|
COLS REV F HC GLD SRF T2/T2*20
|
Facility
|
OP
|
$12,264.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,594.37 |
| Max. Negotiated Rate |
$11,773.82 |
| Rate for Payer: Aetna Commercial |
$9,443.59
|
| Rate for Payer: Anthem Medicaid |
$4,217.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,566.23
|
| Rate for Payer: Cash Price |
$6,132.20
|
| Rate for Payer: Cigna Commercial |
$10,179.45
|
| Rate for Payer: First Health Commercial |
$11,651.18
|
| Rate for Payer: Humana Commercial |
$10,424.74
|
| Rate for Payer: Humana KY Medicaid |
$4,217.73
|
| Rate for Payer: Kentucky WC Medicaid |
$4,260.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,056.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,051.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,679.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,302.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,792.67
|
| Rate for Payer: Ohio Health Group HMO |
$9,198.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,452.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,594.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,801.96
|
| Rate for Payer: PHCS Commercial |
$11,773.82
|
| Rate for Payer: United Healthcare All Payer |
$10,792.67
|
|
|
COLS REV F HC GLD SURF T2/2+*1
|
Facility
|
IP
|
$13,629.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,771.84 |
| Max. Negotiated Rate |
$13,084.32 |
| Rate for Payer: Aetna Commercial |
$10,494.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,631.01
|
| Rate for Payer: Cash Price |
$6,814.75
|
| Rate for Payer: Cigna Commercial |
$11,312.48
|
| Rate for Payer: First Health Commercial |
$12,948.02
|
| Rate for Payer: Humana Commercial |
$11,585.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,176.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,058.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,088.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,993.96
|
| Rate for Payer: Ohio Health Group HMO |
$10,222.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,725.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,771.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,225.14
|
| Rate for Payer: PHCS Commercial |
$13,084.32
|
| Rate for Payer: United Healthcare All Payer |
$11,993.96
|
|
|
COLS REV F HC GLD SURF T2/2+*1
|
Facility
|
OP
|
$13,629.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,771.84 |
| Max. Negotiated Rate |
$13,084.32 |
| Rate for Payer: Aetna Commercial |
$10,494.72
|
| Rate for Payer: Anthem Medicaid |
$4,687.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,631.01
|
| Rate for Payer: Cash Price |
$6,814.75
|
| Rate for Payer: Cigna Commercial |
$11,312.48
|
| Rate for Payer: First Health Commercial |
$12,948.02
|
| Rate for Payer: Humana Commercial |
$11,585.08
|
| Rate for Payer: Humana KY Medicaid |
$4,687.19
|
| Rate for Payer: Kentucky WC Medicaid |
$4,734.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,176.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,058.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,088.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,781.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,993.96
|
| Rate for Payer: Ohio Health Group HMO |
$10,222.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,725.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,771.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,225.14
|
| Rate for Payer: PHCS Commercial |
$13,084.32
|
| Rate for Payer: United Healthcare All Payer |
$11,993.96
|
|
|
COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH CC
|
Facility
|
IP
|
$71,549.74
|
|
|
Service Code
|
MSDRG 454
|
| Min. Negotiated Rate |
$48,551.61 |
| Max. Negotiated Rate |
$71,549.74 |
| Rate for Payer: Anthem Medicaid |
$48,551.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$51,106.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$71,549.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$68,994.40
|
| Rate for Payer: Humana KY Medicaid |
$48,551.61
|
| Rate for Payer: Humana Medicare Advantage |
$51,106.96
|
| Rate for Payer: Kentucky WC Medicaid |
$49,037.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61,328.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$49,522.64
|
|
|
COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH MCC
|
Facility
|
IP
|
$103,662.47
|
|
|
Service Code
|
MSDRG 453
|
| Min. Negotiated Rate |
$70,342.39 |
| Max. Negotiated Rate |
$103,662.47 |
| Rate for Payer: Anthem Medicaid |
$70,342.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$74,044.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$103,662.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$99,960.24
|
| Rate for Payer: Humana KY Medicaid |
$70,342.39
|
| Rate for Payer: Humana Medicare Advantage |
$74,044.62
|
| Rate for Payer: Kentucky WC Medicaid |
$71,045.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$88,853.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$71,749.24
|
|
|
COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITHOUT CC/MCC
|
Facility
|
IP
|
$53,877.26
|
|
|
Service Code
|
MSDRG 455
|
| Min. Negotiated Rate |
$36,559.57 |
| Max. Negotiated Rate |
