|
FECAL LACTOFERRIN QUAL
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
HCPCS 83630
|
| Hospital Charge Code |
30000438
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.70 |
| Max. Negotiated Rate |
$209.28 |
| Rate for Payer: Aetna Commercial |
$167.86
|
| Rate for Payer: Anthem Medicaid |
$19.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$19.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$175.05
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$27.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$19.70
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cigna Commercial |
$180.94
|
| Rate for Payer: First Health Commercial |
$207.10
|
| Rate for Payer: Humana Commercial |
$185.30
|
| Rate for Payer: Humana KY Medicaid |
$19.70
|
| Rate for Payer: Humana Medicare Advantage |
$19.70
|
| Rate for Payer: Kentucky WC Medicaid |
$19.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$178.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$160.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$20.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$191.84
|
| Rate for Payer: Ohio Health Group HMO |
$163.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$43.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$67.58
|
| Rate for Payer: PHCS Commercial |
$209.28
|
| Rate for Payer: United Healthcare All Payer |
$191.84
|
|
|
FECAL MICROBIOTA PREP INSTIL
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
HCPCS G0455
|
| Hospital Charge Code |
30001776
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.66 |
| Max. Negotiated Rate |
$1,106.49 |
| Rate for Payer: Aetna Commercial |
$140.14
|
| Rate for Payer: Anthem Medicaid |
$62.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$790.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$146.15
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,106.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,066.97
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: Cigna Commercial |
$151.06
|
| Rate for Payer: First Health Commercial |
$172.90
|
| Rate for Payer: Humana Commercial |
$154.70
|
| Rate for Payer: Humana KY Medicaid |
$62.59
|
| Rate for Payer: Humana Medicare Advantage |
$790.35
|
| Rate for Payer: Kentucky WC Medicaid |
$63.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$149.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$134.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$948.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$63.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$160.16
|
| Rate for Payer: Ohio Health Group HMO |
$136.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56.42
|
| Rate for Payer: PHCS Commercial |
$174.72
|
| Rate for Payer: United Healthcare All Payer |
$160.16
|
|
|
FECAL MICROBIOTA PREP INSTIL
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
HCPCS G0455
|
| Hospital Charge Code |
30001776
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.66 |
| Max. Negotiated Rate |
$174.72 |
| Rate for Payer: Aetna Commercial |
$140.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$146.15
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: Cigna Commercial |
$151.06
|
| Rate for Payer: First Health Commercial |
$172.90
|
| Rate for Payer: Humana Commercial |
$154.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$149.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$134.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$160.16
|
| Rate for Payer: Ohio Health Group HMO |
$136.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56.42
|
| Rate for Payer: PHCS Commercial |
$174.72
|
| Rate for Payer: United Healthcare All Payer |
$160.16
|
|
|
FEC OCCULT BL IMMUN 1-3 SIM
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS G0328
|
| Hospital Charge Code |
30000254
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Aetna Commercial |
$77.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$80.30
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$83.00
|
| Rate for Payer: First Health Commercial |
$95.00
|
| Rate for Payer: Humana Commercial |
$85.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$82.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$73.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$88.00
|
| Rate for Payer: Ohio Health Group HMO |
$75.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31.00
|
| Rate for Payer: PHCS Commercial |
$96.00
|
| Rate for Payer: United Healthcare All Payer |
$88.00
|
|
|
FEC OCCULT BL IMMUN 1-3 SIM
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS G0328
|
| Hospital Charge Code |
30000254
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Aetna Commercial |
$77.00
|
| Rate for Payer: Anthem Medicaid |
$18.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$18.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$80.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$25.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$18.05
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$83.00
|
| Rate for Payer: First Health Commercial |
$95.00
|
| Rate for Payer: Humana Commercial |
$85.00
|
| Rate for Payer: Humana KY Medicaid |
$18.05
|
| Rate for Payer: Humana Medicare Advantage |
$18.05
|
| Rate for Payer: Kentucky WC Medicaid |
