|
DISPOSABLE KIT NANO SWIVELOCK
|
Facility
|
IP
|
$3,232.50
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$420.22 |
| Max. Negotiated Rate |
$3,103.20 |
| Rate for Payer: Aetna Commercial |
$2,489.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,521.35
|
| Rate for Payer: Cash Price |
$1,616.25
|
| Rate for Payer: Cigna Commercial |
$2,682.98
|
| Rate for Payer: First Health Commercial |
$3,070.88
|
| Rate for Payer: Humana Commercial |
$2,747.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,650.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,385.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$969.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,844.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,424.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$646.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$420.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,002.08
|
| Rate for Payer: PHCS Commercial |
$3,103.20
|
| Rate for Payer: United Healthcare All Payer |
$2,844.60
|
|
|
DISSECTION, DEEP JUGULAR NODE(S)
|
Facility
|
OP
|
$6,985.45
|
|
|
Service Code
|
CPT 38542
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,989.61 |
| Max. Negotiated Rate |
$6,985.45 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,989.61
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,985.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,735.97
|
| Rate for Payer: Humana Medicare Advantage |
$4,989.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,987.53
|
|
|
DISTAL BICEPS REPAIR IMP SYS
|
Facility
|
OP
|
$5,175.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$672.75 |
| Max. Negotiated Rate |
$4,968.00 |
| Rate for Payer: Aetna Commercial |
$3,984.75
|
| Rate for Payer: Anthem Medicaid |
$1,779.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,036.50
|
| Rate for Payer: Cash Price |
$2,587.50
|
| Rate for Payer: Cigna Commercial |
$4,295.25
|
| Rate for Payer: First Health Commercial |
$4,916.25
|
| Rate for Payer: Humana Commercial |
$4,398.75
|
| Rate for Payer: Humana KY Medicaid |
$1,779.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1,797.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,243.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,819.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,552.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,815.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,554.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,881.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,035.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$672.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,604.25
|
| Rate for Payer: PHCS Commercial |
$4,968.00
|
| Rate for Payer: United Healthcare All Payer |
$4,554.00
|
|
|
DISTAL BICEPS REPAIR IMP SYS
|
Facility
|
IP
|
$5,175.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$672.75 |
| Max. Negotiated Rate |
$4,968.00 |
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,036.50
|
| Rate for Payer: Cash Price |
$2,587.50
|
| Rate for Payer: Cigna Commercial |
$4,295.25
|
| Rate for Payer: First Health Commercial |
$4,916.25
|
| Rate for Payer: Humana Commercial |
$4,398.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,243.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,819.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,552.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,554.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,881.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,035.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$672.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,604.25
|
| Rate for Payer: PHCS Commercial |
$4,968.00
|
| Rate for Payer: United Healthcare All Payer |
$4,554.00
|
| Rate for Payer: Aetna Commercial |
$3,984.75
|
|
|
DISTAL FEM AXIAL PIN ONE SIZE
|
Facility
|
IP
|
$13,465.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,750.48 |
| Max. Negotiated Rate |
$12,926.64 |
| Rate for Payer: Aetna Commercial |
$10,368.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,502.90
|
| Rate for Payer: Cash Price |
$6,732.62
|
| Rate for Payer: Cigna Commercial |
$11,176.16
|
| Rate for Payer: First Health Commercial |
$12,791.99
|
| Rate for Payer: Humana Commercial |
$11,445.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,041.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,937.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,039.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,849.42
|
| Rate for Payer: Ohio Health Group HMO |
$10,098.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,693.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,750.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,174.23
|
| Rate for Payer: PHCS Commercial |
$12,926.64
|
| Rate for Payer: United Healthcare All Payer |
$11,849.42
|
|
|
DISTAL FEM AXIAL PIN ONE SIZE
|
Facility
|
OP
|
$13,465.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,750.48 |
| Max. Negotiated Rate |
$12,926.64 |
| Rate for Payer: Aetna Commercial |
$10,368.24
|
| Rate for Payer: Anthem Medicaid |
$4,630.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,502.90
|
| Rate for Payer: Cash Price |
$6,732.62
|
| Rate for Payer: Cigna Commercial |
$11,176.16
|
| Rate for Payer: First Health Commercial |
$12,791.99
|
| Rate for Payer: Humana Commercial |
$11,445.46
|
| Rate for Payer: Humana KY Medicaid |
