|
HUMERAL HD 21MMX52MM
|
Facility
|
IP
|
$9,427.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,828.30 |
| Max. Negotiated Rate |
$9,050.54 |
| Rate for Payer: Aetna Commercial |
$7,259.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,353.57
|
| Rate for Payer: Cash Price |
$4,713.82
|
| Rate for Payer: Cigna Commercial |
$7,824.95
|
| Rate for Payer: First Health Commercial |
$8,956.27
|
| Rate for Payer: Humana Commercial |
$8,013.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,730.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,957.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,828.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,296.33
|
| Rate for Payer: Ohio Health Group HMO |
$7,070.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,542.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,202.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,505.08
|
| Rate for Payer: PHCS Commercial |
$9,050.54
|
| Rate for Payer: United Healthcare All Payer |
$8,296.33
|
|
|
HUMERAL HD 21MMX52MM
|
Facility
|
OP
|
$9,427.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,828.30 |
| Max. Negotiated Rate |
$9,050.54 |
| Rate for Payer: Aetna Commercial |
$7,259.29
|
| Rate for Payer: Anthem Medicaid |
$3,242.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,353.57
|
| Rate for Payer: Cash Price |
$4,713.82
|
| Rate for Payer: Cigna Commercial |
$7,824.95
|
| Rate for Payer: First Health Commercial |
$8,956.27
|
| Rate for Payer: Humana Commercial |
$8,013.50
|
| Rate for Payer: Humana KY Medicaid |
$3,242.17
|
| Rate for Payer: Kentucky WC Medicaid |
$3,275.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,730.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,957.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,828.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,307.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,296.33
|
| Rate for Payer: Ohio Health Group HMO |
$7,070.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,542.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,202.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,505.08
|
| Rate for Payer: PHCS Commercial |
$9,050.54
|
| Rate for Payer: United Healthcare All Payer |
$8,296.33
|
|
|
HUMERAL HD 24MMX46MM
|
Facility
|
IP
|
$9,427.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,828.30 |
| Max. Negotiated Rate |
$9,050.54 |
| Rate for Payer: Aetna Commercial |
$7,259.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,353.57
|
| Rate for Payer: Cash Price |
$4,713.82
|
| Rate for Payer: Cigna Commercial |
$7,824.95
|
| Rate for Payer: First Health Commercial |
$8,956.27
|
| Rate for Payer: Humana Commercial |
$8,013.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,730.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,957.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,828.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,296.33
|
| Rate for Payer: Ohio Health Group HMO |
$7,070.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,542.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,202.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,505.08
|
| Rate for Payer: PHCS Commercial |
$9,050.54
|
| Rate for Payer: United Healthcare All Payer |
$8,296.33
|
|
|
HUMERAL HD 24MMX46MM
|
Facility
|
OP
|
$9,427.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,828.30 |
| Max. Negotiated Rate |
$9,050.54 |
| Rate for Payer: Aetna Commercial |
$7,259.29
|
| Rate for Payer: Anthem Medicaid |
$3,242.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,353.57
|
| Rate for Payer: Cash Price |
$4,713.82
|
| Rate for Payer: Cigna Commercial |
$7,824.95
|
| Rate for Payer: First Health Commercial |
$8,956.27
|
| Rate for Payer: Humana Commercial |
$8,013.50
|
| Rate for Payer: Humana KY Medicaid |
$3,242.17
|
| Rate for Payer: Kentucky WC Medicaid |
$3,275.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,730.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,957.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,828.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,307.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,296.33
|
| Rate for Payer: Ohio Health Group HMO |
$7,070.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,542.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,202.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,505.08
|
| Rate for Payer: PHCS Commercial |
$9,050.54
|
| Rate for Payer: United Healthcare All Payer |
$8,296.33
|
|
|
HUMERAL HD 24MMX52MM
|
Facility
|
OP
|
$9,427.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,828.30 |
| Max. Negotiated Rate |
$9,050.54 |
| Rate for Payer: Aetna Commercial |
$7,259.29
|
