|
CONTINUUM UNI HOLE SHELL 66PP
|
Facility
|
IP
|
$9,041.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,175.40 |
| Max. Negotiated Rate |
$8,679.84 |
| Rate for Payer: Aetna Commercial |
$6,961.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,052.37
|
| Rate for Payer: Cash Price |
$4,520.75
|
| Rate for Payer: Cigna Commercial |
$7,504.44
|
| Rate for Payer: First Health Commercial |
$8,589.42
|
| Rate for Payer: Humana Commercial |
$7,685.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,414.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,672.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,712.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,956.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,781.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,808.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,175.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,802.86
|
| Rate for Payer: PHCS Commercial |
$8,679.84
|
| Rate for Payer: United Healthcare All Payer |
$7,956.52
|
|
|
CONTINUUM UNI HOLE SHELL 68QU
|
Facility
|
OP
|
$9,041.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,175.40 |
| Max. Negotiated Rate |
$8,679.84 |
| Rate for Payer: Aetna Commercial |
$6,961.96
|
| Rate for Payer: Anthem Medicaid |
$3,109.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,052.37
|
| Rate for Payer: Cash Price |
$4,520.75
|
| Rate for Payer: Cigna Commercial |
$7,504.44
|
| Rate for Payer: First Health Commercial |
$8,589.42
|
| Rate for Payer: Humana Commercial |
$7,685.28
|
| Rate for Payer: Humana KY Medicaid |
$3,109.37
|
| Rate for Payer: Kentucky WC Medicaid |
$3,141.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,414.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,672.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,712.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,171.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,956.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,781.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,808.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,175.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,802.86
|
| Rate for Payer: PHCS Commercial |
$8,679.84
|
| Rate for Payer: United Healthcare All Payer |
$7,956.52
|
|
|
CONTINUUM UNI HOLE SHELL 68QU
|
Facility
|
IP
|
$9,041.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,175.40 |
| Max. Negotiated Rate |
$8,679.84 |
| Rate for Payer: Aetna Commercial |
$6,961.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,052.37
|
| Rate for Payer: Cash Price |
$4,520.75
|
| Rate for Payer: Cigna Commercial |
$7,504.44
|
| Rate for Payer: First Health Commercial |
$8,589.42
|
| Rate for Payer: Humana Commercial |
$7,685.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,414.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,672.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,712.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,956.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,781.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,808.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,175.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,802.86
|
| Rate for Payer: PHCS Commercial |
$8,679.84
|
| Rate for Payer: United Healthcare All Payer |
$7,956.52
|
|
|
CONTOUR OF FACE BONE LESION
|
Professional
|
Both
|
$7,665.00
|
|
|
Service Code
|
HCPCS 21029
|
| Hospital Charge Code |
76100369
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$335.86 |
| Max. Negotiated Rate |
$7,665.00 |
| Rate for Payer: Aetna Commercial |
$903.42
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$335.86
|
| Rate for Payer: Anthem Medicaid |
$354.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$7,665.00
|
| Rate for Payer: Cash Price |
$3,832.50
|
| Rate for Payer: Cash Price |
$3,832.50
|
| Rate for Payer: Cigna Commercial |
$983.10
|
| Rate for Payer: Healthspan PPO |
$955.03
|
| Rate for Payer: Humana Medicaid |
$354.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$803.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$361.39
|
| Rate for Payer: Molina Healthcare Passport |
$354.30
|
| Rate for Payer: Multiplan PHCS |
$4,599.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5,365.50
|
| Rate for Payer: UHCCP Medicaid |
$352.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$357.84
|
|
|
CONTOUR OF FACE BONE LESION
|
Facility
|
IP
|
$7,665.00
|
|
|
Service Code
|
HCPCS 21029
|
| Hospital Charge Code |
76100369
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$996.45 |
| Max. Negotiated Rate |
$7,358.40 |
| Rate for Payer: Aetna Commercial |
$5,902.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,978.70
|
| Rate for Payer: Cash Price |
$3,832.50
|
| Rate for Payer: Cigna Commercial |
$6,361.95
