|
EXPL POSTSURG ABDOMEN
|
Professional
|
Both
|
$2,058.00
|
|
|
Service Code
|
HCPCS 35840
|
| Hospital Charge Code |
76101422
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$482.15 |
| Max. Negotiated Rate |
$1,501.60 |
| Rate for Payer: Aetna Commercial |
$1,072.17
|
| Rate for Payer: Ambetter Exchange |
$1,155.08
|
| Rate for Payer: Anthem Medicaid |
$482.15
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,155.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,155.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,386.10
|
| Rate for Payer: Cash Price |
$1,029.00
|
| Rate for Payer: Cash Price |
$1,029.00
|
| Rate for Payer: Cigna Commercial |
$1,020.65
|
| Rate for Payer: Healthspan PPO |
$1,054.15
|
| Rate for Payer: Humana Medicaid |
$482.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$850.47
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,155.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,155.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$491.79
|
| Rate for Payer: Molina Healthcare Passport |
$482.15
|
| Rate for Payer: Multiplan PHCS |
$1,234.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,501.60
|
| Rate for Payer: UHCCP Medicaid |
$720.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$486.97
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,155.08
|
|
|
EXPL POSTSURG ABDOMEN(P
|
Professional
|
Both
|
$2,058.00
|
|
|
Service Code
|
HCPCS 35840
|
| Hospital Charge Code |
761P1422
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$482.15 |
| Max. Negotiated Rate |
$1,501.60 |
| Rate for Payer: Aetna Commercial |
$1,072.17
|
| Rate for Payer: Ambetter Exchange |
$1,155.08
|
| Rate for Payer: Anthem Medicaid |
$482.15
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,155.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,155.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,386.10
|
| Rate for Payer: Cash Price |
$1,029.00
|
| Rate for Payer: Cash Price |
$1,029.00
|
| Rate for Payer: Cigna Commercial |
$1,020.65
|
| Rate for Payer: Healthspan PPO |
$1,054.15
|
| Rate for Payer: Humana Medicaid |
$482.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$850.47
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,155.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,155.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$491.79
|
| Rate for Payer: Molina Healthcare Passport |
$482.15
|
| Rate for Payer: Multiplan PHCS |
$1,234.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,501.60
|
| Rate for Payer: UHCCP Medicaid |
$720.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$486.97
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,155.08
|
|
|
EXPL SUTURE SINUS ABDOMEN
|
Professional
|
Both
|
$6,457.00
|
|
|
Service Code
|
HCPCS 17999
|
| Hospital Charge Code |
76100273
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$4,519.90 |
| Rate for Payer: Cash Price |
$3,228.50
|
| Rate for Payer: Cash Price |
$3,228.50
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$3,874.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,519.90
|
| Rate for Payer: UHCCP Medicaid |
$2,259.95
|
|
|
EXPL SUTURE SINUS ABDOMEN
|
Facility
|
IP
|
$6,457.00
|
|
|
Service Code
|
HCPCS 17999
|
| Hospital Charge Code |
76100273
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,937.10 |
| Max. Negotiated Rate |
$6,198.72 |
| Rate for Payer: Aetna Commercial |
$4,971.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,036.46
|
| Rate for Payer: Cash Price |
$3,228.50
|
| Rate for Payer: Cigna Commercial |
$5,359.31
|
| Rate for Payer: First Health Commercial |
$6,134.15
|
| Rate for Payer: Humana Commercial |
$5,488.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,294.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,765.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,937.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,682.16
|
| Rate for Payer: Ohio Health Group HMO |
$4,842.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,165.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,617.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,455.33
|
| Rate for Payer: PHCS Commercial |
$6,198.72
|
| Rate for Payer: United Healthcare All Payer |
$5,682.16
|
|
|
EXPL SUTURE SINUS ABDOMEN
|
Facility
|
OP
|
$6,457.00
|
|
|
Service Code
|
HCPCS 17999
|
| Hospital Charge Code |
76100273
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$183.59 |
| Max. Negotiated Rate |
$6,198.72 |
| Rate for Payer: Aetna Commercial |
$4,971.89
|
| Rate for Payer: Anthem Medicaid |
$2,220.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,036.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Cash Price |
