|
REF CNSTR LNR 0 DEG 28 66-68 J
|
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 70-76 K
|
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 70-76 K
|
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 32 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 32 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 32 66-68 J
|
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 32 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
|
|
|
REF CNSTR LNR 0 DEG 32 70-76 K
|
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 32 70-76 K
|
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 ADPTR 46-48OD D
|
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 ADPTR 46-48OD D
|
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 ADPTR 50-52OD E
|
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 ADPTR 50-52OD E
|
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 ADPTR 54-56OD F
|
Facility
|
IP
|
$16,087.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,091.34 |
| Max. Negotiated Rate |
$15,443.71 |
| Rate for Payer: Aetna Commercial |
$12,387.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,548.02
|
| Rate for Payer: Cash Price |
$8,043.60
|
| Rate for Payer: Cigna Commercial |
$13,352.38
|
| Rate for Payer: First Health Commercial |
$15,282.84
|
| Rate for Payer: Humana Commercial |
$13,674.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,191.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,872.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,826.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,156.74
|
| Rate for Payer: Ohio Health Group HMO |
$12,065.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,217.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,091.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,987.03
|
| Rate for Payer: PHCS Commercial |
$15,443.71
|
| Rate for Payer: United Healthcare All Payer |
$14,156.74
|
|
|
REF CNSTR LNR ADPTR 54-56OD F
|
Facility
|
OP
|
$16,087.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,091.34 |
| Max. Negotiated Rate |
$15,443.71 |
| Rate for Payer: Aetna Commercial |
$12,387.14
|
| Rate for Payer: Anthem Medicaid |
$5,532.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,548.02
|
| Rate for Payer: Cash Price |
$8,043.60
|
| Rate for Payer: Cigna Commercial |
$13,352.38
|
| Rate for Payer: First Health Commercial |
$15,282.84
|
| Rate for Payer: Humana Commercial |
$13,674.12
|
| Rate for Payer: Humana KY Medicaid |
$5,532.39
|
| Rate for Payer: Kentucky WC Medicaid |
$5,588.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,191.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,872.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,826.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,643.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,156.74
|
| Rate for Payer: Ohio Health Group HMO |
$12,065.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,217.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,091.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,987.03
|
| Rate for Payer: PHCS Commercial |
$15,443.71
|
| Rate for Payer: United Healthcare All Payer |
$14,156.74
|
|
|
REF CNSTR LNR ADPTR 58-60OD G
|
Facility
|
IP
|
$16,087.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,091.34 |
| Max. Negotiated Rate |
$15,443.71 |
| Rate for Payer: Aetna Commercial |
$12,387.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,548.02
|
| Rate for Payer: Cash Price |
$8,043.60
|
| Rate for Payer: Cigna Commercial |
$13,352.38
|
| Rate for Payer: First Health Commercial |
$15,282.84
|
| Rate for Payer: Humana Commercial |
$13,674.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,191.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,872.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,826.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,156.74
|
| Rate for Payer: Ohio Health Group HMO |
$12,065.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,217.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,091.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,987.03
|
| Rate for Payer: PHCS Commercial |
$15,443.71
|
| Rate for Payer: United Healthcare All Payer |
$14,156.74
|
|
|
REF CNSTR LNR ADPTR 58-60OD G
|
Facility
|
OP
|
$16,087.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,091.34 |
| Max. Negotiated Rate |
$15,443.71 |
| Rate for Payer: Aetna Commercial |
$12,387.14
|
| Rate for Payer: Anthem Medicaid |
$5,532.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,548.02
|
| Rate for Payer: Cash Price |
$8,043.60
|
| Rate for Payer: Cigna Commercial |
$13,352.38
|
| Rate for Payer: First Health Commercial |
$15,282.84
|
| Rate for Payer: Humana Commercial |
$13,674.12
|
| Rate for Payer: Humana KY Medicaid |
$5,532.39
|
| Rate for Payer: Kentucky WC Medicaid |
