|
REF XLPE 22 0 DEG 70-76K
|
Facility
|
OP
|
$11,980.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,594.14 |
| Max. Negotiated Rate |
$11,501.23 |
| Rate for Payer: Aetna Commercial |
$9,224.95
|
| Rate for Payer: Anthem Medicaid |
$4,120.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,344.75
|
| Rate for Payer: Cash Price |
$5,990.23
|
| Rate for Payer: Cigna Commercial |
$9,943.77
|
| Rate for Payer: First Health Commercial |
$11,381.43
|
| Rate for Payer: Humana Commercial |
$10,183.38
|
| Rate for Payer: Humana KY Medicaid |
$4,120.08
|
| Rate for Payer: Kentucky WC Medicaid |
$4,162.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,823.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,841.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,594.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,202.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,542.80
|
| Rate for Payer: Ohio Health Group HMO |
$8,985.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,584.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,422.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,266.51
|
| Rate for Payer: PHCS Commercial |
$11,501.23
|
| Rate for Payer: United Healthcare All Payer |
$10,542.80
|
|
|
REF XLPE 22 20 ANT +4 42B
|
Facility
|
OP
|
$8,826.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,647.95 |
| Max. Negotiated Rate |
$8,473.44 |
| Rate for Payer: Aetna Commercial |
$6,796.40
|
| Rate for Payer: Anthem Medicaid |
$3,035.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,884.67
|
| Rate for Payer: Cash Price |
$4,413.25
|
| Rate for Payer: Cigna Commercial |
$7,325.99
|
| Rate for Payer: First Health Commercial |
$8,385.17
|
| Rate for Payer: Humana Commercial |
$7,502.52
|
| Rate for Payer: Humana KY Medicaid |
$3,035.43
|
| Rate for Payer: Kentucky WC Medicaid |
$3,066.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,237.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,513.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,647.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,096.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,767.32
|
| Rate for Payer: Ohio Health Group HMO |
$6,619.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,061.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,679.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,090.28
|
| Rate for Payer: PHCS Commercial |
$8,473.44
|
| Rate for Payer: United Healthcare All Payer |
$7,767.32
|
|
|
REF XLPE 22 20 ANT +4 42B
|
Facility
|
IP
|
$8,826.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,647.95 |
| Max. Negotiated Rate |
$8,473.44 |
| Rate for Payer: Aetna Commercial |
$6,796.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,884.67
|
| Rate for Payer: Cash Price |
$4,413.25
|
| Rate for Payer: Cigna Commercial |
$7,325.99
|
| Rate for Payer: First Health Commercial |
$8,385.17
|
| Rate for Payer: Humana Commercial |
$7,502.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,237.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,513.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,647.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,767.32
|
| Rate for Payer: Ohio Health Group HMO |
$6,619.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,061.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,679.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,090.28
|
| Rate for Payer: PHCS Commercial |
$8,473.44
|
| Rate for Payer: United Healthcare All Payer |
$7,767.32
|
|
|
REF XLPE 22 20 ANT +4 44C
|
Facility
|
OP
|
$8,826.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,647.95 |
| Max. Negotiated Rate |
$8,473.44 |
| Rate for Payer: Aetna Commercial |
$6,796.40
|
| Rate for Payer: Anthem Medicaid |
$3,035.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,884.67
|
| Rate for Payer: Cash Price |
$4,413.25
|
| Rate for Payer: Cigna Commercial |
$7,325.99
|
| Rate for Payer: First Health Commercial |
$8,385.17
|
| Rate for Payer: Humana Commercial |
$7,502.52
|
| Rate for Payer: Humana KY Medicaid |
$3,035.43
|
| Rate for Payer: Kentucky WC Medicaid |
$3,066.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,237.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,513.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,647.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,096.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,767.32
|
| Rate for Payer: Ohio Health Group HMO |
$6,619.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,061.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,679.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,090.28
|
| Rate for Payer: PHCS Commercial |
$8,473.44
|
| Rate for Payer: United Healthcare All Payer |
$7,767.32
|
|
|
