|
REF XLPE 32 20 DEG 54-56F
|
Facility
|
IP
|
$12,040.09
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,612.03 |
| Max. Negotiated Rate |
$11,558.49 |
| Rate for Payer: Aetna Commercial |
$9,270.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,391.27
|
| Rate for Payer: Cash Price |
$6,020.04
|
| Rate for Payer: Cigna Commercial |
$9,993.27
|
| Rate for Payer: First Health Commercial |
$11,438.09
|
| Rate for Payer: Humana Commercial |
$10,234.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,872.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,885.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,612.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,595.28
|
| Rate for Payer: Ohio Health Group HMO |
$9,030.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,632.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,474.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,307.66
|
| Rate for Payer: PHCS Commercial |
$11,558.49
|
| Rate for Payer: United Healthcare All Payer |
$10,595.28
|
|
|
REF XLPE 32 20 DEG 54-56F
|
Facility
|
OP
|
$12,040.09
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,612.03 |
| Max. Negotiated Rate |
$11,558.49 |
| Rate for Payer: Aetna Commercial |
$9,270.87
|
| Rate for Payer: Anthem Medicaid |
$4,140.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,391.27
|
| Rate for Payer: Cash Price |
$6,020.04
|
| Rate for Payer: Cigna Commercial |
$9,993.27
|
| Rate for Payer: First Health Commercial |
$11,438.09
|
| Rate for Payer: Humana Commercial |
$10,234.08
|
| Rate for Payer: Humana KY Medicaid |
$4,140.59
|
| Rate for Payer: Kentucky WC Medicaid |
$4,182.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,872.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,885.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,612.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,223.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,595.28
|
| Rate for Payer: Ohio Health Group HMO |
$9,030.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,632.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,474.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,307.66
|
| Rate for Payer: PHCS Commercial |
$11,558.49
|
| Rate for Payer: United Healthcare All Payer |
$10,595.28
|
|
|
REF XLPE 32 20 DEG 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 32 20 DEG 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 32 20 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 32 20 DEG 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 32 20 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 32 20 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 32 20 DEG 70-76K
|
Facility
|
OP
|
$12,040.09
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,612.03 |
| Max. Negotiated Rate |
$11,558.49 |
| Rate for Payer: Aetna Commercial |
$9,270.87
|
| Rate for Payer: Anthem Medicaid |
$4,140.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,391.27
|
| Rate for Payer: Cash Price |
$6,020.04
|
| Rate for Payer: Cigna Commercial |
$9,993.27
|
| Rate for Payer: First Health Commercial |
$11,438.09
|
| Rate for Payer: Humana Commercial |
$10,234.08
|
| Rate for Payer: Humana KY Medicaid |
$4,140.59
|
| Rate for Payer: Kentucky WC Medicaid |
$4,182.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,872.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,885.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,612.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,223.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,595.28
|
| Rate for Payer: Ohio Health Group HMO |
$9,030.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,632.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,474.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,307.66
|
| Rate for Payer: PHCS Commercial |
$11,558.49
|
| Rate for Payer: United Healthcare All Payer |
$10,595.28
|
|
|
REF XLPE 32 20 DEG 70-76K
|
Facility
|
IP
|
$12,040.09
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,612.03 |
| Max. Negotiated Rate |
$11,558.49 |
| Rate for Payer: Aetna Commercial |
$9,270.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,391.27
|
| Rate for Payer: Cash Price |
$6,020.04
|
| Rate for Payer: Cigna Commercial |
$9,993.27
|
| Rate for Payer: First Health Commercial |
$11,438.09
|
| Rate for Payer: Humana Commercial |
$10,234.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,872.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,885.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,612.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,595.28
|
| Rate for Payer: Ohio Health Group HMO |
$9,030.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,632.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,474.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,307.66
|
| Rate for Payer: PHCS Commercial |
$11,558.49
|
| Rate for Payer: United Healthcare All Payer |
$10,595.28
|
|
|
REF XLPE 36 0 DEG 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 36 0 DEG 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 36 0 DEG 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 36 0 DEG 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 36 0 DEG 62-64H
|
Facility
|
OP
|
$12,433.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,730.11 |
| Max. Negotiated Rate |
$11,936.35 |
| Rate for Payer: Aetna Commercial |
$9,573.95
|
| Rate for Payer: Anthem Medicaid |
$4,275.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,698.29
|
| Rate for Payer: Cash Price |
$6,216.85
|
| Rate for Payer: Cigna Commercial |
$10,319.97
|
| Rate for Payer: First Health Commercial |
$11,812.01
|
| Rate for Payer: Humana Commercial |
$10,568.65
|
| Rate for Payer: Humana KY Medicaid |
$4,275.95
|
| Rate for Payer: Kentucky WC Medicaid |
$4,319.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,195.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,176.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,730.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,361.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,941.66
|
| Rate for Payer: Ohio Health Group HMO |
