|
REF CNSTR LNR 0 DEG 28 62-64 H
|
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 66-68 J
|
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 66-68 J
|
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 70-76 K
|
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 70-76 K
|
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 32 62-64 H
|
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 32 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
|
|
|
REF CNSTR LNR 0 DEG 32 66-68 J
|
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 32 66-68 J
|
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 32 70-76 K
|
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 32 70-76 K
|
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 ADPTR 46-48OD D
|
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 ADPTR 46-48OD D
|
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 ADPTR 50-52OD E
|
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 ADPTR 50-52OD E
|
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 ADPTR 54-56OD F
|
Facility
|
OP
|
$16,617.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,985.22 |
| Max. Negotiated Rate |
$15,952.70 |
| Rate for Payer: Aetna Commercial |
$12,795.40
|
| Rate for Payer: Anthem Medicaid |
$5,714.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,961.57
|
| Rate for Payer: Cash Price |
$8,308.70
|
| Rate for Payer: Cigna Commercial |
$13,792.44
|
| Rate for Payer: First Health Commercial |
$15,786.53
|
| Rate for Payer: Humana Commercial |
$14,124.79
|
| Rate for Payer: Humana KY Medicaid |
$5,714.72
|
| Rate for Payer: Kentucky WC Medicaid |
$5,772.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,626.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,263.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,985.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,829.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,623.31
|
| Rate for Payer: Ohio Health Group HMO |
$12,463.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,293.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,457.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,466.01
|
| Rate for Payer: PHCS Commercial |
$15,952.70
|
| Rate for Payer: United Healthcare All Payer |
$14,623.31
|
|
|
REF CNSTR LNR ADPTR 54-56OD F
|
Facility
|
IP
|
$16,617.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,985.22 |
| Max. Negotiated Rate |
$15,952.70 |
| Rate for Payer: Aetna Commercial |
$12,795.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,961.57
|
| Rate for Payer: Cash Price |
$8,308.70
|
| Rate for Payer: Cigna Commercial |
$13,792.44
|
| Rate for Payer: First Health Commercial |
$15,786.53
|
| Rate for Payer: Humana Commercial |
$14,124.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,626.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,263.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,985.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,623.31
|
| Rate for Payer: Ohio Health Group HMO |
$12,463.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,293.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,457.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,466.01
|
| Rate for Payer: PHCS Commercial |
$15,952.70
|
| Rate for Payer: United Healthcare All Payer |
$14,623.31
|
|
|
REF CNSTR LNR ADPTR 58-60OD G
|
Facility
|
OP
|
$16,617.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,985.22 |
| Max. Negotiated Rate |
$15,952.70 |
| Rate for Payer: Aetna Commercial |
$12,795.40
|
| Rate for Payer: Anthem Medicaid |
$5,714.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,961.57
|
| Rate for Payer: Cash Price |
$8,308.70
|
| Rate for Payer: Cigna Commercial |
$13,792.44
|
| Rate for Payer: First Health Commercial |
$15,786.53
|
| Rate for Payer: Humana Commercial |
$14,124.79
|
| Rate for Payer: Humana KY Medicaid |
$5,714.72
|
| Rate for Payer: Kentucky WC Medicaid |
$5,772.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,626.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,263.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,985.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,829.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,623.31
|
| Rate for Payer: Ohio Health Group HMO |
$12,463.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,293.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,457.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,466.01
|
| Rate for Payer: PHCS Commercial |
$15,952.70
|
| Rate for Payer: United Healthcare All Payer |
$14,623.31
|
|
|
REF CNSTR LNR ADPTR 58-60OD G
|
Facility
|
IP
|
$16,617.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,985.22 |
| Max. Negotiated Rate |
$15,952.70 |
| Rate for Payer: Aetna Commercial |
$12,795.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,961.57
|
| Rate for Payer: Cash Price |
$8,308.70
|
| Rate for Payer: Cigna Commercial |
$13,792.44
|
| Rate for Payer: First Health Commercial |
$15,786.53
|
| Rate for Payer: Humana Commercial |
$14,124.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,626.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,263.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,985.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,623.31
|
| Rate for Payer: Ohio Health Group HMO |
$12,463.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,293.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,457.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,466.01
|
| Rate for Payer: PHCS Commercial |
$15,952.70
|
| Rate for Payer: United Healthcare All Payer |
$14,623.31
|
|
|
REF CNSTR LNR ADPTR 62-64OD H
|
Facility
|
IP
|
$16,617.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,985.22 |
| Max. Negotiated Rate |
$15,952.70 |
| Rate for Payer: Aetna Commercial |
$12,795.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,961.57
|
| Rate for Payer: Cash Price |
$8,308.70
|
| Rate for Payer: Cigna Commercial |
$13,792.44
|
| Rate for Payer: First Health Commercial |
$15,786.53
|
| Rate for Payer: Humana Commercial |
$14,124.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,626.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,263.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,985.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,623.31
