|
SPEC EF 12/14 LS 225MM S
|
Facility
|
IP
|
$23,523.59
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,058.07 |
| Max. Negotiated Rate |
$22,582.65 |
| Rate for Payer: Aetna Commercial |
$18,113.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,348.40
|
| Rate for Payer: Cash Price |
$11,761.79
|
| Rate for Payer: Cigna Commercial |
$19,524.58
|
| Rate for Payer: First Health Commercial |
$22,347.41
|
| Rate for Payer: Humana Commercial |
$19,995.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,289.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,360.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,057.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,700.76
|
| Rate for Payer: Ohio Health Group HMO |
$17,642.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,704.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,058.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,292.31
|
| Rate for Payer: PHCS Commercial |
$22,582.65
|
| Rate for Payer: United Healthcare All Payer |
$20,700.76
|
|
|
SPEC EF 12/14 NR 135MM L
|
Facility
|
OP
|
$23,722.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,083.88 |
| Max. Negotiated Rate |
$22,773.26 |
| Rate for Payer: Aetna Commercial |
$18,266.06
|
| Rate for Payer: Anthem Medicaid |
$8,158.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,503.28
|
| Rate for Payer: Cash Price |
$11,861.07
|
| Rate for Payer: Cigna Commercial |
$19,689.38
|
| Rate for Payer: First Health Commercial |
$22,536.04
|
| Rate for Payer: Humana Commercial |
$20,163.83
|
| Rate for Payer: Humana KY Medicaid |
$8,158.05
|
| Rate for Payer: Kentucky WC Medicaid |
$8,241.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,452.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,506.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,116.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,321.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,875.49
|
| Rate for Payer: Ohio Health Group HMO |
$17,791.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,744.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,083.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,353.87
|
| Rate for Payer: PHCS Commercial |
$22,773.26
|
| Rate for Payer: United Healthcare All Payer |
$20,875.49
|
|
|
SPEC EF 12/14 NR 135MM L
|
Facility
|
IP
|
$23,722.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,083.88 |
| Max. Negotiated Rate |
$22,773.26 |
| Rate for Payer: Aetna Commercial |
$18,266.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,503.28
|
| Rate for Payer: Cash Price |
$11,861.07
|
| Rate for Payer: Cigna Commercial |
$19,689.38
|
| Rate for Payer: First Health Commercial |
$22,536.04
|
| Rate for Payer: Humana Commercial |
$20,163.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,452.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,506.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,116.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,875.49
|
| Rate for Payer: Ohio Health Group HMO |
$17,791.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,744.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,083.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,353.87
|
| Rate for Payer: PHCS Commercial |
$22,773.26
|
| Rate for Payer: United Healthcare All Payer |
$20,875.49
|
|
|
SPEC EF 12/14 NR 135MM M
|
Facility
|
IP
|
$23,722.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,083.88 |
| Max. Negotiated Rate |
$22,773.26 |
| Rate for Payer: Aetna Commercial |
$18,266.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,503.28
|
| Rate for Payer: Cash Price |
$11,861.07
|
| Rate for Payer: Cigna Commercial |
$19,689.38
|
| Rate for Payer: First Health Commercial |
$22,536.04
|
| Rate for Payer: Humana Commercial |
$20,163.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,452.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,506.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,116.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,875.49
|
| Rate for Payer: Ohio Health Group HMO |
$17,791.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,744.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,083.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,353.87
|
| Rate for Payer: PHCS Commercial |
$22,773.26
|
| Rate for Payer: United Healthcare All Payer |
$20,875.49
|
|
|
SPEC EF 12/14 NR 135MM M
|
Facility
|
OP
|
$23,722.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,083.88 |
| Max. Negotiated Rate |
$22,773.26 |
| Rate for Payer: Aetna Commercial |
$18,266.06
|
| Rate for Payer: Anthem Medicaid |
$8,158.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,503.28
|
| Rate for Payer: Cash Price |
$11,861.07
|
| Rate for Payer: Cigna Commercial |
