|
IN PACT ADMIRAL 5*200*130
|
Facility
|
OP
|
$10,764.25
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,399.35 |
| Max. Negotiated Rate |
$10,333.68 |
| Rate for Payer: Aetna Commercial |
$8,288.47
|
| Rate for Payer: Anthem Medicaid |
$3,701.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,396.12
|
| Rate for Payer: Cash Price |
$5,382.12
|
| Rate for Payer: Cigna Commercial |
$8,934.33
|
| Rate for Payer: First Health Commercial |
$10,226.04
|
| Rate for Payer: Humana Commercial |
$9,149.61
|
| Rate for Payer: Humana KY Medicaid |
$3,701.83
|
| Rate for Payer: Kentucky WC Medicaid |
$3,739.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,826.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,944.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,229.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,776.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,472.54
|
| Rate for Payer: Ohio Health Group HMO |
$8,073.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,152.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,399.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,336.92
|
| Rate for Payer: PHCS Commercial |
$10,333.68
|
| Rate for Payer: United Healthcare All Payer |
$9,472.54
|
|
|
IN PACT ADMIRAL 5*250*130
|
Facility
|
OP
|
$8,640.00
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,123.20 |
| Max. Negotiated Rate |
$8,294.40 |
| Rate for Payer: Aetna Commercial |
$6,652.80
|
| Rate for Payer: Anthem Medicaid |
$2,971.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,739.20
|
| Rate for Payer: Cash Price |
$4,320.00
|
| Rate for Payer: Cigna Commercial |
$7,171.20
|
| Rate for Payer: First Health Commercial |
$8,208.00
|
| Rate for Payer: Humana Commercial |
$7,344.00
|
| Rate for Payer: Humana KY Medicaid |
$2,971.30
|
| Rate for Payer: Kentucky WC Medicaid |
$3,001.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,084.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,376.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,592.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,030.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,603.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,123.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,678.40
|
| Rate for Payer: PHCS Commercial |
$8,294.40
|
| Rate for Payer: United Healthcare All Payer |
$7,603.20
|
|
|
IN PACT ADMIRAL 5*250*130
|
Facility
|
IP
|
$8,640.00
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,123.20 |
| Max. Negotiated Rate |
$8,294.40 |
| Rate for Payer: Aetna Commercial |
$6,652.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,739.20
|
| Rate for Payer: Cash Price |
$4,320.00
|
| Rate for Payer: Cigna Commercial |
$7,171.20
|
| Rate for Payer: First Health Commercial |
$8,208.00
|
| Rate for Payer: Humana Commercial |
$7,344.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,084.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,376.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,592.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,603.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,123.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,678.40
|
| Rate for Payer: PHCS Commercial |
$8,294.40
|
| Rate for Payer: United Healthcare All Payer |
$7,603.20
|
|
|
IN PACT ADMIRAL 5*40*130
|
Facility
|
OP
|
$5,490.00
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$713.70 |
| Max. Negotiated Rate |
$5,270.40 |
| Rate for Payer: Aetna Commercial |
$4,227.30
|
| Rate for Payer: Anthem Medicaid |
$1,888.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,282.20
|
| Rate for Payer: Cash Price |
$2,745.00
|
| Rate for Payer: Cigna Commercial |
$4,556.70
|
| Rate for Payer: First Health Commercial |
$5,215.50
|
| Rate for Payer: Humana Commercial |
$4,666.50
|
| Rate for Payer: Humana KY Medicaid |
$1,888.01
|
| Rate for Payer: Kentucky WC Medicaid |
$1,907.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,501.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,051.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,647.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,925.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,831.20
|
| Rate for Payer: Ohio Health Group HMO |
$4,117.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,098.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$713.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,701.90
|
| Rate for Payer: PHCS Commercial |
$5,270.40
|
| Rate for Payer: United Healthcare All Payer |
$4,831.20
|
|
|
IN PACT ADMIRAL 5*40*130
|
Facility
|
IP
|
$5,490.00
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$713.70 |
| Max. Negotiated Rate |
$5,270.40 |
| Rate for Payer: Aetna Commercial |
$4,227.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,282.20
|
| Rate for Payer: Cash Price |
$2,745.00
|
| Rate for Payer: Cigna Commercial |
$4,556.70
|
| Rate for Payer: First Health Commercial |
$5,215.50
|
| Rate for Payer: Humana Commercial |
$4,666.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,501.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,051.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,647.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,831.20
