|
AS INVERSE HUM CUP 0 DEG RETRO
|
Facility
|
OP
|
$8,774.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,140.66 |
| Max. Negotiated Rate |
$8,423.35 |
| Rate for Payer: Aetna Commercial |
$6,756.23
|
| Rate for Payer: Anthem Medicaid |
$3,017.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,843.97
|
| Rate for Payer: Cash Price |
$4,387.16
|
| Rate for Payer: Cigna Commercial |
$7,282.69
|
| Rate for Payer: First Health Commercial |
$8,335.60
|
| Rate for Payer: Humana Commercial |
$7,458.17
|
| Rate for Payer: Humana KY Medicaid |
$3,017.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,048.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,194.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,475.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,632.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,078.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,721.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,580.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,754.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,140.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,720.04
|
| Rate for Payer: PHCS Commercial |
$8,423.35
|
| Rate for Payer: United Healthcare All Payer |
$7,721.40
|
|
|
AS INVERSE HUM CUP 0 DEG RETRO
|
Facility
|
IP
|
$8,774.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,140.66 |
| Max. Negotiated Rate |
$8,423.35 |
| Rate for Payer: Aetna Commercial |
$6,756.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,843.97
|
| Rate for Payer: Cash Price |
$4,387.16
|
| Rate for Payer: Cigna Commercial |
$7,282.69
|
| Rate for Payer: First Health Commercial |
$8,335.60
|
| Rate for Payer: Humana Commercial |
$7,458.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,194.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,475.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,632.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,721.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,580.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,754.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,140.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,720.04
|
| Rate for Payer: PHCS Commercial |
$8,423.35
|
| Rate for Payer: United Healthcare All Payer |
$7,721.40
|
|
|
AS INVERSE HUM CUP+10DEG RETRO
|
Facility
|
OP
|
$8,435.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,096.63 |
| Max. Negotiated Rate |
$8,098.18 |
| Rate for Payer: Aetna Commercial |
$6,495.41
|
| Rate for Payer: Anthem Medicaid |
$2,901.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,579.77
|
| Rate for Payer: Cash Price |
$4,217.80
|
| Rate for Payer: Cigna Commercial |
$7,001.55
|
| Rate for Payer: First Health Commercial |
$8,013.82
|
| Rate for Payer: Humana Commercial |
$7,170.26
|
| Rate for Payer: Humana KY Medicaid |
$2,901.00
|
| Rate for Payer: Kentucky WC Medicaid |
$2,930.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,917.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,225.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,530.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,959.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,423.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,326.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,687.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,096.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,615.04
|
| Rate for Payer: PHCS Commercial |
$8,098.18
|
| Rate for Payer: United Healthcare All Payer |
$7,423.33
|
|
|
AS INVERSE HUM CUP+10DEG RETRO
|
Facility
|
IP
|
$8,435.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,096.63 |
| Max. Negotiated Rate |
$8,098.18 |
| Rate for Payer: Aetna Commercial |
$6,495.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,579.77
|
| Rate for Payer: Cash Price |
$4,217.80
|
| Rate for Payer: Cigna Commercial |
$7,001.55
|
| Rate for Payer: First Health Commercial |
$8,013.82
|
| Rate for Payer: Humana Commercial |
$7,170.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,917.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,225.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,530.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,423.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,326.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,687.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,096.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,615.04
|
| Rate for Payer: PHCS Commercial |
$8,098.18
|
| Rate for Payer: United Healthcare All Payer |
$7,423.33
|
|
|
AS INVERSE HUM CUP-10DEG RETRO
|
Facility
|
IP
|
$8,435.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,096.63 |
| Max. Negotiated Rate |
$8,098.18 |
| Rate for Payer: Aetna Commercial |
$6,495.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,579.77
|
| Rate for Payer: Cash Price |
$4,217.80
|
| Rate for Payer: Cigna Commercial |
$7,001.55
|
| Rate for Payer: First Health Commercial |
$8,013.82
|
| Rate for Payer: Humana Commercial |
$7,170.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,917.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,225.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,530.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,423.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,326.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,687.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,096.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,615.04
|
| Rate for Payer: PHCS Commercial |
$8,098.18
|
| Rate for Payer: United Healthcare All Payer |
$7,423.33
|
|
|
AS INVERSE HUM CUP-10DEG RETRO
|
Facility
|
OP
|
