|
HED FRACTURE MOD CATHCART 46MM
|
Facility
|
OP
|
$5,480.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,644.00 |
| Max. Negotiated Rate |
$5,260.80 |
| Rate for Payer: Aetna Commercial |
$4,219.60
|
| Rate for Payer: Anthem Medicaid |
$1,884.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,274.40
|
| Rate for Payer: Cash Price |
$2,740.00
|
| Rate for Payer: Cigna Commercial |
$4,548.40
|
| Rate for Payer: First Health Commercial |
$5,206.00
|
| Rate for Payer: Humana Commercial |
$4,658.00
|
| Rate for Payer: Humana KY Medicaid |
$1,884.57
|
| Rate for Payer: Kentucky WC Medicaid |
$1,903.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,493.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,044.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,644.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,922.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,822.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,110.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,384.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,767.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,781.20
|
| Rate for Payer: PHCS Commercial |
$5,260.80
|
| Rate for Payer: United Healthcare All Payer |
$4,822.40
|
|
|
HED FRACTURE MOD CATHCART 48MM
|
Facility
|
IP
|
$5,480.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,644.00 |
| Max. Negotiated Rate |
$5,260.80 |
| Rate for Payer: Aetna Commercial |
$4,219.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,274.40
|
| Rate for Payer: Cash Price |
$2,740.00
|
| Rate for Payer: Cigna Commercial |
$4,548.40
|
| Rate for Payer: First Health Commercial |
$5,206.00
|
| Rate for Payer: Humana Commercial |
$4,658.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,493.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,044.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,644.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,822.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,110.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,384.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,767.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,781.20
|
| Rate for Payer: PHCS Commercial |
$5,260.80
|
| Rate for Payer: United Healthcare All Payer |
$4,822.40
|
|
|
HED FRACTURE MOD CATHCART 48MM
|
Facility
|
OP
|
$5,480.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,644.00 |
| Max. Negotiated Rate |
$5,260.80 |
| Rate for Payer: Aetna Commercial |
$4,219.60
|
| Rate for Payer: Anthem Medicaid |
$1,884.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,274.40
|
| Rate for Payer: Cash Price |
$2,740.00
|
| Rate for Payer: Cigna Commercial |
$4,548.40
|
| Rate for Payer: First Health Commercial |
$5,206.00
|
| Rate for Payer: Humana Commercial |
$4,658.00
|
| Rate for Payer: Humana KY Medicaid |
$1,884.57
|
| Rate for Payer: Kentucky WC Medicaid |
$1,903.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,493.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,044.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,644.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,922.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,822.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,110.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,384.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,767.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,781.20
|
| Rate for Payer: PHCS Commercial |
$5,260.80
|
| Rate for Payer: United Healthcare All Payer |
$4,822.40
|
|
|
HED FRACTURE MOD CATHCART 49MM
|
Facility
|
OP
|
$5,480.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,644.00 |
| Max. Negotiated Rate |
$5,260.80 |
| Rate for Payer: Aetna Commercial |
$4,219.60
|
| Rate for Payer: Anthem Medicaid |
$1,884.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,274.40
|
| Rate for Payer: Cash Price |
$2,740.00
|
| Rate for Payer: Cigna Commercial |
$4,548.40
|
| Rate for Payer: First Health Commercial |
$5,206.00
|
| Rate for Payer: Humana Commercial |
$4,658.00
|
| Rate for Payer: Humana KY Medicaid |
$1,884.57
|
| Rate for Payer: Kentucky WC Medicaid |
$1,903.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,493.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,044.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,644.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,922.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,822.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,110.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,384.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,767.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,781.20
|
| Rate for Payer: PHCS Commercial |
$5,260.80
|
| Rate for Payer: United Healthcare All Payer |
$4,822.40
|
|
|
HED FRACTURE MOD CATHCART 49MM
|
Facility
|
IP
|
$5,480.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,644.00 |
| Max. Negotiated Rate |
$5,260.80 |
| Rate for Payer: Aetna Commercial |
$4,219.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,274.40
|
| Rate for Payer: Cash Price |
$2,740.00
|
| Rate for Payer: Cigna Commercial |
$4,548.40
|
| Rate for Payer: First Health Commercial |
$5,206.00
|
| Rate for Payer: Humana Commercial |
