|
FEM COMP TOTAL STABILIZR #13LT
|
Facility
|
OP
|
$19,759.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,568.69 |
| Max. Negotiated Rate |
$18,968.79 |
| Rate for Payer: Aetna Commercial |
$15,214.55
|
| Rate for Payer: Anthem Medicaid |
$6,795.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,412.14
|
| Rate for Payer: Cash Price |
$9,879.58
|
| Rate for Payer: Cigna Commercial |
$16,400.10
|
| Rate for Payer: First Health Commercial |
$18,771.20
|
| Rate for Payer: Humana Commercial |
$16,795.29
|
| Rate for Payer: Humana KY Medicaid |
$6,795.18
|
| Rate for Payer: Kentucky WC Medicaid |
$6,864.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,202.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,582.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,927.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,931.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,388.06
|
| Rate for Payer: Ohio Health Group HMO |
$14,819.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,951.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,568.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,125.34
|
| Rate for Payer: PHCS Commercial |
$18,968.79
|
| Rate for Payer: United Healthcare All Payer |
$17,388.06
|
|
|
FEM COMP TOTAL STABILIZR #13RT
|
Facility
|
OP
|
$19,759.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,568.69 |
| Max. Negotiated Rate |
$18,968.79 |
| Rate for Payer: Aetna Commercial |
$15,214.55
|
| Rate for Payer: Anthem Medicaid |
$6,795.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,412.14
|
| Rate for Payer: Cash Price |
$9,879.58
|
| Rate for Payer: Cigna Commercial |
$16,400.10
|
| Rate for Payer: First Health Commercial |
$18,771.20
|
| Rate for Payer: Humana Commercial |
$16,795.29
|
| Rate for Payer: Humana KY Medicaid |
$6,795.18
|
| Rate for Payer: Kentucky WC Medicaid |
$6,864.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,202.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,582.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,927.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,931.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,388.06
|
| Rate for Payer: Ohio Health Group HMO |
$14,819.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,951.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,568.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,125.34
|
| Rate for Payer: PHCS Commercial |
$18,968.79
|
| Rate for Payer: United Healthcare All Payer |
$17,388.06
|
|
|
FEM COMP TOTAL STABILIZR #13RT
|
Facility
|
IP
|
$19,759.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,568.69 |
| Max. Negotiated Rate |
$18,968.79 |
| Rate for Payer: Aetna Commercial |
$15,214.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,412.14
|
| Rate for Payer: Cash Price |
$9,879.58
|
| Rate for Payer: Cigna Commercial |
$16,400.10
|
| Rate for Payer: First Health Commercial |
$18,771.20
|
| Rate for Payer: Humana Commercial |
$16,795.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,202.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,582.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,927.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,388.06
|
| Rate for Payer: Ohio Health Group HMO |
$14,819.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,951.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,568.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,125.34
|
| Rate for Payer: PHCS Commercial |
$18,968.79
|
| Rate for Payer: United Healthcare All Payer |
$17,388.06
|
|
|
FEM COMP TOTAL STABILIZR #3/LT
|
Facility
|
OP
|
$19,759.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,568.69 |
| Max. Negotiated Rate |
$18,968.79 |
| Rate for Payer: Aetna Commercial |
$15,214.55
|
| Rate for Payer: Anthem Medicaid |
$6,795.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,412.14
|
| Rate for Payer: Cash Price |
$9,879.58
|
| Rate for Payer: Cigna Commercial |
$16,400.10
|
| Rate for Payer: First Health Commercial |
$18,771.20
|
| Rate for Payer: Humana Commercial |
$16,795.29
|
| Rate for Payer: Humana KY Medicaid |
$6,795.18
|
| Rate for Payer: Kentucky WC Medicaid |
$6,864.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,202.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,582.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,927.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,931.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,388.06
|
| Rate for Payer: Ohio Health Group HMO |
$14,819.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,951.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,568.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,125.34
|
| Rate for Payer: PHCS Commercial |
$18,968.79
|
| Rate for Payer: United Healthcare All Payer |
$17,388.06
|
|
