|
INSRT BLAD TMP INDWLCATH CMPLX
|
Facility
|
IP
|
$638.00
|
|
|
Service Code
|
HCPCS 51703
|
| Hospital Charge Code |
76102067
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$191.40 |
| Max. Negotiated Rate |
$612.48 |
| Rate for Payer: Aetna Commercial |
$491.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$497.64
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Cigna Commercial |
$529.54
|
| Rate for Payer: First Health Commercial |
$606.10
|
| Rate for Payer: Humana Commercial |
$542.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$523.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$470.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$191.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$561.44
|
| Rate for Payer: Ohio Health Group HMO |
$478.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$510.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$555.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$440.22
|
| Rate for Payer: PHCS Commercial |
$612.48
|
| Rate for Payer: United Healthcare All Payer |
$561.44
|
|
|
INSRT IABA VIA ASCENDING AORTA
|
Facility
|
IP
|
$2,071.00
|
|
|
Service Code
|
HCPCS 33973
|
| Hospital Charge Code |
76101328
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$621.30 |
| Max. Negotiated Rate |
$1,988.16 |
| Rate for Payer: Aetna Commercial |
$1,594.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,615.38
|
| Rate for Payer: Cash Price |
$1,035.50
|
| Rate for Payer: Cigna Commercial |
$1,718.93
|
| Rate for Payer: First Health Commercial |
$1,967.45
|
| Rate for Payer: Humana Commercial |
$1,760.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,698.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,528.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$621.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,822.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,553.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,656.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,801.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,428.99
|
| Rate for Payer: PHCS Commercial |
$1,988.16
|
| Rate for Payer: United Healthcare All Payer |
$1,822.48
|
|
|
INSRT IABA VIA ASCENDING AORTA
|
Facility
|
OP
|
$2,159.00
|
|
|
Service Code
|
HCPCS 33973
|
| Hospital Charge Code |
48100006
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$647.70 |
| Max. Negotiated Rate |
$2,072.64 |
| Rate for Payer: Aetna Commercial |
$1,662.43
|
| Rate for Payer: Anthem Medicaid |
$742.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,684.02
|
| Rate for Payer: Cash Price |
$1,079.50
|
| Rate for Payer: Cigna Commercial |
$1,791.97
|
| Rate for Payer: First Health Commercial |
$2,051.05
|
| Rate for Payer: Humana Commercial |
$1,835.15
|
| Rate for Payer: Humana KY Medicaid |
$742.48
|
| Rate for Payer: Kentucky WC Medicaid |
$750.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,770.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,593.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$647.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$757.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,899.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,619.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,727.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,878.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,489.71
|
| Rate for Payer: PHCS Commercial |
$2,072.64
|
| Rate for Payer: United Healthcare All Payer |
$1,899.92
|
|
|
INSRT IABA VIA ASCENDING AORTA
|
Facility
|
IP
|
$2,159.00
|
|
|
Service Code
|
HCPCS 33973
|
| Hospital Charge Code |
48100006
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$647.70 |
| Max. Negotiated Rate |
$2,072.64 |
| Rate for Payer: Aetna Commercial |
$1,662.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,684.02
|
| Rate for Payer: Cash Price |
$1,079.50
|
| Rate for Payer: Cigna Commercial |
$1,791.97
|
| Rate for Payer: First Health Commercial |
$2,051.05
|
| Rate for Payer: Humana Commercial |
$1,835.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,770.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,593.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$647.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,899.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,619.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,727.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,878.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,489.71
|
| Rate for Payer: PHCS Commercial |
$2,072.64
|
| Rate for Payer: United Healthcare All Payer |
$1,899.92
|
|
|
INSRT IABA VIA ASCENDING AORTA
|
Facility
|
OP
|
$2,071.00
|
|
|
Service Code
|
HCPCS 33973
|
| Hospital Charge Code |
76101328
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$621.30 |