$4,658.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,493.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,044.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,644.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,822.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,110.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,384.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,767.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,781.20
|
| Rate for Payer: PHCS Commercial |
$5,260.80
|
| Rate for Payer: United Healthcare All Payer |
$4,822.40
|
|
|
HED FRACTURE MOD CATHCART 56MM
|
Facility
|
OP
|
$5,480.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,644.00 |
| Max. Negotiated Rate |
$5,260.80 |
| Rate for Payer: Aetna Commercial |
$4,219.60
|
| Rate for Payer: Anthem Medicaid |
$1,884.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,274.40
|
| Rate for Payer: Cash Price |
$2,740.00
|
| Rate for Payer: Cigna Commercial |
$4,548.40
|
| Rate for Payer: First Health Commercial |
$5,206.00
|
| Rate for Payer: Humana Commercial |
$4,658.00
|
| Rate for Payer: Humana KY Medicaid |
$1,884.57
|
| Rate for Payer: Kentucky WC Medicaid |
$1,903.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,493.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,044.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,644.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,922.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,822.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,110.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,384.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,767.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,781.20
|
| Rate for Payer: PHCS Commercial |
$5,260.80
|
| Rate for Payer: United Healthcare All Payer |
$4,822.40
|
|
|
HED FRACTURE MOD CATHCART 56MM
|
Facility
|
IP
|
$5,480.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,644.00 |
| Max. Negotiated Rate |
$5,260.80 |
| Rate for Payer: Aetna Commercial |
$4,219.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,274.40
|
| Rate for Payer: Cash Price |
$2,740.00
|
| Rate for Payer: Cigna Commercial |
$4,548.40
|
| Rate for Payer: First Health Commercial |
$5,206.00
|
| Rate for Payer: Humana Commercial |
$4,658.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,493.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,044.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,644.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,822.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,110.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,384.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,767.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,781.20
|
| Rate for Payer: PHCS Commercial |
$5,260.80
|
| Rate for Payer: United Healthcare All Payer |
$4,822.40
|
|
|
HED HIP BALL MOD CATHCART 52MM
|
Facility
|
IP
|
$4,280.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,284.00 |
| Max. Negotiated Rate |
$4,108.80 |
| Rate for Payer: Aetna Commercial |
$3,295.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,338.40
|
| Rate for Payer: Cash Price |
$2,140.00
|
| Rate for Payer: Cigna Commercial |
$3,552.40
|
| Rate for Payer: First Health Commercial |
$4,066.00
|
| Rate for Payer: Humana Commercial |
$3,638.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,509.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,158.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,284.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,766.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,210.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,424.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,723.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,953.20
|
| Rate for Payer: PHCS Commercial |
$4,108.80
|
| Rate for Payer: United Healthcare All Payer |
$3,766.40
|
|
|
HED HIP BALL MOD CATHCART 52MM
|
Facility
|
OP
|
$4,280.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,284.00 |
| Max. Negotiated Rate |
$4,108.80 |
| Rate for Payer: Aetna Commercial |
$3,295.60
|
| Rate for Payer: Anthem Medicaid |
$1,471.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,338.40
|
| Rate for Payer: Cash Price |
$2,140.00
|
| Rate for Payer: Cigna Commercial |
$3,552.40
|
| Rate for Payer: First Health Commercial |
$4,066.00
|
| Rate for Payer: Humana Commercial |
$3,638.00
|
| Rate for Payer: Humana KY Medicaid |
$1,471.89
|
| Rate for Payer: Kentucky WC Medicaid |
$1,486.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,509.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,158.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,284.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,501.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,766.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,210.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,424.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,723.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,953.20
|
| Rate for Payer: PHCS Commercial |
$4,108.80
|
| Rate for Payer: United Healthcare All Payer |
$3,766.40
|
|
|
HED HUM COFILD LAT OFFST 28*46
|
Facility
|
IP
|
$5,206.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,561.88 |
| Max. Negotiated Rate |
$4,998.00 |
| Rate for Payer: Aetna Commercial |
$4,008.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,060.88
