|
LEAD 4068-45
|
Facility
|
IP
|
$3,530.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$458.90 |
| Max. Negotiated Rate |
$3,388.80 |
| Rate for Payer: Aetna Commercial |
$2,718.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,753.40
|
| Rate for Payer: Cash Price |
$1,765.00
|
| Rate for Payer: Cigna Commercial |
$2,929.90
|
| Rate for Payer: First Health Commercial |
$3,353.50
|
| Rate for Payer: Humana Commercial |
$3,000.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,894.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,605.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,059.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,106.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,647.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$706.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$458.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,094.30
|
| Rate for Payer: PHCS Commercial |
$3,388.80
|
| Rate for Payer: United Healthcare All Payer |
$3,106.40
|
|
|
LEAD 4068-52
|
Facility
|
IP
|
$3,530.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$458.90 |
| Max. Negotiated Rate |
$3,388.80 |
| Rate for Payer: Aetna Commercial |
$2,718.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,753.40
|
| Rate for Payer: Cash Price |
$1,765.00
|
| Rate for Payer: Cigna Commercial |
$2,929.90
|
| Rate for Payer: First Health Commercial |
$3,353.50
|
| Rate for Payer: Humana Commercial |
$3,000.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,894.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,605.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,059.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,106.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,647.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$706.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$458.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,094.30
|
| Rate for Payer: PHCS Commercial |
$3,388.80
|
| Rate for Payer: United Healthcare All Payer |
$3,106.40
|
|
|
LEAD 4068-52
|
Facility
|
OP
|
$3,530.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$458.90 |
| Max. Negotiated Rate |
$3,388.80 |
| Rate for Payer: Aetna Commercial |
$2,718.10
|
| Rate for Payer: Anthem Medicaid |
$1,213.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,753.40
|
| Rate for Payer: Cash Price |
$1,765.00
|
| Rate for Payer: Cigna Commercial |
$2,929.90
|
| Rate for Payer: First Health Commercial |
$3,353.50
|
| Rate for Payer: Humana Commercial |
$3,000.50
|
| Rate for Payer: Humana KY Medicaid |
$1,213.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,226.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,894.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,605.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,059.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,238.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,106.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,647.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$706.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$458.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,094.30
|
| Rate for Payer: PHCS Commercial |
$3,388.80
|
| Rate for Payer: United Healthcare All Payer |
$3,106.40
|
|
|
LEAD 4068-58
|
Facility
|
IP
|
$3,530.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$458.90 |
| Max. Negotiated Rate |
$3,388.80 |
| Rate for Payer: Aetna Commercial |
$2,718.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,753.40
|
| Rate for Payer: Cash Price |
$1,765.00
|
| Rate for Payer: Cigna Commercial |
$2,929.90
|
| Rate for Payer: First Health Commercial |
$3,353.50
|
| Rate for Payer: Humana Commercial |
$3,000.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,894.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,605.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,059.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,106.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,647.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$706.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$458.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,094.30
|
| Rate for Payer: PHCS Commercial |
$3,388.80
|
| Rate for Payer: United Healthcare All Payer |
$3,106.40
|
|
|
LEAD 4068-58
|
Facility
|
OP
|
$3,530.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$458.90 |
| Max. Negotiated Rate |
$3,388.80 |
| Rate for Payer: Aetna Commercial |
$2,718.10
|
| Rate for Payer: Anthem Medicaid |
$1,213.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,753.40
|
| Rate for Payer: Cash Price |
$1,765.00
|
| Rate for Payer: Cigna Commercial |
$2,929.90
|
| Rate for Payer: First Health Commercial |
$3,353.50
|
| Rate for Payer: Humana Commercial |
$3,000.50
|
| Rate for Payer: Humana KY Medicaid |
$1,213.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,226.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,894.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,605.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,059.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,238.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,106.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,647.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$706.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$458.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,094.30
|
| Rate for Payer: PHCS Commercial |
$3,388.80
|
| Rate for Payer: United Healthcare All Payer |
$3,106.40
|
|
|
LEAD 4092
|
Facility
|
IP
|
$3,530.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$458.90 |
| Max. Negotiated Rate |
