|
M2A MAGNUM PF CUP 520DX461D
|
Facility
|
OP
|
$19,684.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,559.01 |
| Max. Negotiated Rate |
$18,897.31 |
| Rate for Payer: Aetna Commercial |
$15,157.22
|
| Rate for Payer: Anthem Medicaid |
$6,769.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,354.07
|
| Rate for Payer: Cash Price |
$9,842.35
|
| Rate for Payer: Cigna Commercial |
$16,338.30
|
| Rate for Payer: First Health Commercial |
$18,700.46
|
| Rate for Payer: Humana Commercial |
$16,732.00
|
| Rate for Payer: Humana KY Medicaid |
$6,769.57
|
| Rate for Payer: Kentucky WC Medicaid |
$6,838.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,141.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,527.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,905.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,905.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,322.54
|
| Rate for Payer: Ohio Health Group HMO |
$14,763.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,936.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,559.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,102.26
|
| Rate for Payer: PHCS Commercial |
$18,897.31
|
| Rate for Payer: United Healthcare All Payer |
$17,322.54
|
|
|
MA2-MAGNUM 42-50 TPR INSRT-6
|
Facility
|
OP
|
$3,698.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$480.74 |
| Max. Negotiated Rate |
$3,550.08 |
| Rate for Payer: Aetna Commercial |
$2,847.46
|
| Rate for Payer: Anthem Medicaid |
$1,271.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,884.44
|
| Rate for Payer: Cash Price |
$1,849.00
|
| Rate for Payer: Cigna Commercial |
$3,069.34
|
| Rate for Payer: First Health Commercial |
$3,513.10
|
| Rate for Payer: Humana Commercial |
$3,143.30
|
| Rate for Payer: Humana KY Medicaid |
$1,271.74
|
| Rate for Payer: Kentucky WC Medicaid |
$1,284.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,032.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,729.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,109.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,297.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,254.24
|
| Rate for Payer: Ohio Health Group HMO |
$2,773.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$739.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$480.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,146.38
|
| Rate for Payer: PHCS Commercial |
$3,550.08
|
| Rate for Payer: United Healthcare All Payer |
$3,254.24
|
|
|
MA2-MAGNUM 42-50 TPR INSRT-6
|
Facility
|
IP
|
$3,698.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$480.74 |
| Max. Negotiated Rate |
$3,550.08 |
| Rate for Payer: Aetna Commercial |
$2,847.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,884.44
|
| Rate for Payer: Cash Price |
$1,849.00
|
| Rate for Payer: Cigna Commercial |
$3,069.34
|
| Rate for Payer: First Health Commercial |
$3,513.10
|
| Rate for Payer: Humana Commercial |
$3,143.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,032.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,729.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,109.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,254.24
|
| Rate for Payer: Ohio Health Group HMO |
$2,773.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$739.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$480.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,146.38
|
| Rate for Payer: PHCS Commercial |
$3,550.08
|
| Rate for Payer: United Healthcare All Payer |
$3,254.24
|
|
|
MAC 30 5F
|
Facility
|
OP
|
$784.50
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.98 |
| Max. Negotiated Rate |
$753.12 |
| Rate for Payer: Aetna Commercial |
$604.06
|
| Rate for Payer: Anthem Medicaid |
$269.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$611.91
|
| Rate for Payer: Cash Price |
$392.25
|
| Rate for Payer: Cigna Commercial |
$651.14
|
| Rate for Payer: First Health Commercial |
$745.28
|
| Rate for Payer: Humana Commercial |
$666.82
|
| Rate for Payer: Humana KY Medicaid |
$269.79
|
| Rate for Payer: Kentucky WC Medicaid |
$272.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$643.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$578.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$235.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$275.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$690.36
|
| Rate for Payer: Ohio Health Group HMO |
$588.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$243.20
|
| Rate for Payer: PHCS Commercial |
$753.12
|
| Rate for Payer: United Healthcare All Payer |
$690.36
|
|
|
MAC 30 5F
|
Facility
|
IP
|
$784.50
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.98 |
| Max. Negotiated Rate |
$753.12 |
| Rate for Payer: Aetna Commercial |
$604.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$611.91
|
| Rate for Payer: Cash Price |
$392.25
|
| Rate for Payer: Cigna Commercial |
$651.14
|
| Rate for Payer: First Health Commercial |
$745.28
|
| Rate for Payer: Humana Commercial |
$666.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$643.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$578.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$235.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$690.36
