|
REF SP3 3H SHELL 44MM
|
Facility
|
IP
|
$11,760.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,528.13 |
| Max. Negotiated Rate |
$11,290.02 |
| Rate for Payer: Aetna Commercial |
$9,055.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,173.14
|
| Rate for Payer: Cash Price |
$5,880.22
|
| Rate for Payer: Cigna Commercial |
$9,761.17
|
| Rate for Payer: First Health Commercial |
$11,172.42
|
| Rate for Payer: Humana Commercial |
$9,996.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,643.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,679.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,528.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,349.19
|
| Rate for Payer: Ohio Health Group HMO |
$8,820.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,408.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,231.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,114.70
|
| Rate for Payer: PHCS Commercial |
$11,290.02
|
| Rate for Payer: United Healthcare All Payer |
$10,349.19
|
|
|
REF SP3 3H SHELL 44MM
|
Facility
|
OP
|
$11,760.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,528.13 |
| Max. Negotiated Rate |
$11,290.02 |
| Rate for Payer: Aetna Commercial |
$9,055.54
|
| Rate for Payer: Anthem Medicaid |
$4,044.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,173.14
|
| Rate for Payer: Cash Price |
$5,880.22
|
| Rate for Payer: Cigna Commercial |
$9,761.17
|
| Rate for Payer: First Health Commercial |
$11,172.42
|
| Rate for Payer: Humana Commercial |
$9,996.37
|
| Rate for Payer: Humana KY Medicaid |
$4,044.42
|
| Rate for Payer: Kentucky WC Medicaid |
$4,085.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,643.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,679.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,528.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,125.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,349.19
|
| Rate for Payer: Ohio Health Group HMO |
$8,820.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,408.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,231.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,114.70
|
| Rate for Payer: PHCS Commercial |
$11,290.02
|
| Rate for Payer: United Healthcare All Payer |
$10,349.19
|
|
|
REF SP3 3H SHELL 46MM
|
Facility
|
IP
|
$11,760.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,528.13 |
| Max. Negotiated Rate |
$11,290.02 |
| Rate for Payer: Aetna Commercial |
$9,055.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,173.14
|
| Rate for Payer: Cash Price |
$5,880.22
|
| Rate for Payer: Cigna Commercial |
$9,761.17
|
| Rate for Payer: First Health Commercial |
$11,172.42
|
| Rate for Payer: Humana Commercial |
$9,996.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,643.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,679.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,528.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,349.19
|
| Rate for Payer: Ohio Health Group HMO |
$8,820.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,408.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,231.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,114.70
|
| Rate for Payer: PHCS Commercial |
$11,290.02
|
| Rate for Payer: United Healthcare All Payer |
$10,349.19
|
|
|
REF SP3 3H SHELL 46MM
|
Facility
|
OP
|
$11,760.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,528.13 |
| Max. Negotiated Rate |
$11,290.02 |
| Rate for Payer: Aetna Commercial |
$9,055.54
|
| Rate for Payer: Anthem Medicaid |
$4,044.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,173.14
|
| Rate for Payer: Cash Price |
$5,880.22
|
| Rate for Payer: Cigna Commercial |
$9,761.17
|
| Rate for Payer: First Health Commercial |
$11,172.42
|
| Rate for Payer: Humana Commercial |
$9,996.37
|
| Rate for Payer: Humana KY Medicaid |
$4,044.42
|
| Rate for Payer: Kentucky WC Medicaid |
$4,085.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,643.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,679.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,528.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,125.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,349.19
|
| Rate for Payer: Ohio Health Group HMO |
$8,820.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,408.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,231.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,114.70
|
| Rate for Payer: PHCS Commercial |
$11,290.02
|
| Rate for Payer: United Healthcare All Payer |
$10,349.19
|
|
|
REF SP3 3H SHELL 48MM
|
Facility
|
IP
|
$11,760.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,528.13 |
| Max. Negotiated Rate |
$11,290.02 |
| Rate for Payer: Aetna Commercial |