|
| Rate for Payer: Cash Price |
$2,603.12
|
| Rate for Payer: Cigna Commercial |
$4,321.19
|
| Rate for Payer: First Health Commercial |
$4,945.94
|
| Rate for Payer: Humana Commercial |
$4,425.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,269.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,842.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,561.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,581.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,904.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,165.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,529.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,592.31
|
| Rate for Payer: PHCS Commercial |
$4,998.00
|
| Rate for Payer: United Healthcare All Payer |
$4,581.50
|
|
|
HED HUM COFILD LAT OFFST 28*46
|
Facility
|
OP
|
$5,206.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,561.88 |
| Max. Negotiated Rate |
$4,998.00 |
| Rate for Payer: Aetna Commercial |
$4,008.81
|
| Rate for Payer: Anthem Medicaid |
$1,790.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,060.88
|
| Rate for Payer: Cash Price |
$2,603.12
|
| Rate for Payer: Cigna Commercial |
$4,321.19
|
| Rate for Payer: First Health Commercial |
$4,945.94
|
| Rate for Payer: Humana Commercial |
$4,425.31
|
| Rate for Payer: Humana KY Medicaid |
$1,790.43
|
| Rate for Payer: Kentucky WC Medicaid |
$1,808.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,269.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,842.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,561.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,826.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,581.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,904.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,165.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,529.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,592.31
|
| Rate for Payer: PHCS Commercial |
$4,998.00
|
| Rate for Payer: United Healthcare All Payer |
$4,581.50
|
|
|
HED LEGACY COCR 12/14 22MM+3.5
|
Facility
|
OP
|
$4,315.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,294.69 |
| Max. Negotiated Rate |
$4,143.00 |
| Rate for Payer: Aetna Commercial |
$3,323.03
|
| Rate for Payer: Anthem Medicaid |
$1,484.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,366.18
|
| Rate for Payer: Cash Price |
$2,157.81
|
| Rate for Payer: Cigna Commercial |
$3,581.96
|
| Rate for Payer: First Health Commercial |
$4,099.84
|
| Rate for Payer: Humana Commercial |
$3,668.28
|
| Rate for Payer: Humana KY Medicaid |
$1,484.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,499.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,538.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,184.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,294.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,513.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,797.75
|
| Rate for Payer: Ohio Health Group HMO |
$3,236.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,452.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,754.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,977.78
|
| Rate for Payer: PHCS Commercial |
$4,143.00
|
| Rate for Payer: United Healthcare All Payer |
$3,797.75
|
|
|
HED LEGACY COCR 12/14 22MM+3.5
|
Facility
|
IP
|
$4,315.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,294.69 |
| Max. Negotiated Rate |
$4,143.00 |
| Rate for Payer: Aetna Commercial |
$3,323.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,366.18
|
| Rate for Payer: Cash Price |
$2,157.81
|
| Rate for Payer: Cigna Commercial |
$3,581.96
|
| Rate for Payer: First Health Commercial |
$4,099.84
|
| Rate for Payer: Humana Commercial |
$3,668.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,538.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,184.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,294.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,797.75
|
| Rate for Payer: Ohio Health Group HMO |
$3,236.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,452.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,754.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,977.78
|
| Rate for Payer: PHCS Commercial |
$4,143.00
|
| Rate for Payer: United Healthcare All Payer |
$3,797.75
|
|
|
HED LEGACY COCR 12/14 26MM+3.5
|
Facility
|
IP
|
$4,315.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,294.69 |
| Max. Negotiated Rate |
$4,143.00 |
| Rate for Payer: Aetna Commercial |
$3,323.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,366.18
|
| Rate for Payer: Cash Price |
$2,157.81
|
| Rate for Payer: Cigna Commercial |
$3,581.96
|
| Rate for Payer: First Health Commercial |
$4,099.84
|
| Rate for Payer: Humana Commercial |
$3,668.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,538.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,184.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,294.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,797.75
|
| Rate for Payer: Ohio Health Group HMO |
$3,236.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,452.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,754.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,977.78
|
| Rate for Payer: PHCS Commercial |
$4,143.00
|
| Rate for Payer: United Healthcare All Payer |
