|
COCR 12/14 FEM HD 22 +4
|
Facility
|
OP
|
$4,684.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,405.28 |
| Max. Negotiated Rate |
$4,496.88 |
| Rate for Payer: Aetna Commercial |
$3,606.87
|
| Rate for Payer: Anthem Medicaid |
$1,610.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,653.72
|
| Rate for Payer: Cash Price |
$2,342.12
|
| Rate for Payer: Cigna Commercial |
$3,887.93
|
| Rate for Payer: First Health Commercial |
$4,450.04
|
| Rate for Payer: Humana Commercial |
$3,981.61
|
| Rate for Payer: Humana KY Medicaid |
$1,610.91
|
| Rate for Payer: Kentucky WC Medicaid |
$1,627.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,841.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,456.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,405.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,643.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,122.14
|
| Rate for Payer: Ohio Health Group HMO |
$3,513.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,747.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,075.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,232.13
|
| Rate for Payer: PHCS Commercial |
$4,496.88
|
| Rate for Payer: United Healthcare All Payer |
$4,122.14
|
|
|
COCR 12/14 FEM HD 22 +8
|
Facility
|
OP
|
$4,681.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,404.58 |
| Max. Negotiated Rate |
$4,494.64 |
| Rate for Payer: Aetna Commercial |
$3,605.08
|
| Rate for Payer: Anthem Medicaid |
$1,610.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,651.90
|
| Rate for Payer: Cash Price |
$2,340.96
|
| Rate for Payer: Cigna Commercial |
$3,885.99
|
| Rate for Payer: First Health Commercial |
$4,447.82
|
| Rate for Payer: Humana Commercial |
$3,979.63
|
| Rate for Payer: Humana KY Medicaid |
$1,610.11
|
| Rate for Payer: Kentucky WC Medicaid |
$1,626.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,839.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,455.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,404.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,642.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,120.09
|
| Rate for Payer: Ohio Health Group HMO |
$3,511.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,745.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,073.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,230.52
|
| Rate for Payer: PHCS Commercial |
$4,494.64
|
| Rate for Payer: United Healthcare All Payer |
$4,120.09
|
|
|
COCR 12/14 FEM HD 22 +8
|
Facility
|
IP
|
$4,681.92
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,404.58 |
| Max. Negotiated Rate |
$4,494.64 |
| Rate for Payer: Aetna Commercial |
$3,605.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,651.90
|
| Rate for Payer: Cash Price |
$2,340.96
|
| Rate for Payer: Cigna Commercial |
$3,885.99
|
| Rate for Payer: First Health Commercial |
$4,447.82
|
| Rate for Payer: Humana Commercial |
$3,979.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,839.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,455.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,404.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,120.09
|
| Rate for Payer: Ohio Health Group HMO |
$3,511.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,745.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,073.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,230.52
|
| Rate for Payer: PHCS Commercial |
$4,494.64
|
| Rate for Payer: United Healthcare All Payer |
$4,120.09
|
|
|
COCR 12/14 FEM HD 26 +0
|
Facility
|
OP
|
$6,701.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,010.38 |
| Max. Negotiated Rate |
$6,433.23 |
| Rate for Payer: Aetna Commercial |
$5,159.99
|
| Rate for Payer: Anthem Medicaid |
$2,304.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,227.00
|
| Rate for Payer: Cash Price |
$3,350.64
|
| Rate for Payer: Cigna Commercial |
$5,562.06
|
| Rate for Payer: First Health Commercial |
$6,366.22
|
| Rate for Payer: Humana Commercial |
$5,696.09
|
| Rate for Payer: Humana KY Medicaid |
$2,304.57
|
| Rate for Payer: Kentucky WC Medicaid |
$2,328.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,495.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,945.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,010.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,350.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,897.13
|
| Rate for Payer: Ohio Health Group HMO |
$5,025.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,361.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,830.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,623.88
|
| Rate for Payer: PHCS Commercial |
$6,433.23
|
| Rate for Payer: United Healthcare All Payer |
$5,897.13
|
|
|