$9,055.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,173.14
|
| Rate for Payer: Cash Price |
$5,880.22
|
| Rate for Payer: Cigna Commercial |
$9,761.17
|
| Rate for Payer: First Health Commercial |
$11,172.42
|
| Rate for Payer: Humana Commercial |
$9,996.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,643.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,679.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,528.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,349.19
|
| Rate for Payer: Ohio Health Group HMO |
$8,820.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,408.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,231.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,114.70
|
| Rate for Payer: PHCS Commercial |
$11,290.02
|
| Rate for Payer: United Healthcare All Payer |
$10,349.19
|
|
|
REF SP3 3H SHELL 48MM
|
Facility
|
OP
|
$11,760.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,528.13 |
| Max. Negotiated Rate |
$11,290.02 |
| Rate for Payer: Aetna Commercial |
$9,055.54
|
| Rate for Payer: Anthem Medicaid |
$4,044.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,173.14
|
| Rate for Payer: Cash Price |
$5,880.22
|
| Rate for Payer: Cigna Commercial |
$9,761.17
|
| Rate for Payer: First Health Commercial |
$11,172.42
|
| Rate for Payer: Humana Commercial |
$9,996.37
|
| Rate for Payer: Humana KY Medicaid |
$4,044.42
|
| Rate for Payer: Kentucky WC Medicaid |
$4,085.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,643.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,679.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,528.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,125.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,349.19
|
| Rate for Payer: Ohio Health Group HMO |
$8,820.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,408.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,231.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,114.70
|
| Rate for Payer: PHCS Commercial |
$11,290.02
|
| Rate for Payer: United Healthcare All Payer |
$10,349.19
|
|
|
REF SP3 3H SHELL 50MM
|
Facility
|
IP
|
$11,760.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,528.13 |
| Max. Negotiated Rate |
$11,290.02 |
| Rate for Payer: Aetna Commercial |
$9,055.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,173.14
|
| Rate for Payer: Cash Price |
$5,880.22
|
| Rate for Payer: Cigna Commercial |
$9,761.17
|
| Rate for Payer: First Health Commercial |
$11,172.42
|
| Rate for Payer: Humana Commercial |
$9,996.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,643.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,679.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,528.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,349.19
|
| Rate for Payer: Ohio Health Group HMO |
$8,820.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,408.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,231.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,114.70
|
| Rate for Payer: PHCS Commercial |
$11,290.02
|
| Rate for Payer: United Healthcare All Payer |
$10,349.19
|
|
|
REF SP3 3H SHELL 50MM
|
Facility
|
OP
|
$11,760.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,528.13 |
| Max. Negotiated Rate |
$11,290.02 |
| Rate for Payer: Aetna Commercial |
$9,055.54
|
| Rate for Payer: Anthem Medicaid |
$4,044.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,173.14
|
| Rate for Payer: Cash Price |
$5,880.22
|
| Rate for Payer: Cigna Commercial |
$9,761.17
|
| Rate for Payer: First Health Commercial |
$11,172.42
|
| Rate for Payer: Humana Commercial |
$9,996.37
|
| Rate for Payer: Humana KY Medicaid |
$4,044.42
|
| Rate for Payer: Kentucky WC Medicaid |
$4,085.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,643.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,679.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,528.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,125.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,349.19
|
| Rate for Payer: Ohio Health Group HMO |
$8,820.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,408.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,231.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,114.70
|
| Rate for Payer: PHCS Commercial |
$11,290.02
|
| Rate for Payer: United Healthcare All Payer |
$10,349.19
|
|
|
REF SP3 3H SHELL 52MM
|
Facility
|
IP
|
$11,760.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,528.13 |
| Max. Negotiated Rate |
$11,290.02 |
| Rate for Payer: Aetna Commercial |
$9,055.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,173.14
|
| Rate for Payer: Cash Price |
$5,880.22
|
| Rate for Payer: Cigna Commercial |
