CUP TRID 2 CLSTRHOLE HA 50D
|
Facility
|
OP
|
$8,275.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,075.75 |
Max. Negotiated Rate |
$7,944.00 |
Rate for Payer: Aetna Commercial |
$6,371.75
|
Rate for Payer: Anthem Medicaid |
$2,845.77
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
Rate for Payer: Cash Price |
$4,137.50
|
Rate for Payer: Cigna Commercial |
$6,868.25
|
Rate for Payer: First Health Commercial |
$7,861.25
|
Rate for Payer: Humana Commercial |
$7,033.75
|
Rate for Payer: Humana KY Medicaid |
$2,845.77
|
Rate for Payer: Kentucky WC Medicaid |
$2,874.74
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
Rate for Payer: Molina Healthcare Medicaid |
$2,902.87
|
Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
Rate for Payer: PHCS Commercial |
$7,944.00
|
Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
CUP TRID 2 CLSTRHOLE HA 52E
|
Facility
|
IP
|
$8,275.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,075.75 |
Max. Negotiated Rate |
$7,944.00 |
Rate for Payer: Aetna Commercial |
$6,371.75
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
Rate for Payer: Cash Price |
$4,137.50
|
Rate for Payer: Cigna Commercial |
$6,868.25
|
Rate for Payer: First Health Commercial |
$7,861.25
|
Rate for Payer: Humana Commercial |
$7,033.75
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
Rate for Payer: PHCS Commercial |
$7,944.00
|
Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
CUP TRID 2 CLSTRHOLE HA 52E
|
Facility
|
OP
|
$8,275.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,075.75 |
Max. Negotiated Rate |
$7,944.00 |
Rate for Payer: Aetna Commercial |
$6,371.75
|
Rate for Payer: Anthem Medicaid |
$2,845.77
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
Rate for Payer: Cash Price |
$4,137.50
|
Rate for Payer: Cigna Commercial |
$6,868.25
|
Rate for Payer: First Health Commercial |
$7,861.25
|
Rate for Payer: Humana Commercial |
$7,033.75
|
Rate for Payer: Humana KY Medicaid |
$2,845.77
|
Rate for Payer: Kentucky WC Medicaid |
$2,874.74
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
Rate for Payer: Molina Healthcare Medicaid |
$2,902.87
|
Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
Rate for Payer: PHCS Commercial |
$7,944.00
|
Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
CUP TRID 2 CLSTRHOLE HA 54E
|
Facility
|
IP
|
$8,275.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,075.75 |
Max. Negotiated Rate |
$7,944.00 |
Rate for Payer: Aetna Commercial |
$6,371.75
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
Rate for Payer: Cash Price |
$4,137.50
|
Rate for Payer: Cigna Commercial |
$6,868.25
|
Rate for Payer: First Health Commercial |
$7,861.25
|
Rate for Payer: Humana Commercial |
$7,033.75
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
Rate for Payer: PHCS Commercial |
$7,944.00
|
Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
CUP TRID 2 CLSTRHOLE HA 54E
|
Facility
|
OP
|
$8,275.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,075.75 |
Max. Negotiated Rate |
$7,944.00 |
Rate for Payer: Aetna Commercial |
$6,371.75
|
Rate for Payer: Anthem Medicaid |
$2,845.77
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
Rate for Payer: Cash Price |
$4,137.50
|
Rate for Payer: Cigna Commercial |
$6,868.25
|
Rate for Payer: First Health Commercial |
$7,861.25
|
Rate for Payer: Humana Commercial |
$7,033.75
|
Rate for Payer: Humana KY Medicaid |
$2,845.77
|
Rate for Payer: Kentucky WC Medicaid |
$2,874.74
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
Rate for Payer: Molina Healthcare Medicaid |
$2,902.87
|
Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
Rate for Payer: PHCS Commercial |
$7,944.00
|
Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
CUP TRID 2 CLSTRHOLE HA 56F
|
Facility
|
IP
|
$8,275.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,075.75 |
Max. Negotiated Rate |
$7,944.00 |
Rate for Payer: Aetna Commercial |
$6,371.75
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
Rate for Payer: Cash Price |
$4,137.50
|
Rate for Payer: Cigna Commercial |
$6,868.25
|
Rate for Payer: First Health Commercial |
$7,861.25
|
Rate for Payer: Humana Commercial |
$7,033.75
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
Rate for Payer: PHCS Commercial |
$7,944.00
|
Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
CUP TRID 2 CLSTRHOLE HA 56F
|
Facility
|
OP
|
$8,275.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,075.75 |
Max. Negotiated Rate |
$7,944.00 |
Rate for Payer: Aetna Commercial |
$6,371.75
|
Rate for Payer: Anthem Medicaid |
$2,845.77
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
Rate for Payer: Cash Price |
$4,137.50
|
Rate for Payer: Cigna Commercial |
