|
GLENOSPHERE 36+2.5 INF/24
|
Facility
|
OP
|
$11,941.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,582.30 |
| Max. Negotiated Rate |
$11,463.36 |
| Rate for Payer: Aetna Commercial |
$9,194.57
|
| Rate for Payer: Anthem Medicaid |
$4,106.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,313.98
|
| Rate for Payer: Cash Price |
$5,970.50
|
| Rate for Payer: Cigna Commercial |
$9,911.03
|
| Rate for Payer: First Health Commercial |
$11,343.95
|
| Rate for Payer: Humana Commercial |
$10,149.85
|
| Rate for Payer: Humana KY Medicaid |
$4,106.51
|
| Rate for Payer: Kentucky WC Medicaid |
$4,148.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,791.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,812.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,582.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,188.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,508.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,955.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,388.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,239.29
|
| Rate for Payer: PHCS Commercial |
$11,463.36
|
| Rate for Payer: United Healthcare All Payer |
$10,508.08
|
|
|
GLENOSPHERE 36+2.5 INF/24
|
Facility
|
IP
|
$11,941.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,582.30 |
| Max. Negotiated Rate |
$11,463.36 |
| Rate for Payer: Aetna Commercial |
$9,194.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,313.98
|
| Rate for Payer: Cash Price |
$5,970.50
|
| Rate for Payer: Cigna Commercial |
$9,911.03
|
| Rate for Payer: First Health Commercial |
$11,343.95
|
| Rate for Payer: Humana Commercial |
$10,149.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,791.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,812.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,582.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,508.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,955.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,388.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,239.29
|
| Rate for Payer: PHCS Commercial |
$11,463.36
|
| Rate for Payer: United Healthcare All Payer |
$10,508.08
|
|
|
GLENOSPHERE 36/28
|
Facility
|
OP
|
$11,941.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,582.30 |
| Max. Negotiated Rate |
$11,463.36 |
| Rate for Payer: Aetna Commercial |
$9,194.57
|
| Rate for Payer: Anthem Medicaid |
$4,106.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,313.98
|
| Rate for Payer: Cash Price |
$5,970.50
|
| Rate for Payer: Cigna Commercial |
$9,911.03
|
| Rate for Payer: First Health Commercial |
$11,343.95
|
| Rate for Payer: Humana Commercial |
$10,149.85
|
| Rate for Payer: Humana KY Medicaid |
$4,106.51
|
| Rate for Payer: Kentucky WC Medicaid |
$4,148.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,791.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,812.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,582.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,188.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,508.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,955.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,388.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,239.29
|
| Rate for Payer: PHCS Commercial |
$11,463.36
|
| Rate for Payer: United Healthcare All Payer |
$10,508.08
|
|
|
GLENOSPHERE 36/28
|
Facility
|
IP
|
$11,941.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,582.30 |
| Max. Negotiated Rate |
$11,463.36 |
| Rate for Payer: Aetna Commercial |
$9,194.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,313.98
|
| Rate for Payer: Cash Price |
$5,970.50
|
| Rate for Payer: Cigna Commercial |
$9,911.03
|
| Rate for Payer: First Health Commercial |
$11,343.95
|
| Rate for Payer: Humana Commercial |
$10,149.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,791.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,812.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,582.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,508.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,955.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,388.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,239.29
|
| Rate for Payer: PHCS Commercial |
$11,463.36
|
| Rate for Payer: United Healthcare All Payer |
$10,508.08
|
|
|
GLENOSPHERE 36+4 LAT//24
|
Facility
|
OP
|
$11,941.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,582.30 |
| Max. Negotiated Rate |
$11,463.36 |
| Rate for Payer: Aetna Commercial |
$9,194.57
|
| Rate for Payer: Anthem Medicaid |
$4,106.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,313.98
|
| Rate for Payer: Cash Price |
$5,970.50
|
| Rate for Payer: Cigna Commercial |
$9,911.03
|
| Rate for Payer: First Health Commercial |
$11,343.95
|
| Rate for Payer: Humana Commercial |
$10,149.85
|
| Rate for Payer: Humana KY Medicaid |
$4,106.51
|
| Rate for Payer: Kentucky WC Medicaid |
$4,148.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,791.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,812.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,582.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,188.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,508.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,955.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,388.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,239.29
