|
IN PACT ADMIRAL 5*40*130
|
Facility
|
IP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,657.50 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,806.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,812.25
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
IN PACT ADMIRAL 5*80*130
|
Facility
|
OP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,657.50 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem Medicaid |
$1,900.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Humana KY Medicaid |
$1,900.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,919.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,938.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,806.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,812.25
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
IN PACT ADMIRAL 5*80*130
|
Facility
|
IP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,657.50 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,806.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,812.25
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
IN PACT ADMIRAL 6*120*130
|
Facility
|
IP
|
$7,562.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,268.75 |
| Max. Negotiated Rate |
$7,260.00 |
| Rate for Payer: Aetna Commercial |
$5,823.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,898.75
|
| Rate for Payer: Cash Price |
$3,781.25
|
| Rate for Payer: Cigna Commercial |
$6,276.88
|
| Rate for Payer: First Health Commercial |
$7,184.38
|
| Rate for Payer: Humana Commercial |
$6,428.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,201.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,581.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,268.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,655.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,671.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,050.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,579.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,218.12
|
| Rate for Payer: PHCS Commercial |
$7,260.00
|
| Rate for Payer: United Healthcare All Payer |
$6,655.00
|
|
|
IN PACT ADMIRAL 6*120*130
|
Facility
|
OP
|
$7,562.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,268.75 |
| Max. Negotiated Rate |
$7,260.00 |
| Rate for Payer: Aetna Commercial |
$5,823.12
|
| Rate for Payer: Anthem Medicaid |
$2,600.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,898.75
|
| Rate for Payer: Cash Price |
$3,781.25
|
| Rate for Payer: Cigna Commercial |
$6,276.88
|
| Rate for Payer: First Health Commercial |
$7,184.38
|
| Rate for Payer: Humana Commercial |
$6,428.12
|
| Rate for Payer: Humana KY Medicaid |
$2,600.74
|
| Rate for Payer: Kentucky WC Medicaid |
$2,627.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,201.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,581.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,268.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,652.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,655.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,671.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,050.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,579.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,218.12
|
| Rate for Payer: PHCS Commercial |
$7,260.00
|
| Rate for Payer: United Healthcare All Payer |
$6,655.00
|
|
|
IN PACT ADMIRAL 6*150*130
|
Facility
|
OP
|
$7,197.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,159.25 |
| Max. Negotiated Rate |
$6,909.60 |
| Rate for Payer: Aetna Commercial |
$5,542.07
|
| Rate for Payer: Anthem Medicaid |
$2,475.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,614.05
|
| Rate for Payer: Cash Price |
$3,598.75
|
| Rate for Payer: Cigna Commercial |
$5,973.93
|
| Rate for Payer: First Health Commercial |
$6,837.62
|
| Rate for Payer: Humana Commercial |
$6,117.88
|
| Rate for Payer: Humana KY Medicaid |
$2,475.22
|
| Rate for Payer: Kentucky WC Medicaid |
$2,500.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,901.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,311.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,159.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,524.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,333.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,398.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,758.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,261.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,966.27
|
| Rate for Payer: PHCS Commercial |
$6,909.60
|
| Rate for Payer: United Healthcare All Payer |
$6,333.80
|
|
|
IN PACT ADMIRAL 6*150*130
|
Facility
|
IP
|
$7,197.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,159.25 |
| Max. Negotiated Rate |
$6,909.60 |
| Rate for Payer: Aetna Commercial |
$5,542.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,614.05
|
| Rate for Payer: Cash Price |
$3,598.75
|
| Rate for Payer: Cigna Commercial |
$5,973.93
|
| Rate for Payer: First Health Commercial |
$6,837.62
|
| Rate for Payer: Humana Commercial |
$6,117.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,901.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,311.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,159.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,333.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,398.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,758.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,261.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,966.27
|
| Rate for Payer: PHCS Commercial |
$6,909.60
|
| Rate for Payer: United Healthcare All Payer |
$6,333.80
|
|
|
IN PACT ADMIRAL 6*200*130
|
Facility
|
OP
|
$8,292.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,487.75 |
| Max. Negotiated Rate |
$7,960.80 |
| Rate for Payer: Aetna Commercial |
$6,385.23
|
| Rate for Payer: Anthem Medicaid |
$2,851.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,468.15
|
| Rate for Payer: Cash Price |
$4,146.25
|
| Rate for Payer: Cigna Commercial |
$6,882.77
|
| Rate for Payer: First Health Commercial |
$7,877.88
|
| Rate for Payer: Humana Commercial |
$7,048.62
|
| Rate for Payer: Humana KY Medicaid |
$2,851.79
|
| Rate for Payer: Kentucky WC Medicaid |
$2,880.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,799.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,119.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,487.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,909.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,297.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,219.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,634.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,214.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,721.82
|
