|
G II DISHED INS SZ 1-2 21MM
|
Facility
|
OP
|
$5,441.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$707.33 |
| Max. Negotiated Rate |
$5,223.36 |
| Rate for Payer: Aetna Commercial |
$4,189.57
|
| Rate for Payer: Anthem Medicaid |
$1,871.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,243.98
|
| Rate for Payer: Cash Price |
$2,720.50
|
| Rate for Payer: Cigna Commercial |
$4,516.03
|
| Rate for Payer: First Health Commercial |
$5,168.95
|
| Rate for Payer: Humana Commercial |
$4,624.85
|
| Rate for Payer: Humana KY Medicaid |
$1,871.16
|
| Rate for Payer: Kentucky WC Medicaid |
$1,890.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,461.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,015.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,632.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,908.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,788.08
|
| Rate for Payer: Ohio Health Group HMO |
$4,080.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,088.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$707.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,686.71
|
| Rate for Payer: PHCS Commercial |
$5,223.36
|
| Rate for Payer: United Healthcare All Payer |
$4,788.08
|
|
|
G II DISHED INS SZ 1-2 9MM
|
Facility
|
IP
|
$5,441.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$707.33 |
| Max. Negotiated Rate |
$5,223.36 |
| Rate for Payer: Aetna Commercial |
$4,189.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,243.98
|
| Rate for Payer: Cash Price |
$2,720.50
|
| Rate for Payer: Cigna Commercial |
$4,516.03
|
| Rate for Payer: First Health Commercial |
$5,168.95
|
| Rate for Payer: Humana Commercial |
$4,624.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,461.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,015.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,632.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,788.08
|
| Rate for Payer: Ohio Health Group HMO |
$4,080.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,088.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$707.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,686.71
|
| Rate for Payer: PHCS Commercial |
$5,223.36
|
| Rate for Payer: United Healthcare All Payer |
$4,788.08
|
|
|
G II DISHED INS SZ 1-2 9MM
|
Facility
|
OP
|
$5,441.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$707.33 |
| Max. Negotiated Rate |
$5,223.36 |
| Rate for Payer: Aetna Commercial |
$4,189.57
|
| Rate for Payer: Anthem Medicaid |
$1,871.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,243.98
|
| Rate for Payer: Cash Price |
$2,720.50
|
| Rate for Payer: Cigna Commercial |
$4,516.03
|
| Rate for Payer: First Health Commercial |
$5,168.95
|
| Rate for Payer: Humana Commercial |
$4,624.85
|
| Rate for Payer: Humana KY Medicaid |
$1,871.16
|
| Rate for Payer: Kentucky WC Medicaid |
$1,890.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,461.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,015.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,632.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,908.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,788.08
|
| Rate for Payer: Ohio Health Group HMO |
$4,080.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,088.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$707.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,686.71
|
| Rate for Payer: PHCS Commercial |
$5,223.36
|
| Rate for Payer: United Healthcare All Payer |
$4,788.08
|
|
|
G II DISHED INS SZ 3-4 11MM
|
Facility
|
IP
|
$5,007.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.91 |
| Max. Negotiated Rate |
$4,806.72 |
| Rate for Payer: Aetna Commercial |
$3,855.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,905.46
|
| Rate for Payer: Cash Price |
$2,503.50
|
| Rate for Payer: Cigna Commercial |
$4,155.81
|
| Rate for Payer: First Health Commercial |
$4,756.65
|
| Rate for Payer: Humana Commercial |
$4,255.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,105.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,695.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,502.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,406.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,755.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,001.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,552.17
|
| Rate for Payer: PHCS Commercial |
$4,806.72
|
| Rate for Payer: United Healthcare All Payer |
$4,406.16
|
|
|
G II DISHED INS SZ 3-4 11MM
|
Facility
|
OP
|
$5,007.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.91 |
| Max. Negotiated Rate |
$4,806.72 |
| Rate for Payer: Aetna Commercial |
$3,855.39
|
| Rate for Payer: Anthem Medicaid |
$1,721.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,905.46
|
| Rate for Payer: Cash Price |
$2,503.50
|
| Rate for Payer: Cigna Commercial |
$4,155.81
|
| Rate for Payer: First Health Commercial |
$4,756.65
|
| Rate for Payer: Humana Commercial |
$4,255.95
|
| Rate for Payer: Humana KY Medicaid |
$1,721.91
|
| Rate for Payer: Kentucky WC Medicaid |
$1,739.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,105.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,695.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,502.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,756.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,406.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,755.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,001.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,552.17
