|
PINN MAR +4 10D 32ID*52OD
|
Facility
|
OP
|
$7,119.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,135.82 |
| Max. Negotiated Rate |
$6,834.61 |
| Rate for Payer: Aetna Commercial |
$5,481.93
|
| Rate for Payer: Anthem Medicaid |
$2,448.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,553.12
|
| Rate for Payer: Cash Price |
$3,559.70
|
| Rate for Payer: Cigna Commercial |
$5,909.09
|
| Rate for Payer: First Health Commercial |
$6,763.42
|
| Rate for Payer: Humana Commercial |
$6,051.48
|
| Rate for Payer: Humana KY Medicaid |
$2,448.36
|
| Rate for Payer: Kentucky WC Medicaid |
$2,473.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,837.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,254.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,135.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,497.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,265.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,339.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,695.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,193.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,912.38
|
| Rate for Payer: PHCS Commercial |
$6,834.61
|
| Rate for Payer: United Healthcare All Payer |
$6,265.06
|
|
|
PINN MAR +4 10D 32ID*52OD
|
Facility
|
IP
|
$7,119.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,135.82 |
| Max. Negotiated Rate |
$6,834.61 |
| Rate for Payer: Aetna Commercial |
$5,481.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,553.12
|
| Rate for Payer: Cash Price |
$3,559.70
|
| Rate for Payer: Cigna Commercial |
$5,909.09
|
| Rate for Payer: First Health Commercial |
$6,763.42
|
| Rate for Payer: Humana Commercial |
$6,051.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,837.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,254.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,135.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,265.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,339.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,695.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,193.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,912.38
|
| Rate for Payer: PHCS Commercial |
$6,834.61
|
| Rate for Payer: United Healthcare All Payer |
$6,265.06
|
|
|
PINN MAR +4 10D 32ID*54OD
|
Facility
|
OP
|
$7,119.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,135.82 |
| Max. Negotiated Rate |
$6,834.61 |
| Rate for Payer: Aetna Commercial |
$5,481.93
|
| Rate for Payer: Anthem Medicaid |
$2,448.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,553.12
|
| Rate for Payer: Cash Price |
$3,559.70
|
| Rate for Payer: Cigna Commercial |
$5,909.09
|
| Rate for Payer: First Health Commercial |
$6,763.42
|
| Rate for Payer: Humana Commercial |
$6,051.48
|
| Rate for Payer: Humana KY Medicaid |
$2,448.36
|
| Rate for Payer: Kentucky WC Medicaid |
$2,473.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,837.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,254.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,135.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,497.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,265.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,339.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,695.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,193.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,912.38
|
| Rate for Payer: PHCS Commercial |
$6,834.61
|
| Rate for Payer: United Healthcare All Payer |
$6,265.06
|
|
|
PINN MAR +4 10D 32ID*54OD
|
Facility
|
IP
|
$7,119.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,135.82 |
| Max. Negotiated Rate |
$6,834.61 |
| Rate for Payer: Aetna Commercial |
$5,481.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,553.12
|
| Rate for Payer: Cash Price |
$3,559.70
|
| Rate for Payer: Cigna Commercial |
$5,909.09
|
| Rate for Payer: First Health Commercial |
$6,763.42
|
| Rate for Payer: Humana Commercial |
$6,051.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,837.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,254.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,135.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,265.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,339.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,695.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,193.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,912.38
|
| Rate for Payer: PHCS Commercial |
$6,834.61
|
| Rate for Payer: United Healthcare All Payer |
$6,265.06
|
|
|
PINN MAR +4 10D 32ID*56OD
|
Facility
|
IP
|
$7,119.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,135.82 |
| Max. Negotiated Rate |
$6,834.61 |
| Rate for Payer: Aetna Commercial |