| Max. Negotiated Rate |
$1,988.16 |
| Rate for Payer: Aetna Commercial |
$1,594.67
|
| Rate for Payer: Anthem Medicaid |
$712.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,615.38
|
| Rate for Payer: Cash Price |
$1,035.50
|
| Rate for Payer: Cigna Commercial |
$1,718.93
|
| Rate for Payer: First Health Commercial |
$1,967.45
|
| Rate for Payer: Humana Commercial |
$1,760.35
|
| Rate for Payer: Humana KY Medicaid |
$712.22
|
| Rate for Payer: Kentucky WC Medicaid |
$719.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,698.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,528.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$621.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$726.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,822.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,553.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,656.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,801.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,428.99
|
| Rate for Payer: PHCS Commercial |
$1,988.16
|
| Rate for Payer: United Healthcare All Payer |
$1,822.48
|
|
|
INSRT JOURNEY REV STD SZ 3-4 L
|
Facility
|
IP
|
$12,748.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,824.52 |
| Max. Negotiated Rate |
$12,238.46 |
| Rate for Payer: Aetna Commercial |
$9,816.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,943.75
|
| Rate for Payer: Cash Price |
$6,374.20
|
| Rate for Payer: Cigna Commercial |
$10,581.17
|
| Rate for Payer: First Health Commercial |
$12,110.98
|
| Rate for Payer: Humana Commercial |
$10,836.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,453.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,408.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,824.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,218.59
|
| Rate for Payer: Ohio Health Group HMO |
$9,561.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,198.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,091.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,796.40
|
| Rate for Payer: PHCS Commercial |
$12,238.46
|
| Rate for Payer: United Healthcare All Payer |
$11,218.59
|
|
|
INSRT JOURNEY REV STD SZ 3-4 L
|
Facility
|
OP
|
$12,748.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,824.52 |
| Max. Negotiated Rate |
$12,238.46 |
| Rate for Payer: Aetna Commercial |
$9,816.27
|
| Rate for Payer: Anthem Medicaid |
$4,384.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,943.75
|
| Rate for Payer: Cash Price |
$6,374.20
|
| Rate for Payer: Cigna Commercial |
$10,581.17
|
| Rate for Payer: First Health Commercial |
$12,110.98
|
| Rate for Payer: Humana Commercial |
$10,836.14
|
| Rate for Payer: Humana KY Medicaid |
$4,384.17
|
| Rate for Payer: Kentucky WC Medicaid |
$4,428.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,453.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,408.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,824.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,472.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,218.59
|
| Rate for Payer: Ohio Health Group HMO |
$9,561.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,198.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,091.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,796.40
|
| Rate for Payer: PHCS Commercial |
$12,238.46
|
| Rate for Payer: United Healthcare All Payer |
$11,218.59
|
|
|
INSRT JRNY ARTBCS STD 1-2 10 L
|
Facility
|
OP
|
$9,358.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,807.49 |
| Max. Negotiated Rate |
$8,983.97 |
| Rate for Payer: Aetna Commercial |
$7,205.89
|
| Rate for Payer: Anthem Medicaid |
$3,218.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,299.47
|
| Rate for Payer: Cash Price |
$4,679.15
|
| Rate for Payer: Cigna Commercial |
$7,767.39
|
| Rate for Payer: First Health Commercial |
$8,890.39
|
| Rate for Payer: Humana Commercial |
$7,954.56
|
| Rate for Payer: Humana KY Medicaid |
$3,218.32
|
| Rate for Payer: Kentucky WC Medicaid |
$3,251.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,673.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,906.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,807.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,282.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,235.30
|
| Rate for Payer: Ohio Health Group HMO |
$7,018.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,486.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,141.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,457.23
|
| Rate for Payer: PHCS Commercial |
$8,983.97
|
| Rate for Payer: United Healthcare All Payer |
$8,235.30
|
|
|
INSRT JRNY ARTBCS STD 1-2 10 L
|
Facility
|
IP
|
$9,358.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,807.49 |
