
|
| Rate for Payer: Humana Medicare Advantage |
$10.56
|
| Rate for Payer: Kentucky WC Medicaid |
$10.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$75.68
|
| Rate for Payer: Ohio Health Group HMO |
$64.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.66
|
| Rate for Payer: PHCS Commercial |
$82.56
|
| Rate for Payer: United Healthcare All Payer |
$75.68
|
|
|
COMPREHENSIVE OR DIAG EVAL
|
Facility
|
OP
|
$378.00
|
|
|
Service Code
|
HCPCS 92588
|
| Hospital Charge Code |
47000019
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$49.14 |
| Max. Negotiated Rate |
$380.00 |
| Rate for Payer: Aetna Commercial |
$291.06
|
| Rate for Payer: Anthem Medicaid |
$129.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$271.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$294.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$380.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$366.43
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$313.74
|
| Rate for Payer: First Health Commercial |
$359.10
|
| Rate for Payer: Humana Commercial |
$321.30
|
| Rate for Payer: Humana KY Medicaid |
$129.99
|
| Rate for Payer: Humana Medicare Advantage |
$271.43
|
| Rate for Payer: Kentucky WC Medicaid |
$131.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$309.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$278.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$132.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$332.64
|
| Rate for Payer: Ohio Health Group HMO |
$283.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$75.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$49.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$117.18
|
| Rate for Payer: PHCS Commercial |
$362.88
|
| Rate for Payer: United Healthcare All Payer |
$332.64
|
|
|
COMPREHENSIVE OR DIAG EVAL
|
Facility
|
IP
|
$378.00
|
|
|
Service Code
|
HCPCS 92588
|
| Hospital Charge Code |
47000019
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$49.14 |
| Max. Negotiated Rate |
$362.88 |
| Rate for Payer: Aetna Commercial |
$291.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$294.84
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$313.74
|
| Rate for Payer: First Health Commercial |
$359.10
|
| Rate for Payer: Humana Commercial |
$321.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$309.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$278.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$113.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$332.64
|
| Rate for Payer: Ohio Health Group HMO |
$283.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$75.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$49.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$117.18
|
| Rate for Payer: PHCS Commercial |
$362.88
|
| Rate for Payer: United Healthcare All Payer |
$332.64
|
|
|
COMPREHENSIVE OR DIAG EVAL
|
Professional
|
Both
|
$378.00
|
|
|
Service Code
|
HCPCS 92588
|
| Hospital Charge Code |
47000019
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$21.80 |
| Max. Negotiated Rate |
$378.00 |
| Rate for Payer: Aetna Commercial |
$97.11
|
| Rate for Payer: Anthem Medicaid |
$60.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$378.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$111.28
|
| Rate for Payer: Healthspan PPO |
$79.46
|
| Rate for Payer: Humana Medicaid |
$60.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$21.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$61.25
|
| Rate for Payer: Molina Healthcare Passport |
$60.05
|
| Rate for Payer: Multiplan PHCS |
$226.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$264.60
|
| Rate for Payer: UHCCP Medicaid |
$132.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$60.65
|
|
|
COMPREHENSIVE REV STEM 10MM
|
Facility
|
OP
|
$27,159.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,530.79 |
| Max. Negotiated Rate |
$26,073.50 |
| Rate for Payer: Aetna Commercial |
$20,913.12
|
| Rate for Payer: Anthem Medicaid |
$9,340.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,184.72
|
| Rate for Payer: Cash Price |
$13,579.95
|
| Rate for Payer: Cigna Commercial |
$22,542.72
|
| Rate for Payer: First Health Commercial |
$25,801.90
|
| Rate for Payer: Humana Commercial |
$23,085.92
|
| Rate for Payer: Humana KY Medicaid |
$9,340.29
|
| Rate for Payer: Kentucky WC Medicaid |
$9,435.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,271.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,044.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,147.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,527.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,900.71
|
| Rate for Payer: Ohio Health Group HMO |
$20,369.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,431.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,530.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,419.57
