|
AFX 2 BFMN BY BEA25-120/I20-40
|
Facility
|
IP
|
$86,496.20
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25,948.86 |
| Max. Negotiated Rate |
$83,036.35 |
| Rate for Payer: Aetna Commercial |
$66,602.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67,467.04
|
| Rate for Payer: Cash Price |
$43,248.10
|
| Rate for Payer: Cigna Commercial |
$71,791.85
|
| Rate for Payer: First Health Commercial |
$82,171.39
|
| Rate for Payer: Humana Commercial |
$73,521.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70,926.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63,834.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,948.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$76,116.66
|
| Rate for Payer: Ohio Health Group HMO |
$64,872.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69,196.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75,251.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59,682.38
|
| Rate for Payer: PHCS Commercial |
$83,036.35
|
| Rate for Payer: United Healthcare All Payer |
$76,116.66
|
|
|
AFX 2 BFMN BY BEA25-120/I20-40
|
Facility
|
OP
|
$86,496.20
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25,948.86 |
| Max. Negotiated Rate |
$83,036.35 |
| Rate for Payer: Aetna Commercial |
$66,602.07
|
| Rate for Payer: Anthem Medicaid |
$29,746.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67,467.04
|
| Rate for Payer: Cash Price |
$43,248.10
|
| Rate for Payer: Cigna Commercial |
$71,791.85
|
| Rate for Payer: First Health Commercial |
$82,171.39
|
| Rate for Payer: Humana Commercial |
$73,521.77
|
| Rate for Payer: Humana KY Medicaid |
$29,746.04
|
| Rate for Payer: Kentucky WC Medicaid |
$30,048.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70,926.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63,834.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,948.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$30,342.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$76,116.66
|
| Rate for Payer: Ohio Health Group HMO |
$64,872.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69,196.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75,251.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59,682.38
|
| Rate for Payer: PHCS Commercial |
$83,036.35
|
| Rate for Payer: United Healthcare All Payer |
$76,116.66
|
|
|
AFX 2 BFMN BY BEA28-100/I16-40
|
Facility
|
IP
|
$86,496.20
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25,948.86 |
| Max. Negotiated Rate |
$83,036.35 |
| Rate for Payer: Aetna Commercial |
$66,602.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67,467.04
|
| Rate for Payer: Cash Price |
$43,248.10
|
| Rate for Payer: Cigna Commercial |
$71,791.85
|
| Rate for Payer: First Health Commercial |
$82,171.39
|
| Rate for Payer: Humana Commercial |
$73,521.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70,926.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63,834.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,948.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$76,116.66
|
| Rate for Payer: Ohio Health Group HMO |
$64,872.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69,196.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75,251.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59,682.38
|
| Rate for Payer: PHCS Commercial |
$83,036.35
|
| Rate for Payer: United Healthcare All Payer |
$76,116.66
|
|
|
AFX 2 BFMN BY BEA28-100/I16-40
|
Facility
|
OP
|
$86,496.20
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25,948.86 |
| Max. Negotiated Rate |
$83,036.35 |
| Rate for Payer: Aetna Commercial |
$66,602.07
|
| Rate for Payer: Anthem Medicaid |
$29,746.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67,467.04
|
| Rate for Payer: Cash Price |
$43,248.10
|
| Rate for Payer: Cigna Commercial |
$71,791.85
|
| Rate for Payer: First Health Commercial |
$82,171.39
|
| Rate for Payer: Humana Commercial |
$73,521.77
|
| Rate for Payer: Humana KY Medicaid |
$29,746.04
|
| Rate for Payer: Kentucky WC Medicaid |
$30,048.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70,926.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63,834.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,948.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$30,342.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$76,116.66
|
| Rate for Payer: Ohio Health Group HMO |
$64,872.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69,196.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75,251.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59,682.38
|
| Rate for Payer: PHCS Commercial |
$83,036.35
|
| Rate for Payer: United Healthcare All Payer |
$76,116.66
|
|
|
AFX 2 BFMN BY BEA28-110/I16-30
|
Facility
|
IP
|
$86,496.20
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25,948.86 |
| Max. Negotiated Rate |
$83,036.35 |