|
| Rate for Payer: Ohio Health Group HMO |
$588.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$243.20
|
| Rate for Payer: PHCS Commercial |
$753.12
|
| Rate for Payer: United Healthcare All Payer |
$690.36
|
|
|
MAC 3.5 5F
|
Facility
|
IP
|
$784.50
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.98 |
| Max. Negotiated Rate |
$753.12 |
| Rate for Payer: Aetna Commercial |
$604.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$611.91
|
| Rate for Payer: Cash Price |
$392.25
|
| Rate for Payer: Cigna Commercial |
$651.14
|
| Rate for Payer: First Health Commercial |
$745.28
|
| Rate for Payer: Humana Commercial |
$666.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$643.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$578.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$235.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$690.36
|
| Rate for Payer: Ohio Health Group HMO |
$588.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$243.20
|
| Rate for Payer: PHCS Commercial |
$753.12
|
| Rate for Payer: United Healthcare All Payer |
$690.36
|
|
|
MAC 3.5 5F
|
Facility
|
OP
|
$784.50
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.98 |
| Max. Negotiated Rate |
$753.12 |
| Rate for Payer: Aetna Commercial |
$604.06
|
| Rate for Payer: Anthem Medicaid |
$269.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$611.91
|
| Rate for Payer: Cash Price |
$392.25
|
| Rate for Payer: Cigna Commercial |
$651.14
|
| Rate for Payer: First Health Commercial |
$745.28
|
| Rate for Payer: Humana Commercial |
$666.82
|
| Rate for Payer: Humana KY Medicaid |
$269.79
|
| Rate for Payer: Kentucky WC Medicaid |
$272.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$643.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$578.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$235.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$275.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$690.36
|
| Rate for Payer: Ohio Health Group HMO |
$588.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$243.20
|
| Rate for Payer: PHCS Commercial |
$753.12
|
| Rate for Payer: United Healthcare All Payer |
$690.36
|
|
|
MAC 3.5 6F
|
Facility
|
OP
|
$784.50
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.98 |
| Max. Negotiated Rate |
$753.12 |
| Rate for Payer: Aetna Commercial |
$604.06
|
| Rate for Payer: Anthem Medicaid |
$269.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$611.91
|
| Rate for Payer: Cash Price |
$392.25
|
| Rate for Payer: Cigna Commercial |
$651.14
|
| Rate for Payer: First Health Commercial |
$745.28
|
| Rate for Payer: Humana Commercial |
$666.82
|
| Rate for Payer: Humana KY Medicaid |
$269.79
|
| Rate for Payer: Kentucky WC Medicaid |
$272.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$643.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$578.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$235.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$275.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$690.36
|
| Rate for Payer: Ohio Health Group HMO |
$588.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$243.20
|
| Rate for Payer: PHCS Commercial |
$753.12
|
| Rate for Payer: United Healthcare All Payer |
$690.36
|
|
|
MAC 3.5 6F
|
Facility
|
IP
|
$784.50
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.98 |
| Max. Negotiated Rate |
$753.12 |
| Rate for Payer: Aetna Commercial |
$604.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$611.91
|
| Rate for Payer: Cash Price |
$392.25
|
| Rate for Payer: Cigna Commercial |
$651.14
|
| Rate for Payer: First Health Commercial |
$745.28
|
| Rate for Payer: Humana Commercial |
$666.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$643.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$578.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$235.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$690.36
|
| Rate for Payer: Ohio Health Group HMO |
$588.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$243.20
|
| Rate for Payer: PHCS Commercial |
$753.12
|
| Rate for Payer: United Healthcare All Payer |
$690.36
|
|
|
MAC 3.75 5F
|
Facility
|
IP
|
$784.50
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.98 |
| Max. Negotiated Rate |
$753.12 |
| Rate for Payer: Aetna Commercial |
$604.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$611.91
|
| Rate for Payer: Cash Price |
$392.25
|
| Rate for Payer: Cigna Commercial |
$651.14
|
| Rate for Payer: First Health Commercial |
$745.28
|
| Rate for Payer: Humana Commercial |
$666.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$643.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$578.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$235.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$690.36
|
| Rate for Payer: Ohio Health Group HMO |
$588.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$243.20
|
| Rate for Payer: PHCS Commercial |
$753.12
|
| Rate for Payer: United Healthcare All Payer |
$690.36
|
|
|
MAC 3.75 5F
|
Facility
|
OP
|
$784.50
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.98 |
| Max. Negotiated Rate |
$753.12 |
| Rate for Payer: Aetna Commercial |
$604.06
|
| Rate for Payer: Anthem Medicaid |
