|
REF V POR ACET SHELL 68OD
|
Facility
|
OP
|
$11,167.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,451.83 |
| Max. Negotiated Rate |
$10,721.22 |
| Rate for Payer: Aetna Commercial |
$8,599.31
|
| Rate for Payer: Anthem Medicaid |
$3,840.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,710.99
|
| Rate for Payer: Cash Price |
$5,583.97
|
| Rate for Payer: Cigna Commercial |
$9,269.39
|
| Rate for Payer: First Health Commercial |
$10,609.54
|
| Rate for Payer: Humana Commercial |
$9,492.75
|
| Rate for Payer: Humana KY Medicaid |
$3,840.65
|
| Rate for Payer: Kentucky WC Medicaid |
$3,879.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,157.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,241.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,350.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,917.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,827.79
|
| Rate for Payer: Ohio Health Group HMO |
$8,375.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,233.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,451.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,462.06
|
| Rate for Payer: PHCS Commercial |
$10,721.22
|
| Rate for Payer: United Healthcare All Payer |
$9,827.79
|
|
|
REF V POR ACET SHELL 68OD
|
Facility
|
IP
|
$11,167.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,451.83 |
| Max. Negotiated Rate |
$10,721.22 |
| Rate for Payer: Aetna Commercial |
$8,599.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,710.99
|
| Rate for Payer: Cash Price |
$5,583.97
|
| Rate for Payer: Cigna Commercial |
$9,269.39
|
| Rate for Payer: First Health Commercial |
$10,609.54
|
| Rate for Payer: Humana Commercial |
$9,492.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,157.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,241.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,350.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,827.79
|
| Rate for Payer: Ohio Health Group HMO |
$8,375.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,233.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,451.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,462.06
|
| Rate for Payer: PHCS Commercial |
$10,721.22
|
| Rate for Payer: United Healthcare All Payer |
$9,827.79
|
|
|
REF V POR ACET SHELL 70OD
|
Facility
|
IP
|
$11,167.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,451.83 |
| Max. Negotiated Rate |
$10,721.22 |
| Rate for Payer: Aetna Commercial |
$8,599.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,710.99
|
| Rate for Payer: Cash Price |
$5,583.97
|
| Rate for Payer: Cigna Commercial |
$9,269.39
|
| Rate for Payer: First Health Commercial |
$10,609.54
|
| Rate for Payer: Humana Commercial |
$9,492.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,157.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,241.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,350.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,827.79
|
| Rate for Payer: Ohio Health Group HMO |
$8,375.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,233.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,451.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,462.06
|
| Rate for Payer: PHCS Commercial |
$10,721.22
|
| Rate for Payer: United Healthcare All Payer |
$9,827.79
|
|
|
REF V POR ACET SHELL 70OD
|
Facility
|
OP
|
$11,167.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,451.83 |
| Max. Negotiated Rate |
$10,721.22 |
| Rate for Payer: Aetna Commercial |
$8,599.31
|
| Rate for Payer: Anthem Medicaid |
$3,840.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,710.99
|
| Rate for Payer: Cash Price |
$5,583.97
|
| Rate for Payer: Cigna Commercial |
$9,269.39
|
| Rate for Payer: First Health Commercial |
$10,609.54
|
| Rate for Payer: Humana Commercial |
$9,492.75
|
| Rate for Payer: Humana KY Medicaid |
$3,840.65
|
| Rate for Payer: Kentucky WC Medicaid |
$3,879.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,157.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,241.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,350.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,917.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,827.79
|
| Rate for Payer: Ohio Health Group HMO |
$8,375.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,233.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,451.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,462.06
|
| Rate for Payer: PHCS Commercial |
$10,721.22
|
| Rate for Payer: United Healthcare All Payer |
$9,827.79
|
|
|
REF XLPE 22 0 DEG 40A
|
Facility
|
IP
|
$11,734.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,525.45 |
| Max. Negotiated Rate |
$11,264.87 |
