|
DELIVER PLACENTA(T
|
Facility
|
IP
|
$3,731.00
|
|
|
Service Code
|
HCPCS 59414
|
| Hospital Charge Code |
720T0018
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$485.03 |
| Max. Negotiated Rate |
$3,581.76 |
| Rate for Payer: Aetna Commercial |
$2,872.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,910.18
|
| Rate for Payer: Cash Price |
$1,865.50
|
| Rate for Payer: Cigna Commercial |
$3,096.73
|
| Rate for Payer: First Health Commercial |
$3,544.45
|
| Rate for Payer: Humana Commercial |
$3,171.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,059.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,753.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,119.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,283.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,798.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$746.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$485.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,156.61
|
| Rate for Payer: PHCS Commercial |
$3,581.76
|
| Rate for Payer: United Healthcare All Payer |
$3,283.28
|
|
|
DELIVER PLACENTA(T
|
Facility
|
OP
|
$3,731.00
|
|
|
Service Code
|
HCPCS 59414
|
| Hospital Charge Code |
720T0018
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$485.03 |
| Max. Negotiated Rate |
$3,784.94 |
| Rate for Payer: Aetna Commercial |
$2,872.87
|
| Rate for Payer: Anthem Medicaid |
$1,283.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,910.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,784.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,649.77
|
| Rate for Payer: Cash Price |
$1,865.50
|
| Rate for Payer: Cash Price |
$1,865.50
|
| Rate for Payer: Cigna Commercial |
$3,096.73
|
| Rate for Payer: First Health Commercial |
$3,544.45
|
| Rate for Payer: Humana Commercial |
$3,171.35
|
| Rate for Payer: Humana KY Medicaid |
$1,283.09
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,296.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,059.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,753.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,308.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,283.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,798.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$746.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$485.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,156.61
|
| Rate for Payer: PHCS Commercial |
$3,581.76
|
| Rate for Payer: United Healthcare All Payer |
$3,283.28
|
|
|
DELIVERY W/PRENATAL CARE
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 59400
|
| Hospital Charge Code |
72000015
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,050.00 |
| Max. Negotiated Rate |
$3,091.35 |
| Rate for Payer: Aetna Commercial |
$3,091.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,000.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,631.94
|
| Rate for Payer: Healthspan PPO |
$2,200.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,977.98
|
| Rate for Payer: Multiplan PHCS |
$1,800.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,100.00
|
| Rate for Payer: UHCCP Medicaid |
$1,050.00
|
| Rate for Payer: United Healthcare Non-Options |
$1,995.00
|
| Rate for Payer: United Healthcare Options |
$1,805.00
|
|
|
DELIVERY W/PRENATAL CARE
|
Facility
|
IP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 59400
|
| Hospital Charge Code |
72000015
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$390.00 |
| Max. Negotiated Rate |
$2,880.00 |
| Rate for Payer: Aetna Commercial |
$2,310.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,340.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,490.00
|
| Rate for Payer: First Health Commercial |
$2,850.00
|
| Rate for Payer: Humana Commercial |
$2,550.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,460.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,214.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$900.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$390.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$930.00
|
| Rate for Payer: PHCS Commercial |
$2,880.00
|
| Rate for Payer: United Healthcare All Payer |
$2,640.00
|
|
|
DELIVERY W/PRENATAL CARE
|
Facility
|
OP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 59400
|
| Hospital Charge Code |
72000015
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$390.00 |
| Max. Negotiated Rate |
$2,880.00 |
| Rate for Payer: Aetna Commercial |
$2,310.00
|
| Rate for Payer: Anthem Medicaid |
$1,031.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,340.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,490.00
|
| Rate for Payer: First Health Commercial |
$2,850.00
|
| Rate for Payer: Humana Commercial |
$2,550.00
|
| Rate for Payer: Humana KY Medicaid |
$1,031.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,042.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,460.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,214.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$900.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,052.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$390.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$930.00
|
| Rate for Payer: PHCS Commercial |
$2,880.00
|
| Rate for Payer: United Healthcare All Payer |
$2,640.00
|
|
|
DELIVERY W/PRENATAL CARE(P
