|
PALMAZ BLUE SLALOM 4*15*135
|
Facility
|
IP
|
$4,912.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.62 |
| Max. Negotiated Rate |
$4,716.00 |
| Rate for Payer: Aetna Commercial |
$3,782.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,831.75
|
| Rate for Payer: Cash Price |
$2,456.25
|
| Rate for Payer: Cigna Commercial |
$4,077.38
|
| Rate for Payer: First Health Commercial |
$4,666.88
|
| Rate for Payer: Humana Commercial |
$4,175.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,522.88
|
| Rate for Payer: PHCS Commercial |
$4,716.00
|
| Rate for Payer: United Healthcare All Payer |
$4,323.00
|
|
|
PALMAZ BLUE SLALOM 4*15*135
|
Facility
|
OP
|
$4,912.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.62 |
| Max. Negotiated Rate |
$4,716.00 |
| Rate for Payer: Aetna Commercial |
$3,782.62
|
| Rate for Payer: Anthem Medicaid |
$1,689.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,831.75
|
| Rate for Payer: Cash Price |
$2,456.25
|
| Rate for Payer: Cigna Commercial |
$4,077.38
|
| Rate for Payer: First Health Commercial |
$4,666.88
|
| Rate for Payer: Humana Commercial |
$4,175.62
|
| Rate for Payer: Humana KY Medicaid |
$1,689.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,706.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,723.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,522.88
|
| Rate for Payer: PHCS Commercial |
$4,716.00
|
| Rate for Payer: United Healthcare All Payer |
$4,323.00
|
|
|
PALMAZ BLUE SLALOM 4*18*135
|
Facility
|
OP
|
$7,110.65
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$924.38 |
| Max. Negotiated Rate |
$6,826.22 |
| Rate for Payer: Aetna Commercial |
$5,475.20
|
| Rate for Payer: Anthem Medicaid |
$2,445.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,546.31
|
| Rate for Payer: Cash Price |
$3,555.32
|
| Rate for Payer: Cigna Commercial |
$5,901.84
|
| Rate for Payer: First Health Commercial |
$6,755.12
|
| Rate for Payer: Humana Commercial |
$6,044.05
|
| Rate for Payer: Humana KY Medicaid |
$2,445.35
|
| Rate for Payer: Kentucky WC Medicaid |
$2,470.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,830.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,247.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,133.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,494.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,257.37
|
| Rate for Payer: Ohio Health Group HMO |
$5,332.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,422.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$924.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,204.30
|
| Rate for Payer: PHCS Commercial |
$6,826.22
|
| Rate for Payer: United Healthcare All Payer |
$6,257.37
|
|
|
PALMAZ BLUE SLALOM 4*18*135
|
Facility
|
IP
|
$7,110.65
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$924.38 |
| Max. Negotiated Rate |
$6,826.22 |
| Rate for Payer: Aetna Commercial |
$5,475.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,546.31
|
| Rate for Payer: Cash Price |
$3,555.32
|
| Rate for Payer: Cigna Commercial |
$5,901.84
|
| Rate for Payer: First Health Commercial |
$6,755.12
|
| Rate for Payer: Humana Commercial |
$6,044.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,830.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,247.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,133.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,257.37
|
| Rate for Payer: Ohio Health Group HMO |
$5,332.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,422.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$924.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,204.30
|
| Rate for Payer: PHCS Commercial |
$6,826.22
|
| Rate for Payer: United Healthcare All Payer |
$6,257.37
|
|
|
PALMAZ BLUE SLALOM 5*12*135
|
Facility
|
IP
|
$4,912.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.62 |
| Max. Negotiated Rate |
$4,716.00 |
| Rate for Payer: Aetna Commercial |
$3,782.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,831.75
|
| Rate for Payer: Cash Price |
$2,456.25
|
| Rate for Payer: Cigna Commercial |
$4,077.38
|
| Rate for Payer: First Health Commercial |
$4,666.88
|
| Rate for Payer: Humana Commercial |
$4,175.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,522.88
|
| Rate for Payer: PHCS Commercial |
$4,716.00
|
| Rate for Payer: United Healthcare All Payer |
$4,323.00
|
|
|
PALMAZ BLUE SLALOM 5*12*135
|
Facility
|
OP
|
$4,912.50
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.62 |
| Max. Negotiated Rate |
$4,716.00 |
| Rate for Payer: Aetna Commercial |
$3,782.62
|
| Rate for Payer: Anthem Medicaid |
$1,689.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,831.75
|
| Rate for Payer: Cash Price |
$2,456.25
|
| Rate for Payer: Cigna Commercial |
$4,077.38
|
| Rate for Payer: First Health Commercial |
$4,666.88
|
| Rate for Payer: Humana Commercial |
