|
REF ALL POLY 22ID 58OD XLPE
|
Facility
|
OP
|
$7,664.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$996.41 |
| Max. Negotiated Rate |
$7,358.13 |
| Rate for Payer: Aetna Commercial |
$5,901.83
|
| Rate for Payer: Anthem Medicaid |
$2,635.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,978.48
|
| Rate for Payer: Cash Price |
$3,832.36
|
| Rate for Payer: Cigna Commercial |
$6,361.72
|
| Rate for Payer: First Health Commercial |
$7,281.48
|
| Rate for Payer: Humana Commercial |
$6,515.01
|
| Rate for Payer: Humana KY Medicaid |
$2,635.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,662.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,285.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,656.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,299.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,688.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,744.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,748.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,532.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$996.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,376.06
|
| Rate for Payer: PHCS Commercial |
$7,358.13
|
| Rate for Payer: United Healthcare All Payer |
$6,744.95
|
|
|
REF ALL POLY 22ID 58OD XLPE
|
Facility
|
IP
|
$7,664.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$996.41 |
| Max. Negotiated Rate |
$7,358.13 |
| Rate for Payer: Aetna Commercial |
$5,901.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,978.48
|
| Rate for Payer: Cash Price |
$3,832.36
|
| Rate for Payer: Cigna Commercial |
$6,361.72
|
| Rate for Payer: First Health Commercial |
$7,281.48
|
| Rate for Payer: Humana Commercial |
$6,515.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,285.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,656.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,299.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,744.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,748.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,532.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$996.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,376.06
|
| Rate for Payer: PHCS Commercial |
$7,358.13
|
| Rate for Payer: United Healthcare All Payer |
$6,744.95
|
|
|
REF ALL POLY 22ID 61OD XLPE
|
Facility
|
IP
|
$7,664.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$996.41 |
| Max. Negotiated Rate |
$7,358.13 |
| Rate for Payer: Aetna Commercial |
$5,901.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,978.48
|
| Rate for Payer: Cash Price |
$3,832.36
|
| Rate for Payer: Cigna Commercial |
$6,361.72
|
| Rate for Payer: First Health Commercial |
$7,281.48
|
| Rate for Payer: Humana Commercial |
$6,515.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,285.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,656.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,299.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,744.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,748.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,532.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$996.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,376.06
|
| Rate for Payer: PHCS Commercial |
$7,358.13
|
| Rate for Payer: United Healthcare All Payer |
$6,744.95
|
|
|
REF ALL POLY 22ID 61OD XLPE
|
Facility
|
OP
|
$7,664.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$996.41 |
| Max. Negotiated Rate |
$7,358.13 |
| Rate for Payer: Aetna Commercial |
$5,901.83
|
| Rate for Payer: Anthem Medicaid |
$2,635.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,978.48
|
| Rate for Payer: Cash Price |
$3,832.36
|
| Rate for Payer: Cigna Commercial |
$6,361.72
|
| Rate for Payer: First Health Commercial |
$7,281.48
|
| Rate for Payer: Humana Commercial |
$6,515.01
|
| Rate for Payer: Humana KY Medicaid |
$2,635.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,662.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,285.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,656.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,299.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,688.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,744.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,748.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,532.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$996.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,376.06
|
| Rate for Payer: PHCS Commercial |
$7,358.13
|
| Rate for Payer: United Healthcare All Payer |
$6,744.95
|
|
|
REF ALL POLY 28ID 46OD XLPE
|
Facility
|
OP
|
$7,664.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$996.41 |
| Max. Negotiated Rate |
$7,358.13 |
| Rate for Payer: Aetna Commercial |
$5,901.83
|
| Rate for Payer: Anthem Medicaid |
$2,635.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,978.48
|
| Rate for Payer: Cash Price |
$3,832.36
|
| Rate for Payer: Cigna Commercial |
$6,361.72
|
| Rate for Payer: First Health Commercial |
$7,281.48
|
| Rate for Payer: Humana Commercial |
$6,515.01
|
| Rate for Payer: Humana KY Medicaid |
$2,635.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,662.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,285.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,656.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,299.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,688.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,744.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,748.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,532.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$996.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,376.06
|
| Rate for Payer: PHCS Commercial |
