|
HUMERAL HD 24MMX52MM
|
Facility
|
OP
|
$9,227.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,199.59 |
| Max. Negotiated Rate |
$8,858.54 |
| Rate for Payer: Aetna Commercial |
$7,105.29
|
| Rate for Payer: Anthem Medicaid |
$3,173.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,197.57
|
| Rate for Payer: Cash Price |
$4,613.82
|
| Rate for Payer: Cigna Commercial |
$7,658.95
|
| Rate for Payer: First Health Commercial |
$8,766.27
|
| Rate for Payer: Humana Commercial |
$7,843.50
|
| Rate for Payer: Humana KY Medicaid |
$3,173.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3,205.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,566.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,810.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,768.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,237.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,120.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,920.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,845.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,199.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,860.57
|
| Rate for Payer: PHCS Commercial |
$8,858.54
|
| Rate for Payer: United Healthcare All Payer |
$8,120.33
|
|
|
HUMERAL HD 27MMX40MM
|
Facility
|
OP
|
$9,227.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,199.59 |
| Max. Negotiated Rate |
$8,858.54 |
| Rate for Payer: Aetna Commercial |
$7,105.29
|
| Rate for Payer: Anthem Medicaid |
$3,173.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,197.57
|
| Rate for Payer: Cash Price |
$4,613.82
|
| Rate for Payer: Cigna Commercial |
$7,658.95
|
| Rate for Payer: First Health Commercial |
$8,766.27
|
| Rate for Payer: Humana Commercial |
$7,843.50
|
| Rate for Payer: Humana KY Medicaid |
$3,173.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3,205.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,566.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,810.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,768.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,237.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,120.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,920.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,845.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,199.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,860.57
|
| Rate for Payer: PHCS Commercial |
$8,858.54
|
| Rate for Payer: United Healthcare All Payer |
$8,120.33
|
|
|
HUMERAL HD 27MMX40MM
|
Facility
|
IP
|
$9,227.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,199.59 |
| Max. Negotiated Rate |
$8,858.54 |
| Rate for Payer: Aetna Commercial |
$7,105.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,197.57
|
| Rate for Payer: Cash Price |
$4,613.82
|
| Rate for Payer: Cigna Commercial |
$7,658.95
|
| Rate for Payer: First Health Commercial |
$8,766.27
|
| Rate for Payer: Humana Commercial |
$7,843.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,566.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,810.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,768.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,120.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,920.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,845.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,199.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,860.57
|
| Rate for Payer: PHCS Commercial |
$8,858.54
|
| Rate for Payer: United Healthcare All Payer |
$8,120.33
|
|
|
HUMERAL HD 27MMX46MM
|
Facility
|
IP
|
$9,227.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,199.59 |
| Max. Negotiated Rate |
$8,858.54 |
| Rate for Payer: Aetna Commercial |
$7,105.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,197.57
|
| Rate for Payer: Cash Price |
$4,613.82
|
| Rate for Payer: Cigna Commercial |
$7,658.95
|
| Rate for Payer: First Health Commercial |
$8,766.27
|
| Rate for Payer: Humana Commercial |
$7,843.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,566.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,810.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,768.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,120.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,920.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,845.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,199.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,860.57
|
| Rate for Payer: PHCS Commercial |
$8,858.54
|
| Rate for Payer: United Healthcare All Payer |
$8,120.33
|
|
|
HUMERAL HD 27MMX46MM
|
Facility
|
OP
|
$9,227.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,199.59 |
| Max. Negotiated Rate |
$8,858.54 |
| Rate for Payer: Aetna Commercial |
$7,105.29
|
| Rate for Payer: Anthem Medicaid |
$3,173.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,197.57
|
| Rate for Payer: Cash Price |
$4,613.82
|
| Rate for Payer: Cigna Commercial |
$7,658.95
|
| Rate for Payer: First Health Commercial |
$8,766.27
|
| Rate for Payer: Humana Commercial |
$7,843.50
|
| Rate for Payer: Humana KY Medicaid |
$3,173.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3,205.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,566.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,810.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,768.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,237.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,120.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,920.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,845.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,199.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,860.57
|
| Rate for Payer: PHCS Commercial |