| Rate for Payer: Aetna Commercial |
$66,602.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67,467.04
|
| Rate for Payer: Cash Price |
$43,248.10
|
| Rate for Payer: Cigna Commercial |
$71,791.85
|
| Rate for Payer: First Health Commercial |
$82,171.39
|
| Rate for Payer: Humana Commercial |
$73,521.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70,926.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63,834.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,948.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$76,116.66
|
| Rate for Payer: Ohio Health Group HMO |
$64,872.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69,196.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75,251.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59,682.38
|
| Rate for Payer: PHCS Commercial |
$83,036.35
|
| Rate for Payer: United Healthcare All Payer |
$76,116.66
|
|
|
AFX 2 BFMN BY BEA28-110/I16-30
|
Facility
|
OP
|
$86,496.20
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25,948.86 |
| Max. Negotiated Rate |
$83,036.35 |
| Rate for Payer: Aetna Commercial |
$66,602.07
|
| Rate for Payer: Anthem Medicaid |
$29,746.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67,467.04
|
| Rate for Payer: Cash Price |
$43,248.10
|
| Rate for Payer: Cigna Commercial |
$71,791.85
|
| Rate for Payer: First Health Commercial |
$82,171.39
|
| Rate for Payer: Humana Commercial |
$73,521.77
|
| Rate for Payer: Humana KY Medicaid |
$29,746.04
|
| Rate for Payer: Kentucky WC Medicaid |
$30,048.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70,926.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63,834.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,948.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$30,342.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$76,116.66
|
| Rate for Payer: Ohio Health Group HMO |
$64,872.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69,196.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75,251.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59,682.38
|
| Rate for Payer: PHCS Commercial |
$83,036.35
|
| Rate for Payer: United Healthcare All Payer |
$76,116.66
|
|
|
AFX 2 BFMN BY BEA28-120/I16-40
|
Facility
|
IP
|
$86,496.20
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25,948.86 |
| Max. Negotiated Rate |
$83,036.35 |
| Rate for Payer: Aetna Commercial |
$66,602.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67,467.04
|
| Rate for Payer: Cash Price |
$43,248.10
|
| Rate for Payer: Cigna Commercial |
$71,791.85
|
| Rate for Payer: First Health Commercial |
$82,171.39
|
| Rate for Payer: Humana Commercial |
$73,521.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70,926.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63,834.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,948.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$76,116.66
|
| Rate for Payer: Ohio Health Group HMO |
$64,872.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69,196.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75,251.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59,682.38
|
| Rate for Payer: PHCS Commercial |
$83,036.35
|
| Rate for Payer: United Healthcare All Payer |
$76,116.66
|
|
|
AFX 2 BFMN BY BEA28-120/I16-40
|
Facility
|
OP
|
$86,496.20
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25,948.86 |
| Max. Negotiated Rate |
$83,036.35 |
| Rate for Payer: Aetna Commercial |
$66,602.07
|
| Rate for Payer: Anthem Medicaid |
$29,746.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67,467.04
|
| Rate for Payer: Cash Price |
$43,248.10
|
| Rate for Payer: Cigna Commercial |
$71,791.85
|
| Rate for Payer: First Health Commercial |
$82,171.39
|
| Rate for Payer: Humana Commercial |
$73,521.77
|
| Rate for Payer: Humana KY Medicaid |
$29,746.04
|
| Rate for Payer: Kentucky WC Medicaid |
$30,048.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70,926.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63,834.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,948.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$30,342.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$76,116.66
|
| Rate for Payer: Ohio Health Group HMO |
$64,872.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69,196.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75,251.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59,682.38
|
| Rate for Payer: PHCS Commercial |
$83,036.35
|
| Rate for Payer: United Healthcare All Payer |
$76,116.66
|
|
|
AFX 2 BIF MN BDY BEA22-40/I13-
|
Facility
|
OP
|
$86,496.20
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25,948.86 |
| Max. Negotiated Rate |
$83,036.35 |
| Rate for Payer: Aetna Commercial |
$66,602.07
|
| Rate for Payer: Anthem Medicaid |
$29,746.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67,467.04
|
| Rate for Payer: Cash Price |