$3,388.80 |
| Rate for Payer: Aetna Commercial |
$2,718.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,753.40
|
| Rate for Payer: Cash Price |
$1,765.00
|
| Rate for Payer: Cigna Commercial |
$2,929.90
|
| Rate for Payer: First Health Commercial |
$3,353.50
|
| Rate for Payer: Humana Commercial |
$3,000.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,894.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,605.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,059.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,106.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,647.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$706.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$458.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,094.30
|
| Rate for Payer: PHCS Commercial |
$3,388.80
|
| Rate for Payer: United Healthcare All Payer |
$3,106.40
|
|
|
LEAD 4092
|
Facility
|
OP
|
$3,530.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$458.90 |
| Max. Negotiated Rate |
$3,388.80 |
| Rate for Payer: Aetna Commercial |
$2,718.10
|
| Rate for Payer: Anthem Medicaid |
$1,213.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,753.40
|
| Rate for Payer: Cash Price |
$1,765.00
|
| Rate for Payer: Cigna Commercial |
$2,929.90
|
| Rate for Payer: First Health Commercial |
$3,353.50
|
| Rate for Payer: Humana Commercial |
$3,000.50
|
| Rate for Payer: Humana KY Medicaid |
$1,213.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,226.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,894.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,605.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,059.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,238.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,106.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,647.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$706.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$458.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,094.30
|
| Rate for Payer: PHCS Commercial |
$3,388.80
|
| Rate for Payer: United Healthcare All Payer |
$3,106.40
|
|
|
LEAD 4193-78 ATTAIN OTW
|
Facility
|
IP
|
$9,552.50
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,241.82 |
| Max. Negotiated Rate |
$9,170.40 |
| Rate for Payer: Aetna Commercial |
$7,355.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,450.95
|
| Rate for Payer: Cash Price |
$4,776.25
|
| Rate for Payer: Cigna Commercial |
$7,928.58
|
| Rate for Payer: First Health Commercial |
$9,074.88
|
| Rate for Payer: Humana Commercial |
$8,119.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,833.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,049.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,865.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,406.20
|
| Rate for Payer: Ohio Health Group HMO |
$7,164.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,910.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,241.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,961.28
|
| Rate for Payer: PHCS Commercial |
$9,170.40
|
| Rate for Payer: United Healthcare All Payer |
$8,406.20
|
|
|
LEAD 4193-78 ATTAIN OTW
|
Facility
|
OP
|
$9,552.50
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,241.82 |
| Max. Negotiated Rate |
$9,170.40 |
| Rate for Payer: Aetna Commercial |
$7,355.42
|
| Rate for Payer: Anthem Medicaid |
$3,285.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,450.95
|
| Rate for Payer: Cash Price |
$4,776.25
|
| Rate for Payer: Cigna Commercial |
$7,928.58
|
| Rate for Payer: First Health Commercial |
$9,074.88
|
| Rate for Payer: Humana Commercial |
$8,119.62
|
| Rate for Payer: Humana KY Medicaid |
$3,285.10
|
| Rate for Payer: Kentucky WC Medicaid |
$3,318.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,833.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,049.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,865.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,351.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,406.20
|
| Rate for Payer: Ohio Health Group HMO |
$7,164.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,910.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,241.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,961.28
|
| Rate for Payer: PHCS Commercial |
$9,170.40
|
| Rate for Payer: United Healthcare All Payer |
$8,406.20
|
|
|
LEAD 4523-45
|
Facility
|
IP
|
$5,280.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$686.40 |
| Max. Negotiated Rate |
$5,068.80 |
| Rate for Payer: Aetna Commercial |
$4,065.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,118.40
|
| Rate for Payer: Cash Price |
$2,640.00
|
| Rate for Payer: Cigna Commercial |
$4,382.40
|
| Rate for Payer: First Health Commercial |
$5,016.00
|
| Rate for Payer: Humana Commercial |
$4,488.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,329.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,896.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,584.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,646.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,960.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,056.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$686.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,636.80
|
| Rate for Payer: PHCS Commercial |
$5,068.80
|
| Rate for Payer: United Healthcare All Payer |
$4,646.40
|
|
|
LEAD 4523-45
|
Facility
|
OP
|
$5,280.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$686.40 |
| Max. Negotiated Rate |
$5,068.80 |
| Rate for Payer: Aetna Commercial |
$4,065.60
|
| Rate for Payer: Anthem Medicaid |
