|
EXPNDR LOW HGT CPX3 TISS 450CC
|
Facility
|
OP
|
$8,457.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,099.48 |
| Max. Negotiated Rate |
$8,119.20 |
| Rate for Payer: Aetna Commercial |
$6,512.28
|
| Rate for Payer: Anthem Medicaid |
$2,908.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,596.85
|
| Rate for Payer: Cash Price |
$4,228.75
|
| Rate for Payer: Cigna Commercial |
$7,019.72
|
| Rate for Payer: First Health Commercial |
$8,034.62
|
| Rate for Payer: Humana Commercial |
$7,188.88
|
| Rate for Payer: Humana KY Medicaid |
$2,908.53
|
| Rate for Payer: Kentucky WC Medicaid |
$2,938.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,935.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,241.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,537.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,966.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,442.60
|
| Rate for Payer: Ohio Health Group HMO |
$6,343.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,691.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,099.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,621.82
|
| Rate for Payer: PHCS Commercial |
$8,119.20
|
| Rate for Payer: United Healthcare All Payer |
$7,442.60
|
|
|
EXPNDR LOW HGT CPX3 TISS 450CC
|
Facility
|
IP
|
$8,457.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,099.48 |
| Max. Negotiated Rate |
$8,119.20 |
| Rate for Payer: Aetna Commercial |
$6,512.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,596.85
|
| Rate for Payer: Cash Price |
$4,228.75
|
| Rate for Payer: Cigna Commercial |
$7,019.72
|
| Rate for Payer: First Health Commercial |
$8,034.62
|
| Rate for Payer: Humana Commercial |
$7,188.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,935.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,241.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,537.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,442.60
|
| Rate for Payer: Ohio Health Group HMO |
$6,343.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,691.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,099.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,621.82
|
| Rate for Payer: PHCS Commercial |
$8,119.20
|
| Rate for Payer: United Healthcare All Payer |
$7,442.60
|
|
|
EXPNDR LOW HGT CPX3 TISS 550CC
|
Facility
|
IP
|
$8,457.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,099.48 |
| Max. Negotiated Rate |
$8,119.20 |
| Rate for Payer: Aetna Commercial |
$6,512.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,596.85
|
| Rate for Payer: Cash Price |
$4,228.75
|
| Rate for Payer: Cigna Commercial |
$7,019.72
|
| Rate for Payer: First Health Commercial |
$8,034.62
|
| Rate for Payer: Humana Commercial |
$7,188.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,935.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,241.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,537.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,442.60
|
| Rate for Payer: Ohio Health Group HMO |
$6,343.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,691.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,099.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,621.82
|
| Rate for Payer: PHCS Commercial |
$8,119.20
|
| Rate for Payer: United Healthcare All Payer |
$7,442.60
|
|
|
EXPNDR LOW HGT CPX3 TISS 550CC
|
Facility
|
OP
|
$8,457.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,099.48 |
| Max. Negotiated Rate |
$8,119.20 |
| Rate for Payer: Aetna Commercial |
$6,512.28
|
| Rate for Payer: Anthem Medicaid |
$2,908.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,596.85
|
| Rate for Payer: Cash Price |
$4,228.75
|
| Rate for Payer: Cigna Commercial |
$7,019.72
|
| Rate for Payer: First Health Commercial |
$8,034.62
|
| Rate for Payer: Humana Commercial |
$7,188.88
|
| Rate for Payer: Humana KY Medicaid |
$2,908.53
|
| Rate for Payer: Kentucky WC Medicaid |
$2,938.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,935.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,241.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,537.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,966.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,442.60
|
| Rate for Payer: Ohio Health Group HMO |
$6,343.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,691.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,099.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,621.82
|
| Rate for Payer: PHCS Commercial |
$8,119.20
|
| Rate for Payer: United Healthcare All Payer |
$7,442.60
|
|
|
EXPNDR LOW HGT CPX3 TISS 650CC
|
Facility
|
OP
|
$8,457.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,099.48 |
| Max. Negotiated Rate |
$8,119.20 |
| Rate for Payer: Aetna Commercial |
$6,512.28
|
| Rate for Payer: Anthem Medicaid |
