|
S P CONSULT PREP AT SOMC (P
|
Professional
|
Both
|
$110.00
|
|
|
Service Code
|
HCPCS 88323
|
| Hospital Charge Code |
300P2035
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$38.50 |
| Max. Negotiated Rate |
$218.75 |
| Rate for Payer: Aetna Commercial |
$218.75
|
| Rate for Payer: Ambetter Exchange |
$107.93
|
| Rate for Payer: Buckeye Individual/Medicaid |
$107.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$107.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$129.52
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cigna Commercial |
$89.15
|
| Rate for Payer: Healthspan PPO |
$207.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$44.95
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$107.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$107.93
|
| Rate for Payer: Multiplan PHCS |
$66.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$140.31
|
| Rate for Payer: UHCCP Medicaid |
$38.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$52.86
|
| Rate for Payer: Wellcare Medicare Advantage |
$107.93
|
|
|
S P CONSULT PREP AT SOMC (T
|
Facility
|
OP
|
$457.00
|
|
|
Service Code
|
HCPCS 88323
|
| Hospital Charge Code |
300T2035
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$49.37 |
| Max. Negotiated Rate |
$438.72 |
| Rate for Payer: Aetna Commercial |
$351.89
|
| Rate for Payer: Anthem Medicaid |
$49.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$49.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$366.97
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$69.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$49.37
|
| Rate for Payer: Cash Price |
$228.50
|
| Rate for Payer: Cash Price |
$228.50
|
| Rate for Payer: Cigna Commercial |
$379.31
|
| Rate for Payer: First Health Commercial |
$434.15
|
| Rate for Payer: Humana Commercial |
$388.45
|
| Rate for Payer: Humana KY Medicaid |
$49.37
|
| Rate for Payer: Humana Medicare Advantage |
$49.37
|
| Rate for Payer: Kentucky WC Medicaid |
$49.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$374.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$337.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$50.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$402.16
|
| Rate for Payer: Ohio Health Group HMO |
$342.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$365.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$397.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$315.33
|
| Rate for Payer: PHCS Commercial |
$438.72
|
| Rate for Payer: United Healthcare All Payer |
$402.16
|
|
|
S P CONSULT PREP AT SOMC (T
|
Facility
|
IP
|
$457.00
|
|
|
Service Code
|
HCPCS 88323
|
| Hospital Charge Code |
300T2035
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$137.10 |
| Max. Negotiated Rate |
$438.72 |
| Rate for Payer: Aetna Commercial |
$351.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$366.97
|
| Rate for Payer: Cash Price |
$228.50
|
| Rate for Payer: Cigna Commercial |
$379.31
|
| Rate for Payer: First Health Commercial |
$434.15
|
| Rate for Payer: Humana Commercial |
$388.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$374.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$337.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$402.16
|
| Rate for Payer: Ohio Health Group HMO |
$342.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$365.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$397.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$315.33
|
| Rate for Payer: PHCS Commercial |
$438.72
|
| Rate for Payer: United Healthcare All Payer |
$402.16
|
|
|
SPEC COLL SNF/LAB COVID-19
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
HCPCS G2024
|
| Hospital Charge Code |
30001835
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.90 |
| Max. Negotiated Rate |
$41.28 |
| Rate for Payer: Aetna Commercial |
$33.11
|
| Rate for Payer: Anthem Medicaid |
$14.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$34.53
|
| Rate for Payer: Cash Price |
$21.50
|
| Rate for Payer: Cigna Commercial |
$35.69
|
| Rate for Payer: First Health Commercial |
$40.85
|
| Rate for Payer: Humana Commercial |
$36.55
|
| Rate for Payer: Humana KY Medicaid |
$14.79
|
| Rate for Payer: Kentucky WC Medicaid |
$14.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$35.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$31.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$37.84
|
| Rate for Payer: Ohio Health Group HMO |
$32.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29.67
|
| Rate for Payer: PHCS Commercial |
$41.28
|
| Rate for Payer: United Healthcare All Payer |
$37.84
|
|
|
SPEC COLL SNF/LAB COVID-19
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
HCPCS G2024
|
| Hospital Charge Code |
