|
REFL XLPE 35 28 50-52
|
Facility
|
OP
|
$8,810.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,643.29 |
| Max. Negotiated Rate |
$8,458.54 |
| Rate for Payer: Aetna Commercial |
$6,784.45
|
| Rate for Payer: Anthem Medicaid |
$3,030.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,872.56
|
| Rate for Payer: Cash Price |
$4,405.49
|
| Rate for Payer: Cigna Commercial |
$7,313.11
|
| Rate for Payer: First Health Commercial |
$8,370.43
|
| Rate for Payer: Humana Commercial |
$7,489.33
|
| Rate for Payer: Humana KY Medicaid |
$3,030.10
|
| Rate for Payer: Kentucky WC Medicaid |
$3,060.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,225.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,502.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,643.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,090.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,753.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,608.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,048.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,665.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,079.58
|
| Rate for Payer: PHCS Commercial |
$8,458.54
|
| Rate for Payer: United Healthcare All Payer |
$7,753.66
|
|
|
REFL XLPE 35 32 54-56
|
Facility
|
IP
|
$8,810.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,643.29 |
| Max. Negotiated Rate |
$8,458.54 |
| Rate for Payer: Aetna Commercial |
$6,784.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,872.56
|
| Rate for Payer: Cash Price |
$4,405.49
|
| Rate for Payer: Cigna Commercial |
$7,313.11
|
| Rate for Payer: First Health Commercial |
$8,370.43
|
| Rate for Payer: Humana Commercial |
$7,489.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,225.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,502.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,643.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,753.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,608.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,048.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,665.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,079.58
|
| Rate for Payer: PHCS Commercial |
$8,458.54
|
| Rate for Payer: United Healthcare All Payer |
$7,753.66
|
|
|
REFL XLPE 35 32 54-56
|
Facility
|
OP
|
$8,810.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,643.29 |
| Max. Negotiated Rate |
$8,458.54 |
| Rate for Payer: Aetna Commercial |
$6,784.45
|
| Rate for Payer: Anthem Medicaid |
$3,030.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,872.56
|
| Rate for Payer: Cash Price |
$4,405.49
|
| Rate for Payer: Cigna Commercial |
$7,313.11
|
| Rate for Payer: First Health Commercial |
$8,370.43
|
| Rate for Payer: Humana Commercial |
$7,489.33
|
| Rate for Payer: Humana KY Medicaid |
$3,030.10
|
| Rate for Payer: Kentucky WC Medicaid |
$3,060.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,225.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,502.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,643.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,090.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,753.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,608.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,048.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,665.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,079.58
|
| Rate for Payer: PHCS Commercial |
$8,458.54
|
| Rate for Payer: United Healthcare All Payer |
$7,753.66
|
|
|
REFL XLPE 35 32 58-60
|
Facility
|
IP
|
$8,810.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,643.29 |
| Max. Negotiated Rate |
$8,458.54 |
| Rate for Payer: Aetna Commercial |
$6,784.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,872.56
|
| Rate for Payer: Cash Price |
$4,405.49
|
| Rate for Payer: Cigna Commercial |
$7,313.11
|
| Rate for Payer: First Health Commercial |
$8,370.43
|
| Rate for Payer: Humana Commercial |
$7,489.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,225.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,502.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,643.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,753.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,608.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,048.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,665.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,079.58
|
| Rate for Payer: PHCS Commercial |
$8,458.54
|
| Rate for Payer: United Healthcare All Payer |
$7,753.66
|
|
|
REFL XLPE 35 32 58-60
|
Facility
|
OP
|
$8,810.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,643.29 |
| Max. Negotiated Rate |
$8,458.54 |
| Rate for Payer: Aetna Commercial |
$6,784.45
|
| Rate for Payer: Anthem Medicaid |
$3,030.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,872.56
|
| Rate for Payer: Cash Price |
$4,405.49
|
| Rate for Payer: Cigna Commercial |
$7,313.11
|
| Rate for Payer: First Health Commercial |
$8,370.43
|
| Rate for Payer: Humana Commercial |
$7,489.33
|
| Rate for Payer: Humana KY Medicaid |
$3,030.10
|
| Rate for Payer: Kentucky WC Medicaid |
$3,060.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,225.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,502.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,643.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,090.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,753.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,608.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,048.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,665.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,079.58
|
| Rate for Payer: PHCS Commercial |
$8,458.54