$18.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$82.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$73.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$88.00
|
| Rate for Payer: Ohio Health Group HMO |
$75.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31.00
|
| Rate for Payer: PHCS Commercial |
$96.00
|
| Rate for Payer: United Healthcare All Payer |
$88.00
|
|
|
FELBATOL 600 MG TABLET
|
Facility
|
IP
|
$33.85
|
|
|
Service Code
|
NDC 37043101
|
| Hospital Charge Code |
25000664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$32.50 |
| Rate for Payer: Aetna Commercial |
$26.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26.40
|
| Rate for Payer: Cash Price |
$16.92
|
| Rate for Payer: Cigna Commercial |
$28.10
|
| Rate for Payer: First Health Commercial |
$32.16
|
| Rate for Payer: Humana Commercial |
$28.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$29.79
|
| Rate for Payer: Ohio Health Group HMO |
$25.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10.49
|
| Rate for Payer: PHCS Commercial |
$32.50
|
| Rate for Payer: United Healthcare All Payer |
$29.79
|
|
|
FELBATOL 600 MG TABLET
|
Facility
|
OP
|
$33.85
|
|
|
Service Code
|
NDC 37043101
|
| Hospital Charge Code |
25000664
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$32.50 |
| Rate for Payer: Aetna Commercial |
$26.06
|
| Rate for Payer: Anthem Medicaid |
$11.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26.40
|
| Rate for Payer: Cash Price |
$16.92
|
| Rate for Payer: Cigna Commercial |
$28.10
|
| Rate for Payer: First Health Commercial |
$32.16
|
| Rate for Payer: Humana Commercial |
$28.77
|
| Rate for Payer: Humana KY Medicaid |
$11.64
|
| Rate for Payer: Kentucky WC Medicaid |
$11.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$11.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$29.79
|
| Rate for Payer: Ohio Health Group HMO |
$25.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10.49
|
| Rate for Payer: PHCS Commercial |
$32.50
|
| Rate for Payer: United Healthcare All Payer |
$29.79
|
|
|
FELDENE (PIROXICAM) 10MG/1CAP
|
Facility
|
OP
|
$4.81
|
|
|
Service Code
|
NDC 29033001201
|
| Hospital Charge Code |
25000666
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$4.62 |
| Rate for Payer: Aetna Commercial |
$3.70
|
| Rate for Payer: Anthem Medicaid |
$1.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.75
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$3.99
|
| Rate for Payer: First Health Commercial |
$4.57
|
| Rate for Payer: Humana Commercial |
$4.09
|
| Rate for Payer: Humana KY Medicaid |
$1.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.23
|
| Rate for Payer: Ohio Health Group HMO |
$3.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.49
|
| Rate for Payer: PHCS Commercial |
$4.62
|
| Rate for Payer: United Healthcare All Payer |
$4.23
|
|
|
FELDENE (PIROXICAM) 10MG/1CAP
|
Facility
|
IP
|
$4.81
|
|
|
Service Code
|
NDC 29033001201
|
| Hospital Charge Code |
25000666
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$4.62 |
| Rate for Payer: Aetna Commercial |
$3.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.75
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$3.99
|
| Rate for Payer: First Health Commercial |
$4.57
|
| Rate for Payer: Humana Commercial |
$4.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.23
|
| Rate for Payer: Ohio Health Group HMO |
$3.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.49
|
| Rate for Payer: PHCS Commercial |
$4.62
|
| Rate for Payer: United Healthcare All Payer |
$4.23
|
|
|
FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES
|
Facility
|
IP
|
$16,434.84
|
|
|
Service Code
|
MSDRG 748
|
| Min. Negotiated Rate |
$11,152.21 |
| Max. Negotiated Rate |
$16,434.84 |
| Rate for Payer: Anthem Medicaid |
$11,152.21
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,739.17
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16,434.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$15,847.88
|
| Rate for Payer: Humana KY Medicaid |
$11,152.21
|
| Rate for Payer: Humana Medicare Advantage |
$11,739.17
|
| Rate for Payer: Kentucky WC Medicaid |
$11,263.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14,087.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,375.26
|
|
|
FEMARA(LETROZOLE)2.5 MG TAB
|
Facility
|
OP
|
$144.37
|
|
|
Service Code
|
NDC 78024915
|
| Hospital Charge Code |
25000667
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.77 |
| Max. Negotiated Rate |
$138.60 |
| Rate for Payer: Aetna Commercial |
$111.16
|
| Rate for Payer: Anthem Medicaid |
$49.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$112.61
|
| Rate for Payer: Cash Price |
$72.18
|
| Rate for Payer: Cigna Commercial |
$119.83
|
| Rate for Payer: First Health Commercial |
$137.15
|
| Rate for Payer: Humana Commercial |
$122.71
|
| Rate for Payer: Humana KY Medicaid |
$49.65
|
| Rate for Payer: Kentucky WC Medicaid |
$50.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$118.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$106.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$43.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$50.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$127.05
|
| Rate for Payer: Ohio Health Group HMO |
$108.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.75
