|
HEMI-CAP 12MM ARTCMP 1.5M*2.5M
|
Facility
|
OP
|
$10,840.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,252.00 |
| Max. Negotiated Rate |
$10,406.40 |
| Rate for Payer: Aetna Commercial |
$8,346.80
|
| Rate for Payer: Anthem Medicaid |
$3,727.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,455.20
|
| Rate for Payer: Cash Price |
$5,420.00
|
| Rate for Payer: Cigna Commercial |
$8,997.20
|
| Rate for Payer: First Health Commercial |
$10,298.00
|
| Rate for Payer: Humana Commercial |
$9,214.00
|
| Rate for Payer: Humana KY Medicaid |
$3,727.88
|
| Rate for Payer: Kentucky WC Medicaid |
$3,765.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,888.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,999.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,252.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,802.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,539.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,130.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,430.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,479.60
|
| Rate for Payer: PHCS Commercial |
$10,406.40
|
| Rate for Payer: United Healthcare All Payer |
$9,539.20
|
|
|
HEMI-CAP 12MM ARTCMP 2.0M*2.5M
|
Facility
|
OP
|
$10,840.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,252.00 |
| Max. Negotiated Rate |
$10,406.40 |
| Rate for Payer: Aetna Commercial |
$8,346.80
|
| Rate for Payer: Anthem Medicaid |
$3,727.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,455.20
|
| Rate for Payer: Cash Price |
$5,420.00
|
| Rate for Payer: Cigna Commercial |
$8,997.20
|
| Rate for Payer: First Health Commercial |
$10,298.00
|
| Rate for Payer: Humana Commercial |
$9,214.00
|
| Rate for Payer: Humana KY Medicaid |
$3,727.88
|
| Rate for Payer: Kentucky WC Medicaid |
$3,765.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,888.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,999.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,252.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,802.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,539.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,130.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,430.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,479.60
|
| Rate for Payer: PHCS Commercial |
$10,406.40
|
| Rate for Payer: United Healthcare All Payer |
$9,539.20
|
|
|
HEMI-CAP 12MM ARTCMP 2.0M*2.5M
|
Facility
|
IP
|
$10,840.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,252.00 |
| Max. Negotiated Rate |
$10,406.40 |
| Rate for Payer: Aetna Commercial |
$8,346.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,455.20
|
| Rate for Payer: Cash Price |
$5,420.00
|
| Rate for Payer: Cigna Commercial |
$8,997.20
|
| Rate for Payer: First Health Commercial |
$10,298.00
|
| Rate for Payer: Humana Commercial |
$9,214.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,888.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,999.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,252.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,539.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,130.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,430.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,479.60
|
| Rate for Payer: PHCS Commercial |
$10,406.40
|
| Rate for Payer: United Healthcare All Payer |
$9,539.20
|
|
|
HEMI-CAP 12MM ARTCMP 2.0M*3.0M
|
Facility
|
OP
|
$10,840.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,252.00 |
| Max. Negotiated Rate |
$10,406.40 |
| Rate for Payer: Aetna Commercial |
$8,346.80
|
| Rate for Payer: Anthem Medicaid |
$3,727.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,455.20
|
| Rate for Payer: Cash Price |
$5,420.00
|
| Rate for Payer: Cigna Commercial |
$8,997.20
|
| Rate for Payer: First Health Commercial |
$10,298.00
|
| Rate for Payer: Humana Commercial |
$9,214.00
|
| Rate for Payer: Humana KY Medicaid |
$3,727.88
|
| Rate for Payer: Kentucky WC Medicaid |
$3,765.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,888.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,999.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,252.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,802.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,539.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,130.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,430.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,479.60
|
| Rate for Payer: PHCS Commercial |
$10,406.40
|
| Rate for Payer: United Healthcare All Payer |
$9,539.20
|
|
|
HEMI-CAP 12MM ARTCMP 2.0M*3.0M
|
Facility
|
IP
|
$10,840.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,252.00 |
| Max. Negotiated Rate |
$10,406.40 |
| Rate for Payer: Aetna Commercial |
$8,346.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,455.20
|
| Rate for Payer: Cash Price |
$5,420.00
|
| Rate for Payer: Cigna Commercial |
$8,997.20
|
| Rate for Payer: First Health Commercial |
$10,298.00
|
| Rate for Payer: Humana Commercial |
$9,214.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,888.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,999.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,252.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,539.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,130.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,430.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,479.60
|
| Rate for Payer: PHCS Commercial |
$10,406.40
|
| Rate for Payer: United Healthcare All Payer |
$9,539.20
|
|
|
