CONSRV TOT A-CL HD SH NCK 40M
|
Facility
|
OP
|
$7,362.50
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$957.12 |
Max. Negotiated Rate |
$7,068.00 |
Rate for Payer: Aetna Commercial |
$5,669.12
|
Rate for Payer: Anthem Medicaid |
$2,531.96
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
Rate for Payer: Cash Price |
$3,681.25
|
Rate for Payer: Cigna Commercial |
$6,110.88
|
Rate for Payer: First Health Commercial |
$6,994.38
|
Rate for Payer: Humana Commercial |
$6,258.12
|
Rate for Payer: Humana KY Medicaid |
$2,531.96
|
Rate for Payer: Kentucky WC Medicaid |
$2,557.73
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
Rate for Payer: Molina Healthcare Medicaid |
$2,582.76
|
Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
Rate for Payer: PHCS Commercial |
$7,068.00
|
Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
CONSRV TOT A-CL HD SH NCK 42M
|
Facility
|
OP
|
$7,362.50
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$957.12 |
Max. Negotiated Rate |
$7,068.00 |
Rate for Payer: Aetna Commercial |
$5,669.12
|
Rate for Payer: Anthem Medicaid |
$2,531.96
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
Rate for Payer: Cash Price |
$3,681.25
|
Rate for Payer: Cigna Commercial |
$6,110.88
|
Rate for Payer: First Health Commercial |
$6,994.38
|
Rate for Payer: Humana Commercial |
$6,258.12
|
Rate for Payer: Humana KY Medicaid |
$2,531.96
|
Rate for Payer: Kentucky WC Medicaid |
$2,557.73
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
Rate for Payer: Molina Healthcare Medicaid |
$2,582.76
|
Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
Rate for Payer: PHCS Commercial |
$7,068.00
|
Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
CONSRV TOT A-CL HD SH NCK 42M
|
Facility
|
IP
|
$7,362.50
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$957.12 |
Max. Negotiated Rate |
$7,068.00 |
Rate for Payer: Aetna Commercial |
$5,669.12
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
Rate for Payer: Cash Price |
$3,681.25
|
Rate for Payer: Cigna Commercial |
$6,110.88
|
Rate for Payer: First Health Commercial |
$6,994.38
|
Rate for Payer: Humana Commercial |
$6,258.12
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
Rate for Payer: PHCS Commercial |
$7,068.00
|
Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
CONSRV TOT A-CL HD SH NCK 44M
|
Facility
|
OP
|
$7,362.50
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$957.12 |
Max. Negotiated Rate |
$7,068.00 |
Rate for Payer: Aetna Commercial |
$5,669.12
|
Rate for Payer: Anthem Medicaid |
$2,531.96
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
Rate for Payer: Cash Price |
$3,681.25
|
Rate for Payer: Cigna Commercial |
$6,110.88
|
Rate for Payer: First Health Commercial |
$6,994.38
|
Rate for Payer: Humana Commercial |
$6,258.12
|
Rate for Payer: Humana KY Medicaid |
$2,531.96
|
Rate for Payer: Kentucky WC Medicaid |
$2,557.73
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
Rate for Payer: Molina Healthcare Medicaid |
$2,582.76
|
Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
Rate for Payer: PHCS Commercial |
$7,068.00
|
Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
CONSRV TOT A-CL HD SH NCK 44M
|
Facility
|
IP
|
$7,362.50
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$957.12 |
Max. Negotiated Rate |
$7,068.00 |
Rate for Payer: Aetna Commercial |
$5,669.12
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
Rate for Payer: Cash Price |
$3,681.25
|
Rate for Payer: Cigna Commercial |
$6,110.88
|
Rate for Payer: First Health Commercial |
$6,994.38
|
Rate for Payer: Humana Commercial |
$6,258.12
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
Rate for Payer: PHCS Commercial |
$7,068.00
|
Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
CONSRV TOT A-CL HD SH NCK 46M
|
Facility
|
IP
|
$7,362.50
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$957.12 |
Max. Negotiated Rate |
$7,068.00 |
Rate for Payer: Aetna Commercial |
$5,669.12
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
Rate for Payer: Cash Price |
$3,681.25
|
Rate for Payer: Cigna Commercial |
$6,110.88
|
Rate for Payer: First Health Commercial |
$6,994.38
|