|
| Rate for Payer: Ohio Health Group HMO |
$4,117.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,098.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$713.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,701.90
|
| Rate for Payer: PHCS Commercial |
$5,270.40
|
| Rate for Payer: United Healthcare All Payer |
$4,831.20
|
|
|
IN PACT ADMIRAL 5*80*130
|
Facility
|
IP
|
$7,362.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$957.12 |
| Max. Negotiated Rate |
$7,068.00 |
| Rate for Payer: Aetna Commercial |
$5,669.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
| Rate for Payer: Cash Price |
$3,681.25
|
| Rate for Payer: Cigna Commercial |
$6,110.88
|
| Rate for Payer: First Health Commercial |
$6,994.38
|
| Rate for Payer: Humana Commercial |
$6,258.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
| Rate for Payer: PHCS Commercial |
$7,068.00
|
| Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
|
IN PACT ADMIRAL 5*80*130
|
Facility
|
OP
|
$7,362.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$957.12 |
| Max. Negotiated Rate |
$7,068.00 |
| Rate for Payer: Aetna Commercial |
$5,669.12
|
| Rate for Payer: Anthem Medicaid |
$2,531.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
| Rate for Payer: Cash Price |
$3,681.25
|
| Rate for Payer: Cigna Commercial |
$6,110.88
|
| Rate for Payer: First Health Commercial |
$6,994.38
|
| Rate for Payer: Humana Commercial |
$6,258.12
|
| Rate for Payer: Humana KY Medicaid |
$2,531.96
|
| Rate for Payer: Kentucky WC Medicaid |
$2,557.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,582.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
| Rate for Payer: PHCS Commercial |
$7,068.00
|
| Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
|
IN PACT ADMIRAL 6*120*130
|
Facility
|
IP
|
$7,362.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$957.12 |
| Max. Negotiated Rate |
$7,068.00 |
| Rate for Payer: Aetna Commercial |
$5,669.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
| Rate for Payer: Cash Price |
$3,681.25
|
| Rate for Payer: Cigna Commercial |
$6,110.88
|
| Rate for Payer: First Health Commercial |
$6,994.38
|
| Rate for Payer: Humana Commercial |
$6,258.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
| Rate for Payer: PHCS Commercial |
$7,068.00
|
| Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
|
IN PACT ADMIRAL 6*120*130
|
Facility
|
OP
|
$7,362.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$957.12 |
| Max. Negotiated Rate |
$7,068.00 |
| Rate for Payer: Aetna Commercial |
$5,669.12
|
| Rate for Payer: Anthem Medicaid |
$2,531.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
| Rate for Payer: Cash Price |
$3,681.25
|
| Rate for Payer: Cigna Commercial |
$6,110.88
|
| Rate for Payer: First Health Commercial |
$6,994.38
|
| Rate for Payer: Humana Commercial |
$6,258.12
|
| Rate for Payer: Humana KY Medicaid |
$2,531.96
|
| Rate for Payer: Kentucky WC Medicaid |
$2,557.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,582.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
| Rate for Payer: PHCS Commercial |
$7,068.00
|
| Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
|
IN PACT ADMIRAL 6*150*130
|
Facility
|
OP
|
$6,997.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$909.68 |
| Max. Negotiated Rate |
$6,717.60 |
| Rate for Payer: Aetna Commercial |
$5,388.08
|
| Rate for Payer: Anthem Medicaid |
$2,406.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,458.05
|
| Rate for Payer: Cash Price |
$3,498.75
|
| Rate for Payer: Cigna Commercial |
$5,807.92
|
| Rate for Payer: First Health Commercial |
$6,647.62
|
| Rate for Payer: Humana Commercial |
$5,947.88
|
| Rate for Payer: Humana KY Medicaid |
$2,406.44
|
| Rate for Payer: Kentucky WC Medicaid |
$2,430.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,737.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,164.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,099.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,454.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,157.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,248.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$909.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,169.22
|
| Rate for Payer: PHCS Commercial |
$6,717.60
|
| Rate for Payer: United Healthcare All Payer |
$6,157.80
|
|
|
IN PACT ADMIRAL 6*150*130
|
Facility
|
IP
|
$6,997.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$909.68 |
| Max. Negotiated Rate |
$6,717.60 |
| Rate for Payer: Aetna Commercial |
$5,388.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,458.05
|
| Rate for Payer: Cash Price |
$3,498.75
|
| Rate for Payer: Cigna Commercial |
$5,807.92
|
| Rate for Payer: First Health Commercial |
$6,647.62
|
| Rate for Payer: Humana Commercial |
$5,947.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,737.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,164.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,099.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,157.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,248.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$909.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,169.22