$5,481.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,553.12
|
| Rate for Payer: Cash Price |
$3,559.70
|
| Rate for Payer: Cigna Commercial |
$5,909.09
|
| Rate for Payer: First Health Commercial |
$6,763.42
|
| Rate for Payer: Humana Commercial |
$6,051.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,837.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,254.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,135.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,265.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,339.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,695.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,193.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,912.38
|
| Rate for Payer: PHCS Commercial |
$6,834.61
|
| Rate for Payer: United Healthcare All Payer |
$6,265.06
|
|
|
PINN MAR +4 10D 32ID*56OD
|
Facility
|
OP
|
$7,119.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,135.82 |
| Max. Negotiated Rate |
$6,834.61 |
| Rate for Payer: Aetna Commercial |
$5,481.93
|
| Rate for Payer: Anthem Medicaid |
$2,448.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,553.12
|
| Rate for Payer: Cash Price |
$3,559.70
|
| Rate for Payer: Cigna Commercial |
$5,909.09
|
| Rate for Payer: First Health Commercial |
$6,763.42
|
| Rate for Payer: Humana Commercial |
$6,051.48
|
| Rate for Payer: Humana KY Medicaid |
$2,448.36
|
| Rate for Payer: Kentucky WC Medicaid |
$2,473.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,837.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,254.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,135.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,497.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,265.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,339.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,695.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,193.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,912.38
|
| Rate for Payer: PHCS Commercial |
$6,834.61
|
| Rate for Payer: United Healthcare All Payer |
$6,265.06
|
|
|
PINN MAR +4 10D 32ID*58OD
|
Facility
|
IP
|
$7,119.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,135.82 |
| Max. Negotiated Rate |
$6,834.61 |
| Rate for Payer: Aetna Commercial |
$5,481.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,553.12
|
| Rate for Payer: Cash Price |
$3,559.70
|
| Rate for Payer: Cigna Commercial |
$5,909.09
|
| Rate for Payer: First Health Commercial |
$6,763.42
|
| Rate for Payer: Humana Commercial |
$6,051.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,837.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,254.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,135.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,265.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,339.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,695.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,193.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,912.38
|
| Rate for Payer: PHCS Commercial |
$6,834.61
|
| Rate for Payer: United Healthcare All Payer |
$6,265.06
|
|
|
PINN MAR +4 10D 32ID*58OD
|
Facility
|
OP
|
$7,119.39
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,135.82 |
| Max. Negotiated Rate |
$6,834.61 |
| Rate for Payer: Aetna Commercial |
$5,481.93
|
| Rate for Payer: Anthem Medicaid |
$2,448.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,553.12
|
| Rate for Payer: Cash Price |
$3,559.70
|
| Rate for Payer: Cigna Commercial |
$5,909.09
|
| Rate for Payer: First Health Commercial |
$6,763.42
|
| Rate for Payer: Humana Commercial |
$6,051.48
|
| Rate for Payer: Humana KY Medicaid |
$2,448.36
|
| Rate for Payer: Kentucky WC Medicaid |
$2,473.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,837.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,254.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,135.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,497.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,265.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,339.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,695.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,193.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,912.38
|
| Rate for Payer: PHCS Commercial |
$6,834.61
|
| Rate for Payer: United Healthcare All Payer |
$6,265.06
|
|
|
PINN MAR +4 10D 32ID*60OD
|
Facility
|
IP
|
$7,555.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,266.56 |
| Max. Negotiated Rate |
$7,252.99 |
| Rate for Payer: Aetna Commercial |
$5,817.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,893.06
|
| Rate for Payer: Cash Price |
$3,777.60
|
| Rate for Payer: Cigna Commercial |
$6,270.82
|
| Rate for Payer: First Health Commercial |
$7,177.44
