|
GMRS FULL FLAT BLOCK 10MM L 2
|
Facility
|
OP
|
$7,971.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,036.27 |
| Max. Negotiated Rate |
$7,652.47 |
| Rate for Payer: Aetna Commercial |
$6,137.92
|
| Rate for Payer: Anthem Medicaid |
$2,741.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,217.63
|
| Rate for Payer: Cash Price |
$3,985.66
|
| Rate for Payer: Cigna Commercial |
$6,616.20
|
| Rate for Payer: First Health Commercial |
$7,572.75
|
| Rate for Payer: Humana Commercial |
$6,775.62
|
| Rate for Payer: Humana KY Medicaid |
$2,741.34
|
| Rate for Payer: Kentucky WC Medicaid |
$2,769.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,536.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,882.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,391.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,796.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,014.76
|
| Rate for Payer: Ohio Health Group HMO |
$5,978.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,594.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,036.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,471.11
|
| Rate for Payer: PHCS Commercial |
$7,652.47
|
| Rate for Payer: United Healthcare All Payer |
$7,014.76
|
|
|
GMRS FULL FLAT BLOCK 10MM L 2
|
Facility
|
IP
|
$7,971.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,036.27 |
| Max. Negotiated Rate |
$7,652.47 |
| Rate for Payer: Aetna Commercial |
$6,137.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,217.63
|
| Rate for Payer: Cash Price |
$3,985.66
|
| Rate for Payer: Cigna Commercial |
$6,616.20
|
| Rate for Payer: First Health Commercial |
$7,572.75
|
| Rate for Payer: Humana Commercial |
$6,775.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,536.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,882.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,391.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,014.76
|
| Rate for Payer: Ohio Health Group HMO |
$5,978.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,594.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,036.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,471.11
|
| Rate for Payer: PHCS Commercial |
$7,652.47
|
| Rate for Payer: United Healthcare All Payer |
$7,014.76
|
|
|
GMRS FULL FLAT BLOCK 10MM M 2
|
Facility
|
IP
|
$7,971.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,036.27 |
| Max. Negotiated Rate |
$7,652.47 |
| Rate for Payer: Aetna Commercial |
$6,137.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,217.63
|
| Rate for Payer: Cash Price |
$3,985.66
|
| Rate for Payer: Cigna Commercial |
$6,616.20
|
| Rate for Payer: First Health Commercial |
$7,572.75
|
| Rate for Payer: Humana Commercial |
$6,775.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,536.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,882.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,391.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,014.76
|
| Rate for Payer: Ohio Health Group HMO |
$5,978.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,594.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,036.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,471.11
|
| Rate for Payer: PHCS Commercial |
$7,652.47
|
| Rate for Payer: United Healthcare All Payer |
$7,014.76
|
|
|
GMRS FULL FLAT BLOCK 10MM M 2
|
Facility
|
OP
|
$7,971.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,036.27 |
| Max. Negotiated Rate |
$7,652.47 |
| Rate for Payer: Aetna Commercial |
$6,137.92
|
| Rate for Payer: Anthem Medicaid |
$2,741.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,217.63
|
| Rate for Payer: Cash Price |
$3,985.66
|
| Rate for Payer: Cigna Commercial |
$6,616.20
|
| Rate for Payer: First Health Commercial |
$7,572.75
|
| Rate for Payer: Humana Commercial |
$6,775.62
|
| Rate for Payer: Humana KY Medicaid |
$2,741.34
|
| Rate for Payer: Kentucky WC Medicaid |
$2,769.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,536.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,882.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,391.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,796.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,014.76
|
| Rate for Payer: Ohio Health Group HMO |
$5,978.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,594.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,036.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,471.11
|
| Rate for Payer: PHCS Commercial |
$7,652.47
|
| Rate for Payer: United Healthcare All Payer |
$7,014.76
|
|
|
GMRS FULL FLAT BLOCK 10MM SM 2
|
Facility
|
IP
|
$7,971.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,036.27 |
| Max. Negotiated Rate |
$7,652.47 |
| Rate for Payer: Aetna Commercial |