$19,689.38
|
| Rate for Payer: First Health Commercial |
$22,536.04
|
| Rate for Payer: Humana Commercial |
$20,163.83
|
| Rate for Payer: Humana KY Medicaid |
$8,158.05
|
| Rate for Payer: Kentucky WC Medicaid |
$8,241.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,452.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,506.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,116.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,321.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,875.49
|
| Rate for Payer: Ohio Health Group HMO |
$17,791.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,744.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,083.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,353.87
|
| Rate for Payer: PHCS Commercial |
$22,773.26
|
| Rate for Payer: United Healthcare All Payer |
$20,875.49
|
|
|
SPEC EF 12/14 NR 135MM S
|
Facility
|
OP
|
$23,722.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,083.88 |
| Max. Negotiated Rate |
$22,773.26 |
| Rate for Payer: Aetna Commercial |
$18,266.06
|
| Rate for Payer: Anthem Medicaid |
$8,158.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,503.28
|
| Rate for Payer: Cash Price |
$11,861.07
|
| Rate for Payer: Cigna Commercial |
$19,689.38
|
| Rate for Payer: First Health Commercial |
$22,536.04
|
| Rate for Payer: Humana Commercial |
$20,163.83
|
| Rate for Payer: Humana KY Medicaid |
$8,158.05
|
| Rate for Payer: Kentucky WC Medicaid |
$8,241.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,452.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,506.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,116.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,321.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,875.49
|
| Rate for Payer: Ohio Health Group HMO |
$17,791.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,744.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,083.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,353.87
|
| Rate for Payer: PHCS Commercial |
$22,773.26
|
| Rate for Payer: United Healthcare All Payer |
$20,875.49
|
|
|
SPEC EF 12/14 NR 135MM S
|
Facility
|
IP
|
$23,722.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,083.88 |
| Max. Negotiated Rate |
$22,773.26 |
| Rate for Payer: Aetna Commercial |
$18,266.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,503.28
|
| Rate for Payer: Cash Price |
$11,861.07
|
| Rate for Payer: Cigna Commercial |
$19,689.38
|
| Rate for Payer: First Health Commercial |
$22,536.04
|
| Rate for Payer: Humana Commercial |
$20,163.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,452.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,506.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,116.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,875.49
|
| Rate for Payer: Ohio Health Group HMO |
$17,791.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,744.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,083.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,353.87
|
| Rate for Payer: PHCS Commercial |
$22,773.26
|
| Rate for Payer: United Healthcare All Payer |
$20,875.49
|
|
|
SPEC EF 12/14 NR 165MM L
|
Facility
|
IP
|
$23,722.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,083.88 |
| Max. Negotiated Rate |
$22,773.26 |
| Rate for Payer: Aetna Commercial |
$18,266.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,503.28
|
| Rate for Payer: Cash Price |
$11,861.07
|
| Rate for Payer: Cigna Commercial |
$19,689.38
|
| Rate for Payer: First Health Commercial |
$22,536.04
|
| Rate for Payer: Humana Commercial |
$20,163.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,452.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,506.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,116.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,875.49
|
| Rate for Payer: Ohio Health Group HMO |
$17,791.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,744.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,083.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,353.87
|
| Rate for Payer: PHCS Commercial |
$22,773.26
|
| Rate for Payer: United Healthcare All Payer |
$20,875.49
|
|
|
SPEC EF 12/14 NR 165MM L
|
Facility
|
OP
|
$23,722.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,083.88 |
| Max. Negotiated Rate |
$22,773.26 |
| Rate for Payer: Aetna Commercial |
$18,266.06
|
| Rate for Payer: Anthem Medicaid |
$8,158.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,503.28
|
| Rate for Payer: Cash Price |
$11,861.07
|
| Rate for Payer: Cigna Commercial |
$19,689.38
|
| Rate for Payer: First Health Commercial |
$22,536.04
|
| Rate for Payer: Humana Commercial |
$20,163.83
|
| Rate for Payer: Humana KY Medicaid |