$8,435.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,096.63 |
| Max. Negotiated Rate |
$8,098.18 |
| Rate for Payer: Aetna Commercial |
$6,495.41
|
| Rate for Payer: Anthem Medicaid |
$2,901.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,579.77
|
| Rate for Payer: Cash Price |
$4,217.80
|
| Rate for Payer: Cigna Commercial |
$7,001.55
|
| Rate for Payer: First Health Commercial |
$8,013.82
|
| Rate for Payer: Humana Commercial |
$7,170.26
|
| Rate for Payer: Humana KY Medicaid |
$2,901.00
|
| Rate for Payer: Kentucky WC Medicaid |
$2,930.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,917.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,225.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,530.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,959.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,423.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,326.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,687.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,096.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,615.04
|
| Rate for Payer: PHCS Commercial |
$8,098.18
|
| Rate for Payer: United Healthcare All Payer |
$7,423.33
|
|
|
AS INVERSE HUM PE-INLAY 36*0MM
|
Facility
|
OP
|
$7,039.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$915.18 |
| Max. Negotiated Rate |
$6,758.25 |
| Rate for Payer: Aetna Commercial |
$5,420.68
|
| Rate for Payer: Anthem Medicaid |
$2,421.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,491.08
|
| Rate for Payer: Cash Price |
$3,519.92
|
| Rate for Payer: Cigna Commercial |
$5,843.07
|
| Rate for Payer: First Health Commercial |
$6,687.85
|
| Rate for Payer: Humana Commercial |
$5,983.86
|
| Rate for Payer: Humana KY Medicaid |
$2,421.00
|
| Rate for Payer: Kentucky WC Medicaid |
$2,445.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,772.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,195.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,111.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,469.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,195.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,279.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,407.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$915.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,182.35
|
| Rate for Payer: PHCS Commercial |
$6,758.25
|
| Rate for Payer: United Healthcare All Payer |
$6,195.06
|
|
|
AS INVERSE HUM PE-INLAY 36*0MM
|
Facility
|
IP
|
$7,039.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$915.18 |
| Max. Negotiated Rate |
$6,758.25 |
| Rate for Payer: Aetna Commercial |
$5,420.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,491.08
|
| Rate for Payer: Cash Price |
$3,519.92
|
| Rate for Payer: Cigna Commercial |
$5,843.07
|
| Rate for Payer: First Health Commercial |
$6,687.85
|
| Rate for Payer: Humana Commercial |
$5,983.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,772.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,195.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,111.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,195.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,279.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,407.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$915.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,182.35
|
| Rate for Payer: PHCS Commercial |
$6,758.25
|
| Rate for Payer: United Healthcare All Payer |
$6,195.06
|
|
|
AS INVERSE HUM PE-INLAY 40*0MM
|
Facility
|
IP
|
$7,039.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$915.18 |
| Max. Negotiated Rate |
$6,758.25 |
| Rate for Payer: Aetna Commercial |
$5,420.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,491.08
|
| Rate for Payer: Cash Price |
$3,519.92
|
| Rate for Payer: Cigna Commercial |
$5,843.07
|
| Rate for Payer: First Health Commercial |
$6,687.85
|
| Rate for Payer: Humana Commercial |
$5,983.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,772.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,195.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,111.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,195.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,279.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,407.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$915.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,182.35
|
| Rate for Payer: PHCS Commercial |
$6,758.25
|
| Rate for Payer: United Healthcare All Payer |
$6,195.06
|
|
|
AS INVERSE HUM PE-INLAY 40*0MM
|
Facility
|
OP
|
$7,039.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$915.18 |
| Max. Negotiated Rate |
$6,758.25 |
| Rate for Payer: Aetna Commercial |
$5,420.68
|
| Rate for Payer: Anthem Medicaid |
$2,421.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,491.08
|
| Rate for Payer: Cash Price |
$3,519.92
|
| Rate for Payer: Cigna Commercial |
$5,843.07
|
| Rate for Payer: First Health Commercial |
$6,687.85
|
| Rate for Payer: Humana Commercial |
$5,983.86
|
| Rate for Payer: Humana KY Medicaid |
$2,421.00
|
| Rate for Payer: Kentucky WC Medicaid |
$2,445.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,772.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,195.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,111.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,469.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,195.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,279.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,407.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$915.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,182.35
|
| Rate for Payer: PHCS Commercial |
$6,758.25
|