$6,137.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,217.63
|
| Rate for Payer: Cash Price |
$3,985.66
|
| Rate for Payer: Cigna Commercial |
$6,616.20
|
| Rate for Payer: First Health Commercial |
$7,572.75
|
| Rate for Payer: Humana Commercial |
$6,775.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,536.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,882.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,391.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,014.76
|
| Rate for Payer: Ohio Health Group HMO |
$5,978.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,594.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,036.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,471.11
|
| Rate for Payer: PHCS Commercial |
$7,652.47
|
| Rate for Payer: United Healthcare All Payer |
$7,014.76
|
|
|
GMRS FULL FLAT BLOCK 10MM SM 2
|
Facility
|
OP
|
$7,971.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,036.27 |
| Max. Negotiated Rate |
$7,652.47 |
| Rate for Payer: Aetna Commercial |
$6,137.92
|
| Rate for Payer: Anthem Medicaid |
$2,741.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,217.63
|
| Rate for Payer: Cash Price |
$3,985.66
|
| Rate for Payer: Cigna Commercial |
$6,616.20
|
| Rate for Payer: First Health Commercial |
$7,572.75
|
| Rate for Payer: Humana Commercial |
$6,775.62
|
| Rate for Payer: Humana KY Medicaid |
$2,741.34
|
| Rate for Payer: Kentucky WC Medicaid |
$2,769.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,536.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,882.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,391.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,796.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,014.76
|
| Rate for Payer: Ohio Health Group HMO |
$5,978.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,594.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,036.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,471.11
|
| Rate for Payer: PHCS Commercial |
$7,652.47
|
| Rate for Payer: United Healthcare All Payer |
$7,014.76
|
|
|
GMRS HEMI FLAT WDG LFT 5MM L 2
|
Facility
|
IP
|
$5,173.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$672.57 |
| Max. Negotiated Rate |
$4,966.66 |
| Rate for Payer: Aetna Commercial |
$3,983.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,035.41
|
| Rate for Payer: Cash Price |
$2,586.80
|
| Rate for Payer: Cigna Commercial |
$4,294.09
|
| Rate for Payer: First Health Commercial |
$4,914.92
|
| Rate for Payer: Humana Commercial |
$4,397.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,242.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,818.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,552.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,552.77
|
| Rate for Payer: Ohio Health Group HMO |
$3,880.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,034.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$672.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,603.82
|
| Rate for Payer: PHCS Commercial |
$4,966.66
|
| Rate for Payer: United Healthcare All Payer |
$4,552.77
|
|
|
GMRS HEMI FLAT WDG LFT 5MM L 2
|
Facility
|
OP
|
$5,173.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$672.57 |
| Max. Negotiated Rate |
$4,966.66 |
| Rate for Payer: Aetna Commercial |
$3,983.67
|
| Rate for Payer: Anthem Medicaid |
$1,779.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,035.41
|
| Rate for Payer: Cash Price |
$2,586.80
|
| Rate for Payer: Cigna Commercial |
$4,294.09
|
| Rate for Payer: First Health Commercial |
$4,914.92
|
| Rate for Payer: Humana Commercial |
$4,397.56
|
| Rate for Payer: Humana KY Medicaid |
$1,779.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,797.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,242.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,818.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,552.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,814.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,552.77
|
| Rate for Payer: Ohio Health Group HMO |
$3,880.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,034.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$672.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,603.82
|
| Rate for Payer: PHCS Commercial |
$4,966.66
|
| Rate for Payer: United Healthcare All Payer |
$4,552.77
|
|
|
GMRS HEMI FLAT WDG LFT 5MM M 2
|
Facility
|
IP
|
$5,173.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$672.57 |
| Max. Negotiated Rate |
$4,966.66 |
| Rate for Payer: Aetna Commercial |
$3,983.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,035.41
|
| Rate for Payer: Cash Price |
$2,586.80
|
| Rate for Payer: Cigna Commercial |
$4,294.09
|