$2,908.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,596.85
|
| Rate for Payer: Cash Price |
$4,228.75
|
| Rate for Payer: Cigna Commercial |
$7,019.72
|
| Rate for Payer: First Health Commercial |
$8,034.62
|
| Rate for Payer: Humana Commercial |
$7,188.88
|
| Rate for Payer: Humana KY Medicaid |
$2,908.53
|
| Rate for Payer: Kentucky WC Medicaid |
$2,938.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,935.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,241.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,537.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,966.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,442.60
|
| Rate for Payer: Ohio Health Group HMO |
$6,343.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,691.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,099.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,621.82
|
| Rate for Payer: PHCS Commercial |
$8,119.20
|
| Rate for Payer: United Healthcare All Payer |
$7,442.60
|
|
|
EXPNDR LOW HGT CPX3 TISS 650CC
|
Facility
|
IP
|
$8,457.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,099.48 |
| Max. Negotiated Rate |
$8,119.20 |
| Rate for Payer: Aetna Commercial |
$6,512.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,596.85
|
| Rate for Payer: Cash Price |
$4,228.75
|
| Rate for Payer: Cigna Commercial |
$7,019.72
|
| Rate for Payer: First Health Commercial |
$8,034.62
|
| Rate for Payer: Humana Commercial |
$7,188.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,935.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,241.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,537.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,442.60
|
| Rate for Payer: Ohio Health Group HMO |
$6,343.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,691.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,099.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,621.82
|
| Rate for Payer: PHCS Commercial |
$8,119.20
|
| Rate for Payer: United Healthcare All Payer |
$7,442.60
|
|
|
EXPNDR LOW HGT CPX3 TISS 750CC
|
Facility
|
OP
|
$8,457.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,099.48 |
| Max. Negotiated Rate |
$8,119.20 |
| Rate for Payer: Aetna Commercial |
$6,512.28
|
| Rate for Payer: Anthem Medicaid |
$2,908.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,596.85
|
| Rate for Payer: Cash Price |
$4,228.75
|
| Rate for Payer: Cigna Commercial |
$7,019.72
|
| Rate for Payer: First Health Commercial |
$8,034.62
|
| Rate for Payer: Humana Commercial |
$7,188.88
|
| Rate for Payer: Humana KY Medicaid |
$2,908.53
|
| Rate for Payer: Kentucky WC Medicaid |
$2,938.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,935.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,241.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,537.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,966.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,442.60
|
| Rate for Payer: Ohio Health Group HMO |
$6,343.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,691.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,099.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,621.82
|
| Rate for Payer: PHCS Commercial |
$8,119.20
|
| Rate for Payer: United Healthcare All Payer |
$7,442.60
|
|
|
EXPNDR LOW HGT CPX3 TISS 750CC
|
Facility
|
IP
|
$8,457.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,099.48 |
| Max. Negotiated Rate |
$8,119.20 |
| Rate for Payer: Aetna Commercial |
$6,512.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,596.85
|
| Rate for Payer: Cash Price |
$4,228.75
|
| Rate for Payer: Cigna Commercial |
$7,019.72
|
| Rate for Payer: First Health Commercial |
$8,034.62
|
| Rate for Payer: Humana Commercial |
$7,188.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,935.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,241.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,537.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,442.60
|
| Rate for Payer: Ohio Health Group HMO |
$6,343.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,691.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,099.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,621.82
|
| Rate for Payer: PHCS Commercial |
$8,119.20
|
| Rate for Payer: United Healthcare All Payer |
$7,442.60
|
|
|
EXPNDR MED HGT CPX3 TISS 275CC
|
Facility
|
OP
|
$8,457.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,099.48 |
| Max. Negotiated Rate |
$8,119.20 |
| Rate for Payer: Aetna Commercial |
$6,512.28
|
| Rate for Payer: Anthem Medicaid |
$2,908.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,596.85
|
| Rate for Payer: Cash Price |
$4,228.75
|
| Rate for Payer: Cigna Commercial |
$7,019.72
|
| Rate for Payer: First Health Commercial |
