|
HED LEGCY PRICOCR 12/14 36MM+0
|
Facility
|
IP
|
$4,860.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$631.80 |
| Max. Negotiated Rate |
$4,665.60 |
| Rate for Payer: Aetna Commercial |
$3,742.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,790.80
|
| Rate for Payer: Cash Price |
$2,430.00
|
| Rate for Payer: Cigna Commercial |
$4,033.80
|
| Rate for Payer: First Health Commercial |
$4,617.00
|
| Rate for Payer: Humana Commercial |
$4,131.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,985.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,586.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,458.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,276.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,645.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$972.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$631.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,506.60
|
| Rate for Payer: PHCS Commercial |
$4,665.60
|
| Rate for Payer: United Healthcare All Payer |
$4,276.80
|
|
|
HED LEGCY PRICOCR 12/14 36MM+0
|
Facility
|
OP
|
$4,860.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$631.80 |
| Max. Negotiated Rate |
$4,665.60 |
| Rate for Payer: Aetna Commercial |
$3,742.20
|
| Rate for Payer: Anthem Medicaid |
$1,671.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,790.80
|
| Rate for Payer: Cash Price |
$2,430.00
|
| Rate for Payer: Cigna Commercial |
$4,033.80
|
| Rate for Payer: First Health Commercial |
$4,617.00
|
| Rate for Payer: Humana Commercial |
$4,131.00
|
| Rate for Payer: Humana KY Medicaid |
$1,671.35
|
| Rate for Payer: Kentucky WC Medicaid |
$1,688.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,985.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,586.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,458.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,704.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,276.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,645.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$972.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$631.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,506.60
|
| Rate for Payer: PHCS Commercial |
$4,665.60
|
| Rate for Payer: United Healthcare All Payer |
$4,276.80
|
|
|
HED LEGCY PRICOCR 12/14 40MM+0
|
Facility
|
IP
|
$4,860.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$631.80 |
| Max. Negotiated Rate |
$4,665.60 |
| Rate for Payer: Aetna Commercial |
$3,742.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,790.80
|
| Rate for Payer: Cash Price |
$2,430.00
|
| Rate for Payer: Cigna Commercial |
$4,033.80
|
| Rate for Payer: First Health Commercial |
$4,617.00
|
| Rate for Payer: Humana Commercial |
$4,131.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,985.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,586.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,458.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,276.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,645.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$972.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$631.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,506.60
|
| Rate for Payer: PHCS Commercial |
$4,665.60
|
| Rate for Payer: United Healthcare All Payer |
$4,276.80
|
|
|
HED LEGCY PRICOCR 12/14 40MM+0
|
Facility
|
OP
|
$4,860.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$631.80 |
| Max. Negotiated Rate |
$4,665.60 |
| Rate for Payer: Aetna Commercial |
$3,742.20
|
| Rate for Payer: Anthem Medicaid |
$1,671.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,790.80
|
| Rate for Payer: Cash Price |
$2,430.00
|
| Rate for Payer: Cigna Commercial |
$4,033.80
|
| Rate for Payer: First Health Commercial |
$4,617.00
|
| Rate for Payer: Humana Commercial |
$4,131.00
|
| Rate for Payer: Humana KY Medicaid |
$1,671.35
|
| Rate for Payer: Kentucky WC Medicaid |
$1,688.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,985.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,586.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,458.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,704.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,276.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,645.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$972.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$631.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,506.60
|
| Rate for Payer: PHCS Commercial |
$4,665.60
|
| Rate for Payer: United Healthcare All Payer |
$4,276.80
|
|
|
HED LEGCY PRICR 12/14 22MM -2
|
Facility
|
OP
|
$4,361.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$566.96 |
| Max. Negotiated Rate |
$4,186.80 |
| Rate for Payer: Aetna Commercial |
$3,358.16
|
| Rate for Payer: Anthem Medicaid |
$1,499.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,401.78
|
| Rate for Payer: Cash Price |
$2,180.62
|
| Rate for Payer: Cigna Commercial |
$3,619.84
|
| Rate for Payer: First Health Commercial |
$4,143.19
|
| Rate for Payer: Humana Commercial |
$3,707.06
|
| Rate for Payer: Humana KY Medicaid |
$1,499.83
|
| Rate for Payer: Kentucky WC Medicaid |
$1,515.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,576.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,218.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,308.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,529.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,837.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,270.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$872.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$566.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,351.99
