|
REF ALL POLY 32ID 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 32ID 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 32ID 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 32ID 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 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 CEMENT ACET COM 22/40
|
Facility
|
OP
|
$4,749.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$617.45 |
| Max. Negotiated Rate |
$4,559.60 |
| Rate for Payer: Aetna Commercial |
$3,657.18
|
| Rate for Payer: Anthem Medicaid |
$1,633.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,704.67
|
| Rate for Payer: Cash Price |
$2,374.79
|
| Rate for Payer: Cigna Commercial |
$3,942.15
|
| Rate for Payer: First Health Commercial |
$4,512.10
|
| Rate for Payer: Humana Commercial |
$4,037.14
|
| Rate for Payer: Humana KY Medicaid |
$1,633.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,650.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,894.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,505.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,424.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,666.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,179.63
|
| Rate for Payer: Ohio Health Group HMO |
$3,562.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$949.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$617.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,472.37
|
| Rate for Payer: PHCS Commercial |
$4,559.60
|
| Rate for Payer: United Healthcare All Payer |
$4,179.63
|
|
|
REF CEMENT ACET COM 22/40
|
Facility
|
IP
|
$4,749.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$617.45 |
| Max. Negotiated Rate |
$4,559.60 |
| Rate for Payer: Aetna Commercial |
$3,657.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,704.67
|
| Rate for Payer: Cash Price |
$2,374.79
|
| Rate for Payer: Cigna Commercial |
$3,942.15
|
| Rate for Payer: First Health Commercial |
$4,512.10
|
| Rate for Payer: Humana Commercial |
$4,037.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,894.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,505.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,424.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,179.63
|
| Rate for Payer: Ohio Health Group HMO |
$3,562.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$949.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$617.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,472.37
|
| Rate for Payer: PHCS Commercial |
$4,559.60
|
| Rate for Payer: United Healthcare All Payer |
$4,179.63
|
|
|
REF CEMENT ACET COM 22/45
|
Facility
|
OP
|
$4,749.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$617.45 |
| Max. Negotiated Rate |
$4,559.60 |
| Rate for Payer: Aetna Commercial |
$3,657.18
|
| Rate for Payer: Anthem Medicaid |
$1,633.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,704.67
|
| Rate for Payer: Cash Price |
$2,374.79
|
| Rate for Payer: Cigna Commercial |
$3,942.15
|
| Rate for Payer: First Health Commercial |
$4,512.10
|
| Rate for Payer: Humana Commercial |
$4,037.14
|
| Rate for Payer: Humana KY Medicaid |
$1,633.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,650.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,894.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,505.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,424.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,666.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,179.63
|
| Rate for Payer: Ohio Health Group HMO |
$3,562.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$949.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$617.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,472.37
|
| Rate for Payer: PHCS Commercial |
$4,559.60
|
| Rate for Payer: United Healthcare All Payer |
$4,179.63
|
|
|
REF CEMENT ACET COM 22/45
|
Facility
|
IP
|
$4,749.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$617.45 |
| Max. Negotiated Rate |
$4,559.60 |
| Rate for Payer: Aetna Commercial |
$3,657.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,704.67
|
| Rate for Payer: Cash Price |
$2,374.79
|
| Rate for Payer: Cigna Commercial |
$3,942.15
|
| Rate for Payer: First Health Commercial |
$4,512.10
|
| Rate for Payer: Humana Commercial |
$4,037.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,894.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,505.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,424.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,179.63
|
| Rate for Payer: Ohio Health Group HMO |
$3,562.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$949.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$617.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,472.37
|
| Rate for Payer: PHCS Commercial |
$4,559.60
|
| Rate for Payer: United Healthcare All Payer |
$4,179.63
|
|
|
REF CEMENT ACET COM 22/46
|
Facility
|
IP
|
$4,749.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$617.45 |
| Max. Negotiated Rate |
$4,559.60 |
| Rate for Payer: Aetna Commercial |
$3,657.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,704.67
|
| Rate for Payer: Cash Price |
$2,374.79
|
| Rate for Payer: Cigna Commercial |
$3,942.15
|
| Rate for Payer: First Health Commercial |
$4,512.10
|
| Rate for Payer: Humana Commercial |
$4,037.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,894.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,505.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,424.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,179.63
|
| Rate for Payer: Ohio Health Group HMO |
$3,562.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$949.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$617.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,472.37
