|
DESTINATION 7FR 45CM STR CCV
|
Facility
|
IP
|
$1,537.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$199.81 |
| Max. Negotiated Rate |
$1,475.52 |
| Rate for Payer: Aetna Commercial |
$1,183.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,198.86
|
| Rate for Payer: Cash Price |
$768.50
|
| Rate for Payer: Cigna Commercial |
$1,275.71
|
| Rate for Payer: First Health Commercial |
$1,460.15
|
| Rate for Payer: Humana Commercial |
$1,306.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,260.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,134.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$461.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,352.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,152.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$307.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$199.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$476.47
|
| Rate for Payer: PHCS Commercial |
$1,475.52
|
| Rate for Payer: United Healthcare All Payer |
$1,352.56
|
|
|
DESTINATION 7FR ST 90CM RSC06
|
Facility
|
OP
|
$1,572.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$204.36 |
| Max. Negotiated Rate |
$1,509.12 |
| Rate for Payer: Aetna Commercial |
$1,210.44
|
| Rate for Payer: Anthem Medicaid |
$540.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,226.16
|
| Rate for Payer: Cash Price |
$786.00
|
| Rate for Payer: Cigna Commercial |
$1,304.76
|
| Rate for Payer: First Health Commercial |
$1,493.40
|
| Rate for Payer: Humana Commercial |
$1,336.20
|
| Rate for Payer: Humana KY Medicaid |
$540.61
|
| Rate for Payer: Kentucky WC Medicaid |
$546.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,289.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,160.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$471.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$551.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,383.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,179.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$314.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$204.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$487.32
|
| Rate for Payer: PHCS Commercial |
$1,509.12
|
| Rate for Payer: United Healthcare All Payer |
$1,383.36
|
|
|
DESTINATION 7FR ST 90CM RSC06
|
Facility
|
IP
|
$1,572.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$204.36 |
| Max. Negotiated Rate |
$1,509.12 |
| Rate for Payer: Aetna Commercial |
$1,210.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,226.16
|
| Rate for Payer: Cash Price |
$786.00
|
| Rate for Payer: Cigna Commercial |
$1,304.76
|
| Rate for Payer: First Health Commercial |
$1,493.40
|
| Rate for Payer: Humana Commercial |
$1,336.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,289.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,160.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$471.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,383.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,179.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$314.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$204.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$487.32
|
| Rate for Payer: PHCS Commercial |
$1,509.12
|
| Rate for Payer: United Healthcare All Payer |
$1,383.36
|
|
|
DESTINATION 8FR 45CM STR CCV
|
Facility
|
IP
|
$1,537.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$199.81 |
| Max. Negotiated Rate |
$1,475.52 |
| Rate for Payer: Aetna Commercial |
$1,183.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,198.86
|
| Rate for Payer: Cash Price |
$768.50
|
| Rate for Payer: Cigna Commercial |
$1,275.71
|
| Rate for Payer: First Health Commercial |
$1,460.15
|
| Rate for Payer: Humana Commercial |
$1,306.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,260.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,134.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$461.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,352.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,152.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$307.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$199.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$476.47
|
| Rate for Payer: PHCS Commercial |
$1,475.52
|
| Rate for Payer: United Healthcare All Payer |
$1,352.56
|
|
|
DESTINATION 8FR 45CM STR CCV
|
Facility
|
OP
|
$1,537.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$199.81 |
| Max. Negotiated Rate |
$1,475.52 |
| Rate for Payer: Aetna Commercial |
$1,183.49
|
| Rate for Payer: Anthem Medicaid |
$528.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,198.86
|
| Rate for Payer: Cash Price |
$768.50
|
| Rate for Payer: Cigna Commercial |
$1,275.71
|
| Rate for Payer: First Health Commercial |
$1,460.15
|
| Rate for Payer: Humana Commercial |
$1,306.45
|
| Rate for Payer: Humana KY Medicaid |
$528.57
|
| Rate for Payer: Kentucky WC Medicaid |
$533.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,260.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,134.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$461.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$539.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,352.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,152.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$307.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$199.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$476.47