$3,228.50
|
| Rate for Payer: Cash Price |
$3,228.50
|
| Rate for Payer: Cigna Commercial |
$5,359.31
|
| Rate for Payer: First Health Commercial |
$6,134.15
|
| Rate for Payer: Humana Commercial |
$5,488.45
|
| Rate for Payer: Humana KY Medicaid |
$2,220.56
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Kentucky WC Medicaid |
$2,243.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,294.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,765.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,265.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,682.16
|
| Rate for Payer: Ohio Health Group HMO |
$4,842.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,165.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,617.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,455.33
|
| Rate for Payer: PHCS Commercial |
$6,198.72
|
| Rate for Payer: United Healthcare All Payer |
$5,682.16
|
|
|
EXPL SUTURE SINUS ABDOMEN(P
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 17999
|
| Hospital Charge Code |
761P0273
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1,750.00 |
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,750.00
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
|
|
EXPL SUTURE SINUS ABDOMEN(T
|
Facility
|
OP
|
$3,957.00
|
|
|
Service Code
|
HCPCS 17999
|
| Hospital Charge Code |
761T0273
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$183.59 |
| Max. Negotiated Rate |
$3,798.72 |
| Rate for Payer: Aetna Commercial |
$3,046.89
|
| Rate for Payer: Anthem Medicaid |
$1,360.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,086.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Cash Price |
$1,978.50
|
| Rate for Payer: Cash Price |
$1,978.50
|
| Rate for Payer: Cigna Commercial |
$3,284.31
|
| Rate for Payer: First Health Commercial |
$3,759.15
|
| Rate for Payer: Humana Commercial |
$3,363.45
|
| Rate for Payer: Humana KY Medicaid |
$1,360.81
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Kentucky WC Medicaid |
$1,374.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,244.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,920.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,388.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,482.16
|
| Rate for Payer: Ohio Health Group HMO |
$2,967.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,165.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,442.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,730.33
|
| Rate for Payer: PHCS Commercial |
$3,798.72
|
| Rate for Payer: United Healthcare All Payer |
$3,482.16
|
|
|
EXPL SUTURE SINUS ABDOMEN(T
|
Facility
|
IP
|
$3,957.00
|
|
|
Service Code
|
HCPCS 17999
|
| Hospital Charge Code |
761T0273
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,187.10 |
| Max. Negotiated Rate |
$3,798.72 |
| Rate for Payer: Aetna Commercial |
$3,046.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,086.46
|
| Rate for Payer: Cash Price |
$1,978.50
|
| Rate for Payer: Cigna Commercial |
$3,284.31
|
| Rate for Payer: First Health Commercial |
$3,759.15
|
| Rate for Payer: Humana Commercial |
$3,363.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,244.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,920.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,187.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,482.16
|
| Rate for Payer: Ohio Health Group HMO |
$2,967.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,165.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,442.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,730.33
|
| Rate for Payer: PHCS Commercial |
$3,798.72
|
| Rate for Payer: United Healthcare All Payer |
$3,482.16
|
|
|
EXPNDR DERMASPAN M SMH 460-550
|
Facility
|
OP
|
$7,726.75
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,318.03 |
| Max. Negotiated Rate |
$7,417.68 |
| Rate for Payer: Aetna Commercial |
$5,949.60
|
| Rate for Payer: Anthem Medicaid |
$2,657.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,026.86
|
| Rate for Payer: Cash Price |
$3,863.38
|
| Rate for Payer: Cigna Commercial |
$6,413.20
|
| Rate for Payer: First Health Commercial |
$7,340.41
|
| Rate for Payer: Humana Commercial |
$6,567.74
|
| Rate for Payer: Humana KY Medicaid |
$2,657.23
|
| Rate for Payer: Kentucky WC Medicaid |
