|
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
|
|
|
AFX 2 BIFMN BY BEA28-60/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 BIFMN BY BEA28-60/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 BIFMN BY BEA28-70/I20-30
|
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 BIFMN BY BEA28-70/I20-30
|
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 BIFMN BY BEA28-80/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 BIFMN BY BEA28-80/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 BIFMN BY BEA28-80/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 BIFMN BY BEA28-80/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 BEA28-90/I16-3
|
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 BEA28-90/I16-3
|
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 BEA28-90/I20-3
|
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 BEA28-90/I20-3
|
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 WIRE .014
|
Facility
|
IP
|
$1,965.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$589.50 |
| Max. Negotiated Rate |
$1,886.40 |
| Rate for Payer: Aetna Commercial |
$1,513.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,532.70
|
| Rate for Payer: Cash Price |
$982.50
|
| Rate for Payer: Cigna Commercial |
$1,630.95
|
| Rate for Payer: First Health Commercial |
$1,866.75
|
| Rate for Payer: Humana Commercial |
$1,670.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,611.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,450.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$589.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,729.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,473.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,572.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,709.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,355.85
|
| Rate for Payer: PHCS Commercial |
$1,886.40
|
| Rate for Payer: United Healthcare All Payer |
$1,729.20
|
|
|
AFX WIRE .014
|
Facility
|
OP
|
$1,965.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$589.50 |
| Max. Negotiated Rate |
$1,886.40 |
| Rate for Payer: Aetna Commercial |
$1,513.05
|
| Rate for Payer: Anthem Medicaid |
$675.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,532.70
|
| Rate for Payer: Cash Price |
$982.50
|
| Rate for Payer: Cigna Commercial |
$1,630.95
|
| Rate for Payer: First Health Commercial |
$1,866.75
|
| Rate for Payer: Humana Commercial |
$1,670.25
|
| Rate for Payer: Humana KY Medicaid |
$675.76
|
| Rate for Payer: Kentucky WC Medicaid |
$682.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,611.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,450.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$589.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$689.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,729.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,473.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,572.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,709.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,355.85
|
| Rate for Payer: PHCS Commercial |
$1,886.40
|
| Rate for Payer: United Healthcare All Payer |
$1,729.20
|
|
|
AGC FEMORAL MOLD 60MM
|
Facility
|
IP
|
$12,748.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,824.52 |
| Max. Negotiated Rate |
$12,238.46 |
| Rate for Payer: Aetna Commercial |
$9,816.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,943.75
|
| Rate for Payer: Cash Price |
$6,374.20
|
| Rate for Payer: Cigna Commercial |
$10,581.17
|
| Rate for Payer: First Health Commercial |
$12,110.98
|
| Rate for Payer: Humana Commercial |
$10,836.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,453.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,408.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,824.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,218.59
|
| Rate for Payer: Ohio Health Group HMO |
$9,561.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,198.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,091.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,796.40
|
| Rate for Payer: PHCS Commercial |
$12,238.46
|
| Rate for Payer: United Healthcare All Payer |
$11,218.59
|
|
|
AGC FEMORAL MOLD 60MM
|
Facility
|
OP
|
$12,748.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,824.52 |
| Max. Negotiated Rate |
$12,238.46 |
| Rate for Payer: Aetna Commercial |
$9,816.27
|
| Rate for Payer: Anthem Medicaid |
$4,384.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,943.75
|
| Rate for Payer: Cash Price |
$6,374.20
|
| Rate for Payer: Cigna Commercial |
$10,581.17
|
| Rate for Payer: First Health Commercial |
$12,110.98
|
| Rate for Payer: Humana Commercial |
$10,836.14
|
| Rate for Payer: Humana KY Medicaid |
$4,384.17
|
| Rate for Payer: Kentucky WC Medicaid |
