|
HED FRACTURE MOD CATHCART 48MM
|
Facility
|
OP
|
$5,448.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$708.24 |
| Max. Negotiated Rate |
$5,230.08 |
| Rate for Payer: Aetna Commercial |
$4,194.96
|
| Rate for Payer: Anthem Medicaid |
$1,873.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,249.44
|
| Rate for Payer: Cash Price |
$2,724.00
|
| Rate for Payer: Cigna Commercial |
$4,521.84
|
| Rate for Payer: First Health Commercial |
$5,175.60
|
| Rate for Payer: Humana Commercial |
$4,630.80
|
| Rate for Payer: Humana KY Medicaid |
$1,873.57
|
| Rate for Payer: Kentucky WC Medicaid |
$1,892.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,467.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,020.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,634.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,911.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,794.24
|
| Rate for Payer: Ohio Health Group HMO |
$4,086.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,089.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$708.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,688.88
|
| Rate for Payer: PHCS Commercial |
$5,230.08
|
| Rate for Payer: United Healthcare All Payer |
$4,794.24
|
|
|
HED FRACTURE MOD CATHCART 48MM
|
Facility
|
IP
|
$5,448.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$708.24 |
| Max. Negotiated Rate |
$5,230.08 |
| Rate for Payer: Aetna Commercial |
$4,194.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,249.44
|
| Rate for Payer: Cash Price |
$2,724.00
|
| Rate for Payer: Cigna Commercial |
$4,521.84
|
| Rate for Payer: First Health Commercial |
$5,175.60
|
| Rate for Payer: Humana Commercial |
$4,630.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,467.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,020.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,634.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,794.24
|
| Rate for Payer: Ohio Health Group HMO |
$4,086.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,089.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$708.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,688.88
|
| Rate for Payer: PHCS Commercial |
$5,230.08
|
| Rate for Payer: United Healthcare All Payer |
$4,794.24
|
|
|
HED FRACTURE MOD CATHCART 49MM
|
Facility
|
IP
|
$5,448.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$708.24 |
| Max. Negotiated Rate |
$5,230.08 |
| Rate for Payer: Aetna Commercial |
$4,194.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,249.44
|
| Rate for Payer: Cash Price |
$2,724.00
|
| Rate for Payer: Cigna Commercial |
$4,521.84
|
| Rate for Payer: First Health Commercial |
$5,175.60
|
| Rate for Payer: Humana Commercial |
$4,630.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,467.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,020.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,634.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,794.24
|
| Rate for Payer: Ohio Health Group HMO |
$4,086.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,089.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$708.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,688.88
|
| Rate for Payer: PHCS Commercial |
$5,230.08
|
| Rate for Payer: United Healthcare All Payer |
$4,794.24
|
|
|
HED FRACTURE MOD CATHCART 49MM
|
Facility
|
OP
|
$5,448.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$708.24 |
| Max. Negotiated Rate |
$5,230.08 |
| Rate for Payer: Aetna Commercial |
$4,194.96
|
| Rate for Payer: Anthem Medicaid |
$1,873.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,249.44
|
| Rate for Payer: Cash Price |
$2,724.00
|
| Rate for Payer: Cigna Commercial |
$4,521.84
|
| Rate for Payer: First Health Commercial |
$5,175.60
|
| Rate for Payer: Humana Commercial |
$4,630.80
|
| Rate for Payer: Humana KY Medicaid |
$1,873.57
|
| Rate for Payer: Kentucky WC Medicaid |
$1,892.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,467.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,020.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,634.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,911.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,794.24
|
| Rate for Payer: Ohio Health Group HMO |
$4,086.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,089.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$708.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,688.88
|
| Rate for Payer: PHCS Commercial |
$5,230.08
|
| Rate for Payer: United Healthcare All Payer |
$4,794.24
|
|
|
HED FRACTURE MOD CATHCART 56MM
|
Facility
|
IP
|
$5,448.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$708.24 |
| Max. Negotiated Rate |
$5,230.08 |
| Rate for Payer: Aetna Commercial |
$4,194.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,249.44
|
| Rate for Payer: Cash Price |
$2,724.00
|
| Rate for Payer: Cigna Commercial |
$4,521.84
|
| Rate for Payer: First Health Commercial |
$5,175.60
|
| Rate for Payer: Humana Commercial |
$4,630.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,467.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,020.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,634.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,794.24
|
| Rate for Payer: Ohio Health Group HMO |
