|
REF CEMENT ACET COM 28/52
|
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 28/52
|
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 28/55
|
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 28/55
|
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 28/58
|
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 28/58
|
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 28/61
|
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 28/61
|
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 32/49
|
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 32/49
|
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 32/52
|
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 32/52
|
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 32/55
|
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 32/55
|
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 32/58
|
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 32/58
|
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 32/61
|
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 32/61
|
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 CNSTR LNR 0 DEG 28 54-56 F
|
Facility
|
IP
|
$16,929.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,200.85 |
| Max. Negotiated Rate |
$16,252.42 |
| Rate for Payer: Aetna Commercial |
$13,035.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,205.09
|
| Rate for Payer: Cash Price |
$8,464.80
|
| Rate for Payer: Cigna Commercial |
$14,051.57
|
| Rate for Payer: First Health Commercial |
$16,083.12
|
| Rate for Payer: Humana Commercial |
$14,390.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,882.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,494.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,078.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,898.05
|
| Rate for Payer: Ohio Health Group HMO |
$12,697.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,385.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,200.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,248.18
|
| Rate for Payer: PHCS Commercial |
$16,252.42
|
| Rate for Payer: United Healthcare All Payer |
$14,898.05
|
|
|
REF CNSTR LNR 0 DEG 28 54-56 F
|
Facility
|
OP
|
$16,929.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,200.85 |
| Max. Negotiated Rate |
$16,252.42 |
| Rate for Payer: Aetna Commercial |
$13,035.79
|
| Rate for Payer: Anthem Medicaid |
$5,822.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,205.09
|
| Rate for Payer: Cash Price |
$8,464.80
|
| Rate for Payer: Cigna Commercial |
$14,051.57
|
| Rate for Payer: First Health Commercial |
$16,083.12
|
| Rate for Payer: Humana Commercial |
$14,390.16
|
| Rate for Payer: Humana KY Medicaid |
$5,822.09
|
| Rate for Payer: Kentucky WC Medicaid |
$5,881.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,882.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,494.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,078.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,938.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,898.05
|
| Rate for Payer: Ohio Health Group HMO |
$12,697.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,385.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,200.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,248.18
|
| Rate for Payer: PHCS Commercial |
$16,252.42
|
| Rate for Payer: United Healthcare All Payer |
$14,898.05
|
|
|
REF CNSTR LNR 0 DEG 28 58-60 G
|
Facility
|
OP
|
$16,929.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,200.85 |
| Max. Negotiated Rate |
$16,252.42 |
| Rate for Payer: Aetna Commercial |
$13,035.79
|
| Rate for Payer: Anthem Medicaid |
$5,822.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,205.09
|
| Rate for Payer: Cash Price |
$8,464.80
|
| Rate for Payer: Cigna Commercial |
$14,051.57
|
| Rate for Payer: First Health Commercial |
$16,083.12
|
| Rate for Payer: Humana Commercial |
$14,390.16
|
| Rate for Payer: Humana KY Medicaid |
$5,822.09
|
| Rate for Payer: Kentucky WC Medicaid |
$5,881.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,882.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,494.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,078.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,938.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,898.05
|
| Rate for Payer: Ohio Health Group HMO |
$12,697.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,385.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,200.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,248.18
|
| Rate for Payer: PHCS Commercial |
$16,252.42
|
| Rate for Payer: United Healthcare All Payer |
$14,898.05
|
|
|
REF CNSTR LNR 0 DEG 28 58-60 G
|
Facility
|
IP
|
$16,929.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,200.85 |
| Max. Negotiated Rate |
$16,252.42 |
| Rate for Payer: Aetna Commercial |
$13,035.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,205.09
|
| Rate for Payer: Cash Price |
$8,464.80
|
| Rate for Payer: Cigna Commercial |
$14,051.57
|
| Rate for Payer: First Health Commercial |
$16,083.12
|
| Rate for Payer: Humana Commercial |
$14,390.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,882.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,494.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,078.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,898.05
|
| Rate for Payer: Ohio Health Group HMO |
$12,697.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,385.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,200.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,248.18
|
| Rate for Payer: PHCS Commercial |
$16,252.42
|
| Rate for Payer: United Healthcare All Payer |
$14,898.05
|
|
|
REF CNSTR LNR 0 DEG 28 62-64 H
|
Facility
|
OP
|
$16,929.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,200.85 |
| Max. Negotiated Rate |
$16,252.42 |
| Rate for Payer: Aetna Commercial |
$13,035.79
|
| Rate for Payer: Anthem Medicaid |
$5,822.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,205.09
|
| Rate for Payer: Cash Price |
$8,464.80
|
| Rate for Payer: Cigna Commercial |
$14,051.57
|
| Rate for Payer: First Health Commercial |
$16,083.12
|
| Rate for Payer: Humana Commercial |
$14,390.16
|
| Rate for Payer: Humana KY Medicaid |
$5,822.09
|
| Rate for Payer: Kentucky WC Medicaid |
$5,881.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,882.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,494.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,078.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,938.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,898.05
|
| Rate for Payer: Ohio Health Group HMO |
$12,697.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,385.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,200.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,248.18
|
| Rate for Payer: PHCS Commercial |
$16,252.42
|
| Rate for Payer: United Healthcare All Payer |
$14,898.05
|
|
|
REF CNSTR LNR 0 DEG 28 62-64 H
|
Facility
|
IP
|
$16,929.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,200.85 |
| Max. Negotiated Rate |
$16,252.42 |
| Rate for Payer: Aetna Commercial |
$13,035.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,205.09
|
| Rate for Payer: Cash Price |
$8,464.80
|
| Rate for Payer: Cigna Commercial |
$14,051.57
|
| Rate for Payer: First Health Commercial |
$16,083.12
|
| Rate for Payer: Humana Commercial |
$14,390.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,882.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,494.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,078.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,898.05
|
| Rate for Payer: Ohio Health Group HMO |
$12,697.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,385.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,200.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,248.18
|
| Rate for Payer: PHCS Commercial |
$16,252.42
|
| Rate for Payer: United Healthcare All Payer |
$14,898.05
|
|
|
REF CNSTR LNR 0 DEG 28 66-68 J
|
Facility
|
OP
|
$16,929.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,200.85 |
| Max. Negotiated Rate |
$16,252.42 |
| Rate for Payer: Aetna Commercial |
$13,035.79
|
| Rate for Payer: Anthem Medicaid |
$5,822.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,205.09
|
| Rate for Payer: Cash Price |
$8,464.80
|
| Rate for Payer: Cigna Commercial |
$14,051.57
|
| Rate for Payer: First Health Commercial |
$16,083.12
|
| Rate for Payer: Humana Commercial |
$14,390.16
|
| Rate for Payer: Humana KY Medicaid |
$5,822.09
|
| Rate for Payer: Kentucky WC Medicaid |
$5,881.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,882.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,494.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,078.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,938.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,898.05
|
| Rate for Payer: Ohio Health Group HMO |
$12,697.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,385.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,200.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,248.18
|
| Rate for Payer: PHCS Commercial |
$16,252.42
|
| Rate for Payer: United Healthcare All Payer |
$14,898.05
|
|