$8,158.05
|
| Rate for Payer: Kentucky WC Medicaid |
$8,241.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,452.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,506.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,116.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,321.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,875.49
|
| Rate for Payer: Ohio Health Group HMO |
$17,791.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,744.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,083.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,353.87
|
| Rate for Payer: PHCS Commercial |
$22,773.26
|
| Rate for Payer: United Healthcare All Payer |
$20,875.49
|
|
|
SPEC EF 12/14 NR 165MM M
|
Facility
|
IP
|
$23,722.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,083.88 |
| Max. Negotiated Rate |
$22,773.26 |
| Rate for Payer: Aetna Commercial |
$18,266.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,503.28
|
| Rate for Payer: Cash Price |
$11,861.07
|
| Rate for Payer: Cigna Commercial |
$19,689.38
|
| Rate for Payer: First Health Commercial |
$22,536.04
|
| Rate for Payer: Humana Commercial |
$20,163.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,452.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,506.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,116.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,875.49
|
| Rate for Payer: Ohio Health Group HMO |
$17,791.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,744.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,083.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,353.87
|
| Rate for Payer: PHCS Commercial |
$22,773.26
|
| Rate for Payer: United Healthcare All Payer |
$20,875.49
|
|
|
SPEC EF 12/14 NR 165MM M
|
Facility
|
OP
|
$23,722.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,083.88 |
| Max. Negotiated Rate |
$22,773.26 |
| Rate for Payer: Aetna Commercial |
$18,266.06
|
| Rate for Payer: Anthem Medicaid |
$8,158.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,503.28
|
| Rate for Payer: Cash Price |
$11,861.07
|
| Rate for Payer: Cigna Commercial |
$19,689.38
|
| Rate for Payer: First Health Commercial |
$22,536.04
|
| Rate for Payer: Humana Commercial |
$20,163.83
|
| Rate for Payer: Humana KY Medicaid |
$8,158.05
|
| Rate for Payer: Kentucky WC Medicaid |
$8,241.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,452.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,506.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,116.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,321.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,875.49
|
| Rate for Payer: Ohio Health Group HMO |
$17,791.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,744.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,083.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,353.87
|
| Rate for Payer: PHCS Commercial |
$22,773.26
|
| Rate for Payer: United Healthcare All Payer |
$20,875.49
|
|
|
SPEC EF 12/14 NR 165MM S
|
Facility
|
IP
|
$23,722.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,083.88 |
| Max. Negotiated Rate |
$22,773.26 |
| Rate for Payer: Aetna Commercial |
$18,266.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,503.28
|
| Rate for Payer: Cash Price |
$11,861.07
|
| Rate for Payer: Cigna Commercial |
$19,689.38
|
| Rate for Payer: First Health Commercial |
$22,536.04
|
| Rate for Payer: Humana Commercial |
$20,163.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,452.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,506.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,116.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,875.49
|
| Rate for Payer: Ohio Health Group HMO |
$17,791.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,744.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,083.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,353.87
|
| Rate for Payer: PHCS Commercial |
$22,773.26
|
| Rate for Payer: United Healthcare All Payer |
$20,875.49
|
|
|
SPEC EF 12/14 NR 165MM S
|
Facility
|
OP
|
$23,722.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,083.88 |
| Max. Negotiated Rate |
$22,773.26 |
| Rate for Payer: Aetna Commercial |
$18,266.06
|
| Rate for Payer: Anthem Medicaid |
$8,158.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,503.28
|
| Rate for Payer: Cash Price |
$11,861.07
|
| Rate for Payer: Cigna Commercial |
$19,689.38
|
| Rate for Payer: First Health Commercial |
$22,536.04
|
| Rate for Payer: Humana Commercial |
$20,163.83
|
| Rate for Payer: Humana KY Medicaid |
$8,158.05
|
| Rate for Payer: Kentucky WC Medicaid |
