|
SPEC EF POST CENTRALIZER 17MM
|
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 19MM
|
Facility
|
OP
|
$1,745.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$523.72 |
| Max. Negotiated Rate |
$1,675.91 |
| Rate for Payer: Aetna Commercial |
$1,344.22
|
| Rate for Payer: Anthem Medicaid |
$600.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,361.68
|
| Rate for Payer: Cash Price |
$872.87
|
| Rate for Payer: Cigna Commercial |
$1,448.96
|
| Rate for Payer: First Health Commercial |
$1,658.45
|
| Rate for Payer: Humana Commercial |
$1,483.88
|
| Rate for Payer: Humana KY Medicaid |
$600.36
|
| Rate for Payer: Kentucky WC Medicaid |
$606.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,431.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,288.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$523.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$612.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,536.25
|
| Rate for Payer: Ohio Health Group HMO |
$1,309.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,396.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,518.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,204.56
|
| Rate for Payer: PHCS Commercial |
$1,675.91
|
| Rate for Payer: United Healthcare All Payer |
$1,536.25
|
|
|
SPEC EF POST CENTRALIZER 19MM
|
Facility
|
IP
|
$1,745.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$523.72 |
| Max. Negotiated Rate |
$1,675.91 |
| Rate for Payer: Aetna Commercial |
$1,344.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,361.68
|
| Rate for Payer: Cash Price |
$872.87
|
| Rate for Payer: Cigna Commercial |
$1,448.96
|
| Rate for Payer: First Health Commercial |
$1,658.45
|
| Rate for Payer: Humana Commercial |
$1,483.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,431.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,288.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$523.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,536.25
|
| Rate for Payer: Ohio Health Group HMO |
$1,309.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,396.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,518.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,204.56
|
| Rate for Payer: PHCS Commercial |
$1,675.91
|
| Rate for Payer: United Healthcare All Payer |
$1,536.25
|
|
|
SPEC EF POST CENTRALIZER 20MM
|
Facility
|
IP
|
$1,745.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$523.72 |
| Max. Negotiated Rate |
$1,675.91 |
| Rate for Payer: Aetna Commercial |
$1,344.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,361.68
|
| Rate for Payer: Cash Price |
$872.87
|
| Rate for Payer: Cigna Commercial |
$1,448.96
|
| Rate for Payer: First Health Commercial |
$1,658.45
|
| Rate for Payer: Humana Commercial |
$1,483.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,431.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,288.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$523.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,536.25
|
| Rate for Payer: Ohio Health Group HMO |
$1,309.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,396.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,518.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,204.56
|
| Rate for Payer: PHCS Commercial |
$1,675.91
|
| Rate for Payer: United Healthcare All Payer |
$1,536.25
|
|
|
SPEC EF POST CENTRALIZER 20MM
|
Facility
|
OP
|
$1,745.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$523.72 |
| Max. Negotiated Rate |
$1,675.91 |
| Rate for Payer: Aetna Commercial |
$1,344.22
|
| Rate for Payer: Anthem Medicaid |
$600.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,361.68
|
| Rate for Payer: Cash Price |
$872.87
|
| Rate for Payer: Cigna Commercial |
$1,448.96
|
| Rate for Payer: First Health Commercial |
$1,658.45
|
| Rate for Payer: Humana Commercial |
$1,483.88
|
| Rate for Payer: Humana KY Medicaid |
$600.36
|
| Rate for Payer: Kentucky WC Medicaid |
$606.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,431.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,288.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$523.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$612.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,536.25
|
| Rate for Payer: Ohio Health Group HMO |
$1,309.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,396.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,518.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,204.56
|
| Rate for Payer: PHCS Commercial |
$1,675.91
|
| Rate for Payer: United Healthcare All Payer |
$1,536.25
|
|
|
SPEC EF POST CENTRALIZER 21MM
|
Facility
|
IP
|
$1,745.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$523.72 |
| Max. Negotiated Rate |
$1,675.91 |
| Rate for Payer: Aetna Commercial |
$1,344.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,361.68
|
| Rate for Payer: Cash Price |
$872.87
|
| Rate for Payer: Cigna Commercial |
$1,448.96
|
| Rate for Payer: First Health Commercial |
$1,658.45
|
| Rate for Payer: Humana Commercial |
$1,483.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,431.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,288.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$523.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,536.25
|
| Rate for Payer: Ohio Health Group HMO |
$1,309.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,396.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,518.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,204.56