| Max. Negotiated Rate |
$8,983.97 |
| Rate for Payer: Aetna Commercial |
$7,205.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,299.47
|
| Rate for Payer: Cash Price |
$4,679.15
|
| Rate for Payer: Cigna Commercial |
$7,767.39
|
| Rate for Payer: First Health Commercial |
$8,890.39
|
| Rate for Payer: Humana Commercial |
$7,954.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,673.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,906.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,807.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,235.30
|
| Rate for Payer: Ohio Health Group HMO |
$7,018.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,486.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,141.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,457.23
|
| Rate for Payer: PHCS Commercial |
$8,983.97
|
| Rate for Payer: United Healthcare All Payer |
$8,235.30
|
|
|
INSRT JRNY ARTBCS STD 1-2 10 R
|
Facility
|
IP
|
$9,358.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,807.49 |
| Max. Negotiated Rate |
$8,983.97 |
| Rate for Payer: Aetna Commercial |
$7,205.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,299.47
|
| Rate for Payer: Cash Price |
$4,679.15
|
| Rate for Payer: Cigna Commercial |
$7,767.39
|
| Rate for Payer: First Health Commercial |
$8,890.39
|
| Rate for Payer: Humana Commercial |
$7,954.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,673.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,906.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,807.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,235.30
|
| Rate for Payer: Ohio Health Group HMO |
$7,018.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,486.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,141.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,457.23
|
| Rate for Payer: PHCS Commercial |
$8,983.97
|
| Rate for Payer: United Healthcare All Payer |
$8,235.30
|
|
|
INSRT JRNY ARTBCS STD 1-2 10 R
|
Facility
|
OP
|
$9,358.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,807.49 |
| Max. Negotiated Rate |
$8,983.97 |
| Rate for Payer: Aetna Commercial |
$7,205.89
|
| Rate for Payer: Anthem Medicaid |
$3,218.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,299.47
|
| Rate for Payer: Cash Price |
$4,679.15
|
| Rate for Payer: Cigna Commercial |
$7,767.39
|
| Rate for Payer: First Health Commercial |
$8,890.39
|
| Rate for Payer: Humana Commercial |
$7,954.56
|
| Rate for Payer: Humana KY Medicaid |
$3,218.32
|
| Rate for Payer: Kentucky WC Medicaid |
$3,251.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,673.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,906.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,807.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,282.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,235.30
|
| Rate for Payer: Ohio Health Group HMO |
$7,018.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,486.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,141.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,457.23
|
| Rate for Payer: PHCS Commercial |
$8,983.97
|
| Rate for Payer: United Healthcare All Payer |
$8,235.30
|
|
|
INSRT JRNY ARTBCS STD 1-2 11 L
|
Facility
|
OP
|
$9,358.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,807.49 |
| Max. Negotiated Rate |
$8,983.97 |
| Rate for Payer: Aetna Commercial |
$7,205.89
|
| Rate for Payer: Anthem Medicaid |
$3,218.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,299.47
|
| Rate for Payer: Cash Price |
$4,679.15
|
| Rate for Payer: Cigna Commercial |
$7,767.39
|
| Rate for Payer: First Health Commercial |
$8,890.39
|
| Rate for Payer: Humana Commercial |
$7,954.56
|
| Rate for Payer: Humana KY Medicaid |
$3,218.32
|
| Rate for Payer: Kentucky WC Medicaid |
$3,251.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,673.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,906.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,807.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,282.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,235.30
|
| Rate for Payer: Ohio Health Group HMO |
$7,018.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,486.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,141.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,457.23
|
| Rate for Payer: PHCS Commercial |
$8,983.97
|
| Rate for Payer: United Healthcare All Payer |
$8,235.30
|
|
|
INSRT JRNY ARTBCS STD 1-2 11 L
|
Facility
|
IP
|
$9,358.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,807.49 |
| Max. Negotiated Rate |
$8,983.97 |
| Rate for Payer: Aetna Commercial |
$7,205.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,299.47
|
| Rate for Payer: Cash Price |
$4,679.15
|
| Rate for Payer: Cigna Commercial |
