|
PALMAZ BLUE SLALOM 4*18*135
|
Facility
|
OP
|
$7,310.65
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,193.20 |
| Max. Negotiated Rate |
$7,018.22 |
| Rate for Payer: Aetna Commercial |
$5,629.20
|
| Rate for Payer: Anthem Medicaid |
$2,514.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,702.31
|
| Rate for Payer: Cash Price |
$3,655.32
|
| Rate for Payer: Cigna Commercial |
$6,067.84
|
| Rate for Payer: First Health Commercial |
$6,945.12
|
| Rate for Payer: Humana Commercial |
$6,214.05
|
| Rate for Payer: Humana KY Medicaid |
$2,514.13
|
| Rate for Payer: Kentucky WC Medicaid |
$2,539.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,994.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,395.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,193.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,564.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,433.37
|
| Rate for Payer: Ohio Health Group HMO |
$5,482.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,848.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,360.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,044.35
|
| Rate for Payer: PHCS Commercial |
$7,018.22
|
| Rate for Payer: United Healthcare All Payer |
$6,433.37
|
|
|
PALMAZ BLUE SLALOM 5*12*135
|
Facility
|
OP
|
$4,906.25
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,471.88 |
| Max. Negotiated Rate |
$4,710.00 |
| Rate for Payer: Aetna Commercial |
$3,777.81
|
| Rate for Payer: Anthem Medicaid |
$1,687.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,826.88
|
| Rate for Payer: Cash Price |
$2,453.12
|
| Rate for Payer: Cigna Commercial |
$4,072.19
|
| Rate for Payer: First Health Commercial |
$4,660.94
|
| Rate for Payer: Humana Commercial |
$4,170.31
|
| Rate for Payer: Humana KY Medicaid |
$1,687.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,704.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,023.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,620.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,721.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,679.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,268.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,385.31
|
| Rate for Payer: PHCS Commercial |
$4,710.00
|
| Rate for Payer: United Healthcare All Payer |
$4,317.50
|
|
|
PALMAZ BLUE SLALOM 5*12*135
|
Facility
|
IP
|
$4,906.25
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,471.88 |
| Max. Negotiated Rate |
$4,710.00 |
| Rate for Payer: Aetna Commercial |
$3,777.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,826.88
|
| Rate for Payer: Cash Price |
$2,453.12
|
| Rate for Payer: Cigna Commercial |
$4,072.19
|
| Rate for Payer: First Health Commercial |
$4,660.94
|
| Rate for Payer: Humana Commercial |
$4,170.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,023.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,620.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,679.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,268.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,385.31
|
| Rate for Payer: PHCS Commercial |
$4,710.00
|
| Rate for Payer: United Healthcare All Payer |
$4,317.50
|
|
|
PALMAZ BLUE SLALOM 5*12*80
|
Facility
|
OP
|
$4,906.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,471.88 |
| Max. Negotiated Rate |
$4,710.00 |
| Rate for Payer: Aetna Commercial |
$3,777.81
|
| Rate for Payer: Anthem Medicaid |
$1,687.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,826.88
|
| Rate for Payer: Cash Price |
$2,453.12
|
| Rate for Payer: Cigna Commercial |
$4,072.19
|
| Rate for Payer: First Health Commercial |
$4,660.94
|
| Rate for Payer: Humana Commercial |
$4,170.31
|
| Rate for Payer: Humana KY Medicaid |
$1,687.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,704.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,023.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,620.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,721.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,679.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,268.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,385.31
|
| Rate for Payer: PHCS Commercial |
$4,710.00
|
| Rate for Payer: United Healthcare All Payer |
$4,317.50
|
|
|
PALMAZ BLUE SLALOM 5*12*80
|
Facility
|
IP
|
$4,906.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,471.88 |
| Max. Negotiated Rate |
$4,710.00 |
| Rate for Payer: Aetna Commercial |
$3,777.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,826.88
|
| Rate for Payer: Cash Price |
$2,453.12
|
| Rate for Payer: Cigna Commercial |
$4,072.19
|
| Rate for Payer: First Health Commercial |
$4,660.94
|
| Rate for Payer: Humana Commercial |
$4,170.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,023.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,620.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,679.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,268.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,385.31
|
| Rate for Payer: PHCS Commercial |
$4,710.00
|
| Rate for Payer: United Healthcare All Payer |
$4,317.50
|
|
|
PALMAZ BLUE SLALOM 5*15*135
|
Facility
|
OP
|
$5,204.15
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,561.24 |
| Max. Negotiated Rate |
$4,995.98 |
| Rate for Payer: Aetna Commercial |
$4,007.20
|
| Rate for Payer: Anthem Medicaid |
$1,789.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,059.24
|
