|
OFFST STD TPR LCK 133*16.0 PPS
|
Facility
|
IP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,950.00 |
| Max. Negotiated Rate |
$14,400.00 |
| Rate for Payer: Aetna Commercial |
$11,550.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,700.00
|
| Rate for Payer: Cash Price |
$7,500.00
|
| Rate for Payer: Cigna Commercial |
$12,450.00
|
| Rate for Payer: First Health Commercial |
$14,250.00
|
| Rate for Payer: Humana Commercial |
$12,750.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,300.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,070.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,650.00
|
| Rate for Payer: PHCS Commercial |
$14,400.00
|
| Rate for Payer: United Healthcare All Payer |
$13,200.00
|
|
|
OFFST STD TPR LCK 133*17.0 PPS
|
Facility
|
IP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,950.00 |
| Max. Negotiated Rate |
$14,400.00 |
| Rate for Payer: Aetna Commercial |
$11,550.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,700.00
|
| Rate for Payer: Cash Price |
$7,500.00
|
| Rate for Payer: Cigna Commercial |
$12,450.00
|
| Rate for Payer: First Health Commercial |
$14,250.00
|
| Rate for Payer: Humana Commercial |
$12,750.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,300.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,070.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,650.00
|
| Rate for Payer: PHCS Commercial |
$14,400.00
|
| Rate for Payer: United Healthcare All Payer |
$13,200.00
|
|
|
OFFST STD TPR LCK 133*17.0 PPS
|
Facility
|
OP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,950.00 |
| Max. Negotiated Rate |
$14,400.00 |
| Rate for Payer: Aetna Commercial |
$11,550.00
|
| Rate for Payer: Anthem Medicaid |
$5,158.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,700.00
|
| Rate for Payer: Cash Price |
$7,500.00
|
| Rate for Payer: Cigna Commercial |
$12,450.00
|
| Rate for Payer: First Health Commercial |
$14,250.00
|
| Rate for Payer: Humana Commercial |
$12,750.00
|
| Rate for Payer: Humana KY Medicaid |
$5,158.50
|
| Rate for Payer: Kentucky WC Medicaid |
$5,211.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,300.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,070.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,262.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,650.00
|
| Rate for Payer: PHCS Commercial |
$14,400.00
|
| Rate for Payer: United Healthcare All Payer |
$13,200.00
|
|
|
OFFST STD TPR LCK 133*18.0 PPS
|
Facility
|
OP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,950.00 |
| Max. Negotiated Rate |
$14,400.00 |
| Rate for Payer: Aetna Commercial |
$11,550.00
|
| Rate for Payer: Anthem Medicaid |
$5,158.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,700.00
|
| Rate for Payer: Cash Price |
$7,500.00
|
| Rate for Payer: Cigna Commercial |
$12,450.00
|
| Rate for Payer: First Health Commercial |
$14,250.00
|
| Rate for Payer: Humana Commercial |
$12,750.00
|
| Rate for Payer: Humana KY Medicaid |
$5,158.50
|
| Rate for Payer: Kentucky WC Medicaid |
$5,211.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,300.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,070.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,262.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,650.00
|
| Rate for Payer: PHCS Commercial |
$14,400.00
|
| Rate for Payer: United Healthcare All Payer |
$13,200.00
|
|
|
OFFST STD TPR LCK 133*18.0 PPS
|
Facility
|
IP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,950.00 |
| Max. Negotiated Rate |
$14,400.00 |
| Rate for Payer: Aetna Commercial |
$11,550.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,700.00
|
| Rate for Payer: Cash Price |
$7,500.00
|
| Rate for Payer: Cigna Commercial |
$12,450.00
|
| Rate for Payer: First Health Commercial |
$14,250.00
|
| Rate for Payer: Humana Commercial |
$12,750.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,300.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,070.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,650.00
|
| Rate for Payer: PHCS Commercial |
$14,400.00
|
| Rate for Payer: United Healthcare All Payer |
$13,200.00
|
|
|
OFFST STDTPR LCK 133FP*4.0 PPS
|
Facility
|
OP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,950.00 |
| Max. Negotiated Rate |
$14,400.00 |
| Rate for Payer: Aetna Commercial |
$11,550.00
|
| Rate for Payer: Anthem Medicaid |
$5,158.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,700.00
|
| Rate for Payer: Cash Price |
$7,500.00
|
| Rate for Payer: Cigna Commercial |
$12,450.00
|
| Rate for Payer: First Health Commercial |
$14,250.00
|
| Rate for Payer: Humana Commercial |
$12,750.00
|
| Rate for Payer: Humana KY Medicaid |
$5,158.50
|
| Rate for Payer: Kentucky WC Medicaid |