|
| Rate for Payer: PHCS Commercial |
$138.60
|
| Rate for Payer: United Healthcare All Payer |
$127.05
|
|
|
FEMARA(LETROZOLE)2.5 MG TAB
|
Facility
|
IP
|
$144.37
|
|
|
Service Code
|
NDC 78024915
|
| Hospital Charge Code |
25000667
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.77 |
| Max. Negotiated Rate |
$138.60 |
| Rate for Payer: Aetna Commercial |
$111.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$112.61
|
| Rate for Payer: Cash Price |
$72.18
|
| Rate for Payer: Cigna Commercial |
$119.83
|
| Rate for Payer: First Health Commercial |
$137.15
|
| Rate for Payer: Humana Commercial |
$122.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$118.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$106.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$43.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$127.05
|
| Rate for Payer: Ohio Health Group HMO |
$108.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.75
|
| Rate for Payer: PHCS Commercial |
$138.60
|
| Rate for Payer: United Healthcare All Payer |
$127.05
|
|
|
FEM BLUSHINGS POLY RS OSS
|
Facility
|
IP
|
$4,359.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$566.69 |
| Max. Negotiated Rate |
$4,184.78 |
| Rate for Payer: Aetna Commercial |
$3,356.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,400.14
|
| Rate for Payer: Cash Price |
$2,179.57
|
| Rate for Payer: Cigna Commercial |
$3,618.09
|
| Rate for Payer: First Health Commercial |
$4,141.19
|
| Rate for Payer: Humana Commercial |
$3,705.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,574.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,217.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,307.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,836.05
|
| Rate for Payer: Ohio Health Group HMO |
$3,269.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$871.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$566.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,351.34
|
| Rate for Payer: PHCS Commercial |
$4,184.78
|
| Rate for Payer: United Healthcare All Payer |
$3,836.05
|
|
|
FEM BLUSHINGS POLY RS OSS
|
Facility
|
OP
|
$4,359.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$566.69 |
| Max. Negotiated Rate |
$4,184.78 |
| Rate for Payer: Aetna Commercial |
$3,356.55
|
| Rate for Payer: Anthem Medicaid |
$1,499.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,400.14
|
| Rate for Payer: Cash Price |
$2,179.57
|
| Rate for Payer: Cigna Commercial |
$3,618.09
|
| Rate for Payer: First Health Commercial |
$4,141.19
|
| Rate for Payer: Humana Commercial |
$3,705.28
|
| Rate for Payer: Humana KY Medicaid |
$1,499.11
|
| Rate for Payer: Kentucky WC Medicaid |
$1,514.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,574.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,217.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,307.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,529.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,836.05
|
| Rate for Payer: Ohio Health Group HMO |
$3,269.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$871.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$566.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,351.34
|
| Rate for Payer: PHCS Commercial |
$4,184.78
|
| Rate for Payer: United Healthcare All Payer |
$3,836.05
|
|
|
FEM COMP OSS RS 3CM RESUR L
|
Facility
|
OP
|
$69,317.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,011.27 |
| Max. Negotiated Rate |
$66,544.74 |
| Rate for Payer: Aetna Commercial |
$53,374.43
|
| Rate for Payer: Anthem Medicaid |
$23,838.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54,067.60
|
| Rate for Payer: Cash Price |
$34,658.72
|
| Rate for Payer: Cigna Commercial |
$57,533.48
|
| Rate for Payer: First Health Commercial |
$65,851.57
|
| Rate for Payer: Humana Commercial |
$58,919.82
|
| Rate for Payer: Humana KY Medicaid |
$23,838.27
|
| Rate for Payer: Kentucky WC Medicaid |
$24,080.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,840.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51,156.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,795.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,316.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,999.35
|
| Rate for Payer: Ohio Health Group HMO |
$51,988.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,863.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,011.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,488.41
|
| Rate for Payer: PHCS Commercial |
$66,544.74
|
| Rate for Payer: United Healthcare All Payer |
$60,999.35
|
|
|
FEM COMP OSS RS 3CM RESUR L
|
Facility
|
IP
|
$69,317.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,011.27 |
| Max. Negotiated Rate |
$66,544.74 |
| Rate for Payer: Aetna Commercial |
$53,374.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54,067.60
|
| Rate for Payer: Cash Price |
$34,658.72
|
| Rate for Payer: Cigna Commercial |
$57,533.48
|
| Rate for Payer: First Health Commercial |
$65,851.57
|
| Rate for Payer: Humana Commercial |
$58,919.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,840.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51,156.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,795.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,999.35
|