$4,086.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,089.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$708.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,688.88
|
| Rate for Payer: PHCS Commercial |
$5,230.08
|
| Rate for Payer: United Healthcare All Payer |
$4,794.24
|
|
|
HED FRACTURE MOD CATHCART 56MM
|
Facility
|
OP
|
$5,448.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$708.24 |
| Max. Negotiated Rate |
$5,230.08 |
| Rate for Payer: Aetna Commercial |
$4,194.96
|
| Rate for Payer: Anthem Medicaid |
$1,873.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,249.44
|
| Rate for Payer: Cash Price |
$2,724.00
|
| Rate for Payer: Cigna Commercial |
$4,521.84
|
| Rate for Payer: First Health Commercial |
$5,175.60
|
| Rate for Payer: Humana Commercial |
$4,630.80
|
| Rate for Payer: Humana KY Medicaid |
$1,873.57
|
| Rate for Payer: Kentucky WC Medicaid |
$1,892.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,467.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,020.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,634.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,911.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,794.24
|
| Rate for Payer: Ohio Health Group HMO |
$4,086.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,089.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$708.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,688.88
|
| Rate for Payer: PHCS Commercial |
$5,230.08
|
| Rate for Payer: United Healthcare All Payer |
$4,794.24
|
|
|
HED HIP BALL MOD CATHCART 52MM
|
Facility
|
OP
|
$4,328.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$562.64 |
| Max. Negotiated Rate |
$4,154.88 |
| Rate for Payer: Aetna Commercial |
$3,332.56
|
| Rate for Payer: Anthem Medicaid |
$1,488.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,375.84
|
| Rate for Payer: Cash Price |
$2,164.00
|
| Rate for Payer: Cigna Commercial |
$3,592.24
|
| Rate for Payer: First Health Commercial |
$4,111.60
|
| Rate for Payer: Humana Commercial |
$3,678.80
|
| Rate for Payer: Humana KY Medicaid |
$1,488.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,503.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,548.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,194.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,298.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,518.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,808.64
|
| Rate for Payer: Ohio Health Group HMO |
$3,246.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$865.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$562.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,341.68
|
| Rate for Payer: PHCS Commercial |
$4,154.88
|
| Rate for Payer: United Healthcare All Payer |
$3,808.64
|
|
|
HED HIP BALL MOD CATHCART 52MM
|
Facility
|
IP
|
$4,328.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$562.64 |
| Max. Negotiated Rate |
$4,154.88 |
| Rate for Payer: Aetna Commercial |
$3,332.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,375.84
|
| Rate for Payer: Cash Price |
$2,164.00
|
| Rate for Payer: Cigna Commercial |
$3,592.24
|
| Rate for Payer: First Health Commercial |
$4,111.60
|
| Rate for Payer: Humana Commercial |
$3,678.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,548.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,194.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,298.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,808.64
|
| Rate for Payer: Ohio Health Group HMO |
$3,246.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$865.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$562.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,341.68
|
| Rate for Payer: PHCS Commercial |
$4,154.88
|
| Rate for Payer: United Healthcare All Payer |
$3,808.64
|
|
|
HED HUM COFILD LAT OFFST 28*46
|
Facility
|
IP
|
$5,192.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$675.02 |
| Max. Negotiated Rate |
$4,984.80 |
| Rate for Payer: Aetna Commercial |
$3,998.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,050.15
|
| Rate for Payer: Cash Price |
$2,596.25
|
| Rate for Payer: Cigna Commercial |
$4,309.78
|
| Rate for Payer: First Health Commercial |
$4,932.88
|
| Rate for Payer: Humana Commercial |
$4,413.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,257.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,832.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,557.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,569.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,894.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,038.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$675.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,609.68
|
| Rate for Payer: PHCS Commercial |
$4,984.80
|
| Rate for Payer: United Healthcare All Payer |
$4,569.40
|
|
|
HED HUM COFILD LAT OFFST 28*46
|
Facility
|
OP
|
$5,192.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$675.02 |
| Max. Negotiated Rate |
$4,984.80 |
| Rate for Payer: Aetna Commercial |
$3,998.22
|
| Rate for Payer: Anthem Medicaid |
$1,785.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,050.15
|
| Rate for Payer: Cash Price |
$2,596.25
|
| Rate for Payer: Cigna Commercial |
$4,309.78
|
| Rate for Payer: First Health Commercial |
$4,932.88
|
