|
GMRS HEMI FLAT WDG LT 5MM SM 2
|
Facility
|
OP
|
$5,186.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,555.80 |
| Max. Negotiated Rate |
$4,978.56 |
| Rate for Payer: Aetna Commercial |
$3,993.22
|
| Rate for Payer: Anthem Medicaid |
$1,783.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,045.08
|
| Rate for Payer: Cash Price |
$2,593.00
|
| Rate for Payer: Cigna Commercial |
$4,304.38
|
| Rate for Payer: First Health Commercial |
$4,926.70
|
| Rate for Payer: Humana Commercial |
$4,408.10
|
| Rate for Payer: Humana KY Medicaid |
$1,783.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1,801.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,252.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,827.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,555.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,819.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,563.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,889.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,148.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,511.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,578.34
|
| Rate for Payer: PHCS Commercial |
$4,978.56
|
| Rate for Payer: United Healthcare All Payer |
$4,563.68
|
|
|
GMRS HEMI FLAT WDG LT 5MM SM 2
|
Facility
|
IP
|
$5,186.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,555.80 |
| Max. Negotiated Rate |
$4,978.56 |
| Rate for Payer: Aetna Commercial |
$3,993.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,045.08
|
| Rate for Payer: Cash Price |
$2,593.00
|
| Rate for Payer: Cigna Commercial |
$4,304.38
|
| Rate for Payer: First Health Commercial |
$4,926.70
|
| Rate for Payer: Humana Commercial |
$4,408.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,252.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,827.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,555.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,563.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,889.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,148.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,511.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,578.34
|
| Rate for Payer: PHCS Commercial |
$4,978.56
|
| Rate for Payer: United Healthcare All Payer |
$4,563.68
|
|
|
GMRS HEMI FLAT WDG RGT 5MM L 2
|
Facility
|
IP
|
$5,186.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,555.80 |
| Max. Negotiated Rate |
$4,978.56 |
| Rate for Payer: Aetna Commercial |
$3,993.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,045.08
|
| Rate for Payer: Cash Price |
$2,593.00
|
| Rate for Payer: Cigna Commercial |
$4,304.38
|
| Rate for Payer: First Health Commercial |
$4,926.70
|
| Rate for Payer: Humana Commercial |
$4,408.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,252.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,827.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,555.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,563.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,889.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,148.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,511.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,578.34
|
| Rate for Payer: PHCS Commercial |
$4,978.56
|
| Rate for Payer: United Healthcare All Payer |
$4,563.68
|
|
|
GMRS HEMI FLAT WDG RGT 5MM L 2
|
Facility
|
OP
|
$5,186.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,555.80 |
| Max. Negotiated Rate |
$4,978.56 |
| Rate for Payer: Aetna Commercial |
$3,993.22
|
| Rate for Payer: Anthem Medicaid |
$1,783.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,045.08
|
| Rate for Payer: Cash Price |
$2,593.00
|
| Rate for Payer: Cigna Commercial |
$4,304.38
|
| Rate for Payer: First Health Commercial |
$4,926.70
|
| Rate for Payer: Humana Commercial |
$4,408.10
|
| Rate for Payer: Humana KY Medicaid |
$1,783.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1,801.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,252.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,827.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,555.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,819.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,563.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,889.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,148.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,511.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,578.34
|
| Rate for Payer: PHCS Commercial |
$4,978.56
|
| Rate for Payer: United Healthcare All Payer |
$4,563.68
|
|
|
GMRS HEMI FLAT WDG RGT 5MM M 2
|
Facility
|
IP
|
$5,186.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,555.80 |
| Max. Negotiated Rate |
$4,978.56 |
| Rate for Payer: Aetna Commercial |
$3,993.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,045.08
|
| Rate for Payer: Cash Price |
$2,593.00
|
| Rate for Payer: Cigna Commercial |
$4,304.38
|
| Rate for Payer: First Health Commercial |
$4,926.70
|
| Rate for Payer: Humana Commercial |
$4,408.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,252.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,827.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,555.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,563.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,889.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,148.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,511.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,578.34
|
| Rate for Payer: PHCS Commercial |
$4,978.56
|
| Rate for Payer: United Healthcare All Payer |
$4,563.68
|
|
|
GMRS HEMI FLAT WDG RGT 5MM M 2
|
Facility
|
OP
|
$5,186.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,555.80 |