$7,767.39
|
| Rate for Payer: First Health Commercial |
$8,890.39
|
| Rate for Payer: Humana Commercial |
$7,954.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,673.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,906.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,807.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,235.30
|
| Rate for Payer: Ohio Health Group HMO |
$7,018.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,486.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,141.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,457.23
|
| Rate for Payer: PHCS Commercial |
$8,983.97
|
| Rate for Payer: United Healthcare All Payer |
$8,235.30
|
|
|
INSRT JRNY ARTBCS STD 1-2 11 R
|
Facility
|
OP
|
$9,358.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,807.49 |
| Max. Negotiated Rate |
$8,983.97 |
| Rate for Payer: Aetna Commercial |
$7,205.89
|
| Rate for Payer: Anthem Medicaid |
$3,218.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,299.47
|
| Rate for Payer: Cash Price |
$4,679.15
|
| Rate for Payer: Cigna Commercial |
$7,767.39
|
| Rate for Payer: First Health Commercial |
$8,890.39
|
| Rate for Payer: Humana Commercial |
$7,954.56
|
| Rate for Payer: Humana KY Medicaid |
$3,218.32
|
| Rate for Payer: Kentucky WC Medicaid |
$3,251.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,673.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,906.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,807.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,282.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,235.30
|
| Rate for Payer: Ohio Health Group HMO |
$7,018.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,486.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,141.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,457.23
|
| Rate for Payer: PHCS Commercial |
$8,983.97
|
| Rate for Payer: United Healthcare All Payer |
$8,235.30
|
|
|
INSRT JRNY ARTBCS STD 1-2 11 R
|
Facility
|
IP
|
$9,358.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,807.49 |
| Max. Negotiated Rate |
$8,983.97 |
| Rate for Payer: Aetna Commercial |
$7,205.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,299.47
|
| Rate for Payer: Cash Price |
$4,679.15
|
| Rate for Payer: Cigna Commercial |
$7,767.39
|
| Rate for Payer: First Health Commercial |
$8,890.39
|
| Rate for Payer: Humana Commercial |
$7,954.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,673.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,906.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,807.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,235.30
|
| Rate for Payer: Ohio Health Group HMO |
$7,018.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,486.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,141.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,457.23
|
| Rate for Payer: PHCS Commercial |
$8,983.97
|
| Rate for Payer: United Healthcare All Payer |
$8,235.30
|
|
|
INSRT JRNY ARTBCS STD 1-2 13 L
|
Facility
|
IP
|
$9,358.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,807.49 |
| Max. Negotiated Rate |
$8,983.97 |
| Rate for Payer: Aetna Commercial |
$7,205.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,299.47
|
| Rate for Payer: Cash Price |
$4,679.15
|
| Rate for Payer: Cigna Commercial |
$7,767.39
|
| Rate for Payer: First Health Commercial |
$8,890.39
|
| Rate for Payer: Humana Commercial |
$7,954.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,673.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,906.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,807.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,235.30
|
| Rate for Payer: Ohio Health Group HMO |
$7,018.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,486.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,141.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,457.23
|
| Rate for Payer: PHCS Commercial |
$8,983.97
|
| Rate for Payer: United Healthcare All Payer |
$8,235.30
|
|
|
INSRT JRNY ARTBCS STD 1-2 13 L
|
Facility
|
OP
|
$9,358.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,807.49 |
| Max. Negotiated Rate |
$8,983.97 |
| Rate for Payer: Aetna Commercial |
$7,205.89
|
| Rate for Payer: Anthem Medicaid |
$3,218.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,299.47
|
| Rate for Payer: Cash Price |
$4,679.15
|
| Rate for Payer: Cigna Commercial |
$7,767.39
|
| Rate for Payer: First Health Commercial |
$8,890.39
|
| Rate for Payer: Humana Commercial |
$7,954.56
|
| Rate for Payer: Humana KY Medicaid |
$3,218.32
|
| Rate for Payer: Kentucky WC Medicaid |
$3,251.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,673.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,906.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,807.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,282.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,235.30