Rate for Payer: Humana Commercial |
$6,258.12
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
Rate for Payer: PHCS Commercial |
$7,068.00
|
Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
CONSRV TOT A-CL HD SH NCK 46M
|
Facility
|
OP
|
$7,362.50
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$957.12 |
Max. Negotiated Rate |
$7,068.00 |
Rate for Payer: Aetna Commercial |
$5,669.12
|
Rate for Payer: Anthem Medicaid |
$2,531.96
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
Rate for Payer: Cash Price |
$3,681.25
|
Rate for Payer: Cigna Commercial |
$6,110.88
|
Rate for Payer: First Health Commercial |
$6,994.38
|
Rate for Payer: Humana Commercial |
$6,258.12
|
Rate for Payer: Humana KY Medicaid |
$2,531.96
|
Rate for Payer: Kentucky WC Medicaid |
$2,557.73
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
Rate for Payer: Molina Healthcare Medicaid |
$2,582.76
|
Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
Rate for Payer: PHCS Commercial |
$7,068.00
|
Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
CONSRV TOT A-CL HD SH NCK 48M
|
Facility
|
OP
|
$7,362.50
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$957.12 |
Max. Negotiated Rate |
$7,068.00 |
Rate for Payer: Aetna Commercial |
$5,669.12
|
Rate for Payer: Anthem Medicaid |
$2,531.96
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
Rate for Payer: Cash Price |
$3,681.25
|
Rate for Payer: Cigna Commercial |
$6,110.88
|
Rate for Payer: First Health Commercial |
$6,994.38
|
Rate for Payer: Humana Commercial |
$6,258.12
|
Rate for Payer: Humana KY Medicaid |
$2,531.96
|
Rate for Payer: Kentucky WC Medicaid |
$2,557.73
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
Rate for Payer: Molina Healthcare Medicaid |
$2,582.76
|
Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
Rate for Payer: PHCS Commercial |
$7,068.00
|
Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
CONSRV TOT A-CL HD SH NCK 48M
|
Facility
|
IP
|
$7,362.50
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$957.12 |
Max. Negotiated Rate |
$7,068.00 |
Rate for Payer: Aetna Commercial |
$5,669.12
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
Rate for Payer: Cash Price |
$3,681.25
|
Rate for Payer: Cigna Commercial |
$6,110.88
|
Rate for Payer: First Health Commercial |
$6,994.38
|
Rate for Payer: Humana Commercial |
$6,258.12
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
Rate for Payer: PHCS Commercial |
$7,068.00
|
Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
CONSRV TOT A-CL HD SH NCK 50M
|
Facility
|
IP
|
$7,362.50
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$957.12 |
Max. Negotiated Rate |
$7,068.00 |
Rate for Payer: Aetna Commercial |
$5,669.12
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
Rate for Payer: Cash Price |
$3,681.25
|
Rate for Payer: Cigna Commercial |
$6,110.88
|
Rate for Payer: First Health Commercial |
$6,994.38
|
Rate for Payer: Humana Commercial |
$6,258.12
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
Rate for Payer: PHCS Commercial |
$7,068.00
|
Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
CONSRV TOT A-CL HD SH NCK 50M
|
Facility
|
OP
|
$7,362.50
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$957.12 |
Max. Negotiated Rate |
$7,068.00 |
Rate for Payer: Aetna Commercial |
$5,669.12
|
Rate for Payer: Anthem Medicaid |
$2,531.96
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
Rate for Payer: Cash Price |
$3,681.25
|
Rate for Payer: Cigna Commercial |
$6,110.88
|
Rate for Payer: First Health Commercial |
$6,994.38
|
Rate for Payer: Humana Commercial |
$6,258.12
|
Rate for Payer: Humana KY Medicaid |
$2,531.96
|
Rate for Payer: Kentucky WC Medicaid |
$2,557.73
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
Rate for Payer: Molina Healthcare Medicaid |
$2,582.76
|
Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
Rate for Payer: PHCS Commercial |
$7,068.00
|
Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
CONSRV TOT A-CL HD SH NCK 52M
|
Facility
|
OP
|
$7,362.50
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$957.12 |
Max. Negotiated Rate |
$7,068.00 |
Rate for Payer: Aetna Commercial |
$5,669.12
|