30001835
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.90 |
| Max. Negotiated Rate |
$41.28 |
| Rate for Payer: Aetna Commercial |
$33.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$34.53
|
| Rate for Payer: Cash Price |
$21.50
|
| Rate for Payer: Cigna Commercial |
$35.69
|
| Rate for Payer: First Health Commercial |
$40.85
|
| Rate for Payer: Humana Commercial |
$36.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$35.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$31.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$37.84
|
| Rate for Payer: Ohio Health Group HMO |
$32.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29.67
|
| Rate for Payer: PHCS Commercial |
$41.28
|
| Rate for Payer: United Healthcare All Payer |
$37.84
|
|
|
SPEC EF 12/14 LS 165MM L
|
Facility
|
IP
|
$24,236.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,270.97 |
| Max. Negotiated Rate |
$23,267.10 |
| Rate for Payer: Aetna Commercial |
$18,662.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,904.52
|
| Rate for Payer: Cash Price |
$12,118.28
|
| Rate for Payer: Cigna Commercial |
$20,116.34
|
| Rate for Payer: First Health Commercial |
$23,024.73
|
| Rate for Payer: Humana Commercial |
$20,601.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,873.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,886.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,270.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,328.17
|
| Rate for Payer: Ohio Health Group HMO |
$18,177.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,389.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,085.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,723.23
|
| Rate for Payer: PHCS Commercial |
$23,267.10
|
| Rate for Payer: United Healthcare All Payer |
$21,328.17
|
|
|
SPEC EF 12/14 LS 165MM L
|
Facility
|
OP
|
$24,236.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,270.97 |
| Max. Negotiated Rate |
$23,267.10 |
| Rate for Payer: Aetna Commercial |
$18,662.15
|
| Rate for Payer: Anthem Medicaid |
$8,334.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,904.52
|
| Rate for Payer: Cash Price |
$12,118.28
|
| Rate for Payer: Cigna Commercial |
$20,116.34
|
| Rate for Payer: First Health Commercial |
$23,024.73
|
| Rate for Payer: Humana Commercial |
$20,601.08
|
| Rate for Payer: Humana KY Medicaid |
$8,334.95
|
| Rate for Payer: Kentucky WC Medicaid |
$8,419.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,873.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,886.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,270.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,502.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,328.17
|
| Rate for Payer: Ohio Health Group HMO |
$18,177.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,389.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,085.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,723.23
|
| Rate for Payer: PHCS Commercial |
$23,267.10
|
| Rate for Payer: United Healthcare All Payer |
$21,328.17
|
|
|
SPEC EF 12/14 LS 165MM M
|
Facility
|
OP
|
$24,236.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,270.97 |
| Max. Negotiated Rate |
$23,267.10 |
| Rate for Payer: Aetna Commercial |
$18,662.15
|
| Rate for Payer: Anthem Medicaid |
$8,334.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,904.52
|
| Rate for Payer: Cash Price |
$12,118.28
|
| Rate for Payer: Cigna Commercial |
$20,116.34
|
| Rate for Payer: First Health Commercial |
$23,024.73
|
| Rate for Payer: Humana Commercial |
$20,601.08
|
| Rate for Payer: Humana KY Medicaid |
$8,334.95
|
| Rate for Payer: Kentucky WC Medicaid |
$8,419.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,873.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,886.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,270.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,502.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,328.17
|
| Rate for Payer: Ohio Health Group HMO |
$18,177.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,389.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,085.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,723.23
|
| Rate for Payer: PHCS Commercial |
$23,267.10
|
| Rate for Payer: United Healthcare All Payer |
$21,328.17
|
|
|
SPEC EF 12/14 LS 165MM M
|
Facility
|
IP
|
$24,236.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,270.97 |
| Max. Negotiated Rate |
$23,267.10 |
| Rate for Payer: Aetna Commercial |
$18,662.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,904.52
|
| Rate for Payer: Cash Price |
$12,118.28
|
| Rate for Payer: Cigna Commercial |
$20,116.34
|
| Rate for Payer: First Health Commercial |
$23,024.73