|
| Rate for Payer: Humana Commercial |
$6,421.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,195.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,575.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,266.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,648.58
|
| Rate for Payer: Ohio Health Group HMO |
$5,666.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,044.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,573.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,213.09
|
| Rate for Payer: PHCS Commercial |
$7,252.99
|
| Rate for Payer: United Healthcare All Payer |
$6,648.58
|
|
|
PINN MAR +4 10D 32ID*60OD
|
Facility
|
OP
|
$7,555.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,266.56 |
| Max. Negotiated Rate |
$7,252.99 |
| Rate for Payer: Aetna Commercial |
$5,817.50
|
| Rate for Payer: Anthem Medicaid |
$2,598.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,893.06
|
| Rate for Payer: Cash Price |
$3,777.60
|
| Rate for Payer: Cigna Commercial |
$6,270.82
|
| Rate for Payer: First Health Commercial |
$7,177.44
|
| Rate for Payer: Humana Commercial |
$6,421.92
|
| Rate for Payer: Humana KY Medicaid |
$2,598.23
|
| Rate for Payer: Kentucky WC Medicaid |
$2,624.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,195.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,575.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,266.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,650.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,648.58
|
| Rate for Payer: Ohio Health Group HMO |
$5,666.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,044.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,573.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,213.09
|
| Rate for Payer: PHCS Commercial |
$7,252.99
|
| Rate for Payer: United Healthcare All Payer |
$6,648.58
|
|
|
PINN MAR +4 10D 32ID*62OD
|
Facility
|
OP
|
$7,555.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,266.56 |
| Max. Negotiated Rate |
$7,252.99 |
| Rate for Payer: Aetna Commercial |
$5,817.50
|
| Rate for Payer: Anthem Medicaid |
$2,598.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,893.06
|
| Rate for Payer: Cash Price |
$3,777.60
|
| Rate for Payer: Cigna Commercial |
$6,270.82
|
| Rate for Payer: First Health Commercial |
$7,177.44
|
| Rate for Payer: Humana Commercial |
$6,421.92
|
| Rate for Payer: Humana KY Medicaid |
$2,598.23
|
| Rate for Payer: Kentucky WC Medicaid |
$2,624.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,195.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,575.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,266.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,650.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,648.58
|
| Rate for Payer: Ohio Health Group HMO |
$5,666.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,044.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,573.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,213.09
|
| Rate for Payer: PHCS Commercial |
$7,252.99
|
| Rate for Payer: United Healthcare All Payer |
$6,648.58
|
|
|
PINN MAR +4 10D 32ID*62OD
|
Facility
|
IP
|
$7,555.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,266.56 |
| Max. Negotiated Rate |
$7,252.99 |
| Rate for Payer: Aetna Commercial |
$5,817.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,893.06
|
| Rate for Payer: Cash Price |
$3,777.60
|
| Rate for Payer: Cigna Commercial |
$6,270.82
|
| Rate for Payer: First Health Commercial |
$7,177.44
|
| Rate for Payer: Humana Commercial |
$6,421.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,195.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,575.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,266.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,648.58
|
| Rate for Payer: Ohio Health Group HMO |
$5,666.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,044.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,573.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,213.09
|
| Rate for Payer: PHCS Commercial |
$7,252.99
|
| Rate for Payer: United Healthcare All Payer |
$6,648.58
|
|
|
PINN MAR +4 10D 32ID*66OD
|
Facility
|
IP
|
$7,555.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,266.56 |
| Max. Negotiated Rate |
$7,252.99 |
| Rate for Payer: Aetna Commercial |
$5,817.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,893.06
|
| Rate for Payer: Cash Price |
$3,777.60
|
| Rate for Payer: Cigna Commercial |
$6,270.82
|
| Rate for Payer: First Health Commercial |
$7,177.44
|
| Rate for Payer: Humana Commercial |
$6,421.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,195.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,575.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,266.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,648.58