$4,630.70
|
| Rate for Payer: Kentucky WC Medicaid |
$4,677.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,041.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,937.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,039.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,723.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,849.42
|
| Rate for Payer: Ohio Health Group HMO |
$10,098.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,693.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,750.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,174.23
|
| Rate for Payer: PHCS Commercial |
$12,926.64
|
| Rate for Payer: United Healthcare All Payer |
$11,849.42
|
|
|
DISTAL FEMUR SEG 65MM LT
|
Facility
|
OP
|
$36,080.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,690.46 |
| Max. Negotiated Rate |
$34,637.28 |
| Rate for Payer: Aetna Commercial |
$27,781.98
|
| Rate for Payer: Anthem Medicaid |
$12,408.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,142.79
|
| Rate for Payer: Cash Price |
$18,040.25
|
| Rate for Payer: Cigna Commercial |
$29,946.82
|
| Rate for Payer: First Health Commercial |
$34,276.48
|
| Rate for Payer: Humana Commercial |
$30,668.42
|
| Rate for Payer: Humana KY Medicaid |
$12,408.08
|
| Rate for Payer: Kentucky WC Medicaid |
$12,534.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,586.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,627.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,824.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,657.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,750.84
|
| Rate for Payer: Ohio Health Group HMO |
$27,060.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,216.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,690.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,184.96
|
| Rate for Payer: PHCS Commercial |
$34,637.28
|
| Rate for Payer: United Healthcare All Payer |
$31,750.84
|
|
|
DISTAL FEMUR SEG 65MM LT
|
Facility
|
IP
|
$36,080.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,690.46 |
| Max. Negotiated Rate |
$34,637.28 |
| Rate for Payer: Aetna Commercial |
$27,781.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28,142.79
|
| Rate for Payer: Cash Price |
$18,040.25
|
| Rate for Payer: Cigna Commercial |
$29,946.82
|
| Rate for Payer: First Health Commercial |
$34,276.48
|
| Rate for Payer: Humana Commercial |
$30,668.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,586.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,627.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,824.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,750.84
|
| Rate for Payer: Ohio Health Group HMO |
$27,060.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,216.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,690.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,184.96
|
| Rate for Payer: PHCS Commercial |
$34,637.28
|
| Rate for Payer: United Healthcare All Payer |
$31,750.84
|
|
|
DIST FEM AUG BLOCK #11/10MM
|
Facility
|
OP
|
$4,907.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$637.99 |
| Max. Negotiated Rate |
$4,711.30 |
| Rate for Payer: Aetna Commercial |
$3,778.85
|
| Rate for Payer: Anthem Medicaid |
$1,687.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,827.93
|
| Rate for Payer: Cash Price |
$2,453.80
|
| Rate for Payer: Cigna Commercial |
$4,073.31
|
| Rate for Payer: First Health Commercial |
$4,662.22
|
| Rate for Payer: Humana Commercial |
$4,171.46
|
| Rate for Payer: Humana KY Medicaid |
$1,687.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1,704.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,024.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,621.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,472.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,721.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,318.69
|
| Rate for Payer: Ohio Health Group HMO |
$3,680.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$981.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$637.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,521.36
|
| Rate for Payer: PHCS Commercial |
$4,711.30
|
| Rate for Payer: United Healthcare All Payer |
$4,318.69
|
|
|
DIST FEM AUG BLOCK #11/10MM
|
Facility
|
IP
|
$4,907.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$637.99 |
| Max. Negotiated Rate |
$4,711.30 |
| Rate for Payer: Aetna Commercial |
$3,778.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,827.93
|
| Rate for Payer: Cash Price |
$2,453.80
|
| Rate for Payer: Cigna Commercial |
$4,073.31
|
| Rate for Payer: First Health Commercial |
$4,662.22
|
| Rate for Payer: Humana Commercial |
$4,171.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,024.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,621.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,472.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,318.69
|
| Rate for Payer: Ohio Health Group HMO |
$3,680.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$981.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$637.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,521.36
|
| Rate for Payer: PHCS Commercial |
$4,711.30
|
| Rate for Payer: United Healthcare All Payer |
$4,318.69
|
|
|
DIST FEM AUG BLOCK #11/15MM
|
Facility
|
IP
|
$4,907.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$637.99 |
| Max. Negotiated Rate |
