|
HEMI-CAP 12MM ARTCMP 2.0M*2.5M
|
Facility
|
IP
|
$10,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,378.00 |
| Max. Negotiated Rate |
$10,176.00 |
| Rate for Payer: Aetna Commercial |
$8,162.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,268.00
|
| Rate for Payer: Cash Price |
$5,300.00
|
| Rate for Payer: Cigna Commercial |
$8,798.00
|
| Rate for Payer: First Health Commercial |
$10,070.00
|
| Rate for Payer: Humana Commercial |
$9,010.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,692.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,822.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,180.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,328.00
|
| Rate for Payer: Ohio Health Group HMO |
$7,950.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,378.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,286.00
|
| Rate for Payer: PHCS Commercial |
$10,176.00
|
| Rate for Payer: United Healthcare All Payer |
$9,328.00
|
|
|
HEMI-CAP 12MM ARTCMP 2.0M*2.5M
|
Facility
|
OP
|
$10,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,378.00 |
| Max. Negotiated Rate |
$10,176.00 |
| Rate for Payer: Aetna Commercial |
$8,162.00
|
| Rate for Payer: Anthem Medicaid |
$3,645.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,268.00
|
| Rate for Payer: Cash Price |
$5,300.00
|
| Rate for Payer: Cigna Commercial |
$8,798.00
|
| Rate for Payer: First Health Commercial |
$10,070.00
|
| Rate for Payer: Humana Commercial |
$9,010.00
|
| Rate for Payer: Humana KY Medicaid |
$3,645.34
|
| Rate for Payer: Kentucky WC Medicaid |
$3,682.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,692.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,822.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,180.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,718.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,328.00
|
| Rate for Payer: Ohio Health Group HMO |
$7,950.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,378.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,286.00
|
| Rate for Payer: PHCS Commercial |
$10,176.00
|
| Rate for Payer: United Healthcare All Payer |
$9,328.00
|
|
|
HEMI-CAP 12MM ARTCMP 2.0M*3.0M
|
Facility
|
IP
|
$10,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,378.00 |
| Max. Negotiated Rate |
$10,176.00 |
| Rate for Payer: Aetna Commercial |
$8,162.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,268.00
|
| Rate for Payer: Cash Price |
$5,300.00
|
| Rate for Payer: Cigna Commercial |
$8,798.00
|
| Rate for Payer: First Health Commercial |
$10,070.00
|
| Rate for Payer: Humana Commercial |
$9,010.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,692.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,822.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,180.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,328.00
|
| Rate for Payer: Ohio Health Group HMO |
$7,950.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,378.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,286.00
|
| Rate for Payer: PHCS Commercial |
$10,176.00
|
| Rate for Payer: United Healthcare All Payer |
$9,328.00
|
|
|
HEMI-CAP 12MM ARTCMP 2.0M*3.0M
|
Facility
|
OP
|
$10,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,378.00 |
| Max. Negotiated Rate |
$10,176.00 |
| Rate for Payer: Aetna Commercial |
$8,162.00
|
| Rate for Payer: Anthem Medicaid |
$3,645.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,268.00
|
| Rate for Payer: Cash Price |
$5,300.00
|
| Rate for Payer: Cigna Commercial |
$8,798.00
|
| Rate for Payer: First Health Commercial |
$10,070.00
|
| Rate for Payer: Humana Commercial |
$9,010.00
|
| Rate for Payer: Humana KY Medicaid |
$3,645.34
|
| Rate for Payer: Kentucky WC Medicaid |
$3,682.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,692.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,822.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,180.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,718.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,328.00
|
| Rate for Payer: Ohio Health Group HMO |
$7,950.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,378.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,286.00
|
| Rate for Payer: PHCS Commercial |
$10,176.00
|
| Rate for Payer: United Healthcare All Payer |
$9,328.00
|
|
|
HEMI-CAP 15MM ARTCMP 1.5M*2.5M
|
Facility
|
OP
|
$10,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,378.00 |
| Max. Negotiated Rate |
$10,176.00 |
| Rate for Payer: Aetna Commercial |
$8,162.00
|
| Rate for Payer: Anthem Medicaid |