$269.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$611.91
|
| Rate for Payer: Cash Price |
$392.25
|
| Rate for Payer: Cigna Commercial |
$651.14
|
| Rate for Payer: First Health Commercial |
$745.28
|
| Rate for Payer: Humana Commercial |
$666.82
|
| Rate for Payer: Humana KY Medicaid |
$269.79
|
| Rate for Payer: Kentucky WC Medicaid |
$272.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$643.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$578.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$235.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$275.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$690.36
|
| Rate for Payer: Ohio Health Group HMO |
$588.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$243.20
|
| Rate for Payer: PHCS Commercial |
$753.12
|
| Rate for Payer: United Healthcare All Payer |
$690.36
|
|
|
MAC 3.75 6F
|
Facility
|
IP
|
$784.50
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.98 |
| Max. Negotiated Rate |
$753.12 |
| Rate for Payer: Aetna Commercial |
$604.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$611.91
|
| Rate for Payer: Cash Price |
$392.25
|
| Rate for Payer: Cigna Commercial |
$651.14
|
| Rate for Payer: First Health Commercial |
$745.28
|
| Rate for Payer: Humana Commercial |
$666.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$643.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$578.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$235.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$690.36
|
| Rate for Payer: Ohio Health Group HMO |
$588.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$243.20
|
| Rate for Payer: PHCS Commercial |
$753.12
|
| Rate for Payer: United Healthcare All Payer |
$690.36
|
|
|
MAC 3.75 6F
|
Facility
|
OP
|
$784.50
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.98 |
| Max. Negotiated Rate |
$753.12 |
| Rate for Payer: Aetna Commercial |
$604.06
|
| Rate for Payer: Anthem Medicaid |
$269.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$611.91
|
| Rate for Payer: Cash Price |
$392.25
|
| Rate for Payer: Cigna Commercial |
$651.14
|
| Rate for Payer: First Health Commercial |
$745.28
|
| Rate for Payer: Humana Commercial |
$666.82
|
| Rate for Payer: Humana KY Medicaid |
$269.79
|
| Rate for Payer: Kentucky WC Medicaid |
$272.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$643.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$578.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$235.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$275.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$690.36
|
| Rate for Payer: Ohio Health Group HMO |
$588.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$243.20
|
| Rate for Payer: PHCS Commercial |
$753.12
|
| Rate for Payer: United Healthcare All Payer |
$690.36
|
|
|
MAC 4.0 5F
|
Facility
|
OP
|
$784.50
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.98 |
| Max. Negotiated Rate |
$753.12 |
| Rate for Payer: Aetna Commercial |
$604.06
|
| Rate for Payer: Anthem Medicaid |
$269.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$611.91
|
| Rate for Payer: Cash Price |
$392.25
|
| Rate for Payer: Cigna Commercial |
$651.14
|
| Rate for Payer: First Health Commercial |
$745.28
|
| Rate for Payer: Humana Commercial |
$666.82
|
| Rate for Payer: Humana KY Medicaid |
$269.79
|
| Rate for Payer: Kentucky WC Medicaid |
$272.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$643.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$578.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$235.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$275.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$690.36
|
| Rate for Payer: Ohio Health Group HMO |
$588.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$243.20
|
| Rate for Payer: PHCS Commercial |
$753.12
|
| Rate for Payer: United Healthcare All Payer |
$690.36
|
|
|
MAC 4.0 5F
|
Facility
|
IP
|
$784.50
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.98 |
| Max. Negotiated Rate |
$753.12 |
| Rate for Payer: Aetna Commercial |
$604.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$611.91
|
| Rate for Payer: Cash Price |
$392.25
|
| Rate for Payer: Cigna Commercial |
$651.14
|
| Rate for Payer: First Health Commercial |
$745.28
|
| Rate for Payer: Humana Commercial |
$666.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$643.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$578.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$235.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$690.36
|
| Rate for Payer: Ohio Health Group HMO |
$588.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$243.20
|
| Rate for Payer: PHCS Commercial |
$753.12
|
| Rate for Payer: United Healthcare All Payer |
$690.36
|
|
|
MAC 4.0 6F
|
Facility
|
OP
|
$784.50
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.98 |
| Max. Negotiated Rate |
$753.12 |
| Rate for Payer: Aetna Commercial |
$604.06
|
| Rate for Payer: Anthem Medicaid |
$269.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$611.91
|
| Rate for Payer: Cash Price |
$392.25
|
| Rate for Payer: Cigna Commercial |
$651.14
|
| Rate for Payer: First Health Commercial |
$745.28
|
| Rate for Payer: Humana Commercial |
$666.82
|
| Rate for Payer: Humana KY Medicaid |
