|
GC JR 4 ST SH 7F
|
Facility
|
IP
|
$1,068.96
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.96 |
| Max. Negotiated Rate |
$1,026.20 |
| Rate for Payer: Aetna Commercial |
$823.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$833.79
|
| Rate for Payer: Cash Price |
$534.48
|
| Rate for Payer: Cigna Commercial |
$887.24
|
| Rate for Payer: First Health Commercial |
$1,015.51
|
| Rate for Payer: Humana Commercial |
$908.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$876.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$788.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$320.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$940.68
|
| Rate for Payer: Ohio Health Group HMO |
$801.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$213.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$138.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$331.38
|
| Rate for Payer: PHCS Commercial |
$1,026.20
|
| Rate for Payer: United Healthcare All Payer |
$940.68
|
|
|
GC JR 4 ST SH 7F
|
Facility
|
OP
|
$1,068.96
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.96 |
| Max. Negotiated Rate |
$1,026.20 |
| Rate for Payer: Aetna Commercial |
$823.10
|
| Rate for Payer: Anthem Medicaid |
$367.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$833.79
|
| Rate for Payer: Cash Price |
$534.48
|
| Rate for Payer: Cigna Commercial |
$887.24
|
| Rate for Payer: First Health Commercial |
$1,015.51
|
| Rate for Payer: Humana Commercial |
$908.62
|
| Rate for Payer: Humana KY Medicaid |
$367.62
|
| Rate for Payer: Kentucky WC Medicaid |
$371.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$876.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$788.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$320.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$374.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$940.68
|
| Rate for Payer: Ohio Health Group HMO |
$801.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$213.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$138.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$331.38
|
| Rate for Payer: PHCS Commercial |
$1,026.20
|
| Rate for Payer: United Healthcare All Payer |
$940.68
|
|
|
GC JR 5 6F
|
Facility
|
IP
|
$1,068.96
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.96 |
| Max. Negotiated Rate |
$1,026.20 |
| Rate for Payer: Aetna Commercial |
$823.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$833.79
|
| Rate for Payer: Cash Price |
$534.48
|
| Rate for Payer: Cigna Commercial |
$887.24
|
| Rate for Payer: First Health Commercial |
$1,015.51
|
| Rate for Payer: Humana Commercial |
$908.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$876.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$788.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$320.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$940.68
|
| Rate for Payer: Ohio Health Group HMO |
$801.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$213.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$138.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$331.38
|
| Rate for Payer: PHCS Commercial |
$1,026.20
|
| Rate for Payer: United Healthcare All Payer |
$940.68
|
|
|
GC JR 5 6F
|
Facility
|
OP
|
$1,068.96
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.96 |
| Max. Negotiated Rate |
$1,026.20 |
| Rate for Payer: Aetna Commercial |
$823.10
|
| Rate for Payer: Anthem Medicaid |
$367.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$833.79
|
| Rate for Payer: Cash Price |
$534.48
|
| Rate for Payer: Cigna Commercial |
$887.24
|
| Rate for Payer: First Health Commercial |
$1,015.51
|
| Rate for Payer: Humana Commercial |
$908.62
|
| Rate for Payer: Humana KY Medicaid |
$367.62
|
| Rate for Payer: Kentucky WC Medicaid |
$371.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$876.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$788.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$320.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$374.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$940.68
|
| Rate for Payer: Ohio Health Group HMO |
$801.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$213.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$138.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$331.38
|
| Rate for Payer: PHCS Commercial |
$1,026.20
|
| Rate for Payer: United Healthcare All Payer |
$940.68
|
|
|
GC LCB 6F
|
Facility
|
OP
|
$780.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.40 |
| Max. Negotiated Rate |
$748.80 |
| Rate for Payer: Aetna Commercial |
$600.60
|
| Rate for Payer: Anthem Medicaid |
$268.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$608.40
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$647.40
|
| Rate for Payer: First Health Commercial |
$741.00
|
| Rate for Payer: Humana Commercial |
$663.00
|
| Rate for Payer: Humana KY Medicaid |
$268.24
|
| Rate for Payer: Kentucky WC Medicaid |
$270.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$639.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$575.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$234.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$273.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$686.40