|
| Rate for Payer: PHCS Commercial |
$6,717.60
|
| Rate for Payer: United Healthcare All Payer |
$6,157.80
|
|
|
IN PACT ADMIRAL 6*200*130
|
Facility
|
IP
|
$10,764.25
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,399.35 |
| Max. Negotiated Rate |
$10,333.68 |
| Rate for Payer: Aetna Commercial |
$8,288.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,396.12
|
| Rate for Payer: Cash Price |
$5,382.12
|
| Rate for Payer: Cigna Commercial |
$8,934.33
|
| Rate for Payer: First Health Commercial |
$10,226.04
|
| Rate for Payer: Humana Commercial |
$9,149.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,826.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,944.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,229.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,472.54
|
| Rate for Payer: Ohio Health Group HMO |
$8,073.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,152.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,399.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,336.92
|
| Rate for Payer: PHCS Commercial |
$10,333.68
|
| Rate for Payer: United Healthcare All Payer |
$9,472.54
|
|
|
IN PACT ADMIRAL 6*200*130
|
Facility
|
OP
|
$10,764.25
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,399.35 |
| Max. Negotiated Rate |
$10,333.68 |
| Rate for Payer: Aetna Commercial |
$8,288.47
|
| Rate for Payer: Anthem Medicaid |
$3,701.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,396.12
|
| Rate for Payer: Cash Price |
$5,382.12
|
| Rate for Payer: Cigna Commercial |
$8,934.33
|
| Rate for Payer: First Health Commercial |
$10,226.04
|
| Rate for Payer: Humana Commercial |
$9,149.61
|
| Rate for Payer: Humana KY Medicaid |
$3,701.83
|
| Rate for Payer: Kentucky WC Medicaid |
$3,739.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,826.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,944.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,229.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,776.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,472.54
|
| Rate for Payer: Ohio Health Group HMO |
$8,073.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,152.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,399.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,336.92
|
| Rate for Payer: PHCS Commercial |
$10,333.68
|
| Rate for Payer: United Healthcare All Payer |
$9,472.54
|
|
|
IN PACT ADMIRAL 6*250*130
|
Facility
|
OP
|
$11,512.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,496.62 |
| Max. Negotiated Rate |
$11,052.00 |
| Rate for Payer: Aetna Commercial |
$8,864.62
|
| Rate for Payer: Anthem Medicaid |
$3,959.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,979.75
|
| Rate for Payer: Cash Price |
$5,756.25
|
| Rate for Payer: Cigna Commercial |
$9,555.38
|
| Rate for Payer: First Health Commercial |
$10,936.88
|
| Rate for Payer: Humana Commercial |
$9,785.62
|
| Rate for Payer: Humana KY Medicaid |
$3,959.15
|
| Rate for Payer: Kentucky WC Medicaid |
$3,999.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,440.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,496.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,453.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,038.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,131.00
|
| Rate for Payer: Ohio Health Group HMO |
$8,634.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,302.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,496.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,568.88
|
| Rate for Payer: PHCS Commercial |
$11,052.00
|
| Rate for Payer: United Healthcare All Payer |
$10,131.00
|
|
|
IN PACT ADMIRAL 6*250*130
|
Facility
|
IP
|
$11,512.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,496.62 |
| Max. Negotiated Rate |
$11,052.00 |
| Rate for Payer: Aetna Commercial |
$8,864.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,979.75
|
| Rate for Payer: Cash Price |
$5,756.25
|
| Rate for Payer: Cigna Commercial |
$9,555.38
|
| Rate for Payer: First Health Commercial |
$10,936.88
|
| Rate for Payer: Humana Commercial |
$9,785.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,440.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,496.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,453.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,131.00
|
| Rate for Payer: Ohio Health Group HMO |
$8,634.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,302.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,496.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,568.88
|
| Rate for Payer: PHCS Commercial |
$11,052.00
|
| Rate for Payer: United Healthcare All Payer |
$10,131.00
|
|
|
IN PACT ADMIRAL 6*40*130
|
Facility
|
OP
|
$7,362.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$957.12 |
| Max. Negotiated Rate |
$7,068.00 |
| Rate for Payer: Aetna Commercial |
$5,669.12
|
| Rate for Payer: Anthem Medicaid |
$2,531.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
| Rate for Payer: Cash Price |
$3,681.25
|
| Rate for Payer: Cigna Commercial |
$6,110.88
|
| Rate for Payer: First Health Commercial |