|
| Rate for Payer: First Health Commercial |
$7,281.75
|
| Rate for Payer: Humana Commercial |
$6,515.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,285.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,656.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,299.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,745.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,748.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,533.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$996.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,376.15
|
| Rate for Payer: PHCS Commercial |
$7,358.40
|
| Rate for Payer: United Healthcare All Payer |
$6,745.20
|
|
|
CONTOUR OF FACE BONE LESION
|
Facility
|
OP
|
$7,665.00
|
|
|
Service Code
|
HCPCS 21029
|
| Hospital Charge Code |
76100369
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$996.45 |
| Max. Negotiated Rate |
$7,358.40 |
| Rate for Payer: Aetna Commercial |
$5,902.05
|
| Rate for Payer: Anthem Medicaid |
$2,635.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,978.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,897.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,758.63
|
| Rate for Payer: Cash Price |
$3,832.50
|
| Rate for Payer: Cash Price |
$3,832.50
|
| Rate for Payer: Cigna Commercial |
$6,361.95
|
| Rate for Payer: First Health Commercial |
$7,281.75
|
| Rate for Payer: Humana Commercial |
$6,515.25
|
| Rate for Payer: Humana KY Medicaid |
$2,635.99
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Kentucky WC Medicaid |
$2,662.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,285.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,656.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,688.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,745.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,748.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,533.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$996.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,376.15
|
| Rate for Payer: PHCS Commercial |
$7,358.40
|
| Rate for Payer: United Healthcare All Payer |
$6,745.20
|
|
|
CONTOUR OF FACE BONE LESION(P
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
HCPCS 21029
|
| Hospital Charge Code |
761P0369
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$335.86 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$903.42
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$335.86
|
| Rate for Payer: Anthem Medicaid |
$354.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,800.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$983.10
|
| Rate for Payer: Healthspan PPO |
$955.03
|
| Rate for Payer: Humana Medicaid |
$354.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$803.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$361.39
|
| Rate for Payer: Molina Healthcare Passport |
$354.30
|
| Rate for Payer: Multiplan PHCS |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,260.00
|
| Rate for Payer: UHCCP Medicaid |
$352.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$357.84
|
|
|
CONTOUR OF FACE BONE LESION(T
|
Facility
|
OP
|
$5,865.00
|
|
|
Service Code
|
HCPCS 21029
|
| Hospital Charge Code |
761T0369
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$762.45 |
| Max. Negotiated Rate |
$5,630.40 |
| Rate for Payer: Aetna Commercial |
$4,516.05
|
| Rate for Payer: Anthem Medicaid |
$2,016.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,574.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,897.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,758.63
|
| Rate for Payer: Cash Price |
$2,932.50
|
| Rate for Payer: Cash Price |
$2,932.50
|
| Rate for Payer: Cigna Commercial |
$4,867.95
|
| Rate for Payer: First Health Commercial |
$5,571.75
|
| Rate for Payer: Humana Commercial |
$4,985.25
|
| Rate for Payer: Humana KY Medicaid |
$2,016.97
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Kentucky WC Medicaid |
$2,037.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,809.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,328.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,057.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,161.20
|
| Rate for Payer: Ohio Health Group HMO |
$4,398.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,173.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$762.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,818.15
|
| Rate for Payer: PHCS Commercial |
$5,630.40
|
| Rate for Payer: United Healthcare All Payer |
$5,161.20
|
|
|
CONTOUR OF FACE BONE LESION(T
|
Facility
|
IP
|
$5,865.00
|
|
|
Service Code
|
HCPCS 21029
|
| Hospital Charge Code |
761T0369
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$762.45 |
| Max. Negotiated Rate |
$5,630.40 |
| Rate for Payer: Aetna Commercial |
