|
R3 20DEG 32ID DISP TRLLNR 52OD
|
Facility
|
IP
|
$1,565.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$203.45 |
| Max. Negotiated Rate |
$1,502.40 |
| Rate for Payer: Aetna Commercial |
$1,205.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,220.70
|
| Rate for Payer: Cash Price |
$782.50
|
| Rate for Payer: Cigna Commercial |
$1,298.95
|
| Rate for Payer: First Health Commercial |
$1,486.75
|
| Rate for Payer: Humana Commercial |
$1,330.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,283.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,154.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$469.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,377.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,173.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$313.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$203.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$485.15
|
| Rate for Payer: PHCS Commercial |
$1,502.40
|
| Rate for Payer: United Healthcare All Payer |
$1,377.20
|
|
|
R3 20DEG 32ID DISP TRLLNR 54OD
|
Facility
|
IP
|
$1,565.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$203.45 |
| Max. Negotiated Rate |
$1,502.40 |
| Rate for Payer: Aetna Commercial |
$1,205.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,220.70
|
| Rate for Payer: Cash Price |
$782.50
|
| Rate for Payer: Cigna Commercial |
$1,298.95
|
| Rate for Payer: First Health Commercial |
$1,486.75
|
| Rate for Payer: Humana Commercial |
$1,330.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,283.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,154.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$469.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,377.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,173.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$313.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$203.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$485.15
|
| Rate for Payer: PHCS Commercial |
$1,502.40
|
| Rate for Payer: United Healthcare All Payer |
$1,377.20
|
|
|
R3 20DEG 32ID DISP TRLLNR 54OD
|
Facility
|
OP
|
$1,565.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$203.45 |
| Max. Negotiated Rate |
$1,502.40 |
| Rate for Payer: Aetna Commercial |
$1,205.05
|
| Rate for Payer: Anthem Medicaid |
$538.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,220.70
|
| Rate for Payer: Cash Price |
$782.50
|
| Rate for Payer: Cigna Commercial |
$1,298.95
|
| Rate for Payer: First Health Commercial |
$1,486.75
|
| Rate for Payer: Humana Commercial |
$1,330.25
|
| Rate for Payer: Humana KY Medicaid |
$538.20
|
| Rate for Payer: Kentucky WC Medicaid |
$543.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,283.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,154.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$469.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$549.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,377.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,173.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$313.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$203.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$485.15
|
| Rate for Payer: PHCS Commercial |
$1,502.40
|
| Rate for Payer: United Healthcare All Payer |
$1,377.20
|
|
|
R3 20DEG 32ID DISP TRLLNR 56OD
|
Facility
|
IP
|
$1,565.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$203.45 |
| Max. Negotiated Rate |
$1,502.40 |
| Rate for Payer: Aetna Commercial |
$1,205.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,220.70
|
| Rate for Payer: Cash Price |
$782.50
|
| Rate for Payer: Cigna Commercial |
$1,298.95
|
| Rate for Payer: First Health Commercial |
$1,486.75
|
| Rate for Payer: Humana Commercial |
$1,330.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,283.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,154.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$469.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,377.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,173.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$313.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$203.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$485.15
|
| Rate for Payer: PHCS Commercial |
$1,502.40
|
| Rate for Payer: United Healthcare All Payer |
$1,377.20
|
|
|
R3 20DEG 32ID DISP TRLLNR 56OD
|
Facility
|
OP
|
$1,565.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$203.45 |
| Max. Negotiated Rate |
$1,502.40 |
| Rate for Payer: Aetna Commercial |
$1,205.05
|
| Rate for Payer: Anthem Medicaid |
$538.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,220.70
|
| Rate for Payer: Cash Price |
$782.50
|
| Rate for Payer: Cigna Commercial |
$1,298.95
|
| Rate for Payer: First Health Commercial |
$1,486.75
|
| Rate for Payer: Humana Commercial |
$1,330.25
|
| Rate for Payer: Humana KY Medicaid |
$538.20
|
| Rate for Payer: Kentucky WC Medicaid |
$543.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,283.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,154.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$469.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$549.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,377.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,173.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$313.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$203.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$485.15