| Rate for Payer: Ohio Health Group HMO |
$51,988.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,863.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,011.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,488.41
|
| Rate for Payer: PHCS Commercial |
$66,544.74
|
| Rate for Payer: United Healthcare All Payer |
$60,999.35
|
|
|
FEM COMP OSS RS 3CM RESUR R
|
Facility
|
IP
|
$69,317.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,011.27 |
| Max. Negotiated Rate |
$66,544.74 |
| Rate for Payer: Aetna Commercial |
$53,374.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54,067.60
|
| Rate for Payer: Cash Price |
$34,658.72
|
| Rate for Payer: Cigna Commercial |
$57,533.48
|
| Rate for Payer: First Health Commercial |
$65,851.57
|
| Rate for Payer: Humana Commercial |
$58,919.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,840.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51,156.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,795.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,999.35
|
| Rate for Payer: Ohio Health Group HMO |
$51,988.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,863.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,011.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,488.41
|
| Rate for Payer: PHCS Commercial |
$66,544.74
|
| Rate for Payer: United Healthcare All Payer |
$60,999.35
|
|
|
FEM COMP OSS RS 3CM RESUR R
|
Facility
|
OP
|
$69,317.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,011.27 |
| Max. Negotiated Rate |
$66,544.74 |
| Rate for Payer: Aetna Commercial |
$53,374.43
|
| Rate for Payer: Anthem Medicaid |
$23,838.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54,067.60
|
| Rate for Payer: Cash Price |
$34,658.72
|
| Rate for Payer: Cigna Commercial |
$57,533.48
|
| Rate for Payer: First Health Commercial |
$65,851.57
|
| Rate for Payer: Humana Commercial |
$58,919.82
|
| Rate for Payer: Humana KY Medicaid |
$23,838.27
|
| Rate for Payer: Kentucky WC Medicaid |
$24,080.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56,840.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51,156.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,795.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,316.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$60,999.35
|
| Rate for Payer: Ohio Health Group HMO |
$51,988.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,863.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,011.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,488.41
|
| Rate for Payer: PHCS Commercial |
$66,544.74
|
| Rate for Payer: United Healthcare All Payer |
$60,999.35
|
|
|
FEM COMP OSS RS 5CM RESUR L
|
Facility
|
OP
|
$70,194.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,125.27 |
| Max. Negotiated Rate |
$67,386.62 |
| Rate for Payer: Aetna Commercial |
$54,049.69
|
| Rate for Payer: Anthem Medicaid |
$24,139.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54,751.63
|
| Rate for Payer: Cash Price |
$35,097.20
|
| Rate for Payer: Cigna Commercial |
$58,261.35
|
| Rate for Payer: First Health Commercial |
$66,684.68
|
| Rate for Payer: Humana Commercial |
$59,665.24
|
| Rate for Payer: Humana KY Medicaid |
$24,139.85
|
| Rate for Payer: Kentucky WC Medicaid |
$24,385.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57,559.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51,803.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,058.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,624.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$61,771.07
|
| Rate for Payer: Ohio Health Group HMO |
$52,645.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,038.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,125.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,760.26
|
| Rate for Payer: PHCS Commercial |
$67,386.62
|
| Rate for Payer: United Healthcare All Payer |
$61,771.07
|
|
|
FEM COMP OSS RS 5CM RESUR L
|
Facility
|
IP
|
$70,194.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,125.27 |
| Max. Negotiated Rate |
$67,386.62 |
| Rate for Payer: Aetna Commercial |
$54,049.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54,751.63
|
| Rate for Payer: Cash Price |
$35,097.20
|
| Rate for Payer: Cigna Commercial |
$58,261.35
|
| Rate for Payer: First Health Commercial |
$66,684.68
|
| Rate for Payer: Humana Commercial |
$59,665.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57,559.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51,803.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,058.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$61,771.07
|
| Rate for Payer: Ohio Health Group HMO |
$52,645.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,038.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,125.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,760.26
|
| Rate for Payer: PHCS Commercial |
$67,386.62
|
| Rate for Payer: United Healthcare All Payer |
$61,771.07
|
|
|
FEM COMP OSS RS 5CM RESUR R
|
Facility
|
OP
|
$70,194.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,125.27 |
| Max. Negotiated Rate |
$67,386.62 |
| Rate for Payer: Aetna Commercial |
$54,049.69
|
| Rate for Payer: Anthem Medicaid |
$24,139.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54,751.63
|
| Rate for Payer: Cash Price |