|
| Rate for Payer: PHCS Commercial |
$4,186.80
|
| Rate for Payer: United Healthcare All Payer |
$3,837.90
|
|
|
HED LEGCY PRICR 12/14 22MM -2
|
Facility
|
IP
|
$4,361.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$566.96 |
| Max. Negotiated Rate |
$4,186.80 |
| Rate for Payer: Aetna Commercial |
$3,358.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,401.78
|
| Rate for Payer: Cash Price |
$2,180.62
|
| Rate for Payer: Cigna Commercial |
$3,619.84
|
| Rate for Payer: First Health Commercial |
$4,143.19
|
| Rate for Payer: Humana Commercial |
$3,707.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,576.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,218.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,308.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,837.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,270.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$872.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$566.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,351.99
|
| Rate for Payer: PHCS Commercial |
$4,186.80
|
| Rate for Payer: United Healthcare All Payer |
$3,837.90
|
|
|
HED LEGCY PRICR 12/14 26MM+3.5
|
Facility
|
IP
|
$4,361.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$566.96 |
| Max. Negotiated Rate |
$4,186.80 |
| Rate for Payer: Aetna Commercial |
$3,358.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,401.78
|
| Rate for Payer: Cash Price |
$2,180.62
|
| Rate for Payer: Cigna Commercial |
$3,619.84
|
| Rate for Payer: First Health Commercial |
$4,143.19
|
| Rate for Payer: Humana Commercial |
$3,707.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,576.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,218.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,308.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,837.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,270.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$872.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$566.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,351.99
|
| Rate for Payer: PHCS Commercial |
$4,186.80
|
| Rate for Payer: United Healthcare All Payer |
$3,837.90
|
|
|
HED LEGCY PRICR 12/14 26MM+3.5
|
Facility
|
OP
|
$4,361.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$566.96 |
| Max. Negotiated Rate |
$4,186.80 |
| Rate for Payer: Aetna Commercial |
$3,358.16
|
| Rate for Payer: Anthem Medicaid |
$1,499.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,401.78
|
| Rate for Payer: Cash Price |
$2,180.62
|
| Rate for Payer: Cigna Commercial |
$3,619.84
|
| Rate for Payer: First Health Commercial |
$4,143.19
|
| Rate for Payer: Humana Commercial |
$3,707.06
|
| Rate for Payer: Humana KY Medicaid |
$1,499.83
|
| Rate for Payer: Kentucky WC Medicaid |
$1,515.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,576.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,218.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,308.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,529.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,837.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,270.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$872.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$566.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,351.99
|
| Rate for Payer: PHCS Commercial |
$4,186.80
|
| Rate for Payer: United Healthcare All Payer |
$3,837.90
|
|
|
HED LEGCY PRICR 12/14 28MM+3.5
|
Facility
|
OP
|
$4,361.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$566.96 |
| Max. Negotiated Rate |
$4,186.80 |
| Rate for Payer: Aetna Commercial |
$3,358.16
|
| Rate for Payer: Anthem Medicaid |
$1,499.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,401.78
|
| Rate for Payer: Cash Price |
$2,180.62
|
| Rate for Payer: Cigna Commercial |
$3,619.84
|
| Rate for Payer: First Health Commercial |
$4,143.19
|
| Rate for Payer: Humana Commercial |
$3,707.06
|
| Rate for Payer: Humana KY Medicaid |
$1,499.83
|
| Rate for Payer: Kentucky WC Medicaid |
$1,515.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,576.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,218.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,308.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,529.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,837.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,270.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$872.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$566.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,351.99
|
| Rate for Payer: PHCS Commercial |
$4,186.80
|
| Rate for Payer: United Healthcare All Payer |
$3,837.90
|
|
|
HED LEGCY PRICR 12/14 28MM+3.5
|
Facility
|
IP
|
$4,361.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$566.96 |
| Max. Negotiated Rate |
$4,186.80 |
| Rate for Payer: Aetna Commercial |
$3,358.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,401.78
|
| Rate for Payer: Cash Price |
$2,180.62
|
| Rate for Payer: Cigna Commercial |
$3,619.84
|
| Rate for Payer: First Health Commercial |
$4,143.19
|
| Rate for Payer: Humana Commercial |
$3,707.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,576.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,218.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,308.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,837.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,270.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$872.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$566.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,351.99
|
| Rate for Payer: PHCS Commercial |