$43,248.10
|
| Rate for Payer: Cigna Commercial |
$71,791.85
|
| Rate for Payer: First Health Commercial |
$82,171.39
|
| Rate for Payer: Humana Commercial |
$73,521.77
|
| Rate for Payer: Humana KY Medicaid |
$29,746.04
|
| Rate for Payer: Kentucky WC Medicaid |
$30,048.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70,926.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63,834.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,948.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$30,342.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$76,116.66
|
| Rate for Payer: Ohio Health Group HMO |
$64,872.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69,196.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75,251.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59,682.38
|
| Rate for Payer: PHCS Commercial |
$83,036.35
|
| Rate for Payer: United Healthcare All Payer |
$76,116.66
|
|
|
AFX 2 BIF MN BDY BEA22-40/I13-
|
Facility
|
IP
|
$86,496.20
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25,948.86 |
| Max. Negotiated Rate |
$83,036.35 |
| Rate for Payer: Aetna Commercial |
$66,602.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67,467.04
|
| Rate for Payer: Cash Price |
$43,248.10
|
| Rate for Payer: Cigna Commercial |
$71,791.85
|
| Rate for Payer: First Health Commercial |
$82,171.39
|
| Rate for Payer: Humana Commercial |
$73,521.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70,926.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63,834.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,948.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$76,116.66
|
| Rate for Payer: Ohio Health Group HMO |
$64,872.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69,196.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75,251.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59,682.38
|
| Rate for Payer: PHCS Commercial |
$83,036.35
|
| Rate for Payer: United Healthcare All Payer |
$76,116.66
|
|
|
AFX 2 BIF MN BDY BEA22-60/I13-
|
Facility
|
OP
|
$86,496.20
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25,948.86 |
| Max. Negotiated Rate |
$83,036.35 |
| Rate for Payer: Aetna Commercial |
$66,602.07
|
| Rate for Payer: Anthem Medicaid |
$29,746.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67,467.04
|
| Rate for Payer: Cash Price |
$43,248.10
|
| Rate for Payer: Cigna Commercial |
$71,791.85
|
| Rate for Payer: First Health Commercial |
$82,171.39
|
| Rate for Payer: Humana Commercial |
$73,521.77
|
| Rate for Payer: Humana KY Medicaid |
$29,746.04
|
| Rate for Payer: Kentucky WC Medicaid |
$30,048.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70,926.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63,834.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,948.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$30,342.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$76,116.66
|
| Rate for Payer: Ohio Health Group HMO |
$64,872.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69,196.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75,251.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59,682.38
|
| Rate for Payer: PHCS Commercial |
$83,036.35
|
| Rate for Payer: United Healthcare All Payer |
$76,116.66
|
|
|
AFX 2 BIF MN BDY BEA22-60/I13-
|
Facility
|
IP
|
$86,496.20
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25,948.86 |
| Max. Negotiated Rate |
$83,036.35 |
| Rate for Payer: Aetna Commercial |
$66,602.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67,467.04
|
| Rate for Payer: Cash Price |
$43,248.10
|
| Rate for Payer: Cigna Commercial |
$71,791.85
|
| Rate for Payer: First Health Commercial |
$82,171.39
|
| Rate for Payer: Humana Commercial |
$73,521.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70,926.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63,834.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,948.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$76,116.66
|
| Rate for Payer: Ohio Health Group HMO |
$64,872.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69,196.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75,251.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59,682.38
|
| Rate for Payer: PHCS Commercial |
$83,036.35
|
| Rate for Payer: United Healthcare All Payer |
$76,116.66
|
|
|
AFX 2 BIF MN BDY BEA22-70/I16-
|
Facility
|
OP
|
$86,496.20
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25,948.86 |
| Max. Negotiated Rate |
$83,036.35 |
| Rate for Payer: Aetna Commercial |
$66,602.07
|
| Rate for Payer: Anthem Medicaid |
$29,746.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67,467.04
|
| Rate for Payer: Cash Price |
$43,248.10
|
| Rate for Payer: Cigna Commercial |
$71,791.85
|
| Rate for Payer: First Health Commercial |
$82,171.39
|
| Rate for Payer: Humana Commercial |
$73,521.77
|
