|
REF ALL POLY 32ID 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 32ID 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 32ID 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 32ID 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 32ID 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 32ID 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 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 CEMENT ACET COM 22/40
|
Facility
|
OP
|
$4,731.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,419.51 |
| Max. Negotiated Rate |
$4,542.42 |
| Rate for Payer: Aetna Commercial |
$3,643.40
|
| Rate for Payer: Anthem Medicaid |
$1,627.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,690.72
|
| Rate for Payer: Cash Price |
$2,365.84
|
| Rate for Payer: Cigna Commercial |
$3,927.30
|
| Rate for Payer: First Health Commercial |
$4,495.11
|
| Rate for Payer: Humana Commercial |
$4,021.94
|
| Rate for Payer: Humana KY Medicaid |
$1,627.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,643.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,879.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,491.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,419.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,659.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,163.89
|
| Rate for Payer: Ohio Health Group HMO |
$3,548.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,785.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,116.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,264.87
|
| Rate for Payer: PHCS Commercial |
$4,542.42
|
| Rate for Payer: United Healthcare All Payer |
$4,163.89
|
|
|
REF CEMENT ACET COM 22/40
|
Facility
|
IP
|
$4,731.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,419.51 |
| Max. Negotiated Rate |
$4,542.42 |
| Rate for Payer: Aetna Commercial |
$3,643.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,690.72
|
| Rate for Payer: Cash Price |
$2,365.84
|
| Rate for Payer: Cigna Commercial |
$3,927.30
|
| Rate for Payer: First Health Commercial |
$4,495.11
|
| Rate for Payer: Humana Commercial |
$4,021.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,879.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,491.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,419.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,163.89
|
| Rate for Payer: Ohio Health Group HMO |
$3,548.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,785.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,116.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,264.87
|
| Rate for Payer: PHCS Commercial |
$4,542.42
|
| Rate for Payer: United Healthcare All Payer |
$4,163.89
|
|
|
REF CEMENT ACET COM 22/45
|
Facility
|
IP
|
$4,731.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,419.51 |
| Max. Negotiated Rate |
$4,542.42 |
| Rate for Payer: Aetna Commercial |
$3,643.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,690.72
|
| Rate for Payer: Cash Price |
$2,365.84
|
| Rate for Payer: Cigna Commercial |
$3,927.30
|
| Rate for Payer: First Health Commercial |
$4,495.11
|
| Rate for Payer: Humana Commercial |
$4,021.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,879.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,491.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,419.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,163.89
|
| Rate for Payer: Ohio Health Group HMO |
$3,548.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,785.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,116.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,264.87
|
| Rate for Payer: PHCS Commercial |
$4,542.42
|
| Rate for Payer: United Healthcare All Payer |
$4,163.89
|
|
|
REF CEMENT ACET COM 22/45
|
Facility
|
OP
|
$4,731.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,419.51 |
| Max. Negotiated Rate |
$4,542.42 |
| Rate for Payer: Aetna Commercial |
$3,643.40
|
| Rate for Payer: Anthem Medicaid |
$1,627.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,690.72
|
| Rate for Payer: Cash Price |
$2,365.84
|
| Rate for Payer: Cigna Commercial |
$3,927.30
|
| Rate for Payer: First Health Commercial |
$4,495.11
|
| Rate for Payer: Humana Commercial |
$4,021.94
|
| Rate for Payer: Humana KY Medicaid |
$1,627.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,643.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,879.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,491.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,419.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,659.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,163.89
|
| Rate for Payer: Ohio Health Group HMO |
$3,548.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,785.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,116.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,264.87
|
| Rate for Payer: PHCS Commercial |
$4,542.42
|
| Rate for Payer: United Healthcare All Payer |
$4,163.89
|
|
|
REF CEMENT ACET COM 22/46
|
Facility
|
OP
|
$4,731.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,419.51 |
| Max. Negotiated Rate |
$4,542.42 |
| Rate for Payer: Aetna Commercial |
$3,643.40
|
| Rate for Payer: Anthem Medicaid |
