|
GEN CR ART LRG RT INSERT 12MM
|
Facility
|
IP
|
$8,986.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,695.80 |
| Max. Negotiated Rate |
$8,626.56 |
| Rate for Payer: Aetna Commercial |
$6,919.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,009.08
|
| Rate for Payer: Cash Price |
$4,493.00
|
| Rate for Payer: Cigna Commercial |
$7,458.38
|
| Rate for Payer: First Health Commercial |
$8,536.70
|
| Rate for Payer: Humana Commercial |
$7,638.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,368.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,631.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,695.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,907.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,739.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,188.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,817.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,200.34
|
| Rate for Payer: PHCS Commercial |
$8,626.56
|
| Rate for Payer: United Healthcare All Payer |
$7,907.68
|
|
|
GEN CR ART LRG RT INSERT 12MM
|
Facility
|
OP
|
$8,986.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,695.80 |
| Max. Negotiated Rate |
$8,626.56 |
| Rate for Payer: Aetna Commercial |
$6,919.22
|
| Rate for Payer: Anthem Medicaid |
$3,090.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,009.08
|
| Rate for Payer: Cash Price |
$4,493.00
|
| Rate for Payer: Cigna Commercial |
$7,458.38
|
| Rate for Payer: First Health Commercial |
$8,536.70
|
| Rate for Payer: Humana Commercial |
$7,638.10
|
| Rate for Payer: Humana KY Medicaid |
$3,090.29
|
| Rate for Payer: Kentucky WC Medicaid |
$3,121.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,368.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,631.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,695.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,152.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,907.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,739.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,188.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,817.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,200.34
|
| Rate for Payer: PHCS Commercial |
$8,626.56
|
| Rate for Payer: United Healthcare All Payer |
$7,907.68
|
|
|
GENERAL HEALTH PANEL
|
Facility
|
OP
|
$345.00
|
|
|
Service Code
|
HCPCS 80050
|
| Hospital Charge Code |
30000006
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$103.50 |
| Max. Negotiated Rate |
$331.20 |
| Rate for Payer: Aetna Commercial |
$265.65
|
| Rate for Payer: Anthem Medicaid |
$118.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$277.04
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Cigna Commercial |
$286.35
|
| Rate for Payer: First Health Commercial |
$327.75
|
| Rate for Payer: Humana Commercial |
$293.25
|
| Rate for Payer: Humana KY Medicaid |
$118.65
|
| Rate for Payer: Kentucky WC Medicaid |
$119.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$282.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$254.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$103.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$121.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$303.60
|
| Rate for Payer: Ohio Health Group HMO |
$258.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$276.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$300.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$238.05
|
| Rate for Payer: PHCS Commercial |
$331.20
|
| Rate for Payer: United Healthcare All Payer |
$303.60
|
|
|
GENERAL HEALTH PANEL
|
Facility
|
IP
|
$345.00
|
|
|
Service Code
|
HCPCS 80050
|
| Hospital Charge Code |
30000006
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$103.50 |
| Max. Negotiated Rate |
$331.20 |
| Rate for Payer: Aetna Commercial |
$265.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$277.04
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Cigna Commercial |
$286.35
|
| Rate for Payer: First Health Commercial |
$327.75
|
| Rate for Payer: Humana Commercial |
$293.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$282.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$254.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$103.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$303.60
|
| Rate for Payer: Ohio Health Group HMO |
$258.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$276.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$300.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$238.05
|
| Rate for Payer: PHCS Commercial |
$331.20
|
| Rate for Payer: United Healthcare All Payer |
$303.60
|
|
|
GENERATOR
|
Facility
|
OP
|
$41,375.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$12,412.50 |
| Max. Negotiated Rate |
$39,720.00 |
| Rate for Payer: Aetna Commercial |
$31,858.75
|
| Rate for Payer: Anthem Medicaid |
$14,228.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32,272.50
|
| Rate for Payer: Cash Price |
$20,687.50
|
| Rate for Payer: Cigna Commercial |
$34,341.25
|
| Rate for Payer: First Health Commercial |
$39,306.25
|
| Rate for Payer: Humana Commercial |
$35,168.75
|
| Rate for Payer: Humana KY Medicaid |
$14,228.86
|
| Rate for Payer: Kentucky WC Medicaid |
$14,373.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,927.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30,534.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,412.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,514.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$36,410.00
|
| Rate for Payer: Ohio Health Group HMO |
$31,031.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35,996.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,548.75