|
| Rate for Payer: Ohio Health Group HMO |
$12,463.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,293.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,457.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,466.01
|
| Rate for Payer: PHCS Commercial |
$15,952.70
|
| Rate for Payer: United Healthcare All Payer |
$14,623.31
|
|
|
REF CNSTR LNR ADPTR 62-64OD H
|
Facility
|
OP
|
$16,617.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,985.22 |
| Max. Negotiated Rate |
$15,952.70 |
| Rate for Payer: Aetna Commercial |
$12,795.40
|
| Rate for Payer: Anthem Medicaid |
$5,714.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,961.57
|
| Rate for Payer: Cash Price |
$8,308.70
|
| Rate for Payer: Cigna Commercial |
$13,792.44
|
| Rate for Payer: First Health Commercial |
$15,786.53
|
| Rate for Payer: Humana Commercial |
$14,124.79
|
| Rate for Payer: Humana KY Medicaid |
$5,714.72
|
| Rate for Payer: Kentucky WC Medicaid |
$5,772.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,626.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,263.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,985.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,829.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,623.31
|
| Rate for Payer: Ohio Health Group HMO |
$12,463.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,293.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,457.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,466.01
|
| Rate for Payer: PHCS Commercial |
$15,952.70
|
| Rate for Payer: United Healthcare All Payer |
$14,623.31
|
|
|
REF CNSTR LNR ADPTR 66-68OD J
|
Facility
|
OP
|
$16,617.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,985.22 |
| Max. Negotiated Rate |
$15,952.70 |
| Rate for Payer: Aetna Commercial |
$12,795.40
|
| Rate for Payer: Anthem Medicaid |
$5,714.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,961.57
|
| Rate for Payer: Cash Price |
$8,308.70
|
| Rate for Payer: Cigna Commercial |
$13,792.44
|
| Rate for Payer: First Health Commercial |
$15,786.53
|
| Rate for Payer: Humana Commercial |
$14,124.79
|
| Rate for Payer: Humana KY Medicaid |
$5,714.72
|
| Rate for Payer: Kentucky WC Medicaid |
$5,772.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,626.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,263.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,985.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,829.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,623.31
|
| Rate for Payer: Ohio Health Group HMO |
$12,463.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,293.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,457.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,466.01
|
| Rate for Payer: PHCS Commercial |
$15,952.70
|
| Rate for Payer: United Healthcare All Payer |
$14,623.31
|
|
|
REF CNSTR LNR ADPTR 66-68OD J
|
Facility
|
IP
|
$16,617.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,985.22 |
| Max. Negotiated Rate |
$15,952.70 |
| Rate for Payer: Aetna Commercial |
$12,795.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,961.57
|
| Rate for Payer: Cash Price |
$8,308.70
|
| Rate for Payer: Cigna Commercial |
$13,792.44
|
| Rate for Payer: First Health Commercial |
$15,786.53
|
| Rate for Payer: Humana Commercial |
$14,124.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,626.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,263.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,985.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,623.31
|
| Rate for Payer: Ohio Health Group HMO |
$12,463.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,293.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,457.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,466.01
|
| Rate for Payer: PHCS Commercial |
$15,952.70
|
| Rate for Payer: United Healthcare All Payer |
$14,623.31
|
|
|
REF CNSTR LNR ADPTR 70-76OD K
|
Facility
|
OP
|
$16,617.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,985.22 |
| Max. Negotiated Rate |
$15,952.70 |
| Rate for Payer: Aetna Commercial |
$12,795.40
|
| Rate for Payer: Anthem Medicaid |
$5,714.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,961.57
|
| Rate for Payer: Cash Price |
$8,308.70
|
| Rate for Payer: Cigna Commercial |
$13,792.44
|
| Rate for Payer: First Health Commercial |
$15,786.53
|
| Rate for Payer: Humana Commercial |
$14,124.79
|
| Rate for Payer: Humana KY Medicaid |
$5,714.72
|
| Rate for Payer: Kentucky WC Medicaid |
$5,772.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,626.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,263.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,985.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,829.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,623.31
|
| Rate for Payer: Ohio Health Group HMO |
$12,463.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,293.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,457.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,466.01
|
| Rate for Payer: PHCS Commercial |
$15,952.70
|
| Rate for Payer: United Healthcare All Payer |
$14,623.31
|
|
|
REF CNSTR LNR ADPTR 70-76OD K
|
Facility
|
IP
|
$16,617.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,985.22 |
| Max. Negotiated Rate |
$15,952.70 |
| Rate for Payer: Aetna Commercial |
$12,795.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,961.57
|
| Rate for Payer: Cash Price |
$8,308.70
|
| Rate for Payer: Cigna Commercial |
$13,792.44
|
| Rate for Payer: First Health Commercial |
$15,786.53
|
| Rate for Payer: Humana Commercial |
$14,124.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,626.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,263.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,985.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,623.31
|
| Rate for Payer: Ohio Health Group HMO |
$12,463.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,293.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,457.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,466.01
|
| Rate for Payer: PHCS Commercial |
$15,952.70
|
| Rate for Payer: United Healthcare All Payer |
$14,623.31
|
|