$5,211.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,300.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,070.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,262.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,650.00
|
| Rate for Payer: PHCS Commercial |
$14,400.00
|
| Rate for Payer: United Healthcare All Payer |
$13,200.00
|
|
|
OFFST STDTPR LCK 133FP*4.0 PPS
|
Facility
|
IP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,950.00 |
| Max. Negotiated Rate |
$14,400.00 |
| Rate for Payer: Aetna Commercial |
$11,550.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,700.00
|
| Rate for Payer: Cash Price |
$7,500.00
|
| Rate for Payer: Cigna Commercial |
$12,450.00
|
| Rate for Payer: First Health Commercial |
$14,250.00
|
| Rate for Payer: Humana Commercial |
$12,750.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,300.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,070.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,650.00
|
| Rate for Payer: PHCS Commercial |
$14,400.00
|
| Rate for Payer: United Healthcare All Payer |
$13,200.00
|
|
|
OFFST STDTPR LCK 133FP*5.0 PPS
|
Facility
|
OP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,950.00 |
| Max. Negotiated Rate |
$14,400.00 |
| Rate for Payer: Aetna Commercial |
$11,550.00
|
| Rate for Payer: Anthem Medicaid |
$5,158.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,700.00
|
| Rate for Payer: Cash Price |
$7,500.00
|
| Rate for Payer: Cigna Commercial |
$12,450.00
|
| Rate for Payer: First Health Commercial |
$14,250.00
|
| Rate for Payer: Humana Commercial |
$12,750.00
|
| Rate for Payer: Humana KY Medicaid |
$5,158.50
|
| Rate for Payer: Kentucky WC Medicaid |
$5,211.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,300.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,070.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,262.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,650.00
|
| Rate for Payer: PHCS Commercial |
$14,400.00
|
| Rate for Payer: United Healthcare All Payer |
$13,200.00
|
|
|
OFFST STDTPR LCK 133FP*5.0 PPS
|
Facility
|
IP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,950.00 |
| Max. Negotiated Rate |
$14,400.00 |
| Rate for Payer: Aetna Commercial |
$11,550.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,700.00
|
| Rate for Payer: Cash Price |
$7,500.00
|
| Rate for Payer: Cigna Commercial |
$12,450.00
|
| Rate for Payer: First Health Commercial |
$14,250.00
|
| Rate for Payer: Humana Commercial |
$12,750.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,300.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,070.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,650.00
|
| Rate for Payer: PHCS Commercial |
$14,400.00
|
| Rate for Payer: United Healthcare All Payer |
$13,200.00
|
|
|
OFFST STDTPR LCK 133FP*6.0 PPS
|
Facility
|
OP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,950.00 |
| Max. Negotiated Rate |
$14,400.00 |
| Rate for Payer: Aetna Commercial |
$11,550.00
|
| Rate for Payer: Anthem Medicaid |
$5,158.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,700.00
|
| Rate for Payer: Cash Price |
$7,500.00
|
| Rate for Payer: Cigna Commercial |
$12,450.00
|
| Rate for Payer: First Health Commercial |
$14,250.00
|
| Rate for Payer: Humana Commercial |
$12,750.00
|
| Rate for Payer: Humana KY Medicaid |
$5,158.50
|
| Rate for Payer: Kentucky WC Medicaid |
$5,211.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,300.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,070.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,262.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,650.00
|
| Rate for Payer: PHCS Commercial |
$14,400.00
|
| Rate for Payer: United Healthcare All Payer |
$13,200.00
|
|
|
OFFST STDTPR LCK 133FP*6.0 PPS
|
Facility
|
IP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,950.00 |
| Max. Negotiated Rate |
$14,400.00 |
| Rate for Payer: Aetna Commercial |
$11,550.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,700.00
|
| Rate for Payer: Cash Price |
$7,500.00
|
| Rate for Payer: Cigna Commercial |
$12,450.00
|
| Rate for Payer: First Health Commercial |
$14,250.00
|
| Rate for Payer: Humana Commercial |
$12,750.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,300.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,070.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,650.00
|
| Rate for Payer: PHCS Commercial |
$14,400.00
|
| Rate for Payer: United Healthcare All Payer |
$13,200.00
|
|
|
OFFST STDTPR LCK 133FP*7.0 PPS
|
Facility
|
OP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,950.00 |
| Max. Negotiated Rate |
$14,400.00 |
| Rate for Payer: Aetna Commercial |
$11,550.00
|
| Rate for Payer: Anthem Medicaid |
$5,158.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,700.00
|
| Rate for Payer: Cash Price |
