|
REF ALL POLY 22ID 55OD XLPE
|
Facility
|
OP
|
$7,864.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,359.42 |
| Max. Negotiated Rate |
$7,550.13 |
| Rate for Payer: Aetna Commercial |
$6,055.83
|
| Rate for Payer: Anthem Medicaid |
$2,704.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,134.48
|
| Rate for Payer: Cash Price |
$3,932.36
|
| Rate for Payer: Cigna Commercial |
$6,527.72
|
| Rate for Payer: First Health Commercial |
$7,471.48
|
| Rate for Payer: Humana Commercial |
$6,685.01
|
| Rate for Payer: Humana KY Medicaid |
$2,704.68
|
| Rate for Payer: Kentucky WC Medicaid |
$2,732.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,449.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,804.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,359.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,758.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,920.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,898.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,291.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,842.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,426.66
|
| Rate for Payer: PHCS Commercial |
$7,550.13
|
| Rate for Payer: United Healthcare All Payer |
$6,920.95
|
|
|
REF ALL POLY 22ID 55OD XLPE
|
Facility
|
IP
|
$7,864.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,359.42 |
| Max. Negotiated Rate |
$7,550.13 |
| Rate for Payer: Aetna Commercial |
$6,055.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,134.48
|
| Rate for Payer: Cash Price |
$3,932.36
|
| Rate for Payer: Cigna Commercial |
$6,527.72
|
| Rate for Payer: First Health Commercial |
$7,471.48
|
| Rate for Payer: Humana Commercial |
$6,685.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,449.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,804.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,359.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,920.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,898.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,291.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,842.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,426.66
|
| Rate for Payer: PHCS Commercial |
$7,550.13
|
| Rate for Payer: United Healthcare All Payer |
$6,920.95
|
|
|
REF ALL POLY 22ID 58OD XLPE
|
Facility
|
OP
|
$7,864.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,359.42 |
| Max. Negotiated Rate |
$7,550.13 |
| Rate for Payer: Aetna Commercial |
$6,055.83
|
| Rate for Payer: Anthem Medicaid |
$2,704.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,134.48
|
| Rate for Payer: Cash Price |
$3,932.36
|
| Rate for Payer: Cigna Commercial |
$6,527.72
|
| Rate for Payer: First Health Commercial |
$7,471.48
|
| Rate for Payer: Humana Commercial |
$6,685.01
|
| Rate for Payer: Humana KY Medicaid |
$2,704.68
|
| Rate for Payer: Kentucky WC Medicaid |
$2,732.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,449.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,804.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,359.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,758.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,920.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,898.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,291.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,842.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,426.66
|
| Rate for Payer: PHCS Commercial |
$7,550.13
|
| Rate for Payer: United Healthcare All Payer |
$6,920.95
|
|
|
REF ALL POLY 22ID 58OD XLPE
|
Facility
|
IP
|
$7,864.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,359.42 |
| Max. Negotiated Rate |
$7,550.13 |
| Rate for Payer: Aetna Commercial |
$6,055.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,134.48
|
| Rate for Payer: Cash Price |
$3,932.36
|
| Rate for Payer: Cigna Commercial |
$6,527.72
|
| Rate for Payer: First Health Commercial |
$7,471.48
|
| Rate for Payer: Humana Commercial |
$6,685.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,449.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,804.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,359.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,920.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,898.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,291.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,842.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,426.66
|
| Rate for Payer: PHCS Commercial |
$7,550.13
|
| Rate for Payer: United Healthcare All Payer |
$6,920.95
|
|
|
REF ALL POLY 22ID 61OD XLPE
|
Facility
|
OP
|
$7,864.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,359.42 |
| Max. Negotiated Rate |
$7,550.13 |
| Rate for Payer: Aetna Commercial |
$6,055.83
|
| Rate for Payer: Anthem Medicaid |
$2,704.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,134.48
|
| Rate for Payer: Cash Price |
$3,932.36
|
| Rate for Payer: Cigna Commercial |
$6,527.72
|
| Rate for Payer: First Health Commercial |
$7,471.48
|
| Rate for Payer: Humana Commercial |
$6,685.01
|
| Rate for Payer: Humana KY Medicaid |
$2,704.68
|
| Rate for Payer: Kentucky WC Medicaid |
$2,732.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,449.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,804.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,359.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,758.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,920.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,898.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,291.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,842.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,426.66