$3,645.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,268.00
|
| Rate for Payer: Cash Price |
$5,300.00
|
| Rate for Payer: Cigna Commercial |
$8,798.00
|
| Rate for Payer: First Health Commercial |
$10,070.00
|
| Rate for Payer: Humana Commercial |
$9,010.00
|
| Rate for Payer: Humana KY Medicaid |
$3,645.34
|
| Rate for Payer: Kentucky WC Medicaid |
$3,682.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,692.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,822.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,180.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,718.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,328.00
|
| Rate for Payer: Ohio Health Group HMO |
$7,950.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,378.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,286.00
|
| Rate for Payer: PHCS Commercial |
$10,176.00
|
| Rate for Payer: United Healthcare All Payer |
$9,328.00
|
|
|
HEMI-CAP 15MM ARTCMP 1.5M*2.5M
|
Facility
|
IP
|
$10,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,378.00 |
| Max. Negotiated Rate |
$10,176.00 |
| Rate for Payer: Aetna Commercial |
$8,162.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,268.00
|
| Rate for Payer: Cash Price |
$5,300.00
|
| Rate for Payer: Cigna Commercial |
$8,798.00
|
| Rate for Payer: First Health Commercial |
$10,070.00
|
| Rate for Payer: Humana Commercial |
$9,010.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,692.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,822.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,180.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,328.00
|
| Rate for Payer: Ohio Health Group HMO |
$7,950.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,378.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,286.00
|
| Rate for Payer: PHCS Commercial |
$10,176.00
|
| Rate for Payer: United Healthcare All Payer |
$9,328.00
|
|
|
HEMI-CAP 15MM ARTCMP 2.0M*3.0M
|
Facility
|
IP
|
$10,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,378.00 |
| Max. Negotiated Rate |
$10,176.00 |
| Rate for Payer: Aetna Commercial |
$8,162.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,268.00
|
| Rate for Payer: Cash Price |
$5,300.00
|
| Rate for Payer: Cigna Commercial |
$8,798.00
|
| Rate for Payer: First Health Commercial |
$10,070.00
|
| Rate for Payer: Humana Commercial |
$9,010.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,692.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,822.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,180.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,328.00
|
| Rate for Payer: Ohio Health Group HMO |
$7,950.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,378.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,286.00
|
| Rate for Payer: PHCS Commercial |
$10,176.00
|
| Rate for Payer: United Healthcare All Payer |
$9,328.00
|
|
|
HEMI-CAP 15MM ARTCMP 2.0M*3.0M
|
Facility
|
OP
|
$10,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,378.00 |
| Max. Negotiated Rate |
$10,176.00 |
| Rate for Payer: Aetna Commercial |
$8,162.00
|
| Rate for Payer: Anthem Medicaid |
$3,645.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,268.00
|
| Rate for Payer: Cash Price |
$5,300.00
|
| Rate for Payer: Cigna Commercial |
$8,798.00
|
| Rate for Payer: First Health Commercial |
$10,070.00
|
| Rate for Payer: Humana Commercial |
$9,010.00
|
| Rate for Payer: Humana KY Medicaid |
$3,645.34
|
| Rate for Payer: Kentucky WC Medicaid |
$3,682.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,692.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,822.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,180.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,718.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,328.00
|
| Rate for Payer: Ohio Health Group HMO |
$7,950.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,378.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,286.00
|
| Rate for Payer: PHCS Commercial |
$10,176.00
|
| Rate for Payer: United Healthcare All Payer |
$9,328.00
|
|
|
HEMI-CAP 15MM ARTCMP 2.0M*4.0M
|
Facility
|
OP
|
$10,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,378.00 |
| Max. Negotiated Rate |
$10,176.00 |
| Rate for Payer: Aetna Commercial |
$8,162.00
|
| Rate for Payer: Anthem Medicaid |
$3,645.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,268.00
|
| Rate for Payer: Cash Price |
$5,300.00
|
| Rate for Payer: Cigna Commercial |
$8,798.00
|
| Rate for Payer: First Health Commercial |
$10,070.00
|
| Rate for Payer: Humana Commercial |
$9,010.00
|
| Rate for Payer: Humana KY Medicaid |