|
FEM COMP TOTAL STABILIZR #3/LT
|
Facility
|
IP
|
$19,759.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,568.69 |
| Max. Negotiated Rate |
$18,968.79 |
| Rate for Payer: Aetna Commercial |
$15,214.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,412.14
|
| Rate for Payer: Cash Price |
$9,879.58
|
| Rate for Payer: Cigna Commercial |
$16,400.10
|
| Rate for Payer: First Health Commercial |
$18,771.20
|
| Rate for Payer: Humana Commercial |
$16,795.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,202.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,582.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,927.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,388.06
|
| Rate for Payer: Ohio Health Group HMO |
$14,819.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,951.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,568.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,125.34
|
| Rate for Payer: PHCS Commercial |
$18,968.79
|
| Rate for Payer: United Healthcare All Payer |
$17,388.06
|
|
|
FEM COMP TOTAL STABILIZR #3/RT
|
Facility
|
IP
|
$19,757.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,568.50 |
| Max. Negotiated Rate |
$18,967.39 |
| Rate for Payer: Aetna Commercial |
$15,213.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,411.01
|
| Rate for Payer: Cash Price |
$9,878.85
|
| Rate for Payer: Cigna Commercial |
$16,398.89
|
| Rate for Payer: First Health Commercial |
$18,769.82
|
| Rate for Payer: Humana Commercial |
$16,794.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,201.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,581.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,927.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,386.78
|
| Rate for Payer: Ohio Health Group HMO |
$14,818.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,951.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,568.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,124.89
|
| Rate for Payer: PHCS Commercial |
$18,967.39
|
| Rate for Payer: United Healthcare All Payer |
$17,386.78
|
|
|
FEM COMP TOTAL STABILIZR #3/RT
|
Facility
|
OP
|
$19,757.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,568.50 |
| Max. Negotiated Rate |
$18,967.39 |
| Rate for Payer: Aetna Commercial |
$15,213.43
|
| Rate for Payer: Anthem Medicaid |
$6,794.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,411.01
|
| Rate for Payer: Cash Price |
$9,878.85
|
| Rate for Payer: Cigna Commercial |
$16,398.89
|
| Rate for Payer: First Health Commercial |
$18,769.82
|
| Rate for Payer: Humana Commercial |
$16,794.04
|
| Rate for Payer: Humana KY Medicaid |
$6,794.67
|
| Rate for Payer: Kentucky WC Medicaid |
$6,863.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,201.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,581.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,927.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,931.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,386.78
|
| Rate for Payer: Ohio Health Group HMO |
$14,818.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,951.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,568.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,124.89
|
| Rate for Payer: PHCS Commercial |
$18,967.39
|
| Rate for Payer: United Healthcare All Payer |
$17,386.78
|
|
|
FEM COMP TOTAL STABILIZR #5 LT
|
Facility
|
OP
|
$23,426.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,045.47 |
| Max. Negotiated Rate |
$22,489.61 |
| Rate for Payer: Aetna Commercial |
$18,038.54
|
| Rate for Payer: Anthem Medicaid |
$8,056.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,272.81
|
| Rate for Payer: Cash Price |
$11,713.34
|
| Rate for Payer: Cigna Commercial |
$19,444.14
|
| Rate for Payer: First Health Commercial |
$22,255.35
|
| Rate for Payer: Humana Commercial |
$19,912.68
|
| Rate for Payer: Humana KY Medicaid |
$8,056.44
|
| Rate for Payer: Kentucky WC Medicaid |
$8,138.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,209.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,288.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,028.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,218.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,615.48
|
| Rate for Payer: Ohio Health Group HMO |
$17,570.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,685.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,045.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,262.27
|
| Rate for Payer: PHCS Commercial |
$22,489.61
|
| Rate for Payer: United Healthcare All Payer |
$20,615.48
|
|
|
FEM COMP TOTAL STABILIZR #5 LT
|
Facility
|
IP
|
$23,426.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,045.47 |
| Max. Negotiated Rate |
$22,489.61 |
| Rate for Payer: Aetna Commercial |