|
| Rate for Payer: PHCS Commercial |
$11,463.36
|
| Rate for Payer: United Healthcare All Payer |
$10,508.08
|
|
|
GLENOSPHERE 36+4 LAT//24
|
Facility
|
IP
|
$11,941.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,582.30 |
| Max. Negotiated Rate |
$11,463.36 |
| Rate for Payer: Aetna Commercial |
$9,194.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,313.98
|
| Rate for Payer: Cash Price |
$5,970.50
|
| Rate for Payer: Cigna Commercial |
$9,911.03
|
| Rate for Payer: First Health Commercial |
$11,343.95
|
| Rate for Payer: Humana Commercial |
$10,149.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,791.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,812.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,582.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,508.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,955.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,388.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,239.29
|
| Rate for Payer: PHCS Commercial |
$11,463.36
|
| Rate for Payer: United Healthcare All Payer |
$10,508.08
|
|
|
GLENOSPHERE 36+4 LAT/28
|
Facility
|
OP
|
$11,941.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,582.30 |
| Max. Negotiated Rate |
$11,463.36 |
| Rate for Payer: Aetna Commercial |
$9,194.57
|
| Rate for Payer: Anthem Medicaid |
$4,106.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,313.98
|
| Rate for Payer: Cash Price |
$5,970.50
|
| Rate for Payer: Cigna Commercial |
$9,911.03
|
| Rate for Payer: First Health Commercial |
$11,343.95
|
| Rate for Payer: Humana Commercial |
$10,149.85
|
| Rate for Payer: Humana KY Medicaid |
$4,106.51
|
| Rate for Payer: Kentucky WC Medicaid |
$4,148.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,791.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,812.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,582.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,188.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,508.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,955.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,388.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,239.29
|
| Rate for Payer: PHCS Commercial |
$11,463.36
|
| Rate for Payer: United Healthcare All Payer |
$10,508.08
|
|
|
GLENOSPHERE 36+4 LAT/28
|
Facility
|
IP
|
$11,941.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,582.30 |
| Max. Negotiated Rate |
$11,463.36 |
| Rate for Payer: Aetna Commercial |
$9,194.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,313.98
|
| Rate for Payer: Cash Price |
$5,970.50
|
| Rate for Payer: Cigna Commercial |
$9,911.03
|
| Rate for Payer: First Health Commercial |
$11,343.95
|
| Rate for Payer: Humana Commercial |
$10,149.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,791.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,812.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,582.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,508.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,955.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,388.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,239.29
|
| Rate for Payer: PHCS Commercial |
$11,463.36
|
| Rate for Payer: United Healthcare All Payer |
$10,508.08
|
|
|
GLENOSPHERE 39/24
|
Facility
|
IP
|
$11,941.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,582.30 |
| Max. Negotiated Rate |
$11,463.36 |
| Rate for Payer: Aetna Commercial |
$9,194.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,313.98
|
| Rate for Payer: Cash Price |
$5,970.50
|
| Rate for Payer: Cigna Commercial |
$9,911.03
|
| Rate for Payer: First Health Commercial |
$11,343.95
|
| Rate for Payer: Humana Commercial |
$10,149.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,791.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,812.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,582.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,508.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,955.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,388.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,239.29
|
| Rate for Payer: PHCS Commercial |
$11,463.36
|
| Rate for Payer: United Healthcare All Payer |
$10,508.08
|
|
|
GLENOSPHERE 39/24
|
Facility
|
OP
|
$11,941.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,582.30 |
| Max. Negotiated Rate |
$11,463.36 |
| Rate for Payer: Aetna Commercial |
$9,194.57
|
| Rate for Payer: Anthem Medicaid |
$4,106.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,313.98
|
| Rate for Payer: Cash Price |
$5,970.50
|
| Rate for Payer: Cigna Commercial |
$9,911.03
|
| Rate for Payer: First Health Commercial |
$11,343.95
|
| Rate for Payer: Humana Commercial |
$10,149.85
|
| Rate for Payer: Humana KY Medicaid |
$4,106.51
|
| Rate for Payer: Kentucky WC Medicaid |
$4,148.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,791.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,812.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,582.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,188.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,508.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,955.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,388.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,239.29
|
| Rate for Payer: PHCS Commercial |
$11,463.36
|
| Rate for Payer: United Healthcare All Payer |