| Rate for Payer: Aetna Commercial |
$9,035.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,152.71
|
| Rate for Payer: Cash Price |
$5,867.12
|
| Rate for Payer: Cigna Commercial |
$9,739.42
|
| Rate for Payer: First Health Commercial |
$11,147.53
|
| Rate for Payer: Humana Commercial |
$9,974.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,622.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,659.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,520.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,326.13
|
| Rate for Payer: Ohio Health Group HMO |
$8,800.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,346.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,525.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,637.61
|
| Rate for Payer: PHCS Commercial |
$11,264.87
|
| Rate for Payer: United Healthcare All Payer |
$10,326.13
|
|
|
REF XLPE 22 0 DEG 40A
|
Facility
|
OP
|
$11,734.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,525.45 |
| Max. Negotiated Rate |
$11,264.87 |
| Rate for Payer: Aetna Commercial |
$9,035.36
|
| Rate for Payer: Anthem Medicaid |
$4,035.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,152.71
|
| Rate for Payer: Cash Price |
$5,867.12
|
| Rate for Payer: Cigna Commercial |
$9,739.42
|
| Rate for Payer: First Health Commercial |
$11,147.53
|
| Rate for Payer: Humana Commercial |
$9,974.10
|
| Rate for Payer: Humana KY Medicaid |
$4,035.41
|
| Rate for Payer: Kentucky WC Medicaid |
$4,076.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,622.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,659.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,520.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,116.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,326.13
|
| Rate for Payer: Ohio Health Group HMO |
$8,800.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,346.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,525.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,637.61
|
| Rate for Payer: PHCS Commercial |
$11,264.87
|
| Rate for Payer: United Healthcare All Payer |
$10,326.13
|
|
|
REF XLPE 22 0 DEG 42B
|
Facility
|
IP
|
$11,734.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,525.45 |
| Max. Negotiated Rate |
$11,264.87 |
| Rate for Payer: Aetna Commercial |
$9,035.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,152.71
|
| Rate for Payer: Cash Price |
$5,867.12
|
| Rate for Payer: Cigna Commercial |
$9,739.42
|
| Rate for Payer: First Health Commercial |
$11,147.53
|
| Rate for Payer: Humana Commercial |
$9,974.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,622.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,659.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,520.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,326.13
|
| Rate for Payer: Ohio Health Group HMO |
$8,800.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,346.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,525.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,637.61
|
| Rate for Payer: PHCS Commercial |
$11,264.87
|
| Rate for Payer: United Healthcare All Payer |
$10,326.13
|
|
|
REF XLPE 22 0 DEG 42B
|
Facility
|
OP
|
$11,734.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,525.45 |
| Max. Negotiated Rate |
$11,264.87 |
| Rate for Payer: Aetna Commercial |
$9,035.36
|
| Rate for Payer: Anthem Medicaid |
$4,035.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,152.71
|
| Rate for Payer: Cash Price |
$5,867.12
|
| Rate for Payer: Cigna Commercial |
$9,739.42
|
| Rate for Payer: First Health Commercial |
$11,147.53
|
| Rate for Payer: Humana Commercial |
$9,974.10
|
| Rate for Payer: Humana KY Medicaid |
$4,035.41
|
| Rate for Payer: Kentucky WC Medicaid |
$4,076.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,622.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,659.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,520.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,116.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,326.13
|
| Rate for Payer: Ohio Health Group HMO |
$8,800.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,346.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,525.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,637.61
|
| Rate for Payer: PHCS Commercial |
$11,264.87
|
| Rate for Payer: United Healthcare All Payer |
$10,326.13
|
|
|
REF XLPE 22 0 DEG 44C
|
Facility
|
OP
|
$11,734.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,525.45 |
| Max. Negotiated Rate |
$11,264.87 |
| Rate for Payer: Aetna Commercial |
$9,035.36
|
| Rate for Payer: Anthem Medicaid |
$4,035.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,152.71
|
| Rate for Payer: Cash Price |
$5,867.12
|