|
| Rate for Payer: PHCS Commercial |
$4,806.72
|
| Rate for Payer: United Healthcare All Payer |
$4,406.16
|
|
|
G II DISHED INS SZ 3-4 13MM
|
Facility
|
IP
|
$5,007.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.91 |
| Max. Negotiated Rate |
$4,806.72 |
| Rate for Payer: Aetna Commercial |
$3,855.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,905.46
|
| Rate for Payer: Cash Price |
$2,503.50
|
| Rate for Payer: Cigna Commercial |
$4,155.81
|
| Rate for Payer: First Health Commercial |
$4,756.65
|
| Rate for Payer: Humana Commercial |
$4,255.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,105.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,695.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,502.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,406.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,755.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,001.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,552.17
|
| Rate for Payer: PHCS Commercial |
$4,806.72
|
| Rate for Payer: United Healthcare All Payer |
$4,406.16
|
|
|
G II DISHED INS SZ 3-4 13MM
|
Facility
|
OP
|
$5,007.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.91 |
| Max. Negotiated Rate |
$4,806.72 |
| Rate for Payer: Aetna Commercial |
$3,855.39
|
| Rate for Payer: Anthem Medicaid |
$1,721.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,905.46
|
| Rate for Payer: Cash Price |
$2,503.50
|
| Rate for Payer: Cigna Commercial |
$4,155.81
|
| Rate for Payer: First Health Commercial |
$4,756.65
|
| Rate for Payer: Humana Commercial |
$4,255.95
|
| Rate for Payer: Humana KY Medicaid |
$1,721.91
|
| Rate for Payer: Kentucky WC Medicaid |
$1,739.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,105.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,695.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,502.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,756.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,406.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,755.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,001.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,552.17
|
| Rate for Payer: PHCS Commercial |
$4,806.72
|
| Rate for Payer: United Healthcare All Payer |
$4,406.16
|
|
|
G II DISHED INS SZ 3-4 15MM
|
Facility
|
OP
|
$5,007.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.91 |
| Max. Negotiated Rate |
$4,806.72 |
| Rate for Payer: Aetna Commercial |
$3,855.39
|
| Rate for Payer: Anthem Medicaid |
$1,721.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,905.46
|
| Rate for Payer: Cash Price |
$2,503.50
|
| Rate for Payer: Cigna Commercial |
$4,155.81
|
| Rate for Payer: First Health Commercial |
$4,756.65
|
| Rate for Payer: Humana Commercial |
$4,255.95
|
| Rate for Payer: Humana KY Medicaid |
$1,721.91
|
| Rate for Payer: Kentucky WC Medicaid |
$1,739.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,105.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,695.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,502.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,756.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,406.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,755.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,001.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,552.17
|
| Rate for Payer: PHCS Commercial |
$4,806.72
|
| Rate for Payer: United Healthcare All Payer |
$4,406.16
|
|
|
G II DISHED INS SZ 3-4 15MM
|
Facility
|
IP
|
$5,007.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.91 |
| Max. Negotiated Rate |
$4,806.72 |
| Rate for Payer: Aetna Commercial |
$3,855.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,905.46
|
| Rate for Payer: Cash Price |
$2,503.50
|
| Rate for Payer: Cigna Commercial |
$4,155.81
|
| Rate for Payer: First Health Commercial |
$4,756.65
|
| Rate for Payer: Humana Commercial |
$4,255.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,105.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,695.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,502.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,406.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,755.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,001.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,552.17
|
| Rate for Payer: PHCS Commercial |
$4,806.72
|
| Rate for Payer: United Healthcare All Payer |
$4,406.16
|
|
|
G II DISHED INS SZ 3-4 18MM
|
Facility
|
IP
|
$5,007.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.91 |
| Max. Negotiated Rate |
$4,806.72 |
| Rate for Payer: Aetna Commercial |
$3,855.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,905.46
|
| Rate for Payer: Cash Price |
$2,503.50
|
| Rate for Payer: Cigna Commercial |
$4,155.81
|
| Rate for Payer: First Health Commercial |
$4,756.65
|
| Rate for Payer: Humana Commercial |
$4,255.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,105.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,695.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,502.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,406.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,755.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,001.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,552.17
|
| Rate for Payer: PHCS Commercial |
$4,806.72
|
| Rate for Payer: United Healthcare All Payer |
$4,406.16
|
|
|
G II DISHED INS SZ 3-4 18MM
|
Facility
|
OP
|