$8,241.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,452.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,506.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,116.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,321.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,875.49
|
| Rate for Payer: Ohio Health Group HMO |
$17,791.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,744.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,083.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,353.87
|
| Rate for Payer: PHCS Commercial |
$22,773.26
|
| Rate for Payer: United Healthcare All Payer |
$20,875.49
|
|
|
SPEC EF 12/14 NR 195MM L
|
Facility
|
OP
|
$23,722.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,083.88 |
| Max. Negotiated Rate |
$22,773.26 |
| Rate for Payer: Aetna Commercial |
$18,266.06
|
| Rate for Payer: Anthem Medicaid |
$8,158.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,503.28
|
| Rate for Payer: Cash Price |
$11,861.07
|
| Rate for Payer: Cigna Commercial |
$19,689.38
|
| Rate for Payer: First Health Commercial |
$22,536.04
|
| Rate for Payer: Humana Commercial |
$20,163.83
|
| Rate for Payer: Humana KY Medicaid |
$8,158.05
|
| Rate for Payer: Kentucky WC Medicaid |
$8,241.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,452.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,506.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,116.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,321.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,875.49
|
| Rate for Payer: Ohio Health Group HMO |
$17,791.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,744.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,083.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,353.87
|
| Rate for Payer: PHCS Commercial |
$22,773.26
|
| Rate for Payer: United Healthcare All Payer |
$20,875.49
|
|
|
SPEC EF 12/14 NR 195MM L
|
Facility
|
IP
|
$23,722.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,083.88 |
| Max. Negotiated Rate |
$22,773.26 |
| Rate for Payer: Aetna Commercial |
$18,266.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,503.28
|
| Rate for Payer: Cash Price |
$11,861.07
|
| Rate for Payer: Cigna Commercial |
$19,689.38
|
| Rate for Payer: First Health Commercial |
$22,536.04
|
| Rate for Payer: Humana Commercial |
$20,163.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,452.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,506.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,116.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,875.49
|
| Rate for Payer: Ohio Health Group HMO |
$17,791.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,744.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,083.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,353.87
|
| Rate for Payer: PHCS Commercial |
$22,773.26
|
| Rate for Payer: United Healthcare All Payer |
$20,875.49
|
|
|
SPEC EF 12/14 NR 195MM M
|
Facility
|
OP
|
$23,722.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,083.88 |
| Max. Negotiated Rate |
$22,773.26 |
| Rate for Payer: Aetna Commercial |
$18,266.06
|
| Rate for Payer: Anthem Medicaid |
$8,158.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,503.28
|
| Rate for Payer: Cash Price |
$11,861.07
|
| Rate for Payer: Cigna Commercial |
$19,689.38
|
| Rate for Payer: First Health Commercial |
$22,536.04
|
| Rate for Payer: Humana Commercial |
$20,163.83
|
| Rate for Payer: Humana KY Medicaid |
$8,158.05
|
| Rate for Payer: Kentucky WC Medicaid |
$8,241.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,452.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,506.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,116.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,321.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,875.49
|
| Rate for Payer: Ohio Health Group HMO |
$17,791.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,744.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,083.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,353.87
|
| Rate for Payer: PHCS Commercial |
$22,773.26
|
| Rate for Payer: United Healthcare All Payer |
$20,875.49
|
|
|
SPEC EF 12/14 NR 195MM M
|
Facility
|
IP
|
$23,722.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,083.88 |
| Max. Negotiated Rate |
$22,773.26 |
| Rate for Payer: Aetna Commercial |
$18,266.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,503.28
|
| Rate for Payer: Cash Price |
$11,861.07
|
| Rate for Payer: Cigna Commercial |
$19,689.38
|
| Rate for Payer: First Health Commercial |
$22,536.04
|
| Rate for Payer: Humana Commercial |
$20,163.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,452.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,506.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,116.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,875.49