|
| Rate for Payer: PHCS Commercial |
$39,720.00
|
| Rate for Payer: United Healthcare All Payer |
$36,410.00
|
|
|
GENERATOR
|
Facility
|
IP
|
$41,375.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$12,412.50 |
| Max. Negotiated Rate |
$39,720.00 |
| Rate for Payer: Aetna Commercial |
$31,858.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32,272.50
|
| Rate for Payer: Cash Price |
$20,687.50
|
| Rate for Payer: Cigna Commercial |
$34,341.25
|
| Rate for Payer: First Health Commercial |
$39,306.25
|
| Rate for Payer: Humana Commercial |
$35,168.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,927.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30,534.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,412.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$36,410.00
|
| Rate for Payer: Ohio Health Group HMO |
$31,031.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35,996.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,548.75
|
| Rate for Payer: PHCS Commercial |
$39,720.00
|
| Rate for Payer: United Healthcare All Payer |
$36,410.00
|
|
|
GENERATOR ADAPTA SCRR ADSR01
|
Facility
|
OP
|
$12,675.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,802.50 |
| Max. Negotiated Rate |
$12,168.00 |
| Rate for Payer: Aetna Commercial |
$9,759.75
|
| Rate for Payer: Anthem Medicaid |
$4,358.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,886.50
|
| Rate for Payer: Cash Price |
$6,337.50
|
| Rate for Payer: Cigna Commercial |
$10,520.25
|
| Rate for Payer: First Health Commercial |
$12,041.25
|
| Rate for Payer: Humana Commercial |
$10,773.75
|
| Rate for Payer: Humana KY Medicaid |
$4,358.93
|
| Rate for Payer: Kentucky WC Medicaid |
$4,403.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,393.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,354.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,802.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,446.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,154.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,506.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,027.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,745.75
|
| Rate for Payer: PHCS Commercial |
$12,168.00
|
| Rate for Payer: United Healthcare All Payer |
$11,154.00
|
|
|
GENERATOR ADAPTA SCRR ADSR01
|
Facility
|
IP
|
$12,675.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,802.50 |
| Max. Negotiated Rate |
$12,168.00 |
| Rate for Payer: Aetna Commercial |
$9,759.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,886.50
|
| Rate for Payer: Cash Price |
$6,337.50
|
| Rate for Payer: Cigna Commercial |
$10,520.25
|
| Rate for Payer: First Health Commercial |
$12,041.25
|
| Rate for Payer: Humana Commercial |
$10,773.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,393.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,354.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,802.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,154.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,506.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,027.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,745.75
|
| Rate for Payer: PHCS Commercial |
$12,168.00
|
| Rate for Payer: United Healthcare All Payer |
$11,154.00
|
|
|
GENERATOR ADAPTA SCRR ADSR03
|
Facility
|
IP
|
$12,675.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,802.50 |
| Max. Negotiated Rate |
$12,168.00 |
| Rate for Payer: Aetna Commercial |
$9,759.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,886.50
|
| Rate for Payer: Cash Price |
$6,337.50
|
| Rate for Payer: Cigna Commercial |
$10,520.25
|
| Rate for Payer: First Health Commercial |
$12,041.25
|
| Rate for Payer: Humana Commercial |
$10,773.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,393.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,354.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,802.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,154.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,506.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,027.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,745.75
|
| Rate for Payer: PHCS Commercial |
$12,168.00
|
| Rate for Payer: United Healthcare All Payer |
$11,154.00
|
|
|
GENERATOR ADAPTA SCRR ADSR03
|
Facility
|
OP
|
$12,675.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,802.50 |
| Max. Negotiated Rate |
$12,168.00 |
| Rate for Payer: Aetna Commercial |
$9,759.75
|
| Rate for Payer: Anthem Medicaid |
$4,358.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,886.50
|
| Rate for Payer: Cash Price |
$6,337.50
|
| Rate for Payer: Cigna Commercial |
$10,520.25
|
| Rate for Payer: First Health Commercial |
$12,041.25
|
| Rate for Payer: Humana Commercial |
$10,773.75
|
| Rate for Payer: Humana KY Medicaid |
$4,358.93
|
| Rate for Payer: Kentucky WC Medicaid |
$4,403.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,393.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,354.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,802.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,446.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,154.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,506.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,027.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,745.75
|
| Rate for Payer: PHCS Commercial |
$12,168.00
|
| Rate for Payer: United Healthcare All Payer |
$11,154.00
|
|
|
GENERATOR ADAPTA SCRR ADSR06
|
Facility
|
IP
|
$12,675.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,802.50 |
| Max. Negotiated Rate |