| Rate for Payer: Cigna Commercial |
$9,739.42
|
| Rate for Payer: First Health Commercial |
$11,147.53
|
| Rate for Payer: Humana Commercial |
$9,974.10
|
| Rate for Payer: Humana KY Medicaid |
$4,035.41
|
| Rate for Payer: Kentucky WC Medicaid |
$4,076.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,622.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,659.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,520.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,116.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,326.13
|
| Rate for Payer: Ohio Health Group HMO |
$8,800.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,346.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,525.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,637.61
|
| Rate for Payer: PHCS Commercial |
$11,264.87
|
| Rate for Payer: United Healthcare All Payer |
$10,326.13
|
|
|
REF XLPE 22 0 DEG 44C
|
Facility
|
IP
|
$11,734.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,525.45 |
| Max. Negotiated Rate |
$11,264.87 |
| Rate for Payer: Aetna Commercial |
$9,035.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,152.71
|
| Rate for Payer: Cash Price |
$5,867.12
|
| Rate for Payer: Cigna Commercial |
$9,739.42
|
| Rate for Payer: First Health Commercial |
$11,147.53
|
| Rate for Payer: Humana Commercial |
$9,974.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,622.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,659.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,520.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,326.13
|
| Rate for Payer: Ohio Health Group HMO |
$8,800.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,346.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,525.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,637.61
|
| Rate for Payer: PHCS Commercial |
$11,264.87
|
| Rate for Payer: United Healthcare All Payer |
$10,326.13
|
|
|
REF XLPE 22 0 DEG 46-48D
|
Facility
|
OP
|
$11,734.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,525.45 |
| Max. Negotiated Rate |
$11,264.87 |
| Rate for Payer: Aetna Commercial |
$9,035.36
|
| Rate for Payer: Anthem Medicaid |
$4,035.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,152.71
|
| Rate for Payer: Cash Price |
$5,867.12
|
| Rate for Payer: Cigna Commercial |
$9,739.42
|
| Rate for Payer: First Health Commercial |
$11,147.53
|
| Rate for Payer: Humana Commercial |
$9,974.10
|
| Rate for Payer: Humana KY Medicaid |
$4,035.41
|
| Rate for Payer: Kentucky WC Medicaid |
$4,076.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,622.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,659.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,520.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,116.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,326.13
|
| Rate for Payer: Ohio Health Group HMO |
$8,800.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,346.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,525.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,637.61
|
| Rate for Payer: PHCS Commercial |
$11,264.87
|
| Rate for Payer: United Healthcare All Payer |
$10,326.13
|
|
|
REF XLPE 22 0 DEG 46-48D
|
Facility
|
IP
|
$11,734.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,525.45 |
| Max. Negotiated Rate |
$11,264.87 |
| Rate for Payer: Aetna Commercial |
$9,035.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,152.71
|
| Rate for Payer: Cash Price |
$5,867.12
|
| Rate for Payer: Cigna Commercial |
$9,739.42
|
| Rate for Payer: First Health Commercial |
$11,147.53
|
| Rate for Payer: Humana Commercial |
$9,974.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,622.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,659.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,520.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,326.13
|
| Rate for Payer: Ohio Health Group HMO |
$8,800.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,346.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,525.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,637.61
|
| Rate for Payer: PHCS Commercial |
$11,264.87
|
| Rate for Payer: United Healthcare All Payer |
$10,326.13
|
|
|
REF XLPE 22 0 DEG 50-52E
|
Facility
|
IP
|
$11,734.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,525.45 |
| Max. Negotiated Rate |
$11,264.87 |
| Rate for Payer: Aetna Commercial |
$9,035.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,152.71
|
| Rate for Payer: Cash Price |
$5,867.12
|
| Rate for Payer: Cigna Commercial |
$9,739.42
|
| Rate for Payer: First Health Commercial |
$11,147.53
|
| Rate for Payer: Humana Commercial |