$269.79
|
| Rate for Payer: Kentucky WC Medicaid |
$272.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$643.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$578.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$235.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$275.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$690.36
|
| Rate for Payer: Ohio Health Group HMO |
$588.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$243.20
|
| Rate for Payer: PHCS Commercial |
$753.12
|
| Rate for Payer: United Healthcare All Payer |
$690.36
|
|
|
MAC 4.0 6F
|
Facility
|
IP
|
$784.50
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.98 |
| Max. Negotiated Rate |
$753.12 |
| Rate for Payer: Aetna Commercial |
$604.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$611.91
|
| Rate for Payer: Cash Price |
$392.25
|
| Rate for Payer: Cigna Commercial |
$651.14
|
| Rate for Payer: First Health Commercial |
$745.28
|
| Rate for Payer: Humana Commercial |
$666.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$643.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$578.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$235.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$690.36
|
| Rate for Payer: Ohio Health Group HMO |
$588.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$243.20
|
| Rate for Payer: PHCS Commercial |
$753.12
|
| Rate for Payer: United Healthcare All Payer |
$690.36
|
|
|
MACH 4 12CM
|
Facility
|
OP
|
$13,136.75
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,707.78 |
| Max. Negotiated Rate |
$12,611.28 |
| Rate for Payer: Aetna Commercial |
$10,115.30
|
| Rate for Payer: Anthem Medicaid |
$4,517.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,246.66
|
| Rate for Payer: Cash Price |
$6,568.38
|
| Rate for Payer: Cigna Commercial |
$10,903.50
|
| Rate for Payer: First Health Commercial |
$12,479.91
|
| Rate for Payer: Humana Commercial |
$11,166.24
|
| Rate for Payer: Humana KY Medicaid |
$4,517.73
|
| Rate for Payer: Kentucky WC Medicaid |
$4,563.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,772.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,694.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,941.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,608.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,560.34
|
| Rate for Payer: Ohio Health Group HMO |
$9,852.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,627.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,707.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,072.39
|
| Rate for Payer: PHCS Commercial |
$12,611.28
|
| Rate for Payer: United Healthcare All Payer |
$11,560.34
|
|
|
MACH 4 12CM
|
Facility
|
IP
|
$13,136.75
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,707.78 |
| Max. Negotiated Rate |
$12,611.28 |
| Rate for Payer: Humana Commercial |
$11,166.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,772.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,694.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,941.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,560.34
|
| Rate for Payer: Ohio Health Group HMO |
$9,852.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,627.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,707.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,072.39
|
| Rate for Payer: PHCS Commercial |
$12,611.28
|
| Rate for Payer: United Healthcare All Payer |
$11,560.34
|
| Rate for Payer: Aetna Commercial |
$10,115.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,246.66
|
| Rate for Payer: Cash Price |
$6,568.38
|
| Rate for Payer: Cigna Commercial |
$10,903.50
|
| Rate for Payer: First Health Commercial |
$12,479.91
|
|
|
MACH 4 30CM
|
Facility
|
IP
|
$13,136.75
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,707.78 |
| Max. Negotiated Rate |
$12,611.28 |
| Rate for Payer: Aetna Commercial |
$10,115.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,246.66
|
| Rate for Payer: Cash Price |
$6,568.38
|
| Rate for Payer: Cigna Commercial |
$10,903.50
|
| Rate for Payer: First Health Commercial |
$12,479.91
|
| Rate for Payer: Humana Commercial |
$11,166.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,772.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,694.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,941.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,560.34
|
| Rate for Payer: Ohio Health Group HMO |
$9,852.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,627.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,707.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,072.39
|
| Rate for Payer: PHCS Commercial |
$12,611.28
|
| Rate for Payer: United Healthcare All Payer |
$11,560.34
|
|
|
MACH 4 30CM
|
Facility
|
OP
|
$13,136.75
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,707.78 |
| Max. Negotiated Rate |
$12,611.28 |
| Rate for Payer: Aetna Commercial |
$10,115.30
|
| Rate for Payer: Anthem Medicaid |
$4,517.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,246.66
|
| Rate for Payer: Cash Price |
$6,568.38
|
| Rate for Payer: Cigna Commercial |
$10,903.50
|
| Rate for Payer: First Health Commercial |
$12,479.91
|
| Rate for Payer: Humana Commercial |
$11,166.24
|
