|
HED LEGCY PRICOCR 12/14 32MM+7
|
Facility
|
IP
|
$4,315.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,294.69 |
| Max. Negotiated Rate |
$4,143.00 |
| Rate for Payer: Aetna Commercial |
$3,323.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,366.18
|
| Rate for Payer: Cash Price |
$2,157.81
|
| Rate for Payer: Cigna Commercial |
$3,581.96
|
| Rate for Payer: First Health Commercial |
$4,099.84
|
| Rate for Payer: Humana Commercial |
$3,668.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,538.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,184.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,294.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,797.75
|
| Rate for Payer: Ohio Health Group HMO |
$3,236.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,452.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,754.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,977.78
|
| Rate for Payer: PHCS Commercial |
$4,143.00
|
| Rate for Payer: United Healthcare All Payer |
$3,797.75
|
|
|
HED LEGCY PRICOCR 12/14 36MM+0
|
Facility
|
OP
|
$4,850.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,455.00 |
| Max. Negotiated Rate |
$4,656.00 |
| Rate for Payer: Aetna Commercial |
$3,734.50
|
| Rate for Payer: Anthem Medicaid |
$1,667.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,783.00
|
| Rate for Payer: Cash Price |
$2,425.00
|
| Rate for Payer: Cigna Commercial |
$4,025.50
|
| Rate for Payer: First Health Commercial |
$4,607.50
|
| Rate for Payer: Humana Commercial |
$4,122.50
|
| Rate for Payer: Humana KY Medicaid |
$1,667.91
|
| Rate for Payer: Kentucky WC Medicaid |
$1,684.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,977.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,579.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,455.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,701.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,268.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,637.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,219.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,346.50
|
| Rate for Payer: PHCS Commercial |
$4,656.00
|
| Rate for Payer: United Healthcare All Payer |
$4,268.00
|
|
|
HED LEGCY PRICOCR 12/14 36MM+0
|
Facility
|
IP
|
$4,850.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,455.00 |
| Max. Negotiated Rate |
$4,656.00 |
| Rate for Payer: Aetna Commercial |
$3,734.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,783.00
|
| Rate for Payer: Cash Price |
$2,425.00
|
| Rate for Payer: Cigna Commercial |
$4,025.50
|
| Rate for Payer: First Health Commercial |
$4,607.50
|
| Rate for Payer: Humana Commercial |
$4,122.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,977.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,579.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,455.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,268.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,637.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,219.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,346.50
|
| Rate for Payer: PHCS Commercial |
$4,656.00
|
| Rate for Payer: United Healthcare All Payer |
$4,268.00
|
|
|
HED LEGCY PRICOCR 12/14 40MM+0
|
Facility
|
IP
|
$4,850.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,455.00 |
| Max. Negotiated Rate |
$4,656.00 |
| Rate for Payer: Aetna Commercial |
$3,734.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,783.00
|
| Rate for Payer: Cash Price |
$2,425.00
|
| Rate for Payer: Cigna Commercial |
$4,025.50
|
| Rate for Payer: First Health Commercial |
$4,607.50
|
| Rate for Payer: Humana Commercial |
$4,122.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,977.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,579.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,455.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,268.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,637.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,219.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,346.50
|
| Rate for Payer: PHCS Commercial |
$4,656.00
|
| Rate for Payer: United Healthcare All Payer |
$4,268.00
|
|
|
HED LEGCY PRICOCR 12/14 40MM+0
|
Facility
|
OP
|
$4,850.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,455.00 |
| Max. Negotiated Rate |
$4,656.00 |
| Rate for Payer: Aetna Commercial |
$3,734.50
|
| Rate for Payer: Anthem Medicaid |
$1,667.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,783.00
|
| Rate for Payer: Cash Price |
$2,425.00
|
| Rate for Payer: Cigna Commercial |
$4,025.50
|
| Rate for Payer: First Health Commercial |
$4,607.50
|
| Rate for Payer: Humana Commercial |
$4,122.50
|
| Rate for Payer: Humana KY Medicaid |
$1,667.91
|
| Rate for Payer: Kentucky WC Medicaid |
$1,684.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,977.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,579.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,455.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,701.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,268.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,637.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,219.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,346.50
|
| Rate for Payer: PHCS Commercial |
$4,656.00
|
| Rate for Payer: United Healthcare All Payer |
$4,268.00
|
|
|
HED LEGCY PRICR 12/14 22MM -2
|
Facility
|
OP
|
$4,315.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,294.69 |
| Max. Negotiated Rate |
$4,143.00 |
| Rate for Payer: Aetna Commercial |