COCR 12/14 FEM HD 26 +0
|
Facility
|
IP
|
$6,701.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,010.38 |
| Max. Negotiated Rate |
$6,433.23 |
| Rate for Payer: Aetna Commercial |
$5,159.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,227.00
|
| Rate for Payer: Cash Price |
$3,350.64
|
| Rate for Payer: Cigna Commercial |
$5,562.06
|
| Rate for Payer: First Health Commercial |
$6,366.22
|
| Rate for Payer: Humana Commercial |
$5,696.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,495.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,945.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,010.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,897.13
|
| Rate for Payer: Ohio Health Group HMO |
$5,025.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,361.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,830.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,623.88
|
| Rate for Payer: PHCS Commercial |
$6,433.23
|
| Rate for Payer: United Healthcare All Payer |
$5,897.13
|
|
|
COCR 12/14 FEM HD 26 +12
|
Facility
|
IP
|
$6,701.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,010.38 |
| Max. Negotiated Rate |
$6,433.23 |
| Rate for Payer: Aetna Commercial |
$5,159.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,227.00
|
| Rate for Payer: Cash Price |
$3,350.64
|
| Rate for Payer: Cigna Commercial |
$5,562.06
|
| Rate for Payer: First Health Commercial |
$6,366.22
|
| Rate for Payer: Humana Commercial |
$5,696.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,495.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,945.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,010.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,897.13
|
| Rate for Payer: Ohio Health Group HMO |
$5,025.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,361.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,830.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,623.88
|
| Rate for Payer: PHCS Commercial |
$6,433.23
|
| Rate for Payer: United Healthcare All Payer |
$5,897.13
|
|
|
COCR 12/14 FEM HD 26 +12
|
Facility
|
OP
|
$6,701.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,010.38 |
| Max. Negotiated Rate |
$6,433.23 |
| Rate for Payer: Aetna Commercial |
$5,159.99
|
| Rate for Payer: Anthem Medicaid |
$2,304.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,227.00
|
| Rate for Payer: Cash Price |
$3,350.64
|
| Rate for Payer: Cigna Commercial |
$5,562.06
|
| Rate for Payer: First Health Commercial |
$6,366.22
|
| Rate for Payer: Humana Commercial |
$5,696.09
|
| Rate for Payer: Humana KY Medicaid |
$2,304.57
|
| Rate for Payer: Kentucky WC Medicaid |
$2,328.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,495.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,945.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,010.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,350.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,897.13
|
| Rate for Payer: Ohio Health Group HMO |
$5,025.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,361.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,830.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,623.88
|
| Rate for Payer: PHCS Commercial |
$6,433.23
|
| Rate for Payer: United Healthcare All Payer |
$5,897.13
|
|
|
COCR 12/14 FEM HD 26 +4
|
Facility
|
IP
|
$6,701.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,010.38 |
| Max. Negotiated Rate |
$6,433.23 |
| Rate for Payer: Aetna Commercial |
$5,159.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,227.00
|
| Rate for Payer: Cash Price |
$3,350.64
|
| Rate for Payer: Cigna Commercial |
$5,562.06
|
| Rate for Payer: First Health Commercial |
$6,366.22
|
| Rate for Payer: Humana Commercial |
$5,696.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,495.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,945.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,010.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,897.13
|
| Rate for Payer: Ohio Health Group HMO |
$5,025.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,361.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,830.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,623.88
|
| Rate for Payer: PHCS Commercial |
$6,433.23
|
| Rate for Payer: United Healthcare All Payer |
$5,897.13
|
|
|
COCR 12/14 FEM HD 26 +4
|
Facility
|
OP
|
$6,701.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,010.38 |
| Max. Negotiated Rate |
$6,433.23 |
| Rate for Payer: Aetna Commercial |
$5,159.99
|
| Rate for Payer: Anthem Medicaid |
$2,304.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,227.00
|
| Rate for Payer: Cash Price |
$3,350.64
|
| Rate for Payer: Cigna Commercial |
$5,562.06
|
| Rate for Payer: First Health Commercial |