$8,858.54
|
| Rate for Payer: United Healthcare All Payer |
$8,120.33
|
|
|
HUMERAL HD 27MMX52MM
|
Facility
|
OP
|
$9,227.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,199.59 |
| Max. Negotiated Rate |
$8,858.54 |
| Rate for Payer: Aetna Commercial |
$7,105.29
|
| Rate for Payer: Anthem Medicaid |
$3,173.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,197.57
|
| Rate for Payer: Cash Price |
$4,613.82
|
| Rate for Payer: Cigna Commercial |
$7,658.95
|
| Rate for Payer: First Health Commercial |
$8,766.27
|
| Rate for Payer: Humana Commercial |
$7,843.50
|
| Rate for Payer: Humana KY Medicaid |
$3,173.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3,205.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,566.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,810.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,768.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,237.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,120.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,920.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,845.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,199.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,860.57
|
| Rate for Payer: PHCS Commercial |
$8,858.54
|
| Rate for Payer: United Healthcare All Payer |
$8,120.33
|
|
|
HUMERAL HD 27MMX52MM
|
Facility
|
IP
|
$9,227.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,199.59 |
| Max. Negotiated Rate |
$8,858.54 |
| Rate for Payer: Aetna Commercial |
$7,105.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,197.57
|
| Rate for Payer: Cash Price |
$4,613.82
|
| Rate for Payer: Cigna Commercial |
$7,658.95
|
| Rate for Payer: First Health Commercial |
$8,766.27
|
| Rate for Payer: Humana Commercial |
$7,843.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,566.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,810.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,768.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,120.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,920.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,845.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,199.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,860.57
|
| Rate for Payer: PHCS Commercial |
$8,858.54
|
| Rate for Payer: United Healthcare All Payer |
$8,120.33
|
|
|
HUMERAL HD 30MMX46MM
|
Facility
|
OP
|
$9,227.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,199.59 |
| Max. Negotiated Rate |
$8,858.54 |
| Rate for Payer: Aetna Commercial |
$7,105.29
|
| Rate for Payer: Anthem Medicaid |
$3,173.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,197.57
|
| Rate for Payer: Cash Price |
$4,613.82
|
| Rate for Payer: Cigna Commercial |
$7,658.95
|
| Rate for Payer: First Health Commercial |
$8,766.27
|
| Rate for Payer: Humana Commercial |
$7,843.50
|
| Rate for Payer: Humana KY Medicaid |
$3,173.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3,205.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,566.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,810.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,768.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,237.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,120.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,920.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,845.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,199.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,860.57
|
| Rate for Payer: PHCS Commercial |
$8,858.54
|
| Rate for Payer: United Healthcare All Payer |
$8,120.33
|
|
|
HUMERAL HD 30MMX46MM
|
Facility
|
IP
|
$9,227.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,199.59 |
| Max. Negotiated Rate |
$8,858.54 |
| Rate for Payer: Aetna Commercial |
$7,105.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,197.57
|
| Rate for Payer: Cash Price |
$4,613.82
|
| Rate for Payer: Cigna Commercial |
$7,658.95
|
| Rate for Payer: First Health Commercial |
$8,766.27
|
| Rate for Payer: Humana Commercial |
$7,843.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,566.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,810.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,768.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,120.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,920.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,845.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,199.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,860.57
|
| Rate for Payer: PHCS Commercial |
$8,858.54
|
| Rate for Payer: United Healthcare All Payer |
$8,120.33
|
|
|
HUMERAL HD 30MMX52MM
|
Facility
|
OP
|
$9,227.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,199.59 |
| Max. Negotiated Rate |
$8,858.54 |
| Rate for Payer: Aetna Commercial |
$7,105.29
|
| Rate for Payer: Anthem Medicaid |
$3,173.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,197.57
|
| Rate for Payer: Cash Price |
$4,613.82
|
| Rate for Payer: Cigna Commercial |
$7,658.95
|
| Rate for Payer: First Health Commercial |
$8,766.27
|
| Rate for Payer: Humana Commercial |
$7,843.50
|
| Rate for Payer: Humana KY Medicaid |
$3,173.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3,205.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,566.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,810.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,768.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,237.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,120.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,920.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,845.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,199.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,860.57