$4,711.30 |
| Rate for Payer: Aetna Commercial |
$3,778.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,827.93
|
| Rate for Payer: Cash Price |
$2,453.80
|
| Rate for Payer: Cigna Commercial |
$4,073.31
|
| Rate for Payer: First Health Commercial |
$4,662.22
|
| Rate for Payer: Humana Commercial |
$4,171.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,024.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,621.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,472.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,318.69
|
| Rate for Payer: Ohio Health Group HMO |
$3,680.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$981.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$637.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,521.36
|
| Rate for Payer: PHCS Commercial |
$4,711.30
|
| Rate for Payer: United Healthcare All Payer |
$4,318.69
|
|
|
DIST FEM AUG BLOCK #11/15MM
|
Facility
|
OP
|
$4,907.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$637.99 |
| Max. Negotiated Rate |
$4,711.30 |
| Rate for Payer: Aetna Commercial |
$3,778.85
|
| Rate for Payer: Anthem Medicaid |
$1,687.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,827.93
|
| Rate for Payer: Cash Price |
$2,453.80
|
| Rate for Payer: Cigna Commercial |
$4,073.31
|
| Rate for Payer: First Health Commercial |
$4,662.22
|
| Rate for Payer: Humana Commercial |
$4,171.46
|
| Rate for Payer: Humana KY Medicaid |
$1,687.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1,704.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,024.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,621.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,472.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,721.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,318.69
|
| Rate for Payer: Ohio Health Group HMO |
$3,680.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$981.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$637.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,521.36
|
| Rate for Payer: PHCS Commercial |
$4,711.30
|
| Rate for Payer: United Healthcare All Payer |
$4,318.69
|
|
|
DIST FEM AUG BLOCK #11/5MM
|
Facility
|
OP
|
$5,576.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$724.98 |
| Max. Negotiated Rate |
$5,353.73 |
| Rate for Payer: Aetna Commercial |
$4,294.14
|
| Rate for Payer: Anthem Medicaid |
$1,917.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,349.90
|
| Rate for Payer: Cash Price |
$2,788.40
|
| Rate for Payer: Cigna Commercial |
$4,628.74
|
| Rate for Payer: First Health Commercial |
$5,297.96
|
| Rate for Payer: Humana Commercial |
$4,740.28
|
| Rate for Payer: Humana KY Medicaid |
$1,917.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,937.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,572.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,115.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,673.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,956.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,907.58
|
| Rate for Payer: Ohio Health Group HMO |
$4,182.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,115.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$724.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,728.81
|
| Rate for Payer: PHCS Commercial |
$5,353.73
|
| Rate for Payer: United Healthcare All Payer |
$4,907.58
|
|
|
DIST FEM AUG BLOCK #11/5MM
|
Facility
|
IP
|
$5,576.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$724.98 |
| Max. Negotiated Rate |
$5,353.73 |
| Rate for Payer: Aetna Commercial |
$4,294.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,349.90
|
| Rate for Payer: Cash Price |
$2,788.40
|
| Rate for Payer: Cigna Commercial |
$4,628.74
|
| Rate for Payer: First Health Commercial |
$5,297.96
|
| Rate for Payer: Humana Commercial |
$4,740.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,572.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,115.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,673.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,907.58
|
| Rate for Payer: Ohio Health Group HMO |
$4,182.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,115.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$724.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,728.81
|
| Rate for Payer: PHCS Commercial |
$5,353.73
|
| Rate for Payer: United Healthcare All Payer |
$4,907.58
|
|
|
DIST FEM AUG BLOCK #13/05MM
|
Facility
|
IP
|
$5,042.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$655.46 |
| Max. Negotiated Rate |
$4,840.32 |
| Rate for Payer: Aetna Commercial |
$3,882.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,932.76
|
| Rate for Payer: Cash Price |
$2,521.00
|
| Rate for Payer: Cigna Commercial |
$4,184.86
|
| Rate for Payer: First Health Commercial |
$4,789.90
|
| Rate for Payer: Humana Commercial |
$4,285.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,134.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,721.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,512.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,436.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,008.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$655.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,563.02
|
| Rate for Payer: PHCS Commercial |
$4,840.32
|
| Rate for Payer: United Healthcare All Payer |
$4,436.96
|
|
|