$6,868.25
|
Rate for Payer: First Health Commercial |
$7,861.25
|
Rate for Payer: Humana Commercial |
$7,033.75
|
Rate for Payer: Humana KY Medicaid |
$2,845.77
|
Rate for Payer: Kentucky WC Medicaid |
$2,874.74
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
Rate for Payer: Molina Healthcare Medicaid |
$2,902.87
|
Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
Rate for Payer: PHCS Commercial |
$7,944.00
|
Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
CUP TRID 2 CLSTRHOLE HA 58F
|
Facility
|
IP
|
$8,275.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,075.75 |
Max. Negotiated Rate |
$7,944.00 |
Rate for Payer: Aetna Commercial |
$6,371.75
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
Rate for Payer: Cash Price |
$4,137.50
|
Rate for Payer: Cigna Commercial |
$6,868.25
|
Rate for Payer: First Health Commercial |
$7,861.25
|
Rate for Payer: Humana Commercial |
$7,033.75
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
Rate for Payer: PHCS Commercial |
$7,944.00
|
Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
CUP TRID 2 CLSTRHOLE HA 58F
|
Facility
|
OP
|
$8,275.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,075.75 |
Max. Negotiated Rate |
$7,944.00 |
Rate for Payer: Aetna Commercial |
$6,371.75
|
Rate for Payer: Anthem Medicaid |
$2,845.77
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
Rate for Payer: Cash Price |
$4,137.50
|
Rate for Payer: Cigna Commercial |
$6,868.25
|
Rate for Payer: First Health Commercial |
$7,861.25
|
Rate for Payer: Humana Commercial |
$7,033.75
|
Rate for Payer: Humana KY Medicaid |
$2,845.77
|
Rate for Payer: Kentucky WC Medicaid |
$2,874.74
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
Rate for Payer: Molina Healthcare Medicaid |
$2,902.87
|
Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
Rate for Payer: PHCS Commercial |
$7,944.00
|
Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
CUP TRID 2 CLSTRHOLE HA 60G
|
Facility
|
IP
|
$8,275.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,075.75 |
Max. Negotiated Rate |
$7,944.00 |
Rate for Payer: Aetna Commercial |
$6,371.75
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
Rate for Payer: Cash Price |
$4,137.50
|
Rate for Payer: Cigna Commercial |
$6,868.25
|
Rate for Payer: First Health Commercial |
$7,861.25
|
Rate for Payer: Humana Commercial |
$7,033.75
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
Rate for Payer: PHCS Commercial |
$7,944.00
|
Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
CUP TRID 2 CLSTRHOLE HA 60G
|
Facility
|
OP
|
$8,275.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,075.75 |
Max. Negotiated Rate |
$7,944.00 |
Rate for Payer: Aetna Commercial |
$6,371.75
|
Rate for Payer: Anthem Medicaid |
$2,845.77
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
Rate for Payer: Cash Price |
$4,137.50
|
Rate for Payer: Cigna Commercial |
$6,868.25
|
Rate for Payer: First Health Commercial |
$7,861.25
|
Rate for Payer: Humana Commercial |
$7,033.75
|
Rate for Payer: Humana KY Medicaid |
$2,845.77
|
Rate for Payer: Kentucky WC Medicaid |
$2,874.74
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
Rate for Payer: Molina Healthcare Medicaid |
$2,902.87
|
Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
Rate for Payer: PHCS Commercial |
$7,944.00
|
Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
CUP TRID 2 CLSTRHOLE HA 62G
|
Facility
|
OP
|
$8,275.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,075.75 |
Max. Negotiated Rate |
$7,944.00 |
Rate for Payer: Aetna Commercial |
$6,371.75
|
Rate for Payer: Anthem Medicaid |
$2,845.77
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
Rate for Payer: Cash Price |
$4,137.50
|
Rate for Payer: Cigna Commercial |
$6,868.25
|
Rate for Payer: First Health Commercial |
$7,861.25
|
Rate for Payer: Humana Commercial |
$7,033.75
|
Rate for Payer: Humana KY Medicaid |
$2,845.77
|
Rate for Payer: Kentucky WC Medicaid |
$2,874.74
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
Rate for Payer: Molina Healthcare Medicaid |
$2,902.87
|
Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
Rate for Payer: PHCS Commercial |
$7,944.00
|
Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
CUP TRID 2 CLSTRHOLE HA 62G
|
Facility
|
IP
|
$8,275.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,075.75 |
Max. Negotiated Rate |
$7,944.00 |
Rate for Payer: Aetna Commercial |
$6,371.75
|
Rate for Payer: Anthem POS/PPO/Traditional |
$6,454.50
|
Rate for Payer: Cash Price |
$4,137.50
|
Rate for Payer: Cigna Commercial |
$6,868.25
|
Rate for Payer: First Health Commercial |
$7,861.25
|
Rate for Payer: Humana Commercial |
$7,033.75
