|
PINN MAR LIP LNR 32ID*66OD
|
Facility
|
OP
|
$7,171.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,151.59 |
| Max. Negotiated Rate |
$6,885.07 |
| Rate for Payer: Aetna Commercial |
$5,522.40
|
| Rate for Payer: Anthem Medicaid |
$2,466.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,594.12
|
| Rate for Payer: Cash Price |
$3,585.98
|
| Rate for Payer: Cigna Commercial |
$5,952.72
|
| Rate for Payer: First Health Commercial |
$6,813.35
|
| Rate for Payer: Humana Commercial |
$6,096.16
|
| Rate for Payer: Humana KY Medicaid |
$2,466.43
|
| Rate for Payer: Kentucky WC Medicaid |
$2,491.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,881.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,292.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,151.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,515.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,311.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,378.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,737.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,239.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,948.65
|
| Rate for Payer: PHCS Commercial |
$6,885.07
|
| Rate for Payer: United Healthcare All Payer |
$6,311.32
|
|
|
PINN MAR LIP LNR 32ID*66OD
|
Facility
|
IP
|
$7,171.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,151.59 |
| Max. Negotiated Rate |
$6,885.07 |
| Rate for Payer: Aetna Commercial |
$5,522.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,594.12
|
| Rate for Payer: Cash Price |
$3,585.98
|
| Rate for Payer: Cigna Commercial |
$5,952.72
|
| Rate for Payer: First Health Commercial |
$6,813.35
|
| Rate for Payer: Humana Commercial |
$6,096.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,881.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,292.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,151.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,311.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,378.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,737.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,239.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,948.65
|
| Rate for Payer: PHCS Commercial |
$6,885.07
|
| Rate for Payer: United Healthcare All Payer |
$6,311.32
|
|
|
PINN MAR NEUT 36ID*56OD
|
Facility
|
IP
|
$8,803.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,640.93 |
| Max. Negotiated Rate |
$8,450.98 |
| Rate for Payer: Aetna Commercial |
$6,778.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,866.42
|
| Rate for Payer: Cash Price |
$4,401.55
|
| Rate for Payer: Cigna Commercial |
$7,306.57
|
| Rate for Payer: First Health Commercial |
$8,362.94
|
| Rate for Payer: Humana Commercial |
$7,482.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,218.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,496.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,640.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,746.73
|
| Rate for Payer: Ohio Health Group HMO |
$6,602.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,042.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,658.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,074.14
|
| Rate for Payer: PHCS Commercial |
$8,450.98
|
| Rate for Payer: United Healthcare All Payer |
$7,746.73
|
|
|
PINN MAR NEUT 36ID*56OD
|
Facility
|
OP
|
$8,803.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,640.93 |
| Max. Negotiated Rate |
$8,450.98 |
| Rate for Payer: Aetna Commercial |
$6,778.39
|
| Rate for Payer: Anthem Medicaid |
$3,027.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,866.42
|
| Rate for Payer: Cash Price |
$4,401.55
|
| Rate for Payer: Cigna Commercial |
$7,306.57
|
| Rate for Payer: First Health Commercial |
$8,362.94
|
| Rate for Payer: Humana Commercial |
$7,482.64
|
| Rate for Payer: Humana KY Medicaid |
$3,027.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3,058.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,218.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,496.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,640.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,088.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,746.73
|
| Rate for Payer: Ohio Health Group HMO |
$6,602.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,042.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,658.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,074.14
|
| Rate for Payer: PHCS Commercial |
$8,450.98
|
| Rate for Payer: United Healthcare All Payer |
$7,746.73
|
|
|
PINN SECTOR HA ACET CUP 48MM
|
Facility
|
IP
|
$14,201.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,260.52 |
| Max. Negotiated Rate |
$13,633.65 |
| Rate for Payer: Aetna Commercial |