|
| Rate for Payer: PHCS Commercial |
$1,475.52
|
| Rate for Payer: United Healthcare All Payer |
$1,352.56
|
|
|
DESTINO TWIST SHEATH 7F
|
Facility
|
OP
|
$3,862.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$502.12 |
| Max. Negotiated Rate |
$3,708.00 |
| Rate for Payer: Aetna Commercial |
$2,974.12
|
| Rate for Payer: Anthem Medicaid |
$1,328.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,012.75
|
| Rate for Payer: Cash Price |
$1,931.25
|
| Rate for Payer: Cigna Commercial |
$3,205.88
|
| Rate for Payer: First Health Commercial |
$3,669.38
|
| Rate for Payer: Humana Commercial |
$3,283.12
|
| Rate for Payer: Humana KY Medicaid |
$1,328.31
|
| Rate for Payer: Kentucky WC Medicaid |
$1,341.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,167.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,850.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,158.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,354.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,399.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,896.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$772.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$502.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,197.38
|
| Rate for Payer: PHCS Commercial |
$3,708.00
|
| Rate for Payer: United Healthcare All Payer |
$3,399.00
|
|
|
DESTINO TWIST SHEATH 7F
|
Facility
|
IP
|
$3,862.50
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$502.12 |
| Max. Negotiated Rate |
$3,708.00 |
| Rate for Payer: Aetna Commercial |
$2,974.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,012.75
|
| Rate for Payer: Cash Price |
$1,931.25
|
| Rate for Payer: Cigna Commercial |
$3,205.88
|
| Rate for Payer: First Health Commercial |
$3,669.38
|
| Rate for Payer: Humana Commercial |
$3,283.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,167.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,850.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,158.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,399.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,896.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$772.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$502.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,197.38
|
| Rate for Payer: PHCS Commercial |
$3,708.00
|
| Rate for Payer: United Healthcare All Payer |
$3,399.00
|
|
|
DEST MAL LES > 0.5CM FEENL
|
Facility
|
OP
|
$513.00
|
|
|
Service Code
|
HCPCS 17280
|
| Hospital Charge Code |
76100266
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.69 |
| Max. Negotiated Rate |
$492.48 |
| Rate for Payer: Aetna Commercial |
$395.01
|
| Rate for Payer: Anthem Medicaid |
$176.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$400.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cigna Commercial |
$425.79
|
| Rate for Payer: First Health Commercial |
$487.35
|
| Rate for Payer: Humana Commercial |
$436.05
|
| Rate for Payer: Humana KY Medicaid |
$176.42
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$178.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$420.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$378.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$179.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$451.44
|
| Rate for Payer: Ohio Health Group HMO |
$384.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$102.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$159.03
|
| Rate for Payer: PHCS Commercial |
$492.48
|
| Rate for Payer: United Healthcare All Payer |
$451.44
|
|
|
DEST MAL LES > 0.5CM FEENL
|
Facility
|
IP
|
$513.00
|
|
|
Service Code
|
HCPCS 17280
|
| Hospital Charge Code |
76100266
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.69 |
| Max. Negotiated Rate |
$492.48 |
| Rate for Payer: Aetna Commercial |
$395.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$400.14
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cigna Commercial |
$425.79
|
| Rate for Payer: First Health Commercial |
$487.35
|
| Rate for Payer: Humana Commercial |
$436.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$420.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$378.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$153.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$451.44
|
| Rate for Payer: Ohio Health Group HMO |
$384.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$102.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$159.03
|
| Rate for Payer: PHCS Commercial |
$492.48
|
| Rate for Payer: United Healthcare All Payer |
$451.44
|
|
|
DEST MAL LES > 0.5CM FEENL
|
Professional
|
Both
|
$513.00
|
|
|
Service Code
|
HCPCS 17280
|
| Hospital Charge Code |
76100266
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$58.12 |
| Max. Negotiated Rate |
$513.00 |
| Rate for Payer: Aetna Commercial |
$125.25
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$58.12
|
| Rate for Payer: Anthem Medicaid |
$58.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$513.00
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cigna Commercial |
$165.26
|
| Rate for Payer: Healthspan PPO |
$150.22
|
| Rate for Payer: Humana Medicaid |
$58.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$113.66