|
| Rate for Payer: United Healthcare All Payer |
$7,753.66
|
|
|
REFL XLPE 35 32 62-64
|
Facility
|
IP
|
$8,810.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,643.29 |
| Max. Negotiated Rate |
$8,458.54 |
| Rate for Payer: Aetna Commercial |
$6,784.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,872.56
|
| Rate for Payer: Cash Price |
$4,405.49
|
| Rate for Payer: Cigna Commercial |
$7,313.11
|
| Rate for Payer: First Health Commercial |
$8,370.43
|
| Rate for Payer: Humana Commercial |
$7,489.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,225.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,502.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,643.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,753.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,608.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,048.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,665.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,079.58
|
| Rate for Payer: PHCS Commercial |
$8,458.54
|
| Rate for Payer: United Healthcare All Payer |
$7,753.66
|
|
|
REFL XLPE 35 32 62-64
|
Facility
|
OP
|
$8,810.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,643.29 |
| Max. Negotiated Rate |
$8,458.54 |
| Rate for Payer: Aetna Commercial |
$6,784.45
|
| Rate for Payer: Anthem Medicaid |
$3,030.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,872.56
|
| Rate for Payer: Cash Price |
$4,405.49
|
| Rate for Payer: Cigna Commercial |
$7,313.11
|
| Rate for Payer: First Health Commercial |
$8,370.43
|
| Rate for Payer: Humana Commercial |
$7,489.33
|
| Rate for Payer: Humana KY Medicaid |
$3,030.10
|
| Rate for Payer: Kentucky WC Medicaid |
$3,060.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,225.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,502.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,643.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,090.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,753.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,608.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,048.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,665.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,079.58
|
| Rate for Payer: PHCS Commercial |
$8,458.54
|
| Rate for Payer: United Healthcare All Payer |
$7,753.66
|
|
|
REFL XLPE 35 36 58-60
|
Facility
|
IP
|
$8,810.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,643.29 |
| Max. Negotiated Rate |
$8,458.54 |
| Rate for Payer: Aetna Commercial |
$6,784.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,872.56
|
| Rate for Payer: Cash Price |
$4,405.49
|
| Rate for Payer: Cigna Commercial |
$7,313.11
|
| Rate for Payer: First Health Commercial |
$8,370.43
|
| Rate for Payer: Humana Commercial |
$7,489.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,225.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,502.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,643.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,753.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,608.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,048.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,665.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,079.58
|
| Rate for Payer: PHCS Commercial |
$8,458.54
|
| Rate for Payer: United Healthcare All Payer |
$7,753.66
|
|
|
REFL XLPE 35 36 58-60
|
Facility
|
OP
|
$8,810.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,643.29 |
| Max. Negotiated Rate |
$8,458.54 |
| Rate for Payer: Aetna Commercial |
$6,784.45
|
| Rate for Payer: Anthem Medicaid |
$3,030.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,872.56
|
| Rate for Payer: Cash Price |
$4,405.49
|
| Rate for Payer: Cigna Commercial |
$7,313.11
|
| Rate for Payer: First Health Commercial |
$8,370.43
|
| Rate for Payer: Humana Commercial |
$7,489.33
|
| Rate for Payer: Humana KY Medicaid |
$3,030.10
|
| Rate for Payer: Kentucky WC Medicaid |
$3,060.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,225.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,502.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,643.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,090.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,753.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,608.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,048.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,665.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,079.58
|
| Rate for Payer: PHCS Commercial |
$8,458.54
|
| Rate for Payer: United Healthcare All Payer |
$7,753.66
|
|
|
REFL XLPE 35 36 62-64
|
Facility
|
OP
|
$8,810.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,643.29 |
| Max. Negotiated Rate |
$8,458.54 |
| Rate for Payer: Aetna Commercial |
$6,784.45
|
| Rate for Payer: Anthem Medicaid |
$3,030.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,872.56
|
| Rate for Payer: Cash Price |
$4,405.49
|
| Rate for Payer: Cigna Commercial |
$7,313.11
|
| Rate for Payer: First Health Commercial |
$8,370.43
|
| Rate for Payer: Humana Commercial |
$7,489.33
|
| Rate for Payer: Humana KY Medicaid |
$3,030.10
|
| Rate for Payer: Kentucky WC Medicaid |
$3,060.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,225.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,502.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,643.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,090.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,753.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,608.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,048.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,665.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,079.58