$4,186.80
|
| Rate for Payer: United Healthcare All Payer |
$3,837.90
|
|
|
HED LEGCY PRICR 12/14 32MM+3.5
|
Facility
|
OP
|
$4,361.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$566.96 |
| Max. Negotiated Rate |
$4,186.80 |
| Rate for Payer: Aetna Commercial |
$3,358.16
|
| Rate for Payer: Anthem Medicaid |
$1,499.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,401.78
|
| Rate for Payer: Cash Price |
$2,180.62
|
| Rate for Payer: Cigna Commercial |
$3,619.84
|
| Rate for Payer: First Health Commercial |
$4,143.19
|
| Rate for Payer: Humana Commercial |
$3,707.06
|
| Rate for Payer: Humana KY Medicaid |
$1,499.83
|
| Rate for Payer: Kentucky WC Medicaid |
$1,515.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,576.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,218.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,308.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,529.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,837.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,270.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$872.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$566.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,351.99
|
| Rate for Payer: PHCS Commercial |
$4,186.80
|
| Rate for Payer: United Healthcare All Payer |
$3,837.90
|
|
|
HED LEGCY PRICR 12/14 32MM+3.5
|
Facility
|
IP
|
$4,361.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$566.96 |
| Max. Negotiated Rate |
$4,186.80 |
| Rate for Payer: Aetna Commercial |
$3,358.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,401.78
|
| Rate for Payer: Cash Price |
$2,180.62
|
| Rate for Payer: Cigna Commercial |
$3,619.84
|
| Rate for Payer: First Health Commercial |
$4,143.19
|
| Rate for Payer: Humana Commercial |
$3,707.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,576.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,218.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,308.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,837.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,270.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$872.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$566.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,351.99
|
| Rate for Payer: PHCS Commercial |
$4,186.80
|
| Rate for Payer: United Healthcare All Payer |
$3,837.90
|
|
|
HED LEGCY PRICR 12/14 36MM+3.5
|
Facility
|
OP
|
$4,860.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$631.80 |
| Max. Negotiated Rate |
$4,665.60 |
| Rate for Payer: Aetna Commercial |
$3,742.20
|
| Rate for Payer: Anthem Medicaid |
$1,671.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,790.80
|
| Rate for Payer: Cash Price |
$2,430.00
|
| Rate for Payer: Cigna Commercial |
$4,033.80
|
| Rate for Payer: First Health Commercial |
$4,617.00
|
| Rate for Payer: Humana Commercial |
$4,131.00
|
| Rate for Payer: Humana KY Medicaid |
$1,671.35
|
| Rate for Payer: Kentucky WC Medicaid |
$1,688.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,985.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,586.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,458.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,704.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,276.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,645.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$972.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$631.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,506.60
|
| Rate for Payer: PHCS Commercial |
$4,665.60
|
| Rate for Payer: United Healthcare All Payer |
$4,276.80
|
|
|
HED LEGCY PRICR 12/14 36MM+3.5
|
Facility
|
IP
|
$4,860.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$631.80 |
| Max. Negotiated Rate |
$4,665.60 |
| Rate for Payer: Aetna Commercial |
$3,742.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,790.80
|
| Rate for Payer: Cash Price |
$2,430.00
|
| Rate for Payer: Cigna Commercial |
$4,033.80
|
| Rate for Payer: First Health Commercial |
$4,617.00
|
| Rate for Payer: Humana Commercial |
$4,131.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,985.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,586.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,458.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,276.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,645.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$972.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$631.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,506.60
|
| Rate for Payer: PHCS Commercial |
$4,665.60
|
| Rate for Payer: United Healthcare All Payer |
$4,276.80
|
|
|
HED LEGCY PRICR 12/14 36MM+7.0
|
Facility
|
IP
|
$4,860.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$631.80 |
| Max. Negotiated Rate |
$4,665.60 |
| Rate for Payer: Aetna Commercial |
$3,742.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,790.80
|
| Rate for Payer: Cash Price |
$2,430.00
|
| Rate for Payer: Cigna Commercial |
$4,033.80
|
| Rate for Payer: First Health Commercial |
$4,617.00
|
| Rate for Payer: Humana Commercial |
$4,131.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,985.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,586.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,458.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,276.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,645.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$972.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$631.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,506.60
|
| Rate for Payer: PHCS Commercial |
$4,665.60
|
| Rate for Payer: United Healthcare All Payer |