|
| Rate for Payer: Ohio Health Group HMO |
$5,666.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,044.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,573.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,213.09
|
| Rate for Payer: PHCS Commercial |
$7,252.99
|
| Rate for Payer: United Healthcare All Payer |
$6,648.58
|
|
|
PINN MAR +4 10D 32ID*66OD
|
Facility
|
OP
|
$7,555.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,266.56 |
| Max. Negotiated Rate |
$7,252.99 |
| Rate for Payer: Aetna Commercial |
$5,817.50
|
| Rate for Payer: Anthem Medicaid |
$2,598.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,893.06
|
| Rate for Payer: Cash Price |
$3,777.60
|
| Rate for Payer: Cigna Commercial |
$6,270.82
|
| Rate for Payer: First Health Commercial |
$7,177.44
|
| Rate for Payer: Humana Commercial |
$6,421.92
|
| Rate for Payer: Humana KY Medicaid |
$2,598.23
|
| Rate for Payer: Kentucky WC Medicaid |
$2,624.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,195.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,575.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,266.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,650.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,648.58
|
| Rate for Payer: Ohio Health Group HMO |
$5,666.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,044.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,573.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,213.09
|
| Rate for Payer: PHCS Commercial |
$7,252.99
|
| Rate for Payer: United Healthcare All Payer |
$6,648.58
|
|
|
PINN MAR +4 10D 36ID*52OD
|
Facility
|
OP
|
$8,604.21
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,581.26 |
| Max. Negotiated Rate |
$8,260.04 |
| Rate for Payer: Aetna Commercial |
$6,625.24
|
| Rate for Payer: Anthem Medicaid |
$2,958.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,711.28
|
| Rate for Payer: Cash Price |
$4,302.10
|
| Rate for Payer: Cigna Commercial |
$7,141.49
|
| Rate for Payer: First Health Commercial |
$8,174.00
|
| Rate for Payer: Humana Commercial |
$7,313.58
|
| Rate for Payer: Humana KY Medicaid |
$2,958.99
|
| Rate for Payer: Kentucky WC Medicaid |
$2,989.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,055.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,349.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,581.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,018.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,571.70
|
| Rate for Payer: Ohio Health Group HMO |
$6,453.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,883.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,485.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,936.90
|
| Rate for Payer: PHCS Commercial |
$8,260.04
|
| Rate for Payer: United Healthcare All Payer |
$7,571.70
|
|
|
PINN MAR +4 10D 36ID*52OD
|
Facility
|
IP
|
$8,604.21
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,581.26 |
| Max. Negotiated Rate |
$8,260.04 |
| Rate for Payer: Aetna Commercial |
$6,625.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,711.28
|
| Rate for Payer: Cash Price |
$4,302.10
|
| Rate for Payer: Cigna Commercial |
$7,141.49
|
| Rate for Payer: First Health Commercial |
$8,174.00
|
| Rate for Payer: Humana Commercial |
$7,313.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,055.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,349.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,581.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,571.70
|
| Rate for Payer: Ohio Health Group HMO |
$6,453.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,883.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,485.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,936.90
|
| Rate for Payer: PHCS Commercial |
$8,260.04
|
| Rate for Payer: United Healthcare All Payer |
$7,571.70
|
|
|
PINN MAR +4 10D 36ID*54OD
|
Facility
|
IP
|
$8,604.21
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,581.26 |
| Max. Negotiated Rate |
$8,260.04 |
| Rate for Payer: Aetna Commercial |
$6,625.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,711.28
|
| Rate for Payer: Cash Price |
$4,302.10
|
| Rate for Payer: Cigna Commercial |
$7,141.49
|
| Rate for Payer: First Health Commercial |
$8,174.00
|
| Rate for Payer: Humana Commercial |
$7,313.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,055.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,349.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,581.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,571.70
|
| Rate for Payer: Ohio Health Group HMO |
$6,453.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,883.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,485.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,936.90