$18,038.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,272.81
|
| Rate for Payer: Cash Price |
$11,713.34
|
| Rate for Payer: Cigna Commercial |
$19,444.14
|
| Rate for Payer: First Health Commercial |
$22,255.35
|
| Rate for Payer: Humana Commercial |
$19,912.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,209.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,288.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,028.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,615.48
|
| Rate for Payer: Ohio Health Group HMO |
$17,570.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,685.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,045.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,262.27
|
| Rate for Payer: PHCS Commercial |
$22,489.61
|
| Rate for Payer: United Healthcare All Payer |
$20,615.48
|
|
|
FEM COMP TOTAL STABILIZR #5/RT
|
Facility
|
IP
|
$23,426.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,045.47 |
| Max. Negotiated Rate |
$22,489.61 |
| Rate for Payer: Aetna Commercial |
$18,038.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,272.81
|
| Rate for Payer: Cash Price |
$11,713.34
|
| Rate for Payer: Cigna Commercial |
$19,444.14
|
| Rate for Payer: First Health Commercial |
$22,255.35
|
| Rate for Payer: Humana Commercial |
$19,912.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,209.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,288.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,028.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,615.48
|
| Rate for Payer: Ohio Health Group HMO |
$17,570.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,685.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,045.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,262.27
|
| Rate for Payer: PHCS Commercial |
$22,489.61
|
| Rate for Payer: United Healthcare All Payer |
$20,615.48
|
|
|
FEM COMP TOTAL STABILIZR #5/RT
|
Facility
|
OP
|
$23,426.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,045.47 |
| Max. Negotiated Rate |
$22,489.61 |
| Rate for Payer: Aetna Commercial |
$18,038.54
|
| Rate for Payer: Anthem Medicaid |
$8,056.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,272.81
|
| Rate for Payer: Cash Price |
$11,713.34
|
| Rate for Payer: Cigna Commercial |
$19,444.14
|
| Rate for Payer: First Health Commercial |
$22,255.35
|
| Rate for Payer: Humana Commercial |
$19,912.68
|
| Rate for Payer: Humana KY Medicaid |
$8,056.44
|
| Rate for Payer: Kentucky WC Medicaid |
$8,138.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,209.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,288.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,028.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,218.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,615.48
|
| Rate for Payer: Ohio Health Group HMO |
$17,570.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,685.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,045.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,262.27
|
| Rate for Payer: PHCS Commercial |
$22,489.61
|
| Rate for Payer: United Healthcare All Payer |
$20,615.48
|
|
|
FEM COMP TOTAL STABILIZR #7 LT
|
Facility
|
OP
|
$24,545.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,190.86 |
| Max. Negotiated Rate |
$23,563.24 |
| Rate for Payer: Aetna Commercial |
$18,899.68
|
| Rate for Payer: Anthem Medicaid |
$8,441.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,145.13
|
| Rate for Payer: Cash Price |
$12,272.52
|
| Rate for Payer: Cigna Commercial |
$20,372.38
|
| Rate for Payer: First Health Commercial |
$23,317.79
|
| Rate for Payer: Humana Commercial |
$20,863.28
|
| Rate for Payer: Humana KY Medicaid |
$8,441.04
|
| Rate for Payer: Kentucky WC Medicaid |
$8,526.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,126.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,114.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,363.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,610.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,599.64
|
| Rate for Payer: Ohio Health Group HMO |
$18,408.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,909.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,190.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,608.96
|
| Rate for Payer: PHCS Commercial |
$23,563.24
|
| Rate for Payer: United Healthcare All Payer |
$21,599.64
|
|
|
FEM COMP TOTAL STABILIZR #7 LT
|
Facility
|
IP
|
$24,545.04
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,190.86 |
| Max. Negotiated Rate |
$23,563.24 |
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,126.93
|
| Rate for Payer: Aetna Commercial |
$18,899.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,145.13
|
| Rate for Payer: Cash Price |
$12,272.52
|
| Rate for Payer: Cigna Commercial |