|
| Rate for Payer: Ohio Health Group HMO |
$585.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.80
|
| Rate for Payer: PHCS Commercial |
$748.80
|
| Rate for Payer: United Healthcare All Payer |
$686.40
|
|
|
GC LCB 6F
|
Facility
|
IP
|
$780.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.40 |
| Max. Negotiated Rate |
$748.80 |
| Rate for Payer: Aetna Commercial |
$600.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$608.40
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$647.40
|
| Rate for Payer: First Health Commercial |
$741.00
|
| Rate for Payer: Humana Commercial |
$663.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$639.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$575.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$234.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$686.40
|
| Rate for Payer: Ohio Health Group HMO |
$585.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.80
|
| Rate for Payer: PHCS Commercial |
$748.80
|
| Rate for Payer: United Healthcare All Payer |
$686.40
|
|
|
GC LCB 7FR
|
Facility
|
OP
|
$780.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.40 |
| Max. Negotiated Rate |
$748.80 |
| Rate for Payer: Aetna Commercial |
$600.60
|
| Rate for Payer: Anthem Medicaid |
$268.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$608.40
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$647.40
|
| Rate for Payer: First Health Commercial |
$741.00
|
| Rate for Payer: Humana Commercial |
$663.00
|
| Rate for Payer: Humana KY Medicaid |
$268.24
|
| Rate for Payer: Kentucky WC Medicaid |
$270.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$639.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$575.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$234.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$273.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$686.40
|
| Rate for Payer: Ohio Health Group HMO |
$585.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.80
|
| Rate for Payer: PHCS Commercial |
$748.80
|
| Rate for Payer: United Healthcare All Payer |
$686.40
|
|
|
GC LCB 7FR
|
Facility
|
IP
|
$780.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.40 |
| Max. Negotiated Rate |
$748.80 |
| Rate for Payer: Aetna Commercial |
$600.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$608.40
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$647.40
|
| Rate for Payer: First Health Commercial |
$741.00
|
| Rate for Payer: Humana Commercial |
$663.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$639.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$575.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$234.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$686.40
|
| Rate for Payer: Ohio Health Group HMO |
$585.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.80
|
| Rate for Payer: PHCS Commercial |
$748.80
|
| Rate for Payer: United Healthcare All Payer |
$686.40
|
|
|
GC LCB SH 7F
|
Facility
|
IP
|
$780.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.40 |
| Max. Negotiated Rate |
$748.80 |
| Rate for Payer: Aetna Commercial |
$600.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$608.40
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$647.40
|
| Rate for Payer: First Health Commercial |
$741.00
|
| Rate for Payer: Humana Commercial |
$663.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$639.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$575.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$234.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$686.40
|
| Rate for Payer: Ohio Health Group HMO |
$585.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.80
|
| Rate for Payer: PHCS Commercial |
$748.80
|
| Rate for Payer: United Healthcare All Payer |
$686.40
|
|
|
GC LCB SH 7F
|
Facility
|
OP
|
$780.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.40 |
| Max. Negotiated Rate |
$748.80 |
| Rate for Payer: Aetna Commercial |
$600.60
|
| Rate for Payer: Anthem Medicaid |
$268.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$608.40
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$647.40
|
| Rate for Payer: First Health Commercial |
$741.00
|
| Rate for Payer: Humana Commercial |
$663.00
|
| Rate for Payer: Humana KY Medicaid |
$268.24
|
| Rate for Payer: Kentucky WC Medicaid |
$270.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$639.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$575.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$234.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$273.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$686.40
|
| Rate for Payer: Ohio Health Group HMO |
$585.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.80
|
| Rate for Payer: PHCS Commercial |
$748.80
|
| Rate for Payer: United Healthcare All Payer |
$686.40
|
|
|
GC MPA 1 6F 100CM
|
Facility
|
IP
|
$1,108.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$144.04 |
| Max. Negotiated Rate |
$1,063.68 |
| Rate for Payer: Aetna Commercial |
$853.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$864.24
|
| Rate for Payer: Cash Price |
$554.00
|
| Rate for Payer: Cigna Commercial |
$919.64
|
| Rate for Payer: First Health Commercial |
$1,052.60
|