$3,323.03
|
| Rate for Payer: Anthem Medicaid |
$1,484.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,366.18
|
| Rate for Payer: Cash Price |
$2,157.81
|
| Rate for Payer: Cigna Commercial |
$3,581.96
|
| Rate for Payer: First Health Commercial |
$4,099.84
|
| Rate for Payer: Humana Commercial |
$3,668.28
|
| Rate for Payer: Humana KY Medicaid |
$1,484.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,499.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,538.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,184.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,294.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,513.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,797.75
|
| Rate for Payer: Ohio Health Group HMO |
$3,236.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,452.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,754.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,977.78
|
| Rate for Payer: PHCS Commercial |
$4,143.00
|
| Rate for Payer: United Healthcare All Payer |
$3,797.75
|
|
|
HED LEGCY PRICR 12/14 22MM -2
|
Facility
|
IP
|
$4,315.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,294.69 |
| Max. Negotiated Rate |
$4,143.00 |
| Rate for Payer: Aetna Commercial |
$3,323.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,366.18
|
| Rate for Payer: Cash Price |
$2,157.81
|
| Rate for Payer: Cigna Commercial |
$3,581.96
|
| Rate for Payer: First Health Commercial |
$4,099.84
|
| Rate for Payer: Humana Commercial |
$3,668.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,538.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,184.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,294.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,797.75
|
| Rate for Payer: Ohio Health Group HMO |
$3,236.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,452.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,754.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,977.78
|
| Rate for Payer: PHCS Commercial |
$4,143.00
|
| Rate for Payer: United Healthcare All Payer |
$3,797.75
|
|
|
HED LEGCY PRICR 12/14 26MM+3.5
|
Facility
|
IP
|
$4,315.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,294.69 |
| Max. Negotiated Rate |
$4,143.00 |
| Rate for Payer: Aetna Commercial |
$3,323.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,366.18
|
| Rate for Payer: Cash Price |
$2,157.81
|
| Rate for Payer: Cigna Commercial |
$3,581.96
|
| Rate for Payer: First Health Commercial |
$4,099.84
|
| Rate for Payer: Humana Commercial |
$3,668.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,538.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,184.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,294.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,797.75
|
| Rate for Payer: Ohio Health Group HMO |
$3,236.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,452.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,754.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,977.78
|
| Rate for Payer: PHCS Commercial |
$4,143.00
|
| Rate for Payer: United Healthcare All Payer |
$3,797.75
|
|
|
HED LEGCY PRICR 12/14 26MM+3.5
|
Facility
|
OP
|
$4,315.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,294.69 |
| Max. Negotiated Rate |
$4,143.00 |
| Rate for Payer: Aetna Commercial |
$3,323.03
|
| Rate for Payer: Anthem Medicaid |
$1,484.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,366.18
|
| Rate for Payer: Cash Price |
$2,157.81
|
| Rate for Payer: Cigna Commercial |
$3,581.96
|
| Rate for Payer: First Health Commercial |
$4,099.84
|
| Rate for Payer: Humana Commercial |
$3,668.28
|
| Rate for Payer: Humana KY Medicaid |
$1,484.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,499.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,538.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,184.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,294.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,513.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,797.75
|
| Rate for Payer: Ohio Health Group HMO |
$3,236.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,452.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,754.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,977.78
|
| Rate for Payer: PHCS Commercial |
$4,143.00
|
| Rate for Payer: United Healthcare All Payer |
$3,797.75
|
|
|
HED LEGCY PRICR 12/14 28MM+3.5
|
Facility
|
IP
|
$4,315.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,294.69 |
| Max. Negotiated Rate |
$4,143.00 |
| Rate for Payer: Aetna Commercial |
$3,323.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,366.18
|
| Rate for Payer: Cash Price |
$2,157.81
|
| Rate for Payer: Cigna Commercial |
$3,581.96
|
| Rate for Payer: First Health Commercial |
$4,099.84
|
| Rate for Payer: Humana Commercial |
$3,668.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,538.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,184.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,294.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,797.75
|
| Rate for Payer: Ohio Health Group HMO |
$3,236.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,452.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,754.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,977.78
|
| Rate for Payer: PHCS Commercial |
$4,143.00
|
| Rate for Payer: United Healthcare All Payer |
$3,797.75
|
|
|
HED LEGCY PRICR 12/14 28MM+3.5
|
Facility
|
OP
|
$4,315.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,294.69 |
| Max. Negotiated Rate |
