|
CL PHLNGL FX PRX/MID PXFT WMAN
|
Facility
|
IP
|
$932.00
|
|
|
Service Code
|
HCPCS 26725
|
| Hospital Charge Code |
45000144
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$279.60 |
| Max. Negotiated Rate |
$894.72 |
| Rate for Payer: Aetna Commercial |
$717.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$726.96
|
| Rate for Payer: Cash Price |
$466.00
|
| Rate for Payer: Cigna Commercial |
$773.56
|
| Rate for Payer: First Health Commercial |
$885.40
|
| Rate for Payer: Humana Commercial |
$792.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$764.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$687.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$279.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$820.16
|
| Rate for Payer: Ohio Health Group HMO |
$699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$745.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$810.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$643.08
|
| Rate for Payer: PHCS Commercial |
$894.72
|
| Rate for Payer: United Healthcare All Payer |
$820.16
|
|
|
CL PHLNGL FX PRX/MID PXFT WMAN
|
Facility
|
IP
|
$1,562.00
|
|
|
Service Code
|
HCPCS 26725
|
| Hospital Charge Code |
76100737
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$468.60 |
| Max. Negotiated Rate |
$1,499.52 |
| Rate for Payer: Aetna Commercial |
$1,202.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,218.36
|
| Rate for Payer: Cash Price |
$781.00
|
| Rate for Payer: Cigna Commercial |
$1,296.46
|
| Rate for Payer: First Health Commercial |
$1,483.90
|
| Rate for Payer: Humana Commercial |
$1,327.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,280.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,152.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$468.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,374.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,171.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,249.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,358.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,077.78
|
| Rate for Payer: PHCS Commercial |
$1,499.52
|
| Rate for Payer: United Healthcare All Payer |
$1,374.56
|
|
|
CL PHLNGL FX PRX/MID PXFT WMAN
|
Facility
|
IP
|
$932.00
|
|
|
Service Code
|
HCPCS 26725
|
| Hospital Charge Code |
761T0737
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$279.60 |
| Max. Negotiated Rate |
$894.72 |
| Rate for Payer: Aetna Commercial |
$717.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$726.96
|
| Rate for Payer: Cash Price |
$466.00
|
| Rate for Payer: Cigna Commercial |
$773.56
|
| Rate for Payer: First Health Commercial |
$885.40
|
| Rate for Payer: Humana Commercial |
$792.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$764.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$687.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$279.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$820.16
|
| Rate for Payer: Ohio Health Group HMO |
$699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$745.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$810.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$643.08
|
| Rate for Payer: PHCS Commercial |
$894.72
|
| Rate for Payer: United Healthcare All Payer |
$820.16
|
|
|
CL PHLNGL FX PRX/MID PXFT WMAN
|
Facility
|
OP
|
$932.00
|
|
|
Service Code
|
HCPCS 26725
|
| Hospital Charge Code |
761T0737
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$894.72 |
| Rate for Payer: Aetna Commercial |
$717.64
|
| Rate for Payer: Anthem Medicaid |
$320.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$726.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$466.00
|
| Rate for Payer: Cash Price |
$466.00
|
| Rate for Payer: Cigna Commercial |
$773.56
|
| Rate for Payer: First Health Commercial |
$885.40
|
| Rate for Payer: Humana Commercial |
$792.20
|
| Rate for Payer: Humana KY Medicaid |
$320.51
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$323.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$764.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$687.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$326.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$820.16
|
| Rate for Payer: Ohio Health Group HMO |
$699.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$745.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$810.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$643.08
|
| Rate for Payer: PHCS Commercial |
$894.72
|
| Rate for Payer: United Healthcare All Payer |
$820.16
|
|
|
CL PHLNGL FX PRX/MID PXFT WMAN
|
Professional
|
Both
|
$1,562.00
|
|
|
Service Code
|
HCPCS 26725
|
| Hospital Charge Code |
76100737
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$140.21 |
| Max. Negotiated Rate |
$937.20 |
| Rate for Payer: Aetna Commercial |
$417.54
|
| Rate for Payer: Ambetter Exchange |
$296.44
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$158.50
|
| Rate for Payer: Anthem Medicaid |
$140.21
|
| Rate for Payer: Buckeye Individual/Medicaid |
