|
GC H-STICK 6F
|
Facility
|
IP
|
$840.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$806.40 |
| Rate for Payer: Aetna Commercial |
$646.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$655.20
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$697.20
|
| Rate for Payer: First Health Commercial |
$798.00
|
| Rate for Payer: Humana Commercial |
$714.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$688.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$619.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$252.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$739.20
|
| Rate for Payer: Ohio Health Group HMO |
$630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$730.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$579.60
|
| Rate for Payer: PHCS Commercial |
$806.40
|
| Rate for Payer: United Healthcare All Payer |
$739.20
|
|
|
GC H-STICK 6F 55CM
|
Facility
|
IP
|
$1,130.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$339.00 |
| Max. Negotiated Rate |
$1,084.80 |
| Rate for Payer: Aetna Commercial |
$870.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$881.40
|
| Rate for Payer: Cash Price |
$565.00
|
| Rate for Payer: Cigna Commercial |
$937.90
|
| Rate for Payer: First Health Commercial |
$1,073.50
|
| Rate for Payer: Humana Commercial |
$960.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$926.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$833.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$339.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$994.40
|
| Rate for Payer: Ohio Health Group HMO |
$847.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$904.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$983.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$779.70
|
| Rate for Payer: PHCS Commercial |
$1,084.80
|
| Rate for Payer: United Healthcare All Payer |
$994.40
|
|
|
GC H-STICK 6F 55CM
|
Facility
|
OP
|
$1,130.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$339.00 |
| Max. Negotiated Rate |
$1,084.80 |
| Rate for Payer: Aetna Commercial |
$870.10
|
| Rate for Payer: Anthem Medicaid |
$388.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$881.40
|
| Rate for Payer: Cash Price |
$565.00
|
| Rate for Payer: Cigna Commercial |
$937.90
|
| Rate for Payer: First Health Commercial |
$1,073.50
|
| Rate for Payer: Humana Commercial |
$960.50
|
| Rate for Payer: Humana KY Medicaid |
$388.61
|
| Rate for Payer: Kentucky WC Medicaid |
$392.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$926.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$833.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$339.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$396.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$994.40
|
| Rate for Payer: Ohio Health Group HMO |
$847.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$904.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$983.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$779.70
|
| Rate for Payer: PHCS Commercial |
$1,084.80
|
| Rate for Payer: United Healthcare All Payer |
$994.40
|
|
|
GC H-STICK 7 F
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem Medicaid |
$275.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Humana KY Medicaid |
$275.12
|
| Rate for Payer: Kentucky WC Medicaid |
$277.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$280.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
GC H-STICK 7 F
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
GC IM 6F
|
Facility
|
IP
|
$1,150.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$345.00 |
| Max. Negotiated Rate |
$1,104.00 |
| Rate for Payer: Aetna Commercial |
$885.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$897.00
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cigna Commercial |
$954.50
|
| Rate for Payer: First Health Commercial |
$1,092.50
|
| Rate for Payer: Humana Commercial |
$977.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$943.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$848.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,012.00
|
| Rate for Payer: Ohio Health Group HMO |
$862.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,000.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$793.50
|
| Rate for Payer: PHCS Commercial |
$1,104.00
|
| Rate for Payer: United Healthcare All Payer |
$1,012.00
|
|
|
GC IM 6F
|
Facility
|
OP
|
$1,150.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$345.00 |
| Max. Negotiated Rate |
$1,104.00 |
| Rate for Payer: Aetna Commercial |
$885.50
|
| Rate for Payer: Anthem Medicaid |
$395.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$897.00
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cigna Commercial |
$954.50
|
| Rate for Payer: First Health Commercial |
$1,092.50
|
| Rate for Payer: Humana Commercial |
$977.50
|
| Rate for Payer: Humana KY Medicaid |
$395.49
|
| Rate for Payer: Kentucky WC Medicaid |
$399.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$943.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$848.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$403.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,012.00
|
| Rate for Payer: Ohio Health Group HMO |
$862.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,000.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$793.50
|
| Rate for Payer: PHCS Commercial |
$1,104.00
|
| Rate for Payer: United Healthcare All Payer |
$1,012.00
|
|
|
GC IM 6R 55CM
|
Facility
|
IP
|
$1,158.70
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$347.61 |
| Max. Negotiated Rate |
$1,112.35 |
| Rate for Payer: Aetna Commercial |