| Rate for Payer: Cash Price |
$2,602.07
|
| Rate for Payer: Cigna Commercial |
$4,319.44
|
| Rate for Payer: First Health Commercial |
$4,943.94
|
| Rate for Payer: Humana Commercial |
$4,423.53
|
| Rate for Payer: Humana KY Medicaid |
$1,789.71
|
| Rate for Payer: Kentucky WC Medicaid |
$1,807.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,267.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,840.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,561.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,825.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,579.65
|
| Rate for Payer: Ohio Health Group HMO |
$3,903.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,163.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,527.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,590.86
|
| Rate for Payer: PHCS Commercial |
$4,995.98
|
| Rate for Payer: United Healthcare All Payer |
$4,579.65
|
|
|
PALMAZ BLUE SLALOM 5*15*135
|
Facility
|
IP
|
$5,204.15
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,561.24 |
| Max. Negotiated Rate |
$4,995.98 |
| Rate for Payer: Aetna Commercial |
$4,007.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,059.24
|
| Rate for Payer: Cash Price |
$2,602.07
|
| Rate for Payer: Cigna Commercial |
$4,319.44
|
| Rate for Payer: First Health Commercial |
$4,943.94
|
| Rate for Payer: Humana Commercial |
$4,423.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,267.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,840.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,561.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,579.65
|
| Rate for Payer: Ohio Health Group HMO |
$3,903.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,163.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,527.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,590.86
|
| Rate for Payer: PHCS Commercial |
$4,995.98
|
| Rate for Payer: United Healthcare All Payer |
$4,579.65
|
|
|
PALMAZ BLUE SLALOM 5*15*80
|
Facility
|
OP
|
$4,906.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,471.88 |
| Max. Negotiated Rate |
$4,710.00 |
| Rate for Payer: Aetna Commercial |
$3,777.81
|
| Rate for Payer: Anthem Medicaid |
$1,687.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,826.88
|
| Rate for Payer: Cash Price |
$2,453.12
|
| Rate for Payer: Cigna Commercial |
$4,072.19
|
| Rate for Payer: First Health Commercial |
$4,660.94
|
| Rate for Payer: Humana Commercial |
$4,170.31
|
| Rate for Payer: Humana KY Medicaid |
$1,687.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,704.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,023.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,620.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,721.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,679.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,268.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,385.31
|
| Rate for Payer: PHCS Commercial |
$4,710.00
|
| Rate for Payer: United Healthcare All Payer |
$4,317.50
|
|
|
PALMAZ BLUE SLALOM 5*15*80
|
Facility
|
IP
|
$4,906.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,471.88 |
| Max. Negotiated Rate |
$4,710.00 |
| Rate for Payer: Aetna Commercial |
$3,777.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,826.88
|
| Rate for Payer: Cash Price |
$2,453.12
|
| Rate for Payer: Cigna Commercial |
$4,072.19
|
| Rate for Payer: First Health Commercial |
$4,660.94
|
| Rate for Payer: Humana Commercial |
$4,170.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,023.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,620.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,679.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,268.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,385.31
|
| Rate for Payer: PHCS Commercial |
$4,710.00
|
| Rate for Payer: United Healthcare All Payer |
$4,317.50
|
|
|
PALMAZ BLUE SLALOM 5*18*135
|
Facility
|
OP
|
$5,051.56
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,515.47 |
| Max. Negotiated Rate |
$4,849.50 |
| Rate for Payer: Aetna Commercial |
$3,889.70
|
| Rate for Payer: Anthem Medicaid |
$1,737.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,940.22
|
| Rate for Payer: Cash Price |
$2,525.78
|
| Rate for Payer: Cigna Commercial |
$4,192.79
|
| Rate for Payer: First Health Commercial |
$4,798.98
|
| Rate for Payer: Humana Commercial |
$4,293.83
|
| Rate for Payer: Humana KY Medicaid |
$1,737.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,754.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,142.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,728.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,515.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,772.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,445.37
|
| Rate for Payer: Ohio Health Group HMO |
$3,788.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,041.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,394.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,485.58
|
| Rate for Payer: PHCS Commercial |
$4,849.50
|
| Rate for Payer: United Healthcare All Payer |
$4,445.37
|
|
|
PALMAZ BLUE SLALOM 5*18*135
|
Facility
|
IP
|
$5,051.56
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,515.47 |
| Max. Negotiated Rate |
$4,849.50 |
| Rate for Payer: Aetna Commercial |
$3,889.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,940.22
|
| Rate for Payer: Cash Price |
$2,525.78