|
| Rate for Payer: PHCS Commercial |
$7,550.13
|
| Rate for Payer: United Healthcare All Payer |
$6,920.95
|
|
|
REF ALL POLY 22ID 61OD XLPE
|
Facility
|
IP
|
$7,864.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,359.42 |
| Max. Negotiated Rate |
$7,550.13 |
| Rate for Payer: Aetna Commercial |
$6,055.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,134.48
|
| Rate for Payer: Cash Price |
$3,932.36
|
| Rate for Payer: Cigna Commercial |
$6,527.72
|
| Rate for Payer: First Health Commercial |
$7,471.48
|
| Rate for Payer: Humana Commercial |
$6,685.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,449.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,804.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,359.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,920.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,898.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,291.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,842.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,426.66
|
| Rate for Payer: PHCS Commercial |
$7,550.13
|
| Rate for Payer: United Healthcare All Payer |
$6,920.95
|
|
|
REF ALL POLY 28ID 46OD XLPE
|
Facility
|
OP
|
$7,864.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,359.42 |
| Max. Negotiated Rate |
$7,550.13 |
| Rate for Payer: Aetna Commercial |
$6,055.83
|
| Rate for Payer: Anthem Medicaid |
$2,704.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,134.48
|
| Rate for Payer: Cash Price |
$3,932.36
|
| Rate for Payer: Cigna Commercial |
$6,527.72
|
| Rate for Payer: First Health Commercial |
$7,471.48
|
| Rate for Payer: Humana Commercial |
$6,685.01
|
| Rate for Payer: Humana KY Medicaid |
$2,704.68
|
| Rate for Payer: Kentucky WC Medicaid |
$2,732.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,449.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,804.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,359.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,758.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,920.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,898.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,291.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,842.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,426.66
|
| Rate for Payer: PHCS Commercial |
$7,550.13
|
| Rate for Payer: United Healthcare All Payer |
$6,920.95
|
|
|
REF ALL POLY 28ID 46OD XLPE
|
Facility
|
IP
|
$7,864.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,359.42 |
| Max. Negotiated Rate |
$7,550.13 |
| Rate for Payer: Aetna Commercial |
$6,055.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,134.48
|
| Rate for Payer: Cash Price |
$3,932.36
|
| Rate for Payer: Cigna Commercial |
$6,527.72
|
| Rate for Payer: First Health Commercial |
$7,471.48
|
| Rate for Payer: Humana Commercial |
$6,685.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,449.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,804.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,359.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,920.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,898.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,291.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,842.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,426.66
|
| Rate for Payer: PHCS Commercial |
$7,550.13
|
| Rate for Payer: United Healthcare All Payer |
$6,920.95
|
|
|
REF ALL POLY 28ID 49OD XLPE
|
Facility
|
OP
|
$7,864.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,359.42 |
| Max. Negotiated Rate |
$7,550.13 |
| Rate for Payer: Aetna Commercial |
$6,055.83
|
| Rate for Payer: Anthem Medicaid |
$2,704.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,134.48
|
| Rate for Payer: Cash Price |
$3,932.36
|
| Rate for Payer: Cigna Commercial |
$6,527.72
|
| Rate for Payer: First Health Commercial |
$7,471.48
|
| Rate for Payer: Humana Commercial |
$6,685.01
|
| Rate for Payer: Humana KY Medicaid |
$2,704.68
|
| Rate for Payer: Kentucky WC Medicaid |
$2,732.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,449.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,804.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,359.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,758.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,920.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,898.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,291.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,842.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,426.66
|
| Rate for Payer: PHCS Commercial |
$7,550.13
|
| Rate for Payer: United Healthcare All Payer |
$6,920.95
|
|
|
REF ALL POLY 28ID 49OD XLPE
|
Facility
|
IP
|
$7,864.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,359.42 |
| Max. Negotiated Rate |
$7,550.13 |
| Rate for Payer: Aetna Commercial |
$6,055.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,134.48
|
| Rate for Payer: Cash Price |
$3,932.36
|
| Rate for Payer: Cigna Commercial |
$6,527.72
|
| Rate for Payer: First Health Commercial |
$7,471.48
|
| Rate for Payer: Humana Commercial |
$6,685.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,449.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,804.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,359.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,920.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,898.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,291.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,842.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,426.66
|
| Rate for Payer: PHCS Commercial |
$7,550.13
|