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 59400
|
| Hospital Charge Code |
720P0015
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,050.00 |
| Max. Negotiated Rate |
$3,091.35 |
| Rate for Payer: Aetna Commercial |
$3,091.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,000.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,631.94
|
| Rate for Payer: Healthspan PPO |
$2,200.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,977.98
|
| Rate for Payer: Multiplan PHCS |
$1,800.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,100.00
|
| Rate for Payer: UHCCP Medicaid |
$1,050.00
|
| Rate for Payer: United Healthcare Non-Options |
$1,995.00
|
| Rate for Payer: United Healthcare Options |
$1,805.00
|
|
|
DELSYM 30 MG/5ML SUSPENSION
|
Facility
|
IP
|
$4.54
|
|
|
Service Code
|
NDC 904631256
|
| Hospital Charge Code |
25000525
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.36 |
| Rate for Payer: Aetna Commercial |
$3.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.54
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Cigna Commercial |
$3.77
|
| Rate for Payer: First Health Commercial |
$4.31
|
| Rate for Payer: Humana Commercial |
$3.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.00
|
| Rate for Payer: Ohio Health Group HMO |
$3.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.41
|
| Rate for Payer: PHCS Commercial |
$4.36
|
| Rate for Payer: United Healthcare All Payer |
$4.00
|
|
|
DELSYM 30 MG/5ML SUSPENSION
|
Facility
|
OP
|
$4.54
|
|
|
Service Code
|
NDC 904631256
|
| Hospital Charge Code |
25000525
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$4.36 |
| Rate for Payer: Aetna Commercial |
$3.50
|
| Rate for Payer: Anthem Medicaid |
$1.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.54
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Cigna Commercial |
$3.77
|
| Rate for Payer: First Health Commercial |
$4.31
|
| Rate for Payer: Humana Commercial |
$3.86
|
| Rate for Payer: Humana KY Medicaid |
$1.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.00
|
| Rate for Payer: Ohio Health Group HMO |
$3.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.41
|
| Rate for Payer: PHCS Commercial |
$4.36
|
| Rate for Payer: United Healthcare All Payer |
$4.00
|
|
|
DELTA CER HEAD +0 36MM 11/13
|
Facility
|
OP
|
$9,783.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,271.91 |
| Max. Negotiated Rate |
$9,392.55 |
| Rate for Payer: Aetna Commercial |
$7,533.61
|
| Rate for Payer: Anthem Medicaid |
$3,364.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,631.45
|
| Rate for Payer: Cash Price |
$4,891.96
|
| Rate for Payer: Cigna Commercial |
$8,120.65
|
| Rate for Payer: First Health Commercial |
$9,294.71
|
| Rate for Payer: Humana Commercial |
$8,316.32
|
| Rate for Payer: Humana KY Medicaid |
$3,364.69
|
| Rate for Payer: Kentucky WC Medicaid |
$3,398.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,022.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,220.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,935.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,432.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,609.84
|
| Rate for Payer: Ohio Health Group HMO |
$7,337.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,956.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,271.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,033.01
|
| Rate for Payer: PHCS Commercial |
$9,392.55
|
| Rate for Payer: United Healthcare All Payer |
$8,609.84
|
|
|
DELTA CER HEAD +0 36MM 11/13
|
Facility
|
IP
|
$9,783.91
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,271.91 |
| Max. Negotiated Rate |
$9,392.55 |
| Rate for Payer: Aetna Commercial |
$7,533.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,631.45
|
| Rate for Payer: Cash Price |
$4,891.96
|
| Rate for Payer: Cigna Commercial |
$8,120.65
|
| Rate for Payer: First Health Commercial |
$9,294.71
|
| Rate for Payer: Humana Commercial |
$8,316.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,022.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,220.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,935.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,609.84
|
| Rate for Payer: Ohio Health Group HMO |
$7,337.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,956.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,271.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,033.01
|
| Rate for Payer: PHCS Commercial |
$9,392.55
|
| Rate for Payer: United Healthcare All Payer |
$8,609.84
|
|
|
DELTA CER HEAD 11/13 28MM +0
|
Facility
|
OP
|
$9,050.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,176.53 |
| Max. Negotiated Rate |
$8,688.25 |
| Rate for Payer: Aetna Commercial |
$6,968.70
|
| Rate for Payer: Anthem Medicaid |
$3,112.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,059.20
|
| Rate for Payer: Cash Price |
$4,525.13
|
| Rate for Payer: Cigna Commercial |
$7,511.72
|
| Rate for Payer: First Health Commercial |
$8,597.75
|
| Rate for Payer: Humana Commercial |
$7,692.72
|
| Rate for Payer: Humana KY Medicaid |
$3,112.38
|
| Rate for Payer: Kentucky WC Medicaid |
$3,144.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,421.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,679.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,715.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,174.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,964.23