$9,974.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,622.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,659.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,520.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,326.13
|
| Rate for Payer: Ohio Health Group HMO |
$8,800.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,346.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,525.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,637.61
|
| Rate for Payer: PHCS Commercial |
$11,264.87
|
| Rate for Payer: United Healthcare All Payer |
$10,326.13
|
|
|
REF XLPE 22 0 DEG 50-52E
|
Facility
|
OP
|
$11,734.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,525.45 |
| Max. Negotiated Rate |
$11,264.87 |
| Rate for Payer: Aetna Commercial |
$9,035.36
|
| Rate for Payer: Anthem Medicaid |
$4,035.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,152.71
|
| Rate for Payer: Cash Price |
$5,867.12
|
| Rate for Payer: Cigna Commercial |
$9,739.42
|
| Rate for Payer: First Health Commercial |
$11,147.53
|
| Rate for Payer: Humana Commercial |
$9,974.10
|
| Rate for Payer: Humana KY Medicaid |
$4,035.41
|
| Rate for Payer: Kentucky WC Medicaid |
$4,076.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,622.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,659.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,520.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,116.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,326.13
|
| Rate for Payer: Ohio Health Group HMO |
$8,800.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,346.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,525.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,637.61
|
| Rate for Payer: PHCS Commercial |
$11,264.87
|
| Rate for Payer: United Healthcare All Payer |
$10,326.13
|
|
|
REF XLPE 22 0 DEG 54-56F
|
Facility
|
OP
|
$11,734.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,525.45 |
| Max. Negotiated Rate |
$11,264.87 |
| Rate for Payer: Aetna Commercial |
$9,035.36
|
| Rate for Payer: Anthem Medicaid |
$4,035.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,152.71
|
| Rate for Payer: Cash Price |
$5,867.12
|
| Rate for Payer: Cigna Commercial |
$9,739.42
|
| Rate for Payer: First Health Commercial |
$11,147.53
|
| Rate for Payer: Humana Commercial |
$9,974.10
|
| Rate for Payer: Humana KY Medicaid |
$4,035.41
|
| Rate for Payer: Kentucky WC Medicaid |
$4,076.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,622.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,659.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,520.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,116.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,326.13
|
| Rate for Payer: Ohio Health Group HMO |
$8,800.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,346.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,525.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,637.61
|
| Rate for Payer: PHCS Commercial |
$11,264.87
|
| Rate for Payer: United Healthcare All Payer |
$10,326.13
|
|
|
REF XLPE 22 0 DEG 54-56F
|
Facility
|
IP
|
$11,734.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,525.45 |
| Max. Negotiated Rate |
$11,264.87 |
| Rate for Payer: Aetna Commercial |
$9,035.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,152.71
|
| Rate for Payer: Cash Price |
$5,867.12
|
| Rate for Payer: Cigna Commercial |
$9,739.42
|
| Rate for Payer: First Health Commercial |
$11,147.53
|
| Rate for Payer: Humana Commercial |
$9,974.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,622.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,659.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,520.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,326.13
|
| Rate for Payer: Ohio Health Group HMO |
$8,800.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,346.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,525.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,637.61
|
| Rate for Payer: PHCS Commercial |
$11,264.87
|
| Rate for Payer: United Healthcare All Payer |
$10,326.13
|
|
|
REF XLPE 22 0 DEG 58-60G
|
Facility
|
IP
|
$11,734.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,525.45 |
| Max. Negotiated Rate |
$11,264.87 |
| Rate for Payer: Aetna Commercial |
$9,035.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,152.71
|
| Rate for Payer: Cash Price |
$5,867.12
|
| Rate for Payer: Cigna Commercial |
$9,739.42
|
| Rate for Payer: First Health Commercial |
$11,147.53
|
| Rate for Payer: Humana Commercial |
$9,974.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,622.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,659.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,520.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,326.13
|