$9,761.17
|
| Rate for Payer: First Health Commercial |
$11,172.42
|
| Rate for Payer: Humana Commercial |
$9,996.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,643.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,679.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,528.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,349.19
|
| Rate for Payer: Ohio Health Group HMO |
$8,820.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,408.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,231.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,114.70
|
| Rate for Payer: PHCS Commercial |
$11,290.02
|
| Rate for Payer: United Healthcare All Payer |
$10,349.19
|
|
|
REF SP3 3H SHELL 52MM
|
Facility
|
OP
|
$11,760.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,528.13 |
| Max. Negotiated Rate |
$11,290.02 |
| Rate for Payer: Aetna Commercial |
$9,055.54
|
| Rate for Payer: Anthem Medicaid |
$4,044.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,173.14
|
| Rate for Payer: Cash Price |
$5,880.22
|
| Rate for Payer: Cigna Commercial |
$9,761.17
|
| Rate for Payer: First Health Commercial |
$11,172.42
|
| Rate for Payer: Humana Commercial |
$9,996.37
|
| Rate for Payer: Humana KY Medicaid |
$4,044.42
|
| Rate for Payer: Kentucky WC Medicaid |
$4,085.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,643.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,679.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,528.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,125.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,349.19
|
| Rate for Payer: Ohio Health Group HMO |
$8,820.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,408.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,231.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,114.70
|
| Rate for Payer: PHCS Commercial |
$11,290.02
|
| Rate for Payer: United Healthcare All Payer |
$10,349.19
|
|
|
REF SP3 3H SHELL 54MM
|
Facility
|
OP
|
$11,760.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,528.13 |
| Max. Negotiated Rate |
$11,290.02 |
| Rate for Payer: Aetna Commercial |
$9,055.54
|
| Rate for Payer: Anthem Medicaid |
$4,044.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,173.14
|
| Rate for Payer: Cash Price |
$5,880.22
|
| Rate for Payer: Cigna Commercial |
$9,761.17
|
| Rate for Payer: First Health Commercial |
$11,172.42
|
| Rate for Payer: Humana Commercial |
$9,996.37
|
| Rate for Payer: Humana KY Medicaid |
$4,044.42
|
| Rate for Payer: Kentucky WC Medicaid |
$4,085.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,643.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,679.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,528.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,125.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,349.19
|
| Rate for Payer: Ohio Health Group HMO |
$8,820.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,408.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,231.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,114.70
|
| Rate for Payer: PHCS Commercial |
$11,290.02
|
| Rate for Payer: United Healthcare All Payer |
$10,349.19
|
|
|
REF SP3 3H SHELL 54MM
|
Facility
|
IP
|
$11,760.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,528.13 |
| Max. Negotiated Rate |
$11,290.02 |
| Rate for Payer: Aetna Commercial |
$9,055.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,173.14
|
| Rate for Payer: Cash Price |
$5,880.22
|
| Rate for Payer: Cigna Commercial |
$9,761.17
|
| Rate for Payer: First Health Commercial |
$11,172.42
|
| Rate for Payer: Humana Commercial |
$9,996.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,643.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,679.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,528.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,349.19
|
| Rate for Payer: Ohio Health Group HMO |
$8,820.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,408.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,231.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,114.70
|
| Rate for Payer: PHCS Commercial |
$11,290.02
|
| Rate for Payer: United Healthcare All Payer |
$10,349.19
|
|
|
REF SP3 3H SHELL 56MM
|
Facility
|
IP
|
$11,760.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,528.13 |
| Max. Negotiated Rate |
$11,290.02 |
| Rate for Payer: Aetna Commercial |
$9,055.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,173.14
|
| Rate for Payer: Cash Price |
$5,880.22
|
| Rate for Payer: Cigna Commercial |
$9,761.17
|
| Rate for Payer: First Health Commercial |
$11,172.42
|
| Rate for Payer: Humana Commercial |