| Rate for Payer: United Healthcare All Payer |
$6,195.06
|
|
|
AS INVERSE HUM PE-INLAY 40*3MM
|
Facility
|
OP
|
$7,039.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$915.18 |
| Max. Negotiated Rate |
$6,758.25 |
| Rate for Payer: Aetna Commercial |
$5,420.68
|
| Rate for Payer: Anthem Medicaid |
$2,421.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,491.08
|
| Rate for Payer: Cash Price |
$3,519.92
|
| Rate for Payer: Cigna Commercial |
$5,843.07
|
| Rate for Payer: First Health Commercial |
$6,687.85
|
| Rate for Payer: Humana Commercial |
$5,983.86
|
| Rate for Payer: Humana KY Medicaid |
$2,421.00
|
| Rate for Payer: Kentucky WC Medicaid |
$2,445.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,772.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,195.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,111.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,469.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,195.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,279.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,407.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$915.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,182.35
|
| Rate for Payer: PHCS Commercial |
$6,758.25
|
| Rate for Payer: United Healthcare All Payer |
$6,195.06
|
|
|
AS INVERSE HUM PE-INLAY 40*3MM
|
Facility
|
IP
|
$7,039.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$915.18 |
| Max. Negotiated Rate |
$6,758.25 |
| Rate for Payer: Aetna Commercial |
$5,420.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,491.08
|
| Rate for Payer: Cash Price |
$3,519.92
|
| Rate for Payer: Cigna Commercial |
$5,843.07
|
| Rate for Payer: First Health Commercial |
$6,687.85
|
| Rate for Payer: Humana Commercial |
$5,983.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,772.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,195.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,111.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,195.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,279.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,407.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$915.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,182.35
|
| Rate for Payer: PHCS Commercial |
$6,758.25
|
| Rate for Payer: United Healthcare All Payer |
$6,195.06
|
|
|
AS INVERSE HUM PE-INLAY 40*6MM
|
Facility
|
IP
|
$7,039.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$915.18 |
| Max. Negotiated Rate |
$6,758.25 |
| Rate for Payer: Aetna Commercial |
$5,420.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,491.08
|
| Rate for Payer: Cash Price |
$3,519.92
|
| Rate for Payer: Cigna Commercial |
$5,843.07
|
| Rate for Payer: First Health Commercial |
$6,687.85
|
| Rate for Payer: Humana Commercial |
$5,983.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,772.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,195.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,111.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,195.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,279.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,407.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$915.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,182.35
|
| Rate for Payer: PHCS Commercial |
$6,758.25
|
| Rate for Payer: United Healthcare All Payer |
$6,195.06
|
|
|
AS INVERSE HUM PE-INLAY 40*6MM
|
Facility
|
OP
|
$7,039.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$915.18 |
| Max. Negotiated Rate |
$6,758.25 |
| Rate for Payer: Aetna Commercial |
$5,420.68
|
| Rate for Payer: Anthem Medicaid |
$2,421.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,491.08
|
| Rate for Payer: Cash Price |
$3,519.92
|
| Rate for Payer: Cigna Commercial |
$5,843.07
|
| Rate for Payer: First Health Commercial |
$6,687.85
|
| Rate for Payer: Humana Commercial |
$5,983.86
|
| Rate for Payer: Humana KY Medicaid |
$2,421.00
|
| Rate for Payer: Kentucky WC Medicaid |
$2,445.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,772.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,195.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,111.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,469.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,195.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,279.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,407.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$915.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,182.35
|
| Rate for Payer: PHCS Commercial |
$6,758.25
|
| Rate for Payer: United Healthcare All Payer |
$6,195.06
|
|
|
AS INV HUM CUP+9M 0 DEG RETR+6
|
Facility
|
IP
|
$8,774.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,140.66 |
| Max. Negotiated Rate |
$8,423.35 |
| Rate for Payer: Aetna Commercial |
$6,756.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,843.97
|
| Rate for Payer: Cash Price |
$4,387.16
|
| Rate for Payer: Cigna Commercial |
$7,282.69
|
| Rate for Payer: First Health Commercial |
$8,335.60
|
| Rate for Payer: Humana Commercial |
$7,458.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,194.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,475.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,632.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,721.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,580.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,754.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,140.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,720.04
|
| Rate for Payer: PHCS Commercial |
$8,423.35
|
| Rate for Payer: United Healthcare All Payer |
$7,721.40
|
|
|
AS INV HUM CUP+9M 0 DEG RETR+6
|
Facility