$10,935.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,077.34
|
| Rate for Payer: Cash Price |
$7,100.86
|
| Rate for Payer: Cigna Commercial |
$11,787.43
|
| Rate for Payer: First Health Commercial |
$13,491.63
|
| Rate for Payer: Humana Commercial |
$12,071.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,645.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,480.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,260.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,497.51
|
| Rate for Payer: Ohio Health Group HMO |
$10,651.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,361.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,355.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,799.19
|
| Rate for Payer: PHCS Commercial |
$13,633.65
|
| Rate for Payer: United Healthcare All Payer |
$12,497.51
|
|
|
PINN SECTOR HA ACET CUP 48MM
|
Facility
|
OP
|
$14,201.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,260.52 |
| Max. Negotiated Rate |
$13,633.65 |
| Rate for Payer: Aetna Commercial |
$10,935.32
|
| Rate for Payer: Anthem Medicaid |
$4,883.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,077.34
|
| Rate for Payer: Cash Price |
$7,100.86
|
| Rate for Payer: Cigna Commercial |
$11,787.43
|
| Rate for Payer: First Health Commercial |
$13,491.63
|
| Rate for Payer: Humana Commercial |
$12,071.46
|
| Rate for Payer: Humana KY Medicaid |
$4,883.97
|
| Rate for Payer: Kentucky WC Medicaid |
$4,933.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,645.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,480.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,260.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,981.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,497.51
|
| Rate for Payer: Ohio Health Group HMO |
$10,651.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,361.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,355.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,799.19
|
| Rate for Payer: PHCS Commercial |
$13,633.65
|
| Rate for Payer: United Healthcare All Payer |
$12,497.51
|
|
|
PINN SECTOR HA ACET CUP 50MM
|
Facility
|
IP
|
$14,201.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,260.52 |
| Max. Negotiated Rate |
$13,633.65 |
| Rate for Payer: Aetna Commercial |
$10,935.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,077.34
|
| Rate for Payer: Cash Price |
$7,100.86
|
| Rate for Payer: Cigna Commercial |
$11,787.43
|
| Rate for Payer: First Health Commercial |
$13,491.63
|
| Rate for Payer: Humana Commercial |
$12,071.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,645.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,480.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,260.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,497.51
|
| Rate for Payer: Ohio Health Group HMO |
$10,651.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,361.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,355.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,799.19
|
| Rate for Payer: PHCS Commercial |
$13,633.65
|
| Rate for Payer: United Healthcare All Payer |
$12,497.51
|
|
|
PINN SECTOR HA ACET CUP 50MM
|
Facility
|
OP
|
$14,201.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,260.52 |
| Max. Negotiated Rate |
$13,633.65 |
| Rate for Payer: Aetna Commercial |
$10,935.32
|
| Rate for Payer: Anthem Medicaid |
$4,883.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,077.34
|
| Rate for Payer: Cash Price |
$7,100.86
|
| Rate for Payer: Cigna Commercial |
$11,787.43
|
| Rate for Payer: First Health Commercial |
$13,491.63
|
| Rate for Payer: Humana Commercial |
$12,071.46
|
| Rate for Payer: Humana KY Medicaid |
$4,883.97
|
| Rate for Payer: Kentucky WC Medicaid |
$4,933.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,645.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,480.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,260.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,981.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,497.51
|
| Rate for Payer: Ohio Health Group HMO |
$10,651.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,361.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,355.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,799.19
|
| Rate for Payer: PHCS Commercial |
$13,633.65
|
| Rate for Payer: United Healthcare All Payer |
$12,497.51
|
|
|
PINN SECTOR HA ACET CUP 52MM
|
Facility
|
IP
|
$14,201.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,260.52 |
| Max. Negotiated Rate |
$13,633.65 |
| Rate for Payer: Aetna Commercial |
$10,935.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,077.34
|
| Rate for Payer: Cash Price |
$7,100.86
|
| Rate for Payer: Cigna Commercial |
$11,787.43
|