$9,325.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,946.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,817.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,579.25
|
| Rate for Payer: PHCS Commercial |
$11,936.35
|
| Rate for Payer: United Healthcare All Payer |
$10,941.66
|
|
|
REF XLPE 36 0 DEG 62-64H
|
Facility
|
IP
|
$12,433.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,730.11 |
| Max. Negotiated Rate |
$11,936.35 |
| Rate for Payer: Aetna Commercial |
$9,573.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,698.29
|
| Rate for Payer: Cash Price |
$6,216.85
|
| Rate for Payer: Cigna Commercial |
$10,319.97
|
| Rate for Payer: First Health Commercial |
$11,812.01
|
| Rate for Payer: Humana Commercial |
$10,568.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,195.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,176.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,730.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,941.66
|
| Rate for Payer: Ohio Health Group HMO |
$9,325.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,946.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,817.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,579.25
|
| Rate for Payer: PHCS Commercial |
$11,936.35
|
| Rate for Payer: United Healthcare All Payer |
$10,941.66
|
|
|
REF XLPE 36 0 DEG 66-68J
|
Facility
|
IP
|
$13,065.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,919.76 |
| Max. Negotiated Rate |
$12,543.22 |
| Rate for Payer: Aetna Commercial |
$10,060.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,191.36
|
| Rate for Payer: Cash Price |
$6,532.93
|
| Rate for Payer: Cigna Commercial |
$10,844.66
|
| Rate for Payer: First Health Commercial |
$12,412.56
|
| Rate for Payer: Humana Commercial |
$11,105.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,714.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,642.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,919.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,497.95
|
| Rate for Payer: Ohio Health Group HMO |
$9,799.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,452.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,367.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,015.44
|
| Rate for Payer: PHCS Commercial |
$12,543.22
|
| Rate for Payer: United Healthcare All Payer |
$11,497.95
|
|
|
REF XLPE 36 0 DEG 66-68J
|
Facility
|
OP
|
$13,065.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,919.76 |
| Max. Negotiated Rate |
$12,543.22 |
| Rate for Payer: Aetna Commercial |
$10,060.70
|
| Rate for Payer: Anthem Medicaid |
$4,493.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,191.36
|
| Rate for Payer: Cash Price |
$6,532.93
|
| Rate for Payer: Cigna Commercial |
$10,844.66
|
| Rate for Payer: First Health Commercial |
$12,412.56
|
| Rate for Payer: Humana Commercial |
$11,105.97
|
| Rate for Payer: Humana KY Medicaid |
$4,493.35
|
| Rate for Payer: Kentucky WC Medicaid |
$4,539.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,714.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,642.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,919.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,583.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,497.95
|
| Rate for Payer: Ohio Health Group HMO |
$9,799.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,452.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,367.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,015.44
|
| Rate for Payer: PHCS Commercial |
$12,543.22
|
| Rate for Payer: United Healthcare All Payer |
$11,497.95
|
|
|
REF XLPE 36 0 DEG 70-76K
|
Facility
|
OP
|
$13,065.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,919.76 |
| Max. Negotiated Rate |
$12,543.22 |
| Rate for Payer: Aetna Commercial |
$10,060.70
|
| Rate for Payer: Anthem Medicaid |
$4,493.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,191.36
|
| Rate for Payer: Cash Price |
$6,532.93
|
| Rate for Payer: Cigna Commercial |
$10,844.66
|
| Rate for Payer: First Health Commercial |
$12,412.56
|
| Rate for Payer: Humana Commercial |
$11,105.97
|
| Rate for Payer: Humana KY Medicaid |
$4,493.35
|
| Rate for Payer: Kentucky WC Medicaid |
$4,539.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,714.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,642.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,919.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,583.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,497.95
|
| Rate for Payer: Ohio Health Group HMO |
$9,799.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,452.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,367.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,015.44
|
| Rate for Payer: PHCS Commercial |
$12,543.22
|
| Rate for Payer: United Healthcare All Payer |
$11,497.95
|
|
|
REF XLPE 36 0 DEG 70-76K
|
Facility
|
IP
|
$13,065.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,919.76 |
| Max. Negotiated Rate |
$12,543.22 |
| Rate for Payer: Aetna Commercial |
$10,060.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,191.36
|
| Rate for Payer: Cash Price |
$6,532.93
|
| Rate for Payer: Cigna Commercial |
$10,844.66
|
| Rate for Payer: First Health Commercial |
$12,412.56
|
| Rate for Payer: Humana Commercial |
$11,105.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,714.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,642.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,919.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,497.95
|
| Rate for Payer: Ohio Health Group HMO |
$9,799.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,452.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,367.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,015.44
|
| Rate for Payer: PHCS Commercial |
$12,543.22
|
| Rate for Payer: United Healthcare All Payer |
$11,497.95
|
|
|
REF XLPE 36 0 LAT +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 36 0 LAT +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 36 0 LAT +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 36 0 LAT +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 36 0 LAT +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
|
|