| Max. Negotiated Rate |
$4,978.56 |
| Rate for Payer: Aetna Commercial |
$3,993.22
|
| Rate for Payer: Anthem Medicaid |
$1,783.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,045.08
|
| Rate for Payer: Cash Price |
$2,593.00
|
| Rate for Payer: Cigna Commercial |
$4,304.38
|
| Rate for Payer: First Health Commercial |
$4,926.70
|
| Rate for Payer: Humana Commercial |
$4,408.10
|
| Rate for Payer: Humana KY Medicaid |
$1,783.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1,801.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,252.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,827.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,555.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,819.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,563.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,889.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,148.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,511.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,578.34
|
| Rate for Payer: PHCS Commercial |
$4,978.56
|
| Rate for Payer: United Healthcare All Payer |
$4,563.68
|
|
|
GMRS HEMI FLAT WDG RT 10MM L 2
|
Facility
|
IP
|
$5,186.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,555.80 |
| Max. Negotiated Rate |
$4,978.56 |
| Rate for Payer: Aetna Commercial |
$3,993.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,045.08
|
| Rate for Payer: Cash Price |
$2,593.00
|
| Rate for Payer: Cigna Commercial |
$4,304.38
|
| Rate for Payer: First Health Commercial |
$4,926.70
|
| Rate for Payer: Humana Commercial |
$4,408.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,252.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,827.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,555.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,563.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,889.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,148.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,511.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,578.34
|
| Rate for Payer: PHCS Commercial |
$4,978.56
|
| Rate for Payer: United Healthcare All Payer |
$4,563.68
|
|
|
GMRS HEMI FLAT WDG RT 10MM L 2
|
Facility
|
OP
|
$5,186.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,555.80 |
| Max. Negotiated Rate |
$4,978.56 |
| Rate for Payer: Aetna Commercial |
$3,993.22
|
| Rate for Payer: Anthem Medicaid |
$1,783.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,045.08
|
| Rate for Payer: Cash Price |
$2,593.00
|
| Rate for Payer: Cigna Commercial |
$4,304.38
|
| Rate for Payer: First Health Commercial |
$4,926.70
|
| Rate for Payer: Humana Commercial |
$4,408.10
|
| Rate for Payer: Humana KY Medicaid |
$1,783.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1,801.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,252.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,827.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,555.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,819.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,563.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,889.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,148.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,511.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,578.34
|
| Rate for Payer: PHCS Commercial |
$4,978.56
|
| Rate for Payer: United Healthcare All Payer |
$4,563.68
|
|
|
GMRS HEMI FLAT WDG RT 10MM M 2
|
Facility
|
IP
|
$5,186.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,555.80 |
| Max. Negotiated Rate |
$4,978.56 |
| Rate for Payer: Aetna Commercial |
$3,993.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,045.08
|
| Rate for Payer: Cash Price |
$2,593.00
|
| Rate for Payer: Cigna Commercial |
$4,304.38
|
| Rate for Payer: First Health Commercial |
$4,926.70
|
| Rate for Payer: Humana Commercial |
$4,408.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,252.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,827.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,555.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,563.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,889.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,148.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,511.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,578.34
|
| Rate for Payer: PHCS Commercial |
$4,978.56
|
| Rate for Payer: United Healthcare All Payer |
$4,563.68
|
|
|
GMRS HEMI FLAT WDG RT 10MM M 2
|
Facility
|
OP
|
$5,186.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,555.80 |
| Max. Negotiated Rate |
$4,978.56 |
| Rate for Payer: Aetna Commercial |
$3,993.22
|
| Rate for Payer: Anthem Medicaid |
$1,783.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,045.08
|
| Rate for Payer: Cash Price |
$2,593.00
|
| Rate for Payer: Cigna Commercial |
$4,304.38
|
| Rate for Payer: First Health Commercial |
$4,926.70
|
| Rate for Payer: Humana Commercial |
$4,408.10
|
| Rate for Payer: Humana KY Medicaid |
$1,783.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1,801.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,252.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,827.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,555.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,819.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,563.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,889.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,148.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,511.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,578.34
|
| Rate for Payer: PHCS Commercial |
$4,978.56
|
| Rate for Payer: United Healthcare All Payer |
$4,563.68
|
|
|
GMRS HEMI FLAT WDG RT 10MM SM1
|
Facility
