|
REFL XLPE 35 32 54-56
|
Facility
|
OP
|
$8,610.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.43 |
| Max. Negotiated Rate |
$8,266.54 |
| Rate for Payer: Aetna Commercial |
$6,630.45
|
| Rate for Payer: Anthem Medicaid |
$2,961.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,716.56
|
| Rate for Payer: Cash Price |
$4,305.49
|
| Rate for Payer: Cigna Commercial |
$7,147.11
|
| Rate for Payer: First Health Commercial |
$8,180.43
|
| Rate for Payer: Humana Commercial |
$7,319.33
|
| Rate for Payer: Humana KY Medicaid |
$2,961.32
|
| Rate for Payer: Kentucky WC Medicaid |
$2,991.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,061.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,354.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,583.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,020.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,577.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,458.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,722.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,669.40
|
| Rate for Payer: PHCS Commercial |
$8,266.54
|
| Rate for Payer: United Healthcare All Payer |
$7,577.66
|
|
|
REFL XLPE 35 32 58-60
|
Facility
|
IP
|
$8,610.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.43 |
| Max. Negotiated Rate |
$8,266.54 |
| Rate for Payer: Aetna Commercial |
$6,630.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,716.56
|
| Rate for Payer: Cash Price |
$4,305.49
|
| Rate for Payer: Cigna Commercial |
$7,147.11
|
| Rate for Payer: First Health Commercial |
$8,180.43
|
| Rate for Payer: Humana Commercial |
$7,319.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,061.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,354.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,583.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,577.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,458.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,722.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,669.40
|
| Rate for Payer: PHCS Commercial |
$8,266.54
|
| Rate for Payer: United Healthcare All Payer |
$7,577.66
|
|
|
REFL XLPE 35 32 58-60
|
Facility
|
OP
|
$8,610.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.43 |
| Max. Negotiated Rate |
$8,266.54 |
| Rate for Payer: Aetna Commercial |
$6,630.45
|
| Rate for Payer: Anthem Medicaid |
$2,961.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,716.56
|
| Rate for Payer: Cash Price |
$4,305.49
|
| Rate for Payer: Cigna Commercial |
$7,147.11
|
| Rate for Payer: First Health Commercial |
$8,180.43
|
| Rate for Payer: Humana Commercial |
$7,319.33
|
| Rate for Payer: Humana KY Medicaid |
$2,961.32
|
| Rate for Payer: Kentucky WC Medicaid |
$2,991.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,061.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,354.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,583.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,020.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,577.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,458.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,722.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,669.40
|
| Rate for Payer: PHCS Commercial |
$8,266.54
|
| Rate for Payer: United Healthcare All Payer |
$7,577.66
|
|
|
REFL XLPE 35 32 62-64
|
Facility
|
OP
|
$8,610.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.43 |
| Max. Negotiated Rate |
$8,266.54 |
| Rate for Payer: Aetna Commercial |
$6,630.45
|
| Rate for Payer: Anthem Medicaid |
$2,961.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,716.56
|
| Rate for Payer: Cash Price |
$4,305.49
|
| Rate for Payer: Cigna Commercial |
$7,147.11
|
| Rate for Payer: First Health Commercial |
$8,180.43
|
| Rate for Payer: Humana Commercial |
$7,319.33
|
| Rate for Payer: Humana KY Medicaid |
$2,961.32
|
| Rate for Payer: Kentucky WC Medicaid |
$2,991.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,061.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,354.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,583.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,020.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,577.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,458.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,722.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,669.40
|
| Rate for Payer: PHCS Commercial |
$8,266.54
|
| Rate for Payer: United Healthcare All Payer |
$7,577.66
|
|
|
REFL XLPE 35 32 62-64
|
Facility
|
IP
|
$8,610.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.43 |
| Max. Negotiated Rate |
$8,266.54 |
| Rate for Payer: Aetna Commercial |
$6,630.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,716.56
|
| Rate for Payer: Cash Price |
$4,305.49
|
| Rate for Payer: Cigna Commercial |
$7,147.11
|
| Rate for Payer: First Health Commercial |
$8,180.43
|
| Rate for Payer: Humana Commercial |
$7,319.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,061.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,354.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,583.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,577.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,458.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,722.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,669.40
|
| Rate for Payer: PHCS Commercial |
$8,266.54
|
| Rate for Payer: United Healthcare All Payer |
$7,577.66
|
|
|
REFL XLPE 35 36 58-60
|
Facility
|
IP
|