|
| Rate for Payer: PHCS Commercial |
$26,073.50
|
| Rate for Payer: United Healthcare All Payer |
$23,900.71
|
|
|
COMPREHENSIVE REV STEM 10MM
|
Facility
|
IP
|
$27,159.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,530.79 |
| Max. Negotiated Rate |
$26,073.50 |
| Rate for Payer: Aetna Commercial |
$20,913.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,184.72
|
| Rate for Payer: Cash Price |
$13,579.95
|
| Rate for Payer: Cigna Commercial |
$22,542.72
|
| Rate for Payer: First Health Commercial |
$25,801.90
|
| Rate for Payer: Humana Commercial |
$23,085.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,271.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,044.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,147.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,900.71
|
| Rate for Payer: Ohio Health Group HMO |
$20,369.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,431.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,530.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,419.57
|
| Rate for Payer: PHCS Commercial |
$26,073.50
|
| Rate for Payer: United Healthcare All Payer |
$23,900.71
|
|
|
COMPREHENSIVE REV STEM 12MM
|
Facility
|
OP
|
$27,159.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,530.79 |
| Max. Negotiated Rate |
$26,073.50 |
| Rate for Payer: Aetna Commercial |
$20,913.12
|
| Rate for Payer: Anthem Medicaid |
$9,340.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,184.72
|
| Rate for Payer: Cash Price |
$13,579.95
|
| Rate for Payer: Cigna Commercial |
$22,542.72
|
| Rate for Payer: First Health Commercial |
$25,801.90
|
| Rate for Payer: Humana Commercial |
$23,085.92
|
| Rate for Payer: Humana KY Medicaid |
$9,340.29
|
| Rate for Payer: Kentucky WC Medicaid |
$9,435.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,271.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,044.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,147.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,527.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,900.71
|
| Rate for Payer: Ohio Health Group HMO |
$20,369.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,431.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,530.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,419.57
|
| Rate for Payer: PHCS Commercial |
$26,073.50
|
| Rate for Payer: United Healthcare All Payer |
$23,900.71
|
|
|
COMPREHENSIVE REV STEM 12MM
|
Facility
|
IP
|
$27,159.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,530.79 |
| Max. Negotiated Rate |
$26,073.50 |
| Rate for Payer: Aetna Commercial |
$20,913.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,184.72
|
| Rate for Payer: Cash Price |
$13,579.95
|
| Rate for Payer: Cigna Commercial |
$22,542.72
|
| Rate for Payer: First Health Commercial |
$25,801.90
|
| Rate for Payer: Humana Commercial |
$23,085.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,271.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,044.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,147.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,900.71
|
| Rate for Payer: Ohio Health Group HMO |
$20,369.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,431.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,530.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,419.57
|
| Rate for Payer: PHCS Commercial |
$26,073.50
|
| Rate for Payer: United Healthcare All Payer |
$23,900.71
|
|
|
COMPREHENSIVE REV STEM 14MM
|
Facility
|
OP
|
$27,159.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,530.79 |
| Max. Negotiated Rate |
$26,073.50 |
| Rate for Payer: Aetna Commercial |
$20,913.12
|
| Rate for Payer: Anthem Medicaid |
$9,340.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,184.72
|
| Rate for Payer: Cash Price |
$13,579.95
|
| Rate for Payer: Cigna Commercial |
$22,542.72
|
| Rate for Payer: First Health Commercial |
$25,801.90
|
| Rate for Payer: Humana Commercial |
$23,085.92
|
| Rate for Payer: Humana KY Medicaid |
$9,340.29
|
| Rate for Payer: Kentucky WC Medicaid |
$9,435.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,271.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,044.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,147.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,527.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,900.71
|
| Rate for Payer: Ohio Health Group HMO |
$20,369.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,431.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,530.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,419.57
|
| Rate for Payer: PHCS Commercial |
$26,073.50
|
| Rate for Payer: United Healthcare All Payer |
$23,900.71
|
|
|
COMPREHENSIVE REV STEM 14MM
|
Facility
|
IP
|