| Rate for Payer: First Health Commercial |
$13,491.63
|
| Rate for Payer: Humana Commercial |
$12,071.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,645.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,480.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,260.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,497.51
|
| Rate for Payer: Ohio Health Group HMO |
$10,651.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,361.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,355.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,799.19
|
| Rate for Payer: PHCS Commercial |
$13,633.65
|
| Rate for Payer: United Healthcare All Payer |
$12,497.51
|
|
|
PINN SECTOR HA ACET CUP 52MM
|
Facility
|
OP
|
$14,201.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,260.52 |
| Max. Negotiated Rate |
$13,633.65 |
| Rate for Payer: Aetna Commercial |
$10,935.32
|
| Rate for Payer: Anthem Medicaid |
$4,883.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,077.34
|
| Rate for Payer: Cash Price |
$7,100.86
|
| Rate for Payer: Cigna Commercial |
$11,787.43
|
| Rate for Payer: First Health Commercial |
$13,491.63
|
| Rate for Payer: Humana Commercial |
$12,071.46
|
| Rate for Payer: Humana KY Medicaid |
$4,883.97
|
| Rate for Payer: Kentucky WC Medicaid |
$4,933.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,645.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,480.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,260.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,981.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,497.51
|
| Rate for Payer: Ohio Health Group HMO |
$10,651.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,361.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,355.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,799.19
|
| Rate for Payer: PHCS Commercial |
$13,633.65
|
| Rate for Payer: United Healthcare All Payer |
$12,497.51
|
|
|
PINN SECTOR HA ACET CUP 54MM
|
Facility
|
OP
|
$14,201.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,260.52 |
| Max. Negotiated Rate |
$13,633.65 |
| Rate for Payer: Aetna Commercial |
$10,935.32
|
| Rate for Payer: Anthem Medicaid |
$4,883.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,077.34
|
| Rate for Payer: Cash Price |
$7,100.86
|
| Rate for Payer: Cigna Commercial |
$11,787.43
|
| Rate for Payer: First Health Commercial |
$13,491.63
|
| Rate for Payer: Humana Commercial |
$12,071.46
|
| Rate for Payer: Humana KY Medicaid |
$4,883.97
|
| Rate for Payer: Kentucky WC Medicaid |
$4,933.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,645.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,480.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,260.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,981.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,497.51
|
| Rate for Payer: Ohio Health Group HMO |
$10,651.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,361.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,355.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,799.19
|
| Rate for Payer: PHCS Commercial |
$13,633.65
|
| Rate for Payer: United Healthcare All Payer |
$12,497.51
|
|
|
PINN SECTOR HA ACET CUP 54MM
|
Facility
|
IP
|
$14,201.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,260.52 |
| Max. Negotiated Rate |
$13,633.65 |
| Rate for Payer: Aetna Commercial |
$10,935.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,077.34
|
| Rate for Payer: Cash Price |
$7,100.86
|
| Rate for Payer: Cigna Commercial |
$11,787.43
|
| Rate for Payer: First Health Commercial |
$13,491.63
|
| Rate for Payer: Humana Commercial |
$12,071.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,645.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,480.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,260.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,497.51
|
| Rate for Payer: Ohio Health Group HMO |
$10,651.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,361.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,355.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,799.19
|
| Rate for Payer: PHCS Commercial |
$13,633.65
|
| Rate for Payer: United Healthcare All Payer |
$12,497.51
|
|
|
PINN SECTOR HA ACET CUP 56MM
|
Facility
|
OP
|
$14,201.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,260.52 |
| Max. Negotiated Rate |
$13,633.65 |
| Rate for Payer: Aetna Commercial |
$10,935.32
|
| Rate for Payer: Anthem Medicaid |
$4,883.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,077.34
|
| Rate for Payer: Cash Price |
$7,100.86
|
| Rate for Payer: Cigna Commercial |
$11,787.43
|
| Rate for Payer: First Health Commercial |
$13,491.63
|
| Rate for Payer: Humana Commercial |
$12,071.46
|