|
| Rate for Payer: Ohio Health Group HMO |
$17,791.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,744.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,083.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,353.87
|
| Rate for Payer: PHCS Commercial |
$22,773.26
|
| Rate for Payer: United Healthcare All Payer |
$20,875.49
|
|
|
SPEC EF 12/14 NR 195MM S
|
Facility
|
IP
|
$23,722.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,083.88 |
| Max. Negotiated Rate |
$22,773.26 |
| Rate for Payer: Aetna Commercial |
$18,266.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,503.28
|
| Rate for Payer: Cash Price |
$11,861.07
|
| Rate for Payer: Cigna Commercial |
$19,689.38
|
| Rate for Payer: First Health Commercial |
$22,536.04
|
| Rate for Payer: Humana Commercial |
$20,163.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,452.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,506.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,116.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,875.49
|
| Rate for Payer: Ohio Health Group HMO |
$17,791.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,744.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,083.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,353.87
|
| Rate for Payer: PHCS Commercial |
$22,773.26
|
| Rate for Payer: United Healthcare All Payer |
$20,875.49
|
|
|
SPEC EF 12/14 NR 195MM S
|
Facility
|
OP
|
$23,722.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,083.88 |
| Max. Negotiated Rate |
$22,773.26 |
| Rate for Payer: Aetna Commercial |
$18,266.06
|
| Rate for Payer: Anthem Medicaid |
$8,158.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,503.28
|
| Rate for Payer: Cash Price |
$11,861.07
|
| Rate for Payer: Cigna Commercial |
$19,689.38
|
| Rate for Payer: First Health Commercial |
$22,536.04
|
| Rate for Payer: Humana Commercial |
$20,163.83
|
| Rate for Payer: Humana KY Medicaid |
$8,158.05
|
| Rate for Payer: Kentucky WC Medicaid |
$8,241.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,452.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,506.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,116.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,321.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,875.49
|
| Rate for Payer: Ohio Health Group HMO |
$17,791.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,744.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,083.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,353.87
|
| Rate for Payer: PHCS Commercial |
$22,773.26
|
| Rate for Payer: United Healthcare All Payer |
$20,875.49
|
|
|
SPEC EF 12/14 NR 225MM L
|
Facility
|
IP
|
$23,722.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,083.88 |
| Max. Negotiated Rate |
$22,773.26 |
| Rate for Payer: Aetna Commercial |
$18,266.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,503.28
|
| Rate for Payer: Cash Price |
$11,861.07
|
| Rate for Payer: Cigna Commercial |
$19,689.38
|
| Rate for Payer: First Health Commercial |
$22,536.04
|
| Rate for Payer: Humana Commercial |
$20,163.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,452.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,506.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,116.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,875.49
|
| Rate for Payer: Ohio Health Group HMO |
$17,791.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,744.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,083.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,353.87
|
| Rate for Payer: PHCS Commercial |
$22,773.26
|
| Rate for Payer: United Healthcare All Payer |
$20,875.49
|
|
|
SPEC EF 12/14 NR 225MM L
|
Facility
|
OP
|
$23,722.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,083.88 |
| Max. Negotiated Rate |
$22,773.26 |
| Rate for Payer: Aetna Commercial |
$18,266.06
|
| Rate for Payer: Anthem Medicaid |
$8,158.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,503.28
|
| Rate for Payer: Cash Price |
$11,861.07
|
| Rate for Payer: Cigna Commercial |
$19,689.38
|
| Rate for Payer: First Health Commercial |
$22,536.04
|
| Rate for Payer: Humana Commercial |
$20,163.83
|
| Rate for Payer: Humana KY Medicaid |
$8,158.05
|
| Rate for Payer: Kentucky WC Medicaid |
$8,241.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,452.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,506.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,116.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,321.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,875.49
|
| Rate for Payer: Ohio Health Group HMO |
$17,791.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,744.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,083.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,353.87