$53,877.26 |
| Rate for Payer: Anthem Medicaid |
$36,559.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$38,483.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$53,877.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$51,953.08
|
| Rate for Payer: Humana KY Medicaid |
$36,559.57
|
| Rate for Payer: Humana Medicare Advantage |
$38,483.76
|
| Rate for Payer: Kentucky WC Medicaid |
$36,925.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46,180.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$37,290.76
|
|
|
COMBIVENT RESPIMAT INHALER 4GM
|
Facility
|
IP
|
$1,094.34
|
|
|
Service Code
|
NDC 597002402
|
| Hospital Charge Code |
25002959
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.26 |
| Max. Negotiated Rate |
$1,050.57 |
| Rate for Payer: Aetna Commercial |
$842.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$853.59
|
| Rate for Payer: Cash Price |
$547.17
|
| Rate for Payer: Cigna Commercial |
$908.30
|
| Rate for Payer: First Health Commercial |
$1,039.62
|
| Rate for Payer: Humana Commercial |
$930.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$897.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$807.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$328.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$963.02
|
| Rate for Payer: Ohio Health Group HMO |
$820.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$218.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$142.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$339.25
|
| Rate for Payer: PHCS Commercial |
$1,050.57
|
| Rate for Payer: United Healthcare All Payer |
$963.02
|
|
|
COMBIVENT RESPIMAT INHALER 4GM
|
Facility
|
OP
|
$1,094.34
|
|
|
Service Code
|
NDC 597002402
|
| Hospital Charge Code |
25002959
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.26 |
| Max. Negotiated Rate |
$1,050.57 |
| Rate for Payer: Aetna Commercial |
$842.64
|
| Rate for Payer: Anthem Medicaid |
$376.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$853.59
|
| Rate for Payer: Cash Price |
$547.17
|
| Rate for Payer: Cigna Commercial |
$908.30
|
| Rate for Payer: First Health Commercial |
$1,039.62
|
| Rate for Payer: Humana Commercial |
$930.19
|
| Rate for Payer: Humana KY Medicaid |
$376.34
|
| Rate for Payer: Kentucky WC Medicaid |
$380.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$897.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$807.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$328.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$383.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$963.02
|
| Rate for Payer: Ohio Health Group HMO |
$820.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$218.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$142.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$339.25
|
| Rate for Payer: PHCS Commercial |
$1,050.57
|
| Rate for Payer: United Healthcare All Payer |
$963.02
|
|
|
COMMON RAGWEED IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000877
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
COMMON RAGWEED IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000877
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Humana KY Medicaid |
$5.22
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Kentucky WC Medicaid |
$5.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
COMM/WORK REINTEGRATION
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
HCPCS 97537
|
| Hospital Charge Code |
44000021
|
|
Hospital Revenue Code
|
441
|
| Min. Negotiated Rate |
$11.70 |
| Max. Negotiated Rate |
$86.40 |
| Rate for Payer: Aetna Commercial |
$69.30
|
| Rate for Payer: Anthem Medicaid |
$30.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$70.20
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$74.70
|
| Rate for Payer: First Health Commercial |
$85.50
|
| Rate for Payer: Humana Commercial |
$76.50
|
| Rate for Payer: Humana KY Medicaid |
$30.95
|
| Rate for Payer: Kentucky WC Medicaid |
$31.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$73.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$66.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$31.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$79.20
|
| Rate for Payer: Ohio Health Group HMO |
$67.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27.90
|
| Rate for Payer: PHCS Commercial |
$86.40
|
| Rate for Payer: United Healthcare All Payer |
$79.20
|
|
|
COMM/WORK REINTEGRATION
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
HCPCS 97537
|
| Hospital Charge Code |
44000021
|
|
Hospital Revenue Code
|
441
|
| Min. Negotiated Rate |
$11.70 |
| Max. Negotiated Rate |
$86.40 |
| Rate for Payer: Aetna Commercial |
$69.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$70.20
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$74.70
|
| Rate for Payer: First Health Commercial |
$85.50
|
| Rate for Payer: Humana Commercial |
$76.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$73.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$66.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$79.20
|
| Rate for Payer: Ohio Health Group HMO |
$67.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27.90