|
OP
|
$5,186.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,555.80 |
| Max. Negotiated Rate |
$4,978.56 |
| Rate for Payer: Aetna Commercial |
$3,993.22
|
| Rate for Payer: Anthem Medicaid |
$1,783.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,045.08
|
| Rate for Payer: Cash Price |
$2,593.00
|
| Rate for Payer: Cigna Commercial |
$4,304.38
|
| Rate for Payer: First Health Commercial |
$4,926.70
|
| Rate for Payer: Humana Commercial |
$4,408.10
|
| Rate for Payer: Humana KY Medicaid |
$1,783.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1,801.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,252.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,827.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,555.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,819.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,563.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,889.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,148.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,511.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,578.34
|
| Rate for Payer: PHCS Commercial |
$4,978.56
|
| Rate for Payer: United Healthcare All Payer |
$4,563.68
|
|
|
GMRS HEMI FLAT WDG RT 10MM SM1
|
Facility
|
IP
|
$5,186.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,555.80 |
| Max. Negotiated Rate |
$4,978.56 |
| Rate for Payer: Aetna Commercial |
$3,993.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,045.08
|
| Rate for Payer: Cash Price |
$2,593.00
|
| Rate for Payer: Cigna Commercial |
$4,304.38
|
| Rate for Payer: First Health Commercial |
$4,926.70
|
| Rate for Payer: Humana Commercial |
$4,408.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,252.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,827.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,555.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,563.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,889.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,148.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,511.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,578.34
|
| Rate for Payer: PHCS Commercial |
$4,978.56
|
| Rate for Payer: United Healthcare All Payer |
$4,563.68
|
|
|
GMRS HEMI FLAT WDG RT 10MM SM2
|
Facility
|
IP
|
$5,186.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,555.80 |
| Max. Negotiated Rate |
$4,978.56 |
| Rate for Payer: Aetna Commercial |
$3,993.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,045.08
|
| Rate for Payer: Cash Price |
$2,593.00
|
| Rate for Payer: Cigna Commercial |
$4,304.38
|
| Rate for Payer: First Health Commercial |
$4,926.70
|
| Rate for Payer: Humana Commercial |
$4,408.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,252.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,827.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,555.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,563.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,889.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,148.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,511.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,578.34
|
| Rate for Payer: PHCS Commercial |
$4,978.56
|
| Rate for Payer: United Healthcare All Payer |
$4,563.68
|
|
|
GMRS HEMI FLAT WDG RT 10MM SM2
|
Facility
|
OP
|
$5,186.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,555.80 |
| Max. Negotiated Rate |
$4,978.56 |
| Rate for Payer: Aetna Commercial |
$3,993.22
|
| Rate for Payer: Anthem Medicaid |
$1,783.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,045.08
|
| Rate for Payer: Cash Price |
$2,593.00
|
| Rate for Payer: Cigna Commercial |
$4,304.38
|
| Rate for Payer: First Health Commercial |
$4,926.70
|
| Rate for Payer: Humana Commercial |
$4,408.10
|
| Rate for Payer: Humana KY Medicaid |
$1,783.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1,801.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,252.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,827.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,555.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,819.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,563.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,889.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,148.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,511.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,578.34
|
| Rate for Payer: PHCS Commercial |
$4,978.56
|
| Rate for Payer: United Healthcare All Payer |
$4,563.68
|
|
|
GMRS HEMI FLAT WDG RT 5MM SM 2
|
Facility
|
OP
|
$5,186.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,555.80 |
| Max. Negotiated Rate |
$4,978.56 |
| Rate for Payer: Aetna Commercial |
$3,993.22
|
| Rate for Payer: Anthem Medicaid |
$1,783.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,045.08
|
| Rate for Payer: Cash Price |
$2,593.00
|
| Rate for Payer: Cigna Commercial |
$4,304.38
|
| Rate for Payer: First Health Commercial |
$4,926.70
|
| Rate for Payer: Humana Commercial |
$4,408.10
|
| Rate for Payer: Humana KY Medicaid |
$1,783.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1,801.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,252.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,827.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,555.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,819.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,563.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,889.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,148.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,511.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,578.34
|
| Rate for Payer: PHCS Commercial |
$4,978.56
|
