|
PLUS PROMOS GLENOID 4-29
|
Facility
|
OP
|
$8,640.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,123.20 |
| Max. Negotiated Rate |
$8,294.40 |
| Rate for Payer: Aetna Commercial |
$6,652.80
|
| Rate for Payer: Anthem Medicaid |
$2,971.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,739.20
|
| Rate for Payer: Cash Price |
$4,320.00
|
| Rate for Payer: Cigna Commercial |
$7,171.20
|
| Rate for Payer: First Health Commercial |
$8,208.00
|
| Rate for Payer: Humana Commercial |
$7,344.00
|
| Rate for Payer: Humana KY Medicaid |
$2,971.30
|
| Rate for Payer: Kentucky WC Medicaid |
$3,001.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,084.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,376.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,592.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,030.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,603.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,123.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,678.40
|
| Rate for Payer: PHCS Commercial |
$8,294.40
|
| Rate for Payer: United Healthcare All Payer |
$7,603.20
|
|
|
PLUS PROMOS GLENOID 4-29
|
Facility
|
IP
|
$8,640.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,123.20 |
| Max. Negotiated Rate |
$8,294.40 |
| Rate for Payer: Aetna Commercial |
$6,652.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,739.20
|
| Rate for Payer: Cash Price |
$4,320.00
|
| Rate for Payer: Cigna Commercial |
$7,171.20
|
| Rate for Payer: First Health Commercial |
$8,208.00
|
| Rate for Payer: Humana Commercial |
$7,344.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,084.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,376.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,592.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,603.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,123.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,678.40
|
| Rate for Payer: PHCS Commercial |
$8,294.40
|
| Rate for Payer: United Healthcare All Payer |
$7,603.20
|
|
|
PLUS PROMOS GLENOID BASE PLATE
|
Facility
|
IP
|
$11,081.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,440.63 |
| Max. Negotiated Rate |
$10,638.53 |
| Rate for Payer: Aetna Commercial |
$8,532.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,643.80
|
| Rate for Payer: Cash Price |
$5,540.90
|
| Rate for Payer: Cigna Commercial |
$9,197.89
|
| Rate for Payer: First Health Commercial |
$10,527.71
|
| Rate for Payer: Humana Commercial |
$9,419.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,087.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,178.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,324.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,751.98
|
| Rate for Payer: Ohio Health Group HMO |
$8,311.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,216.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,440.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,435.36
|
| Rate for Payer: PHCS Commercial |
$10,638.53
|
| Rate for Payer: United Healthcare All Payer |
$9,751.98
|
|
|
PLUS PROMOS GLENOID BASE PLATE
|
Facility
|
OP
|
$11,081.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,440.63 |
| Max. Negotiated Rate |
$10,638.53 |
| Rate for Payer: Aetna Commercial |
$8,532.99
|
| Rate for Payer: Anthem Medicaid |
$3,811.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,643.80
|
| Rate for Payer: Cash Price |
$5,540.90
|
| Rate for Payer: Cigna Commercial |
$9,197.89
|
| Rate for Payer: First Health Commercial |
$10,527.71
|
| Rate for Payer: Humana Commercial |
$9,419.53
|
| Rate for Payer: Humana KY Medicaid |
$3,811.03
|
| Rate for Payer: Kentucky WC Medicaid |
$3,849.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,087.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,178.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,324.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,887.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,751.98
|
| Rate for Payer: Ohio Health Group HMO |
$8,311.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,216.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,440.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,435.36
|
| Rate for Payer: PHCS Commercial |
$10,638.53
|
| Rate for Payer: United Healthcare All Payer |
$9,751.98
|
|
|
PLUS PROMOS HUMERAL HD R 19/+2
|
Facility
|
IP
|
$9,753.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,267.92 |
| Max. Negotiated Rate |
$9,363.12 |
| Rate for Payer: Aetna Commercial |
$7,510.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,607.54
|
| Rate for Payer: Cash Price |
$4,876.62
|
| Rate for Payer: Cigna Commercial |
$8,095.20
|
| Rate for Payer: First Health Commercial |
$9,265.59
|
| Rate for Payer: Humana Commercial |
$8,290.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,997.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,197.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,925.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,582.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,314.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,950.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,267.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,023.51
|
| Rate for Payer: PHCS Commercial |
$9,363.12
|
| Rate for Payer: United Healthcare All Payer |
$8,582.86
|
|
|
PLUS PROMOS HUMERAL HD R 19/+2
|
Facility
|
OP
|
$9,753.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,267.92 |
| Max. Negotiated Rate |
$9,363.12 |
| Rate for Payer: Aetna Commercial |
$7,510.00
|
| Rate for Payer: Anthem Medicaid |