$3,645.34
|
| Rate for Payer: Kentucky WC Medicaid |
$3,682.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,692.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,822.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,180.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,718.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,328.00
|
| Rate for Payer: Ohio Health Group HMO |
$7,950.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,378.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,286.00
|
| Rate for Payer: PHCS Commercial |
$10,176.00
|
| Rate for Payer: United Healthcare All Payer |
$9,328.00
|
|
|
HEMI-CAP 15MM ARTCMP 2.0M*4.0M
|
Facility
|
IP
|
$10,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,378.00 |
| Max. Negotiated Rate |
$10,176.00 |
| Rate for Payer: Aetna Commercial |
$8,162.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,268.00
|
| Rate for Payer: Cash Price |
$5,300.00
|
| Rate for Payer: Cigna Commercial |
$8,798.00
|
| Rate for Payer: First Health Commercial |
$10,070.00
|
| Rate for Payer: Humana Commercial |
$9,010.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,692.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,822.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,180.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,328.00
|
| Rate for Payer: Ohio Health Group HMO |
$7,950.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,378.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,286.00
|
| Rate for Payer: PHCS Commercial |
$10,176.00
|
| Rate for Payer: United Healthcare All Payer |
$9,328.00
|
|
|
HEMI-CAP 15MM ARTCMP 2.5M*3.5M
|
Facility
|
IP
|
$10,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,378.00 |
| Max. Negotiated Rate |
$10,176.00 |
| Rate for Payer: Aetna Commercial |
$8,162.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,268.00
|
| Rate for Payer: Cash Price |
$5,300.00
|
| Rate for Payer: Cigna Commercial |
$8,798.00
|
| Rate for Payer: First Health Commercial |
$10,070.00
|
| Rate for Payer: Humana Commercial |
$9,010.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,692.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,822.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,180.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,328.00
|
| Rate for Payer: Ohio Health Group HMO |
$7,950.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,378.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,286.00
|
| Rate for Payer: PHCS Commercial |
$10,176.00
|
| Rate for Payer: United Healthcare All Payer |
$9,328.00
|
|
|
HEMI-CAP 15MM ARTCMP 2.5M*3.5M
|
Facility
|
OP
|
$10,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,378.00 |
| Max. Negotiated Rate |
$10,176.00 |
| Rate for Payer: Aetna Commercial |
$8,162.00
|
| Rate for Payer: Anthem Medicaid |
$3,645.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,268.00
|
| Rate for Payer: Cash Price |
$5,300.00
|
| Rate for Payer: Cigna Commercial |
$8,798.00
|
| Rate for Payer: First Health Commercial |
$10,070.00
|
| Rate for Payer: Humana Commercial |
$9,010.00
|
| Rate for Payer: Humana KY Medicaid |
$3,645.34
|
| Rate for Payer: Kentucky WC Medicaid |
$3,682.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,692.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,822.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,180.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,718.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,328.00
|
| Rate for Payer: Ohio Health Group HMO |
$7,950.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,378.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,286.00
|
| Rate for Payer: PHCS Commercial |
$10,176.00
|
| Rate for Payer: United Healthcare All Payer |
$9,328.00
|
|
|
HEMI-CAP 15MM ARTCMP 2.5M*4.5M
|
Facility
|
IP
|
$10,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,378.00 |
| Max. Negotiated Rate |
$10,176.00 |
| Rate for Payer: Aetna Commercial |
$8,162.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,268.00
|
| Rate for Payer: Cash Price |
$5,300.00
|
| Rate for Payer: Cigna Commercial |
$8,798.00
|
| Rate for Payer: First Health Commercial |
$10,070.00
|
| Rate for Payer: Humana Commercial |
$9,010.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,692.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,822.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,180.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,328.00
|
| Rate for Payer: Ohio Health Group HMO |
$7,950.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,378.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,286.00