|
| Rate for Payer: PHCS Commercial |
$86.40
|
| Rate for Payer: United Healthcare All Payer |
$79.20
|
|
|
COMP 25MM ART 2.5MM OFFSET
|
Facility
|
OP
|
$23,860.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,101.84 |
| Max. Negotiated Rate |
$22,905.89 |
| Rate for Payer: Aetna Commercial |
$18,372.43
|
| Rate for Payer: Anthem Medicaid |
$8,205.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
| Rate for Payer: Cash Price |
$11,930.15
|
| Rate for Payer: Cigna Commercial |
$19,804.05
|
| Rate for Payer: First Health Commercial |
$22,667.28
|
| Rate for Payer: Humana Commercial |
$20,281.26
|
| Rate for Payer: Humana KY Medicaid |
$8,205.56
|
| Rate for Payer: Kentucky WC Medicaid |
$8,289.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,370.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
| Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
| Rate for Payer: PHCS Commercial |
$22,905.89
|
| Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
|
COMP 25MM ART 2.5MM OFFSET
|
Facility
|
IP
|
$23,860.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,101.84 |
| Max. Negotiated Rate |
$22,905.89 |
| Rate for Payer: Aetna Commercial |
$18,372.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
| Rate for Payer: Cash Price |
$11,930.15
|
| Rate for Payer: Cigna Commercial |
$19,804.05
|
| Rate for Payer: First Health Commercial |
$22,667.28
|
| Rate for Payer: Humana Commercial |
$20,281.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
| Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
| Rate for Payer: PHCS Commercial |
$22,905.89
|
| Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
|
COMP 25MM ART 2.5MM OFFSET CE
|
Facility
|
OP
|
$23,860.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,101.84 |
| Max. Negotiated Rate |
$22,905.89 |
| Rate for Payer: Aetna Commercial |
$18,372.43
|
| Rate for Payer: Anthem Medicaid |
$8,205.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
| Rate for Payer: Cash Price |
$11,930.15
|
| Rate for Payer: Cigna Commercial |
$19,804.05
|
| Rate for Payer: First Health Commercial |
$22,667.28
|
| Rate for Payer: Humana Commercial |
$20,281.26
|
| Rate for Payer: Humana KY Medicaid |
$8,205.56
|
| Rate for Payer: Kentucky WC Medicaid |
$8,289.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,370.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
| Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
| Rate for Payer: PHCS Commercial |
$22,905.89
|
| Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
|
COMP 25MM ART 2.5MM OFFSET CE
|
Facility
|
IP
|
$23,860.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,101.84 |
| Max. Negotiated Rate |
$22,905.89 |
| Rate for Payer: Aetna Commercial |
$18,372.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
| Rate for Payer: Cash Price |
$11,930.15
|
| Rate for Payer: Cigna Commercial |
$19,804.05
|
| Rate for Payer: First Health Commercial |
$22,667.28
|
| Rate for Payer: Humana Commercial |
$20,281.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
| Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
| Rate for Payer: PHCS Commercial |
$22,905.89
|
| Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
|
COMP 25MM ART 3.0MM OFFSET
|
Facility
|
IP
|
$23,860.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,101.84 |
| Max. Negotiated Rate |
$22,905.89 |
| Rate for Payer: Aetna Commercial |
$18,372.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
| Rate for Payer: Cash Price |
$11,930.15
|
| Rate for Payer: Cigna Commercial |
$19,804.05
|
| Rate for Payer: First Health Commercial |
$22,667.28
|
| Rate for Payer: Humana Commercial |
$20,281.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
| Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
| Rate for Payer: PHCS Commercial |
$22,905.89
|
| Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
|
COMP 25MM ART 3.0MM OFFSET
|
Facility
|
OP
|
$23,860.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,101.84 |
| Max. Negotiated Rate |
$22,905.89 |
| Rate for Payer: Aetna Commercial |
$18,372.43
|
| Rate for Payer: Anthem Medicaid |
$8,205.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
| Rate for Payer: Cash Price |
$11,930.15
|
| Rate for Payer: Cigna Commercial |
$19,804.05
|
| Rate for Payer: First Health Commercial |
$22,667.28
|
| Rate for Payer: Humana Commercial |
$20,281.26
|
| Rate for Payer: Humana KY Medicaid |
$8,205.56
|
| Rate for Payer: Kentucky WC Medicaid |
$8,289.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,370.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
| Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
| Rate for Payer: PHCS Commercial |
$22,905.89
|
| Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
|
COMP 25MM ART 3.0MM OFFSET CE
|
Facility
|
OP
|
$23,860.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,101.84 |
| Max. Negotiated Rate |
$22,905.89 |
| Rate for Payer: Aetna Commercial |
$18,372.43
|
| Rate for Payer: Anthem Medicaid |
$8,205.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
| Rate for Payer: Cash Price |
$11,930.15
|
| Rate for Payer: Cigna Commercial |
$19,804.05
|
| Rate for Payer: First Health Commercial |