REF XLPE 22 20 ANT +4 44C
|
Facility
|
IP
|
$8,826.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,647.95 |
| Max. Negotiated Rate |
$8,473.44 |
| Rate for Payer: Aetna Commercial |
$6,796.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,884.67
|
| Rate for Payer: Cash Price |
$4,413.25
|
| Rate for Payer: Cigna Commercial |
$7,325.99
|
| Rate for Payer: First Health Commercial |
$8,385.17
|
| Rate for Payer: Humana Commercial |
$7,502.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,237.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,513.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,647.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,767.32
|
| Rate for Payer: Ohio Health Group HMO |
$6,619.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,061.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,679.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,090.28
|
| Rate for Payer: PHCS Commercial |
$8,473.44
|
| Rate for Payer: United Healthcare All Payer |
$7,767.32
|
|
|
REF XLPE 22 20 ANT +4 46-48D
|
Facility
|
OP
|
$8,826.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,647.95 |
| Max. Negotiated Rate |
$8,473.44 |
| Rate for Payer: Aetna Commercial |
$6,796.40
|
| Rate for Payer: Anthem Medicaid |
$3,035.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,884.67
|
| Rate for Payer: Cash Price |
$4,413.25
|
| Rate for Payer: Cigna Commercial |
$7,325.99
|
| Rate for Payer: First Health Commercial |
$8,385.17
|
| Rate for Payer: Humana Commercial |
$7,502.52
|
| Rate for Payer: Humana KY Medicaid |
$3,035.43
|
| Rate for Payer: Kentucky WC Medicaid |
$3,066.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,237.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,513.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,647.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,096.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,767.32
|
| Rate for Payer: Ohio Health Group HMO |
$6,619.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,061.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,679.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,090.28
|
| Rate for Payer: PHCS Commercial |
$8,473.44
|
| Rate for Payer: United Healthcare All Payer |
$7,767.32
|
|
|
REF XLPE 22 20 ANT +4 46-48D
|
Facility
|
IP
|
$8,826.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,647.95 |
| Max. Negotiated Rate |
$8,473.44 |
| Rate for Payer: Aetna Commercial |
$6,796.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,884.67
|
| Rate for Payer: Cash Price |
$4,413.25
|
| Rate for Payer: Cigna Commercial |
$7,325.99
|
| Rate for Payer: First Health Commercial |
$8,385.17
|
| Rate for Payer: Humana Commercial |
$7,502.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,237.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,513.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,647.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,767.32
|
| Rate for Payer: Ohio Health Group HMO |
$6,619.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,061.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,679.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,090.28
|
| Rate for Payer: PHCS Commercial |
$8,473.44
|
| Rate for Payer: United Healthcare All Payer |
$7,767.32
|
|
|
REF XLPE 22 20 ANT +4 50-52E
|
Facility
|
IP
|
$8,826.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,647.95 |
| Max. Negotiated Rate |
$8,473.44 |
| Rate for Payer: Aetna Commercial |
$6,796.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,884.67
|
| Rate for Payer: Cash Price |
$4,413.25
|
| Rate for Payer: Cigna Commercial |
$7,325.99
|
| Rate for Payer: First Health Commercial |
$8,385.17
|
| Rate for Payer: Humana Commercial |
$7,502.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,237.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,513.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,647.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,767.32
|
| Rate for Payer: Ohio Health Group HMO |
$6,619.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,061.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,679.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,090.28
|
| Rate for Payer: PHCS Commercial |
$8,473.44
|
| Rate for Payer: United Healthcare All Payer |
$7,767.32
|
|
|
REF XLPE 22 20 ANT +4 50-52E
|
Facility
|
OP
|
$8,826.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,647.95 |
| Max. Negotiated Rate |
$8,473.44 |
| Rate for Payer: Aetna Commercial |
$6,796.40
|
| Rate for Payer: Anthem Medicaid |
$3,035.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,884.67
|
| Rate for Payer: Cash Price |
$4,413.25
|
| Rate for Payer: Cigna Commercial |
$7,325.99
|
| Rate for Payer: First Health Commercial |