| Rate for Payer: First Health Commercial |
$4,914.92
|
| Rate for Payer: Humana Commercial |
$4,397.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,242.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,818.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,552.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,552.77
|
| Rate for Payer: Ohio Health Group HMO |
$3,880.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,034.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$672.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,603.82
|
| Rate for Payer: PHCS Commercial |
$4,966.66
|
| Rate for Payer: United Healthcare All Payer |
$4,552.77
|
|
|
GMRS HEMI FLAT WDG LFT 5MM M 2
|
Facility
|
OP
|
$5,173.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$672.57 |
| Max. Negotiated Rate |
$4,966.66 |
| Rate for Payer: Aetna Commercial |
$3,983.67
|
| Rate for Payer: Anthem Medicaid |
$1,779.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,035.41
|
| Rate for Payer: Cash Price |
$2,586.80
|
| Rate for Payer: Cigna Commercial |
$4,294.09
|
| Rate for Payer: First Health Commercial |
$4,914.92
|
| Rate for Payer: Humana Commercial |
$4,397.56
|
| Rate for Payer: Humana KY Medicaid |
$1,779.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,797.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,242.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,818.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,552.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,814.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,552.77
|
| Rate for Payer: Ohio Health Group HMO |
$3,880.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,034.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$672.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,603.82
|
| Rate for Payer: PHCS Commercial |
$4,966.66
|
| Rate for Payer: United Healthcare All Payer |
$4,552.77
|
|
|
GMRS HEMI FLAT WDG LT 10MM L 2
|
Facility
|
IP
|
$5,173.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$672.57 |
| Max. Negotiated Rate |
$4,966.66 |
| Rate for Payer: Aetna Commercial |
$3,983.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,035.41
|
| Rate for Payer: Cash Price |
$2,586.80
|
| Rate for Payer: Cigna Commercial |
$4,294.09
|
| Rate for Payer: First Health Commercial |
$4,914.92
|
| Rate for Payer: Humana Commercial |
$4,397.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,242.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,818.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,552.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,552.77
|
| Rate for Payer: Ohio Health Group HMO |
$3,880.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,034.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$672.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,603.82
|
| Rate for Payer: PHCS Commercial |
$4,966.66
|
| Rate for Payer: United Healthcare All Payer |
$4,552.77
|
|
|
GMRS HEMI FLAT WDG LT 10MM L 2
|
Facility
|
OP
|
$5,173.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$672.57 |
| Max. Negotiated Rate |
$4,966.66 |
| Rate for Payer: Aetna Commercial |
$3,983.67
|
| Rate for Payer: Anthem Medicaid |
$1,779.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,035.41
|
| Rate for Payer: Cash Price |
$2,586.80
|
| Rate for Payer: Cigna Commercial |
$4,294.09
|
| Rate for Payer: First Health Commercial |
$4,914.92
|
| Rate for Payer: Humana Commercial |
$4,397.56
|
| Rate for Payer: Humana KY Medicaid |
$1,779.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,797.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,242.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,818.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,552.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,814.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,552.77
|
| Rate for Payer: Ohio Health Group HMO |
$3,880.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,034.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$672.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,603.82
|
| Rate for Payer: PHCS Commercial |
$4,966.66
|
| Rate for Payer: United Healthcare All Payer |
$4,552.77
|
|
|
GMRS HEMI FLAT WDG LT 10MM M 2
|
Facility
|
OP
|
$5,173.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$672.57 |
| Max. Negotiated Rate |
$4,966.66 |
| Rate for Payer: Aetna Commercial |
$3,983.67
|
| Rate for Payer: Anthem Medicaid |
$1,779.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,035.41
|
| Rate for Payer: Cash Price |
$2,586.80
|
| Rate for Payer: Cigna Commercial |
$4,294.09
|
| Rate for Payer: First Health Commercial |
$4,914.92
|
| Rate for Payer: Humana Commercial |
$4,397.56
|
