|
REF XLPE 28 20 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 28 20 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 28 20 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 28 20 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 28 20 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 28 20 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 28 20 DEG 66-68J
|
Facility
|
OP
|
$11,793.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,533.16 |
| Max. Negotiated Rate |
$11,321.81 |
| Rate for Payer: Aetna Commercial |
$9,081.03
|
| Rate for Payer: Anthem Medicaid |
$4,055.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,198.97
|
| Rate for Payer: Cash Price |
$5,896.77
|
| Rate for Payer: Cigna Commercial |
$9,788.65
|
| Rate for Payer: First Health Commercial |
$11,203.87
|
| Rate for Payer: Humana Commercial |
$10,024.52
|
| Rate for Payer: Humana KY Medicaid |
$4,055.80
|
| Rate for Payer: Kentucky WC Medicaid |
$4,097.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,670.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,703.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,538.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,137.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,378.32
|
| Rate for Payer: Ohio Health Group HMO |
$8,845.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,358.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,533.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,656.00
|
| Rate for Payer: PHCS Commercial |
$11,321.81
|
| Rate for Payer: United Healthcare All Payer |
$10,378.32
|
|
|
REF XLPE 28 20 DEG 66-68J
|
Facility
|
IP
|
$11,793.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,533.16 |
| Max. Negotiated Rate |
$11,321.81 |
| Rate for Payer: Aetna Commercial |
$9,081.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,198.97
|
| Rate for Payer: Cash Price |
$5,896.77
|
| Rate for Payer: Cigna Commercial |
$9,788.65
|
| Rate for Payer: First Health Commercial |
$11,203.87
|
| Rate for Payer: Humana Commercial |
$10,024.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,670.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,703.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,538.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,378.32
|
| Rate for Payer: Ohio Health Group HMO |
$8,845.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,358.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,533.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,656.00
|
| Rate for Payer: PHCS Commercial |
$11,321.81
|
| Rate for Payer: United Healthcare All Payer |
$10,378.32
|
|
|
REF XLPE 28 20 DEG 70-76K
|
Facility
|
IP
|
$11,793.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,533.16 |
| Max. Negotiated Rate |
$11,321.81 |
| Rate for Payer: Aetna Commercial |
$9,081.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,198.97
|
| Rate for Payer: Cash Price |
$5,896.77
|
| Rate for Payer: Cigna Commercial |
$9,788.65
|
| Rate for Payer: First Health Commercial |
$11,203.87
|
| Rate for Payer: Humana Commercial |
$10,024.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,670.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,703.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,538.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,378.32
|
| Rate for Payer: Ohio Health Group HMO |
$8,845.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,358.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,533.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,656.00
|
| Rate for Payer: PHCS Commercial |
$11,321.81
|
| Rate for Payer: United Healthcare All Payer |
$10,378.32
|
|
|
REF XLPE 28 20 DEG 70-76K
|
Facility
|
OP
|
$11,793.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,533.16 |
| Max. Negotiated Rate |
$11,321.81 |
| Rate for Payer: Aetna Commercial |
$9,081.03
|
| Rate for Payer: Anthem Medicaid |
$4,055.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,198.97
|
| Rate for Payer: Cash Price |
$5,896.77
|
| Rate for Payer: Cigna Commercial |
$9,788.65
|
| Rate for Payer: First Health Commercial |
$11,203.87
|
| Rate for Payer: Humana Commercial |
$10,024.52
|
| Rate for Payer: Humana KY Medicaid |
$4,055.80
|
| Rate for Payer: Kentucky WC Medicaid |
$4,097.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,670.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,703.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,538.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,137.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,378.32
|
| Rate for Payer: Ohio Health Group HMO |
$8,845.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,358.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,533.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,656.00
|
| Rate for Payer: PHCS Commercial |
$11,321.81
|
| Rate for Payer: United Healthcare All Payer |
$10,378.32
|
|
|
REF XLPE 32 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 32 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 32 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 32 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 32 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 32 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 32 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 32 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 32 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 32 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 32 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 32 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 32 0 LAT +4 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 32 0 LAT +4 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 32 0 LAT +4 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
|
|