|
| Rate for Payer: Ohio Health Group HMO |
$6,787.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,810.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,176.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,805.58
|
| Rate for Payer: PHCS Commercial |
$8,688.25
|
| Rate for Payer: United Healthcare All Payer |
$7,964.23
|
|
|
DELTA CER HEAD 11/13 28MM +0
|
Facility
|
IP
|
$9,050.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,176.53 |
| Max. Negotiated Rate |
$8,688.25 |
| Rate for Payer: Aetna Commercial |
$6,968.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,059.20
|
| Rate for Payer: Cash Price |
$4,525.13
|
| Rate for Payer: Cigna Commercial |
$7,511.72
|
| Rate for Payer: First Health Commercial |
$8,597.75
|
| Rate for Payer: Humana Commercial |
$7,692.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,421.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,679.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,715.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,964.23
|
| Rate for Payer: Ohio Health Group HMO |
$6,787.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,810.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,176.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,805.58
|
| Rate for Payer: PHCS Commercial |
$8,688.25
|
| Rate for Payer: United Healthcare All Payer |
$7,964.23
|
|
|
DELTA CER HEAD 11/13 28MM +3
|
Facility
|
IP
|
$9,050.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,176.53 |
| Max. Negotiated Rate |
$8,688.25 |
| Rate for Payer: Aetna Commercial |
$6,968.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,059.20
|
| Rate for Payer: Cash Price |
$4,525.13
|
| Rate for Payer: Cigna Commercial |
$7,511.72
|
| Rate for Payer: First Health Commercial |
$8,597.75
|
| Rate for Payer: Humana Commercial |
$7,692.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,421.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,679.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,715.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,964.23
|
| Rate for Payer: Ohio Health Group HMO |
$6,787.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,810.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,176.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,805.58
|
| Rate for Payer: PHCS Commercial |
$8,688.25
|
| Rate for Payer: United Healthcare All Payer |
$7,964.23
|
|
|
DELTA CER HEAD 11/13 28MM +3
|
Facility
|
OP
|
$9,050.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,176.53 |
| Max. Negotiated Rate |
$8,688.25 |
| Rate for Payer: Aetna Commercial |
$6,968.70
|
| Rate for Payer: Anthem Medicaid |
$3,112.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,059.20
|
| Rate for Payer: Cash Price |
$4,525.13
|
| Rate for Payer: Cigna Commercial |
$7,511.72
|
| Rate for Payer: First Health Commercial |
$8,597.75
|
| Rate for Payer: Humana Commercial |
$7,692.72
|
| Rate for Payer: Humana KY Medicaid |
$3,112.38
|
| Rate for Payer: Kentucky WC Medicaid |
$3,144.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,421.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,679.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,715.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,174.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,964.23
|
| Rate for Payer: Ohio Health Group HMO |
$6,787.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,810.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,176.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,805.58
|
| Rate for Payer: PHCS Commercial |
$8,688.25
|
| Rate for Payer: United Healthcare All Payer |
$7,964.23
|
|
|
DELTA CER HEAD 11/13 28MM +6
|
Facility
|
IP
|
$10,024.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,303.23 |
| Max. Negotiated Rate |
$9,623.82 |
| Rate for Payer: Aetna Commercial |
$7,719.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,819.35
|
| Rate for Payer: Cash Price |
$5,012.40
|
| Rate for Payer: Cigna Commercial |
$8,320.59
|
| Rate for Payer: First Health Commercial |
$9,523.57
|
| Rate for Payer: Humana Commercial |
$8,521.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,220.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,398.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,007.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,821.83
|
| Rate for Payer: Ohio Health Group HMO |
$7,518.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,004.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,303.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,107.69
|
| Rate for Payer: PHCS Commercial |
$9,623.82
|
| Rate for Payer: United Healthcare All Payer |
$8,821.83
|
|
|
DELTA CER HEAD 11/13 28MM +6
|
Facility
|
OP
|
$10,024.81
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,303.23 |
| Max. Negotiated Rate |
$9,623.82 |
| Rate for Payer: Aetna Commercial |
$7,719.10
|
| Rate for Payer: Anthem Medicaid |
$3,447.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,819.35
|
| Rate for Payer: Cash Price |
$5,012.40
|
| Rate for Payer: Cigna Commercial |
$8,320.59
|
| Rate for Payer: First Health Commercial |
$9,523.57
|
| Rate for Payer: Humana Commercial |
$8,521.09
|
| Rate for Payer: Humana KY Medicaid |
$3,447.53
|
| Rate for Payer: Kentucky WC Medicaid |