$4,516.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,574.70
|
| Rate for Payer: Cash Price |
$2,932.50
|
| Rate for Payer: Cigna Commercial |
$4,867.95
|
| Rate for Payer: First Health Commercial |
$5,571.75
|
| Rate for Payer: Humana Commercial |
$4,985.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,809.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,328.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,759.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,161.20
|
| Rate for Payer: Ohio Health Group HMO |
$4,398.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,173.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$762.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,818.15
|
| Rate for Payer: PHCS Commercial |
$5,630.40
|
| Rate for Payer: United Healthcare All Payer |
$5,161.20
|
|
|
CONTR ACE RECN RNG 50OD 46ID L
|
Facility
|
IP
|
$12,279.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,596.39 |
| Max. Negotiated Rate |
$11,788.71 |
| Rate for Payer: Aetna Commercial |
$9,455.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,578.33
|
| Rate for Payer: Cash Price |
$6,139.96
|
| Rate for Payer: Cigna Commercial |
$10,192.33
|
| Rate for Payer: First Health Commercial |
$11,665.91
|
| Rate for Payer: Humana Commercial |
$10,437.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,069.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,062.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,683.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,806.32
|
| Rate for Payer: Ohio Health Group HMO |
$9,209.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,455.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,596.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,806.77
|
| Rate for Payer: PHCS Commercial |
$11,788.71
|
| Rate for Payer: United Healthcare All Payer |
$10,806.32
|
|
|
CONTR ACE RECN RNG 50OD 46ID L
|
Facility
|
OP
|
$12,279.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,596.39 |
| Max. Negotiated Rate |
$11,788.71 |
| Rate for Payer: Aetna Commercial |
$9,455.53
|
| Rate for Payer: Anthem Medicaid |
$4,223.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,578.33
|
| Rate for Payer: Cash Price |
$6,139.96
|
| Rate for Payer: Cigna Commercial |
$10,192.33
|
| Rate for Payer: First Health Commercial |
$11,665.91
|
| Rate for Payer: Humana Commercial |
$10,437.92
|
| Rate for Payer: Humana KY Medicaid |
$4,223.06
|
| Rate for Payer: Kentucky WC Medicaid |
$4,266.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,069.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,062.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,683.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,307.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,806.32
|
| Rate for Payer: Ohio Health Group HMO |
$9,209.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,455.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,596.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,806.77
|
| Rate for Payer: PHCS Commercial |
$11,788.71
|
| Rate for Payer: United Healthcare All Payer |
$10,806.32
|
|
|
CONTR ACE RECN RNG 50OD 46ID R
|
Facility
|
IP
|
$12,279.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,596.39 |
| Max. Negotiated Rate |
$11,788.71 |
| Rate for Payer: Aetna Commercial |
$9,455.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,578.33
|
| Rate for Payer: Cash Price |
$6,139.96
|
| Rate for Payer: Cigna Commercial |
$10,192.33
|
| Rate for Payer: First Health Commercial |
$11,665.91
|
| Rate for Payer: Humana Commercial |
$10,437.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,069.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,062.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,683.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,806.32
|
| Rate for Payer: Ohio Health Group HMO |
$9,209.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,455.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,596.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,806.77
|
| Rate for Payer: PHCS Commercial |
$11,788.71
|
| Rate for Payer: United Healthcare All Payer |
$10,806.32
|
|
|
CONTR ACE RECN RNG 50OD 46ID R
|
Facility
|
OP
|
$12,279.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,596.39 |
| Max. Negotiated Rate |
$11,788.71 |
| Rate for Payer: Aetna Commercial |
$9,455.53
|
| Rate for Payer: Anthem Medicaid |
$4,223.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,578.33
|
| Rate for Payer: Cash Price |
$6,139.96
|
| Rate for Payer: Cigna Commercial |
$10,192.33
|
| Rate for Payer: First Health Commercial |
$11,665.91
|
| Rate for Payer: Humana Commercial |
$10,437.92
|
| Rate for Payer: Humana KY Medicaid |
$4,223.06
|
| Rate for Payer: Kentucky WC Medicaid |