$4,143.00 |
| Rate for Payer: Aetna Commercial |
$3,323.03
|
| Rate for Payer: Anthem Medicaid |
$1,484.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,366.18
|
| Rate for Payer: Cash Price |
$2,157.81
|
| Rate for Payer: Cigna Commercial |
$3,581.96
|
| Rate for Payer: First Health Commercial |
$4,099.84
|
| Rate for Payer: Humana Commercial |
$3,668.28
|
| Rate for Payer: Humana KY Medicaid |
$1,484.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,499.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,538.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,184.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,294.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,513.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,797.75
|
| Rate for Payer: Ohio Health Group HMO |
$3,236.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,452.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,754.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,977.78
|
| Rate for Payer: PHCS Commercial |
$4,143.00
|
| Rate for Payer: United Healthcare All Payer |
$3,797.75
|
|
|
HED LEGCY PRICR 12/14 32MM+3.5
|
Facility
|
OP
|
$4,315.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,294.69 |
| Max. Negotiated Rate |
$4,143.00 |
| Rate for Payer: Aetna Commercial |
$3,323.03
|
| Rate for Payer: Anthem Medicaid |
$1,484.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,366.18
|
| Rate for Payer: Cash Price |
$2,157.81
|
| Rate for Payer: Cigna Commercial |
$3,581.96
|
| Rate for Payer: First Health Commercial |
$4,099.84
|
| Rate for Payer: Humana Commercial |
$3,668.28
|
| Rate for Payer: Humana KY Medicaid |
$1,484.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,499.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,538.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,184.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,294.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,513.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,797.75
|
| Rate for Payer: Ohio Health Group HMO |
$3,236.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,452.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,754.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,977.78
|
| Rate for Payer: PHCS Commercial |
$4,143.00
|
| Rate for Payer: United Healthcare All Payer |
$3,797.75
|
|
|
HED LEGCY PRICR 12/14 32MM+3.5
|
Facility
|
IP
|
$4,315.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,294.69 |
| Max. Negotiated Rate |
$4,143.00 |
| Rate for Payer: Aetna Commercial |
$3,323.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,366.18
|
| Rate for Payer: Cash Price |
$2,157.81
|
| Rate for Payer: Cigna Commercial |
$3,581.96
|
| Rate for Payer: First Health Commercial |
$4,099.84
|
| Rate for Payer: Humana Commercial |
$3,668.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,538.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,184.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,294.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,797.75
|
| Rate for Payer: Ohio Health Group HMO |
$3,236.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,452.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,754.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,977.78
|
| Rate for Payer: PHCS Commercial |
$4,143.00
|
| Rate for Payer: United Healthcare All Payer |
$3,797.75
|
|
|
HED LEGCY PRICR 12/14 36MM+3.5
|
Facility
|
IP
|
$4,850.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,455.00 |
| Max. Negotiated Rate |
$4,656.00 |
| Rate for Payer: Aetna Commercial |
$3,734.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,783.00
|
| Rate for Payer: Cash Price |
$2,425.00
|
| Rate for Payer: Cigna Commercial |
$4,025.50
|
| Rate for Payer: First Health Commercial |
$4,607.50
|
| Rate for Payer: Humana Commercial |
$4,122.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,977.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,579.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,455.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,268.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,637.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,219.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,346.50
|
| Rate for Payer: PHCS Commercial |
$4,656.00
|
| Rate for Payer: United Healthcare All Payer |
$4,268.00
|
|
|
HED LEGCY PRICR 12/14 36MM+3.5
|
Facility
|
OP
|
$4,850.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,455.00 |
| Max. Negotiated Rate |
$4,656.00 |
| Rate for Payer: Aetna Commercial |
$3,734.50
|
| Rate for Payer: Anthem Medicaid |
$1,667.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,783.00
|
| Rate for Payer: Cash Price |
$2,425.00
|
| Rate for Payer: Cigna Commercial |
$4,025.50
|
| Rate for Payer: First Health Commercial |
$4,607.50
|
| Rate for Payer: Humana Commercial |
$4,122.50
|
| Rate for Payer: Humana KY Medicaid |
$1,667.91
|
| Rate for Payer: Kentucky WC Medicaid |
$1,684.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,977.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,579.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,455.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,701.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,268.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,637.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,219.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,346.50
|
| Rate for Payer: PHCS Commercial |
$4,656.00
|
| Rate for Payer: United Healthcare All Payer |
$4,268.00
|
|
|
