|
AFX 2 BIFMNBDY BEA25-80/I20-40
|
Facility
|
IP
|
$23,046.35
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,996.03 |
| Max. Negotiated Rate |
$22,124.50 |
| Rate for Payer: Aetna Commercial |
$17,745.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,976.15
|
| Rate for Payer: Cash Price |
$11,523.17
|
| Rate for Payer: Cigna Commercial |
$19,128.47
|
| Rate for Payer: First Health Commercial |
$21,894.03
|
| Rate for Payer: Humana Commercial |
$19,589.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,898.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,008.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,913.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,280.79
|
| Rate for Payer: Ohio Health Group HMO |
$17,284.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,609.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,996.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,144.37
|
| Rate for Payer: PHCS Commercial |
$22,124.50
|
| Rate for Payer: United Healthcare All Payer |
$20,280.79
|
|
|
AFX 2 BIFMNBDY BEA25-80/I20-40
|
Facility
|
OP
|
$23,046.35
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,996.03 |
| Max. Negotiated Rate |
$22,124.50 |
| Rate for Payer: Aetna Commercial |
$17,745.69
|
| Rate for Payer: Anthem Medicaid |
$7,925.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,976.15
|
| Rate for Payer: Cash Price |
$11,523.17
|
| Rate for Payer: Cigna Commercial |
$19,128.47
|
| Rate for Payer: First Health Commercial |
$21,894.03
|
| Rate for Payer: Humana Commercial |
$19,589.40
|
| Rate for Payer: Humana KY Medicaid |
$7,925.64
|
| Rate for Payer: Kentucky WC Medicaid |
$8,006.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,898.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,008.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,913.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,084.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,280.79
|
| Rate for Payer: Ohio Health Group HMO |
$17,284.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,609.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,996.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,144.37
|
| Rate for Payer: PHCS Commercial |
$22,124.50
|
| Rate for Payer: United Healthcare All Payer |
$20,280.79
|
|
|
AFX 2 BIF MN BY BEA25-100/I16-
|
Facility
|
IP
|
$83,496.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,854.53 |
| Max. Negotiated Rate |
$80,156.54 |
| Rate for Payer: Aetna Commercial |
$64,292.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65,127.19
|
| Rate for Payer: Cash Price |
$41,748.20
|
| Rate for Payer: Cigna Commercial |
$69,302.01
|
| Rate for Payer: First Health Commercial |
$79,321.58
|
| Rate for Payer: Humana Commercial |
$70,971.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68,467.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61,620.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,048.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$73,476.83
|
| Rate for Payer: Ohio Health Group HMO |
$62,622.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,699.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,854.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,883.88
|
| Rate for Payer: PHCS Commercial |
$80,156.54
|
| Rate for Payer: United Healthcare All Payer |
$73,476.83
|
|
|
AFX 2 BIF MN BY BEA25-100/I16-
|
Facility
|
OP
|
$83,496.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,854.53 |
| Max. Negotiated Rate |
$80,156.54 |
| Rate for Payer: Aetna Commercial |
$64,292.23
|
| Rate for Payer: Anthem Medicaid |
$28,714.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65,127.19
|
| Rate for Payer: Cash Price |
$41,748.20
|
| Rate for Payer: Cigna Commercial |
$69,302.01
|
| Rate for Payer: First Health Commercial |
$79,321.58
|
| Rate for Payer: Humana Commercial |
$70,971.94
|
| Rate for Payer: Humana KY Medicaid |
$28,714.41
|
| Rate for Payer: Kentucky WC Medicaid |
$29,006.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68,467.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61,620.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,048.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$29,290.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$73,476.83
|
| Rate for Payer: Ohio Health Group HMO |
$62,622.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,699.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,854.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,883.88
|
| Rate for Payer: PHCS Commercial |
$80,156.54
|
| Rate for Payer: United Healthcare All Payer |
$73,476.83
|
|
|
AFX 2 BIF MN BY BEA28-100/I20-
|
Facility
|
OP
|
$83,496.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,854.53 |
| Max. Negotiated Rate |
$80,156.54 |
