|
COCR 12/14 FEM HD 32 -3
|
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 -3
|
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 +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 32 +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 32 +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 32 +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 36 +0
|
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 36 +0
|
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 36 +12
|
Facility
|
OP
|
$7,945.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,383.61 |
| Max. Negotiated Rate |
$7,627.56 |
| Rate for Payer: Aetna Commercial |
$6,117.94
|
| Rate for Payer: Anthem Medicaid |
$2,732.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,197.40
|
| Rate for Payer: Cash Price |
$3,972.69
|
| Rate for Payer: Cigna Commercial |
$6,594.67
|
| Rate for Payer: First Health Commercial |
$7,548.11
|
| Rate for Payer: Humana Commercial |
$6,753.57
|
| Rate for Payer: Humana KY Medicaid |
$2,732.42
|
| Rate for Payer: Kentucky WC Medicaid |
$2,760.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,515.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,863.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,383.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,787.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,991.93
|
| Rate for Payer: Ohio Health Group HMO |
$5,959.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,356.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,912.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,482.31
|
| Rate for Payer: PHCS Commercial |
$7,627.56
|
| Rate for Payer: United Healthcare All Payer |
$6,991.93
|
|
|
COCR 12/14 FEM HD 36 +12
|
Facility
|
IP
|
$7,945.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,383.61 |
| Max. Negotiated Rate |
$7,627.56 |
| Rate for Payer: Aetna Commercial |
$6,117.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,197.40
|
| Rate for Payer: Cash Price |
$3,972.69
|
| Rate for Payer: Cigna Commercial |
$6,594.67
|
| Rate for Payer: First Health Commercial |
$7,548.11
|
| Rate for Payer: Humana Commercial |
$6,753.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,515.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,863.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,383.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,991.93
|
| Rate for Payer: Ohio Health Group HMO |
$5,959.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,356.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,912.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,482.31
|
| Rate for Payer: PHCS Commercial |
$7,627.56
|
| Rate for Payer: United Healthcare All Payer |
$6,991.93
|
|
|
COCR 12/14 FEM HD 36 -3
|
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 36 -3
|
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 36 +4
|
Facility
|
OP
|
$7,945.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,383.61 |
| Max. Negotiated Rate |
$7,627.56 |
| Rate for Payer: Aetna Commercial |
$6,117.94
|
| Rate for Payer: Anthem Medicaid |
$2,732.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,197.40
|
| Rate for Payer: Cash Price |
$3,972.69
|
| Rate for Payer: Cigna Commercial |
$6,594.67
|
| Rate for Payer: First Health Commercial |
$7,548.11
|
| Rate for Payer: Humana Commercial |
$6,753.57
|
| Rate for Payer: Humana KY Medicaid |
$2,732.42
|
| Rate for Payer: Kentucky WC Medicaid |
$2,760.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,515.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,863.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,383.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,787.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,991.93
|
| Rate for Payer: Ohio Health Group HMO |
$5,959.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,356.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,912.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,482.31
|
| Rate for Payer: PHCS Commercial |
$7,627.56
|
| Rate for Payer: United Healthcare All Payer |
$6,991.93
|
|
|
COCR 12/14 FEM HD 36 +4
|
Facility
|
IP
|
$7,945.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,383.61 |
| Max. Negotiated Rate |
$7,627.56 |
| Rate for Payer: Aetna Commercial |
$6,117.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,197.40
|
| Rate for Payer: Cash Price |
$3,972.69
|
| Rate for Payer: Cigna Commercial |
$6,594.67
|
| Rate for Payer: First Health Commercial |
$7,548.11
|
| Rate for Payer: Humana Commercial |
$6,753.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,515.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,863.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,383.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,991.93
|
| Rate for Payer: Ohio Health Group HMO |
$5,959.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,356.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,912.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,482.31
|
| Rate for Payer: PHCS Commercial |
$7,627.56
|
| Rate for Payer: United Healthcare All Payer |
$6,991.93
|
|
|
COCR 12/14 FEM HD 36 +8
|
Facility
|
IP
|
$5,563.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,669.19 |
| Max. Negotiated Rate |
$5,341.40 |
| Rate for Payer: Aetna Commercial |
$4,284.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,339.89
|
| Rate for Payer: Cash Price |
$2,781.98
|
| Rate for Payer: Cigna Commercial |
$4,618.09
|
| Rate for Payer: First Health Commercial |
$5,285.76
|
| Rate for Payer: Humana Commercial |
$4,729.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,562.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,106.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,669.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,896.28
|
| Rate for Payer: Ohio Health Group HMO |
$4,172.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,451.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,840.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,839.13
|
| Rate for Payer: PHCS Commercial |
$5,341.40
|
| Rate for Payer: United Healthcare All Payer |
$4,896.28
|
|
|
COCR 12/14 FEM HD 36 +8
|
Facility
|
OP
|
$5,563.96
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,669.19 |
| Max. Negotiated Rate |
$5,341.40 |
| Rate for Payer: Aetna Commercial |
$4,284.25
|
| Rate for Payer: Anthem Medicaid |
$1,913.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,339.89
|
| Rate for Payer: Cash Price |
$2,781.98
|
| Rate for Payer: Cigna Commercial |
$4,618.09
|
| Rate for Payer: First Health Commercial |
$5,285.76
|
| Rate for Payer: Humana Commercial |
$4,729.37
|
| Rate for Payer: Humana KY Medicaid |