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$59.81
|
| Rate for Payer: Molina Healthcare Passport |
$58.64
|
| Rate for Payer: Multiplan PHCS |
$307.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$359.10
|
| Rate for Payer: UHCCP Medicaid |
$61.03
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$59.23
|
|
|
DEST MAL LES > 0.5CM FEENL(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 17280
|
| Hospital Charge Code |
761P0266
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$58.12 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Aetna Commercial |
$125.25
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$58.12
|
| Rate for Payer: Anthem Medicaid |
$58.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$250.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$165.26
|
| Rate for Payer: Healthspan PPO |
$150.22
|
| Rate for Payer: Humana Medicaid |
$58.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$113.66
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$59.81
|
| Rate for Payer: Molina Healthcare Passport |
$58.64
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$61.03
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$59.23
|
|
|
DEST MAL LES > 0.5CM FEENL(T
|
Facility
|
IP
|
$263.00
|
|
|
Service Code
|
HCPCS 17280
|
| Hospital Charge Code |
761T0266
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$34.19 |
| Max. Negotiated Rate |
$252.48 |
| Rate for Payer: Aetna Commercial |
$202.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$205.14
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cigna Commercial |
$218.29
|
| Rate for Payer: First Health Commercial |
$249.85
|
| Rate for Payer: Humana Commercial |
$223.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$215.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$194.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$231.44
|
| Rate for Payer: Ohio Health Group HMO |
$197.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$81.53
|
| Rate for Payer: PHCS Commercial |
$252.48
|
| Rate for Payer: United Healthcare All Payer |
$231.44
|
|
|
DEST MAL LES > 0.5CM FEENL(T
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
HCPCS 17280
|
| Hospital Charge Code |
761T0266
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$34.19 |
| Max. Negotiated Rate |
$252.48 |
| Rate for Payer: Aetna Commercial |
$202.51
|
| Rate for Payer: Anthem Medicaid |
$90.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$205.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cigna Commercial |
$218.29
|
| Rate for Payer: First Health Commercial |
$249.85
|
| Rate for Payer: Humana Commercial |
$223.55
|
| Rate for Payer: Humana KY Medicaid |
$90.45
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$91.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$215.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$194.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$92.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$231.44
|
| Rate for Payer: Ohio Health Group HMO |
$197.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$81.53
|
| Rate for Payer: PHCS Commercial |
$252.48
|
| Rate for Payer: United Healthcare All Payer |
$231.44
|
|
|
DEST MAL LES < 0.5CM SNHFG
|
Professional
|
Both
|
$494.94
|
|
|
Service Code
|
HCPCS 17270
|
| Hospital Charge Code |
76100260
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$53.47 |
| Max. Negotiated Rate |
$494.94 |
| Rate for Payer: Aetna Commercial |
$137.65
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$53.47
|
| Rate for Payer: Anthem Medicaid |
$58.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$494.94
|
| Rate for Payer: Cash Price |
$247.47
|
| Rate for Payer: Cash Price |
$247.47
|
| Rate for Payer: Cigna Commercial |
$178.48
|
| Rate for Payer: Healthspan PPO |
$160.14
|
| Rate for Payer: Humana Medicaid |
$58.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$124.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$59.31
|
| Rate for Payer: Molina Healthcare Passport |
$58.15
|
| Rate for Payer: Multiplan PHCS |
$296.96
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$346.46
|
| Rate for Payer: UHCCP Medicaid |
$56.14
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$58.73
|
|
|
DEST MAL LES < 0.5CM SNHFG
|
Facility
|
IP
|
$494.94
|
|
|
Service Code
|
HCPCS 17270
|
| Hospital Charge Code |
76100260
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.34 |
| Max. Negotiated Rate |
$475.14 |
| Rate for Payer: Aetna Commercial |
$381.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$386.05
|
| Rate for Payer: Cash Price |
$247.47
|
| Rate for Payer: Cigna Commercial |
$410.80
|
| Rate for Payer: First Health Commercial |
$470.19
|
| Rate for Payer: Humana Commercial |
$420.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$405.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$365.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$148.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$435.55
|
| Rate for Payer: Ohio Health Group HMO |
$371.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$98.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$153.43
|
| Rate for Payer: PHCS Commercial |
$475.14
|
| Rate for Payer: United Healthcare All Payer |
$435.55
|
|
|
DEST MAL LES < 0.5CM SNHFG
|
Facility