$4,175.62
|
| Rate for Payer: Humana KY Medicaid |
$1,689.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,706.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,723.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,522.88
|
| Rate for Payer: PHCS Commercial |
$4,716.00
|
| Rate for Payer: United Healthcare All Payer |
$4,323.00
|
|
|
PALMAZ BLUE SLALOM 5*12*80
|
Facility
|
IP
|
$4,912.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.62 |
| Max. Negotiated Rate |
$4,716.00 |
| Rate for Payer: Aetna Commercial |
$3,782.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,831.75
|
| Rate for Payer: Cash Price |
$2,456.25
|
| Rate for Payer: Cigna Commercial |
$4,077.38
|
| Rate for Payer: First Health Commercial |
$4,666.88
|
| Rate for Payer: Humana Commercial |
$4,175.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,522.88
|
| Rate for Payer: PHCS Commercial |
$4,716.00
|
| Rate for Payer: United Healthcare All Payer |
$4,323.00
|
|
|
PALMAZ BLUE SLALOM 5*12*80
|
Facility
|
OP
|
$4,912.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.62 |
| Max. Negotiated Rate |
$4,716.00 |
| Rate for Payer: Aetna Commercial |
$3,782.62
|
| Rate for Payer: Anthem Medicaid |
$1,689.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,831.75
|
| Rate for Payer: Cash Price |
$2,456.25
|
| Rate for Payer: Cigna Commercial |
$4,077.38
|
| Rate for Payer: First Health Commercial |
$4,666.88
|
| Rate for Payer: Humana Commercial |
$4,175.62
|
| Rate for Payer: Humana KY Medicaid |
$1,689.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,706.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,723.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,522.88
|
| Rate for Payer: PHCS Commercial |
$4,716.00
|
| Rate for Payer: United Healthcare All Payer |
$4,323.00
|
|
|
PALMAZ BLUE SLALOM 5*15*135
|
Facility
|
OP
|
$5,048.12
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$656.26 |
| Max. Negotiated Rate |
$4,846.20 |
| Rate for Payer: Aetna Commercial |
$3,887.05
|
| Rate for Payer: Anthem Medicaid |
$1,736.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,937.53
|
| Rate for Payer: Cash Price |
$2,524.06
|
| Rate for Payer: Cigna Commercial |
$4,189.94
|
| Rate for Payer: First Health Commercial |
$4,795.71
|
| Rate for Payer: Humana Commercial |
$4,290.90
|
| Rate for Payer: Humana KY Medicaid |
$1,736.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,753.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,139.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,725.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,514.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,770.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,442.35
|
| Rate for Payer: Ohio Health Group HMO |
$3,786.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,009.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$656.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,564.92
|
| Rate for Payer: PHCS Commercial |
$4,846.20
|
| Rate for Payer: United Healthcare All Payer |
$4,442.35
|
|
|
PALMAZ BLUE SLALOM 5*15*135
|
Facility
|
IP
|
$5,048.12
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$656.26 |
| Max. Negotiated Rate |
$4,846.20 |
| Rate for Payer: Aetna Commercial |
$3,887.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,937.53
|
| Rate for Payer: Cash Price |
$2,524.06
|
| Rate for Payer: Cigna Commercial |
$4,189.94
|
| Rate for Payer: First Health Commercial |
$4,795.71
|
| Rate for Payer: Humana Commercial |
$4,290.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,139.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,725.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,514.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,442.35
|
| Rate for Payer: Ohio Health Group HMO |
$3,786.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,009.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$656.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,564.92
|
| Rate for Payer: PHCS Commercial |
$4,846.20
|
| Rate for Payer: United Healthcare All Payer |
$4,442.35
|
|
|
PALMAZ BLUE SLALOM 5*15*80
|
Facility
|
OP
|
$4,912.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.62 |
| Max. Negotiated Rate |
$4,716.00 |
| Rate for Payer: Aetna Commercial |
$3,782.62
|
| Rate for Payer: Anthem Medicaid |
$1,689.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,831.75
|
| Rate for Payer: Cash Price |
$2,456.25
|
| Rate for Payer: Cigna Commercial |
$4,077.38
|
| Rate for Payer: First Health Commercial |
$4,666.88
|
| Rate for Payer: Humana Commercial |
$4,175.62
|
| Rate for Payer: Humana KY Medicaid |
$1,689.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,706.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,723.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,522.88
|
| Rate for Payer: PHCS Commercial |
$4,716.00