|
| Rate for Payer: PHCS Commercial |
$10,176.00
|
| Rate for Payer: United Healthcare All Payer |
$9,328.00
|
|
|
HEMI-CAP 15MM ARTCMP 2.5M*4.5M
|
Facility
|
OP
|
$10,600.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,378.00 |
| Max. Negotiated Rate |
$10,176.00 |
| Rate for Payer: Aetna Commercial |
$8,162.00
|
| Rate for Payer: Anthem Medicaid |
$3,645.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,268.00
|
| Rate for Payer: Cash Price |
$5,300.00
|
| Rate for Payer: Cigna Commercial |
$8,798.00
|
| Rate for Payer: First Health Commercial |
$10,070.00
|
| Rate for Payer: Humana Commercial |
$9,010.00
|
| Rate for Payer: Humana KY Medicaid |
$3,645.34
|
| Rate for Payer: Kentucky WC Medicaid |
$3,682.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,692.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,822.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,180.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,718.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,328.00
|
| Rate for Payer: Ohio Health Group HMO |
$7,950.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,378.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,286.00
|
| Rate for Payer: PHCS Commercial |
$10,176.00
|
| Rate for Payer: United Healthcare All Payer |
$9,328.00
|
|
|
HEMI CK/HK LGNSZ1-2 10MM LL/RM
|
Facility
|
OP
|
$9,685.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,259.14 |
| Max. Negotiated Rate |
$9,298.30 |
| Rate for Payer: Aetna Commercial |
$7,458.01
|
| Rate for Payer: Anthem Medicaid |
$3,330.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,554.87
|
| Rate for Payer: Cash Price |
$4,842.86
|
| Rate for Payer: Cigna Commercial |
$8,039.16
|
| Rate for Payer: First Health Commercial |
$9,201.44
|
| Rate for Payer: Humana Commercial |
$8,232.87
|
| Rate for Payer: Humana KY Medicaid |
$3,330.92
|
| Rate for Payer: Kentucky WC Medicaid |
$3,364.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,942.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,148.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,905.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,397.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,523.44
|
| Rate for Payer: Ohio Health Group HMO |
$7,264.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,937.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,259.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,002.58
|
| Rate for Payer: PHCS Commercial |
$9,298.30
|
| Rate for Payer: United Healthcare All Payer |
$8,523.44
|
|
|
HEMI CK/HK LGNSZ1-2 10MM LL/RM
|
Facility
|
IP
|
$9,685.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,259.14 |
| Max. Negotiated Rate |
$9,298.30 |
| Rate for Payer: Aetna Commercial |
$7,458.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,554.87
|
| Rate for Payer: Cash Price |
$4,842.86
|
| Rate for Payer: Cigna Commercial |
$8,039.16
|
| Rate for Payer: First Health Commercial |
$9,201.44
|
| Rate for Payer: Humana Commercial |
$8,232.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,942.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,148.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,905.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,523.44
|
| Rate for Payer: Ohio Health Group HMO |
$7,264.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,937.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,259.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,002.58
|
| Rate for Payer: PHCS Commercial |
$9,298.30
|
| Rate for Payer: United Healthcare All Payer |
$8,523.44
|
|
|
HEMI CK/HK LGNSZ1-2 15MM LL/RM
|
Facility
|
OP
|
$9,685.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,259.14 |
| Max. Negotiated Rate |
$9,298.30 |
| Rate for Payer: Aetna Commercial |
$7,458.01
|
| Rate for Payer: Anthem Medicaid |
$3,330.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,554.87
|
| Rate for Payer: Cash Price |
$4,842.86
|
| Rate for Payer: Cigna Commercial |
$8,039.16
|
| Rate for Payer: First Health Commercial |
$9,201.44
|
| Rate for Payer: Humana Commercial |
$8,232.87
|
| Rate for Payer: Humana KY Medicaid |
$3,330.92
|
| Rate for Payer: Kentucky WC Medicaid |
$3,364.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,942.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,148.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,905.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,397.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,523.44
|
| Rate for Payer: Ohio Health Group HMO |
