|
SPEC EF POST CENTRALIZER 16MM
|
Facility
|
OP
|
$1,538.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$200.02 |
| Max. Negotiated Rate |
$1,477.04 |
| Rate for Payer: Aetna Commercial |
$1,184.71
|
| Rate for Payer: Anthem Medicaid |
$529.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,200.09
|
| Rate for Payer: Cash Price |
$769.29
|
| Rate for Payer: Cigna Commercial |
$1,277.02
|
| Rate for Payer: First Health Commercial |
$1,461.65
|
| Rate for Payer: Humana Commercial |
$1,307.79
|
| Rate for Payer: Humana KY Medicaid |
$529.12
|
| Rate for Payer: Kentucky WC Medicaid |
$534.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,261.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,135.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$461.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$539.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,353.95
|
| Rate for Payer: Ohio Health Group HMO |
$1,153.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$307.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$200.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$476.96
|
| Rate for Payer: PHCS Commercial |
$1,477.04
|
| Rate for Payer: United Healthcare All Payer |
$1,353.95
|
|
|
SPEC EF POST CENTRALIZER 16MM
|
Facility
|
IP
|
$1,538.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$200.02 |
| Max. Negotiated Rate |
$1,477.04 |
| Rate for Payer: Aetna Commercial |
$1,184.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,200.09
|
| Rate for Payer: Cash Price |
$769.29
|
| Rate for Payer: Cigna Commercial |
$1,277.02
|
| Rate for Payer: First Health Commercial |
$1,461.65
|
| Rate for Payer: Humana Commercial |
$1,307.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,261.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,135.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$461.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,353.95
|
| Rate for Payer: Ohio Health Group HMO |
$1,153.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$307.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$200.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$476.96
|
| Rate for Payer: PHCS Commercial |
$1,477.04
|
| Rate for Payer: United Healthcare All Payer |
$1,353.95
|
|
|
SPEC EF POST CENTRALIZER 17MM
|
Facility
|
OP
|
$1,538.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$200.02 |
| Max. Negotiated Rate |
$1,477.04 |
| Rate for Payer: Aetna Commercial |
$1,184.71
|
| Rate for Payer: Anthem Medicaid |
$529.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,200.09
|
| Rate for Payer: Cash Price |
$769.29
|
| Rate for Payer: Cigna Commercial |
$1,277.02
|
| Rate for Payer: First Health Commercial |
$1,461.65
|
| Rate for Payer: Humana Commercial |
$1,307.79
|
| Rate for Payer: Humana KY Medicaid |
$529.12
|
| Rate for Payer: Kentucky WC Medicaid |
$534.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,261.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,135.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$461.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$539.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,353.95
|
| Rate for Payer: Ohio Health Group HMO |
$1,153.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$307.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$200.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$476.96
|
| Rate for Payer: PHCS Commercial |
$1,477.04
|
| Rate for Payer: United Healthcare All Payer |
$1,353.95
|
|
|
SPEC EF POST CENTRALIZER 17MM
|
Facility
|
IP
|
$1,538.58
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$200.02 |
| Max. Negotiated Rate |
$1,477.04 |
| Rate for Payer: Aetna Commercial |
$1,184.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,200.09
|
| Rate for Payer: Cash Price |
$769.29
|
| Rate for Payer: Cigna Commercial |
$1,277.02
|
| Rate for Payer: First Health Commercial |
$1,461.65
|
| Rate for Payer: Humana Commercial |
$1,307.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,261.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,135.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$461.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,353.95
|
| Rate for Payer: Ohio Health Group HMO |
$1,153.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$307.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$200.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$476.96
|
| Rate for Payer: PHCS Commercial |
$1,477.04
|
| Rate for Payer: United Healthcare All Payer |
$1,353.95
|
|
|
SPEC EF POST CENTRALIZER 19MM
|
Facility
|
IP
|
$1,760.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$228.87 |
| Max. Negotiated Rate |
$1,690.13 |
| Rate for Payer: Aetna Commercial |
$1,355.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,373.23