| Rate for Payer: Humana KY Medicaid |
$4,883.97
|
| Rate for Payer: Kentucky WC Medicaid |
$4,933.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,645.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,480.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,260.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,981.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,497.51
|
| Rate for Payer: Ohio Health Group HMO |
$10,651.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,361.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,355.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,799.19
|
| Rate for Payer: PHCS Commercial |
$13,633.65
|
| Rate for Payer: United Healthcare All Payer |
$12,497.51
|
|
|
PINN SECTOR HA ACET CUP 56MM
|
Facility
|
IP
|
$14,201.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,260.52 |
| Max. Negotiated Rate |
$13,633.65 |
| Rate for Payer: Aetna Commercial |
$10,935.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,077.34
|
| Rate for Payer: Cash Price |
$7,100.86
|
| Rate for Payer: Cigna Commercial |
$11,787.43
|
| Rate for Payer: First Health Commercial |
$13,491.63
|
| Rate for Payer: Humana Commercial |
$12,071.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,645.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,480.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,260.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,497.51
|
| Rate for Payer: Ohio Health Group HMO |
$10,651.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,361.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,355.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,799.19
|
| Rate for Payer: PHCS Commercial |
$13,633.65
|
| Rate for Payer: United Healthcare All Payer |
$12,497.51
|
|
|
PINN SECTOR HA ACET CUP 58MM
|
Facility
|
IP
|
$14,201.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,260.52 |
| Max. Negotiated Rate |
$13,633.65 |
| Rate for Payer: Aetna Commercial |
$10,935.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,077.34
|
| Rate for Payer: Cash Price |
$7,100.86
|
| Rate for Payer: Cigna Commercial |
$11,787.43
|
| Rate for Payer: First Health Commercial |
$13,491.63
|
| Rate for Payer: Humana Commercial |
$12,071.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,645.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,480.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,260.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,497.51
|
| Rate for Payer: Ohio Health Group HMO |
$10,651.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,361.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,355.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,799.19
|
| Rate for Payer: PHCS Commercial |
$13,633.65
|
| Rate for Payer: United Healthcare All Payer |
$12,497.51
|
|
|
PINN SECTOR HA ACET CUP 58MM
|
Facility
|
OP
|
$14,201.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,260.52 |
| Max. Negotiated Rate |
$13,633.65 |
| Rate for Payer: Aetna Commercial |
$10,935.32
|
| Rate for Payer: Anthem Medicaid |
$4,883.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,077.34
|
| Rate for Payer: Cash Price |
$7,100.86
|
| Rate for Payer: Cigna Commercial |
$11,787.43
|
| Rate for Payer: First Health Commercial |
$13,491.63
|
| Rate for Payer: Humana Commercial |
$12,071.46
|
| Rate for Payer: Humana KY Medicaid |
$4,883.97
|
| Rate for Payer: Kentucky WC Medicaid |
$4,933.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,645.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,480.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,260.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,981.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,497.51
|
| Rate for Payer: Ohio Health Group HMO |
$10,651.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,361.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,355.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,799.19
|
| Rate for Payer: PHCS Commercial |
$13,633.65
|
| Rate for Payer: United Healthcare All Payer |
$12,497.51
|
|
|
PINN SECTOR HA ACET CUP 60MM
|
Facility
|
OP
|
$14,201.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,260.52 |
| Max. Negotiated Rate |
$13,633.65 |
| Rate for Payer: Aetna Commercial |
$10,935.32
|
| Rate for Payer: Anthem Medicaid |
$4,883.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,077.34
|
| Rate for Payer: Cash Price |
$7,100.86
|
| Rate for Payer: Cigna Commercial |
$11,787.43
|
| Rate for Payer: First Health Commercial |
$13,491.63
|
| Rate for Payer: Humana Commercial |
$12,071.46
|
| Rate for Payer: Humana KY Medicaid |
$4,883.97
|
| Rate for Payer: Kentucky WC Medicaid |