|
| Rate for Payer: Humana Commercial |
$20,601.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,873.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,886.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,270.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,328.17
|
| Rate for Payer: Ohio Health Group HMO |
$18,177.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,389.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,085.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,723.23
|
| Rate for Payer: PHCS Commercial |
$23,267.10
|
| Rate for Payer: United Healthcare All Payer |
$21,328.17
|
|
|
SPEC EF 12/14 LS 165MM S
|
Facility
|
IP
|
$24,236.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,270.97 |
| Max. Negotiated Rate |
$23,267.10 |
| Rate for Payer: Aetna Commercial |
$18,662.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,904.52
|
| Rate for Payer: Cash Price |
$12,118.28
|
| Rate for Payer: Cigna Commercial |
$20,116.34
|
| Rate for Payer: First Health Commercial |
$23,024.73
|
| Rate for Payer: Humana Commercial |
$20,601.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,873.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,886.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,270.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,328.17
|
| Rate for Payer: Ohio Health Group HMO |
$18,177.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,389.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,085.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,723.23
|
| Rate for Payer: PHCS Commercial |
$23,267.10
|
| Rate for Payer: United Healthcare All Payer |
$21,328.17
|
|
|
SPEC EF 12/14 LS 165MM S
|
Facility
|
OP
|
$24,236.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,270.97 |
| Max. Negotiated Rate |
$23,267.10 |
| Rate for Payer: Aetna Commercial |
$18,662.15
|
| Rate for Payer: Anthem Medicaid |
$8,334.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,904.52
|
| Rate for Payer: Cash Price |
$12,118.28
|
| Rate for Payer: Cigna Commercial |
$20,116.34
|
| Rate for Payer: First Health Commercial |
$23,024.73
|
| Rate for Payer: Humana Commercial |
$20,601.08
|
| Rate for Payer: Humana KY Medicaid |
$8,334.95
|
| Rate for Payer: Kentucky WC Medicaid |
$8,419.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,873.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,886.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,270.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,502.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,328.17
|
| Rate for Payer: Ohio Health Group HMO |
$18,177.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,389.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,085.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,723.23
|
| Rate for Payer: PHCS Commercial |
$23,267.10
|
| Rate for Payer: United Healthcare All Payer |
$21,328.17
|
|
|
SPEC EF 12/14 LS 195MM L
|
Facility
|
IP
|
$24,236.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,270.97 |
| Max. Negotiated Rate |
$23,267.10 |
| Rate for Payer: Aetna Commercial |
$18,662.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,904.52
|
| Rate for Payer: Cash Price |
$12,118.28
|
| Rate for Payer: Cigna Commercial |
$20,116.34
|
| Rate for Payer: First Health Commercial |
$23,024.73
|
| Rate for Payer: Humana Commercial |
$20,601.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,873.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,886.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,270.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,328.17
|
| Rate for Payer: Ohio Health Group HMO |
$18,177.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,389.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,085.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,723.23
|
| Rate for Payer: PHCS Commercial |
$23,267.10
|
| Rate for Payer: United Healthcare All Payer |
$21,328.17
|
|
|
SPEC EF 12/14 LS 195MM L
|
Facility
|
OP
|
$24,236.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,270.97 |
| Max. Negotiated Rate |
$23,267.10 |
| Rate for Payer: Aetna Commercial |
$18,662.15
|
| Rate for Payer: Anthem Medicaid |
$8,334.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,904.52
|
| Rate for Payer: Cash Price |
$12,118.28
|
| Rate for Payer: Cigna Commercial |
$20,116.34
|
| Rate for Payer: First Health Commercial |
$23,024.73
|
| Rate for Payer: Humana Commercial |
$20,601.08
|
| Rate for Payer: Humana KY Medicaid |
$8,334.95
|
| Rate for Payer: Kentucky WC Medicaid |
$8,419.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,873.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,886.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,270.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,502.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,328.17
