|
DEUCE FEM SZ 3 RT
|
Facility
|
IP
|
$23,694.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,108.41 |
| Max. Negotiated Rate |
$22,746.90 |
| Rate for Payer: Aetna Commercial |
$18,244.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,481.86
|
| Rate for Payer: Cash Price |
$11,847.34
|
| Rate for Payer: Cigna Commercial |
$19,666.59
|
| Rate for Payer: First Health Commercial |
$22,509.96
|
| Rate for Payer: Humana Commercial |
$20,140.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,429.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,486.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,108.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,851.33
|
| Rate for Payer: Ohio Health Group HMO |
$17,771.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,955.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,614.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,349.34
|
| Rate for Payer: PHCS Commercial |
$22,746.90
|
| Rate for Payer: United Healthcare All Payer |
$20,851.33
|
|
|
DEUCE FEM SZ 4 LT
|
Facility
|
OP
|
$23,694.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,108.41 |
| Max. Negotiated Rate |
$22,746.90 |
| Rate for Payer: Aetna Commercial |
$18,244.91
|
| Rate for Payer: Anthem Medicaid |
$8,148.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,481.86
|
| Rate for Payer: Cash Price |
$11,847.34
|
| Rate for Payer: Cigna Commercial |
$19,666.59
|
| Rate for Payer: First Health Commercial |
$22,509.96
|
| Rate for Payer: Humana Commercial |
$20,140.49
|
| Rate for Payer: Humana KY Medicaid |
$8,148.60
|
| Rate for Payer: Kentucky WC Medicaid |
$8,231.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,429.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,486.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,108.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,312.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,851.33
|
| Rate for Payer: Ohio Health Group HMO |
$17,771.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,955.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,614.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,349.34
|
| Rate for Payer: PHCS Commercial |
$22,746.90
|
| Rate for Payer: United Healthcare All Payer |
$20,851.33
|
|
|
DEUCE FEM SZ 4 LT
|
Facility
|
IP
|
$23,694.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,108.41 |
| Max. Negotiated Rate |
$22,746.90 |
| Rate for Payer: Aetna Commercial |
$18,244.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,481.86
|
| Rate for Payer: Cash Price |
$11,847.34
|
| Rate for Payer: Cigna Commercial |
$19,666.59
|
| Rate for Payer: First Health Commercial |
$22,509.96
|
| Rate for Payer: Humana Commercial |
$20,140.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,429.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,486.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,108.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,851.33
|
| Rate for Payer: Ohio Health Group HMO |
$17,771.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,955.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,614.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,349.34
|
| Rate for Payer: PHCS Commercial |
$22,746.90
|
| Rate for Payer: United Healthcare All Payer |
$20,851.33
|
|
|
DEUCE FEM SZ 4 RT
|
Facility
|
IP
|
$18,662.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,598.77 |
| Max. Negotiated Rate |
$17,916.08 |
| Rate for Payer: Aetna Commercial |
$14,370.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,556.81
|
| Rate for Payer: Cash Price |
$9,331.29
|
| Rate for Payer: Cigna Commercial |
$15,489.94
|
| Rate for Payer: First Health Commercial |
$17,729.45
|
| Rate for Payer: Humana Commercial |
$15,863.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,303.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,772.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,598.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,423.07
|
| Rate for Payer: Ohio Health Group HMO |
$13,996.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,930.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,236.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,877.18
|
| Rate for Payer: PHCS Commercial |
$17,916.08
|
| Rate for Payer: United Healthcare All Payer |
$16,423.07
|
|
|
DEUCE FEM SZ 4 RT
|
Facility
|
OP
|
$18,662.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,598.77 |
| Max. Negotiated Rate |
$17,916.08 |
| Rate for Payer: Aetna Commercial |
$14,370.19
|
| Rate for Payer: Anthem Medicaid |
$6,418.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,556.81
|
| Rate for Payer: Cash Price |
$9,331.29
|
| Rate for Payer: Cigna Commercial |
$15,489.94
|
| Rate for Payer: First Health Commercial |
$17,729.45
|
| Rate for Payer: Humana Commercial |
$15,863.19
|
| Rate for Payer: Humana KY Medicaid |
$6,418.06
|
| Rate for Payer: Kentucky WC Medicaid |
$6,483.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,303.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,772.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,598.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,546.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,423.07
|
| Rate for Payer: Ohio Health Group HMO |
$13,996.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,930.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,236.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,877.18
|
| Rate for Payer: PHCS Commercial |
$17,916.08
|
| Rate for Payer: United Healthcare All Payer |