$4,428.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,453.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,408.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,824.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,472.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,218.59
|
| Rate for Payer: Ohio Health Group HMO |
$9,561.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,198.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,091.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,796.40
|
| Rate for Payer: PHCS Commercial |
$12,238.46
|
| Rate for Payer: United Healthcare All Payer |
$11,218.59
|
|
|
AGC FEMORAL MOLD 65MM
|
Facility
|
IP
|
$12,748.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,824.52 |
| Max. Negotiated Rate |
$12,238.46 |
| Rate for Payer: Aetna Commercial |
$9,816.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,943.75
|
| Rate for Payer: Cash Price |
$6,374.20
|
| Rate for Payer: Cigna Commercial |
$10,581.17
|
| Rate for Payer: First Health Commercial |
$12,110.98
|
| Rate for Payer: Humana Commercial |
$10,836.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,453.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,408.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,824.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,218.59
|
| Rate for Payer: Ohio Health Group HMO |
$9,561.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,198.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,091.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,796.40
|
| Rate for Payer: PHCS Commercial |
$12,238.46
|
| Rate for Payer: United Healthcare All Payer |
$11,218.59
|
|
|
AGC FEMORAL MOLD 65MM
|
Facility
|
OP
|
$12,748.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,824.52 |
| Max. Negotiated Rate |
$12,238.46 |
| Rate for Payer: Aetna Commercial |
$9,816.27
|
| Rate for Payer: Anthem Medicaid |
$4,384.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,943.75
|
| Rate for Payer: Cash Price |
$6,374.20
|
| Rate for Payer: Cigna Commercial |
$10,581.17
|
| Rate for Payer: First Health Commercial |
$12,110.98
|
| Rate for Payer: Humana Commercial |
$10,836.14
|
| Rate for Payer: Humana KY Medicaid |
$4,384.17
|
| Rate for Payer: Kentucky WC Medicaid |
$4,428.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,453.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,408.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,824.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,472.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,218.59
|
| Rate for Payer: Ohio Health Group HMO |
$9,561.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,198.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,091.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,796.40
|
| Rate for Payer: PHCS Commercial |
$12,238.46
|
| Rate for Payer: United Healthcare All Payer |
$11,218.59
|
|
|
AGC FEMORAL MOLD 70MM
|
Facility
|
IP
|
$12,748.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,824.52 |
| Max. Negotiated Rate |
$12,238.46 |
| Rate for Payer: Aetna Commercial |
$9,816.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,943.75
|
| Rate for Payer: Cash Price |
$6,374.20
|
| Rate for Payer: Cigna Commercial |
$10,581.17
|
| Rate for Payer: First Health Commercial |
$12,110.98
|
| Rate for Payer: Humana Commercial |
$10,836.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,453.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,408.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,824.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,218.59
|
| Rate for Payer: Ohio Health Group HMO |
$9,561.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,198.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,091.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,796.40
|
| Rate for Payer: PHCS Commercial |
$12,238.46
|
| Rate for Payer: United Healthcare All Payer |
$11,218.59
|
|
|
AGC FEMORAL MOLD 70MM
|
Facility
|
OP
|
$12,748.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,824.52 |
| Max. Negotiated Rate |
$12,238.46 |
| Rate for Payer: Aetna Commercial |
$9,816.27
|
| Rate for Payer: Anthem Medicaid |
$4,384.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,943.75
|
| Rate for Payer: Cash Price |
$6,374.20
|
| Rate for Payer: Cigna Commercial |
$10,581.17
|
| Rate for Payer: First Health Commercial |
$12,110.98
|
| Rate for Payer: Humana Commercial |
$10,836.14
|
| Rate for Payer: Humana KY Medicaid |
$4,384.17
|
| Rate for Payer: Kentucky WC Medicaid |
$4,428.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,453.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,408.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,824.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,472.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,218.59
|
| Rate for Payer: Ohio Health Group HMO |