|
| Rate for Payer: PHCS Commercial |
$4,559.60
|
| Rate for Payer: United Healthcare All Payer |
$4,179.63
|
|
|
REF CEMENT ACET COM 22/46
|
Facility
|
OP
|
$4,749.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$617.45 |
| Max. Negotiated Rate |
$4,559.60 |
| Rate for Payer: Aetna Commercial |
$3,657.18
|
| Rate for Payer: Anthem Medicaid |
$1,633.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,704.67
|
| Rate for Payer: Cash Price |
$2,374.79
|
| Rate for Payer: Cigna Commercial |
$3,942.15
|
| Rate for Payer: First Health Commercial |
$4,512.10
|
| Rate for Payer: Humana Commercial |
$4,037.14
|
| Rate for Payer: Humana KY Medicaid |
$1,633.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,650.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,894.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,505.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,424.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,666.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,179.63
|
| Rate for Payer: Ohio Health Group HMO |
$3,562.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$949.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$617.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,472.37
|
| Rate for Payer: PHCS Commercial |
$4,559.60
|
| Rate for Payer: United Healthcare All Payer |
$4,179.63
|
|
|
REF CEMENT ACET COM 22/49
|
Facility
|
OP
|
$4,749.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$617.45 |
| Max. Negotiated Rate |
$4,559.60 |
| Rate for Payer: Aetna Commercial |
$3,657.18
|
| Rate for Payer: Anthem Medicaid |
$1,633.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,704.67
|
| Rate for Payer: Cash Price |
$2,374.79
|
| Rate for Payer: Cigna Commercial |
$3,942.15
|
| Rate for Payer: First Health Commercial |
$4,512.10
|
| Rate for Payer: Humana Commercial |
$4,037.14
|
| Rate for Payer: Humana KY Medicaid |
$1,633.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,650.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,894.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,505.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,424.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,666.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,179.63
|
| Rate for Payer: Ohio Health Group HMO |
$3,562.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$949.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$617.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,472.37
|
| Rate for Payer: PHCS Commercial |
$4,559.60
|
| Rate for Payer: United Healthcare All Payer |
$4,179.63
|
|
|
REF CEMENT ACET COM 22/49
|
Facility
|
IP
|
$4,749.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$617.45 |
| Max. Negotiated Rate |
$4,559.60 |
| Rate for Payer: Aetna Commercial |
$3,657.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,704.67
|
| Rate for Payer: Cash Price |
$2,374.79
|
| Rate for Payer: Cigna Commercial |
$3,942.15
|
| Rate for Payer: First Health Commercial |
$4,512.10
|
| Rate for Payer: Humana Commercial |
$4,037.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,894.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,505.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,424.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,179.63
|
| Rate for Payer: Ohio Health Group HMO |
$3,562.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$949.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$617.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,472.37
|
| Rate for Payer: PHCS Commercial |
$4,559.60
|
| Rate for Payer: United Healthcare All Payer |
$4,179.63
|
|
|
REF CEMENT ACET COM 22/52
|
Facility
|
OP
|
$4,749.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$617.45 |
| Max. Negotiated Rate |
$4,559.60 |
| Rate for Payer: Aetna Commercial |
$3,657.18
|
| Rate for Payer: Anthem Medicaid |
$1,633.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,704.67
|
| Rate for Payer: Cash Price |
$2,374.79
|
| Rate for Payer: Cigna Commercial |
$3,942.15
|
| Rate for Payer: First Health Commercial |
$4,512.10
|
| Rate for Payer: Humana Commercial |
$4,037.14
|
| Rate for Payer: Humana KY Medicaid |
$1,633.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,650.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,894.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,505.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,424.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,666.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,179.63
|
| Rate for Payer: Ohio Health Group HMO |
$3,562.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$949.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$617.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,472.37
|
| Rate for Payer: PHCS Commercial |
$4,559.60
|
| Rate for Payer: United Healthcare All Payer |
$4,179.63
|
|
|
REF CEMENT ACET COM 22/52
|
Facility
|
IP
|
$4,749.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$617.45 |
| Max. Negotiated Rate |
$4,559.60 |
| Rate for Payer: Aetna Commercial |
$3,657.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,704.67
|
| Rate for Payer: Cash Price |
$2,374.79
|
| Rate for Payer: Cigna Commercial |
$3,942.15
|
| Rate for Payer: First Health Commercial |
$4,512.10
|
| Rate for Payer: Humana Commercial |
$4,037.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,894.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,505.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,424.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,179.63
|
| Rate for Payer: Ohio Health Group HMO |
$3,562.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$949.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$617.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,472.37