$892.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$903.79
|
| Rate for Payer: Cash Price |
$579.35
|
| Rate for Payer: Cigna Commercial |
$961.72
|
| Rate for Payer: First Health Commercial |
$1,100.77
|
| Rate for Payer: Humana Commercial |
$984.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$950.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$855.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$347.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,019.66
|
| Rate for Payer: Ohio Health Group HMO |
$869.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$926.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,008.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$799.50
|
| Rate for Payer: PHCS Commercial |
$1,112.35
|
| Rate for Payer: United Healthcare All Payer |
$1,019.66
|
|
|
GC IM 6R 55CM
|
Facility
|
OP
|
$1,158.70
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$347.61 |
| Max. Negotiated Rate |
$1,112.35 |
| Rate for Payer: Aetna Commercial |
$892.20
|
| Rate for Payer: Anthem Medicaid |
$398.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$903.79
|
| Rate for Payer: Cash Price |
$579.35
|
| Rate for Payer: Cigna Commercial |
$961.72
|
| Rate for Payer: First Health Commercial |
$1,100.77
|
| Rate for Payer: Humana Commercial |
$984.89
|
| Rate for Payer: Humana KY Medicaid |
$398.48
|
| Rate for Payer: Kentucky WC Medicaid |
$402.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$950.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$855.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$347.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$406.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,019.66
|
| Rate for Payer: Ohio Health Group HMO |
$869.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$926.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,008.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$799.50
|
| Rate for Payer: PHCS Commercial |
$1,112.35
|
| Rate for Payer: United Healthcare All Payer |
$1,019.66
|
|
|
GC JL 3.5 6F 100C
|
Facility
|
IP
|
$1,150.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$345.00 |
| Max. Negotiated Rate |
$1,104.00 |
| Rate for Payer: Aetna Commercial |
$885.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$897.00
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cigna Commercial |
$954.50
|
| Rate for Payer: First Health Commercial |
$1,092.50
|
| Rate for Payer: Humana Commercial |
$977.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$943.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$848.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,012.00
|
| Rate for Payer: Ohio Health Group HMO |
$862.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,000.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$793.50
|
| Rate for Payer: PHCS Commercial |
$1,104.00
|
| Rate for Payer: United Healthcare All Payer |
$1,012.00
|
|
|
GC JL 3.5 6F 100C
|
Facility
|
OP
|
$1,150.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$345.00 |
| Max. Negotiated Rate |
$1,104.00 |
| Rate for Payer: Aetna Commercial |
$885.50
|
| Rate for Payer: Anthem Medicaid |
$395.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$897.00
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cigna Commercial |
$954.50
|
| Rate for Payer: First Health Commercial |
$1,092.50
|
| Rate for Payer: Humana Commercial |
$977.50
|
| Rate for Payer: Humana KY Medicaid |
$395.49
|
| Rate for Payer: Kentucky WC Medicaid |
$399.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$943.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$848.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$403.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,012.00
|
| Rate for Payer: Ohio Health Group HMO |
$862.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,000.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$793.50
|
| Rate for Payer: PHCS Commercial |
$1,104.00
|
| Rate for Payer: United Healthcare All Payer |
$1,012.00
|
|
|
GC JL 3.5 7F
|
Facility
|
IP
|
$840.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$806.40 |
| Rate for Payer: Aetna Commercial |
$646.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$655.20
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$697.20
|
| Rate for Payer: First Health Commercial |
$798.00
|
| Rate for Payer: Humana Commercial |
$714.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$688.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$619.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$252.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$739.20
|
| Rate for Payer: Ohio Health Group HMO |
$630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$730.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$579.60
|
| Rate for Payer: PHCS Commercial |
$806.40
|
| Rate for Payer: United Healthcare All Payer |
$739.20
|
|
|
GC JL 3.5 7F
|
Facility
|
OP
|
$840.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$806.40 |
| Rate for Payer: Aetna Commercial |
$646.80
|
| Rate for Payer: Anthem Medicaid |
$288.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$655.20
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$697.20
|
| Rate for Payer: First Health Commercial |
$798.00
|
| Rate for Payer: Humana Commercial |
$714.00
|
| Rate for Payer: Humana KY Medicaid |
$288.88
|
| Rate for Payer: Kentucky WC Medicaid |
$291.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$688.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$619.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$252.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$294.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$739.20