DIST FEM AUG BLOCK #13/05MM
|
Facility
|
OP
|
$5,042.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$655.46 |
| Max. Negotiated Rate |
$4,840.32 |
| Rate for Payer: Aetna Commercial |
$3,882.34
|
| Rate for Payer: Anthem Medicaid |
$1,733.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,932.76
|
| Rate for Payer: Cash Price |
$2,521.00
|
| Rate for Payer: Cigna Commercial |
$4,184.86
|
| Rate for Payer: First Health Commercial |
$4,789.90
|
| Rate for Payer: Humana Commercial |
$4,285.70
|
| Rate for Payer: Humana KY Medicaid |
$1,733.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,751.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,134.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,721.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,512.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,768.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,436.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,008.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$655.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,563.02
|
| Rate for Payer: PHCS Commercial |
$4,840.32
|
| Rate for Payer: United Healthcare All Payer |
$4,436.96
|
|
|
DIST FEM AUG BLOCK #13/10MM
|
Facility
|
IP
|
$5,042.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$655.46 |
| Max. Negotiated Rate |
$4,840.32 |
| Rate for Payer: Aetna Commercial |
$3,882.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,932.76
|
| Rate for Payer: Cash Price |
$2,521.00
|
| Rate for Payer: Cigna Commercial |
$4,184.86
|
| Rate for Payer: First Health Commercial |
$4,789.90
|
| Rate for Payer: Humana Commercial |
$4,285.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,134.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,721.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,512.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,436.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,008.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$655.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,563.02
|
| Rate for Payer: PHCS Commercial |
$4,840.32
|
| Rate for Payer: United Healthcare All Payer |
$4,436.96
|
|
|
DIST FEM AUG BLOCK #13/10MM
|
Facility
|
OP
|
$5,042.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$655.46 |
| Max. Negotiated Rate |
$4,840.32 |
| Rate for Payer: Aetna Commercial |
$3,882.34
|
| Rate for Payer: Anthem Medicaid |
$1,733.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,932.76
|
| Rate for Payer: Cash Price |
$2,521.00
|
| Rate for Payer: Cigna Commercial |
$4,184.86
|
| Rate for Payer: First Health Commercial |
$4,789.90
|
| Rate for Payer: Humana Commercial |
$4,285.70
|
| Rate for Payer: Humana KY Medicaid |
$1,733.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,751.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,134.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,721.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,512.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,768.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,436.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,008.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$655.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,563.02
|
| Rate for Payer: PHCS Commercial |
$4,840.32
|
| Rate for Payer: United Healthcare All Payer |
$4,436.96
|
|
|
DIST FEM AUG BLOCK #13/15MM
|
Facility
|
OP
|
$5,042.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$655.46 |
| Max. Negotiated Rate |
$4,840.32 |
| Rate for Payer: Aetna Commercial |
$3,882.34
|
| Rate for Payer: Anthem Medicaid |
$1,733.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,932.76
|
| Rate for Payer: Cash Price |
$2,521.00
|
| Rate for Payer: Cigna Commercial |
$4,184.86
|
| Rate for Payer: First Health Commercial |
$4,789.90
|
| Rate for Payer: Humana Commercial |
$4,285.70
|
| Rate for Payer: Humana KY Medicaid |
$1,733.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,751.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,134.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,721.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,512.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,768.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,436.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,008.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$655.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,563.02
|
| Rate for Payer: PHCS Commercial |
$4,840.32
|
| Rate for Payer: United Healthcare All Payer |
$4,436.96
|
|
|
DIST FEM AUG BLOCK #13/15MM
|
Facility
|
IP
|
$5,042.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$655.46 |
| Max. Negotiated Rate |
$4,840.32 |
| Rate for Payer: Aetna Commercial |
$3,882.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,932.76
|
| Rate for Payer: Cash Price |
$2,521.00
|
| Rate for Payer: Cigna Commercial |
$4,184.86
|
| Rate for Payer: First Health Commercial |
$4,789.90
|
| Rate for Payer: Humana Commercial |
$4,285.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,134.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,721.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,512.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,436.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,008.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$655.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,563.02
|