| Rate for Payer: United Healthcare All Payer |
$6,920.95
|
|
|
REF ALL POLY 28ID 52OD XLPE
|
Facility
|
IP
|
$7,864.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,359.42 |
| Max. Negotiated Rate |
$7,550.13 |
| Rate for Payer: Aetna Commercial |
$6,055.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,134.48
|
| Rate for Payer: Cash Price |
$3,932.36
|
| Rate for Payer: Cigna Commercial |
$6,527.72
|
| Rate for Payer: First Health Commercial |
$7,471.48
|
| Rate for Payer: Humana Commercial |
$6,685.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,449.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,804.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,359.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,920.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,898.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,291.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,842.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,426.66
|
| Rate for Payer: PHCS Commercial |
$7,550.13
|
| Rate for Payer: United Healthcare All Payer |
$6,920.95
|
|
|
REF ALL POLY 28ID 52OD XLPE
|
Facility
|
OP
|
$7,864.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,359.42 |
| Max. Negotiated Rate |
$7,550.13 |
| Rate for Payer: Aetna Commercial |
$6,055.83
|
| Rate for Payer: Anthem Medicaid |
$2,704.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,134.48
|
| Rate for Payer: Cash Price |
$3,932.36
|
| Rate for Payer: Cigna Commercial |
$6,527.72
|
| Rate for Payer: First Health Commercial |
$7,471.48
|
| Rate for Payer: Humana Commercial |
$6,685.01
|
| Rate for Payer: Humana KY Medicaid |
$2,704.68
|
| Rate for Payer: Kentucky WC Medicaid |
$2,732.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,449.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,804.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,359.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,758.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,920.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,898.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,291.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,842.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,426.66
|
| Rate for Payer: PHCS Commercial |
$7,550.13
|
| Rate for Payer: United Healthcare All Payer |
$6,920.95
|
|
|
REF ALL POLY 28ID 55OD XLPE
|
Facility
|
OP
|
$7,864.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,359.42 |
| Max. Negotiated Rate |
$7,550.13 |
| Rate for Payer: Aetna Commercial |
$6,055.83
|
| Rate for Payer: Anthem Medicaid |
$2,704.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,134.48
|
| Rate for Payer: Cash Price |
$3,932.36
|
| Rate for Payer: Cigna Commercial |
$6,527.72
|
| Rate for Payer: First Health Commercial |
$7,471.48
|
| Rate for Payer: Humana Commercial |
$6,685.01
|
| Rate for Payer: Humana KY Medicaid |
$2,704.68
|
| Rate for Payer: Kentucky WC Medicaid |
$2,732.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,449.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,804.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,359.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,758.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,920.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,898.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,291.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,842.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,426.66
|
| Rate for Payer: PHCS Commercial |
$7,550.13
|
| Rate for Payer: United Healthcare All Payer |
$6,920.95
|
|
|
REF ALL POLY 28ID 55OD XLPE
|
Facility
|
IP
|
$7,864.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,359.42 |
| Max. Negotiated Rate |
$7,550.13 |
| Rate for Payer: Aetna Commercial |
$6,055.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,134.48
|
| Rate for Payer: Cash Price |
$3,932.36
|
| Rate for Payer: Cigna Commercial |
$6,527.72
|
| Rate for Payer: First Health Commercial |
$7,471.48
|
| Rate for Payer: Humana Commercial |
$6,685.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,449.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,804.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,359.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,920.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,898.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,291.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,842.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,426.66
|
| Rate for Payer: PHCS Commercial |
$7,550.13
|
| Rate for Payer: United Healthcare All Payer |
$6,920.95
|
|
|
REF ALL POLY 28ID 58OD XLPE
|
Facility
|
OP
|
$7,864.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,359.42 |
| Max. Negotiated Rate |
$7,550.13 |
| Rate for Payer: Aetna Commercial |
$6,055.83
|
| Rate for Payer: Anthem Medicaid |
$2,704.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,134.48
|
| Rate for Payer: Cash Price |
$3,932.36
|
| Rate for Payer: Cigna Commercial |
$6,527.72
|
| Rate for Payer: First Health Commercial |
$7,471.48
|
| Rate for Payer: Humana Commercial |
$6,685.01
|
| Rate for Payer: Humana KY Medicaid |
$2,704.68
|
| Rate for Payer: Kentucky WC Medicaid |
$2,732.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,449.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,804.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,359.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,758.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,920.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,898.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,291.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,842.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,426.66