|
| Rate for Payer: Cash Price |
$880.28
|
| Rate for Payer: Cigna Commercial |
$1,461.26
|
| Rate for Payer: First Health Commercial |
$1,672.52
|
| Rate for Payer: Humana Commercial |
$1,496.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,443.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,299.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$528.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,549.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,320.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$352.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$228.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$545.77
|
| Rate for Payer: PHCS Commercial |
$1,690.13
|
| Rate for Payer: United Healthcare All Payer |
$1,549.28
|
|
|
SPEC EF POST CENTRALIZER 19MM
|
Facility
|
OP
|
$1,760.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$228.87 |
| Max. Negotiated Rate |
$1,690.13 |
| Rate for Payer: Aetna Commercial |
$1,355.62
|
| Rate for Payer: Anthem Medicaid |
$605.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,373.23
|
| Rate for Payer: Cash Price |
$880.28
|
| Rate for Payer: Cigna Commercial |
$1,461.26
|
| Rate for Payer: First Health Commercial |
$1,672.52
|
| Rate for Payer: Humana Commercial |
$1,496.47
|
| Rate for Payer: Humana KY Medicaid |
$605.45
|
| Rate for Payer: Kentucky WC Medicaid |
$611.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,443.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,299.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$528.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$617.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,549.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,320.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$352.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$228.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$545.77
|
| Rate for Payer: PHCS Commercial |
$1,690.13
|
| Rate for Payer: United Healthcare All Payer |
$1,549.28
|
|
|
SPEC EF POST CENTRALIZER 20MM
|
Facility
|
IP
|
$1,760.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$228.87 |
| Max. Negotiated Rate |
$1,690.13 |
| Rate for Payer: Aetna Commercial |
$1,355.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,373.23
|
| Rate for Payer: Cash Price |
$880.28
|
| Rate for Payer: Cigna Commercial |
$1,461.26
|
| Rate for Payer: First Health Commercial |
$1,672.52
|
| Rate for Payer: Humana Commercial |
$1,496.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,443.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,299.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$528.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,549.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,320.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$352.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$228.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$545.77
|
| Rate for Payer: PHCS Commercial |
$1,690.13
|
| Rate for Payer: United Healthcare All Payer |
$1,549.28
|
|
|
SPEC EF POST CENTRALIZER 20MM
|
Facility
|
OP
|
$1,760.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$228.87 |
| Max. Negotiated Rate |
$1,690.13 |
| Rate for Payer: Aetna Commercial |
$1,355.62
|
| Rate for Payer: Anthem Medicaid |
$605.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,373.23
|
| Rate for Payer: Cash Price |
$880.28
|
| Rate for Payer: Cigna Commercial |
$1,461.26
|
| Rate for Payer: First Health Commercial |
$1,672.52
|
| Rate for Payer: Humana Commercial |
$1,496.47
|
| Rate for Payer: Humana KY Medicaid |
$605.45
|
| Rate for Payer: Kentucky WC Medicaid |
$611.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,443.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,299.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$528.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$617.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,549.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,320.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$352.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$228.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$545.77
|
| Rate for Payer: PHCS Commercial |
$1,690.13
|
| Rate for Payer: United Healthcare All Payer |
$1,549.28
|
|
|
SPEC EF POST CENTRALIZER 21MM
|
Facility
|
OP
|
$1,760.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$228.87 |
| Max. Negotiated Rate |
$1,690.13 |
| Rate for Payer: Aetna Commercial |
$1,355.62
|
| Rate for Payer: Anthem Medicaid |
$605.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,373.23
|
| Rate for Payer: Cash Price |
$880.28
|
| Rate for Payer: Cigna Commercial |
$1,461.26
|
| Rate for Payer: First Health Commercial |
$1,672.52