$1,627.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,690.72
|
| Rate for Payer: Cash Price |
$2,365.84
|
| Rate for Payer: Cigna Commercial |
$3,927.30
|
| Rate for Payer: First Health Commercial |
$4,495.11
|
| Rate for Payer: Humana Commercial |
$4,021.94
|
| Rate for Payer: Humana KY Medicaid |
$1,627.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,643.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,879.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,491.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,419.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,659.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,163.89
|
| Rate for Payer: Ohio Health Group HMO |
$3,548.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,785.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,116.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,264.87
|
| Rate for Payer: PHCS Commercial |
$4,542.42
|
| Rate for Payer: United Healthcare All Payer |
$4,163.89
|
|
|
REF CEMENT ACET COM 22/46
|
Facility
|
IP
|
$4,731.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,419.51 |
| Max. Negotiated Rate |
$4,542.42 |
| Rate for Payer: Aetna Commercial |
$3,643.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,690.72
|
| Rate for Payer: Cash Price |
$2,365.84
|
| Rate for Payer: Cigna Commercial |
$3,927.30
|
| Rate for Payer: First Health Commercial |
$4,495.11
|
| Rate for Payer: Humana Commercial |
$4,021.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,879.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,491.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,419.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,163.89
|
| Rate for Payer: Ohio Health Group HMO |
$3,548.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,785.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,116.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,264.87
|
| Rate for Payer: PHCS Commercial |
$4,542.42
|
| Rate for Payer: United Healthcare All Payer |
$4,163.89
|
|
|
REF CEMENT ACET COM 22/49
|
Facility
|
IP
|
$4,731.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,419.51 |
| Max. Negotiated Rate |
$4,542.42 |
| Rate for Payer: Aetna Commercial |
$3,643.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,690.72
|
| Rate for Payer: Cash Price |
$2,365.84
|
| Rate for Payer: Cigna Commercial |
$3,927.30
|
| Rate for Payer: First Health Commercial |
$4,495.11
|
| Rate for Payer: Humana Commercial |
$4,021.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,879.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,491.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,419.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,163.89
|
| Rate for Payer: Ohio Health Group HMO |
$3,548.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,785.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,116.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,264.87
|
| Rate for Payer: PHCS Commercial |
$4,542.42
|
| Rate for Payer: United Healthcare All Payer |
$4,163.89
|
|
|
REF CEMENT ACET COM 22/49
|
Facility
|
OP
|
$4,731.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,419.51 |
| Max. Negotiated Rate |
$4,542.42 |
| Rate for Payer: Aetna Commercial |
$3,643.40
|
| Rate for Payer: Anthem Medicaid |
$1,627.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,690.72
|
| Rate for Payer: Cash Price |
$2,365.84
|
| Rate for Payer: Cigna Commercial |
$3,927.30
|
| Rate for Payer: First Health Commercial |
$4,495.11
|
| Rate for Payer: Humana Commercial |
$4,021.94
|
| Rate for Payer: Humana KY Medicaid |
$1,627.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,643.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,879.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,491.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,419.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,659.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,163.89
|
| Rate for Payer: Ohio Health Group HMO |
$3,548.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,785.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,116.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,264.87
|
| Rate for Payer: PHCS Commercial |
$4,542.42
|
| Rate for Payer: United Healthcare All Payer |
$4,163.89
|
|
|
REF CEMENT ACET COM 22/52
|
Facility
|
IP
|
$4,731.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,419.51 |
| Max. Negotiated Rate |
$4,542.42 |
| Rate for Payer: Aetna Commercial |
$3,643.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,690.72
|
| Rate for Payer: Cash Price |
$2,365.84
|
| Rate for Payer: Cigna Commercial |
$3,927.30
|
| Rate for Payer: First Health Commercial |
$4,495.11
|
| Rate for Payer: Humana Commercial |
$4,021.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,879.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,491.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,419.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,163.89
|
| Rate for Payer: Ohio Health Group HMO |
$3,548.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,785.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,116.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,264.87
|