|
| Rate for Payer: PHCS Commercial |
$4,559.60
|
| Rate for Payer: United Healthcare All Payer |
$4,179.63
|
|
|
REF CEMENT ACET COM 22/55
|
Facility
|
OP
|
$4,749.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$617.45 |
| Max. Negotiated Rate |
$4,559.60 |
| Rate for Payer: Aetna Commercial |
$3,657.18
|
| Rate for Payer: Anthem Medicaid |
$1,633.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,704.67
|
| Rate for Payer: Cash Price |
$2,374.79
|
| Rate for Payer: Cigna Commercial |
$3,942.15
|
| Rate for Payer: First Health Commercial |
$4,512.10
|
| Rate for Payer: Humana Commercial |
$4,037.14
|
| Rate for Payer: Humana KY Medicaid |
$1,633.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,650.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,894.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,505.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,424.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,666.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,179.63
|
| Rate for Payer: Ohio Health Group HMO |
$3,562.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$949.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$617.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,472.37
|
| Rate for Payer: PHCS Commercial |
$4,559.60
|
| Rate for Payer: United Healthcare All Payer |
$4,179.63
|
|
|
REF CEMENT ACET COM 22/55
|
Facility
|
IP
|
$4,749.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$617.45 |
| Max. Negotiated Rate |
$4,559.60 |
| Rate for Payer: Aetna Commercial |
$3,657.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,704.67
|
| Rate for Payer: Cash Price |
$2,374.79
|
| Rate for Payer: Cigna Commercial |
$3,942.15
|
| Rate for Payer: First Health Commercial |
$4,512.10
|
| Rate for Payer: Humana Commercial |
$4,037.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,894.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,505.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,424.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,179.63
|
| Rate for Payer: Ohio Health Group HMO |
$3,562.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$949.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$617.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,472.37
|
| Rate for Payer: PHCS Commercial |
$4,559.60
|
| Rate for Payer: United Healthcare All Payer |
$4,179.63
|
|
|
REF CEMENT ACET COM 22/58
|
Facility
|
IP
|
$4,749.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$617.45 |
| Max. Negotiated Rate |
$4,559.60 |
| Rate for Payer: Aetna Commercial |
$3,657.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,704.67
|
| Rate for Payer: Cash Price |
$2,374.79
|
| Rate for Payer: Cigna Commercial |
$3,942.15
|
| Rate for Payer: First Health Commercial |
$4,512.10
|
| Rate for Payer: Humana Commercial |
$4,037.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,894.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,505.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,424.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,179.63
|
| Rate for Payer: Ohio Health Group HMO |
$3,562.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$949.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$617.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,472.37
|
| Rate for Payer: PHCS Commercial |
$4,559.60
|
| Rate for Payer: United Healthcare All Payer |
$4,179.63
|
|
|
REF CEMENT ACET COM 22/58
|
Facility
|
OP
|
$4,749.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$617.45 |
| Max. Negotiated Rate |
$4,559.60 |
| Rate for Payer: Aetna Commercial |
$3,657.18
|
| Rate for Payer: Anthem Medicaid |
$1,633.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,704.67
|
| Rate for Payer: Cash Price |
$2,374.79
|
| Rate for Payer: Cigna Commercial |
$3,942.15
|
| Rate for Payer: First Health Commercial |
$4,512.10
|
| Rate for Payer: Humana Commercial |
$4,037.14
|
| Rate for Payer: Humana KY Medicaid |
$1,633.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,650.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,894.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,505.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,424.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,666.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,179.63
|
| Rate for Payer: Ohio Health Group HMO |
$3,562.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$949.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$617.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,472.37
|
| Rate for Payer: PHCS Commercial |
$4,559.60
|
| Rate for Payer: United Healthcare All Payer |
$4,179.63
|
|
|
REF CEMENT ACET COM 22/61
|
Facility
|
IP
|
$4,749.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$617.45 |
| Max. Negotiated Rate |
$4,559.60 |
| Rate for Payer: Aetna Commercial |
$3,657.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,704.67
|
| Rate for Payer: Cash Price |
$2,374.79
|
| Rate for Payer: Cigna Commercial |
$3,942.15
|
| Rate for Payer: First Health Commercial |
$4,512.10
|
| Rate for Payer: Humana Commercial |
$4,037.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,894.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,505.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,424.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,179.63
|
| Rate for Payer: Ohio Health Group HMO |
$3,562.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$949.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$617.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,472.37
|
| Rate for Payer: PHCS Commercial |
$4,559.60
|
| Rate for Payer: United Healthcare All Payer |
$4,179.63
|
|
|
REF CEMENT ACET COM 22/61
|