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$6,785.50
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,106.95
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,482.50
|
Rate for Payer: Ohio Health Choice Commercial |
$7,282.00
|
Rate for Payer: Ohio Health Group HMO |
$6,206.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,655.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.75
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.25
|
Rate for Payer: PHCS Commercial |
$7,944.00
|
Rate for Payer: United Healthcare All Payer |
$7,282.00
|
|
CUP UNIV 2H SHL 40MM S20
|
Facility
|
OP
|
$7,180.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$933.40 |
Max. Negotiated Rate |
$6,892.80 |
Rate for Payer: Aetna Commercial |
$5,528.60
|
Rate for Payer: Anthem Medicaid |
$2,469.20
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,600.40
|
Rate for Payer: Cash Price |
$3,590.00
|
Rate for Payer: Cigna Commercial |
$5,959.40
|
Rate for Payer: First Health Commercial |
$6,821.00
|
Rate for Payer: Humana Commercial |
$6,103.00
|
Rate for Payer: Humana KY Medicaid |
$2,469.20
|
Rate for Payer: Kentucky WC Medicaid |
$2,494.33
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$5,887.60
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,298.84
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.00
|
Rate for Payer: Molina Healthcare Medicaid |
$2,518.74
|
Rate for Payer: Ohio Health Choice Commercial |
$6,318.40
|
Rate for Payer: Ohio Health Group HMO |
$5,385.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,436.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$933.40
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,225.80
|
Rate for Payer: PHCS Commercial |
$6,892.80
|
Rate for Payer: United Healthcare All Payer |
$6,318.40
|
|
CUP UNIV 2H SHL 40MM S20
|
Facility
|
IP
|
$7,180.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$933.40 |
Max. Negotiated Rate |
$6,892.80 |
Rate for Payer: Aetna Commercial |
$5,528.60
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,600.40
|
Rate for Payer: Cash Price |
$3,590.00
|
Rate for Payer: Cigna Commercial |
$5,959.40
|
Rate for Payer: First Health Commercial |
$6,821.00
|
Rate for Payer: Humana Commercial |
$6,103.00
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$5,887.60
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,298.84
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.00
|
Rate for Payer: Ohio Health Choice Commercial |
$6,318.40
|
Rate for Payer: Ohio Health Group HMO |
$5,385.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,436.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$933.40
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,225.80
|
Rate for Payer: PHCS Commercial |
$6,892.80
|
Rate for Payer: United Healthcare All Payer |
$6,318.40
|
|
CUP UNIV 2H SHL 42MM S20
|
Facility
|
IP
|
$7,180.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$933.40 |
Max. Negotiated Rate |
$6,892.80 |
Rate for Payer: Aetna Commercial |
$5,528.60
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,600.40
|
Rate for Payer: Cash Price |
$3,590.00
|
Rate for Payer: Cigna Commercial |
$5,959.40
|
Rate for Payer: First Health Commercial |
$6,821.00
|
Rate for Payer: Humana Commercial |
$6,103.00
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$5,887.60
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,298.84
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.00
|
Rate for Payer: Ohio Health Choice Commercial |
$6,318.40
|
Rate for Payer: Ohio Health Group HMO |
$5,385.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,436.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$933.40
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,225.80
|
Rate for Payer: PHCS Commercial |
$6,892.80
|
Rate for Payer: United Healthcare All Payer |
$6,318.40
|
|
CUP UNIV 2H SHL 42MM S20
|
Facility
|
OP
|
$7,180.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$933.40 |
Max. Negotiated Rate |
$6,892.80 |
Rate for Payer: Aetna Commercial |
$5,528.60
|
Rate for Payer: Anthem Medicaid |
$2,469.20
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,600.40
|
Rate for Payer: Cash Price |
$3,590.00
|
Rate for Payer: Cigna Commercial |
$5,959.40
|
Rate for Payer: First Health Commercial |
$6,821.00
|
Rate for Payer: Humana Commercial |
$6,103.00
|
Rate for Payer: Humana KY Medicaid |
$2,469.20
|
Rate for Payer: Kentucky WC Medicaid |
$2,494.33
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$5,887.60
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,298.84
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.00
|
Rate for Payer: Molina Healthcare Medicaid |
$2,518.74
|