$296.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$296.44
|
| Rate for Payer: CareSource Just4Me Medicare |
$355.73
|
| Rate for Payer: Cash Price |
$781.00
|
| Rate for Payer: Cash Price |
$781.00
|
| Rate for Payer: Cigna Commercial |
$524.26
|
| Rate for Payer: Healthspan PPO |
$417.47
|
| Rate for Payer: Humana Medicaid |
$140.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$364.28
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$296.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$296.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$143.01
|
| Rate for Payer: Molina Healthcare Passport |
$140.21
|
| Rate for Payer: Multiplan PHCS |
$937.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$385.37
|
| Rate for Payer: UHCCP Medicaid |
$166.43
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$141.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$296.44
|
|
|
CL RESERVOIR 75CC
|
Facility
|
OP
|
$13,493.41
|
|
|
Service Code
|
HCPCS C1813
|
| Hospital Charge Code |
27000110
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,048.02 |
| Max. Negotiated Rate |
$12,953.67 |
| Rate for Payer: Aetna Commercial |
$10,389.93
|
| Rate for Payer: Anthem Medicaid |
$4,640.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,524.86
|
| Rate for Payer: Cash Price |
$6,746.70
|
| Rate for Payer: Cigna Commercial |
$11,199.53
|
| Rate for Payer: First Health Commercial |
$12,818.74
|
| Rate for Payer: Humana Commercial |
$11,469.40
|
| Rate for Payer: Humana KY Medicaid |
$4,640.38
|
| Rate for Payer: Kentucky WC Medicaid |
$4,687.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,064.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,958.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,048.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,733.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,874.20
|
| Rate for Payer: Ohio Health Group HMO |
$10,120.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,794.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,739.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,310.45
|
| Rate for Payer: PHCS Commercial |
$12,953.67
|
| Rate for Payer: United Healthcare All Payer |
$11,874.20
|
|
|
CL RESERVOIR 75CC
|
Facility
|
IP
|
$13,493.41
|
|
|
Service Code
|
HCPCS C1813
|
| Hospital Charge Code |
27000110
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,048.02 |
| Max. Negotiated Rate |
$12,953.67 |
| Rate for Payer: Aetna Commercial |
$10,389.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,524.86
|
| Rate for Payer: Cash Price |
$6,746.70
|
| Rate for Payer: Cigna Commercial |
$11,199.53
|
| Rate for Payer: First Health Commercial |
$12,818.74
|
| Rate for Payer: Humana Commercial |
$11,469.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,064.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,958.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,048.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,874.20
|
| Rate for Payer: Ohio Health Group HMO |
$10,120.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,794.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,739.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,310.45
|
| Rate for Payer: PHCS Commercial |
$12,953.67
|
| Rate for Payer: United Healthcare All Payer |
$11,874.20
|
|
|
CLSD CARPOMTCARDISLOWMANEAJNT
|
Facility
|
OP
|
$347.00
|
|
|
Service Code
|
HCPCS 26670
|
| Hospital Charge Code |
45000141
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$119.33 |
| Max. Negotiated Rate |
$333.12 |
| Rate for Payer: Aetna Commercial |
$267.19
|
| Rate for Payer: Anthem Medicaid |
$119.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$270.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$173.50
|
| Rate for Payer: Cash Price |
$173.50
|
| Rate for Payer: Cigna Commercial |
$288.01
|
| Rate for Payer: First Health Commercial |
$329.65
|
| Rate for Payer: Humana Commercial |
$294.95
|
| Rate for Payer: Humana KY Medicaid |
$119.33
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$120.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$284.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$256.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$121.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$305.36
|
| Rate for Payer: Ohio Health Group HMO |
$260.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$277.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$301.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$239.43
|
| Rate for Payer: PHCS Commercial |
$333.12
|
| Rate for Payer: United Healthcare All Payer |
$305.36
|
|
|
CLSD CARPOMTCARDISLOWMANEAJNT
|
Facility
|
IP
|
$335.00
|
|
|
Service Code
|
HCPCS 26670
|
| Hospital Charge Code |
76100729
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$100.50 |
| Max. Negotiated Rate |
$321.60 |
| Rate for Payer: Aetna Commercial |
$257.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$261.30
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cigna Commercial |