Facility
|
OP
|
$4,749.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$617.45 |
| Max. Negotiated Rate |
$4,559.60 |
| Rate for Payer: Aetna Commercial |
$3,657.18
|
| Rate for Payer: Anthem Medicaid |
$1,633.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,704.67
|
| Rate for Payer: Cash Price |
$2,374.79
|
| Rate for Payer: Cigna Commercial |
$3,942.15
|
| Rate for Payer: First Health Commercial |
$4,512.10
|
| Rate for Payer: Humana Commercial |
$4,037.14
|
| Rate for Payer: Humana KY Medicaid |
$1,633.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,650.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,894.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,505.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,424.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,666.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,179.63
|
| Rate for Payer: Ohio Health Group HMO |
$3,562.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$949.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$617.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,472.37
|
| Rate for Payer: PHCS Commercial |
$4,559.60
|
| Rate for Payer: United Healthcare All Payer |
$4,179.63
|
|
|
REF CEMENT ACET COM 28/46
|
Facility
|
OP
|
$4,749.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$617.45 |
| Max. Negotiated Rate |
$4,559.60 |
| Rate for Payer: Aetna Commercial |
$3,657.18
|
| Rate for Payer: Anthem Medicaid |
$1,633.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,704.67
|
| Rate for Payer: Cash Price |
$2,374.79
|
| Rate for Payer: Cigna Commercial |
$3,942.15
|
| Rate for Payer: First Health Commercial |
$4,512.10
|
| Rate for Payer: Humana Commercial |
$4,037.14
|
| Rate for Payer: Humana KY Medicaid |
$1,633.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,650.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,894.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,505.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,424.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,666.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,179.63
|
| Rate for Payer: Ohio Health Group HMO |
$3,562.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$949.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$617.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,472.37
|
| Rate for Payer: PHCS Commercial |
$4,559.60
|
| Rate for Payer: United Healthcare All Payer |
$4,179.63
|
|
|
REF CEMENT ACET COM 28/46
|
Facility
|
IP
|
$4,749.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$617.45 |
| Max. Negotiated Rate |
$4,559.60 |
| Rate for Payer: Aetna Commercial |
$3,657.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,704.67
|
| Rate for Payer: Cash Price |
$2,374.79
|
| Rate for Payer: Cigna Commercial |
$3,942.15
|
| Rate for Payer: First Health Commercial |
$4,512.10
|
| Rate for Payer: Humana Commercial |
$4,037.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,894.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,505.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,424.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,179.63
|
| Rate for Payer: Ohio Health Group HMO |
$3,562.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$949.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$617.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,472.37
|
| Rate for Payer: PHCS Commercial |
$4,559.60
|
| Rate for Payer: United Healthcare All Payer |
$4,179.63
|
|
|
REF CEMENT ACET COM 28/49
|
Facility
|
OP
|
$4,749.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$617.45 |
| Max. Negotiated Rate |
$4,559.60 |
| Rate for Payer: Aetna Commercial |
$3,657.18
|
| Rate for Payer: Anthem Medicaid |
$1,633.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,704.67
|
| Rate for Payer: Cash Price |
$2,374.79
|
| Rate for Payer: Cigna Commercial |
$3,942.15
|
| Rate for Payer: First Health Commercial |
$4,512.10
|
| Rate for Payer: Humana Commercial |
$4,037.14
|
| Rate for Payer: Humana KY Medicaid |
$1,633.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,650.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,894.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,505.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,424.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,666.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,179.63
|
| Rate for Payer: Ohio Health Group HMO |
$3,562.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$949.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$617.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,472.37
|
| Rate for Payer: PHCS Commercial |
$4,559.60
|
| Rate for Payer: United Healthcare All Payer |
$4,179.63
|
|
|
REF CEMENT ACET COM 28/49
|
Facility
|
IP
|
$4,749.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$617.45 |
| Max. Negotiated Rate |
$4,559.60 |
| Rate for Payer: Aetna Commercial |
$3,657.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,704.67
|
| Rate for Payer: Cash Price |
$2,374.79
|
| Rate for Payer: Cigna Commercial |
$3,942.15
|
| Rate for Payer: First Health Commercial |
$4,512.10
|
| Rate for Payer: Humana Commercial |
$4,037.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,894.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,505.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,424.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,179.63
|
| Rate for Payer: Ohio Health Group HMO |
$3,562.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$949.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$617.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,472.37
|
| Rate for Payer: PHCS Commercial |
$4,559.60
|
| Rate for Payer: United Healthcare All Payer |
$4,179.63
|
|