$4,933.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,645.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,480.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,260.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,981.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,497.51
|
| Rate for Payer: Ohio Health Group HMO |
$10,651.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,361.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,355.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,799.19
|
| Rate for Payer: PHCS Commercial |
$13,633.65
|
| Rate for Payer: United Healthcare All Payer |
$12,497.51
|
|
|
PINN SECTOR HA ACET CUP 60MM
|
Facility
|
IP
|
$14,201.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,260.52 |
| Max. Negotiated Rate |
$13,633.65 |
| Rate for Payer: Aetna Commercial |
$10,935.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,077.34
|
| Rate for Payer: Cash Price |
$7,100.86
|
| Rate for Payer: Cigna Commercial |
$11,787.43
|
| Rate for Payer: First Health Commercial |
$13,491.63
|
| Rate for Payer: Humana Commercial |
$12,071.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,645.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,480.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,260.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,497.51
|
| Rate for Payer: Ohio Health Group HMO |
$10,651.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,361.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,355.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,799.19
|
| Rate for Payer: PHCS Commercial |
$13,633.65
|
| Rate for Payer: United Healthcare All Payer |
$12,497.51
|
|
|
PINN SECTOR HA ACET CUP 62MM
|
Facility
|
OP
|
$14,201.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,260.52 |
| Max. Negotiated Rate |
$13,633.65 |
| Rate for Payer: Aetna Commercial |
$10,935.32
|
| Rate for Payer: Anthem Medicaid |
$4,883.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,077.34
|
| Rate for Payer: Cash Price |
$7,100.86
|
| Rate for Payer: Cigna Commercial |
$11,787.43
|
| Rate for Payer: First Health Commercial |
$13,491.63
|
| Rate for Payer: Humana Commercial |
$12,071.46
|
| Rate for Payer: Humana KY Medicaid |
$4,883.97
|
| Rate for Payer: Kentucky WC Medicaid |
$4,933.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,645.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,480.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,260.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,981.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,497.51
|
| Rate for Payer: Ohio Health Group HMO |
$10,651.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,361.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,355.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,799.19
|
| Rate for Payer: PHCS Commercial |
$13,633.65
|
| Rate for Payer: United Healthcare All Payer |
$12,497.51
|
|
|
PINN SECTOR HA ACET CUP 62MM
|
Facility
|
IP
|
$14,201.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,260.52 |
| Max. Negotiated Rate |
$13,633.65 |
| Rate for Payer: Aetna Commercial |
$10,935.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,077.34
|
| Rate for Payer: Cash Price |
$7,100.86
|
| Rate for Payer: Cigna Commercial |
$11,787.43
|
| Rate for Payer: First Health Commercial |
$13,491.63
|
| Rate for Payer: Humana Commercial |
$12,071.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,645.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,480.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,260.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,497.51
|
| Rate for Payer: Ohio Health Group HMO |
$10,651.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,361.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,355.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,799.19
|
| Rate for Payer: PHCS Commercial |
$13,633.65
|
| Rate for Payer: United Healthcare All Payer |
$12,497.51
|
|
|
PINN SECTOR HA ACET CUP 64MM
|
Facility
|
OP
|
$14,201.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,260.52 |
| Max. Negotiated Rate |
$13,633.65 |
| Rate for Payer: Aetna Commercial |
$10,935.32
|
| Rate for Payer: Anthem Medicaid |
$4,883.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,077.34
|
| Rate for Payer: Cash Price |
$7,100.86
|
| Rate for Payer: Cigna Commercial |
$11,787.43
|
| Rate for Payer: First Health Commercial |
$13,491.63
|
| Rate for Payer: Humana Commercial |
$12,071.46
|
| Rate for Payer: Humana KY Medicaid |
$4,883.97
|
| Rate for Payer: Kentucky WC Medicaid |
$4,933.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,645.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,480.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,260.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,981.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,497.51