$4,266.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,069.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,062.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,683.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,307.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,806.32
|
| Rate for Payer: Ohio Health Group HMO |
$9,209.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,455.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,596.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,806.77
|
| Rate for Payer: PHCS Commercial |
$11,788.71
|
| Rate for Payer: United Healthcare All Payer |
$10,806.32
|
|
|
CONTR ACE RECN RNG 56OD 52ID L
|
Facility
|
OP
|
$20,648.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,684.28 |
| Max. Negotiated Rate |
$19,822.37 |
| Rate for Payer: Aetna Commercial |
$15,899.19
|
| Rate for Payer: Anthem Medicaid |
$7,100.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,105.67
|
| Rate for Payer: Cash Price |
$10,324.15
|
| Rate for Payer: Cigna Commercial |
$17,138.09
|
| Rate for Payer: First Health Commercial |
$19,615.88
|
| Rate for Payer: Humana Commercial |
$17,551.06
|
| Rate for Payer: Humana KY Medicaid |
$7,100.95
|
| Rate for Payer: Kentucky WC Medicaid |
$7,173.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,931.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,238.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,194.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,243.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,170.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,486.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,129.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,684.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,400.97
|
| Rate for Payer: PHCS Commercial |
$19,822.37
|
| Rate for Payer: United Healthcare All Payer |
$18,170.50
|
|
|
CONTR ACE RECN RNG 56OD 52ID L
|
Facility
|
IP
|
$20,648.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,684.28 |
| Max. Negotiated Rate |
$19,822.37 |
| Rate for Payer: Aetna Commercial |
$15,899.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,105.67
|
| Rate for Payer: Cash Price |
$10,324.15
|
| Rate for Payer: Cigna Commercial |
$17,138.09
|
| Rate for Payer: First Health Commercial |
$19,615.88
|
| Rate for Payer: Humana Commercial |
$17,551.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,931.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,238.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,194.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,170.50
|
| Rate for Payer: Ohio Health Group HMO |
$15,486.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,129.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,684.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,400.97
|
| Rate for Payer: PHCS Commercial |
$19,822.37
|
| Rate for Payer: United Healthcare All Payer |
$18,170.50
|
|
|
CONTR ACE RECN RNG 56OD 52ID R
|
Facility
|
IP
|
$21,991.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,858.90 |
| Max. Negotiated Rate |
$21,111.84 |
| Rate for Payer: Aetna Commercial |
$16,933.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,153.37
|
| Rate for Payer: Cash Price |
$10,995.75
|
| Rate for Payer: Cigna Commercial |
$18,252.94
|
| Rate for Payer: First Health Commercial |
$20,891.92
|
| Rate for Payer: Humana Commercial |
$18,692.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,033.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,229.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,597.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,352.52
|
| Rate for Payer: Ohio Health Group HMO |
$16,493.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,398.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,858.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,817.36
|
| Rate for Payer: PHCS Commercial |
$21,111.84
|
| Rate for Payer: United Healthcare All Payer |
$19,352.52
|
|
|
CONTR ACE RECN RNG 56OD 52ID R
|
Facility
|
OP
|
$21,991.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,858.90 |
| Max. Negotiated Rate |
$21,111.84 |
| Rate for Payer: Aetna Commercial |
$16,933.46
|
| Rate for Payer: Anthem Medicaid |
$7,562.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,153.37
|
| Rate for Payer: Cash Price |
$10,995.75
|
| Rate for Payer: Cigna Commercial |
$18,252.94
|
| Rate for Payer: First Health Commercial |
$20,891.92
|
| Rate for Payer: Humana Commercial |
$18,692.78
|
| Rate for Payer: Humana KY Medicaid |
$7,562.88
|
| Rate for Payer: Kentucky WC Medicaid |
$7,639.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,033.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,229.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,597.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,714.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,352.52