|
| Rate for Payer: United Healthcare All Payer |
$4,323.00
|
|
|
PALMAZ BLUE SLALOM 5*15*80
|
Facility
|
IP
|
$4,912.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.62 |
| Max. Negotiated Rate |
$4,716.00 |
| Rate for Payer: Aetna Commercial |
$3,782.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,831.75
|
| Rate for Payer: Cash Price |
$2,456.25
|
| Rate for Payer: Cigna Commercial |
$4,077.38
|
| Rate for Payer: First Health Commercial |
$4,666.88
|
| Rate for Payer: Humana Commercial |
$4,175.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,522.88
|
| Rate for Payer: PHCS Commercial |
$4,716.00
|
| Rate for Payer: United Healthcare All Payer |
$4,323.00
|
|
|
PALMAZ BLUE SLALOM 5*18*135
|
Facility
|
IP
|
$5,048.12
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$656.26 |
| Max. Negotiated Rate |
$4,846.20 |
| Rate for Payer: Aetna Commercial |
$3,887.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,937.53
|
| Rate for Payer: Cash Price |
$2,524.06
|
| Rate for Payer: Cigna Commercial |
$4,189.94
|
| Rate for Payer: First Health Commercial |
$4,795.71
|
| Rate for Payer: Humana Commercial |
$4,290.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,139.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,725.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,514.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,442.35
|
| Rate for Payer: Ohio Health Group HMO |
$3,786.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,009.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$656.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,564.92
|
| Rate for Payer: PHCS Commercial |
$4,846.20
|
| Rate for Payer: United Healthcare All Payer |
$4,442.35
|
|
|
PALMAZ BLUE SLALOM 5*18*135
|
Facility
|
OP
|
$5,048.12
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$656.26 |
| Max. Negotiated Rate |
$4,846.20 |
| Rate for Payer: Aetna Commercial |
$3,887.05
|
| Rate for Payer: Anthem Medicaid |
$1,736.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,937.53
|
| Rate for Payer: Cash Price |
$2,524.06
|
| Rate for Payer: Cigna Commercial |
$4,189.94
|
| Rate for Payer: First Health Commercial |
$4,795.71
|
| Rate for Payer: Humana Commercial |
$4,290.90
|
| Rate for Payer: Humana KY Medicaid |
$1,736.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,753.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,139.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,725.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,514.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,770.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,442.35
|
| Rate for Payer: Ohio Health Group HMO |
$3,786.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,009.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$656.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,564.92
|
| Rate for Payer: PHCS Commercial |
$4,846.20
|
| Rate for Payer: United Healthcare All Payer |
$4,442.35
|
|
|
PALMAZ BLUE SLALOM 5*18*80
|
Facility
|
OP
|
$5,048.12
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$656.26 |
| Max. Negotiated Rate |
$4,846.20 |
| Rate for Payer: Aetna Commercial |
$3,887.05
|
| Rate for Payer: Anthem Medicaid |
$1,736.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,937.53
|
| Rate for Payer: Cash Price |
$2,524.06
|
| Rate for Payer: Cigna Commercial |
$4,189.94
|
| Rate for Payer: First Health Commercial |
$4,795.71
|
| Rate for Payer: Humana Commercial |
$4,290.90
|
| Rate for Payer: Humana KY Medicaid |
$1,736.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,753.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,139.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,725.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,514.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,770.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,442.35
|
| Rate for Payer: Ohio Health Group HMO |
$3,786.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,009.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$656.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,564.92
|
| Rate for Payer: PHCS Commercial |
$4,846.20
|
| Rate for Payer: United Healthcare All Payer |
$4,442.35
|
|
|
PALMAZ BLUE SLALOM 5*18*80
|
Facility
|
IP
|
$5,048.12
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$656.26 |
| Max. Negotiated Rate |
$4,846.20 |
| Rate for Payer: Aetna Commercial |
$3,887.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,937.53
|
| Rate for Payer: Cash Price |
$2,524.06
|
| Rate for Payer: Cigna Commercial |
$4,189.94
|
| Rate for Payer: First Health Commercial |
$4,795.71
|
| Rate for Payer: Humana Commercial |
$4,290.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,139.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,725.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,514.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,442.35