| Rate for Payer: Aetna Commercial |
$64,292.23
|
| Rate for Payer: Anthem Medicaid |
$28,714.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65,127.19
|
| Rate for Payer: Cash Price |
$41,748.20
|
| Rate for Payer: Cigna Commercial |
$69,302.01
|
| Rate for Payer: First Health Commercial |
$79,321.58
|
| Rate for Payer: Humana Commercial |
$70,971.94
|
| Rate for Payer: Humana KY Medicaid |
$28,714.41
|
| Rate for Payer: Kentucky WC Medicaid |
$29,006.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68,467.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61,620.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,048.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$29,290.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$73,476.83
|
| Rate for Payer: Ohio Health Group HMO |
$62,622.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,699.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,854.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,883.88
|
| Rate for Payer: PHCS Commercial |
$80,156.54
|
| Rate for Payer: United Healthcare All Payer |
$73,476.83
|
|
|
AFX 2 BIF MN BY BEA28-100/I20-
|
Facility
|
IP
|
$83,496.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,854.53 |
| Max. Negotiated Rate |
$80,156.54 |
| Rate for Payer: Aetna Commercial |
$64,292.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65,127.19
|
| Rate for Payer: Cash Price |
$41,748.20
|
| Rate for Payer: Cigna Commercial |
$69,302.01
|
| Rate for Payer: First Health Commercial |
$79,321.58
|
| Rate for Payer: Humana Commercial |
$70,971.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68,467.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61,620.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,048.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$73,476.83
|
| Rate for Payer: Ohio Health Group HMO |
$62,622.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,699.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,854.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,883.88
|
| Rate for Payer: PHCS Commercial |
$80,156.54
|
| Rate for Payer: United Healthcare All Payer |
$73,476.83
|
|
|
AFX 2 BIF MN BY BEA28-110/I20-
|
Facility
|
IP
|
$83,496.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,854.53 |
| Max. Negotiated Rate |
$80,156.54 |
| Rate for Payer: Aetna Commercial |
$64,292.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65,127.19
|
| Rate for Payer: Cash Price |
$41,748.20
|
| Rate for Payer: Cigna Commercial |
$69,302.01
|
| Rate for Payer: First Health Commercial |
$79,321.58
|
| Rate for Payer: Humana Commercial |
$70,971.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68,467.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61,620.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,048.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$73,476.83
|
| Rate for Payer: Ohio Health Group HMO |
$62,622.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,699.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,854.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,883.88
|
| Rate for Payer: PHCS Commercial |
$80,156.54
|
| Rate for Payer: United Healthcare All Payer |
$73,476.83
|
|
|
AFX 2 BIF MN BY BEA28-110/I20-
|
Facility
|
OP
|
$83,496.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,854.53 |
| Max. Negotiated Rate |
$80,156.54 |
| Rate for Payer: Aetna Commercial |
$64,292.23
|
| Rate for Payer: Anthem Medicaid |
$28,714.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65,127.19
|
| Rate for Payer: Cash Price |
$41,748.20
|
| Rate for Payer: Cigna Commercial |
$69,302.01
|
| Rate for Payer: First Health Commercial |
$79,321.58
|
| Rate for Payer: Humana Commercial |
$70,971.94
|
| Rate for Payer: Humana KY Medicaid |
$28,714.41
|
| Rate for Payer: Kentucky WC Medicaid |
$29,006.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68,467.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61,620.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,048.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$29,290.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$73,476.83
|
| Rate for Payer: Ohio Health Group HMO |
$62,622.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,699.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,854.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,883.88
|
| Rate for Payer: PHCS Commercial |
$80,156.54
|
| Rate for Payer: United Healthcare All Payer |
$73,476.83
|
|
|
AFX 2 BIF MN BY BEA28-120/I20-
|
Facility
|
IP
|
$83,496.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,854.53 |
| Max. Negotiated Rate |
$80,156.54 |
| Rate for Payer: Aetna Commercial |
$64,292.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65,127.19
|
| Rate for Payer: Cash Price |
$41,748.20
|