$7,264.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,937.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,259.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,002.58
|
| Rate for Payer: PHCS Commercial |
$9,298.30
|
| Rate for Payer: United Healthcare All Payer |
$8,523.44
|
|
|
HEMI CK/HK LGNSZ1-2 15MM LL/RM
|
Facility
|
IP
|
$9,685.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,259.14 |
| Max. Negotiated Rate |
$9,298.30 |
| Rate for Payer: Aetna Commercial |
$7,458.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,554.87
|
| Rate for Payer: Cash Price |
$4,842.86
|
| Rate for Payer: Cigna Commercial |
$8,039.16
|
| Rate for Payer: First Health Commercial |
$9,201.44
|
| Rate for Payer: Humana Commercial |
$8,232.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,942.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,148.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,905.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,523.44
|
| Rate for Payer: Ohio Health Group HMO |
$7,264.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,937.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,259.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,002.58
|
| Rate for Payer: PHCS Commercial |
$9,298.30
|
| Rate for Payer: United Healthcare All Payer |
$8,523.44
|
|
|
HEMI CK/HK LGN SZ1-2 5MM LL/RM
|
Facility
|
OP
|
$9,685.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,259.14 |
| Max. Negotiated Rate |
$9,298.30 |
| Rate for Payer: Aetna Commercial |
$7,458.01
|
| Rate for Payer: Anthem Medicaid |
$3,330.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,554.87
|
| Rate for Payer: Cash Price |
$4,842.86
|
| Rate for Payer: Cigna Commercial |
$8,039.16
|
| Rate for Payer: First Health Commercial |
$9,201.44
|
| Rate for Payer: Humana Commercial |
$8,232.87
|
| Rate for Payer: Humana KY Medicaid |
$3,330.92
|
| Rate for Payer: Kentucky WC Medicaid |
$3,364.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,942.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,148.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,905.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,397.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,523.44
|
| Rate for Payer: Ohio Health Group HMO |
$7,264.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,937.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,259.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,002.58
|
| Rate for Payer: PHCS Commercial |
$9,298.30
|
| Rate for Payer: United Healthcare All Payer |
$8,523.44
|
|
|
HEMI CK/HK LGN SZ1-2 5MM LL/RM
|
Facility
|
IP
|
$9,685.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,259.14 |
| Max. Negotiated Rate |
$9,298.30 |
| Rate for Payer: Aetna Commercial |
$7,458.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,554.87
|
| Rate for Payer: Cash Price |
$4,842.86
|
| Rate for Payer: Cigna Commercial |
$8,039.16
|
| Rate for Payer: First Health Commercial |
$9,201.44
|
| Rate for Payer: Humana Commercial |
$8,232.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,942.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,148.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,905.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,523.44
|
| Rate for Payer: Ohio Health Group HMO |
$7,264.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,937.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,259.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,002.58
|
| Rate for Payer: PHCS Commercial |
$9,298.30
|
| Rate for Payer: United Healthcare All Payer |
$8,523.44
|
|
|
HEMI CK/HK LGNSZ3-4 10MM LL/RM
|
Facility
|
IP
|
$9,685.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,259.14 |
| Max. Negotiated Rate |
$9,298.30 |
| Rate for Payer: Aetna Commercial |
$7,458.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,554.87
|
| Rate for Payer: Cash Price |
$4,842.86
|
| Rate for Payer: Cigna Commercial |
$8,039.16
|
| Rate for Payer: First Health Commercial |
$9,201.44
|
| Rate for Payer: Humana Commercial |
$8,232.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,942.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,148.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,905.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,523.44
|
| Rate for Payer: Ohio Health Group HMO |
$7,264.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,937.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,259.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,002.58
|
| Rate for Payer: PHCS Commercial |
$9,298.30
|
| Rate for Payer: United Healthcare All Payer |