|
OP
|
$494.94
|
|
|
Service Code
|
HCPCS 17270
|
| Hospital Charge Code |
76100260
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.34 |
| Max. Negotiated Rate |
$475.14 |
| Rate for Payer: Aetna Commercial |
$381.10
|
| Rate for Payer: Anthem Medicaid |
$170.21
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$386.05
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$247.47
|
| Rate for Payer: Cash Price |
$247.47
|
| Rate for Payer: Cigna Commercial |
$410.80
|
| Rate for Payer: First Health Commercial |
$470.19
|
| Rate for Payer: Humana Commercial |
$420.70
|
| Rate for Payer: Humana KY Medicaid |
$170.21
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$171.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$405.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$365.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$173.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$435.55
|
| Rate for Payer: Ohio Health Group HMO |
$371.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$98.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$153.43
|
| Rate for Payer: PHCS Commercial |
$475.14
|
| Rate for Payer: United Healthcare All Payer |
$435.55
|
|
|
DEST MAL LES < 0.5CM SNHFG(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 17270
|
| Hospital Charge Code |
761P0260
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$53.47 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna Commercial |
$137.65
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$53.47
|
| Rate for Payer: Anthem Medicaid |
$58.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$200.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$178.48
|
| Rate for Payer: Healthspan PPO |
$160.14
|
| Rate for Payer: Humana Medicaid |
$58.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$124.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$59.31
|
| Rate for Payer: Molina Healthcare Passport |
$58.15
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$140.00
|
| Rate for Payer: UHCCP Medicaid |
$56.14
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$58.73
|
|
|
DEST MAL LES < 0.5CM SNHFG(T
|
Facility
|
IP
|
$294.94
|
|
|
Service Code
|
HCPCS 17270
|
| Hospital Charge Code |
761T0260
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$38.34 |
| Max. Negotiated Rate |
$283.14 |
| Rate for Payer: Aetna Commercial |
$227.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$230.05
|
| Rate for Payer: Cash Price |
$147.47
|
| Rate for Payer: Cigna Commercial |
$244.80
|
| Rate for Payer: First Health Commercial |
$280.19
|
| Rate for Payer: Humana Commercial |
$250.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$241.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$217.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$88.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$259.55
|
| Rate for Payer: Ohio Health Group HMO |
$221.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$91.43
|
| Rate for Payer: PHCS Commercial |
$283.14
|
| Rate for Payer: United Healthcare All Payer |
$259.55
|
|
|
DEST MAL LES < 0.5CM SNHFG(T
|
Facility
|
OP
|
$294.94
|
|
|
Service Code
|
HCPCS 17270
|
| Hospital Charge Code |
761T0260
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$38.34 |
| Max. Negotiated Rate |
$283.14 |
| Rate for Payer: Aetna Commercial |
$227.10
|
| Rate for Payer: Anthem Medicaid |
$101.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$230.05
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$147.47
|
| Rate for Payer: Cash Price |
$147.47
|
| Rate for Payer: Cigna Commercial |
$244.80
|
| Rate for Payer: First Health Commercial |
$280.19
|
| Rate for Payer: Humana Commercial |
$250.70
|
| Rate for Payer: Humana KY Medicaid |
$101.43
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$102.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$241.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$217.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$103.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$259.55
|
| Rate for Payer: Ohio Health Group HMO |
$221.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$91.43
|
| Rate for Payer: PHCS Commercial |
$283.14
|
| Rate for Payer: United Healthcare All Payer |
$259.55
|
|
|
DEST MAL LES 1.1-2CM TAL
|
Professional
|
Both
|
$664.26
|
|
|
Service Code
|
HCPCS 17262
|
| Hospital Charge Code |
76100256
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$69.39 |
| Max. Negotiated Rate |
$664.26 |
| Rate for Payer: Aetna Commercial |
$163.01
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$69.39
|
| Rate for Payer: Anthem Medicaid |
$73.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$664.26
|
| Rate for Payer: Cash Price |
$332.13
|
| Rate for Payer: Cash Price |
$332.13
|
| Rate for Payer: Cigna Commercial |
$216.61
|
| Rate for Payer: Healthspan PPO |
$188.12
|
| Rate for Payer: Humana Medicaid |
$73.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$146.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$74.65
|
| Rate for Payer: Molina Healthcare Passport |
$73.19
|
| Rate for Payer: Multiplan PHCS |
$398.56
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$464.98
|
| Rate for Payer: UHCCP Medicaid |
$72.86
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$73.92
|
|
|
DEST MAL LES 1.1-2CM TAL
|