| Rate for Payer: Humana KY Medicaid |
$1,779.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,797.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,242.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,818.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,552.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,814.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,552.77
|
| Rate for Payer: Ohio Health Group HMO |
$3,880.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,034.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$672.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,603.82
|
| Rate for Payer: PHCS Commercial |
$4,966.66
|
| Rate for Payer: United Healthcare All Payer |
$4,552.77
|
|
|
GMRS HEMI FLAT WDG LT 10MM M 2
|
Facility
|
IP
|
$5,173.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$672.57 |
| Max. Negotiated Rate |
$4,966.66 |
| Rate for Payer: Aetna Commercial |
$3,983.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,035.41
|
| Rate for Payer: Cash Price |
$2,586.80
|
| Rate for Payer: Cigna Commercial |
$4,294.09
|
| Rate for Payer: First Health Commercial |
$4,914.92
|
| Rate for Payer: Humana Commercial |
$4,397.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,242.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,818.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,552.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,552.77
|
| Rate for Payer: Ohio Health Group HMO |
$3,880.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,034.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$672.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,603.82
|
| Rate for Payer: PHCS Commercial |
$4,966.66
|
| Rate for Payer: United Healthcare All Payer |
$4,552.77
|
|
|
GMRS HEMI FLAT WDG LT 10MM SM1
|
Facility
|
OP
|
$5,173.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$672.57 |
| Max. Negotiated Rate |
$4,966.66 |
| Rate for Payer: Aetna Commercial |
$3,983.67
|
| Rate for Payer: Anthem Medicaid |
$1,779.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,035.41
|
| Rate for Payer: Cash Price |
$2,586.80
|
| Rate for Payer: Cigna Commercial |
$4,294.09
|
| Rate for Payer: First Health Commercial |
$4,914.92
|
| Rate for Payer: Humana Commercial |
$4,397.56
|
| Rate for Payer: Humana KY Medicaid |
$1,779.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,797.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,242.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,818.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,552.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,814.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,552.77
|
| Rate for Payer: Ohio Health Group HMO |
$3,880.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,034.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$672.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,603.82
|
| Rate for Payer: PHCS Commercial |
$4,966.66
|
| Rate for Payer: United Healthcare All Payer |
$4,552.77
|
|
|
GMRS HEMI FLAT WDG LT 10MM SM1
|
Facility
|
IP
|
$5,173.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$672.57 |
| Max. Negotiated Rate |
$4,966.66 |
| Rate for Payer: Aetna Commercial |
$3,983.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,035.41
|
| Rate for Payer: Cash Price |
$2,586.80
|
| Rate for Payer: Cigna Commercial |
$4,294.09
|
| Rate for Payer: First Health Commercial |
$4,914.92
|
| Rate for Payer: Humana Commercial |
$4,397.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,242.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,818.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,552.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,552.77
|
| Rate for Payer: Ohio Health Group HMO |
$3,880.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,034.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$672.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,603.82
|
| Rate for Payer: PHCS Commercial |
$4,966.66
|
| Rate for Payer: United Healthcare All Payer |
$4,552.77
|
|
|
GMRS HEMI FLAT WDG LT 10MM SM2
|
Facility
|
OP
|
$5,173.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$672.57 |
| Max. Negotiated Rate |
$4,966.66 |
| Rate for Payer: Aetna Commercial |
$3,983.67
|
| Rate for Payer: Anthem Medicaid |
$1,779.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,035.41
|
| Rate for Payer: Cash Price |
$2,586.80
|
| Rate for Payer: Cigna Commercial |
$4,294.09
|
| Rate for Payer: First Health Commercial |
$4,914.92
|
| Rate for Payer: Humana Commercial |
$4,397.56
|
| Rate for Payer: Humana KY Medicaid |