HED LEGCY PRICR 12/14 36MM+7.0
|
Facility
|
OP
|
$4,850.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,455.00 |
| Max. Negotiated Rate |
$4,656.00 |
| Rate for Payer: Aetna Commercial |
$3,734.50
|
| Rate for Payer: Anthem Medicaid |
$1,667.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,783.00
|
| Rate for Payer: Cash Price |
$2,425.00
|
| Rate for Payer: Cigna Commercial |
$4,025.50
|
| Rate for Payer: First Health Commercial |
$4,607.50
|
| Rate for Payer: Humana Commercial |
$4,122.50
|
| Rate for Payer: Humana KY Medicaid |
$1,667.91
|
| Rate for Payer: Kentucky WC Medicaid |
$1,684.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,977.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,579.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,455.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,701.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,268.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,637.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,219.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,346.50
|
| Rate for Payer: PHCS Commercial |
$4,656.00
|
| Rate for Payer: United Healthcare All Payer |
$4,268.00
|
|
|
HED LEGCY PRICR 12/14 36MM+7.0
|
Facility
|
IP
|
$4,850.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,455.00 |
| Max. Negotiated Rate |
$4,656.00 |
| Rate for Payer: Aetna Commercial |
$3,734.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,783.00
|
| Rate for Payer: Cash Price |
$2,425.00
|
| Rate for Payer: Cigna Commercial |
$4,025.50
|
| Rate for Payer: First Health Commercial |
$4,607.50
|
| Rate for Payer: Humana Commercial |
$4,122.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,977.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,579.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,455.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,268.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,637.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,219.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,346.50
|
| Rate for Payer: PHCS Commercial |
$4,656.00
|
| Rate for Payer: United Healthcare All Payer |
$4,268.00
|
|
|
HED LEGCY PRICR 12/14 40MM+3.5
|
Facility
|
IP
|
$4,850.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,455.00 |
| Max. Negotiated Rate |
$4,656.00 |
| Rate for Payer: Aetna Commercial |
$3,734.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,783.00
|
| Rate for Payer: Cash Price |
$2,425.00
|
| Rate for Payer: Cigna Commercial |
$4,025.50
|
| Rate for Payer: First Health Commercial |
$4,607.50
|
| Rate for Payer: Humana Commercial |
$4,122.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,977.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,579.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,455.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,268.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,637.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,219.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,346.50
|
| Rate for Payer: PHCS Commercial |
$4,656.00
|
| Rate for Payer: United Healthcare All Payer |
$4,268.00
|
|
|
HED LEGCY PRICR 12/14 40MM+3.5
|
Facility
|
OP
|
$4,850.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,455.00 |
| Max. Negotiated Rate |
$4,656.00 |
| Rate for Payer: Aetna Commercial |
$3,734.50
|
| Rate for Payer: Anthem Medicaid |
$1,667.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,783.00
|
| Rate for Payer: Cash Price |
$2,425.00
|
| Rate for Payer: Cigna Commercial |
$4,025.50
|
| Rate for Payer: First Health Commercial |
$4,607.50
|
| Rate for Payer: Humana Commercial |
$4,122.50
|
| Rate for Payer: Humana KY Medicaid |
$1,667.91
|
| Rate for Payer: Kentucky WC Medicaid |
$1,684.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,977.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,579.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,455.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,701.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,268.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,637.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,219.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,346.50
|
| Rate for Payer: PHCS Commercial |
$4,656.00
|
| Rate for Payer: United Healthcare All Payer |
$4,268.00
|
|
|
HED LEGCY PRICR 12/14 40MM+7.0
|
Facility
|
IP
|
$4,850.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,455.00 |
| Max. Negotiated Rate |
$4,656.00 |
| Rate for Payer: Aetna Commercial |
$3,734.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,783.00
|
| Rate for Payer: Cash Price |
$2,425.00
|
| Rate for Payer: Cigna Commercial |
$4,025.50
|
| Rate for Payer: First Health Commercial |
$4,607.50
|
| Rate for Payer: Humana Commercial |
$4,122.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,977.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,579.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,455.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,268.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,637.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,219.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,346.50
|
| Rate for Payer: PHCS Commercial |
$4,656.00
|
| Rate for Payer: United Healthcare All Payer |
$4,268.00
|
|
|
HED LEGCY PRICR 12/14 40MM+7.0
|
Facility
|
OP
|
$4,850.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,455.00 |
| Max. Negotiated Rate |
$4,656.00 |
| Rate for Payer: Aetna Commercial |
$3,734.50
|
| Rate for Payer: Anthem Medicaid |