Rate for Payer: Anthem Medicaid |
$2,531.96
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
Rate for Payer: Cash Price |
$3,681.25
|
Rate for Payer: Cigna Commercial |
$6,110.88
|
Rate for Payer: First Health Commercial |
$6,994.38
|
Rate for Payer: Humana Commercial |
$6,258.12
|
Rate for Payer: Humana KY Medicaid |
$2,531.96
|
Rate for Payer: Kentucky WC Medicaid |
$2,557.73
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
Rate for Payer: Molina Healthcare Medicaid |
$2,582.76
|
Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
Rate for Payer: PHCS Commercial |
$7,068.00
|
Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
CONSRV TOT A-CL HD SH NCK 52M
|
Facility
|
IP
|
$7,362.50
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$957.12 |
Max. Negotiated Rate |
$7,068.00 |
Rate for Payer: Aetna Commercial |
$5,669.12
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
Rate for Payer: Cash Price |
$3,681.25
|
Rate for Payer: Cigna Commercial |
$6,110.88
|
Rate for Payer: First Health Commercial |
$6,994.38
|
Rate for Payer: Humana Commercial |
$6,258.12
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
Rate for Payer: PHCS Commercial |
$7,068.00
|
Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
CONSRV TOT A-CL HD SH NCK 54M
|
Facility
|
IP
|
$7,362.50
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$957.12 |
Max. Negotiated Rate |
$7,068.00 |
Rate for Payer: Aetna Commercial |
$5,669.12
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
Rate for Payer: Cash Price |
$3,681.25
|
Rate for Payer: Cigna Commercial |
$6,110.88
|
Rate for Payer: First Health Commercial |
$6,994.38
|
Rate for Payer: Humana Commercial |
$6,258.12
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
Rate for Payer: PHCS Commercial |
$7,068.00
|
Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
CONSRV TOT A-CL HD SH NCK 54M
|
Facility
|
OP
|
$7,362.50
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$957.12 |
Max. Negotiated Rate |
$7,068.00 |
Rate for Payer: Aetna Commercial |
$5,669.12
|
Rate for Payer: Anthem Medicaid |
$2,531.96
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
Rate for Payer: Cash Price |
$3,681.25
|
Rate for Payer: Cigna Commercial |
$6,110.88
|
Rate for Payer: First Health Commercial |
$6,994.38
|
Rate for Payer: Humana Commercial |
$6,258.12
|
Rate for Payer: Humana KY Medicaid |
$2,531.96
|
Rate for Payer: Kentucky WC Medicaid |
$2,557.73
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
Rate for Payer: Molina Healthcare Medicaid |
$2,582.76
|
Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
Rate for Payer: PHCS Commercial |
$7,068.00
|
Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
CONSRV TOT A-CL HD SH NCK 56M
|
Facility
|
IP
|
$7,362.50
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$957.12 |
Max. Negotiated Rate |
$7,068.00 |
Rate for Payer: Aetna Commercial |
$5,669.12
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
Rate for Payer: Cash Price |
$3,681.25
|
Rate for Payer: Cigna Commercial |
$6,110.88
|
Rate for Payer: First Health Commercial |
$6,994.38
|
Rate for Payer: Humana Commercial |
$6,258.12
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
Rate for Payer: PHCS Commercial |
$7,068.00
|
Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
CONSRV TOT A-CL HD SH NCK 56M
|
Facility
|
OP
|
$7,362.50
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$957.12 |
Max. Negotiated Rate |
$7,068.00 |
Rate for Payer: Aetna Commercial |
$5,669.12
|
Rate for Payer: Anthem Medicaid |
$2,531.96
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
Rate for Payer: Cash Price |
$3,681.25
|
Rate for Payer: Cigna Commercial |
$6,110.88
|
Rate for Payer: First Health Commercial |
$6,994.38
|
Rate for Payer: Humana Commercial |
$6,258.12
|
Rate for Payer: Humana KY Medicaid |
$2,531.96
|
Rate for Payer: Kentucky WC Medicaid |
$2,557.73
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
Rate for Payer: Molina Healthcare Medicaid |
$2,582.76
|
Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
Rate for Payer: PHCS Commercial |
$7,068.00
|
Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
CONSTRAINED INSERT 22MM
