|
REF CEMENT ACET COM 28/49
|
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 28/49
|
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 28/52
|
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 28/52
|
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 28/55
|
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 28/55
|
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 28/58
|
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 28/58
|
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 28/61
|
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 28/61
|
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 32/49
|
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 32/49
|
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 32/52
|
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 32/52
|
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 32/55
|
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 32/55
|
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 32/58
|
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 32/58
|
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 32/61
|
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 32/61
|
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 CNSTR LNR 0 DEG 28 54-56 F
|
Facility
|
IP
|
$17,483.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,244.96 |
| Max. Negotiated Rate |
$16,783.87 |
| Rate for Payer: Aetna Commercial |
$13,462.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,636.90
|
| Rate for Payer: Cash Price |
$8,741.60
|
| Rate for Payer: Cigna Commercial |
$14,511.06
|
| Rate for Payer: First Health Commercial |
$16,609.04
|
| Rate for Payer: Humana Commercial |
$14,860.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,336.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,902.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,244.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,385.22
|
| Rate for Payer: Ohio Health Group HMO |
$13,112.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,986.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,210.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,063.41
|
| Rate for Payer: PHCS Commercial |
$16,783.87
|
| Rate for Payer: United Healthcare All Payer |
$15,385.22
|
|
|
REF CNSTR LNR 0 DEG 28 54-56 F
|
Facility
|
OP
|
$17,483.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,244.96 |
| Max. Negotiated Rate |
$16,783.87 |
| Rate for Payer: Aetna Commercial |
$13,462.06
|
| Rate for Payer: Anthem Medicaid |
$6,012.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,636.90
|
| Rate for Payer: Cash Price |
$8,741.60
|
| Rate for Payer: Cigna Commercial |
$14,511.06
|
| Rate for Payer: First Health Commercial |
$16,609.04
|
| Rate for Payer: Humana Commercial |
$14,860.72
|
| Rate for Payer: Humana KY Medicaid |
$6,012.47
|
| Rate for Payer: Kentucky WC Medicaid |
$6,073.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,336.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,902.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,244.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,133.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,385.22
|
| Rate for Payer: Ohio Health Group HMO |
$13,112.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,986.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,210.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,063.41
|
| Rate for Payer: PHCS Commercial |
$16,783.87
|
| Rate for Payer: United Healthcare All Payer |
$15,385.22
|
|
|
REF CNSTR LNR 0 DEG 28 58-60 G
|
Facility
|
IP
|
$17,483.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,244.96 |
| Max. Negotiated Rate |
$16,783.87 |
| Rate for Payer: Aetna Commercial |
$13,462.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,636.90
|
| Rate for Payer: Cash Price |
$8,741.60
|
| Rate for Payer: Cigna Commercial |
$14,511.06
|
| Rate for Payer: First Health Commercial |
$16,609.04
|
| Rate for Payer: Humana Commercial |
$14,860.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,336.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,902.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,244.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,385.22
|
| Rate for Payer: Ohio Health Group HMO |
$13,112.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,986.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,210.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,063.41
|
| Rate for Payer: PHCS Commercial |
$16,783.87
|
| Rate for Payer: United Healthcare All Payer |
$15,385.22
|
|
|
REF CNSTR LNR 0 DEG 28 58-60 G
|
Facility
|
OP
|
$17,483.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,244.96 |
| Max. Negotiated Rate |
$16,783.87 |
| Rate for Payer: Aetna Commercial |
$13,462.06
|
| Rate for Payer: Anthem Medicaid |
$6,012.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,636.90
|
| Rate for Payer: Cash Price |
$8,741.60
|
| Rate for Payer: Cigna Commercial |
$14,511.06
|
| Rate for Payer: First Health Commercial |
$16,609.04
|
| Rate for Payer: Humana Commercial |
$14,860.72
|
| Rate for Payer: Humana KY Medicaid |
$6,012.47
|
| Rate for Payer: Kentucky WC Medicaid |
$6,073.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,336.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,902.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,244.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,133.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,385.22
|
| Rate for Payer: Ohio Health Group HMO |
$13,112.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,986.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,210.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,063.41
|
| Rate for Payer: PHCS Commercial |
$16,783.87
|
| Rate for Payer: United Healthcare All Payer |
$15,385.22
|
|
|
REF CNSTR LNR 0 DEG 28 62-64 H
|
Facility
|
OP
|
$17,483.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,244.96 |
| Max. Negotiated Rate |
$16,783.87 |
| Rate for Payer: Aetna Commercial |
$13,462.06
|
| Rate for Payer: Anthem Medicaid |
$6,012.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,636.90
|
| Rate for Payer: Cash Price |
$8,741.60
|
| Rate for Payer: Cigna Commercial |
$14,511.06
|
| Rate for Payer: First Health Commercial |
$16,609.04
|
| Rate for Payer: Humana Commercial |
$14,860.72
|
| Rate for Payer: Humana KY Medicaid |
$6,012.47
|
| Rate for Payer: Kentucky WC Medicaid |
$6,073.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,336.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,902.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,244.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,133.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,385.22
|
| Rate for Payer: Ohio Health Group HMO |
$13,112.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,986.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,210.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,063.41
|
| Rate for Payer: PHCS Commercial |
$16,783.87
|
| Rate for Payer: United Healthcare All Payer |
$15,385.22
|
|