$12,168.00 |
| Rate for Payer: Aetna Commercial |
$9,759.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,886.50
|
| Rate for Payer: Cash Price |
$6,337.50
|
| Rate for Payer: Cigna Commercial |
$10,520.25
|
| Rate for Payer: First Health Commercial |
$12,041.25
|
| Rate for Payer: Humana Commercial |
$10,773.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,393.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,354.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,802.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,154.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,506.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,027.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,745.75
|
| Rate for Payer: PHCS Commercial |
$12,168.00
|
| Rate for Payer: United Healthcare All Payer |
$11,154.00
|
|
|
GENERATOR ADAPTA SCRR ADSR06
|
Facility
|
OP
|
$12,675.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,802.50 |
| Max. Negotiated Rate |
$12,168.00 |
| Rate for Payer: Aetna Commercial |
$9,759.75
|
| Rate for Payer: Anthem Medicaid |
$4,358.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,886.50
|
| Rate for Payer: Cash Price |
$6,337.50
|
| Rate for Payer: Cigna Commercial |
$10,520.25
|
| Rate for Payer: First Health Commercial |
$12,041.25
|
| Rate for Payer: Humana Commercial |
$10,773.75
|
| Rate for Payer: Humana KY Medicaid |
$4,358.93
|
| Rate for Payer: Kentucky WC Medicaid |
$4,403.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,393.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,354.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,802.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,446.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,154.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,506.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,027.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,745.75
|
| Rate for Payer: PHCS Commercial |
$12,168.00
|
| Rate for Payer: United Healthcare All Payer |
$11,154.00
|
|
|
GENERATOR ALTRUA 40 DCRR S404
|
Facility
|
OP
|
$26,438.75
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$7,931.62 |
| Max. Negotiated Rate |
$25,381.20 |
| Rate for Payer: Aetna Commercial |
$20,357.84
|
| Rate for Payer: Anthem Medicaid |
$9,092.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,622.22
|
| Rate for Payer: Cash Price |
$13,219.38
|
| Rate for Payer: Cigna Commercial |
$21,944.16
|
| Rate for Payer: First Health Commercial |
$25,116.81
|
| Rate for Payer: Humana Commercial |
$22,472.94
|
| Rate for Payer: Humana KY Medicaid |
$9,092.29
|
| Rate for Payer: Kentucky WC Medicaid |
$9,184.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,679.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,511.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,931.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,274.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,266.10
|
| Rate for Payer: Ohio Health Group HMO |
$19,829.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,151.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,001.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,242.74
|
| Rate for Payer: PHCS Commercial |
$25,381.20
|
| Rate for Payer: United Healthcare All Payer |
$23,266.10
|
|
|
GENERATOR ALTRUA 40 DCRR S404
|
Facility
|
IP
|
$26,438.75
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$7,931.62 |
| Max. Negotiated Rate |
$25,381.20 |
| Rate for Payer: Aetna Commercial |
$20,357.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,622.22
|
| Rate for Payer: Cash Price |
$13,219.38
|
| Rate for Payer: Cigna Commercial |
$21,944.16
|
| Rate for Payer: First Health Commercial |
$25,116.81
|
| Rate for Payer: Humana Commercial |
$22,472.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,679.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,511.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,931.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$23,266.10
|
| Rate for Payer: Ohio Health Group HMO |
$19,829.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,151.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,001.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,242.74
|
| Rate for Payer: PHCS Commercial |
$25,381.20
|
| Rate for Payer: United Healthcare All Payer |
$23,266.10
|
|
|
GENERATOR ALTRUA 40 SCRR S401
|
Facility
|
IP
|
$17,350.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,205.00 |
| Max. Negotiated Rate |
$16,656.00 |
| Rate for Payer: Aetna Commercial |
$13,359.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,533.00
|
| Rate for Payer: Cash Price |
$8,675.00
|
| Rate for Payer: Cigna Commercial |
$14,400.50
|
| Rate for Payer: First Health Commercial |
$16,482.50
|
| Rate for Payer: Humana Commercial |
$14,747.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,227.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,804.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,205.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,268.00
|
| Rate for Payer: Ohio Health Group HMO |
$13,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,094.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,971.50
|
| Rate for Payer: PHCS Commercial |
$16,656.00
|
| Rate for Payer: United Healthcare All Payer |
$15,268.00
|
|
|
GENERATOR ALTRUA 40 SCRR S401
|
Facility
|
OP
|
$17,350.00
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,205.00 |
| Max. Negotiated Rate |
$16,656.00 |
| Rate for Payer: Aetna Commercial |
$13,359.50
|
| Rate for Payer: Anthem Medicaid |
$5,966.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,533.00
|