$3,797.75
|
|
|
HED LEGACY COCR 12/14 26MM+3.5
|
Facility
|
OP
|
$4,315.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,294.69 |
| Max. Negotiated Rate |
$4,143.00 |
| Rate for Payer: Aetna Commercial |
$3,323.03
|
| Rate for Payer: Anthem Medicaid |
$1,484.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,366.18
|
| Rate for Payer: Cash Price |
$2,157.81
|
| Rate for Payer: Cigna Commercial |
$3,581.96
|
| Rate for Payer: First Health Commercial |
$4,099.84
|
| Rate for Payer: Humana Commercial |
$3,668.28
|
| Rate for Payer: Humana KY Medicaid |
$1,484.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,499.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,538.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,184.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,294.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,513.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,797.75
|
| Rate for Payer: Ohio Health Group HMO |
$3,236.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,452.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,754.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,977.78
|
| Rate for Payer: PHCS Commercial |
$4,143.00
|
| Rate for Payer: United Healthcare All Payer |
$3,797.75
|
|
|
HED LEGCY COCR 12/14 26MM -3.5
|
Facility
|
IP
|
$4,315.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,294.69 |
| Max. Negotiated Rate |
$4,143.00 |
| Rate for Payer: Aetna Commercial |
$3,323.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,366.18
|
| Rate for Payer: Cash Price |
$2,157.81
|
| Rate for Payer: Cigna Commercial |
$3,581.96
|
| Rate for Payer: First Health Commercial |
$4,099.84
|
| Rate for Payer: Humana Commercial |
$3,668.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,538.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,184.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,294.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,797.75
|
| Rate for Payer: Ohio Health Group HMO |
$3,236.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,452.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,754.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,977.78
|
| Rate for Payer: PHCS Commercial |
$4,143.00
|
| Rate for Payer: United Healthcare All Payer |
$3,797.75
|
|
|
HED LEGCY COCR 12/14 26MM -3.5
|
Facility
|
OP
|
$4,315.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,294.69 |
| Max. Negotiated Rate |
$4,143.00 |
| Rate for Payer: Aetna Commercial |
$3,323.03
|
| Rate for Payer: Anthem Medicaid |
$1,484.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,366.18
|
| Rate for Payer: Cash Price |
$2,157.81
|
| Rate for Payer: Cigna Commercial |
$3,581.96
|
| Rate for Payer: First Health Commercial |
$4,099.84
|
| Rate for Payer: Humana Commercial |
$3,668.28
|
| Rate for Payer: Humana KY Medicaid |
$1,484.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,499.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,538.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,184.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,294.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,513.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,797.75
|
| Rate for Payer: Ohio Health Group HMO |
$3,236.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,452.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,754.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,977.78
|
| Rate for Payer: PHCS Commercial |
$4,143.00
|
| Rate for Payer: United Healthcare All Payer |
$3,797.75
|
|
|
HED LEGCY PRCR 12/14 26MM+10.5
|
Facility
|
OP
|
$4,315.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,294.69 |
| Max. Negotiated Rate |
$4,143.00 |
| Rate for Payer: Aetna Commercial |
$3,323.03
|
| Rate for Payer: Anthem Medicaid |
$1,484.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,366.18
|
| Rate for Payer: Cash Price |
$2,157.81
|
| Rate for Payer: Cigna Commercial |
$3,581.96
|
| Rate for Payer: First Health Commercial |
$4,099.84
|
| Rate for Payer: Humana Commercial |
$3,668.28
|
| Rate for Payer: Humana KY Medicaid |
$1,484.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,499.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,538.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,184.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,294.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,513.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,797.75
|
| Rate for Payer: Ohio Health Group HMO |
$3,236.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,452.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,754.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,977.78
|
| Rate for Payer: PHCS Commercial |
$4,143.00
|
| Rate for Payer: United Healthcare All Payer |
$3,797.75
|
|
|
HED LEGCY PRCR 12/14 26MM+10.5
|
Facility
|
IP
|
$4,315.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,294.69 |
| Max. Negotiated Rate |
$4,143.00 |
| Rate for Payer: Aetna Commercial |
$3,323.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,366.18
|
| Rate for Payer: Cash Price |
$2,157.81
|
| Rate for Payer: Cigna Commercial |
$3,581.96
|
| Rate for Payer: First Health Commercial |
$4,099.84
|
| Rate for Payer: Humana Commercial |