$7,358.13
|
| Rate for Payer: United Healthcare All Payer |
$6,744.95
|
|
|
REF ALL POLY 28ID 46OD XLPE
|
Facility
|
IP
|
$7,664.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$996.41 |
| Max. Negotiated Rate |
$7,358.13 |
| Rate for Payer: Aetna Commercial |
$5,901.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,978.48
|
| Rate for Payer: Cash Price |
$3,832.36
|
| Rate for Payer: Cigna Commercial |
$6,361.72
|
| Rate for Payer: First Health Commercial |
$7,281.48
|
| Rate for Payer: Humana Commercial |
$6,515.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,285.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,656.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,299.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,744.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,748.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,532.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$996.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,376.06
|
| Rate for Payer: PHCS Commercial |
$7,358.13
|
| Rate for Payer: United Healthcare All Payer |
$6,744.95
|
|
|
REF ALL POLY 28ID 49OD XLPE
|
Facility
|
IP
|
$7,664.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$996.41 |
| Max. Negotiated Rate |
$7,358.13 |
| Rate for Payer: Aetna Commercial |
$5,901.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,978.48
|
| Rate for Payer: Cash Price |
$3,832.36
|
| Rate for Payer: Cigna Commercial |
$6,361.72
|
| Rate for Payer: First Health Commercial |
$7,281.48
|
| Rate for Payer: Humana Commercial |
$6,515.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,285.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,656.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,299.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,744.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,748.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,532.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$996.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,376.06
|
| Rate for Payer: PHCS Commercial |
$7,358.13
|
| Rate for Payer: United Healthcare All Payer |
$6,744.95
|
|
|
REF ALL POLY 28ID 49OD XLPE
|
Facility
|
OP
|
$7,664.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$996.41 |
| Max. Negotiated Rate |
$7,358.13 |
| Rate for Payer: Aetna Commercial |
$5,901.83
|
| Rate for Payer: Anthem Medicaid |
$2,635.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,978.48
|
| Rate for Payer: Cash Price |
$3,832.36
|
| Rate for Payer: Cigna Commercial |
$6,361.72
|
| Rate for Payer: First Health Commercial |
$7,281.48
|
| Rate for Payer: Humana Commercial |
$6,515.01
|
| Rate for Payer: Humana KY Medicaid |
$2,635.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,662.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,285.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,656.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,299.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,688.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,744.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,748.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,532.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$996.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,376.06
|
| Rate for Payer: PHCS Commercial |
$7,358.13
|
| Rate for Payer: United Healthcare All Payer |
$6,744.95
|
|
|
REF ALL POLY 28ID 52OD XLPE
|
Facility
|
OP
|
$7,664.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$996.41 |
| Max. Negotiated Rate |
$7,358.13 |
| Rate for Payer: Aetna Commercial |
$5,901.83
|
| Rate for Payer: Anthem Medicaid |
$2,635.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,978.48
|
| Rate for Payer: Cash Price |
$3,832.36
|
| Rate for Payer: Cigna Commercial |
$6,361.72
|
| Rate for Payer: First Health Commercial |
$7,281.48
|
| Rate for Payer: Humana Commercial |
$6,515.01
|
| Rate for Payer: Humana KY Medicaid |
$2,635.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,662.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,285.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,656.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,299.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,688.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,744.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,748.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,532.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$996.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,376.06
|
| Rate for Payer: PHCS Commercial |
$7,358.13
|
| Rate for Payer: United Healthcare All Payer |
$6,744.95
|
|
|
REF ALL POLY 28ID 52OD XLPE
|
Facility
|
IP
|
$7,664.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$996.41 |
| Max. Negotiated Rate |
$7,358.13 |
| Rate for Payer: Aetna Commercial |
$5,901.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,978.48
|
| Rate for Payer: Cash Price |
$3,832.36
|
| Rate for Payer: Cigna Commercial |
$6,361.72
|
| Rate for Payer: First Health Commercial |
$7,281.48
|
| Rate for Payer: Humana Commercial |
$6,515.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,285.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,656.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,299.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,744.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,748.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,532.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$996.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,376.06
|
| Rate for Payer: PHCS Commercial |
$7,358.13
|
| Rate for Payer: United Healthcare All Payer |
$6,744.95
|
|
|
REF ALL POLY 28ID 55OD XLPE
|
Facility