|
| Rate for Payer: PHCS Commercial |
$7,550.13
|
| Rate for Payer: United Healthcare All Payer |
$6,920.95
|
|
|
REF ALL POLY 28ID 58OD XLPE
|
Facility
|
IP
|
$7,864.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,359.42 |
| Max. Negotiated Rate |
$7,550.13 |
| Rate for Payer: Aetna Commercial |
$6,055.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,134.48
|
| Rate for Payer: Cash Price |
$3,932.36
|
| Rate for Payer: Cigna Commercial |
$6,527.72
|
| Rate for Payer: First Health Commercial |
$7,471.48
|
| Rate for Payer: Humana Commercial |
$6,685.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,449.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,804.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,359.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,920.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,898.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,291.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,842.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,426.66
|
| Rate for Payer: PHCS Commercial |
$7,550.13
|
| Rate for Payer: United Healthcare All Payer |
$6,920.95
|
|
|
REF ALL POLY 28ID 61OD XLPE
|
Facility
|
IP
|
$7,864.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,359.42 |
| Max. Negotiated Rate |
$7,550.13 |
| Rate for Payer: Aetna Commercial |
$6,055.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,134.48
|
| Rate for Payer: Cash Price |
$3,932.36
|
| Rate for Payer: Cigna Commercial |
$6,527.72
|
| Rate for Payer: First Health Commercial |
$7,471.48
|
| Rate for Payer: Humana Commercial |
$6,685.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,449.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,804.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,359.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,920.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,898.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,291.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,842.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,426.66
|
| Rate for Payer: PHCS Commercial |
$7,550.13
|
| Rate for Payer: United Healthcare All Payer |
$6,920.95
|
|
|
REF ALL POLY 28ID 61OD XLPE
|
Facility
|
OP
|
$7,864.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,359.42 |
| Max. Negotiated Rate |
$7,550.13 |
| Rate for Payer: Aetna Commercial |
$6,055.83
|
| Rate for Payer: Anthem Medicaid |
$2,704.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,134.48
|
| Rate for Payer: Cash Price |
$3,932.36
|
| Rate for Payer: Cigna Commercial |
$6,527.72
|
| Rate for Payer: First Health Commercial |
$7,471.48
|
| Rate for Payer: Humana Commercial |
$6,685.01
|
| Rate for Payer: Humana KY Medicaid |
$2,704.68
|
| Rate for Payer: Kentucky WC Medicaid |
$2,732.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,449.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,804.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,359.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,758.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,920.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,898.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,291.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,842.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,426.66
|
| Rate for Payer: PHCS Commercial |
$7,550.13
|
| Rate for Payer: United Healthcare All Payer |
$6,920.95
|
|
|
REF ALL POLY 28ID 64OD XLPE
|
Facility
|
OP
|
$7,864.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,359.42 |
| Max. Negotiated Rate |
$7,550.13 |
| Rate for Payer: Aetna Commercial |
$6,055.83
|
| Rate for Payer: Anthem Medicaid |
$2,704.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,134.48
|
| Rate for Payer: Cash Price |
$3,932.36
|
| Rate for Payer: Cigna Commercial |
$6,527.72
|
| Rate for Payer: First Health Commercial |
$7,471.48
|
| Rate for Payer: Humana Commercial |
$6,685.01
|
| Rate for Payer: Humana KY Medicaid |
$2,704.68
|
| Rate for Payer: Kentucky WC Medicaid |
$2,732.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,449.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,804.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,359.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,758.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,920.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,898.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,291.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,842.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,426.66
|
| Rate for Payer: PHCS Commercial |
$7,550.13
|
| Rate for Payer: United Healthcare All Payer |
$6,920.95
|
|
|
REF ALL POLY 28ID 64OD XLPE
|
Facility
|
IP
|
$7,864.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,359.42 |
| Max. Negotiated Rate |
$7,550.13 |
| Rate for Payer: Aetna Commercial |
$6,055.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,134.48
|
| Rate for Payer: Cash Price |
$3,932.36
|
| Rate for Payer: Cigna Commercial |
$6,527.72
|
| Rate for Payer: First Health Commercial |
$7,471.48
|
| Rate for Payer: Humana Commercial |
$6,685.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,449.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,804.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,359.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,920.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,898.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,291.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,842.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,426.66
|
| Rate for Payer: PHCS Commercial |