| Rate for Payer: Humana Commercial |
$941.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$908.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$817.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$332.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$975.04
|
| Rate for Payer: Ohio Health Group HMO |
$831.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$221.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$144.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$343.48
|
| Rate for Payer: PHCS Commercial |
$1,063.68
|
| Rate for Payer: United Healthcare All Payer |
$975.04
|
|
|
GC MPA 1 6F 100CM
|
Facility
|
OP
|
$1,108.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$144.04 |
| Max. Negotiated Rate |
$1,063.68 |
| Rate for Payer: Aetna Commercial |
$853.16
|
| Rate for Payer: Anthem Medicaid |
$381.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$864.24
|
| Rate for Payer: Cash Price |
$554.00
|
| Rate for Payer: Cigna Commercial |
$919.64
|
| Rate for Payer: First Health Commercial |
$1,052.60
|
| Rate for Payer: Humana Commercial |
$941.80
|
| Rate for Payer: Humana KY Medicaid |
$381.04
|
| Rate for Payer: Kentucky WC Medicaid |
$384.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$908.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$817.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$332.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$388.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$975.04
|
| Rate for Payer: Ohio Health Group HMO |
$831.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$221.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$144.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$343.48
|
| Rate for Payer: PHCS Commercial |
$1,063.68
|
| Rate for Payer: United Healthcare All Payer |
$975.04
|
|
|
GC MPA 1 6F 55CM
|
Facility
|
OP
|
$1,755.65
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$228.23 |
| Max. Negotiated Rate |
$1,685.42 |
| Rate for Payer: Aetna Commercial |
$1,351.85
|
| Rate for Payer: Anthem Medicaid |
$603.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,369.41
|
| Rate for Payer: Cash Price |
$877.82
|
| Rate for Payer: Cigna Commercial |
$1,457.19
|
| Rate for Payer: First Health Commercial |
$1,667.87
|
| Rate for Payer: Humana Commercial |
$1,492.30
|
| Rate for Payer: Humana KY Medicaid |
$603.77
|
| Rate for Payer: Kentucky WC Medicaid |
$609.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,439.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,295.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$526.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$615.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,544.97
|
| Rate for Payer: Ohio Health Group HMO |
$1,316.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$351.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$228.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$544.25
|
| Rate for Payer: PHCS Commercial |
$1,685.42
|
| Rate for Payer: United Healthcare All Payer |
$1,544.97
|
|
|
GC MPA 1 6F 55CM
|
Facility
|
IP
|
$1,755.65
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$228.23 |
| Max. Negotiated Rate |
$1,685.42 |
| Rate for Payer: Aetna Commercial |
$1,351.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,369.41
|
| Rate for Payer: Cash Price |
$877.82
|
| Rate for Payer: Cigna Commercial |
$1,457.19
|
| Rate for Payer: First Health Commercial |
$1,667.87
|
| Rate for Payer: Humana Commercial |
$1,492.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,439.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,295.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$526.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,544.97
|
| Rate for Payer: Ohio Health Group HMO |
$1,316.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$351.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$228.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$544.25
|
| Rate for Payer: PHCS Commercial |
$1,685.42
|
| Rate for Payer: United Healthcare All Payer |
$1,544.97
|
|
|
GC MPA 1 7F
|
Facility
|
OP
|
$780.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.40 |
| Max. Negotiated Rate |
$748.80 |
| Rate for Payer: Aetna Commercial |
$600.60
|
| Rate for Payer: Anthem Medicaid |
$268.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$608.40
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$647.40
|
| Rate for Payer: First Health Commercial |
$741.00
|
| Rate for Payer: Humana Commercial |
$663.00
|
| Rate for Payer: Humana KY Medicaid |
$268.24
|
| Rate for Payer: Kentucky WC Medicaid |
$270.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$639.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$575.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$234.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$273.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$686.40
|
| Rate for Payer: Ohio Health Group HMO |
$585.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.80
|
| Rate for Payer: PHCS Commercial |
$748.80
|
| Rate for Payer: United Healthcare All Payer |
$686.40
|
|
|
GC MPA 1 7F
|
Facility
|
IP
|
$780.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.40 |
| Max. Negotiated Rate |
$748.80 |