Rate for Payer: Ohio Health Choice Commercial |
$6,318.40
|
Rate for Payer: Ohio Health Group HMO |
$5,385.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,436.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$933.40
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,225.80
|
Rate for Payer: PHCS Commercial |
$6,892.80
|
Rate for Payer: United Healthcare All Payer |
$6,318.40
|
|
CUP UNIV 2H SHL 44MM S21
|
Facility
|
IP
|
$7,180.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$933.40 |
Max. Negotiated Rate |
$6,892.80 |
Rate for Payer: Aetna Commercial |
$5,528.60
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,600.40
|
Rate for Payer: Cash Price |
$3,590.00
|
Rate for Payer: Cigna Commercial |
$5,959.40
|
Rate for Payer: First Health Commercial |
$6,821.00
|
Rate for Payer: Humana Commercial |
$6,103.00
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$5,887.60
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,298.84
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.00
|
Rate for Payer: Ohio Health Choice Commercial |
$6,318.40
|
Rate for Payer: Ohio Health Group HMO |
$5,385.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,436.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$933.40
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,225.80
|
Rate for Payer: PHCS Commercial |
$6,892.80
|
Rate for Payer: United Healthcare All Payer |
$6,318.40
|
|
CUP UNIV 2H SHL 44MM S21
|
Facility
|
OP
|
$7,180.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$933.40 |
Max. Negotiated Rate |
$6,892.80 |
Rate for Payer: Aetna Commercial |
$5,528.60
|
Rate for Payer: Anthem Medicaid |
$2,469.20
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,600.40
|
Rate for Payer: Cash Price |
$3,590.00
|
Rate for Payer: Cigna Commercial |
$5,959.40
|
Rate for Payer: First Health Commercial |
$6,821.00
|
Rate for Payer: Humana Commercial |
$6,103.00
|
Rate for Payer: Humana KY Medicaid |
$2,469.20
|
Rate for Payer: Kentucky WC Medicaid |
$2,494.33
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$5,887.60
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,298.84
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.00
|
Rate for Payer: Molina Healthcare Medicaid |
$2,518.74
|
Rate for Payer: Ohio Health Choice Commercial |
$6,318.40
|
Rate for Payer: Ohio Health Group HMO |
$5,385.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,436.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$933.40
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,225.80
|
Rate for Payer: PHCS Commercial |
$6,892.80
|
Rate for Payer: United Healthcare All Payer |
$6,318.40
|
|
CUP UNIV 2H SHL 46MM S22
|
Facility
|
OP
|
$7,180.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$933.40 |
Max. Negotiated Rate |
$6,892.80 |
Rate for Payer: Aetna Commercial |
$5,528.60
|
Rate for Payer: Anthem Medicaid |
$2,469.20
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,600.40
|
Rate for Payer: Cash Price |
$3,590.00
|
Rate for Payer: Cigna Commercial |
$5,959.40
|
Rate for Payer: First Health Commercial |
$6,821.00
|
Rate for Payer: Humana Commercial |
$6,103.00
|
Rate for Payer: Humana KY Medicaid |
$2,469.20
|
Rate for Payer: Kentucky WC Medicaid |
$2,494.33
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$5,887.60
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,298.84
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.00
|
Rate for Payer: Molina Healthcare Medicaid |
$2,518.74
|
Rate for Payer: Ohio Health Choice Commercial |
$6,318.40
|
Rate for Payer: Ohio Health Group HMO |
$5,385.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,436.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$933.40
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,225.80
|
Rate for Payer: PHCS Commercial |
$6,892.80
|
Rate for Payer: United Healthcare All Payer |
$6,318.40
|
|
CUP UNIV 2H SHL 46MM S22
|
Facility
|
IP
|
$7,180.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$933.40 |
Max. Negotiated Rate |
$6,892.80 |
Rate for Payer: Aetna Commercial |
$5,528.60
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,600.40
|
Rate for Payer: Cash Price |
$3,590.00
|
Rate for Payer: Cigna Commercial |
$5,959.40
|
Rate for Payer: First Health Commercial |
$6,821.00
|
Rate for Payer: Humana Commercial |
$6,103.00
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$5,887.60
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,298.84
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.00
|
Rate for Payer: Ohio Health Choice Commercial |
$6,318.40
|
Rate for Payer: Ohio Health Group HMO |
$5,385.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,436.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$933.40
