|
REF XLPE 26 0 DEG 62-64H
|
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 26 0 DEG 66-68J
|
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 26 0 DEG 66-68J
|
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 26 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 26 0 DEG 70-76K
|
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 26 20 ANT +4 40A
|
Facility
|
IP
|
$8,026.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,407.82 |
| Max. Negotiated Rate |
$7,705.01 |
| Rate for Payer: Aetna Commercial |
$6,180.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,260.32
|
| Rate for Payer: Cash Price |
$4,013.02
|
| Rate for Payer: Cigna Commercial |
$6,661.62
|
| Rate for Payer: First Health Commercial |
$7,624.75
|
| Rate for Payer: Humana Commercial |
$6,822.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,581.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,923.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,407.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,062.92
|
| Rate for Payer: Ohio Health Group HMO |
$6,019.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,420.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,982.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,537.97
|
| Rate for Payer: PHCS Commercial |
$7,705.01
|
| Rate for Payer: United Healthcare All Payer |
$7,062.92
|
|
|
REF XLPE 26 20 ANT +4 40A
|
Facility
|
OP
|
$8,026.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,407.82 |
| Max. Negotiated Rate |
$7,705.01 |
| Rate for Payer: Aetna Commercial |
$6,180.06
|
| Rate for Payer: Anthem Medicaid |
$2,760.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,260.32
|
| Rate for Payer: Cash Price |
$4,013.02
|
| Rate for Payer: Cigna Commercial |
$6,661.62
|
| Rate for Payer: First Health Commercial |
$7,624.75
|
| Rate for Payer: Humana Commercial |
$6,822.14
|
| Rate for Payer: Humana KY Medicaid |
$2,760.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,788.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,581.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,923.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,407.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,815.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,062.92
|
| Rate for Payer: Ohio Health Group HMO |
$6,019.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,420.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,982.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,537.97
|
| Rate for Payer: PHCS Commercial |
$7,705.01
|
| Rate for Payer: United Healthcare All Payer |
$7,062.92
|
|
|
REF XLPE 26 20 ANT +4 42B
|
Facility
|
OP
|
$8,026.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,407.82 |
| Max. Negotiated Rate |
$7,705.01 |
| Rate for Payer: Aetna Commercial |
$6,180.06
|
| Rate for Payer: Anthem Medicaid |
$2,760.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,260.32
|
| Rate for Payer: Cash Price |
$4,013.02
|
| Rate for Payer: Cigna Commercial |
$6,661.62
|
| Rate for Payer: First Health Commercial |
$7,624.75
|
| Rate for Payer: Humana Commercial |
$6,822.14
|
| Rate for Payer: Humana KY Medicaid |
$2,760.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,788.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,581.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,923.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,407.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,815.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,062.92
|
| Rate for Payer: Ohio Health Group HMO |
$6,019.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,420.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,982.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,537.97
|
| Rate for Payer: PHCS Commercial |
$7,705.01
|
| Rate for Payer: United Healthcare All Payer |
$7,062.92
|
|
|
REF XLPE 26 20 ANT +4 42B
|
Facility
|
IP
|
$8,026.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,407.82 |
| Max. Negotiated Rate |
$7,705.01 |
| Rate for Payer: Aetna Commercial |
$6,180.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,260.32
|
| Rate for Payer: Cash Price |
$4,013.02
|
| Rate for Payer: Cigna Commercial |
$6,661.62
|
| Rate for Payer: First Health Commercial |
$7,624.75
|
| Rate for Payer: Humana Commercial |
$6,822.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,581.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,923.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,407.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,062.92
|
| Rate for Payer: Ohio Health Group HMO |
$6,019.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,420.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,982.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,537.97
|
| Rate for Payer: PHCS Commercial |
$7,705.01
|
| Rate for Payer: United Healthcare All Payer |
$7,062.92
|
|
|
REF XLPE 26 20 ANT +4 44C
|
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
|
|
|
REF XLPE 26 20 ANT +4 44C
|
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 XLPE 26 20 ANT +4 46-48D
|
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 XLPE 26 20 ANT +4 46-48D
|