|
| Rate for Payer: PHCS Commercial |
$1,502.40
|
| Rate for Payer: United Healthcare All Payer |
$1,377.20
|
|
|
R3 20DEG 32ID DISP TRLLNR 58OD
|
Facility
|
OP
|
$1,565.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$203.45 |
| Max. Negotiated Rate |
$1,502.40 |
| Rate for Payer: Aetna Commercial |
$1,205.05
|
| Rate for Payer: Anthem Medicaid |
$538.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,220.70
|
| Rate for Payer: Cash Price |
$782.50
|
| Rate for Payer: Cigna Commercial |
$1,298.95
|
| Rate for Payer: First Health Commercial |
$1,486.75
|
| Rate for Payer: Humana Commercial |
$1,330.25
|
| Rate for Payer: Humana KY Medicaid |
$538.20
|
| Rate for Payer: Kentucky WC Medicaid |
$543.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,283.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,154.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$469.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$549.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,377.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,173.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$313.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$203.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$485.15
|
| Rate for Payer: PHCS Commercial |
$1,502.40
|
| Rate for Payer: United Healthcare All Payer |
$1,377.20
|
|
|
R3 20DEG 32ID DISP TRLLNR 58OD
|
Facility
|
IP
|
$1,565.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$203.45 |
| Max. Negotiated Rate |
$1,502.40 |
| Rate for Payer: Aetna Commercial |
$1,205.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,220.70
|
| Rate for Payer: Cash Price |
$782.50
|
| Rate for Payer: Cigna Commercial |
$1,298.95
|
| Rate for Payer: First Health Commercial |
$1,486.75
|
| Rate for Payer: Humana Commercial |
$1,330.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,283.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,154.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$469.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,377.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,173.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$313.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$203.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$485.15
|
| Rate for Payer: PHCS Commercial |
$1,502.40
|
| Rate for Payer: United Healthcare All Payer |
$1,377.20
|
|
|
R3 20DEG 32ID DISP TRLLNR 60OD
|
Facility
|
IP
|
$1,565.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$203.45 |
| Max. Negotiated Rate |
$1,502.40 |
| Rate for Payer: Aetna Commercial |
$1,205.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,220.70
|
| Rate for Payer: Cash Price |
$782.50
|
| Rate for Payer: Cigna Commercial |
$1,298.95
|
| Rate for Payer: First Health Commercial |
$1,486.75
|
| Rate for Payer: Humana Commercial |
$1,330.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,283.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,154.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$469.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,377.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,173.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$313.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$203.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$485.15
|
| Rate for Payer: PHCS Commercial |
$1,502.40
|
| Rate for Payer: United Healthcare All Payer |
$1,377.20
|
|
|
R3 20DEG 32ID DISP TRLLNR 60OD
|
Facility
|
OP
|
$1,565.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$203.45 |
| Max. Negotiated Rate |
$1,502.40 |
| Rate for Payer: Aetna Commercial |
$1,205.05
|
| Rate for Payer: Anthem Medicaid |
$538.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,220.70
|
| Rate for Payer: Cash Price |
$782.50
|
| Rate for Payer: Cigna Commercial |
$1,298.95
|
| Rate for Payer: First Health Commercial |
$1,486.75
|
| Rate for Payer: Humana Commercial |
$1,330.25
|
| Rate for Payer: Humana KY Medicaid |
$538.20
|
| Rate for Payer: Kentucky WC Medicaid |
$543.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,283.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,154.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$469.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$549.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,377.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,173.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$313.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$203.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$485.15
|
| Rate for Payer: PHCS Commercial |
$1,502.40
|
| Rate for Payer: United Healthcare All Payer |
$1,377.20
|
|
|
R3 20DEG 32ID DISP TRLLNR 62OD
|
Facility
|
IP
|
$1,565.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$203.45 |
| Max. Negotiated Rate |
$1,502.40 |
| Rate for Payer: Aetna Commercial |
$1,205.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,220.70
|
| Rate for Payer: Cash Price |
$782.50
|
| Rate for Payer: Cigna Commercial |
$1,298.95
|
| Rate for Payer: First Health Commercial |
$1,486.75
|
| Rate for Payer: Humana Commercial |
$1,330.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,283.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,154.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$469.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,377.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,173.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$313.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$203.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$485.15
