|
GEN P/S ART INSR *MED LT 8 MM*
|
Facility
|
IP
|
$8,786.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,142.18 |
| Max. Negotiated Rate |
$8,434.56 |
| Rate for Payer: Aetna Commercial |
$6,765.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,853.08
|
| Rate for Payer: Cash Price |
$4,393.00
|
| Rate for Payer: Cigna Commercial |
$7,292.38
|
| Rate for Payer: First Health Commercial |
$8,346.70
|
| Rate for Payer: Humana Commercial |
$7,468.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,204.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,484.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,635.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,731.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,589.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,757.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,142.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,723.66
|
| Rate for Payer: PHCS Commercial |
$8,434.56
|
| Rate for Payer: United Healthcare All Payer |
$7,731.68
|
|
|
GEN P/S ART INSR *MED LT 8 MM*
|
Facility
|
OP
|
$8,786.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,142.18 |
| Max. Negotiated Rate |
$8,434.56 |
| Rate for Payer: Aetna Commercial |
$6,765.22
|
| Rate for Payer: Anthem Medicaid |
$3,021.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,853.08
|
| Rate for Payer: Cash Price |
$4,393.00
|
| Rate for Payer: Cigna Commercial |
$7,292.38
|
| Rate for Payer: First Health Commercial |
$8,346.70
|
| Rate for Payer: Humana Commercial |
$7,468.10
|
| Rate for Payer: Humana KY Medicaid |
$3,021.51
|
| Rate for Payer: Kentucky WC Medicaid |
$3,052.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,204.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,484.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,635.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,082.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,731.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,589.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,757.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,142.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,723.66
|
| Rate for Payer: PHCS Commercial |
$8,434.56
|
| Rate for Payer: United Healthcare All Payer |
$7,731.68
|
|
|
GEN P/S ART INSR *SM LT 10 MM*
|
Facility
|
IP
|
$8,786.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,142.18 |
| Max. Negotiated Rate |
$8,434.56 |
| Rate for Payer: Aetna Commercial |
$6,765.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,853.08
|
| Rate for Payer: Cash Price |
$4,393.00
|
| Rate for Payer: Cigna Commercial |
$7,292.38
|
| Rate for Payer: First Health Commercial |
$8,346.70
|
| Rate for Payer: Humana Commercial |
$7,468.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,204.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,484.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,635.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,731.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,589.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,757.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,142.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,723.66
|
| Rate for Payer: PHCS Commercial |
$8,434.56
|
| Rate for Payer: United Healthcare All Payer |
$7,731.68
|
|
|
GEN P/S ART INSR *SM LT 10 MM*
|
Facility
|
OP
|
$8,786.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,142.18 |
| Max. Negotiated Rate |
$8,434.56 |
| Rate for Payer: Aetna Commercial |
$6,765.22
|
| Rate for Payer: Anthem Medicaid |
$3,021.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,853.08
|
| Rate for Payer: Cash Price |
$4,393.00
|
| Rate for Payer: Cigna Commercial |
$7,292.38
|
| Rate for Payer: First Health Commercial |
$8,346.70
|
| Rate for Payer: Humana Commercial |
$7,468.10
|
| Rate for Payer: Humana KY Medicaid |
$3,021.51
|
| Rate for Payer: Kentucky WC Medicaid |
$3,052.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,204.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,484.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,635.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,082.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,731.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,589.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,757.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,142.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,723.66
|
| Rate for Payer: PHCS Commercial |
$8,434.56
|
| Rate for Payer: United Healthcare All Payer |
$7,731.68
|
|
|
GEN P/S ART INSR *SM LT 12 MM*
|
Facility
|
IP
|
$8,786.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,142.18 |
| Max. Negotiated Rate |
$8,434.56 |
| Rate for Payer: Aetna Commercial |
$6,765.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,853.08
|
| Rate for Payer: Cash Price |
$4,393.00
|
| Rate for Payer: Cigna Commercial |
$7,292.38
|
| Rate for Payer: First Health Commercial |
$8,346.70
|
| Rate for Payer: Humana Commercial |
$7,468.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,204.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,484.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,635.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,731.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,589.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,757.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,142.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,723.66
|
| Rate for Payer: PHCS Commercial |
$8,434.56
|
| Rate for Payer: United Healthcare All Payer |
$7,731.68
|
|
|
GEN P/S ART INSR *SM LT 12 MM*
|
Facility
|
OP
|