|
IP
|
$7,664.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$996.41 |
| Max. Negotiated Rate |
$7,358.13 |
| Rate for Payer: Aetna Commercial |
$5,901.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,978.48
|
| Rate for Payer: Cash Price |
$3,832.36
|
| Rate for Payer: Cigna Commercial |
$6,361.72
|
| Rate for Payer: First Health Commercial |
$7,281.48
|
| Rate for Payer: Humana Commercial |
$6,515.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,285.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,656.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,299.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,744.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,748.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,532.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$996.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,376.06
|
| Rate for Payer: PHCS Commercial |
$7,358.13
|
| Rate for Payer: United Healthcare All Payer |
$6,744.95
|
|
|
REF ALL POLY 28ID 55OD XLPE
|
Facility
|
OP
|
$7,664.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$996.41 |
| Max. Negotiated Rate |
$7,358.13 |
| Rate for Payer: Aetna Commercial |
$5,901.83
|
| Rate for Payer: Anthem Medicaid |
$2,635.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,978.48
|
| Rate for Payer: Cash Price |
$3,832.36
|
| Rate for Payer: Cigna Commercial |
$6,361.72
|
| Rate for Payer: First Health Commercial |
$7,281.48
|
| Rate for Payer: Humana Commercial |
$6,515.01
|
| Rate for Payer: Humana KY Medicaid |
$2,635.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,662.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,285.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,656.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,299.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,688.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,744.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,748.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,532.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$996.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,376.06
|
| Rate for Payer: PHCS Commercial |
$7,358.13
|
| Rate for Payer: United Healthcare All Payer |
$6,744.95
|
|
|
REF ALL POLY 28ID 58OD XLPE
|
Facility
|
IP
|
$7,664.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$996.41 |
| Max. Negotiated Rate |
$7,358.13 |
| Rate for Payer: Aetna Commercial |
$5,901.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,978.48
|
| Rate for Payer: Cash Price |
$3,832.36
|
| Rate for Payer: Cigna Commercial |
$6,361.72
|
| Rate for Payer: First Health Commercial |
$7,281.48
|
| Rate for Payer: Humana Commercial |
$6,515.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,285.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,656.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,299.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,744.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,748.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,532.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$996.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,376.06
|
| Rate for Payer: PHCS Commercial |
$7,358.13
|
| Rate for Payer: United Healthcare All Payer |
$6,744.95
|
|
|
REF ALL POLY 28ID 58OD XLPE
|
Facility
|
OP
|
$7,664.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$996.41 |
| Max. Negotiated Rate |
$7,358.13 |
| Rate for Payer: Aetna Commercial |
$5,901.83
|
| Rate for Payer: Anthem Medicaid |
$2,635.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,978.48
|
| Rate for Payer: Cash Price |
$3,832.36
|
| Rate for Payer: Cigna Commercial |
$6,361.72
|
| Rate for Payer: First Health Commercial |
$7,281.48
|
| Rate for Payer: Humana Commercial |
$6,515.01
|
| Rate for Payer: Humana KY Medicaid |
$2,635.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,662.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,285.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,656.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,299.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,688.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,744.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,748.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,532.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$996.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,376.06
|
| Rate for Payer: PHCS Commercial |
$7,358.13
|
| Rate for Payer: United Healthcare All Payer |
$6,744.95
|
|
|
REF ALL POLY 28ID 61OD XLPE
|
Facility
|
IP
|
$7,664.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$996.41 |
| Max. Negotiated Rate |
$7,358.13 |
| Rate for Payer: Aetna Commercial |
$5,901.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,978.48
|
| Rate for Payer: Cash Price |
$3,832.36
|
| Rate for Payer: Cigna Commercial |
$6,361.72
|
| Rate for Payer: First Health Commercial |
$7,281.48
|
| Rate for Payer: Humana Commercial |
$6,515.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,285.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,656.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,299.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,744.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,748.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,532.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$996.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,376.06
|
| Rate for Payer: PHCS Commercial |
$7,358.13
|
| Rate for Payer: United Healthcare All Payer |
$6,744.95
|
|
|
REF ALL POLY 28ID 61OD XLPE
|
Facility
|
OP
|
$7,664.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$996.41 |
| Max. Negotiated Rate |
$7,358.13 |