$7,500.00
|
| Rate for Payer: Cigna Commercial |
$12,450.00
|
| Rate for Payer: First Health Commercial |
$14,250.00
|
| Rate for Payer: Humana Commercial |
$12,750.00
|
| Rate for Payer: Humana KY Medicaid |
$5,158.50
|
| Rate for Payer: Kentucky WC Medicaid |
$5,211.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,300.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,070.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,262.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,650.00
|
| Rate for Payer: PHCS Commercial |
$14,400.00
|
| Rate for Payer: United Healthcare All Payer |
$13,200.00
|
|
|
OFFST STDTPR LCK 133FP*7.0 PPS
|
Facility
|
IP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,950.00 |
| Max. Negotiated Rate |
$14,400.00 |
| Rate for Payer: Aetna Commercial |
$11,550.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,700.00
|
| Rate for Payer: Cash Price |
$7,500.00
|
| Rate for Payer: Cigna Commercial |
$12,450.00
|
| Rate for Payer: First Health Commercial |
$14,250.00
|
| Rate for Payer: Humana Commercial |
$12,750.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,300.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,070.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,650.00
|
| Rate for Payer: PHCS Commercial |
$14,400.00
|
| Rate for Payer: United Healthcare All Payer |
$13,200.00
|
|
|
OFFST STDTPR LCK 133FP*8.0 PPS
|
Facility
|
OP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,950.00 |
| Max. Negotiated Rate |
$14,400.00 |
| Rate for Payer: Aetna Commercial |
$11,550.00
|
| Rate for Payer: Anthem Medicaid |
$5,158.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,700.00
|
| Rate for Payer: Cash Price |
$7,500.00
|
| Rate for Payer: Cigna Commercial |
$12,450.00
|
| Rate for Payer: First Health Commercial |
$14,250.00
|
| Rate for Payer: Humana Commercial |
$12,750.00
|
| Rate for Payer: Humana KY Medicaid |
$5,158.50
|
| Rate for Payer: Kentucky WC Medicaid |
$5,211.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,300.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,070.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,262.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,650.00
|
| Rate for Payer: PHCS Commercial |
$14,400.00
|
| Rate for Payer: United Healthcare All Payer |
$13,200.00
|
|
|
OFFST STDTPR LCK 133FP*8.0 PPS
|
Facility
|
IP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,950.00 |
| Max. Negotiated Rate |
$14,400.00 |
| Rate for Payer: Aetna Commercial |
$11,550.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,700.00
|
| Rate for Payer: Cash Price |
$7,500.00
|
| Rate for Payer: Cigna Commercial |
$12,450.00
|
| Rate for Payer: First Health Commercial |
$14,250.00
|
| Rate for Payer: Humana Commercial |
$12,750.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,300.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,070.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,650.00
|
| Rate for Payer: PHCS Commercial |
$14,400.00
|
| Rate for Payer: United Healthcare All Payer |
$13,200.00
|
|
|
O-F II ACET SHELL 44MM
|
Facility
|
IP
|
$7,106.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$923.82 |
| Max. Negotiated Rate |
$6,822.02 |
| Rate for Payer: Aetna Commercial |
$5,471.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,542.89
|
| Rate for Payer: Cash Price |
$3,553.14
|
| Rate for Payer: Cigna Commercial |
$5,898.20
|
| Rate for Payer: First Health Commercial |
$6,750.96
|
| Rate for Payer: Humana Commercial |
$6,040.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,827.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,244.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,131.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,253.52
|
| Rate for Payer: Ohio Health Group HMO |
$5,329.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,421.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$923.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,202.94
|
| Rate for Payer: PHCS Commercial |
$6,822.02
|
| Rate for Payer: United Healthcare All Payer |
$6,253.52
|
|
|
O-F II ACET SHELL 44MM
|
Facility
|
OP
|
$7,106.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$923.82 |
| Max. Negotiated Rate |
$6,822.02 |
| Rate for Payer: Aetna Commercial |
$5,471.83
|
| Rate for Payer: Anthem Medicaid |
$2,443.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,542.89
|
| Rate for Payer: Cash Price |
$3,553.14
|
| Rate for Payer: Cigna Commercial |
$5,898.20
|
| Rate for Payer: First Health Commercial |
$6,750.96
|
| Rate for Payer: Humana Commercial |
$6,040.33
|
| Rate for Payer: Humana KY Medicaid |
$2,443.85
|
| Rate for Payer: Kentucky WC Medicaid |