| Rate for Payer: United Healthcare All Payer |
$4,563.68
|
|
|
GMRS HEMI FLAT WDG RT 5MM SM 2
|
Facility
|
IP
|
$5,186.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,555.80 |
| Max. Negotiated Rate |
$4,978.56 |
| Rate for Payer: Aetna Commercial |
$3,993.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,045.08
|
| Rate for Payer: Cash Price |
$2,593.00
|
| Rate for Payer: Cigna Commercial |
$4,304.38
|
| Rate for Payer: First Health Commercial |
$4,926.70
|
| Rate for Payer: Humana Commercial |
$4,408.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,252.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,827.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,555.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,563.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,889.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,148.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,511.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,578.34
|
| Rate for Payer: PHCS Commercial |
$4,978.56
|
| Rate for Payer: United Healthcare All Payer |
$4,563.68
|
|
|
GMRS INSRT SMPROX TIB COMP 10M
|
Facility
|
OP
|
$2,096.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$628.94 |
| Max. Negotiated Rate |
$2,012.62 |
| Rate for Payer: Aetna Commercial |
$1,614.29
|
| Rate for Payer: Anthem Medicaid |
$720.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,635.25
|
| Rate for Payer: Cash Price |
$1,048.24
|
| Rate for Payer: Cigna Commercial |
$1,740.08
|
| Rate for Payer: First Health Commercial |
$1,991.66
|
| Rate for Payer: Humana Commercial |
$1,782.01
|
| Rate for Payer: Humana KY Medicaid |
$720.98
|
| Rate for Payer: Kentucky WC Medicaid |
$728.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,719.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,547.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$628.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$735.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,844.90
|
| Rate for Payer: Ohio Health Group HMO |
$1,572.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,677.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,823.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,446.57
|
| Rate for Payer: PHCS Commercial |
$2,012.62
|
| Rate for Payer: United Healthcare All Payer |
$1,844.90
|
|
|
GMRS INSRT SMPROX TIB COMP 10M
|
Facility
|
IP
|
$2,096.48
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$628.94 |
| Max. Negotiated Rate |
$2,012.62 |
| Rate for Payer: Aetna Commercial |
$1,614.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,635.25
|
| Rate for Payer: Cash Price |
$1,048.24
|
| Rate for Payer: Cigna Commercial |
$1,740.08
|
| Rate for Payer: First Health Commercial |
$1,991.66
|
| Rate for Payer: Humana Commercial |
$1,782.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,719.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,547.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$628.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,844.90
|
| Rate for Payer: Ohio Health Group HMO |
$1,572.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,677.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,823.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,446.57
|
| Rate for Payer: PHCS Commercial |
$2,012.62
|
| Rate for Payer: United Healthcare All Payer |
$1,844.90
|
|
|
GMRS MRH KEEL TIB BASEPLAT L 2
|
Facility
|
OP
|
$13,259.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,977.78 |
| Max. Negotiated Rate |
$12,728.89 |
| Rate for Payer: Aetna Commercial |
$10,209.63
|
| Rate for Payer: Anthem Medicaid |
$4,559.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,342.22
|
| Rate for Payer: Cash Price |
$6,629.63
|
| Rate for Payer: Cigna Commercial |
$11,005.19
|
| Rate for Payer: First Health Commercial |
$12,596.30
|
| Rate for Payer: Humana Commercial |
$11,270.37
|
| Rate for Payer: Humana KY Medicaid |
$4,559.86
|
| Rate for Payer: Kentucky WC Medicaid |
$4,606.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,872.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,785.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,977.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,651.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,668.15
|
| Rate for Payer: Ohio Health Group HMO |
$9,944.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,607.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,535.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,148.89
|
| Rate for Payer: PHCS Commercial |
$12,728.89
|
| Rate for Payer: United Healthcare All Payer |
$11,668.15
|
|
|
GMRS MRH KEEL TIB BASEPLAT L 2
|
Facility
|
IP
|
$13,259.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,977.78 |
| Max. Negotiated Rate |
$12,728.89 |
| Rate for Payer: Aetna Commercial |
$10,209.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,342.22
|
| Rate for Payer: Cash Price |
$6,629.63
|
| Rate for Payer: Cigna Commercial |
$11,005.19
|
| Rate for Payer: First Health Commercial |
$12,596.30
|
| Rate for Payer: Humana Commercial |
$11,270.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,872.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,785.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,977.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,668.15
|
| Rate for Payer: Ohio Health Group HMO |
$9,944.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,607.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,535.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,148.89
|
| Rate for Payer: PHCS Commercial |
$12,728.89
|
| Rate for Payer: United Healthcare All Payer |
$11,668.15
|
|
|
GMRS MRH KEEL TIB BASEPLAT M 2
|
Facility
|
IP
|
$15,787.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,736.14 |