| Rate for Payer: Cigna Commercial |
$69,302.01
|
| Rate for Payer: First Health Commercial |
$79,321.58
|
| Rate for Payer: Humana Commercial |
$70,971.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68,467.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61,620.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,048.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$73,476.83
|
| Rate for Payer: Ohio Health Group HMO |
$62,622.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,699.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,854.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,883.88
|
| Rate for Payer: PHCS Commercial |
$80,156.54
|
| Rate for Payer: United Healthcare All Payer |
$73,476.83
|
|
|
AFX 2 BIF MN BY BEA28-120/I20-
|
Facility
|
OP
|
$83,496.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,854.53 |
| Max. Negotiated Rate |
$80,156.54 |
| Rate for Payer: Aetna Commercial |
$64,292.23
|
| Rate for Payer: Anthem Medicaid |
$28,714.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65,127.19
|
| Rate for Payer: Cash Price |
$41,748.20
|
| Rate for Payer: Cigna Commercial |
$69,302.01
|
| Rate for Payer: First Health Commercial |
$79,321.58
|
| Rate for Payer: Humana Commercial |
$70,971.94
|
| Rate for Payer: Humana KY Medicaid |
$28,714.41
|
| Rate for Payer: Kentucky WC Medicaid |
$29,006.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68,467.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61,620.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,048.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$29,290.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$73,476.83
|
| Rate for Payer: Ohio Health Group HMO |
$62,622.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,699.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,854.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,883.88
|
| Rate for Payer: PHCS Commercial |
$80,156.54
|
| Rate for Payer: United Healthcare All Payer |
$73,476.83
|
|
|
AFX 2 BIFMN BY BEA28-60/I16-40
|
Facility
|
OP
|
$83,496.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,854.53 |
| Max. Negotiated Rate |
$80,156.54 |
| Rate for Payer: Aetna Commercial |
$64,292.23
|
| Rate for Payer: Anthem Medicaid |
$28,714.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65,127.19
|
| Rate for Payer: Cash Price |
$41,748.20
|
| Rate for Payer: Cigna Commercial |
$69,302.01
|
| Rate for Payer: First Health Commercial |
$79,321.58
|
| Rate for Payer: Humana Commercial |
$70,971.94
|
| Rate for Payer: Humana KY Medicaid |
$28,714.41
|
| Rate for Payer: Kentucky WC Medicaid |
$29,006.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68,467.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61,620.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,048.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$29,290.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$73,476.83
|
| Rate for Payer: Ohio Health Group HMO |
$62,622.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,699.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,854.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,883.88
|
| Rate for Payer: PHCS Commercial |
$80,156.54
|
| Rate for Payer: United Healthcare All Payer |
$73,476.83
|
|
|
AFX 2 BIFMN BY BEA28-60/I16-40
|
Facility
|
IP
|
$83,496.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,854.53 |
| Max. Negotiated Rate |
$80,156.54 |
| Rate for Payer: Aetna Commercial |
$64,292.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65,127.19
|
| Rate for Payer: Cash Price |
$41,748.20
|
| Rate for Payer: Cigna Commercial |
$69,302.01
|
| Rate for Payer: First Health Commercial |
$79,321.58
|
| Rate for Payer: Humana Commercial |
$70,971.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68,467.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61,620.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,048.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$73,476.83
|
| Rate for Payer: Ohio Health Group HMO |
$62,622.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,699.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,854.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,883.88
|
| Rate for Payer: PHCS Commercial |
$80,156.54
|
| Rate for Payer: United Healthcare All Payer |
$73,476.83
|
|
|
AFX 2 BIFMN BY BEA28-70/I20-30
|
Facility
|
IP
|
$83,496.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,854.53 |
| Max. Negotiated Rate |
$80,156.54 |
| Rate for Payer: Aetna Commercial |
$64,292.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65,127.19
|
| Rate for Payer: Cash Price |
$41,748.20
|
| Rate for Payer: Cigna Commercial |
$69,302.01
|
| Rate for Payer: First Health Commercial |
$79,321.58
|
| Rate for Payer: Humana Commercial |