$1,815.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,118.40
|
| Rate for Payer: Cash Price |
$2,640.00
|
| Rate for Payer: Cigna Commercial |
$4,382.40
|
| Rate for Payer: First Health Commercial |
$5,016.00
|
| Rate for Payer: Humana Commercial |
$4,488.00
|
| Rate for Payer: Humana KY Medicaid |
$1,815.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,834.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,329.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,896.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,584.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,852.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,646.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,960.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,056.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$686.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,636.80
|
| Rate for Payer: PHCS Commercial |
$5,068.80
|
| Rate for Payer: United Healthcare All Payer |
$4,646.40
|
|
|
LEAD 4568-45
|
Facility
|
OP
|
$3,530.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$458.90 |
| Max. Negotiated Rate |
$3,388.80 |
| Rate for Payer: Aetna Commercial |
$2,718.10
|
| Rate for Payer: Anthem Medicaid |
$1,213.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,753.40
|
| Rate for Payer: Cash Price |
$1,765.00
|
| Rate for Payer: Cigna Commercial |
$2,929.90
|
| Rate for Payer: First Health Commercial |
$3,353.50
|
| Rate for Payer: Humana Commercial |
$3,000.50
|
| Rate for Payer: Humana KY Medicaid |
$1,213.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,226.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,894.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,605.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,059.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,238.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,106.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,647.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$706.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$458.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,094.30
|
| Rate for Payer: PHCS Commercial |
$3,388.80
|
| Rate for Payer: United Healthcare All Payer |
$3,106.40
|
|
|
LEAD 4568-45
|
Facility
|
IP
|
$3,530.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$458.90 |
| Max. Negotiated Rate |
$3,388.80 |
| Rate for Payer: Aetna Commercial |
$2,718.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,753.40
|
| Rate for Payer: Cash Price |
$1,765.00
|
| Rate for Payer: Cigna Commercial |
$2,929.90
|
| Rate for Payer: First Health Commercial |
$3,353.50
|
| Rate for Payer: Humana Commercial |
$3,000.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,894.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,605.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,059.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,106.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,647.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$706.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$458.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,094.30
|
| Rate for Payer: PHCS Commercial |
$3,388.80
|
| Rate for Payer: United Healthcare All Payer |
$3,106.40
|
|
|
LEAD 4568-53
|
Facility
|
IP
|
$3,530.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$458.90 |
| Max. Negotiated Rate |
$3,388.80 |
| Rate for Payer: Aetna Commercial |
$2,718.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,753.40
|
| Rate for Payer: Cash Price |
$1,765.00
|
| Rate for Payer: Cigna Commercial |
$2,929.90
|
| Rate for Payer: First Health Commercial |
$3,353.50
|
| Rate for Payer: Humana Commercial |
$3,000.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,894.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,605.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,059.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,106.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,647.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$706.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$458.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,094.30
|
| Rate for Payer: PHCS Commercial |
$3,388.80
|
| Rate for Payer: United Healthcare All Payer |
$3,106.40
|
|
|
LEAD 4568-53
|
Facility
|
OP
|
$3,530.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$458.90 |
| Max. Negotiated Rate |
$3,388.80 |
| Rate for Payer: Aetna Commercial |
$2,718.10
|
| Rate for Payer: Anthem Medicaid |
$1,213.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,753.40
|
| Rate for Payer: Cash Price |
$1,765.00
|
| Rate for Payer: Cigna Commercial |
$2,929.90
|
| Rate for Payer: First Health Commercial |
$3,353.50
|
| Rate for Payer: Humana Commercial |
$3,000.50
|
| Rate for Payer: Humana KY Medicaid |
$1,213.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,226.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,894.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,605.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,059.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,238.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,106.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,647.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$706.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$458.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,094.30
|
| Rate for Payer: PHCS Commercial |
$3,388.80
|
| Rate for Payer: United Healthcare All Payer |
$3,106.40
|
|
|
LEAD 5068-52
|
Facility
|
IP
|
$3,530.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$458.90 |
| Max. Negotiated Rate |
$3,388.80 |