$8,385.17
|
| Rate for Payer: Humana Commercial |
$7,502.52
|
| Rate for Payer: Humana KY Medicaid |
$3,035.43
|
| Rate for Payer: Kentucky WC Medicaid |
$3,066.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,237.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,513.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,647.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,096.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,767.32
|
| Rate for Payer: Ohio Health Group HMO |
$6,619.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,061.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,679.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,090.28
|
| Rate for Payer: PHCS Commercial |
$8,473.44
|
| Rate for Payer: United Healthcare All Payer |
$7,767.32
|
|
|
REF XLPE 22 20 ANT +4 54-56F
|
Facility
|
OP
|
$8,826.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,647.95 |
| Max. Negotiated Rate |
$8,473.44 |
| Rate for Payer: Aetna Commercial |
$6,796.40
|
| Rate for Payer: Anthem Medicaid |
$3,035.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,884.67
|
| Rate for Payer: Cash Price |
$4,413.25
|
| Rate for Payer: Cigna Commercial |
$7,325.99
|
| Rate for Payer: First Health Commercial |
$8,385.17
|
| Rate for Payer: Humana Commercial |
$7,502.52
|
| Rate for Payer: Humana KY Medicaid |
$3,035.43
|
| Rate for Payer: Kentucky WC Medicaid |
$3,066.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,237.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,513.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,647.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,096.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,767.32
|
| Rate for Payer: Ohio Health Group HMO |
$6,619.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,061.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,679.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,090.28
|
| Rate for Payer: PHCS Commercial |
$8,473.44
|
| Rate for Payer: United Healthcare All Payer |
$7,767.32
|
|
|
REF XLPE 22 20 ANT +4 54-56F
|
Facility
|
IP
|
$8,826.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,647.95 |
| Max. Negotiated Rate |
$8,473.44 |
| Rate for Payer: Aetna Commercial |
$6,796.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,884.67
|
| Rate for Payer: Cash Price |
$4,413.25
|
| Rate for Payer: Cigna Commercial |
$7,325.99
|
| Rate for Payer: First Health Commercial |
$8,385.17
|
| Rate for Payer: Humana Commercial |
$7,502.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,237.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,513.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,647.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,767.32
|
| Rate for Payer: Ohio Health Group HMO |
$6,619.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,061.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,679.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,090.28
|
| Rate for Payer: PHCS Commercial |
$8,473.44
|
| Rate for Payer: United Healthcare All Payer |
$7,767.32
|
|
|
REF XLPE 22 20 ANT +4 58-60G
|
Facility
|
OP
|
$8,826.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,647.95 |
| Max. Negotiated Rate |
$8,473.44 |
| Rate for Payer: Aetna Commercial |
$6,796.40
|
| Rate for Payer: Anthem Medicaid |
$3,035.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,884.67
|
| Rate for Payer: Cash Price |
$4,413.25
|
| Rate for Payer: Cigna Commercial |
$7,325.99
|
| Rate for Payer: First Health Commercial |
$8,385.17
|
| Rate for Payer: Humana Commercial |
$7,502.52
|
| Rate for Payer: Humana KY Medicaid |
$3,035.43
|
| Rate for Payer: Kentucky WC Medicaid |
$3,066.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,237.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,513.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,647.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,096.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,767.32
|
| Rate for Payer: Ohio Health Group HMO |
$6,619.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,061.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,679.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,090.28
|
| Rate for Payer: PHCS Commercial |
$8,473.44
|
| Rate for Payer: United Healthcare All Payer |
$7,767.32
|
|
|
REF XLPE 22 20 ANT +4 58-60G
|
Facility
|
IP
|
$8,826.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,647.95 |
| Max. Negotiated Rate |
$8,473.44 |
| Rate for Payer: Aetna Commercial |
$6,796.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,884.67
|
| Rate for Payer: Cash Price |
$4,413.25
|
| Rate for Payer: Cigna Commercial |
$7,325.99
|
| Rate for Payer: First Health Commercial |
$8,385.17
|