$70,971.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68,467.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61,620.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,048.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$73,476.83
|
| Rate for Payer: Ohio Health Group HMO |
$62,622.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,699.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,854.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,883.88
|
| Rate for Payer: PHCS Commercial |
$80,156.54
|
| Rate for Payer: United Healthcare All Payer |
$73,476.83
|
|
|
AFX 2 BIFMN BY BEA28-70/I20-30
|
Facility
|
OP
|
$83,496.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,854.53 |
| Max. Negotiated Rate |
$80,156.54 |
| Rate for Payer: Aetna Commercial |
$64,292.23
|
| Rate for Payer: Anthem Medicaid |
$28,714.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65,127.19
|
| Rate for Payer: Cash Price |
$41,748.20
|
| Rate for Payer: Cigna Commercial |
$69,302.01
|
| Rate for Payer: First Health Commercial |
$79,321.58
|
| Rate for Payer: Humana Commercial |
$70,971.94
|
| Rate for Payer: Humana KY Medicaid |
$28,714.41
|
| Rate for Payer: Kentucky WC Medicaid |
$29,006.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68,467.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61,620.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,048.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$29,290.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$73,476.83
|
| Rate for Payer: Ohio Health Group HMO |
$62,622.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,699.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,854.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,883.88
|
| Rate for Payer: PHCS Commercial |
$80,156.54
|
| Rate for Payer: United Healthcare All Payer |
$73,476.83
|
|
|
AFX 2 BIFMN BY BEA28-80/I16-40
|
Facility
|
OP
|
$83,496.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,854.53 |
| Max. Negotiated Rate |
$80,156.54 |
| Rate for Payer: Aetna Commercial |
$64,292.23
|
| Rate for Payer: Anthem Medicaid |
$28,714.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65,127.19
|
| Rate for Payer: Cash Price |
$41,748.20
|
| Rate for Payer: Cigna Commercial |
$69,302.01
|
| Rate for Payer: First Health Commercial |
$79,321.58
|
| Rate for Payer: Humana Commercial |
$70,971.94
|
| Rate for Payer: Humana KY Medicaid |
$28,714.41
|
| Rate for Payer: Kentucky WC Medicaid |
$29,006.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68,467.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61,620.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,048.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$29,290.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$73,476.83
|
| Rate for Payer: Ohio Health Group HMO |
$62,622.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,699.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,854.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,883.88
|
| Rate for Payer: PHCS Commercial |
$80,156.54
|
| Rate for Payer: United Healthcare All Payer |
$73,476.83
|
|
|
AFX 2 BIFMN BY BEA28-80/I16-40
|
Facility
|
IP
|
$83,496.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,854.53 |
| Max. Negotiated Rate |
$80,156.54 |
| Rate for Payer: Aetna Commercial |
$64,292.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65,127.19
|
| Rate for Payer: Cash Price |
$41,748.20
|
| Rate for Payer: Cigna Commercial |
$69,302.01
|
| Rate for Payer: First Health Commercial |
$79,321.58
|
| Rate for Payer: Humana Commercial |
$70,971.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68,467.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61,620.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,048.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$73,476.83
|
| Rate for Payer: Ohio Health Group HMO |
$62,622.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,699.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,854.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,883.88
|
| Rate for Payer: PHCS Commercial |
$80,156.54
|
| Rate for Payer: United Healthcare All Payer |
$73,476.83
|
|
|
AFX 2 BIFMN BY BEA28-80/I20-40
|
Facility
|
OP
|
$83,496.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,854.53 |
| Max. Negotiated Rate |
$80,156.54 |
| Rate for Payer: Aetna Commercial |
$64,292.23
|
| Rate for Payer: Anthem Medicaid |
$28,714.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65,127.19
|
| Rate for Payer: Cash Price |
$41,748.20
|
| Rate for Payer: Cigna Commercial |
$69,302.01
|
| Rate for Payer: First Health Commercial |
$79,321.58
|
| Rate for Payer: Humana Commercial |
$70,971.94
|
| Rate for Payer: Humana KY Medicaid |
$28,714.41
|
| Rate for Payer: Kentucky WC Medicaid |