$8,786.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,142.18 |
| Max. Negotiated Rate |
$8,434.56 |
| Rate for Payer: Aetna Commercial |
$6,765.22
|
| Rate for Payer: Anthem Medicaid |
$3,021.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,853.08
|
| Rate for Payer: Cash Price |
$4,393.00
|
| Rate for Payer: Cigna Commercial |
$7,292.38
|
| Rate for Payer: First Health Commercial |
$8,346.70
|
| Rate for Payer: Humana Commercial |
$7,468.10
|
| Rate for Payer: Humana KY Medicaid |
$3,021.51
|
| Rate for Payer: Kentucky WC Medicaid |
$3,052.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,204.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,484.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,635.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,082.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,731.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,589.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,757.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,142.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,723.66
|
| Rate for Payer: PHCS Commercial |
$8,434.56
|
| Rate for Payer: United Healthcare All Payer |
$7,731.68
|
|
|
GEN P/S ART INSR *SM LT 15 MM*
|
Facility
|
IP
|
$8,786.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,142.18 |
| Max. Negotiated Rate |
$8,434.56 |
| Rate for Payer: Aetna Commercial |
$6,765.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,853.08
|
| Rate for Payer: Cash Price |
$4,393.00
|
| Rate for Payer: Cigna Commercial |
$7,292.38
|
| Rate for Payer: First Health Commercial |
$8,346.70
|
| Rate for Payer: Humana Commercial |
$7,468.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,204.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,484.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,635.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,731.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,589.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,757.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,142.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,723.66
|
| Rate for Payer: PHCS Commercial |
$8,434.56
|
| Rate for Payer: United Healthcare All Payer |
$7,731.68
|
|
|
GEN P/S ART INSR *SM LT 15 MM*
|
Facility
|
OP
|
$8,786.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,142.18 |
| Max. Negotiated Rate |
$8,434.56 |
| Rate for Payer: Aetna Commercial |
$6,765.22
|
| Rate for Payer: Anthem Medicaid |
$3,021.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,853.08
|
| Rate for Payer: Cash Price |
$4,393.00
|
| Rate for Payer: Cigna Commercial |
$7,292.38
|
| Rate for Payer: First Health Commercial |
$8,346.70
|
| Rate for Payer: Humana Commercial |
$7,468.10
|
| Rate for Payer: Humana KY Medicaid |
$3,021.51
|
| Rate for Payer: Kentucky WC Medicaid |
$3,052.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,204.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,484.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,635.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,082.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,731.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,589.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,757.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,142.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,723.66
|
| Rate for Payer: PHCS Commercial |
$8,434.56
|
| Rate for Payer: United Healthcare All Payer |
$7,731.68
|
|
|
GEN P/S ART INSR *SM LT 20 MM*
|
Facility
|
OP
|
$8,786.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,142.18 |
| Max. Negotiated Rate |
$8,434.56 |
| Rate for Payer: Aetna Commercial |
$6,765.22
|
| Rate for Payer: Anthem Medicaid |
$3,021.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,853.08
|
| Rate for Payer: Cash Price |
$4,393.00
|
| Rate for Payer: Cigna Commercial |
$7,292.38
|
| Rate for Payer: First Health Commercial |
$8,346.70
|
| Rate for Payer: Humana Commercial |
$7,468.10
|
| Rate for Payer: Humana KY Medicaid |
$3,021.51
|
| Rate for Payer: Kentucky WC Medicaid |
$3,052.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,204.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,484.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,635.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,082.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,731.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,589.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,757.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,142.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,723.66
|
| Rate for Payer: PHCS Commercial |
$8,434.56
|
| Rate for Payer: United Healthcare All Payer |
$7,731.68
|
|
|
GEN P/S ART INSR *SM LT 20 MM*
|
Facility
|
IP
|
$8,786.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,142.18 |
| Max. Negotiated Rate |
$8,434.56 |
| Rate for Payer: Aetna Commercial |
$6,765.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,853.08
|
| Rate for Payer: Cash Price |
$4,393.00
|
| Rate for Payer: Cigna Commercial |
$7,292.38
|
| Rate for Payer: First Health Commercial |
$8,346.70
|
| Rate for Payer: Humana Commercial |
$7,468.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,204.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,484.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,635.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,731.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,589.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,757.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,142.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,723.66
|
| Rate for Payer: PHCS Commercial |
$8,434.56
|