|
| Rate for Payer: PHCS Commercial |
$1,502.40
|
| Rate for Payer: United Healthcare All Payer |
$1,377.20
|
|
|
R3 20DEG 32ID DISP TRLLNR 62OD
|
Facility
|
OP
|
$1,565.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$203.45 |
| Max. Negotiated Rate |
$1,502.40 |
| Rate for Payer: Aetna Commercial |
$1,205.05
|
| Rate for Payer: Anthem Medicaid |
$538.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,220.70
|
| Rate for Payer: Cash Price |
$782.50
|
| Rate for Payer: Cigna Commercial |
$1,298.95
|
| Rate for Payer: First Health Commercial |
$1,486.75
|
| Rate for Payer: Humana Commercial |
$1,330.25
|
| Rate for Payer: Humana KY Medicaid |
$538.20
|
| Rate for Payer: Kentucky WC Medicaid |
$543.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,283.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,154.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$469.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$549.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,377.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,173.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$313.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$203.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$485.15
|
| Rate for Payer: PHCS Commercial |
$1,502.40
|
| Rate for Payer: United Healthcare All Payer |
$1,377.20
|
|
|
R3 20 DEG 32MM XLPE 50MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
R3 20 DEG 32MM XLPE 50MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
R3 20 DEG 32MM XLPE 52MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
R3 20 DEG 32MM XLPE 52MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
R3 20 DEG 32MM XLPE 54MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
R3 20 DEG 32MM XLPE 54MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
R3 20 DEG 32MM XLPE 56MM
|
Facility
|
IP
|
$10,954.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,424.03 |
| Max. Negotiated Rate |
$10,515.89 |
| Rate for Payer: Aetna Commercial |
$8,434.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,544.16
|
| Rate for Payer: Cash Price |
$5,477.02
|
| Rate for Payer: Cigna Commercial |
$9,091.86
|
| Rate for Payer: First Health Commercial |
$10,406.35
|
| Rate for Payer: Humana Commercial |
$9,310.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,982.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,084.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,286.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,639.56
|
| Rate for Payer: Ohio Health Group HMO |
$8,215.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,190.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,424.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,395.76
|
| Rate for Payer: PHCS Commercial |
$10,515.89
|
| Rate for Payer: United Healthcare All Payer |
$9,639.56
|
|
|
R3 20 DEG 32MM XLPE 56MM
|
Facility
|
OP
|
$10,954.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,424.03 |
| Max. Negotiated Rate |
$10,515.89 |
| Rate for Payer: Aetna Commercial |
$8,434.62
|
| Rate for Payer: Anthem Medicaid |
$3,767.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,544.16
|
| Rate for Payer: Cash Price |
$5,477.02
|
| Rate for Payer: Cigna Commercial |
$9,091.86
|
| Rate for Payer: First Health Commercial |
$10,406.35
|
| Rate for Payer: Humana Commercial |
$9,310.94
|
| Rate for Payer: Humana KY Medicaid |
$3,767.10
|
| Rate for Payer: Kentucky WC Medicaid |
$3,805.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,982.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,084.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,286.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,842.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,639.56
|
| Rate for Payer: Ohio Health Group HMO |
$8,215.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,190.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,424.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,395.76
|
| Rate for Payer: PHCS Commercial |
$10,515.89
|
| Rate for Payer: United Healthcare All Payer |
$9,639.56
|
|
|
R3 20 DEG 32MM XLPE 58MM
|
Facility
|
OP
|
$10,954.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,424.03 |
| Max. Negotiated Rate |
$10,515.89 |
| Rate for Payer: Aetna Commercial |
$8,434.62
|
| Rate for Payer: Anthem Medicaid |
$3,767.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,544.16
|
| Rate for Payer: Cash Price |
$5,477.02
|
| Rate for Payer: Cigna Commercial |
$9,091.86
|
| Rate for Payer: First Health Commercial |
$10,406.35
|
| Rate for Payer: Humana Commercial |
$9,310.94
|
| Rate for Payer: Humana KY Medicaid |
$3,767.10
|
| Rate for Payer: Kentucky WC Medicaid |
$3,805.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,982.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,084.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,286.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,842.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,639.56
|
| Rate for Payer: Ohio Health Group HMO |
$8,215.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,190.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,424.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,395.76
|
| Rate for Payer: PHCS Commercial |
$10,515.89
|
| Rate for Payer: United Healthcare All Payer |