$6,366.22
|
| Rate for Payer: Humana Commercial |
$5,696.09
|
| Rate for Payer: Humana KY Medicaid |
$2,304.57
|
| Rate for Payer: Kentucky WC Medicaid |
$2,328.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,495.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,945.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,010.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,350.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,897.13
|
| Rate for Payer: Ohio Health Group HMO |
$5,025.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,361.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,830.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,623.88
|
| Rate for Payer: PHCS Commercial |
$6,433.23
|
| Rate for Payer: United Healthcare All Payer |
$5,897.13
|
|
|
COCR 12/14 FEM HD 26 +8
|
Facility
|
OP
|
$6,701.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,010.38 |
| Max. Negotiated Rate |
$6,433.23 |
| Rate for Payer: Aetna Commercial |
$5,159.99
|
| Rate for Payer: Anthem Medicaid |
$2,304.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,227.00
|
| Rate for Payer: Cash Price |
$3,350.64
|
| Rate for Payer: Cigna Commercial |
$5,562.06
|
| Rate for Payer: First Health Commercial |
$6,366.22
|
| Rate for Payer: Humana Commercial |
$5,696.09
|
| Rate for Payer: Humana KY Medicaid |
$2,304.57
|
| Rate for Payer: Kentucky WC Medicaid |
$2,328.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,495.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,945.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,010.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,350.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,897.13
|
| Rate for Payer: Ohio Health Group HMO |
$5,025.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,361.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,830.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,623.88
|
| Rate for Payer: PHCS Commercial |
$6,433.23
|
| Rate for Payer: United Healthcare All Payer |
$5,897.13
|
|
|
COCR 12/14 FEM HD 26 +8
|
Facility
|
IP
|
$6,701.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,010.38 |
| Max. Negotiated Rate |
$6,433.23 |
| Rate for Payer: Aetna Commercial |
$5,159.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,227.00
|
| Rate for Payer: Cash Price |
$3,350.64
|
| Rate for Payer: Cigna Commercial |
$5,562.06
|
| Rate for Payer: First Health Commercial |
$6,366.22
|
| Rate for Payer: Humana Commercial |
$5,696.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,495.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,945.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,010.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,897.13
|
| Rate for Payer: Ohio Health Group HMO |
$5,025.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,361.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,830.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,623.88
|
| Rate for Payer: PHCS Commercial |
$6,433.23
|
| Rate for Payer: United Healthcare All Payer |
$5,897.13
|
|
|
COCR 12/14 FEM HD 28 +12
|
Facility
|
OP
|
$3,687.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,106.25 |
| Max. Negotiated Rate |
$3,540.00 |
| Rate for Payer: Aetna Commercial |
$2,839.38
|
| Rate for Payer: Anthem Medicaid |
$1,268.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,876.25
|
| Rate for Payer: Cash Price |
$1,843.75
|
| Rate for Payer: Cigna Commercial |
$3,060.62
|
| Rate for Payer: First Health Commercial |
$3,503.12
|
| Rate for Payer: Humana Commercial |
$3,134.38
|
| Rate for Payer: Humana KY Medicaid |
$1,268.13
|
| Rate for Payer: Kentucky WC Medicaid |
$1,281.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,023.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,721.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,106.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,293.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,245.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,765.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,950.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,208.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,544.38
|
| Rate for Payer: PHCS Commercial |
$3,540.00
|
| Rate for Payer: United Healthcare All Payer |
$3,245.00
|
|
|
COCR 12/14 FEM HD 28 +12
|
Facility
|
IP
|
$3,687.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,106.25 |
| Max. Negotiated Rate |
$3,540.00 |
| Rate for Payer: Aetna Commercial |
$2,839.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,876.25
|
| Rate for Payer: Cash Price |
$1,843.75
|
| Rate for Payer: Cigna Commercial |
$3,060.62
|
| Rate for Payer: First Health Commercial |
$3,503.12
|