|
| Rate for Payer: Humana Commercial |
$1,496.47
|
| Rate for Payer: Humana KY Medicaid |
$605.45
|
| Rate for Payer: Kentucky WC Medicaid |
$611.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,443.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,299.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$528.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$617.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,549.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,320.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$352.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$228.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$545.77
|
| Rate for Payer: PHCS Commercial |
$1,690.13
|
| Rate for Payer: United Healthcare All Payer |
$1,549.28
|
|
|
SPEC EF POST CENTRALIZER 21MM
|
Facility
|
IP
|
$1,760.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$228.87 |
| Max. Negotiated Rate |
$1,690.13 |
| Rate for Payer: Aetna Commercial |
$1,355.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,373.23
|
| Rate for Payer: Cash Price |
$880.28
|
| Rate for Payer: Cigna Commercial |
$1,461.26
|
| Rate for Payer: First Health Commercial |
$1,672.52
|
| Rate for Payer: Humana Commercial |
$1,496.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,443.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,299.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$528.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,549.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,320.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$352.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$228.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$545.77
|
| Rate for Payer: PHCS Commercial |
$1,690.13
|
| Rate for Payer: United Healthcare All Payer |
$1,549.28
|
|
|
SPEC EF PRI HO 12/14 SZ 1
|
Facility
|
OP
|
$16,969.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,206.02 |
| Max. Negotiated Rate |
$16,290.60 |
| Rate for Payer: Aetna Commercial |
$13,066.42
|
| Rate for Payer: Anthem Medicaid |
$5,835.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,236.12
|
| Rate for Payer: Cash Price |
$8,484.69
|
| Rate for Payer: Cigna Commercial |
$14,084.59
|
| Rate for Payer: First Health Commercial |
$16,120.91
|
| Rate for Payer: Humana Commercial |
$14,423.97
|
| Rate for Payer: Humana KY Medicaid |
$5,835.77
|
| Rate for Payer: Kentucky WC Medicaid |
$5,895.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,914.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,523.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,090.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,952.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,933.05
|
| Rate for Payer: Ohio Health Group HMO |
$12,727.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,393.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,206.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,260.51
|
| Rate for Payer: PHCS Commercial |
$16,290.60
|
| Rate for Payer: United Healthcare All Payer |
$14,933.05
|
|
|
SPEC EF PRI HO 12/14 SZ 1
|
Facility
|
IP
|
$16,969.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,206.02 |
| Max. Negotiated Rate |
$16,290.60 |
| Rate for Payer: Aetna Commercial |
$13,066.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,236.12
|
| Rate for Payer: Cash Price |
$8,484.69
|
| Rate for Payer: Cigna Commercial |
$14,084.59
|
| Rate for Payer: First Health Commercial |
$16,120.91
|
| Rate for Payer: Humana Commercial |
$14,423.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,914.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,523.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,090.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,933.05
|
| Rate for Payer: Ohio Health Group HMO |
$12,727.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,393.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,206.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,260.51
|
| Rate for Payer: PHCS Commercial |
$16,290.60
|
| Rate for Payer: United Healthcare All Payer |
$14,933.05
|
|
|
SPEC EF PRI HO 12/14 SZ 2
|
Facility
|
IP
|
$16,969.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,206.02 |
| Max. Negotiated Rate |
$16,290.60 |
| Rate for Payer: Aetna Commercial |
$13,066.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,236.12
|
| Rate for Payer: Cash Price |
$8,484.69
|
| Rate for Payer: Cigna Commercial |
$14,084.59
|
| Rate for Payer: First Health Commercial |
$16,120.91
|
| Rate for Payer: Humana Commercial |
$14,423.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,914.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,523.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,090.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,933.05