$1,667.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,783.00
|
| Rate for Payer: Cash Price |
$2,425.00
|
| Rate for Payer: Cigna Commercial |
$4,025.50
|
| Rate for Payer: First Health Commercial |
$4,607.50
|
| Rate for Payer: Humana Commercial |
$4,122.50
|
| Rate for Payer: Humana KY Medicaid |
$1,667.91
|
| Rate for Payer: Kentucky WC Medicaid |
$1,684.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,977.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,579.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,455.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,701.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,268.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,637.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,219.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,346.50
|
| Rate for Payer: PHCS Commercial |
$4,656.00
|
| Rate for Payer: United Healthcare All Payer |
$4,268.00
|
|
|
HED V40 TPR LFIT ANA 36MM +10
|
Facility
|
IP
|
$4,463.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,338.94 |
| Max. Negotiated Rate |
$4,284.62 |
| Rate for Payer: Aetna Commercial |
$3,436.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,481.26
|
| Rate for Payer: Cash Price |
$2,231.57
|
| Rate for Payer: Cigna Commercial |
$3,704.41
|
| Rate for Payer: First Health Commercial |
$4,239.99
|
| Rate for Payer: Humana Commercial |
$3,793.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,659.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,293.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,338.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,927.57
|
| Rate for Payer: Ohio Health Group HMO |
$3,347.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,570.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,882.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,079.57
|
| Rate for Payer: PHCS Commercial |
$4,284.62
|
| Rate for Payer: United Healthcare All Payer |
$3,927.57
|
|
|
HED V40 TPR LFIT ANA 36MM +10
|
Facility
|
OP
|
$4,463.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,338.94 |
| Max. Negotiated Rate |
$4,284.62 |
| Rate for Payer: Aetna Commercial |
$3,436.63
|
| Rate for Payer: Anthem Medicaid |
$1,534.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,481.26
|
| Rate for Payer: Cash Price |
$2,231.57
|
| Rate for Payer: Cigna Commercial |
$3,704.41
|
| Rate for Payer: First Health Commercial |
$4,239.99
|
| Rate for Payer: Humana Commercial |
$3,793.68
|
| Rate for Payer: Humana KY Medicaid |
$1,534.88
|
| Rate for Payer: Kentucky WC Medicaid |
$1,550.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,659.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,293.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,338.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,565.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,927.57
|
| Rate for Payer: Ohio Health Group HMO |
$3,347.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,570.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,882.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,079.57
|
| Rate for Payer: PHCS Commercial |
$4,284.62
|
| Rate for Payer: United Healthcare All Payer |
$3,927.57
|
|
|
HEEL LT (OS CALCIS) 2V
|
Facility
|
OP
|
$404.00
|
|
|
Service Code
|
HCPCS 73650
|
| Hospital Charge Code |
32000111
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$387.84 |
| Rate for Payer: Aetna Commercial |
$311.08
|
| Rate for Payer: Anthem Medicaid |
$138.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$315.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$202.00
|
| Rate for Payer: Cash Price |
$202.00
|
| Rate for Payer: Cigna Commercial |
$335.32
|
| Rate for Payer: First Health Commercial |
$383.80
|
| Rate for Payer: Humana Commercial |
$343.40
|
| Rate for Payer: Humana KY Medicaid |
$138.94
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$140.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$331.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$298.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$141.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$355.52
|
| Rate for Payer: Ohio Health Group HMO |
$303.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$323.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$351.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$278.76
|
| Rate for Payer: PHCS Commercial |
$387.84
|
| Rate for Payer: United Healthcare All Payer |
$355.52
|
|
|
HEEL LT (OS CALCIS) 2V
|
Facility
|
IP
|
$404.00
|
|
|
Service Code
|
HCPCS 73650
|
| Hospital Charge Code |
32000111
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$121.20 |
| Max. Negotiated Rate |
$387.84 |
| Rate for Payer: Aetna Commercial |
$311.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$315.12
|
| Rate for Payer: Cash Price |
$202.00
|
| Rate for Payer: Cigna Commercial |
$335.32
|
| Rate for Payer: First Health Commercial |
$383.80
|
| Rate for Payer: Humana Commercial |
$343.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$331.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$298.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$121.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$355.52
|
| Rate for Payer: Ohio Health Group HMO |
$303.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$323.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$351.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$278.76
|
| Rate for Payer: PHCS Commercial |
$387.84
|
| Rate for Payer: United Healthcare All Payer |
$355.52
|
|
