GII CR DEEP FLX INSRT S 5-6 15
|
Facility
|
OP
|
$5,000.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$650.00 |
Max. Negotiated Rate |
$4,800.00 |
Rate for Payer: Aetna Commercial |
$3,850.00
|
Rate for Payer: Anthem Medicaid |
$1,719.50
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
Rate for Payer: Cash Price |
$2,500.00
|
Rate for Payer: Cigna Commercial |
$4,150.00
|
Rate for Payer: First Health Commercial |
$4,750.00
|
Rate for Payer: Humana Commercial |
$4,250.00
|
Rate for Payer: Humana KY Medicaid |
$1,719.50
|
Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
Rate for Payer: PHCS Commercial |
$4,800.00
|
Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
GII CR DEEP FLX INSRT S 5-6 15
|
Facility
|
IP
|
$5,000.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$650.00 |
Max. Negotiated Rate |
$4,800.00 |
Rate for Payer: Aetna Commercial |
$3,850.00
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
Rate for Payer: Cash Price |
$2,500.00
|
Rate for Payer: Cigna Commercial |
$4,150.00
|
Rate for Payer: First Health Commercial |
$4,750.00
|
Rate for Payer: Humana Commercial |
$4,250.00
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
Rate for Payer: PHCS Commercial |
$4,800.00
|
Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
GII CR DEEP FLX INSRT S 5-6 18
|
Facility
|
OP
|
$5,000.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$650.00 |
Max. Negotiated Rate |
$4,800.00 |
Rate for Payer: Aetna Commercial |
$3,850.00
|
Rate for Payer: Anthem Medicaid |
$1,719.50
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
Rate for Payer: Cash Price |
$2,500.00
|
Rate for Payer: Cigna Commercial |
$4,150.00
|
Rate for Payer: First Health Commercial |
$4,750.00
|
Rate for Payer: Humana Commercial |
$4,250.00
|
Rate for Payer: Humana KY Medicaid |
$1,719.50
|
Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
Rate for Payer: PHCS Commercial |
$4,800.00
|
Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
GII CR DEEP FLX INSRT S 5-6 18
|
Facility
|
IP
|
$5,000.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$650.00 |
Max. Negotiated Rate |
$4,800.00 |
Rate for Payer: Aetna Commercial |
$3,850.00
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
Rate for Payer: Cash Price |
$2,500.00
|
Rate for Payer: Cigna Commercial |
$4,150.00
|
Rate for Payer: First Health Commercial |
$4,750.00
|
Rate for Payer: Humana Commercial |
$4,250.00
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
Rate for Payer: PHCS Commercial |
$4,800.00
|
Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
GII CR DEEP FLX INSRT S 5-6 9M
|
Facility
|
IP
|
$5,000.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$650.00 |
Max. Negotiated Rate |
$4,800.00 |
Rate for Payer: Aetna Commercial |
$3,850.00
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
Rate for Payer: Cash Price |
$2,500.00
|
Rate for Payer: Cigna Commercial |
$4,150.00
|
Rate for Payer: First Health Commercial |
$4,750.00
|
Rate for Payer: Humana Commercial |
$4,250.00
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
Rate for Payer: PHCS Commercial |
$4,800.00
|
Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
GII CR DEEP FLX INSRT S 5-6 9M
|
Facility
|
OP
|
$5,000.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$650.00 |
Max. Negotiated Rate |
$4,800.00 |
Rate for Payer: Aetna Commercial |
$3,850.00
|
Rate for Payer: Anthem Medicaid |
$1,719.50
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
Rate for Payer: Cash Price |
$2,500.00
|
Rate for Payer: Cigna Commercial |
$4,150.00
|
Rate for Payer: First Health Commercial |
$4,750.00
|
Rate for Payer: Humana Commercial |
$4,250.00
|
Rate for Payer: Humana KY Medicaid |
$1,719.50
|
Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
Rate for Payer: PHCS Commercial |
$4,800.00
|
Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
GII CR DEEP FLX INSRT S 7-8 11
|
Facility
|
IP
|
$5,000.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$650.00 |
Max. Negotiated Rate |
$4,800.00 |
Rate for Payer: Aetna Commercial |