$2,684.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,335.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,702.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,318.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,710.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,799.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,795.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,181.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,722.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,331.46
|
| Rate for Payer: PHCS Commercial |
$7,417.68
|
| Rate for Payer: United Healthcare All Payer |
$6,799.54
|
|
|
EXPNDR DERMASPAN M SMH 460-550
|
Facility
|
IP
|
$7,726.75
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,318.03 |
| Max. Negotiated Rate |
$7,417.68 |
| Rate for Payer: Aetna Commercial |
$5,949.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,026.86
|
| Rate for Payer: Cash Price |
$3,863.38
|
| Rate for Payer: Cigna Commercial |
$6,413.20
|
| Rate for Payer: First Health Commercial |
$7,340.41
|
| Rate for Payer: Humana Commercial |
$6,567.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,335.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,702.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,318.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,799.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,795.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,181.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,722.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,331.46
|
| Rate for Payer: PHCS Commercial |
$7,417.68
|
| Rate for Payer: United Healthcare All Payer |
$6,799.54
|
|
|
EXPNDR LOW HGT CPX3 TISS 250CC
|
Facility
|
OP
|
$8,657.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,597.25 |
| Max. Negotiated Rate |
$8,311.20 |
| Rate for Payer: Aetna Commercial |
$6,666.27
|
| Rate for Payer: Anthem Medicaid |
$2,977.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,752.85
|
| Rate for Payer: Cash Price |
$4,328.75
|
| Rate for Payer: Cigna Commercial |
$7,185.73
|
| Rate for Payer: First Health Commercial |
$8,224.62
|
| Rate for Payer: Humana Commercial |
$7,358.88
|
| Rate for Payer: Humana KY Medicaid |
$2,977.31
|
| Rate for Payer: Kentucky WC Medicaid |
$3,007.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,099.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,389.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,597.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,037.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,618.60
|
| Rate for Payer: Ohio Health Group HMO |
$6,493.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,926.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,532.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,973.68
|
| Rate for Payer: PHCS Commercial |
$8,311.20
|
| Rate for Payer: United Healthcare All Payer |
$7,618.60
|
|
|
EXPNDR LOW HGT CPX3 TISS 250CC
|
Facility
|
IP
|
$8,657.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,597.25 |
| Max. Negotiated Rate |
$8,311.20 |
| Rate for Payer: Aetna Commercial |
$6,666.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,752.85
|
| Rate for Payer: Cash Price |
$4,328.75
|
| Rate for Payer: Cigna Commercial |
$7,185.73
|
| Rate for Payer: First Health Commercial |
$8,224.62
|
| Rate for Payer: Humana Commercial |
$7,358.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,099.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,389.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,597.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,618.60
|
| Rate for Payer: Ohio Health Group HMO |
$6,493.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,926.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,532.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,973.68
|
| Rate for Payer: PHCS Commercial |
$8,311.20
|
| Rate for Payer: United Healthcare All Payer |
$7,618.60
|
|
|
EXPNDR LOW HGT CPX3 TISS 350CC
|
Facility
|
OP
|
$8,657.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,597.25 |
| Max. Negotiated Rate |
$8,311.20 |
| Rate for Payer: Aetna Commercial |
$6,666.27
|
| Rate for Payer: Anthem Medicaid |
$2,977.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,752.85
|
| Rate for Payer: Cash Price |
$4,328.75
|
| Rate for Payer: Cigna Commercial |
$7,185.73
|
| Rate for Payer: First Health Commercial |
$8,224.62
|
| Rate for Payer: Humana Commercial |
$7,358.88
|
| Rate for Payer: Humana KY Medicaid |
$2,977.31
|
| Rate for Payer: Kentucky WC Medicaid |
$3,007.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,099.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,389.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,597.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,037.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,618.60
|