|
| Rate for Payer: PHCS Commercial |
$8,260.04
|
| Rate for Payer: United Healthcare All Payer |
$7,571.70
|
|
|
PINN MAR +4 10D 36ID*54OD
|
Facility
|
OP
|
$8,604.21
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,581.26 |
| Max. Negotiated Rate |
$8,260.04 |
| Rate for Payer: Aetna Commercial |
$6,625.24
|
| Rate for Payer: Anthem Medicaid |
$2,958.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,711.28
|
| Rate for Payer: Cash Price |
$4,302.10
|
| Rate for Payer: Cigna Commercial |
$7,141.49
|
| Rate for Payer: First Health Commercial |
$8,174.00
|
| Rate for Payer: Humana Commercial |
$7,313.58
|
| Rate for Payer: Humana KY Medicaid |
$2,958.99
|
| Rate for Payer: Kentucky WC Medicaid |
$2,989.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,055.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,349.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,581.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,018.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,571.70
|
| Rate for Payer: Ohio Health Group HMO |
$6,453.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,883.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,485.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,936.90
|
| Rate for Payer: PHCS Commercial |
$8,260.04
|
| Rate for Payer: United Healthcare All Payer |
$7,571.70
|
|
|
PINN MAR +4 LNR 36ID*52OD
|
Facility
|
IP
|
$8,604.21
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,581.26 |
| Max. Negotiated Rate |
$8,260.04 |
| Rate for Payer: Aetna Commercial |
$6,625.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,711.28
|
| Rate for Payer: Cash Price |
$4,302.10
|
| Rate for Payer: Cigna Commercial |
$7,141.49
|
| Rate for Payer: First Health Commercial |
$8,174.00
|
| Rate for Payer: Humana Commercial |
$7,313.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,055.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,349.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,581.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,571.70
|
| Rate for Payer: Ohio Health Group HMO |
$6,453.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,883.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,485.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,936.90
|
| Rate for Payer: PHCS Commercial |
$8,260.04
|
| Rate for Payer: United Healthcare All Payer |
$7,571.70
|
|
|
PINN MAR +4 LNR 36ID*52OD
|
Facility
|
OP
|
$8,604.21
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,581.26 |
| Max. Negotiated Rate |
$8,260.04 |
| Rate for Payer: Aetna Commercial |
$6,625.24
|
| Rate for Payer: Anthem Medicaid |
$2,958.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,711.28
|
| Rate for Payer: Cash Price |
$4,302.10
|
| Rate for Payer: Cigna Commercial |
$7,141.49
|
| Rate for Payer: First Health Commercial |
$8,174.00
|
| Rate for Payer: Humana Commercial |
$7,313.58
|
| Rate for Payer: Humana KY Medicaid |
$2,958.99
|
| Rate for Payer: Kentucky WC Medicaid |
$2,989.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,055.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,349.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,581.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,018.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,571.70
|
| Rate for Payer: Ohio Health Group HMO |
$6,453.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,883.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,485.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,936.90
|
| Rate for Payer: PHCS Commercial |
$8,260.04
|
| Rate for Payer: United Healthcare All Payer |
$7,571.70
|
|
|
PINN MAR+4 LNR NEUT 36ID*56OD
|
Facility
|
OP
|
$8,604.21
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,581.26 |
| Max. Negotiated Rate |
$8,260.04 |
| Rate for Payer: Aetna Commercial |
$6,625.24
|
| Rate for Payer: Anthem Medicaid |
$2,958.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,711.28
|
| Rate for Payer: Cash Price |
$4,302.10
|
| Rate for Payer: Cigna Commercial |
$7,141.49
|
| Rate for Payer: First Health Commercial |
$8,174.00
|
| Rate for Payer: Humana Commercial |
$7,313.58
|
| Rate for Payer: Humana KY Medicaid |
$2,958.99
|
| Rate for Payer: Kentucky WC Medicaid |
$2,989.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,055.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,349.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,581.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,018.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,571.70
|
| Rate for Payer: Ohio Health Group HMO |
$6,453.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,883.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,485.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,936.90
