|
PRIM CPCS COCR HO 12/14 SZ 3
|
Facility
|
OP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem Medicaid |
$2,845.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Humana KY Medicaid |
$2,845.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,874.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,902.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
PRIM CPCS COCR HO 12/14 SZ 4
|
Facility
|
IP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
PRIM CPCS COCR HO 12/14 SZ 4
|
Facility
|
OP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem Medicaid |
$2,845.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Humana KY Medicaid |
$2,845.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,874.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,902.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
PRIM CPCS COCR HO 12/14 SZ 5
|
Facility
|
OP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem Medicaid |
$2,845.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Humana KY Medicaid |
$2,845.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,874.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,902.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
PRIM CPCS COCR HO 12/14 SZ 5
|
Facility
|
IP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
PRIM CPCS COCR SO 12/14 SZ 0
|
Facility
|
OP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem Medicaid |
$2,845.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Humana KY Medicaid |
$2,845.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,874.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,902.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
PRIM CPCS COCR SO 12/14 SZ 0
|
Facility
|
IP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
PRIM CPCS COCR SO 12/14 SZ 1
|
Facility
|
IP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
PRIM CPCS COCR SO 12/14 SZ 1
|
Facility
|
OP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem Medicaid |
$2,845.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Humana KY Medicaid |
$2,845.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,874.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,902.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
PRIM CPCS COCR SO 12/14 SZ 2
|
Facility
|
OP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem Medicaid |
$2,845.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Humana KY Medicaid |
$2,845.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,874.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,902.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
PRIM CPCS COCR SO 12/14 SZ 2
|
Facility
|
IP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
PRIM CPCS COCR SO 12/14 SZ 3
|
Facility
|
IP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
PRIM CPCS COCR SO 12/14 SZ 3
|
Facility
|
OP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem Medicaid |
$2,845.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Humana KY Medicaid |
$2,845.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,874.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,902.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
PRIM CPCS COCR SO 12/14 SZ 5
|
Facility
|
OP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem Medicaid |
$2,845.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Humana KY Medicaid |
$2,845.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,874.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,902.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
PRIM CPCS COCR SO 12/14 SZ 5
|
Facility
|
IP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.75 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$6,371.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
| Rate for Payer: Cash Price |
$4,137.50
|
| Rate for Payer: Cigna Commercial |
$6,868.25
|
| Rate for Payer: First Health Commercial |
$7,861.25
|
| Rate for Payer: Humana Commercial |
$7,033.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
| Rate for Payer: PHCS Commercial |
$7,944.00
|
| Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
|
PRIM ECH FC HO SZ 18
|
Facility
|
OP
|
$9,735.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,265.55 |
| Max. Negotiated Rate |
$9,345.60 |
| Rate for Payer: Aetna Commercial |
$7,495.95
|
| Rate for Payer: Anthem Medicaid |
$3,347.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,593.30
|
| Rate for Payer: Cash Price |
$4,867.50
|
| Rate for Payer: Cigna Commercial |
$8,080.05
|
| Rate for Payer: First Health Commercial |
$9,248.25
|
| Rate for Payer: Humana Commercial |
$8,274.75
|
| Rate for Payer: Humana KY Medicaid |
$3,347.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,381.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,982.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,184.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,920.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,415.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,566.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,301.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,947.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,265.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,017.85
|
| Rate for Payer: PHCS Commercial |
$9,345.60
|
| Rate for Payer: United Healthcare All Payer |
$8,566.80
|
|
|
PRIM ECH FC HO SZ 18
|
Facility
|
IP
|
$9,735.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,265.55 |
| Max. Negotiated Rate |
$9,345.60 |
| Rate for Payer: Aetna Commercial |
$7,495.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,593.30
|
| Rate for Payer: Cash Price |
$4,867.50
|
| Rate for Payer: Cigna Commercial |
$8,080.05
|
| Rate for Payer: First Health Commercial |
$9,248.25
|
| Rate for Payer: Humana Commercial |
$8,274.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,982.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,184.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,920.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,566.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,301.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,947.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,265.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,017.85
|
| Rate for Payer: PHCS Commercial |
$9,345.60
|
| Rate for Payer: United Healthcare All Payer |
$8,566.80
|
|
|
PRIM ECH FC HO SZ 19
|
Facility
|
OP
|
$9,735.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,265.55 |
| Max. Negotiated Rate |
$9,345.60 |
| Rate for Payer: Aetna Commercial |
$7,495.95
|
| Rate for Payer: Anthem Medicaid |
$3,347.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,593.30
|
| Rate for Payer: Cash Price |
$4,867.50
|
| Rate for Payer: Cigna Commercial |
$8,080.05
|
| Rate for Payer: First Health Commercial |
$9,248.25
|
| Rate for Payer: Humana Commercial |
$8,274.75
|
| Rate for Payer: Humana KY Medicaid |
$3,347.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,381.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,982.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,184.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,920.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,415.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,566.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,301.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,947.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,265.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,017.85
|
| Rate for Payer: PHCS Commercial |
$9,345.60
|
| Rate for Payer: United Healthcare All Payer |
$8,566.80
|
|
|
PRIM ECH FC HO SZ 19
|
Facility
|
IP
|
$9,735.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,265.55 |
| Max. Negotiated Rate |