$16,423.07
|
|
|
DEUCE FEM SZ 5 LT
|
Facility
|
IP
|
$23,694.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,108.41 |
| Max. Negotiated Rate |
$22,746.90 |
| Rate for Payer: Aetna Commercial |
$18,244.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,481.86
|
| Rate for Payer: Cash Price |
$11,847.34
|
| Rate for Payer: Cigna Commercial |
$19,666.59
|
| Rate for Payer: First Health Commercial |
$22,509.96
|
| Rate for Payer: Humana Commercial |
$20,140.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,429.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,486.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,108.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,851.33
|
| Rate for Payer: Ohio Health Group HMO |
$17,771.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,955.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,614.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,349.34
|
| Rate for Payer: PHCS Commercial |
$22,746.90
|
| Rate for Payer: United Healthcare All Payer |
$20,851.33
|
|
|
DEUCE FEM SZ 5 LT
|
Facility
|
OP
|
$23,694.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,108.41 |
| Max. Negotiated Rate |
$22,746.90 |
| Rate for Payer: Aetna Commercial |
$18,244.91
|
| Rate for Payer: Anthem Medicaid |
$8,148.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,481.86
|
| Rate for Payer: Cash Price |
$11,847.34
|
| Rate for Payer: Cigna Commercial |
$19,666.59
|
| Rate for Payer: First Health Commercial |
$22,509.96
|
| Rate for Payer: Humana Commercial |
$20,140.49
|
| Rate for Payer: Humana KY Medicaid |
$8,148.60
|
| Rate for Payer: Kentucky WC Medicaid |
$8,231.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,429.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,486.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,108.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,312.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,851.33
|
| Rate for Payer: Ohio Health Group HMO |
$17,771.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,955.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,614.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,349.34
|
| Rate for Payer: PHCS Commercial |
$22,746.90
|
| Rate for Payer: United Healthcare All Payer |
$20,851.33
|
|
|
DEUCE FEM SZ 5 RT
|
Facility
|
OP
|
$23,694.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,108.41 |
| Max. Negotiated Rate |
$22,746.90 |
| Rate for Payer: Aetna Commercial |
$18,244.91
|
| Rate for Payer: Anthem Medicaid |
$8,148.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,481.86
|
| Rate for Payer: Cash Price |
$11,847.34
|
| Rate for Payer: Cigna Commercial |
$19,666.59
|
| Rate for Payer: First Health Commercial |
$22,509.96
|
| Rate for Payer: Humana Commercial |
$20,140.49
|
| Rate for Payer: Humana KY Medicaid |
$8,148.60
|
| Rate for Payer: Kentucky WC Medicaid |
$8,231.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,429.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,486.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,108.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,312.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,851.33
|
| Rate for Payer: Ohio Health Group HMO |
$17,771.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,955.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,614.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,349.34
|
| Rate for Payer: PHCS Commercial |
$22,746.90
|
| Rate for Payer: United Healthcare All Payer |
$20,851.33
|
|
|
DEUCE FEM SZ 5 RT
|
Facility
|
IP
|
$23,694.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,108.41 |
| Max. Negotiated Rate |
$22,746.90 |
| Rate for Payer: Aetna Commercial |
$18,244.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,481.86
|
| Rate for Payer: Cash Price |
$11,847.34
|
| Rate for Payer: Cigna Commercial |
$19,666.59
|
| Rate for Payer: First Health Commercial |
$22,509.96
|
| Rate for Payer: Humana Commercial |
$20,140.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,429.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,486.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,108.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,851.33
|
| Rate for Payer: Ohio Health Group HMO |
$17,771.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,955.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,614.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,349.34
|
| Rate for Payer: PHCS Commercial |
$22,746.90
|
| Rate for Payer: United Healthcare All Payer |
$20,851.33
|
|
|
DEUCE FEM SZ 6 LT
|
Facility
|
IP
|
$23,694.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,108.41 |
| Max. Negotiated Rate |
$22,746.90 |
| Rate for Payer: Aetna Commercial |
$18,244.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,481.86
|
| Rate for Payer: Cash Price |
$11,847.34
|
| Rate for Payer: Cigna Commercial |
$19,666.59
|
| Rate for Payer: First Health Commercial |
$22,509.96
|
| Rate for Payer: Humana Commercial |
$20,140.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,429.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,486.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,108.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,851.33
|
| Rate for Payer: Ohio Health Group HMO |
$17,771.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,955.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,614.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,349.34
|
| Rate for Payer: PHCS Commercial |
$22,746.90
|
| Rate for Payer: United Healthcare All Payer |