| Rate for Payer: United Healthcare All Payer |
$7,731.68
|
|
|
GEN P/S ART INSR *SM LT 25 MM*
|
Facility
|
OP
|
$8,786.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,142.18 |
| Max. Negotiated Rate |
$8,434.56 |
| Rate for Payer: Aetna Commercial |
$6,765.22
|
| Rate for Payer: Anthem Medicaid |
$3,021.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,853.08
|
| Rate for Payer: Cash Price |
$4,393.00
|
| Rate for Payer: Cigna Commercial |
$7,292.38
|
| Rate for Payer: First Health Commercial |
$8,346.70
|
| Rate for Payer: Humana Commercial |
$7,468.10
|
| Rate for Payer: Humana KY Medicaid |
$3,021.51
|
| Rate for Payer: Kentucky WC Medicaid |
$3,052.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,204.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,484.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,635.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,082.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,731.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,589.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,757.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,142.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,723.66
|
| Rate for Payer: PHCS Commercial |
$8,434.56
|
| Rate for Payer: United Healthcare All Payer |
$7,731.68
|
|
|
GEN P/S ART INSR *SM LT 25 MM*
|
Facility
|
IP
|
$8,786.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,142.18 |
| Max. Negotiated Rate |
$8,434.56 |
| Rate for Payer: Aetna Commercial |
$6,765.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,853.08
|
| Rate for Payer: Cash Price |
$4,393.00
|
| Rate for Payer: Cigna Commercial |
$7,292.38
|
| Rate for Payer: First Health Commercial |
$8,346.70
|
| Rate for Payer: Humana Commercial |
$7,468.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,204.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,484.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,635.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,731.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,589.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,757.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,142.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,723.66
|
| Rate for Payer: PHCS Commercial |
$8,434.56
|
| Rate for Payer: United Healthcare All Payer |
$7,731.68
|
|
|
GEN P/S ART INSR *SM LT 8 MM*
|
Facility
|
OP
|
$8,786.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,142.18 |
| Max. Negotiated Rate |
$8,434.56 |
| Rate for Payer: Aetna Commercial |
$6,765.22
|
| Rate for Payer: Anthem Medicaid |
$3,021.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,853.08
|
| Rate for Payer: Cash Price |
$4,393.00
|
| Rate for Payer: Cigna Commercial |
$7,292.38
|
| Rate for Payer: First Health Commercial |
$8,346.70
|
| Rate for Payer: Humana Commercial |
$7,468.10
|
| Rate for Payer: Humana KY Medicaid |
$3,021.51
|
| Rate for Payer: Kentucky WC Medicaid |
$3,052.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,204.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,484.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,635.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,082.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,731.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,589.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,757.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,142.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,723.66
|
| Rate for Payer: PHCS Commercial |
$8,434.56
|
| Rate for Payer: United Healthcare All Payer |
$7,731.68
|
|
|
GEN P/S ART INSR *SM LT 8 MM*
|
Facility
|
IP
|
$8,786.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,142.18 |
| Max. Negotiated Rate |
$8,434.56 |
| Rate for Payer: Aetna Commercial |
$6,765.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,853.08
|
| Rate for Payer: Cash Price |
$4,393.00
|
| Rate for Payer: Cigna Commercial |
$7,292.38
|
| Rate for Payer: First Health Commercial |
$8,346.70
|
| Rate for Payer: Humana Commercial |
$7,468.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,204.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,484.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,635.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,731.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,589.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,757.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,142.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,723.66
|
| Rate for Payer: PHCS Commercial |
$8,434.56
|
| Rate for Payer: United Healthcare All Payer |
$7,731.68
|
|
|
GEN P/S ART INSR X-LGE LT 10MM
|
Facility
|
OP
|
$8,786.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,142.18 |
| Max. Negotiated Rate |
$8,434.56 |
| Rate for Payer: Aetna Commercial |
$6,765.22
|
| Rate for Payer: Anthem Medicaid |
$3,021.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,853.08
|
| Rate for Payer: Cash Price |
$4,393.00
|
| Rate for Payer: Cigna Commercial |
$7,292.38
|
| Rate for Payer: First Health Commercial |
$8,346.70
|
| Rate for Payer: Humana Commercial |
$7,468.10
|
| Rate for Payer: Humana KY Medicaid |
$3,021.51
|
| Rate for Payer: Kentucky WC Medicaid |
$3,052.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,204.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,484.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,635.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,082.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,731.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,589.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,757.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,142.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,723.66