$8,034.62
|
| Rate for Payer: Humana Commercial |
$7,188.88
|
| Rate for Payer: Humana KY Medicaid |
$2,908.53
|
| Rate for Payer: Kentucky WC Medicaid |
$2,938.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,935.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,241.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,537.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,966.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,442.60
|
| Rate for Payer: Ohio Health Group HMO |
$6,343.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,691.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,099.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,621.82
|
| Rate for Payer: PHCS Commercial |
$8,119.20
|
| Rate for Payer: United Healthcare All Payer |
$7,442.60
|
|
|
EXPNDR MED HGT CPX3 TISS 275CC
|
Facility
|
IP
|
$8,457.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,099.48 |
| Max. Negotiated Rate |
$8,119.20 |
| Rate for Payer: Aetna Commercial |
$6,512.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,596.85
|
| Rate for Payer: Cash Price |
$4,228.75
|
| Rate for Payer: Cigna Commercial |
$7,019.72
|
| Rate for Payer: First Health Commercial |
$8,034.62
|
| Rate for Payer: Humana Commercial |
$7,188.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,935.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,241.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,537.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,442.60
|
| Rate for Payer: Ohio Health Group HMO |
$6,343.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,691.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,099.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,621.82
|
| Rate for Payer: PHCS Commercial |
$8,119.20
|
| Rate for Payer: United Healthcare All Payer |
$7,442.60
|
|
|
EXPNDR MED HGT CPX3 TISS 450CC
|
Facility
|
OP
|
$8,457.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,099.48 |
| Max. Negotiated Rate |
$8,119.20 |
| Rate for Payer: Aetna Commercial |
$6,512.28
|
| Rate for Payer: Anthem Medicaid |
$2,908.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,596.85
|
| Rate for Payer: Cash Price |
$4,228.75
|
| Rate for Payer: Cigna Commercial |
$7,019.72
|
| Rate for Payer: First Health Commercial |
$8,034.62
|
| Rate for Payer: Humana Commercial |
$7,188.88
|
| Rate for Payer: Humana KY Medicaid |
$2,908.53
|
| Rate for Payer: Kentucky WC Medicaid |
$2,938.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,935.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,241.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,537.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,966.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,442.60
|
| Rate for Payer: Ohio Health Group HMO |
$6,343.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,691.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,099.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,621.82
|
| Rate for Payer: PHCS Commercial |
$8,119.20
|
| Rate for Payer: United Healthcare All Payer |
$7,442.60
|
|
|
EXPNDR MED HGT CPX3 TISS 450CC
|
Facility
|
IP
|
$8,457.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,099.48 |
| Max. Negotiated Rate |
$8,119.20 |
| Rate for Payer: Aetna Commercial |
$6,512.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,596.85
|
| Rate for Payer: Cash Price |
$4,228.75
|
| Rate for Payer: Cigna Commercial |
$7,019.72
|
| Rate for Payer: First Health Commercial |
$8,034.62
|
| Rate for Payer: Humana Commercial |
$7,188.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,935.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,241.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,537.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,442.60
|
| Rate for Payer: Ohio Health Group HMO |
$6,343.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,691.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,099.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,621.82
|
| Rate for Payer: PHCS Commercial |
$8,119.20
|
| Rate for Payer: United Healthcare All Payer |
$7,442.60
|
|
|
EXPNDR MED HGT CPX3 TISS 550CC
|
Facility
|
OP
|
$8,457.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,099.48 |
| Max. Negotiated Rate |
$8,119.20 |
| Rate for Payer: Aetna Commercial |
$6,512.28
|
| Rate for Payer: Anthem Medicaid |
$2,908.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,596.85
|
| Rate for Payer: Cash Price |
$4,228.75
|
| Rate for Payer: Cigna Commercial |
$7,019.72
|
| Rate for Payer: First Health Commercial |
$8,034.62
|
| Rate for Payer: Humana Commercial |
$7,188.88
|
| Rate for Payer: Humana KY Medicaid |
$2,908.53
|
| Rate for Payer: Kentucky WC Medicaid |