| Rate for Payer: Humana KY Medicaid |
$29,746.04
|
| Rate for Payer: Kentucky WC Medicaid |
$30,048.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70,926.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63,834.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,948.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$30,342.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$76,116.66
|
| Rate for Payer: Ohio Health Group HMO |
$64,872.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69,196.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75,251.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59,682.38
|
| Rate for Payer: PHCS Commercial |
$83,036.35
|
| Rate for Payer: United Healthcare All Payer |
$76,116.66
|
|
|
AFX 2 BIF MN BDY BEA22-70/I16-
|
Facility
|
IP
|
$86,496.20
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25,948.86 |
| Max. Negotiated Rate |
$83,036.35 |
| Rate for Payer: Aetna Commercial |
$66,602.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67,467.04
|
| Rate for Payer: Cash Price |
$43,248.10
|
| Rate for Payer: Cigna Commercial |
$71,791.85
|
| Rate for Payer: First Health Commercial |
$82,171.39
|
| Rate for Payer: Humana Commercial |
$73,521.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70,926.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63,834.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,948.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$76,116.66
|
| Rate for Payer: Ohio Health Group HMO |
$64,872.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69,196.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75,251.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59,682.38
|
| Rate for Payer: PHCS Commercial |
$83,036.35
|
| Rate for Payer: United Healthcare All Payer |
$76,116.66
|
|
|
AFX 2 BIF MN BDY BEA22-80/I16-
|
Facility
|
OP
|
$86,496.20
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25,948.86 |
| Max. Negotiated Rate |
$83,036.35 |
| Rate for Payer: Aetna Commercial |
$66,602.07
|
| Rate for Payer: Anthem Medicaid |
$29,746.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67,467.04
|
| Rate for Payer: Cash Price |
$43,248.10
|
| Rate for Payer: Cigna Commercial |
$71,791.85
|
| Rate for Payer: First Health Commercial |
$82,171.39
|
| Rate for Payer: Humana Commercial |
$73,521.77
|
| Rate for Payer: Humana KY Medicaid |
$29,746.04
|
| Rate for Payer: Kentucky WC Medicaid |
$30,048.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70,926.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63,834.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,948.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$30,342.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$76,116.66
|
| Rate for Payer: Ohio Health Group HMO |
$64,872.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69,196.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75,251.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59,682.38
|
| Rate for Payer: PHCS Commercial |
$83,036.35
|
| Rate for Payer: United Healthcare All Payer |
$76,116.66
|
|
|
AFX 2 BIF MN BDY BEA22-80/I16-
|
Facility
|
IP
|
$86,496.20
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25,948.86 |
| Max. Negotiated Rate |
$83,036.35 |
| Rate for Payer: Aetna Commercial |
$66,602.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67,467.04
|
| Rate for Payer: Cash Price |
$43,248.10
|
| Rate for Payer: Cigna Commercial |
$71,791.85
|
| Rate for Payer: First Health Commercial |
$82,171.39
|
| Rate for Payer: Humana Commercial |
$73,521.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70,926.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63,834.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,948.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$76,116.66
|
| Rate for Payer: Ohio Health Group HMO |
$64,872.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69,196.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75,251.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59,682.38
|
| Rate for Payer: PHCS Commercial |
$83,036.35
|
| Rate for Payer: United Healthcare All Payer |
$76,116.66
|
|
|
AFX 2 BIFMNBDY BEA25-80/I20-40
|
Facility
|
IP
|
$86,496.20
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25,948.86 |
| Max. Negotiated Rate |
$83,036.35 |
| Rate for Payer: Aetna Commercial |
$66,602.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67,467.04
|
| Rate for Payer: Cash Price |
$43,248.10
|
| Rate for Payer: Cigna Commercial |
$71,791.85
|
| Rate for Payer: First Health Commercial |
$82,171.39
|
| Rate for Payer: Humana Commercial |
$73,521.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70,926.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63,834.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,948.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$76,116.66