| Rate for Payer: Ohio Health Group HMO |
$8,800.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,346.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,525.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,637.61
|
| Rate for Payer: PHCS Commercial |
$11,264.87
|
| Rate for Payer: United Healthcare All Payer |
$10,326.13
|
|
|
REF XLPE 22 0 DEG 58-60G
|
Facility
|
OP
|
$11,734.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,525.45 |
| Max. Negotiated Rate |
$11,264.87 |
| Rate for Payer: Aetna Commercial |
$9,035.36
|
| Rate for Payer: Anthem Medicaid |
$4,035.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,152.71
|
| Rate for Payer: Cash Price |
$5,867.12
|
| Rate for Payer: Cigna Commercial |
$9,739.42
|
| Rate for Payer: First Health Commercial |
$11,147.53
|
| Rate for Payer: Humana Commercial |
$9,974.10
|
| Rate for Payer: Humana KY Medicaid |
$4,035.41
|
| Rate for Payer: Kentucky WC Medicaid |
$4,076.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,622.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,659.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,520.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,116.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,326.13
|
| Rate for Payer: Ohio Health Group HMO |
$8,800.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,346.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,525.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,637.61
|
| Rate for Payer: PHCS Commercial |
$11,264.87
|
| Rate for Payer: United Healthcare All Payer |
$10,326.13
|
|
|
REF XLPE 22 0 DEG 62-64H
|
Facility
|
IP
|
$11,734.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,525.45 |
| Max. Negotiated Rate |
$11,264.87 |
| Rate for Payer: Aetna Commercial |
$9,035.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,152.71
|
| Rate for Payer: Cash Price |
$5,867.12
|
| Rate for Payer: Cigna Commercial |
$9,739.42
|
| Rate for Payer: First Health Commercial |
$11,147.53
|
| Rate for Payer: Humana Commercial |
$9,974.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,622.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,659.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,520.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,326.13
|
| Rate for Payer: Ohio Health Group HMO |
$8,800.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,346.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,525.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,637.61
|
| Rate for Payer: PHCS Commercial |
$11,264.87
|
| Rate for Payer: United Healthcare All Payer |
$10,326.13
|
|
|
REF XLPE 22 0 DEG 62-64H
|
Facility
|
OP
|
$11,734.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,525.45 |
| Max. Negotiated Rate |
$11,264.87 |
| Rate for Payer: Aetna Commercial |
$9,035.36
|
| Rate for Payer: Anthem Medicaid |
$4,035.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,152.71
|
| Rate for Payer: Cash Price |
$5,867.12
|
| Rate for Payer: Cigna Commercial |
$9,739.42
|
| Rate for Payer: First Health Commercial |
$11,147.53
|
| Rate for Payer: Humana Commercial |
$9,974.10
|
| Rate for Payer: Humana KY Medicaid |
$4,035.41
|
| Rate for Payer: Kentucky WC Medicaid |
$4,076.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,622.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,659.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,520.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,116.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,326.13
|
| Rate for Payer: Ohio Health Group HMO |
$8,800.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,346.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,525.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,637.61
|
| Rate for Payer: PHCS Commercial |
$11,264.87
|
| Rate for Payer: United Healthcare All Payer |
$10,326.13
|
|
|
REF XLPE 22 0 DEG 66-68J
|
Facility
|
OP
|
$11,734.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,525.45 |
| Max. Negotiated Rate |
$11,264.87 |
| Rate for Payer: Aetna Commercial |
$9,035.36
|
| Rate for Payer: Anthem Medicaid |
$4,035.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,152.71
|
| Rate for Payer: Cash Price |
$5,867.12
|
| Rate for Payer: Cigna Commercial |
$9,739.42
|
| Rate for Payer: First Health Commercial |
$11,147.53
|
| Rate for Payer: Humana Commercial |
$9,974.10
|
| Rate for Payer: Humana KY Medicaid |
$4,035.41
|
| Rate for Payer: Kentucky WC Medicaid |
$4,076.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,622.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,659.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,520.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,116.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,326.13