$8,610.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.43 |
| Max. Negotiated Rate |
$8,266.54 |
| Rate for Payer: Aetna Commercial |
$6,630.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,716.56
|
| Rate for Payer: Cash Price |
$4,305.49
|
| Rate for Payer: Cigna Commercial |
$7,147.11
|
| Rate for Payer: First Health Commercial |
$8,180.43
|
| Rate for Payer: Humana Commercial |
$7,319.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,061.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,354.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,583.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,577.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,458.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,722.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,669.40
|
| Rate for Payer: PHCS Commercial |
$8,266.54
|
| Rate for Payer: United Healthcare All Payer |
$7,577.66
|
|
|
REFL XLPE 35 36 58-60
|
Facility
|
OP
|
$8,610.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.43 |
| Max. Negotiated Rate |
$8,266.54 |
| Rate for Payer: Aetna Commercial |
$6,630.45
|
| Rate for Payer: Anthem Medicaid |
$2,961.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,716.56
|
| Rate for Payer: Cash Price |
$4,305.49
|
| Rate for Payer: Cigna Commercial |
$7,147.11
|
| Rate for Payer: First Health Commercial |
$8,180.43
|
| Rate for Payer: Humana Commercial |
$7,319.33
|
| Rate for Payer: Humana KY Medicaid |
$2,961.32
|
| Rate for Payer: Kentucky WC Medicaid |
$2,991.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,061.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,354.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,583.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,020.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,577.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,458.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,722.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,669.40
|
| Rate for Payer: PHCS Commercial |
$8,266.54
|
| Rate for Payer: United Healthcare All Payer |
$7,577.66
|
|
|
REFL XLPE 35 36 62-64
|
Facility
|
IP
|
$8,610.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.43 |
| Max. Negotiated Rate |
$8,266.54 |
| Rate for Payer: Aetna Commercial |
$6,630.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,716.56
|
| Rate for Payer: Cash Price |
$4,305.49
|
| Rate for Payer: Cigna Commercial |
$7,147.11
|
| Rate for Payer: First Health Commercial |
$8,180.43
|
| Rate for Payer: Humana Commercial |
$7,319.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,061.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,354.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,583.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,577.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,458.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,722.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,669.40
|
| Rate for Payer: PHCS Commercial |
$8,266.54
|
| Rate for Payer: United Healthcare All Payer |
$7,577.66
|
|
|
REFL XLPE 35 36 62-64
|
Facility
|
OP
|
$8,610.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.43 |
| Max. Negotiated Rate |
$8,266.54 |
| Rate for Payer: Aetna Commercial |
$6,630.45
|
| Rate for Payer: Anthem Medicaid |
$2,961.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,716.56
|
| Rate for Payer: Cash Price |
$4,305.49
|
| Rate for Payer: Cigna Commercial |
$7,147.11
|
| Rate for Payer: First Health Commercial |
$8,180.43
|
| Rate for Payer: Humana Commercial |
$7,319.33
|
| Rate for Payer: Humana KY Medicaid |
$2,961.32
|
| Rate for Payer: Kentucky WC Medicaid |
$2,991.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,061.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,354.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,583.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,020.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,577.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,458.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,722.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,669.40
|
| Rate for Payer: PHCS Commercial |
$8,266.54
|
| Rate for Payer: United Healthcare All Payer |
$7,577.66
|
|
|
REFL XLPE 35 36 66-68
|
Facility
|
IP
|
$8,610.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.43 |
| Max. Negotiated Rate |
$8,266.54 |
| Rate for Payer: Aetna Commercial |
$6,630.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,716.56
|
| Rate for Payer: Cash Price |
$4,305.49
|
| Rate for Payer: Cigna Commercial |
$7,147.11
|
| Rate for Payer: First Health Commercial |
$8,180.43
|
| Rate for Payer: Humana Commercial |
$7,319.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,061.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,354.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,583.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,577.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,458.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,722.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,669.40
|
| Rate for Payer: PHCS Commercial |
$8,266.54
|
| Rate for Payer: United Healthcare All Payer |
$7,577.66
|
|
|
REFL XLPE 35 36 66-68
|
Facility
|
OP
|
$8,610.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.43 |
| Max. Negotiated Rate |
$8,266.54 |
| Rate for Payer: Aetna Commercial |
$6,630.45
|
| Rate for Payer: Anthem Medicaid |
$2,961.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,716.56
|
| Rate for Payer: Cash Price |
$4,305.49
|