| Rate for Payer: Ohio Health Group HMO |
$6,493.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,926.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,532.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,973.68
|
| Rate for Payer: PHCS Commercial |
$8,311.20
|
| Rate for Payer: United Healthcare All Payer |
$7,618.60
|
|
|
EXPNDR LOW HGT CPX3 TISS 350CC
|
Facility
|
IP
|
$8,657.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,597.25 |
| Max. Negotiated Rate |
$8,311.20 |
| Rate for Payer: Aetna Commercial |
$6,666.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,752.85
|
| Rate for Payer: Cash Price |
$4,328.75
|
| Rate for Payer: Cigna Commercial |
$7,185.73
|
| Rate for Payer: First Health Commercial |
$8,224.62
|
| Rate for Payer: Humana Commercial |
$7,358.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,099.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,389.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,597.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,618.60
|
| Rate for Payer: Ohio Health Group HMO |
$6,493.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,926.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,532.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,973.68
|
| Rate for Payer: PHCS Commercial |
$8,311.20
|
| Rate for Payer: United Healthcare All Payer |
$7,618.60
|
|
|
EXPNDR LOW HGT CPX3 TISS 450CC
|
Facility
|
IP
|
$8,657.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,597.25 |
| Max. Negotiated Rate |
$8,311.20 |
| Rate for Payer: Aetna Commercial |
$6,666.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,752.85
|
| Rate for Payer: Cash Price |
$4,328.75
|
| Rate for Payer: Cigna Commercial |
$7,185.73
|
| Rate for Payer: First Health Commercial |
$8,224.62
|
| Rate for Payer: Humana Commercial |
$7,358.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,099.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,389.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,597.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,618.60
|
| Rate for Payer: Ohio Health Group HMO |
$6,493.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,926.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,532.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,973.68
|
| Rate for Payer: PHCS Commercial |
$8,311.20
|
| Rate for Payer: United Healthcare All Payer |
$7,618.60
|
|
|
EXPNDR LOW HGT CPX3 TISS 450CC
|
Facility
|
OP
|
$8,657.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,597.25 |
| Max. Negotiated Rate |
$8,311.20 |
| Rate for Payer: Aetna Commercial |
$6,666.27
|
| Rate for Payer: Anthem Medicaid |
$2,977.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,752.85
|
| Rate for Payer: Cash Price |
$4,328.75
|
| Rate for Payer: Cigna Commercial |
$7,185.73
|
| Rate for Payer: First Health Commercial |
$8,224.62
|
| Rate for Payer: Humana Commercial |
$7,358.88
|
| Rate for Payer: Humana KY Medicaid |
$2,977.31
|
| Rate for Payer: Kentucky WC Medicaid |
$3,007.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,099.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,389.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,597.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,037.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,618.60
|
| Rate for Payer: Ohio Health Group HMO |
$6,493.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,926.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,532.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,973.68
|
| Rate for Payer: PHCS Commercial |
$8,311.20
|
| Rate for Payer: United Healthcare All Payer |
$7,618.60
|
|
|
EXPNDR LOW HGT CPX3 TISS 550CC
|
Facility
|
OP
|
$8,657.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,597.25 |
| Max. Negotiated Rate |
$8,311.20 |
| Rate for Payer: Aetna Commercial |
$6,666.27
|
| Rate for Payer: Anthem Medicaid |
$2,977.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,752.85
|
| Rate for Payer: Cash Price |
$4,328.75
|
| Rate for Payer: Cigna Commercial |
$7,185.73
|
| Rate for Payer: First Health Commercial |
$8,224.62
|
| Rate for Payer: Humana Commercial |
$7,358.88
|
| Rate for Payer: Humana KY Medicaid |
$2,977.31
|
| Rate for Payer: Kentucky WC Medicaid |
$3,007.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,099.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,389.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,597.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,037.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,618.60
|
| Rate for Payer: Ohio Health Group HMO |