|
OP
|
$8,774.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,140.66 |
| Max. Negotiated Rate |
$8,423.35 |
| Rate for Payer: Aetna Commercial |
$6,756.23
|
| Rate for Payer: Anthem Medicaid |
$3,017.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,843.97
|
| Rate for Payer: Cash Price |
$4,387.16
|
| Rate for Payer: Cigna Commercial |
$7,282.69
|
| Rate for Payer: First Health Commercial |
$8,335.60
|
| Rate for Payer: Humana Commercial |
$7,458.17
|
| Rate for Payer: Humana KY Medicaid |
$3,017.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,048.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,194.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,475.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,632.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,078.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,721.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,580.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,754.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,140.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,720.04
|
| Rate for Payer: PHCS Commercial |
$8,423.35
|
| Rate for Payer: United Healthcare All Payer |
$7,721.40
|
|
|
AS INV HUM CUP+9MM 0 DEG RETRO
|
Facility
|
IP
|
$8,774.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,140.66 |
| Max. Negotiated Rate |
$8,423.35 |
| Rate for Payer: Aetna Commercial |
$6,756.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,843.97
|
| Rate for Payer: Cash Price |
$4,387.16
|
| Rate for Payer: Cigna Commercial |
$7,282.69
|
| Rate for Payer: First Health Commercial |
$8,335.60
|
| Rate for Payer: Humana Commercial |
$7,458.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,194.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,475.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,632.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,721.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,580.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,754.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,140.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,720.04
|
| Rate for Payer: PHCS Commercial |
$8,423.35
|
| Rate for Payer: United Healthcare All Payer |
$7,721.40
|
|
|
AS INV HUM CUP+9MM 0 DEG RETRO
|
Facility
|
OP
|
$8,774.32
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,140.66 |
| Max. Negotiated Rate |
$8,423.35 |
| Rate for Payer: Aetna Commercial |
$6,756.23
|
| Rate for Payer: Anthem Medicaid |
$3,017.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,843.97
|
| Rate for Payer: Cash Price |
$4,387.16
|
| Rate for Payer: Cigna Commercial |
$7,282.69
|
| Rate for Payer: First Health Commercial |
$8,335.60
|
| Rate for Payer: Humana Commercial |
$7,458.17
|
| Rate for Payer: Humana KY Medicaid |
$3,017.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,048.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,194.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,475.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,632.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,078.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,721.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,580.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,754.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,140.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,720.04
|
| Rate for Payer: PHCS Commercial |
$8,423.35
|
| Rate for Payer: United Healthcare All Payer |
$7,721.40
|
|
|
AS INV HUM PE-INLY 0MM 40MM HD
|
Facility
|
IP
|
$7,039.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$915.18 |
| Max. Negotiated Rate |
$6,758.25 |
| Rate for Payer: Aetna Commercial |
$5,420.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,491.08
|
| Rate for Payer: Cash Price |
$3,519.92
|
| Rate for Payer: Cigna Commercial |
$5,843.07
|
| Rate for Payer: First Health Commercial |
$6,687.85
|
| Rate for Payer: Humana Commercial |
$5,983.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,772.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,195.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,111.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,195.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,279.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,407.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$915.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,182.35
|
| Rate for Payer: PHCS Commercial |
$6,758.25
|
| Rate for Payer: United Healthcare All Payer |
$6,195.06
|
|
|
AS INV HUM PE-INLY 0MM 40MM HD
|
Facility
|
OP
|
$7,039.84
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$915.18 |
| Max. Negotiated Rate |
$6,758.25 |
| Rate for Payer: Aetna Commercial |
$5,420.68
|
| Rate for Payer: Anthem Medicaid |
$2,421.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,491.08
|
| Rate for Payer: Cash Price |
$3,519.92
|
| Rate for Payer: Cigna Commercial |
$5,843.07
|
| Rate for Payer: First Health Commercial |
$6,687.85
|
| Rate for Payer: Humana Commercial |
$5,983.86
|
| Rate for Payer: Humana KY Medicaid |
$2,421.00
|
| Rate for Payer: Kentucky WC Medicaid |
$2,445.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,772.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,195.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,111.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,469.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,195.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,279.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,407.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$915.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,182.35
|