$10,508.08
|
|
|
GLENOSPHERE 39+2.5 INF/24
|
Facility
|
IP
|
$11,941.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,582.30 |
| Max. Negotiated Rate |
$11,463.36 |
| Rate for Payer: Aetna Commercial |
$9,194.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,313.98
|
| Rate for Payer: Cash Price |
$5,970.50
|
| Rate for Payer: Cigna Commercial |
$9,911.03
|
| Rate for Payer: First Health Commercial |
$11,343.95
|
| Rate for Payer: Humana Commercial |
$10,149.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,791.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,812.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,582.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,508.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,955.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,388.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,239.29
|
| Rate for Payer: PHCS Commercial |
$11,463.36
|
| Rate for Payer: United Healthcare All Payer |
$10,508.08
|
|
|
GLENOSPHERE 39+2.5 INF/24
|
Facility
|
OP
|
$11,941.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,582.30 |
| Max. Negotiated Rate |
$11,463.36 |
| Rate for Payer: Aetna Commercial |
$9,194.57
|
| Rate for Payer: Anthem Medicaid |
$4,106.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,313.98
|
| Rate for Payer: Cash Price |
$5,970.50
|
| Rate for Payer: Cigna Commercial |
$9,911.03
|
| Rate for Payer: First Health Commercial |
$11,343.95
|
| Rate for Payer: Humana Commercial |
$10,149.85
|
| Rate for Payer: Humana KY Medicaid |
$4,106.51
|
| Rate for Payer: Kentucky WC Medicaid |
$4,148.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,791.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,812.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,582.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,188.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,508.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,955.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,388.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,239.29
|
| Rate for Payer: PHCS Commercial |
$11,463.36
|
| Rate for Payer: United Healthcare All Payer |
$10,508.08
|
|
|
GLENOSPHERE 39+2.5 INF/28
|
Facility
|
OP
|
$11,941.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,582.30 |
| Max. Negotiated Rate |
$11,463.36 |
| Rate for Payer: Aetna Commercial |
$9,194.57
|
| Rate for Payer: Anthem Medicaid |
$4,106.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,313.98
|
| Rate for Payer: Cash Price |
$5,970.50
|
| Rate for Payer: Cigna Commercial |
$9,911.03
|
| Rate for Payer: First Health Commercial |
$11,343.95
|
| Rate for Payer: Humana Commercial |
$10,149.85
|
| Rate for Payer: Humana KY Medicaid |
$4,106.51
|
| Rate for Payer: Kentucky WC Medicaid |
$4,148.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,791.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,812.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,582.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,188.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,508.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,955.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,388.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,239.29
|
| Rate for Payer: PHCS Commercial |
$11,463.36
|
| Rate for Payer: United Healthcare All Payer |
$10,508.08
|
|
|
GLENOSPHERE 39+2.5 INF/28
|
Facility
|
IP
|
$11,941.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,582.30 |
| Max. Negotiated Rate |
$11,463.36 |
| Rate for Payer: Aetna Commercial |
$9,194.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,313.98
|
| Rate for Payer: Cash Price |
$5,970.50
|
| Rate for Payer: Cigna Commercial |
$9,911.03
|
| Rate for Payer: First Health Commercial |
$11,343.95
|
| Rate for Payer: Humana Commercial |
$10,149.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,791.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,812.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,582.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,508.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,955.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,388.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,239.29
|
| Rate for Payer: PHCS Commercial |
$11,463.36
|
| Rate for Payer: United Healthcare All Payer |
$10,508.08
|
|
|
GLENOSPHERE 39/28
|
Facility
|
OP
|
$11,941.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,582.30 |
| Max. Negotiated Rate |
$11,463.36 |
| Rate for Payer: Aetna Commercial |
$9,194.57
|
| Rate for Payer: Anthem Medicaid |
$4,106.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,313.98
|
| Rate for Payer: Cash Price |
$5,970.50
|
| Rate for Payer: Cigna Commercial |
$9,911.03
|
| Rate for Payer: First Health Commercial |
$11,343.95
|
| Rate for Payer: Humana Commercial |
$10,149.85
|
| Rate for Payer: Humana KY Medicaid |
$4,106.51
|
| Rate for Payer: Kentucky WC Medicaid |
$4,148.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,791.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,812.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,582.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,188.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,508.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,955.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,388.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,239.29