$9,996.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,643.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,679.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,528.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,349.19
|
| Rate for Payer: Ohio Health Group HMO |
$8,820.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,408.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,231.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,114.70
|
| Rate for Payer: PHCS Commercial |
$11,290.02
|
| Rate for Payer: United Healthcare All Payer |
$10,349.19
|
|
|
REF SP3 3H SHELL 56MM
|
Facility
|
OP
|
$11,760.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,528.13 |
| Max. Negotiated Rate |
$11,290.02 |
| Rate for Payer: Aetna Commercial |
$9,055.54
|
| Rate for Payer: Anthem Medicaid |
$4,044.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,173.14
|
| Rate for Payer: Cash Price |
$5,880.22
|
| Rate for Payer: Cigna Commercial |
$9,761.17
|
| Rate for Payer: First Health Commercial |
$11,172.42
|
| Rate for Payer: Humana Commercial |
$9,996.37
|
| Rate for Payer: Humana KY Medicaid |
$4,044.42
|
| Rate for Payer: Kentucky WC Medicaid |
$4,085.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,643.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,679.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,528.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,125.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,349.19
|
| Rate for Payer: Ohio Health Group HMO |
$8,820.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,408.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,231.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,114.70
|
| Rate for Payer: PHCS Commercial |
$11,290.02
|
| Rate for Payer: United Healthcare All Payer |
$10,349.19
|
|
|
REF SP3 3H SHELL 58MM
|
Facility
|
OP
|
$11,760.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,528.13 |
| Max. Negotiated Rate |
$11,290.02 |
| Rate for Payer: Aetna Commercial |
$9,055.54
|
| Rate for Payer: Anthem Medicaid |
$4,044.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,173.14
|
| Rate for Payer: Cash Price |
$5,880.22
|
| Rate for Payer: Cigna Commercial |
$9,761.17
|
| Rate for Payer: First Health Commercial |
$11,172.42
|
| Rate for Payer: Humana Commercial |
$9,996.37
|
| Rate for Payer: Humana KY Medicaid |
$4,044.42
|
| Rate for Payer: Kentucky WC Medicaid |
$4,085.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,643.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,679.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,528.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,125.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,349.19
|
| Rate for Payer: Ohio Health Group HMO |
$8,820.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,408.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,231.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,114.70
|
| Rate for Payer: PHCS Commercial |
$11,290.02
|
| Rate for Payer: United Healthcare All Payer |
$10,349.19
|
|
|
REF SP3 3H SHELL 58MM
|
Facility
|
IP
|
$11,760.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,528.13 |
| Max. Negotiated Rate |
$11,290.02 |
| Rate for Payer: Aetna Commercial |
$9,055.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,173.14
|
| Rate for Payer: Cash Price |
$5,880.22
|
| Rate for Payer: Cigna Commercial |
$9,761.17
|
| Rate for Payer: First Health Commercial |
$11,172.42
|
| Rate for Payer: Humana Commercial |
$9,996.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,643.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,679.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,528.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,349.19
|
| Rate for Payer: Ohio Health Group HMO |
$8,820.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,408.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,231.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,114.70
|
| Rate for Payer: PHCS Commercial |
$11,290.02
|
| Rate for Payer: United Healthcare All Payer |
$10,349.19
|
|
|
REF SP3 3H SHELL 60MM
|
Facility
|
OP
|
$11,760.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,528.13 |
| Max. Negotiated Rate |
$11,290.02 |
| Rate for Payer: Aetna Commercial |
$9,055.54
|
| Rate for Payer: Anthem Medicaid |
$4,044.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,173.14
|
| Rate for Payer: Cash Price |
$5,880.22
|
| Rate for Payer: Cigna Commercial |
$9,761.17
|
| Rate for Payer: First Health Commercial |
$11,172.42
|
| Rate for Payer: Humana Commercial |
$9,996.37
|
| Rate for Payer: Humana KY Medicaid |
$4,044.42
|
| Rate for Payer: Kentucky WC Medicaid |