| Rate for Payer: PHCS Commercial |
$4,542.42
|
| Rate for Payer: United Healthcare All Payer |
$4,163.89
|
|
|
REF CEMENT ACET COM 22/52
|
Facility
|
OP
|
$4,731.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,419.51 |
| Max. Negotiated Rate |
$4,542.42 |
| Rate for Payer: Aetna Commercial |
$3,643.40
|
| Rate for Payer: Anthem Medicaid |
$1,627.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,690.72
|
| Rate for Payer: Cash Price |
$2,365.84
|
| Rate for Payer: Cigna Commercial |
$3,927.30
|
| Rate for Payer: First Health Commercial |
$4,495.11
|
| Rate for Payer: Humana Commercial |
$4,021.94
|
| Rate for Payer: Humana KY Medicaid |
$1,627.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,643.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,879.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,491.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,419.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,659.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,163.89
|
| Rate for Payer: Ohio Health Group HMO |
$3,548.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,785.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,116.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,264.87
|
| Rate for Payer: PHCS Commercial |
$4,542.42
|
| Rate for Payer: United Healthcare All Payer |
$4,163.89
|
|
|
REF CEMENT ACET COM 22/55
|
Facility
|
IP
|
$4,731.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,419.51 |
| Max. Negotiated Rate |
$4,542.42 |
| Rate for Payer: Aetna Commercial |
$3,643.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,690.72
|
| Rate for Payer: Cash Price |
$2,365.84
|
| Rate for Payer: Cigna Commercial |
$3,927.30
|
| Rate for Payer: First Health Commercial |
$4,495.11
|
| Rate for Payer: Humana Commercial |
$4,021.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,879.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,491.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,419.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,163.89
|
| Rate for Payer: Ohio Health Group HMO |
$3,548.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,785.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,116.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,264.87
|
| Rate for Payer: PHCS Commercial |
$4,542.42
|
| Rate for Payer: United Healthcare All Payer |
$4,163.89
|
|
|
REF CEMENT ACET COM 22/55
|
Facility
|
OP
|
$4,731.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,419.51 |
| Max. Negotiated Rate |
$4,542.42 |
| Rate for Payer: Aetna Commercial |
$3,643.40
|
| Rate for Payer: Anthem Medicaid |
$1,627.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,690.72
|
| Rate for Payer: Cash Price |
$2,365.84
|
| Rate for Payer: Cigna Commercial |
$3,927.30
|
| Rate for Payer: First Health Commercial |
$4,495.11
|
| Rate for Payer: Humana Commercial |
$4,021.94
|
| Rate for Payer: Humana KY Medicaid |
$1,627.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,643.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,879.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,491.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,419.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,659.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,163.89
|
| Rate for Payer: Ohio Health Group HMO |
$3,548.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,785.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,116.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,264.87
|
| Rate for Payer: PHCS Commercial |
$4,542.42
|
| Rate for Payer: United Healthcare All Payer |
$4,163.89
|
|
|
REF CEMENT ACET COM 22/58
|
Facility
|
IP
|
$4,731.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,419.51 |
| Max. Negotiated Rate |
$4,542.42 |
| Rate for Payer: Aetna Commercial |
$3,643.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,690.72
|
| Rate for Payer: Cash Price |
$2,365.84
|
| Rate for Payer: Cigna Commercial |
$3,927.30
|
| Rate for Payer: First Health Commercial |
$4,495.11
|
| Rate for Payer: Humana Commercial |
$4,021.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,879.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,491.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,419.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,163.89
|
| Rate for Payer: Ohio Health Group HMO |
$3,548.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,785.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,116.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,264.87
|
| Rate for Payer: PHCS Commercial |
$4,542.42
|
| Rate for Payer: United Healthcare All Payer |
$4,163.89
|
|
|
REF CEMENT ACET COM 22/58
|
Facility
|
OP
|
$4,731.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,419.51 |
| Max. Negotiated Rate |
$4,542.42 |
| Rate for Payer: Aetna Commercial |
$3,643.40
|
| Rate for Payer: Anthem Medicaid |
$1,627.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,690.72
|
| Rate for Payer: Cash Price |
$2,365.84
|
| Rate for Payer: Cigna Commercial |
$3,927.30
|
| Rate for Payer: First Health Commercial |
$4,495.11
|
| Rate for Payer: Humana Commercial |
$4,021.94
|
| Rate for Payer: Humana KY Medicaid |