|
| Rate for Payer: PHCS Commercial |
$22,773.26
|
| Rate for Payer: United Healthcare All Payer |
$20,875.49
|
|
|
SPEC EF 12/14 NR 225MM M
|
Facility
|
IP
|
$23,722.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,083.88 |
| Max. Negotiated Rate |
$22,773.26 |
| Rate for Payer: Aetna Commercial |
$18,266.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,503.28
|
| Rate for Payer: Cash Price |
$11,861.07
|
| Rate for Payer: Cigna Commercial |
$19,689.38
|
| Rate for Payer: First Health Commercial |
$22,536.04
|
| Rate for Payer: Humana Commercial |
$20,163.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,452.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,506.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,116.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,875.49
|
| Rate for Payer: Ohio Health Group HMO |
$17,791.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,744.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,083.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,353.87
|
| Rate for Payer: PHCS Commercial |
$22,773.26
|
| Rate for Payer: United Healthcare All Payer |
$20,875.49
|
|
|
SPEC EF 12/14 NR 225MM M
|
Facility
|
OP
|
$23,722.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,083.88 |
| Max. Negotiated Rate |
$22,773.26 |
| Rate for Payer: Aetna Commercial |
$18,266.06
|
| Rate for Payer: Anthem Medicaid |
$8,158.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,503.28
|
| Rate for Payer: Cash Price |
$11,861.07
|
| Rate for Payer: Cigna Commercial |
$19,689.38
|
| Rate for Payer: First Health Commercial |
$22,536.04
|
| Rate for Payer: Humana Commercial |
$20,163.83
|
| Rate for Payer: Humana KY Medicaid |
$8,158.05
|
| Rate for Payer: Kentucky WC Medicaid |
$8,241.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,452.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,506.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,116.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,321.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,875.49
|
| Rate for Payer: Ohio Health Group HMO |
$17,791.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,744.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,083.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,353.87
|
| Rate for Payer: PHCS Commercial |
$22,773.26
|
| Rate for Payer: United Healthcare All Payer |
$20,875.49
|
|
|
SPEC EF 12/14 NR 225MM S
|
Facility
|
IP
|
$23,722.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,083.88 |
| Max. Negotiated Rate |
$22,773.26 |
| Rate for Payer: Aetna Commercial |
$18,266.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,503.28
|
| Rate for Payer: Cash Price |
$11,861.07
|
| Rate for Payer: Cigna Commercial |
$19,689.38
|
| Rate for Payer: First Health Commercial |
$22,536.04
|
| Rate for Payer: Humana Commercial |
$20,163.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,452.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,506.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,116.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,875.49
|
| Rate for Payer: Ohio Health Group HMO |
$17,791.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,744.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,083.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,353.87
|
| Rate for Payer: PHCS Commercial |
$22,773.26
|
| Rate for Payer: United Healthcare All Payer |
$20,875.49
|
|
|
SPEC EF 12/14 NR 225MM S
|
Facility
|
OP
|
$23,722.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,083.88 |
| Max. Negotiated Rate |
$22,773.26 |
| Rate for Payer: Aetna Commercial |
$18,266.06
|
| Rate for Payer: Anthem Medicaid |
$8,158.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,503.28
|
| Rate for Payer: Cash Price |
$11,861.07
|
| Rate for Payer: Cigna Commercial |
$19,689.38
|
| Rate for Payer: First Health Commercial |
$22,536.04
|
| Rate for Payer: Humana Commercial |
$20,163.83
|
| Rate for Payer: Humana KY Medicaid |
$8,158.05
|
| Rate for Payer: Kentucky WC Medicaid |
$8,241.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,452.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,506.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,116.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,321.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,875.49
|
| Rate for Payer: Ohio Health Group HMO |
$17,791.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,744.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,083.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,353.87
|
| Rate for Payer: PHCS Commercial |
$22,773.26
|
| Rate for Payer: United Healthcare All Payer |
$20,875.49
|
|