$20,851.33
|
|
|
DEUCE FEM SZ 6 LT
|
Facility
|
OP
|
$23,694.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,108.41 |
| Max. Negotiated Rate |
$22,746.90 |
| Rate for Payer: Aetna Commercial |
$18,244.91
|
| Rate for Payer: Anthem Medicaid |
$8,148.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,481.86
|
| Rate for Payer: Cash Price |
$11,847.34
|
| Rate for Payer: Cigna Commercial |
$19,666.59
|
| Rate for Payer: First Health Commercial |
$22,509.96
|
| Rate for Payer: Humana Commercial |
$20,140.49
|
| Rate for Payer: Humana KY Medicaid |
$8,148.60
|
| Rate for Payer: Kentucky WC Medicaid |
$8,231.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,429.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,486.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,108.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,312.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,851.33
|
| Rate for Payer: Ohio Health Group HMO |
$17,771.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,955.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,614.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,349.34
|
| Rate for Payer: PHCS Commercial |
$22,746.90
|
| Rate for Payer: United Healthcare All Payer |
$20,851.33
|
|
|
DEUCE FEM SZ 6 RT
|
Facility
|
OP
|
$23,694.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,108.41 |
| Max. Negotiated Rate |
$22,746.90 |
| Rate for Payer: Aetna Commercial |
$18,244.91
|
| Rate for Payer: Anthem Medicaid |
$8,148.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,481.86
|
| Rate for Payer: Cash Price |
$11,847.34
|
| Rate for Payer: Cigna Commercial |
$19,666.59
|
| Rate for Payer: First Health Commercial |
$22,509.96
|
| Rate for Payer: Humana Commercial |
$20,140.49
|
| Rate for Payer: Humana KY Medicaid |
$8,148.60
|
| Rate for Payer: Kentucky WC Medicaid |
$8,231.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,429.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,486.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,108.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,312.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,851.33
|
| Rate for Payer: Ohio Health Group HMO |
$17,771.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,955.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,614.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,349.34
|
| Rate for Payer: PHCS Commercial |
$22,746.90
|
| Rate for Payer: United Healthcare All Payer |
$20,851.33
|
|
|
DEUCE FEM SZ 6 RT
|
Facility
|
IP
|
$23,694.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,108.41 |
| Max. Negotiated Rate |
$22,746.90 |
| Rate for Payer: Aetna Commercial |
$18,244.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,481.86
|
| Rate for Payer: Cash Price |
$11,847.34
|
| Rate for Payer: Cigna Commercial |
$19,666.59
|
| Rate for Payer: First Health Commercial |
$22,509.96
|
| Rate for Payer: Humana Commercial |
$20,140.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,429.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,486.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,108.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,851.33
|
| Rate for Payer: Ohio Health Group HMO |
$17,771.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,955.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,614.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,349.34
|
| Rate for Payer: PHCS Commercial |
$22,746.90
|
| Rate for Payer: United Healthcare All Payer |
$20,851.33
|
|
|
DEUCE FEM SZ 7 LT
|
Facility
|
IP
|
$23,694.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,108.41 |
| Max. Negotiated Rate |
$22,746.90 |
| Rate for Payer: Aetna Commercial |
$18,244.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,481.86
|
| Rate for Payer: Cash Price |
$11,847.34
|
| Rate for Payer: Cigna Commercial |
$19,666.59
|
| Rate for Payer: First Health Commercial |
$22,509.96
|
| Rate for Payer: Humana Commercial |
$20,140.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,429.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,486.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,108.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,851.33
|
| Rate for Payer: Ohio Health Group HMO |
$17,771.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,955.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,614.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,349.34
|
| Rate for Payer: PHCS Commercial |
$22,746.90
|
| Rate for Payer: United Healthcare All Payer |
$20,851.33
|
|
|
DEUCE FEM SZ 7 LT
|
Facility
|
OP
|
$23,694.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,108.41 |
| Max. Negotiated Rate |
$22,746.90 |
| Rate for Payer: Aetna Commercial |
$18,244.91
|
| Rate for Payer: Anthem Medicaid |
$8,148.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,481.86
|
| Rate for Payer: Cash Price |
$11,847.34
|
| Rate for Payer: Cigna Commercial |
$19,666.59
|
| Rate for Payer: First Health Commercial |
$22,509.96
|
| Rate for Payer: Humana Commercial |
$20,140.49
|
| Rate for Payer: Humana KY Medicaid |
$8,148.60
|
| Rate for Payer: Kentucky WC Medicaid |
$8,231.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,429.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,486.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,108.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,312.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,851.33
|
| Rate for Payer: Ohio Health Group HMO |