$1,779.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,797.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,242.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,818.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,552.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,814.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,552.77
|
| Rate for Payer: Ohio Health Group HMO |
$3,880.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,034.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$672.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,603.82
|
| Rate for Payer: PHCS Commercial |
$4,966.66
|
| Rate for Payer: United Healthcare All Payer |
$4,552.77
|
|
|
GMRS HEMI FLAT WDG LT 10MM SM2
|
Facility
|
IP
|
$5,173.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$672.57 |
| Max. Negotiated Rate |
$4,966.66 |
| Rate for Payer: Aetna Commercial |
$3,983.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,035.41
|
| Rate for Payer: Cash Price |
$2,586.80
|
| Rate for Payer: Cigna Commercial |
$4,294.09
|
| Rate for Payer: First Health Commercial |
$4,914.92
|
| Rate for Payer: Humana Commercial |
$4,397.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,242.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,818.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,552.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,552.77
|
| Rate for Payer: Ohio Health Group HMO |
$3,880.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,034.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$672.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,603.82
|
| Rate for Payer: PHCS Commercial |
$4,966.66
|
| Rate for Payer: United Healthcare All Payer |
$4,552.77
|
|
|
GMRS HEMI FLAT WDG LT 5MM SM 1
|
Facility
|
OP
|
$5,173.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$672.57 |
| Max. Negotiated Rate |
$4,966.66 |
| Rate for Payer: Aetna Commercial |
$3,983.67
|
| Rate for Payer: Anthem Medicaid |
$1,779.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,035.41
|
| Rate for Payer: Cash Price |
$2,586.80
|
| Rate for Payer: Cigna Commercial |
$4,294.09
|
| Rate for Payer: First Health Commercial |
$4,914.92
|
| Rate for Payer: Humana Commercial |
$4,397.56
|
| Rate for Payer: Humana KY Medicaid |
$1,779.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,797.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,242.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,818.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,552.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,814.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,552.77
|
| Rate for Payer: Ohio Health Group HMO |
$3,880.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,034.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$672.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,603.82
|
| Rate for Payer: PHCS Commercial |
$4,966.66
|
| Rate for Payer: United Healthcare All Payer |
$4,552.77
|
|
|
GMRS HEMI FLAT WDG LT 5MM SM 1
|
Facility
|
IP
|
$5,173.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$672.57 |
| Max. Negotiated Rate |
$4,966.66 |
| Rate for Payer: Aetna Commercial |
$3,983.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,035.41
|
| Rate for Payer: Cash Price |
$2,586.80
|
| Rate for Payer: Cigna Commercial |
$4,294.09
|
| Rate for Payer: First Health Commercial |
$4,914.92
|
| Rate for Payer: Humana Commercial |
$4,397.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,242.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,818.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,552.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,552.77
|
| Rate for Payer: Ohio Health Group HMO |
$3,880.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,034.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$672.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,603.82
|
| Rate for Payer: PHCS Commercial |
$4,966.66
|
| Rate for Payer: United Healthcare All Payer |
$4,552.77
|
|
|
GMRS HEMI FLAT WDG LT 5MM SM 2
|
Facility
|
IP
|
$5,173.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$672.57 |
| Max. Negotiated Rate |
$4,966.66 |
| Rate for Payer: Aetna Commercial |
$3,983.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,035.41
|
| Rate for Payer: Cash Price |
$2,586.80
|
| Rate for Payer: Cigna Commercial |
$4,294.09
|
| Rate for Payer: First Health Commercial |
$4,914.92
|
| Rate for Payer: Humana Commercial |
$4,397.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,242.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,818.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,552.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,552.77
|
| Rate for Payer: Ohio Health Group HMO |
$3,880.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,034.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$672.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,603.82