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
|
|
|
REF XLPE 26 20 ANT +4 50-52E
|
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 26 20 ANT +4 50-52E
|
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 26 20 ANT +4 54-56F
|
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 26 20 ANT +4 54-56F
|
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 26 20 ANT +4 58-60G
|
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 26 20 ANT +4 58-60G
|
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 26 20 ANT +4 62-64H
|
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 26 20 ANT +4 62-64H
|
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 26 20 ANT +4 66-68J
|
Facility
|
OP
|
$8,026.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,407.82 |
| Max. Negotiated Rate |
$7,705.01 |
| Rate for Payer: Aetna Commercial |
$6,180.06
|
| Rate for Payer: Anthem Medicaid |
$2,760.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,260.32
|
| Rate for Payer: Cash Price |
$4,013.02
|
| Rate for Payer: Cigna Commercial |
$6,661.62
|
| Rate for Payer: First Health Commercial |
$7,624.75
|
| Rate for Payer: Humana Commercial |
$6,822.14
|
| Rate for Payer: Humana KY Medicaid |
$2,760.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,788.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,581.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,923.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,407.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,815.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,062.92
|
| Rate for Payer: Ohio Health Group HMO |
$6,019.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,420.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,982.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,537.97
|
| Rate for Payer: PHCS Commercial |
$7,705.01
|
| Rate for Payer: United Healthcare All Payer |
$7,062.92
|
|
|
REF XLPE 26 20 ANT +4 66-68J
|
Facility
|
IP
|
$8,026.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,407.82 |
| Max. Negotiated Rate |
$7,705.01 |
| Rate for Payer: Aetna Commercial |
$6,180.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,260.32
|
| Rate for Payer: Cash Price |
$4,013.02
|
| Rate for Payer: Cigna Commercial |
$6,661.62
|
| Rate for Payer: First Health Commercial |
$7,624.75
|
| Rate for Payer: Humana Commercial |
$6,822.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,581.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,923.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,407.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,062.92
|
| Rate for Payer: Ohio Health Group HMO |
$6,019.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,420.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,982.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,537.97
|
| Rate for Payer: PHCS Commercial |
$7,705.01
|
| Rate for Payer: United Healthcare All Payer |
$7,062.92
|
|
|
REF XLPE 26 20 ANT +4 70-76K
|
Facility
|
IP
|
$8,026.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,407.82 |
| Max. Negotiated Rate |
$7,705.01 |
| Rate for Payer: Aetna Commercial |
$6,180.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,260.32
|
| Rate for Payer: Cash Price |
$4,013.02
|
| Rate for Payer: Cigna Commercial |
$6,661.62
|
| Rate for Payer: First Health Commercial |
$7,624.75
|
| Rate for Payer: Humana Commercial |
$6,822.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,581.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,923.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,407.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,062.92
|
| Rate for Payer: Ohio Health Group HMO |
$6,019.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,420.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,982.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,537.97
|
| Rate for Payer: PHCS Commercial |
$7,705.01
|
| Rate for Payer: United Healthcare All Payer |
$7,062.92
|
|
|
REF XLPE 26 20 ANT +4 70-76K
|
Facility
|
OP
|
$8,026.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,407.82 |
| Max. Negotiated Rate |
$7,705.01 |
| Rate for Payer: Aetna Commercial |
$6,180.06
|
| Rate for Payer: Anthem Medicaid |
$2,760.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,260.32
|
| Rate for Payer: Cash Price |
$4,013.02
|
| Rate for Payer: Cigna Commercial |
$6,661.62
|
| Rate for Payer: First Health Commercial |
$7,624.75
|
| Rate for Payer: Humana Commercial |
$6,822.14
|
| Rate for Payer: Humana KY Medicaid |
$2,760.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,788.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,581.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,923.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,407.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,815.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,062.92
|
| Rate for Payer: Ohio Health Group HMO |
$6,019.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,420.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,982.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,537.97
|
| Rate for Payer: PHCS Commercial |
$7,705.01
|
| Rate for Payer: United Healthcare All Payer |
$7,062.92
|
|