| Rate for Payer: Aetna Commercial |
$5,901.83
|
| Rate for Payer: Anthem Medicaid |
$2,635.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,978.48
|
| Rate for Payer: Cash Price |
$3,832.36
|
| Rate for Payer: Cigna Commercial |
$6,361.72
|
| Rate for Payer: First Health Commercial |
$7,281.48
|
| Rate for Payer: Humana Commercial |
$6,515.01
|
| Rate for Payer: Humana KY Medicaid |
$2,635.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,662.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,285.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,656.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,299.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,688.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,744.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,748.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,532.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$996.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,376.06
|
| Rate for Payer: PHCS Commercial |
$7,358.13
|
| Rate for Payer: United Healthcare All Payer |
$6,744.95
|
|
|
REF ALL POLY 28ID 64OD XLPE
|
Facility
|
OP
|
$7,664.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$996.41 |
| Max. Negotiated Rate |
$7,358.13 |
| Rate for Payer: Aetna Commercial |
$5,901.83
|
| Rate for Payer: Anthem Medicaid |
$2,635.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,978.48
|
| Rate for Payer: Cash Price |
$3,832.36
|
| Rate for Payer: Cigna Commercial |
$6,361.72
|
| Rate for Payer: First Health Commercial |
$7,281.48
|
| Rate for Payer: Humana Commercial |
$6,515.01
|
| Rate for Payer: Humana KY Medicaid |
$2,635.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,662.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,285.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,656.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,299.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,688.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,744.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,748.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,532.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$996.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,376.06
|
| Rate for Payer: PHCS Commercial |
$7,358.13
|
| Rate for Payer: United Healthcare All Payer |
$6,744.95
|
|
|
REF ALL POLY 28ID 64OD XLPE
|
Facility
|
IP
|
$7,664.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$996.41 |
| Max. Negotiated Rate |
$7,358.13 |
| Rate for Payer: Aetna Commercial |
$5,901.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,978.48
|
| Rate for Payer: Cash Price |
$3,832.36
|
| Rate for Payer: Cigna Commercial |
$6,361.72
|
| Rate for Payer: First Health Commercial |
$7,281.48
|
| Rate for Payer: Humana Commercial |
$6,515.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,285.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,656.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,299.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,744.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,748.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,532.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$996.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,376.06
|
| Rate for Payer: PHCS Commercial |
$7,358.13
|
| Rate for Payer: United Healthcare All Payer |
$6,744.95
|
|
|
REF ALL POLY 32ID 49OD XLPE
|
Facility
|
OP
|
$9,454.86
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,229.13 |
| Max. Negotiated Rate |
$9,076.67 |
| Rate for Payer: Aetna Commercial |
$7,280.24
|
| Rate for Payer: Anthem Medicaid |
$3,251.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,374.79
|
| Rate for Payer: Cash Price |
$4,727.43
|
| Rate for Payer: Cigna Commercial |
$7,847.53
|
| Rate for Payer: First Health Commercial |
$8,982.12
|
| Rate for Payer: Humana Commercial |
$8,036.63
|
| Rate for Payer: Humana KY Medicaid |
$3,251.53
|
| Rate for Payer: Kentucky WC Medicaid |
$3,284.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,752.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,977.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,836.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,316.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,320.28
|
| Rate for Payer: Ohio Health Group HMO |
$7,091.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,890.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,229.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,931.01
|
| Rate for Payer: PHCS Commercial |
$9,076.67
|
| Rate for Payer: United Healthcare All Payer |
$8,320.28
|
|
|
REF ALL POLY 32ID 49OD XLPE
|
Facility
|
IP
|
$9,454.86
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,229.13 |
| Max. Negotiated Rate |
$9,076.67 |
| Rate for Payer: Aetna Commercial |
$7,280.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,374.79
|
| Rate for Payer: Cash Price |
$4,727.43
|
| Rate for Payer: Cigna Commercial |
$7,847.53
|
| Rate for Payer: First Health Commercial |
$8,982.12
|
| Rate for Payer: Humana Commercial |
$8,036.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,752.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,977.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,836.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,320.28
|
| Rate for Payer: Ohio Health Group HMO |
$7,091.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,890.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,229.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,931.01
|
| Rate for Payer: PHCS Commercial |
$9,076.67
|
| Rate for Payer: United Healthcare All Payer |
$8,320.28
|
|
|
REF ALL POLY 32ID 52OD XLPE
|
Facility
|
OP
|
$7,664.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$996.41 |