| Rate for Payer: Humana Commercial |
$3,134.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,023.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,721.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,106.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,245.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,765.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,950.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,208.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,544.38
|
| Rate for Payer: PHCS Commercial |
$3,540.00
|
| Rate for Payer: United Healthcare All Payer |
$3,245.00
|
|
|
COCR 12/14 FEM HD 28 +16
|
Facility
|
OP
|
$3,687.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,106.25 |
| Max. Negotiated Rate |
$3,540.00 |
| Rate for Payer: Aetna Commercial |
$2,839.38
|
| Rate for Payer: Anthem Medicaid |
$1,268.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,876.25
|
| Rate for Payer: Cash Price |
$1,843.75
|
| Rate for Payer: Cigna Commercial |
$3,060.62
|
| Rate for Payer: First Health Commercial |
$3,503.12
|
| Rate for Payer: Humana Commercial |
$3,134.38
|
| Rate for Payer: Humana KY Medicaid |
$1,268.13
|
| Rate for Payer: Kentucky WC Medicaid |
$1,281.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,023.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,721.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,106.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,293.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,245.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,765.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,950.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,208.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,544.38
|
| Rate for Payer: PHCS Commercial |
$3,540.00
|
| Rate for Payer: United Healthcare All Payer |
$3,245.00
|
|
|
COCR 12/14 FEM HD 28 +16
|
Facility
|
IP
|
$3,687.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,106.25 |
| Max. Negotiated Rate |
$3,540.00 |
| Rate for Payer: Aetna Commercial |
$2,839.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,876.25
|
| Rate for Payer: Cash Price |
$1,843.75
|
| Rate for Payer: Cigna Commercial |
$3,060.62
|
| Rate for Payer: First Health Commercial |
$3,503.12
|
| Rate for Payer: Humana Commercial |
$3,134.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,023.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,721.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,106.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,245.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,765.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,950.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,208.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,544.38
|
| Rate for Payer: PHCS Commercial |
$3,540.00
|
| Rate for Payer: United Healthcare All Payer |
$3,245.00
|
|
|
COCR 12/14 FEM HD 28 -3
|
Facility
|
OP
|
$3,687.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,106.25 |
| Max. Negotiated Rate |
$3,540.00 |
| Rate for Payer: Aetna Commercial |
$2,839.38
|
| Rate for Payer: Anthem Medicaid |
$1,268.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,876.25
|
| Rate for Payer: Cash Price |
$1,843.75
|
| Rate for Payer: Cigna Commercial |
$3,060.62
|
| Rate for Payer: First Health Commercial |
$3,503.12
|
| Rate for Payer: Humana Commercial |
$3,134.38
|
| Rate for Payer: Humana KY Medicaid |
$1,268.13
|
| Rate for Payer: Kentucky WC Medicaid |
$1,281.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,023.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,721.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,106.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,293.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,245.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,765.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,950.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,208.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,544.38
|
| Rate for Payer: PHCS Commercial |
$3,540.00
|
| Rate for Payer: United Healthcare All Payer |
$3,245.00
|
|
|
COCR 12/14 FEM HD 28 -3
|
Facility
|
IP
|
$3,687.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,106.25 |
| Max. Negotiated Rate |
$3,540.00 |
| Rate for Payer: Aetna Commercial |
$2,839.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,876.25
|
| Rate for Payer: Cash Price |
$1,843.75
|
| Rate for Payer: Cigna Commercial |
$3,060.62
|
| Rate for Payer: First Health Commercial |
$3,503.12
|
| Rate for Payer: Humana Commercial |