| Rate for Payer: Humana Commercial |
$7,502.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,237.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,513.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,647.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,767.32
|
| Rate for Payer: Ohio Health Group HMO |
$6,619.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,061.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,679.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,090.28
|
| Rate for Payer: PHCS Commercial |
$8,473.44
|
| Rate for Payer: United Healthcare All Payer |
$7,767.32
|
|
|
REF XLPE 22 20 ANT +4 62-64H
|
Facility
|
IP
|
$8,311.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,493.44 |
| Max. Negotiated Rate |
$7,979.02 |
| Rate for Payer: Aetna Commercial |
$6,399.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,482.95
|
| Rate for Payer: Cash Price |
$4,155.74
|
| Rate for Payer: Cigna Commercial |
$6,898.53
|
| Rate for Payer: First Health Commercial |
$7,895.91
|
| Rate for Payer: Humana Commercial |
$7,064.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,815.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,133.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,493.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,314.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,233.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,649.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,230.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,734.92
|
| Rate for Payer: PHCS Commercial |
$7,979.02
|
| Rate for Payer: United Healthcare All Payer |
$7,314.10
|
|
|
REF XLPE 22 20 ANT +4 62-64H
|
Facility
|
OP
|
$8,311.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,493.44 |
| Max. Negotiated Rate |
$7,979.02 |
| Rate for Payer: Aetna Commercial |
$6,399.84
|
| Rate for Payer: Anthem Medicaid |
$2,858.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,482.95
|
| Rate for Payer: Cash Price |
$4,155.74
|
| Rate for Payer: Cigna Commercial |
$6,898.53
|
| Rate for Payer: First Health Commercial |
$7,895.91
|
| Rate for Payer: Humana Commercial |
$7,064.76
|
| Rate for Payer: Humana KY Medicaid |
$2,858.32
|
| Rate for Payer: Kentucky WC Medicaid |
$2,887.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,815.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,133.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,493.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,915.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,314.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,233.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,649.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,230.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,734.92
|
| Rate for Payer: PHCS Commercial |
$7,979.02
|
| Rate for Payer: United Healthcare All Payer |
$7,314.10
|
|
|
REF XLPE 22 20 ANT +4 66-68J
|
Facility
|
OP
|
$8,311.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,493.44 |
| Max. Negotiated Rate |
$7,979.02 |
| Rate for Payer: Aetna Commercial |
$6,399.84
|
| Rate for Payer: Anthem Medicaid |
$2,858.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,482.95
|
| Rate for Payer: Cash Price |
$4,155.74
|
| Rate for Payer: Cigna Commercial |
$6,898.53
|
| Rate for Payer: First Health Commercial |
$7,895.91
|
| Rate for Payer: Humana Commercial |
$7,064.76
|
| Rate for Payer: Humana KY Medicaid |
$2,858.32
|
| Rate for Payer: Kentucky WC Medicaid |
$2,887.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,815.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,133.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,493.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,915.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,314.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,233.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,649.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,230.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,734.92
|
| Rate for Payer: PHCS Commercial |
$7,979.02
|
| Rate for Payer: United Healthcare All Payer |
$7,314.10
|
|
|
REF XLPE 22 20 ANT +4 66-68J
|
Facility
|
IP
|
$8,311.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,493.44 |
| Max. Negotiated Rate |
$7,979.02 |
| Rate for Payer: Aetna Commercial |
$6,399.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,482.95
|
| Rate for Payer: Cash Price |
$4,155.74
|
| Rate for Payer: Cigna Commercial |
$6,898.53
|
| Rate for Payer: First Health Commercial |
$7,895.91
|
| Rate for Payer: Humana Commercial |
