|
SPEC EF 12/14 NR 135MM M
|
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 M
|
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
|
|
|
SPEC EF 12/14 NR 135MM S
|
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 S
|
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
|
|
|
SPEC EF 12/14 NR 165MM 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
|
|
|
SPEC EF 12/14 NR 165MM 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 165MM M
|
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
|
|
|
SPEC EF 12/14 NR 165MM M
|
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 165MM S
|
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 165MM S
|
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
|
|
|
SPEC EF 12/14 NR 195MM 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
|
|
|
SPEC EF 12/14 NR 195MM 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 195MM M
|
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 195MM M
|
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
|
|
|
SPEC EF 12/14 NR 195MM S
|
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
|
|
|
SPEC EF 12/14 NR 195MM S
|
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 225MM 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
|
|
|
SPEC EF 12/14 NR 225MM 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 225MM M
|
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 225MM M
|
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
|
|
|
SPEC EF 12/14 NR 225MM S
|
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
|
|
|
SPEC EF 12/14 NR 225MM S
|
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 POST CENTRALIZER 16MM
|
Facility
|
IP
|
$1,513.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$453.99 |
| Max. Negotiated Rate |
$1,452.78 |
| Rate for Payer: Aetna Commercial |
$1,165.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,180.38
|
| Rate for Payer: Cash Price |
$756.66
|
| Rate for Payer: Cigna Commercial |
$1,256.05
|
| Rate for Payer: First Health Commercial |
$1,437.64
|
| Rate for Payer: Humana Commercial |
$1,286.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,240.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,116.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$453.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,331.71
|
| Rate for Payer: Ohio Health Group HMO |
$1,134.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,210.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,316.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,044.18
|
| Rate for Payer: PHCS Commercial |
$1,452.78
|
| Rate for Payer: United Healthcare All Payer |
$1,331.71
|
|
|
SPEC EF POST CENTRALIZER 16MM
|
Facility
|
OP
|
$1,513.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$453.99 |
| Max. Negotiated Rate |
$1,452.78 |
| Rate for Payer: Aetna Commercial |
$1,165.25
|
| Rate for Payer: Anthem Medicaid |
$520.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,180.38
|
| Rate for Payer: Cash Price |
$756.66
|
| Rate for Payer: Cigna Commercial |
$1,256.05
|
| Rate for Payer: First Health Commercial |
$1,437.64
|
| Rate for Payer: Humana Commercial |
$1,286.31
|
| Rate for Payer: Humana KY Medicaid |
$520.43
|
| Rate for Payer: Kentucky WC Medicaid |
$525.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,240.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,116.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$453.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$530.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,331.71
|
| Rate for Payer: Ohio Health Group HMO |
$1,134.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,210.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,316.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,044.18
|
| Rate for Payer: PHCS Commercial |
$1,452.78
|
| Rate for Payer: United Healthcare All Payer |
$1,331.71
|
|
|
SPEC EF POST CENTRALIZER 17MM
|
Facility
|
IP
|
$1,513.31
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$453.99 |
| Max. Negotiated Rate |
$1,452.78 |
| Rate for Payer: Aetna Commercial |
$1,165.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,180.38
|
| Rate for Payer: Cash Price |
$756.66
|
| Rate for Payer: Cigna Commercial |
$1,256.05
|
| Rate for Payer: First Health Commercial |
$1,437.64
|
| Rate for Payer: Humana Commercial |
$1,286.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,240.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,116.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$453.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,331.71
|
| Rate for Payer: Ohio Health Group HMO |
$1,134.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,210.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,316.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,044.18
|
| Rate for Payer: PHCS Commercial |
$1,452.78
|
| Rate for Payer: United Healthcare All Payer |
$1,331.71
|
|