$3,134.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,023.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,721.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,106.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,245.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,765.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,950.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,208.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,544.38
|
| Rate for Payer: PHCS Commercial |
$3,540.00
|
| Rate for Payer: United Healthcare All Payer |
$3,245.00
|
|
|
COCR 12/14 FEM HD 28 +4
|
Facility
|
IP
|
$3,687.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,106.25 |
| Max. Negotiated Rate |
$3,540.00 |
| Rate for Payer: Aetna Commercial |
$2,839.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,876.25
|
| Rate for Payer: Cash Price |
$1,843.75
|
| Rate for Payer: Cigna Commercial |
$3,060.62
|
| Rate for Payer: First Health Commercial |
$3,503.12
|
| Rate for Payer: Humana Commercial |
$3,134.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,023.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,721.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,106.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,245.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,765.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,950.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,208.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,544.38
|
| Rate for Payer: PHCS Commercial |
$3,540.00
|
| Rate for Payer: United Healthcare All Payer |
$3,245.00
|
|
|
COCR 12/14 FEM HD 28 +4
|
Facility
|
OP
|
$3,687.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,106.25 |
| Max. Negotiated Rate |
$3,540.00 |
| Rate for Payer: Aetna Commercial |
$2,839.38
|
| Rate for Payer: Anthem Medicaid |
$1,268.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,876.25
|
| Rate for Payer: Cash Price |
$1,843.75
|
| Rate for Payer: Cigna Commercial |
$3,060.62
|
| Rate for Payer: First Health Commercial |
$3,503.12
|
| Rate for Payer: Humana Commercial |
$3,134.38
|
| Rate for Payer: Humana KY Medicaid |
$1,268.13
|
| Rate for Payer: Kentucky WC Medicaid |
$1,281.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,023.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,721.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,106.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,293.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,245.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,765.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,950.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,208.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,544.38
|
| Rate for Payer: PHCS Commercial |
$3,540.00
|
| Rate for Payer: United Healthcare All Payer |
$3,245.00
|
|
|
COCR 12/14 FEM HD 32 +0
|
Facility
|
IP
|
$6,701.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,010.38 |
| Max. Negotiated Rate |
$6,433.23 |
| Rate for Payer: Aetna Commercial |
$5,159.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,227.00
|
| Rate for Payer: Cash Price |
$3,350.64
|
| Rate for Payer: Cigna Commercial |
$5,562.06
|
| Rate for Payer: First Health Commercial |
$6,366.22
|
| Rate for Payer: Humana Commercial |
$5,696.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,495.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,945.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,010.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,897.13
|
| Rate for Payer: Ohio Health Group HMO |
$5,025.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,361.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,830.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,623.88
|
| Rate for Payer: PHCS Commercial |
$6,433.23
|
| Rate for Payer: United Healthcare All Payer |
$5,897.13
|
|
|
COCR 12/14 FEM HD 32 +0
|
Facility
|
OP
|
$6,701.28
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,010.38 |
| Max. Negotiated Rate |
$6,433.23 |
| Rate for Payer: Aetna Commercial |
$5,159.99
|
| Rate for Payer: Anthem Medicaid |
$2,304.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,227.00
|
| Rate for Payer: Cash Price |
$3,350.64
|
| Rate for Payer: Cigna Commercial |
$5,562.06
|
| Rate for Payer: First Health Commercial |
$6,366.22
|
| Rate for Payer: Humana Commercial |
$5,696.09
|
| Rate for Payer: Humana KY Medicaid |
$2,304.57
|
| Rate for Payer: Kentucky WC Medicaid |
$2,328.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,495.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,945.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,010.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,350.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,897.13
|
| Rate for Payer: Ohio Health Group HMO |