|
| Rate for Payer: PHCS Commercial |
$1,675.91
|
| Rate for Payer: United Healthcare All Payer |
$1,536.25
|
|
|
SPEC EF POST CENTRALIZER 21MM
|
Facility
|
OP
|
$1,745.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$523.72 |
| Max. Negotiated Rate |
$1,675.91 |
| Rate for Payer: Aetna Commercial |
$1,344.22
|
| Rate for Payer: Anthem Medicaid |
$600.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,361.68
|
| Rate for Payer: Cash Price |
$872.87
|
| Rate for Payer: Cigna Commercial |
$1,448.96
|
| Rate for Payer: First Health Commercial |
$1,658.45
|
| Rate for Payer: Humana Commercial |
$1,483.88
|
| Rate for Payer: Humana KY Medicaid |
$600.36
|
| Rate for Payer: Kentucky WC Medicaid |
$606.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,431.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,288.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$523.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$612.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,536.25
|
| Rate for Payer: Ohio Health Group HMO |
$1,309.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,396.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,518.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,204.56
|
| Rate for Payer: PHCS Commercial |
$1,675.91
|
| Rate for Payer: United Healthcare All Payer |
$1,536.25
|
|
|
SPEC EF PRI HO 12/14 SZ 1
|
Facility
|
OP
|
$17,524.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,257.22 |
| Max. Negotiated Rate |
$16,823.12 |
| Rate for Payer: Aetna Commercial |
$13,493.54
|
| Rate for Payer: Anthem Medicaid |
$6,026.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,668.78
|
| Rate for Payer: Cash Price |
$8,762.04
|
| Rate for Payer: Cigna Commercial |
$14,544.99
|
| Rate for Payer: First Health Commercial |
$16,647.88
|
| Rate for Payer: Humana Commercial |
$14,895.47
|
| Rate for Payer: Humana KY Medicaid |
$6,026.53
|
| Rate for Payer: Kentucky WC Medicaid |
$6,087.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,369.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,932.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,257.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,147.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,421.19
|
| Rate for Payer: Ohio Health Group HMO |
$13,143.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,019.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,245.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,091.62
|
| Rate for Payer: PHCS Commercial |
$16,823.12
|
| Rate for Payer: United Healthcare All Payer |
$15,421.19
|
|
|
SPEC EF PRI HO 12/14 SZ 1
|
Facility
|
IP
|
$17,524.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,257.22 |
| Max. Negotiated Rate |
$16,823.12 |
| Rate for Payer: Aetna Commercial |
$13,493.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,668.78
|
| Rate for Payer: Cash Price |
$8,762.04
|
| Rate for Payer: Cigna Commercial |
$14,544.99
|
| Rate for Payer: First Health Commercial |
$16,647.88
|
| Rate for Payer: Humana Commercial |
$14,895.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,369.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,932.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,257.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,421.19
|
| Rate for Payer: Ohio Health Group HMO |
$13,143.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,019.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,245.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,091.62
|
| Rate for Payer: PHCS Commercial |
$16,823.12
|
| Rate for Payer: United Healthcare All Payer |
$15,421.19
|
|
|
SPEC EF PRI HO 12/14 SZ 2
|
Facility
|
IP
|
$17,524.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,257.22 |
| Max. Negotiated Rate |
$16,823.12 |
| Rate for Payer: Aetna Commercial |
$13,493.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,668.78
|
| Rate for Payer: Cash Price |
$8,762.04
|
| Rate for Payer: Cigna Commercial |
$14,544.99
|
| Rate for Payer: First Health Commercial |
$16,647.88
|
| Rate for Payer: Humana Commercial |
$14,895.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,369.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,932.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,257.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,421.19
|
| Rate for Payer: Ohio Health Group HMO |
$13,143.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,019.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,245.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,091.62
|
| Rate for Payer: PHCS Commercial |
$16,823.12
|
| Rate for Payer: United Healthcare All Payer |
$15,421.19
|
|
|
SPEC EF PRI HO 12/14 SZ 2
|
Facility
|
OP
|
$17,524.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,257.22 |
| Max. Negotiated Rate |
$16,823.12 |
| Rate for Payer: Aetna Commercial |
$13,493.54
|
| Rate for Payer: Anthem Medicaid |
$6,026.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,668.78
|
| Rate for Payer: Cash Price |
$8,762.04
|
| Rate for Payer: Cigna Commercial |
$14,544.99
|
| Rate for Payer: First Health Commercial |
$16,647.88
|
| Rate for Payer: Humana Commercial |
$14,895.47
|
| Rate for Payer: Humana KY Medicaid |
$6,026.53
|
| Rate for Payer: Kentucky WC Medicaid |
$6,087.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,369.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,932.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,257.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,147.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,421.19