$5,588.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,191.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,872.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,826.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,643.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,156.74
|
| Rate for Payer: Ohio Health Group HMO |
$12,065.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,217.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,091.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,987.03
|
| Rate for Payer: PHCS Commercial |
$15,443.71
|
| Rate for Payer: United Healthcare All Payer |
$14,156.74
|
|
|
REF CNSTR LNR ADPTR 62-64OD H
|
Facility
|
OP
|
$16,087.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,091.34 |
| Max. Negotiated Rate |
$15,443.71 |
| Rate for Payer: Aetna Commercial |
$12,387.14
|
| Rate for Payer: Anthem Medicaid |
$5,532.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,548.02
|
| Rate for Payer: Cash Price |
$8,043.60
|
| Rate for Payer: Cigna Commercial |
$13,352.38
|
| Rate for Payer: First Health Commercial |
$15,282.84
|
| Rate for Payer: Humana Commercial |
$13,674.12
|
| Rate for Payer: Humana KY Medicaid |
$5,532.39
|
| Rate for Payer: Kentucky WC Medicaid |
$5,588.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,191.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,872.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,826.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,643.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,156.74
|
| Rate for Payer: Ohio Health Group HMO |
$12,065.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,217.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,091.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,987.03
|
| Rate for Payer: PHCS Commercial |
$15,443.71
|
| Rate for Payer: United Healthcare All Payer |
$14,156.74
|
|
|
REF CNSTR LNR ADPTR 62-64OD H
|
Facility
|
IP
|
$16,087.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,091.34 |
| Max. Negotiated Rate |
$15,443.71 |
| Rate for Payer: Aetna Commercial |
$12,387.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,548.02
|
| Rate for Payer: Cash Price |
$8,043.60
|
| Rate for Payer: Cigna Commercial |
$13,352.38
|
| Rate for Payer: First Health Commercial |
$15,282.84
|
| Rate for Payer: Humana Commercial |
$13,674.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,191.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,872.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,826.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,156.74
|
| Rate for Payer: Ohio Health Group HMO |
$12,065.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,217.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,091.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,987.03
|
| Rate for Payer: PHCS Commercial |
$15,443.71
|
| Rate for Payer: United Healthcare All Payer |
$14,156.74
|
|
|
REF CNSTR LNR ADPTR 66-68OD J
|
Facility
|
IP
|
$16,087.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,091.34 |
| Max. Negotiated Rate |
$15,443.71 |
| Rate for Payer: Aetna Commercial |
$12,387.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,548.02
|
| Rate for Payer: Cash Price |
$8,043.60
|
| Rate for Payer: Cigna Commercial |
$13,352.38
|
| Rate for Payer: First Health Commercial |
$15,282.84
|
| Rate for Payer: Humana Commercial |
$13,674.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,191.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,872.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,826.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,156.74
|
| Rate for Payer: Ohio Health Group HMO |
$12,065.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,217.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,091.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,987.03
|
| Rate for Payer: PHCS Commercial |
$15,443.71
|
| Rate for Payer: United Healthcare All Payer |
$14,156.74
|
|
|
REF CNSTR LNR ADPTR 66-68OD J
|
Facility
|
OP
|
$16,087.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,091.34 |
| Max. Negotiated Rate |
$15,443.71 |
| Rate for Payer: Aetna Commercial |
$12,387.14
|
| Rate for Payer: Anthem Medicaid |
$5,532.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,548.02
|
| Rate for Payer: Cash Price |
$8,043.60
|
| Rate for Payer: Cigna Commercial |
$13,352.38
|
| Rate for Payer: First Health Commercial |
$15,282.84
|
| Rate for Payer: Humana Commercial |
$13,674.12
|
| Rate for Payer: Humana KY Medicaid |
$5,532.39
|
| Rate for Payer: Kentucky WC Medicaid |
$5,588.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,191.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,872.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,826.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,643.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,156.74
|
| Rate for Payer: Ohio Health Group HMO |