|
| Rate for Payer: Cigna Commercial |
$4,192.79
|
| Rate for Payer: First Health Commercial |
$4,798.98
|
| Rate for Payer: Humana Commercial |
$4,293.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,142.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,728.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,515.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,445.37
|
| Rate for Payer: Ohio Health Group HMO |
$3,788.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,041.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,394.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,485.58
|
| Rate for Payer: PHCS Commercial |
$4,849.50
|
| Rate for Payer: United Healthcare All Payer |
$4,445.37
|
|
|
PALMAZ BLUE SLALOM 5*18*80
|
Facility
|
IP
|
$5,051.56
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,515.47 |
| Max. Negotiated Rate |
$4,849.50 |
| Rate for Payer: Aetna Commercial |
$3,889.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,940.22
|
| Rate for Payer: Cash Price |
$2,525.78
|
| Rate for Payer: Cigna Commercial |
$4,192.79
|
| Rate for Payer: First Health Commercial |
$4,798.98
|
| Rate for Payer: Humana Commercial |
$4,293.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,142.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,728.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,515.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,445.37
|
| Rate for Payer: Ohio Health Group HMO |
$3,788.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,041.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,394.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,485.58
|
| Rate for Payer: PHCS Commercial |
$4,849.50
|
| Rate for Payer: United Healthcare All Payer |
$4,445.37
|
|
|
PALMAZ BLUE SLALOM 5*18*80
|
Facility
|
OP
|
$5,051.56
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,515.47 |
| Max. Negotiated Rate |
$4,849.50 |
| Rate for Payer: Aetna Commercial |
$3,889.70
|
| Rate for Payer: Anthem Medicaid |
$1,737.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,940.22
|
| Rate for Payer: Cash Price |
$2,525.78
|
| Rate for Payer: Cigna Commercial |
$4,192.79
|
| Rate for Payer: First Health Commercial |
$4,798.98
|
| Rate for Payer: Humana Commercial |
$4,293.83
|
| Rate for Payer: Humana KY Medicaid |
$1,737.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,754.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,142.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,728.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,515.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,772.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,445.37
|
| Rate for Payer: Ohio Health Group HMO |
$3,788.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,041.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,394.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,485.58
|
| Rate for Payer: PHCS Commercial |
$4,849.50
|
| Rate for Payer: United Healthcare All Payer |
$4,445.37
|
|
|
PALMAZ BLUE SLALOM 5*24*135
|
Facility
|
OP
|
$4,906.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,471.88 |
| Max. Negotiated Rate |
$4,710.00 |
| Rate for Payer: Aetna Commercial |
$3,777.81
|
| Rate for Payer: Anthem Medicaid |
$1,687.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,826.88
|
| Rate for Payer: Cash Price |
$2,453.12
|
| Rate for Payer: Cigna Commercial |
$4,072.19
|
| Rate for Payer: First Health Commercial |
$4,660.94
|
| Rate for Payer: Humana Commercial |
$4,170.31
|
| Rate for Payer: Humana KY Medicaid |
$1,687.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,704.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,023.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,620.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,721.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,679.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,268.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,385.31
|
| Rate for Payer: PHCS Commercial |
$4,710.00
|
| Rate for Payer: United Healthcare All Payer |
$4,317.50
|
|
|
PALMAZ BLUE SLALOM 5*24*135
|
Facility
|
IP
|
$4,906.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,471.88 |
| Max. Negotiated Rate |
$4,710.00 |
| Rate for Payer: Aetna Commercial |
$3,777.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,826.88
|
| Rate for Payer: Cash Price |
$2,453.12
|
| Rate for Payer: Cigna Commercial |
$4,072.19
|
| Rate for Payer: First Health Commercial |
$4,660.94
|
| Rate for Payer: Humana Commercial |
$4,170.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,023.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,620.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,679.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,268.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,385.31
|
| Rate for Payer: PHCS Commercial |
$4,710.00
|
| Rate for Payer: United Healthcare All Payer |
$4,317.50
|
|
|
PALMAZ BLUE SLALOM 6*12*135
|
Facility
|
IP
|
$5,204.15
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,561.24 |
| Max. Negotiated Rate |
$4,995.98 |
| Rate for Payer: Aetna Commercial |
$4,007.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,059.24
|
| Rate for Payer: Cash Price |
$2,602.07
|
| Rate for Payer: Cigna Commercial |
$4,319.44
|
| Rate for Payer: First Health Commercial |
$4,943.94
|
| Rate for Payer: Humana Commercial |