$20,372.38
|
| Rate for Payer: First Health Commercial |
$23,317.79
|
| Rate for Payer: Humana Commercial |
$20,863.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,114.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,363.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,599.64
|
| Rate for Payer: Ohio Health Group HMO |
$18,408.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,909.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,190.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,608.96
|
| Rate for Payer: PHCS Commercial |
$23,563.24
|
| Rate for Payer: United Healthcare All Payer |
$21,599.64
|
|
|
FEM COMP TOTAL STABILIZR #7 RT
|
Facility
|
IP
|
$23,426.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,045.47 |
| Max. Negotiated Rate |
$22,489.61 |
| Rate for Payer: Aetna Commercial |
$18,038.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,272.81
|
| Rate for Payer: Cash Price |
$11,713.34
|
| Rate for Payer: Cigna Commercial |
$19,444.14
|
| Rate for Payer: First Health Commercial |
$22,255.35
|
| Rate for Payer: Humana Commercial |
$19,912.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,209.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,288.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,028.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,615.48
|
| Rate for Payer: Ohio Health Group HMO |
$17,570.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,685.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,045.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,262.27
|
| Rate for Payer: PHCS Commercial |
$22,489.61
|
| Rate for Payer: United Healthcare All Payer |
$20,615.48
|
|
|
FEM COMP TOTAL STABILIZR #7 RT
|
Facility
|
OP
|
$23,426.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,045.47 |
| Max. Negotiated Rate |
$22,489.61 |
| Rate for Payer: Aetna Commercial |
$18,038.54
|
| Rate for Payer: Anthem Medicaid |
$8,056.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,272.81
|
| Rate for Payer: Cash Price |
$11,713.34
|
| Rate for Payer: Cigna Commercial |
$19,444.14
|
| Rate for Payer: First Health Commercial |
$22,255.35
|
| Rate for Payer: Humana Commercial |
$19,912.68
|
| Rate for Payer: Humana KY Medicaid |
$8,056.44
|
| Rate for Payer: Kentucky WC Medicaid |
$8,138.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,209.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,288.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,028.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,218.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,615.48
|
| Rate for Payer: Ohio Health Group HMO |
$17,570.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,685.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,045.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,262.27
|
| Rate for Payer: PHCS Commercial |
$22,489.61
|
| Rate for Payer: United Healthcare All Payer |
$20,615.48
|
|
|
FEM COMP TOTAL STABILIZR #9 RT
|
Facility
|
OP
|
$23,426.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,045.47 |
| Max. Negotiated Rate |
$22,489.61 |
| Rate for Payer: Aetna Commercial |
$18,038.54
|
| Rate for Payer: Anthem Medicaid |
$8,056.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,272.81
|
| Rate for Payer: Cash Price |
$11,713.34
|
| Rate for Payer: Cigna Commercial |
$19,444.14
|
| Rate for Payer: First Health Commercial |
$22,255.35
|
| Rate for Payer: Humana Commercial |
$19,912.68
|
| Rate for Payer: Humana KY Medicaid |
$8,056.44
|
| Rate for Payer: Kentucky WC Medicaid |
$8,138.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,209.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,288.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,028.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,218.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,615.48
|
| Rate for Payer: Ohio Health Group HMO |
$17,570.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,685.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,045.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,262.27
|
| Rate for Payer: PHCS Commercial |
$22,489.61
|
| Rate for Payer: United Healthcare All Payer |
$20,615.48
|
|
|
FEM COMP TOTAL STABILIZR #9 RT
|
Facility
|
IP
|
$23,426.68
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,045.47 |
| Max. Negotiated Rate |
$22,489.61 |
| Rate for Payer: Aetna Commercial |
$18,038.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,272.81
|
| Rate for Payer: Cash Price |
$11,713.34
|
| Rate for Payer: Cigna Commercial |
$19,444.14
|
| Rate for Payer: First Health Commercial |
$22,255.35
|
| Rate for Payer: Humana Commercial |
$19,912.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,209.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,288.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,028.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,615.48