|
| Rate for Payer: PHCS Commercial |
$11,463.36
|
| Rate for Payer: United Healthcare All Payer |
$10,508.08
|
|
|
GLENOSPHERE 39/28
|
Facility
|
IP
|
$11,941.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,582.30 |
| Max. Negotiated Rate |
$11,463.36 |
| Rate for Payer: Aetna Commercial |
$9,194.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,313.98
|
| Rate for Payer: Cash Price |
$5,970.50
|
| Rate for Payer: Cigna Commercial |
$9,911.03
|
| Rate for Payer: First Health Commercial |
$11,343.95
|
| Rate for Payer: Humana Commercial |
$10,149.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,791.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,812.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,582.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,508.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,955.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,388.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,239.29
|
| Rate for Payer: PHCS Commercial |
$11,463.36
|
| Rate for Payer: United Healthcare All Payer |
$10,508.08
|
|
|
GLENOSPHERE 39+4 LAT//24
|
Facility
|
OP
|
$11,941.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,582.30 |
| Max. Negotiated Rate |
$11,463.36 |
| Rate for Payer: Aetna Commercial |
$9,194.57
|
| Rate for Payer: Anthem Medicaid |
$4,106.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,313.98
|
| Rate for Payer: Cash Price |
$5,970.50
|
| Rate for Payer: Cigna Commercial |
$9,911.03
|
| Rate for Payer: First Health Commercial |
$11,343.95
|
| Rate for Payer: Humana Commercial |
$10,149.85
|
| Rate for Payer: Humana KY Medicaid |
$4,106.51
|
| Rate for Payer: Kentucky WC Medicaid |
$4,148.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,791.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,812.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,582.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,188.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,508.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,955.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,388.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,239.29
|
| Rate for Payer: PHCS Commercial |
$11,463.36
|
| Rate for Payer: United Healthcare All Payer |
$10,508.08
|
|
|
GLENOSPHERE 39+4 LAT//24
|
Facility
|
IP
|
$11,941.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,582.30 |
| Max. Negotiated Rate |
$11,463.36 |
| Rate for Payer: Aetna Commercial |
$9,194.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,313.98
|
| Rate for Payer: Cash Price |
$5,970.50
|
| Rate for Payer: Cigna Commercial |
$9,911.03
|
| Rate for Payer: First Health Commercial |
$11,343.95
|
| Rate for Payer: Humana Commercial |
$10,149.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,791.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,812.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,582.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,508.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,955.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,388.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,239.29
|
| Rate for Payer: PHCS Commercial |
$11,463.36
|
| Rate for Payer: United Healthcare All Payer |
$10,508.08
|
|
|
GLENOSPHERE 39+4 LAT/28
|
Facility
|
OP
|
$11,941.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,582.30 |
| Max. Negotiated Rate |
$11,463.36 |
| Rate for Payer: Aetna Commercial |
$9,194.57
|
| Rate for Payer: Anthem Medicaid |
$4,106.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,313.98
|
| Rate for Payer: Cash Price |
$5,970.50
|
| Rate for Payer: Cigna Commercial |
$9,911.03
|
| Rate for Payer: First Health Commercial |
$11,343.95
|
| Rate for Payer: Humana Commercial |
$10,149.85
|
| Rate for Payer: Humana KY Medicaid |
$4,106.51
|
| Rate for Payer: Kentucky WC Medicaid |
$4,148.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,791.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,812.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,582.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,188.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,508.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,955.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,388.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,239.29
|
| Rate for Payer: PHCS Commercial |
$11,463.36
|
| Rate for Payer: United Healthcare All Payer |
$10,508.08
|
|
|
GLENOSPHERE 39+4 LAT/28
|
Facility
|
IP
|
$11,941.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,582.30 |
| Max. Negotiated Rate |
$11,463.36 |
| Rate for Payer: Aetna Commercial |
$9,194.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,313.98
|
| Rate for Payer: Cash Price |
$5,970.50
|
| Rate for Payer: Cigna Commercial |
$9,911.03
|
| Rate for Payer: First Health Commercial |
$11,343.95
|
| Rate for Payer: Humana Commercial |
$10,149.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,791.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,812.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,582.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,508.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,955.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,388.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,239.29
|
| Rate for Payer: PHCS Commercial |