$2,938.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,935.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,241.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,537.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,966.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,442.60
|
| Rate for Payer: Ohio Health Group HMO |
$6,343.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,691.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,099.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,621.82
|
| Rate for Payer: PHCS Commercial |
$8,119.20
|
| Rate for Payer: United Healthcare All Payer |
$7,442.60
|
|
|
EXPNDR MED HGT CPX3 TISS 550CC
|
Facility
|
IP
|
$8,457.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,099.48 |
| Max. Negotiated Rate |
$8,119.20 |
| Rate for Payer: Aetna Commercial |
$6,512.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,596.85
|
| Rate for Payer: Cash Price |
$4,228.75
|
| Rate for Payer: Cigna Commercial |
$7,019.72
|
| Rate for Payer: First Health Commercial |
$8,034.62
|
| Rate for Payer: Humana Commercial |
$7,188.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,935.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,241.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,537.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,442.60
|
| Rate for Payer: Ohio Health Group HMO |
$6,343.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,691.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,099.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,621.82
|
| Rate for Payer: PHCS Commercial |
$8,119.20
|
| Rate for Payer: United Healthcare All Payer |
$7,442.60
|
|
|
EXPNDR MED HGT CPX3 TISS 650CC
|
Facility
|
IP
|
$8,457.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,099.48 |
| Max. Negotiated Rate |
$8,119.20 |
| Rate for Payer: Aetna Commercial |
$6,512.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,596.85
|
| Rate for Payer: Cash Price |
$4,228.75
|
| Rate for Payer: Cigna Commercial |
$7,019.72
|
| Rate for Payer: First Health Commercial |
$8,034.62
|
| Rate for Payer: Humana Commercial |
$7,188.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,935.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,241.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,537.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,442.60
|
| Rate for Payer: Ohio Health Group HMO |
$6,343.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,691.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,099.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,621.82
|
| Rate for Payer: PHCS Commercial |
$8,119.20
|
| Rate for Payer: United Healthcare All Payer |
$7,442.60
|
|
|
EXPNDR MED HGT CPX3 TISS 650CC
|
Facility
|
OP
|
$8,457.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,099.48 |
| Max. Negotiated Rate |
$8,119.20 |
| Rate for Payer: Aetna Commercial |
$6,512.28
|
| Rate for Payer: Anthem Medicaid |
$2,908.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,596.85
|
| Rate for Payer: Cash Price |
$4,228.75
|
| Rate for Payer: Cigna Commercial |
$7,019.72
|
| Rate for Payer: First Health Commercial |
$8,034.62
|
| Rate for Payer: Humana Commercial |
$7,188.88
|
| Rate for Payer: Humana KY Medicaid |
$2,908.53
|
| Rate for Payer: Kentucky WC Medicaid |
$2,938.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,935.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,241.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,537.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,966.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,442.60
|
| Rate for Payer: Ohio Health Group HMO |
$6,343.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,691.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,099.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,621.82
|
| Rate for Payer: PHCS Commercial |
$8,119.20
|
| Rate for Payer: United Healthcare All Payer |
$7,442.60
|
|
|
EXPNDR MED HGT CPX3 TISS 800CC
|
Facility
|
IP
|
$8,457.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,099.48 |
| Max. Negotiated Rate |
$8,119.20 |
| Rate for Payer: Aetna Commercial |
$6,512.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,596.85
|
| Rate for Payer: Cash Price |
$4,228.75
|
| Rate for Payer: Cigna Commercial |
$7,019.72
|
| Rate for Payer: First Health Commercial |
$8,034.62
|
| Rate for Payer: Humana Commercial |
$7,188.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,935.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,241.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,537.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,442.60
|
| Rate for Payer: Ohio Health Group HMO |
$6,343.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,691.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,099.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,621.82