| Rate for Payer: Aetna Commercial |
$600.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$608.40
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$647.40
|
| Rate for Payer: First Health Commercial |
$741.00
|
| Rate for Payer: Humana Commercial |
$663.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$639.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$575.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$234.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$686.40
|
| Rate for Payer: Ohio Health Group HMO |
$585.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.80
|
| Rate for Payer: PHCS Commercial |
$748.80
|
| Rate for Payer: United Healthcare All Payer |
$686.40
|
|
|
GC MPA-1 9F 90CM
|
Facility
|
OP
|
$1,554.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$202.08 |
| Max. Negotiated Rate |
$1,492.32 |
| Rate for Payer: Aetna Commercial |
$1,196.96
|
| Rate for Payer: Anthem Medicaid |
$534.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,212.51
|
| Rate for Payer: Cash Price |
$777.25
|
| Rate for Payer: Cigna Commercial |
$1,290.24
|
| Rate for Payer: First Health Commercial |
$1,476.78
|
| Rate for Payer: Humana Commercial |
$1,321.32
|
| Rate for Payer: Humana KY Medicaid |
$534.59
|
| Rate for Payer: Kentucky WC Medicaid |
$540.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,274.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,147.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$466.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$545.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,367.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,165.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$310.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$202.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$481.90
|
| Rate for Payer: PHCS Commercial |
$1,492.32
|
| Rate for Payer: United Healthcare All Payer |
$1,367.96
|
|
|
GC MPA-1 9F 90CM
|
Facility
|
IP
|
$1,554.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$202.08 |
| Max. Negotiated Rate |
$1,492.32 |
| Rate for Payer: Aetna Commercial |
$1,196.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,212.51
|
| Rate for Payer: Cash Price |
$777.25
|
| Rate for Payer: Cigna Commercial |
$1,290.24
|
| Rate for Payer: First Health Commercial |
$1,476.78
|
| Rate for Payer: Humana Commercial |
$1,321.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,274.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,147.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$466.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,367.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,165.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$310.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$202.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$481.90
|
| Rate for Payer: PHCS Commercial |
$1,492.32
|
| Rate for Payer: United Healthcare All Payer |
$1,367.96
|
|
|
GC MPA 1 SH 7F
|
Facility
|
OP
|
$780.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.40 |
| Max. Negotiated Rate |
$748.80 |
| Rate for Payer: Aetna Commercial |
$600.60
|
| Rate for Payer: Anthem Medicaid |
$268.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$608.40
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$647.40
|
| Rate for Payer: First Health Commercial |
$741.00
|
| Rate for Payer: Humana Commercial |
$663.00
|
| Rate for Payer: Humana KY Medicaid |
$268.24
|
| Rate for Payer: Kentucky WC Medicaid |
$270.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$639.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$575.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$234.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$273.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$686.40
|
| Rate for Payer: Ohio Health Group HMO |
$585.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.80
|
| Rate for Payer: PHCS Commercial |
$748.80
|
| Rate for Payer: United Healthcare All Payer |
$686.40
|
|
|
GC MPA 1 SH 7F
|
Facility
|
IP
|
$780.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.40 |
| Max. Negotiated Rate |
$748.80 |
| Rate for Payer: Aetna Commercial |
$600.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$608.40
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$647.40
|
| Rate for Payer: First Health Commercial |
$741.00
|
| Rate for Payer: Humana Commercial |
$663.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$639.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$575.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$234.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$686.40
|
| Rate for Payer: Ohio Health Group HMO |
$585.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.80
|
| Rate for Payer: PHCS Commercial |
$748.80
|
| Rate for Payer: United Healthcare All Payer |
$686.40
|
|
|
GC RBC SH 7F
|
Facility
|
OP
|
$1,068.96
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.96 |
| Max. Negotiated Rate |
$1,026.20 |
| Rate for Payer: Aetna Commercial |
$823.10
|
| Rate for Payer: Anthem Medicaid |
$367.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$833.79
|
| Rate for Payer: Cash Price |
$534.48
|
| Rate for Payer: Cigna Commercial |
$887.24
|