|
| Rate for Payer: Ohio Health Group HMO |
$12,727.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,393.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,206.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,260.51
|
| Rate for Payer: PHCS Commercial |
$16,290.60
|
| Rate for Payer: United Healthcare All Payer |
$14,933.05
|
|
|
SPEC EF PRI HO 12/14 SZ 2
|
Facility
|
OP
|
$16,969.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,206.02 |
| Max. Negotiated Rate |
$16,290.60 |
| Rate for Payer: Aetna Commercial |
$13,066.42
|
| Rate for Payer: Anthem Medicaid |
$5,835.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,236.12
|
| Rate for Payer: Cash Price |
$8,484.69
|
| Rate for Payer: Cigna Commercial |
$14,084.59
|
| Rate for Payer: First Health Commercial |
$16,120.91
|
| Rate for Payer: Humana Commercial |
$14,423.97
|
| Rate for Payer: Humana KY Medicaid |
$5,835.77
|
| Rate for Payer: Kentucky WC Medicaid |
$5,895.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,914.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,523.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,090.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,952.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,933.05
|
| Rate for Payer: Ohio Health Group HMO |
$12,727.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,393.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,206.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,260.51
|
| Rate for Payer: PHCS Commercial |
$16,290.60
|
| Rate for Payer: United Healthcare All Payer |
$14,933.05
|
|
|
SPEC EF PRI HO 12/14 SZ 3
|
Facility
|
IP
|
$16,969.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,206.02 |
| Max. Negotiated Rate |
$16,290.60 |
| Rate for Payer: Aetna Commercial |
$13,066.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,236.12
|
| Rate for Payer: Cash Price |
$8,484.69
|
| Rate for Payer: Cigna Commercial |
$14,084.59
|
| Rate for Payer: First Health Commercial |
$16,120.91
|
| Rate for Payer: Humana Commercial |
$14,423.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,914.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,523.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,090.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,933.05
|
| Rate for Payer: Ohio Health Group HMO |
$12,727.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,393.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,206.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,260.51
|
| Rate for Payer: PHCS Commercial |
$16,290.60
|
| Rate for Payer: United Healthcare All Payer |
$14,933.05
|
|
|
SPEC EF PRI HO 12/14 SZ 3
|
Facility
|
OP
|
$16,969.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,206.02 |
| Max. Negotiated Rate |
$16,290.60 |
| Rate for Payer: Aetna Commercial |
$13,066.42
|
| Rate for Payer: Anthem Medicaid |
$5,835.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,236.12
|
| Rate for Payer: Cash Price |
$8,484.69
|
| Rate for Payer: Cigna Commercial |
$14,084.59
|
| Rate for Payer: First Health Commercial |
$16,120.91
|
| Rate for Payer: Humana Commercial |
$14,423.97
|
| Rate for Payer: Humana KY Medicaid |
$5,835.77
|
| Rate for Payer: Kentucky WC Medicaid |
$5,895.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,914.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,523.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,090.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,952.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,933.05
|
| Rate for Payer: Ohio Health Group HMO |
$12,727.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,393.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,206.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,260.51
|
| Rate for Payer: PHCS Commercial |
$16,290.60
|
| Rate for Payer: United Healthcare All Payer |
$14,933.05
|
|
|
SPEC EF PRI HO 12/14 SZ 4
|
Facility
|
OP
|
$16,969.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,206.02 |
| Max. Negotiated Rate |
$16,290.60 |
| Rate for Payer: Aetna Commercial |
$13,066.42
|
| Rate for Payer: Anthem Medicaid |
$5,835.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,236.12
|
| Rate for Payer: Cash Price |
$8,484.69
|
| Rate for Payer: Cigna Commercial |
$14,084.59
|
| Rate for Payer: First Health Commercial |
$16,120.91
|
| Rate for Payer: Humana Commercial |
$14,423.97
|
| Rate for Payer: Humana KY Medicaid |
$5,835.77
|
| Rate for Payer: Kentucky WC Medicaid |
$5,895.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,914.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,523.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,090.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,952.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,933.05