| Rate for Payer: Cigna Commercial |
$7,147.11
|
| Rate for Payer: First Health Commercial |
$8,180.43
|
| Rate for Payer: Humana Commercial |
$7,319.33
|
| Rate for Payer: Humana KY Medicaid |
$2,961.32
|
| Rate for Payer: Kentucky WC Medicaid |
$2,991.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,061.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,354.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,583.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,020.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,577.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,458.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,722.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,669.40
|
| Rate for Payer: PHCS Commercial |
$8,266.54
|
| Rate for Payer: United Healthcare All Payer |
$7,577.66
|
|
|
REFL XLPE 35 36 70-76
|
Facility
|
IP
|
$8,610.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.43 |
| Max. Negotiated Rate |
$8,266.54 |
| Rate for Payer: Aetna Commercial |
$6,630.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,716.56
|
| Rate for Payer: Cash Price |
$4,305.49
|
| Rate for Payer: Cigna Commercial |
$7,147.11
|
| Rate for Payer: First Health Commercial |
$8,180.43
|
| Rate for Payer: Humana Commercial |
$7,319.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,061.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,354.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,583.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,577.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,458.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,722.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,669.40
|
| Rate for Payer: PHCS Commercial |
$8,266.54
|
| Rate for Payer: United Healthcare All Payer |
$7,577.66
|
|
|
REFL XLPE 35 36 70-76
|
Facility
|
OP
|
$8,610.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.43 |
| Max. Negotiated Rate |
$8,266.54 |
| Rate for Payer: Aetna Commercial |
$6,630.45
|
| Rate for Payer: Anthem Medicaid |
$2,961.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,716.56
|
| Rate for Payer: Cash Price |
$4,305.49
|
| Rate for Payer: Cigna Commercial |
$7,147.11
|
| Rate for Payer: First Health Commercial |
$8,180.43
|
| Rate for Payer: Humana Commercial |
$7,319.33
|
| Rate for Payer: Humana KY Medicaid |
$2,961.32
|
| Rate for Payer: Kentucky WC Medicaid |
$2,991.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,061.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,354.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,583.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,020.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,577.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,458.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,722.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,669.40
|
| Rate for Payer: PHCS Commercial |
$8,266.54
|
| Rate for Payer: United Healthcare All Payer |
$7,577.66
|
|
|
REF NH HA SHELL SZ 46MM
|
Facility
|
OP
|
$11,508.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,496.15 |
| Max. Negotiated Rate |
$11,048.50 |
| Rate for Payer: Aetna Commercial |
$8,861.81
|
| Rate for Payer: Anthem Medicaid |
$3,957.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,976.90
|
| Rate for Payer: Cash Price |
$5,754.42
|
| Rate for Payer: Cigna Commercial |
$9,552.35
|
| Rate for Payer: First Health Commercial |
$10,933.41
|
| Rate for Payer: Humana Commercial |
$9,782.52
|
| Rate for Payer: Humana KY Medicaid |
$3,957.89
|
| Rate for Payer: Kentucky WC Medicaid |
$3,998.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,437.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,493.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,452.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,037.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,127.79
|
| Rate for Payer: Ohio Health Group HMO |
$8,631.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,301.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,496.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,567.74
|
| Rate for Payer: PHCS Commercial |
$11,048.50
|
| Rate for Payer: United Healthcare All Payer |
$10,127.79
|
|
|
REF NH HA SHELL SZ 46MM
|
Facility
|
IP
|
$11,508.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,496.15 |
| Max. Negotiated Rate |
$11,048.50 |
| Rate for Payer: Aetna Commercial |
$8,861.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,976.90
|
| Rate for Payer: Cash Price |
$5,754.42
|
| Rate for Payer: Cigna Commercial |
$9,552.35
|
| Rate for Payer: First Health Commercial |
$10,933.41
|
| Rate for Payer: Humana Commercial |
$9,782.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,437.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,493.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,452.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,127.79
|
| Rate for Payer: Ohio Health Group HMO |
$8,631.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,301.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,496.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,567.74
|
| Rate for Payer: PHCS Commercial |
$11,048.50
|
| Rate for Payer: United Healthcare All Payer |
$10,127.79
|
|
|
REF NH HA SHELL SZ 48MM
|
Facility
|
IP
|
$11,508.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,496.15 |
| Max. Negotiated Rate |
$11,048.50 |
| Rate for Payer: Aetna Commercial |
$8,861.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,976.90
|
| Rate for Payer: Cash Price |