|
| Rate for Payer: Ohio Health Group HMO |
$64,872.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69,196.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75,251.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59,682.38
|
| Rate for Payer: PHCS Commercial |
$83,036.35
|
| Rate for Payer: United Healthcare All Payer |
$76,116.66
|
|
|
AFX 2 BIFMNBDY BEA25-80/I20-40
|
Facility
|
OP
|
$86,496.20
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25,948.86 |
| Max. Negotiated Rate |
$83,036.35 |
| Rate for Payer: Aetna Commercial |
$66,602.07
|
| Rate for Payer: Anthem Medicaid |
$29,746.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67,467.04
|
| Rate for Payer: Cash Price |
$43,248.10
|
| Rate for Payer: Cigna Commercial |
$71,791.85
|
| Rate for Payer: First Health Commercial |
$82,171.39
|
| Rate for Payer: Humana Commercial |
$73,521.77
|
| Rate for Payer: Humana KY Medicaid |
$29,746.04
|
| Rate for Payer: Kentucky WC Medicaid |
$30,048.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70,926.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63,834.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,948.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$30,342.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$76,116.66
|
| Rate for Payer: Ohio Health Group HMO |
$64,872.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69,196.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75,251.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59,682.38
|
| Rate for Payer: PHCS Commercial |
$83,036.35
|
| Rate for Payer: United Healthcare All Payer |
$76,116.66
|
|
|
AFX 2 BIF MN BY BEA25-100/I16-
|
Facility
|
OP
|
$86,496.20
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25,948.86 |
| Max. Negotiated Rate |
$83,036.35 |
| Rate for Payer: Aetna Commercial |
$66,602.07
|
| Rate for Payer: Anthem Medicaid |
$29,746.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67,467.04
|
| Rate for Payer: Cash Price |
$43,248.10
|
| Rate for Payer: Cigna Commercial |
$71,791.85
|
| Rate for Payer: First Health Commercial |
$82,171.39
|
| Rate for Payer: Humana Commercial |
$73,521.77
|
| Rate for Payer: Humana KY Medicaid |
$29,746.04
|
| Rate for Payer: Kentucky WC Medicaid |
$30,048.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70,926.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63,834.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,948.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$30,342.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$76,116.66
|
| Rate for Payer: Ohio Health Group HMO |
$64,872.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69,196.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75,251.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59,682.38
|
| Rate for Payer: PHCS Commercial |
$83,036.35
|
| Rate for Payer: United Healthcare All Payer |
$76,116.66
|
|
|
AFX 2 BIF MN BY BEA25-100/I16-
|
Facility
|
IP
|
$86,496.20
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25,948.86 |
| Max. Negotiated Rate |
$83,036.35 |
| Rate for Payer: Aetna Commercial |
$66,602.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67,467.04
|
| Rate for Payer: Cash Price |
$43,248.10
|
| Rate for Payer: Cigna Commercial |
$71,791.85
|
| Rate for Payer: First Health Commercial |
$82,171.39
|
| Rate for Payer: Humana Commercial |
$73,521.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70,926.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63,834.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,948.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$76,116.66
|
| Rate for Payer: Ohio Health Group HMO |
$64,872.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69,196.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75,251.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59,682.38
|
| Rate for Payer: PHCS Commercial |
$83,036.35
|
| Rate for Payer: United Healthcare All Payer |
$76,116.66
|
|
|
AFX 2 BIF MN BY BEA28-100/I20-
|
Facility
|
OP
|
$86,496.20
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25,948.86 |
| Max. Negotiated Rate |
$83,036.35 |
| Rate for Payer: Aetna Commercial |
$66,602.07
|
| Rate for Payer: Anthem Medicaid |
$29,746.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67,467.04
|
| Rate for Payer: Cash Price |
$43,248.10
|
| Rate for Payer: Cigna Commercial |
$71,791.85
|
| Rate for Payer: First Health Commercial |
$82,171.39
|
| Rate for Payer: Humana Commercial |
$73,521.77
|
| Rate for Payer: Humana KY Medicaid |
$29,746.04
|
| Rate for Payer: Kentucky WC Medicaid |
$30,048.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70,926.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63,834.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,948.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$30,342.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$76,116.66