|
| Rate for Payer: Ohio Health Group HMO |
$7,018.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,486.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,141.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,457.23
|
| Rate for Payer: PHCS Commercial |
$8,983.97
|
| Rate for Payer: United Healthcare All Payer |
$8,235.30
|
|
|
INSRT JRNY ARTBCS STD 1-2 13 R
|
Facility
|
OP
|
$9,358.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,807.49 |
| Max. Negotiated Rate |
$8,983.97 |
| Rate for Payer: Aetna Commercial |
$7,205.89
|
| Rate for Payer: Anthem Medicaid |
$3,218.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,299.47
|
| Rate for Payer: Cash Price |
$4,679.15
|
| Rate for Payer: Cigna Commercial |
$7,767.39
|
| Rate for Payer: First Health Commercial |
$8,890.39
|
| Rate for Payer: Humana Commercial |
$7,954.56
|
| Rate for Payer: Humana KY Medicaid |
$3,218.32
|
| Rate for Payer: Kentucky WC Medicaid |
$3,251.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,673.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,906.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,807.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,282.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,235.30
|
| Rate for Payer: Ohio Health Group HMO |
$7,018.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,486.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,141.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,457.23
|
| Rate for Payer: PHCS Commercial |
$8,983.97
|
| Rate for Payer: United Healthcare All Payer |
$8,235.30
|
|
|
INSRT JRNY ARTBCS STD 1-2 13 R
|
Facility
|
IP
|
$9,358.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,807.49 |
| Max. Negotiated Rate |
$8,983.97 |
| Rate for Payer: Aetna Commercial |
$7,205.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,299.47
|
| Rate for Payer: Cash Price |
$4,679.15
|
| Rate for Payer: Cigna Commercial |
$7,767.39
|
| Rate for Payer: First Health Commercial |
$8,890.39
|
| Rate for Payer: Humana Commercial |
$7,954.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,673.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,906.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,807.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,235.30
|
| Rate for Payer: Ohio Health Group HMO |
$7,018.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,486.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,141.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,457.23
|
| Rate for Payer: PHCS Commercial |
$8,983.97
|
| Rate for Payer: United Healthcare All Payer |
$8,235.30
|
|
|
INSRT JRNY ARTBCS STD 1-2 15 L
|
Facility
|
OP
|
$9,358.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,807.49 |
| Max. Negotiated Rate |
$8,983.97 |
| Rate for Payer: Aetna Commercial |
$7,205.89
|
| Rate for Payer: Anthem Medicaid |
$3,218.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,299.47
|
| Rate for Payer: Cash Price |
$4,679.15
|
| Rate for Payer: Cigna Commercial |
$7,767.39
|
| Rate for Payer: First Health Commercial |
$8,890.39
|
| Rate for Payer: Humana Commercial |
$7,954.56
|
| Rate for Payer: Humana KY Medicaid |
$3,218.32
|
| Rate for Payer: Kentucky WC Medicaid |
$3,251.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,673.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,906.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,807.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,282.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,235.30
|
| Rate for Payer: Ohio Health Group HMO |
$7,018.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,486.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,141.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,457.23
|
| Rate for Payer: PHCS Commercial |
$8,983.97
|
| Rate for Payer: United Healthcare All Payer |
$8,235.30
|
|
|
INSRT JRNY ARTBCS STD 1-2 15 L
|
Facility
|
IP
|
$9,358.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,807.49 |
| Max. Negotiated Rate |
$8,983.97 |
| Rate for Payer: Aetna Commercial |
$7,205.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,299.47
|
| Rate for Payer: Cash Price |
$4,679.15
|
| Rate for Payer: Cigna Commercial |
$7,767.39
|
| Rate for Payer: First Health Commercial |
$8,890.39
|
| Rate for Payer: Humana Commercial |
$7,954.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,673.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,906.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,807.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,235.30
|
| Rate for Payer: Ohio Health Group HMO |