$3,668.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,538.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,184.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,294.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,797.75
|
| Rate for Payer: Ohio Health Group HMO |
$3,236.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,452.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,754.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,977.78
|
| Rate for Payer: PHCS Commercial |
$4,143.00
|
| Rate for Payer: United Healthcare All Payer |
$3,797.75
|
|
|
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 |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| 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
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| 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
|
IP
|
$4,315.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,294.69 |
| Max. Negotiated Rate |
$4,143.00 |
| Rate for Payer: Aetna Commercial |
$3,323.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,366.18
|
| Rate for Payer: Cash Price |
$2,157.81
|
| Rate for Payer: Cigna Commercial |
$3,581.96
|
| Rate for Payer: First Health Commercial |
$4,099.84
|
| Rate for Payer: Humana Commercial |
$3,668.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,538.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,184.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,294.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,797.75
|
| Rate for Payer: Ohio Health Group HMO |
$3,236.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,452.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,754.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,977.78
|
| Rate for Payer: PHCS Commercial |
$4,143.00
|
| Rate for Payer: United Healthcare All Payer |
$3,797.75
|
|
|
HED LEGCY PRCR 12/14 28MM -3.5
|
Facility
|
OP
|
$4,315.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,294.69 |
| Max. Negotiated Rate |
$4,143.00 |
| Rate for Payer: Aetna Commercial |
$3,323.03
|
| Rate for Payer: Anthem Medicaid |
$1,484.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,366.18
|
| Rate for Payer: Cash Price |
$2,157.81
|
| Rate for Payer: Cigna Commercial |
$3,581.96
|
| Rate for Payer: First Health Commercial |
$4,099.84
|
| Rate for Payer: Humana Commercial |
$3,668.28
|
| Rate for Payer: Humana KY Medicaid |
$1,484.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,499.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,538.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,184.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,294.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,513.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,797.75
|
| Rate for Payer: Ohio Health Group HMO |
$3,236.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,452.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,754.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,977.78
|
| Rate for Payer: PHCS Commercial |
$4,143.00
|
| Rate for Payer: United Healthcare All Payer |
$3,797.75
|
|
|
HED LEGCY PRCR 12/14 32MM+10.5
|
Facility
|
OP
|
$4,315.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,294.69 |
| Max. Negotiated Rate |
$4,143.00 |
| Rate for Payer: Aetna Commercial |
$3,323.03
|
| Rate for Payer: Anthem Medicaid |
$1,484.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,366.18
|
| Rate for Payer: Cash Price |
$2,157.81
|
| Rate for Payer: Cigna Commercial |
$3,581.96
|
| Rate for Payer: First Health Commercial |
$4,099.84
|
| Rate for Payer: Humana Commercial |
$3,668.28
|
| Rate for Payer: Humana KY Medicaid |
$1,484.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,499.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,538.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,184.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,294.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,513.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,797.75
|
| Rate for Payer: Ohio Health Group HMO |
$3,236.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,452.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,754.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,977.78
|
| Rate for Payer: PHCS Commercial |
$4,143.00
|
| Rate for Payer: United Healthcare All Payer |
$3,797.75
|
|
|
HED LEGCY PRCR 12/14 32MM+10.5
|
Facility
|
IP
|
$4,315.62
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,294.69 |
| Max. Negotiated Rate |
$4,143.00 |
| Rate for Payer: Aetna Commercial |
$3,323.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,366.18
|
| Rate for Payer: Cash Price |
$2,157.81
|
| Rate for Payer: Cigna Commercial |
$3,581.96
|
| Rate for Payer: First Health Commercial |
$4,099.84
|
| Rate for Payer: Humana Commercial |
$3,668.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,538.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,184.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,294.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,797.75
|
| Rate for Payer: Ohio Health Group HMO |
$3,236.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,452.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,754.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,977.78
|
| Rate for Payer: PHCS Commercial |
$4,143.00
|
| Rate for Payer: United Healthcare All Payer |
$3,797.75
|
|