$5,007.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.91 |
| Max. Negotiated Rate |
$4,806.72 |
| Rate for Payer: Aetna Commercial |
$3,855.39
|
| Rate for Payer: Anthem Medicaid |
$1,721.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,905.46
|
| Rate for Payer: Cash Price |
$2,503.50
|
| Rate for Payer: Cigna Commercial |
$4,155.81
|
| Rate for Payer: First Health Commercial |
$4,756.65
|
| Rate for Payer: Humana Commercial |
$4,255.95
|
| Rate for Payer: Humana KY Medicaid |
$1,721.91
|
| Rate for Payer: Kentucky WC Medicaid |
$1,739.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,105.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,695.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,502.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,756.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,406.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,755.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,001.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,552.17
|
| Rate for Payer: PHCS Commercial |
$4,806.72
|
| Rate for Payer: United Healthcare All Payer |
$4,406.16
|
|
|
G II DISHED INS SZ 3-4 21MM
|
Facility
|
OP
|
$5,007.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.91 |
| Max. Negotiated Rate |
$4,806.72 |
| Rate for Payer: Aetna Commercial |
$3,855.39
|
| Rate for Payer: Anthem Medicaid |
$1,721.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,905.46
|
| Rate for Payer: Cash Price |
$2,503.50
|
| Rate for Payer: Cigna Commercial |
$4,155.81
|
| Rate for Payer: First Health Commercial |
$4,756.65
|
| Rate for Payer: Humana Commercial |
$4,255.95
|
| Rate for Payer: Humana KY Medicaid |
$1,721.91
|
| Rate for Payer: Kentucky WC Medicaid |
$1,739.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,105.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,695.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,502.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,756.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,406.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,755.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,001.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,552.17
|
| Rate for Payer: PHCS Commercial |
$4,806.72
|
| Rate for Payer: United Healthcare All Payer |
$4,406.16
|
|
|
G II DISHED INS SZ 3-4 21MM
|
Facility
|
IP
|
$5,007.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.91 |
| Max. Negotiated Rate |
$4,806.72 |
| Rate for Payer: Aetna Commercial |
$3,855.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,905.46
|
| Rate for Payer: Cash Price |
$2,503.50
|
| Rate for Payer: Cigna Commercial |
$4,155.81
|
| Rate for Payer: First Health Commercial |
$4,756.65
|
| Rate for Payer: Humana Commercial |
$4,255.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,105.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,695.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,502.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,406.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,755.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,001.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,552.17
|
| Rate for Payer: PHCS Commercial |
$4,806.72
|
| Rate for Payer: United Healthcare All Payer |
$4,406.16
|
|
|
G II DISHED INS SZ 3-4 9MM
|
Facility
|
OP
|
$5,007.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.91 |
| Max. Negotiated Rate |
$4,806.72 |
| Rate for Payer: Aetna Commercial |
$3,855.39
|
| Rate for Payer: Anthem Medicaid |
$1,721.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,905.46
|
| Rate for Payer: Cash Price |
$2,503.50
|
| Rate for Payer: Cigna Commercial |
$4,155.81
|
| Rate for Payer: First Health Commercial |
$4,756.65
|
| Rate for Payer: Humana Commercial |
$4,255.95
|
| Rate for Payer: Humana KY Medicaid |
$1,721.91
|
| Rate for Payer: Kentucky WC Medicaid |
$1,739.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,105.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,695.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,502.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,756.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,406.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,755.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,001.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,552.17
|
| Rate for Payer: PHCS Commercial |
$4,806.72
|
| Rate for Payer: United Healthcare All Payer |
$4,406.16
|
|
|
G II DISHED INS SZ 3-4 9MM
|
Facility
|
IP
|
$5,007.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.91 |
| Max. Negotiated Rate |
$4,806.72 |
| Rate for Payer: Aetna Commercial |
$3,855.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,905.46
|
| Rate for Payer: Cash Price |
$2,503.50
|
| Rate for Payer: Cigna Commercial |
$4,155.81
|
| Rate for Payer: First Health Commercial |
$4,756.65
|
| Rate for Payer: Humana Commercial |
$4,255.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,105.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,695.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,502.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,406.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,755.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,001.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,552.17
|
| Rate for Payer: PHCS Commercial |
$4,806.72
|
| Rate for Payer: United Healthcare All Payer |
$4,406.16
|
|
|
G II DISHED INS SZ 5-6 11MM
|
Facility
|
IP
|
$5,007.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.91 |