$4,423.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,267.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,840.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,561.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,579.65
|
| Rate for Payer: Ohio Health Group HMO |
$3,903.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,163.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,527.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,590.86
|
| Rate for Payer: PHCS Commercial |
$4,995.98
|
| Rate for Payer: United Healthcare All Payer |
$4,579.65
|
|
|
PALMAZ BLUE SLALOM 6*12*135
|
Facility
|
OP
|
$5,204.15
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,561.24 |
| Max. Negotiated Rate |
$4,995.98 |
| Rate for Payer: Aetna Commercial |
$4,007.20
|
| Rate for Payer: Anthem Medicaid |
$1,789.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,059.24
|
| Rate for Payer: Cash Price |
$2,602.07
|
| Rate for Payer: Cigna Commercial |
$4,319.44
|
| Rate for Payer: First Health Commercial |
$4,943.94
|
| Rate for Payer: Humana Commercial |
$4,423.53
|
| Rate for Payer: Humana KY Medicaid |
$1,789.71
|
| Rate for Payer: Kentucky WC Medicaid |
$1,807.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,267.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,840.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,561.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,825.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,579.65
|
| Rate for Payer: Ohio Health Group HMO |
$3,903.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,163.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,527.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,590.86
|
| Rate for Payer: PHCS Commercial |
$4,995.98
|
| Rate for Payer: United Healthcare All Payer |
$4,579.65
|
|
|
PALMAZ BLUE SLALOM 6*12*80
|
Facility
|
IP
|
$5,204.15
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,561.24 |
| Max. Negotiated Rate |
$4,995.98 |
| Rate for Payer: Aetna Commercial |
$4,007.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,059.24
|
| Rate for Payer: Cash Price |
$2,602.07
|
| Rate for Payer: Cigna Commercial |
$4,319.44
|
| Rate for Payer: First Health Commercial |
$4,943.94
|
| Rate for Payer: Humana Commercial |
$4,423.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,267.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,840.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,561.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,579.65
|
| Rate for Payer: Ohio Health Group HMO |
$3,903.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,163.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,527.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,590.86
|
| Rate for Payer: PHCS Commercial |
$4,995.98
|
| Rate for Payer: United Healthcare All Payer |
$4,579.65
|
|
|
PALMAZ BLUE SLALOM 6*12*80
|
Facility
|
OP
|
$5,204.15
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,561.24 |
| Max. Negotiated Rate |
$4,995.98 |
| Rate for Payer: Aetna Commercial |
$4,007.20
|
| Rate for Payer: Anthem Medicaid |
$1,789.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,059.24
|
| Rate for Payer: Cash Price |
$2,602.07
|
| Rate for Payer: Cigna Commercial |
$4,319.44
|
| Rate for Payer: First Health Commercial |
$4,943.94
|
| Rate for Payer: Humana Commercial |
$4,423.53
|
| Rate for Payer: Humana KY Medicaid |
$1,789.71
|
| Rate for Payer: Kentucky WC Medicaid |
$1,807.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,267.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,840.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,561.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,825.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,579.65
|
| Rate for Payer: Ohio Health Group HMO |
$3,903.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,163.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,527.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,590.86
|
| Rate for Payer: PHCS Commercial |
$4,995.98
|
| Rate for Payer: United Healthcare All Payer |
$4,579.65
|
|
|
PALMAZ BLUE SLALOM 6*15*135
|
Facility
|
IP
|
$5,204.15
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,561.24 |
| Max. Negotiated Rate |
$4,995.98 |
| Rate for Payer: Aetna Commercial |
$4,007.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,059.24
|
| Rate for Payer: Cash Price |
$2,602.07
|
| Rate for Payer: Cigna Commercial |
$4,319.44
|
| Rate for Payer: First Health Commercial |
$4,943.94
|
| Rate for Payer: Humana Commercial |
$4,423.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,267.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,840.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,561.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,579.65
|
| Rate for Payer: Ohio Health Group HMO |
$3,903.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,163.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,527.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,590.86
|
| Rate for Payer: PHCS Commercial |
$4,995.98
|
| Rate for Payer: United Healthcare All Payer |
$4,579.65
|
|
|
PALMAZ BLUE SLALOM 6*15*135
|
Facility
|
OP
|
$5,204.15
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,561.24 |
| Max. Negotiated Rate |
$4,995.98 |
| Rate for Payer: Aetna Commercial |
$4,007.20
|
| Rate for Payer: Anthem Medicaid |
$1,789.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,059.24
|
| Rate for Payer: Cash Price |
$2,602.07
|