$27,159.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,530.79 |
| Max. Negotiated Rate |
$26,073.50 |
| Rate for Payer: Aetna Commercial |
$20,913.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,184.72
|
| Rate for Payer: Cash Price |
$13,579.95
|
| Rate for Payer: Cigna Commercial |
$22,542.72
|
| Rate for Payer: First Health Commercial |
$25,801.90
|
| Rate for Payer: Humana Commercial |
$23,085.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,271.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,044.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,147.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,900.71
|
| Rate for Payer: Ohio Health Group HMO |
$20,369.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,431.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,530.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,419.57
|
| Rate for Payer: PHCS Commercial |
$26,073.50
|
| Rate for Payer: United Healthcare All Payer |
$23,900.71
|
|
|
COMPREHENSIVE REV STEM 4MM
|
Facility
|
IP
|
$27,159.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,530.79 |
| Max. Negotiated Rate |
$26,073.50 |
| Rate for Payer: Aetna Commercial |
$20,913.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,184.72
|
| Rate for Payer: Cash Price |
$13,579.95
|
| Rate for Payer: Cigna Commercial |
$22,542.72
|
| Rate for Payer: First Health Commercial |
$25,801.90
|
| Rate for Payer: Humana Commercial |
$23,085.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,271.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,044.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,147.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,900.71
|
| Rate for Payer: Ohio Health Group HMO |
$20,369.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,431.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,530.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,419.57
|
| Rate for Payer: PHCS Commercial |
$26,073.50
|
| Rate for Payer: United Healthcare All Payer |
$23,900.71
|
|
|
COMPREHENSIVE REV STEM 4MM
|
Facility
|
OP
|
$27,159.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,530.79 |
| Max. Negotiated Rate |
$26,073.50 |
| Rate for Payer: Aetna Commercial |
$20,913.12
|
| Rate for Payer: Anthem Medicaid |
$9,340.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,184.72
|
| Rate for Payer: Cash Price |
$13,579.95
|
| Rate for Payer: Cigna Commercial |
$22,542.72
|
| Rate for Payer: First Health Commercial |
$25,801.90
|
| Rate for Payer: Humana Commercial |
$23,085.92
|
| Rate for Payer: Humana KY Medicaid |
$9,340.29
|
| Rate for Payer: Kentucky WC Medicaid |
$9,435.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,271.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,044.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,147.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,527.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,900.71
|
| Rate for Payer: Ohio Health Group HMO |
$20,369.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,431.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,530.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,419.57
|
| Rate for Payer: PHCS Commercial |
$26,073.50
|
| Rate for Payer: United Healthcare All Payer |
$23,900.71
|
|
|
COMPREHENSIVE REV STEM 6MM
|
Facility
|
IP
|
$21,538.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,800.06 |
| Max. Negotiated Rate |
$20,677.34 |
| Rate for Payer: Aetna Commercial |
$16,584.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,800.34
|
| Rate for Payer: Cash Price |
$10,769.45
|
| Rate for Payer: Cigna Commercial |
$17,877.29
|
| Rate for Payer: First Health Commercial |
$20,461.96
|
| Rate for Payer: Humana Commercial |
$18,308.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,661.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,895.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,461.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,954.23
|
| Rate for Payer: Ohio Health Group HMO |
$16,154.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,307.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,800.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,677.06
|
| Rate for Payer: PHCS Commercial |
$20,677.34
|
| Rate for Payer: United Healthcare All Payer |
$18,954.23
|
|
|
COMPREHENSIVE REV STEM 6MM
|
Facility
|
OP
|
$21,538.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,800.06 |
| Max. Negotiated Rate |
$20,677.34 |
| Rate for Payer: Aetna Commercial |
$16,584.95
|
| Rate for Payer: Anthem Medicaid |
$7,407.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,800.34
|
| Rate for Payer: Cash Price |
$10,769.45
|
| Rate for Payer: Cigna Commercial |
$17,877.29
|
| Rate for Payer: First Health Commercial |
$20,461.96
|
| Rate for Payer: Humana Commercial |