$278.05
|
| Rate for Payer: First Health Commercial |
$318.25
|
| Rate for Payer: Humana Commercial |
$284.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$274.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$247.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$100.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$294.80
|
| Rate for Payer: Ohio Health Group HMO |
$251.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$268.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$291.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$231.15
|
| Rate for Payer: PHCS Commercial |
$321.60
|
| Rate for Payer: United Healthcare All Payer |
$294.80
|
|
|
CLSD CARPOMTCARDISLOWMANEAJNT
|
Facility
|
OP
|
$335.00
|
|
|
Service Code
|
HCPCS 26670
|
| Hospital Charge Code |
76100729
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$115.21 |
| Max. Negotiated Rate |
$321.60 |
| Rate for Payer: Aetna Commercial |
$257.95
|
| Rate for Payer: Anthem Medicaid |
$115.21
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$261.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cigna Commercial |
$278.05
|
| Rate for Payer: First Health Commercial |
$318.25
|
| Rate for Payer: Humana Commercial |
$284.75
|
| Rate for Payer: Humana KY Medicaid |
$115.21
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$116.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$274.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$247.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$117.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$294.80
|
| Rate for Payer: Ohio Health Group HMO |
$251.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$268.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$291.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$231.15
|
| Rate for Payer: PHCS Commercial |
$321.60
|
| Rate for Payer: United Healthcare All Payer |
$294.80
|
|
|
CLSD CARPOMTCARDISLOWMANEAJNT
|
Facility
|
IP
|
$347.00
|
|
|
Service Code
|
HCPCS 26670
|
| Hospital Charge Code |
45000141
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$104.10 |
| Max. Negotiated Rate |
$333.12 |
| Rate for Payer: Aetna Commercial |
$267.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$270.66
|
| Rate for Payer: Cash Price |
$173.50
|
| Rate for Payer: Cigna Commercial |
$288.01
|
| Rate for Payer: First Health Commercial |
$329.65
|
| Rate for Payer: Humana Commercial |
$294.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$284.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$256.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$104.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$305.36
|
| Rate for Payer: Ohio Health Group HMO |
$260.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$277.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$301.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$239.43
|
| Rate for Payer: PHCS Commercial |
$333.12
|
| Rate for Payer: United Healthcare All Payer |
$305.36
|
|
|
CLSD CARPOMTCRDDSLOTHMBW/MANEA
|
Facility
|
IP
|
$322.00
|
|
|
Service Code
|
HCPCS 26641
|
| Hospital Charge Code |
45000140
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$309.12 |
| Rate for Payer: Aetna Commercial |
$247.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$251.16
|
| Rate for Payer: Cash Price |
$161.00
|
| Rate for Payer: Cigna Commercial |
$267.26
|
| Rate for Payer: First Health Commercial |
$305.90
|
| Rate for Payer: Humana Commercial |
$273.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$264.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$237.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$96.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$283.36
|
| Rate for Payer: Ohio Health Group HMO |
$241.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$257.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$280.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$222.18
|
| Rate for Payer: PHCS Commercial |
$309.12
|
| Rate for Payer: United Healthcare All Payer |
$283.36
|
|
|
CLSD CARPOMTCRDDSLOTHMBW/MANEA
|
Facility
|
IP
|
$322.00
|
|
|
Service Code
|
HCPCS 26641
|
| Hospital Charge Code |
76100726
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$309.12 |
| Rate for Payer: Aetna Commercial |
$247.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$251.16
|
| Rate for Payer: Cash Price |
$161.00
|
| Rate for Payer: Cigna Commercial |
$267.26
|
| Rate for Payer: First Health Commercial |
$305.90
|
| Rate for Payer: Humana Commercial |
$273.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$264.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$237.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$96.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$283.36
|
| Rate for Payer: Ohio Health Group HMO |
$241.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$257.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$280.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$222.18