| Max. Negotiated Rate |
$15,155.64 |
| Rate for Payer: Aetna Commercial |
$12,156.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,313.95
|
| Rate for Payer: Cash Price |
$7,893.56
|
| Rate for Payer: Cigna Commercial |
$13,103.31
|
| Rate for Payer: First Health Commercial |
$14,997.76
|
| Rate for Payer: Humana Commercial |
$13,419.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,945.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,650.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,736.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,892.67
|
| Rate for Payer: Ohio Health Group HMO |
$11,840.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,629.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,734.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,893.11
|
| Rate for Payer: PHCS Commercial |
$15,155.64
|
| Rate for Payer: United Healthcare All Payer |
$13,892.67
|
|
|
GMRS MRH KEEL TIB BASEPLAT M 2
|
Facility
|
OP
|
$15,787.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,736.14 |
| Max. Negotiated Rate |
$15,155.64 |
| Rate for Payer: Aetna Commercial |
$12,156.08
|
| Rate for Payer: Anthem Medicaid |
$5,429.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,313.95
|
| Rate for Payer: Cash Price |
$7,893.56
|
| Rate for Payer: Cigna Commercial |
$13,103.31
|
| Rate for Payer: First Health Commercial |
$14,997.76
|
| Rate for Payer: Humana Commercial |
$13,419.05
|
| Rate for Payer: Humana KY Medicaid |
$5,429.19
|
| Rate for Payer: Kentucky WC Medicaid |
$5,484.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,945.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,650.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,736.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,538.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,892.67
|
| Rate for Payer: Ohio Health Group HMO |
$11,840.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,629.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,734.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,893.11
|
| Rate for Payer: PHCS Commercial |
$15,155.64
|
| Rate for Payer: United Healthcare All Payer |
$13,892.67
|
|
|
GMRS MRH KEEL TIB BASEPLT SM 1
|
Facility
|
IP
|
$14,360.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,308.08 |
| Max. Negotiated Rate |
$13,785.85 |
| Rate for Payer: Aetna Commercial |
$11,057.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,201.00
|
| Rate for Payer: Cash Price |
$7,180.13
|
| Rate for Payer: Cigna Commercial |
$11,919.02
|
| Rate for Payer: First Health Commercial |
$13,642.25
|
| Rate for Payer: Humana Commercial |
$12,206.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,775.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,597.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,308.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,637.03
|
| Rate for Payer: Ohio Health Group HMO |
$10,770.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,488.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,493.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,908.58
|
| Rate for Payer: PHCS Commercial |
$13,785.85
|
| Rate for Payer: United Healthcare All Payer |
$12,637.03
|
|
|
GMRS MRH KEEL TIB BASEPLT SM 1
|
Facility
|
OP
|
$14,360.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,308.08 |
| Max. Negotiated Rate |
$13,785.85 |
| Rate for Payer: Aetna Commercial |
$11,057.40
|
| Rate for Payer: Anthem Medicaid |
$4,938.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,201.00
|
| Rate for Payer: Cash Price |
$7,180.13
|
| Rate for Payer: Cigna Commercial |
$11,919.02
|
| Rate for Payer: First Health Commercial |
$13,642.25
|
| Rate for Payer: Humana Commercial |
$12,206.22
|
| Rate for Payer: Humana KY Medicaid |
$4,938.49
|
| Rate for Payer: Kentucky WC Medicaid |
$4,988.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,775.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,597.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,308.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,037.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,637.03
|
| Rate for Payer: Ohio Health Group HMO |
$10,770.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,488.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,493.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,908.58
|
| Rate for Payer: PHCS Commercial |
$13,785.85
|
| Rate for Payer: United Healthcare All Payer |
$12,637.03
|
|
|
GMRS MRH KEEL TIB BASEPLT SM 2
|
Facility
|
OP
|
$17,337.05
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,201.11 |
| Max. Negotiated Rate |
$16,643.57 |
| Rate for Payer: Aetna Commercial |
$13,349.53
|
| Rate for Payer: Anthem Medicaid |
$5,962.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,522.90
|
| Rate for Payer: Cash Price |
$8,668.52
|
| Rate for Payer: Cigna Commercial |
$14,389.75
|
| Rate for Payer: First Health Commercial |
$16,470.20
|
| Rate for Payer: Humana Commercial |
$14,736.49
|
| Rate for Payer: Humana KY Medicaid |
$5,962.21
|
| Rate for Payer: Kentucky WC Medicaid |
$6,022.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,216.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,794.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,201.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,081.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,256.60
|
| Rate for Payer: Ohio Health Group HMO |
$13,002.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,869.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,083.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,962.56
|
| Rate for Payer: PHCS Commercial |
$16,643.57
|
| Rate for Payer: United Healthcare All Payer |
$15,256.60
|
|