$1,627.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,643.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,879.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,491.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,419.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,659.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,163.89
|
| Rate for Payer: Ohio Health Group HMO |
$3,548.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,785.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,116.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,264.87
|
| Rate for Payer: PHCS Commercial |
$4,542.42
|
| Rate for Payer: United Healthcare All Payer |
$4,163.89
|
|
|
REF CEMENT ACET COM 22/61
|
Facility
|
IP
|
$4,731.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,419.51 |
| Max. Negotiated Rate |
$4,542.42 |
| Rate for Payer: Aetna Commercial |
$3,643.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,690.72
|
| Rate for Payer: Cash Price |
$2,365.84
|
| Rate for Payer: Cigna Commercial |
$3,927.30
|
| Rate for Payer: First Health Commercial |
$4,495.11
|
| Rate for Payer: Humana Commercial |
$4,021.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,879.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,491.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,419.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,163.89
|
| Rate for Payer: Ohio Health Group HMO |
$3,548.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,785.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,116.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,264.87
|
| Rate for Payer: PHCS Commercial |
$4,542.42
|
| Rate for Payer: United Healthcare All Payer |
$4,163.89
|
|
|
REF CEMENT ACET COM 22/61
|
Facility
|
OP
|
$4,731.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,419.51 |
| Max. Negotiated Rate |
$4,542.42 |
| Rate for Payer: Aetna Commercial |
$3,643.40
|
| Rate for Payer: Anthem Medicaid |
$1,627.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,690.72
|
| Rate for Payer: Cash Price |
$2,365.84
|
| Rate for Payer: Cigna Commercial |
$3,927.30
|
| Rate for Payer: First Health Commercial |
$4,495.11
|
| Rate for Payer: Humana Commercial |
$4,021.94
|
| Rate for Payer: Humana KY Medicaid |
$1,627.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,643.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,879.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,491.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,419.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,659.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,163.89
|
| Rate for Payer: Ohio Health Group HMO |
$3,548.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,785.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,116.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,264.87
|
| Rate for Payer: PHCS Commercial |
$4,542.42
|
| Rate for Payer: United Healthcare All Payer |
$4,163.89
|
|
|
REF CEMENT ACET COM 28/46
|
Facility
|
IP
|
$4,731.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,419.51 |
| Max. Negotiated Rate |
$4,542.42 |
| Rate for Payer: Aetna Commercial |
$3,643.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,690.72
|
| Rate for Payer: Cash Price |
$2,365.84
|
| Rate for Payer: Cigna Commercial |
$3,927.30
|
| Rate for Payer: First Health Commercial |
$4,495.11
|
| Rate for Payer: Humana Commercial |
$4,021.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,879.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,491.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,419.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,163.89
|
| Rate for Payer: Ohio Health Group HMO |
$3,548.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,785.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,116.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,264.87
|
| Rate for Payer: PHCS Commercial |
$4,542.42
|
| Rate for Payer: United Healthcare All Payer |
$4,163.89
|
|
|
REF CEMENT ACET COM 28/46
|
Facility
|
OP
|
$4,731.69
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,419.51 |
| Max. Negotiated Rate |
$4,542.42 |
| Rate for Payer: Aetna Commercial |
$3,643.40
|
| Rate for Payer: Anthem Medicaid |
$1,627.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,690.72
|
| Rate for Payer: Cash Price |
$2,365.84
|
| Rate for Payer: Cigna Commercial |
$3,927.30
|
| Rate for Payer: First Health Commercial |
$4,495.11
|
| Rate for Payer: Humana Commercial |
$4,021.94
|
| Rate for Payer: Humana KY Medicaid |
$1,627.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,643.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,879.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,491.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,419.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,659.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,163.89
|
| Rate for Payer: Ohio Health Group HMO |
$3,548.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,785.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,116.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,264.87
|
| Rate for Payer: PHCS Commercial |
$4,542.42
|
| Rate for Payer: United Healthcare All Payer |
$4,163.89
|
|