| Rate for Payer: Cash Price |
$8,675.00
|
| Rate for Payer: Cigna Commercial |
$14,400.50
|
| Rate for Payer: First Health Commercial |
$16,482.50
|
| Rate for Payer: Humana Commercial |
$14,747.50
|
| Rate for Payer: Humana KY Medicaid |
$5,966.66
|
| Rate for Payer: Kentucky WC Medicaid |
$6,027.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,227.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,804.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,205.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,086.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,268.00
|
| Rate for Payer: Ohio Health Group HMO |
$13,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,094.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,971.50
|
| Rate for Payer: PHCS Commercial |
$16,656.00
|
| Rate for Payer: United Healthcare All Payer |
$15,268.00
|
|
|
GENERATOR ALTRUA 60 SCRR S601
|
Facility
|
IP
|
$13,959.50
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,187.85 |
| Max. Negotiated Rate |
$13,401.12 |
| Rate for Payer: Aetna Commercial |
$10,748.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,888.41
|
| Rate for Payer: Cash Price |
$6,979.75
|
| Rate for Payer: Cigna Commercial |
$11,586.39
|
| Rate for Payer: First Health Commercial |
$13,261.52
|
| Rate for Payer: Humana Commercial |
$11,865.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,446.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,302.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,187.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,284.36
|
| Rate for Payer: Ohio Health Group HMO |
$10,469.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,167.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,144.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,632.06
|
| Rate for Payer: PHCS Commercial |
$13,401.12
|
| Rate for Payer: United Healthcare All Payer |
$12,284.36
|
|
|
GENERATOR ALTRUA 60 SCRR S601
|
Facility
|
OP
|
$13,959.50
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27000088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,187.85 |
| Max. Negotiated Rate |
$13,401.12 |
| Rate for Payer: Aetna Commercial |
$10,748.82
|
| Rate for Payer: Anthem Medicaid |
$4,800.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,888.41
|
| Rate for Payer: Cash Price |
$6,979.75
|
| Rate for Payer: Cigna Commercial |
$11,586.39
|
| Rate for Payer: First Health Commercial |
$13,261.52
|
| Rate for Payer: Humana Commercial |
$11,865.58
|
| Rate for Payer: Humana KY Medicaid |
$4,800.67
|
| Rate for Payer: Kentucky WC Medicaid |
$4,849.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,446.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,302.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,187.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,896.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,284.36
|
| Rate for Payer: Ohio Health Group HMO |
$10,469.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,167.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,144.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,632.06
|
| Rate for Payer: PHCS Commercial |
$13,401.12
|
| Rate for Payer: United Healthcare All Payer |
$12,284.36
|
|
|
GENERATOR ALTRUA DCRR S208
|
Facility
|
OP
|
$20,000.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$6,000.00 |
| Max. Negotiated Rate |
$19,200.00 |
| Rate for Payer: Aetna Commercial |
$15,400.00
|
| Rate for Payer: Anthem Medicaid |
$6,878.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,600.00
|
| Rate for Payer: Cash Price |
$10,000.00
|
| Rate for Payer: Cigna Commercial |
$16,600.00
|
| Rate for Payer: First Health Commercial |
$19,000.00
|
| Rate for Payer: Humana Commercial |
$17,000.00
|
| Rate for Payer: Humana KY Medicaid |
$6,878.00
|
| Rate for Payer: Kentucky WC Medicaid |
$6,948.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,400.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,760.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,000.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,016.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,600.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,000.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,400.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,800.00
|
| Rate for Payer: PHCS Commercial |
$19,200.00
|
| Rate for Payer: United Healthcare All Payer |
$17,600.00
|
|
|
GENERATOR ALTRUA DCRR S208
|
Facility
|
IP
|
$20,000.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$6,000.00 |
| Max. Negotiated Rate |
$19,200.00 |
| Rate for Payer: Aetna Commercial |
$15,400.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,600.00
|
| Rate for Payer: Cash Price |
$10,000.00
|
| Rate for Payer: Cigna Commercial |
$16,600.00
|
| Rate for Payer: First Health Commercial |
$19,000.00
|
| Rate for Payer: Humana Commercial |
$17,000.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,400.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,760.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,000.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,600.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,000.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,400.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,800.00
|
| Rate for Payer: PHCS Commercial |
$19,200.00
|
| Rate for Payer: United Healthcare All Payer |
$17,600.00
|
|
|
GENERATOR ALTRUA DCRR S606
|
Facility
|
IP
|
$18,460.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,538.00 |
| Max. Negotiated Rate |
$17,721.60 |
| Rate for Payer: Aetna Commercial |
$14,214.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,398.80