$22,667.28
|
| Rate for Payer: Humana Commercial |
$20,281.26
|
| Rate for Payer: Humana KY Medicaid |
$8,205.56
|
| Rate for Payer: Kentucky WC Medicaid |
$8,289.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,370.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
| Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
| Rate for Payer: PHCS Commercial |
$22,905.89
|
| Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
|
COMP 25MM ART 3.0MM OFFSET CE
|
Facility
|
IP
|
$23,860.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,101.84 |
| Max. Negotiated Rate |
$22,905.89 |
| Rate for Payer: Aetna Commercial |
$18,372.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
| Rate for Payer: Cash Price |
$11,930.15
|
| Rate for Payer: Cigna Commercial |
$19,804.05
|
| Rate for Payer: First Health Commercial |
$22,667.28
|
| Rate for Payer: Humana Commercial |
$20,281.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
| Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
| Rate for Payer: PHCS Commercial |
$22,905.89
|
| Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
|
COMP 25MM ART 3.5MM OFFSET
|
Facility
|
OP
|
$23,860.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,101.84 |
| Max. Negotiated Rate |
$22,905.89 |
| Rate for Payer: Aetna Commercial |
$18,372.43
|
| Rate for Payer: Anthem Medicaid |
$8,205.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
| Rate for Payer: Cash Price |
$11,930.15
|
| Rate for Payer: Cigna Commercial |
$19,804.05
|
| Rate for Payer: First Health Commercial |
$22,667.28
|
| Rate for Payer: Humana Commercial |
$20,281.26
|
| Rate for Payer: Humana KY Medicaid |
$8,205.56
|
| Rate for Payer: Kentucky WC Medicaid |
$8,289.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,370.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
| Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
| Rate for Payer: PHCS Commercial |
$22,905.89
|
| Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
|
COMP 25MM ART 3.5MM OFFSET
|
Facility
|
IP
|
$23,860.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,101.84 |
| Max. Negotiated Rate |
$22,905.89 |
| Rate for Payer: Aetna Commercial |
$18,372.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
| Rate for Payer: Cash Price |
$11,930.15
|
| Rate for Payer: Cigna Commercial |
$19,804.05
|
| Rate for Payer: First Health Commercial |
$22,667.28
|
| Rate for Payer: Humana Commercial |
$20,281.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
| Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
| Rate for Payer: PHCS Commercial |
$22,905.89
|
| Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
|
COMP 25MM ART 3.5MM OFFSET CE
|
Facility
|
IP
|
$23,860.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,101.84 |
| Max. Negotiated Rate |
$22,905.89 |
| Rate for Payer: Aetna Commercial |
$18,372.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
| Rate for Payer: Cash Price |
$11,930.15
|
| Rate for Payer: Cigna Commercial |
$19,804.05
|
| Rate for Payer: First Health Commercial |
$22,667.28
|
| Rate for Payer: Humana Commercial |
$20,281.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
| Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
| Rate for Payer: PHCS Commercial |
$22,905.89
|
| Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
|
COMP 25MM ART 3.5MM OFFSET CE
|
Facility
|
OP
|
$23,860.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,101.84 |
| Max. Negotiated Rate |
$22,905.89 |
| Rate for Payer: Aetna Commercial |
$18,372.43
|
| Rate for Payer: Anthem Medicaid |
$8,205.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
| Rate for Payer: Cash Price |
$11,930.15
|
| Rate for Payer: Cigna Commercial |
$19,804.05
|
| Rate for Payer: First Health Commercial |
$22,667.28
|
| Rate for Payer: Humana Commercial |
$20,281.26
|
| Rate for Payer: Humana KY Medicaid |
$8,205.56
|
| Rate for Payer: Kentucky WC Medicaid |
$8,289.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,370.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
| Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
| Rate for Payer: PHCS Commercial |
$22,905.89
|
| Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
|
COMP 25MM ART 4.0MM OFFSET
|
Facility
|
IP
|
$23,860.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,101.84 |
| Max. Negotiated Rate |
$22,905.89 |
| Rate for Payer: Aetna Commercial |
$18,372.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,611.03
|
| Rate for Payer: Cash Price |
$11,930.15
|
| Rate for Payer: Cigna Commercial |
$19,804.05
|
| Rate for Payer: First Health Commercial |
$22,667.28
|
| Rate for Payer: Humana Commercial |
$20,281.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,565.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,608.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,158.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,997.06
|
| Rate for Payer: Ohio Health Group HMO |
$17,895.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,772.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,396.69
|
| Rate for Payer: PHCS Commercial |
$22,905.89
|
| Rate for Payer: United Healthcare All Payer |
$20,997.06
|
|