$18,308.06
|
| Rate for Payer: Humana KY Medicaid |
$7,407.23
|
| Rate for Payer: Kentucky WC Medicaid |
$7,482.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,661.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,895.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,461.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,555.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,954.23
|
| Rate for Payer: Ohio Health Group HMO |
$16,154.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,307.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,800.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,677.06
|
| Rate for Payer: PHCS Commercial |
$20,677.34
|
| Rate for Payer: United Healthcare All Payer |
$18,954.23
|
|
|
COMPREHENSIVE REV STEM 8MM
|
Facility
|
OP
|
$27,159.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,530.79 |
| Max. Negotiated Rate |
$26,073.50 |
| Rate for Payer: Aetna Commercial |
$20,913.12
|
| Rate for Payer: Anthem Medicaid |
$9,340.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,184.72
|
| Rate for Payer: Cash Price |
$13,579.95
|
| Rate for Payer: Cigna Commercial |
$22,542.72
|
| Rate for Payer: First Health Commercial |
$25,801.90
|
| Rate for Payer: Humana Commercial |
$23,085.92
|
| Rate for Payer: Humana KY Medicaid |
$9,340.29
|
| Rate for Payer: Kentucky WC Medicaid |
$9,435.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,271.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,044.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,147.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,527.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,900.71
|
| Rate for Payer: Ohio Health Group HMO |
$20,369.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,431.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,530.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,419.57
|
| Rate for Payer: PHCS Commercial |
$26,073.50
|
| Rate for Payer: United Healthcare All Payer |
$23,900.71
|
|
|
COMPREHENSIVE REV STEM 8MM
|
Facility
|
IP
|
$27,159.90
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,530.79 |
| Max. Negotiated Rate |
$26,073.50 |
| Rate for Payer: Aetna Commercial |
$20,913.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,184.72
|
| Rate for Payer: Cash Price |
$13,579.95
|
| Rate for Payer: Cigna Commercial |
$22,542.72
|
| Rate for Payer: First Health Commercial |
$25,801.90
|
| Rate for Payer: Humana Commercial |
$23,085.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,271.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,044.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,147.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,900.71
|
| Rate for Payer: Ohio Health Group HMO |
$20,369.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,431.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,530.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,419.57
|
| Rate for Payer: PHCS Commercial |
$26,073.50
|
| Rate for Payer: United Healthcare All Payer |
$23,900.71
|
|
|
COMPRES.3 FINGR JACK DISP DISC
|
Facility
|
IP
|
$451.67
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$58.72 |
| Max. Negotiated Rate |
$433.60 |
| Rate for Payer: Aetna Commercial |
$347.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$352.30
|
| Rate for Payer: Cash Price |
$225.83
|
| Rate for Payer: Cigna Commercial |
$374.89
|
| Rate for Payer: First Health Commercial |
$429.09
|
| Rate for Payer: Humana Commercial |
$383.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$370.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$333.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$135.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$397.47
|
| Rate for Payer: Ohio Health Group HMO |
$338.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$140.02
|
| Rate for Payer: PHCS Commercial |
$433.60
|
| Rate for Payer: United Healthcare All Payer |
$397.47
|
|
|
COMPRES.3 FINGR JACK DISP DISC
|
Facility
|
OP
|
$451.67
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$58.72 |
| Max. Negotiated Rate |
$433.60 |
| Rate for Payer: Aetna Commercial |
$347.79
|
| Rate for Payer: Anthem Medicaid |
$155.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$352.30
|
| Rate for Payer: Cash Price |
$225.83
|
| Rate for Payer: Cigna Commercial |
$374.89
|
| Rate for Payer: First Health Commercial |
$429.09
|
| Rate for Payer: Humana Commercial |
$383.92
|
| Rate for Payer: Humana KY Medicaid |
$155.33
|
| Rate for Payer: Kentucky WC Medicaid |
$156.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$370.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$333.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$135.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$158.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$397.47