$7,064.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,815.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,133.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,493.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,314.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,233.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,649.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,230.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,734.92
|
| Rate for Payer: PHCS Commercial |
$7,979.02
|
| Rate for Payer: United Healthcare All Payer |
$7,314.10
|
|
|
REF XLPE 22 20 ANT +4 70-76K
|
Facility
|
OP
|
$8,311.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,493.44 |
| Max. Negotiated Rate |
$7,979.02 |
| Rate for Payer: Aetna Commercial |
$6,399.84
|
| Rate for Payer: Anthem Medicaid |
$2,858.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,482.95
|
| Rate for Payer: Cash Price |
$4,155.74
|
| Rate for Payer: Cigna Commercial |
$6,898.53
|
| Rate for Payer: First Health Commercial |
$7,895.91
|
| Rate for Payer: Humana Commercial |
$7,064.76
|
| Rate for Payer: Humana KY Medicaid |
$2,858.32
|
| Rate for Payer: Kentucky WC Medicaid |
$2,887.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,815.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,133.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,493.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,915.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,314.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,233.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,649.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,230.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,734.92
|
| Rate for Payer: PHCS Commercial |
$7,979.02
|
| Rate for Payer: United Healthcare All Payer |
$7,314.10
|
|
|
REF XLPE 22 20 ANT +4 70-76K
|
Facility
|
IP
|
$8,311.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,493.44 |
| Max. Negotiated Rate |
$7,979.02 |
| Rate for Payer: Aetna Commercial |
$6,399.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,482.95
|
| Rate for Payer: Cash Price |
$4,155.74
|
| Rate for Payer: Cigna Commercial |
$6,898.53
|
| Rate for Payer: First Health Commercial |
$7,895.91
|
| Rate for Payer: Humana Commercial |
$7,064.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,815.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,133.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,493.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,314.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,233.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,649.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,230.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,734.92
|
| Rate for Payer: PHCS Commercial |
$7,979.02
|
| Rate for Payer: United Healthcare All Payer |
$7,314.10
|
|
|
REF XLPE 22 20 DEG 40A
|
Facility
|
OP
|
$11,980.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,594.14 |
| Max. Negotiated Rate |
$11,501.23 |
| Rate for Payer: Aetna Commercial |
$9,224.95
|
| Rate for Payer: Anthem Medicaid |
$4,120.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,344.75
|
| Rate for Payer: Cash Price |
$5,990.23
|
| Rate for Payer: Cigna Commercial |
$9,943.77
|
| Rate for Payer: First Health Commercial |
$11,381.43
|
| Rate for Payer: Humana Commercial |
$10,183.38
|
| Rate for Payer: Humana KY Medicaid |
$4,120.08
|
| Rate for Payer: Kentucky WC Medicaid |
$4,162.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,823.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,841.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,594.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,202.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,542.80
|
| Rate for Payer: Ohio Health Group HMO |
$8,985.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,584.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,422.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,266.51
|
| Rate for Payer: PHCS Commercial |
$11,501.23
|
| Rate for Payer: United Healthcare All Payer |
$10,542.80
|
|
|
REF XLPE 22 20 DEG 40A
|
Facility
|
IP
|
$11,980.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,594.14 |
| Max. Negotiated Rate |
$11,501.23 |
| Rate for Payer: Aetna Commercial |
$9,224.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,344.75
|
| Rate for Payer: Cash Price |
$5,990.23
|
| Rate for Payer: Cigna Commercial |
$9,943.77
|
| Rate for Payer: First Health Commercial |
$11,381.43
|
| Rate for Payer: Humana Commercial |
$10,183.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,823.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,841.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,594.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,542.80
|
| Rate for Payer: Ohio Health Group HMO |