| Rate for Payer: Humana Commercial |
$4,413.62
|
| Rate for Payer: Humana KY Medicaid |
$1,785.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,803.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,257.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,832.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,557.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,821.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,569.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,894.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,038.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$675.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,609.68
|
| Rate for Payer: PHCS Commercial |
$4,984.80
|
| Rate for Payer: United Healthcare All Payer |
$4,569.40
|
|
|
HED LEGACY COCR 12/14 22MM+3.5
|
Facility
|
IP
|
$4,361.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$566.96 |
| Max. Negotiated Rate |
$4,186.80 |
| Rate for Payer: Aetna Commercial |
$3,358.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,401.78
|
| Rate for Payer: Cash Price |
$2,180.62
|
| Rate for Payer: Cigna Commercial |
$3,619.84
|
| Rate for Payer: First Health Commercial |
$4,143.19
|
| Rate for Payer: Humana Commercial |
$3,707.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,576.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,218.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,308.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,837.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,270.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$872.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$566.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,351.99
|
| Rate for Payer: PHCS Commercial |
$4,186.80
|
| Rate for Payer: United Healthcare All Payer |
$3,837.90
|
|
|
HED LEGACY COCR 12/14 22MM+3.5
|
Facility
|
OP
|
$4,361.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$566.96 |
| Max. Negotiated Rate |
$4,186.80 |
| Rate for Payer: Aetna Commercial |
$3,358.16
|
| Rate for Payer: Anthem Medicaid |
$1,499.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,401.78
|
| Rate for Payer: Cash Price |
$2,180.62
|
| Rate for Payer: Cigna Commercial |
$3,619.84
|
| Rate for Payer: First Health Commercial |
$4,143.19
|
| Rate for Payer: Humana Commercial |
$3,707.06
|
| Rate for Payer: Humana KY Medicaid |
$1,499.83
|
| Rate for Payer: Kentucky WC Medicaid |
$1,515.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,576.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,218.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,308.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,529.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,837.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,270.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$872.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$566.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,351.99
|
| Rate for Payer: PHCS Commercial |
$4,186.80
|
| Rate for Payer: United Healthcare All Payer |
$3,837.90
|
|
|
HED LEGACY COCR 12/14 26MM+3.5
|
Facility
|
IP
|
$4,361.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$566.96 |
| Max. Negotiated Rate |
$4,186.80 |
| Rate for Payer: Aetna Commercial |
$3,358.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,401.78
|
| Rate for Payer: Cash Price |
$2,180.62
|
| Rate for Payer: Cigna Commercial |
$3,619.84
|
| Rate for Payer: First Health Commercial |
$4,143.19
|
| Rate for Payer: Humana Commercial |
$3,707.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,576.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,218.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,308.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,837.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,270.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$872.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$566.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,351.99
|
| Rate for Payer: PHCS Commercial |
$4,186.80
|
| Rate for Payer: United Healthcare All Payer |
$3,837.90
|
|
|
HED LEGACY COCR 12/14 26MM+3.5
|
Facility
|
OP
|
$4,361.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$566.96 |
| Max. Negotiated Rate |
$4,186.80 |
| Rate for Payer: Aetna Commercial |
$3,358.16
|
| Rate for Payer: Anthem Medicaid |
$1,499.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,401.78
|
| Rate for Payer: Cash Price |
$2,180.62
|
| Rate for Payer: Cigna Commercial |
$3,619.84
|
| Rate for Payer: First Health Commercial |
$4,143.19
|
| Rate for Payer: Humana Commercial |
$3,707.06
|
| Rate for Payer: Humana KY Medicaid |
$1,499.83
|
| Rate for Payer: Kentucky WC Medicaid |
$1,515.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,576.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,218.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,308.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,529.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,837.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,270.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$872.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$566.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,351.99
|
| Rate for Payer: PHCS Commercial |
$4,186.80
|