Facility
|
OP
|
$664.26
|
|
|
Service Code
|
HCPCS 17262
|
| Hospital Charge Code |
76100256
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$86.35 |
| Max. Negotiated Rate |
$637.69 |
| Rate for Payer: Aetna Commercial |
$511.48
|
| Rate for Payer: Anthem Medicaid |
$228.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$518.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$332.13
|
| Rate for Payer: Cash Price |
$332.13
|
| Rate for Payer: Cigna Commercial |
$551.34
|
| Rate for Payer: First Health Commercial |
$631.05
|
| Rate for Payer: Humana Commercial |
$564.62
|
| Rate for Payer: Humana KY Medicaid |
$228.44
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$230.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$544.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$490.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$233.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$584.55
|
| Rate for Payer: Ohio Health Group HMO |
$498.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$132.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$86.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$205.92
|
| Rate for Payer: PHCS Commercial |
$637.69
|
| Rate for Payer: United Healthcare All Payer |
$584.55
|
|
|
DEST MAL LES 1.1-2CM TAL
|
Facility
|
IP
|
$664.26
|
|
|
Service Code
|
HCPCS 17262
|
| Hospital Charge Code |
76100256
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$86.35 |
| Max. Negotiated Rate |
$637.69 |
| Rate for Payer: Aetna Commercial |
$511.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$518.12
|
| Rate for Payer: Cash Price |
$332.13
|
| Rate for Payer: Cigna Commercial |
$551.34
|
| Rate for Payer: First Health Commercial |
$631.05
|
| Rate for Payer: Humana Commercial |
$564.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$544.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$490.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$199.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$584.55
|
| Rate for Payer: Ohio Health Group HMO |
$498.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$132.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$86.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$205.92
|
| Rate for Payer: PHCS Commercial |
$637.69
|
| Rate for Payer: United Healthcare All Payer |
$584.55
|
|
|
DEST MAL LES 1.1-2CM TAL(P
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 17262
|
| Hospital Charge Code |
761P0256
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$69.39 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna Commercial |
$163.01
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$69.39
|
| Rate for Payer: Anthem Medicaid |
$73.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$350.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$216.61
|
| Rate for Payer: Healthspan PPO |
$188.12
|
| Rate for Payer: Humana Medicaid |
$73.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$146.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$74.65
|
| Rate for Payer: Molina Healthcare Passport |
$73.19
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$245.00
|
| Rate for Payer: UHCCP Medicaid |
$72.86
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$73.92
|
|
|
DEST MAL LES 1.1-2CM TAL(T
|
Facility
|
OP
|
$314.26
|
|
|
Service Code
|
HCPCS 17262
|
| Hospital Charge Code |
761T0256
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$40.85 |
| Max. Negotiated Rate |
$301.69 |
| Rate for Payer: Aetna Commercial |
$241.98
|
| Rate for Payer: Anthem Medicaid |
$108.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$245.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$157.13
|
| Rate for Payer: Cash Price |
$157.13
|
| Rate for Payer: Cigna Commercial |
$260.84
|
| Rate for Payer: First Health Commercial |
$298.55
|
| Rate for Payer: Humana Commercial |
$267.12
|
| Rate for Payer: Humana KY Medicaid |
$108.07
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$109.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$257.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$231.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$110.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$276.55
|
| Rate for Payer: Ohio Health Group HMO |
$235.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$97.42
|
| Rate for Payer: PHCS Commercial |
$301.69
|
| Rate for Payer: United Healthcare All Payer |
$276.55
|
|
|
DEST MAL LES 1.1-2CM TAL(T
|
Facility
|
IP
|
$314.26
|
|
|
Service Code
|
HCPCS 17262
|
| Hospital Charge Code |
761T0256
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$40.85 |
| Max. Negotiated Rate |
$301.69 |
| Rate for Payer: Aetna Commercial |
$241.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$245.12
|
| Rate for Payer: Cash Price |
$157.13
|
| Rate for Payer: Cigna Commercial |
$260.84
|
| Rate for Payer: First Health Commercial |
$298.55
|
| Rate for Payer: Humana Commercial |
$267.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$257.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$231.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$276.55
|
| Rate for Payer: Ohio Health Group HMO |
$235.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$97.42
|
| Rate for Payer: PHCS Commercial |
$301.69
|
| Rate for Payer: United Healthcare All Payer |
$276.55
|
|
