|
SPEC EF PRI SO 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 SO 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 SO 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 SO 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 SO 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 SO CLS 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 SO CLS 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 SO CLS 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 SO CLS 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 SO CLS 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 SO CLS 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 SO CLS 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 SO CLS 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 SO CLS 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 SO CLS 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
|
|
|
SPECIAL ANESTH PT<1 YO
|
Facility
|
IP
|
$257.00
|
|
|
Service Code
|
HCPCS 99100
|
| Hospital Charge Code |
37000176
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$33.41 |
| Max. Negotiated Rate |
$246.72 |
| Rate for Payer: Aetna Commercial |
$197.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$200.46
|
| Rate for Payer: Cash Price |
$128.50
|
| Rate for Payer: Cigna Commercial |
$213.31
|
| Rate for Payer: First Health Commercial |
$244.15
|
| Rate for Payer: Humana Commercial |
$218.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$210.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$189.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$77.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$226.16
|
| Rate for Payer: Ohio Health Group HMO |
$192.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$51.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$79.67
|
| Rate for Payer: PHCS Commercial |
$246.72
|
| Rate for Payer: United Healthcare All Payer |
$226.16
|
|
|
SPECIAL ANESTH PT<1 YO
|
Professional
|
Both
|
$257.00
|
|
|
Service Code
|
HCPCS 99100
|
| Hospital Charge Code |
37000176
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$25.00 |
| Max. Negotiated Rate |
$257.00 |
| Rate for Payer: Aetna Commercial |
$78.34
|
| Rate for Payer: Anthem Medicaid |
$25.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$257.00
|
| Rate for Payer: Cash Price |
$128.50
|
| Rate for Payer: Cash Price |
$128.50
|
| Rate for Payer: Healthspan PPO |
$61.00
|
| Rate for Payer: Humana Medicaid |
$25.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$25.50
|
| Rate for Payer: Molina Healthcare Passport |
$25.00
|
| Rate for Payer: Multiplan PHCS |
$154.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$179.90
|
| Rate for Payer: UHCCP Medicaid |
$89.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$25.25
|
|
|
SPECIAL ANESTH PT<1 YO
|
Facility
|
OP
|
$257.00
|
|
|
Service Code
|
HCPCS 99100
|
| Hospital Charge Code |
37000176
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$33.41 |
| Max. Negotiated Rate |
$246.72 |
| Rate for Payer: Aetna Commercial |
$197.89
|
| Rate for Payer: Anthem Medicaid |
$88.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$200.46
|
| Rate for Payer: Cash Price |
$128.50
|
| Rate for Payer: Cigna Commercial |
$213.31
|
| Rate for Payer: First Health Commercial |
$244.15
|
| Rate for Payer: Humana Commercial |
$218.45
|
| Rate for Payer: Humana KY Medicaid |
$88.38
|
| Rate for Payer: Kentucky WC Medicaid |
$89.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$210.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$189.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$77.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$90.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$226.16
|
| Rate for Payer: Ohio Health Group HMO |
$192.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$51.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$79.67
|
| Rate for Payer: PHCS Commercial |
$246.72
|
| Rate for Payer: United Healthcare All Payer |
$226.16
|
|
|
SPECIAL ANESTH PT<1 YO(P
|
Professional
|
Both
|
$85.00
|
|
|
Service Code
|
HCPCS 99100
|
| Hospital Charge Code |
370P0176
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$25.00 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Aetna Commercial |
$78.34
|
| Rate for Payer: Anthem Medicaid |
$25.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$85.00
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Healthspan PPO |
$61.00
|
| Rate for Payer: Humana Medicaid |
$25.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$25.50
|
| Rate for Payer: Molina Healthcare Passport |
$25.00
|
| Rate for Payer: Multiplan PHCS |
$51.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$59.50
|
| Rate for Payer: UHCCP Medicaid |
$29.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$25.25
|
|
|
SPECIAL ANESTH PT<1 YO(T
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
HCPCS 99100
|
| Hospital Charge Code |
370T0176
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$22.36 |
| Max. Negotiated Rate |
$165.12 |
| Rate for Payer: Aetna Commercial |
$132.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$134.16
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Cigna Commercial |
$142.76
|
| Rate for Payer: First Health Commercial |
$163.40
|
| Rate for Payer: Humana Commercial |
$146.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$141.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$151.36
|
| Rate for Payer: Ohio Health Group HMO |
$129.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.32
|
| Rate for Payer: PHCS Commercial |
$165.12
|
| Rate for Payer: United Healthcare All Payer |
$151.36
|
|
|
SPECIAL ANESTH PT<1 YO(T