| Rate for Payer: United Healthcare All Payer |
$3,837.90
|
|
|
HED LEGCY COCR 12/14 26MM -3.5
|
Facility
|
IP
|
$4,361.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$566.96 |
| Max. Negotiated Rate |
$4,186.80 |
| Rate for Payer: Aetna Commercial |
$3,358.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,401.78
|
| Rate for Payer: Cash Price |
$2,180.62
|
| Rate for Payer: Cigna Commercial |
$3,619.84
|
| Rate for Payer: First Health Commercial |
$4,143.19
|
| Rate for Payer: Humana Commercial |
$3,707.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,576.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,218.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,308.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,837.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,270.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$872.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$566.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,351.99
|
| Rate for Payer: PHCS Commercial |
$4,186.80
|
| Rate for Payer: United Healthcare All Payer |
$3,837.90
|
|
|
HED LEGCY COCR 12/14 26MM -3.5
|
Facility
|
OP
|
$4,361.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$566.96 |
| Max. Negotiated Rate |
$4,186.80 |
| Rate for Payer: Aetna Commercial |
$3,358.16
|
| Rate for Payer: Anthem Medicaid |
$1,499.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,401.78
|
| Rate for Payer: Cash Price |
$2,180.62
|
| Rate for Payer: Cigna Commercial |
$3,619.84
|
| Rate for Payer: First Health Commercial |
$4,143.19
|
| Rate for Payer: Humana Commercial |
$3,707.06
|
| Rate for Payer: Humana KY Medicaid |
$1,499.83
|
| Rate for Payer: Kentucky WC Medicaid |
$1,515.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,576.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,218.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,308.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,529.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,837.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,270.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$872.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$566.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,351.99
|
| Rate for Payer: PHCS Commercial |
$4,186.80
|
| Rate for Payer: United Healthcare All Payer |
$3,837.90
|
|
|
HED LEGCY PRCR 12/14 26MM+10.5
|
Facility
|
IP
|
$4,361.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$566.96 |
| Max. Negotiated Rate |
$4,186.80 |
| Rate for Payer: Aetna Commercial |
$3,358.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,401.78
|
| Rate for Payer: Cash Price |
$2,180.62
|
| Rate for Payer: Cigna Commercial |
$3,619.84
|
| Rate for Payer: First Health Commercial |
$4,143.19
|
| Rate for Payer: Humana Commercial |
$3,707.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,576.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,218.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,308.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,837.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,270.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$872.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$566.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,351.99
|
| Rate for Payer: PHCS Commercial |
$4,186.80
|
| Rate for Payer: United Healthcare All Payer |
$3,837.90
|
|
|
HED LEGCY PRCR 12/14 26MM+10.5
|
Facility
|
OP
|
$4,361.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$566.96 |
| Max. Negotiated Rate |
$4,186.80 |
| Rate for Payer: Aetna Commercial |
$3,358.16
|
| Rate for Payer: Anthem Medicaid |
$1,499.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,401.78
|
| Rate for Payer: Cash Price |
$2,180.62
|
| Rate for Payer: Cigna Commercial |
$3,619.84
|
| Rate for Payer: First Health Commercial |
$4,143.19
|
| Rate for Payer: Humana Commercial |
$3,707.06
|
| Rate for Payer: Humana KY Medicaid |
$1,499.83
|
| Rate for Payer: Kentucky WC Medicaid |
$1,515.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,576.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,218.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,308.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,529.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,837.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,270.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$872.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$566.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,351.99
|
| Rate for Payer: PHCS Commercial |
$4,186.80
|
| Rate for Payer: United Healthcare All Payer |
$3,837.90
|
|
|
HED LEGCY PRCR 12/14 26MM -3.5
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
HED LEGCY PRCR 12/14 26MM -3.5
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
HED LEGCY PRCR 12/14 28MM -3.5
|
Facility
|
OP
|
$4,361.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$566.96 |
| Max. Negotiated Rate |
$4,186.80 |
| Rate for Payer: Aetna Commercial |
$3,358.16
|
| Rate for Payer: Anthem Medicaid |
$1,499.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,401.78
|
| Rate for Payer: Cash Price |
$2,180.62
|
| Rate for Payer: Cigna Commercial |
$3,619.84
|
| Rate for Payer: First Health Commercial |
$4,143.19
|
| Rate for Payer: Humana Commercial |
$3,707.06
|