|
| Rate for Payer: Ohio Health Group HMO |
$17,570.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,685.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,045.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,262.27
|
| Rate for Payer: PHCS Commercial |
$22,489.61
|
| Rate for Payer: United Healthcare All Payer |
$20,615.48
|
|
|
FEM COMP TOTAL STABLIZR #11 LT
|
Facility
|
IP
|
$22,372.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,908.43 |
| Max. Negotiated Rate |
$21,477.66 |
| Rate for Payer: Aetna Commercial |
$17,226.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,450.60
|
| Rate for Payer: Cash Price |
$11,186.28
|
| Rate for Payer: Cigna Commercial |
$18,569.22
|
| Rate for Payer: First Health Commercial |
$21,253.93
|
| Rate for Payer: Humana Commercial |
$19,016.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,345.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,510.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,711.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,687.85
|
| Rate for Payer: Ohio Health Group HMO |
$16,779.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,474.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,908.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,935.49
|
| Rate for Payer: PHCS Commercial |
$21,477.66
|
| Rate for Payer: United Healthcare All Payer |
$19,687.85
|
|
|
FEM COMP TOTAL STABLIZR #11 LT
|
Facility
|
OP
|
$22,372.56
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,908.43 |
| Max. Negotiated Rate |
$21,477.66 |
| Rate for Payer: Aetna Commercial |
$17,226.87
|
| Rate for Payer: Anthem Medicaid |
$7,693.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,450.60
|
| Rate for Payer: Cash Price |
$11,186.28
|
| Rate for Payer: Cigna Commercial |
$18,569.22
|
| Rate for Payer: First Health Commercial |
$21,253.93
|
| Rate for Payer: Humana Commercial |
$19,016.68
|
| Rate for Payer: Humana KY Medicaid |
$7,693.92
|
| Rate for Payer: Kentucky WC Medicaid |
$7,772.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,345.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,510.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,711.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,848.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,687.85
|
| Rate for Payer: Ohio Health Group HMO |
$16,779.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,474.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,908.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,935.49
|
| Rate for Payer: PHCS Commercial |
$21,477.66
|
| Rate for Payer: United Healthcare All Payer |
$19,687.85
|
|
|
FEM CPS SEG OSS TPR 8.5CM L
|
Facility
|
OP
|
$72,656.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,445.38 |
| Max. Negotiated Rate |
$69,750.53 |
| Rate for Payer: Aetna Commercial |
$55,945.74
|
| Rate for Payer: Anthem Medicaid |
$24,986.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,672.30
|
| Rate for Payer: Cash Price |
$36,328.40
|
| Rate for Payer: Cigna Commercial |
$60,305.14
|
| Rate for Payer: First Health Commercial |
$69,023.96
|
| Rate for Payer: Humana Commercial |
$61,758.28
|
| Rate for Payer: Humana KY Medicaid |
$24,986.67
|
| Rate for Payer: Kentucky WC Medicaid |
$25,240.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,578.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,620.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,797.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,488.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,937.98
|
| Rate for Payer: Ohio Health Group HMO |
$54,492.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,531.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,445.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,523.61
|
| Rate for Payer: PHCS Commercial |
$69,750.53
|
| Rate for Payer: United Healthcare All Payer |
$63,937.98
|
|
|
FEM CPS SEG OSS TPR 8.5CM L
|
Facility
|
IP
|
$72,656.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,445.38 |
| Max. Negotiated Rate |
$69,750.53 |
| Rate for Payer: Aetna Commercial |
$55,945.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,672.30
|
| Rate for Payer: Cash Price |
$36,328.40
|
| Rate for Payer: Cigna Commercial |
$60,305.14
|
| Rate for Payer: First Health Commercial |
$69,023.96
|
| Rate for Payer: Humana Commercial |
$61,758.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,578.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,620.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,797.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,937.98
|
| Rate for Payer: Ohio Health Group HMO |