$2,468.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,827.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,244.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,131.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,492.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,253.52
|
| Rate for Payer: Ohio Health Group HMO |
$5,329.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,421.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$923.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,202.94
|
| Rate for Payer: PHCS Commercial |
$6,822.02
|
| Rate for Payer: United Healthcare All Payer |
$6,253.52
|
|
|
O-F II ACET SHELL 46MM
|
Facility
|
IP
|
$7,106.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$923.82 |
| Max. Negotiated Rate |
$6,822.02 |
| Rate for Payer: Aetna Commercial |
$5,471.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,542.89
|
| Rate for Payer: Cash Price |
$3,553.14
|
| Rate for Payer: Cigna Commercial |
$5,898.20
|
| Rate for Payer: First Health Commercial |
$6,750.96
|
| Rate for Payer: Humana Commercial |
$6,040.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,827.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,244.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,131.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,253.52
|
| Rate for Payer: Ohio Health Group HMO |
$5,329.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,421.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$923.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,202.94
|
| Rate for Payer: PHCS Commercial |
$6,822.02
|
| Rate for Payer: United Healthcare All Payer |
$6,253.52
|
|
|
O-F II ACET SHELL 46MM
|
Facility
|
OP
|
$7,106.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$923.82 |
| Max. Negotiated Rate |
$6,822.02 |
| Rate for Payer: Aetna Commercial |
$5,471.83
|
| Rate for Payer: Anthem Medicaid |
$2,443.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,542.89
|
| Rate for Payer: Cash Price |
$3,553.14
|
| Rate for Payer: Cigna Commercial |
$5,898.20
|
| Rate for Payer: First Health Commercial |
$6,750.96
|
| Rate for Payer: Humana Commercial |
$6,040.33
|
| Rate for Payer: Humana KY Medicaid |
$2,443.85
|
| Rate for Payer: Kentucky WC Medicaid |
$2,468.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,827.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,244.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,131.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,492.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,253.52
|
| Rate for Payer: Ohio Health Group HMO |
$5,329.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,421.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$923.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,202.94
|
| Rate for Payer: PHCS Commercial |
$6,822.02
|
| Rate for Payer: United Healthcare All Payer |
$6,253.52
|
|
|
O-F II ACET SHELL 48MM
|
Facility
|
IP
|
$7,106.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$923.82 |
| Max. Negotiated Rate |
$6,822.02 |
| Rate for Payer: Aetna Commercial |
$5,471.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,542.89
|
| Rate for Payer: Cash Price |
$3,553.14
|
| Rate for Payer: Cigna Commercial |
$5,898.20
|
| Rate for Payer: First Health Commercial |
$6,750.96
|
| Rate for Payer: Humana Commercial |
$6,040.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,827.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,244.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,131.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,253.52
|
| Rate for Payer: Ohio Health Group HMO |
$5,329.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,421.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$923.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,202.94
|
| Rate for Payer: PHCS Commercial |
$6,822.02
|
| Rate for Payer: United Healthcare All Payer |
$6,253.52
|
|
|
O-F II ACET SHELL 48MM
|
Facility
|
OP
|
$7,106.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$923.82 |
| Max. Negotiated Rate |
$6,822.02 |
| Rate for Payer: Aetna Commercial |
$5,471.83
|
| Rate for Payer: Anthem Medicaid |
$2,443.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,542.89
|
| Rate for Payer: Cash Price |
$3,553.14
|
| Rate for Payer: Cigna Commercial |
$5,898.20
|
| Rate for Payer: First Health Commercial |
$6,750.96
|
| Rate for Payer: Humana Commercial |
$6,040.33
|
| Rate for Payer: Humana KY Medicaid |
$2,443.85
|
| Rate for Payer: Kentucky WC Medicaid |
$2,468.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,827.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,244.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,131.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,492.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,253.52
|
| Rate for Payer: Ohio Health Group HMO |