$35,097.20
|
| Rate for Payer: Cigna Commercial |
$58,261.35
|
| Rate for Payer: First Health Commercial |
$66,684.68
|
| Rate for Payer: Humana Commercial |
$59,665.24
|
| Rate for Payer: Humana KY Medicaid |
$24,139.85
|
| Rate for Payer: Kentucky WC Medicaid |
$24,385.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57,559.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51,803.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,058.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,624.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$61,771.07
|
| Rate for Payer: Ohio Health Group HMO |
$52,645.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,038.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,125.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,760.26
|
| Rate for Payer: PHCS Commercial |
$67,386.62
|
| Rate for Payer: United Healthcare All Payer |
$61,771.07
|
|
|
FEM COMP OSS RS 5CM RESUR R
|
Facility
|
IP
|
$70,194.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,125.27 |
| Max. Negotiated Rate |
$67,386.62 |
| Rate for Payer: Aetna Commercial |
$54,049.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54,751.63
|
| Rate for Payer: Cash Price |
$35,097.20
|
| Rate for Payer: Cigna Commercial |
$58,261.35
|
| Rate for Payer: First Health Commercial |
$66,684.68
|
| Rate for Payer: Humana Commercial |
$59,665.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57,559.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51,803.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,058.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$61,771.07
|
| Rate for Payer: Ohio Health Group HMO |
$52,645.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,038.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,125.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,760.26
|
| Rate for Payer: PHCS Commercial |
$67,386.62
|
| Rate for Payer: United Healthcare All Payer |
$61,771.07
|
|
|
FEM COMP TOTAL STABILIZR #11RT
|
Facility
|
OP
|
$23,426.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,045.47 |
| Max. Negotiated Rate |
$22,489.61 |
| Rate for Payer: Aetna Commercial |
$18,038.54
|
| Rate for Payer: Anthem Medicaid |
$8,056.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,272.81
|
| Rate for Payer: Cash Price |
$11,713.34
|
| Rate for Payer: Cigna Commercial |
$19,444.14
|
| Rate for Payer: First Health Commercial |
$22,255.35
|
| Rate for Payer: Humana Commercial |
$19,912.68
|
| Rate for Payer: Humana KY Medicaid |
$8,056.44
|
| Rate for Payer: Kentucky WC Medicaid |
$8,138.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,209.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,288.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,028.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,218.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,615.48
|
| Rate for Payer: Ohio Health Group HMO |
$17,570.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,685.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,045.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,262.27
|
| Rate for Payer: PHCS Commercial |
$22,489.61
|
| Rate for Payer: United Healthcare All Payer |
$20,615.48
|
|
|
FEM COMP TOTAL STABILIZR #11RT
|
Facility
|
IP
|
$23,426.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,045.47 |
| Max. Negotiated Rate |
$22,489.61 |
| Rate for Payer: Aetna Commercial |
$18,038.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,272.81
|
| Rate for Payer: Cash Price |
$11,713.34
|
| Rate for Payer: Cigna Commercial |
$19,444.14
|
| Rate for Payer: First Health Commercial |
$22,255.35
|
| Rate for Payer: Humana Commercial |
$19,912.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,209.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,288.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,028.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,615.48
|
| Rate for Payer: Ohio Health Group HMO |
$17,570.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,685.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,045.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,262.27
|
| Rate for Payer: PHCS Commercial |
$22,489.61
|
| Rate for Payer: United Healthcare All Payer |
$20,615.48
|
|
|
FEM COMP TOTAL STABILIZR #13LT
|
Facility
|
IP
|
$19,759.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,568.69 |
| Max. Negotiated Rate |
$18,968.79 |
| Rate for Payer: Aetna Commercial |
$15,214.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,412.14
|
| Rate for Payer: Cash Price |
$9,879.58
|
| Rate for Payer: Cigna Commercial |
$16,400.10
|
| Rate for Payer: First Health Commercial |
$18,771.20
|
| Rate for Payer: Humana Commercial |
$16,795.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,202.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,582.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,927.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,388.06
|
| Rate for Payer: Ohio Health Group HMO |
$14,819.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,951.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,568.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,125.34
|
| Rate for Payer: PHCS Commercial |
$18,968.79
|
| Rate for Payer: United Healthcare All Payer |
$17,388.06
|
|