$54,492.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,531.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,445.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,523.61
|
| Rate for Payer: PHCS Commercial |
$69,750.53
|
| Rate for Payer: United Healthcare All Payer |
$63,937.98
|
|
|
FEM CPS SEG OSS TPR 8.5CM R
|
Facility
|
OP
|
$72,656.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,445.38 |
| Max. Negotiated Rate |
$69,750.53 |
| Rate for Payer: Aetna Commercial |
$55,945.74
|
| Rate for Payer: Anthem Medicaid |
$24,986.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,672.30
|
| Rate for Payer: Cash Price |
$36,328.40
|
| Rate for Payer: Cigna Commercial |
$60,305.14
|
| Rate for Payer: First Health Commercial |
$69,023.96
|
| Rate for Payer: Humana Commercial |
$61,758.28
|
| Rate for Payer: Humana KY Medicaid |
$24,986.67
|
| Rate for Payer: Kentucky WC Medicaid |
$25,240.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,578.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,620.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,797.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,488.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,937.98
|
| Rate for Payer: Ohio Health Group HMO |
$54,492.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,531.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,445.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,523.61
|
| Rate for Payer: PHCS Commercial |
$69,750.53
|
| Rate for Payer: United Healthcare All Payer |
$63,937.98
|
|
|
FEM CPS SEG OSS TPR 8.5CM R
|
Facility
|
IP
|
$72,656.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,445.38 |
| Max. Negotiated Rate |
$69,750.53 |
| Rate for Payer: Aetna Commercial |
$55,945.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56,672.30
|
| Rate for Payer: Cash Price |
$36,328.40
|
| Rate for Payer: Cigna Commercial |
$60,305.14
|
| Rate for Payer: First Health Commercial |
$69,023.96
|
| Rate for Payer: Humana Commercial |
$61,758.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59,578.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53,620.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21,797.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$63,937.98
|
| Rate for Payer: Ohio Health Group HMO |
$54,492.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,531.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,445.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22,523.61
|
| Rate for Payer: PHCS Commercial |
$69,750.53
|
| Rate for Payer: United Healthcare All Payer |
$63,937.98
|
|
|
FEM C/R GNS II SZ4 RT
|
Facility
|
OP
|
$7,545.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$980.85 |
| Max. Negotiated Rate |
$7,243.20 |
| Rate for Payer: Aetna Commercial |
$5,809.65
|
| Rate for Payer: Anthem Medicaid |
$2,594.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,885.10
|
| Rate for Payer: Cash Price |
$3,772.50
|
| Rate for Payer: Cigna Commercial |
$6,262.35
|
| Rate for Payer: First Health Commercial |
$7,167.75
|
| Rate for Payer: Humana Commercial |
$6,413.25
|
| Rate for Payer: Humana KY Medicaid |
$2,594.73
|
| Rate for Payer: Kentucky WC Medicaid |
$2,621.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,186.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,568.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,263.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,646.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,639.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,658.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,509.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$980.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,338.95
|
| Rate for Payer: PHCS Commercial |
$7,243.20
|
| Rate for Payer: United Healthcare All Payer |
$6,639.60
|
|
|
FEM C/R GNS II SZ4 RT
|
Facility
|
IP
|
$7,545.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$980.85 |
| Max. Negotiated Rate |
$7,243.20 |
| Rate for Payer: Aetna Commercial |
$5,809.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,885.10
|
| Rate for Payer: Cash Price |
$3,772.50
|
| Rate for Payer: Cigna Commercial |
$6,262.35
|
| Rate for Payer: First Health Commercial |
$7,167.75
|
| Rate for Payer: Humana Commercial |
$6,413.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,186.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,568.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,263.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,639.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,658.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,509.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$980.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,338.95
|
| Rate for Payer: PHCS Commercial |
$7,243.20
|
| Rate for Payer: United Healthcare All Payer |
$6,639.60
|
|