| Rate for Payer: Anthem Medicaid |
$3,242.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,353.57
|
| Rate for Payer: Cash Price |
$4,713.82
|
| Rate for Payer: Cigna Commercial |
$7,824.95
|
| Rate for Payer: First Health Commercial |
$8,956.27
|
| Rate for Payer: Humana Commercial |
$8,013.50
|
| Rate for Payer: Humana KY Medicaid |
$3,242.17
|
| Rate for Payer: Kentucky WC Medicaid |
$3,275.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,730.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,957.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,828.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,307.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,296.33
|
| Rate for Payer: Ohio Health Group HMO |
$7,070.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,542.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,202.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,505.08
|
| Rate for Payer: PHCS Commercial |
$9,050.54
|
| Rate for Payer: United Healthcare All Payer |
$8,296.33
|
|
|
HUMERAL HD 24MMX52MM
|
Facility
|
IP
|
$9,427.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,828.30 |
| Max. Negotiated Rate |
$9,050.54 |
| Rate for Payer: Aetna Commercial |
$7,259.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,353.57
|
| Rate for Payer: Cash Price |
$4,713.82
|
| Rate for Payer: Cigna Commercial |
$7,824.95
|
| Rate for Payer: First Health Commercial |
$8,956.27
|
| Rate for Payer: Humana Commercial |
$8,013.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,730.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,957.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,828.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,296.33
|
| Rate for Payer: Ohio Health Group HMO |
$7,070.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,542.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,202.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,505.08
|
| Rate for Payer: PHCS Commercial |
$9,050.54
|
| Rate for Payer: United Healthcare All Payer |
$8,296.33
|
|
|
HUMERAL HD 27MMX40MM
|
Facility
|
OP
|
$9,427.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,828.30 |
| Max. Negotiated Rate |
$9,050.54 |
| Rate for Payer: Aetna Commercial |
$7,259.29
|
| Rate for Payer: Anthem Medicaid |
$3,242.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,353.57
|
| Rate for Payer: Cash Price |
$4,713.82
|
| Rate for Payer: Cigna Commercial |
$7,824.95
|
| Rate for Payer: First Health Commercial |
$8,956.27
|
| Rate for Payer: Humana Commercial |
$8,013.50
|
| Rate for Payer: Humana KY Medicaid |
$3,242.17
|
| Rate for Payer: Kentucky WC Medicaid |
$3,275.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,730.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,957.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,828.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,307.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,296.33
|
| Rate for Payer: Ohio Health Group HMO |
$7,070.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,542.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,202.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,505.08
|
| Rate for Payer: PHCS Commercial |
$9,050.54
|
| Rate for Payer: United Healthcare All Payer |
$8,296.33
|
|
|
HUMERAL HD 27MMX40MM
|
Facility
|
IP
|
$9,427.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,828.30 |
| Max. Negotiated Rate |
$9,050.54 |
| Rate for Payer: Aetna Commercial |
$7,259.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,353.57
|
| Rate for Payer: Cash Price |
$4,713.82
|
| Rate for Payer: Cigna Commercial |
$7,824.95
|
| Rate for Payer: First Health Commercial |
$8,956.27
|
| Rate for Payer: Humana Commercial |
$8,013.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,730.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,957.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,828.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,296.33
|
| Rate for Payer: Ohio Health Group HMO |
$7,070.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,542.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,202.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,505.08
|
| Rate for Payer: PHCS Commercial |
$9,050.54
|
| Rate for Payer: United Healthcare All Payer |
$8,296.33
|
|
|
HUMERAL HD 27MMX46MM
|
Facility
|
IP
|
$9,427.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,828.30 |
| Max. Negotiated Rate |
$9,050.54 |
| Rate for Payer: Aetna Commercial |
$7,259.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,353.57
|
| Rate for Payer: Cash Price |
$4,713.82
|
| Rate for Payer: Cigna Commercial |
$7,824.95
|
| Rate for Payer: First Health Commercial |
$8,956.27
|