|
| Rate for Payer: Ohio Health Group HMO |
$13,143.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,019.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,245.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,091.62
|
| Rate for Payer: PHCS Commercial |
$16,823.12
|
| Rate for Payer: United Healthcare All Payer |
$15,421.19
|
|
|
SPEC EF PRI HO 12/14 SZ 3
|
Facility
|
OP
|
$17,524.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,257.22 |
| Max. Negotiated Rate |
$16,823.12 |
| Rate for Payer: Aetna Commercial |
$13,493.54
|
| Rate for Payer: Anthem Medicaid |
$6,026.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,668.78
|
| Rate for Payer: Cash Price |
$8,762.04
|
| Rate for Payer: Cigna Commercial |
$14,544.99
|
| Rate for Payer: First Health Commercial |
$16,647.88
|
| Rate for Payer: Humana Commercial |
$14,895.47
|
| Rate for Payer: Humana KY Medicaid |
$6,026.53
|
| Rate for Payer: Kentucky WC Medicaid |
$6,087.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,369.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,932.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,257.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,147.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,421.19
|
| Rate for Payer: Ohio Health Group HMO |
$13,143.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,019.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,245.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,091.62
|
| Rate for Payer: PHCS Commercial |
$16,823.12
|
| Rate for Payer: United Healthcare All Payer |
$15,421.19
|
|
|
SPEC EF PRI HO 12/14 SZ 3
|
Facility
|
IP
|
$17,524.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,257.22 |
| Max. Negotiated Rate |
$16,823.12 |
| Rate for Payer: Aetna Commercial |
$13,493.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,668.78
|
| Rate for Payer: Cash Price |
$8,762.04
|
| Rate for Payer: Cigna Commercial |
$14,544.99
|
| Rate for Payer: First Health Commercial |
$16,647.88
|
| Rate for Payer: Humana Commercial |
$14,895.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,369.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,932.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,257.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,421.19
|
| Rate for Payer: Ohio Health Group HMO |
$13,143.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,019.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,245.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,091.62
|
| Rate for Payer: PHCS Commercial |
$16,823.12
|
| Rate for Payer: United Healthcare All Payer |
$15,421.19
|
|
|
SPEC EF PRI HO 12/14 SZ 4
|
Facility
|
OP
|
$17,524.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,257.22 |
| Max. Negotiated Rate |
$16,823.12 |
| Rate for Payer: Aetna Commercial |
$13,493.54
|
| Rate for Payer: Anthem Medicaid |
$6,026.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,668.78
|
| Rate for Payer: Cash Price |
$8,762.04
|
| Rate for Payer: Cigna Commercial |
$14,544.99
|
| Rate for Payer: First Health Commercial |
$16,647.88
|
| Rate for Payer: Humana Commercial |
$14,895.47
|
| Rate for Payer: Humana KY Medicaid |
$6,026.53
|
| Rate for Payer: Kentucky WC Medicaid |
$6,087.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,369.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,932.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,257.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,147.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,421.19
|
| Rate for Payer: Ohio Health Group HMO |
$13,143.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,019.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,245.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,091.62
|
| Rate for Payer: PHCS Commercial |
$16,823.12
|
| Rate for Payer: United Healthcare All Payer |
$15,421.19
|
|
|
SPEC EF PRI HO 12/14 SZ 4
|
Facility
|
IP
|
$17,524.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,257.22 |
| Max. Negotiated Rate |
$16,823.12 |
| Rate for Payer: Aetna Commercial |
$13,493.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,668.78
|
| Rate for Payer: Cash Price |
$8,762.04
|
| Rate for Payer: Cigna Commercial |
$14,544.99
|
| Rate for Payer: First Health Commercial |
$16,647.88
|
| Rate for Payer: Humana Commercial |
$14,895.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,369.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,932.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,257.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,421.19
|
| Rate for Payer: Ohio Health Group HMO |
$13,143.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,019.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,245.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,091.62
|
| Rate for Payer: PHCS Commercial |
$16,823.12
|
| Rate for Payer: United Healthcare All Payer |
$15,421.19
|
|
|
SPEC EF PRI HO 12/14 SZ 5
|
Facility
|
IP
|
$17,524.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,257.22 |
| Max. Negotiated Rate |
$16,823.12 |
| Rate for Payer: Aetna Commercial |
$13,493.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,668.78
|
| Rate for Payer: Cash Price |
$8,762.04
|
| Rate for Payer: Cigna Commercial |
$14,544.99
|
| Rate for Payer: First Health Commercial |
$16,647.88
|
| Rate for Payer: Humana Commercial |