$1,913.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1,932.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,562.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,106.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,669.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,951.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,896.28
|
| Rate for Payer: Ohio Health Group HMO |
$4,172.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,451.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,840.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,839.13
|
| Rate for Payer: PHCS Commercial |
$5,341.40
|
| Rate for Payer: United Healthcare All Payer |
$4,896.28
|
|
|
COCR FEM 12/14 FEM HD 28 +8
|
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 FEM 12/14 FEM HD 28 +8
|
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 FEM HD GT 28OD +0
|
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 FEM HD GT 28OD +0
|
Facility
|
IP
|
$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 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: 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: 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 FEM HEAD 28M TPR +0 NCK
|
Facility
|
OP
|
$3,875.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,162.50 |
| Max. Negotiated Rate |
$3,720.00 |
| Rate for Payer: Aetna Commercial |
$2,983.75
|
| Rate for Payer: Anthem Medicaid |
$1,332.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,022.50
|
| Rate for Payer: Cash Price |
$1,937.50
|
| Rate for Payer: Cigna Commercial |
$3,216.25
|
| Rate for Payer: First Health Commercial |
$3,681.25
|
| Rate for Payer: Humana Commercial |
$3,293.75
|
| Rate for Payer: Humana KY Medicaid |
$1,332.61
|
| Rate for Payer: Kentucky WC Medicaid |
$1,346.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,177.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,859.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,162.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,359.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,410.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,906.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,371.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,673.75
|
| Rate for Payer: PHCS Commercial |
$3,720.00
|
| Rate for Payer: United Healthcare All Payer |
$3,410.00
|
|
|
COCR FEM HEAD 28M TPR +0 NCK
|
Facility
|
IP
|
$3,875.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,162.50 |
| Max. Negotiated Rate |
$3,720.00 |
| Rate for Payer: Aetna Commercial |
$2,983.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,022.50
|
| Rate for Payer: Cash Price |
$1,937.50
|
| Rate for Payer: Cigna Commercial |
$3,216.25
|
| Rate for Payer: First Health Commercial |
$3,681.25
|
| Rate for Payer: Humana Commercial |
$3,293.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,177.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,859.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,162.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,410.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,906.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,371.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,673.75
|
| Rate for Payer: PHCS Commercial |
$3,720.00
|
| Rate for Payer: United Healthcare All Payer |
$3,410.00
|
|
|
COCR FEM HEAD 28M TPR +3.5 NCK
|
Facility
|
IP
|
$3,875.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,162.50 |
| Max. Negotiated Rate |
$3,720.00 |
| Rate for Payer: Aetna Commercial |
$2,983.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,022.50
|
| Rate for Payer: Cash Price |
$1,937.50
|
| Rate for Payer: Cigna Commercial |
$3,216.25
|
| Rate for Payer: First Health Commercial |
$3,681.25
|
| Rate for Payer: Humana Commercial |
$3,293.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,177.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,859.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,162.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,410.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,906.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,371.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,673.75
|
| Rate for Payer: PHCS Commercial |
$3,720.00
|
| Rate for Payer: United Healthcare All Payer |
$3,410.00
|
|
|
COCR FEM HEAD 28M TPR +3.5 NCK
|
Facility
|
OP
|
$3,875.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,162.50 |
| Max. Negotiated Rate |
$3,720.00 |
| Rate for Payer: Aetna Commercial |
$2,983.75
|
| Rate for Payer: Anthem Medicaid |
$1,332.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,022.50
|
| Rate for Payer: Cash Price |
$1,937.50
|
| Rate for Payer: Cigna Commercial |
$3,216.25
|
| Rate for Payer: First Health Commercial |
$3,681.25
|
| Rate for Payer: Humana Commercial |
$3,293.75
|
| Rate for Payer: Humana KY Medicaid |
$1,332.61
|
| Rate for Payer: Kentucky WC Medicaid |
$1,346.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,177.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,859.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,162.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,359.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,410.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,906.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,371.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,673.75
|
| Rate for Payer: PHCS Commercial |
$3,720.00
|
| Rate for Payer: United Healthcare All Payer |
$3,410.00
|
|
|
COCR FEM HEAD 28M TPR -3.5 NCK
|
Facility
|
OP
|
$3,875.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,162.50 |
| Max. Negotiated Rate |
$3,720.00 |
| Rate for Payer: Aetna Commercial |
$2,983.75
|
| Rate for Payer: Anthem Medicaid |
$1,332.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,022.50
|
| Rate for Payer: Cash Price |
$1,937.50
|
| Rate for Payer: Cigna Commercial |
$3,216.25
|
| Rate for Payer: First Health Commercial |
$3,681.25
|
| Rate for Payer: Humana Commercial |
$3,293.75
|
| Rate for Payer: Humana KY Medicaid |
$1,332.61
|
| Rate for Payer: Kentucky WC Medicaid |
$1,346.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,177.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,859.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,162.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,359.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,410.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,906.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,371.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,673.75
|
| Rate for Payer: PHCS Commercial |
$3,720.00
|
| Rate for Payer: United Healthcare All Payer |
$3,410.00
|
|