| Rate for Payer: Humana Commercial |
$8,013.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,730.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,957.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,828.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,296.33
|
| Rate for Payer: Ohio Health Group HMO |
$7,070.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,542.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,202.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,505.08
|
| Rate for Payer: PHCS Commercial |
$9,050.54
|
| Rate for Payer: United Healthcare All Payer |
$8,296.33
|
|
|
HUMERAL HD 27MMX46MM
|
Facility
|
OP
|
$9,427.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,828.30 |
| Max. Negotiated Rate |
$9,050.54 |
| Rate for Payer: Aetna Commercial |
$7,259.29
|
| Rate for Payer: Anthem Medicaid |
$3,242.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,353.57
|
| Rate for Payer: Cash Price |
$4,713.82
|
| Rate for Payer: Cigna Commercial |
$7,824.95
|
| Rate for Payer: First Health Commercial |
$8,956.27
|
| Rate for Payer: Humana Commercial |
$8,013.50
|
| Rate for Payer: Humana KY Medicaid |
$3,242.17
|
| Rate for Payer: Kentucky WC Medicaid |
$3,275.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,730.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,957.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,828.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,307.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,296.33
|
| Rate for Payer: Ohio Health Group HMO |
$7,070.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,542.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,202.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,505.08
|
| Rate for Payer: PHCS Commercial |
$9,050.54
|
| Rate for Payer: United Healthcare All Payer |
$8,296.33
|
|
|
HUMERAL HD 27MMX52MM
|
Facility
|
IP
|
$9,427.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,828.30 |
| Max. Negotiated Rate |
$9,050.54 |
| Rate for Payer: Aetna Commercial |
$7,259.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,353.57
|
| Rate for Payer: Cash Price |
$4,713.82
|
| Rate for Payer: Cigna Commercial |
$7,824.95
|
| Rate for Payer: First Health Commercial |
$8,956.27
|
| Rate for Payer: Humana Commercial |
$8,013.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,730.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,957.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,828.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,296.33
|
| Rate for Payer: Ohio Health Group HMO |
$7,070.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,542.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,202.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,505.08
|
| Rate for Payer: PHCS Commercial |
$9,050.54
|
| Rate for Payer: United Healthcare All Payer |
$8,296.33
|
|
|
HUMERAL HD 27MMX52MM
|
Facility
|
OP
|
$9,427.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,828.30 |
| Max. Negotiated Rate |
$9,050.54 |
| Rate for Payer: Aetna Commercial |
$7,259.29
|
| Rate for Payer: Anthem Medicaid |
$3,242.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,353.57
|
| Rate for Payer: Cash Price |
$4,713.82
|
| Rate for Payer: Cigna Commercial |
$7,824.95
|
| Rate for Payer: First Health Commercial |
$8,956.27
|
| Rate for Payer: Humana Commercial |
$8,013.50
|
| Rate for Payer: Humana KY Medicaid |
$3,242.17
|
| Rate for Payer: Kentucky WC Medicaid |
$3,275.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,730.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,957.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,828.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,307.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,296.33
|
| Rate for Payer: Ohio Health Group HMO |
$7,070.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,542.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,202.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,505.08
|
| Rate for Payer: PHCS Commercial |
$9,050.54
|
| Rate for Payer: United Healthcare All Payer |
$8,296.33
|
|
|
HUMERAL HD 30MMX46MM
|
Facility
|
OP
|
$9,427.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,828.30 |
| Max. Negotiated Rate |
$9,050.54 |
| Rate for Payer: Aetna Commercial |
$7,259.29
|
| Rate for Payer: Anthem Medicaid |
$3,242.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,353.57
|
| Rate for Payer: Cash Price |
$4,713.82
|
| Rate for Payer: Cigna Commercial |
$7,824.95
|
| Rate for Payer: First Health Commercial |
$8,956.27
|
| Rate for Payer: Humana Commercial |
$8,013.50
|
| Rate for Payer: Humana KY Medicaid |
$3,242.17
|
| Rate for Payer: Kentucky WC Medicaid |