| Rate for Payer: Humana KY Medicaid |
$4,517.73
|
| Rate for Payer: Kentucky WC Medicaid |
$4,563.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,772.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,694.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,941.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,608.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,560.34
|
| Rate for Payer: Ohio Health Group HMO |
$9,852.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,627.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,707.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,072.39
|
| Rate for Payer: PHCS Commercial |
$12,611.28
|
| Rate for Payer: United Healthcare All Payer |
$11,560.34
|
|
|
MACH 4 40CM
|
Facility
|
IP
|
$13,136.75
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,707.78 |
| Max. Negotiated Rate |
$12,611.28 |
| Rate for Payer: Aetna Commercial |
$10,115.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,246.66
|
| Rate for Payer: Cash Price |
$6,568.38
|
| Rate for Payer: Cigna Commercial |
$10,903.50
|
| Rate for Payer: First Health Commercial |
$12,479.91
|
| Rate for Payer: Humana Commercial |
$11,166.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,772.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,694.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,941.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,560.34
|
| Rate for Payer: Ohio Health Group HMO |
$9,852.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,627.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,707.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,072.39
|
| Rate for Payer: PHCS Commercial |
$12,611.28
|
| Rate for Payer: United Healthcare All Payer |
$11,560.34
|
|
|
MACH 4 40CM
|
Facility
|
OP
|
$13,136.75
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,707.78 |
| Max. Negotiated Rate |
$12,611.28 |
| Rate for Payer: Aetna Commercial |
$10,115.30
|
| Rate for Payer: Anthem Medicaid |
$4,517.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,246.66
|
| Rate for Payer: Cash Price |
$6,568.38
|
| Rate for Payer: Cigna Commercial |
$10,903.50
|
| Rate for Payer: First Health Commercial |
$12,479.91
|
| Rate for Payer: Humana Commercial |
$11,166.24
|
| Rate for Payer: Humana KY Medicaid |
$4,517.73
|
| Rate for Payer: Kentucky WC Medicaid |
$4,563.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,772.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,694.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,941.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,608.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,560.34
|
| Rate for Payer: Ohio Health Group HMO |
$9,852.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,627.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,707.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,072.39
|
| Rate for Payer: PHCS Commercial |
$12,611.28
|
| Rate for Payer: United Healthcare All Payer |
$11,560.34
|
|
|
MACH 4 50CM
|
Facility
|
IP
|
$13,136.75
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,707.78 |
| Max. Negotiated Rate |
$12,611.28 |
| Rate for Payer: Aetna Commercial |
$10,115.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,246.66
|
| Rate for Payer: Cash Price |
$6,568.38
|
| Rate for Payer: Cigna Commercial |
$10,903.50
|
| Rate for Payer: First Health Commercial |
$12,479.91
|
| Rate for Payer: Humana Commercial |
$11,166.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,772.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,694.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,941.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,560.34
|
| Rate for Payer: Ohio Health Group HMO |
$9,852.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,627.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,707.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,072.39
|
| Rate for Payer: PHCS Commercial |
$12,611.28
|
| Rate for Payer: United Healthcare All Payer |
$11,560.34
|
|
|
MACH 4 50CM
|
Facility
|
OP
|
$13,136.75
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,707.78 |
| Max. Negotiated Rate |
$12,611.28 |
| Rate for Payer: Aetna Commercial |
$10,115.30
|
| Rate for Payer: Anthem Medicaid |
$4,517.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,246.66
|
| Rate for Payer: Cash Price |
$6,568.38
|
| Rate for Payer: Cigna Commercial |
$10,903.50
|
| Rate for Payer: First Health Commercial |
$12,479.91
|
| Rate for Payer: Humana Commercial |
$11,166.24
|
| Rate for Payer: Humana KY Medicaid |
$4,517.73
|
| Rate for Payer: Kentucky WC Medicaid |
$4,563.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,772.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,694.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,941.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,608.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,560.34
|
| Rate for Payer: Ohio Health Group HMO |
$9,852.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,627.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,707.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,072.39
|
| Rate for Payer: PHCS Commercial |
$12,611.28
|
| Rate for Payer: United Healthcare All Payer |
$11,560.34
|
|