$6,493.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,926.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,532.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,973.68
|
| Rate for Payer: PHCS Commercial |
$8,311.20
|
| Rate for Payer: United Healthcare All Payer |
$7,618.60
|
|
|
EXPNDR LOW HGT CPX3 TISS 550CC
|
Facility
|
IP
|
$8,657.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,597.25 |
| Max. Negotiated Rate |
$8,311.20 |
| Rate for Payer: Aetna Commercial |
$6,666.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,752.85
|
| Rate for Payer: Cash Price |
$4,328.75
|
| Rate for Payer: Cigna Commercial |
$7,185.73
|
| Rate for Payer: First Health Commercial |
$8,224.62
|
| Rate for Payer: Humana Commercial |
$7,358.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,099.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,389.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,597.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,618.60
|
| Rate for Payer: Ohio Health Group HMO |
$6,493.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,926.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,532.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,973.68
|
| Rate for Payer: PHCS Commercial |
$8,311.20
|
| Rate for Payer: United Healthcare All Payer |
$7,618.60
|
|
|
EXPNDR LOW HGT CPX3 TISS 650CC
|
Facility
|
OP
|
$8,657.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,597.25 |
| Max. Negotiated Rate |
$8,311.20 |
| Rate for Payer: Aetna Commercial |
$6,666.27
|
| Rate for Payer: Anthem Medicaid |
$2,977.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,752.85
|
| Rate for Payer: Cash Price |
$4,328.75
|
| Rate for Payer: Cigna Commercial |
$7,185.73
|
| Rate for Payer: First Health Commercial |
$8,224.62
|
| Rate for Payer: Humana Commercial |
$7,358.88
|
| Rate for Payer: Humana KY Medicaid |
$2,977.31
|
| Rate for Payer: Kentucky WC Medicaid |
$3,007.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,099.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,389.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,597.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,037.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,618.60
|
| Rate for Payer: Ohio Health Group HMO |
$6,493.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,926.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,532.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,973.68
|
| Rate for Payer: PHCS Commercial |
$8,311.20
|
| Rate for Payer: United Healthcare All Payer |
$7,618.60
|
|
|
EXPNDR LOW HGT CPX3 TISS 650CC
|
Facility
|
IP
|
$8,657.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,597.25 |
| Max. Negotiated Rate |
$8,311.20 |
| Rate for Payer: Aetna Commercial |
$6,666.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,752.85
|
| Rate for Payer: Cash Price |
$4,328.75
|
| Rate for Payer: Cigna Commercial |
$7,185.73
|
| Rate for Payer: First Health Commercial |
$8,224.62
|
| Rate for Payer: Humana Commercial |
$7,358.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,099.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,389.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,597.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,618.60
|
| Rate for Payer: Ohio Health Group HMO |
$6,493.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,926.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,532.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,973.68
|
| Rate for Payer: PHCS Commercial |
$8,311.20
|
| Rate for Payer: United Healthcare All Payer |
$7,618.60
|
|
|
EXPNDR LOW HGT CPX3 TISS 750CC
|
Facility
|
IP
|
$8,657.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,597.25 |
| Max. Negotiated Rate |
$8,311.20 |
| Rate for Payer: Aetna Commercial |
$6,666.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,752.85
|
| Rate for Payer: Cash Price |
$4,328.75
|
| Rate for Payer: Cigna Commercial |
$7,185.73
|
| Rate for Payer: First Health Commercial |
$8,224.62
|
| Rate for Payer: Humana Commercial |
$7,358.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,099.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,389.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,597.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,618.60
|
| Rate for Payer: Ohio Health Group HMO |
$6,493.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,926.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,532.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,973.68
|
| Rate for Payer: PHCS Commercial |
$8,311.20
|
| Rate for Payer: United Healthcare All Payer |
$7,618.60
|
|
|