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
HCPCS 99100
|
| Hospital Charge Code |
370T0176
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$22.36 |
| Max. Negotiated Rate |
$165.12 |
| Rate for Payer: Aetna Commercial |
$132.44
|
| Rate for Payer: Anthem Medicaid |
$59.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$134.16
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Cigna Commercial |
$142.76
|
| Rate for Payer: First Health Commercial |
$163.40
|
| Rate for Payer: Humana Commercial |
$146.20
|
| Rate for Payer: Humana KY Medicaid |
$59.15
|
| Rate for Payer: Kentucky WC Medicaid |
$59.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$141.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$60.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$151.36
|
| Rate for Payer: Ohio Health Group HMO |
$129.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.32
|
| Rate for Payer: PHCS Commercial |
$165.12
|
| Rate for Payer: United Healthcare All Payer |
$151.36
|
|
|
SPECIAL DEV PROC PER 15 MIN
|
Facility
|
OP
|
$5,161.00
|
|
| Hospital Charge Code |
36001262
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$670.93 |
| Max. Negotiated Rate |
$4,954.56 |
| Rate for Payer: Aetna Commercial |
$3,973.97
|
| Rate for Payer: Anthem Medicaid |
$1,774.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,025.58
|
| Rate for Payer: Cash Price |
$2,580.50
|
| Rate for Payer: Cigna Commercial |
$4,283.63
|
| Rate for Payer: First Health Commercial |
$4,902.95
|
| Rate for Payer: Humana Commercial |
$4,386.85
|
| Rate for Payer: Humana KY Medicaid |
$1,774.87
|
| Rate for Payer: Kentucky WC Medicaid |
$1,792.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,232.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,808.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,548.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,810.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,541.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,870.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,032.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$670.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,599.91
|
| Rate for Payer: PHCS Commercial |
$4,954.56
|
| Rate for Payer: United Healthcare All Payer |
$4,541.68
|
|
|
SPECIAL DEV PROC PER 15 MIN
|
Facility
|
IP
|
$5,161.00
|
|
| Hospital Charge Code |
36001262
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$670.93 |
| Max. Negotiated Rate |
$4,954.56 |
| Rate for Payer: Aetna Commercial |
$3,973.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,025.58
|
| Rate for Payer: Cash Price |
$2,580.50
|
| Rate for Payer: Cigna Commercial |
$4,283.63
|
| Rate for Payer: First Health Commercial |
$4,902.95
|
| Rate for Payer: Humana Commercial |
$4,386.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,232.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,808.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,548.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,541.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,870.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,032.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$670.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,599.91
|
| Rate for Payer: PHCS Commercial |
$4,954.56
|
| Rate for Payer: United Healthcare All Payer |
$4,541.68
|
|
|
SPECIAL GROUP THERAPY
|
Facility
|
IP
|
$262.00
|
|
|
Service Code
|
HCPCS 90853
|
| Hospital Charge Code |
90000011
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$34.06 |
| Max. Negotiated Rate |
$251.52 |
| Rate for Payer: Aetna Commercial |
$201.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$204.36
|
| Rate for Payer: Cash Price |
$131.00
|
| Rate for Payer: Cigna Commercial |
$217.46
|
| Rate for Payer: First Health Commercial |
$248.90
|
| Rate for Payer: Humana Commercial |
$222.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$214.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$193.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$230.56
|
| Rate for Payer: Ohio Health Group HMO |
$196.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$81.22
|
| Rate for Payer: PHCS Commercial |
$251.52
|
| Rate for Payer: United Healthcare All Payer |
$230.56
|
|
|
SPECIAL GROUP THERAPY
|
Facility
|
OP
|
$262.00
|
|
|
Service Code
|
HCPCS 90853
|
| Hospital Charge Code |
90000011
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$34.06 |
| Max. Negotiated Rate |
$251.52 |
| Rate for Payer: Aetna Commercial |
$201.74
|
| Rate for Payer: Anthem Medicaid |
$90.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$77.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$204.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$107.91
|
| Rate for Payer: CareSource Just4Me Medicare |
$104.06
|
| Rate for Payer: Cash Price |
$131.00
|
| Rate for Payer: Cash Price |
$131.00
|
| Rate for Payer: Cigna Commercial |
$217.46
|
| Rate for Payer: First Health Commercial |
$248.90
|
| Rate for Payer: Humana Commercial |
$222.70
|
| Rate for Payer: Humana KY Medicaid |
$90.10
|
| Rate for Payer: Humana Medicare Advantage |
$77.08
|
| Rate for Payer: Kentucky WC Medicaid |
$91.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$214.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$193.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$92.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$91.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$230.56
|
| Rate for Payer: Ohio Health Group HMO |
$196.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$81.22
|
| Rate for Payer: PHCS Commercial |
$251.52
|
| Rate for Payer: United Healthcare All Payer |
$230.56
|
|