|
| Rate for Payer: Ohio Health Group HMO |
$630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$730.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$579.60
|
| Rate for Payer: PHCS Commercial |
$806.40
|
| Rate for Payer: United Healthcare All Payer |
$739.20
|
|
|
GC JL 3.5 SH 6F 100CM
|
Facility
|
OP
|
$1,150.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$345.00 |
| Max. Negotiated Rate |
$1,104.00 |
| Rate for Payer: Aetna Commercial |
$885.50
|
| Rate for Payer: Anthem Medicaid |
$395.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$897.00
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cigna Commercial |
$954.50
|
| Rate for Payer: First Health Commercial |
$1,092.50
|
| Rate for Payer: Humana Commercial |
$977.50
|
| Rate for Payer: Humana KY Medicaid |
$395.49
|
| Rate for Payer: Kentucky WC Medicaid |
$399.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$943.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$848.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$403.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,012.00
|
| Rate for Payer: Ohio Health Group HMO |
$862.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,000.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$793.50
|
| Rate for Payer: PHCS Commercial |
$1,104.00
|
| Rate for Payer: United Healthcare All Payer |
$1,012.00
|
|
|
GC JL 3.5 SH 6F 100CM
|
Facility
|
IP
|
$1,150.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$345.00 |
| Max. Negotiated Rate |
$1,104.00 |
| Rate for Payer: Aetna Commercial |
$885.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$897.00
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cigna Commercial |
$954.50
|
| Rate for Payer: First Health Commercial |
$1,092.50
|
| Rate for Payer: Humana Commercial |
$977.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$943.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$848.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,012.00
|
| Rate for Payer: Ohio Health Group HMO |
$862.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,000.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$793.50
|
| Rate for Payer: PHCS Commercial |
$1,104.00
|
| Rate for Payer: United Healthcare All Payer |
$1,012.00
|
|
|
GC JL 3.5 SH 7F
|
Facility
|
OP
|
$1,104.60
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$331.38 |
| Max. Negotiated Rate |
$1,060.42 |
| Rate for Payer: Aetna Commercial |
$850.54
|
| Rate for Payer: Anthem Medicaid |
$379.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$861.59
|
| Rate for Payer: Cash Price |
$552.30
|
| Rate for Payer: Cigna Commercial |
$916.82
|
| Rate for Payer: First Health Commercial |
$1,049.37
|
| Rate for Payer: Humana Commercial |
$938.91
|
| Rate for Payer: Humana KY Medicaid |
$379.87
|
| Rate for Payer: Kentucky WC Medicaid |
$383.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$905.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$815.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$331.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$387.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$972.05
|
| Rate for Payer: Ohio Health Group HMO |
$828.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$883.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$961.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$762.17
|
| Rate for Payer: PHCS Commercial |
$1,060.42
|
| Rate for Payer: United Healthcare All Payer |
$972.05
|
|
|
GC JL 3.5 SH 7F
|
Facility
|
IP
|
$1,104.60
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$331.38 |
| Max. Negotiated Rate |
$1,060.42 |
| Rate for Payer: Aetna Commercial |
$850.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$861.59
|
| Rate for Payer: Cash Price |
$552.30
|
| Rate for Payer: Cigna Commercial |
$916.82
|
| Rate for Payer: First Health Commercial |
$1,049.37
|
| Rate for Payer: Humana Commercial |
$938.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$905.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$815.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$331.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$972.05
|
| Rate for Payer: Ohio Health Group HMO |
$828.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$883.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$961.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$762.17
|
| Rate for Payer: PHCS Commercial |
$1,060.42
|
| Rate for Payer: United Healthcare All Payer |
$972.05
|
|
|
GC JL 3 6F
|
Facility
|
OP
|
$1,150.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$345.00 |
| Max. Negotiated Rate |
$1,104.00 |
| Rate for Payer: Aetna Commercial |
$885.50
|
| Rate for Payer: Anthem Medicaid |
$395.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$897.00
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cigna Commercial |
$954.50
|
| Rate for Payer: First Health Commercial |
$1,092.50
|
| Rate for Payer: Humana Commercial |
$977.50
|
| Rate for Payer: Humana KY Medicaid |
$395.49
|
| Rate for Payer: Kentucky WC Medicaid |
$399.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$943.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$848.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$403.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,012.00
|
| Rate for Payer: Ohio Health Group HMO |
$862.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,000.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$793.50
|
| Rate for Payer: PHCS Commercial |
$1,104.00
|
| Rate for Payer: United Healthcare All Payer |
$1,012.00
|
|
|
GC JL 3 6F
|
Facility
|
IP
|