|
| Rate for Payer: PHCS Commercial |
$8,458.54
|
| Rate for Payer: United Healthcare All Payer |
$7,753.66
|
|
|
REFL XLPE 35 36 62-64
|
Facility
|
IP
|
$8,810.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,643.29 |
| Max. Negotiated Rate |
$8,458.54 |
| Rate for Payer: Aetna Commercial |
$6,784.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,872.56
|
| Rate for Payer: Cash Price |
$4,405.49
|
| Rate for Payer: Cigna Commercial |
$7,313.11
|
| Rate for Payer: First Health Commercial |
$8,370.43
|
| Rate for Payer: Humana Commercial |
$7,489.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,225.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,502.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,643.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,753.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,608.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,048.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,665.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,079.58
|
| Rate for Payer: PHCS Commercial |
$8,458.54
|
| Rate for Payer: United Healthcare All Payer |
$7,753.66
|
|
|
REFL XLPE 35 36 66-68
|
Facility
|
IP
|
$8,810.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,643.29 |
| Max. Negotiated Rate |
$8,458.54 |
| Rate for Payer: Aetna Commercial |
$6,784.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,872.56
|
| Rate for Payer: Cash Price |
$4,405.49
|
| Rate for Payer: Cigna Commercial |
$7,313.11
|
| Rate for Payer: First Health Commercial |
$8,370.43
|
| Rate for Payer: Humana Commercial |
$7,489.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,225.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,502.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,643.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,753.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,608.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,048.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,665.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,079.58
|
| Rate for Payer: PHCS Commercial |
$8,458.54
|
| Rate for Payer: United Healthcare All Payer |
$7,753.66
|
|
|
REFL XLPE 35 36 66-68
|
Facility
|
OP
|
$8,810.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,643.29 |
| Max. Negotiated Rate |
$8,458.54 |
| Rate for Payer: Aetna Commercial |
$6,784.45
|
| Rate for Payer: Anthem Medicaid |
$3,030.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,872.56
|
| Rate for Payer: Cash Price |
$4,405.49
|
| Rate for Payer: Cigna Commercial |
$7,313.11
|
| Rate for Payer: First Health Commercial |
$8,370.43
|
| Rate for Payer: Humana Commercial |
$7,489.33
|
| Rate for Payer: Humana KY Medicaid |
$3,030.10
|
| Rate for Payer: Kentucky WC Medicaid |
$3,060.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,225.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,502.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,643.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,090.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,753.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,608.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,048.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,665.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,079.58
|
| Rate for Payer: PHCS Commercial |
$8,458.54
|
| Rate for Payer: United Healthcare All Payer |
$7,753.66
|
|
|
REFL XLPE 35 36 70-76
|
Facility
|
IP
|
$8,810.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,643.29 |
| Max. Negotiated Rate |
$8,458.54 |
| Rate for Payer: Aetna Commercial |
$6,784.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,872.56
|
| Rate for Payer: Cash Price |
$4,405.49
|
| Rate for Payer: Cigna Commercial |
$7,313.11
|
| Rate for Payer: First Health Commercial |
$8,370.43
|
| Rate for Payer: Humana Commercial |
$7,489.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,225.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,502.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,643.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,753.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,608.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,048.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,665.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,079.58
|
| Rate for Payer: PHCS Commercial |
$8,458.54
|
| Rate for Payer: United Healthcare All Payer |
$7,753.66
|
|
|
REFL XLPE 35 36 70-76
|
Facility
|
OP
|
$8,810.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,643.29 |
| Max. Negotiated Rate |
$8,458.54 |
| Rate for Payer: Aetna Commercial |
$6,784.45
|
| Rate for Payer: Anthem Medicaid |
$3,030.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,872.56
|
| Rate for Payer: Cash Price |
$4,405.49
|
| Rate for Payer: Cigna Commercial |
$7,313.11
|
| Rate for Payer: First Health Commercial |
$8,370.43
|
| Rate for Payer: Humana Commercial |
$7,489.33
|
| Rate for Payer: Humana KY Medicaid |
$3,030.10
|
| Rate for Payer: Kentucky WC Medicaid |
$3,060.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,225.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,502.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,643.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,090.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,753.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,608.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,048.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,665.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,079.58
|
| Rate for Payer: PHCS Commercial |
$8,458.54
|
| Rate for Payer: United Healthcare All Payer |
$7,753.66
|
|
|