|
| Rate for Payer: PHCS Commercial |
$309.12
|
| Rate for Payer: United Healthcare All Payer |
$283.36
|
|
|
CLSD CARPOMTCRDDSLOTHMBW/MANEA
|
Facility
|
OP
|
$322.00
|
|
|
Service Code
|
HCPCS 26641
|
| Hospital Charge Code |
76100726
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$110.74 |
| Max. Negotiated Rate |
$310.30 |
| Rate for Payer: Aetna Commercial |
$247.94
|
| Rate for Payer: Anthem Medicaid |
$110.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$251.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$161.00
|
| Rate for Payer: Cash Price |
$161.00
|
| Rate for Payer: Cigna Commercial |
$267.26
|
| Rate for Payer: First Health Commercial |
$305.90
|
| Rate for Payer: Humana Commercial |
$273.70
|
| Rate for Payer: Humana KY Medicaid |
$110.74
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$111.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$264.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$237.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$112.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$283.36
|
| Rate for Payer: Ohio Health Group HMO |
$241.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$257.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$280.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$222.18
|
| Rate for Payer: PHCS Commercial |
$309.12
|
| Rate for Payer: United Healthcare All Payer |
$283.36
|
|
|
CLSD CARPOMTCRDDSLOTHMBW/MANEA
|
Facility
|
OP
|
$322.00
|
|
|
Service Code
|
HCPCS 26641
|
| Hospital Charge Code |
45000140
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$110.74 |
| Max. Negotiated Rate |
$310.30 |
| Rate for Payer: Aetna Commercial |
$247.94
|
| Rate for Payer: Anthem Medicaid |
$110.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$251.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$161.00
|
| Rate for Payer: Cash Price |
$161.00
|
| Rate for Payer: Cigna Commercial |
$267.26
|
| Rate for Payer: First Health Commercial |
$305.90
|
| Rate for Payer: Humana Commercial |
$273.70
|
| Rate for Payer: Humana KY Medicaid |
$110.74
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$111.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$264.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$237.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$112.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$283.36
|
| Rate for Payer: Ohio Health Group HMO |
$241.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$257.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$280.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$222.18
|
| Rate for Payer: PHCS Commercial |
$309.12
|
| Rate for Payer: United Healthcare All Payer |
$283.36
|
|
|
CLSD MTCARPOPHLGLDISLOSNGLWMAN
|
Facility
|
IP
|
$335.00
|
|
|
Service Code
|
HCPCS 26700
|
| Hospital Charge Code |
76100733
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$100.50 |
| Max. Negotiated Rate |
$321.60 |
| Rate for Payer: Aetna Commercial |
$257.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$261.30
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cigna Commercial |
$278.05
|
| Rate for Payer: First Health Commercial |
$318.25
|
| Rate for Payer: Humana Commercial |
$284.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$274.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$247.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$100.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$294.80
|
| Rate for Payer: Ohio Health Group HMO |
$251.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$268.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$291.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$231.15
|
| Rate for Payer: PHCS Commercial |
$321.60
|
| Rate for Payer: United Healthcare All Payer |
$294.80
|
|
|
CLSD MTCARPOPHLGLDISLOSNGLWMAN
|
Professional
|
Both
|
$335.00
|
|
|
Service Code
|
HCPCS 26700
|
| Hospital Charge Code |
76100733
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$129.91 |
| Max. Negotiated Rate |
$426.82 |
| Rate for Payer: Aetna Commercial |
$395.50
|
| Rate for Payer: Ambetter Exchange |
$306.34
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$162.13
|
| Rate for Payer: Anthem Medicaid |
$129.91
|
| Rate for Payer: Buckeye Individual/Medicaid |
$306.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$306.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$367.61
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cigna Commercial |
$426.82
|
| Rate for Payer: Healthspan PPO |
$382.48
|
| Rate for Payer: Humana Medicaid |
$129.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$353.57
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$306.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$306.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$132.51
|
| Rate for Payer: Molina Healthcare Passport |
$129.91
|
| Rate for Payer: Multiplan PHCS |
$201.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$398.24
|
| Rate for Payer: UHCCP Medicaid |