| Max. Negotiated Rate |
$4,806.72 |
| Rate for Payer: Aetna Commercial |
$3,855.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,905.46
|
| Rate for Payer: Cash Price |
$2,503.50
|
| Rate for Payer: Cigna Commercial |
$4,155.81
|
| Rate for Payer: First Health Commercial |
$4,756.65
|
| Rate for Payer: Humana Commercial |
$4,255.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,105.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,695.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,502.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,406.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,755.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,001.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,552.17
|
| Rate for Payer: PHCS Commercial |
$4,806.72
|
| Rate for Payer: United Healthcare All Payer |
$4,406.16
|
|
|
G II DISHED INS SZ 5-6 11MM
|
Facility
|
OP
|
$5,007.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.91 |
| Max. Negotiated Rate |
$4,806.72 |
| Rate for Payer: Aetna Commercial |
$3,855.39
|
| Rate for Payer: Anthem Medicaid |
$1,721.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,905.46
|
| Rate for Payer: Cash Price |
$2,503.50
|
| Rate for Payer: Cigna Commercial |
$4,155.81
|
| Rate for Payer: First Health Commercial |
$4,756.65
|
| Rate for Payer: Humana Commercial |
$4,255.95
|
| Rate for Payer: Humana KY Medicaid |
$1,721.91
|
| Rate for Payer: Kentucky WC Medicaid |
$1,739.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,105.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,695.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,502.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,756.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,406.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,755.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,001.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,552.17
|
| Rate for Payer: PHCS Commercial |
$4,806.72
|
| Rate for Payer: United Healthcare All Payer |
$4,406.16
|
|
|
G II DISHED INS SZ 5-6 9MM
|
Facility
|
IP
|
$5,007.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.91 |
| Max. Negotiated Rate |
$4,806.72 |
| Rate for Payer: Aetna Commercial |
$3,855.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,905.46
|
| Rate for Payer: Cash Price |
$2,503.50
|
| Rate for Payer: Cigna Commercial |
$4,155.81
|
| Rate for Payer: First Health Commercial |
$4,756.65
|
| Rate for Payer: Humana Commercial |
$4,255.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,105.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,695.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,502.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,406.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,755.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,001.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,552.17
|
| Rate for Payer: PHCS Commercial |
$4,806.72
|
| Rate for Payer: United Healthcare All Payer |
$4,406.16
|
|
|
G II DISHED INS SZ 5-6 9MM
|
Facility
|
OP
|
$5,007.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.91 |
| Max. Negotiated Rate |
$4,806.72 |
| Rate for Payer: Aetna Commercial |
$3,855.39
|
| Rate for Payer: Anthem Medicaid |
$1,721.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,905.46
|
| Rate for Payer: Cash Price |
$2,503.50
|
| Rate for Payer: Cigna Commercial |
$4,155.81
|
| Rate for Payer: First Health Commercial |
$4,756.65
|
| Rate for Payer: Humana Commercial |
$4,255.95
|
| Rate for Payer: Humana KY Medicaid |
$1,721.91
|
| Rate for Payer: Kentucky WC Medicaid |
$1,739.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,105.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,695.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,502.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,756.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,406.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,755.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,001.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,552.17
|
| Rate for Payer: PHCS Commercial |
$4,806.72
|
| Rate for Payer: United Healthcare All Payer |
$4,406.16
|
|
|
GII HA POR TIBIAL SZ 2 LT
|
Facility
|
OP
|
$9,251.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,202.68 |
| Max. Negotiated Rate |
$8,881.32 |
| Rate for Payer: Aetna Commercial |
$7,123.56
|
| Rate for Payer: Anthem Medicaid |
$3,181.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,216.08
|
| Rate for Payer: Cash Price |
$4,625.69
|
| Rate for Payer: Cigna Commercial |
$7,678.65
|
| Rate for Payer: First Health Commercial |
$8,788.81
|
| Rate for Payer: Humana Commercial |
$7,863.67
|
| Rate for Payer: Humana KY Medicaid |
$3,181.55
|
| Rate for Payer: Kentucky WC Medicaid |
$3,213.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,586.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,827.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,775.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,245.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,141.21
|
| Rate for Payer: Ohio Health Group HMO |
$6,938.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,850.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,202.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,867.93
|
| Rate for Payer: PHCS Commercial |
$8,881.32
|
| Rate for Payer: United Healthcare All Payer |
$8,141.21
|
|
|
GII HA POR TIBIAL SZ 2 LT
|
Facility
|
IP
|