$8,985.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,584.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,422.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,266.51
|
| Rate for Payer: PHCS Commercial |
$11,501.23
|
| Rate for Payer: United Healthcare All Payer |
$10,542.80
|
|
|
REF XLPE 22 20 DEG 42B
|
Facility
|
OP
|
$11,980.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,594.14 |
| Max. Negotiated Rate |
$11,501.23 |
| Rate for Payer: Aetna Commercial |
$9,224.95
|
| Rate for Payer: Anthem Medicaid |
$4,120.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,344.75
|
| Rate for Payer: Cash Price |
$5,990.23
|
| Rate for Payer: Cigna Commercial |
$9,943.77
|
| Rate for Payer: First Health Commercial |
$11,381.43
|
| Rate for Payer: Humana Commercial |
$10,183.38
|
| Rate for Payer: Humana KY Medicaid |
$4,120.08
|
| Rate for Payer: Kentucky WC Medicaid |
$4,162.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,823.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,841.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,594.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,202.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,542.80
|
| Rate for Payer: Ohio Health Group HMO |
$8,985.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,584.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,422.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,266.51
|
| Rate for Payer: PHCS Commercial |
$11,501.23
|
| Rate for Payer: United Healthcare All Payer |
$10,542.80
|
|
|
REF XLPE 22 20 DEG 42B
|
Facility
|
IP
|
$11,980.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,594.14 |
| Max. Negotiated Rate |
$11,501.23 |
| Rate for Payer: Aetna Commercial |
$9,224.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,344.75
|
| Rate for Payer: Cash Price |
$5,990.23
|
| Rate for Payer: Cigna Commercial |
$9,943.77
|
| Rate for Payer: First Health Commercial |
$11,381.43
|
| Rate for Payer: Humana Commercial |
$10,183.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,823.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,841.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,594.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,542.80
|
| Rate for Payer: Ohio Health Group HMO |
$8,985.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,584.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,422.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,266.51
|
| Rate for Payer: PHCS Commercial |
$11,501.23
|
| Rate for Payer: United Healthcare All Payer |
$10,542.80
|
|
|
REF XLPE 22 20 DEG 44C
|
Facility
|
IP
|
$11,980.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,594.14 |
| Max. Negotiated Rate |
$11,501.23 |
| Rate for Payer: Aetna Commercial |
$9,224.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,344.75
|
| Rate for Payer: Cash Price |
$5,990.23
|
| Rate for Payer: Cigna Commercial |
$9,943.77
|
| Rate for Payer: First Health Commercial |
$11,381.43
|
| Rate for Payer: Humana Commercial |
$10,183.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,823.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,841.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,594.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,542.80
|
| Rate for Payer: Ohio Health Group HMO |
$8,985.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,584.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,422.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,266.51
|
| Rate for Payer: PHCS Commercial |
$11,501.23
|
| Rate for Payer: United Healthcare All Payer |
$10,542.80
|
|
|
REF XLPE 22 20 DEG 44C
|
Facility
|
OP
|
$11,980.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,594.14 |
| Max. Negotiated Rate |
$11,501.23 |
| Rate for Payer: Aetna Commercial |
$9,224.95
|
| Rate for Payer: Anthem Medicaid |
$4,120.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,344.75
|
| Rate for Payer: Cash Price |
$5,990.23
|
| Rate for Payer: Cigna Commercial |
$9,943.77
|
| Rate for Payer: First Health Commercial |
$11,381.43
|
| Rate for Payer: Humana Commercial |
$10,183.38
|
| Rate for Payer: Humana KY Medicaid |
$4,120.08
|
| Rate for Payer: Kentucky WC Medicaid |
$4,162.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,823.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,841.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,594.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,202.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,542.80
|
| Rate for Payer: Ohio Health Group HMO |
$8,985.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,584.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,422.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,266.51
|
| Rate for Payer: PHCS Commercial |
$11,501.23
|
| Rate for Payer: United Healthcare All Payer |
$10,542.80
|
|