$29,006.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68,467.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61,620.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,048.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$29,290.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$73,476.83
|
| Rate for Payer: Ohio Health Group HMO |
$62,622.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,699.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,854.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,883.88
|
| Rate for Payer: PHCS Commercial |
$80,156.54
|
| Rate for Payer: United Healthcare All Payer |
$73,476.83
|
|
|
AFX 2 BIFMN BY BEA28-80/I20-40
|
Facility
|
IP
|
$83,496.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,854.53 |
| Max. Negotiated Rate |
$80,156.54 |
| Rate for Payer: Aetna Commercial |
$64,292.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65,127.19
|
| Rate for Payer: Cash Price |
$41,748.20
|
| Rate for Payer: Cigna Commercial |
$69,302.01
|
| Rate for Payer: First Health Commercial |
$79,321.58
|
| Rate for Payer: Humana Commercial |
$70,971.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68,467.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61,620.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,048.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$73,476.83
|
| Rate for Payer: Ohio Health Group HMO |
$62,622.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,699.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,854.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,883.88
|
| Rate for Payer: PHCS Commercial |
$80,156.54
|
| Rate for Payer: United Healthcare All Payer |
$73,476.83
|
|
|
AFX 2 BIF MN BY BEA28-90/I16-3
|
Facility
|
IP
|
$83,496.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,854.53 |
| Max. Negotiated Rate |
$80,156.54 |
| Rate for Payer: Aetna Commercial |
$64,292.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65,127.19
|
| Rate for Payer: Cash Price |
$41,748.20
|
| Rate for Payer: Cigna Commercial |
$69,302.01
|
| Rate for Payer: First Health Commercial |
$79,321.58
|
| Rate for Payer: Humana Commercial |
$70,971.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68,467.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61,620.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,048.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$73,476.83
|
| Rate for Payer: Ohio Health Group HMO |
$62,622.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,699.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,854.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,883.88
|
| Rate for Payer: PHCS Commercial |
$80,156.54
|
| Rate for Payer: United Healthcare All Payer |
$73,476.83
|
|
|
AFX 2 BIF MN BY BEA28-90/I16-3
|
Facility
|
OP
|
$83,496.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,854.53 |
| Max. Negotiated Rate |
$80,156.54 |
| Rate for Payer: Aetna Commercial |
$64,292.23
|
| Rate for Payer: Anthem Medicaid |
$28,714.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65,127.19
|
| Rate for Payer: Cash Price |
$41,748.20
|
| Rate for Payer: Cigna Commercial |
$69,302.01
|
| Rate for Payer: First Health Commercial |
$79,321.58
|
| Rate for Payer: Humana Commercial |
$70,971.94
|
| Rate for Payer: Humana KY Medicaid |
$28,714.41
|
| Rate for Payer: Kentucky WC Medicaid |
$29,006.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68,467.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61,620.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,048.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$29,290.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$73,476.83
|
| Rate for Payer: Ohio Health Group HMO |
$62,622.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,699.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,854.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,883.88
|
| Rate for Payer: PHCS Commercial |
$80,156.54
|
| Rate for Payer: United Healthcare All Payer |
$73,476.83
|
|
|
AFX 2 BIF MN BY BEA28-90/I20-3
|
Facility
|
OP
|
$83,496.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,854.53 |
| Max. Negotiated Rate |
$80,156.54 |
| Rate for Payer: Aetna Commercial |
$64,292.23
|
| Rate for Payer: Anthem Medicaid |
$28,714.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65,127.19
|
| Rate for Payer: Cash Price |
$41,748.20
|
| Rate for Payer: Cigna Commercial |
$69,302.01
|
| Rate for Payer: First Health Commercial |
$79,321.58
|
| Rate for Payer: Humana Commercial |
$70,971.94
|
| Rate for Payer: Humana KY Medicaid |
$28,714.41
|
| Rate for Payer: Kentucky WC Medicaid |
$29,006.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68,467.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61,620.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,048.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$29,290.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$73,476.83