$8,523.44
|
|
|
HEMI CK/HK LGNSZ3-4 10MM LL/RM
|
Facility
|
OP
|
$9,685.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,259.14 |
| Max. Negotiated Rate |
$9,298.30 |
| Rate for Payer: Aetna Commercial |
$7,458.01
|
| Rate for Payer: Anthem Medicaid |
$3,330.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,554.87
|
| Rate for Payer: Cash Price |
$4,842.86
|
| Rate for Payer: Cigna Commercial |
$8,039.16
|
| Rate for Payer: First Health Commercial |
$9,201.44
|
| Rate for Payer: Humana Commercial |
$8,232.87
|
| Rate for Payer: Humana KY Medicaid |
$3,330.92
|
| Rate for Payer: Kentucky WC Medicaid |
$3,364.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,942.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,148.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,905.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,397.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,523.44
|
| Rate for Payer: Ohio Health Group HMO |
$7,264.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,937.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,259.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,002.58
|
| Rate for Payer: PHCS Commercial |
$9,298.30
|
| Rate for Payer: United Healthcare All Payer |
$8,523.44
|
|
|
HEMI CK/HK LGNSZ3-4 15MM LL/RM
|
Facility
|
OP
|
$9,685.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,259.14 |
| Max. Negotiated Rate |
$9,298.30 |
| Rate for Payer: Aetna Commercial |
$7,458.01
|
| Rate for Payer: Anthem Medicaid |
$3,330.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,554.87
|
| Rate for Payer: Cash Price |
$4,842.86
|
| Rate for Payer: Cigna Commercial |
$8,039.16
|
| Rate for Payer: First Health Commercial |
$9,201.44
|
| Rate for Payer: Humana Commercial |
$8,232.87
|
| Rate for Payer: Humana KY Medicaid |
$3,330.92
|
| Rate for Payer: Kentucky WC Medicaid |
$3,364.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,942.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,148.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,905.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,397.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,523.44
|
| Rate for Payer: Ohio Health Group HMO |
$7,264.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,937.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,259.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,002.58
|
| Rate for Payer: PHCS Commercial |
$9,298.30
|
| Rate for Payer: United Healthcare All Payer |
$8,523.44
|
|
|
HEMI CK/HK LGNSZ3-4 15MM LL/RM
|
Facility
|
IP
|
$9,685.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,259.14 |
| Max. Negotiated Rate |
$9,298.30 |
| Rate for Payer: Aetna Commercial |
$7,458.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,554.87
|
| Rate for Payer: Cash Price |
$4,842.86
|
| Rate for Payer: Cigna Commercial |
$8,039.16
|
| Rate for Payer: First Health Commercial |
$9,201.44
|
| Rate for Payer: Humana Commercial |
$8,232.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,942.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,148.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,905.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,523.44
|
| Rate for Payer: Ohio Health Group HMO |
$7,264.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,937.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,259.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,002.58
|
| Rate for Payer: PHCS Commercial |
$9,298.30
|
| Rate for Payer: United Healthcare All Payer |
$8,523.44
|
|
|
HEMI CK/HK LGNSZ5-6 10MM LL/RM
|
Facility
|
IP
|
$9,685.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,259.14 |
| Max. Negotiated Rate |
$9,298.30 |
| Rate for Payer: Aetna Commercial |
$7,458.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,554.87
|
| Rate for Payer: Cash Price |
$4,842.86
|
| Rate for Payer: Cigna Commercial |
$8,039.16
|
| Rate for Payer: First Health Commercial |
$9,201.44
|
| Rate for Payer: Humana Commercial |
$8,232.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,942.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,148.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,905.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,523.44
|
| Rate for Payer: Ohio Health Group HMO |
$7,264.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,937.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,259.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,002.58
|
| Rate for Payer: PHCS Commercial |
$9,298.30
|
| Rate for Payer: United Healthcare All Payer |
$8,523.44
|
|