$5,754.42
|
| Rate for Payer: Cigna Commercial |
$9,552.35
|
| Rate for Payer: First Health Commercial |
$10,933.41
|
| Rate for Payer: Humana Commercial |
$9,782.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,437.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,493.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,452.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,127.79
|
| Rate for Payer: Ohio Health Group HMO |
$8,631.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,301.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,496.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,567.74
|
| Rate for Payer: PHCS Commercial |
$11,048.50
|
| Rate for Payer: United Healthcare All Payer |
$10,127.79
|
|
|
REF NH HA SHELL SZ 48MM
|
Facility
|
OP
|
$11,508.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,496.15 |
| Max. Negotiated Rate |
$11,048.50 |
| Rate for Payer: Aetna Commercial |
$8,861.81
|
| Rate for Payer: Anthem Medicaid |
$3,957.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,976.90
|
| Rate for Payer: Cash Price |
$5,754.42
|
| Rate for Payer: Cigna Commercial |
$9,552.35
|
| Rate for Payer: First Health Commercial |
$10,933.41
|
| Rate for Payer: Humana Commercial |
$9,782.52
|
| Rate for Payer: Humana KY Medicaid |
$3,957.89
|
| Rate for Payer: Kentucky WC Medicaid |
$3,998.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,437.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,493.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,452.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,037.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,127.79
|
| Rate for Payer: Ohio Health Group HMO |
$8,631.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,301.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,496.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,567.74
|
| Rate for Payer: PHCS Commercial |
$11,048.50
|
| Rate for Payer: United Healthcare All Payer |
$10,127.79
|
|
|
REF NH HA SHELL SZ 50MM
|
Facility
|
IP
|
$11,508.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,496.15 |
| Max. Negotiated Rate |
$11,048.50 |
| Rate for Payer: Aetna Commercial |
$8,861.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,976.90
|
| Rate for Payer: Cash Price |
$5,754.42
|
| Rate for Payer: Cigna Commercial |
$9,552.35
|
| Rate for Payer: First Health Commercial |
$10,933.41
|
| Rate for Payer: Humana Commercial |
$9,782.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,437.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,493.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,452.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,127.79
|
| Rate for Payer: Ohio Health Group HMO |
$8,631.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,301.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,496.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,567.74
|
| Rate for Payer: PHCS Commercial |
$11,048.50
|
| Rate for Payer: United Healthcare All Payer |
$10,127.79
|
|
|
REF NH HA SHELL SZ 50MM
|
Facility
|
OP
|
$11,508.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,496.15 |
| Max. Negotiated Rate |
$11,048.50 |
| Rate for Payer: Aetna Commercial |
$8,861.81
|
| Rate for Payer: Anthem Medicaid |
$3,957.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,976.90
|
| Rate for Payer: Cash Price |
$5,754.42
|
| Rate for Payer: Cigna Commercial |
$9,552.35
|
| Rate for Payer: First Health Commercial |
$10,933.41
|
| Rate for Payer: Humana Commercial |
$9,782.52
|
| Rate for Payer: Humana KY Medicaid |
$3,957.89
|
| Rate for Payer: Kentucky WC Medicaid |
$3,998.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,437.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,493.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,452.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,037.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,127.79
|
| Rate for Payer: Ohio Health Group HMO |
$8,631.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,301.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,496.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,567.74
|
| Rate for Payer: PHCS Commercial |
$11,048.50
|
| Rate for Payer: United Healthcare All Payer |
$10,127.79
|
|
|
REF NH HA SHELL SZ 52MM
|
Facility
|
IP
|
$11,508.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,496.15 |
| Max. Negotiated Rate |
$11,048.50 |
| Rate for Payer: Aetna Commercial |
$8,861.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,976.90
|
| Rate for Payer: Cash Price |
$5,754.42
|
| Rate for Payer: Cigna Commercial |
$9,552.35
|
| Rate for Payer: First Health Commercial |
$10,933.41
|
| Rate for Payer: Humana Commercial |
$9,782.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,437.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,493.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,452.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,127.79
|
| Rate for Payer: Ohio Health Group HMO |
$8,631.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,301.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,496.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,567.74
|
| Rate for Payer: PHCS Commercial |
$11,048.50
|
| Rate for Payer: United Healthcare All Payer |
$10,127.79
|
|
|
REF NH HA SHELL SZ 52MM
|
Facility
|
OP
|
$11,508.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,496.15 |
| Max. Negotiated Rate |
$11,048.50 |
| Rate for Payer: Aetna Commercial |
$8,861.81
|
| Rate for Payer: Anthem Medicaid |