$4,085.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,643.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,679.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,528.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,125.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,349.19
|
| Rate for Payer: Ohio Health Group HMO |
$8,820.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,408.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,231.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,114.70
|
| Rate for Payer: PHCS Commercial |
$11,290.02
|
| Rate for Payer: United Healthcare All Payer |
$10,349.19
|
|
|
REF SP3 3H SHELL 60MM
|
Facility
|
IP
|
$11,760.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,528.13 |
| Max. Negotiated Rate |
$11,290.02 |
| Rate for Payer: Aetna Commercial |
$9,055.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,173.14
|
| Rate for Payer: Cash Price |
$5,880.22
|
| Rate for Payer: Cigna Commercial |
$9,761.17
|
| Rate for Payer: First Health Commercial |
$11,172.42
|
| Rate for Payer: Humana Commercial |
$9,996.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,643.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,679.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,528.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,349.19
|
| Rate for Payer: Ohio Health Group HMO |
$8,820.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,408.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,231.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,114.70
|
| Rate for Payer: PHCS Commercial |
$11,290.02
|
| Rate for Payer: United Healthcare All Payer |
$10,349.19
|
|
|
REF SP3 3H SHELL 62MM
|
Facility
|
IP
|
$11,760.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,528.13 |
| Max. Negotiated Rate |
$11,290.02 |
| Rate for Payer: Aetna Commercial |
$9,055.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,173.14
|
| Rate for Payer: Cash Price |
$5,880.22
|
| Rate for Payer: Cigna Commercial |
$9,761.17
|
| Rate for Payer: First Health Commercial |
$11,172.42
|
| Rate for Payer: Humana Commercial |
$9,996.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,643.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,679.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,528.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,349.19
|
| Rate for Payer: Ohio Health Group HMO |
$8,820.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,408.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,231.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,114.70
|
| Rate for Payer: PHCS Commercial |
$11,290.02
|
| Rate for Payer: United Healthcare All Payer |
$10,349.19
|
|
|
REF SP3 3H SHELL 62MM
|
Facility
|
OP
|
$11,760.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,528.13 |
| Max. Negotiated Rate |
$11,290.02 |
| Rate for Payer: Aetna Commercial |
$9,055.54
|
| Rate for Payer: Anthem Medicaid |
$4,044.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,173.14
|
| Rate for Payer: Cash Price |
$5,880.22
|
| Rate for Payer: Cigna Commercial |
$9,761.17
|
| Rate for Payer: First Health Commercial |
$11,172.42
|
| Rate for Payer: Humana Commercial |
$9,996.37
|
| Rate for Payer: Humana KY Medicaid |
$4,044.42
|
| Rate for Payer: Kentucky WC Medicaid |
$4,085.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,643.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,679.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,528.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,125.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,349.19
|
| Rate for Payer: Ohio Health Group HMO |
$8,820.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,408.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,231.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,114.70
|
| Rate for Payer: PHCS Commercial |
$11,290.02
|
| Rate for Payer: United Healthcare All Payer |
$10,349.19
|
|
|
REF SP3 3H SHELL 64MM
|
Facility
|
OP
|
$11,760.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,528.13 |
| Max. Negotiated Rate |
$11,290.02 |
| Rate for Payer: Aetna Commercial |
$9,055.54
|
| Rate for Payer: Anthem Medicaid |
$4,044.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,173.14
|
| Rate for Payer: Cash Price |
$5,880.22
|
| Rate for Payer: Cigna Commercial |
$9,761.17
|
| Rate for Payer: First Health Commercial |
$11,172.42
|
| Rate for Payer: Humana Commercial |
$9,996.37
|
| Rate for Payer: Humana KY Medicaid |
$4,044.42
|
| Rate for Payer: Kentucky WC Medicaid |
$4,085.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,643.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,679.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,528.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,125.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,349.19