$14,895.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,369.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,932.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,257.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,421.19
|
| Rate for Payer: Ohio Health Group HMO |
$13,143.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,019.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,245.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,091.62
|
| Rate for Payer: PHCS Commercial |
$16,823.12
|
| Rate for Payer: United Healthcare All Payer |
$15,421.19
|
|
|
SPEC EF PRI HO 12/14 SZ 5
|
Facility
|
OP
|
$17,524.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,257.22 |
| Max. Negotiated Rate |
$16,823.12 |
| Rate for Payer: Aetna Commercial |
$13,493.54
|
| Rate for Payer: Anthem Medicaid |
$6,026.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,668.78
|
| Rate for Payer: Cash Price |
$8,762.04
|
| Rate for Payer: Cigna Commercial |
$14,544.99
|
| Rate for Payer: First Health Commercial |
$16,647.88
|
| Rate for Payer: Humana Commercial |
$14,895.47
|
| Rate for Payer: Humana KY Medicaid |
$6,026.53
|
| Rate for Payer: Kentucky WC Medicaid |
$6,087.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,369.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,932.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,257.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,147.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,421.19
|
| Rate for Payer: Ohio Health Group HMO |
$13,143.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,019.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,245.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,091.62
|
| Rate for Payer: PHCS Commercial |
$16,823.12
|
| Rate for Payer: United Healthcare All Payer |
$15,421.19
|
|
|
SPEC EF PRI SO 12/14 SZ 1
|
Facility
|
IP
|
$17,524.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,257.22 |
| Max. Negotiated Rate |
$16,823.12 |
| Rate for Payer: Aetna Commercial |
$13,493.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,668.78
|
| Rate for Payer: Cash Price |
$8,762.04
|
| Rate for Payer: Cigna Commercial |
$14,544.99
|
| Rate for Payer: First Health Commercial |
$16,647.88
|
| Rate for Payer: Humana Commercial |
$14,895.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,369.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,932.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,257.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,421.19
|
| Rate for Payer: Ohio Health Group HMO |
$13,143.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,019.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,245.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,091.62
|
| Rate for Payer: PHCS Commercial |
$16,823.12
|
| Rate for Payer: United Healthcare All Payer |
$15,421.19
|
|
|
SPEC EF PRI SO 12/14 SZ 1
|
Facility
|
OP
|
$17,524.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,257.22 |
| Max. Negotiated Rate |
$16,823.12 |
| Rate for Payer: Aetna Commercial |
$13,493.54
|
| Rate for Payer: Anthem Medicaid |
$6,026.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,668.78
|
| Rate for Payer: Cash Price |
$8,762.04
|
| Rate for Payer: Cigna Commercial |
$14,544.99
|
| Rate for Payer: First Health Commercial |
$16,647.88
|
| Rate for Payer: Humana Commercial |
$14,895.47
|
| Rate for Payer: Humana KY Medicaid |
$6,026.53
|
| Rate for Payer: Kentucky WC Medicaid |
$6,087.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,369.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,932.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,257.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,147.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,421.19
|
| Rate for Payer: Ohio Health Group HMO |
$13,143.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,019.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,245.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,091.62
|
| Rate for Payer: PHCS Commercial |
$16,823.12
|
| Rate for Payer: United Healthcare All Payer |
$15,421.19
|
|
|
SPEC EF PRI SO 12/14 SZ 2
|
Facility
|
IP
|
$17,524.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,257.22 |
| Max. Negotiated Rate |
$16,823.12 |
| Rate for Payer: Aetna Commercial |
$13,493.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,668.78
|
| Rate for Payer: Cash Price |
$8,762.04
|
| Rate for Payer: Cigna Commercial |
$14,544.99
|
| Rate for Payer: First Health Commercial |
$16,647.88
|
| Rate for Payer: Humana Commercial |
$14,895.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,369.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,932.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,257.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,421.19
|
| Rate for Payer: Ohio Health Group HMO |
$13,143.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,019.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,245.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,091.62
|
| Rate for Payer: PHCS Commercial |
$16,823.12
|
| Rate for Payer: United Healthcare All Payer |
$15,421.19
|
|
|
SPEC EF PRI SO 12/14 SZ 2
|
Facility
|
OP
|
$17,524.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,257.22 |
| Max. Negotiated Rate |
$16,823.12 |
| Rate for Payer: Aetna Commercial |
$13,493.54
|
| Rate for Payer: Anthem Medicaid |
$6,026.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,668.78
|
| Rate for Payer: Cash Price |