HEMI-CAP 15MM ARTCMP 1.5M*2.5M
|
Facility
|
IP
|
$10,840.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,252.00 |
| Max. Negotiated Rate |
$10,406.40 |
| Rate for Payer: Aetna Commercial |
$8,346.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,455.20
|
| Rate for Payer: Cash Price |
$5,420.00
|
| Rate for Payer: Cigna Commercial |
$8,997.20
|
| Rate for Payer: First Health Commercial |
$10,298.00
|
| Rate for Payer: Humana Commercial |
$9,214.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,888.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,999.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,252.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,539.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,130.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,430.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,479.60
|
| Rate for Payer: PHCS Commercial |
$10,406.40
|
| Rate for Payer: United Healthcare All Payer |
$9,539.20
|
|
|
HEMI-CAP 15MM ARTCMP 1.5M*2.5M
|
Facility
|
OP
|
$10,840.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,252.00 |
| Max. Negotiated Rate |
$10,406.40 |
| Rate for Payer: Aetna Commercial |
$8,346.80
|
| Rate for Payer: Anthem Medicaid |
$3,727.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,455.20
|
| Rate for Payer: Cash Price |
$5,420.00
|
| Rate for Payer: Cigna Commercial |
$8,997.20
|
| Rate for Payer: First Health Commercial |
$10,298.00
|
| Rate for Payer: Humana Commercial |
$9,214.00
|
| Rate for Payer: Humana KY Medicaid |
$3,727.88
|
| Rate for Payer: Kentucky WC Medicaid |
$3,765.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,888.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,999.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,252.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,802.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,539.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,130.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,430.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,479.60
|
| Rate for Payer: PHCS Commercial |
$10,406.40
|
| Rate for Payer: United Healthcare All Payer |
$9,539.20
|
|
|
HEMI-CAP 15MM ARTCMP 2.0M*3.0M
|
Facility
|
OP
|
$10,840.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,252.00 |
| Max. Negotiated Rate |
$10,406.40 |
| Rate for Payer: Aetna Commercial |
$8,346.80
|
| Rate for Payer: Anthem Medicaid |
$3,727.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,455.20
|
| Rate for Payer: Cash Price |
$5,420.00
|
| Rate for Payer: Cigna Commercial |
$8,997.20
|
| Rate for Payer: First Health Commercial |
$10,298.00
|
| Rate for Payer: Humana Commercial |
$9,214.00
|
| Rate for Payer: Humana KY Medicaid |
$3,727.88
|
| Rate for Payer: Kentucky WC Medicaid |
$3,765.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,888.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,999.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,252.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,802.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,539.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,130.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,430.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,479.60
|
| Rate for Payer: PHCS Commercial |
$10,406.40
|
| Rate for Payer: United Healthcare All Payer |
$9,539.20
|
|
|
HEMI-CAP 15MM ARTCMP 2.0M*3.0M
|
Facility
|
IP
|
$10,840.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,252.00 |
| Max. Negotiated Rate |
$10,406.40 |
| Rate for Payer: Aetna Commercial |
$8,346.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,455.20
|
| Rate for Payer: Cash Price |
$5,420.00
|
| Rate for Payer: Cigna Commercial |
$8,997.20
|
| Rate for Payer: First Health Commercial |
$10,298.00
|
| Rate for Payer: Humana Commercial |
$9,214.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,888.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,999.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,252.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,539.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,130.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,430.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,479.60
|
| Rate for Payer: PHCS Commercial |
$10,406.40
|
| Rate for Payer: United Healthcare All Payer |
$9,539.20
|
|
|
HEMI-CAP 15MM ARTCMP 2.0M*4.0M
|
Facility
|
OP
|
$10,840.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,252.00 |
| Max. Negotiated Rate |
$10,406.40 |
| Rate for Payer: Aetna Commercial |
$8,346.80
|
| Rate for Payer: Anthem Medicaid |
$3,727.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,455.20
|
| Rate for Payer: Cash Price |
$5,420.00
|
| Rate for Payer: Cigna Commercial |
$8,997.20
|
| Rate for Payer: First Health Commercial |
$10,298.00
|
| Rate for Payer: Humana Commercial |
$9,214.00
|
| Rate for Payer: Humana KY Medicaid |
$3,727.88
|
| Rate for Payer: Kentucky WC Medicaid |
$3,765.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,888.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,999.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,252.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,802.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,539.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,130.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,430.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,479.60
|
| Rate for Payer: PHCS Commercial |
$10,406.40
|
| Rate for Payer: United Healthcare All Payer |
$9,539.20
|
|
|
HEMI-CAP 15MM ARTCMP 2.0M*4.0M