|
Facility
|
IP
|
$12,045.40
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,565.90 |
Max. Negotiated Rate |
$11,563.58 |
Rate for Payer: Aetna Commercial |
$9,274.96
|
Rate for Payer: Anthem POS/PPO/Traditional |
$9,395.41
|
Rate for Payer: Cash Price |
$6,022.70
|
Rate for Payer: Cigna Commercial |
$9,997.68
|
Rate for Payer: First Health Commercial |
$11,443.13
|
Rate for Payer: Humana Commercial |
$10,238.59
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$9,877.23
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,889.51
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$3,613.62
|
Rate for Payer: Ohio Health Choice Commercial |
$10,599.95
|
Rate for Payer: Ohio Health Group HMO |
$9,034.05
|
Rate for Payer: Ohio Health Group PPO Differential |
$2,409.08
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,565.90
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,734.07
|
Rate for Payer: PHCS Commercial |
$11,563.58
|
Rate for Payer: United Healthcare All Payer |
$10,599.95
|
|
CONSTRAINED INSERT 22MM
|
Facility
|
OP
|
$12,045.40
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,565.90 |
Max. Negotiated Rate |
$11,563.58 |
Rate for Payer: Aetna Commercial |
$9,274.96
|
Rate for Payer: Anthem Medicaid |
$4,142.41
|
Rate for Payer: Anthem POS/PPO/Traditional |
$9,395.41
|
Rate for Payer: Cash Price |
$6,022.70
|
Rate for Payer: Cigna Commercial |
$9,997.68
|
Rate for Payer: First Health Commercial |
$11,443.13
|
Rate for Payer: Humana Commercial |
$10,238.59
|
Rate for Payer: Humana KY Medicaid |
$4,142.41
|
Rate for Payer: Kentucky WC Medicaid |
$4,184.57
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$9,877.23
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,889.51
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$3,613.62
|
Rate for Payer: Molina Healthcare Medicaid |
$4,225.53
|
Rate for Payer: Ohio Health Choice Commercial |
$10,599.95
|
Rate for Payer: Ohio Health Group HMO |
$9,034.05
|
Rate for Payer: Ohio Health Group PPO Differential |
$2,409.08
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,565.90
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,734.07
|
Rate for Payer: PHCS Commercial |
$11,563.58
|
Rate for Payer: United Healthcare All Payer |
$10,599.95
|
|
CONSULTATION WITH FAMILY
|
Professional
|
Both
|
$354.50
|
|
Service Code
|
HCPCS 90887
|
Hospital Charge Code |
90000013
|
Hospital Revenue Code
|
900
|
Min. Negotiated Rate |
$87.62 |
Max. Negotiated Rate |
$354.50 |
Rate for Payer: Aetna Commercial |
$115.60
|
Rate for Payer: Buckeye Medicare Advantage |
$354.50
|
Rate for Payer: Cash Price |
$177.25
|
Rate for Payer: Cash Price |
$177.25
|
Rate for Payer: Cigna Commercial |
$107.17
|
Rate for Payer: Healthspan PPO |
$99.52
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$87.62
|
Rate for Payer: Multiplan PHCS |
$212.70
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$248.15
|
Rate for Payer: UHCCP Medicaid |
$124.08
|
|
CONSULTATION WITH FAMILY
|
Facility
|
IP
|
$354.50
|
|
Service Code
|
HCPCS 90887
|
Hospital Charge Code |
90000013
|
Hospital Revenue Code
|
900
|
Min. Negotiated Rate |
$46.08 |
Max. Negotiated Rate |
$340.32 |
Rate for Payer: Aetna Commercial |
$272.96
|
Rate for Payer: Anthem POS/PPO/Traditional |
$276.51
|
Rate for Payer: Cash Price |
$177.25
|
Rate for Payer: Cigna Commercial |
$294.24
|
Rate for Payer: First Health Commercial |
$336.78
|
Rate for Payer: Humana Commercial |
$301.32
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$290.69
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$261.62
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$106.35
|
Rate for Payer: Ohio Health Choice Commercial |
$311.96
|
Rate for Payer: Ohio Health Group HMO |
$265.88
|
Rate for Payer: Ohio Health Group PPO Differential |
$70.90
|
Rate for Payer: Ohio Health Group PPO No Differential |
$46.08
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$109.90
|
Rate for Payer: PHCS Commercial |
$340.32
|
Rate for Payer: United Healthcare All Payer |
$311.96
|
|
CONSULTATION WITH FAMILY
|
Facility
|
OP
|
$354.50
|
|
Service Code
|
HCPCS 90887
|
Hospital Charge Code |
90000013
|