REF NH HA SHELL SZ 46MM
|
Facility
|
IP
|
$11,753.83
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,526.15 |
| Max. Negotiated Rate |
$11,283.68 |
| Rate for Payer: Aetna Commercial |
$9,050.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,167.99
|
| Rate for Payer: Cash Price |
$5,876.92
|
| Rate for Payer: Cigna Commercial |
$9,755.68
|
| Rate for Payer: First Health Commercial |
$11,166.14
|
| Rate for Payer: Humana Commercial |
$9,990.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,638.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,674.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,526.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,343.37
|
| Rate for Payer: Ohio Health Group HMO |
$8,815.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,403.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,225.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,110.14
|
| Rate for Payer: PHCS Commercial |
$11,283.68
|
| Rate for Payer: United Healthcare All Payer |
$10,343.37
|
|
|
REF NH HA SHELL SZ 46MM
|
Facility
|
OP
|
$11,753.83
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,526.15 |
| Max. Negotiated Rate |
$11,283.68 |
| Rate for Payer: Aetna Commercial |
$9,050.45
|
| Rate for Payer: Anthem Medicaid |
$4,042.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,167.99
|
| Rate for Payer: Cash Price |
$5,876.92
|
| Rate for Payer: Cigna Commercial |
$9,755.68
|
| Rate for Payer: First Health Commercial |
$11,166.14
|
| Rate for Payer: Humana Commercial |
$9,990.76
|
| Rate for Payer: Humana KY Medicaid |
$4,042.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,083.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,638.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,674.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,526.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,123.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,343.37
|
| Rate for Payer: Ohio Health Group HMO |
$8,815.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,403.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,225.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,110.14
|
| Rate for Payer: PHCS Commercial |
$11,283.68
|
| Rate for Payer: United Healthcare All Payer |
$10,343.37
|
|
|
REF NH HA SHELL SZ 48MM
|
Facility
|
IP
|
$11,753.83
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,526.15 |
| Max. Negotiated Rate |
$11,283.68 |
| Rate for Payer: Aetna Commercial |
$9,050.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,167.99
|
| Rate for Payer: Cash Price |
$5,876.92
|
| Rate for Payer: Cigna Commercial |
$9,755.68
|
| Rate for Payer: First Health Commercial |
$11,166.14
|
| Rate for Payer: Humana Commercial |
$9,990.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,638.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,674.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,526.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,343.37
|
| Rate for Payer: Ohio Health Group HMO |
$8,815.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,403.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,225.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,110.14
|
| Rate for Payer: PHCS Commercial |
$11,283.68
|
| Rate for Payer: United Healthcare All Payer |
$10,343.37
|
|
|
REF NH HA SHELL SZ 48MM
|
Facility
|
OP
|
$11,753.83
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,526.15 |
| Max. Negotiated Rate |
$11,283.68 |
| Rate for Payer: Aetna Commercial |
$9,050.45
|
| Rate for Payer: Anthem Medicaid |
$4,042.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,167.99
|
| Rate for Payer: Cash Price |
$5,876.92
|
| Rate for Payer: Cigna Commercial |
$9,755.68
|
| Rate for Payer: First Health Commercial |
$11,166.14
|
| Rate for Payer: Humana Commercial |
$9,990.76
|
| Rate for Payer: Humana KY Medicaid |
$4,042.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,083.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,638.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,674.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,526.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,123.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,343.37
|
| Rate for Payer: Ohio Health Group HMO |
$8,815.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,403.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,225.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,110.14
|
| Rate for Payer: PHCS Commercial |
$11,283.68
|
| Rate for Payer: United Healthcare All Payer |
$10,343.37
|
|
|
REF NH HA SHELL SZ 50MM
|
Facility
|
OP
|
$11,753.83
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,526.15 |
| Max. Negotiated Rate |
$11,283.68 |
| Rate for Payer: Aetna Commercial |
$9,050.45
|
| Rate for Payer: Anthem Medicaid |
$4,042.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,167.99
|
| Rate for Payer: Cash Price |
$5,876.92
|
| Rate for Payer: Cigna Commercial |
$9,755.68
|
| Rate for Payer: First Health Commercial |
$11,166.14
|
| Rate for Payer: Humana Commercial |
$9,990.76
|
| Rate for Payer: Humana KY Medicaid |
$4,042.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,083.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,638.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,674.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,526.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,123.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,343.37
|
| Rate for Payer: Ohio Health Group HMO |
$8,815.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,403.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,225.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,110.14
|