|
Facility
|
IP
|
$10,840.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,252.00 |
| Max. Negotiated Rate |
$10,406.40 |
| Rate for Payer: Aetna Commercial |
$8,346.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,455.20
|
| Rate for Payer: Cash Price |
$5,420.00
|
| Rate for Payer: Cigna Commercial |
$8,997.20
|
| Rate for Payer: First Health Commercial |
$10,298.00
|
| Rate for Payer: Humana Commercial |
$9,214.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,888.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,999.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,252.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,539.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,130.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,430.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,479.60
|
| Rate for Payer: PHCS Commercial |
$10,406.40
|
| Rate for Payer: United Healthcare All Payer |
$9,539.20
|
|
|
HEMI-CAP 15MM ARTCMP 2.5M*3.5M
|
Facility
|
IP
|
$10,840.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,252.00 |
| Max. Negotiated Rate |
$10,406.40 |
| Rate for Payer: Aetna Commercial |
$8,346.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,455.20
|
| Rate for Payer: Cash Price |
$5,420.00
|
| Rate for Payer: Cigna Commercial |
$8,997.20
|
| Rate for Payer: First Health Commercial |
$10,298.00
|
| Rate for Payer: Humana Commercial |
$9,214.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,888.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,999.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,252.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,539.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,130.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,430.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,479.60
|
| Rate for Payer: PHCS Commercial |
$10,406.40
|
| Rate for Payer: United Healthcare All Payer |
$9,539.20
|
|
|
HEMI-CAP 15MM ARTCMP 2.5M*3.5M
|
Facility
|
OP
|
$10,840.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,252.00 |
| Max. Negotiated Rate |
$10,406.40 |
| Rate for Payer: Aetna Commercial |
$8,346.80
|
| Rate for Payer: Anthem Medicaid |
$3,727.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,455.20
|
| Rate for Payer: Cash Price |
$5,420.00
|
| Rate for Payer: Cigna Commercial |
$8,997.20
|
| Rate for Payer: First Health Commercial |
$10,298.00
|
| Rate for Payer: Humana Commercial |
$9,214.00
|
| Rate for Payer: Humana KY Medicaid |
$3,727.88
|
| Rate for Payer: Kentucky WC Medicaid |
$3,765.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,888.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,999.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,252.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,802.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,539.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,130.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,430.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,479.60
|
| Rate for Payer: PHCS Commercial |
$10,406.40
|
| Rate for Payer: United Healthcare All Payer |
$9,539.20
|
|
|
HEMI-CAP 15MM ARTCMP 2.5M*4.5M
|
Facility
|
OP
|
$10,840.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,252.00 |
| Max. Negotiated Rate |
$10,406.40 |
| Rate for Payer: Aetna Commercial |
$8,346.80
|
| Rate for Payer: Anthem Medicaid |
$3,727.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,455.20
|
| Rate for Payer: Cash Price |
$5,420.00
|
| Rate for Payer: Cigna Commercial |
$8,997.20
|
| Rate for Payer: First Health Commercial |
$10,298.00
|
| Rate for Payer: Humana Commercial |
$9,214.00
|
| Rate for Payer: Humana KY Medicaid |
$3,727.88
|
| Rate for Payer: Kentucky WC Medicaid |
$3,765.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,888.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,999.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,252.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,802.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,539.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,130.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,430.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,479.60
|
| Rate for Payer: PHCS Commercial |
$10,406.40
|
| Rate for Payer: United Healthcare All Payer |
$9,539.20
|
|
|
HEMI-CAP 15MM ARTCMP 2.5M*4.5M
|
Facility
|
IP
|
$10,840.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,252.00 |
| Max. Negotiated Rate |
$10,406.40 |
| Rate for Payer: Aetna Commercial |
$8,346.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,455.20
|
| Rate for Payer: Cash Price |
$5,420.00
|
| Rate for Payer: Cigna Commercial |
$8,997.20
|
| Rate for Payer: First Health Commercial |
$10,298.00
|
| Rate for Payer: Humana Commercial |
$9,214.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,888.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,999.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,252.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,539.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,130.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,430.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,479.60
|
| Rate for Payer: PHCS Commercial |
$10,406.40
|
| Rate for Payer: United Healthcare All Payer |
$9,539.20
|
|
|
HEMI CK/HK LGNSZ1-2 10MM LL/RM
|
Facility
|
OP
|
$9,885.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,965.72 |
| Max. Negotiated Rate |
$9,490.30 |
| Rate for Payer: Aetna Commercial |
$7,612.01
|
| Rate for Payer: Anthem Medicaid |