|
| Rate for Payer: PHCS Commercial |
$8,260.04
|
| Rate for Payer: United Healthcare All Payer |
$7,571.70
|
|
|
PINN MAR+4 LNR NEUT 36ID*56OD
|
Facility
|
IP
|
$8,604.21
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,581.26 |
| Max. Negotiated Rate |
$8,260.04 |
| Rate for Payer: Aetna Commercial |
$6,625.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,711.28
|
| Rate for Payer: Cash Price |
$4,302.10
|
| Rate for Payer: Cigna Commercial |
$7,141.49
|
| Rate for Payer: First Health Commercial |
$8,174.00
|
| Rate for Payer: Humana Commercial |
$7,313.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,055.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,349.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,581.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,571.70
|
| Rate for Payer: Ohio Health Group HMO |
$6,453.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,883.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,485.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,936.90
|
| Rate for Payer: PHCS Commercial |
$8,260.04
|
| Rate for Payer: United Healthcare All Payer |
$7,571.70
|
|
|
PINN MAR+4 LNR NEUT 36ID*58OD
|
Facility
|
OP
|
$8,604.21
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,581.26 |
| Max. Negotiated Rate |
$8,260.04 |
| Rate for Payer: Aetna Commercial |
$6,625.24
|
| Rate for Payer: Anthem Medicaid |
$2,958.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,711.28
|
| Rate for Payer: Cash Price |
$4,302.10
|
| Rate for Payer: Cigna Commercial |
$7,141.49
|
| Rate for Payer: First Health Commercial |
$8,174.00
|
| Rate for Payer: Humana Commercial |
$7,313.58
|
| Rate for Payer: Humana KY Medicaid |
$2,958.99
|
| Rate for Payer: Kentucky WC Medicaid |
$2,989.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,055.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,349.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,581.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,018.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,571.70
|
| Rate for Payer: Ohio Health Group HMO |
$6,453.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,883.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,485.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,936.90
|
| Rate for Payer: PHCS Commercial |
$8,260.04
|
| Rate for Payer: United Healthcare All Payer |
$7,571.70
|
|
|
PINN MAR+4 LNR NEUT 36ID*58OD
|
Facility
|
IP
|
$8,604.21
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,581.26 |
| Max. Negotiated Rate |
$8,260.04 |
| Rate for Payer: Aetna Commercial |
$6,625.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,711.28
|
| Rate for Payer: Cash Price |
$4,302.10
|
| Rate for Payer: Cigna Commercial |
$7,141.49
|
| Rate for Payer: First Health Commercial |
$8,174.00
|
| Rate for Payer: Humana Commercial |
$7,313.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,055.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,349.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,581.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,571.70
|
| Rate for Payer: Ohio Health Group HMO |
$6,453.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,883.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,485.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,936.90
|
| Rate for Payer: PHCS Commercial |
$8,260.04
|
| Rate for Payer: United Healthcare All Payer |
$7,571.70
|
|
|
PINN MAR+4 LNR NEUT 36ID*60OD
|
Facility
|
OP
|
$8,604.21
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,581.26 |
| Max. Negotiated Rate |
$8,260.04 |
| Rate for Payer: Aetna Commercial |
$6,625.24
|
| Rate for Payer: Anthem Medicaid |
$2,958.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,711.28
|
| Rate for Payer: Cash Price |
$4,302.10
|
| Rate for Payer: Cigna Commercial |
$7,141.49
|
| Rate for Payer: First Health Commercial |
$8,174.00
|
| Rate for Payer: Humana Commercial |
$7,313.58
|
| Rate for Payer: Humana KY Medicaid |
$2,958.99
|
| Rate for Payer: Kentucky WC Medicaid |
$2,989.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,055.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,349.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,581.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,018.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,571.70
|
| Rate for Payer: Ohio Health Group HMO |
$6,453.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,883.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,485.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,936.90
|
| Rate for Payer: PHCS Commercial |
$8,260.04
|
| Rate for Payer: United Healthcare All Payer |
$7,571.70
|
|