| Rate for Payer: PHCS Commercial |
$7,960.80
|
| Rate for Payer: United Healthcare All Payer |
$7,297.40
|
|
|
IN PACT ADMIRAL 6*200*130
|
Facility
|
IP
|
$8,292.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,487.75 |
| Max. Negotiated Rate |
$7,960.80 |
| Rate for Payer: Aetna Commercial |
$6,385.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,468.15
|
| Rate for Payer: Cash Price |
$4,146.25
|
| Rate for Payer: Cigna Commercial |
$6,882.77
|
| Rate for Payer: First Health Commercial |
$7,877.88
|
| Rate for Payer: Humana Commercial |
$7,048.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,799.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,119.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,487.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,297.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,219.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,634.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,214.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,721.82
|
| Rate for Payer: PHCS Commercial |
$7,960.80
|
| Rate for Payer: United Healthcare All Payer |
$7,297.40
|
|
|
IN PACT ADMIRAL 6*250*130
|
Facility
|
IP
|
$11,757.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,527.25 |
| Max. Negotiated Rate |
$11,287.20 |
| Rate for Payer: Aetna Commercial |
$9,053.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,170.85
|
| Rate for Payer: Cash Price |
$5,878.75
|
| Rate for Payer: Cigna Commercial |
$9,758.73
|
| Rate for Payer: First Health Commercial |
$11,169.62
|
| Rate for Payer: Humana Commercial |
$9,993.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,641.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,677.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,527.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,346.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,818.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,406.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,229.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,112.68
|
| Rate for Payer: PHCS Commercial |
$11,287.20
|
| Rate for Payer: United Healthcare All Payer |
$10,346.60
|
|
|
IN PACT ADMIRAL 6*250*130
|
Facility
|
OP
|
$11,757.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,527.25 |
| Max. Negotiated Rate |
$11,287.20 |
| Rate for Payer: Aetna Commercial |
$9,053.27
|
| Rate for Payer: Anthem Medicaid |
$4,043.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,170.85
|
| Rate for Payer: Cash Price |
$5,878.75
|
| Rate for Payer: Cigna Commercial |
$9,758.73
|
| Rate for Payer: First Health Commercial |
$11,169.62
|
| Rate for Payer: Humana Commercial |
$9,993.88
|
| Rate for Payer: Humana KY Medicaid |
$4,043.40
|
| Rate for Payer: Kentucky WC Medicaid |
$4,084.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,641.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,677.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,527.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,124.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,346.60
|
| Rate for Payer: Ohio Health Group HMO |
$8,818.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,406.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,229.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,112.68
|
| Rate for Payer: PHCS Commercial |
$11,287.20
|
| Rate for Payer: United Healthcare All Payer |
$10,346.60
|
|
|
IN PACT ADMIRAL 6*40*130
|
Facility
|
OP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,657.50 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem Medicaid |
$1,900.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Humana KY Medicaid |
$1,900.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,919.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,938.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,806.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,812.25
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
IN PACT ADMIRAL 6*40*130
|
Facility
|
IP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,657.50 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,806.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,812.25
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
IN PACT ADMIRAL 6*60*130
|
Facility
|
IP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,657.50 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,806.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,812.25
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
IN PACT ADMIRAL 6*60*130
|
Facility
|
OP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,657.50 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem Medicaid |
$1,900.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Humana KY Medicaid |
$1,900.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,919.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,938.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,806.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,812.25
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
IN PACT ADMIRAL 6*80*130
|
Facility
|
IP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,657.50 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,806.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,812.25
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
IN PACT ADMIRAL 6*80*130
|
Facility
|
OP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,657.50 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem Medicaid |
$1,900.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Humana KY Medicaid |
$1,900.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,919.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,938.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,806.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,812.25
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
IN PACT ADMIRAL 7*40*130
|
Facility
|
IP
|
$8,146.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,443.95 |
| Max. Negotiated Rate |
$7,820.64 |
| Rate for Payer: Aetna Commercial |
$6,272.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,354.27
|
| Rate for Payer: Cash Price |
$4,073.25
|
| Rate for Payer: Cigna Commercial |
$6,761.60
|
| Rate for Payer: First Health Commercial |
$7,739.18
|
| Rate for Payer: Humana Commercial |
$6,924.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,680.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,012.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,443.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,168.92
|
| Rate for Payer: Ohio Health Group HMO |
$6,109.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,517.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,087.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,621.09