$1,150.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$345.00 |
| Max. Negotiated Rate |
$1,104.00 |
| Rate for Payer: Aetna Commercial |
$885.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$897.00
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cigna Commercial |
$954.50
|
| Rate for Payer: First Health Commercial |
$1,092.50
|
| Rate for Payer: Humana Commercial |
$977.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$943.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$848.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,012.00
|
| Rate for Payer: Ohio Health Group HMO |
$862.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,000.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$793.50
|
| Rate for Payer: PHCS Commercial |
$1,104.00
|
| Rate for Payer: United Healthcare All Payer |
$1,012.00
|
|
|
GC JL 3 7F
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem Medicaid |
$275.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Humana KY Medicaid |
$275.12
|
| Rate for Payer: Kentucky WC Medicaid |
$277.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$280.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
GC JL 3 7F
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
GC JL 3 SH 7F
|
Facility
|
OP
|
$1,104.60
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$331.38 |
| Max. Negotiated Rate |
$1,060.42 |
| Rate for Payer: Aetna Commercial |
$850.54
|
| Rate for Payer: Anthem Medicaid |
$379.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$861.59
|
| Rate for Payer: Cash Price |
$552.30
|
| Rate for Payer: Cigna Commercial |
$916.82
|
| Rate for Payer: First Health Commercial |
$1,049.37
|
| Rate for Payer: Humana Commercial |
$938.91
|
| Rate for Payer: Humana KY Medicaid |
$379.87
|
| Rate for Payer: Kentucky WC Medicaid |
$383.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$905.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$815.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$331.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$387.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$972.05
|
| Rate for Payer: Ohio Health Group HMO |
$828.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$883.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$961.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$762.17
|
| Rate for Payer: PHCS Commercial |
$1,060.42
|
| Rate for Payer: United Healthcare All Payer |
$972.05
|
|
|
GC JL 3 SH 7F
|
Facility
|
IP
|
$1,104.60
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$331.38 |
| Max. Negotiated Rate |
$1,060.42 |
| Rate for Payer: Aetna Commercial |
$850.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$861.59
|
| Rate for Payer: Cash Price |
$552.30
|
| Rate for Payer: Cigna Commercial |
$916.82
|
| Rate for Payer: First Health Commercial |
$1,049.37
|
| Rate for Payer: Humana Commercial |
$938.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$905.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$815.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$331.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$972.05
|
| Rate for Payer: Ohio Health Group HMO |
$828.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$883.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$961.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$762.17
|
| Rate for Payer: PHCS Commercial |
$1,060.42
|
| Rate for Payer: United Healthcare All Payer |
$972.05
|
|
|
GC JL 4.5 7F
|
Facility
|
OP
|
$1,104.60
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$331.38 |
| Max. Negotiated Rate |
$1,060.42 |
| Rate for Payer: Aetna Commercial |
$850.54
|
| Rate for Payer: Anthem Medicaid |
$379.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$861.59
|
| Rate for Payer: Cash Price |
$552.30
|
| Rate for Payer: Cigna Commercial |
$916.82
|
| Rate for Payer: First Health Commercial |
$1,049.37
|
| Rate for Payer: Humana Commercial |
$938.91
|
| Rate for Payer: Humana KY Medicaid |
$379.87
|
| Rate for Payer: Kentucky WC Medicaid |
$383.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$905.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$815.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$331.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$387.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$972.05
|
| Rate for Payer: Ohio Health Group HMO |
$828.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$883.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$961.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$762.17
|
| Rate for Payer: PHCS Commercial |
$1,060.42
|
| Rate for Payer: United Healthcare All Payer |
$972.05
|
|
|
GC JL 4.5 7F
|
Facility
|
IP
|
$1,104.60
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$331.38 |
| Max. Negotiated Rate |
$1,060.42 |
| Rate for Payer: Aetna Commercial |
$850.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$861.59
|
| Rate for Payer: Cash Price |
$552.30
|
| Rate for Payer: Cigna Commercial |
$916.82
|
| Rate for Payer: First Health Commercial |
$1,049.37
|
| Rate for Payer: Humana Commercial |
$938.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$905.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$815.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$331.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$972.05
|
| Rate for Payer: Ohio Health Group HMO |
$828.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$883.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$961.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$762.17
|
| Rate for Payer: PHCS Commercial |
$1,060.42
|
| Rate for Payer: United Healthcare All Payer |
$972.05
|
|