$4,276.80
|
|
|
HED LEGCY PRICR 12/14 36MM+7.0
|
Facility
|
OP
|
$4,860.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$631.80 |
| Max. Negotiated Rate |
$4,665.60 |
| Rate for Payer: Aetna Commercial |
$3,742.20
|
| Rate for Payer: Anthem Medicaid |
$1,671.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,790.80
|
| Rate for Payer: Cash Price |
$2,430.00
|
| Rate for Payer: Cigna Commercial |
$4,033.80
|
| Rate for Payer: First Health Commercial |
$4,617.00
|
| Rate for Payer: Humana Commercial |
$4,131.00
|
| Rate for Payer: Humana KY Medicaid |
$1,671.35
|
| Rate for Payer: Kentucky WC Medicaid |
$1,688.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,985.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,586.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,458.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,704.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,276.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,645.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$972.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$631.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,506.60
|
| Rate for Payer: PHCS Commercial |
$4,665.60
|
| Rate for Payer: United Healthcare All Payer |
$4,276.80
|
|
|
HED LEGCY PRICR 12/14 40MM+3.5
|
Facility
|
OP
|
$4,860.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$631.80 |
| Max. Negotiated Rate |
$4,665.60 |
| Rate for Payer: Aetna Commercial |
$3,742.20
|
| Rate for Payer: Anthem Medicaid |
$1,671.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,790.80
|
| Rate for Payer: Cash Price |
$2,430.00
|
| Rate for Payer: Cigna Commercial |
$4,033.80
|
| Rate for Payer: First Health Commercial |
$4,617.00
|
| Rate for Payer: Humana Commercial |
$4,131.00
|
| Rate for Payer: Humana KY Medicaid |
$1,671.35
|
| Rate for Payer: Kentucky WC Medicaid |
$1,688.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,985.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,586.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,458.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,704.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,276.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,645.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$972.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$631.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,506.60
|
| Rate for Payer: PHCS Commercial |
$4,665.60
|
| Rate for Payer: United Healthcare All Payer |
$4,276.80
|
|
|
HED LEGCY PRICR 12/14 40MM+3.5
|
Facility
|
IP
|
$4,860.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$631.80 |
| Max. Negotiated Rate |
$4,665.60 |
| Rate for Payer: Aetna Commercial |
$3,742.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,790.80
|
| Rate for Payer: Cash Price |
$2,430.00
|
| Rate for Payer: Cigna Commercial |
$4,033.80
|
| Rate for Payer: First Health Commercial |
$4,617.00
|
| Rate for Payer: Humana Commercial |
$4,131.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,985.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,586.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,458.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,276.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,645.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$972.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$631.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,506.60
|
| Rate for Payer: PHCS Commercial |
$4,665.60
|
| Rate for Payer: United Healthcare All Payer |
$4,276.80
|
|
|
HED LEGCY PRICR 12/14 40MM+7.0
|
Facility
|
OP
|
$4,860.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$631.80 |
| Max. Negotiated Rate |
$4,665.60 |
| Rate for Payer: Aetna Commercial |
$3,742.20
|
| Rate for Payer: Anthem Medicaid |
$1,671.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,790.80
|
| Rate for Payer: Cash Price |
$2,430.00
|
| Rate for Payer: Cigna Commercial |
$4,033.80
|
| Rate for Payer: First Health Commercial |
$4,617.00
|
| Rate for Payer: Humana Commercial |
$4,131.00
|
| Rate for Payer: Humana KY Medicaid |
$1,671.35
|
| Rate for Payer: Kentucky WC Medicaid |
$1,688.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,985.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,586.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,458.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,704.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,276.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,645.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$972.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$631.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,506.60
|
| Rate for Payer: PHCS Commercial |
$4,665.60
|
| Rate for Payer: United Healthcare All Payer |
$4,276.80
|
|
|
HED LEGCY PRICR 12/14 40MM+7.0
|
Facility
|
IP
|
$4,860.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$631.80 |
| Max. Negotiated Rate |
$4,665.60 |
| Rate for Payer: Aetna Commercial |
$3,742.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,790.80
|
| Rate for Payer: Cash Price |
$2,430.00
|
| Rate for Payer: Cigna Commercial |
$4,033.80
|
| Rate for Payer: First Health Commercial |
$4,617.00
|
| Rate for Payer: Humana Commercial |
$4,131.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,985.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,586.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,458.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,276.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,645.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$972.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$631.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,506.60