|
| Rate for Payer: Ohio Health Group HMO |
$12,727.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,393.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,206.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,260.51
|
| Rate for Payer: PHCS Commercial |
$16,290.60
|
| Rate for Payer: United Healthcare All Payer |
$14,933.05
|
|
|
SPEC EF PRI HO 12/14 SZ 4
|
Facility
|
IP
|
$16,969.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,206.02 |
| Max. Negotiated Rate |
$16,290.60 |
| Rate for Payer: Aetna Commercial |
$13,066.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,236.12
|
| Rate for Payer: Cash Price |
$8,484.69
|
| Rate for Payer: Cigna Commercial |
$14,084.59
|
| Rate for Payer: First Health Commercial |
$16,120.91
|
| Rate for Payer: Humana Commercial |
$14,423.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,914.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,523.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,090.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,933.05
|
| Rate for Payer: Ohio Health Group HMO |
$12,727.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,393.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,206.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,260.51
|
| Rate for Payer: PHCS Commercial |
$16,290.60
|
| Rate for Payer: United Healthcare All Payer |
$14,933.05
|
|
|
SPEC EF PRI HO 12/14 SZ 5
|
Facility
|
OP
|
$16,969.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,206.02 |
| Max. Negotiated Rate |
$16,290.60 |
| Rate for Payer: Aetna Commercial |
$13,066.42
|
| Rate for Payer: Anthem Medicaid |
$5,835.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,236.12
|
| Rate for Payer: Cash Price |
$8,484.69
|
| Rate for Payer: Cigna Commercial |
$14,084.59
|
| Rate for Payer: First Health Commercial |
$16,120.91
|
| Rate for Payer: Humana Commercial |
$14,423.97
|
| Rate for Payer: Humana KY Medicaid |
$5,835.77
|
| Rate for Payer: Kentucky WC Medicaid |
$5,895.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,914.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,523.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,090.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,952.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,933.05
|
| Rate for Payer: Ohio Health Group HMO |
$12,727.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,393.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,206.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,260.51
|
| Rate for Payer: PHCS Commercial |
$16,290.60
|
| Rate for Payer: United Healthcare All Payer |
$14,933.05
|
|
|
SPEC EF PRI HO 12/14 SZ 5
|
Facility
|
IP
|
$16,969.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,206.02 |
| Max. Negotiated Rate |
$16,290.60 |
| Rate for Payer: Aetna Commercial |
$13,066.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,236.12
|
| Rate for Payer: Cash Price |
$8,484.69
|
| Rate for Payer: Cigna Commercial |
$14,084.59
|
| Rate for Payer: First Health Commercial |
$16,120.91
|
| Rate for Payer: Humana Commercial |
$14,423.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,914.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,523.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,090.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,933.05
|
| Rate for Payer: Ohio Health Group HMO |
$12,727.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,393.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,206.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,260.51
|
| Rate for Payer: PHCS Commercial |
$16,290.60
|
| Rate for Payer: United Healthcare All Payer |
$14,933.05
|
|
|
SPEC EF PRI SO 12/14 SZ 1
|
Facility
|
OP
|
$16,969.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,206.02 |
| Max. Negotiated Rate |
$16,290.60 |
| Rate for Payer: Aetna Commercial |
$13,066.42
|
| Rate for Payer: Anthem Medicaid |
$5,835.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,236.12
|
| Rate for Payer: Cash Price |
$8,484.69
|
| Rate for Payer: Cigna Commercial |
$14,084.59
|
| Rate for Payer: First Health Commercial |
$16,120.91
|
| Rate for Payer: Humana Commercial |
$14,423.97
|
| Rate for Payer: Humana KY Medicaid |
$5,835.77
|
| Rate for Payer: Kentucky WC Medicaid |
$5,895.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,914.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,523.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,090.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,952.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,933.05
|
| Rate for Payer: Ohio Health Group HMO |
$12,727.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,393.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,206.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,260.51