$9,639.56
|
|
|
R3 20 DEG 32MM XLPE 58MM
|
Facility
|
IP
|
$10,954.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,424.03 |
| Max. Negotiated Rate |
$10,515.89 |
| Rate for Payer: Aetna Commercial |
$8,434.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,544.16
|
| Rate for Payer: Cash Price |
$5,477.02
|
| Rate for Payer: Cigna Commercial |
$9,091.86
|
| Rate for Payer: First Health Commercial |
$10,406.35
|
| Rate for Payer: Humana Commercial |
$9,310.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,982.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,084.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,286.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,639.56
|
| Rate for Payer: Ohio Health Group HMO |
$8,215.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,190.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,424.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,395.76
|
| Rate for Payer: PHCS Commercial |
$10,515.89
|
| Rate for Payer: United Healthcare All Payer |
$9,639.56
|
|
|
R3 20 DEG 32MM XLPE 60MM
|
Facility
|
OP
|
$10,954.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,424.03 |
| Max. Negotiated Rate |
$10,515.89 |
| Rate for Payer: Aetna Commercial |
$8,434.62
|
| Rate for Payer: Anthem Medicaid |
$3,767.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,544.16
|
| Rate for Payer: Cash Price |
$5,477.02
|
| Rate for Payer: Cigna Commercial |
$9,091.86
|
| Rate for Payer: First Health Commercial |
$10,406.35
|
| Rate for Payer: Humana Commercial |
$9,310.94
|
| Rate for Payer: Humana KY Medicaid |
$3,767.10
|
| Rate for Payer: Kentucky WC Medicaid |
$3,805.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,982.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,084.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,286.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,842.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,639.56
|
| Rate for Payer: Ohio Health Group HMO |
$8,215.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,190.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,424.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,395.76
|
| Rate for Payer: PHCS Commercial |
$10,515.89
|
| Rate for Payer: United Healthcare All Payer |
$9,639.56
|
|
|
R3 20 DEG 32MM XLPE 60MM
|
Facility
|
IP
|
$10,954.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,424.03 |
| Max. Negotiated Rate |
$10,515.89 |
| Rate for Payer: Aetna Commercial |
$8,434.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,544.16
|
| Rate for Payer: Cash Price |
$5,477.02
|
| Rate for Payer: Cigna Commercial |
$9,091.86
|
| Rate for Payer: First Health Commercial |
$10,406.35
|
| Rate for Payer: Humana Commercial |
$9,310.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,982.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,084.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,286.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,639.56
|
| Rate for Payer: Ohio Health Group HMO |
$8,215.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,190.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,424.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,395.76
|
| Rate for Payer: PHCS Commercial |
$10,515.89
|
| Rate for Payer: United Healthcare All Payer |
$9,639.56
|
|
|
R3 20DEG 36ID DISP TRLLNR 52OD
|
Facility
|
OP
|
$749.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$97.48 |
| Max. Negotiated Rate |
$719.86 |
| Rate for Payer: Aetna Commercial |
$577.38
|
| Rate for Payer: Anthem Medicaid |
$257.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$584.88
|
| Rate for Payer: Cash Price |
$374.92
|
| Rate for Payer: Cigna Commercial |
$622.38
|
| Rate for Payer: First Health Commercial |
$712.36
|
| Rate for Payer: Humana Commercial |
$637.37
|
| Rate for Payer: Humana KY Medicaid |
$257.87
|
| Rate for Payer: Kentucky WC Medicaid |
$260.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$614.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$553.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$224.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$263.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$659.87
|
| Rate for Payer: Ohio Health Group HMO |
$562.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$149.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$232.45
|
| Rate for Payer: PHCS Commercial |
$719.86
|
| Rate for Payer: United Healthcare All Payer |
$659.87
|
|
|
R3 20DEG 36ID DISP TRLLNR 52OD
|
Facility
|
IP
|
$749.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$97.48 |
| Max. Negotiated Rate |
$719.86 |
| Rate for Payer: Aetna Commercial |
$577.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$584.88
|
| Rate for Payer: Cash Price |
$374.92
|
| Rate for Payer: Cigna Commercial |
$622.38
|
| Rate for Payer: First Health Commercial |
$712.36
|
| Rate for Payer: Humana Commercial |
$637.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$614.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$553.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$224.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$659.87
|
| Rate for Payer: Ohio Health Group HMO |
$562.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$149.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$232.45
|
| Rate for Payer: PHCS Commercial |
$719.86
|
| Rate for Payer: United Healthcare All Payer |
$659.87
|
|