$3,482.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,220.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,398.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,007.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,516.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,821.83
|
| Rate for Payer: Ohio Health Group HMO |
$7,518.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,004.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,303.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,107.69
|
| Rate for Payer: PHCS Commercial |
$9,623.82
|
| Rate for Payer: United Healthcare All Payer |
$8,821.83
|
|
|
DELTA CER HEAD 11/13 32MM +0
|
Facility
|
OP
|
$9,050.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,176.53 |
| Max. Negotiated Rate |
$8,688.25 |
| Rate for Payer: Aetna Commercial |
$6,968.70
|
| Rate for Payer: Anthem Medicaid |
$3,112.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,059.20
|
| Rate for Payer: Cash Price |
$4,525.13
|
| Rate for Payer: Cigna Commercial |
$7,511.72
|
| Rate for Payer: First Health Commercial |
$8,597.75
|
| Rate for Payer: Humana Commercial |
$7,692.72
|
| Rate for Payer: Humana KY Medicaid |
$3,112.38
|
| Rate for Payer: Kentucky WC Medicaid |
$3,144.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,421.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,679.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,715.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,174.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,964.23
|
| Rate for Payer: Ohio Health Group HMO |
$6,787.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,810.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,176.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,805.58
|
| Rate for Payer: PHCS Commercial |
$8,688.25
|
| Rate for Payer: United Healthcare All Payer |
$7,964.23
|
|
|
DELTA CER HEAD 11/13 32MM +0
|
Facility
|
IP
|
$9,050.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,176.53 |
| Max. Negotiated Rate |
$8,688.25 |
| Rate for Payer: Aetna Commercial |
$6,968.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,059.20
|
| Rate for Payer: Cash Price |
$4,525.13
|
| Rate for Payer: Cigna Commercial |
$7,511.72
|
| Rate for Payer: First Health Commercial |
$8,597.75
|
| Rate for Payer: Humana Commercial |
$7,692.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,421.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,679.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,715.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,964.23
|
| Rate for Payer: Ohio Health Group HMO |
$6,787.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,810.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,176.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,805.58
|
| Rate for Payer: PHCS Commercial |
$8,688.25
|
| Rate for Payer: United Healthcare All Payer |
$7,964.23
|
|
|
DELTA CER HEAD 11/13 32MM +3
|
Facility
|
IP
|
$9,050.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,176.53 |
| Max. Negotiated Rate |
$8,688.25 |
| Rate for Payer: Aetna Commercial |
$6,968.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,059.20
|
| Rate for Payer: Cash Price |
$4,525.13
|
| Rate for Payer: Cigna Commercial |
$7,511.72
|
| Rate for Payer: First Health Commercial |
$8,597.75
|
| Rate for Payer: Humana Commercial |
$7,692.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,421.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,679.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,715.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,964.23
|
| Rate for Payer: Ohio Health Group HMO |
$6,787.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,810.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,176.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,805.58
|
| Rate for Payer: PHCS Commercial |
$8,688.25
|
| Rate for Payer: United Healthcare All Payer |
$7,964.23
|
|
|
DELTA CER HEAD 11/13 32MM +3
|
Facility
|
OP
|
$9,050.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,176.53 |
| Max. Negotiated Rate |
$8,688.25 |
| Rate for Payer: Aetna Commercial |
$6,968.70
|
| Rate for Payer: Anthem Medicaid |
$3,112.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,059.20
|
| Rate for Payer: Cash Price |
$4,525.13
|
| Rate for Payer: Cigna Commercial |
$7,511.72
|
| Rate for Payer: First Health Commercial |
$8,597.75
|
| Rate for Payer: Humana Commercial |
$7,692.72
|
| Rate for Payer: Humana KY Medicaid |
$3,112.38
|
| Rate for Payer: Kentucky WC Medicaid |
$3,144.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,421.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,679.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,715.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,174.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,964.23
|
| Rate for Payer: Ohio Health Group HMO |
$6,787.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,810.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,176.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,805.58
|
| Rate for Payer: PHCS Commercial |
$8,688.25
|
| Rate for Payer: United Healthcare All Payer |
$7,964.23
|
|
|
DELTA CER HEAD 11/13 32MM +6
|
Facility
|
OP
|
$9,420.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,224.65 |
| Max. Negotiated Rate |
$9,043.56 |
| Rate for Payer: Aetna Commercial |
$7,253.68
|