$3,850.00
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
Rate for Payer: Cash Price |
$2,500.00
|
Rate for Payer: Cigna Commercial |
$4,150.00
|
Rate for Payer: First Health Commercial |
$4,750.00
|
Rate for Payer: Humana Commercial |
$4,250.00
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
Rate for Payer: PHCS Commercial |
$4,800.00
|
Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
GII CR DEEP FLX INSRT S 7-8 11
|
Facility
|
OP
|
$5,000.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$650.00 |
Max. Negotiated Rate |
$4,800.00 |
Rate for Payer: Aetna Commercial |
$3,850.00
|
Rate for Payer: Anthem Medicaid |
$1,719.50
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
Rate for Payer: Cash Price |
$2,500.00
|
Rate for Payer: Cigna Commercial |
$4,150.00
|
Rate for Payer: First Health Commercial |
$4,750.00
|
Rate for Payer: Humana Commercial |
$4,250.00
|
Rate for Payer: Humana KY Medicaid |
$1,719.50
|
Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
Rate for Payer: PHCS Commercial |
$4,800.00
|
Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
GII CR DEEP FLX INSRT S 7-8 13
|
Facility
|
OP
|
$5,000.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$650.00 |
Max. Negotiated Rate |
$4,800.00 |
Rate for Payer: Aetna Commercial |
$3,850.00
|
Rate for Payer: Anthem Medicaid |
$1,719.50
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
Rate for Payer: Cash Price |
$2,500.00
|
Rate for Payer: Cigna Commercial |
$4,150.00
|
Rate for Payer: First Health Commercial |
$4,750.00
|
Rate for Payer: Humana Commercial |
$4,250.00
|
Rate for Payer: Humana KY Medicaid |
$1,719.50
|
Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
Rate for Payer: PHCS Commercial |
$4,800.00
|
Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
GII CR DEEP FLX INSRT S 7-8 13
|
Facility
|
IP
|
$5,000.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$650.00 |
Max. Negotiated Rate |
$4,800.00 |
Rate for Payer: Aetna Commercial |
$3,850.00
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
Rate for Payer: Cash Price |
$2,500.00
|
Rate for Payer: Cigna Commercial |
$4,150.00
|
Rate for Payer: First Health Commercial |
$4,750.00
|
Rate for Payer: Humana Commercial |
$4,250.00
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
Rate for Payer: PHCS Commercial |
$4,800.00
|
Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
GII CR DEEP FLX INSRT S 7-8 15
|
Facility
|
OP
|
$5,000.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$650.00 |
Max. Negotiated Rate |
$4,800.00 |
Rate for Payer: Aetna Commercial |
$3,850.00
|
Rate for Payer: Anthem Medicaid |
$1,719.50
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
Rate for Payer: Cash Price |
$2,500.00
|
Rate for Payer: Cigna Commercial |
$4,150.00
|
Rate for Payer: First Health Commercial |
$4,750.00
|
Rate for Payer: Humana Commercial |
$4,250.00
|
Rate for Payer: Humana KY Medicaid |
$1,719.50
|
Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
Rate for Payer: PHCS Commercial |
$4,800.00
|
Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
GII CR DEEP FLX INSRT S 7-8 15
|
Facility
|
IP
|
$5,000.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$650.00 |
Max. Negotiated Rate |
$4,800.00 |
Rate for Payer: Aetna Commercial |
$3,850.00
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
Rate for Payer: Cash Price |
$2,500.00
|
Rate for Payer: Cigna Commercial |
$4,150.00
|
Rate for Payer: First Health Commercial |
$4,750.00
|
Rate for Payer: Humana Commercial |
$4,250.00
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
Rate for Payer: PHCS Commercial |
$4,800.00
|
Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
GII CR DEEP FLX INSRT S 7-8 18
|
Facility
|
IP
|
$5,000.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$650.00 |
Max. Negotiated Rate |
$4,800.00 |
Rate for Payer: Aetna Commercial |
$3,850.00
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
Rate for Payer: Cash Price |
$2,500.00
|
Rate for Payer: Cigna Commercial |
$4,150.00
|
Rate for Payer: First Health Commercial |