| Rate for Payer: PHCS Commercial |
$6,758.25
|
| Rate for Payer: United Healthcare All Payer |
$6,195.06
|
|
|
AS INV HUM PE-INLY 3MM 40MM HD
|
Facility
|
OP
|
$6,822.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$886.90 |
| Max. Negotiated Rate |
$6,549.41 |
| Rate for Payer: Aetna Commercial |
$5,253.17
|
| Rate for Payer: Anthem Medicaid |
$2,346.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,321.39
|
| Rate for Payer: Cash Price |
$3,411.15
|
| Rate for Payer: Cigna Commercial |
$5,662.51
|
| Rate for Payer: First Health Commercial |
$6,481.18
|
| Rate for Payer: Humana Commercial |
$5,798.96
|
| Rate for Payer: Humana KY Medicaid |
$2,346.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,370.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,594.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,034.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,046.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,393.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,003.62
|
| Rate for Payer: Ohio Health Group HMO |
$5,116.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,364.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$886.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,114.91
|
| Rate for Payer: PHCS Commercial |
$6,549.41
|
| Rate for Payer: United Healthcare All Payer |
$6,003.62
|
|
|
AS INV HUM PE-INLY 3MM 40MM HD
|
Facility
|
IP
|
$6,822.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$886.90 |
| Max. Negotiated Rate |
$6,549.41 |
| Rate for Payer: Aetna Commercial |
$5,253.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,321.39
|
| Rate for Payer: Cash Price |
$3,411.15
|
| Rate for Payer: Cigna Commercial |
$5,662.51
|
| Rate for Payer: First Health Commercial |
$6,481.18
|
| Rate for Payer: Humana Commercial |
$5,798.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,594.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,034.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,046.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,003.62
|
| Rate for Payer: Ohio Health Group HMO |
$5,116.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,364.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$886.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,114.91
|
| Rate for Payer: PHCS Commercial |
$6,549.41
|
| Rate for Payer: United Healthcare All Payer |
$6,003.62
|
|
|
AS INV HUM PE-INLY 6MM 40MM HD
|
Facility
|
OP
|
$6,822.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$886.90 |
| Max. Negotiated Rate |
$6,549.41 |
| Rate for Payer: Aetna Commercial |
$5,253.17
|
| Rate for Payer: Anthem Medicaid |
$2,346.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,321.39
|
| Rate for Payer: Cash Price |
$3,411.15
|
| Rate for Payer: Cigna Commercial |
$5,662.51
|
| Rate for Payer: First Health Commercial |
$6,481.18
|
| Rate for Payer: Humana Commercial |
$5,798.96
|
| Rate for Payer: Humana KY Medicaid |
$2,346.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,370.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,594.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,034.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,046.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,393.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,003.62
|
| Rate for Payer: Ohio Health Group HMO |
$5,116.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,364.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$886.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,114.91
|
| Rate for Payer: PHCS Commercial |
$6,549.41
|
| Rate for Payer: United Healthcare All Payer |
$6,003.62
|
|
|
AS INV HUM PE-INLY 6MM 40MM HD
|
Facility
|
IP
|
$6,822.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$886.90 |
| Max. Negotiated Rate |
$6,549.41 |
| Rate for Payer: Aetna Commercial |
$5,253.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,321.39
|
| Rate for Payer: Cash Price |
$3,411.15
|
| Rate for Payer: Cigna Commercial |
$5,662.51
|
| Rate for Payer: First Health Commercial |
$6,481.18
|
| Rate for Payer: Humana Commercial |
$5,798.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,594.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,034.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,046.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,003.62
|
| Rate for Payer: Ohio Health Group HMO |
$5,116.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,364.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$886.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,114.91
|
| Rate for Payer: PHCS Commercial |
$6,549.41
|
| Rate for Payer: United Healthcare All Payer |
$6,003.62
|
|
|
AS INVRS HUM CUP +20 DEG RETRO
|
Facility
|
IP
|
$8,435.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,096.63 |
| Max. Negotiated Rate |
$8,098.18 |
| Rate for Payer: Aetna Commercial |
$6,495.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,579.77
|
| Rate for Payer: Cash Price |
$4,217.80
|
| Rate for Payer: Cigna Commercial |
$7,001.55
|
| Rate for Payer: First Health Commercial |
$8,013.82
|
| Rate for Payer: Humana Commercial |
$7,170.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,917.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,225.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,530.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,423.33
|
| Rate for Payer: Ohio Health Group HMO |
$6,326.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,687.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,096.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,615.04
|
| Rate for Payer: PHCS Commercial |
$8,098.18
|
| Rate for Payer: United Healthcare All Payer |
$7,423.33
|
|