$3,354.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,607.54
|
| Rate for Payer: Cash Price |
$4,876.62
|
| Rate for Payer: Cigna Commercial |
$8,095.20
|
| Rate for Payer: First Health Commercial |
$9,265.59
|
| Rate for Payer: Humana Commercial |
$8,290.26
|
| Rate for Payer: Humana KY Medicaid |
$3,354.14
|
| Rate for Payer: Kentucky WC Medicaid |
$3,388.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,997.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,197.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,925.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,421.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,582.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,314.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,950.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,267.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,023.51
|
| Rate for Payer: PHCS Commercial |
$9,363.12
|
| Rate for Payer: United Healthcare All Payer |
$8,582.86
|
|
|
PLUS PROMOS HUMERAL HD R 20/+4
|
Facility
|
OP
|
$8,710.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,132.33 |
| Max. Negotiated Rate |
$8,361.85 |
| Rate for Payer: Aetna Commercial |
$6,706.90
|
| Rate for Payer: Anthem Medicaid |
$2,995.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,794.00
|
| Rate for Payer: Cash Price |
$4,355.13
|
| Rate for Payer: Cigna Commercial |
$7,229.52
|
| Rate for Payer: First Health Commercial |
$8,274.75
|
| Rate for Payer: Humana Commercial |
$7,403.72
|
| Rate for Payer: Humana KY Medicaid |
$2,995.46
|
| Rate for Payer: Kentucky WC Medicaid |
$3,025.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,142.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,428.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,613.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,055.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,665.03
|
| Rate for Payer: Ohio Health Group HMO |
$6,532.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,742.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,132.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,700.18
|
| Rate for Payer: PHCS Commercial |
$8,361.85
|
| Rate for Payer: United Healthcare All Payer |
$7,665.03
|
|
|
PLUS PROMOS HUMERAL HD R 20/+4
|
Facility
|
IP
|
$8,710.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,132.33 |
| Max. Negotiated Rate |
$8,361.85 |
| Rate for Payer: Aetna Commercial |
$6,706.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,794.00
|
| Rate for Payer: Cash Price |
$4,355.13
|
| Rate for Payer: Cigna Commercial |
$7,229.52
|
| Rate for Payer: First Health Commercial |
$8,274.75
|
| Rate for Payer: Humana Commercial |
$7,403.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,142.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,428.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,613.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,665.03
|
| Rate for Payer: Ohio Health Group HMO |
$6,532.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,742.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,132.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,700.18
|
| Rate for Payer: PHCS Commercial |
$8,361.85
|
| Rate for Payer: United Healthcare All Payer |
$7,665.03
|
|
|
PLUS PROMOS HUMERAL HD R 21/+5
|
Facility
|
OP
|
$9,753.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,267.92 |
| Max. Negotiated Rate |
$9,363.12 |
| Rate for Payer: Aetna Commercial |
$7,510.00
|
| Rate for Payer: Anthem Medicaid |
$3,354.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,607.54
|
| Rate for Payer: Cash Price |
$4,876.62
|
| Rate for Payer: Cigna Commercial |
$8,095.20
|
| Rate for Payer: First Health Commercial |
$9,265.59
|
| Rate for Payer: Humana Commercial |
$8,290.26
|
| Rate for Payer: Humana KY Medicaid |
$3,354.14
|
| Rate for Payer: Kentucky WC Medicaid |
$3,388.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,997.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,197.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,925.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,421.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,582.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,314.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,950.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,267.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,023.51
|
| Rate for Payer: PHCS Commercial |
$9,363.12
|
| Rate for Payer: United Healthcare All Payer |
$8,582.86
|
|
|
PLUS PROMOS HUMERAL HD R 21/+5
|
Facility
|
IP
|
$9,753.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,267.92 |
| Max. Negotiated Rate |
$9,363.12 |
| Rate for Payer: Aetna Commercial |
$7,510.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,607.54
|
| Rate for Payer: Cash Price |
$4,876.62
|
| Rate for Payer: Cigna Commercial |
$8,095.20
|
| Rate for Payer: First Health Commercial |
$9,265.59
|
| Rate for Payer: Humana Commercial |
$8,290.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,997.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,197.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,925.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,582.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,314.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,950.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,267.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,023.51
|
| Rate for Payer: PHCS Commercial |
$9,363.12
|
| Rate for Payer: United Healthcare All Payer |
$8,582.86
|
|
|
PLUS PROMOS HUM HD R 21/H17+4
|
Facility
|
IP
|
$8,710.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,132.33 |