| Rate for Payer: Cigna Commercial |
$4,319.44
|
| Rate for Payer: First Health Commercial |
$4,943.94
|
| Rate for Payer: Humana Commercial |
$4,423.53
|
| Rate for Payer: Humana KY Medicaid |
$1,789.71
|
| Rate for Payer: Kentucky WC Medicaid |
$1,807.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,267.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,840.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,561.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,825.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,579.65
|
| Rate for Payer: Ohio Health Group HMO |
$3,903.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,163.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,527.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,590.86
|
| Rate for Payer: PHCS Commercial |
$4,995.98
|
| Rate for Payer: United Healthcare All Payer |
$4,579.65
|
|
|
PALMAZ BLUE SLALOM 6*15*80
|
Facility
|
OP
|
$5,051.56
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,515.47 |
| Max. Negotiated Rate |
$4,849.50 |
| Rate for Payer: Aetna Commercial |
$3,889.70
|
| Rate for Payer: Anthem Medicaid |
$1,737.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,940.22
|
| Rate for Payer: Cash Price |
$2,525.78
|
| Rate for Payer: Cigna Commercial |
$4,192.79
|
| Rate for Payer: First Health Commercial |
$4,798.98
|
| Rate for Payer: Humana Commercial |
$4,293.83
|
| Rate for Payer: Humana KY Medicaid |
$1,737.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,754.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,142.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,728.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,515.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,772.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,445.37
|
| Rate for Payer: Ohio Health Group HMO |
$3,788.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,041.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,394.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,485.58
|
| Rate for Payer: PHCS Commercial |
$4,849.50
|
| Rate for Payer: United Healthcare All Payer |
$4,445.37
|
|
|
PALMAZ BLUE SLALOM 6*15*80
|
Facility
|
IP
|
$5,051.56
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,515.47 |
| Max. Negotiated Rate |
$4,849.50 |
| Rate for Payer: Aetna Commercial |
$3,889.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,940.22
|
| Rate for Payer: Cash Price |
$2,525.78
|
| Rate for Payer: Cigna Commercial |
$4,192.79
|
| Rate for Payer: First Health Commercial |
$4,798.98
|
| Rate for Payer: Humana Commercial |
$4,293.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,142.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,728.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,515.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,445.37
|
| Rate for Payer: Ohio Health Group HMO |
$3,788.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,041.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,394.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,485.58
|
| Rate for Payer: PHCS Commercial |
$4,849.50
|
| Rate for Payer: United Healthcare All Payer |
$4,445.37
|
|
|
PALMAZ BLUE SLALOM 6*18*135
|
Facility
|
IP
|
$5,204.15
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,561.24 |
| Max. Negotiated Rate |
$4,995.98 |
| Rate for Payer: Aetna Commercial |
$4,007.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,059.24
|
| Rate for Payer: Cash Price |
$2,602.07
|
| Rate for Payer: Cigna Commercial |
$4,319.44
|
| Rate for Payer: First Health Commercial |
$4,943.94
|
| Rate for Payer: Humana Commercial |
$4,423.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,267.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,840.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,561.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,579.65
|
| Rate for Payer: Ohio Health Group HMO |
$3,903.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,163.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,527.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,590.86
|
| Rate for Payer: PHCS Commercial |
$4,995.98
|
| Rate for Payer: United Healthcare All Payer |
$4,579.65
|
|
|
PALMAZ BLUE SLALOM 6*18*135
|
Facility
|
OP
|
$5,204.15
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,561.24 |
| Max. Negotiated Rate |
$4,995.98 |
| Rate for Payer: Aetna Commercial |
$4,007.20
|
| Rate for Payer: Anthem Medicaid |
$1,789.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,059.24
|
| Rate for Payer: Cash Price |
$2,602.07
|
| Rate for Payer: Cigna Commercial |
$4,319.44
|
| Rate for Payer: First Health Commercial |
$4,943.94
|
| Rate for Payer: Humana Commercial |
$4,423.53
|
| Rate for Payer: Humana KY Medicaid |
$1,789.71
|
| Rate for Payer: Kentucky WC Medicaid |
$1,807.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,267.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,840.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,561.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,825.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,579.65
|
| Rate for Payer: Ohio Health Group HMO |
$3,903.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,163.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,527.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,590.86
|
| Rate for Payer: PHCS Commercial |
$4,995.98
|
| Rate for Payer: United Healthcare All Payer |
$4,579.65
|
|