|
| Rate for Payer: Ohio Health Group HMO |
$18,177.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,389.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,085.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,723.23
|
| Rate for Payer: PHCS Commercial |
$23,267.10
|
| Rate for Payer: United Healthcare All Payer |
$21,328.17
|
|
|
SPEC EF 12/14 LS 195MM M
|
Facility
|
OP
|
$24,236.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,270.97 |
| Max. Negotiated Rate |
$23,267.10 |
| Rate for Payer: Aetna Commercial |
$18,662.15
|
| Rate for Payer: Anthem Medicaid |
$8,334.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,904.52
|
| Rate for Payer: Cash Price |
$12,118.28
|
| Rate for Payer: Cigna Commercial |
$20,116.34
|
| Rate for Payer: First Health Commercial |
$23,024.73
|
| Rate for Payer: Humana Commercial |
$20,601.08
|
| Rate for Payer: Humana KY Medicaid |
$8,334.95
|
| Rate for Payer: Kentucky WC Medicaid |
$8,419.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,873.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,886.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,270.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,502.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,328.17
|
| Rate for Payer: Ohio Health Group HMO |
$18,177.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,389.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,085.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,723.23
|
| Rate for Payer: PHCS Commercial |
$23,267.10
|
| Rate for Payer: United Healthcare All Payer |
$21,328.17
|
|
|
SPEC EF 12/14 LS 195MM M
|
Facility
|
IP
|
$24,236.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,270.97 |
| Max. Negotiated Rate |
$23,267.10 |
| Rate for Payer: Aetna Commercial |
$18,662.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,904.52
|
| Rate for Payer: Cash Price |
$12,118.28
|
| Rate for Payer: Cigna Commercial |
$20,116.34
|
| Rate for Payer: First Health Commercial |
$23,024.73
|
| Rate for Payer: Humana Commercial |
$20,601.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,873.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,886.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,270.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,328.17
|
| Rate for Payer: Ohio Health Group HMO |
$18,177.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,389.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,085.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,723.23
|
| Rate for Payer: PHCS Commercial |
$23,267.10
|
| Rate for Payer: United Healthcare All Payer |
$21,328.17
|
|
|
SPEC EF 12/14 LS 195MM S
|
Facility
|
OP
|
$24,236.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,270.97 |
| Max. Negotiated Rate |
$23,267.10 |
| Rate for Payer: Aetna Commercial |
$18,662.15
|
| Rate for Payer: Anthem Medicaid |
$8,334.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,904.52
|
| Rate for Payer: Cash Price |
$12,118.28
|
| Rate for Payer: Cigna Commercial |
$20,116.34
|
| Rate for Payer: First Health Commercial |
$23,024.73
|
| Rate for Payer: Humana Commercial |
$20,601.08
|
| Rate for Payer: Humana KY Medicaid |
$8,334.95
|
| Rate for Payer: Kentucky WC Medicaid |
$8,419.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,873.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,886.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,270.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,502.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,328.17
|
| Rate for Payer: Ohio Health Group HMO |
$18,177.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,389.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,085.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,723.23
|
| Rate for Payer: PHCS Commercial |
$23,267.10
|
| Rate for Payer: United Healthcare All Payer |
$21,328.17
|
|
|
SPEC EF 12/14 LS 195MM S
|
Facility
|
IP
|
$24,236.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,270.97 |
| Max. Negotiated Rate |
$23,267.10 |
| Rate for Payer: Aetna Commercial |
$18,662.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,904.52
|
| Rate for Payer: Cash Price |
$12,118.28
|
| Rate for Payer: Cigna Commercial |
$20,116.34
|
| Rate for Payer: First Health Commercial |
$23,024.73
|
| Rate for Payer: Humana Commercial |
$20,601.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,873.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,886.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,270.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,328.17
|
| Rate for Payer: Ohio Health Group HMO |