|
| Rate for Payer: PHCS Commercial |
$8,434.56
|
| Rate for Payer: United Healthcare All Payer |
$7,731.68
|
|
|
GEN P/S ART INSR X-LGE LT 10MM
|
Facility
|
IP
|
$8,786.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,142.18 |
| Max. Negotiated Rate |
$8,434.56 |
| Rate for Payer: Aetna Commercial |
$6,765.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,853.08
|
| Rate for Payer: Cash Price |
$4,393.00
|
| Rate for Payer: Cigna Commercial |
$7,292.38
|
| Rate for Payer: First Health Commercial |
$8,346.70
|
| Rate for Payer: Humana Commercial |
$7,468.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,204.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,484.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,635.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,731.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,589.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,757.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,142.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,723.66
|
| Rate for Payer: PHCS Commercial |
$8,434.56
|
| Rate for Payer: United Healthcare All Payer |
$7,731.68
|
|
|
GEN P/S ART INSR X-LGE LT 12MM
|
Facility
|
OP
|
$8,786.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,142.18 |
| Max. Negotiated Rate |
$8,434.56 |
| Rate for Payer: Aetna Commercial |
$6,765.22
|
| Rate for Payer: Anthem Medicaid |
$3,021.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,853.08
|
| Rate for Payer: Cash Price |
$4,393.00
|
| Rate for Payer: Cigna Commercial |
$7,292.38
|
| Rate for Payer: First Health Commercial |
$8,346.70
|
| Rate for Payer: Humana Commercial |
$7,468.10
|
| Rate for Payer: Humana KY Medicaid |
$3,021.51
|
| Rate for Payer: Kentucky WC Medicaid |
$3,052.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,204.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,484.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,635.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,082.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,731.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,589.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,757.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,142.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,723.66
|
| Rate for Payer: PHCS Commercial |
$8,434.56
|
| Rate for Payer: United Healthcare All Payer |
$7,731.68
|
|
|
GEN P/S ART INSR X-LGE LT 12MM
|
Facility
|
IP
|
$8,786.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,142.18 |
| Max. Negotiated Rate |
$8,434.56 |
| Rate for Payer: Aetna Commercial |
$6,765.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,853.08
|
| Rate for Payer: Cash Price |
$4,393.00
|
| Rate for Payer: Cigna Commercial |
$7,292.38
|
| Rate for Payer: First Health Commercial |
$8,346.70
|
| Rate for Payer: Humana Commercial |
$7,468.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,204.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,484.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,635.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,731.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,589.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,757.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,142.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,723.66
|
| Rate for Payer: PHCS Commercial |
$8,434.56
|
| Rate for Payer: United Healthcare All Payer |
$7,731.68
|
|
|
GEN P/S ART INSR X-LGE LT 15MM
|
Facility
|
IP
|
$8,786.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,142.18 |
| Max. Negotiated Rate |
$8,434.56 |
| Rate for Payer: Aetna Commercial |
$6,765.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,853.08
|
| Rate for Payer: Cash Price |
$4,393.00
|
| Rate for Payer: Cigna Commercial |
$7,292.38
|
| Rate for Payer: First Health Commercial |
$8,346.70
|
| Rate for Payer: Humana Commercial |
$7,468.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,204.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,484.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,635.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,731.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,589.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,757.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,142.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,723.66
|
| Rate for Payer: PHCS Commercial |
$8,434.56
|
| Rate for Payer: United Healthcare All Payer |
$7,731.68
|
|
|
GEN P/S ART INSR X-LGE LT 15MM
|
Facility
|
OP
|
$8,786.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,142.18 |
| Max. Negotiated Rate |
$8,434.56 |
| Rate for Payer: Aetna Commercial |
$6,765.22
|
| Rate for Payer: Anthem Medicaid |
$3,021.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,853.08
|
| Rate for Payer: Cash Price |
$4,393.00
|
| Rate for Payer: Cigna Commercial |
$7,292.38
|
| Rate for Payer: First Health Commercial |
$8,346.70
|
| Rate for Payer: Humana Commercial |
$7,468.10
|
| Rate for Payer: Humana KY Medicaid |
$3,021.51
|
| Rate for Payer: Kentucky WC Medicaid |
$3,052.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,204.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,484.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,635.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,082.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,731.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,589.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,757.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,142.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,723.66
|
| Rate for Payer: PHCS Commercial |