|
| Rate for Payer: Ohio Health Group HMO |
$16,493.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,398.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,858.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,817.36
|
| Rate for Payer: PHCS Commercial |
$21,111.84
|
| Rate for Payer: United Healthcare All Payer |
$19,352.52
|
|
|
CONTR ACE RECN RNG 62OD 58ID L
|
Facility
|
IP
|
$12,279.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,596.39 |
| Max. Negotiated Rate |
$11,788.71 |
| Rate for Payer: Aetna Commercial |
$9,455.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,578.33
|
| Rate for Payer: Cash Price |
$6,139.96
|
| Rate for Payer: Cigna Commercial |
$10,192.33
|
| Rate for Payer: First Health Commercial |
$11,665.91
|
| Rate for Payer: Humana Commercial |
$10,437.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,069.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,062.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,683.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,806.32
|
| Rate for Payer: Ohio Health Group HMO |
$9,209.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,455.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,596.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,806.77
|
| Rate for Payer: PHCS Commercial |
$11,788.71
|
| Rate for Payer: United Healthcare All Payer |
$10,806.32
|
|
|
CONTR ACE RECN RNG 62OD 58ID L
|
Facility
|
OP
|
$12,279.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,596.39 |
| Max. Negotiated Rate |
$11,788.71 |
| Rate for Payer: Aetna Commercial |
$9,455.53
|
| Rate for Payer: Anthem Medicaid |
$4,223.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,578.33
|
| Rate for Payer: Cash Price |
$6,139.96
|
| Rate for Payer: Cigna Commercial |
$10,192.33
|
| Rate for Payer: First Health Commercial |
$11,665.91
|
| Rate for Payer: Humana Commercial |
$10,437.92
|
| Rate for Payer: Humana KY Medicaid |
$4,223.06
|
| Rate for Payer: Kentucky WC Medicaid |
$4,266.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,069.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,062.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,683.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,307.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,806.32
|
| Rate for Payer: Ohio Health Group HMO |
$9,209.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,455.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,596.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,806.77
|
| Rate for Payer: PHCS Commercial |
$11,788.71
|
| Rate for Payer: United Healthcare All Payer |
$10,806.32
|
|
|
CONTR ACE RECN RNG 62OD 58ID R
|
Facility
|
OP
|
$12,279.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,596.39 |
| Max. Negotiated Rate |
$11,788.71 |
| Rate for Payer: Aetna Commercial |
$9,455.53
|
| Rate for Payer: Anthem Medicaid |
$4,223.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,578.33
|
| Rate for Payer: Cash Price |
$6,139.96
|
| Rate for Payer: Cigna Commercial |
$10,192.33
|
| Rate for Payer: First Health Commercial |
$11,665.91
|
| Rate for Payer: Humana Commercial |
$10,437.92
|
| Rate for Payer: Humana KY Medicaid |
$4,223.06
|
| Rate for Payer: Kentucky WC Medicaid |
$4,266.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,069.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,062.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,683.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,307.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,806.32
|
| Rate for Payer: Ohio Health Group HMO |
$9,209.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,455.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,596.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,806.77
|
| Rate for Payer: PHCS Commercial |
$11,788.71
|
| Rate for Payer: United Healthcare All Payer |
$10,806.32
|
|
|
CONTR ACE RECN RNG 62OD 58ID R
|
Facility
|
IP
|
$12,279.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,596.39 |
| Max. Negotiated Rate |
$11,788.71 |
| Rate for Payer: Aetna Commercial |
$9,455.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,578.33
|
| Rate for Payer: Cash Price |
$6,139.96
|
| Rate for Payer: Cigna Commercial |
$10,192.33
|
| Rate for Payer: First Health Commercial |
$11,665.91
|
| Rate for Payer: Humana Commercial |
$10,437.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,069.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,062.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,683.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,806.32
|
| Rate for Payer: Ohio Health Group HMO |