|
| Rate for Payer: PHCS Commercial |
$4,665.60
|
| Rate for Payer: United Healthcare All Payer |
$4,276.80
|
|
|
HED V40 TPR LFIT ANA 36MM +10
|
Facility
|
OP
|
$4,522.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$587.88 |
| Max. Negotiated Rate |
$4,341.26 |
| Rate for Payer: Aetna Commercial |
$3,482.06
|
| Rate for Payer: Anthem Medicaid |
$1,555.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,527.28
|
| Rate for Payer: Cash Price |
$2,261.07
|
| Rate for Payer: Cigna Commercial |
$3,753.38
|
| Rate for Payer: First Health Commercial |
$4,296.04
|
| Rate for Payer: Humana Commercial |
$3,843.83
|
| Rate for Payer: Humana KY Medicaid |
$1,555.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,570.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,708.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,337.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,356.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,586.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,979.49
|
| Rate for Payer: Ohio Health Group HMO |
$3,391.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$904.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$587.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,401.87
|
| Rate for Payer: PHCS Commercial |
$4,341.26
|
| Rate for Payer: United Healthcare All Payer |
$3,979.49
|
|
|
HED V40 TPR LFIT ANA 36MM +10
|
Facility
|
IP
|
$4,522.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$587.88 |
| Max. Negotiated Rate |
$4,341.26 |
| Rate for Payer: Aetna Commercial |
$3,482.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,527.28
|
| Rate for Payer: Cash Price |
$2,261.07
|
| Rate for Payer: Cigna Commercial |
$3,753.38
|
| Rate for Payer: First Health Commercial |
$4,296.04
|
| Rate for Payer: Humana Commercial |
$3,843.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,708.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,337.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,356.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,979.49
|
| Rate for Payer: Ohio Health Group HMO |
$3,391.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$904.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$587.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,401.87
|
| Rate for Payer: PHCS Commercial |
$4,341.26
|
| Rate for Payer: United Healthcare All Payer |
$3,979.49
|
|
|
HEEL LT (OS CALCIS) 2V
|
Professional
|
Both
|
$382.00
|
|
|
Service Code
|
HCPCS 73650
|
| Hospital Charge Code |
32000111
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.38 |
| Max. Negotiated Rate |
$382.00 |
| Rate for Payer: Aetna Commercial |
$39.73
|
| Rate for Payer: Anthem Medicaid |
$19.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$382.00
|
| Rate for Payer: Cash Price |
$191.00
|
| Rate for Payer: Cash Price |
$191.00
|
| Rate for Payer: Cigna Commercial |
$39.18
|
| Rate for Payer: Healthspan PPO |
$37.23
|
| Rate for Payer: Humana Medicaid |
$19.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$20.00
|
| Rate for Payer: Molina Healthcare Passport |
$19.61
|
| Rate for Payer: Multiplan PHCS |
$229.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$267.40
|
| Rate for Payer: UHCCP Medicaid |
$133.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$19.81
|
|
|
HEEL LT (OS CALCIS) 2V
|
Facility
|
OP
|
$382.00
|
|
|
Service Code
|
HCPCS 73650
|
| Hospital Charge Code |
32000111
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$49.66 |
| Max. Negotiated Rate |
$366.72 |
| Rate for Payer: Aetna Commercial |
$294.14
|
| Rate for Payer: Anthem Medicaid |
$131.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$297.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$191.00
|
| Rate for Payer: Cash Price |
$191.00
|
| Rate for Payer: Cigna Commercial |
$317.06
|
| Rate for Payer: First Health Commercial |
$362.90
|
| Rate for Payer: Humana Commercial |
$324.70
|
| Rate for Payer: Humana KY Medicaid |
$131.37
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$132.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$313.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$281.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$134.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$336.16
|
| Rate for Payer: Ohio Health Group HMO |
$286.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$76.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$49.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$118.42
|
| Rate for Payer: PHCS Commercial |
$366.72
|
| Rate for Payer: United Healthcare All Payer |
$336.16
|
|
|
HEEL LT (OS CALCIS) 2V
|
Facility
|
IP
|
$382.00
|
|
|
Service Code
|
HCPCS 73650
|
| Hospital Charge Code |
32000111
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$49.66 |
| Max. Negotiated Rate |
$366.72 |
| Rate for Payer: Aetna Commercial |
$294.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$297.96
|
| Rate for Payer: Cash Price |
$191.00
|
| Rate for Payer: Cigna Commercial |
$317.06
|
| Rate for Payer: First Health Commercial |
$362.90
|
| Rate for Payer: Humana Commercial |
$324.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$313.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$281.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$336.16
|
| Rate for Payer: Ohio Health Group HMO |
$286.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$76.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$49.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$118.42
|
| Rate for Payer: PHCS Commercial |
$366.72
|
| Rate for Payer: United Healthcare All Payer |
$336.16
|
|
