|
PALMAZ BLUE SLALOM 6*15*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*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 6*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 6*18*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 6*18*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 6*24*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*24*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 7*12*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 7*12*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 7*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 7*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 7*14*135
|
Facility
|
OP
|
$5,190.54
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$674.77 |
| Max. Negotiated Rate |
$4,982.92 |
| Rate for Payer: Aetna Commercial |
$3,996.72
|
| Rate for Payer: Anthem Medicaid |
$1,785.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,048.62
|
| Rate for Payer: Cash Price |
$2,595.27
|
| Rate for Payer: Cigna Commercial |
$4,308.15
|
| Rate for Payer: First Health Commercial |
$4,931.01
|
| Rate for Payer: Humana Commercial |
$4,411.96
|
| Rate for Payer: Humana KY Medicaid |
$1,785.03
|
| Rate for Payer: Kentucky WC Medicaid |
$1,803.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,256.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,830.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,557.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,820.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,567.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,892.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,038.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$674.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,609.07
|
| Rate for Payer: PHCS Commercial |
$4,982.92
|
| Rate for Payer: United Healthcare All Payer |
$4,567.68
|
|
|
PALMAZ BLUE SLALOM 7*14*135
|
Facility
|
IP
|
$5,190.54
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$674.77 |
| Max. Negotiated Rate |
$4,982.92 |
| Rate for Payer: Aetna Commercial |
$3,996.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,048.62
|
| Rate for Payer: Cash Price |
$2,595.27
|
| Rate for Payer: Cigna Commercial |
$4,308.15
|
| Rate for Payer: First Health Commercial |
$4,931.01
|
| Rate for Payer: Humana Commercial |
$4,411.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,256.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,830.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,557.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,567.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,892.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,038.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$674.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,609.07
|
| Rate for Payer: PHCS Commercial |
$4,982.92
|
| Rate for Payer: United Healthcare All Payer |
$4,567.68
|
|
|
PALMAZ BLUE SLALOM 7*14*80
|
Facility
|
OP
|
$5,190.54
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$674.77 |
| Max. Negotiated Rate |
$4,982.92 |
| Rate for Payer: Aetna Commercial |
$3,996.72
|
| Rate for Payer: Anthem Medicaid |
$1,785.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,048.62
|
| Rate for Payer: Cash Price |
$2,595.27
|
| Rate for Payer: Cigna Commercial |
$4,308.15
|
| Rate for Payer: First Health Commercial |
$4,931.01
|
| Rate for Payer: Humana Commercial |
$4,411.96
|
| Rate for Payer: Humana KY Medicaid |
$1,785.03
|
| Rate for Payer: Kentucky WC Medicaid |
$1,803.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,256.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,830.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,557.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,820.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,567.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,892.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,038.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$674.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,609.07
|
| Rate for Payer: PHCS Commercial |
$4,982.92
|
| Rate for Payer: United Healthcare All Payer |
$4,567.68
|
|
|
PALMAZ BLUE SLALOM 7*14*80
|
Facility
|
IP
|
$5,190.54
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$674.77 |
| Max. Negotiated Rate |
$4,982.92 |
| Rate for Payer: Aetna Commercial |
$3,996.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,048.62
|
| Rate for Payer: Cash Price |
$2,595.27
|
| Rate for Payer: Cigna Commercial |
$4,308.15
|
| Rate for Payer: First Health Commercial |
$4,931.01
|
| Rate for Payer: Humana Commercial |
$4,411.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,256.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,830.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,557.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,567.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,892.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,038.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$674.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,609.07
|
| Rate for Payer: PHCS Commercial |
$4,982.92
|
| Rate for Payer: United Healthcare All Payer |
$4,567.68
|
|
|
PALMAZ BLUE SLALOM 7*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 7*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 7*18*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 7*18*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 7*24*135
|
Facility
|
IP
|
$5,190.54
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$674.77 |
| Max. Negotiated Rate |
$4,982.92 |
| Rate for Payer: Aetna Commercial |
$3,996.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,048.62
|
| Rate for Payer: Cash Price |
$2,595.27
|
| Rate for Payer: Cigna Commercial |
$4,308.15
|
| Rate for Payer: First Health Commercial |
$4,931.01
|
| Rate for Payer: Humana Commercial |
$4,411.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,256.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,830.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,557.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,567.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,892.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,038.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$674.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,609.07
|
| Rate for Payer: PHCS Commercial |
$4,982.92
|
| Rate for Payer: United Healthcare All Payer |
$4,567.68
|
|
|
PALMAZ BLUE SLALOM 7*24*135
|
Facility
|
OP
|
$5,190.54
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$674.77 |
| Max. Negotiated Rate |
$4,982.92 |
| Rate for Payer: Aetna Commercial |
$3,996.72
|
| Rate for Payer: Anthem Medicaid |
$1,785.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,048.62
|
| Rate for Payer: Cash Price |
$2,595.27
|
| Rate for Payer: Cigna Commercial |
$4,308.15
|
| Rate for Payer: First Health Commercial |
$4,931.01
|
| Rate for Payer: Humana Commercial |
$4,411.96
|
| Rate for Payer: Humana KY Medicaid |
$1,785.03
|
| Rate for Payer: Kentucky WC Medicaid |
$1,803.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,256.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,830.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,557.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,820.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,567.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,892.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,038.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$674.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,609.07
|
| Rate for Payer: PHCS Commercial |
$4,982.92
|
| Rate for Payer: United Healthcare All Payer |
$4,567.68
|
|
|
PALMAZ GENESIS STENT 12*40*80
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
PALMAZ GENESIS STENT 12*40*80
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
PALMAZ GENESIS STENT 12*50*80
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
PALMAZ GENESIS STENT 12*50*80
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