$6,994.38
|
| Rate for Payer: Humana Commercial |
$6,258.12
|
| Rate for Payer: Humana KY Medicaid |
$2,531.96
|
| Rate for Payer: Kentucky WC Medicaid |
$2,557.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,582.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
| Rate for Payer: PHCS Commercial |
$7,068.00
|
| Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
|
IN PACT ADMIRAL 6*40*130
|
Facility
|
IP
|
$7,362.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$957.12 |
| Max. Negotiated Rate |
$7,068.00 |
| Rate for Payer: Aetna Commercial |
$5,669.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.75
|
| Rate for Payer: Cash Price |
$3,681.25
|
| Rate for Payer: Cigna Commercial |
$6,110.88
|
| Rate for Payer: First Health Commercial |
$6,994.38
|
| Rate for Payer: Humana Commercial |
$6,258.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,037.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,433.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,479.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,521.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,472.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.38
|
| Rate for Payer: PHCS Commercial |
$7,068.00
|
| Rate for Payer: United Healthcare All Payer |
$6,479.00
|
|
|
IN PACT ADMIRAL 6*60*130
|
Facility
|
IP
|
$5,490.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$713.70 |
| Max. Negotiated Rate |
$5,270.40 |
| Rate for Payer: Aetna Commercial |
$4,227.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,282.20
|
| Rate for Payer: Cash Price |
$2,745.00
|
| Rate for Payer: Cigna Commercial |
$4,556.70
|
| Rate for Payer: First Health Commercial |
$5,215.50
|
| Rate for Payer: Humana Commercial |
$4,666.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,501.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,051.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,647.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,831.20
|
| Rate for Payer: Ohio Health Group HMO |
$4,117.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,098.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$713.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,701.90
|
| Rate for Payer: PHCS Commercial |
$5,270.40
|
| Rate for Payer: United Healthcare All Payer |
$4,831.20
|
|
|
IN PACT ADMIRAL 6*60*130
|
Facility
|
OP
|
$5,490.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$713.70 |
| Max. Negotiated Rate |
$5,270.40 |
| Rate for Payer: Aetna Commercial |
$4,227.30
|
| Rate for Payer: Anthem Medicaid |
$1,888.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,282.20
|
| Rate for Payer: Cash Price |
$2,745.00
|
| Rate for Payer: Cigna Commercial |
$4,556.70
|
| Rate for Payer: First Health Commercial |
$5,215.50
|
| Rate for Payer: Humana Commercial |
$4,666.50
|
| Rate for Payer: Humana KY Medicaid |
$1,888.01
|
| Rate for Payer: Kentucky WC Medicaid |
$1,907.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,501.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,051.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,647.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,925.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,831.20
|
| Rate for Payer: Ohio Health Group HMO |
$4,117.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,098.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$713.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,701.90
|
| Rate for Payer: PHCS Commercial |
$5,270.40
|
| Rate for Payer: United Healthcare All Payer |
$4,831.20
|
|
|
IN PACT ADMIRAL 6*80*130
|
Facility
|
IP
|
$5,490.00
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$713.70 |
| Max. Negotiated Rate |
$5,270.40 |
| Rate for Payer: Aetna Commercial |
$4,227.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,282.20
|
| Rate for Payer: Cash Price |
$2,745.00
|
| Rate for Payer: Cigna Commercial |
$4,556.70
|
| Rate for Payer: First Health Commercial |
$5,215.50
|
| Rate for Payer: Humana Commercial |
$4,666.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,501.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,051.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,647.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,831.20
|
| Rate for Payer: Ohio Health Group HMO |
$4,117.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,098.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$713.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,701.90
|
| Rate for Payer: PHCS Commercial |
$5,270.40
|
| Rate for Payer: United Healthcare All Payer |
$4,831.20
|
|
|
IN PACT ADMIRAL 6*80*130
|
Facility
|
OP
|
$5,490.00
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$713.70 |
| Max. Negotiated Rate |
$5,270.40 |
| Rate for Payer: Aetna Commercial |
$4,227.30
|
| Rate for Payer: Anthem Medicaid |
$1,888.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,282.20
|
| Rate for Payer: Cash Price |
$2,745.00
|
| Rate for Payer: Cigna Commercial |
$4,556.70
|
| Rate for Payer: First Health Commercial |
$5,215.50
|
| Rate for Payer: Humana Commercial |
$4,666.50
|
| Rate for Payer: Humana KY Medicaid |
$1,888.01
|
| Rate for Payer: Kentucky WC Medicaid |