$18,177.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,389.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,085.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,723.23
|
| Rate for Payer: PHCS Commercial |
$23,267.10
|
| Rate for Payer: United Healthcare All Payer |
$21,328.17
|
|
|
SPEC EF 12/14 LS 225MM L
|
Facility
|
IP
|
$25,004.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,501.43 |
| Max. Negotiated Rate |
$24,004.56 |
| Rate for Payer: Aetna Commercial |
$19,253.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,503.71
|
| Rate for Payer: Cash Price |
$12,502.38
|
| Rate for Payer: Cigna Commercial |
$20,753.94
|
| Rate for Payer: First Health Commercial |
$23,754.51
|
| Rate for Payer: Humana Commercial |
$21,254.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,503.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,453.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,501.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,004.18
|
| Rate for Payer: Ohio Health Group HMO |
$18,753.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,003.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,754.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,253.28
|
| Rate for Payer: PHCS Commercial |
$24,004.56
|
| Rate for Payer: United Healthcare All Payer |
$22,004.18
|
|
|
SPEC EF 12/14 LS 225MM L
|
Facility
|
OP
|
$25,004.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,501.43 |
| Max. Negotiated Rate |
$24,004.56 |
| Rate for Payer: Aetna Commercial |
$19,253.66
|
| Rate for Payer: Anthem Medicaid |
$8,599.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,503.71
|
| Rate for Payer: Cash Price |
$12,502.38
|
| Rate for Payer: Cigna Commercial |
$20,753.94
|
| Rate for Payer: First Health Commercial |
$23,754.51
|
| Rate for Payer: Humana Commercial |
$21,254.04
|
| Rate for Payer: Humana KY Medicaid |
$8,599.13
|
| Rate for Payer: Kentucky WC Medicaid |
$8,686.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,503.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,453.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,501.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,771.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,004.18
|
| Rate for Payer: Ohio Health Group HMO |
$18,753.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,003.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,754.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,253.28
|
| Rate for Payer: PHCS Commercial |
$24,004.56
|
| Rate for Payer: United Healthcare All Payer |
$22,004.18
|
|
|
SPEC EF 12/14 LS 225MM M
|
Facility
|
IP
|
$24,236.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,270.97 |
| Max. Negotiated Rate |
$23,267.10 |
| Rate for Payer: Aetna Commercial |
$18,662.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,904.52
|
| Rate for Payer: Cash Price |
$12,118.28
|
| Rate for Payer: Cigna Commercial |
$20,116.34
|
| Rate for Payer: First Health Commercial |
$23,024.73
|
| Rate for Payer: Humana Commercial |
$20,601.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,873.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,886.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,270.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,328.17
|
| Rate for Payer: Ohio Health Group HMO |
$18,177.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,389.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,085.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,723.23
|
| Rate for Payer: PHCS Commercial |
$23,267.10
|
| Rate for Payer: United Healthcare All Payer |
$21,328.17
|
|
|
SPEC EF 12/14 LS 225MM M
|
Facility
|
OP
|
$24,236.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,270.97 |
| Max. Negotiated Rate |
$23,267.10 |
| Rate for Payer: Aetna Commercial |
$18,662.15
|
| Rate for Payer: Anthem Medicaid |
$8,334.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,904.52
|
| Rate for Payer: Cash Price |
$12,118.28
|
| Rate for Payer: Cigna Commercial |
$20,116.34
|
| Rate for Payer: First Health Commercial |
$23,024.73
|
| Rate for Payer: Humana Commercial |
$20,601.08
|
| Rate for Payer: Humana KY Medicaid |
$8,334.95
|
| Rate for Payer: Kentucky WC Medicaid |
$8,419.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,873.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,886.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,270.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,502.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,328.17
|
| Rate for Payer: Ohio Health Group HMO |
$18,177.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,389.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,085.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,723.23