$9,345.60 |
| Rate for Payer: Aetna Commercial |
$7,495.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,593.30
|
| Rate for Payer: Cash Price |
$4,867.50
|
| Rate for Payer: Cigna Commercial |
$8,080.05
|
| Rate for Payer: First Health Commercial |
$9,248.25
|
| Rate for Payer: Humana Commercial |
$8,274.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,982.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,184.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,920.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,566.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,301.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,947.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,265.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,017.85
|
| Rate for Payer: PHCS Commercial |
$9,345.60
|
| Rate for Payer: United Healthcare All Payer |
$8,566.80
|
|
|
PRIM FULLCOAT ECH SZ 11 ST
|
Facility
|
OP
|
$9,735.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,265.55 |
| Max. Negotiated Rate |
$9,345.60 |
| Rate for Payer: Aetna Commercial |
$7,495.95
|
| Rate for Payer: Anthem Medicaid |
$3,347.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,593.30
|
| Rate for Payer: Cash Price |
$4,867.50
|
| Rate for Payer: Cigna Commercial |
$8,080.05
|
| Rate for Payer: First Health Commercial |
$9,248.25
|
| Rate for Payer: Humana Commercial |
$8,274.75
|
| Rate for Payer: Humana KY Medicaid |
$3,347.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,381.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,982.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,184.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,920.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,415.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,566.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,301.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,947.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,265.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,017.85
|
| Rate for Payer: PHCS Commercial |
$9,345.60
|
| Rate for Payer: United Healthcare All Payer |
$8,566.80
|
|
|
PRIM FULLCOAT ECH SZ 11 ST
|
Facility
|
IP
|
$9,735.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,265.55 |
| Max. Negotiated Rate |
$9,345.60 |
| Rate for Payer: Aetna Commercial |
$7,495.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,593.30
|
| Rate for Payer: Cash Price |
$4,867.50
|
| Rate for Payer: Cigna Commercial |
$8,080.05
|
| Rate for Payer: First Health Commercial |
$9,248.25
|
| Rate for Payer: Humana Commercial |
$8,274.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,982.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,184.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,920.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,566.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,301.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,947.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,265.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,017.85
|
| Rate for Payer: PHCS Commercial |
$9,345.60
|
| Rate for Payer: United Healthcare All Payer |
$8,566.80
|
|
|
PRIM FULLCOAT ECH SZ 12 HO
|
Facility
|
OP
|
$9,735.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,265.55 |
| Max. Negotiated Rate |
$9,345.60 |
| Rate for Payer: Aetna Commercial |
$7,495.95
|
| Rate for Payer: Anthem Medicaid |
$3,347.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,593.30
|
| Rate for Payer: Cash Price |
$4,867.50
|
| Rate for Payer: Cigna Commercial |
$8,080.05
|
| Rate for Payer: First Health Commercial |
$9,248.25
|
| Rate for Payer: Humana Commercial |
$8,274.75
|
| Rate for Payer: Humana KY Medicaid |
$3,347.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,381.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,982.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,184.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,920.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,415.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,566.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,301.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,947.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,265.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,017.85
|
| Rate for Payer: PHCS Commercial |
$9,345.60
|
| Rate for Payer: United Healthcare All Payer |
$8,566.80
|
|
|
PRIM FULLCOAT ECH SZ 12 HO
|
Facility
|
IP
|
$9,735.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,265.55 |
| Max. Negotiated Rate |
$9,345.60 |
| Rate for Payer: Aetna Commercial |
$7,495.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,593.30
|
| Rate for Payer: Cash Price |
$4,867.50
|
| Rate for Payer: Cigna Commercial |
$8,080.05
|
| Rate for Payer: First Health Commercial |
$9,248.25
|
| Rate for Payer: Humana Commercial |
$8,274.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,982.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,184.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,920.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,566.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,301.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,947.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,265.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,017.85
|
| Rate for Payer: PHCS Commercial |
$9,345.60
|
| Rate for Payer: United Healthcare All Payer |
$8,566.80
|
|
|
PRIM FULLCOAT ECH SZ 12 ST
|
Facility
|
IP
|
$9,735.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,265.55 |
| Max. Negotiated Rate |
$9,345.60 |
| Rate for Payer: Aetna Commercial |
$7,495.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,593.30
|
| Rate for Payer: Cash Price |
$4,867.50
|
| Rate for Payer: Cigna Commercial |
$8,080.05
|
| Rate for Payer: First Health Commercial |
$9,248.25
|
| Rate for Payer: Humana Commercial |
$8,274.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,982.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,184.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,920.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,566.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,301.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,947.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,265.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,017.85
|
| Rate for Payer: PHCS Commercial |
$9,345.60
|
| Rate for Payer: United Healthcare All Payer |
$8,566.80
|
|
|
PRIM FULLCOAT ECH SZ 12 ST
|
Facility
|
OP
|
$9,735.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,265.55 |
| Max. Negotiated Rate |
$9,345.60 |
| Rate for Payer: Aetna Commercial |
$7,495.95
|
| Rate for Payer: Anthem Medicaid |
$3,347.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,593.30
|
| Rate for Payer: Cash Price |
$4,867.50
|
| Rate for Payer: Cigna Commercial |
$8,080.05
|
| Rate for Payer: First Health Commercial |
$9,248.25
|
| Rate for Payer: Humana Commercial |
$8,274.75
|
| Rate for Payer: Humana KY Medicaid |
$3,347.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,381.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,982.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,184.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,920.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,415.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,566.80
|
| Rate for Payer: Ohio Health Group HMO |
$7,301.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,947.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,265.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,017.85
|
| Rate for Payer: PHCS Commercial |
$9,345.60
|
| Rate for Payer: United Healthcare All Payer |
$8,566.80
|
|