|
| Rate for Payer: PHCS Commercial |
$8,858.54
|
| Rate for Payer: United Healthcare All Payer |
$8,120.33
|
|
|
HUMERAL HD 30MMX52MM
|
Facility
|
IP
|
$9,227.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,199.59 |
| Max. Negotiated Rate |
$8,858.54 |
| Rate for Payer: Aetna Commercial |
$7,105.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,197.57
|
| Rate for Payer: Cash Price |
$4,613.82
|
| Rate for Payer: Cigna Commercial |
$7,658.95
|
| Rate for Payer: First Health Commercial |
$8,766.27
|
| Rate for Payer: Humana Commercial |
$7,843.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,566.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,810.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,768.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,120.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,920.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,845.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,199.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,860.57
|
| Rate for Payer: PHCS Commercial |
$8,858.54
|
| Rate for Payer: United Healthcare All Payer |
$8,120.33
|
|
|
HUMERAL HD 30MMX56MM
|
Facility
|
OP
|
$9,227.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,199.59 |
| Max. Negotiated Rate |
$8,858.54 |
| Rate for Payer: Aetna Commercial |
$7,105.29
|
| Rate for Payer: Anthem Medicaid |
$3,173.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,197.57
|
| Rate for Payer: Cash Price |
$4,613.82
|
| Rate for Payer: Cigna Commercial |
$7,658.95
|
| Rate for Payer: First Health Commercial |
$8,766.27
|
| Rate for Payer: Humana Commercial |
$7,843.50
|
| Rate for Payer: Humana KY Medicaid |
$3,173.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3,205.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,566.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,810.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,768.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,237.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,120.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,920.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,845.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,199.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,860.57
|
| Rate for Payer: PHCS Commercial |
$8,858.54
|
| Rate for Payer: United Healthcare All Payer |
$8,120.33
|
|
|
HUMERAL HD 30MMX56MM
|
Facility
|
IP
|
$9,227.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,199.59 |
| Max. Negotiated Rate |
$8,858.54 |
| Rate for Payer: Aetna Commercial |
$7,105.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,197.57
|
| Rate for Payer: Cash Price |
$4,613.82
|
| Rate for Payer: Cigna Commercial |
$7,658.95
|
| Rate for Payer: First Health Commercial |
$8,766.27
|
| Rate for Payer: Humana Commercial |
$7,843.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,566.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,810.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,768.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,120.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,920.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,845.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,199.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,860.57
|
| Rate for Payer: PHCS Commercial |
$8,858.54
|
| Rate for Payer: United Healthcare All Payer |
$8,120.33
|
|
|
HUMERAL HD 33MMX46MM
|
Facility
|
IP
|
$9,227.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,199.59 |
| Max. Negotiated Rate |
$8,858.54 |
| Rate for Payer: Aetna Commercial |
$7,105.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,197.57
|
| Rate for Payer: Cash Price |
$4,613.82
|
| Rate for Payer: Cigna Commercial |
$7,658.95
|
| Rate for Payer: First Health Commercial |
$8,766.27
|
| Rate for Payer: Humana Commercial |
$7,843.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,566.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,810.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,768.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,120.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,920.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,845.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,199.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,860.57
|
| Rate for Payer: PHCS Commercial |
$8,858.54
|
| Rate for Payer: United Healthcare All Payer |
$8,120.33
|
|
|
HUMERAL HD 33MMX46MM
|
Facility
|
OP
|
$9,227.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,199.59 |
| Max. Negotiated Rate |
$8,858.54 |
| Rate for Payer: Aetna Commercial |
$7,105.29
|
| Rate for Payer: Anthem Medicaid |
$3,173.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,197.57
|
| Rate for Payer: Cash Price |
$4,613.82
|
| Rate for Payer: Cigna Commercial |
$7,658.95
|
| Rate for Payer: First Health Commercial |
$8,766.27
|
| Rate for Payer: Humana Commercial |
$7,843.50
|
| Rate for Payer: Humana KY Medicaid |
$3,173.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3,205.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,566.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,810.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,768.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,237.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,120.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,920.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,845.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,199.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,860.57
|
| Rate for Payer: PHCS Commercial |
$8,858.54
|