|
| Rate for Payer: Ohio Health Group HMO |
$64,872.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69,196.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75,251.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59,682.38
|
| Rate for Payer: PHCS Commercial |
$83,036.35
|
| Rate for Payer: United Healthcare All Payer |
$76,116.66
|
|
|
AFX 2 BIF MN BY BEA28-100/I20-
|
Facility
|
IP
|
$86,496.20
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25,948.86 |
| Max. Negotiated Rate |
$83,036.35 |
| Rate for Payer: Aetna Commercial |
$66,602.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67,467.04
|
| Rate for Payer: Cash Price |
$43,248.10
|
| Rate for Payer: Cigna Commercial |
$71,791.85
|
| Rate for Payer: First Health Commercial |
$82,171.39
|
| Rate for Payer: Humana Commercial |
$73,521.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70,926.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63,834.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,948.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$76,116.66
|
| Rate for Payer: Ohio Health Group HMO |
$64,872.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69,196.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75,251.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59,682.38
|
| Rate for Payer: PHCS Commercial |
$83,036.35
|
| Rate for Payer: United Healthcare All Payer |
$76,116.66
|
|
|
AFX 2 BIF MN BY BEA28-110/I20-
|
Facility
|
IP
|
$86,496.20
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25,948.86 |
| Max. Negotiated Rate |
$83,036.35 |
| Rate for Payer: Aetna Commercial |
$66,602.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67,467.04
|
| Rate for Payer: Cash Price |
$43,248.10
|
| Rate for Payer: Cigna Commercial |
$71,791.85
|
| Rate for Payer: First Health Commercial |
$82,171.39
|
| Rate for Payer: Humana Commercial |
$73,521.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70,926.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63,834.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,948.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$76,116.66
|
| Rate for Payer: Ohio Health Group HMO |
$64,872.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69,196.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75,251.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59,682.38
|
| Rate for Payer: PHCS Commercial |
$83,036.35
|
| Rate for Payer: United Healthcare All Payer |
$76,116.66
|
|
|
AFX 2 BIF MN BY BEA28-110/I20-
|
Facility
|
OP
|
$86,496.20
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25,948.86 |
| Max. Negotiated Rate |
$83,036.35 |
| Rate for Payer: Aetna Commercial |
$66,602.07
|
| Rate for Payer: Anthem Medicaid |
$29,746.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67,467.04
|
| Rate for Payer: Cash Price |
$43,248.10
|
| Rate for Payer: Cigna Commercial |
$71,791.85
|
| Rate for Payer: First Health Commercial |
$82,171.39
|
| Rate for Payer: Humana Commercial |
$73,521.77
|
| Rate for Payer: Humana KY Medicaid |
$29,746.04
|
| Rate for Payer: Kentucky WC Medicaid |
$30,048.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70,926.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63,834.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,948.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$30,342.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$76,116.66
|
| Rate for Payer: Ohio Health Group HMO |
$64,872.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69,196.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75,251.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59,682.38
|
| Rate for Payer: PHCS Commercial |
$83,036.35
|
| Rate for Payer: United Healthcare All Payer |
$76,116.66
|
|
|
AFX 2 BIF MN BY BEA28-120/I20-
|
Facility
|
IP
|
$86,496.20
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25,948.86 |
| Max. Negotiated Rate |
$83,036.35 |
| Rate for Payer: Aetna Commercial |
$66,602.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$67,467.04
|
| Rate for Payer: Cash Price |
$43,248.10
|
| Rate for Payer: Cigna Commercial |
$71,791.85
|
| Rate for Payer: First Health Commercial |
$82,171.39
|
| Rate for Payer: Humana Commercial |
$73,521.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$70,926.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$63,834.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,948.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$76,116.66
|
| Rate for Payer: Ohio Health Group HMO |
$64,872.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$69,196.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75,251.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59,682.38
|
| Rate for Payer: PHCS Commercial |
$83,036.35
|
| Rate for Payer: United Healthcare All Payer |
$76,116.66
|
|