$9,251.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,202.68 |
| Max. Negotiated Rate |
$8,881.32 |
| Rate for Payer: Aetna Commercial |
$7,123.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,216.08
|
| Rate for Payer: Cash Price |
$4,625.69
|
| Rate for Payer: Cigna Commercial |
$7,678.65
|
| Rate for Payer: First Health Commercial |
$8,788.81
|
| Rate for Payer: Humana Commercial |
$7,863.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,586.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,827.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,775.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,141.21
|
| Rate for Payer: Ohio Health Group HMO |
$6,938.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,850.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,202.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,867.93
|
| Rate for Payer: PHCS Commercial |
$8,881.32
|
| Rate for Payer: United Healthcare All Payer |
$8,141.21
|
|
|
GII HA POR TIBIAL SZ 2 RT
|
Facility
|
OP
|
$12,534.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,629.48 |
| Max. Negotiated Rate |
$12,033.12 |
| Rate for Payer: Aetna Commercial |
$9,651.56
|
| Rate for Payer: Anthem Medicaid |
$4,310.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,776.91
|
| Rate for Payer: Cash Price |
$6,267.25
|
| Rate for Payer: Cigna Commercial |
$10,403.64
|
| Rate for Payer: First Health Commercial |
$11,907.78
|
| Rate for Payer: Humana Commercial |
$10,654.32
|
| Rate for Payer: Humana KY Medicaid |
$4,310.61
|
| Rate for Payer: Kentucky WC Medicaid |
$4,354.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,278.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,250.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,760.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,397.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,030.36
|
| Rate for Payer: Ohio Health Group HMO |
$9,400.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,506.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,629.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,885.70
|
| Rate for Payer: PHCS Commercial |
$12,033.12
|
| Rate for Payer: United Healthcare All Payer |
$11,030.36
|
|
|
GII HA POR TIBIAL SZ 2 RT
|
Facility
|
IP
|
$12,534.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,629.48 |
| Max. Negotiated Rate |
$12,033.12 |
| Rate for Payer: Aetna Commercial |
$9,651.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,776.91
|
| Rate for Payer: Cash Price |
$6,267.25
|
| Rate for Payer: Cigna Commercial |
$10,403.64
|
| Rate for Payer: First Health Commercial |
$11,907.78
|
| Rate for Payer: Humana Commercial |
$10,654.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,278.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,250.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,760.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,030.36
|
| Rate for Payer: Ohio Health Group HMO |
$9,400.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,506.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,629.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,885.70
|
| Rate for Payer: PHCS Commercial |
$12,033.12
|
| Rate for Payer: United Healthcare All Payer |
$11,030.36
|
|
|
GII HA POR TIBIAL SZ 3 LT
|
Facility
|
OP
|
$8,545.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,110.86 |
| Max. Negotiated Rate |
$8,203.30 |
| Rate for Payer: Aetna Commercial |
$6,579.73
|
| Rate for Payer: Anthem Medicaid |
$2,938.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,665.18
|
| Rate for Payer: Cash Price |
$4,272.55
|
| Rate for Payer: Cigna Commercial |
$7,092.43
|
| Rate for Payer: First Health Commercial |
$8,117.84
|
| Rate for Payer: Humana Commercial |
$7,263.34
|
| Rate for Payer: Humana KY Medicaid |
$2,938.66
|
| Rate for Payer: Kentucky WC Medicaid |
$2,968.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,006.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,306.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,563.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,997.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,519.69
|
| Rate for Payer: Ohio Health Group HMO |
$6,408.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,709.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,110.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,648.98
|
| Rate for Payer: PHCS Commercial |
$8,203.30
|
| Rate for Payer: United Healthcare All Payer |
$7,519.69
|
|
|
GII HA POR TIBIAL SZ 3 LT
|
Facility
|
IP
|
$8,545.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,110.86 |
| Max. Negotiated Rate |
$8,203.30 |
| Rate for Payer: Aetna Commercial |
$6,579.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,665.18
|
| Rate for Payer: Cash Price |
$4,272.55
|
| Rate for Payer: Cigna Commercial |
$7,092.43
|
| Rate for Payer: First Health Commercial |
$8,117.84
|
| Rate for Payer: Humana Commercial |
$7,263.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,006.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,306.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,563.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,519.69
|
| Rate for Payer: Ohio Health Group HMO |
$6,408.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,709.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,110.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,648.98
|
| Rate for Payer: PHCS Commercial |
$8,203.30
|
| Rate for Payer: United Healthcare All Payer |
$7,519.69
|
|