$170.24
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$131.21
|
| Rate for Payer: Wellcare Medicare Advantage |
$306.34
|
|
|
CLSD MTCARPOPHLGLDISLOSNGLWMAN
|
Facility
|
OP
|
$335.00
|
|
|
Service Code
|
HCPCS 26700
|
| Hospital Charge Code |
45000142
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$115.21 |
| Max. Negotiated Rate |
$321.60 |
| Rate for Payer: Aetna Commercial |
$257.95
|
| Rate for Payer: Anthem Medicaid |
$115.21
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$261.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cigna Commercial |
$278.05
|
| Rate for Payer: First Health Commercial |
$318.25
|
| Rate for Payer: Humana Commercial |
$284.75
|
| Rate for Payer: Humana KY Medicaid |
$115.21
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$116.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$274.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$247.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$117.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$294.80
|
| Rate for Payer: Ohio Health Group HMO |
$251.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$268.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$291.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$231.15
|
| Rate for Payer: PHCS Commercial |
$321.60
|
| Rate for Payer: United Healthcare All Payer |
$294.80
|
|
|
CLSD MTCARPOPHLGLDISLOSNGLWMAN
|
Facility
|
OP
|
$335.00
|
|
|
Service Code
|
HCPCS 26700
|
| Hospital Charge Code |
76100733
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$115.21 |
| Max. Negotiated Rate |
$321.60 |
| Rate for Payer: Aetna Commercial |
$257.95
|
| Rate for Payer: Anthem Medicaid |
$115.21
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$261.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cigna Commercial |
$278.05
|
| Rate for Payer: First Health Commercial |
$318.25
|
| Rate for Payer: Humana Commercial |
$284.75
|
| Rate for Payer: Humana KY Medicaid |
$115.21
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$116.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$274.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$247.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$117.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$294.80
|
| Rate for Payer: Ohio Health Group HMO |
$251.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$268.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$291.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$231.15
|
| Rate for Payer: PHCS Commercial |
$321.60
|
| Rate for Payer: United Healthcare All Payer |
$294.80
|
|
|
CLSD MTCARPOPHLGLDISLOSNGLWMAN
|
Facility
|
IP
|
$335.00
|
|
|
Service Code
|
HCPCS 26700
|
| Hospital Charge Code |
45000142
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$100.50 |
| Max. Negotiated Rate |
$321.60 |
| Rate for Payer: Aetna Commercial |
$257.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$261.30
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cigna Commercial |
$278.05
|
| Rate for Payer: First Health Commercial |
$318.25
|
| Rate for Payer: Humana Commercial |
$284.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$274.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$247.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$100.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$294.80
|
| Rate for Payer: Ohio Health Group HMO |
$251.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$268.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$291.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$231.15
|
| Rate for Payer: PHCS Commercial |
$321.60
|
| Rate for Payer: United Healthcare All Payer |
$294.80
|
|
|
CLSD MTCRPOPHLGLDISLOSNGLWANES
|
Facility
|
IP
|
$2,248.00
|
|
|
Service Code
|
HCPCS 26705
|
| Hospital Charge Code |
45000143
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$674.40 |
| Max. Negotiated Rate |
$2,158.08 |
| Rate for Payer: Aetna Commercial |
$1,730.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,753.44
|
| Rate for Payer: Cash Price |
$1,124.00
|
| Rate for Payer: Cigna Commercial |
$1,865.84
|
| Rate for Payer: First Health Commercial |
$2,135.60
|
| Rate for Payer: Humana Commercial |
$1,910.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,843.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,659.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$674.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,978.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,686.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,798.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,955.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,551.12
|
| Rate for Payer: PHCS Commercial |
$2,158.08
|
| Rate for Payer: United Healthcare All Payer |
$1,978.24
|
|
|
CLSD MTCRPOPHLGLDISLOSNGLWANES
|
Facility
|
OP
|
$2,248.00
|
|
|
Service Code
|
HCPCS 26705
|
| Hospital Charge Code |
45000143
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$773.09 |
| Max. Negotiated Rate |