$9,561.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,198.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,091.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,796.40
|
| Rate for Payer: PHCS Commercial |
$12,238.46
|
| Rate for Payer: United Healthcare All Payer |
$11,218.59
|
|
|
AGC FEMORAL MOLD 75MM
|
Facility
|
IP
|
$12,748.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,824.52 |
| Max. Negotiated Rate |
$12,238.46 |
| Rate for Payer: Aetna Commercial |
$9,816.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,943.75
|
| Rate for Payer: Cash Price |
$6,374.20
|
| Rate for Payer: Cigna Commercial |
$10,581.17
|
| Rate for Payer: First Health Commercial |
$12,110.98
|
| Rate for Payer: Humana Commercial |
$10,836.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,453.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,408.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,824.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,218.59
|
| Rate for Payer: Ohio Health Group HMO |
$9,561.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,198.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,091.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,796.40
|
| Rate for Payer: PHCS Commercial |
$12,238.46
|
| Rate for Payer: United Healthcare All Payer |
$11,218.59
|
|
|
AGC FEMORAL MOLD 75MM
|
Facility
|
OP
|
$12,748.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,824.52 |
| Max. Negotiated Rate |
$12,238.46 |
| Rate for Payer: Aetna Commercial |
$9,816.27
|
| Rate for Payer: Anthem Medicaid |
$4,384.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,943.75
|
| Rate for Payer: Cash Price |
$6,374.20
|
| Rate for Payer: Cigna Commercial |
$10,581.17
|
| Rate for Payer: First Health Commercial |
$12,110.98
|
| Rate for Payer: Humana Commercial |
$10,836.14
|
| Rate for Payer: Humana KY Medicaid |
$4,384.17
|
| Rate for Payer: Kentucky WC Medicaid |
$4,428.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,453.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,408.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,824.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,472.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,218.59
|
| Rate for Payer: Ohio Health Group HMO |
$9,561.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,198.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,091.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,796.40
|
| Rate for Payer: PHCS Commercial |
$12,238.46
|
| Rate for Payer: United Healthcare All Payer |
$11,218.59
|
|
|
AGC TIBIAL MOLD 65MM
|
Facility
|
IP
|
$7,409.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,222.76 |
| Max. Negotiated Rate |
$7,112.83 |
| Rate for Payer: Aetna Commercial |
$5,705.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,779.18
|
| Rate for Payer: Cash Price |
$3,704.60
|
| Rate for Payer: Cigna Commercial |
$6,149.64
|
| Rate for Payer: First Health Commercial |
$7,038.74
|
| Rate for Payer: Humana Commercial |
$6,297.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,075.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,467.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,222.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,520.10
|
| Rate for Payer: Ohio Health Group HMO |
$5,556.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,927.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,446.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,112.35
|
| Rate for Payer: PHCS Commercial |
$7,112.83
|
| Rate for Payer: United Healthcare All Payer |
$6,520.10
|
|
|
AGC TIBIAL MOLD 65MM
|
Facility
|
OP
|
$7,409.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,222.76 |
| Max. Negotiated Rate |
$7,112.83 |
| Rate for Payer: Aetna Commercial |
$5,705.08
|
| Rate for Payer: Anthem Medicaid |
$2,548.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,779.18
|
| Rate for Payer: Cash Price |
$3,704.60
|
| Rate for Payer: Cigna Commercial |
$6,149.64
|
| Rate for Payer: First Health Commercial |
$7,038.74
|
| Rate for Payer: Humana Commercial |
$6,297.82
|
| Rate for Payer: Humana KY Medicaid |
$2,548.02
|
| Rate for Payer: Kentucky WC Medicaid |
$2,573.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,075.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,467.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,222.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,599.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,520.10
|
| Rate for Payer: Ohio Health Group HMO |
$5,556.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,927.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,446.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,112.35
|
| Rate for Payer: PHCS Commercial |
$7,112.83
|
| Rate for Payer: United Healthcare All Payer |
$6,520.10
|
|