|
| Rate for Payer: Cash Price |
$9,230.00
|
| Rate for Payer: Cigna Commercial |
$15,321.80
|
| Rate for Payer: First Health Commercial |
$17,537.00
|
| Rate for Payer: Humana Commercial |
$15,691.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,137.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,623.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,538.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,244.80
|
| Rate for Payer: Ohio Health Group HMO |
$13,845.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,768.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,060.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,737.40
|
| Rate for Payer: PHCS Commercial |
$17,721.60
|
| Rate for Payer: United Healthcare All Payer |
$16,244.80
|
|
|
GENERATOR ALTRUA DCRR S606
|
Facility
|
OP
|
$18,460.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,538.00 |
| Max. Negotiated Rate |
$17,721.60 |
| Rate for Payer: Aetna Commercial |
$14,214.20
|
| Rate for Payer: Anthem Medicaid |
$6,348.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,398.80
|
| Rate for Payer: Cash Price |
$9,230.00
|
| Rate for Payer: Cigna Commercial |
$15,321.80
|
| Rate for Payer: First Health Commercial |
$17,537.00
|
| Rate for Payer: Humana Commercial |
$15,691.00
|
| Rate for Payer: Humana KY Medicaid |
$6,348.39
|
| Rate for Payer: Kentucky WC Medicaid |
$6,413.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,137.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,623.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,538.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,475.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,244.80
|
| Rate for Payer: Ohio Health Group HMO |
$13,845.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,768.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,060.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,737.40
|
| Rate for Payer: PHCS Commercial |
$17,721.60
|
| Rate for Payer: United Healthcare All Payer |
$16,244.80
|
|
|
GENERATOR ATLAS DCRR V-242
|
Facility
|
IP
|
$78,900.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$23,670.00 |
| Max. Negotiated Rate |
$75,744.00 |
| Rate for Payer: Aetna Commercial |
$60,753.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61,542.00
|
| Rate for Payer: Cash Price |
$39,450.00
|
| Rate for Payer: Cigna Commercial |
$65,487.00
|
| Rate for Payer: First Health Commercial |
$74,955.00
|
| Rate for Payer: Humana Commercial |
$67,065.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,698.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58,228.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,670.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$69,432.00
|
| Rate for Payer: Ohio Health Group HMO |
$59,175.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68,643.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54,441.00
|
| Rate for Payer: PHCS Commercial |
$75,744.00
|
| Rate for Payer: United Healthcare All Payer |
$69,432.00
|
|
|
GENERATOR ATLAS DCRR V-242
|
Facility
|
OP
|
$78,900.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27000087
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$23,670.00 |
| Max. Negotiated Rate |
$75,744.00 |
| Rate for Payer: Aetna Commercial |
$60,753.00
|
| Rate for Payer: Anthem Medicaid |
$27,133.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61,542.00
|
| Rate for Payer: Cash Price |
$39,450.00
|
| Rate for Payer: Cigna Commercial |
$65,487.00
|
| Rate for Payer: First Health Commercial |
$74,955.00
|
| Rate for Payer: Humana Commercial |
$67,065.00
|
| Rate for Payer: Humana KY Medicaid |
$27,133.71
|
| Rate for Payer: Kentucky WC Medicaid |
$27,409.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64,698.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58,228.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,670.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,678.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$69,432.00
|
| Rate for Payer: Ohio Health Group HMO |
$59,175.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68,643.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54,441.00
|
| Rate for Payer: PHCS Commercial |
$75,744.00
|
| Rate for Payer: United Healthcare All Payer |
$69,432.00
|
|
|
GENERATOR CONSULTA C4TR01
|
Facility
|
OP
|
$33,612.50
|
|
|
Service Code
|
HCPCS C2621
|
| Hospital Charge Code |
27000086
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,083.75 |
| Max. Negotiated Rate |
$32,268.00 |
| Rate for Payer: Aetna Commercial |
$25,881.62
|
| Rate for Payer: Anthem Medicaid |
$11,559.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$26,217.75
|
| Rate for Payer: Cash Price |
$16,806.25
|
| Rate for Payer: Cigna Commercial |
$27,898.38
|
| Rate for Payer: First Health Commercial |
$31,931.88
|
| Rate for Payer: Humana Commercial |
$28,570.62
|
| Rate for Payer: Humana KY Medicaid |
$11,559.34
|
| Rate for Payer: Kentucky WC Medicaid |
$11,676.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,562.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,806.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,083.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,791.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,579.00
|
| Rate for Payer: Ohio Health Group HMO |
$25,209.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26,890.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29,242.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23,192.62
|
| Rate for Payer: PHCS Commercial |
$32,268.00
|
| Rate for Payer: United Healthcare All Payer |
$29,579.00
|
|