$8,434.56
|
| Rate for Payer: United Healthcare All Payer |
$7,731.68
|
|
|
GEN P/S ART INSR X-LGE LT 20MM
|
Facility
|
OP
|
$8,786.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,142.18 |
| Max. Negotiated Rate |
$8,434.56 |
| Rate for Payer: Aetna Commercial |
$6,765.22
|
| Rate for Payer: Anthem Medicaid |
$3,021.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,853.08
|
| Rate for Payer: Cash Price |
$4,393.00
|
| Rate for Payer: Cigna Commercial |
$7,292.38
|
| Rate for Payer: First Health Commercial |
$8,346.70
|
| Rate for Payer: Humana Commercial |
$7,468.10
|
| Rate for Payer: Humana KY Medicaid |
$3,021.51
|
| Rate for Payer: Kentucky WC Medicaid |
$3,052.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,204.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,484.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,635.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,082.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,731.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,589.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,757.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,142.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,723.66
|
| Rate for Payer: PHCS Commercial |
$8,434.56
|
| Rate for Payer: United Healthcare All Payer |
$7,731.68
|
|
|
GEN P/S ART INSR X-LGE LT 20MM
|
Facility
|
IP
|
$8,786.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,142.18 |
| Max. Negotiated Rate |
$8,434.56 |
| Rate for Payer: Aetna Commercial |
$6,765.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,853.08
|
| Rate for Payer: Cash Price |
$4,393.00
|
| Rate for Payer: Cigna Commercial |
$7,292.38
|
| Rate for Payer: First Health Commercial |
$8,346.70
|
| Rate for Payer: Humana Commercial |
$7,468.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,204.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,484.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,635.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,731.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,589.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,757.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,142.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,723.66
|
| Rate for Payer: PHCS Commercial |
$8,434.56
|
| Rate for Payer: United Healthcare All Payer |
$7,731.68
|
|
|
GEN P/S ART INSR X-LGE LT 8 MM
|
Facility
|
IP
|
$8,786.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,142.18 |
| Max. Negotiated Rate |
$8,434.56 |
| Rate for Payer: Aetna Commercial |
$6,765.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,853.08
|
| Rate for Payer: Cash Price |
$4,393.00
|
| Rate for Payer: Cigna Commercial |
$7,292.38
|
| Rate for Payer: First Health Commercial |
$8,346.70
|
| Rate for Payer: Humana Commercial |
$7,468.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,204.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,484.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,635.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,731.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,589.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,757.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,142.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,723.66
|
| Rate for Payer: PHCS Commercial |
$8,434.56
|
| Rate for Payer: United Healthcare All Payer |
$7,731.68
|
|
|
GEN P/S ART INSR X-LGE LT 8 MM
|
Facility
|
OP
|
$8,786.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,142.18 |
| Max. Negotiated Rate |
$8,434.56 |
| Rate for Payer: Aetna Commercial |
$6,765.22
|
| Rate for Payer: Anthem Medicaid |
$3,021.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,853.08
|
| Rate for Payer: Cash Price |
$4,393.00
|
| Rate for Payer: Cigna Commercial |
$7,292.38
|
| Rate for Payer: First Health Commercial |
$8,346.70
|
| Rate for Payer: Humana Commercial |
$7,468.10
|
| Rate for Payer: Humana KY Medicaid |
$3,021.51
|
| Rate for Payer: Kentucky WC Medicaid |
$3,052.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,204.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,484.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,635.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,082.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,731.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,589.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,757.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,142.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,723.66
|
| Rate for Payer: PHCS Commercial |
$8,434.56
|
| Rate for Payer: United Healthcare All Payer |
$7,731.68
|
|
|
GEN P/S ART INS X-LGE LT 25 MM
|
Facility
|
IP
|
$8,786.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,142.18 |
| Max. Negotiated Rate |
$8,434.56 |
| Rate for Payer: Aetna Commercial |
$6,765.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,853.08
|
| Rate for Payer: Cash Price |
$4,393.00
|
| Rate for Payer: Cigna Commercial |
$7,292.38
|
| Rate for Payer: First Health Commercial |
$8,346.70
|
| Rate for Payer: Humana Commercial |
$7,468.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,204.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,484.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,635.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,731.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,589.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,757.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,142.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,723.66
|
| Rate for Payer: PHCS Commercial |
$8,434.56
|
| Rate for Payer: United Healthcare All Payer |
$7,731.68
|
|