| Max. Negotiated Rate |
$8,361.85 |
| Rate for Payer: Aetna Commercial |
$6,706.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,794.00
|
| Rate for Payer: Cash Price |
$4,355.13
|
| Rate for Payer: Cigna Commercial |
$7,229.52
|
| Rate for Payer: First Health Commercial |
$8,274.75
|
| Rate for Payer: Humana Commercial |
$7,403.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,142.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,428.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,613.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,665.03
|
| Rate for Payer: Ohio Health Group HMO |
$6,532.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,742.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,132.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,700.18
|
| Rate for Payer: PHCS Commercial |
$8,361.85
|
| Rate for Payer: United Healthcare All Payer |
$7,665.03
|
|
|
PLUS PROMOS HUM HD R 21/H17+4
|
Facility
|
OP
|
$8,710.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,132.33 |
| Max. Negotiated Rate |
$8,361.85 |
| Rate for Payer: Aetna Commercial |
$6,706.90
|
| Rate for Payer: Anthem Medicaid |
$2,995.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,794.00
|
| Rate for Payer: Cash Price |
$4,355.13
|
| Rate for Payer: Cigna Commercial |
$7,229.52
|
| Rate for Payer: First Health Commercial |
$8,274.75
|
| Rate for Payer: Humana Commercial |
$7,403.72
|
| Rate for Payer: Humana KY Medicaid |
$2,995.46
|
| Rate for Payer: Kentucky WC Medicaid |
$3,025.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,142.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,428.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,613.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,055.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,665.03
|
| Rate for Payer: Ohio Health Group HMO |
$6,532.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,742.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,132.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,700.18
|
| Rate for Payer: PHCS Commercial |
$8,361.85
|
| Rate for Payer: United Healthcare All Payer |
$7,665.03
|
|
|
PLUS PROMOS HUM HD R22/ H17+6
|
Facility
|
OP
|
$9,753.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,267.92 |
| Max. Negotiated Rate |
$9,363.12 |
| Rate for Payer: Aetna Commercial |
$7,510.00
|
| Rate for Payer: Anthem Medicaid |
$3,354.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,607.54
|
| Rate for Payer: Cash Price |
$4,876.62
|
| Rate for Payer: Cigna Commercial |
$8,095.20
|
| Rate for Payer: First Health Commercial |
$9,265.59
|
| Rate for Payer: Humana Commercial |
$8,290.26
|
| Rate for Payer: Humana KY Medicaid |
$3,354.14
|
| Rate for Payer: Kentucky WC Medicaid |
$3,388.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,997.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,197.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,925.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,421.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,582.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,314.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,950.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,267.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,023.51
|
| Rate for Payer: PHCS Commercial |
$9,363.12
|
| Rate for Payer: United Healthcare All Payer |
$8,582.86
|
|
|
PLUS PROMOS HUM HD R22/ H17+6
|
Facility
|
IP
|
$9,753.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,267.92 |
| Max. Negotiated Rate |
$9,363.12 |
| Rate for Payer: Aetna Commercial |
$7,510.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,607.54
|
| Rate for Payer: Cash Price |
$4,876.62
|
| Rate for Payer: Cigna Commercial |
$8,095.20
|
| Rate for Payer: First Health Commercial |
$9,265.59
|
| Rate for Payer: Humana Commercial |
$8,290.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,997.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,197.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,925.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,582.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,314.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,950.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,267.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,023.51
|
| Rate for Payer: PHCS Commercial |
$9,363.12
|
| Rate for Payer: United Healthcare All Payer |
$8,582.86
|
|
|
PLUS PROMOS HUM HD R 22/H18+4
|
Facility
|
OP
|
$8,710.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,132.33 |
| Max. Negotiated Rate |
$8,361.85 |
| Rate for Payer: Aetna Commercial |
$6,706.90
|
| Rate for Payer: Anthem Medicaid |
$2,995.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,794.00
|
| Rate for Payer: Cash Price |
$4,355.13
|
| Rate for Payer: Cigna Commercial |
$7,229.52
|
| Rate for Payer: First Health Commercial |
$8,274.75
|
| Rate for Payer: Humana Commercial |
$7,403.72
|
| Rate for Payer: Humana KY Medicaid |
$2,995.46
|
| Rate for Payer: Kentucky WC Medicaid |
$3,025.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,142.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,428.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,613.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,055.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,665.03
|
| Rate for Payer: Ohio Health Group HMO |
$6,532.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,742.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,132.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,700.18
|
| Rate for Payer: PHCS Commercial |