|
| Rate for Payer: PHCS Commercial |
$8,119.20
|
| Rate for Payer: United Healthcare All Payer |
$7,442.60
|
|
|
EXPNDR MED HGT CPX3 TISS 800CC
|
Facility
|
OP
|
$8,457.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,099.48 |
| Max. Negotiated Rate |
$8,119.20 |
| Rate for Payer: Aetna Commercial |
$6,512.28
|
| Rate for Payer: Anthem Medicaid |
$2,908.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,596.85
|
| Rate for Payer: Cash Price |
$4,228.75
|
| Rate for Payer: Cigna Commercial |
$7,019.72
|
| Rate for Payer: First Health Commercial |
$8,034.62
|
| Rate for Payer: Humana Commercial |
$7,188.88
|
| Rate for Payer: Humana KY Medicaid |
$2,908.53
|
| Rate for Payer: Kentucky WC Medicaid |
$2,938.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,935.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,241.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,537.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,966.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,442.60
|
| Rate for Payer: Ohio Health Group HMO |
$6,343.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,691.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,099.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,621.82
|
| Rate for Payer: PHCS Commercial |
$8,119.20
|
| Rate for Payer: United Healthcare All Payer |
$7,442.60
|
|
|
EXPORT ASPIRATION CATH 6FR
|
Facility
|
IP
|
$3,547.50
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$461.18 |
| Max. Negotiated Rate |
$3,405.60 |
| Rate for Payer: Aetna Commercial |
$2,731.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,767.05
|
| Rate for Payer: Cash Price |
$1,773.75
|
| Rate for Payer: Cigna Commercial |
$2,944.42
|
| Rate for Payer: First Health Commercial |
$3,370.12
|
| Rate for Payer: Humana Commercial |
$3,015.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,908.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,618.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,064.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,121.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,660.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$709.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$461.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,099.72
|
| Rate for Payer: PHCS Commercial |
$3,405.60
|
| Rate for Payer: United Healthcare All Payer |
$3,121.80
|
|
|
EXPORT ASPIRATION CATH 6FR
|
Facility
|
OP
|
$3,547.50
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$461.18 |
| Max. Negotiated Rate |
$3,405.60 |
| Rate for Payer: Aetna Commercial |
$2,731.58
|
| Rate for Payer: Anthem Medicaid |
$1,219.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,767.05
|
| Rate for Payer: Cash Price |
$1,773.75
|
| Rate for Payer: Cigna Commercial |
$2,944.42
|
| Rate for Payer: First Health Commercial |
$3,370.12
|
| Rate for Payer: Humana Commercial |
$3,015.38
|
| Rate for Payer: Humana KY Medicaid |
$1,219.99
|
| Rate for Payer: Kentucky WC Medicaid |
$1,232.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,908.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,618.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,064.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,244.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,121.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,660.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$709.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$461.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,099.72
|
| Rate for Payer: PHCS Commercial |
$3,405.60
|
| Rate for Payer: United Healthcare All Payer |
$3,121.80
|
|
|
EXPRESS SD 5*15
|
Facility
|
IP
|
$7,382.58
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$959.74 |
| Max. Negotiated Rate |
$7,087.28 |
| Rate for Payer: Aetna Commercial |
$5,684.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,758.41
|
| Rate for Payer: Cash Price |
$3,691.29
|
| Rate for Payer: Cigna Commercial |
$6,127.54
|
| Rate for Payer: First Health Commercial |
$7,013.45
|
| Rate for Payer: Humana Commercial |
$6,275.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,053.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,448.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,214.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,496.67
|
| Rate for Payer: Ohio Health Group HMO |
$5,536.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,476.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$959.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,288.60
|
| Rate for Payer: PHCS Commercial |
$7,087.28
|
| Rate for Payer: United Healthcare All Payer |
$6,496.67
|
|
|
EXPRESS SD 5*15
|
Facility
|
OP
|
$7,382.58
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$959.74 |