$4,750.00
|
Rate for Payer: Humana Commercial |
$4,250.00
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
Rate for Payer: PHCS Commercial |
$4,800.00
|
Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
GII CR DEEP FLX INSRT S 7-8 18
|
Facility
|
OP
|
$5,000.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$650.00 |
Max. Negotiated Rate |
$4,800.00 |
Rate for Payer: Aetna Commercial |
$3,850.00
|
Rate for Payer: Anthem Medicaid |
$1,719.50
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
Rate for Payer: Cash Price |
$2,500.00
|
Rate for Payer: Cigna Commercial |
$4,150.00
|
Rate for Payer: First Health Commercial |
$4,750.00
|
Rate for Payer: Humana Commercial |
$4,250.00
|
Rate for Payer: Humana KY Medicaid |
$1,719.50
|
Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
Rate for Payer: PHCS Commercial |
$4,800.00
|
Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
GII CR DEEP FLX INST S 1-2 11M
|
Facility
|
OP
|
$5,000.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$650.00 |
Max. Negotiated Rate |
$4,800.00 |
Rate for Payer: Aetna Commercial |
$3,850.00
|
Rate for Payer: Anthem Medicaid |
$1,719.50
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
Rate for Payer: Cash Price |
$2,500.00
|
Rate for Payer: Cigna Commercial |
$4,150.00
|
Rate for Payer: First Health Commercial |
$4,750.00
|
Rate for Payer: Humana Commercial |
$4,250.00
|
Rate for Payer: Humana KY Medicaid |
$1,719.50
|
Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
Rate for Payer: PHCS Commercial |
$4,800.00
|
Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
GII CR DEEP FLX INST S 1-2 11M
|
Facility
|
IP
|
$5,000.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$650.00 |
Max. Negotiated Rate |
$4,800.00 |
Rate for Payer: Aetna Commercial |
$3,850.00
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
Rate for Payer: Cash Price |
$2,500.00
|
Rate for Payer: Cigna Commercial |
$4,150.00
|
Rate for Payer: First Health Commercial |
$4,750.00
|
Rate for Payer: Humana Commercial |
$4,250.00
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
Rate for Payer: PHCS Commercial |
$4,800.00
|
Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
GII CR DEEP FLX INST S 1-2 13M
|
Facility
|
OP
|
$5,000.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$650.00 |
Max. Negotiated Rate |
$4,800.00 |
Rate for Payer: Aetna Commercial |
$3,850.00
|
Rate for Payer: Anthem Medicaid |
$1,719.50
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
Rate for Payer: Cash Price |
$2,500.00
|
Rate for Payer: Cigna Commercial |
$4,150.00
|
Rate for Payer: First Health Commercial |
$4,750.00
|
Rate for Payer: Humana Commercial |
$4,250.00
|
Rate for Payer: Humana KY Medicaid |
$1,719.50
|
Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
Rate for Payer: PHCS Commercial |
$4,800.00
|
Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
GII CR DEEP FLX INST S 1-2 13M
|
Facility
|
IP
|
$5,000.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$650.00 |
Max. Negotiated Rate |
$4,800.00 |
Rate for Payer: Aetna Commercial |
$3,850.00
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
Rate for Payer: Cash Price |
$2,500.00
|
Rate for Payer: Cigna Commercial |
$4,150.00
|
Rate for Payer: First Health Commercial |
$4,750.00
|
Rate for Payer: Humana Commercial |
$4,250.00
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
Rate for Payer: PHCS Commercial |
$4,800.00
|
Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
GII CR DEEP FLX INST S 1-2 15M
|
Facility
|
IP
|
$5,000.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$650.00 |
Max. Negotiated Rate |
$4,800.00 |
Rate for Payer: Aetna Commercial |
$3,850.00
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
Rate for Payer: Cash Price |
$2,500.00
|
Rate for Payer: Cigna Commercial |
$4,150.00
|
Rate for Payer: First Health Commercial |
$4,750.00
|
Rate for Payer: Humana Commercial |
$4,250.00
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
Rate for Payer: PHCS Commercial |
$4,800.00
|
Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
GII CR DEEP FLX INST S 1-2 15M
|
Facility
|
OP
|
$5,000.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$650.00 |
Max. Negotiated Rate |
$4,800.00 |
Rate for Payer: Aetna Commercial |
$3,850.00
|
Rate for Payer: Anthem Medicaid |
$1,719.50
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
Rate for Payer: Cash Price |
$2,500.00
|
Rate for Payer: Cigna Commercial |
$4,150.00
|
Rate for Payer: First Health Commercial |
$4,750.00
|
Rate for Payer: Humana Commercial |
$4,250.00
|
Rate for Payer: Humana KY Medicaid |
$1,719.50
|
Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
Rate for Payer: PHCS Commercial |
$4,800.00
|
Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
GII CR DEEP FLX INST S 1-2 18M
|
Facility
|
OP
|
$5,000.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$650.00 |
Max. Negotiated Rate |
$4,800.00 |
Rate for Payer: Aetna Commercial |
$3,850.00
|
Rate for Payer: Anthem Medicaid |
$1,719.50
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
Rate for Payer: Cash Price |
$2,500.00
|
Rate for Payer: Cigna Commercial |
$4,150.00
|
Rate for Payer: First Health Commercial |
$4,750.00
|
Rate for Payer: Humana Commercial |
$4,250.00
|
Rate for Payer: Humana KY Medicaid |
$1,719.50
|
Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
Rate for Payer: PHCS Commercial |
$4,800.00
|
Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
GII CR DEEP FLX INST S 1-2 18M
|
Facility
|
IP
|
$5,000.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$650.00 |
Max. Negotiated Rate |
$4,800.00 |
Rate for Payer: Aetna Commercial |
$3,850.00
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
Rate for Payer: Cash Price |
$2,500.00
|
Rate for Payer: Cigna Commercial |
$4,150.00
|
Rate for Payer: First Health Commercial |
$4,750.00
|
Rate for Payer: Humana Commercial |
$4,250.00
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
Rate for Payer: PHCS Commercial |
$4,800.00
|
Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
GII C/R DP TIB SZ 3*13MM R
|
Facility
|
OP
|
$5,000.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$650.00 |
Max. Negotiated Rate |
$4,800.00 |
Rate for Payer: Aetna Commercial |
$3,850.00
|
Rate for Payer: Anthem Medicaid |
$1,719.50
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
Rate for Payer: Cash Price |
$2,500.00
|
Rate for Payer: Cigna Commercial |
$4,150.00
|
Rate for Payer: First Health Commercial |
$4,750.00
|
Rate for Payer: Humana Commercial |
$4,250.00
|
Rate for Payer: Humana KY Medicaid |
$1,719.50
|
Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
Rate for Payer: PHCS Commercial |
$4,800.00
|
Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
GII C/R DP TIB SZ 3*13MM R
|
Facility
|
IP
|
$5,000.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$650.00 |
Max. Negotiated Rate |
$4,800.00 |
Rate for Payer: Aetna Commercial |
$3,850.00
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
Rate for Payer: Cash Price |
$2,500.00
|
Rate for Payer: Cigna Commercial |
$4,150.00
|
Rate for Payer: First Health Commercial |
$4,750.00
|
Rate for Payer: Humana Commercial |
$4,250.00
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
Rate for Payer: PHCS Commercial |
$4,800.00
|
Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
GII C/R DP TIB SZ 4*13MM L
|
Facility
|
OP
|
$5,000.00
|
|
Service Code
|
HCPCS C1776
|
Hospital Charge Code |
27000011
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$650.00 |
Max. Negotiated Rate |
$4,800.00 |
Rate for Payer: Aetna Commercial |
$3,850.00
|
Rate for Payer: Anthem Medicaid |
$1,719.50
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
Rate for Payer: Cash Price |
$2,500.00
|
Rate for Payer: Cigna Commercial |
$4,150.00
|
Rate for Payer: First Health Commercial |
$4,750.00
|
Rate for Payer: Humana Commercial |
$4,250.00
|
Rate for Payer: Humana KY Medicaid |
$1,719.50
|
Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
Rate for Payer: PHCS Commercial |
$4,800.00
|
Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|