$7,018.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,486.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,141.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,457.23
|
| Rate for Payer: PHCS Commercial |
$8,983.97
|
| Rate for Payer: United Healthcare All Payer |
$8,235.30
|
|
|
INSRT JRNY ARTBCS STD 1-2 15 R
|
Facility
|
IP
|
$9,358.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,807.49 |
| Max. Negotiated Rate |
$8,983.97 |
| Rate for Payer: Aetna Commercial |
$7,205.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,299.47
|
| Rate for Payer: Cash Price |
$4,679.15
|
| Rate for Payer: Cigna Commercial |
$7,767.39
|
| Rate for Payer: First Health Commercial |
$8,890.39
|
| Rate for Payer: Humana Commercial |
$7,954.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,673.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,906.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,807.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,235.30
|
| Rate for Payer: Ohio Health Group HMO |
$7,018.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,486.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,141.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,457.23
|
| Rate for Payer: PHCS Commercial |
$8,983.97
|
| Rate for Payer: United Healthcare All Payer |
$8,235.30
|
|
|
INSRT JRNY ARTBCS STD 1-2 15 R
|
Facility
|
OP
|
$9,358.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,807.49 |
| Max. Negotiated Rate |
$8,983.97 |
| Rate for Payer: Aetna Commercial |
$7,205.89
|
| Rate for Payer: Anthem Medicaid |
$3,218.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,299.47
|
| Rate for Payer: Cash Price |
$4,679.15
|
| Rate for Payer: Cigna Commercial |
$7,767.39
|
| Rate for Payer: First Health Commercial |
$8,890.39
|
| Rate for Payer: Humana Commercial |
$7,954.56
|
| Rate for Payer: Humana KY Medicaid |
$3,218.32
|
| Rate for Payer: Kentucky WC Medicaid |
$3,251.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,673.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,906.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,807.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,282.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,235.30
|
| Rate for Payer: Ohio Health Group HMO |
$7,018.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,486.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,141.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,457.23
|
| Rate for Payer: PHCS Commercial |
$8,983.97
|
| Rate for Payer: United Healthcare All Payer |
$8,235.30
|
|
|
INSRT JRNY ARTBCS STD 1-2 18 L
|
Facility
|
IP
|
$9,358.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,807.49 |
| Max. Negotiated Rate |
$8,983.97 |
| Rate for Payer: Aetna Commercial |
$7,205.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,299.47
|
| Rate for Payer: Cash Price |
$4,679.15
|
| Rate for Payer: Cigna Commercial |
$7,767.39
|
| Rate for Payer: First Health Commercial |
$8,890.39
|
| Rate for Payer: Humana Commercial |
$7,954.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,673.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,906.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,807.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,235.30
|
| Rate for Payer: Ohio Health Group HMO |
$7,018.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,486.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,141.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,457.23
|
| Rate for Payer: PHCS Commercial |
$8,983.97
|
| Rate for Payer: United Healthcare All Payer |
$8,235.30
|
|
|
INSRT JRNY ARTBCS STD 1-2 18 L
|
Facility
|
OP
|
$9,358.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,807.49 |
| Max. Negotiated Rate |
$8,983.97 |
| Rate for Payer: Aetna Commercial |
$7,205.89
|
| Rate for Payer: Anthem Medicaid |
$3,218.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,299.47
|
| Rate for Payer: Cash Price |
$4,679.15
|
| Rate for Payer: Cigna Commercial |
$7,767.39
|
| Rate for Payer: First Health Commercial |
$8,890.39
|
| Rate for Payer: Humana Commercial |
$7,954.56
|
| Rate for Payer: Humana KY Medicaid |
$3,218.32
|
| Rate for Payer: Kentucky WC Medicaid |
$3,251.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,673.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,906.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,807.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,282.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,235.30
|
| Rate for Payer: Ohio Health Group HMO |
$7,018.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,486.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,141.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,457.23
|
| Rate for Payer: PHCS Commercial |
$8,983.97
|
| Rate for Payer: United Healthcare All Payer |
$8,235.30
|
|