|
| Rate for Payer: PHCS Commercial |
$16,290.60
|
| Rate for Payer: United Healthcare All Payer |
$14,933.05
|
|
|
SPEC EF PRI SO 12/14 SZ 1
|
Facility
|
IP
|
$16,969.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,206.02 |
| Max. Negotiated Rate |
$16,290.60 |
| Rate for Payer: Aetna Commercial |
$13,066.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,236.12
|
| Rate for Payer: Cash Price |
$8,484.69
|
| Rate for Payer: Cigna Commercial |
$14,084.59
|
| Rate for Payer: First Health Commercial |
$16,120.91
|
| Rate for Payer: Humana Commercial |
$14,423.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,914.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,523.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,090.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,933.05
|
| Rate for Payer: Ohio Health Group HMO |
$12,727.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,393.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,206.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,260.51
|
| Rate for Payer: PHCS Commercial |
$16,290.60
|
| Rate for Payer: United Healthcare All Payer |
$14,933.05
|
|
|
SPEC EF PRI SO 12/14 SZ 2
|
Facility
|
IP
|
$16,969.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,206.02 |
| Max. Negotiated Rate |
$16,290.60 |
| Rate for Payer: Aetna Commercial |
$13,066.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,236.12
|
| Rate for Payer: Cash Price |
$8,484.69
|
| Rate for Payer: Cigna Commercial |
$14,084.59
|
| Rate for Payer: First Health Commercial |
$16,120.91
|
| Rate for Payer: Humana Commercial |
$14,423.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,914.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,523.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,090.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,933.05
|
| Rate for Payer: Ohio Health Group HMO |
$12,727.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,393.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,206.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,260.51
|
| Rate for Payer: PHCS Commercial |
$16,290.60
|
| Rate for Payer: United Healthcare All Payer |
$14,933.05
|
|
|
SPEC EF PRI SO 12/14 SZ 2
|
Facility
|
OP
|
$16,969.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,206.02 |
| Max. Negotiated Rate |
$16,290.60 |
| Rate for Payer: Aetna Commercial |
$13,066.42
|
| Rate for Payer: Anthem Medicaid |
$5,835.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,236.12
|
| Rate for Payer: Cash Price |
$8,484.69
|
| Rate for Payer: Cigna Commercial |
$14,084.59
|
| Rate for Payer: First Health Commercial |
$16,120.91
|
| Rate for Payer: Humana Commercial |
$14,423.97
|
| Rate for Payer: Humana KY Medicaid |
$5,835.77
|
| Rate for Payer: Kentucky WC Medicaid |
$5,895.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,914.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,523.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,090.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,952.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,933.05
|
| Rate for Payer: Ohio Health Group HMO |
$12,727.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,393.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,206.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,260.51
|
| Rate for Payer: PHCS Commercial |
$16,290.60
|
| Rate for Payer: United Healthcare All Payer |
$14,933.05
|
|
|
SPEC EF PRI SO 12/14 SZ 3
|
Facility
|
OP
|
$16,969.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,206.02 |
| Max. Negotiated Rate |
$16,290.60 |
| Rate for Payer: Aetna Commercial |
$13,066.42
|
| Rate for Payer: Anthem Medicaid |
$5,835.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,236.12
|
| Rate for Payer: Cash Price |
$8,484.69
|
| Rate for Payer: Cigna Commercial |
$14,084.59
|
| Rate for Payer: First Health Commercial |
$16,120.91
|
| Rate for Payer: Humana Commercial |
$14,423.97
|
| Rate for Payer: Humana KY Medicaid |
$5,835.77
|
| Rate for Payer: Kentucky WC Medicaid |
$5,895.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,914.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,523.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,090.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,952.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,933.05
|
| Rate for Payer: Ohio Health Group HMO |
$12,727.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,393.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,206.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,260.51
|
| Rate for Payer: PHCS Commercial |
$16,290.60
|
| Rate for Payer: United Healthcare All Payer |
$14,933.05
|
|