$5,025.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,361.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,830.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,623.88
|
| Rate for Payer: PHCS Commercial |
$6,433.23
|
| Rate for Payer: United Healthcare All Payer |
$5,897.13
|
|
|
COCR 12/14 FEM HD 32 +12
|
Facility
|
OP
|
$7,265.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,179.78 |
| Max. Negotiated Rate |
$6,975.30 |
| Rate for Payer: Aetna Commercial |
$5,594.77
|
| Rate for Payer: Anthem Medicaid |
$2,498.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,667.43
|
| Rate for Payer: Cash Price |
$3,632.97
|
| Rate for Payer: Cigna Commercial |
$6,030.73
|
| Rate for Payer: First Health Commercial |
$6,902.64
|
| Rate for Payer: Humana Commercial |
$6,176.05
|
| Rate for Payer: Humana KY Medicaid |
$2,498.76
|
| Rate for Payer: Kentucky WC Medicaid |
$2,524.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,958.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,362.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,179.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,548.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,394.03
|
| Rate for Payer: Ohio Health Group HMO |
$5,449.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,812.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,321.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,013.50
|
| Rate for Payer: PHCS Commercial |
$6,975.30
|
| Rate for Payer: United Healthcare All Payer |
$6,394.03
|
|
|
COCR 12/14 FEM HD 32 +12
|
Facility
|
IP
|
$7,265.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,179.78 |
| Max. Negotiated Rate |
$6,975.30 |
| Rate for Payer: Aetna Commercial |
$5,594.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,667.43
|
| Rate for Payer: Cash Price |
$3,632.97
|
| Rate for Payer: Cigna Commercial |
$6,030.73
|
| Rate for Payer: First Health Commercial |
$6,902.64
|
| Rate for Payer: Humana Commercial |
$6,176.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,958.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,362.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,179.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,394.03
|
| Rate for Payer: Ohio Health Group HMO |
$5,449.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,812.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,321.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,013.50
|
| Rate for Payer: PHCS Commercial |
$6,975.30
|
| Rate for Payer: United Healthcare All Payer |
$6,394.03
|
|
|
COCR 12/14 FEM HD 32 +16
|
Facility
|
IP
|
$7,265.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,179.78 |
| Max. Negotiated Rate |
$6,975.30 |
| Rate for Payer: Aetna Commercial |
$5,594.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,667.43
|
| Rate for Payer: Cash Price |
$3,632.97
|
| Rate for Payer: Cigna Commercial |
$6,030.73
|
| Rate for Payer: First Health Commercial |
$6,902.64
|
| Rate for Payer: Humana Commercial |
$6,176.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,958.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,362.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,179.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,394.03
|
| Rate for Payer: Ohio Health Group HMO |
$5,449.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,812.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,321.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,013.50
|
| Rate for Payer: PHCS Commercial |
$6,975.30
|
| Rate for Payer: United Healthcare All Payer |
$6,394.03
|
|
|
COCR 12/14 FEM HD 32 +16
|
Facility
|
OP
|
$7,265.94
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,179.78 |
| Max. Negotiated Rate |
$6,975.30 |
| Rate for Payer: Aetna Commercial |
$5,594.77
|
| Rate for Payer: Anthem Medicaid |
$2,498.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,667.43
|
| Rate for Payer: Cash Price |
$3,632.97
|
| Rate for Payer: Cigna Commercial |
$6,030.73
|
| Rate for Payer: First Health Commercial |
$6,902.64
|
| Rate for Payer: Humana Commercial |
$6,176.05
|
| Rate for Payer: Humana KY Medicaid |
$2,498.76
|
| Rate for Payer: Kentucky WC Medicaid |
$2,524.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,958.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,362.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,179.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,548.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,394.03
|
| Rate for Payer: Ohio Health Group HMO |
$5,449.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,812.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,321.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,013.50
|
| Rate for Payer: PHCS Commercial |
$6,975.30
|
| Rate for Payer: United Healthcare All Payer |
$6,394.03
|
|