$3,399.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,710.87
|
| Rate for Payer: Cash Price |
$4,942.86
|
| Rate for Payer: Cigna Commercial |
$8,205.16
|
| Rate for Payer: First Health Commercial |
$9,391.44
|
| Rate for Payer: Humana Commercial |
$8,402.87
|
| Rate for Payer: Humana KY Medicaid |
$3,399.70
|
| Rate for Payer: Kentucky WC Medicaid |
$3,434.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,106.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,295.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,965.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,467.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,699.44
|
| Rate for Payer: Ohio Health Group HMO |
$7,414.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,908.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,600.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,821.15
|
| Rate for Payer: PHCS Commercial |
$9,490.30
|
| Rate for Payer: United Healthcare All Payer |
$8,699.44
|
|
|
HEMI CK/HK LGNSZ1-2 10MM LL/RM
|
Facility
|
IP
|
$9,885.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,965.72 |
| Max. Negotiated Rate |
$9,490.30 |
| Rate for Payer: Aetna Commercial |
$7,612.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,710.87
|
| Rate for Payer: Cash Price |
$4,942.86
|
| Rate for Payer: Cigna Commercial |
$8,205.16
|
| Rate for Payer: First Health Commercial |
$9,391.44
|
| Rate for Payer: Humana Commercial |
$8,402.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,106.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,295.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,965.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,699.44
|
| Rate for Payer: Ohio Health Group HMO |
$7,414.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,908.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,600.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,821.15
|
| Rate for Payer: PHCS Commercial |
$9,490.30
|
| Rate for Payer: United Healthcare All Payer |
$8,699.44
|
|
|
HEMI CK/HK LGNSZ1-2 15MM LL/RM
|
Facility
|
OP
|
$9,885.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,965.72 |
| Max. Negotiated Rate |
$9,490.30 |
| Rate for Payer: Aetna Commercial |
$7,612.01
|
| Rate for Payer: Anthem Medicaid |
$3,399.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,710.87
|
| Rate for Payer: Cash Price |
$4,942.86
|
| Rate for Payer: Cigna Commercial |
$8,205.16
|
| Rate for Payer: First Health Commercial |
$9,391.44
|
| Rate for Payer: Humana Commercial |
$8,402.87
|
| Rate for Payer: Humana KY Medicaid |
$3,399.70
|
| Rate for Payer: Kentucky WC Medicaid |
$3,434.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,106.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,295.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,965.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,467.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,699.44
|
| Rate for Payer: Ohio Health Group HMO |
$7,414.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,908.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,600.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,821.15
|
| Rate for Payer: PHCS Commercial |
$9,490.30
|
| Rate for Payer: United Healthcare All Payer |
$8,699.44
|
|
|
HEMI CK/HK LGNSZ1-2 15MM LL/RM
|
Facility
|
IP
|
$9,885.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,965.72 |
| Max. Negotiated Rate |
$9,490.30 |
| Rate for Payer: Aetna Commercial |
$7,612.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,710.87
|
| Rate for Payer: Cash Price |
$4,942.86
|
| Rate for Payer: Cigna Commercial |
$8,205.16
|
| Rate for Payer: First Health Commercial |
$9,391.44
|
| Rate for Payer: Humana Commercial |
$8,402.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,106.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,295.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,965.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,699.44
|
| Rate for Payer: Ohio Health Group HMO |
$7,414.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,908.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,600.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,821.15
|
| Rate for Payer: PHCS Commercial |
$9,490.30
|
| Rate for Payer: United Healthcare All Payer |
$8,699.44
|
|
|
HEMI CK/HK LGN SZ1-2 5MM LL/RM
|
Facility
|
OP
|
$9,885.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,965.72 |
| Max. Negotiated Rate |
$9,490.30 |
| Rate for Payer: Aetna Commercial |
$7,612.01
|
| Rate for Payer: Anthem Medicaid |
$3,399.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,710.87
|
| Rate for Payer: Cash Price |
$4,942.86
|
| Rate for Payer: Cigna Commercial |
$8,205.16
|
| Rate for Payer: First Health Commercial |
$9,391.44
|
| Rate for Payer: Humana Commercial |
$8,402.87
|
| Rate for Payer: Humana KY Medicaid |
$3,399.70
|
| Rate for Payer: Kentucky WC Medicaid |
$3,434.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,106.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,295.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,965.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,467.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,699.44
|
| Rate for Payer: Ohio Health Group HMO |
$7,414.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,908.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,600.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,821.15
|
| Rate for Payer: PHCS Commercial |
$9,490.30
|
| Rate for Payer: United Healthcare All Payer |
$8,699.44
|
|
|
HEMI CK/HK LGN SZ1-2 5MM LL/RM