$2,158.08 |
| Rate for Payer: Aetna Commercial |
$1,730.96
|
| Rate for Payer: Anthem Medicaid |
$773.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,753.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| Rate for Payer: Cash Price |
$1,124.00
|
| Rate for Payer: Cash Price |
$1,124.00
|
| Rate for Payer: Cigna Commercial |
$1,865.84
|
| Rate for Payer: First Health Commercial |
$2,135.60
|
| Rate for Payer: Humana Commercial |
$1,910.80
|
| Rate for Payer: Humana KY Medicaid |
$773.09
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$780.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,843.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,659.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$788.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,978.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,686.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,798.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,955.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,551.12
|
| Rate for Payer: PHCS Commercial |
$2,158.08
|
| Rate for Payer: United Healthcare All Payer |
$1,978.24
|
|
|
CLSD MTCRPOPHLGLDISLOSNGLWANES
|
Facility
|
OP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 26705
|
| Hospital Charge Code |
76100734
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$725.97 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$1,625.47
|
| Rate for Payer: Anthem Medicaid |
$725.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,646.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| Rate for Payer: Cash Price |
$1,055.50
|
| Rate for Payer: Cash Price |
$1,055.50
|
| Rate for Payer: Cigna Commercial |
$1,752.13
|
| Rate for Payer: First Health Commercial |
$2,005.45
|
| Rate for Payer: Humana Commercial |
$1,794.35
|
| Rate for Payer: Humana KY Medicaid |
$725.97
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$733.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,731.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,557.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$740.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,857.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,583.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,688.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,836.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,456.59
|
| Rate for Payer: PHCS Commercial |
$2,026.56
|
| Rate for Payer: United Healthcare All Payer |
$1,857.68
|
|
|
CLSD MTCRPOPHLGLDISLOSNGLWANES
|
Professional
|
Both
|
$2,111.00
|
|
|
Service Code
|
HCPCS 26705
|
| Hospital Charge Code |
76100734
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$171.38 |
| Max. Negotiated Rate |
$1,266.60 |
| Rate for Payer: Aetna Commercial |
$511.80
|
| Rate for Payer: Ambetter Exchange |
$383.54
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$200.03
|
| Rate for Payer: Anthem Medicaid |
$171.38
|
| Rate for Payer: Buckeye Individual/Medicaid |
$383.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$383.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$460.25
|
| Rate for Payer: Cash Price |
$1,055.50
|
| Rate for Payer: Cash Price |
$1,055.50
|
| Rate for Payer: Cigna Commercial |
$562.83
|
| Rate for Payer: Healthspan PPO |
$500.92
|
| Rate for Payer: Humana Medicaid |
$171.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$453.80
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$383.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$383.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$174.81
|
| Rate for Payer: Molina Healthcare Passport |
$171.38
|
| Rate for Payer: Multiplan PHCS |
$1,266.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$498.60
|
| Rate for Payer: UHCCP Medicaid |
$210.03
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$173.09
|
| Rate for Payer: Wellcare Medicare Advantage |
$383.54
|
|
|
CLSD MTCRPOPHLGLDISLOSNGLWANES
|
Facility
|
IP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 26705
|
| Hospital Charge Code |
76100734
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$633.30 |
| Max. Negotiated Rate |
$2,026.56 |
| Rate for Payer: Aetna Commercial |
$1,625.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,646.58
|
| Rate for Payer: Cash Price |
$1,055.50
|
| Rate for Payer: Cigna Commercial |
$1,752.13
|
| Rate for Payer: First Health Commercial |
$2,005.45
|
| Rate for Payer: Humana Commercial |
$1,794.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,731.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,557.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$633.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,857.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,583.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,688.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,836.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,456.59
|
| Rate for Payer: PHCS Commercial |
$2,026.56
|
| Rate for Payer: United Healthcare All Payer |
$1,857.68
|
|