| Rate for Payer: Aetna Commercial |
$2,718.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,753.40
|
| Rate for Payer: Cash Price |
$1,765.00
|
| Rate for Payer: Cigna Commercial |
$2,929.90
|
| Rate for Payer: First Health Commercial |
$3,353.50
|
| Rate for Payer: Humana Commercial |
$3,000.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,894.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,605.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,059.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,106.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,647.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$706.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$458.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,094.30
|
| Rate for Payer: PHCS Commercial |
$3,388.80
|
| Rate for Payer: United Healthcare All Payer |
$3,106.40
|
|
|
LEAD 5068-52
|
Facility
|
OP
|
$3,530.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$458.90 |
| Max. Negotiated Rate |
$3,388.80 |
| Rate for Payer: Aetna Commercial |
$2,718.10
|
| Rate for Payer: Anthem Medicaid |
$1,213.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,753.40
|
| Rate for Payer: Cash Price |
$1,765.00
|
| Rate for Payer: Cigna Commercial |
$2,929.90
|
| Rate for Payer: First Health Commercial |
$3,353.50
|
| Rate for Payer: Humana Commercial |
$3,000.50
|
| Rate for Payer: Humana KY Medicaid |
$1,213.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,226.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,894.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,605.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,059.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,238.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,106.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,647.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$706.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$458.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,094.30
|
| Rate for Payer: PHCS Commercial |
$3,388.80
|
| Rate for Payer: United Healthcare All Payer |
$3,106.40
|
|
|
LEAD 5068-58
|
Facility
|
OP
|
$3,530.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$458.90 |
| Max. Negotiated Rate |
$3,388.80 |
| Rate for Payer: Aetna Commercial |
$2,718.10
|
| Rate for Payer: Anthem Medicaid |
$1,213.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,753.40
|
| Rate for Payer: Cash Price |
$1,765.00
|
| Rate for Payer: Cigna Commercial |
$2,929.90
|
| Rate for Payer: First Health Commercial |
$3,353.50
|
| Rate for Payer: Humana Commercial |
$3,000.50
|
| Rate for Payer: Humana KY Medicaid |
$1,213.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,226.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,894.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,605.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,059.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,238.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,106.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,647.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$706.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$458.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,094.30
|
| Rate for Payer: PHCS Commercial |
$3,388.80
|
| Rate for Payer: United Healthcare All Payer |
$3,106.40
|
|
|
LEAD 5068-58
|
Facility
|
IP
|
$3,530.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$458.90 |
| Max. Negotiated Rate |
$3,388.80 |
| Rate for Payer: Aetna Commercial |
$2,718.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,753.40
|
| Rate for Payer: Cash Price |
$1,765.00
|
| Rate for Payer: Cigna Commercial |
$2,929.90
|
| Rate for Payer: First Health Commercial |
$3,353.50
|
| Rate for Payer: Humana Commercial |
$3,000.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,894.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,605.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,059.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,106.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,647.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$706.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$458.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,094.30
|
| Rate for Payer: PHCS Commercial |
$3,388.80
|
| Rate for Payer: United Healthcare All Payer |
$3,106.40
|
|
|
LEAD 5076-45 BI SIL STEROID SC
|
Facility
|
OP
|
$3,111.30
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$404.47 |
| Max. Negotiated Rate |
$2,986.85 |
| Rate for Payer: Aetna Commercial |
$2,395.70
|
| Rate for Payer: Anthem Medicaid |
$1,069.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,426.81
|
| Rate for Payer: Cash Price |
$1,555.65
|
| Rate for Payer: Cigna Commercial |
$2,582.38
|
| Rate for Payer: First Health Commercial |
$2,955.74
|
| Rate for Payer: Humana Commercial |
$2,644.60
|
| Rate for Payer: Humana KY Medicaid |
$1,069.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,080.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,551.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,296.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$933.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,091.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,737.94
|
| Rate for Payer: Ohio Health Group HMO |
$2,333.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$622.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$404.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$964.50
|
| Rate for Payer: PHCS Commercial |
$2,986.85
|
| Rate for Payer: United Healthcare All Payer |
$2,737.94
|
|
|
LEAD 5076-45 BI SIL STEROID SC