| Rate for Payer: PHCS Commercial |
$11,283.68
|
| Rate for Payer: United Healthcare All Payer |
$10,343.37
|
|
|
REF NH HA SHELL SZ 50MM
|
Facility
|
IP
|
$11,753.83
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,526.15 |
| Max. Negotiated Rate |
$11,283.68 |
| Rate for Payer: Aetna Commercial |
$9,050.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,167.99
|
| Rate for Payer: Cash Price |
$5,876.92
|
| Rate for Payer: Cigna Commercial |
$9,755.68
|
| Rate for Payer: First Health Commercial |
$11,166.14
|
| Rate for Payer: Humana Commercial |
$9,990.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,638.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,674.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,526.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,343.37
|
| Rate for Payer: Ohio Health Group HMO |
$8,815.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,403.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,225.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,110.14
|
| Rate for Payer: PHCS Commercial |
$11,283.68
|
| Rate for Payer: United Healthcare All Payer |
$10,343.37
|
|
|
REF NH HA SHELL SZ 52MM
|
Facility
|
IP
|
$11,753.83
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,526.15 |
| Max. Negotiated Rate |
$11,283.68 |
| Rate for Payer: Aetna Commercial |
$9,050.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,167.99
|
| Rate for Payer: Cash Price |
$5,876.92
|
| Rate for Payer: Cigna Commercial |
$9,755.68
|
| Rate for Payer: First Health Commercial |
$11,166.14
|
| Rate for Payer: Humana Commercial |
$9,990.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,638.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,674.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,526.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,343.37
|
| Rate for Payer: Ohio Health Group HMO |
$8,815.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,403.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,225.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,110.14
|
| Rate for Payer: PHCS Commercial |
$11,283.68
|
| Rate for Payer: United Healthcare All Payer |
$10,343.37
|
|
|
REF NH HA SHELL SZ 52MM
|
Facility
|
OP
|
$11,753.83
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,526.15 |
| Max. Negotiated Rate |
$11,283.68 |
| Rate for Payer: Aetna Commercial |
$9,050.45
|
| Rate for Payer: Anthem Medicaid |
$4,042.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,167.99
|
| Rate for Payer: Cash Price |
$5,876.92
|
| Rate for Payer: Cigna Commercial |
$9,755.68
|
| Rate for Payer: First Health Commercial |
$11,166.14
|
| Rate for Payer: Humana Commercial |
$9,990.76
|
| Rate for Payer: Humana KY Medicaid |
$4,042.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,083.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,638.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,674.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,526.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,123.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,343.37
|
| Rate for Payer: Ohio Health Group HMO |
$8,815.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,403.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,225.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,110.14
|
| Rate for Payer: PHCS Commercial |
$11,283.68
|
| Rate for Payer: United Healthcare All Payer |
$10,343.37
|
|
|
REF NH HA SHELL SZ 54MM
|
Facility
|
IP
|
$11,753.83
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,526.15 |
| Max. Negotiated Rate |
$11,283.68 |
| Rate for Payer: Aetna Commercial |
$9,050.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,167.99
|
| Rate for Payer: Cash Price |
$5,876.92
|
| Rate for Payer: Cigna Commercial |
$9,755.68
|
| Rate for Payer: First Health Commercial |
$11,166.14
|
| Rate for Payer: Humana Commercial |
$9,990.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,638.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,674.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,526.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,343.37
|
| Rate for Payer: Ohio Health Group HMO |
$8,815.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,403.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,225.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,110.14
|
| Rate for Payer: PHCS Commercial |
$11,283.68
|
| Rate for Payer: United Healthcare All Payer |
$10,343.37
|
|
|
REF NH HA SHELL SZ 54MM
|
Facility
|
OP
|
$11,753.83
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,526.15 |
| Max. Negotiated Rate |
$11,283.68 |
| Rate for Payer: Aetna Commercial |
$9,050.45
|
| Rate for Payer: Anthem Medicaid |
$4,042.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,167.99
|
| Rate for Payer: Cash Price |
$5,876.92
|
| Rate for Payer: Cigna Commercial |
$9,755.68
|
| Rate for Payer: First Health Commercial |
$11,166.14
|
| Rate for Payer: Humana Commercial |
$9,990.76
|
| Rate for Payer: Humana KY Medicaid |
$4,042.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,083.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,638.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,674.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,526.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,123.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,343.37
|
| Rate for Payer: Ohio Health Group HMO |
$8,815.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,403.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,225.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,110.14
|
| Rate for Payer: PHCS Commercial |
$11,283.68
|
| Rate for Payer: United Healthcare All Payer |
$10,343.37
|
|