|
| Rate for Payer: Ohio Health Group HMO |
$8,820.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,408.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,231.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,114.70
|
| Rate for Payer: PHCS Commercial |
$11,290.02
|
| Rate for Payer: United Healthcare All Payer |
$10,349.19
|
|
|
REF SP3 3H SHELL 64MM
|
Facility
|
IP
|
$11,760.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,528.13 |
| Max. Negotiated Rate |
$11,290.02 |
| Rate for Payer: Aetna Commercial |
$9,055.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,173.14
|
| Rate for Payer: Cash Price |
$5,880.22
|
| Rate for Payer: Cigna Commercial |
$9,761.17
|
| Rate for Payer: First Health Commercial |
$11,172.42
|
| Rate for Payer: Humana Commercial |
$9,996.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,643.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,679.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,528.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,349.19
|
| Rate for Payer: Ohio Health Group HMO |
$8,820.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,408.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,231.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,114.70
|
| Rate for Payer: PHCS Commercial |
$11,290.02
|
| Rate for Payer: United Healthcare All Payer |
$10,349.19
|
|
|
REF SP3 3H SHELL 66MM
|
Facility
|
IP
|
$11,760.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,528.13 |
| Max. Negotiated Rate |
$11,290.02 |
| Rate for Payer: Aetna Commercial |
$9,055.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,173.14
|
| Rate for Payer: Cash Price |
$5,880.22
|
| Rate for Payer: Cigna Commercial |
$9,761.17
|
| Rate for Payer: First Health Commercial |
$11,172.42
|
| Rate for Payer: Humana Commercial |
$9,996.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,643.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,679.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,528.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,349.19
|
| Rate for Payer: Ohio Health Group HMO |
$8,820.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,408.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,231.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,114.70
|
| Rate for Payer: PHCS Commercial |
$11,290.02
|
| Rate for Payer: United Healthcare All Payer |
$10,349.19
|
|
|
REF SP3 3H SHELL 66MM
|
Facility
|
OP
|
$11,760.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,528.13 |
| Max. Negotiated Rate |
$11,290.02 |
| Rate for Payer: Aetna Commercial |
$9,055.54
|
| Rate for Payer: Anthem Medicaid |
$4,044.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,173.14
|
| Rate for Payer: Cash Price |
$5,880.22
|
| Rate for Payer: Cigna Commercial |
$9,761.17
|
| Rate for Payer: First Health Commercial |
$11,172.42
|
| Rate for Payer: Humana Commercial |
$9,996.37
|
| Rate for Payer: Humana KY Medicaid |
$4,044.42
|
| Rate for Payer: Kentucky WC Medicaid |
$4,085.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,643.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,679.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,528.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,125.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,349.19
|
| Rate for Payer: Ohio Health Group HMO |
$8,820.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,408.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,231.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,114.70
|
| Rate for Payer: PHCS Commercial |
$11,290.02
|
| Rate for Payer: United Healthcare All Payer |
$10,349.19
|
|
|
REF SP3 3H SHELL 68MM
|
Facility
|
IP
|
$11,760.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,528.13 |
| Max. Negotiated Rate |
$11,290.02 |
| Rate for Payer: Aetna Commercial |
$9,055.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,173.14
|
| Rate for Payer: Cash Price |
$5,880.22
|
| Rate for Payer: Cigna Commercial |
$9,761.17
|
| Rate for Payer: First Health Commercial |
$11,172.42
|
| Rate for Payer: Humana Commercial |
$9,996.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,643.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,679.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,528.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,349.19
|
| Rate for Payer: Ohio Health Group HMO |
$8,820.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,408.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,231.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,114.70
|
| Rate for Payer: PHCS Commercial |
$11,290.02
|
| Rate for Payer: United Healthcare All Payer |
$10,349.19
|
|