| Max. Negotiated Rate |
$7,087.28 |
| Rate for Payer: Aetna Commercial |
$5,684.59
|
| Rate for Payer: Anthem Medicaid |
$2,538.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,758.41
|
| Rate for Payer: Cash Price |
$3,691.29
|
| Rate for Payer: Cigna Commercial |
$6,127.54
|
| Rate for Payer: First Health Commercial |
$7,013.45
|
| Rate for Payer: Humana Commercial |
$6,275.19
|
| Rate for Payer: Humana KY Medicaid |
$2,538.87
|
| Rate for Payer: Kentucky WC Medicaid |
$2,564.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,053.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,448.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,214.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,589.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,496.67
|
| Rate for Payer: Ohio Health Group HMO |
$5,536.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,476.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$959.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,288.60
|
| Rate for Payer: PHCS Commercial |
$7,087.28
|
| Rate for Payer: United Healthcare All Payer |
$6,496.67
|
|
|
EXPRESS SHUNT MINI POST FLOW
|
Facility
|
OP
|
$6,540.70
|
|
|
Service Code
|
HCPCS L8612
|
| Hospital Charge Code |
27000189
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$850.29 |
| Max. Negotiated Rate |
$6,279.07 |
| Rate for Payer: Aetna Commercial |
$5,036.34
|
| Rate for Payer: Anthem Medicaid |
$2,249.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,101.75
|
| Rate for Payer: Cash Price |
$3,270.35
|
| Rate for Payer: Cigna Commercial |
$5,428.78
|
| Rate for Payer: First Health Commercial |
$6,213.66
|
| Rate for Payer: Humana Commercial |
$5,559.60
|
| Rate for Payer: Humana KY Medicaid |
$2,249.35
|
| Rate for Payer: Kentucky WC Medicaid |
$2,272.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,363.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,827.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,962.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,294.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,755.82
|
| Rate for Payer: Ohio Health Group HMO |
$4,905.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,308.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$850.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,027.62
|
| Rate for Payer: PHCS Commercial |
$6,279.07
|
| Rate for Payer: United Healthcare All Payer |
$5,755.82
|
|
|
EXPRESS SHUNT MINI POST FLOW
|
Facility
|
IP
|
$6,540.70
|
|
|
Service Code
|
HCPCS L8612
|
| Hospital Charge Code |
27000189
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$850.29 |
| Max. Negotiated Rate |
$6,279.07 |
| Rate for Payer: Aetna Commercial |
$5,036.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,101.75
|
| Rate for Payer: Cash Price |
$3,270.35
|
| Rate for Payer: Cigna Commercial |
$5,428.78
|
| Rate for Payer: First Health Commercial |
$6,213.66
|
| Rate for Payer: Humana Commercial |
$5,559.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,363.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,827.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,962.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,755.82
|
| Rate for Payer: Ohio Health Group HMO |
$4,905.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,308.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$850.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,027.62
|
| Rate for Payer: PHCS Commercial |
$6,279.07
|
| Rate for Payer: United Healthcare All Payer |
$5,755.82
|
|
|
EXPRESS STENT 10*57
|
Facility
|
OP
|
$7,711.08
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,002.44 |
| Max. Negotiated Rate |
$7,402.64 |
| Rate for Payer: Aetna Commercial |
$5,937.53
|
| Rate for Payer: Anthem Medicaid |
$2,651.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,014.64
|
| Rate for Payer: Cash Price |
$3,855.54
|
| Rate for Payer: Cigna Commercial |
$6,400.20
|
| Rate for Payer: First Health Commercial |
$7,325.53
|
| Rate for Payer: Humana Commercial |
$6,554.42
|
| Rate for Payer: Humana KY Medicaid |
$2,651.84
|
| Rate for Payer: Kentucky WC Medicaid |
$2,678.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,323.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,690.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,313.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,705.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,785.75
|
| Rate for Payer: Ohio Health Group HMO |
$5,783.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,542.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,002.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,390.43
|
| Rate for Payer: PHCS Commercial |
$7,402.64
|
| Rate for Payer: United Healthcare All Payer |
$6,785.75
|
|