| Max. Negotiated Rate |
$7,358.13 |
| Rate for Payer: Aetna Commercial |
$5,901.83
|
| Rate for Payer: Anthem Medicaid |
$2,635.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,978.48
|
| Rate for Payer: Cash Price |
$3,832.36
|
| Rate for Payer: Cigna Commercial |
$6,361.72
|
| Rate for Payer: First Health Commercial |
$7,281.48
|
| Rate for Payer: Humana Commercial |
$6,515.01
|
| Rate for Payer: Humana KY Medicaid |
$2,635.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,662.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,285.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,656.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,299.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,688.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,744.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,748.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,532.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$996.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,376.06
|
| Rate for Payer: PHCS Commercial |
$7,358.13
|
| Rate for Payer: United Healthcare All Payer |
$6,744.95
|
|
|
REF ALL POLY 32ID 52OD XLPE
|
Facility
|
IP
|
$7,664.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$996.41 |
| Max. Negotiated Rate |
$7,358.13 |
| Rate for Payer: Aetna Commercial |
$5,901.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,978.48
|
| Rate for Payer: Cash Price |
$3,832.36
|
| Rate for Payer: Cigna Commercial |
$6,361.72
|
| Rate for Payer: First Health Commercial |
$7,281.48
|
| Rate for Payer: Humana Commercial |
$6,515.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,285.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,656.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,299.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,744.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,748.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,532.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$996.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,376.06
|
| Rate for Payer: PHCS Commercial |
$7,358.13
|
| Rate for Payer: United Healthcare All Payer |
$6,744.95
|
|
|
REF ALL POLY 32ID 55OD XLPE
|
Facility
|
OP
|
$7,664.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$996.41 |
| Max. Negotiated Rate |
$7,358.13 |
| Rate for Payer: Aetna Commercial |
$5,901.83
|
| Rate for Payer: Anthem Medicaid |
$2,635.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,978.48
|
| Rate for Payer: Cash Price |
$3,832.36
|
| Rate for Payer: Cigna Commercial |
$6,361.72
|
| Rate for Payer: First Health Commercial |
$7,281.48
|
| Rate for Payer: Humana Commercial |
$6,515.01
|
| Rate for Payer: Humana KY Medicaid |
$2,635.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,662.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,285.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,656.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,299.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,688.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,744.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,748.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,532.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$996.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,376.06
|
| Rate for Payer: PHCS Commercial |
$7,358.13
|
| Rate for Payer: United Healthcare All Payer |
$6,744.95
|
|
|
REF ALL POLY 32ID 55OD XLPE
|
Facility
|
IP
|
$7,664.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$996.41 |
| Max. Negotiated Rate |
$7,358.13 |
| Rate for Payer: Aetna Commercial |
$5,901.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,978.48
|
| Rate for Payer: Cash Price |
$3,832.36
|
| Rate for Payer: Cigna Commercial |
$6,361.72
|
| Rate for Payer: First Health Commercial |
$7,281.48
|
| Rate for Payer: Humana Commercial |
$6,515.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,285.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,656.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,299.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,744.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,748.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,532.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$996.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,376.06
|
| Rate for Payer: PHCS Commercial |
$7,358.13
|
| Rate for Payer: United Healthcare All Payer |
$6,744.95
|
|
|
REF ALL POLY 32ID 58OD XLPE
|
Facility
|
OP
|
$7,664.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$996.41 |
| Max. Negotiated Rate |
$7,358.13 |
| Rate for Payer: Aetna Commercial |
$5,901.83
|
| Rate for Payer: Anthem Medicaid |
$2,635.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,978.48
|
| Rate for Payer: Cash Price |
$3,832.36
|
| Rate for Payer: Cigna Commercial |
$6,361.72
|
| Rate for Payer: First Health Commercial |
$7,281.48
|
| Rate for Payer: Humana Commercial |
$6,515.01
|
| Rate for Payer: Humana KY Medicaid |
$2,635.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,662.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,285.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,656.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,299.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,688.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,744.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,748.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,532.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$996.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,376.06
|
| Rate for Payer: PHCS Commercial |
$7,358.13
|
| Rate for Payer: United Healthcare All Payer |
$6,744.95
|
|