| Rate for Payer: PHCS Commercial |
$4,840.32
|
| Rate for Payer: United Healthcare All Payer |
$4,436.96
|
|
|
DIST FEM AUG BLOCK #3/10MM
|
Facility
|
IP
|
$5,042.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$655.46 |
| Max. Negotiated Rate |
$4,840.32 |
| Rate for Payer: Aetna Commercial |
$3,882.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,932.76
|
| Rate for Payer: Cash Price |
$2,521.00
|
| Rate for Payer: Cigna Commercial |
$4,184.86
|
| Rate for Payer: First Health Commercial |
$4,789.90
|
| Rate for Payer: Humana Commercial |
$4,285.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,134.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,721.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,512.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,436.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,008.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$655.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,563.02
|
| Rate for Payer: PHCS Commercial |
$4,840.32
|
| Rate for Payer: United Healthcare All Payer |
$4,436.96
|
|
|
DIST FEM AUG BLOCK #3/10MM
|
Facility
|
OP
|
$5,042.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$655.46 |
| Max. Negotiated Rate |
$4,840.32 |
| Rate for Payer: Aetna Commercial |
$3,882.34
|
| Rate for Payer: Anthem Medicaid |
$1,733.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,932.76
|
| Rate for Payer: Cash Price |
$2,521.00
|
| Rate for Payer: Cigna Commercial |
$4,184.86
|
| Rate for Payer: First Health Commercial |
$4,789.90
|
| Rate for Payer: Humana Commercial |
$4,285.70
|
| Rate for Payer: Humana KY Medicaid |
$1,733.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,751.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,134.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,721.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,512.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,768.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,436.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,008.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$655.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,563.02
|
| Rate for Payer: PHCS Commercial |
$4,840.32
|
| Rate for Payer: United Healthcare All Payer |
$4,436.96
|
|
|
DIST FEM AUG BLOCK #3/15MM
|
Facility
|
OP
|
$5,042.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$655.46 |
| Max. Negotiated Rate |
$4,840.32 |
| Rate for Payer: Aetna Commercial |
$3,882.34
|
| Rate for Payer: Anthem Medicaid |
$1,733.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,932.76
|
| Rate for Payer: Cash Price |
$2,521.00
|
| Rate for Payer: Cigna Commercial |
$4,184.86
|
| Rate for Payer: First Health Commercial |
$4,789.90
|
| Rate for Payer: Humana Commercial |
$4,285.70
|
| Rate for Payer: Humana KY Medicaid |
$1,733.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,751.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,134.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,721.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,512.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,768.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,436.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,008.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$655.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,563.02
|
| Rate for Payer: PHCS Commercial |
$4,840.32
|
| Rate for Payer: United Healthcare All Payer |
$4,436.96
|
|
|
DIST FEM AUG BLOCK #3/15MM
|
Facility
|
IP
|
$5,042.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$655.46 |
| Max. Negotiated Rate |
$4,840.32 |
| Rate for Payer: Aetna Commercial |
$3,882.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,932.76
|
| Rate for Payer: Cash Price |
$2,521.00
|
| Rate for Payer: Cigna Commercial |
$4,184.86
|
| Rate for Payer: First Health Commercial |
$4,789.90
|
| Rate for Payer: Humana Commercial |
$4,285.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,134.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,721.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,512.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,436.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,008.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$655.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,563.02
|
| Rate for Payer: PHCS Commercial |
$4,840.32
|
| Rate for Payer: United Healthcare All Payer |
$4,436.96
|
|
|
DIST FEM AUG BLOCK #3/5MM
|
Facility
|
IP
|
$5,042.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$655.46 |
| Max. Negotiated Rate |
$4,840.32 |
| Rate for Payer: Aetna Commercial |
$3,882.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,932.76
|
| Rate for Payer: Cash Price |
$2,521.00
|
| Rate for Payer: Cigna Commercial |
$4,184.86
|
| Rate for Payer: First Health Commercial |
$4,789.90
|
| Rate for Payer: Humana Commercial |
$4,285.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,134.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,721.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,512.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,436.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,008.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$655.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,563.02
|
| Rate for Payer: PHCS Commercial |
$4,840.32
|
| Rate for Payer: United Healthcare All Payer |
$4,436.96
|
|