$17,771.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,955.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,614.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,349.34
|
| Rate for Payer: PHCS Commercial |
$22,746.90
|
| Rate for Payer: United Healthcare All Payer |
$20,851.33
|
|
|
DEUCE FEM SZ 7 RT
|
Facility
|
OP
|
$23,694.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,108.41 |
| Max. Negotiated Rate |
$22,746.90 |
| Rate for Payer: Aetna Commercial |
$18,244.91
|
| Rate for Payer: Anthem Medicaid |
$8,148.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,481.86
|
| Rate for Payer: Cash Price |
$11,847.34
|
| Rate for Payer: Cigna Commercial |
$19,666.59
|
| Rate for Payer: First Health Commercial |
$22,509.96
|
| Rate for Payer: Humana Commercial |
$20,140.49
|
| Rate for Payer: Humana KY Medicaid |
$8,148.60
|
| Rate for Payer: Kentucky WC Medicaid |
$8,231.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,429.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,486.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,108.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,312.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,851.33
|
| Rate for Payer: Ohio Health Group HMO |
$17,771.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,955.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,614.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,349.34
|
| Rate for Payer: PHCS Commercial |
$22,746.90
|
| Rate for Payer: United Healthcare All Payer |
$20,851.33
|
|
|
DEUCE FEM SZ 7 RT
|
Facility
|
IP
|
$23,694.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,108.41 |
| Max. Negotiated Rate |
$22,746.90 |
| Rate for Payer: Aetna Commercial |
$18,244.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,481.86
|
| Rate for Payer: Cash Price |
$11,847.34
|
| Rate for Payer: Cigna Commercial |
$19,666.59
|
| Rate for Payer: First Health Commercial |
$22,509.96
|
| Rate for Payer: Humana Commercial |
$20,140.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,429.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,486.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,108.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,851.33
|
| Rate for Payer: Ohio Health Group HMO |
$17,771.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,955.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,614.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,349.34
|
| Rate for Payer: PHCS Commercial |
$22,746.90
|
| Rate for Payer: United Healthcare All Payer |
$20,851.33
|
|
|
DEUCE FEM SZ 8 LT
|
Facility
|
IP
|
$23,694.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,108.41 |
| Max. Negotiated Rate |
$22,746.90 |
| Rate for Payer: Aetna Commercial |
$18,244.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,481.86
|
| Rate for Payer: Cash Price |
$11,847.34
|
| Rate for Payer: Cigna Commercial |
$19,666.59
|
| Rate for Payer: First Health Commercial |
$22,509.96
|
| Rate for Payer: Humana Commercial |
$20,140.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,429.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,486.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,108.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,851.33
|
| Rate for Payer: Ohio Health Group HMO |
$17,771.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,955.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,614.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,349.34
|
| Rate for Payer: PHCS Commercial |
$22,746.90
|
| Rate for Payer: United Healthcare All Payer |
$20,851.33
|
|
|
DEUCE FEM SZ 8 LT
|
Facility
|
OP
|
$23,694.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,108.41 |
| Max. Negotiated Rate |
$22,746.90 |
| Rate for Payer: Aetna Commercial |
$18,244.91
|
| Rate for Payer: Anthem Medicaid |
$8,148.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,481.86
|
| Rate for Payer: Cash Price |
$11,847.34
|
| Rate for Payer: Cigna Commercial |
$19,666.59
|
| Rate for Payer: First Health Commercial |
$22,509.96
|
| Rate for Payer: Humana Commercial |
$20,140.49
|
| Rate for Payer: Humana KY Medicaid |
$8,148.60
|
| Rate for Payer: Kentucky WC Medicaid |
$8,231.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,429.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,486.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,108.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,312.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,851.33
|
| Rate for Payer: Ohio Health Group HMO |
$17,771.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,955.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,614.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,349.34
|
| Rate for Payer: PHCS Commercial |
$22,746.90
|
| Rate for Payer: United Healthcare All Payer |
$20,851.33
|
|
|
DEUCE FEM SZ 8 RT
|
Facility
|
IP
|
$23,694.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,108.41 |
| Max. Negotiated Rate |
$22,746.90 |
| Rate for Payer: Aetna Commercial |
$18,244.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,481.86
|
| Rate for Payer: Cash Price |
$11,847.34
|
| Rate for Payer: Cigna Commercial |
$19,666.59
|
| Rate for Payer: First Health Commercial |
$22,509.96
|
| Rate for Payer: Humana Commercial |
$20,140.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,429.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,486.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,108.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,851.33
|
| Rate for Payer: Ohio Health Group HMO |