| Rate for Payer: Humana KY Medicaid |
$1,499.83
|
| Rate for Payer: Kentucky WC Medicaid |
$1,515.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,576.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,218.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,308.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,529.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,837.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,270.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$872.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$566.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,351.99
|
| Rate for Payer: PHCS Commercial |
$4,186.80
|
| Rate for Payer: United Healthcare All Payer |
$3,837.90
|
|
|
HED LEGCY PRCR 12/14 28MM -3.5
|
Facility
|
IP
|
$4,361.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$566.96 |
| Max. Negotiated Rate |
$4,186.80 |
| Rate for Payer: Aetna Commercial |
$3,358.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,401.78
|
| Rate for Payer: Cash Price |
$2,180.62
|
| Rate for Payer: Cigna Commercial |
$3,619.84
|
| Rate for Payer: First Health Commercial |
$4,143.19
|
| Rate for Payer: Humana Commercial |
$3,707.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,576.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,218.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,308.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,837.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,270.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$872.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$566.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,351.99
|
| Rate for Payer: PHCS Commercial |
$4,186.80
|
| Rate for Payer: United Healthcare All Payer |
$3,837.90
|
|
|
HED LEGCY PRCR 12/14 32MM+10.5
|
Facility
|
OP
|
$4,361.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$566.96 |
| Max. Negotiated Rate |
$4,186.80 |
| Rate for Payer: Aetna Commercial |
$3,358.16
|
| Rate for Payer: Anthem Medicaid |
$1,499.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,401.78
|
| Rate for Payer: Cash Price |
$2,180.62
|
| Rate for Payer: Cigna Commercial |
$3,619.84
|
| Rate for Payer: First Health Commercial |
$4,143.19
|
| Rate for Payer: Humana Commercial |
$3,707.06
|
| Rate for Payer: Humana KY Medicaid |
$1,499.83
|
| Rate for Payer: Kentucky WC Medicaid |
$1,515.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,576.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,218.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,308.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,529.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,837.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,270.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$872.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$566.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,351.99
|
| Rate for Payer: PHCS Commercial |
$4,186.80
|
| Rate for Payer: United Healthcare All Payer |
$3,837.90
|
|
|
HED LEGCY PRCR 12/14 32MM+10.5
|
Facility
|
IP
|
$4,361.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$566.96 |
| Max. Negotiated Rate |
$4,186.80 |
| Rate for Payer: Aetna Commercial |
$3,358.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,401.78
|
| Rate for Payer: Cash Price |
$2,180.62
|
| Rate for Payer: Cigna Commercial |
$3,619.84
|
| Rate for Payer: First Health Commercial |
$4,143.19
|
| Rate for Payer: Humana Commercial |
$3,707.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,576.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,218.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,308.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,837.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,270.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$872.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$566.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,351.99
|
| Rate for Payer: PHCS Commercial |
$4,186.80
|
| Rate for Payer: United Healthcare All Payer |
$3,837.90
|
|
|
HED LEGCY PRCR 12/14 32MM -3.5
|
Facility
|
OP
|
$4,361.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$566.96 |
| Max. Negotiated Rate |
$4,186.80 |
| Rate for Payer: Aetna Commercial |
$3,358.16
|
| Rate for Payer: Anthem Medicaid |
$1,499.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,401.78
|
| Rate for Payer: Cash Price |
$2,180.62
|
| Rate for Payer: Cigna Commercial |
$3,619.84
|
| Rate for Payer: First Health Commercial |
$4,143.19
|
| Rate for Payer: Humana Commercial |
$3,707.06
|
| Rate for Payer: Humana KY Medicaid |
$1,499.83
|
| Rate for Payer: Kentucky WC Medicaid |
$1,515.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,576.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,218.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,308.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,529.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,837.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,270.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$872.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$566.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,351.99
|
| Rate for Payer: PHCS Commercial |
$4,186.80
|
| Rate for Payer: United Healthcare All Payer |
$3,837.90
|
|