|
| Rate for Payer: Ohio Health Group HMO |
$3,786.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,009.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$656.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,564.92
|
| Rate for Payer: PHCS Commercial |
$4,846.20
|
| Rate for Payer: United Healthcare All Payer |
$4,442.35
|
|
|
PALMAZ BLUE SLALOM 5*24*135
|
Facility
|
IP
|
$4,912.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.62 |
| Max. Negotiated Rate |
$4,716.00 |
| Rate for Payer: Aetna Commercial |
$3,782.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,831.75
|
| Rate for Payer: Cash Price |
$2,456.25
|
| Rate for Payer: Cigna Commercial |
$4,077.38
|
| Rate for Payer: First Health Commercial |
$4,666.88
|
| Rate for Payer: Humana Commercial |
$4,175.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,522.88
|
| Rate for Payer: PHCS Commercial |
$4,716.00
|
| Rate for Payer: United Healthcare All Payer |
$4,323.00
|
|
|
PALMAZ BLUE SLALOM 5*24*135
|
Facility
|
OP
|
$4,912.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.62 |
| Max. Negotiated Rate |
$4,716.00 |
| Rate for Payer: Aetna Commercial |
$3,782.62
|
| Rate for Payer: Anthem Medicaid |
$1,689.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,831.75
|
| Rate for Payer: Cash Price |
$2,456.25
|
| Rate for Payer: Cigna Commercial |
$4,077.38
|
| Rate for Payer: First Health Commercial |
$4,666.88
|
| Rate for Payer: Humana Commercial |
$4,175.62
|
| Rate for Payer: Humana KY Medicaid |
$1,689.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,706.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,723.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,522.88
|
| Rate for Payer: PHCS Commercial |
$4,716.00
|
| Rate for Payer: United Healthcare All Payer |
$4,323.00
|
|
|
PALMAZ BLUE SLALOM 6*12*135
|
Facility
|
IP
|
$5,048.12
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$656.26 |
| Max. Negotiated Rate |
$4,846.20 |
| Rate for Payer: Aetna Commercial |
$3,887.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,937.53
|
| Rate for Payer: Cash Price |
$2,524.06
|
| Rate for Payer: Cigna Commercial |
$4,189.94
|
| Rate for Payer: First Health Commercial |
$4,795.71
|
| Rate for Payer: Humana Commercial |
$4,290.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,139.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,725.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,514.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,442.35
|
| Rate for Payer: Ohio Health Group HMO |
$3,786.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,009.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$656.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,564.92
|
| Rate for Payer: PHCS Commercial |
$4,846.20
|
| Rate for Payer: United Healthcare All Payer |
$4,442.35
|
|
|
PALMAZ BLUE SLALOM 6*12*135
|
Facility
|
OP
|
$5,048.12
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$656.26 |
| Max. Negotiated Rate |
$4,846.20 |
| Rate for Payer: Aetna Commercial |
$3,887.05
|
| Rate for Payer: Anthem Medicaid |
$1,736.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,937.53
|
| Rate for Payer: Cash Price |
$2,524.06
|
| Rate for Payer: Cigna Commercial |
$4,189.94
|
| Rate for Payer: First Health Commercial |
$4,795.71
|
| Rate for Payer: Humana Commercial |
$4,290.90
|
| Rate for Payer: Humana KY Medicaid |
$1,736.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,753.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,139.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,725.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,514.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,770.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,442.35
|
| Rate for Payer: Ohio Health Group HMO |
$3,786.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,009.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$656.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,564.92
|
| Rate for Payer: PHCS Commercial |
$4,846.20
|
| Rate for Payer: United Healthcare All Payer |
$4,442.35
|
|
|
PALMAZ BLUE SLALOM 6*12*80
|
Facility
|
OP
|
$5,048.12
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$656.26 |
| Max. Negotiated Rate |
$4,846.20 |
| Rate for Payer: Aetna Commercial |
$3,887.05
|
| Rate for Payer: Anthem Medicaid |
$1,736.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,937.53
|
| Rate for Payer: Cash Price |
$2,524.06
|
| Rate for Payer: Cigna Commercial |
$4,189.94
|
| Rate for Payer: First Health Commercial |
$4,795.71
|
| Rate for Payer: Humana Commercial |
$4,290.90
|
| Rate for Payer: Humana KY Medicaid |
$1,736.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,753.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,139.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,725.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,514.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,770.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,442.35