|
| Rate for Payer: PHCS Commercial |
$23,267.10
|
| Rate for Payer: United Healthcare All Payer |
$21,328.17
|
|
|
SPEC EF 12/14 LS 225MM S
|
Facility
|
IP
|
$24,236.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,270.97 |
| Max. Negotiated Rate |
$23,267.10 |
| Rate for Payer: Aetna Commercial |
$18,662.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,904.52
|
| Rate for Payer: Cash Price |
$12,118.28
|
| Rate for Payer: Cigna Commercial |
$20,116.34
|
| Rate for Payer: First Health Commercial |
$23,024.73
|
| Rate for Payer: Humana Commercial |
$20,601.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,873.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,886.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,270.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,328.17
|
| Rate for Payer: Ohio Health Group HMO |
$18,177.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,389.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,085.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,723.23
|
| Rate for Payer: PHCS Commercial |
$23,267.10
|
| Rate for Payer: United Healthcare All Payer |
$21,328.17
|
|
|
SPEC EF 12/14 LS 225MM S
|
Facility
|
OP
|
$24,236.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,270.97 |
| Max. Negotiated Rate |
$23,267.10 |
| Rate for Payer: Aetna Commercial |
$18,662.15
|
| Rate for Payer: Anthem Medicaid |
$8,334.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,904.52
|
| Rate for Payer: Cash Price |
$12,118.28
|
| Rate for Payer: Cigna Commercial |
$20,116.34
|
| Rate for Payer: First Health Commercial |
$23,024.73
|
| Rate for Payer: Humana Commercial |
$20,601.08
|
| Rate for Payer: Humana KY Medicaid |
$8,334.95
|
| Rate for Payer: Kentucky WC Medicaid |
$8,419.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,873.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,886.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,270.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,502.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,328.17
|
| Rate for Payer: Ohio Health Group HMO |
$18,177.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,389.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,085.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,723.23
|
| Rate for Payer: PHCS Commercial |
$23,267.10
|
| Rate for Payer: United Healthcare All Payer |
$21,328.17
|
|
|
SPEC EF 12/14 NR 135MM L
|
Facility
|
OP
|
$24,440.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,332.17 |
| Max. Negotiated Rate |
$23,462.94 |
| Rate for Payer: Aetna Commercial |
$18,819.23
|
| Rate for Payer: Anthem Medicaid |
$8,405.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,063.64
|
| Rate for Payer: Cash Price |
$12,220.28
|
| Rate for Payer: Cigna Commercial |
$20,285.66
|
| Rate for Payer: First Health Commercial |
$23,218.53
|
| Rate for Payer: Humana Commercial |
$20,774.48
|
| Rate for Payer: Humana KY Medicaid |
$8,405.11
|
| Rate for Payer: Kentucky WC Medicaid |
$8,490.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,041.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,037.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,332.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,573.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,507.69
|
| Rate for Payer: Ohio Health Group HMO |
$18,330.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,552.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,263.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,863.99
|
| Rate for Payer: PHCS Commercial |
$23,462.94
|
| Rate for Payer: United Healthcare All Payer |
$21,507.69
|
|
|
SPEC EF 12/14 NR 135MM L
|
Facility
|
IP
|
$24,440.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,332.17 |
| Max. Negotiated Rate |
$23,462.94 |
| Rate for Payer: Aetna Commercial |
$18,819.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,063.64
|
| Rate for Payer: Cash Price |
$12,220.28
|
| Rate for Payer: Cigna Commercial |
$20,285.66
|
| Rate for Payer: First Health Commercial |
$23,218.53
|
| Rate for Payer: Humana Commercial |
$20,774.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,041.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,037.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,332.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,507.69
|
| Rate for Payer: Ohio Health Group HMO |
$18,330.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,552.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21,263.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,863.99
|
| Rate for Payer: PHCS Commercial |
$23,462.94
|
| Rate for Payer: United Healthcare All Payer |
$21,507.69
|
|