$17,771.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,955.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,614.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,349.34
|
| Rate for Payer: PHCS Commercial |
$22,746.90
|
| Rate for Payer: United Healthcare All Payer |
$20,851.33
|
|
|
DEUCE FEM SZ 8 RT
|
Facility
|
OP
|
$23,694.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,108.41 |
| Max. Negotiated Rate |
$22,746.90 |
| Rate for Payer: Aetna Commercial |
$18,244.91
|
| Rate for Payer: Anthem Medicaid |
$8,148.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,481.86
|
| Rate for Payer: Cash Price |
$11,847.34
|
| Rate for Payer: Cigna Commercial |
$19,666.59
|
| Rate for Payer: First Health Commercial |
$22,509.96
|
| Rate for Payer: Humana Commercial |
$20,140.49
|
| Rate for Payer: Humana KY Medicaid |
$8,148.60
|
| Rate for Payer: Kentucky WC Medicaid |
$8,231.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,429.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,486.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,108.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,312.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,851.33
|
| Rate for Payer: Ohio Health Group HMO |
$17,771.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,955.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,614.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,349.34
|
| Rate for Payer: PHCS Commercial |
$22,746.90
|
| Rate for Payer: United Healthcare All Payer |
$20,851.33
|
|
|
DEVELOP COGNITIVE SKILL DRCT
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
HCPCS 97129
|
| Hospital Charge Code |
43000016
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$42.24 |
| Rate for Payer: Aetna Commercial |
$33.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$34.32
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Cigna Commercial |
$36.52
|
| Rate for Payer: First Health Commercial |
$41.80
|
| Rate for Payer: Humana Commercial |
$37.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$36.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$32.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$38.72
|
| Rate for Payer: Ohio Health Group HMO |
$33.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$35.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30.36
|
| Rate for Payer: PHCS Commercial |
$42.24
|
| Rate for Payer: United Healthcare All Payer |
$38.72
|
|
|
DEVELOP COGNITIVE SKILL DRCT
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
HCPCS 97129
|
| Hospital Charge Code |
43000016
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$42.24 |
| Rate for Payer: Aetna Commercial |
$33.88
|
| Rate for Payer: Anthem Medicaid |
$15.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$34.32
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Cigna Commercial |
$36.52
|
| Rate for Payer: First Health Commercial |
$41.80
|
| Rate for Payer: Humana Commercial |
$37.40
|
| Rate for Payer: Humana KY Medicaid |
$15.13
|
| Rate for Payer: Kentucky WC Medicaid |
$15.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$36.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$32.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$38.72
|
| Rate for Payer: Ohio Health Group HMO |
$33.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$35.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30.36
|
| Rate for Payer: PHCS Commercial |
$42.24
|
| Rate for Payer: United Healthcare All Payer |
$38.72
|
|
|
DEVELOPMENTAL SCREEN W/SCORE
|
Facility
|
OP
|
$206.00
|
|
|
Service Code
|
HCPCS 96110
|
| Hospital Charge Code |
51000046
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$61.80 |
| Max. Negotiated Rate |
$197.76 |
| Rate for Payer: Aetna Commercial |
$158.62
|
| Rate for Payer: Anthem Medicaid |
$70.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$160.68
|
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Cigna Commercial |
$170.98
|
| Rate for Payer: First Health Commercial |
$195.70
|
| Rate for Payer: Humana Commercial |
$175.10
|
| Rate for Payer: Humana KY Medicaid |
$70.84
|
| Rate for Payer: Kentucky WC Medicaid |
$71.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$168.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$152.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$72.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$181.28
|
| Rate for Payer: Ohio Health Group HMO |
$154.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$164.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$179.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$142.14
|
| Rate for Payer: PHCS Commercial |
$197.76
|
| Rate for Payer: United Healthcare All Payer |
$181.28
|
|
|
DEVELOPMENTAL SCREEN W/SCORE
|
Professional
|
Both
|
$206.00
|
|
|
Service Code
|
HCPCS 96110
|
| Hospital Charge Code |
51000046
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.22 |
| Max. Negotiated Rate |
$144.20 |
| Rate for Payer: Aetna Commercial |
$22.44
|
| Rate for Payer: Anthem Medicaid |
$32.19
|
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Cigna Commercial |
$17.52
|
| Rate for Payer: Healthspan PPO |
$21.03
|
| Rate for Payer: Humana Medicaid |
$32.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$9.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$32.83
|
| Rate for Payer: Molina Healthcare Passport |
$32.19
|
| Rate for Payer: Multiplan PHCS |
$123.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$144.20
|
| Rate for Payer: UHCCP Medicaid |
$72.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$32.51
|
|