$3,275.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,730.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,957.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,828.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,307.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,296.33
|
| Rate for Payer: Ohio Health Group HMO |
$7,070.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,542.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,202.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,505.08
|
| Rate for Payer: PHCS Commercial |
$9,050.54
|
| Rate for Payer: United Healthcare All Payer |
$8,296.33
|
|
|
HUMERAL HD 30MMX46MM
|
Facility
|
IP
|
$9,427.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,828.30 |
| Max. Negotiated Rate |
$9,050.54 |
| Rate for Payer: Aetna Commercial |
$7,259.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,353.57
|
| Rate for Payer: Cash Price |
$4,713.82
|
| Rate for Payer: Cigna Commercial |
$7,824.95
|
| Rate for Payer: First Health Commercial |
$8,956.27
|
| Rate for Payer: Humana Commercial |
$8,013.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,730.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,957.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,828.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,296.33
|
| Rate for Payer: Ohio Health Group HMO |
$7,070.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,542.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,202.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,505.08
|
| Rate for Payer: PHCS Commercial |
$9,050.54
|
| Rate for Payer: United Healthcare All Payer |
$8,296.33
|
|
|
HUMERAL HD 30MMX52MM
|
Facility
|
IP
|
$9,427.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,828.30 |
| Max. Negotiated Rate |
$9,050.54 |
| Rate for Payer: Aetna Commercial |
$7,259.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,353.57
|
| Rate for Payer: Cash Price |
$4,713.82
|
| Rate for Payer: Cigna Commercial |
$7,824.95
|
| Rate for Payer: First Health Commercial |
$8,956.27
|
| Rate for Payer: Humana Commercial |
$8,013.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,730.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,957.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,828.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,296.33
|
| Rate for Payer: Ohio Health Group HMO |
$7,070.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,542.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,202.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,505.08
|
| Rate for Payer: PHCS Commercial |
$9,050.54
|
| Rate for Payer: United Healthcare All Payer |
$8,296.33
|
|
|
HUMERAL HD 30MMX52MM
|
Facility
|
OP
|
$9,427.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,828.30 |
| Max. Negotiated Rate |
$9,050.54 |
| Rate for Payer: Aetna Commercial |
$7,259.29
|
| Rate for Payer: Anthem Medicaid |
$3,242.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,353.57
|
| Rate for Payer: Cash Price |
$4,713.82
|
| Rate for Payer: Cigna Commercial |
$7,824.95
|
| Rate for Payer: First Health Commercial |
$8,956.27
|
| Rate for Payer: Humana Commercial |
$8,013.50
|
| Rate for Payer: Humana KY Medicaid |
$3,242.17
|
| Rate for Payer: Kentucky WC Medicaid |
$3,275.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,730.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,957.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,828.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,307.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,296.33
|
| Rate for Payer: Ohio Health Group HMO |
$7,070.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,542.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,202.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,505.08
|
| Rate for Payer: PHCS Commercial |
$9,050.54
|
| Rate for Payer: United Healthcare All Payer |
$8,296.33
|
|
|
HUMERAL HD 30MMX56MM
|
Facility
|
OP
|
$9,427.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,828.30 |
| Max. Negotiated Rate |
$9,050.54 |
| Rate for Payer: Aetna Commercial |
$7,259.29
|
| Rate for Payer: Anthem Medicaid |
$3,242.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,353.57
|
| Rate for Payer: Cash Price |
$4,713.82
|
| Rate for Payer: Cigna Commercial |
$7,824.95
|
| Rate for Payer: First Health Commercial |
$8,956.27
|
| Rate for Payer: Humana Commercial |
$8,013.50
|
| Rate for Payer: Humana KY Medicaid |
$3,242.17
|
| Rate for Payer: Kentucky WC Medicaid |
$3,275.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,730.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,957.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,828.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,307.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,296.33