|
| Rate for Payer: PHCS Commercial |
$7,820.64
|
| Rate for Payer: United Healthcare All Payer |
$7,168.92
|
|
|
IN PACT ADMIRAL 7*40*130
|
Facility
|
OP
|
$8,146.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,443.95 |
| Max. Negotiated Rate |
$7,820.64 |
| Rate for Payer: Aetna Commercial |
$6,272.81
|
| Rate for Payer: Anthem Medicaid |
$2,801.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,354.27
|
| Rate for Payer: Cash Price |
$4,073.25
|
| Rate for Payer: Cigna Commercial |
$6,761.60
|
| Rate for Payer: First Health Commercial |
$7,739.18
|
| Rate for Payer: Humana Commercial |
$6,924.52
|
| Rate for Payer: Humana KY Medicaid |
$2,801.58
|
| Rate for Payer: Kentucky WC Medicaid |
$2,830.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,680.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,012.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,443.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,857.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,168.92
|
| Rate for Payer: Ohio Health Group HMO |
$6,109.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,517.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,087.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,621.09
|
| Rate for Payer: PHCS Commercial |
$7,820.64
|
| Rate for Payer: United Healthcare All Payer |
$7,168.92
|
|
|
IN PACT ADMIRAL 7*60*130
|
Facility
|
IP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,657.50 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,806.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,812.25
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
IN PACT ADMIRAL 7*60*130
|
Facility
|
OP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,657.50 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem Medicaid |
$1,900.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Humana KY Medicaid |
$1,900.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,919.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,938.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,806.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,812.25
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
IN PACT ADMIRAL 7*80*130
|
Facility
|
OP
|
$8,146.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,443.95 |
| Max. Negotiated Rate |
$7,820.64 |
| Rate for Payer: Aetna Commercial |
$6,272.81
|
| Rate for Payer: Anthem Medicaid |
$2,801.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,354.27
|
| Rate for Payer: Cash Price |
$4,073.25
|
| Rate for Payer: Cigna Commercial |
$6,761.60
|
| Rate for Payer: First Health Commercial |
$7,739.18
|
| Rate for Payer: Humana Commercial |
$6,924.52
|
| Rate for Payer: Humana KY Medicaid |
$2,801.58
|
| Rate for Payer: Kentucky WC Medicaid |
$2,830.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,680.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,012.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,443.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,857.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,168.92
|
| Rate for Payer: Ohio Health Group HMO |
$6,109.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,517.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,087.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,621.09
|
| Rate for Payer: PHCS Commercial |
$7,820.64
|
| Rate for Payer: United Healthcare All Payer |
$7,168.92
|
|
|
IN PACT ADMIRAL 7*80*130
|
Facility
|
IP
|
$8,146.50
|
|
|
Service Code
|
HCPCS C2623
|
| Hospital Charge Code |
27000276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,443.95 |
| Max. Negotiated Rate |
$7,820.64 |
| Rate for Payer: Aetna Commercial |
$6,272.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,354.27
|
| Rate for Payer: Cash Price |
$4,073.25
|
| Rate for Payer: Cigna Commercial |
$6,761.60
|
| Rate for Payer: First Health Commercial |
$7,739.18
|
| Rate for Payer: Humana Commercial |
$6,924.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,680.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,012.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,443.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,168.92
|
| Rate for Payer: Ohio Health Group HMO |
$6,109.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,517.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,087.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,621.09
|
| Rate for Payer: PHCS Commercial |
$7,820.64
|
| Rate for Payer: United Healthcare All Payer |
$7,168.92
|
|
|
INPATIENT HEMODIALYSIS
|
Facility
|
OP
|
$432.00
|
|
| Hospital Charge Code |
80000002
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$129.60 |
| Max. Negotiated Rate |
$414.72 |
| Rate for Payer: Aetna Commercial |
$332.64
|
| Rate for Payer: Anthem Medicaid |
$148.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$336.96
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cigna Commercial |
$358.56
|
| Rate for Payer: First Health Commercial |
$410.40
|
| Rate for Payer: Humana Commercial |
$367.20
|
| Rate for Payer: Humana KY Medicaid |
$148.56
|
| Rate for Payer: Kentucky WC Medicaid |
$150.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$354.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$318.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$129.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$151.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$380.16
|
| Rate for Payer: Ohio Health Group HMO |
$324.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$345.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$375.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$298.08
|
| Rate for Payer: PHCS Commercial |
$414.72
|
| Rate for Payer: United Healthcare All Payer |
$380.16
|
|
|
INPATIENT HEMODIALYSIS
|
Facility
|
IP
|
$432.00
|
|
| Hospital Charge Code |
80000002
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$129.60 |
| Max. Negotiated Rate |
$414.72 |
| Rate for Payer: Aetna Commercial |
$332.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$336.96
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cigna Commercial |
$358.56
|
| Rate for Payer: First Health Commercial |
$410.40
|
| Rate for Payer: Humana Commercial |
$367.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$354.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$318.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$129.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$380.16
|
| Rate for Payer: Ohio Health Group HMO |
$324.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$345.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$375.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$298.08
|
| Rate for Payer: PHCS Commercial |
$414.72
|
| Rate for Payer: United Healthcare All Payer |
$380.16
|
|