|
| Rate for Payer: Ohio Health Group HMO |
$8,800.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,346.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,525.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,637.61
|
| Rate for Payer: PHCS Commercial |
$11,264.87
|
| Rate for Payer: United Healthcare All Payer |
$10,326.13
|
|
|
REF XLPE 22 0 DEG 66-68J
|
Facility
|
IP
|
$11,734.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,525.45 |
| Max. Negotiated Rate |
$11,264.87 |
| Rate for Payer: Aetna Commercial |
$9,035.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,152.71
|
| Rate for Payer: Cash Price |
$5,867.12
|
| Rate for Payer: Cigna Commercial |
$9,739.42
|
| Rate for Payer: First Health Commercial |
$11,147.53
|
| Rate for Payer: Humana Commercial |
$9,974.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,622.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,659.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,520.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,326.13
|
| Rate for Payer: Ohio Health Group HMO |
$8,800.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,346.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,525.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,637.61
|
| Rate for Payer: PHCS Commercial |
$11,264.87
|
| Rate for Payer: United Healthcare All Payer |
$10,326.13
|
|
|
REF XLPE 22 0 DEG 70-76K
|
Facility
|
IP
|
$11,734.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,525.45 |
| Max. Negotiated Rate |
$11,264.87 |
| Rate for Payer: Aetna Commercial |
$9,035.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,152.71
|
| Rate for Payer: Cash Price |
$5,867.12
|
| Rate for Payer: Cigna Commercial |
$9,739.42
|
| Rate for Payer: First Health Commercial |
$11,147.53
|
| Rate for Payer: Humana Commercial |
$9,974.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,622.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,659.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,520.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,326.13
|
| Rate for Payer: Ohio Health Group HMO |
$8,800.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,346.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,525.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,637.61
|
| Rate for Payer: PHCS Commercial |
$11,264.87
|
| Rate for Payer: United Healthcare All Payer |
$10,326.13
|
|
|
REF XLPE 22 0 DEG 70-76K
|
Facility
|
OP
|
$11,734.24
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,525.45 |
| Max. Negotiated Rate |
$11,264.87 |
| Rate for Payer: Aetna Commercial |
$9,035.36
|
| Rate for Payer: Anthem Medicaid |
$4,035.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,152.71
|
| Rate for Payer: Cash Price |
$5,867.12
|
| Rate for Payer: Cigna Commercial |
$9,739.42
|
| Rate for Payer: First Health Commercial |
$11,147.53
|
| Rate for Payer: Humana Commercial |
$9,974.10
|
| Rate for Payer: Humana KY Medicaid |
$4,035.41
|
| Rate for Payer: Kentucky WC Medicaid |
$4,076.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,622.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,659.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,520.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,116.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,326.13
|
| Rate for Payer: Ohio Health Group HMO |
$8,800.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,346.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,525.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,637.61
|
| Rate for Payer: PHCS Commercial |
$11,264.87
|
| Rate for Payer: United Healthcare All Payer |
$10,326.13
|
|
|
REF XLPE 22 20 ANT +4 42B
|
Facility
|
IP
|
$8,626.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,121.44 |
| Max. Negotiated Rate |
$8,281.44 |
| Rate for Payer: Aetna Commercial |
$6,642.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,728.67
|
| Rate for Payer: Cash Price |
$4,313.25
|
| Rate for Payer: Cigna Commercial |
$7,160.00
|
| Rate for Payer: First Health Commercial |
$8,195.18
|
| Rate for Payer: Humana Commercial |
$7,332.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,073.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,366.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,587.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,591.32
|
| Rate for Payer: Ohio Health Group HMO |
$6,469.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,725.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,121.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,674.22
|
| Rate for Payer: PHCS Commercial |
$8,281.44
|
| Rate for Payer: United Healthcare All Payer |
$7,591.32
|
|