$3,957.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,976.90
|
| Rate for Payer: Cash Price |
$5,754.42
|
| Rate for Payer: Cigna Commercial |
$9,552.35
|
| Rate for Payer: First Health Commercial |
$10,933.41
|
| Rate for Payer: Humana Commercial |
$9,782.52
|
| Rate for Payer: Humana KY Medicaid |
$3,957.89
|
| Rate for Payer: Kentucky WC Medicaid |
$3,998.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,437.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,493.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,452.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,037.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,127.79
|
| Rate for Payer: Ohio Health Group HMO |
$8,631.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,301.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,496.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,567.74
|
| Rate for Payer: PHCS Commercial |
$11,048.50
|
| Rate for Payer: United Healthcare All Payer |
$10,127.79
|
|
|
REF NH HA SHELL SZ 54MM
|
Facility
|
OP
|
$11,508.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,496.15 |
| Max. Negotiated Rate |
$11,048.50 |
| Rate for Payer: Aetna Commercial |
$8,861.81
|
| Rate for Payer: Anthem Medicaid |
$3,957.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,976.90
|
| Rate for Payer: Cash Price |
$5,754.42
|
| Rate for Payer: Cigna Commercial |
$9,552.35
|
| Rate for Payer: First Health Commercial |
$10,933.41
|
| Rate for Payer: Humana Commercial |
$9,782.52
|
| Rate for Payer: Humana KY Medicaid |
$3,957.89
|
| Rate for Payer: Kentucky WC Medicaid |
$3,998.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,437.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,493.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,452.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,037.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,127.79
|
| Rate for Payer: Ohio Health Group HMO |
$8,631.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,301.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,496.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,567.74
|
| Rate for Payer: PHCS Commercial |
$11,048.50
|
| Rate for Payer: United Healthcare All Payer |
$10,127.79
|
|
|
REF NH HA SHELL SZ 54MM
|
Facility
|
IP
|
$11,508.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,496.15 |
| Max. Negotiated Rate |
$11,048.50 |
| Rate for Payer: Aetna Commercial |
$8,861.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,976.90
|
| Rate for Payer: Cash Price |
$5,754.42
|
| Rate for Payer: Cigna Commercial |
$9,552.35
|
| Rate for Payer: First Health Commercial |
$10,933.41
|
| Rate for Payer: Humana Commercial |
$9,782.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,437.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,493.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,452.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,127.79
|
| Rate for Payer: Ohio Health Group HMO |
$8,631.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,301.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,496.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,567.74
|
| Rate for Payer: PHCS Commercial |
$11,048.50
|
| Rate for Payer: United Healthcare All Payer |
$10,127.79
|
|
|
REF NH HA SHELL SZ 56MM
|
Facility
|
IP
|
$11,508.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,496.15 |
| Max. Negotiated Rate |
$11,048.50 |
| Rate for Payer: Aetna Commercial |
$8,861.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,976.90
|
| Rate for Payer: Cash Price |
$5,754.42
|
| Rate for Payer: Cigna Commercial |
$9,552.35
|
| Rate for Payer: First Health Commercial |
$10,933.41
|
| Rate for Payer: Humana Commercial |
$9,782.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,437.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,493.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,452.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,127.79
|
| Rate for Payer: Ohio Health Group HMO |
$8,631.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,301.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,496.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,567.74
|
| Rate for Payer: PHCS Commercial |
$11,048.50
|
| Rate for Payer: United Healthcare All Payer |
$10,127.79
|
|
|
REF NH HA SHELL SZ 56MM
|
Facility
|
OP
|
$11,508.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,496.15 |
| Max. Negotiated Rate |
$11,048.50 |
| Rate for Payer: Aetna Commercial |
$8,861.81
|
| Rate for Payer: Anthem Medicaid |
$3,957.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,976.90
|
| Rate for Payer: Cash Price |
$5,754.42
|
| Rate for Payer: Cigna Commercial |
$9,552.35
|
| Rate for Payer: First Health Commercial |
$10,933.41
|
| Rate for Payer: Humana Commercial |
$9,782.52
|
| Rate for Payer: Humana KY Medicaid |
$3,957.89
|
| Rate for Payer: Kentucky WC Medicaid |
$3,998.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,437.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,493.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,452.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,037.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,127.79
|
| Rate for Payer: Ohio Health Group HMO |
$8,631.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,301.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,496.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,567.74
|
| Rate for Payer: PHCS Commercial |
$11,048.50
|
| Rate for Payer: United Healthcare All Payer |
$10,127.79
|
|