| Rate for Payer: Anthem Medicaid |
$3,239.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,347.89
|
| Rate for Payer: Cash Price |
$4,710.19
|
| Rate for Payer: Cigna Commercial |
$7,818.91
|
| Rate for Payer: First Health Commercial |
$8,949.35
|
| Rate for Payer: Humana Commercial |
$8,007.31
|
| Rate for Payer: Humana KY Medicaid |
$3,239.67
|
| Rate for Payer: Kentucky WC Medicaid |
$3,272.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,724.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,952.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,826.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,304.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,289.93
|
| Rate for Payer: Ohio Health Group HMO |
$7,065.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,884.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,224.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,920.31
|
| Rate for Payer: PHCS Commercial |
$9,043.56
|
| Rate for Payer: United Healthcare All Payer |
$8,289.93
|
|
|
DELTA CER HEAD 11/13 32MM +6
|
Facility
|
IP
|
$9,420.37
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,224.65 |
| Max. Negotiated Rate |
$9,043.56 |
| Rate for Payer: Aetna Commercial |
$7,253.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,347.89
|
| Rate for Payer: Cash Price |
$4,710.19
|
| Rate for Payer: Cigna Commercial |
$7,818.91
|
| Rate for Payer: First Health Commercial |
$8,949.35
|
| Rate for Payer: Humana Commercial |
$8,007.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,724.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,952.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,826.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,289.93
|
| Rate for Payer: Ohio Health Group HMO |
$7,065.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,884.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,224.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,920.31
|
| Rate for Payer: PHCS Commercial |
$9,043.56
|
| Rate for Payer: United Healthcare All Payer |
$8,289.93
|
|
|
DELTA CER HEAD 12/14 28MM +1.5
|
Facility
|
IP
|
$8,889.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,155.69 |
| Max. Negotiated Rate |
$8,534.32 |
| Rate for Payer: Aetna Commercial |
$6,845.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,934.14
|
| Rate for Payer: Cash Price |
$4,444.96
|
| Rate for Payer: Cigna Commercial |
$7,378.63
|
| Rate for Payer: First Health Commercial |
$8,445.42
|
| Rate for Payer: Humana Commercial |
$7,556.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,289.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,560.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,666.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,823.13
|
| Rate for Payer: Ohio Health Group HMO |
$6,667.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,777.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,155.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,755.88
|
| Rate for Payer: PHCS Commercial |
$8,534.32
|
| Rate for Payer: United Healthcare All Payer |
$7,823.13
|
|
|
DELTA CER HEAD 12/14 28MM +1.5
|
Facility
|
OP
|
$8,889.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,155.69 |
| Max. Negotiated Rate |
$8,534.32 |
| Rate for Payer: Aetna Commercial |
$6,845.24
|
| Rate for Payer: Anthem Medicaid |
$3,057.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,934.14
|
| Rate for Payer: Cash Price |
$4,444.96
|
| Rate for Payer: Cigna Commercial |
$7,378.63
|
| Rate for Payer: First Health Commercial |
$8,445.42
|
| Rate for Payer: Humana Commercial |
$7,556.43
|
| Rate for Payer: Humana KY Medicaid |
$3,057.24
|
| Rate for Payer: Kentucky WC Medicaid |
$3,088.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,289.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,560.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,666.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,118.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,823.13
|
| Rate for Payer: Ohio Health Group HMO |
$6,667.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,777.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,155.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,755.88
|
| Rate for Payer: PHCS Commercial |
$8,534.32
|
| Rate for Payer: United Healthcare All Payer |
$7,823.13
|
|
|
DELTA CER HEAD 12/14 28MM +5
|
Facility
|
IP
|
$9,050.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,176.53 |
| Max. Negotiated Rate |
$8,688.25 |
| Rate for Payer: Aetna Commercial |
$6,968.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,059.20
|
| Rate for Payer: Cash Price |
$4,525.13
|
| Rate for Payer: Cigna Commercial |
$7,511.72
|
| Rate for Payer: First Health Commercial |
$8,597.75
|
| Rate for Payer: Humana Commercial |
$7,692.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,421.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,679.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,715.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,964.23
|
| Rate for Payer: Ohio Health Group HMO |
$6,787.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,810.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,176.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,805.58
|
| Rate for Payer: PHCS Commercial |
$8,688.25
|
| Rate for Payer: United Healthcare All Payer |
$7,964.23
|
|