|
Facility
|
IP
|
$9,885.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,965.72 |
| Max. Negotiated Rate |
$9,490.30 |
| Rate for Payer: Aetna Commercial |
$7,612.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,710.87
|
| Rate for Payer: Cash Price |
$4,942.86
|
| Rate for Payer: Cigna Commercial |
$8,205.16
|
| Rate for Payer: First Health Commercial |
$9,391.44
|
| Rate for Payer: Humana Commercial |
$8,402.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,106.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,295.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,965.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,699.44
|
| Rate for Payer: Ohio Health Group HMO |
$7,414.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,908.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,600.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,821.15
|
| Rate for Payer: PHCS Commercial |
$9,490.30
|
| Rate for Payer: United Healthcare All Payer |
$8,699.44
|
|
|
HEMI CK/HK LGNSZ3-4 10MM LL/RM
|
Facility
|
OP
|
$9,885.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,965.72 |
| Max. Negotiated Rate |
$9,490.30 |
| Rate for Payer: Aetna Commercial |
$7,612.01
|
| Rate for Payer: Anthem Medicaid |
$3,399.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,710.87
|
| Rate for Payer: Cash Price |
$4,942.86
|
| Rate for Payer: Cigna Commercial |
$8,205.16
|
| Rate for Payer: First Health Commercial |
$9,391.44
|
| Rate for Payer: Humana Commercial |
$8,402.87
|
| Rate for Payer: Humana KY Medicaid |
$3,399.70
|
| Rate for Payer: Kentucky WC Medicaid |
$3,434.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,106.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,295.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,965.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,467.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,699.44
|
| Rate for Payer: Ohio Health Group HMO |
$7,414.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,908.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,600.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,821.15
|
| Rate for Payer: PHCS Commercial |
$9,490.30
|
| Rate for Payer: United Healthcare All Payer |
$8,699.44
|
|
|
HEMI CK/HK LGNSZ3-4 10MM LL/RM
|
Facility
|
IP
|
$9,885.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,965.72 |
| Max. Negotiated Rate |
$9,490.30 |
| Rate for Payer: Aetna Commercial |
$7,612.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,710.87
|
| Rate for Payer: Cash Price |
$4,942.86
|
| Rate for Payer: Cigna Commercial |
$8,205.16
|
| Rate for Payer: First Health Commercial |
$9,391.44
|
| Rate for Payer: Humana Commercial |
$8,402.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,106.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,295.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,965.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,699.44
|
| Rate for Payer: Ohio Health Group HMO |
$7,414.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,908.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,600.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,821.15
|
| Rate for Payer: PHCS Commercial |
$9,490.30
|
| Rate for Payer: United Healthcare All Payer |
$8,699.44
|
|
|
HEMI CK/HK LGNSZ3-4 15MM LL/RM
|
Facility
|
IP
|
$9,885.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,965.72 |
| Max. Negotiated Rate |
$9,490.30 |
| Rate for Payer: Aetna Commercial |
$7,612.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,710.87
|
| Rate for Payer: Cash Price |
$4,942.86
|
| Rate for Payer: Cigna Commercial |
$8,205.16
|
| Rate for Payer: First Health Commercial |
$9,391.44
|
| Rate for Payer: Humana Commercial |
$8,402.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,106.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,295.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,965.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,699.44
|
| Rate for Payer: Ohio Health Group HMO |
$7,414.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,908.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,600.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,821.15
|
| Rate for Payer: PHCS Commercial |
$9,490.30
|
| Rate for Payer: United Healthcare All Payer |
$8,699.44
|
|
|
HEMI CK/HK LGNSZ3-4 15MM LL/RM
|
Facility
|
OP
|
$9,885.73
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,965.72 |
| Max. Negotiated Rate |
$9,490.30 |
| Rate for Payer: Aetna Commercial |
$7,612.01
|
| Rate for Payer: Anthem Medicaid |
$3,399.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,710.87
|
| Rate for Payer: Cash Price |
$4,942.86
|
| Rate for Payer: Cigna Commercial |
$8,205.16
|
| Rate for Payer: First Health Commercial |
$9,391.44
|
| Rate for Payer: Humana Commercial |
$8,402.87
|
| Rate for Payer: Humana KY Medicaid |
$3,399.70
|
| Rate for Payer: Kentucky WC Medicaid |
$3,434.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,106.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,295.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,965.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,467.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,699.44
|
| Rate for Payer: Ohio Health Group HMO |
$7,414.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,908.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,600.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,821.15
|
| Rate for Payer: PHCS Commercial |
$9,490.30
|
| Rate for Payer: United Healthcare All Payer |
$8,699.44
|
|