|
| Rate for Payer: Ohio Health Group HMO |
$3,786.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,009.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$656.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,564.92
|
| Rate for Payer: PHCS Commercial |
$4,846.20
|
| Rate for Payer: United Healthcare All Payer |
$4,442.35
|
|
|
PALMAZ BLUE SLALOM 6*12*80
|
Facility
|
IP
|
$5,048.12
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$656.26 |
| Max. Negotiated Rate |
$4,846.20 |
| Rate for Payer: Aetna Commercial |
$3,887.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,937.53
|
| Rate for Payer: Cash Price |
$2,524.06
|
| Rate for Payer: Cigna Commercial |
$4,189.94
|
| Rate for Payer: First Health Commercial |
$4,795.71
|
| Rate for Payer: Humana Commercial |
$4,290.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,139.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,725.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,514.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,442.35
|
| Rate for Payer: Ohio Health Group HMO |
$3,786.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,009.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$656.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,564.92
|
| Rate for Payer: PHCS Commercial |
$4,846.20
|
| Rate for Payer: United Healthcare All Payer |
$4,442.35
|
|
|
PALMAZ BLUE SLALOM 6*15*135
|
Facility
|
IP
|
$5,048.12
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$656.26 |
| Max. Negotiated Rate |
$4,846.20 |
| Rate for Payer: Aetna Commercial |
$3,887.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,937.53
|
| Rate for Payer: Cash Price |
$2,524.06
|
| Rate for Payer: Cigna Commercial |
$4,189.94
|
| Rate for Payer: First Health Commercial |
$4,795.71
|
| Rate for Payer: Humana Commercial |
$4,290.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,139.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,725.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,514.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,442.35
|
| Rate for Payer: Ohio Health Group HMO |
$3,786.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,009.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$656.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,564.92
|
| Rate for Payer: PHCS Commercial |
$4,846.20
|
| Rate for Payer: United Healthcare All Payer |
$4,442.35
|
|
|
PALMAZ BLUE SLALOM 6*15*135
|
Facility
|
OP
|
$5,048.12
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$656.26 |
| Max. Negotiated Rate |
$4,846.20 |
| Rate for Payer: Aetna Commercial |
$3,887.05
|
| Rate for Payer: Anthem Medicaid |
$1,736.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,937.53
|
| Rate for Payer: Cash Price |
$2,524.06
|
| Rate for Payer: Cigna Commercial |
$4,189.94
|
| Rate for Payer: First Health Commercial |
$4,795.71
|
| Rate for Payer: Humana Commercial |
$4,290.90
|
| Rate for Payer: Humana KY Medicaid |
$1,736.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,753.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,139.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,725.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,514.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,770.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,442.35
|
| Rate for Payer: Ohio Health Group HMO |
$3,786.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,009.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$656.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,564.92
|
| Rate for Payer: PHCS Commercial |
$4,846.20
|
| Rate for Payer: United Healthcare All Payer |
$4,442.35
|
|
|
PALMAZ BLUE SLALOM 6*15*80
|
Facility
|
IP
|
$5,048.12
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$656.26 |
| Max. Negotiated Rate |
$4,846.20 |
| Rate for Payer: Aetna Commercial |
$3,887.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,937.53
|
| Rate for Payer: Cash Price |
$2,524.06
|
| Rate for Payer: Cigna Commercial |
$4,189.94
|
| Rate for Payer: First Health Commercial |
$4,795.71
|
| Rate for Payer: Humana Commercial |
$4,290.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,139.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,725.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,514.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,442.35
|
| Rate for Payer: Ohio Health Group HMO |
$3,786.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,009.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$656.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,564.92
|
| Rate for Payer: PHCS Commercial |
$4,846.20
|
| Rate for Payer: United Healthcare All Payer |
$4,442.35
|
|