$8,361.85
|
| Rate for Payer: United Healthcare All Payer |
$7,665.03
|
|
|
PLUS PROMOS HUM HD R 22/H18+4
|
Facility
|
IP
|
$8,710.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,132.33 |
| Max. Negotiated Rate |
$8,361.85 |
| Rate for Payer: Aetna Commercial |
$6,706.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,794.00
|
| Rate for Payer: Cash Price |
$4,355.13
|
| Rate for Payer: Cigna Commercial |
$7,229.52
|
| Rate for Payer: First Health Commercial |
$8,274.75
|
| Rate for Payer: Humana Commercial |
$7,403.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,142.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,428.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,613.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,665.03
|
| Rate for Payer: Ohio Health Group HMO |
$6,532.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,742.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,132.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,700.18
|
| Rate for Payer: PHCS Commercial |
$8,361.85
|
| Rate for Payer: United Healthcare All Payer |
$7,665.03
|
|
|
PLUS PROMOS HUM HD R 23/+7
|
Facility
|
IP
|
$9,753.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,267.92 |
| Max. Negotiated Rate |
$9,363.12 |
| Rate for Payer: Aetna Commercial |
$7,510.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,607.54
|
| Rate for Payer: Cash Price |
$4,876.62
|
| Rate for Payer: Cigna Commercial |
$8,095.20
|
| Rate for Payer: First Health Commercial |
$9,265.59
|
| Rate for Payer: Humana Commercial |
$8,290.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,997.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,197.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,925.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,582.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,314.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,950.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,267.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,023.51
|
| Rate for Payer: PHCS Commercial |
$9,363.12
|
| Rate for Payer: United Healthcare All Payer |
$8,582.86
|
|
|
PLUS PROMOS HUM HD R 23/+7
|
Facility
|
OP
|
$9,753.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,267.92 |
| Max. Negotiated Rate |
$9,363.12 |
| Rate for Payer: Aetna Commercial |
$7,510.00
|
| Rate for Payer: Anthem Medicaid |
$3,354.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,607.54
|
| Rate for Payer: Cash Price |
$4,876.62
|
| Rate for Payer: Cigna Commercial |
$8,095.20
|
| Rate for Payer: First Health Commercial |
$9,265.59
|
| Rate for Payer: Humana Commercial |
$8,290.26
|
| Rate for Payer: Humana KY Medicaid |
$3,354.14
|
| Rate for Payer: Kentucky WC Medicaid |
$3,388.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,997.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,197.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,925.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,421.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,582.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,314.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,950.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,267.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,023.51
|
| Rate for Payer: PHCS Commercial |
$9,363.12
|
| Rate for Payer: United Healthcare All Payer |
$8,582.86
|
|
|
PLUS PROMOS HUM HD R 23/H19+4
|
Facility
|
IP
|
$9,753.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,267.92 |
| Max. Negotiated Rate |
$9,363.12 |
| Rate for Payer: Aetna Commercial |
$7,510.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,607.54
|
| Rate for Payer: Cash Price |
$4,876.62
|
| Rate for Payer: Cigna Commercial |
$8,095.20
|
| Rate for Payer: First Health Commercial |
$9,265.59
|
| Rate for Payer: Humana Commercial |
$8,290.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,997.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,197.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,925.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,582.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,314.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,950.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,267.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,023.51
|
| Rate for Payer: PHCS Commercial |
$9,363.12
|
| Rate for Payer: United Healthcare All Payer |
$8,582.86
|
|
|
PLUS PROMOS HUM HD R 23/H19+4
|
Facility
|
OP
|
$9,753.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,267.92 |
| Max. Negotiated Rate |
$9,363.12 |
| Rate for Payer: Aetna Commercial |
$7,510.00
|
| Rate for Payer: Anthem Medicaid |
$3,354.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,607.54
|
| Rate for Payer: Cash Price |
$4,876.62
|
| Rate for Payer: Cigna Commercial |
$8,095.20
|
| Rate for Payer: First Health Commercial |
$9,265.59
|
| Rate for Payer: Humana Commercial |
$8,290.26
|
| Rate for Payer: Humana KY Medicaid |
$3,354.14
|
| Rate for Payer: Kentucky WC Medicaid |
$3,388.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,997.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,197.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,925.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,421.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,582.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,314.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,950.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,267.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,023.51
|
| Rate for Payer: PHCS Commercial |
$9,363.12
|