|
| Rate for Payer: Ohio Health Group HMO |
$7,070.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,542.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,202.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,505.08
|
| Rate for Payer: PHCS Commercial |
$9,050.54
|
| Rate for Payer: United Healthcare All Payer |
$8,296.33
|
|
|
HUMERAL HD 30MMX56MM
|
Facility
|
IP
|
$9,427.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,828.30 |
| Max. Negotiated Rate |
$9,050.54 |
| Rate for Payer: Aetna Commercial |
$7,259.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,353.57
|
| Rate for Payer: Cash Price |
$4,713.82
|
| Rate for Payer: Cigna Commercial |
$7,824.95
|
| Rate for Payer: First Health Commercial |
$8,956.27
|
| Rate for Payer: Humana Commercial |
$8,013.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,730.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,957.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,828.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,296.33
|
| Rate for Payer: Ohio Health Group HMO |
$7,070.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,542.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,202.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,505.08
|
| Rate for Payer: PHCS Commercial |
$9,050.54
|
| Rate for Payer: United Healthcare All Payer |
$8,296.33
|
|
|
HUMERAL HD 33MMX46MM
|
Facility
|
OP
|
$9,427.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,828.30 |
| Max. Negotiated Rate |
$9,050.54 |
| Rate for Payer: Aetna Commercial |
$7,259.29
|
| Rate for Payer: Anthem Medicaid |
$3,242.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,353.57
|
| Rate for Payer: Cash Price |
$4,713.82
|
| Rate for Payer: Cigna Commercial |
$7,824.95
|
| Rate for Payer: First Health Commercial |
$8,956.27
|
| Rate for Payer: Humana Commercial |
$8,013.50
|
| Rate for Payer: Humana KY Medicaid |
$3,242.17
|
| Rate for Payer: Kentucky WC Medicaid |
$3,275.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,730.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,957.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,828.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,307.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,296.33
|
| Rate for Payer: Ohio Health Group HMO |
$7,070.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,542.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,202.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,505.08
|
| Rate for Payer: PHCS Commercial |
$9,050.54
|
| Rate for Payer: United Healthcare All Payer |
$8,296.33
|
|
|
HUMERAL HD 33MMX46MM
|
Facility
|
IP
|
$9,427.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,828.30 |
| Max. Negotiated Rate |
$9,050.54 |
| Rate for Payer: Aetna Commercial |
$7,259.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,353.57
|
| Rate for Payer: Cash Price |
$4,713.82
|
| Rate for Payer: Cigna Commercial |
$7,824.95
|
| Rate for Payer: First Health Commercial |
$8,956.27
|
| Rate for Payer: Humana Commercial |
$8,013.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,730.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,957.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,828.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,296.33
|
| Rate for Payer: Ohio Health Group HMO |
$7,070.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,542.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,202.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,505.08
|
| Rate for Payer: PHCS Commercial |
$9,050.54
|
| Rate for Payer: United Healthcare All Payer |
$8,296.33
|
|
|
HUMERAL HD 33MMX52MM
|
Facility
|
OP
|
$9,427.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,828.30 |
| Max. Negotiated Rate |
$9,050.54 |
| Rate for Payer: Aetna Commercial |
$7,259.29
|
| Rate for Payer: Anthem Medicaid |
$3,242.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,353.57
|
| Rate for Payer: Cash Price |
$4,713.82
|
| Rate for Payer: Cigna Commercial |
$7,824.95
|
| Rate for Payer: First Health Commercial |
$8,956.27
|
| Rate for Payer: Humana Commercial |
$8,013.50
|
| Rate for Payer: Humana KY Medicaid |
$3,242.17
|
| Rate for Payer: Kentucky WC Medicaid |
$3,275.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,730.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,957.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,828.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,307.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,296.33
|
| Rate for Payer: Ohio Health Group HMO |
$7,070.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,542.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,202.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,505.08