$1,907.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,501.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,051.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,647.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,925.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,831.20
|
| Rate for Payer: Ohio Health Group HMO |
$4,117.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,098.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$713.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,701.90
|
| Rate for Payer: PHCS Commercial |
$5,270.40
|
| Rate for Payer: United Healthcare All Payer |
$4,831.20
|
|
|
IN PACT ADMIRAL 7*40*130
|
Facility
|
OP
|
$7,946.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,033.04 |
| Max. Negotiated Rate |
$7,628.64 |
| Rate for Payer: Aetna Commercial |
$6,118.80
|
| Rate for Payer: Anthem Medicaid |
$2,732.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,198.27
|
| Rate for Payer: Cash Price |
$3,973.25
|
| Rate for Payer: Cigna Commercial |
$6,595.60
|
| Rate for Payer: First Health Commercial |
$7,549.18
|
| Rate for Payer: Humana Commercial |
$6,754.52
|
| Rate for Payer: Humana KY Medicaid |
$2,732.80
|
| Rate for Payer: Kentucky WC Medicaid |
$2,760.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,516.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,864.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,383.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,787.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,992.92
|
| Rate for Payer: Ohio Health Group HMO |
$5,959.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,589.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,033.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,463.42
|
| Rate for Payer: PHCS Commercial |
$7,628.64
|
| Rate for Payer: United Healthcare All Payer |
$6,992.92
|
|
|
IN PACT ADMIRAL 7*40*130
|
Facility
|
IP
|
$7,946.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,033.04 |
| Max. Negotiated Rate |
$7,628.64 |
| Rate for Payer: Aetna Commercial |
$6,118.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,198.27
|
| Rate for Payer: Cash Price |
$3,973.25
|
| Rate for Payer: Cigna Commercial |
$6,595.60
|
| Rate for Payer: First Health Commercial |
$7,549.18
|
| Rate for Payer: Humana Commercial |
$6,754.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,516.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,864.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,383.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,992.92
|
| Rate for Payer: Ohio Health Group HMO |
$5,959.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,589.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,033.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,463.42
|
| Rate for Payer: PHCS Commercial |
$7,628.64
|
| Rate for Payer: United Healthcare All Payer |
$6,992.92
|
|
|
IN PACT ADMIRAL 7*60*130
|
Facility
|
OP
|
$7,946.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,033.04 |
| Max. Negotiated Rate |
$7,628.64 |
| Rate for Payer: Aetna Commercial |
$6,118.80
|
| Rate for Payer: Anthem Medicaid |
$2,732.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,198.27
|
| Rate for Payer: Cash Price |
$3,973.25
|
| Rate for Payer: Cigna Commercial |
$6,595.60
|
| Rate for Payer: First Health Commercial |
$7,549.18
|
| Rate for Payer: Humana Commercial |
$6,754.52
|
| Rate for Payer: Humana KY Medicaid |
$2,732.80
|
| Rate for Payer: Kentucky WC Medicaid |
$2,760.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,516.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,864.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,383.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,787.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,992.92
|
| Rate for Payer: Ohio Health Group HMO |
$5,959.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,589.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,033.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,463.42
|
| Rate for Payer: PHCS Commercial |
$7,628.64
|
| Rate for Payer: United Healthcare All Payer |
$6,992.92
|
|
|
IN PACT ADMIRAL 7*60*130
|
Facility
|
IP
|
$7,946.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,033.04 |
| Max. Negotiated Rate |
$7,628.64 |
| Rate for Payer: Aetna Commercial |
$6,118.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,198.27
|
| Rate for Payer: Cash Price |
$3,973.25
|
| Rate for Payer: Cigna Commercial |
$6,595.60
|
| Rate for Payer: First Health Commercial |
$7,549.18
|
| Rate for Payer: Humana Commercial |
$6,754.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,516.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,864.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,383.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,992.92
|
| Rate for Payer: Ohio Health Group HMO |
$5,959.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,589.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,033.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,463.42
|
| Rate for Payer: PHCS Commercial |
$7,628.64
|
| Rate for Payer: United Healthcare All Payer |
$6,992.92
|
|
