|
GC XB 4.5 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 XB 4.5 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 XB 4.5 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 XB 4.5 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 XB 4.5 SH 6F 100CM
|
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 XB 4.5 SH 6F 100CM
|
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 XB 4 6F
|
Facility
|
IP
|
$816.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$106.08 |
| Max. Negotiated Rate |
$783.36 |
| Rate for Payer: Aetna Commercial |
$628.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$636.48
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cigna Commercial |
$677.28
|
| Rate for Payer: First Health Commercial |
$775.20
|
| Rate for Payer: Humana Commercial |
$693.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$669.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$602.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$718.08
|
| Rate for Payer: Ohio Health Group HMO |
$612.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$163.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$106.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$252.96
|
| Rate for Payer: PHCS Commercial |
$783.36
|
| Rate for Payer: United Healthcare All Payer |
$718.08
|
|
|
GC XB 4 6F
|
Facility
|
OP
|
$816.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$106.08 |
| Max. Negotiated Rate |
$783.36 |
| Rate for Payer: Aetna Commercial |
$628.32
|
| Rate for Payer: Anthem Medicaid |
$280.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$636.48
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cigna Commercial |
$677.28
|
| Rate for Payer: First Health Commercial |
$775.20
|
| Rate for Payer: Humana Commercial |
$693.60
|
| Rate for Payer: Humana KY Medicaid |
$280.62
|
| Rate for Payer: Kentucky WC Medicaid |
$283.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$669.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$602.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$286.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$718.08
|
| Rate for Payer: Ohio Health Group HMO |
$612.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$163.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$106.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$252.96
|
| Rate for Payer: PHCS Commercial |
$783.36
|
| Rate for Payer: United Healthcare All Payer |
$718.08
|
|
|
GC XB 4 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 XB 4 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 XB 4 SH 6F 100CM
|
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 XB 4 SH 6F 100CM
|
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 XB 4 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 XB 4 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 XBC 3 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 XBC 3 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 XBC 4 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 XBC 4 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 XB LAD 3.5 5F
|
Facility
|
OP
|
$789.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$102.57 |
| Max. Negotiated Rate |
$757.44 |
| Rate for Payer: Aetna Commercial |
$607.53
|
| Rate for Payer: Anthem Medicaid |
$271.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$615.42
|
| Rate for Payer: Cash Price |
$394.50
|
| Rate for Payer: Cigna Commercial |
$654.87
|
| Rate for Payer: First Health Commercial |
$749.55
|
| Rate for Payer: Humana Commercial |
$670.65
|
| Rate for Payer: Humana KY Medicaid |
$271.34
|
| Rate for Payer: Kentucky WC Medicaid |
$274.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$646.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$582.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$236.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$276.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$694.32
|
| Rate for Payer: Ohio Health Group HMO |
$591.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$157.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$244.59
|
| Rate for Payer: PHCS Commercial |
$757.44
|
| Rate for Payer: United Healthcare All Payer |
$694.32
|
|
|
GC XB LAD 3.5 5F
|
Facility
|
IP
|
$789.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$102.57 |
| Max. Negotiated Rate |
$757.44 |
| Rate for Payer: Aetna Commercial |
$607.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$615.42
|
| Rate for Payer: Cash Price |
$394.50
|
| Rate for Payer: Cigna Commercial |
$654.87
|
| Rate for Payer: First Health Commercial |
$749.55
|
| Rate for Payer: Humana Commercial |
$670.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$646.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$582.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$236.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$694.32
|
| Rate for Payer: Ohio Health Group HMO |
$591.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$157.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$244.59
|
| Rate for Payer: PHCS Commercial |
$757.44
|
| Rate for Payer: United Healthcare All Payer |
$694.32
|
|
|
GC XB LAD 3.5 6F
|
Facility
|
IP
|
$816.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$106.08 |
| Max. Negotiated Rate |
$783.36 |
| Rate for Payer: Aetna Commercial |
$628.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$636.48
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cigna Commercial |
$677.28
|
| Rate for Payer: First Health Commercial |
$775.20
|
| Rate for Payer: Humana Commercial |
$693.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$669.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$602.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$718.08
|
| Rate for Payer: Ohio Health Group HMO |
$612.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$163.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$106.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$252.96
|
| Rate for Payer: PHCS Commercial |
$783.36
|
| Rate for Payer: United Healthcare All Payer |
$718.08
|
|
|
GC XB LAD 3.5 6F
|
Facility
|
OP
|
$816.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$106.08 |
| Max. Negotiated Rate |
$783.36 |
| Rate for Payer: Aetna Commercial |
$628.32
|
| Rate for Payer: Anthem Medicaid |
$280.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$636.48
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cigna Commercial |
$677.28
|
| Rate for Payer: First Health Commercial |
$775.20
|
| Rate for Payer: Humana Commercial |
$693.60
|
| Rate for Payer: Humana KY Medicaid |
$280.62
|
| Rate for Payer: Kentucky WC Medicaid |
$283.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$669.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$602.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$286.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$718.08
|
| Rate for Payer: Ohio Health Group HMO |
$612.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$163.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$106.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$252.96
|
| Rate for Payer: PHCS Commercial |
$783.36
|
| Rate for Payer: United Healthcare All Payer |
$718.08
|
|
|
GC XB LAD 3.5 7F
|
Facility
|
OP
|
$816.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$106.08 |
| Max. Negotiated Rate |
$783.36 |
| Rate for Payer: Aetna Commercial |
$628.32
|
| Rate for Payer: Anthem Medicaid |
$280.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$636.48
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cigna Commercial |
$677.28
|
| Rate for Payer: First Health Commercial |
$775.20
|
| Rate for Payer: Humana Commercial |
$693.60
|
| Rate for Payer: Humana KY Medicaid |
$280.62
|
| Rate for Payer: Kentucky WC Medicaid |
$283.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$669.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$602.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$286.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$718.08
|
| Rate for Payer: Ohio Health Group HMO |
$612.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$163.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$106.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$252.96
|
| Rate for Payer: PHCS Commercial |
$783.36
|
| Rate for Payer: United Healthcare All Payer |
$718.08
|
|
|
GC XB LAD 3.5 7F
|
Facility
|
IP
|
$816.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$106.08 |
| Max. Negotiated Rate |
$783.36 |
| Rate for Payer: Aetna Commercial |
$628.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$636.48
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cigna Commercial |
$677.28
|
| Rate for Payer: First Health Commercial |
$775.20
|
| Rate for Payer: Humana Commercial |
$693.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$669.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$602.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$718.08
|
| Rate for Payer: Ohio Health Group HMO |
$612.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$163.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$106.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$252.96
|
| Rate for Payer: PHCS Commercial |
$783.36
|
| Rate for Payer: United Healthcare All Payer |
$718.08
|
|
|
GC XB LAD 3.5 SH 6F 100CM
|
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
|
|