| Rate for Payer: United Healthcare All Payer |
$8,582.86
|
|
|
PLUS PROMOS HUM HD R 24/+7
|
Facility
|
IP
|
$9,753.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,267.92 |
| Max. Negotiated Rate |
$9,363.12 |
| Rate for Payer: Aetna Commercial |
$7,510.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,607.54
|
| Rate for Payer: Cash Price |
$4,876.62
|
| Rate for Payer: Cigna Commercial |
$8,095.20
|
| Rate for Payer: First Health Commercial |
$9,265.59
|
| Rate for Payer: Humana Commercial |
$8,290.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,997.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,197.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,925.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,582.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,314.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,950.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,267.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,023.51
|
| Rate for Payer: PHCS Commercial |
$9,363.12
|
| Rate for Payer: United Healthcare All Payer |
$8,582.86
|
|
|
PLUS PROMOS HUM HD R 24/+7
|
Facility
|
OP
|
$9,753.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,267.92 |
| Max. Negotiated Rate |
$9,363.12 |
| Rate for Payer: Aetna Commercial |
$7,510.00
|
| Rate for Payer: Anthem Medicaid |
$3,354.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,607.54
|
| Rate for Payer: Cash Price |
$4,876.62
|
| Rate for Payer: Cigna Commercial |
$8,095.20
|
| Rate for Payer: First Health Commercial |
$9,265.59
|
| Rate for Payer: Humana Commercial |
$8,290.26
|
| Rate for Payer: Humana KY Medicaid |
$3,354.14
|
| Rate for Payer: Kentucky WC Medicaid |
$3,388.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,997.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,197.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,925.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,421.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,582.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,314.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,950.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,267.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,023.51
|
| Rate for Payer: PHCS Commercial |
$9,363.12
|
| Rate for Payer: United Healthcare All Payer |
$8,582.86
|
|
|
PLUS PROMOS HUM HD R 24/H20+4
|
Facility
|
OP
|
$8,710.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,132.33 |
| Max. Negotiated Rate |
$8,361.85 |
| Rate for Payer: Aetna Commercial |
$6,706.90
|
| Rate for Payer: Anthem Medicaid |
$2,995.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,794.00
|
| Rate for Payer: Cash Price |
$4,355.13
|
| Rate for Payer: Cigna Commercial |
$7,229.52
|
| Rate for Payer: First Health Commercial |
$8,274.75
|
| Rate for Payer: Humana Commercial |
$7,403.72
|
| Rate for Payer: Humana KY Medicaid |
$2,995.46
|
| Rate for Payer: Kentucky WC Medicaid |
$3,025.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,142.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,428.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,613.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,055.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,665.03
|
| Rate for Payer: Ohio Health Group HMO |
$6,532.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,742.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,132.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,700.18
|
| Rate for Payer: PHCS Commercial |
$8,361.85
|
| Rate for Payer: United Healthcare All Payer |
$7,665.03
|
|
|
PLUS PROMOS HUM HD R 24/H20+4
|
Facility
|
IP
|
$8,710.26
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,132.33 |
| Max. Negotiated Rate |
$8,361.85 |
| Rate for Payer: Aetna Commercial |
$6,706.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,794.00
|
| Rate for Payer: Cash Price |
$4,355.13
|
| Rate for Payer: Cigna Commercial |
$7,229.52
|
| Rate for Payer: First Health Commercial |
$8,274.75
|
| Rate for Payer: Humana Commercial |
$7,403.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,142.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,428.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,613.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,665.03
|
| Rate for Payer: Ohio Health Group HMO |
$6,532.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,742.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,132.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,700.18
|
| Rate for Payer: PHCS Commercial |
$8,361.85
|
| Rate for Payer: United Healthcare All Payer |
$7,665.03
|
|
|
PLUS PROMOS HUM HD R 25/+7
|
Facility
|
IP
|
$9,753.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,267.92 |
| Max. Negotiated Rate |
$9,363.12 |
| Rate for Payer: Aetna Commercial |
$7,510.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,607.54
|
| Rate for Payer: Cash Price |
$4,876.62
|
| Rate for Payer: Cigna Commercial |
$8,095.20
|
| Rate for Payer: First Health Commercial |
$9,265.59
|
| Rate for Payer: Humana Commercial |
$8,290.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,997.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,197.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,925.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,582.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,314.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,950.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,267.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,023.51
|
| Rate for Payer: PHCS Commercial |
$9,363.12
|
| Rate for Payer: United Healthcare All Payer |
$8,582.86
|
|