| Rate for Payer: First Health Commercial |
$1,015.51
|
| Rate for Payer: Humana Commercial |
$908.62
|
| Rate for Payer: Humana KY Medicaid |
$367.62
|
| Rate for Payer: Kentucky WC Medicaid |
$371.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$876.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$788.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$320.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$374.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$940.68
|
| Rate for Payer: Ohio Health Group HMO |
$801.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$213.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$138.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$331.38
|
| Rate for Payer: PHCS Commercial |
$1,026.20
|
| Rate for Payer: United Healthcare All Payer |
$940.68
|
|
|
GC RBC SH 7F
|
Facility
|
IP
|
$1,068.96
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.96 |
| Max. Negotiated Rate |
$1,026.20 |
| Rate for Payer: Aetna Commercial |
$823.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$833.79
|
| Rate for Payer: Cash Price |
$534.48
|
| Rate for Payer: Cigna Commercial |
$887.24
|
| Rate for Payer: First Health Commercial |
$1,015.51
|
| Rate for Payer: Humana Commercial |
$908.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$876.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$788.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$320.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$940.68
|
| Rate for Payer: Ohio Health Group HMO |
$801.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$213.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$138.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$331.38
|
| Rate for Payer: PHCS Commercial |
$1,026.20
|
| Rate for Payer: United Healthcare All Payer |
$940.68
|
|
|
GC RCB 7FR
|
Facility
|
IP
|
$1,068.96
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.96 |
| Max. Negotiated Rate |
$1,026.20 |
| Rate for Payer: Aetna Commercial |
$823.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$833.79
|
| Rate for Payer: Cash Price |
$534.48
|
| Rate for Payer: Cigna Commercial |
$887.24
|
| Rate for Payer: First Health Commercial |
$1,015.51
|
| Rate for Payer: Humana Commercial |
$908.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$876.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$788.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$320.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$940.68
|
| Rate for Payer: Ohio Health Group HMO |
$801.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$213.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$138.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$331.38
|
| Rate for Payer: PHCS Commercial |
$1,026.20
|
| Rate for Payer: United Healthcare All Payer |
$940.68
|
|
|
GC RCB 7FR
|
Facility
|
OP
|
$1,068.96
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.96 |
| Max. Negotiated Rate |
$1,026.20 |
| Rate for Payer: Aetna Commercial |
$823.10
|
| Rate for Payer: Anthem Medicaid |
$367.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$833.79
|
| Rate for Payer: Cash Price |
$534.48
|
| Rate for Payer: Cigna Commercial |
$887.24
|
| Rate for Payer: First Health Commercial |
$1,015.51
|
| Rate for Payer: Humana Commercial |
$908.62
|
| Rate for Payer: Humana KY Medicaid |
$367.62
|
| Rate for Payer: Kentucky WC Medicaid |
$371.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$876.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$788.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$320.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$374.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$940.68
|
| Rate for Payer: Ohio Health Group HMO |
$801.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$213.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$138.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$331.38
|
| Rate for Payer: PHCS Commercial |
$1,026.20
|
| Rate for Payer: United Healthcare All Payer |
$940.68
|
|
|
GC RDC 6FR 55CM
|
Facility
|
OP
|
$1,102.84
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$143.37 |
| Max. Negotiated Rate |
$1,058.73 |
| Rate for Payer: Aetna Commercial |
$849.19
|
| Rate for Payer: Anthem Medicaid |
$379.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$860.22
|
| Rate for Payer: Cash Price |
$551.42
|
| Rate for Payer: Cigna Commercial |
$915.36
|
| Rate for Payer: First Health Commercial |
$1,047.70
|
| Rate for Payer: Humana Commercial |
$937.41
|
| Rate for Payer: Humana KY Medicaid |
$379.27
|
| Rate for Payer: Kentucky WC Medicaid |
$383.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$904.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$813.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$330.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$386.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$970.50
|
| Rate for Payer: Ohio Health Group HMO |
$827.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$220.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$143.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$341.88
|
| Rate for Payer: PHCS Commercial |
$1,058.73
|
| Rate for Payer: United Healthcare All Payer |
$970.50
|
|