|
| Rate for Payer: Ohio Health Group HMO |
$10,651.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,361.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,355.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,799.19
|
| Rate for Payer: PHCS Commercial |
$13,633.65
|
| Rate for Payer: United Healthcare All Payer |
$12,497.51
|
|
|
PINN SECTOR HA ACET CUP 64MM
|
Facility
|
IP
|
$14,201.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,260.52 |
| Max. Negotiated Rate |
$13,633.65 |
| Rate for Payer: Aetna Commercial |
$10,935.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,077.34
|
| Rate for Payer: Cash Price |
$7,100.86
|
| Rate for Payer: Cigna Commercial |
$11,787.43
|
| Rate for Payer: First Health Commercial |
$13,491.63
|
| Rate for Payer: Humana Commercial |
$12,071.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,645.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,480.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,260.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,497.51
|
| Rate for Payer: Ohio Health Group HMO |
$10,651.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,361.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,355.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,799.19
|
| Rate for Payer: PHCS Commercial |
$13,633.65
|
| Rate for Payer: United Healthcare All Payer |
$12,497.51
|
|
|
PINN SECTOR HA ACET CUP 66MM
|
Facility
|
OP
|
$14,201.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,260.52 |
| Max. Negotiated Rate |
$13,633.65 |
| Rate for Payer: Aetna Commercial |
$10,935.32
|
| Rate for Payer: Anthem Medicaid |
$4,883.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,077.34
|
| Rate for Payer: Cash Price |
$7,100.86
|
| Rate for Payer: Cigna Commercial |
$11,787.43
|
| Rate for Payer: First Health Commercial |
$13,491.63
|
| Rate for Payer: Humana Commercial |
$12,071.46
|
| Rate for Payer: Humana KY Medicaid |
$4,883.97
|
| Rate for Payer: Kentucky WC Medicaid |
$4,933.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,645.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,480.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,260.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,981.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,497.51
|
| Rate for Payer: Ohio Health Group HMO |
$10,651.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,361.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,355.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,799.19
|
| Rate for Payer: PHCS Commercial |
$13,633.65
|
| Rate for Payer: United Healthcare All Payer |
$12,497.51
|
|
|
PINN SECTOR HA ACET CUP 66MM
|
Facility
|
IP
|
$14,201.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,260.52 |
| Max. Negotiated Rate |
$13,633.65 |
| Rate for Payer: Aetna Commercial |
$10,935.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,077.34
|
| Rate for Payer: Cash Price |
$7,100.86
|
| Rate for Payer: Cigna Commercial |
$11,787.43
|
| Rate for Payer: First Health Commercial |
$13,491.63
|
| Rate for Payer: Humana Commercial |
$12,071.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,645.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,480.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,260.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,497.51
|
| Rate for Payer: Ohio Health Group HMO |
$10,651.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,361.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,355.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,799.19
|
| Rate for Payer: PHCS Commercial |
$13,633.65
|
| Rate for Payer: United Healthcare All Payer |
$12,497.51
|
|
|
PIN TEMP SMOOTH 1.1*15MM
|
Facility
|
IP
|
$1,485.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$445.50 |
| Max. Negotiated Rate |
$1,425.60 |
| Rate for Payer: Aetna Commercial |
$1,143.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,158.30
|
| Rate for Payer: Cash Price |
$742.50
|
| Rate for Payer: Cigna Commercial |
$1,232.55
|
| Rate for Payer: First Health Commercial |
$1,410.75
|
| Rate for Payer: Humana Commercial |
$1,262.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,217.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,095.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$445.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,306.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,113.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,188.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,291.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,024.65
|
| Rate for Payer: PHCS Commercial |
$1,425.60
|
| Rate for Payer: United Healthcare All Payer |
$1,306.80
|
|