|
Facility
|
IP
|
$3,111.30
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$404.47 |
| Max. Negotiated Rate |
$2,986.85 |
| Rate for Payer: Aetna Commercial |
$2,395.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,426.81
|
| Rate for Payer: Cash Price |
$1,555.65
|
| Rate for Payer: Cigna Commercial |
$2,582.38
|
| Rate for Payer: First Health Commercial |
$2,955.74
|
| Rate for Payer: Humana Commercial |
$2,644.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,551.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,296.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$933.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,737.94
|
| Rate for Payer: Ohio Health Group HMO |
$2,333.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$622.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$404.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$964.50
|
| Rate for Payer: PHCS Commercial |
$2,986.85
|
| Rate for Payer: United Healthcare All Payer |
$2,737.94
|
|
|
LEAD 5076-52 BI SIL STEROID FI
|
Facility
|
IP
|
$3,111.30
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$404.47 |
| Max. Negotiated Rate |
$2,986.85 |
| Rate for Payer: Aetna Commercial |
$2,395.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,426.81
|
| Rate for Payer: Cash Price |
$1,555.65
|
| Rate for Payer: Cigna Commercial |
$2,582.38
|
| Rate for Payer: First Health Commercial |
$2,955.74
|
| Rate for Payer: Humana Commercial |
$2,644.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,551.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,296.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$933.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,737.94
|
| Rate for Payer: Ohio Health Group HMO |
$2,333.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$622.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$404.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$964.50
|
| Rate for Payer: PHCS Commercial |
$2,986.85
|
| Rate for Payer: United Healthcare All Payer |
$2,737.94
|
|
|
LEAD 5076-52 BI SIL STEROID FI
|
Facility
|
OP
|
$3,111.30
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$404.47 |
| Max. Negotiated Rate |
$2,986.85 |
| Rate for Payer: Aetna Commercial |
$2,395.70
|
| Rate for Payer: Anthem Medicaid |
$1,069.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,426.81
|
| Rate for Payer: Cash Price |
$1,555.65
|
| Rate for Payer: Cigna Commercial |
$2,582.38
|
| Rate for Payer: First Health Commercial |
$2,955.74
|
| Rate for Payer: Humana Commercial |
$2,644.60
|
| Rate for Payer: Humana KY Medicaid |
$1,069.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,080.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,551.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,296.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$933.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,091.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,737.94
|
| Rate for Payer: Ohio Health Group HMO |
$2,333.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$622.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$404.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$964.50
|
| Rate for Payer: PHCS Commercial |
$2,986.85
|
| Rate for Payer: United Healthcare All Payer |
$2,737.94
|
|
|
LEAD 5076-58 BI SIL STEROID FI
|
Facility
|
OP
|
$3,111.30
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$404.47 |
| Max. Negotiated Rate |
$2,986.85 |
| Rate for Payer: Aetna Commercial |
$2,395.70
|
| Rate for Payer: Anthem Medicaid |
$1,069.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,426.81
|
| Rate for Payer: Cash Price |
$1,555.65
|
| Rate for Payer: Cigna Commercial |
$2,582.38
|
| Rate for Payer: First Health Commercial |
$2,955.74
|
| Rate for Payer: Humana Commercial |
$2,644.60
|
| Rate for Payer: Humana KY Medicaid |
$1,069.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,080.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,551.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,296.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$933.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,091.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,737.94
|
| Rate for Payer: Ohio Health Group HMO |
$2,333.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$622.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$404.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$964.50
|
| Rate for Payer: PHCS Commercial |
$2,986.85
|
| Rate for Payer: United Healthcare All Payer |
$2,737.94
|
|
|
LEAD 5076-58 BI SIL STEROID FI
|
Facility
|
IP
|
$3,111.30
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
27000066
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$404.47 |
| Max. Negotiated Rate |
$2,986.85 |
| Rate for Payer: Aetna Commercial |
$2,395.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,426.81
|
| Rate for Payer: Cash Price |
$1,555.65
|
| Rate for Payer: Cigna Commercial |
$2,582.38
|
| Rate for Payer: First Health Commercial |
$2,955.74
|
| Rate for Payer: Humana Commercial |
$2,644.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,551.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,296.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$933.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,737.94
|
| Rate for Payer: Ohio Health Group HMO |
$2,333.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$622.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$404.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$964.50
|
| Rate for Payer: PHCS Commercial |
$2,986.85
|
| Rate for Payer: United Healthcare All Payer |
$2,737.94
|
|