EXPNDR LOW HGT CPX3 TISS 750CC
|
Facility
|
OP
|
$8,657.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,597.25 |
| Max. Negotiated Rate |
$8,311.20 |
| Rate for Payer: Aetna Commercial |
$6,666.27
|
| Rate for Payer: Anthem Medicaid |
$2,977.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,752.85
|
| Rate for Payer: Cash Price |
$4,328.75
|
| Rate for Payer: Cigna Commercial |
$7,185.73
|
| Rate for Payer: First Health Commercial |
$8,224.62
|
| Rate for Payer: Humana Commercial |
$7,358.88
|
| Rate for Payer: Humana KY Medicaid |
$2,977.31
|
| Rate for Payer: Kentucky WC Medicaid |
$3,007.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,099.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,389.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,597.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,037.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,618.60
|
| Rate for Payer: Ohio Health Group HMO |
$6,493.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,926.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,532.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,973.68
|
| Rate for Payer: PHCS Commercial |
$8,311.20
|
| Rate for Payer: United Healthcare All Payer |
$7,618.60
|
|
|
EXPNDR MED HGT CPX3 TISS 275CC
|
Facility
|
IP
|
$8,657.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,597.25 |
| Max. Negotiated Rate |
$8,311.20 |
| Rate for Payer: Aetna Commercial |
$6,666.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,752.85
|
| Rate for Payer: Cash Price |
$4,328.75
|
| Rate for Payer: Cigna Commercial |
$7,185.73
|
| Rate for Payer: First Health Commercial |
$8,224.62
|
| Rate for Payer: Humana Commercial |
$7,358.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,099.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,389.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,597.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,618.60
|
| Rate for Payer: Ohio Health Group HMO |
$6,493.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,926.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,532.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,973.68
|
| Rate for Payer: PHCS Commercial |
$8,311.20
|
| Rate for Payer: United Healthcare All Payer |
$7,618.60
|
|
|
EXPNDR MED HGT CPX3 TISS 275CC
|
Facility
|
OP
|
$8,657.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,597.25 |
| Max. Negotiated Rate |
$8,311.20 |
| Rate for Payer: Aetna Commercial |
$6,666.27
|
| Rate for Payer: Anthem Medicaid |
$2,977.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,752.85
|
| Rate for Payer: Cash Price |
$4,328.75
|
| Rate for Payer: Cigna Commercial |
$7,185.73
|
| Rate for Payer: First Health Commercial |
$8,224.62
|
| Rate for Payer: Humana Commercial |
$7,358.88
|
| Rate for Payer: Humana KY Medicaid |
$2,977.31
|
| Rate for Payer: Kentucky WC Medicaid |
$3,007.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,099.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,389.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,597.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,037.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,618.60
|
| Rate for Payer: Ohio Health Group HMO |
$6,493.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,926.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,532.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,973.68
|
| Rate for Payer: PHCS Commercial |
$8,311.20
|
| Rate for Payer: United Healthcare All Payer |
$7,618.60
|
|
|
EXPNDR MED HGT CPX3 TISS 450CC
|
Facility
|
IP
|
$8,657.50
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
27000109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,597.25 |
| Max. Negotiated Rate |
$8,311.20 |
| Rate for Payer: Aetna Commercial |
$6,666.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,752.85
|
| Rate for Payer: Cash Price |
$4,328.75
|
| Rate for Payer: Cigna Commercial |
$7,185.73
|
| Rate for Payer: First Health Commercial |
$8,224.62
|
| Rate for Payer: Humana Commercial |
$7,358.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,099.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,389.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,597.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,618.60
|
| Rate for Payer: Ohio Health Group HMO |
$6,493.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,926.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,532.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,973.68
|
| Rate for Payer: PHCS Commercial |
$8,311.20
|
| Rate for Payer: United Healthcare All Payer |
$7,618.60
|
|