$11,463.36
|
| Rate for Payer: United Healthcare All Payer |
$10,508.08
|
|
|
GLENOSPHERE 42/24
|
Facility
|
OP
|
$11,941.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,582.30 |
| Max. Negotiated Rate |
$11,463.36 |
| Rate for Payer: Aetna Commercial |
$9,194.57
|
| Rate for Payer: Anthem Medicaid |
$4,106.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,313.98
|
| Rate for Payer: Cash Price |
$5,970.50
|
| Rate for Payer: Cigna Commercial |
$9,911.03
|
| Rate for Payer: First Health Commercial |
$11,343.95
|
| Rate for Payer: Humana Commercial |
$10,149.85
|
| Rate for Payer: Humana KY Medicaid |
$4,106.51
|
| Rate for Payer: Kentucky WC Medicaid |
$4,148.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,791.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,812.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,582.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,188.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,508.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,955.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,388.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,239.29
|
| Rate for Payer: PHCS Commercial |
$11,463.36
|
| Rate for Payer: United Healthcare All Payer |
$10,508.08
|
|
|
GLENOSPHERE 42/24
|
Facility
|
IP
|
$11,941.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,582.30 |
| Max. Negotiated Rate |
$11,463.36 |
| Rate for Payer: Aetna Commercial |
$9,194.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,313.98
|
| Rate for Payer: Cash Price |
$5,970.50
|
| Rate for Payer: Cigna Commercial |
$9,911.03
|
| Rate for Payer: First Health Commercial |
$11,343.95
|
| Rate for Payer: Humana Commercial |
$10,149.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,791.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,812.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,582.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,508.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,955.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,388.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,239.29
|
| Rate for Payer: PHCS Commercial |
$11,463.36
|
| Rate for Payer: United Healthcare All Payer |
$10,508.08
|
|
|
GLENOSPHERE 42+2.5 INF/24
|
Facility
|
IP
|
$11,941.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,582.30 |
| Max. Negotiated Rate |
$11,463.36 |
| Rate for Payer: Aetna Commercial |
$9,194.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,313.98
|
| Rate for Payer: Cash Price |
$5,970.50
|
| Rate for Payer: Cigna Commercial |
$9,911.03
|
| Rate for Payer: First Health Commercial |
$11,343.95
|
| Rate for Payer: Humana Commercial |
$10,149.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,791.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,812.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,582.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,508.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,955.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,388.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,239.29
|
| Rate for Payer: PHCS Commercial |
$11,463.36
|
| Rate for Payer: United Healthcare All Payer |
$10,508.08
|
|
|
GLENOSPHERE 42+2.5 INF/24
|
Facility
|
OP
|
$11,941.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,582.30 |
| Max. Negotiated Rate |
$11,463.36 |
| Rate for Payer: Aetna Commercial |
$9,194.57
|
| Rate for Payer: Anthem Medicaid |
$4,106.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,313.98
|
| Rate for Payer: Cash Price |
$5,970.50
|
| Rate for Payer: Cigna Commercial |
$9,911.03
|
| Rate for Payer: First Health Commercial |
$11,343.95
|
| Rate for Payer: Humana Commercial |
$10,149.85
|
| Rate for Payer: Humana KY Medicaid |
$4,106.51
|
| Rate for Payer: Kentucky WC Medicaid |
$4,148.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,791.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,812.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,582.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,188.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,508.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,955.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,388.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,239.29
|
| Rate for Payer: PHCS Commercial |
$11,463.36
|
| Rate for Payer: United Healthcare All Payer |
$10,508.08
|
|
|
GLENOSPHERE 42+2.5 INF/28
|
Facility
|
IP
|
$11,941.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,582.30 |
| Max. Negotiated Rate |
$11,463.36 |
| Rate for Payer: Aetna Commercial |
$9,194.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,313.98
|
| Rate for Payer: Cash Price |
$5,970.50
|
| Rate for Payer: Cigna Commercial |
$9,911.03
|
| Rate for Payer: First Health Commercial |
$11,343.95
|
| Rate for Payer: Humana Commercial |
$10,149.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,791.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,812.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,582.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,508.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,955.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,388.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,239.29
|
| Rate for Payer: PHCS Commercial |
$11,463.36
|
| Rate for Payer: United Healthcare All Payer |
$10,508.08
|
|