| Rate for Payer: United Healthcare All Payer |
$8,120.33
|
|
|
HUMERAL HD 33MMX52MM
|
Facility
|
IP
|
$9,227.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,199.59 |
| Max. Negotiated Rate |
$8,858.54 |
| Rate for Payer: Aetna Commercial |
$7,105.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,197.57
|
| Rate for Payer: Cash Price |
$4,613.82
|
| Rate for Payer: Cigna Commercial |
$7,658.95
|
| Rate for Payer: First Health Commercial |
$8,766.27
|
| Rate for Payer: Humana Commercial |
$7,843.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,566.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,810.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,768.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,120.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,920.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,845.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,199.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,860.57
|
| Rate for Payer: PHCS Commercial |
$8,858.54
|
| Rate for Payer: United Healthcare All Payer |
$8,120.33
|
|
|
HUMERAL HD 33MMX52MM
|
Facility
|
OP
|
$9,227.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,199.59 |
| Max. Negotiated Rate |
$8,858.54 |
| Rate for Payer: Aetna Commercial |
$7,105.29
|
| Rate for Payer: Anthem Medicaid |
$3,173.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,197.57
|
| Rate for Payer: Cash Price |
$4,613.82
|
| Rate for Payer: Cigna Commercial |
$7,658.95
|
| Rate for Payer: First Health Commercial |
$8,766.27
|
| Rate for Payer: Humana Commercial |
$7,843.50
|
| Rate for Payer: Humana KY Medicaid |
$3,173.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3,205.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,566.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,810.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,768.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,237.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,120.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,920.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,845.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,199.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,860.57
|
| Rate for Payer: PHCS Commercial |
$8,858.54
|
| Rate for Payer: United Healthcare All Payer |
$8,120.33
|
|
|
HUMERAL HD 33MMX56MM
|
Facility
|
OP
|
$9,227.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,199.59 |
| Max. Negotiated Rate |
$8,858.54 |
| Rate for Payer: Aetna Commercial |
$7,105.29
|
| Rate for Payer: Anthem Medicaid |
$3,173.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,197.57
|
| Rate for Payer: Cash Price |
$4,613.82
|
| Rate for Payer: Cigna Commercial |
$7,658.95
|
| Rate for Payer: First Health Commercial |
$8,766.27
|
| Rate for Payer: Humana Commercial |
$7,843.50
|
| Rate for Payer: Humana KY Medicaid |
$3,173.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3,205.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,566.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,810.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,768.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,237.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,120.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,920.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,845.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,199.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,860.57
|
| Rate for Payer: PHCS Commercial |
$8,858.54
|
| Rate for Payer: United Healthcare All Payer |
$8,120.33
|
|
|
HUMERAL HD 33MMX56MM
|
Facility
|
IP
|
$9,227.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,199.59 |
| Max. Negotiated Rate |
$8,858.54 |
| Rate for Payer: Aetna Commercial |
$7,105.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,197.57
|
| Rate for Payer: Cash Price |
$4,613.82
|
| Rate for Payer: Cigna Commercial |
$7,658.95
|
| Rate for Payer: First Health Commercial |
$8,766.27
|
| Rate for Payer: Humana Commercial |
$7,843.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,566.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,810.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,768.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,120.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,920.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,845.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,199.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,860.57
|
| Rate for Payer: PHCS Commercial |
$8,858.54
|
| Rate for Payer: United Healthcare All Payer |
$8,120.33
|
|
|
HUMERAL HD. 36MMX52MM
|
Facility
|
OP
|
$9,227.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,199.59 |
| Max. Negotiated Rate |
$8,858.54 |
| Rate for Payer: Aetna Commercial |
$7,105.29
|
| Rate for Payer: Anthem Medicaid |
$3,173.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,197.57
|
| Rate for Payer: Cash Price |
$4,613.82
|
| Rate for Payer: Cigna Commercial |
$7,658.95
|
| Rate for Payer: First Health Commercial |
$8,766.27
|
| Rate for Payer: Humana Commercial |
$7,843.50
|
| Rate for Payer: Humana KY Medicaid |
$3,173.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3,205.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,566.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,810.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,768.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,237.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,120.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,920.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,845.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,199.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,860.57