$12,065.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,217.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,091.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,987.03
|
| Rate for Payer: PHCS Commercial |
$15,443.71
|
| Rate for Payer: United Healthcare All Payer |
$14,156.74
|
|
|
REF CNSTR LNR ADPTR 70-76OD K
|
Facility
|
IP
|
$16,087.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,091.34 |
| Max. Negotiated Rate |
$15,443.71 |
| Rate for Payer: Aetna Commercial |
$12,387.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,548.02
|
| Rate for Payer: Cash Price |
$8,043.60
|
| Rate for Payer: Cigna Commercial |
$13,352.38
|
| Rate for Payer: First Health Commercial |
$15,282.84
|
| Rate for Payer: Humana Commercial |
$13,674.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,191.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,872.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,826.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,156.74
|
| Rate for Payer: Ohio Health Group HMO |
$12,065.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,217.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,091.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,987.03
|
| Rate for Payer: PHCS Commercial |
$15,443.71
|
| Rate for Payer: United Healthcare All Payer |
$14,156.74
|
|
|
REF CNSTR LNR ADPTR 70-76OD K
|
Facility
|
OP
|
$16,087.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,091.34 |
| Max. Negotiated Rate |
$15,443.71 |
| Rate for Payer: Aetna Commercial |
$12,387.14
|
| Rate for Payer: Anthem Medicaid |
$5,532.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,548.02
|
| Rate for Payer: Cash Price |
$8,043.60
|
| Rate for Payer: Cigna Commercial |
$13,352.38
|
| Rate for Payer: First Health Commercial |
$15,282.84
|
| Rate for Payer: Humana Commercial |
$13,674.12
|
| Rate for Payer: Humana KY Medicaid |
$5,532.39
|
| Rate for Payer: Kentucky WC Medicaid |
$5,588.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,191.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,872.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,826.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,643.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,156.74
|
| Rate for Payer: Ohio Health Group HMO |
$12,065.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,217.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,091.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,987.03
|
| Rate for Payer: PHCS Commercial |
$15,443.71
|
| Rate for Payer: United Healthcare All Payer |
$14,156.74
|
|
|
REF FSO 3 42MM OD
|
Facility
|
OP
|
$8,958.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,164.60 |
| Max. Negotiated Rate |
$8,600.12 |
| Rate for Payer: Aetna Commercial |
$6,898.01
|
| Rate for Payer: Anthem Medicaid |
$3,080.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,987.60
|
| Rate for Payer: Cash Price |
$4,479.23
|
| Rate for Payer: Cigna Commercial |
$7,435.52
|
| Rate for Payer: First Health Commercial |
$8,510.54
|
| Rate for Payer: Humana Commercial |
$7,614.69
|
| Rate for Payer: Humana KY Medicaid |
$3,080.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,112.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,345.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,611.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,687.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,142.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,883.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,718.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,791.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,164.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,777.12
|
| Rate for Payer: PHCS Commercial |
$8,600.12
|
| Rate for Payer: United Healthcare All Payer |
$7,883.44
|
|
|
REF FSO 3 42MM OD
|
Facility
|
IP
|
$8,958.46
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,164.60 |
| Max. Negotiated Rate |
$8,600.12 |
| Rate for Payer: Aetna Commercial |
$6,898.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,987.60
|
| Rate for Payer: Cash Price |
$4,479.23
|
| Rate for Payer: Cigna Commercial |
$7,435.52
|
| Rate for Payer: First Health Commercial |
$8,510.54
|
| Rate for Payer: Humana Commercial |
$7,614.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,345.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,611.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,687.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,883.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,718.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,791.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,164.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,777.12
|
| Rate for Payer: PHCS Commercial |
$8,600.12
|
| Rate for Payer: United Healthcare All Payer |
$7,883.44
|
|
