|
REF XLPE 6 26 AMT +4 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 6 26 AMT +4 46-48D
|
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 6 26 AMT +4 46-48D
|
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 6 26 AMT +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 6 26 AMT +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 6 26 AMT +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 6 26 AMT +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 6 26 AMT +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 6 26 AMT +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 6 26 AMT +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 6 26 AMT +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 6 28 AMT +4 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
|
|
|
REF XLPE 6 28 AMT +4 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 6 28 AMT +4 46-48D
|
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 6 28 AMT +4 46-48D
|
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 6 28 AMT +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 6 28 AMT +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 6 28 AMT +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 6 28 AMT +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 6 28 AMT +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 6 28 AMT +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 6 28 AMT +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 6 28 AMT +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 6 28 AMT +4 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 6 28 AMT +4 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
|
|