|
| Rate for Payer: Ohio Health Group HMO |
$338.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$140.02
|
| Rate for Payer: PHCS Commercial |
$433.60
|
| Rate for Payer: United Healthcare All Payer |
$397.47
|
|
|
COMPRES ELPSH SPDL W PINS 400F
|
Facility
|
OP
|
$26,445.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,437.97 |
| Max. Negotiated Rate |
$25,388.12 |
| Rate for Payer: Cigna Commercial |
$21,950.15
|
| Rate for Payer: Aetna Commercial |
$20,363.39
|
| Rate for Payer: Anthem Medicaid |
$9,094.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,627.85
|
| Rate for Payer: Cash Price |
$13,222.98
|
| Rate for Payer: First Health Commercial |
$25,123.66
|
| Rate for Payer: Humana Commercial |
$22,479.07
|
| Rate for Payer: Humana KY Medicaid |
$9,094.77
|
| Rate for Payer: Kentucky WC Medicaid |
$9,187.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,685.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,517.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,933.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,277.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,272.44
|
| Rate for Payer: Ohio Health Group HMO |
$19,834.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,289.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,437.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,198.25
|
| Rate for Payer: PHCS Commercial |
$25,388.12
|
| Rate for Payer: United Healthcare All Payer |
$23,272.44
|
|
|
COMPRES ELPSH SPDL W PINS 400F
|
Facility
|
IP
|
$26,445.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,437.97 |
| Max. Negotiated Rate |
$25,388.12 |
| Rate for Payer: Aetna Commercial |
$20,363.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,627.85
|
| Rate for Payer: Cash Price |
$13,222.98
|
| Rate for Payer: Cigna Commercial |
$21,950.15
|
| Rate for Payer: First Health Commercial |
$25,123.66
|
| Rate for Payer: Humana Commercial |
$22,479.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,685.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,517.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,933.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,272.44
|
| Rate for Payer: Ohio Health Group HMO |
$19,834.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,289.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,437.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,198.25
|
| Rate for Payer: PHCS Commercial |
$25,388.12
|
| Rate for Payer: United Healthcare All Payer |
$23,272.44
|
|
|
COMPRES ELPSH SPDL W PINS 600F
|
Facility
|
OP
|
$26,445.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,437.97 |
| Max. Negotiated Rate |
$25,388.12 |
| Rate for Payer: Aetna Commercial |
$20,363.39
|
| Rate for Payer: Anthem Medicaid |
$9,094.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,627.85
|
| Rate for Payer: Cash Price |
$13,222.98
|
| Rate for Payer: Cigna Commercial |
$21,950.15
|
| Rate for Payer: First Health Commercial |
$25,123.66
|
| Rate for Payer: Humana Commercial |
$22,479.07
|
| Rate for Payer: Humana KY Medicaid |
$9,094.77
|
| Rate for Payer: Kentucky WC Medicaid |
$9,187.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,685.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,517.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,933.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,277.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,272.44
|
| Rate for Payer: Ohio Health Group HMO |
$19,834.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,289.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,437.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,198.25
|
| Rate for Payer: PHCS Commercial |
$25,388.12
|
| Rate for Payer: United Healthcare All Payer |
$23,272.44
|
|
|
COMPRES ELPSH SPDL W PINS 600F
|
Facility
|
IP
|
$26,445.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,437.97 |
| Max. Negotiated Rate |
$25,388.12 |
| Rate for Payer: Aetna Commercial |
$20,363.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,627.85
|
| Rate for Payer: Cash Price |
$13,222.98
|
| Rate for Payer: Cigna Commercial |
$21,950.15
|
| Rate for Payer: First Health Commercial |
$25,123.66
|
| Rate for Payer: Humana Commercial |
$22,479.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,685.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,517.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,933.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,272.44
|
| Rate for Payer: Ohio Health Group HMO |
$19,834.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,289.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,437.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,198.25
|
| Rate for Payer: PHCS Commercial |
$25,388.12
|
| Rate for Payer: United Healthcare All Payer |
$23,272.44
|
|