$9,209.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,455.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,596.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,806.77
|
| Rate for Payer: PHCS Commercial |
$11,788.71
|
| Rate for Payer: United Healthcare All Payer |
$10,806.32
|
|
|
CONTR ACE RECN RNG 68OD 64ID L
|
Facility
|
IP
|
$12,279.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,596.39 |
| Max. Negotiated Rate |
$11,788.71 |
| Rate for Payer: Aetna Commercial |
$9,455.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,578.33
|
| Rate for Payer: Cash Price |
$6,139.96
|
| Rate for Payer: Cigna Commercial |
$10,192.33
|
| Rate for Payer: First Health Commercial |
$11,665.91
|
| Rate for Payer: Humana Commercial |
$10,437.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,069.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,062.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,683.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,806.32
|
| Rate for Payer: Ohio Health Group HMO |
$9,209.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,455.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,596.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,806.77
|
| Rate for Payer: PHCS Commercial |
$11,788.71
|
| Rate for Payer: United Healthcare All Payer |
$10,806.32
|
|
|
CONTR ACE RECN RNG 68OD 64ID L
|
Facility
|
OP
|
$12,279.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,596.39 |
| Max. Negotiated Rate |
$11,788.71 |
| Rate for Payer: Aetna Commercial |
$9,455.53
|
| Rate for Payer: Anthem Medicaid |
$4,223.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,578.33
|
| Rate for Payer: Cash Price |
$6,139.96
|
| Rate for Payer: Cigna Commercial |
$10,192.33
|
| Rate for Payer: First Health Commercial |
$11,665.91
|
| Rate for Payer: Humana Commercial |
$10,437.92
|
| Rate for Payer: Humana KY Medicaid |
$4,223.06
|
| Rate for Payer: Kentucky WC Medicaid |
$4,266.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,069.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,062.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,683.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,307.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,806.32
|
| Rate for Payer: Ohio Health Group HMO |
$9,209.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,455.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,596.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,806.77
|
| Rate for Payer: PHCS Commercial |
$11,788.71
|
| Rate for Payer: United Healthcare All Payer |
$10,806.32
|
|
|
CONTR ACE RECN RNG 68OD 64ID R
|
Facility
|
OP
|
$12,279.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,596.39 |
| Max. Negotiated Rate |
$11,788.71 |
| Rate for Payer: Aetna Commercial |
$9,455.53
|
| Rate for Payer: Anthem Medicaid |
$4,223.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,578.33
|
| Rate for Payer: Cash Price |
$6,139.96
|
| Rate for Payer: Cigna Commercial |
$10,192.33
|
| Rate for Payer: First Health Commercial |
$11,665.91
|
| Rate for Payer: Humana Commercial |
$10,437.92
|
| Rate for Payer: Humana KY Medicaid |
$4,223.06
|
| Rate for Payer: Kentucky WC Medicaid |
$4,266.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,069.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,062.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,683.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,307.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,806.32
|
| Rate for Payer: Ohio Health Group HMO |
$9,209.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,455.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,596.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,806.77
|
| Rate for Payer: PHCS Commercial |
$11,788.71
|
| Rate for Payer: United Healthcare All Payer |
$10,806.32
|
|
|
CONTR ACE RECN RNG 68OD 64ID R
|
Facility
|
IP
|
$12,279.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,596.39 |
| Max. Negotiated Rate |
$11,788.71 |
| Rate for Payer: Aetna Commercial |
$9,455.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,578.33
|
| Rate for Payer: Cash Price |
$6,139.96
|
| Rate for Payer: Cigna Commercial |
$10,192.33
|
| Rate for Payer: First Health Commercial |
$11,665.91
|
| Rate for Payer: Humana Commercial |
$10,437.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,069.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,062.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,683.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,806.32
|
| Rate for Payer: Ohio Health Group HMO |
$9,209.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,455.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,596.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,806.77
|
| Rate for Payer: PHCS Commercial |
$11,788.71
|
| Rate for Payer: United Healthcare All Payer |
$10,806.32
|
|