|
| Rate for Payer: PHCS Commercial |
$4,966.66
|
| Rate for Payer: United Healthcare All Payer |
$4,552.77
|
|
|
GMRS HEMI FLAT WDG LT 5MM SM 2
|
Facility
|
OP
|
$5,173.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$672.57 |
| Max. Negotiated Rate |
$4,966.66 |
| Rate for Payer: Aetna Commercial |
$3,983.67
|
| Rate for Payer: Anthem Medicaid |
$1,779.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,035.41
|
| Rate for Payer: Cash Price |
$2,586.80
|
| Rate for Payer: Cigna Commercial |
$4,294.09
|
| Rate for Payer: First Health Commercial |
$4,914.92
|
| Rate for Payer: Humana Commercial |
$4,397.56
|
| Rate for Payer: Humana KY Medicaid |
$1,779.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,797.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,242.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,818.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,552.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,814.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,552.77
|
| Rate for Payer: Ohio Health Group HMO |
$3,880.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,034.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$672.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,603.82
|
| Rate for Payer: PHCS Commercial |
$4,966.66
|
| Rate for Payer: United Healthcare All Payer |
$4,552.77
|
|
|
GMRS HEMI FLAT WDG RGT 5MM L 2
|
Facility
|
IP
|
$5,173.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$672.57 |
| Max. Negotiated Rate |
$4,966.66 |
| Rate for Payer: Aetna Commercial |
$3,983.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,035.41
|
| Rate for Payer: Cash Price |
$2,586.80
|
| Rate for Payer: Cigna Commercial |
$4,294.09
|
| Rate for Payer: First Health Commercial |
$4,914.92
|
| Rate for Payer: Humana Commercial |
$4,397.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,242.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,818.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,552.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,552.77
|
| Rate for Payer: Ohio Health Group HMO |
$3,880.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,034.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$672.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,603.82
|
| Rate for Payer: PHCS Commercial |
$4,966.66
|
| Rate for Payer: United Healthcare All Payer |
$4,552.77
|
|
|
GMRS HEMI FLAT WDG RGT 5MM L 2
|
Facility
|
OP
|
$5,173.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$672.57 |
| Max. Negotiated Rate |
$4,966.66 |
| Rate for Payer: Aetna Commercial |
$3,983.67
|
| Rate for Payer: Anthem Medicaid |
$1,779.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,035.41
|
| Rate for Payer: Cash Price |
$2,586.80
|
| Rate for Payer: Cigna Commercial |
$4,294.09
|
| Rate for Payer: First Health Commercial |
$4,914.92
|
| Rate for Payer: Humana Commercial |
$4,397.56
|
| Rate for Payer: Humana KY Medicaid |
$1,779.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,797.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,242.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,818.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,552.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,814.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,552.77
|
| Rate for Payer: Ohio Health Group HMO |
$3,880.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,034.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$672.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,603.82
|
| Rate for Payer: PHCS Commercial |
$4,966.66
|
| Rate for Payer: United Healthcare All Payer |
$4,552.77
|
|
|
GMRS HEMI FLAT WDG RGT 5MM M 2
|
Facility
|
IP
|
$5,173.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$672.57 |
| Max. Negotiated Rate |
$4,966.66 |
| Rate for Payer: Aetna Commercial |
$3,983.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,035.41
|
| Rate for Payer: Cash Price |
$2,586.80
|
| Rate for Payer: Cigna Commercial |
$4,294.09
|
| Rate for Payer: First Health Commercial |
$4,914.92
|
| Rate for Payer: Humana Commercial |
$4,397.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,242.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,818.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,552.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,552.77
|
| Rate for Payer: Ohio Health Group HMO |
$3,880.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,034.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$672.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,603.82
|
| Rate for Payer: PHCS Commercial |
$4,966.66
|
| Rate for Payer: United Healthcare All Payer |
$4,552.77
|
|