$5,329.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,421.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$923.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,202.94
|
| Rate for Payer: PHCS Commercial |
$6,822.02
|
| Rate for Payer: United Healthcare All Payer |
$6,253.52
|
|
|
O-F II ACET SHELL 50MM
|
Facility
|
OP
|
$7,106.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$923.82 |
| Max. Negotiated Rate |
$6,822.02 |
| Rate for Payer: Aetna Commercial |
$5,471.83
|
| Rate for Payer: Anthem Medicaid |
$2,443.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,542.89
|
| Rate for Payer: Cash Price |
$3,553.14
|
| Rate for Payer: Cigna Commercial |
$5,898.20
|
| Rate for Payer: First Health Commercial |
$6,750.96
|
| Rate for Payer: Humana Commercial |
$6,040.33
|
| Rate for Payer: Humana KY Medicaid |
$2,443.85
|
| Rate for Payer: Kentucky WC Medicaid |
$2,468.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,827.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,244.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,131.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,492.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,253.52
|
| Rate for Payer: Ohio Health Group HMO |
$5,329.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,421.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$923.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,202.94
|
| Rate for Payer: PHCS Commercial |
$6,822.02
|
| Rate for Payer: United Healthcare All Payer |
$6,253.52
|
|
|
O-F II ACET SHELL 50MM
|
Facility
|
IP
|
$7,106.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$923.82 |
| Max. Negotiated Rate |
$6,822.02 |
| Rate for Payer: Aetna Commercial |
$5,471.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,542.89
|
| Rate for Payer: Cash Price |
$3,553.14
|
| Rate for Payer: Cigna Commercial |
$5,898.20
|
| Rate for Payer: First Health Commercial |
$6,750.96
|
| Rate for Payer: Humana Commercial |
$6,040.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,827.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,244.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,131.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,253.52
|
| Rate for Payer: Ohio Health Group HMO |
$5,329.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,421.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$923.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,202.94
|
| Rate for Payer: PHCS Commercial |
$6,822.02
|
| Rate for Payer: United Healthcare All Payer |
$6,253.52
|
|
|
O-F II ACET SHELL 52MM
|
Facility
|
OP
|
$7,106.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$923.82 |
| Max. Negotiated Rate |
$6,822.02 |
| Rate for Payer: Aetna Commercial |
$5,471.83
|
| Rate for Payer: Anthem Medicaid |
$2,443.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,542.89
|
| Rate for Payer: Cash Price |
$3,553.14
|
| Rate for Payer: Cigna Commercial |
$5,898.20
|
| Rate for Payer: First Health Commercial |
$6,750.96
|
| Rate for Payer: Humana Commercial |
$6,040.33
|
| Rate for Payer: Humana KY Medicaid |
$2,443.85
|
| Rate for Payer: Kentucky WC Medicaid |
$2,468.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,827.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,244.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,131.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,492.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,253.52
|
| Rate for Payer: Ohio Health Group HMO |
$5,329.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,421.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$923.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,202.94
|
| Rate for Payer: PHCS Commercial |
$6,822.02
|
| Rate for Payer: United Healthcare All Payer |
$6,253.52
|
|
|
O-F II ACET SHELL 52MM
|
Facility
|
IP
|
$7,106.27
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$923.82 |
| Max. Negotiated Rate |
$6,822.02 |
| Rate for Payer: Aetna Commercial |
$5,471.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,542.89
|
| Rate for Payer: Cash Price |
$3,553.14
|
| Rate for Payer: Cigna Commercial |
$5,898.20
|
| Rate for Payer: First Health Commercial |
$6,750.96
|
| Rate for Payer: Humana Commercial |
$6,040.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,827.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,244.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,131.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,253.52
|
| Rate for Payer: Ohio Health Group HMO |
$5,329.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,421.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$923.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,202.94
|
| Rate for Payer: PHCS Commercial |
$6,822.02
|
| Rate for Payer: United Healthcare All Payer |
$6,253.52
|
|