$7,550.13
|
| Rate for Payer: United Healthcare All Payer |
$6,920.95
|
|
|
REF ALL POLY 32ID 49OD XLPE
|
Facility
|
OP
|
$9,654.86
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,896.46 |
| Max. Negotiated Rate |
$9,268.67 |
| Rate for Payer: Aetna Commercial |
$7,434.24
|
| Rate for Payer: Anthem Medicaid |
$3,320.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,530.79
|
| Rate for Payer: Cash Price |
$4,827.43
|
| Rate for Payer: Cigna Commercial |
$8,013.53
|
| Rate for Payer: First Health Commercial |
$9,172.12
|
| Rate for Payer: Humana Commercial |
$8,206.63
|
| Rate for Payer: Humana KY Medicaid |
$3,320.31
|
| Rate for Payer: Kentucky WC Medicaid |
$3,354.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,916.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,125.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,896.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,386.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,496.28
|
| Rate for Payer: Ohio Health Group HMO |
$7,241.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,723.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,399.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,661.85
|
| Rate for Payer: PHCS Commercial |
$9,268.67
|
| Rate for Payer: United Healthcare All Payer |
$8,496.28
|
|
|
REF ALL POLY 32ID 49OD XLPE
|
Facility
|
IP
|
$9,654.86
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,896.46 |
| Max. Negotiated Rate |
$9,268.67 |
| Rate for Payer: Aetna Commercial |
$7,434.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,530.79
|
| Rate for Payer: Cash Price |
$4,827.43
|
| Rate for Payer: Cigna Commercial |
$8,013.53
|
| Rate for Payer: First Health Commercial |
$9,172.12
|
| Rate for Payer: Humana Commercial |
$8,206.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,916.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,125.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,896.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,496.28
|
| Rate for Payer: Ohio Health Group HMO |
$7,241.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,723.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,399.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,661.85
|
| Rate for Payer: PHCS Commercial |
$9,268.67
|
| Rate for Payer: United Healthcare All Payer |
$8,496.28
|
|
|
REF ALL POLY 32ID 52OD XLPE
|
Facility
|
OP
|
$7,864.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,359.42 |
| Max. Negotiated Rate |
$7,550.13 |
| Rate for Payer: Aetna Commercial |
$6,055.83
|
| Rate for Payer: Anthem Medicaid |
$2,704.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,134.48
|
| Rate for Payer: Cash Price |
$3,932.36
|
| Rate for Payer: Cigna Commercial |
$6,527.72
|
| Rate for Payer: First Health Commercial |
$7,471.48
|
| Rate for Payer: Humana Commercial |
$6,685.01
|
| Rate for Payer: Humana KY Medicaid |
$2,704.68
|
| Rate for Payer: Kentucky WC Medicaid |
$2,732.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,449.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,804.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,359.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,758.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,920.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,898.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,291.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,842.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,426.66
|
| Rate for Payer: PHCS Commercial |
$7,550.13
|
| Rate for Payer: United Healthcare All Payer |
$6,920.95
|
|
|
REF ALL POLY 32ID 52OD XLPE
|
Facility
|
IP
|
$7,864.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,359.42 |
| Max. Negotiated Rate |
$7,550.13 |
| Rate for Payer: Aetna Commercial |
$6,055.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,134.48
|
| Rate for Payer: Cash Price |
$3,932.36
|
| Rate for Payer: Cigna Commercial |
$6,527.72
|
| Rate for Payer: First Health Commercial |
$7,471.48
|
| Rate for Payer: Humana Commercial |
$6,685.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,449.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,804.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,359.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,920.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,898.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,291.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,842.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,426.66
|
| Rate for Payer: PHCS Commercial |
$7,550.13
|
| Rate for Payer: United Healthcare All Payer |
$6,920.95
|
|
|
REF ALL POLY 32ID 55OD XLPE
|
Facility
|
IP
|
$7,864.72
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,359.42 |
| Max. Negotiated Rate |
$7,550.13 |
| Rate for Payer: Aetna Commercial |
$6,055.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,134.48
|
| Rate for Payer: Cash Price |
$3,932.36
|
| Rate for Payer: Cigna Commercial |
$6,527.72
|
| Rate for Payer: First Health Commercial |
$7,471.48
|
| Rate for Payer: Humana Commercial |
$6,685.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,449.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,804.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,359.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,920.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,898.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,291.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,842.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,426.66
|
| Rate for Payer: PHCS Commercial |
$7,550.13
|
| Rate for Payer: United Healthcare All Payer |
$6,920.95
|
|