|
| Rate for Payer: Ohio Health Group HMO |
$62,622.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,699.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,854.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,883.88
|
| Rate for Payer: PHCS Commercial |
$80,156.54
|
| Rate for Payer: United Healthcare All Payer |
$73,476.83
|
|
|
AFX 2 BIF MN BY BEA28-90/I20-3
|
Facility
|
IP
|
$83,496.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,854.53 |
| Max. Negotiated Rate |
$80,156.54 |
| Rate for Payer: Aetna Commercial |
$64,292.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65,127.19
|
| Rate for Payer: Cash Price |
$41,748.20
|
| Rate for Payer: Cigna Commercial |
$69,302.01
|
| Rate for Payer: First Health Commercial |
$79,321.58
|
| Rate for Payer: Humana Commercial |
$70,971.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68,467.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61,620.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25,048.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$73,476.83
|
| Rate for Payer: Ohio Health Group HMO |
$62,622.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,699.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,854.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$25,883.88
|
| Rate for Payer: PHCS Commercial |
$80,156.54
|
| Rate for Payer: United Healthcare All Payer |
$73,476.83
|
|
|
AFX WIRE .014
|
Facility
|
OP
|
$1,962.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$255.12 |
| Max. Negotiated Rate |
$1,884.00 |
| Rate for Payer: Aetna Commercial |
$1,511.12
|
| Rate for Payer: Anthem Medicaid |
$674.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,530.75
|
| Rate for Payer: Cash Price |
$981.25
|
| Rate for Payer: Cigna Commercial |
$1,628.88
|
| Rate for Payer: First Health Commercial |
$1,864.38
|
| Rate for Payer: Humana Commercial |
$1,668.12
|
| Rate for Payer: Humana KY Medicaid |
$674.90
|
| Rate for Payer: Kentucky WC Medicaid |
$681.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,609.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,448.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$588.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$688.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,727.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,471.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$392.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$255.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$608.38
|
| Rate for Payer: PHCS Commercial |
$1,884.00
|
| Rate for Payer: United Healthcare All Payer |
$1,727.00
|
|
|
AFX WIRE .014
|
Facility
|
IP
|
$1,962.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$255.12 |
| Max. Negotiated Rate |
$1,884.00 |
| Rate for Payer: Aetna Commercial |
$1,511.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,530.75
|
| Rate for Payer: Cash Price |
$981.25
|
| Rate for Payer: Cigna Commercial |
$1,628.88
|
| Rate for Payer: First Health Commercial |
$1,864.38
|
| Rate for Payer: Humana Commercial |
$1,668.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,609.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,448.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$588.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,727.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,471.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$392.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$255.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$608.38
|
| Rate for Payer: PHCS Commercial |
$1,884.00
|
| Rate for Payer: United Healthcare All Payer |
$1,727.00
|
|
|
AGC FEMORAL MOLD 60MM
|
Facility
|
IP
|
$12,498.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,624.74 |
| Max. Negotiated Rate |
$11,998.08 |
| Rate for Payer: Aetna Commercial |
$9,623.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,748.44
|
| Rate for Payer: Cash Price |
$6,249.00
|
| Rate for Payer: Cigna Commercial |
$10,373.34
|
| Rate for Payer: First Health Commercial |
$11,873.10
|
| Rate for Payer: Humana Commercial |
$10,623.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,248.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,223.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,749.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,998.24
|
| Rate for Payer: Ohio Health Group HMO |
$9,373.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,499.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,624.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,874.38
|
| Rate for Payer: PHCS Commercial |
$11,998.08
|
| Rate for Payer: United Healthcare All Payer |
$10,998.24
|
|