$8,762.04
|
| Rate for Payer: Cigna Commercial |
$14,544.99
|
| Rate for Payer: First Health Commercial |
$16,647.88
|
| Rate for Payer: Humana Commercial |
$14,895.47
|
| Rate for Payer: Humana KY Medicaid |
$6,026.53
|
| Rate for Payer: Kentucky WC Medicaid |
$6,087.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,369.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,932.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,257.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,147.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,421.19
|
| Rate for Payer: Ohio Health Group HMO |
$13,143.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,019.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,245.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,091.62
|
| Rate for Payer: PHCS Commercial |
$16,823.12
|
| Rate for Payer: United Healthcare All Payer |
$15,421.19
|
|
|
SPEC EF PRI SO 12/14 SZ 3
|
Facility
|
OP
|
$17,524.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,257.22 |
| Max. Negotiated Rate |
$16,823.12 |
| Rate for Payer: Aetna Commercial |
$13,493.54
|
| Rate for Payer: Anthem Medicaid |
$6,026.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,668.78
|
| Rate for Payer: Cash Price |
$8,762.04
|
| Rate for Payer: Cigna Commercial |
$14,544.99
|
| Rate for Payer: First Health Commercial |
$16,647.88
|
| Rate for Payer: Humana Commercial |
$14,895.47
|
| Rate for Payer: Humana KY Medicaid |
$6,026.53
|
| Rate for Payer: Kentucky WC Medicaid |
$6,087.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,369.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,932.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,257.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,147.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,421.19
|
| Rate for Payer: Ohio Health Group HMO |
$13,143.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,019.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,245.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,091.62
|
| Rate for Payer: PHCS Commercial |
$16,823.12
|
| Rate for Payer: United Healthcare All Payer |
$15,421.19
|
|
|
SPEC EF PRI SO 12/14 SZ 3
|
Facility
|
IP
|
$17,524.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,257.22 |
| Max. Negotiated Rate |
$16,823.12 |
| Rate for Payer: Aetna Commercial |
$13,493.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,668.78
|
| Rate for Payer: Cash Price |
$8,762.04
|
| Rate for Payer: Cigna Commercial |
$14,544.99
|
| Rate for Payer: First Health Commercial |
$16,647.88
|
| Rate for Payer: Humana Commercial |
$14,895.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,369.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,932.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,257.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,421.19
|
| Rate for Payer: Ohio Health Group HMO |
$13,143.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,019.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,245.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,091.62
|
| Rate for Payer: PHCS Commercial |
$16,823.12
|
| Rate for Payer: United Healthcare All Payer |
$15,421.19
|
|
|
SPEC EF PRI SO 12/14 SZ 4
|
Facility
|
IP
|
$17,524.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,257.22 |
| Max. Negotiated Rate |
$16,823.12 |
| Rate for Payer: Aetna Commercial |
$13,493.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,668.78
|
| Rate for Payer: Cash Price |
$8,762.04
|
| Rate for Payer: Cigna Commercial |
$14,544.99
|
| Rate for Payer: First Health Commercial |
$16,647.88
|
| Rate for Payer: Humana Commercial |
$14,895.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,369.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,932.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,257.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,421.19
|
| Rate for Payer: Ohio Health Group HMO |
$13,143.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,019.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,245.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,091.62
|
| Rate for Payer: PHCS Commercial |
$16,823.12
|
| Rate for Payer: United Healthcare All Payer |
$15,421.19
|
|
|
SPEC EF PRI SO 12/14 SZ 4
|
Facility
|
OP
|
$17,524.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,257.22 |
| Max. Negotiated Rate |
$16,823.12 |
| Rate for Payer: Aetna Commercial |
$13,493.54
|
| Rate for Payer: Anthem Medicaid |
$6,026.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,668.78
|
| Rate for Payer: Cash Price |
$8,762.04
|
| Rate for Payer: Cigna Commercial |
$14,544.99
|
| Rate for Payer: First Health Commercial |
$16,647.88
|
| Rate for Payer: Humana Commercial |
$14,895.47
|
| Rate for Payer: Humana KY Medicaid |
$6,026.53
|
| Rate for Payer: Kentucky WC Medicaid |
$6,087.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,369.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,932.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,257.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,147.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,421.19
|
| Rate for Payer: Ohio Health Group HMO |
$13,143.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,019.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,245.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,091.62
|
| Rate for Payer: PHCS Commercial |
$16,823.12
|
| Rate for Payer: United Healthcare All Payer |
$15,421.19
|
|