|
| Rate for Payer: PHCS Commercial |
$9,050.54
|
| Rate for Payer: United Healthcare All Payer |
$8,296.33
|
|
|
HUMERAL HD 33MMX52MM
|
Facility
|
IP
|
$9,427.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,828.30 |
| Max. Negotiated Rate |
$9,050.54 |
| Rate for Payer: Aetna Commercial |
$7,259.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,353.57
|
| Rate for Payer: Cash Price |
$4,713.82
|
| Rate for Payer: Cigna Commercial |
$7,824.95
|
| Rate for Payer: First Health Commercial |
$8,956.27
|
| Rate for Payer: Humana Commercial |
$8,013.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,730.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,957.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,828.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,296.33
|
| Rate for Payer: Ohio Health Group HMO |
$7,070.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,542.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,202.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,505.08
|
| Rate for Payer: PHCS Commercial |
$9,050.54
|
| Rate for Payer: United Healthcare All Payer |
$8,296.33
|
|
|
HUMERAL HD 33MMX56MM
|
Facility
|
IP
|
$9,427.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,828.30 |
| Max. Negotiated Rate |
$9,050.54 |
| Rate for Payer: Aetna Commercial |
$7,259.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,353.57
|
| Rate for Payer: Cash Price |
$4,713.82
|
| Rate for Payer: Cigna Commercial |
$7,824.95
|
| Rate for Payer: First Health Commercial |
$8,956.27
|
| Rate for Payer: Humana Commercial |
$8,013.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,730.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,957.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,828.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,296.33
|
| Rate for Payer: Ohio Health Group HMO |
$7,070.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,542.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,202.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,505.08
|
| Rate for Payer: PHCS Commercial |
$9,050.54
|
| Rate for Payer: United Healthcare All Payer |
$8,296.33
|
|
|
HUMERAL HD 33MMX56MM
|
Facility
|
OP
|
$9,427.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,828.30 |
| Max. Negotiated Rate |
$9,050.54 |
| Rate for Payer: Aetna Commercial |
$7,259.29
|
| Rate for Payer: Anthem Medicaid |
$3,242.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,353.57
|
| Rate for Payer: Cash Price |
$4,713.82
|
| Rate for Payer: Cigna Commercial |
$7,824.95
|
| Rate for Payer: First Health Commercial |
$8,956.27
|
| Rate for Payer: Humana Commercial |
$8,013.50
|
| Rate for Payer: Humana KY Medicaid |
$3,242.17
|
| Rate for Payer: Kentucky WC Medicaid |
$3,275.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,730.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,957.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,828.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,307.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,296.33
|
| Rate for Payer: Ohio Health Group HMO |
$7,070.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,542.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,202.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,505.08
|
| Rate for Payer: PHCS Commercial |
$9,050.54
|
| Rate for Payer: United Healthcare All Payer |
$8,296.33
|
|
|
HUMERAL HD. 36MMX52MM
|
Facility
|
OP
|
$9,427.65
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,828.30 |
| Max. Negotiated Rate |
$9,050.54 |
| Rate for Payer: Aetna Commercial |
$7,259.29
|
| Rate for Payer: Anthem Medicaid |
$3,242.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,353.57
|
| Rate for Payer: Cash Price |
$4,713.82
|
| Rate for Payer: Cigna Commercial |
$7,824.95
|
| Rate for Payer: First Health Commercial |
$8,956.27
|
| Rate for Payer: Humana Commercial |
$8,013.50
|
| Rate for Payer: Humana KY Medicaid |
$3,242.17
|
| Rate for Payer: Kentucky WC Medicaid |
$3,275.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,730.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,957.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,828.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,307.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,296.33
|
| Rate for Payer: Ohio Health Group HMO |
$7,070.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,542.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,202.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,505.08
|
| Rate for Payer: PHCS Commercial |
$9,050.54
|
| Rate for Payer: United Healthcare All Payer |
$8,296.33
|
|