|
| Rate for Payer: PHCS Commercial |
$8,858.54
|
| Rate for Payer: United Healthcare All Payer |
$8,120.33
|
|
|
HUMERAL HD. 36MMX52MM
|
Facility
|
IP
|
$9,227.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,199.59 |
| Max. Negotiated Rate |
$8,858.54 |
| Rate for Payer: Aetna Commercial |
$7,105.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,197.57
|
| Rate for Payer: Cash Price |
$4,613.82
|
| Rate for Payer: Cigna Commercial |
$7,658.95
|
| Rate for Payer: First Health Commercial |
$8,766.27
|
| Rate for Payer: Humana Commercial |
$7,843.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,566.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,810.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,768.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,120.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,920.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,845.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,199.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,860.57
|
| Rate for Payer: PHCS Commercial |
$8,858.54
|
| Rate for Payer: United Healthcare All Payer |
$8,120.33
|
|
|
HUMERAL HD 36MMX56MM
|
Facility
|
OP
|
$9,227.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,199.59 |
| Max. Negotiated Rate |
$8,858.54 |
| Rate for Payer: Aetna Commercial |
$7,105.29
|
| Rate for Payer: Anthem Medicaid |
$3,173.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,197.57
|
| Rate for Payer: Cash Price |
$4,613.82
|
| Rate for Payer: Cigna Commercial |
$7,658.95
|
| Rate for Payer: First Health Commercial |
$8,766.27
|
| Rate for Payer: Humana Commercial |
$7,843.50
|
| Rate for Payer: Humana KY Medicaid |
$3,173.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3,205.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,566.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,810.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,768.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,237.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,120.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,920.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,845.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,199.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,860.57
|
| Rate for Payer: PHCS Commercial |
$8,858.54
|
| Rate for Payer: United Healthcare All Payer |
$8,120.33
|
|
|
HUMERAL HD 36MMX56MM
|
Facility
|
IP
|
$9,227.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,199.59 |
| Max. Negotiated Rate |
$8,858.54 |
| Rate for Payer: Aetna Commercial |
$7,105.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,197.57
|
| Rate for Payer: Cash Price |
$4,613.82
|
| Rate for Payer: Cigna Commercial |
$7,658.95
|
| Rate for Payer: First Health Commercial |
$8,766.27
|
| Rate for Payer: Humana Commercial |
$7,843.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,566.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,810.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,768.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,120.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,920.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,845.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,199.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,860.57
|
| Rate for Payer: PHCS Commercial |
$8,858.54
|
| Rate for Payer: United Healthcare All Payer |
$8,120.33
|
|
|
HUMERAL HD 39MMX56MM
|
Facility
|
IP
|
$9,227.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,199.59 |
| Max. Negotiated Rate |
$8,858.54 |
| Rate for Payer: Aetna Commercial |
$7,105.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,197.57
|
| Rate for Payer: Cash Price |
$4,613.82
|
| Rate for Payer: Cigna Commercial |
$7,658.95
|
| Rate for Payer: First Health Commercial |
$8,766.27
|
| Rate for Payer: Humana Commercial |
$7,843.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,566.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,810.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,768.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,120.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,920.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,845.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,199.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,860.57
|
| Rate for Payer: PHCS Commercial |
$8,858.54
|
| Rate for Payer: United Healthcare All Payer |
$8,120.33
|
|
|
HUMERAL HD 39MMX56MM
|
Facility
|
OP
|
$9,227.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,199.59 |
| Max. Negotiated Rate |
$8,858.54 |
| Rate for Payer: Aetna Commercial |
$7,105.29
|
| Rate for Payer: Anthem Medicaid |
$3,173.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,197.57
|
| Rate for Payer: Cash Price |
$4,613.82
|
| Rate for Payer: Cigna Commercial |
$7,658.95
|
| Rate for Payer: First Health Commercial |
$8,766.27
|
| Rate for Payer: Humana Commercial |
$7,843.50
|
| Rate for Payer: Humana KY Medicaid |
$3,173.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3,205.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,566.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,810.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,768.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,237.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,120.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,920.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,845.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,199.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,860.57
|
| Rate for Payer: PHCS Commercial |
$8,858.54
|
| Rate for Payer: United Healthcare All Payer |
$8,120.33
|
|