Hospital Revenue Code
|
900
|
Min. Negotiated Rate |
$46.08 |
Max. Negotiated Rate |
$340.32 |
Rate for Payer: Aetna Commercial |
$272.96
|
Rate for Payer: Anthem Medicaid |
$121.91
|
Rate for Payer: Anthem POS/PPO/Traditional |
$276.51
|
Rate for Payer: Cash Price |
$177.25
|
Rate for Payer: Cigna Commercial |
$294.24
|
Rate for Payer: First Health Commercial |
$336.78
|
Rate for Payer: Humana Commercial |
$301.32
|
Rate for Payer: Humana KY Medicaid |
$121.91
|
Rate for Payer: Kentucky WC Medicaid |
$123.15
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$290.69
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$261.62
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$106.35
|
Rate for Payer: Molina Healthcare Medicaid |
$124.36
|
Rate for Payer: Ohio Health Choice Commercial |
$311.96
|
Rate for Payer: Ohio Health Group HMO |
$265.88
|
Rate for Payer: Ohio Health Group PPO Differential |
$70.90
|
Rate for Payer: Ohio Health Group PPO No Differential |
$46.08
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$109.90
|
Rate for Payer: PHCS Commercial |
$340.32
|
Rate for Payer: United Healthcare All Payer |
$311.96
|
|
CONSULTATION WITH FAMILY(P
|
Professional
|
Both
|
$150.00
|
|
Service Code
|
HCPCS 90887
|
Hospital Charge Code |
900P0013
|
Hospital Revenue Code
|
900
|
Min. Negotiated Rate |
$52.50 |
Max. Negotiated Rate |
$150.00 |
Rate for Payer: Aetna Commercial |
$115.60
|
Rate for Payer: Buckeye Medicare Advantage |
$150.00
|
Rate for Payer: Cash Price |
$75.00
|
Rate for Payer: Cash Price |
$75.00
|
Rate for Payer: Cigna Commercial |
$107.17
|
Rate for Payer: Healthspan PPO |
$99.52
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$87.62
|
Rate for Payer: Multiplan PHCS |
$90.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.00
|
Rate for Payer: UHCCP Medicaid |
$52.50
|
|
CONSULTATION WITH FAMILY(T
|
Facility
|
OP
|
$204.50
|
|
Service Code
|
HCPCS 90887
|
Hospital Charge Code |
900T0013
|
Hospital Revenue Code
|
900
|
Min. Negotiated Rate |
$26.58 |
Max. Negotiated Rate |
$196.32 |
Rate for Payer: Aetna Commercial |
$157.46
|
Rate for Payer: Anthem Medicaid |
$70.33
|
Rate for Payer: Anthem POS/PPO/Traditional |
$159.51
|
Rate for Payer: Cash Price |
$102.25
|
Rate for Payer: Cigna Commercial |
$169.74
|
Rate for Payer: First Health Commercial |
$194.28
|
Rate for Payer: Humana Commercial |
$173.82
|
Rate for Payer: Humana KY Medicaid |
$70.33
|
Rate for Payer: Kentucky WC Medicaid |
$71.04
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$167.69
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$150.92
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$61.35
|
Rate for Payer: Molina Healthcare Medicaid |
$71.74
|
Rate for Payer: Ohio Health Choice Commercial |
$179.96
|
Rate for Payer: Ohio Health Group HMO |
$153.38
|
Rate for Payer: Ohio Health Group PPO Differential |
$40.90
|
Rate for Payer: Ohio Health Group PPO No Differential |
$26.58
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.40
|
Rate for Payer: PHCS Commercial |
$196.32
|
Rate for Payer: United Healthcare All Payer |
$179.96
|
|
CONSULTATION WITH FAMILY(T
|
Facility
|
IP
|
$204.50
|
|
Service Code
|
HCPCS 90887
|
Hospital Charge Code |
900T0013
|
Hospital Revenue Code
|
900
|
Min. Negotiated Rate |
$26.58 |
Max. Negotiated Rate |
$196.32 |
Rate for Payer: Aetna Commercial |
$157.46
|
Rate for Payer: Anthem POS/PPO/Traditional |
$159.51
|
Rate for Payer: Cash Price |
$102.25
|
Rate for Payer: Cigna Commercial |
$169.74
|
Rate for Payer: First Health Commercial |
$194.28
|
Rate for Payer: Humana Commercial |
$173.82
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$167.69
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$150.92
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$61.35
|
Rate for Payer: Ohio Health Choice Commercial |
$179.96
|
Rate for Payer: Ohio Health Group HMO |
$153.38
|
Rate for Payer: Ohio Health Group PPO Differential |
$40.90
|
Rate for Payer: Ohio Health Group PPO No Differential |
$26.58
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.40
|
Rate for Payer: PHCS Commercial |
$196.32
|
Rate for Payer: United Healthcare All Payer |
$179.96
|
|