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,225.80
|
Rate for Payer: PHCS Commercial |
$6,892.80
|
Rate for Payer: United Healthcare All Payer |
$6,318.40
|
|
CUP UNIV 2H SHL 48MM S22
|
Facility
|
OP
|
$7,180.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$933.40 |
Max. Negotiated Rate |
$6,892.80 |
Rate for Payer: Aetna Commercial |
$5,528.60
|
Rate for Payer: Anthem Medicaid |
$2,469.20
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,600.40
|
Rate for Payer: Cash Price |
$3,590.00
|
Rate for Payer: Cigna Commercial |
$5,959.40
|
Rate for Payer: First Health Commercial |
$6,821.00
|
Rate for Payer: Humana Commercial |
$6,103.00
|
Rate for Payer: Humana KY Medicaid |
$2,469.20
|
Rate for Payer: Kentucky WC Medicaid |
$2,494.33
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$5,887.60
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,298.84
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.00
|
Rate for Payer: Molina Healthcare Medicaid |
$2,518.74
|
Rate for Payer: Ohio Health Choice Commercial |
$6,318.40
|
Rate for Payer: Ohio Health Group HMO |
$5,385.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,436.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$933.40
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,225.80
|
Rate for Payer: PHCS Commercial |
$6,892.80
|
Rate for Payer: United Healthcare All Payer |
$6,318.40
|
|
CUP UNIV 2H SHL 48MM S22
|
Facility
|
IP
|
$7,180.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$933.40 |
Max. Negotiated Rate |
$6,892.80 |
Rate for Payer: Aetna Commercial |
$5,528.60
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,600.40
|
Rate for Payer: Cash Price |
$3,590.00
|
Rate for Payer: Cigna Commercial |
$5,959.40
|
Rate for Payer: First Health Commercial |
$6,821.00
|
Rate for Payer: Humana Commercial |
$6,103.00
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$5,887.60
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,298.84
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.00
|
Rate for Payer: Ohio Health Choice Commercial |
$6,318.40
|
Rate for Payer: Ohio Health Group HMO |
$5,385.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,436.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$933.40
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,225.80
|
Rate for Payer: PHCS Commercial |
$6,892.80
|
Rate for Payer: United Healthcare All Payer |
$6,318.40
|
|
CUP UNIV 2H SHL 50MM S23
|
Facility
|
OP
|
$7,180.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$933.40 |
Max. Negotiated Rate |
$6,892.80 |
Rate for Payer: Aetna Commercial |
$5,528.60
|
Rate for Payer: Anthem Medicaid |
$2,469.20
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,600.40
|
Rate for Payer: Cash Price |
$3,590.00
|
Rate for Payer: Cigna Commercial |
$5,959.40
|
Rate for Payer: First Health Commercial |
$6,821.00
|
Rate for Payer: Humana Commercial |
$6,103.00
|
Rate for Payer: Humana KY Medicaid |
$2,469.20
|
Rate for Payer: Kentucky WC Medicaid |
$2,494.33
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$5,887.60
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,298.84
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.00
|
Rate for Payer: Molina Healthcare Medicaid |
$2,518.74
|
Rate for Payer: Ohio Health Choice Commercial |
$6,318.40
|
Rate for Payer: Ohio Health Group HMO |
$5,385.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,436.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$933.40
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,225.80
|
Rate for Payer: PHCS Commercial |
$6,892.80
|
Rate for Payer: United Healthcare All Payer |
$6,318.40
|
|
CUP UNIV 2H SHL 50MM S23
|
Facility
|
IP
|
$7,180.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$933.40 |
Max. Negotiated Rate |
$6,892.80 |
Rate for Payer: Aetna Commercial |
$5,528.60
|
Rate for Payer: Anthem POS/PPO/Traditional |
$5,600.40
|
Rate for Payer: Cash Price |
$3,590.00
|
Rate for Payer: Cigna Commercial |
$5,959.40
|
Rate for Payer: First Health Commercial |
$6,821.00
|
Rate for Payer: Humana Commercial |
$6,103.00
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$5,887.60
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,298.84
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.00
|
Rate for Payer: Ohio Health Choice Commercial |
$6,318.40
|
Rate for Payer: Ohio Health Group HMO |
$5,385.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,436.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$933.40
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,225.80
|
Rate for Payer: PHCS Commercial |
$6,892.80
|
Rate for Payer: United Healthcare All Payer |
$6,318.40
|
|